PubMed Health⌕ Search

Biomedical subjects

F Procaccio

Publications and source records attributed to F Procaccio.

At least 19 recordsLinked to original sources
PubMed2001

Electrophysiologic monitoring in neurointensive care.

Cumulative evidence of potential benefits of electroencephalography (EEG) and evoked potentials in the management of patients with acute cerebral damage has been confirmed. Continuous EEG monitoring is the best method for detecting nonconvulsive seizures and is strongly recommended for the treatment of status epilepticus. Continuously displayed, validated quantitative EEG may facilitate early detection of secondary cerebral insults and may play a decision-making role in the management of patients with head injury, stroke, or subarachnoid hemorrhage. Long-latency auditory evoked potentials and cognitive components constitute a new field of interest for the progress of comatose patients. Motor evoked potentials may become clinically important both in acutely injured and elective postoperative patients. In the neurointensive care units adequate techniques can be selected to answer targeted clinical questions. The efficacy can be improved by implementing educational projects based on ad hoc training of nurses and neurointensive care specialists.

Acute Disease↗
PubMed2001

[Prevalence of nosocomial infections in Intensive Care Units in Triveneto area, Italy].

BACKGROUND: Nosocomial infection is one of the most common complications affecting patients admitted in intensive care units (ICU). The aim of this study is to evaluate rates of ICU-acquired infections, potential risk factors for these infections, causative microorganisms and antibiotic resistance patterns. METHODS: A 1-day point-prevalence study was conducted in 39 ICUs in Triveneto area (Italy) in November 1998. The overall study population included 188 patients with mean age of 61.4+/-19.3 years; the mean SAPS II score at entry into the ICU was 44.4+/-16.8 and the median duration of hospitalization was 9 days (range 2-636). RESULTS: A total of 59 patients (31.4%) had 79 episodes of ICU-acquired infections; pneumonia (45.5%), bloodstream infection (30.4%), and urinary tract infection (11.4%) were the most frequent types of infection. The leading causative microorganisms were S. aureus (24.4%, 77% of them were resistant to methicillin), Enterobacteriaceae (24.4%), P. aeruginosa (23.2%), fungi (12.2%), coagulase-negative staphylococci (7.3%) and Enterococcus spp (4.9%). Independent risk factors for nosocomial infections were duration of hospitalization >7 days (OR 4.29, 95% CI 1.82-10.1), SAPS II score >30 (OR 3.34, 95% CI 1.0-11.18), total parenteral nutrition (OR 2.69, 95% CI 1.19-6.07) and tracheostomy (OR 1.88, 95% CI 0.84-4.20). CONCLUSIONS: Nosocomial infections are relatively frequent in Triveneto area ICUs. The predominance of pneumonia and bloodstream infection, and the high frequency of antibiotic-resistant pathogens indicate that resources had to be assigned towards the implementation of control programs of those infections, monitoring of antibiotic resistance and prescription, and antibiotic therapy guidelines.

Adolescent↗
PubMed2000

Guidelines for the treatment of adults with severe head trauma (part I). Initial assessment; evaluation and pre-hospital treatment; current criteria for hospital admission; systemic and cerebral monitoring.

