Biomedical subjects

Sergio Livigni

Publications and source records attributed to Sergio Livigni.

5 recordsLinked to original sources

PubMed2006

Autologous mesenchymal stem cells: clinical applications in amyotrophic lateral sclerosis.

OBJECTIVES: Our study was aimed to evaluate the feasibility and safety of intraspinal cord implantation of autologous mesenchymal stem cells (MSCs) in a few well-monitored amyotrophic lateral sclerosis (ALS) patients. METHODS: Seven patients affected by definite ALS were enrolled in the study and two patients were treated for compassionate use and monitored for at least 3 years. Bone marrow was collected from the posterior iliac crest according to the standard procedure and MSCs were expanded ex vivo according to Pittenger's protocol. The cells were suspended in 2 ml autologous cerebrospinal fluid and transplanted into the spinal cord by a micrometric pump injector. RESULTS: The in vitro expanded MSCs did not show any bacterial o fungal contamination, hemopoietic cell contamination, chromosomic alterations and early cellular senescence. No patient manifested major adverse events such as respiratory failure or death. Minor adverse events were intercostal pain irradiation and leg sensory dysesthesia, both reversible after a mean period of 6 weeks. No modification of the spinal cord volume or other signs of abnormal cell proliferation were observed. A significant slowing down of the linear decline of the forced vital capacity was evident in four patients 36 months after MSCs transplantation. CONCLUSIONS: Our results demonstrate that direct injection of autologous expanded MSCs into the spinal cord of ALS patients is safe, with no significant acute or late toxicity, and well tolerated. The clinical results seem to be encouraging.

Adult↗

PubMed2006

Efficacy and safety of a low-flow veno-venous carbon dioxide removal device: results of an experimental study in adult sheep.

INTRODUCTION: Extracorporeal lung assist, an extreme resource in patients with acute respiratory failure (ARF), is expanding its indications since knowledge about ventilator-induced lung injury has increased and protective ventilation has become the standard in ARF. METHODS: A prospective study on seven adult sheep was conducted to quantify carbon dioxide (CO2) removal and evaluate the safety of an extracorporeal membrane gas exchanger placed in a veno-venous pump-driven bypass. Animals were anaesthetised, intubated, ventilated in order to reach hypercapnia, and then connected to the CO2 removal device. Five animals were treated for three hours, one for nine hours, and one for 12 hours. At the end of the experiment, general anaesthesia was discontinued and animals were extubated. All of them survived. RESULTS: No significant haemodynamic variations occurred during the experiment. Maintaining an extracorporeal blood flow of 300 ml/minute (4.5% to 5.3% of the mean cardiac output), a constant removal of arterial CO2, with an average reduction of 17% to 22%, was observed. Arterial partial pressure of carbon dioxide (PaCO2) returned to baseline after treatment discontinuation. No adverse events were observed. CONCLUSION: We obtained a significant reduction of PaCO2 using low blood flow rates, if compared with other techniques. Percutaneous venous access, simplicity of circuit, minimal anticoagulation requirements, blood flow rate, and haemodynamic impact of this device are more similar to renal replacement therapy than to common extracorporeal respiratory assistance, making it feasible not only in just a few dedicated centres but in a large number of intensive care units as well.

Aging↗

PubMed2005

Study protocol: the DOse REsponse Multicentre International collaborative initiative (DO-RE-MI).

INTRODUCTION: Current practices for renal replacement therapy in intensive care units (ICUs) remain poorly defined. The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI) will address the issue of how the different modes of renal replacement therapy are currently chosen and performed. Here, we describe the study protocol, which was approved by the Scientific and Steering Committees. METHODS: DO-RE-MI is an observational, multicentre study conducted in ICUs. The primary end-point will be the delivered dose of dialysis, which will be compared with ICU mortality, 28-day mortality, hospital mortality, ICU length of stay and number of days of mechanical ventilation. The secondary end-point will be the haemodynamic response to renal replacement therapy, expressed as percentage reduction in noradrenaline (norepinephrine) requirement. Based on the the sample analysis calculation, at least 162 patients must be recruited. Anonymized patient data will be entered online in electronic case report forms and uploaded to an internet website. Each participating centre will have 2 months to become acquainted with the electronic case report forms. After this period official recruitment will begin. Patient data belong to the respective centre, which may use the database for its own needs. However, all centres have agreed to participate in a joint effort to achieve the sample size needed for statistical analysis. CONCLUSION: The study will hopefully help to collect useful information on the current practice of renal replacement therapy in ICUs. It will also provide a centre-based collection of data that will be useful for monitoring all aspects of extracorporeal support, such as incidence, frequency, and duration.

