Biomedical subjects

Roberta Costa

Publications and source records attributed to Roberta Costa.

15 recordsLinked to original sources

PubMed2006

Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask.

RATIONALE: The helmet is a new interface with the potential of increasing the success rate of non-invasive ventilation by improving tolerance. OBJECTIVES: To perform a physiological comparison between the helmet and the conventional facial mask in delivering non-invasive ventilation in hypercapnic patients with chronic obstructive pulmonary disease. METHODS: Prospective, controlled, randomized study with cross-over design. In 10 patients we evaluated gas exchange, inspiratory effort, patient-ventilator synchrony and patient tolerance after 30 min of non-invasive ventilation delivered either by helmet or facial mask; both trials were preceded by periods of spontaneous unassisted breathing. MEASUREMENTS: Arterial blood gases, inspiratory effort, duration of diaphragm contraction and ventilator assistance, effort-to-support delays (at the beginning and at the end of inspiration), number of ineffective efforts, and patient comfort. MAIN RESULTS: Non-invasive ventilation improved gas exchange (p<0.05) and inspiratory effort (p<0.01) with both interfaces. The helmet, however, was less efficient than the mask in reducing inspiratory effort (p<0.05) and worsened the patient-ventilator synchrony, as indicated by the longer delays to trigger on (p<0.05) and cycle off (p<0.05) the mechanical assistance and by the number of ineffective efforts (p<0.005). Patient comfort was no different with the two interfaces. CONCLUSIONS: Helmet and facial mask were equally tolerated and both were effective in ameliorating gas exchange and decreasing inspiratory effort. The helmet, however, was less efficient in decreasing inspiratory effort and worsened the patient-ventilator interaction.

Aged↗

PubMed2006

Electrical impedance tomography's correlation to lung volume is not influenced by anthropometric parameters.

STUDY OBJECTIVES: Electrical impedance tomography (EIT) is able to reflect physiological parameters such as real-time changes in global and regional lung volume. EIT can aid in the assessment of lung recruitment, and its use has been validated in preliminary studies monitoring mechanical ventilation at the bedside. ICU patients vary widely in their body habitus, and obesity is becoming more prevalent. Our primary research purpose was to establish whether anthropometric parameters influence EIT's reliability. Our secondary question was whether body position alters its correlation to spirometric measurements. SUBJECTS: 22 healthy adult volunteers (12 male, 10 female) with broadly variable anthropometric parameters. INTERVENTIONS: Simultaneous measurements of changes in lung volume using EIT imaging and a pneumotachograph were obtained with two breathing patterns (quiet and deep breathing) and in four body positions (standing, sitting, semi-reclining and supine). MEASUREMENTS AND RESULTS: Correlation between measurements of changes in lung volume using EIT imaging and a pneumotachograph was excellent. Variations attributable to anthropometric measurements accounted for at most a 1.3% difference. CONCLUSIONS: Anthropometric variability and body position do not adversely influence the EIT estimation of changes in lung volume. These data suggest EIT could be used to monitor critically ill mechanically ventilated adults with variable body habitus regardless of position.

Adult↗

PubMed2005

Distinctive lack of CD48 expression in subsets of human dendritic cells tunes NK cell activation.

CD48 is a glycosyl phosphatidylinositol anchor protein known to be virtually expressed by all human leukocytes. Its ligand, 2B4, is a signaling lymphocyte activation molecule-related receptor involved in NK cell activation. Because dendritic cells (DCs) are strong inducers of NK cell functions, we analyzed the expression of CD48 in different human DC subsets. We observed that monocytes differentiating in DCs promptly down-regulate CD48. Similarly, DCs isolated from inflamed lymph nodes generally do not express CD48. Plasmocytoid DCs do not express CD48 either, whereas myeloid DCs harbored in blood, bone marrow, and thymus express it. In addition, we showed that CD48 expression in DCs affects NK cell functions during NK/DC cross-talk, because NK cells obtained from normal donors and from X-linked lymphoproliferative disease patients are, respectively, triggered or inhibited by DCs expressing surface CD48. Remarkably, IFN-gamma production by lymph node NK cells, in contrast to blood NK cells, can be negatively modulated by 2B4/CD48 interactions, indicating a 2B4 inhibitory pathway in lymph node NK cells. Therefore, the CD48 deficiency of DCs harbored in inflamed lymph nodes that we report in this study might be relevant to successfully activate lymph node NK cells in the early phase of the immune response. Our results show that distinct subsets of human DCs, differently from all other mononuclear hemopoietic cells, specifically do not express CD48. Moreover, the expression of CD48 depends on the anatomic location of DCs and might be related to the tissue-specific 2B4 function (activating or inhibitory) of the NK cells with which they interact.

