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  • 1
    Electronic Resource
    Electronic Resource
    A new device to remove obstruction from endotracheal tubes during mechanical ventilation in critically ill patients (1994)
    Springer
    Intensive care medicine 20 (1994), S. 573-576 
    Details
    ISSN: 1432-1238
    Keywords: Mechanical ventilation ; Endotracheal tubes ; Obstruction ; Acute respiratory failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the efficiency of a new device developed to remove obstructions from endotracheal tubes (ETT) in mechanically ventilated patients. Design Open study in mechanically ventilated sedated and paralyzed ICU patients. Setting General ICU and Laboratory of Respiratory Mechanics of the University of Rome “La Sapienza”. Patients 8 consecutive unselected mechanically ventilated, critically ill patients in which a partial obstruction of ETT was suspected on the basis of an increase of the peak inspiratory pressure (〉20%) plus the difficult introduction of a standard suction catheter. Interventions Obstructions to ETT were removed with an experimental “obstruction remover” (OR) Measurements “In vivo” ETT airflow resistance (0.25; 0.5; 0.75; 1l/s) was evaluated before and after use of the OR; the work of breathing necessary to overcome ETT resistance (WOBett) was also evaluated before and after OR use. Results The use of OR significantly reduced in all patients the ETT “in vivo” resistance (From 5.5±2.3 to 2.9±0.5 cmH2O/l/s at 0.25l/s,p〈0.05; from 9±2.4 to 3.8±0.8 cmH2O/l/s at 0.51l/s; from 12.2±3.5 to 5.7±1.2 cmH2O/l/s at 0.75l/s; from 16.9±6 to 9.3±3.8 cmH2O/l/s at 1l/s,p〈0.01 respectively). Also the WOBett was significantly reduced after use of the OR (from 0.66±0.19 to 0.34±0.08 J/l;p〈0.05) Conclusion This experimental device can be safely and successfully used to remove obstructions from the ETT lumen, without suspending mechanical ventilation, reducing the need for rapid ETT substitution in emergency and life-threatening situations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01705724
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  • 2
    Electronic Resource
    Electronic Resource
    Do we know the costs of what we prescribe? (1998)
    Springer
    Intensive care medicine 24 (1998), S. 1194-1198 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cost analysis ; ICU ; Equipment ; Drugs
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the level of cost awareness of drugs and devices among intensive care unit (ICU) doctors with variable levels of experience (senior intensivists, junior intensivists, residents). Design: Interview-questionnaire. Setting: ICU of the University of Rome “La Sapienza”. Participants: 60 ICU doctors (40 specialists in anaesthesia and intensive care, 20 residents). Measurements and results: The estimated prices of drugs and devices were compared with the correct prices; responses within a range ± 20 % of the true price were arbitrarily considered correct; all the subgroups of doctors made inaccurate estimates of the prices, showing an absence of any impact of professional experience of cost awareness. Conclusion: The doctors in the study showed a high level of inacurrate cost awareness of drugs and devices.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050744
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  • 3
    Electronic Resource
    Electronic Resource
    Early and late onset bacteremia have different risk factors in trauma patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 735-741 
    Details
    ISSN: 1432-1238
    Keywords: Trauma ; Early bacteremia ; Late bacteremia ; Polymicrobial bacteremia ; Abdominal injury ; Intravascular catheters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The aim of this study was to identify risk factors and to describe epidemiological patterns for early—(EOB) and late—onset bacteremias (LOB) after trauma. Design A prospective study conducted on 141 consecutive trauma patients. Setting A general intensive care unit (ICU) of a university hospital. Patients All multiple trauma patients admitted to our general intensive care unit (ICU) from December 1990 to May 1992 were prospectively enrolled in the study. The following information was collected for each patient and recorded in a computer database: demography, severity of trauma according to the Abbreviated Injury Scale (AIS), severtity of trauma according to the Glasgow Coma Scale (GCS), presence of pneumothorax, pulmonary contusion, rib fractures, hemothorax, and abdominal trauma, use of mechanical ventilation, and placement of central venous catheters. Bacteremias were defined as EOB when onset occurred within 96 h after trauma, and as LOB when appearing after 96 h from trauma. Results Thirty-seven patients developed