Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery

Background. Patients following major cardiac surgery are increasingly elderly and present many comorbidities. For these reasons their post-operative phase is often burdened by several complications requiring a long stay in Critical Care and prolonged mechanical ventilation. Most of these patients, when transferred to our Intensive Cardiac Rehabilitation Unit, still have a percutaneous tracheostomy due to respiratory mechanical dysfunction. The aim of our work is to present new rehabilitative care strategies in such compromised patients. Methods and materials. We studied 27 elderly critically ill tracheostomized patients who were split into 2 Groups (A = 11 and B = 16). The Groups were homogeneous for age and for left ventricular ejection fraction. Group A received a standard treatment including cautious mobilisation and respiratory unspecific physiotherapy. Group B received an earlier and more aggressive treatment with a specific respiratory physiotherapy including Positive Expiration Pressure (PEP) directly connected to the tracheostomy cannula. A protocol for tracheostomy decannulation by assessment of the Peak Expiratory Flow during cough (PCEF≥ 180 L/min.) has been defined in order to verify the patients ability to develop a mechanically effective cough to obtain weaning from tracheostomy. Besides, in the patients of Group B, we carried out a screening of the swallowing dysfunction. Results. Four patients of Group A deceased while in Group B there were no deaths. Furthermore patients of Group B showed a statistically significant improvement of mobility and respiratory indexes. In Group B only one patient was discharged with tracheostomy cannula in site because he did not reach standard criteria for decannulation and his PCEF value was not satisfactory. This patient underwent percutaneous gastrostomy. Conclusions. A precocious and intensive rehabilitation, based on specific respiratory physiotherapy, significantly improves mobility and respiratory indexes of patients with tracheostomy. The PCEF and the swallowing deficit evaluation allows an earlier tracheostomy decannulation with lower risk of complications

Photolithography-based realization of Frequency Steerable Acoustic Sensors on PVDF substrate

none4siDesign, fabrication and testing of a frequencysteerable acoustic transducer (FSAT) is presented in this paper. The proposed device concept allows directional guided wave sensing for structural health monitoring (SHM) applications. The direction of an incoming wave is univocally encoded in the spectrum of the output signal thanks to the spatial filtering effect produced by the peculiar shape of the FSAT. Accurate localization of acoustic events within a two-dimensional half-plane can thus be performed with very small hardware and software complexity by processing the time-trace recorded by a single device. Photolithography-based fabrication on a polyvinylidene fluoride (PVDF) substrate provides a flexible and lightweight transducer with a number of attractive features for integrated and wireless SHM.noneE. Baravelli; L. De Marchi; M. Ruzzene; N. SpecialeE. Baravelli; L. De Marchi; M. Ruzzene; N. Special

Fabrication and Characterization of a Wavenumber-Spiral Frequency-Steerable Acoustic Transducer for Source Localization in Plate Structures

This paper reports on the fabrication and the experimental characterization of a wavenumber frequency-steerable acoustic transducer (WS-FSAT). Here, the transducer is employed for the localization of broadband acoustic events corresponding to the propagation of guided elastic waves in an isotropic plate. The WS-FSAT records the plate response and defines the source location through a time-frequency analysis of the received signal. This is achieved by exploiting the frequency selective response of the transducer which directly maps the dominant component of the received signal to the direction of arrival of the incoming wave. This feature is the result of the spatial filtering effect produced by the characteristic shape of the sensing surface, which is designed in the wavenumber domain. Experiments are performed on a prototype fabricated on a polyvinylidene fluoride substrate mounted on an aluminum test plate. Tests are conducted for various source locations, and with multiple sources activated simultaneously. The results highlight the robustness of the proposed device, its good sensitivity and angular resolution, as well as the low complexity of hardware and signal processing. This paper suggests the WS-FSAT as an attractive solution for the detection of broadband acoustic events, such as impacts on structural substrates, and its potential use as part of active structural health monitoring systems based on pitch-catch or pulse-echo operations

Exercise Training in Post-COVID-19 Patients: The Need for a Multifactorial Protocol for a Multifactorial Pathophysiology

The battle against COVID-19 has entered a new phase with Rehabilitation Centres being among the major players, because the medical outcome of COVID-19 patients does not end with the control of pulmonary inflammation marked by a negative virology test, as many patients continue to suffer from long-COVID-19 syndrome. Exercise training is known to be highly valuable in patients with cardiac or lung disease, and it exerts beneficial effects on the immune system and inflammation. We therefore reviewed past and recent papers about exercise training, considering the multifactorial features characterizing post-COVID-19 patients’ clinical conditions. Consequently, we conceived a proposal for a post-COVID-19 patient exercise protocol as a combination of multiple recommended exercise training regimens. Specifically, we built pre-evaluation and exercise training for post-COVID-19 patients taking advantage of the various programs of exercise already validated for diseases that may share pathophysiological and clinical characteristics with long-COVID-19

Ejection fraction-velocity ratio for the assessment of aortic bioprosthetic valves in patients with systolic dysfunction

The continuity equation (CE) represents the 'gold standard' for the evaluation of aortic valve area in patients with aortic stenosis, but it is time-consuming and subject to error, and can be technically demanding. Recently, a new echocardiographic nonflow corrected index was introduced and demonstrated excellent accuracy in quantifying the effective orifice area (EOA) in native aortic valves and bioprostheses. This new index, the ejection fraction (EF)-velocity ratio (EFVR), is obtained by dividing the percentage left ventricular EF by the maximum aortic gradient

Ejection fraction/velocity ratio identifies prosthesis-patient mismatches in patients with aortic bioprosthetic valves and left ventricular dysfunction

Recently, a new echocardiographic nonflow corrected index (ejection fraction/velocity ratio [EFVR] = percent left ventricular ejection fraction [EF]/maximum aortic gradient) has been introduced and has shown excellent accuracy in quantifying the effective orifice area (EOA) in native aortic valves and bio-prostheses. The objective of this study was to assess the utility of the EFVR to quantify the indexed EOA in patients with an aortic bioprosthesis and left ventricular dysfunction considering an indexed EOA value of 0.85 cm(2)/m(2) or less to be indicative of a prosthesis-patient mismatch (PPM), defined as an EOA of the inserted prosthetic valve of less than that of the normal human valve

Acute superior vena cava syndrome after insertion of implantable cardioverter defibrillator

We describe a rare case of superior vena cava syndrome that occurred a few hours after insertion of an implantable cardioverter defibrillator through the right subclavian vein in a patient with previous dual chamber DDD pacemaker. The patient was successfully treated with anticoagulant therapy showing a fast clinical and instrumental improvement