Antigens, CD↗

PubMed2005

Physiologic evaluation of different levels of assistance during noninvasive ventilation delivered through a helmet.

OBJECTIVE: To evaluate the effects of various levels of pressure support (PS) during noninvasive ventilation delivered through a helmet on breathing pattern, inspiratory effort, CO2 rebreathing, and comfort. DESIGN: Physiologic study. SETTING: University-affiliated hospital. PATIENTS AND PARTICIPANTS: Eight healthy volunteers. INTERVENTIONS: Volunteers received ventilation through a helmet with four different PS/positive end-expiratory pressure combinations (5/5 cm H2O, 10/5 cm H2O, 15/5 cm H2O, and 10/10 cm H2O) applied in random order. MEASUREMENTS AND RESULTS: The ventilatory respiratory rate, esophageal respiratory rate (RRpes), airway pressure, esophageal pressure tracings, esophageal swing, and pressure-time product (PTP) [PTP per breath, PTP per minute, and PTP per liter] were evaluated. We also measured the partial pressure of inspired CO2 (Pi(CO2)) at the airway opening, mean partial pressure of expired CO2 (Pe(CO2)), CO2 production (V(CO2)), minute ventilation (V(E)) delivered to the helmet (V(E)h), and the true inspired V(E). By subtracting V(E) from V(E)h, we obtained the Ve washing the helmet (V(E)wh). A visual analog scale (from 0 to 10) was used to evaluate comfort. Compared to spontaneous breathing, different levels of PS progressively increased tidal volume (V(T)) and decreased RRpes, reducing inspiratory effort. The increased levels of assistance did not produce significant changes in Pi(CO2), end-tidal CO2, and V(CO2). Pe(CO2) had a slight decrease when increasing the level of PS from 5 to 10 cm H2O (p < 0.05). Despite the presence of constant values of Ve, the increase of PS produced an increase in V(E)wh, without significant differences comparing 10 cm H2O and 15 cm H2O of PS. The subjects had a slight but not significant increase in discomfort by augmenting the level of assistance. At the highest level of PS (15 cm H2O), the discomfort was significantly higher (p < 0.001) than at the other levels of assistance. CONCLUSION: In volunteers, the helmet is efficient in ventilation, allowing a Vt increase and RRpes reduction. A significant discomfort was present only at the highest level of assistance; however, it did not affect patient/ventilator interaction.

Adult↗

PubMed2005

Eosinophil granulocytes account for indoleamine 2,3-dioxygenase-mediated immune escape in human non-small cell lung cancer.

Indoleamine 2,3-dioxygenase (IDO), a catabolizing enzyme of tryptophan, is supposed to play a role in tumor immune escape. Its expression in solid tumors has not yet been well elucidated: IDO can be expressed by the tumor cells themselves, or by ill-defined infiltrating cells, possibly depending on tumor type. We have investigated IDO expression in 25 cases of non-small cell lung cancer (NSCLC). Using histochemistry and immunohistochemistry, we found that IDO was expressed not by tumor cells, but by normal cells infiltrating the peritumoral stroma. These cells were neither macrophages nor dendritic cells, and were identified as eosinophil granulocytes. The amount of IDO-positive eosinophils varied in different cases, ranging from a few cells to more than 50 per field at x200 magnification. IDO protein in NSCLC was enzymatically active. Therefore, at least in NSCLC cases displaying a large amount of these cells in the inflammatory infiltrate, IDO-positive eosinophils could exert an effective immunosuppressive action. On analyzing the 17 patients with adequate follow-up, a significant relationship was found between the amount of IDO-positive infiltrate and overall survival. This finding suggests that the degree of IDO-positive infiltrate could be a prognostic marker in NSCLC.

Adult↗

PubMed2005

Analgesia in PACU: intravenous opioids.

