Antibiotic use in departments of internal medicine of Lazio

Antimicrobial therapy is inappropriate in 9 to 64% of the patients hospitalized. We evaluated the antibiotic use in Internal Medicine wards of an Italian region (Lazio) by a prospective multicenter, observational study. One thousand and nine patients were evaluated. Patients under antimicrobial treatment (PUAT) were 588 (58.2%), patients without treatment (PWT) 421 (41.8%). Infections were classified as community acquired (47.8%), hospital acquired (10.3%) or healthcare-associated (11.4%); the remaining 30.5% of infections did not receive any epidemiological classification. Samples for microbiological examination were collected in 41.6% of PUAT. The antibiotic choice was empiric in 94.8% of the cases and protected penicillins were selected in 48% of the cases. The mean duration of treatment was 9.5±6 standard deviation (SD) days. Only 6% of the patients switched from intravenous to oral therapy. Age, length of hospital stay and mortality were higher for PUAT than for PWT (mean age: 75.9±15 SD vs 74.2±15 SD years, P<0.02; length of hospital stay: 13.7±10.4 SD vs 10±8.4 SD days, P<0.01; mortality: 15.9% vs 3.1%). Antibiotic stewardship needs to be implemented all over the hospitals of Lazio region

Clinical use of Heliox in Asthma and COPD

Heliox is a low density gas mixture of helium and oxygen commonly used in deep diving (> 6 ATM). This mixture has been also used for clinical purposes, particularly in the critical care setting. Due to of its physical proprieties, Heliox breathing reduces air flow resistances within the bronchial tree; in patients with obstructive lung diseases Heliox may also reduce the work of breathing and improve pulmonary gas exchange efficiency. Beneficial effects have been documented in severe asthma attacks and in patients with chronic obstructive pulmonary disease. A reduction in WOB during mechanical ventilation and an increase in exercise endurance capacity have also been described in COPD. Heliox has been also used in the treatment of upper airways obstruction, bronchiolitis and bronchopulmonary dysplasia. Despite the encouraging results, Heliox use in routine practice remains controversial because of technical implications and high costs

Clinical use of Heliox in Asthma and COPD

Heliox is a low density gas mixture of helium and oxygen commonly used in deep diving (> 6 ATM). This mixture has been also used for clinical purposes, particularly in the critical care setting. Due to of its physical proprieties, Heliox breathing reduces air flow resistances within the bronchial tree; in patients with obstructive lung diseases Heliox may also reduce the work of breathing and improve pulmonary gas exchange efficiency. Beneficial effects have been documented in severe asthma attacks and in patients with chronic obstructive pulmonary disease. A reduction in WOB during mechanical ventilation and an increase in exercise endurance capacity have also been described in COPD. Heliox has been also used in the treatment of upper airways obstruction, bronchiolitis and bronchopulmonary dysplasia. Despite the encouraging results, Heliox use in routine practice remains controversial because of technical implications and high costs

Exercise respiratory cycle time components in patients with emphysema

Background: We have recently demonstrated that in patients with COPD the severity of emphysema (E) measured by high resolution computed tomography (HRCT) correlated with: ratio VTpeak/FEV1; VE/VCO2 slope and PETCO2 values at peak exercise. The aim of this study was to further investigate if exercise respiratory cycle time components correlated with % of E measured by HRCT. Method: Twelve patients (age = 65±8 yrs; FEV1 = 55±17%pred) with moderate to severe E (quantified by lung HRCT as % voxels < −910 HU) were evaluated with incremental cardiopulmonary exercise testing (CPET). Mean inspiratory time (TiM), mean total respiratory cycle time (TtotM), mean expiratory time during exercise (TeM) and mean expiratory time during the last third of exercise (TeM-end), has been calculated. Results: Both TeM and TeM-end had a good linear correlation with % of E (r = 0,61; p = 0,004 and r = 0,63; p = 0,003). Moreover, by dividing the patients in two groups based on the % of E (>50% and <50%), we observed that patients with higher % of E had longer TeM (TeM: 1,72±0,26sec vs 1,34±0,27sec, p = 0,005) and TeM-end. A good linear correlation has been observed also between TeM and PETCO2 and VE/VCO2 (r = 0,64; p = 0,002 and r = 0,7; p = 0,0005). TeM did not correlated with resting lung function values or inspiratory capacity (IC). Conclusion: The data confirm that distinct physiologic response pattern can be detected at CPET in these patients

Cardiopulmonary exercise testing in the functional and prognostic evaluation of patients with pulmonary diseases

Exercise testing is increasingly utilized to evaluate the level of exercise intolerance in patients with lung and heart diseases. Cardiopulmonary exercise testing (CPET) is considered the gold standard to study a patient's level of exercise limitation and its causes. The 2 CPET protocols most frequently used in the clinical setting are the maximal incremental and the constant work rate tests. The aim of this review is to focus on the main respiratory diseases for which exercise tolerance is indicated; for example, chronic obstructive pulmonary disease, interstitial lung disease, primary pulmonary hypertension and cystic fibrosis. This review also focuses on the variables/indices that are utilized in the functional and prognostic evaluation. The recognition of abnormal response patterns of ventilatory, cardiac and metabolic limitation to exercise may help in the diagnostic evaluation. In addition, CPET indexes can provide important functional and prognostic information regarding patients with pulmonary disease. Exercise indices, such as peak oxygen uptake (V'O 2 peak), ventilatory equivalents for carbon dioxide production (V'E-/V'CO2) and arterial oxygen saturation (S pO2), have in fact proven to be better predictors of prognosis than lung function measurements obtained at rest. Moreover, useful information on the effects of therapeutic interventions may be obtained by CPET by studying the changes in endurance capacity during high-intensity constant work rate protocols. Copyright © 2009 S. Karger AG

Muscle function in COPD: a complex interplay

The skeletal muscles play an essential role in life, providing the mechanical basis for respiration and movement. Skeletal muscle dysfunction is prevalent in all stages of chronic obstructive pulmonary disease (COPD), and significantly influences symptoms, functional capacity, health related quality of life, health resource usage and even mortality. Furthermore, in contrast to the lungs, the skeletal muscles are potentially remedial with existing therapy, namely exercise-training. This review summarizes clinical and laboratory observations of the respiratory and peripheral skeletal muscles (in particular the diaphragm and quadriceps), and current understanding of the underlying etiological processes. As further progress is made in the elucidation of the molecular mechanisms of skeletal muscle dysfunction, new pharmacological therapies are likely to emerge to treat this important extra-pulmonary manifestation of COPD