If pragmatic recommendations for treatment of severely head-injured patients could really be applied, they would probably have a considerable impact in terms of reduction in mortality and disability. Since 1995 a Group of Italian Neurointensivists and Neurosurgeons belonging to the Italian Societies of Neurosurgery (SINch) and Anesthesiology & Intensive Care (SIAARTI) has produced this first part of recommendations that are completed by Medical treatment (Part II) and Surgical treatment criteria (Part III). These recommendations reflect a multidisciplinary consent but are based on scientific evidence, when available, and take origin mainly from expert opinions and the current clinical and organizational situation. For this aspect they differ from other American and European guidelines, which are strictly based on criteria of proven efficacy. These recommendations aim at providing a practical reference for all those dealing with severe head injuries from first-aid to intensive care units, setting out the minimal goals of management to be reached throughout the country. For these reasons they need continual critical review and updating. Main clinical aims are: 1) to prevent secondary cerebral damage by continuous and meticulous maintenance of systemic homeostasis 2) to standardize methods of neurological evaluation and CT scan classification and scheduling; 3) to give simple indications for systemic and cerebral monitoring 4) to pragmatically discuss the organizational scenarios and specify the minimal safe clinical approach when patients are treated in non-specialized settings. Briefly, smooth tracheal intubation and ventilation in all comatose patients, administration of rapidly metabolized sedative and analgesic drugs to permit frequent neurological evaluation, restoration of volemia and systolic blood pressure above 110 mm Hg, oxygen saturation >95% and normocapnia, are all recommended from the very early treatment and transport. Homogeneity of language, reliable and correctly tested Glasgow Coma Score and pupillary reflexes, and a simple CT scan classification are recommended to improve communications and clinical decisions in the multidisciplinary setting of management. In comatose patients, cerebral perfusion pressure, intracranial pressure and oxygen jugular saturation must be monitored according to specific criteria, which are described. Therapy with hyperventilation and mannitol should be used only in case of clinical deterioration and uncal herniation. This therapy could be useful to gain time to reach neurosurgery. The aim of these recommendations is to achieve safer management of severely brain injured patients, immediate diagnosis of clinical deterioration and successful identification and treatment of surgical lesions. The impact of these guidelines requires further verification.

Adult↗
PubMed2000

Guidelines for the treatment of adults with severe head trauma (part II). Criteria for medical treatment.

Since 1995 a Group of Italian Neurointensivists and Neurosurgeons belonging to the Italian Societies of Neurosurgery (SINch) and Anesthesia & Intensive Care (SIAARTI) has produced some recommendations for treatment of adults with severe head trauma. They have been published in 3 parts: Part I (Initial assessment, Evaluation and pre-hospital treatment, Criteria for hospital admission, Systemic and cerebral monitoring), Part II (Medical treatment) and Part III (Surgical treatment criteria). These recommendations reflect a multidisciplinary consent and are mostly based on expert opinion. The main aim is to provide a practical reference for all those dealing with severe head injuries from first-aid to intensive care units, setting out the minimal goals of management to be reached throughout the Country. These recommendations need a continuous critical review and updating. Medical treatment is aimed at preventing or minimizing secondary brain damage following acute brain injury, provided that surgical masses have been promptly identified and removed. In order to assure cerebral perfusion, systemic hemodynamics and respiratory exchanges should be normal. Volemia is crucial, and mean arterial pressure should remain above 90 mmHg. Good general intensive care, including gastroprotection, water-electrolyte balance, infection control, nutrition and physiotherapy, is assumed as the basis for brain-oriented therapy. Intracranial hypertension requires an approach based on various steps. First, factors that can directly rise intracranial pressure (ICP) such as venous outflow obstruction, fever, pain etc. should be checked and corrected. Second, Mannitol, CSF withdrawal, sedation and moderate hyperventilation should be applied. This can be done by targeting specific problems with specific treatment (which is possible when the cause of ICP rise is known) or in a step-wise approach, by using less aggressive interventions before than more aggressive ones, with a higher risk of complications. Third, extreme treatment, such as barbiturates, should be reserved to cases with refractory intracranial hypertension. The main goal of ICP treatment is not simply ICP reduction, but the maintenance of adequate cerebral perfusion pressure.

Adult↗
PubMed2000

Guidelines for the treatment of adults with severe head trauma (part III). Criteria for surgical treatment.

