High Flow Nasal Cannulae in preterm infants

Despite of improved survival of premature infants, the incidence of long term pulmonary complications, mostly associated with ventilation-induced lung injury, remains high. Non invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. Although nasal continuous positive airway pressure (NCPAP) is an effective mode of NIV, traumatic nasal complications and intolerance of the nasal interface are common. Recently high flow nasal cannula (HFNC) is emerging as an efficient, better tolerated form of NIV, allowing better access to the baby's face, which may improve nursing, feeding and bonding. The aim of this review is to discuss the available evidence of effectiveness and safety of HFNC in preterm newborns with respiratory distress syndrome (RDS). It is known that distending pressure generated by HFNC increases with increasing flow rate and decreasing infant size and varies according to the amount of leaks by nose and mouth. The effects of HFNC on lung mechanics, its clinical efficacy and safety are still insufficiently investigated. In conclusion, there is a growing evidence of the feasibility of HFNC as an alternative mode of NIV. However, further larger randomized trials are required, before being able to recommend HFNC in the treatment of moderate respiratory distress of preterm infants

Comparison between two different modes of non-invasive ventilatory support in preterm newborn infants with respiratory distress syndrome mild to moderate: preliminary data

Despite of improved survival of premature infants, the incidence of long term pulmonary complications, mostly associated with ventilation-induced lung injury, remains high. Non invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. Although nasal continuous positive airway pressure (NCPAP) is an effective mode of NIV, traumatic nasal complications and intolerance of the nasal interface are common. Recently high flow nasal cannula (HFNC) is emerging as a better tolerated form of NIV, allowing better access to the baby's face, which may improve nursing, feeding and bonding. HFNC may be effective in the treatment of some neonatal respiratory conditions while being more user-friendly for care-givers than conventional NCPAP. Limited evidence is available to support the specific role, efficacy and safety of HFNC in newborns and to demonstrate efficacy compared with NCPAP; some studies suggest a potential role for HFNC in respiratory care of the neonate as a distinct non invasive ventilatory support. We present the preliminary data of a randomized clinical trial; the aim of this study was to assess efficacy and safety of HFNC compared to NCPAP in preterm newborns with mild to moderate respiratory distress syndrome (RDS)

[Assessment of pulmonary function in a follow-up of premature infants: our experience].

Respiratory diseases are a major cause of morbidity in neonates, especially preterm infants; a long term complication of prematurity such as bronchopulmonary dysplasia (BPD) is particularly relevant today. The exact role of the Pulmonary Function Test (PFT) in this area is not yet well defined; the PFT in newborns and infants - in contrast to what happens in uncooperative children and adults - are routinely used only in a few centers. The assessment of pulmonary function in newborns and infants, however, is nowadays possible with the same reliability that in cooperative patients with the possibility to extend the assessment of polmonary function from bench to bed. The assessment of pulmonary function must be carried out with non invasive and safe methods, at the bedside, with the possibility of continuous monitoring and providing adequate calculation and management of data. The ability to assess lung function helps to define the mechanisms of respiratory failure, improving the treatment and its effects and is therefore a useful tool in the follow-up of newborn and infant with pulmonary disease

Observations on comatose survivors of cardiopulmonary resuscitation with generalized myoclonus

BACKGROUND: There is only limited data on improvements of critical medical care is resulting in a better outcome of comatose survivors of cardiopulmonary resuscitation (CPR) with generalized myoclonus. There is also a paucity of data on the temporal dynamics of electroenephalographic (EEG) abnormalities in these patients. METHODS: Serial EEG examinations were done in 50 comatose survivors of CPR with generalized myoclonus seen over an 8 years period. RESULTS: Generalized myoclonus occurred within 24 hours after CPR. It was associated with burst-suppression EEG (n = 42), continuous generalized epileptiform discharges (n = 5), alpha-coma-EEG (n = 52), and low amplitude (10 μV <) recording (n = 1). Except in 3 patients, these EEG-patterns were followed by another of these always nonreactive patterns within one day, mainly alpha-coma-EEG (n = 10) and continuous generalized epileptiform discharges (n = 9). Serial recordings disclosed a variety of EEG-sequences composed of these EEG-patterns, finally leading to isoelectric or flat recordings. Forty-five patients died within 2 weeks, 5 patients survived and remained in a permanent vegetative state. CONCLUSION: Generalized myoclonus in comatose survivors of CPR still implies a poor outcome despite advances in critical care medicine. Anticonvulsive drugs are usually ineffective. All postanoxic EEG-patterns are transient and followed by a variety of EEG sequences composed of different EEG patterns, each of which is recognized as an unfavourable sign. Different EEG-patterns in anoxic encephalopathy may reflect different forms of neocortical dysfunction, which occur at different stages of a dynamic process finally leading to severe neuronal loss

Design, Università e Industria. Il ruolo del disegno industriale nel rapporto tra percorsi formativi e mondo delle imprese

Il lavoro che si presenta nasce in questa prospettiva per rispondere agli obiettivi di Lisbona 2010, con focus specifico sulle esperienze che stanno maturando all’interno del Politecnico di Milano – Facoltà del Design per la validazione, e conseguente conferma in forma strutturale, delle innovazioni nei percorsi formativi delle facoltà che fanno capo a questo indirizzo. In effetti l’adeguamento, soprattutto per quel che concerne la didattica ma anche la ricerca, è finalizzato a un’integrazione dei rapporti università – impresa: tale collaborazione può essere una risposta al rilancio della ricerca anche nell’industria che, in particolare in Italia, soffre della micro dimensione e quindi della mancanza di massa critica per affrontare in autonomia i temi dell’innovazione di prodotto e di processo. Questa integrazione appare quindi fondamentale anche per la sempre più spinta internazionalizzazione delle imprese, che anche le più recenti analisi di enti paraistituzionali (ICE, Censis) indicano in ripresa e comunque appare essenziale per uno sviluppo più spinto e concretamente sostenibile. L’adeguamento, di cui il libro propone modelli e soluzioni applicative, rappresenta quindi una risposta che nasce non solo dall’interno dell’Accademia ma anche dalle esigenze del contesto economico-sociale, in cui l’università opera. Ovviamente per il terreno da cui nasce, particolare rilevanza, tra tutte le attività d’impresa, viene data alla fase di progettazione, di prodotto e di processo, che a sua volta trova il cuore nel disegno industriale, tanto che il percorso dell’opera potrebbe essere indicato come il ruolo del disegno industriale al centro dell’impegno strategico di Università e mondo produttivo. Nell’itinerario che si traccia si mira a passare da una prima schematizzazione del contesto che muta, ad una teorizzazione dei modelli formativi, finalizzati a preparare nuovi profili professionali, quali si stanno sperimentando nella Facoltà del Design del Politecnico di Milano