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Biomedical subjects

N Petrucci

Publications and source records attributed to N Petrucci.

7 recordsLinked to original sources
PubMed2004

Ventilation with lower tidal volumes versus traditional tidal volumes in adults for acute lung injury and acute respiratory distress syndrome.

BACKGROUND: Patients with acute respiratory distress syndrome and acute lung injury require mechanical ventilatory support. Acute respiratory distress syndrome and acute lung injury are further complicated by ventilator-induced lung injury. Lung-protective ventilation strategies may lead to improved survival. OBJECTIVES: To assess the effects of ventilation with lower tidal volume on morbidity and mortality in patients aged 16 years or older affected by acute respiratory distress syndrome and acute lung injury. A secondary objective was to determine whether the comparison between low and conventional tidal volume was different if a plateau airway pressure of greater than 30 to 35 cm H20 was used. SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library issue 4, 2003; MEDLINE (1966 to October 2003); EMBASE and CINAHL (1982 to October 2003); intensive care journals and conference proceedings; databases of ongoing research, reference lists and 'grey literature'. SELECTION CRITERIA: Randomized trials comparing ventilation using either lower tidal volume or low airway driving pressure (plateau pressure 30 cm H(2)O or less), resulting in tidal volume of 7 ml/kg or less versus ventilation that uses Vt in the range of 10 to 15 ml/kg, in adults (aged 16 years or older). DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Wherever appropriate, results were pooled. Fixed and random effects models were applied. MAIN RESULTS: Five trials, involving 1202 patients, were eligible. Mortality at day 28 was significantly reduced by lung-protective ventilation: relative risk 0.74 (confidence interval 0.61 to 0.88), whereas beneficial effect on long-term mortality was uncertain: relative risk 0.84 (confidence interval 0.68 to 1.05). The comparison between low and conventional tidal volume was not significantly different if a plateau pressure less than or equal to 31 cm H2O in control group was used: relative risk 1.13 (confidence interval 0.88 to 1.45). There was insufficient evidence about morbidity and long term outcomes. REVIEWERS' CONCLUSIONS: Clinical heterogeneity, such as different lengths of follow up and higher plateau pressure in control arms in two trials make the interpretation of the combined results difficult. Mortality is significantly reduced at day 28 and the effects on long term mortality are uncertain, although the possibility of a clinically relevant benefit cannot be excluded.

Adult↗
PubMed2003

Ventilation with lower tidal volumes versus traditional tidal volumes in adults for acute lung injury and acute respiratory distress syndrome.

BACKGROUND: Patients with acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) require mechanical ventilatory support. ALI/ARDS is further complicated by ventilator-induced lung injury. Lung-protective ventilation strategies may lead to improved survival. OBJECTIVES: To assess the effects of ventilation with lower tidal volume (Vt) on morbidity and mortality in adults patients affected by ALI/ARDS. A secondary objective was to determine whether the comparison between low and conventional Vt is different if a plateau airway pressure of greater than 30 to 35 cm H20 was used. SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library issue 3, 2002; MEDLINE (1966 to June 2002); EMBASE and CINAHL (1982 to June 2002); intensive care journals and conference proceedings; databases of ongoing research, reference lists and 'grey literature'. SELECTION CRITERIA: Randomized trials comparing ventilation using lower Vt and/or low airway driving pressure (plateau pressure 30 cm H2O or less), resulting in Vt of 7 ml/kg or less versus ventilation that uses Vt in the range of 10 to 15 ml/kg, in adults (16 year-old or greater). DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Wherever appropriate, results were pooled. Fixed and random effects models were applied. MAIN RESULTS: Five trials, involving 1202 patients, were eligible. The test for heterogeneity gave a P-value of 0.12. Ventilation with lower Vt was associated with a decreased mortality at the end of the follow up period for each trial: 216/605 (35.7%) versus 249/597 (41.7%), relative risk (RR) 0.85 (CI 0.74 to 0.98). The effect of the intervention was not statistically significant when a random effects model was used: RR 0.91 (CI 0.72 to 1.14). Mortality at day 28 was significantly reduced by lung-protective ventilation: RR 0.74 (CI 0.61 to 0.88). The comparison between low and conventional Vt was not significantly different if a plateau pressure less than or equal to 31 cm H2O in control group was used: RR 1.13 (CI 0.88 to 1.45). There was insufficient evidence about morbidity and long term outcomes. REVIEWER'S CONCLUSIONS: Clinical heterogeneity, such as different lengths of follow up and higher plateau pressure in control arms in two trials make the interpretation of the combined results difficult. Mortality is significantly reduced at day 28 and the effects on long term mortality are uncertain, although the possibility of a clinically relevant benefit cannot be excluded. There is no evidence that low Vt ventilation is beneficial in patients where hypercapnia is potentially harmful.

