Indici per la valutazione della qualit? ecologica dei laghi

Collection of methods to evaluate lake quality using biological element

Evaluation of a systematic approach to weaning of tracheotomized neurological patients: an early interrupted randomized controlled trial

BACKGROUND: While a systematic approach to weaning reduces the rate of extubation failure in intubated brain-injured patients, no data are available on the weaning outcome of these patients after tracheotomy. We aimed to assess whether a systematic approach to disconnect tracheotomized neurological and neurosurgical patients off the ventilator (intervention) is superior to the sole physician’s judgment (control). Based on previous work in intubated patients, we hypothesized a reduction of the rate of failure within 48 h from 15 to 5 %. Secondary endpoints were duration of mechanical ventilation, ICU length of stay and mortality. METHODS: We designed a single center randomized controlled study. Since no data are available on tracheotomized patients, we based our a priori power analysis on results derived from intubated patients and calculated an overall sample size of 280 patients. RESULTS: After inclusion of 168 consecutive patients, the trial was interrupted because the attending physicians judged the observed rate of reconnection to be much greater than expected. The overall rate of failure was 29 %, confirming the physicians’ judgment. Twenty-one patients (24 %) in the intervention group and 27 (33 %) controls were reconnected to the ventilator within 48 h (p = 0.222). The main reasons for failure were respiratory distress (80 and 88 % in the treatment and control group, respectively), hemodynamic impairment (15 and 4 % in the treatment and control group, respectively), neurological deterioration (4 % in the control group only). The duration of mechanical ventilation was of 412 ± 202 h and 402 ± 189 h, in the control and intervention group, respectively. ICU length of stay was on average of 23 days for both groups. ICU mortality was 6 % in the control and 2 % in the intervention group without significant differences. CONCLUSION: We found no difference between the two groups under evaluation, with a rate of failure much higher than expected. Consequent to the early interruption, our study results to be underpowered. Based on the results of the present study, a further trial should overall enroll 790 patients. Trial registration: ACTRN1261200037288

New records of the spiny-cheek crayfish Faxonius limosus (Rafinesque, 1817): expansion in subalpine lakes in North-western Italy

We report the first occurrence record of the spiny-cheek crayfish Faxonius limosus in two North-western Italian lakes: Orta and Mergozzo. We also confirm the occurrence of the species in Lake Maggiore. Faxonius limosus is native to the east coast of the USA. Since the end of the 19th century, it was introduced to Europe, where it rapidly spread in Poland, Russia, France, and Germany. In 1991, it was recorded for the first time in Italy in Lake Iseo (Lombardy region; NW Italy), and soon it has spread in Northern and Central Italy. Although Faxonius limosus is included in the list of European Union Concern, only two reports suggested the occurrence of this species in lakes Maggiore, Orta and Mergozzo, but these were never confirmed by experts. The aim of the present paper is to shed light on the distribution of F. limosus along the coasts of the three North-western Italian lakes. To this end, we used visual census and trapping to detect the occurrence of F. limosus, providing also georeferenced and environmental information of its habitat. We discovered 31 new occurrence localities (18 municipalities) for the species, scattered across the three lakes. These new findings highlight the urgency of implementing monitoring and management programs to prevent F. limosus spread and to mitigate its potential ecological impacts

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease