Efficacy and safety of a low-flow veno-venous carbon dioxide removal device: results of an experimental study in adult sheep

INTRODUCTION: Extracorporeal lung assist, an extreme resource in patients with acute respiratory failure (ARF), is expanding its indications since knowledge about ventilator-induced lung injury has increased and protective ventilation has become the standard in ARF. METHODS: A prospective study on seven adult sheep was conducted to quantify carbon dioxide (CO(2)) removal and evaluate the safety of an extracorporeal membrane gas exchanger placed in a veno-venous pump-driven bypass. Animals were anaesthetised, intubated, ventilated in order to reach hypercapnia, and then connected to the CO(2 )removal device. Five animals were treated for three hours, one for nine hours, and one for 12 hours. At the end of the experiment, general anaesthesia was discontinued and animals were extubated. All of them survived. RESULTS: No significant haemodynamic variations occurred during the experiment. Maintaining an extracorporeal blood flow of 300 ml/minute (4.5% to 5.3% of the mean cardiac output), a constant removal of arterial CO(2), with an average reduction of 17% to 22%, was observed. Arterial partial pressure of carbon dioxide (PaCO(2)) returned to baseline after treatment discontinuation. No adverse events were observed. CONCLUSION: We obtained a significant reduction of PaCO(2 )using low blood flow rates, if compared with other techniques. Percutaneous venous access, simplicity of circuit, minimal anticoagulation requirements, blood flow rate, and haemodynamic impact of this device are more similar to renal replacement therapy than to common extracorporeal respiratory assistance, making it feasible not only in just a few dedicated centres but in a large number of intensive care units as well

Study protocol: The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI)

INTRODUCTION: Current practices for renal replacement therapy in intensive care units (ICUs) remain poorly defined. The DOse REsponse Multicentre International collaborative initiative (DO-RE-MI) will address the issue of how the different modes of renal replacement therapy are currently chosen and performed. Here, we describe the study protocol, which was approved by the Scientific and Steering Committees. METHODS: DO-RE-MI is an observational, multicentre study conducted in ICUs. The primary end-point will be the delivered dose of dialysis, which will be compared with ICU mortality, 28-day mortality, hospital mortality, ICU length of stay and number of days of mechanical ventilation. The secondary end-point will be the haemodynamic response to renal replacement therapy, expressed as percentage reduction in noradrenaline (norepinephrine) requirement. Based on the the sample analysis calculation, at least 162 patients must be recruited. Anonymized patient data will be entered online in electronic case report forms and uploaded to an internet website. Each participating centre will have 2 months to become acquainted with the electronic case report forms. After this period official recruitment will begin. Patient data belong to the respective centre, which may use the database for its own needs. However, all centres have agreed to participate in a joint effort to achieve the sample size needed for statistical analysis. CONCLUSION: The study will hopefully help to collect useful information on the current practice of renal replacement therapy in ICUs. It will also provide a centre-based collection of data that will be useful for monitoring all aspects of extracorporeal support, such as incidence, frequency, and duration

INfluenza Vaccine Indication During therapy with Immune checkpoint inhibitors: a transversal challenge. The INVIDIa study

Aim: Considering the unmet need for the counseling of cancer patients treated with immune checkpoint inhibitors (CKI) about influenza vaccination, an explorative study was planned to assess flu vaccine efficacy in this population. Methods: INVIDIa was a retrospective, multicenter study, enrolling consecutive advanced cancer outpatients receiving CKI during the influenza season 2016-2017. Results: Of 300 patients, 79 received flu vaccine. The incidence of influenza syndrome was 24.1% among vaccinated, versus 11.8% of controls; odds ratio: 2.4; 95% CI: 1.23-4.59; p = 0.009. The clinical ineffectiveness of vaccine was more pronounced among elderly: 37.8% among vaccinated patients, versus 6.1% of unvaccinated, odds ratio: 9.28; 95% CI: 2.77-31.14; p < 0.0001. Conclusion: Although influenza vaccine may be clinically ineffective in advanced cancer patients receiving CKI, it seems not to negatively impact the efficacy of anticancer therapy

Tempeste e naufragi

Il naufragio nei romanzi di Jules Verne è riuso, riscrittura di testi anteriori. Qui si esamina in particolare il rapporto tra "Le Sphinx des glaces" e "Le avventure di Gordon Pym" di Poe

Avatars des Cenci (Stendhal, Artaud, Moravia)

Da Stendhal, ad Artaud, a Moravia: la tragica vicenda dei Cenci acquista singolari risonanze e diventa metafora del Teatro in se stesso

Politically incorrect. Su Montaigne e Stendhal

Montaigne e Stendhal rappresentano lo stesso nodo problematico: l'incompatibilità tra la sfera del politico e la sfera estetica

Le Coeur mangé, un mythe littéraire. Entretien avec Mariella Di Maio

Intervista apparsa nel programma dell'Opéra Comique dedicato alla rappresentazione di "Written on Skin", di G. Bnjaminet M. Crimp, opera tratta dalla leggenda del "Cuore mangiato

Musiques pour la Stilla

Considerazioni sulla funzione della musica in Le Chateau des Carpathes de J Verne, all'origine dell'opera di Philippe Hersant che è al centro di questo numero speciale dell'"Avant-Scène Opéra".Considérations sur la fonction de la musique dans Le Chateau des Carpathes de J. Verne, à l'origine de l'opéra de Philippe Hersant qui donne le titre à ce numéro spécial de l"Avant-Scène Opéra"

Le récit de la peinture

Analisi dettagliata di un articolo di J.-K. Huysmans, raccolto in "Cartains". Si cerca di dimostrare che l'interpretazione del quadro del Louvre attribuito à "Bianchi",uno dei "primitivi" italiani, si basa su una nozione di racconto squisitamente moderna.Analyse détaillée d'un article de J.-K.Huysmans, recueilli dans "Certains".On essaie de montrer que l'interprétation du tableau du Louvre attribué à "Bianchi", peintre primitif italien, se base sur une notion de récit tout à fait moderne

Balzac et l'Italie. Lectures croisées

Di Maio Mariella. Balzac et l'Italie. Lectures croisées. In: Romantisme, 2005, n°128. La virtuosité. pp. 138-139