Blood Pressure↗

PubMed2003

Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock.

OBJECTIVE: The objective was to examine the effect of repeated applications of coupled plasmafiltration-adsorption on the hemodynamic response in septic shock patients hospitalized in intensive care units (ICUs). DESIGN: Prospective, intention-to-treat. SETTING: General ICU of a tertiary care, non-teaching, 400-bed, city hospital. PATIENTS AND PARTICIPANTS: Twelve consecutive mechanically ventilated septic shock patients, with or without concomitant acute renal failure (ARF). INTERVENTION: A median of 10 consecutive sessions (prescribed treatment time: 10 h/session; delivered duration: 8.43+/-1.37 h/min) of coupled plasmafiltration-adsorption for each patient. MEASUREMENTS AND RESULTS: Mean arterial pressure (77.2+/-12.5 [CI 95%; 74.5-79.8] vs. 83.3+/-14.1 [CI 95%; 80.3-86.3] mm Hg; [ p<0.001]), cardiac index (4.03+/-0.89 [CI 95%; 3.83-4.22] vs. 3.46+/-0.82 [CI 95%; 3.28-3.64] L/m(2)/min; [ p<0.001]), systemic vascular resistance index (1,388+/-496 [CI 95%; 1,278-1,497] vs. 1,753+/-516 [CI 95%; 1,639-1,867] dynes x s/cm(5); [ p<0.001]), PO2/FIO2 ratio (204+/-87 [CI 95%; 185-223] vs. 238+/-82 [CI 95%; 220-256]; [ p<0.001]), significantly improved during 100 global treatments (pre- vs. post-treatment values). Intra-thoracic blood volume and extra-vascular lung water did not change across treatments. Vasopressor requirement was reduced: norepinephrine decrease from an infusion rate of 0.13+/-0.07 (CI 95%; 0.06-0.16) to 0 gamma/kg/min after a mean of 5.3+/-2.7 sessions. C reactive protein (CRP) significantly decreased (from 29.3+/-7.3 vs. 7.9+/-4.8; p<0.0001) during treatment. Survival was 90% at day 28 and 70% at day 90. CONCLUSION: Coupled plasmafiltration-adsorption was a feasible and safe extracorporeal treatment and exerted a remarkable improvement in the hemodynamics, the pulmonary function, and the outcome in septic shock patients with or without concomitant ARF.

APACHE↗

PubMed2003

The anesthetic conserving device compared with conventional circle system used under different flow conditions for inhaled anesthesia.

UNLABELLED: The Anesthetic Conserving Device (ACD) is a high-flow anesthesia system closed to volatile anesthetics only. We compared the ACD with a circle system under different fresh gas flow (FGF) conditions. Eighty-one patients undergoing major surgery were randomly allocated to receive sevoflurane from a circle circuit combined either with the ACD placed at the Y-piece (n = 41) or with a vaporizer (n = 40). The FGF was set to 8 L/min in the ACD system, where the circle circuit served as a nonrebreather. In the conventional circle system without ACD, the vaporizer was supplied with 1-, 1.5-, 3-, and 6-L/min FGFs. We compared the ACD with the circle system under the four FGFs in terms of sevoflurane dosing, sevoflurane consumption, humidification efficiency, and environmental pollution. The ACD and the low-flow circle system (1.5- and 1-L/min FGFs) resulted in the smallest sevoflurane consumption. The increase in inspired sevoflurane concentration was faster with the circle system than with the ACD only with FGFs > or =3 L/min. The removal of ACD from the circuit allowed the fastest washout of sevoflurane. Respiratory gas humidification was always adequate. Sevoflurane ambient concentration with the ACD was 1-70 ppb. The ACD is a valid and simple alternative to low-flow systems. IMPLICATIONS: The Anesthetic Conserving Device (ACD) is a new device for anesthetic vapor delivery. We demonstrated that the ACD reduces anesthetic consumption and environmental pollution similarly to a low-flow circle system, offering advantages such as simplicity, no toxicity from compounds produced in the absorber, and potential cost savings.

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