PubMed Health⌕ Search

Biomedical subjects

E De Robertis

Publications and source records attributed to E De Robertis.

At least 19 recordsLinked to original sources
PubMed2006

Conscious analgosedation for radiofrequency ablation of lung neoplasm.

AIM: Radiofrequency ablation (RFA) is a minimally invasive therapy for pulmonary malignant cancers in patients with medical co-morbidities or refusal of surgery. The aim of this study was to evaluate a conscious analgosedation protocol for RFA of lung neoplasm. METHODS: Ten RFAs were performed. Following analgesic premedication patients underwent local anesthesia (lidocaine 2%) and propofol infusion. RESULTS: The procedures were always uneventful. Postoperative severe pain was not reported; a deep sedation was required to allow the quick and safe management of RFA. CONCLUSIONS: Spontaneous breathing sedation is safe in monitored and well-oxygenated patients and may limit the incidence of tension pneumothorax. Postoperative period needs a proper pain control for the first 24 h. Data on the long-term efficacy of lung tumor RFA are not yet available.

Aged↗
PubMed2005

Hypophosphatemia and metabolic acidosis.

The aim of the paper was to describe an unusual case of non lactic metabolic acidosis connected to hypophosphatemia and refractory to infusion of bicarbonate. A 37 year old man was admitted to Intensive Care Unit with a severe metabolic acidosis. On admission the arterial gas analysis showed non lactic metabolic acidosis (pH 7.17; base excess [BE] -20.3; lactic acid 0.8 mMol/L), with hypoxemia and critical hypocapnia. Despite therapy with bicarbonate the acidosis persisted. After 4 hours glucose phosphate was administered, although the phosphoremia was unknown. After phosphate supplementation an improvement of acidosis was observed. Our hypothesis is that in the kidney phosphate depletion caused impaired tubular reabsorption of bicarbonate, which led to a non lactic metabolic acidosis.

Acidosis↗
PubMed2005

S100B is a sensitive but not specific prognostic index in comatose patients after cardiac arrest.

AIM: The aim of this study was to compare serum S100B levels and EEG findings as prognostic indexes in comatose (GCS<8) patients after cardiac arrest. METHODS: S100B serum levels were assessed 12 h after the event and EEG findings were recorded within 24 h in comatose cardiac arrest survivors. At hospital discharge, patients were divided into groups according the Glasgow-outcome scale (GOS): group 1 with bad neurological outcome and group 2 with good neurological outcome (GOS 4-5). S100B levels and EEG findings were retrospectively tested about their predictive value. RESULTS: S100B has a very low specificity (37.5%) while S100B sensitivity is 100%. EEG findings specificity is 75% and sensitivity 50%. S100B was not significantly lower in patients who recovered consciousness (10 patients) and there was no significant difference in EEGs findings between group 1 and 2. CONCLUSIONS: The association of serum S100B levels with EEG might be helpful when used together to formulate outcome in comatose patients within 24 h after cardiac arrest. However, increased levels of S100B 12 h after a cardiac arrest might be expression of a still amendable brain damage.

Aged↗
PubMed2005

Incidence of antimicrobial-resistant ventilator associated pneumonia: an eighteen-month survey.

AIM: Microbes commonly involved in ventilator associated pneumonia (VAP) are difficult to eradicate: Pseudomonas aeruginosa and Acinetobacter baumannii are often resistant to piperacillin, aztreonam and ceftazidim while Klebsiella pneumoniae and other Enterobacteriaceae are resistant to third generation cephalosporins. Physicians need to tailor their therapeutic approach depending on individual patients and clinical setting, firmly based on local epidemiology. The aim of this study was to assess the incidence of VAP caused by multidrug-resistant bacteria in our ICU. METHODS: We conducted a retrospective review of all patients mechanically ventilated for longer than 72 h, who developed pneumonia over an eighteen-month period for whom final culture data were available. One-hundred and forty-three patients admitted to a University Hospital medical surgical ICU were included in this survey. VAP was diagnosed by Centers for Disease Control and Prevention criteria and confirmed by mini- bronchoalveolar lavage. RESULTS: In this study, the incidence of VAP in the period January 1, 2002-June 31, 2003 was very high, accounting for about 20% of all at-risk cases. Multiresistant agents were involved in about 57% of VAP occurring within 7 days of mechanical ventilation, and in 80% of late VAP. CONCLUSIONS: This study revealed differences in VAP incidence and features among our ICU and literature data, indicating a need for caution when using hospital infection surveillance data for comparisons and choice of therapy. In our setting, with high levels of antibiotic resistance, combined approaches of non-antibiotic using strategies and education programs might be beneficial.

