Biomedical subjects

S Scalvini

Publications and source records attributed to S Scalvini.

28 records · Page 2Linked to original sources

PubMed1993

Non-invasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COLD patients.

OBJECTIVE: 1) To compare the clinical usefulness of both non-invasive pressure support ventilation (NPSV) and non-invasive intermittent positive pressure ventilation in assist-control (A/C) mode (NIPPV) in chronic obstructive lung disease (COLD) patients with acute hypercapnic respiratory failure: 2) to compare retrospectively the usefulness of non-invasive mechanical ventilation (NMV) with standard medical therapy alone. DESIGN: Prospective randomized retrospective study. SETTING: 2 Respiratory intermediate intensive units. PATIENTS: 29 COLD patients (age: 62 +/- 8 years) with chronic respiratory failure were hospitalized in a department for rehabilitation during acute relapses of their disease. They were transferred to our intermediate intensive care unit (IICU) and submitted randomly to either NPSV (16 patients) or NIPPV (13 patients). MEASUREMENTS AND RESULTS: Blood gas analysis, dynamic flows, clinical variables, success rate, time of ventilation, side effects and subjective score of compliance to therapy. Therapy was considered successful when endotracheal intubation was avoided and patients were returned to their condition prior to exacerbation. No statistically significant difference was found between NPSV and NIPPV in success rate (NPSV 87.5%; NIPPV 77%) or in time of ventilation (NPSV: 69 +/- 49; NIPPV: 57 +/- 49 h). A better compliance to non-invasive mechanical ventilation (NMV) was found in NPSV patients than in NIPPV patients; side effects were observed less frequently in the NPSV group. Comparison of the success rate of NMV was retrospectively performed with 35 control COLD patients with chronic respiratory insufficiency who had undergone an acute relapse of their disease in the 2 years preceding the institution of the IICU and had been treated with oxygen and medical therapy alone. Patients submitted to NMV showed a greater success rate than control (82 versus 54%) after a period of ventilation ranging from 4-216 h. CONCLUSION: Non-invasive mechanical ventilation performed either by NPSV or NIPPV may improve the outcome of acute exacerbations of COLD, as compared to medical therapy alone. NPSV seems to be more acceptable to patients in comparison with NIPPV.

Acute Disease↗

PubMed1993

Cardiopulmonary intermediate intensive unit: time course of two years activity.

Intermediate intensive care may be defined as a post comprehensive programme, where monitoring, combined with necessary treatment, improves and maintains physiological functions to complete the cure of underlying diseases. The aims of this paper are: 1) to describe the caring activity that patients admitted to our 12 bed Cardiopulmonary Intermediate Intensive Unit (CPIIU) experience and, 2) to demonstrate that a noninvasive choice does not worsen mortality and the quality of care needed to improve patient outcome. From September 1st 1990 to September 30th 1992, 775 patients (135 respiratory subjects) were admitted. The majority of these patients came from Coronary Intensive Units or Medical and Surgical Intensive Care Units. Noninvasive cardiorespiratory monitoring was assessed in these patients, to obtain their clinical improvement. After this post acute observance, our patients were followed during a stabilization programme in the cardiopulmonary rehabilitation division until a day-hospital or home care programme was carried out. By implementing the CPIIU principles in our department we have reduced the number of deaths and the necessity for Intensive Care Unit admission (from 19 to 9.6%). The estimated risk of death proposed by Apache score was higher than that recorded in our patients (estimated Apache = 25 and 6% for respiratory and cardiac patients, respectively; actual Apache = 10.4 and 3.1% for the same patients, respectively). Average hospitalisation days in our CPIIU was 18 +/- 9. Our CPIIU showed a mean daily cost for each patient of $370.6.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Physical rehabilitation in coronary patients who have suffered from episodes of cardiac failure.

