Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

Prefazione Civilt\ue0 del mare e nevigazioni interculturali: sponde d'Europa e l' "isola" Trieste

Si tratta dell'introduzione di Zoppellari (individuata dalla sigla AZ) alla Parte III del volume "Civilt\ue0 del mare e navigazioni interculturali: sponde d'Europa e l'"isola" Trieste.. La Prefazione dei curatori, nella sua interezza, va dalla p. 7 alla p. 15

Civilt\ue0 del mare e navigazioni interculturali: sponde d'Europa e l' "isola" Trieste

4Nel solco di una ricerca sulle culture del mare in ambito europeo ed extraeuropeo da diversi anni intrapresa a Trieste, questo volume raccoglie i risultati di un nuovo studio progettato e realizzato da alcuni membri del Dipartimento di Studi Umanistici dell’Università di Trieste, con il contributo di colleghi degli Atenei di Bologna, Milano, Limoges e dello European College of Liberal Arts di Berlino. Le quattro sezioni in cui è strutturato il volume intendono rendere conto dell’intreccio di prospettive che sostanzia ogni riflessione critica sulle diverse forme di espressione delle culture del mare, in un dialogare di competenze e geografie culturali che tocca le sponde d’Europa: il Mare del Nord, la Manica, il Mediterraneo e l’Adriatico. Un “gioco” di sponde che raccorda l’idea di mare aperto, “stretto”, come il fiordo e la Manica, di mare chiuso, sia con le dinamiche storiche della portualità, sia con la presenza, ineludibile, dell’isola come unità del pensiero e del luogo, della forma e dello spazio, punto nodale che raccoglie in tensione le varie maglie di una rete più ampia. Si tratta, allora, di concepire il mare e lo spazio costiero come luogo delle tradizioni e delle contraddizioni, spazio che vive e si trasforma insieme all’identità delle genti che lo abitano. Civiltà del mare è impreziosito, a conclusione delle quattro sezioni, da un breve e intenso racconto inedito in Italia, Les yeux volés, di MAHI BINEBINE, che pubblichiamo per gentile concessione dell’autore.co-curatela (in particolare, responsabile Parte IV: L'Isola Trieste fra culture di terra e di mare) del volume interdisciplinare "Civiltà del mare e navigazioni interculturali: sponde d'Europa e l'"isola" Trieste", pubblicato con fondi del Dipartimento di Studi Umanistici. Altri curatori: Quazzolo, P (Parte I: Figure e rappresentazioni del mare nel teatro, nel cinema e nelle arti figurative); Gefter Wondrich, R. (Parte II: I racconti del mare: alcuni archetipi narrativi del romanzo italiano tra Ottocento e Novecento); Zoppellari A. (Parte III: Storia, territorio e urbanistica delle civiltà marittime).nonenoneFerrini C.; Gefter R.; Quazzolo P.; Zoppellari A.Ferrini, C.; Gefter, R.; Quazzolo, Paolo; Zoppellari, A

Inhibition of lymphocytic neuropathy target esterase predicts the development of organophosphate-induced delayed polyneuropathy.

Neuropathy Target Esterase (NTE) is the molecular target in the nervous system for organophosphorus esters (OP) when they cause delayed polyneuropathy. Some NTE activity was recently found also in blood lymphocytes. An unsuccessful suicide attempt with the widely used pesticide chlorpyrifos (0,0-diethyl-0-3,5,6,-trichloro-2-pyridyl phosphorothioate) is reported, where prior inhibition of lymphocytic NTE correlates with the delayed development of polyneuropathy. A 42-year-old man drank approximately 300 mg/kg chlorpyrifos. The subsequent severe cholinergic syndrome lasted for 17 days with varying degrees of severity. Thirty days after intoxication the clinical and electrophysiological examination of the peripheral nervous system was normal but lymphocytic NTE was about 60% inhibited. On day 43 the patient began to complain of paresthesia and leg weakness. Clinical examination, electrophysiology and a nerve biopsy revealed signs of a peripheral polyneuropathy, axonal in type. This case report indicates that measurement of lymphocytic NTE might be used as a clinical test to predict the development of OP-induced delayed polyneuropathy

Paraquat poisoning:kinetics and elimination through haemoperfusion and forced diuresis

Paraquat poisonin

Evaluation of postoperative pain after gynecologic surgery: a dedicated form

Introduction:Aim of this study is to evaluate the prevalence and intensity of postoperative pain and to find pain-related factors in women undergoing gynecologic surgery, using a dedicated form. Methods: The sample is divided into three groups, according to the type of surgical access (transversal laparotomy TL, longitudinal laparotomy LL, vaginal VAG). Each patient received postoperative painkillers according to hospital therapy protocols. Postoperative pain episodes that have been recorded during the first three days after surgery (days 0,1,2)) were studied. Pain intensity was measured using Numerical Rating Scale (NRS). Results:The 64% of operated women complained at least one episode of pain during the three days after surgery. Among women complaining pain, its intensity was moderate for the 89% (NRS 4-7) and it was severe only in few cases (11%), mainly in the VAG group. The due-hour painkillers administration was associated to a lower percentage of pain episodes if compared to the "rescue doses". Conclusions: Pain control is important to promote safe surgery. A dedicated form is useful to assess this vital sign. The results present a detailed pictureof this extremely subjective symptom and they suggest how to improve the analgesic therapies when necessary