Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies

Abitare in campagna in età romana. Indizi epigrafici dai territori di Brixia, Verona e Mediolanum

The authors propose a reflection on the epigraphic documents referring to several members of the urban élites (including seviri and seviri Augustales), who owned residence and rural estates which were regularly visited by them. The survey regards three cities in the North of Italy (Brixia, Verona and Mediolanum) where most of the inscriptions were found

Age-related changes in peripheral benzodiazepine receptors of human platelets.

Using H-3-PK 11195 as radioligand, the number and affinity of peripheral benzodiazepine receptors in platelets of 15 elderly healthy subjects were compared to those of 15 young subjects. The results showed that the dissociation constant (K(d)) was significantly higher in the elderly than in the young subjects, while the density of binding sites did not differ. These findings suggest that the age-related changes in peripheral benzodiazepine receptors may be coupled with secondary changes in their hypothesized functions

CHANGES IN PERIPHERAL BENZODIAZEPINE RECEPTORS IN PATIENTS WITH PANIC DISORDER AND OBSESSIVE-COMPULSIVE DISORDER

Peripheral benzodiazepine (BDZ) receptors were investigated through the binding of the specific ligand H-3-PK-11195 to platelet membranes, in 17 patients suffering from panic disorder (PD) and in 16 patients affected by obsessive-compulsive disorder (OCD). The results, showing that the density (B-max) of peripheral BDZ receptors was significantly lower in patients with PD than in controls or OC patients, suggest that the number of platelet BDZ receptors varies with different anxiety disorders and that perhaps this marker may be beneficial in differentiating some subtypes of these disorders

Patient blood management in cardiac surgery: The “Granducato algorithm”

Background: Patients undergoing cardiac surgery are subject to severe alterations of the coagulation system. The four cardiac surgery centers in Tuscany (Italy)structured and shared an algorithm (Granducato Patient Blood Management algorithm, G-PBMa)with predefined interventions for patient blood management. The aim of the study is to analyze the impact of that algorithm on the transfusion needs and bleeding-related outcomes in a large patient population. Methods: Multicenter retrospective observational study on 3839 patients undergoing cardiac surgery at the four cardiac centers in Tuscany. The G-PBMa was released at the end of 2015 and it was structured in three parts: pre-, intra-, and post-operative. The year 2014, before the G-PBMa (1955 patients)and the year 2016 (1884 patients)after the G-PBMa in place were compared. Logistic regression analyses were used. Results: The main changes introduced were the routine application of viscoelastic tests in bleeding patients (+72%)and the use of fibrinogen and prothrombin complex concentrate (+67%). The G-PBMa resulted in a significant reduction in the overall transfusion rate and in the transfusion rate of the separate blood products (relative risk for transfusions: 0.75, 95% confidence interval 0.65–0.85, P = 0.001). For preoperative hemoglobin values of between 8 and 10 g/dL, the absolute difference in RBC transfusion rate before and after the G-PBMa introduction ranged around 15%–17%. The G-PBMa introduction determined lower (P = 0.02)chest drain blood loss, lower (P = 0.001)postoperative acute kidney injury and shorter (P = 0.001)hospital stay. Conclusions: The G-PBMa was effective in reducing blood loss, transfusion requirements, and resulted in a better outcome

Orientação sexual para jovens adultos com deficiência auditiva Sexual orientation for young adults with hearing impairments

o estudo investigou o tema da sexualidade junto a 14 jovens adultos com deficiência auditiva de 18 a 35 anos de idade, no Centro de Distúrbios da Audição Linguagem e Visão (CEDALVI) que faz parte do HRAC-USP/Bauru. Os objetivos foram: identificar quais as necessidades de informação no que diz respeito à sexualidade; intervir, através de um programa de orientação sexual, informando e discutindo sobre temas referentes à sexualidade e verificar a aquisição de informação obtida com o programa de orientação sexual. Para tal, foi realizado um programa de orientação sexual, com três encontros abordando os seguintes temas: Órgãos sexuais e relações de gênero, Relacionamento afetivo e Gravidez, doenças sexualmente transmissíveis e auto-estima. Utilizou-se para a coleta dos dados um questionário inicial, questionários com questões fechadas, falso e verdadeiro, tipo pré e pós-teste no início e ao final de cada encontro e uma entrevista de avaliação processual, ao final do programa. Observou-se que o termo sexualidade continua sendo reduzido ao ato sexual ou as formas de prevenção de doenças ou métodos contraceptivos por grande parte dos jovens e a fonte de informação mais citada foi a mídia. O tema de maior número de acertos no pós-teste foi Órgãos sexuais e relações de gênero e todos, em geral, avaliaram positivamente a participação no programa. Concluiu-se que é necessário que a sexualidade seja cada vez mais incluída em programas de reabilitação, garantindo o acesso a informação e a discussão do tema, tão importante na vida desses jovens.<br>the study investigated the theme of sexuality among 14 hearing impaired young adults, aged 18 to 35 years, at the Center for Hearing, Language and Visual Disturbances (CEDALVI), a service of the HRAC-USP/Bauru. The aims were: to identify what kinds of information on sexuality were needed; to intervene through a sexual orientation program, so as to inform and discuss themes related to sexuality and to assess the information obtained by means of the sexual education program. To this end, a sexual orientation program was set up with three sessions concerning the following themes: Sexual organs and gender relationships, Caring relationships and Pregnancy, sexually transmitted diseases and self-esteem. Data was collected through a first time questionnaire, with closed true and false questions, with pre and post-tests applied at the beginning and the end of each meeting, followed by interviews to evaluate the whole process at the end of the program. The results showed that most young adults still view the term sexuality as restricted to sexual intercourse or to prevention of sexually transmitted diseases or to contraceptive methods and the media was cited as the main source of information. In the post-test, the greatest number of correct responses occurred for the theme Sexual organs and gender relationships; in general, all participants offered positive reviews for participation in the program. The conclusion was that it is paramount to include sexual orientation in rehabilitation programs, guaranteeing access to information and promoting discussion of such subjects in these young people's lives