The effects of bicycle training for 5 weeks were evaluated in 12 patients after myocardial infarction with left ventricular dysfunction (left ventricular ejection fraction < 40%) and at least one episode of cardiac failure in the past. The patients were divided into two groups of six according to the Weber classification: Group B (VO2/kg/min: 16-20) and Group C (VO2/kg/min: 10-15). Cardiopulmonary and hemodynamic parameters were evaluated during a maximal exercise test and a simultaneous catheterization of the right side of the heart before and after the training. An increase in the capacity for work was recorded in Group B (p < 0.02), while Group C remained unchanged. A statistically significant increase in minute ventilation (p < 0.05) and VO2/kg/min (p < 0.0006) was recorded in Group B. Group C showed an increase in the mean pulmonary arterial pressure (p < 0.03). All of the other parameters remained unchanged after training. We conclude that physical rehabilitation improves the tolerance to exercise in patients with a mildly depressed cardiac function (Group B) but not in patients with a very depressed cardiac function (Group C).

Cardiac Output↗

PubMed1992

Acute exacerbations in severe COLD patients. Treatment using positive pressure ventilation by nasal mask.

We retrospectively evaluated the clinical effectiveness of a treatment schedule with intermittent positive pressure ventilation via nasal mask in 49 patients with acute exacerbations of COLD. According to the ability to successfully tolerate a preliminary trial with NIPPV, patients were submitted either to standard treatment plus NIPPV (25 patients) or to ST alone (24 patients). The ST consisted of medical, oxygen and physical therapy. The NIPPV was delivered by a volume cycled ventilator in control mode at least 4 h a day for five consecutive days a week, for three weeks. Comparison of baseline with measurements performed after 10 and 21 days of treatment respectively showed a significant improvement in PaO2 and in PaCO2 in both groups. After 21 days of treatment, VC, FEV1, inspiratory muscle strength, and dyspnea significantly improved in both groups. No significant difference was found between groups at any time of treatment. We conclude that the treatment schedule of NIPPV used is not more effective than ST alone in acute exacerbations of COLD.

Aged↗

PubMed1992

Time course of pulmonary function before admission into ICU. A two-year retrospective study of COLD patients with hypercapnia.

Changes in cardiopulmonary function were retrospectively evaluated back to two years before acute exacerbations requiring ICU admission in 16 COLD patients with chronic hypercapnic respiratory insufficiency (age: 61 +/- 6 years, group A). Fifteen hypercapnic COLD patients matched for age, sex, lung function, and blood gas values not requiring an ICU admission in a period of two years, served as control subjects (age: 66 +/- 7, group B). Periodic assessments of spirometry, arterial blood gas values, echocardiography, body weight, and red blood cell count performed in stable state were compared for differences between groups and changes over a period of two years. The results indicated that basal body weight, rate of deterioration over time in FEV1, VC, blood gas values, bicarbonates, and RVD may be related to the necessity of ICU admission in COLD patients with hypercapnic respiratory insufficiency.

Aged↗

PubMed1992

Right ventricular diastolic function in chronic obstructive lung disease.

Early detection of diastolic dysfunction in chronic obstructive lung disease (COLD) patients could have great prognostic value. Echocardiography has been shown to be a useful technique in studying left ventricular diastolic function. A noninvasive method of studying right ventricular diastolic function has not yet been reported. Pulsed Doppler echocardiography was used to assess right ventricular diastolic function in three groups of subjects: Group I: 35 COLD patients with pulmonary hypertension; Group II: 32 COLD patients without pulmonary hypertension; and Group III: 18 control subjects. Ratios between peak atrial filling velocity (A) and peak early filling velocity (E) (A/E), deceleration half times of the right ventricular rapid filling wave (DHT), and the interval between pulmonary valve closure and tricuspid valve opening (isovolumic relaxation times) (Pc-To) were significantly different in Group I in comparison to Groups II and III. Sensitivity of A/E ratio and Pc-To were 82 and 77%, respectively, and specificity 90 and 72%, respectively; positive predictive values were 90 and 75%, respectively, and negative predictive value 82 and 74% respectively. The multiple correlation coefficient between A/E, acceleration time (ACT), DHT, Pc-To and mean pulmonary artery pressure was 0.75 for Groups I and II together. In conclusion 2D echo-Doppler proved to be useful in evaluating right ventricular diastolic function in all hypertensive COLD patients, revealing a high correlation between diastolic parameters and mean pulmonary artery pressure in both normotensive and hypertensive COLD patients.