Adult↗
PubMed2004

[Organ donor and health policy: the anaesthesia and reanimation].

The possibility of tissues and organs transplantation is nowadays an ordinary surgical procedure for patients that do not have other way of treatment. Today the principal objective of the National Health Care System is the improvement in the transplantation activities. To achieve this objective it is necessary to sustain and promote donation, which is still the principal resource that can be used to satisfy the needs of the patients in waiting list for transplantation. In Italy much has been done by Institutions and physicians with excellent results, both in terms of number of donations and quality of transplantations. But it is still not sufficient. A non homogeneity is still observed between different Provinces, not only in terms of donation, but also in terms of number of transplantation. This situation does not contribute to guarantee the same level of accessibility to health care assistance, which patients deserve. To solve these problems the National Health Care Plan 2003-2005 has indicated, among the strategic objectives, a better utilization of organs and a more deep campaign of information for all citizens. It is important that all the Institutions and all the operators involved would give more attention to the donation process problems and would always be active and efficient. Only keeping a high level of involvement of the local coordinators and of the anaesthetists and intensive, pivotal figures in the process of donation, and reminding to all citizens the possibility of a "love sign", fruit of a decision born by a personal analysis, it will be possible to offer a possibility of life to the patients for whom up today no other treatments exists.

Anesthesia↗
PubMed2004

Use of quinupristin/dalfopristin in a critical patient with a methicillin-resistant Staphilococcus aureus infection.

The growing incidence of infections due to Gram-positive multiresistant germs has stimulated research into new drugs endowed with broader activity, that are useful in case of infections unresponsive to common antibiotics. The case of a 28-year-old man infected with a methicillin resistant Staphylococcus aureus non responder to therapy with glycopeptide antibiotics is reported. At admission the patient presented a septic condition and required mechanical ventilation. Antibiotic therapy was immediately started with teicoplanin+meropenem. Blood culture and bronchial aspirate evidenced a methicillin resistant Staphylococcus aureus with high sensibility to glycopeptide antibiotics. Although this therapy produced a slight improvement in clinical condition and the patient was extubated, fever and leucocytosis associated with a BAL positive to methicillin resistant Staphylococcus aureus, in vitro susceptible to glycopeptides, persisted. Considering the possibility of a non-responder condition of the patient to glycopeptide antibiotics, quinupristin/dalfopristin was added. The streptogramin produced a quick improvement in clinical condition with resolution of sepsis and culture sterilization. The patient improved progressively and was discharged. In conclusion, in our experience the association quinupristin/dalfopristin was effective in the resolution of a critical methicillin resistant Staphylococcus aureus infection non responder to classical treatment with glycopeptide antibiotics that showed a high sensibility in vitro.

Adult↗
PubMed2003

Derecruitment of the lung induced by stepwise lowering of positive end-expiratory pressure in patients with adult respiratory distress syndrome.

BACKGROUND AND OBJECTIVE: It has recently been suggested that recruitment proceeds far above the lower inflection point of the elastic pressure-volume (Pel/V) curve of the respiratory system. Accordingly, the value of the lower inflection point as a guide to set the positive end-expiratory pressure (PEEP) has been challenged. Our aim was to evaluate the derecruitment induced by stepwise decreasing PEEP levels. METHODS: Seven consecutive sedated and paralysed patients with acute respiratory distress syndrome were studied. Multiple Pel/V curves of the respiratory system were recorded at PEEP levels progressively decreasing in steps of 3.75 cmH2O from + 15 to zero according to the principles of the low flow inflation method. RESULTS: Multiple Pel/V curves shifted towards lower volumes at decreasing PEEP. Dynamic compliance was higher for Pel/V curves recorded from lower PEEP levels. A high correlation (r = 0.99) was found between dynamic compliance and PEEP. The lower inflection point was on average 9.2 cmH2O. However, the transition between the lower segment and the linear part of the Pel/V curve was in general smooth to the eye. The upper inflection point was on average 23.8 cmH2O. A high correlation (r = 0.98) between the upper inflection point and PEEP was found. CONCLUSIONS: The lower inflection point is a poor indicator of alveolar closure. The evaluation of derecruitment induced by a stepwise reduction in PEEP seems to be more useful than individual titration of PEEP and tidal volume in patients with adult respiratory distress syndrome.