Critically ill patients, particularly those under mechanical ventilation, require analgo-sedation to control noxious stimuli and enhance comfort. Despite their harmful side effects, such as respiratory depression, physical dependence and difficult arousal, opioids are effective in providing a good level of analgesia and comfort. Traditional opioids (morphine and fentanyl) have been shown effective in providing analgesia; however, the respiratory adverse effects and their pharmacokinetics, with an high risk of accumulation, limits their use, especially for a long-term sedation. In the last decade, new synthetic opioids with limited side effects and favourable pharmacokinetics profile, such as Sufentanil and Remifentanil, have been investigated to evaluate their efficacy in mitigating pain and enhancing comfort in critically ill patients.

Analgesics, Opioid↗

PubMed2004

Noninvasive vs invasive ventilation in COPD patients with severe acute respiratory failure deemed to require ventilatory assistance.

OBJECTIVE: To determine whether non-invasive ventilation (NIV) may be an effective and safe alternative to invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) meeting criteria for mechanical ventilation. DESIGN AND SETTING: Matched case-control study conducted in ICU. PATIENTS AND INTERVENTION: NIV was prospectively applied to 64 COPD patients with advanced ARF. Their outcomes were compared with those of a control group of 64 COPD patients matched on age, FEV(1), Simplified Acute Physiology Score II, and pH at ICU admission, previously treated in the same ICU with conventional invasive mechanical ventilation. METHODS AND RESULTS: NIV failed in 40 patients who required intubation. Mortality rate, duration of mechanical ventilation, and lengths of ICU and post-ICU stay were not different between the two groups. The NIV group had fewer complications ( P = 0.01) and showed a trend toward a lower proportion of patients remaining on mechanical ventilation after 30 days ( P = 0.056). Compared to the control group, the outcomes of the patients who failed NIV were no different. Compared to the patients who received intubation, those who succeeded NIV had reduced mortality rate and lengths of ICU and post-ICU stay. CONCLUSIONS: In COPD patients with advanced hypercapnic acute respiratory failure, NIV had a high rate of failure, but, nevertheless, provided some advantages, compared to conventional invasive ventilation. Subgroup analysis suggested that the delay in intubation was not deleterious in the patients who failed NIV, whereas a better outcome was confirmed for the patients who avoided intubation.

Acute Disease↗

PubMed2004

Noise exposure during noninvasive ventilation with a helmet, a nasal mask, and a facial mask.

OBJECTIVE: To assess noise exposure during noninvasive ventilation (NIV) with different types of interface (helmet, nasal, and facial masks). SUBJECTS AND METHODS: Ten "naive" healthy volunteers underwent NIV at pressure support levels of 10 and 15 cmH2O with: (a) helmet, (b) helmet equipped with HME filters at the junctions between the helmet and the inspiratory and expiratory branches of the respiratory circuit, (c) nasal mask, and (d) facial mask. Noise intensity was assessed with a sound level meter by placing a microphone near the right ear. Noise intensity and degree of discomfort were also assessed subjectively with a visual analogue scale. RESULTS: Inside the helmet noise exceeded 100 dB. Noise intensity was poorly affected by pressure support level and unaffected by the presence of HME filters. During NIV with nasal or facial masks the noise did not exceed 70 dB (i.e., noise was not louder than the usual noise background in ICU). Subjective evaluation of noise intensity mirrored objective measurements; however, the presence of HME filters was associated with the feeling of less noise inside the helmet. The discomfort associated with the helmet did not significantly differ from that associated with the masks. CONCLUSIONS: NIV helmet is associated with significantly greater noise than nasal and facial masks, but is as comfortable as masks, at least in the short term. Medium- and long-term exposure to loud noise may potentially impair ear function and increase the patient's discomfort.

Adult↗

PubMed2004

Sedation with sufentanil in patients receiving pressure support ventilation has no effects on respiration: a pilot study.

PURPOSE: To evaluate the effects of sedation with sufentanil on respiratory drive, respiratory pattern, and gas exchange of critically ill patients during pressure support ventilation. METHODS: In this prospective observational cohort study, we observed 12 adult patients receiving partial ventilatory support for acute respiratory failure. Each subject received a continuous infusion of sufentanil at 0.2 to 0.3 micro g x kg(-1) x hr(-1) to obtain a modified Ramsay sedation score between 2 and 3. In basal conditions and at variable distance from the beginning of the sufentanil infusion (10', 30', 60', 120', 24 hr) we evaluated gas exchange, hemodynamic variables, respiratory rate (RR), tidal volume (TV), respiratory pattern, respiratory drive (P0.1) and inspiratory impedance of the respiratory system [P0.1/TV/inspiratory time (Ti)]. RESULTS: The continuous iv administration of 0.2 to 0.3 micro g x kg(-1) x hr(-1) of sufentanil resulted in the desired level of sedation. No significant heart rate, heart rhythm and blood pressure changes were observed. Sufentanil infusion did not affect TV, minute volume, Ti/inspiratory duty cycle, RR, P0.1, P0.1/TV/Ti and gas exchange did not change significantly over the study period. CONCLUSION: A continuous infusion of sufentanil induces "awake" sedation with no detectable effects on respiratory variables in critically ill patients during partial ventilatory support.

