Biomedical subjects

Simonetta Masieri

Publications and source records attributed to Simonetta Masieri.

6 recordsLinked to original sources

PubMed2005

The potential dangers of treating head injury patients with corticosteroids.

In the past, corticosteroids were given to head-injured patients in order to prevent secondary brain damage, even if clinical trials had been inconclusive and potential risks of complications were of concern. Recently, CRASH, a large, multi-centre study on short-term, high-dose corticosteroid treatment in head trauma, was interrupted after enrolling > 10,000 patients because corticosteroid treatment was associated with significantly higher mortality within two weeks. Participating clinicians were not requested to judge the causes of death, but rates of infections and gastrointestinal haemorrhages did not differ between treated patients and controls. Other potential corticosteroid complications include metabolic derangements (particularly hyperglycaemia), adrenal insufficiency and critical illness myopathy. Furthermore, experimental data suggest that corticosteroids may have some harmful effects on neural tissue. In this review, the potential risks of treating head-injured patients with corticosteroids are examined.

Adrenal Cortex Hormones↗

PubMed2005

Postoperative delirium.

Delirium is a global impairment of upper brain functions caused by an organic substrate. It is frequently observed in the postoperative period, particularly in elderly people. Vascular and orthopedic surgery and long-duration surgery are associated with a higher incidence of postoperative delirium. When it occurs, postoperative delirium makes patient management much more difficult, increases costs, and, above all, causes severe discomfort to the patient. Delirium is also associated with higher postoperative mortality and morbidity, and with delayed functional recovery, but it is still unclear whether worse prognosis is directly caused by delirium or results from the neurological damage of which delirium is simply a symptom. Drug therapy should be part of a complex approach to prevent and treat this complication. Neuroleptics like haloperidol and droperidol, and benzodiazepines are usually employed in order to control symptoms like agitation, restlessness, and altered perceptions. Atypical neuroleptics, like risperidone, have not yet been studied in postoperative delirium, although some case reports in which they were successfully used have been published. Physiostigmine is effective in delirium caused by anticholinergic syndrome; vitamins may be useful in alcoholics; melatonin use has been suggested in order to prevent and treat delirium by normalizing sleep-wake cycle alterations. Environmental interventions are often costless and may be very useful to prevent and treat postoperative delirium in patients at risk.

Anti-Anxiety Agents↗

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

New indications for corticosteroids in intensive care units.

In last years an increasing number of evidences has been gained that inflammatory response plays a major role in critical illness. The acronym SIRS (Systemic Inflammatory Response Syndrome) has been introduced to define the condition in which the inflammatory reaction exceeds local mechanisms of containment and inflammatory mediators invade the bloodstream causing systemic disturbances. Theoretically, the use of corticosteroids offers a potent tool to control the excess of inflammatory reaction, but initial trials on Adult Respiratory Distress Syndrome (ARDS), head trauma, and septic shock showed not only that mortality was unaffected, but also that morbidity could increase. Recently, however, some new studies have suggested that corticosteroids given at dosages lower than those initially tested, could positively affect late stages of ARDS by preventing pulmonary fibrosis, and septic shock by improving hemodynamics and facilitating the weaning from catecholamines. To date, it is not clear whether these effects are related to the correction of an adrenocortical dysfunction.

Adrenal Cortex Hormones↗

PubMed2003

Effects of non-invasive ventilation on middle ear function in healthy volunteers.

OBJECTIVES: To evaluate the effects of non-invasive ventilation (NIV) with facial mask or helmet on middle ear (ME). DESIGN. Prospective, randomised study. SETTING: University hospital. PARTICIPANTS: Ten healthy subjects randomly allocated in two groups of five subjects each. INTERVENTIONS: NIV for 1 h, with helmet (group H) or facial mask (group M). Flow-triggered pressure support was 10 cmH(2)O, PEEP 5 cmH(2)O, FiO(2) 0.21. MEASUREMENTS AND RESULTS: Impedenzometry was performed before NIV and 5 min after NIV ended; it was repeated 60 min later. In group H the acoustic compliance increased after NIV from 2.0+/-.6 ml to 2.3+/-.6 ml ( P<.01), suggesting that the tympanic membrane became less stiff; 1 h later the compliance returned to basal values (2.0+/-.7 ml); in group M the compliance was unaffected (from 2.0+/-.5 ml to 2.0+/-.4 ml; 1.9+/-.4 ml 1 h later). The acoustic reflex, i.e., the contraction of the stapedial muscle in response to an auditory stimulus, involving the acoustic and facial nerves, was also evaluated during impedenzometry at 250 Hz, 500 Hz, 1,000 Hz, and 4,000 Hz; no significant change of the threshold was observed. CONCLUSIONS: The tympanic membrane is tighten by the tensor tympani and a reversible loosening suggests muscle fatigue in response to the application of intermittent positive pressure applied to the external ear during NIV with helmet. The loss of tensor tympani protective action could theoretically predispose the middle and inner ear to mechanical damage during NIV with helmet, suggesting the use of protective devices (ear plugs) in selective cases requiring long-term, high-pressure treatment.

Adult↗

PubMed2002

Furosemide protective effect against airway obstruction.

Furosemide (frusemide) is mainly employed as a powerful diuretic that inhibits Na and K reabsorption in renal tubules. However other valuable pharmacological effects have been discovered that include a protective action from bronchospasm. The effects of furosemide on airways have been recognized to be more and more complex as far as an increasing amount of studies have been produced on this subject. The drug shows no acute bronchodilator effect, but prevents or attenuates bronchospasm caused by many factors, such as hyperpnea, drugs (metabisulphite, bradykinin, AMP), physical agents (hypo- and hypertonic aerosols), and allergen challenge in asthmatic patients. Furosemide is also active on upper airway mucosa, on which the drug decreases nasal resistance in patients affected by non-allergic rhinitis and exhibits a protective effect on nasal mucosa reactivity to the specific allergen in atopic subjects. The mechanism of action of furosemide on airways has not yet been fully cleared and interference with electrolyte epithelial transport, prostaglandins, inflammatory cell activity, vascular and neural regulation has been hypothesized. The interest for clinical application of inhaled furosemide has grown in last years. Some Authors have investigated whether the drug is effective in acute asthma attacks or not. Furosemide is one of the drugs currently used to prevent exercise-induced asthma. More recently, inhaled furosemide has been observed to decrease the sensation of experimentally-induced dyspnea. Apart from possible therapeutic application, studies about furosemide effects on respiratory mucosa can contribute to better understand the physiology of upper and lower airways.

Administration, Inhalation↗