Inferior vena cava collapsibility to guide fluid removal in slow continuous ultrafiltration: A pilot study

Objective: To investigate whether ultrasound determination of the inferior vena cava diameter (IVCD) and its collapsibility index (IVCCI) could be used to optimize the fluid removal rate while avoiding hypotension during slow continuous ultrafiltration (SCUF). Methods: Twenty-four consecutive patients [13 men and 11 women, mean age 72 ± 5 years; New York Heart Association (NYHA) functional classes III-IV] with acute decompensated heart failure (ADHF) and diuretic resistance were admitted to our 16-bed medical ICU. Blood pressure (BP), heart rate (HR), respiratory rate (RR), blood samples for hematocrit, creatinine, sodium, potassium, and arterial BGA plus lactate were obtained at baseline and than every 2 h from the beginning of SCUF. IVCD, assessed by M-mode subcostal echocardiography during spontaneous breathing, was evaluated before SCUF, at 12 h, and just after the cessation of the procedure. The IVCCI was calculated as follows: [(IVCDmax - IVCDmin)/IVCD max] × 100. Results: Mean UF time was 20.3 ± 4.6 h with a mean volume of 287.6 ± 96.2 ml h-1 and a total ultrafiltrate production of 5,780.8 ± 1,994.6 ml. No significant difference in MAP, HR, RR, and IVCD before and after UF was found. IVCCI increased significantly after UF (P 30%. In all the other patients, a significant increase in IVCCI was obtained without any hemodynamic instability. Conclusion: IVC ultrasound is a rapid, simple, and non-invasive means for bedside monitoring of intravascular volume during SCUF and may guide fluid removal velocity. © 2010 Copyright jointly hold by Springer and ESICM

Ancient Roman Mortars from Anfiteatro Flavio (Pozzuoli, Southern Italy): A Mineralogical, Petrographic and Chemical Study

This research is based on the characterization of ancient mortars from the Anfiteatro Flavio (Pozzuoli) dating back to the 1st and 2nd century CE through a multi-analytical approach involving macroscopic, mineralogical, petrographic, and chemical investigations. The goal that has been set is to deepen knowledge about mortar mix design, the provenance of used raw materials, and secondary minerogenetic processes that have occurred within ancient Roman mortars. Results show that: (i) raw materials for mortar preparation have a local provenance, i.e., Phlegraean Fields area; (ii) mortars can be considered as hydraulic; (iii) calcite presence could be due to a non-complete calcination process, an improper slaking or to exposition of materials to the subaerial environment; (iv) gypsum is due to calcite sulfation process; (v) halite presence is due to marine aerosol exposition. The achieved information testifies that, for at least two centuries, Roman builders considered the identified mortar mix as optimal for their buildings, but also contributes to the understanding of their technical skills and represents an important first step to planning future restoration operations

Evaluation of short-term effectiveness of the disease management program “Di.Pro.Di.” on continuity of care of patients with congestive heart failure

This paper aimed to assess the early effectiveness of a disease management program (DMP), called “Dimissione Protetta Difficile” (Di.Pro.Di) conducted by personnel from the intensive care unit (ICU) of Public Hospital S. Paolo, Naples, Italy. Di.Pro.Di significantly reduces the number and risk of rehospitalizations and total hospital length of stay