Adult↗
PubMed2000

Severe neurotoxic reaction associated with oral ingestion of low-dose diethyltoluamide-containing insect repellent in a child.

N,N-Diethyl-m-toluamide (DEET) is the major component of almost all tick repellent products. Reports of severe adverse reactions following voluntary ingestion are rare and primarily involve adults. This report describes a case of a toxic reaction after ingestion of low doses (80 mg/kg) of DEET in a child. The signs and symptoms were coma and seizures within 2 hours of ingestion. The patient recovered without sequelae. It is concluded that even scant doses of DEET may provoke severe encephalopathy in small children, and caution should be used when leaving this chemical unattended.

Child, Preschool↗
PubMed1999

Exposure of the critically ill patient to extremely low-frequency electromagnetic fields in the intensive care environment.

OBJECTIVE: To measure the electromagnetic emission of intensive care medical equipment, in order to assess whether a potentially dangerous magnetic flux is present around the patient, and to evaluate the exposure conditions of the patient to extremely-low-frequency electromagnetic fields (ELF EMF). DESIGN: Descriptive study. SETTING: Intensive care unit (ICU) at a general hospital. MEASUREMENT AND RESULTS: The flux density of alternating (AC) 50-H2, EMF was measured and mapped around electrical devices in a six-beds adult ICU furnished with standard equipment (ventilator, monitor, infusion pumps, heated airbed, humidifier). The overall flux density in the patient area was assessed by measuring the field intensity at the patient's head during the day and at night over 6 days. The magnetic flux density was not uniformly distributed around each device, being higher [up to 40 microTesla (microT)] close to fan motors and mains supply. In 83 % of the patients a field intensity > 0.20 microT (safety limit) was detected. CONCLUSIONS: The ICU environment is at risk from electromagnetic pollution, the long-term stay of chronic patients and their "day-long" exposure are additional risk factors. EMFs drop off as the distance from the equipment is increased, according to the inverse-square law, and the exposure risk may be minimized by keeping a safety distance from the EMF source. The actual value of that safety distance may be variable and depends on several factors: (1) type of equipment, (2) orientation of equipment, (3) equipment "overcrowding" and (4) available space in each bed space. The magnetic flux density should be monitored regularly in every ICU for the specific design of each unit.

Aged↗
PubMed1993

[End-tidal CO2 as a predictive index of regional perfusion and its relation to aortic flow. A clinical study during peripheral vascular surgery].

Using a new haemodynamic monitoring system, we prospectively measured the end-tidal carbon dioxide (ETCO2) and the aortic blood flow (ABF) in 7 patients undergoing major vascular surgery to evaluate the usefulness of ETCO2 as a predictive indicator of regional blood flow. Previous studies demonstrated a high correlation between ETCO2 and Cardiac Output during CPR (r = 0.79), this allows us to conclude that ETCO2, under conditions of constant ventilation, reflects the circulatory status. We investigated the relationship between ETCO2 and ABF, and our observations confirmed that the two parameters undergo highly significant variations (p < 0.001), but low correlation was found (r = 0.15), so the increase in ETCO2 after aortic declamping depended on re-perfusion of ischaemic regions. The ETCO2 concentration increased immediately in 6 patients after declamping (p < 0.05). In 1 patient, the increase wasn't significant, but he underwent a new operation because of malfunction of the prosthesis. Our findings suggest that ETCO2 monitoring may provide clinically useful information about regional perfusion that can be used to guide therapy.

Aged↗
PubMedDate not supplied

Persistence of sympathetic spectral component of heart rate variability was associated with neurological recovery in severe head injury. Case report.

OBJECTIVE: To report a case of a patient affected by severe head injury where sympathetic and parasympathetic activity was evaluated by measurements of spectral analysis of heart rate variability, in serial determinations. The sympathetic component of the power spectrum never disappeared, despite signs of brain stem damage. SETTING: Intensive Therapy Unit of a University Hospital (J. Radcliffe Hospital, Oxford, England). INTERVENTIONS: None. MEASUREMENTS: Electrocardiogram, 256 R-R intervals for each step and respiration obtained by impedance plethysmography. The signals were recorded on FM tape and then digitized off-line by an analogic-to-digital converter. A program processed the signals identifying the peak of each R wave and obtaining the R-R interval (tachogram) and the Power Spectrum by Fourier transformation and autoregressive analysis. CONCLUSIONS: Persistence of sympathetic activity of Heart Rate Variability Power Spectrum indirectly reflected the integrity of the vasomotor centres allocated in the brain stem and was associated with good outcome.

Adult↗