Current concepts of ARDS : a narrative review

Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description dates back in the late 1970s, a new definition has recently been proposed. However, the definition remains based on clinical characteristic. In the present review, the diagnostic workup and the pathophysiology of the syndrome will be presented. Therapeutic approaches to ARDS, including lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids and recruitment manoeuvres will be reviewed. We will underline how a holistic framework of respiratory and hemodynamic support should be provided to patients with ARDS, aiming to ensure adequate gas exchange by promoting lung recruitment while minimizing the risk of ventilator-induced lung injury. To do so, lung recruitability should be considered, as well as the avoidance of lung overstress by monitoring transpulmonary pressure or airway driving pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extra-corporeal life support (alone or in combination) should be taken into account

Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted

Pulsed laser deposition of glass-like cluster assembled carbon films

Carbon films have been synthesized at room temperature in helium atmosphere, at high pressure, on (1 0 0) Si substrates by pulsed KrF excimer laser ablation of highly oriented pyrolitic graphite. By changing laser power density (from 8.5 to 19 MW mm−2) and gas pressure (from 0.6 Pa to 2 kPa), nanometer sized clusterassembledfilms were obtained. Film morphology, as studied by scanning electron microscopy, changes with increasing helium pressure, from dense columns, to node-like morphology, then to an open dendritic structure. Carbon coordination was studied by visible Raman spectroscopy in all films. They are structurally disordered, sp2 coordinated and belong to the family of glass-likecarbons. The deduced film coherence length agrees with the average size of carbon aggregates that build up the films, as measured by transmission electron microscopy in representative samples. The average number of carbon atoms per cluster, that depends on helium (high) pressure, was obtained by a simple model

Propensity score to reduce bias in observational studies : the case of enteral sedation in ICU patients

To reduce structural biases of observational studies, the use of propensity score (PS), a subject's probability of receiving a specific treatment conditional on the observed covariates, has been proposed the use of the probability that a subject would have been treated allows to adjoust the estimation of the treatment effect, creating a "quasi randomized" trial. The three techniques in using PS (matching, stratification and regression adjustment) were here applied to compare intravenous and enteral approach for sedative therapy in ICU