Adult↗
PubMed2003

[Rhabdomyolysis associated with respiratory infection in chronic psychiatric patients during neuroleptic treatment].

Rhabdomyolysis is a disorder characterized by skeletal muscle injury and fatal complications at times. The causes of rhabdomyolysis are usually traumatic and non-traumatic, such as neuroleptic malignant syndrome and rhabdomyolysis associated to septicemia. The cases of 2 schizophrenic patients with rhabdomyolisis during pneumonia infection and neuroleptic therapy are reported. At admission, both patients had important respiratory distress and hyperthermia; the clinical conditions required endotracheal intubation. Blood and urine cultures were always negative, while the bronchial sputum culture was positive. The diagnosis of rhabdomyolysis was confirmed by myoglobinemia dosage and ortholuidine test. Pneumonia infection was treated with antibiotic specific therapy whereas renal failure was treated with adequate hydratation and strained diuresis. The absence of muscle rigidity, the improvement of X-r images and the reduction of corporeal temperature, during antibiotic treatment, excluded neuroleptic malignant syndrome. The impro-vement allowed extubation and discharge of the patients from intensive care unit. In both cases neuroleptic malignant syndrome was excluded, therefore rhabdomyolysis was the consequence of pneumonia infection or of a combination of factors capable to cause an important damage of skeletal muscles.

Acute Kidney Injury↗
PubMed2002

Luxatio cordis due to right pericardium tear, a difficult diagnosis: report of a case.

BACKGROUND: Dislocation of the heart is a rare complication of thoracic blunt trauma. A high index of suspicion of pericardium rupture is necessary to formulate an early diagnosis to reduce morbidity and mortality. PATIENTS: A 23-year-old man suffered a blunt thoracoabdominal trauma and was admitted 3 days later to a university hospital ICU for right heart luxation due to right pericardial tear. Mechanical ventilation delayed radiological findings. METHODS AND RESULTS: Surgery by repositioning the heart and repairing the pericardial tear allowed restoration of hemodynamic equilibrium.

Accidents, Traffic↗
PubMed2001

Aspiration of dead space allows isocapnic low tidal volume ventilation in acute lung injury. Relationships to gas exchange and mechanics.

OBJECTIVE: In acute lung injury (ALI) mechanical ventilation damages lungs. We hypothesised that aspiration and replacement of dead space during expiration (ASPIDS) allows normocapnic ventilation at higher end-expiratory pressure (PEEP) and reduced tidal volume (V(T)), peak and plateau pressures (Paw(peak), Paw(plat)), thus avoiding lung damage. SETTING: University Hospital. PATIENTS: Seven consecutive sedated and paralysed ALI patients were studied. INTERVENTIONS AND MEASUREMENTS: Single breath test for CO(2) and multiple elastic pressure volume (Pel/V) curves recorded from different end-expiratory pressures guided ventilatory setting at ASPIDS. ASPIDS was studied at respiratory rate (RR) of 14 min(-1) and then 20 min(-1) with minute ventilation maintaining stable CO(2) elimination. RESULTS: Alveolar and airway dead spaces were 24.3% and 31.3% of V(T), respectively. Multiple Pel/V curves showed a shift towards lower volume at decreasing PEEP, thus indicating that patients required a higher PEEP. At ASPIDS, PEEP was increased from 8.9 cmH(2)O to 12.6 cmH(2)O and VT reduced from 11 ml/kg to 8.9 ml/kg at RR 14 min(-1) and to 6.9 ml/kg at RR 20 min(-1). A significant decrease in Paw(peak) (36.7 vs 32 at RR 14 min(-1) and 28.7 at RR 20 min(-1)) and Paw(plat) (29.9 vs 27.3 at RR 14 min-1 and 24.1 at RR 20 min-1) were observed. PaCO(2) remained stable. No intrinsic PEEP developed. No side effects were noticed. CONCLUSIONS: ASPIDS allowed the use of higher PEEP at lower V(T) and inflation pressure and constant PaCO(2). Multiple Pel/V curves gave insight into the tendency of lungs to collapse.

Aged↗
PubMed2001

Elastic properties of the lung and the chest wall in young and adult healthy pigs.