The Guidelines of the surgical management of severe head injury in adults, as evolved by the Neurotraumatology Group of the Italian Neurosurgery Society and the Italian Society for Anaesthesia, Analgesia, Reanimation and Intensive Care are presented and briefly discussed. Guidelines presented here are of a pragmatic nature, based on consensus and expert opinion. Aspects pertaining to specific indications to surgery and/or to the possibility of conservative management of different traumatic intracranial lesions are highlighted. The importance of surgery in preventing secondary insults to the traumatised brain is emphasised.

Adult↗
PubMed1998

[Immediate treatment of factors leading to death or sever cerebral damage in patients with subarachnoid hemorrhage].

Subarachnoid haemorrhage (SAH) is a medical emergency. Extracerebral factors may cause avoidable deaths, secondary cerebral damage and ultraearly rebleeding. Severe hypertension, hypotension, arrhythmias and pulmonary edema frequently occur; rapid referral with adequate treatment and monitoring (clinical, ABP, SO2, ECG) to neurosurgical centers is warranted. Practice guidelines should be addressed to obtain quality and continuity of management in the early diagnostic phase; intensive global medical approach should be ensured by neuranesthesists and intensivists to achieve optimal cerebral conditions before surgical or endovascular treatment.

Brain Damage, Chronic↗
PubMed1998

[Strategy for intensive care in patients with subarachnoid hemorrhage].

Severe medical complications account for 20-30% of all deaths in patients with subarachnoid hemorrhage. High quality of intensive care is needed to prevent and correct pulmonary complications and electrolyte disturbances. Guidelines of intensive medical treatment should be defined to control intracranial hypertension and ischemic secondary cerebral damage in comatose patients. Extensive monitoring is necessary to achieve adequate observation in the perioperative period and safe treatment of vasospasm. A multidisciplinary approach in a critical area with intensive and sub-intensive beds, based on the cooperative role of neurosurgeons and anesthetists/intensivists, could improve the medical care, reducing complications, ICU stay and costs.

Critical Care↗
PubMed1993

[Continuous monitoring of brain electrical activity as a guide to treatment of acute brain lesion].

Cortical activity of the brain can be monitored continuously by simple, cheap and non-invasive methods. Nevertheless routine monitoring in Neuro ICUs seldom includes traditional or processed EEG. Our clinical experience with the Cerebral Function Monitor (CFM) indicates that a reliable guide to treatment of acute cerebral lesion can be obtained in different clinical situations and steps of management. ISCHEMIA: the lower border voltage of the CFM correlates with the minimum level of cortical activity and mirrors different degrees of cortical metabolic depression. Cerebral oligaemia is reflected consistently in a an increase in periods of EEG suppression, particularly in the arterial boundary zones where the CFM electrodes are located. CFM is a reliable warning of impending ischaemia. THERAPY: during the administration of hypnotics, development of a burst suppression EEG pattern signifies adequate dosage for maximal reduction of cerebral metabolism (CMRO2), cerebral blood flow (CBF) and intracranial pressure. Values of CFM lower border voltage predict the efficacy of hypnotic agents in ICP reduction therapy after severe head injury. Hyperventilation, mannitol and i.v. anaesthetic agents may be beneficial or detrimental in different conditions of CBF and metabolic demand; concomitant recording of oxygen jugular bulb saturation (SjO2) and CFM identifies different clinical situations of the CBF/CMRO2 ratio (adequate perfusion, relative hyperaemia, compensated and non compensated hypoperfusion, cerebral infarct) and offers a clinical guide to targeted therapy. SEIZURES: generalized and focal sub-clinical seizures are easily recognizable on the CFM trace; continuous EEG/CFM monitoring is mandatory in status epilepticus to choose and titrate drugs. RESEARCH: continuous polygraphic recording of CFM together with ABP, ICP and SjO2 is a good method to appreciate spontaneous pathophysiological dynamics and the relationship between treatment, nursing and cerebral events. Frustrating artifacts and "wandering electrodes" could be eliminated by qualified nursing and improved ICU environment; early control of CBF/CMRO2 derangement and prevention of ischaemic secondary damage could take advantage from validated guidelines based on continuous EEG/CFM monitoring.

