EOLO: Sistema per la regolazione controllata di gas ad uso medico per terapia e diagnosi

not availableIl progetto riguarda principalmente l\u27ossigeno terapia e la somministrazione di ossido nitrico per terapia e diagnostica La somministrazione controllata di gas ad uso terapeutico ? oggi una pratica clinica consolidata in special modo nella ossigeno terapia per patologie quali le broncopneumopatie croniche ostruttive (BPCO). Nuove terapie con altri gas quali l\u27ossido nitrico NO rappresentano metodiche in corso di validazione clinica ma gi? accettate da organismi di controllo quali FDA, soprattutto nei casi di ipertensione polmonare primitiva. Ci si riferisce quindi a sistemi di somministrazione di gas, come quelli rammentati, mettendo a punto metodiche originarie di "feedback" su parametri fisiologici, misurati durante la terapia in modo incruento, per gestire i relativi dispositivi di erogazione del gas stesso e al monitoraggio delle variabili biologiche rilevanti da parte di centri opportuni. Le malattie respiratorie, dopo le malattie cardiocircolatorie ed i tumori, sono tra le maggiori cause di morte nel mondo. Il loro trend ? crescente, essendo esse causate, fra l\u27altro, da fattori come il fumo e l\u27inquinamento, che sono a loro volta in crescita. Da qui la necessit? di realizzare sistemi semplici ed efficaci per il controllo della strumentazione di ossigenoterapia in una vasta popolazione, anche per gli usi domiciliari. Non ultimo diventa importante con questi numeri, pensare ad una razionalizzazione automatica dei consumi di ossigeno. Per quel che riguarda l\u27ipertensione polmonare, altra patologia verso cui EOLO ? rivolto, un potenziale rimedio ? costituito dalla somministrazione in dosi terapeutiche di Ossido Nitrico in sostituzione ad esempio delle prostacicline con il vantaggio di non ricorrere ad applicazioni invasive cruente e di evitare effetti collaterali sistemici. L\u27uso di questo gas medicale ? per? limitata in quanto il mercato non propone dispositivi per la somministrazione di ossido nitrico ottimizzati alle sue indicazioni d\u27uso. Le indicazione d\u27uso prevedono, infatti, la somministrazione di ossido nitrico a bassi dosaggi(5-40 ppm) e la limitazione del tempo di contatto tra l\u27ossido nitrico e i gas inalatori che il paziente deve respirare. Tale metodologia di somministrazione ? requisito essenziale per il suo impiego, in quanto questo gas si combina molto velocemente con l\u27ossigeno formando Biossido d\u27Azoto (NO2), un gas altamente nocivo. Il biossido di azoto reagendo a sua volta con l\u27acqua forma acido nitrico (HNO3), che ? un acido particolarmente reattivo quindi pericoloso

The prognostic value of ultrasound lung comets in patients with pulmonary hypertension

Background: Ultrasound Lung Comets (ULCs) consist of multiple comet tails originating from thickened interlobular septa, due to water or connective tissue accumulation. Therefore they are detectable in patients with several lung diseases. Aim: To assess the prognostic value of ULCs in patients with pulmonary hypertension. Materials and methods: 33 in-hospital patients (age 67?13 years, 16 females) admitted to the Pneumology Division of Clinical Physiology in Pisa with diagnosis of idiopathic or secondary pulmonary hypertension were evaluated upon admission with a comprehensive 2D and Doppler echocardiography, and chest sonography with ULCs assessment. A patient ULC score was obtained by summing the number of comets from each of the scanning spaces in the anterior right and left hemithorax, from second to fifth intercostal spaces. By echocardiography, we measured Tricuspid Annular Plane Systolic Excursion (TAPSE) as an index of right ventricular function, and Pulmonary Artery Systolic Pressure (PASP) from tricuspid regurgitant jet velocity. Results: During the follow-up, 16 events occurred: 4 deaths, 12 new admission for the worsening of symptoms or respiratory function. A ROC analysis identified 14 ULCs as the best diagnostic cut-off to predict events with 94 % sensitivity and 71 % specificity. The 9-months event-free survival was higher in patients with no ULCs and lower in patients with ULCs (see Figure). There was a weak significant correlation between ULCs and PAPs (r=.541, p<.001) and no correlation between ULCs and TAPSE (r=.088, p=ns). Conclusion: ULCs are a simple, user-friendly, radiation-free bedside sign of thickened lung interlobular septa, adding a useful information for straightforward prognostic stratification of patients with pulmonary hypertension

Anesthetic management in atrial fibrillation ablation procedure: Adding non-invasive ventilation to deep sedation