bacteremia during their ICU stay (26%): 11 (29.7%) EOB and 26 (70.3%) LOB. Gram-positive cocci were isolated more frequently in EOB than in LOB (x 2=4.1,P=0.04). The risk of EOB was significantly increased by the presence of pulmonary contusion [relative risk (RR) 15.0; confidence interval (CI) 1.99-113.25], pneumonia before the onset of bacteremia (RR 3.56; CI 1.17-10.69), AIS score greater than 32 and an abdominal injury score greater than 9 (RR 3.11; CI 1.02-9.49), while intravascular catheters and mechanical ventilation did not represent risk factors for EOB. LOB had a very different pattern and their risk was significantly increased by exposure to intravascular catheters (RR 4.96; CI 1.23-19.94) and to mechanical ventilation lasting more than 7 days (RR 3.6; CI 1.6-8.1). Conclusions Scoring with the AIS of the abdominal and thoracic trauma at admission to the ICU appears a useful tool for identifying trauma patients at increased risk of EOB. A rigorous policy of catheter placement and maintenance as a means of reducing late bacteremias in trauma patients is essential.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709514
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  • 4
    Electronic Resource
    Electronic Resource
    Respiratory system mechanics in the early phase of acute respiratory failure due to severe kyphoscoliosis (1997)
    Springer
    Intensive care medicine 23 (1997), S. 539-544 
    Details
    ISSN: 1432-1238
    Keywords: Key words Kyphoscoliosis ; Mechanical ventilation ; Respiratory mechanics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate respiratory mechanics in the early phase of decompensation in a group of seven patients with severe kyphoscoliosis (KS) (Cobb angle 〉 90 °) requiring mechanical ventilatory support. Design: Prospective clinical study with a control group. Setting: General intensive care unit at University of Rome “La Sapienza”. Patients: Seven consecutive patients affected by severe KS in the early phase of acute decompensation and a control group of six ASA (American Society of Anesthesiology) 1 subjects who were mechanically ventilated during minor surgery. Measurements and results: Respiratory mechanics were evaluated during constant flow-controlled mechanical ventilation at zero end-expiratory pressure with the end-inspiratory and end-expiratory occlusion technique. In five patients who showed increased ohmic resistance (RRSmin), we evaluated the possibility of reversing this increase with a charge dose of 6 mg/kg doxophylline i. v. In four KS patients, in whom a reliable esophageal pressure was confirmed by a positive occlusion test, we separated respiratory system data into lung and chest wall component. All KS patients showed reduced values of respiratory compliance (CRS) and increased respiratory resistance (RRS). The average basal values of CRS were 36 ± 10 vs 58 ± 8.5 cmH2O in control patients; RRSmax was 20 ± 3.1 vs. 4.5 ± 1.2 cmH2O/l per s; RRSmin 6.2 ± 1.2 vs. 2 ± 0.5 cmH2O/l per s: ΔRRS 14 ± 2.6 cmH2O vs 2.4 ± 0.7 cmH2O/l per s. All KS patients showed low values of intrinsic positive end-expiratory pressure (PEEPi) (1.8 ± 1.5 cmH2O). Separation of lung and chest-wall mechanics, performed only in four patients, showed a reduction in both lung (66.7 ± 7.2 ml/cmH2O) and chest wall values (84 ± 8.2 ml/cmH2O), while both RmaxL and RmaxCW were increased (16.6 ± 2 and 2.8 ± 0.4 cmH2O/l per s, respectively). Infusion of doxophylline did not significantly change respiratory mechanics when evaluated 15, 30, and 45 min after the infusion. Conclusions: During acute decompensation, both lung and chest-wall compliance are severely reduced in KS patients: conversely, and, contrary to that in patients with chronic obstructive pulmonary disease, increases in airway resistance and PEEPi seem to play only a secondary role.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050370
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  • 5
    Electronic Resource
    Electronic Resource
    Evaluation of respiratory system resistance in mechanically ventilated patients: The role of the endotracheal tube (1994)
    Springer
    Intensive care medicine 20 (1994), S. 421-424 
    Details
    ISSN: 1432-1238