Adult↗

PubMed2004

Twelve-year experience with left atrial resection in the treatment of non-small cell lung cancer.

BACKGROUND: We retrospectively reviewed our 12-year experience in the surgical treatment of non-small cell lung cancer invading the left atrium. End points of the study were overall survival and factors potentially affecting survival. METHODS: Nineteen consecutive patients with lung cancer invading the left atrium underwent surgery. Three patients with N2 disease underwent induction chemotherapy. Patients with either incomplete resections or pN2 disease received postoperative chemoradiotherapy. RESULTS: Five-year survival was 14%, and the median survival time was 25 months. These figures refer to a very homogeneous group of patients with respect to the extent of atrial infiltration. Patients with N2 disease tended to have a worse outcome than patients with N0 or N1 disease (p = 0.06). The 3 patients with N2 disease who underwent induction chemotherapy were alive and disease-free at 30, 15, and 11 months from surgery. Survival was not affected by histology, type of surgery, or completeness of resection. Three patients with residual cancer in the atrial resection margin underwent postoperative chemoradiotherapy and are alive at 25, 17, and 15 months after surgery. CONCLUSIONS: In spite of the poor survival rates we report, the present experience suggests that more-favorable results could be expected by the routine preoperative use of positron emission tomographic scan staging, a more-extensive assessment of atrial invasion, the application of induction chemotherapy in patients with N2 disease, and postoperative chemoradiotherapy in patients with tumors abutting the atrial resection margin.

Aged↗

PubMed2003

New modes of mechanical ventilation: proportional assist ventilation, neurally adjusted ventilatory assist, and fractal ventilation.

Increased knowledge of the mechanisms that determine respiratory failure has led to the development of new technologies aimed at improving ventilatory treatment. Proportional assist ventilation and neurally adjusted ventilatory assist have been designed with the goal of improving patient-ventilator interaction by matching the ventilator support with the neural output of the respiratory centers. With proportional assist ventilation, the support is continuously readjusted in proportion to the predicted inspiratory effort. Neurally adjusted ventilatory assist is an experimental mode in which the assistance is delivered in proportion to the electrical activity of the diaphragm, assessed by means of an esophageal electrode. Biologically variable (or fractal) ventilation is a new, volume-targeted, controlled ventilation mode aimed at improving oxygenation; it incorporates the breath-to-breath variability that characterizes a natural breathing pattern.

Algorithms↗

PubMed2002

A low-dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically-ill patients.

PURPOSE: To study the analgesic and sedative effects of remifentanil in critically-ill patients. METHODS: Remifentanil infusion was started at 0.02 microg x kg(-1) x min(-1) in ten mechanically ventilated critically-ill patients, and the infusion rate was increased to 0.05, 0.10, 0.15, 0.20, and 0.25 microg x kg(-1) x min(-1) every 30 min. Basally and 25 min after each increase we measured: the Ramsey sedation score (RSS) and the respiratory response subscore of comfort scale (CSRR); the bispectral index (BIS) before and after lightly touching tracheal mucosa; heart rate and systemic arterial pressure; respiratory variables; plasma epinephrine and norepinephrine levels. RESULTS: Infusion rates up to 0.05 microg x kg(-1) x min(-1) were effective against agitation and achieved a good degree of adaption to the respirator in all patients (RSS 2 or more and CSRR 3 or less); BIS decreased significantly; respiratory and circulatory variables were unaffected; mean plasma epinephrine levels decreased. At infusion rates higher than 0.05 microg x kg(-1) x min(-1) RSS but not BIS decreased further and patient arousability caused by noxious stimuli was not prevented; respiratory drive suppression occurred at the infusion rates higher than 0.05 microg x kg(-1) x min(-1) in four patients; bradycardia and arterial hypotension was observed in three patients; plasma epinephrine levels decreased significantly, while norepinephrine was unaffected; severe itching was experienced by one patient. CONCLUSIONS: Low doses of remifentanil (up to 0.05 microg x kg(-1) x min(-1)) can be useful in critically-ill patients in order to achieve calm and sedation. Higher doses can inhibit respiratory drive and require controlled mechanical ventilation.