Anesthetic management of patients undergoing pulmonary vein isolation for atrial fibrillation has specific requirements. The feasibility of non-invasive ventilation (NIV) added to deep sedation procedure was evaluated. Seventy-two patients who underwent ablation procedure were retrospectively revised, performed with (57%) or without (43%) application of NIV (Respironic® latex-free total face mask connected to Garbin ventilator-Linde Inc.) during deep sedation (Midazolam 0.01–0.02 mg/kg, fentanyl 2.5–5 μg/kg and propofol: bolus dose 1–1.5 mg/kg, maintenance 2–4 mg/kg/h). In the two groups (NIV vs deep sedation), differences were detected in intraprocedural (pH 7.37 ± 0.05 vs 7.32 ± 0.05, p = 0.001; PaO2 117.10 ± 27.25 vs 148.17 ± 45.29, p = 0.004; PaCO2 43.37 ± 6.91 vs 49.33 ± 7.34, p = 0.002) and in percentage variation with respect to basal values (pH −0.52 ± 0.83 vs −1.44 ± 0.87, p = 0.002; PaCO2 7.21 ± 15.55 vs 34.91 ± 25.76, p = 0.001) of arterial blood gas parameters. Two episodes of respiratory complications, treated with application of NIV, were reported in deep sedation procedure. Endotracheal intubation was not necessary in any case. Adverse events related to electrophysiological procedures and recurrence of atrial fibrillation were recorded, respectively, in 36% and 29% of cases. NIV proved to be feasible in this context and maintained better respiratory homeostasis and better arterial blood gas balance when added to deep sedation

Arterial base de&#64257;cit in pulmonary embolism is an index of severity and diagnostic delay

In acute pulmonary embolism, patients free from circulatory failure usually present a blood gas pattern consistent with respiratory alkalosis. We investigated whether the appearance of arterial base deficit in these patients indicates disease severity and diagnostic delay. Twenty-four consecutive patients with pulmonary embolism were retrospectively evaluated. Twelve patients had arterial base excess > or =0 mmol/L (Group 1), and 12 patients arterial base deficit <0 mmol/L (Group 2). No patient showed signs of circulatory failure. Group 1 was characterized by a mean base excess of 2.2 +/- 1.7 mmol/L, while in Group 2, the mean base deficit was -1.9 +/- 0.7 mmol/L (p < 0.0001). At 1 week since the embolism, 11 patients of Group 1 and 6 of Group 2 received a PE diagnosis (p < 0.05). The vascular obstruction index was more severe in Group 2 than in Group 1 (48 +/- 12 vs. 36 +/- 17%, respectively, p < 0.05). In Group 2, the PaCO(2) was lower (33 +/- 3 vs. 36 +/- 5 mmHg, respectively, p < 0.05), the arterial pH was decreased (7.442 +/- 0.035 vs. 7.472 +/- 0.050, respectively, p = 0.097), the Pv(50) was lower (28.3 +/- 1.7 vs. 29.8 +/- 1.6 mmHg, respectively, p < 0.05), the aHCO(3) (-) was lower (22.5 +/- 0.7 vs. 26.1 +/- 1.6 mmol/L, respectively; p < 0.0001), while between the Groups, O(2) delivery, O(2) mixed venous saturation, and O(2) extraction ratio were equivalent. Despite no signs of circulatory failure, an arterial Base deficit develops in patients with respiratory alkalosis subsequent to more severe pulmonary vascular obstruction. Diagnostic delay favors a base deficit. Depending on the degree of hypocapnia, there may be limitation of peripheral O(2) uptake despite adequate O(2) availability. Progressive bicarbonate deficit suggests an increased risk for underlying conditions such as cardio-respiratory disorders or cancer, and requires close control and treatment

Right ventricular overload and cardiovascular neuroendocrine derangement in systemic sclerosis

Aim Systemic sclerosis (SSc) may be associated with right ventricular overload, secondary to pulmonary hypertension. In heart failure patients, neuroendocrine derangements can influence clinical evolution and prognosis. The aim of this study was to investigate neurohormonal control affected in SSc patients with and without right ventricular impairment. Methods and results A prospective series of 28 patients with SSc was studied. In addition to conventional evaluations, extensive neuroendocrine studies were done, including assays of both the vasoconstrictor system (plasma renin activity [PRA], aldosterone and catecholamines) and vasodilatory molecules (brain natriuretic peptide [BNP] and atrial natriuretic peptide [ANP]). A significant relation was observed between echo-Doppler estimated pulmonary systolic pressure (PAP) and neurohormonal activation, in particular between PAP and BNP (R = 0.58, p = 0.004), ANP (R = 0.65, p 40 mmHg confirmed at cardiac catheterization) had higher levels of ANP and BNP (147 +/- 26 vs 34 +/- 6 pg/mL and 344 86 vs 30 7 pg/mL, respectively, p < 0.001), PRA (6.4 +/- 1.9 vs 1.8 +/- 0.4 ng/ mL/h, p < 0.001) and aldosterone (257 +/- 86 vs 114 +/- 22 pg/mL, p = 0.02). These patients had increased plasma noradrenaline, but not adrenaline (701 87 vs 452 66 pg/mL, p < 0.001). Conclusion SSc patients with right heart failure have a neurohormonal derangement, showing overactivity of the vasoconstrictive system, counteracted by oversecretion of cardiac natriuretic hormones. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved