Unidirectional endobronchial valves for management of persistent air-leaks. Results of a multicenter study

Background: To evaluate the efficacy of Endo-Bronchial Valves in the management of persistent air-leaks (PALs) and the procedural cost. Methods: It was a retrospective multicenter study including consecutive patients with PALs for alveolar pleural fistula (APF) undergoing valve treatment. We assessed the efficacy and the cost of the procedure. Results: Seventy-four patients with persistent air leaks due to various etiologies were included in the analysis. In all cases the air leaks were severe and refractory to standard treatments. Sixty-seven (91%) patients underwent valve treatment obtaining a complete resolution of air-leaks in 59 (88%) patients; a reduction of air-leaks in 6 (9%); and no benefits in 2 (3%). The comparison of data before and after valve treatment showed a significant reduction of air-leak duration (16.2±8.8 versus 5.0±1.7 days; P<0.0001); chest tube removal (16.2±8.8 versus 7.3±2.7 days; P<0.0001); and length of hospital stay (LOS) (16.2±8.8 versus 9.7±2.8 days; P=0.004). Seven patients not undergoing valve treatment underwent pneumo-peritoneum with pleurodesis (n=6) or only pleurodesis (n=1). In only 1 (14%) patient, the chest drainage was removed 23 days later while the remaining 6 (86%) were discharged with a domiciliary chest drainage removed after 157±41 days. No significant difference was found in health cost before and after endobronchial valve (EBV) implant (P=0.3). Conclusions: Valve treatment for persistent air leaks is an effective procedure. The reduction of hospitalization costs related to early resolution of air-leaks could overcome the procedural cost

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Ematoma intestinale spontaneo come complicanza del trattamento anticoagulante

L’emoperitoneo e l’ematoma intestinale sono rare complicanze del trattamento con anticoagulanti orali. Dolori addominali in paziente in trattamento anticoagulante pongono un problema diagnostico; oltre a un addome acuto di altro tipo, bisogna considerare possibili lesioni emorragiche rare in un paziente senza difetti di coagulazione. L’importanza di riconoscere queste complicanze è legata alla possibilità di tentare un trattamento conservativo e risolutivo, evitando l’intervento chirurgico in pazienti che abitualmente presentano gravi patologie associate. Presentiamo il caso di un malato con emoperitoneo ed ematoma intramurale intestinale le cui alterazioni degli esami ematochimici e l’instabilità emodinamica hanno reso necessario il trattamento chirurgico d’urgenza

Stakeholders’ perception towards ecosystem services provided by forests: comparison among three Balkans countries

The stakeholders’ involvement in forest management is a key point to facilitate the exchange of information between decision makers and the local community, to reduce conflicts between forest users, and to increase social acceptance of decisions made. The aims of the present study are to identify the stakeholders’ preferences towards ecosystem services provided by forests and to analyze the impacts of forest management practices on ecosystem services in the Balkan region. To achieve these aims a face-to-face survey was conducted in three study areas in the Balkans: Shkrel district in Albania; Rugova valley in Kosovo; Knjazevac municipality in Serbia. The three study areas are in a rural context and they are characterized by strong linkages between the local community and natural resources. The questionnaire – provided as a digital application – was administered to a representative sample of stakeholders in each pilot area. The stakeholders were selected among four main groups of interest: public administrations; environmental NGOs, tourism promoters, and private actors of forest-wood chain. The results show that for the Balkan respondents the most important ecosystem services are supporting services (lifecycle maintenance, habitats protection), followed by provisioning services (wood for manufacturing, fuelwood, water supply)

Functional Evaluation at 1-Year Follow-Up of Laparoscopic Nissen-Rossetti Fundoplication

Laparoscopic Nissen fundoplication is currently the gold standard for surgical treatment of gastroesophageal reflux disease. The aim of this study was to present our experience with this procedure at 1 year of follow-up. Forty patients were operated on between January 2006 and July 2007, and 30 underwent a 24-hour postoperative pH-metry study. Ninety-two percent of the patients were asymptomatic at a follow-up of 12 months. All pH-metric parameters improved. DeMeester and Johnson's score was reduced from 44.7 to 7.75; endoscopy with histologic samples revealed the healing of esophagitis in all patients; 4 (13%) patients complained of dysphagia, which resolved within 1 month after surgery. Twenty-seven (90%) patients were completely satisfied by their surgical results. One year after surgery, 24-hour ph-metric results show that laparoscopic Nissen fundoplication can completely control acid reflux with relatively few complications and a high degree of patient satisfaction

New perspective for the upscaling of plant functional response to flooding stress in salt marshes using remote sensing

Abstract Understanding the response of salt marshes to flooding is crucial to foresee the fate of these fragile ecosystems, requiring an upscaling approach. In this study we related plant species and community response to multispectral indices aiming at parsing the power of remote sensing to detect the environmental stress due to flooding in lagoon salt marshes. We studied the response of Salicornia fruticosa (L.) L. and associated plant community along a flooding and soil texture gradient in nine lagoon salt marshes in northern Italy. We considered community (i.e., species richness, dry biomass, plant height, dry matter content) and individual traits (i.e., annual growth, pigments, and secondary metabolites) to analyze the effect of flooding depth and its interplay with soil properties. We also carried out a drone multispectral survey, to obtain remote sensing-derived vegetation indices for the upscaling of plant responses to flooding. Plant diversity, biomass and growth all declined as inundation depth increased. The increase of soil clay content exacerbated flooding stress shaping S. fruticosa growth and physiological responses. Multispectral indices were negatively related with flooding depth. We found key species traits rather than other community traits to better explain the variance of multispectral indices. In particular stem length and pigment content (i.e., betacyanin, carotenoids) were more effective than other community traits to predict the spectral indices in an upscaling perspective of salt marsh response to flooding. We proved multispectral indices to potentially capture plant growth and plant eco-physiological responses to flooding at the large scale. These results represent a first fundamental step to establish long term spatial monitoring of marsh acclimation to sea level rise with remote sensing. We further stressed the importance to focus on key species traits as mediators of the entire ecosystem changes, in an ecological upscaling perspective