Policlinico Umberto I. Piano di ristrutturazione del sistema urbanistico ed edilizio del Policlinico Umberto I.

Il Piano per la ristrutturazione, la riqualificazione e la riorganizzazione strutturale del Policlinico è il risultato di una sfida che il Dipartimento Itaca ha accettato e condiviso con la Direzione dell'Azienda. Una sfida che abbiamo voluto raccogliere per impegno civico oltre che per interessi disciplinari; per un senso di responsabilità che ci ha spinto a lavorare per modificare le attuali condizioni dell'organizzazione urbana, edilizia ed ambientale del Policlinico. Una sfida mirata a valorizzare il tanto che questo pezzo di città è in grado di esprimere ripristinando quelle condizioni di qualità dello spazio urbano e ambientale di cui ormai si percepiscono solo frammenti e proponendo nuovi assetti architettonici, compatibili con le esigenze poste dalle specificità funzionali a cui questo comparto è destinato oggi e nei futuri scenari.The plan for the restructuring, upgrading and structural reorganization of the General Hospital is the result of a challenge that the Department Ithaca has accepted and agreed with the Management Company. A challenge that we wanted to collect for civic engagement as well as disciplinary interests, a sense of responsibility that has led us to work to change the current conditions of urban organization, construction and environmental Polyclinic. A challenge aimed at enhancing the extent that this part of the city is able to express terms of restoring the quality of urban space and the environment to which we now perceive only fragments and proposing new architectural structure, compatible with the requirements posed by the functional specificity that this fund is likely today and in the future scenarios

Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial

Background: Postoperative pulmonary complications (PPC) may result in longer duration of in-hospital stay and even mortality. Both thoracic surgery and intraoperative mechanical ventilation settings add considerably to the risk of PPC. It is unclear if one-lung ventilation (OLV) for thoracic surgery with a strategy of intraoperative high positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM) reduces PPC, compared to low PEEP without RM. Methods: PROTHOR is an international, multicenter, randomized, controlled, assessor-blinded, two-arm trial initiated by investigators of the PROtective VEntilation NETwork. In total, 2378 patients will be randomly assigned to one of two different intraoperative mechanical ventilation strategies. Investigators screen patients aged 18 years or older, scheduled for open thoracic or video-assisted thoracoscopic surgery under general anesthesia requiring OLV, with a maximal body mass index of 35 kg/m2, and a planned duration of surgery of more than 60 min. Further, the expected duration of OLV shall be longer than two-lung ventilation, and lung separation is planned with a double lumen tube. Patients will be randomly assigned to PEEP of 10 cmH2O with lung RM, or PEEP of 5 cmH2O without RM. During two-lung ventilation tidal volume is set at 7 mL/kg predicted body weight and, during OLV, it will be decreased to 5 mL/kg. The occurrence of PPC will be recorded as a collapsed composite of single adverse pulmonary events and represents the primary endpoint. Discussion: PROTHOR is the first randomized controlled trial in patients undergoing thoracic surgery with OLV that is adequately powered to compare the effects of intraoperative high PEEP with RM versus low PEEP without RM on PPC. The results of the PROTHOR trial will support anesthesiologists in their decision to set intraoperative PEEP during protective ventilation for OLV in thoracic surgery. Trial registration: The trial was registered in clinicaltrials.gov (NCT02963025) on 15 November 2016