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R Malacrida

Publications and source records attributed to R Malacrida.

17 recordsLinked to original sources
PubMed1992

Esophageal electrodes allow precise assessment of cardiac output by bioimpedance.

OBJECTIVES: To analyze the impact of the position of the thoracic external electrodes on the values of cardiac output measured by electrical bioimpedance and to compare the results obtained by bioimpedance with those values determined by thermodilution in critically ill patients. DESIGN: Open, prospective, comparative trial. SETTING: ICU of a teaching hospital. PATIENTS: Twenty healthy volunteers and ten critically ill patients. INTERVENTIONS: Measurements of cardiac output by bioimpedance at rest and after physical activity in normal volunteers and after changing the neck or xiphoid electrodes. Comparisons of cardiac output obtained by thermodilution and bioimpedance with internal and external electrodes in patients. MEASUREMENTS AND MAIN RESULTS: Mean +/- SD values are presented. Cardiac output values at rest and after exercise were 6.7 +/- 1.3 and 10.8 +/- 2.6 L/min at rest and after exercise, respectively (p less than .001). Displacement of the xiphoid electrodes 3 cm in the caudal direction was accompanied by a decrease of the mean cardiac output from 7.1 +/- 1.2 to 5.8 +/- 1.3 L/min (p less than .001) and displacement 3 and 6 cm cranially was accompanied by increases in cardiac output from 7.1 +/- 1.2 to 8.1 +/- 1.4 L/min (p less than .001) and 8.6 +/- 1.5 L/min (p less than .001), respectively. In the ten patients, cardiac output measurements were virtually identical when results obtained by thermodilution (6.7 +/- 3.1 L/min) were compared with those results obtained by bioimpedance using internal esophageal (6.6 +/- 3.1 L/min), but not external (4.7 +/- 1.6 L/min) electrodes. CONCLUSIONS: a) The values of cardiac output derived from measurements obtained by bioimpedance using internal electrodes were comparable with those values derived from thermodilution. b) Values of cardiac output from bioimpedance studies with external electrodes were dependent on the position of the xiphoid electrodes.

Adult↗
PubMed1992

Pharmacokinetics of midazolam administered by continuous intravenous infusion to intensive care patients.

OBJECTIVE: To determine the pharmacokinetics of continuously infused midazolam in patients during intensive care. DESIGN: Descriptive trial. SETTING: General ICU in a Swiss hospital. SUBJECTS: Eight critically ill patients requiring mechanical ventilation. INTERVENTIONS: To achieve an appropriate level of long-term sedation, the rate of iv infusion of midazolam in ICU patients was adjusted individually to between 6 and 15 mg/hr. Blood samples were taken during and after the continuous infusion of midazolam. MEASUREMENTS: Measurements included plasma concentration time profiles of midazolam and pharmacokinetic parameters, such as elimination half-life, clearance, and volume of distribution. RESULTS: The elimination half-life was prolonged (mean 5.4 vs. 2.3 hrs) and the volume of distribution was larger (3.1 vs. 0.9 L/kg) in patients vs. healthy volunteers. The clearance did not differ between groups (6.3 vs. 4.9 mL/min/kg in patients vs. volunteers, respectively). CONCLUSIONS: The increased volume of distribution in our critically ill patients is the major determinant for the observed slower elimination of midazolam. It is unlikely that the hepatic metabolism of midazolam was impaired in these patients.

Adult↗
PubMed1991

Computer-aided self-observation psychological stressors in an ICU.

We have developed a procedure for a computer-aided self-observation method in stressful situations. Staff members of an ICU recorded their experiences on a computer placed in the ICU, immediately after having experienced a stressful event. The computer asked for and stored psychologically relevant information about cognitive, affective and behavioural aspects. An external stress memory of an ICU was established, allowing a personal/institution-orientated stress diagnosis to be made on the basis of 192 episodes. Sixteen nurses in an intensive care unit in a Swiss hospital used this methodology for 12 weeks. One hundred and ninety-two stressful events were recorded (12 episodes per person), forming a good sample of the stressful episodes for the unit. To the same 16 nurses and 31 nurses at the same hospital (N total = 47) the Nursing Stress Scale was administered. The results from both groups showed that problems dealing with death and work load were predominant. Nurse characteristics such as levels of training (unskilled, skilled) and experience (number of years working as a nurse) were analysed by different statistical procedures and related to their stress experience.

Adaptation, Psychological↗
PubMed1990

[Poisoning with cholinesterase inhibitors].

A 32-year-old woman who had ingested 300 ml of a potent cholinesterase inhibitor insecticide (Fonofos) with suicidal intent became progressively comatose and finally suffered respiratory arrest. Tracheal intubation, mechanical ventilation, vigorous gastric lavage and intravenous administration of atropine and obidoxime brought about complete clinical recovery within 24 hours of ingestion of this potentially fatal dose of Fonofos.

Adult↗
PubMed1990

[Post-traumatic coma and pre-traumatic memory].