Aged↗

PubMed2002

New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet--a pilot controlled trial.

OBJECTIVE: To assess the efficacy of noninvasive pressure support ventilation (NPSV) using a new special helmet as first-line intervention to treat patients with hypoxemic acute respiratory failure (ARF), in comparison to NPSV using standard facial mask. DESIGN AND SETTING: Prospective clinical pilot investigation with matched control group in three intensive care units of university hospitals. PATIENTS AND METHODS: Thirty-three consecutive patients without chronic obstructive pulmonary disease and with hypoxemic ARF (defined as severe dyspnea at rest, respiratory rate >30 breaths/min, PaO2:FiO2 < 200, and active contraction of the accessory muscles of respiration) were enrolled. Each patient treated with NPSV by helmet was matched with two controls with ARF treated with NPSV via a facial mask, selected by simplified acute physiologic score II, age, PaO2/FiO2, and arterial pH at admission. Primary end points were the improvement of gas exchanges, the need for endotracheal intubation, and the complications related to NPSV. RESULTS: The 33 patients and the 66 controls had similar characteristics at baseline. Both groups improved oxygenation after NPSV. Eight patients (24%) in the helmet group and 21 patients (32%) in the facial mask group (p = .3) failed NPSV and were intubated. No patients failed NPSV because of intolerance of the technique in the helmet group in comparison with 8 patients (38%) in the mask group (p = .047). Complications related to the technique (skin necrosis, gastric distension, and eye irritation) were fewer in the helmet group compared with the mask group (no patients vs. 14 patients (21%), p = .002). The helmet allowed the continuous application of NPSV for a longer period of time (p = .05). Length of stay in the intensive care unit, intensive care, and hospital mortality were not different. CONCLUSIONS: NPSV by helmet successfully treated hypoxemic ARF, with better tolerance and fewer complications than facial mask NPSV.

Adult↗

PubMedDate not supplied

Alfentanil does not increase resistance of the respiratory system in ASA I patients ventilated mechanically during general anesthesia.

PURPOSE: Several experimental and clinical studies have demonstrated a direct bronchoconstrictor effect of opioids on smooth bronchial musculature following iv administration. The aim of this study was to evaluate the effects of alfentanil on respiratory system mechanics in a group of ASA I patients ventilated mechanically during general anesthesia. CLINICAL FEATURES: Twenty consecutive ASA I patients (ten men and ten women) scheduled for general surgery interventions were studied (mean age 45.4 +/- 9.9 yr, mean weight 61.9 +/- 6.7 kg). Exclusion criteria were a history of chronic obstructive pulmonary disease, asthma or other pulmonary disease, atopy, wheezes, smoking and age below 18 yr. Subjects were randomly divided in two groups: Group A, receiving alfentanil at a 15 microg x kg(-1) dose and Group B receiving alfentanil at a 30 microg x kg(-1) dose. Respiratory mechanic variables were acquired at baseline (T0) and after three, ten and 15 min (T1, T2 and T3, respectively). We compared the basal values to the values measured at each time interval; basal values, prior to drug administration, served as control for each patient. P values < 0.05 were considered statistically significant. RESULTS: We did not observe significant differences in respiratory mechanic variables after the administration of alfentanil, 15 and 30 microg x kg(-1). More specifically, respiratory system compliance and the different subcomponents of respiratory system resistances (i.e., maximum, minimum and delta resistance of respiratory system) were within normal limits and did not vary after alfentanil administration. CONCLUSION: No respiratory adverse effect was reported after alfentanil iv administration.

Adult↗

PubMedDate not supplied

Mediastinal chondrosarcoma.

The authors report a rare case of primary chondrosarcoma of the anterior mediastinum showing unusual pathological and clinical features, namely 1) the lack of any anatomical relationship between the tumor and cartilage-containing organs, and 2) an indolent behavior with long-term survival. In spite of early disease recurrence and repeated surgery, the patient is in good health five years after primary surgery. The reported case suggests that 1) primary chondrosarcomas of the anterior mediastinum may have a better prognosis than previously recognized, 2) the disease can remain confined within the chest for as long as five years, and 3) repeated surgery may contribute to long-term survival.

Adult↗