Echocardiography, Doppler↗

PubMed1990

[Thrombolytic therapy in the treatment of thromboembolism of the right cardiac cavity during pulmonary embolism: our experience with rt-PA and review of the literature].

In 4 consecutive patients admitted for multiple pulmonary embolism 2-dimensional echocardiography showed large right atrial migrant thromboemboli in transit, floating and prolapsing into the right ventricle in diastole. This pattern was always associated with the echocardiographic signs of pulmonary hypertension. All the patients were treated with intravenous infusion of 100 mg of rt-PA in 3 hours. rt-PA determined the dissolution and disappearance of the right atrial thromboemboli (it took 4 hours in 2 patients and 5 hours in the remaining 2), and the concomitant disappearance of the echocardiographic signs of pulmonary hypertension. During and after the rt-PA therapy there was no evidence of further pulmonary embolism. The fibrinolytic treatment for right atrial thromboemboli during multiple pulmonary embolism is a promising alternative to right atrial thrombectomy: our results indicate that rt-PA acts rapidly and is effective and safe; if these results will be confirmed in a larger group of patients, rt-PA could become the first-choice therapy of right atrial thromboembolus.

Aged↗

PubMed1988

Coxsackie virus heart disease: 15 years after.

From 1969 to 1973, 68 patients were admitted to the 4th Division of Medicine of the Brescia Civil Hospital with the diagnosis of viral myocarditis. The patients were divided into two groups according to the results of the Coxsackie virus complement fixing antibodies test: Group 1 (42 patients) with a fourfold or greater rising antibody titre; Group 2 (26 patients) with a negative serum test. Both groups were examined after a follow-up period of 15 years. Ten patients from Group 1 died. The diagnoses were chronic myocarditis (three cases); chronic cardiomyopathy-pulmonary embolism (one case); chronic cardiomyopathy-liver cirrhosis (one case); dilated cardiomyopathy-sudden death (two cases); congestive cardiomyopathy (three cases). No Group 2 patients died. The 15-year mortality rate of Group 1 was significantly higher than that of Group 2 (Fisher Test: p less than 0.005). In conclusion, the natural history of Coxsackie virus heart disease is characterized by two possibilities: a complete recovery from a clinical point of view, in some cases with only minor T wave abnormalities, or evolution into a chronic disease (dilated cardiomyopathy) having a high mortality rate within 10 years of the onset of the acute disease.

Cardiomyopathy, Dilated↗

PubMed1988

Noninvasive assessment of pulmonary hypertension: a simultaneous echo-Doppler hemodynamic study.

Thirty patients with stable chronic obstructive lung disease (COLD) underwent an echo-Doppler examination before and during right heart catheterization. No statistically significant differences between observations for any of two-dimensional echo-Doppler parameters were found. The measurement of all parameters taken during the catheterization correlated better with mean pulmonary artery pressure (mPAP) than those taken before. This difference was most evident for the isovolumetric acceleration time (r = 0.71 before versus r = 0.85 during the catheterization) and relaxation time (r = -0.75 before versus r = -0.87 during the catheterization). The multiple correlation coefficient for all measured parameters and mPAP was 0.83 before and 0.92 during the catheterization. In conclusion, in patients with COLD, it appears possible to get reliable information about PAP using noninvasive techniques.

Adult↗

PubMedDate not supplied

Telemedicine: a new frontier for effective healthcare services.

Telemedicine can be defined as the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interest of advancing the health of individuals and their communities. Such a wide definition includes many health care activities and a large number of applications have been tried, with variable degrees of interaction between all the players in the health care system. This review, starting from the need and opportunity that we are now facing to capitalize the great technological improvements in the field of information and communication technologies to improve also our health services, will illustrate the history, classification and main field of application of Telemedicine. Lastly, the available data on the application of Telemedicine for patients with respiratory diseases will be reviewed.

Health Services↗