Understanding of the elastic pressure/volume (Pel/V) curve is still limited in health and disease. The aim of the present study was to elucidate the Pel/V curve and elastance of the respiratory system (ERS) lung (EL) and chest wall (ECW) in healthy pigs. Six young (20.8 kg) and seven adult (58.9 kg), anaesthetized, paralysed and ventilated pigs were studied. Pel/V curves were recorded at zero end-expiratory pressure (ZEEP) and at positive end-expiratory pressure (PEEP) up to 40 cmH2O with a computer controlled ventilator during an insufflation at a low, constant flow. Pel/V curves of the respiratory system showed a complex pattern in both young and adult pigs. During the insufflation, ERS decreased, increased, fell, and increased again. A second Pel/V curve recorded immediately after the first one showed lower elastance and only one early fall in ERS. ECW fell over the initial segment and was then nearly stable. Difference between 1st and 2nd curves reflected changes in EL caused by recruitment during the 1st insufflation. At PEEP, such signs of collapse and recruitment were reduced. A strong tendency to lung collapse contributes to a complex pattern of elastic pressure/volume curves. At low volumes and distending pressures the chest wall contributes significantly to changes in respiratory system elastance.

Aging↗
PubMed2000

Application of a computerised method to measure static pressure volume curve in acute respiratory distress syndrome.

OBJECTIVE: To assess the safety and the bedside feasibility of a new computerised method to record the static pressure-volume curves (Pst/V) of the respiratory system. DESIGN: The Pst/V curves were recorded in 13 medical patients with the acute respiratory distress syndrome (ARDS). During the Pst/V curve tracing the following parameters were recorded: time required for the recording and the automatic analysis of the Pst/V curve and modifications in electrocardiograms, blood pressure, and arterial oxygen saturation (SaO(2)). SETTING: The study was performed in the intensive care unit of the University of Naples "Federico II". RESULTS: No statistically significant modifications in heart rate (HR, b min(-1)), blood pressure (BP, mmHg), and SaO(2) were observed between conditions at baseline (HR 97.2 +/- 17.7; BP 65.4 +/- 9.3; SaO(2) 93.6 +/- 2.0), during the recording (HR 99.8 +/- 19.5; BP 66.2 +/- 11.6; SaO(2) 93.7 +/- 2.4), and 2 min after the procedure (HR 98.2 +/- 17.8; BP 65.2 +/- 11.7; SaO(2) 93.7 +/- 1.9). The Pst/V curves were recorded in 8.38 +/- 1. 19 min and fully analysed in 2.69 +/- 0.85 min. Mean value of static compliance was 41.1 +/- 12.7 ml cmH(2)O(-1). A lower inflection point was found in ten patients (mean value 9.2 +/- 1.9 cmH(2)O). CONCLUSIONS: In ARDS patients, the present new computerised method gave valuable data to ordinary intensivists and was shown to be safe, easy, and fast.

APACHE↗
PubMed2000

Effects of NO inhalation on pulmonary leukocyte sequestration and blood volume in porcine endotoxaemia.

OBJECTIVE: Sequestration and migration of activated neutrophils plays a major role in the pulmonary injury typical of septic shock and the adult respiratory distress syndrome. Inhaled NO may counteract alveolar-capillary damage attributed to activated neutrophils. The present study describes a method to directly demonstrate the effects of NO inhalation on endotoxin-induced sequestration of 99mTc-labelled leukocytes [As(t)] in the lungs of pigs. DESIGN: Prospective controlled study. SETTING: Laboratory for experimental surgery at a university medical centre. SUBJECTS: Anaesthetised and ventilated pigs. INTERVENTIONS: To induce inflammatory shock 26 animals received a continuous endotoxin infusion. Thirteen animals inhaled NO from the start of the experiments, while 13 served as controls. In 13 animals from both groups, leukocytes were labelled in vitro and reinjected, while in the 13 others erythrocytes were labelled in vivo to provide corrections for changes in blood volume. MEASUREMENTS AND RESULTS: The pulmonary distribution of 99mTc-labelled leukocytes or erythrocytes was studied dynamically for 180 min. After correction for changes in pulmonary and heart blood volume (PBV, HBV), leukocyte sequestration curves were generated. Endotoxin induced pulmonary vasoconstriction, reduced PBV, impaired oxygenation, and caused a maximum increase in As(t) of 30% in the lungs. NO inhalation attenuated pulmonary vasoconstriction and the reduction in PBV. The maximum increase in As(t) was reduced to 15% of baseline. CONCLUSIONS: Inhaled NO exerts its main vascular effects in the pulmonary microvasculature, the primary site of physiological neutrophil margination and pathological adhesion of activated leukocytes. Early use of NO inhalation may offer protection against the development of more lasting pulmonary failure in septic shock by reducing leukocyte sequestration in the lungs.

Administration, Inhalation↗