Instead of thinking that it is impossible to enter in the internal world of a comatose patient, we are now put before a new and encouraging prospective, that of the possibility, even though minimal, of influencing the vital residual organisation of the patient and to induce him perhaps to accept again external stimulations, which previously were too intense. As loss of conscience often causes loss of memory, our intention was to examine the problem of memory loss in comatose patients after accidents. The analysis of 50 questionnaires distributed to trauma-patients awakening from a comatose state and interviews give clear indications that: 1) the patients remember absolutely nothing during the time of the coma; 2) in the majority of cases (34) the patients remember in the moment preceding the accident a clear autodestructive tendency especially if they were the cause of the accident; and 3) almost all patients (41) agree to have benefited greatly from the trauma itself and from its memory.

Amnesia↗
PubMed1989

[Utilization of helicopters for the prevention of secondary cerebral lesions in severe craniocerebral injuries].

The prehospital emergency treatment of craniocerebral trauma tries to avoid secondary cerebral lesions by controlling respiration and circulation. The therapy consists of heavy sedation with Midazolam, analgesia with morphine, artificial hyperventilation, PaO2 over 12 kPa and average arterial pressure above 80 mmHg. Our series of 46 patients recovered between 1982-1988 had a hospital mortality of 23%. 46% of the patients were polytraumatized. A normal neurologic state 6 months from the accident was registered in 86.4%. For 13.6% it was slightly pathological and no vigilant coma state was reported. The most effective rehabilitation method at the site of the accident has to secure the cerebral oxygen supply and reduce potential increase in intracranial pressure for avoid secondary cerebral lesions.

Adult↗
PubMed1988

[Systemic thrombolysis using streptokinase. Experiences at the Civic Hospital of Lugano in the framework of the ISIS-2 study].

With a small group of Swiss hospitals we had an opportunity of participating in ISIS-2, the major study on thrombolysis in acute myocardial infarction. Experience with our microcosm (Ospedale Civico Lugano) was compared with the macrocosm of the results of ISIS-2 in 17,187 randomized patients (in brackets). Mortality was 5.1% (7.8%) in our streptokinase group and 15.8% (12.8%) in our placebo group. In the ISIS-2 study the combination of thrombolytic therapy with streptokinase, and of antiplatelet therapy with aspirin, showed a reduction of approximately one third in acute mortality of myocardial infarction, stroke and reinfarction. Our experience confirms the reduced incidence of allergic side effects (3.5%), major bleeding (0.3%) and minor bleeding (2.9%) during or after thrombolytic therapy.

Administration, Oral↗
PubMed1988

Essential and non-essential amino acid requirement in injured patients receiving total parenteral nutrition.

The metabolic derangements of injury are known to influence nitrogen (N) requirements whilst less is known about individual amino acid (AA) requirements. This study was designed to investigate prospectively N vs AA requirement in 36 injured patients treated with total parenteral nutrition (TPN). The non-protein caloric input was 30 kcal kg-1 day-1 and three AA solutions were assessed containing the same AAs but in different proportion. Overall N intake was set at 0.35 g N kg-1 day-1 for solution A and B and 0.24 g N kg-1 day-1 for solution C. Solution B was similar to A, both being enriched in branched chain AAs (BCAA: 0.69 g kg-1 day-1 in B compared with 0.55 g kg-1 day-1 in A) while decreased in aromatic and sulphurated forms (1.75 times the normal need). Solution C was designed to maintain a daily input of BCAA similar to A (0.52 g kg-1 day-1) but with the supply of aromatic and sulphurated AA between solutions A and B, the supply of other AAs (lysine, theonine, histidine, arginine, glycine) being dependent on the selected N intake. For all the essential AAs the supply was always greater than normal allowances. Increasing BCAA over 0.55 g kg-1 day-1 did not improve N balance when N intake was 0.35 g kg-1 day-1, whilst nutrition with solution C was unable to maintain N balance. Moreover we found indirect evidence that this N intake, 0.52 g kg-1 day-1 was more sparing than 0.37 g kg-1 day-1 of BCAA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

["Soft" parameters and invisible resuscitation].

Caring for a patient implies performing technical interventions and caring for the whole person, recognising his/her personal life, habits, family, wills. The working experience of an intensive care unit of Bellinzona is described: the theoretical framework that led the health team to start this new approach to intensive care patients and its translation in everyday practice. Verbal and non verbal communication skills (with the patient and the team) are pivotal in this approach; relatives are considered partners in the care of the patient and an essential element of the caring environment. Nurses identified meaningful data (soft data) related to living experience of the patient, to the interaction with the healing environment, his/her patterns of communication, and their use in the intensive care unit is described.

Communication↗
PubMedDate not supplied

[The inducers of stress in a hospital department].

The stress level of general medical ward (18), intensive care (15) and emergency department nurses (13) was measured with a questionnaire. For 13 intensive care and 3 emergency department nurses stress level was measured also with a computerized system (COMES). Main sources of stress among nursing personnel are death and dying, and workload. There are no differences between full time and part time nurses and apparently intensive care and emergency department nurses do not experience more stress than general medical ward nurses.

Adaptation, Psychological↗