Acute Disease↗
PubMed1992

[Continuous monitoring of O2 saturation in cerebral blood. A guide for the nursing of brain trauma patients in coma].

Manual ventilation is frequently performed by nurses to control increases in intracranial pressure (ICP) or during physiotherapy in head injured comatose patients. The effects of manual ventilation (n = 251) on ICP, cerebral perfusion pressure (CPP) and EEG have been studied in 18 mechanically ventilated patients. A fall in ICP was easily obtained but a fall in arterial blood pressure was often present at the same time. Thus a reduction in CPP resulted in 36% of occasions. Prophylactic boluses of thiopental (n = 67) before noxious stimuli obtained a fall in ICP in 99% of occasions but resulted in a decrease in CPP in 46%. The fall in ICP, due to the decrease in cerebral blood flow (CBF) by hypocapnia or metabolic depression and/or arterial hypotension, may be beneficial in hyperaemic brains but may precipitate cerebral hypoxia in ischaemic lesions. Relevant information about cortical metabolism (CMR) may be obtained from EEG monitoring by Cerebral Function Monitor but, unfortunately, no data about CBF are clinically available. The Authors suggest that the continuous monitoring of jugular bulb oxygen saturation (SjO2) may offer a clinically useful index of CBF adequacy to CMR. Findings from a preliminary study in 5 patients demonstrate that a severe decrease in SjO2 has been frequently caused by manual ventilation, hypothetically related to severe cerebral ischemia. High levels of SjO2 have been induced by endotracheal suction and physiotherapy, probably related to severe hyperemia. As prevention of ischaemic and hyperaemic insults is a major goal of treatment, the A. suggest that these undesirable effects of nursing might be avoided if nurses could take advantage of continuous monitoring of SjO2.

Adolescent↗
PubMed1991

Effects of thiopentone and mannitol on cerebral perfusion pressure and E.E.G. in head injured patients with intracranial hypertension.

The effects on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and EEG monitored by Cerebral Function Monitor (CFM) were compared after bolus administration of mannitol (n = 55) and thiopentone (n = 67) to control intracranial hypertension in 18 severely head injured patients. Mannitol increased CPP in 89% of occasions and thiopentone in only 54% (p < 0.001). Thiopentone caused a mean increase in CPP +0.6 kPa (+5.0 +/- 1.6 mmHg) when the minimum pre-bolus voltage of CFM was above 4 microV and a fall in CPP -0.5 kPa (-4.1 +/- 1.6 mmHg) when cortical electrical activity was already severely depressed (p < 0.0002). When pre-bolus CFM was below 4 microV mannitol was superior to thiopentone. This different effect on CPP was due to a significantly greater fall in mean arterial pressure in the thiopentone sub-group -1.6 versus -0.3 kPa (-12.4 +/- 1.5 mmHg, -2.8 +/- 1.2 mmHg; p < 0.001). Severe and unpredictable hypotension occurred, particularly in the thiopentone low CFM sub-group. This symptomatic therapy seems inadequate but a targeted treatment of intracranial hypertension could be possible only with a more sophisticated monitoring, including continuous data on cerebral blood flow and adequacy to metabolic demand.

Adolescent↗
PubMed1990

Kynurenic acid synthesis by human glioma.

Biopsy material from human gliomas obtained during neurosurgery was used to investigate whether pathological human brain tissue is capable of producing kynurenic acid (KYNA), a natural brain metabolite which can act as an antagonist at excitatory amino acid receptors. Upon in vitro exposure to 40, 200 or 1000 microM L-kynurenine, the immediate bioprecursor of KYNA, freshly prepared tissue slices in a dose-dependent fashion produced KYNA which was detected in the incubation medium. De novo synthesized KYNA was identified by several chromatographic procedures. Astrocytomas produced significantly more KYNA than glioblastomas.

Adult↗