    Keywords: Mechanical ventilation ; Endotracheal tube ; Respiratory system resistance ; Airway resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To investigate the role played by the endotracheal tube (ETT) in the correct evaluation of respiratory system mechanics with the end inflation occlusion method during constant flow controlled mechanical ventilation. Setting General ICU, university of Rome “La Sapienza”. Patients 12 consecutive patients undergoing controlled mechanical ventilation. Methods We compared the values of minimal resistance of the respiratory system (i.e. airway resistance) (RRS min) obtained: i) subtracting the theoretical value of ETT resistance from the difference between P max and P1, measured on airway pressure tracings obtained from the distal end of the ETT; ii) directly measuring airway pressure 2 cm below the ETT, thus automatically excluding ETT resistance from the data. Results The values of RRS min obtained by measuring airway pressure below the ETT were significantly lower than those obtained by measuring airway pressure at the distal end of the ETT and subtracting the theoretical ETT resistance (4.5±2.8 versus 2.5±1.6 cm H2O/l/s,p〈0.01). Conclusion When precise measurements of ohmic resistances are required in mechanically ventilated patients, the measurements must be obtained from airways pressure data obtained at tracheal level. The “in vivo” positioning of ETT significantly increases the airflow resistance of the ETT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01710652
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  • 6
    Electronic Resource
    Electronic Resource
    Nitric oxide and right ventricular function (1996)
    Springer
    Intensive care medicine 22 (1996), S. 612-613 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01708111
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  • 7
    Electronic Resource
    Electronic Resource
    Early and late onset bacteremia have different risk factors in trauma patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 735-741 
    Details
    ISSN: 1432-1238
    Keywords: Key words Trauma ; Early bacteremia ; Late bacteremia ; Polymicrobial bacteremia ; Abdominal injury ; Intravascular catheters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The aim of this study was to identify risk factors and to describe epidemiological patterns for early – (EOB) and late – onset bacteremias (LOB) after trauma. Design: A prospective study conducted on 141 consecutive trauma patients. Setting: A general intensive care unit (ICU) of a university hospital. Patients: All multiple trauma patients admitted to our general intensive care unit (ICU) from December 1990 to May 1992 were prospectively enrolled in the study. The following information was collected for each patient and recorded in a computer database: demography, severity of trauma according to the Abbreviated Injury Scale (AIS), severity of coma according to the Glasgow Coma Scale (GCS), presence of pneumothorax, pulmonary contusion, rib fractures, hemothorax, and abdominal trauma, use of mechanical ventilation, and placement of central venous catheters. Bacteremias were defined as EOB when onset occurred within 96 h after trauma, and as LOB when appearing after 96 h from trauma. Results: Thirty-seven patients developed bacteremia during their ICU stay (26%): 11 (29.7%) EOB and 26 (70.3%) LOB. Gram-positive cocci were isolated more frequently in EOB than in LOB (ξ2=4.1, P=0.04). The risk of EOB was significantly increased by the presence of pulmonary contusion [relative risk (RR) 15.0; confidence interval (CI) 1.99–113.25], pneumonia before the onset of bacteremia (RR 3.56; CI 1.17–10.69), AIS score greater than 32 and an abdominal injury score greater than 9 (RR 3.11; CI 1.02–9.49), while intravascular catheters and mechanical ventilation did not represent risk factors for EOB. LOB had a very different pattern and their risk was significantly increased by exposure to intravascular catheters (RR 4.96; CI 1.23–19.94) and to mechanical ventilation lasting more than 7 days (RR 3.6; CI 1.6–8.1). Conclusions: Scoring with the AIS of the abdominal and thoracic trauma at admission to the ICU appears a useful tool for identifying trauma patients at increased risk of EOB. A rigorous policy of catheter placement and maintenance as a means of reducing late bacteremias in trauma patients is essential.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709514
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  • 8
    Electronic Resource
    Electronic Resource
    Paralysis has no effect on chest wall and respiratory system mechanics of mechanically ventilated, sedated patients (1995)
    Springer
    Intensive care medicine 21 (1995), S. 808-812 
    Details
    ISSN: 1432-1238
    Keywords: Muscle relaxants ; Sedation ; Respiratory system mechanics ; Chest wall mechanics ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the separate effects of sedation and paralysis on chest wall and respiratory system mechanics of mechanically ventilated, critically ill patients.Setting: ICU of the University “La Sapienza” Hospital, Rome. Patients and participants 13 critically ill patients were enrolled in this study. All were affected by disease involving both lungs and chest wall mechanics (ARDS in 4 patients, closed chest trauma without flail chest in 4 patients, cardiogenic pulmonary oedema with fluidic overload in 5 patients). Measurements and results Respiratory system and chest wall mechanics were evaluated during constant flow controlled mechanical ventilation in basal conditions (i. e. with the patients under apnoic sedation) and after paralysis with pancuronium bromide. In details, we simultaneously recorded airflow, tracheal pressure, esophageal pressure and tidal volume; with the end-inspiratory and end-expiratory airway occlusion technique we could evaluate respiratory system and chest wall elastance and resistances. Lung mechanics was evaluated by subtracting chest wall from respiratory system data. All data obtained in basal conditions (with the patients sedated with thiopental or propofol) and after muscle paralysis were compared using the Student'st test for paired data. The administration of pancuronium bromide to sedated patients induced a complete muscle paralysis without producing significant modification both to the viscoelastic and to the resistive parameters of chest wall and respiratory system. Conclusions This study demonstrates the lack of additive effects of muscle paralysis in mechanically ventilated, sedated patients. Also in view of the possible side effects of muscle paralysis, our results question the usefulness of generalyzed administration of neuromuscular blocking drugs in mechanically ventilated patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01700963
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  • 9
    Electronic Resource
    Electronic Resource
    Risk factors for acute renal failure in trauma patients (1998)
    Springer
    Intensive care medicine 24 (1998), S. 808-814 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute renal failure ; Trauma ; Rhabdomiolysis ; Mechanical ventilation ; Hemoperitoneum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To elucidate the risk factors for the development of acute renal failure (ARF) in severe trauma. Design: Prospective observational study. Setting: A general intensive care unit (ICU) of a university hospital. Patients: A cohort of 153 consecutive trauma patients admitted to the ICU over a period of 30 months. Results: Forty-eight (31 %) patients developed ARF. They were older than the 105 patients without ARF (p = 0.002), had a higher Injury Severity Score (ISS) (p 〈 0.001), higher mortality (p 〈 0.001), a more compromised neurological condition (p = 0.007), and their arterial pressure at study entry was lower (p = 0.0015). In the univariate analysis, the risk of ARF increased by age, ISS 〉 17, the presence of hemoperitoneum, shock, hypotension, or bone fractures, rhabdomyolysis with creatine phosphokinase (CPK) 〉 10 000 IU/l, presence of acute lung injury requiring mechanical ventilation, and Glasgow Coma Score 〈 10. Sepsis and use of nephrotoxic agents were not associated with an increased risk of ARF. In the logistic model, the need for mechanical ventilation with a positive end-expiratory pressure 〉 6 cm H2O, rhabdomyolysis with CPK 〉 10 000 IU/l, and hemoperitoneum were the three conditions most strongly associated with ARF. Conclusions: The identified risk factors for post-traumatic acute renal failure may help the provision of future strategies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050670
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  • 10
    Electronic Resource
    Electronic Resource
    Detection of leukotrienes B4, C4 and of their isomers in arterial, mixed venous blood and bronchoalveolar lavage fluid from ARDS patients (1989)
    Springer
    Intensive care medicine 15 (1989), S. 296-301 
    Details
    ISSN: 1432-1238
    Keywords: ARDS ; Leukotrienes ; Humoral mediators
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Seven patients with the adult respiratory distress syndrome (ARDS) were studied. As a control group we used 6 surgical patients who underwent minor surgical operation (inguinal hernia). For both groups the same sample collection and analysis was used. The presence of leuktorienes (LTs) B4 and C4 and of their isomers 11-trans LTC4 and Δ6-trans-12-epi LTB4 was determined in arterial, mixed venous blood and in bronchoalveolar lavage (BAL) fluid. The samples, analysed by reverse phase high performance liquid chromatography (RP-HPLC), showed a similar chromatographic picture among ARDS patients, while the control group showed no detectable amounts of LTs in BAL or blood. The distribution of these arachidonic acid metabolites in mixed venous blood, arterial blood and BAL seems to suggest pulmonary metabolism and/or inactivation. It is suggested that these mediators act as humoral factors in pathogenesis of the ARDS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00263864
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