Biomedical subjects

A R De Gaudio

Publications and source records attributed to A R De Gaudio.

At least 19 recordsLinked to original sources

PubMed2006

Bispectral Index compared to Ramsay score for sedation monitoring in intensive care units.

AIM: Continuous monitoring is of paramount importance in order to obtain a correct level of sedation in ICU patients. Clinical scoring systems, although simple and inexpensive, are often inadequate in evaluating the patient level of consciousness. Among instrumental tools for sedation monitoring, Bispectral Index (BIS) is now widely used due to its reliability and applicability. Nevertheless some doubts still exist regarding its usefulness in ICU. METHODS: Sedation, obtained with propofol or midazolam, was monitored with Ramsay scale and BIS in 40 patients admitted in ICU for postoperative monitoring after major abdominal or vascular surgery. A correlation between Ramsay score and BIS values was searched using Pearson test. RESULTS: A good correlation between Ramsay score and BIS values was observed. At the deeper levels of sedation a wide range of BIS values corresponds to Ramsay score 6, indicating various levels of central nervous system depression that are not identified by clinical evaluation. CONCLUSIONS: BIS monitoring is useful in ICU patients and allows a finest differentiation of sedation level in deeply sedated ICU patients.

Abdomen↗

PubMed2005

Intraoperative positive fluid balance improves tissue diffusion of ceftizoxime.

AIM OF STUDY: To demonstrate that administration of fluids and the consequent improvement of fluid balance during a surgical procedure can modify the tissue diffusion of ceftizoxime. METHODS: Twenty-eight patients (30-79 years) undergoing major abdominal surgery of the colon were administered ceftizoxime 30 mg/kg i.v. at induction of anesthesia. A sample of arterial blood was taken before administration of the drug (t0) and then again at the time of vascular occlusion of the colon segment to be removed (t1). A sample of the segment of removed colon was taken. The patients were divided into two groups on the basis of the fluid balance between t0 and t1: group A (n = 17) with a fluid balance <1,000 ml and group B (n = 11) with a fluid balance >1,000 ml. The parameters evaluated in each group were: weight, height and age of the patients, serum and tissue antibiotic concentration, percent ratio of serum and tissue concentration, time elapsed between t0 and t1, volume of administered fluids between t0 and t1, diuresis and hourly diuresis between t0 and t1 and body fluid distribution, obtained using a bioelectrical impedance analyzer. The mean results obtained in the two groups were then compared using Student's t test. RESULTS: The balance of fluids calculated up to t1 was 675 +/- 308 ml for group A and 1,411 +/- 405 ml for group B (p < 0.01). The means of the recorded values that showed statistically significant differences were: mean percent concentration ratio (43.6 +/- 8.4 vs. 84 +/- 16%; p < 0.05), concentration in the colonic segment (16.3 +/- 7.9 vs. 37.2 +/- 25.9 mg/ml; p < 0.05), urinary volume gathered up to t1 (538 +/- 557 vs. 169 +/- 104 ml; p < 0.05), hourly urinary volume up to t1 (311.1 +/- 296 vs. 97.6 +/- 77.9 ml/h; p < 0.05), percent variation of resistance (95.1 +/- 5.1 vs. 89.7 +/- 8.6; p < 0.05). The other means did not show any significant statistical differences. CONCLUSIONS: A higher tissue water level seems to facilitate the penetration of the antibiotic into the tissue according to the pharmacokinetic characteristics of ceftizoxime: high amount of free drug (not bound to plasma proteins) and high hydrosolubility.

Adult↗

PubMed2005

A-line autoregression index monitoring to titrate inhalational anaesthesia: effects on sevoflurane consumption, emergence time and memory.

BACKGROUND: A-line autoregression index (AAI) is a parameter derived from auditory evoked potentials proposed as depth of anaesthesia monitor. We evaluated the effects of AAI guidance on sevoflurane consumption, emergence time, explicit and implicit memory. METHODS: One hundred patients submitted to major abdominal surgery were randomized into two groups. In group A (n = 50), sevoflurane was titrated according to AAI (target = 20 +/- 5), in group B (n = 50) according to clinical signs. Anaesthesia was induced with fentanyl, propofol, atracurium and maintained with sevoflurane. The mean value of sevoflurane consumption (g/min) and emergence time has been assessed in both groups. After emergence, A test of explicit memory was administered. We assessed implicit memory using a category generation test. RESULTS: In group A, mean sevoflurane consumption was significantly (P = 0.0001) reduced by 20.4% and mean emergence time was significantly (P = 0.00012) shorter by 2 min with respect to group B. No patients experienced explicit memory while the difference between the two groups in implicit memory results was not significant (P = 0107). CONCLUSIONS: AAI titration of anaesthesia allows a significant reduction in sevoflurane consumption and emergence time without significant effects on the incidence of explicit and implicit memory. Nevertheless the relationship between AAI and memory requires studies in larger groups of patients.

Abdomen↗

PubMed2005

Sedation in PACU: indications, monitoring, complications.

The aim of the present article is to review the indications, the monitoring and the complications of sedation in the post-anaesthesia care unit (PACU). In this setting, sedation is often an unwanted side effect of anaesthetic drugs that delay discharge, however it could be specifically indicated. Such indications include postoperative anxiety and agitation, airway management and mechanical ventilation, protection against myocardial ischaemia and intracranial hypertension control. Whenever sedation is used, an appropriate monitoring is useful to achieve an adequate level for the specific indication. Methods for sedation monitoring in PACU may be subjective (clinical scales) or objective (lower oesophageal sphincter contractility measurement, heart rate variability, evoked potentials and parameters derived from the electroencephalogram). The target score of the most common clinical scales has been reviewed according to the specific indication. An adequate monitoring is fundamental to avoid the complications of sedation including bradycardia, hypotension, prolonged mechanical ventilation and increased risk of respiratory tract infection as pointed out by many recent data. Therefore, sedation should be used carefully and with an adequate monitoring in post-operative patients not to affect negatively morbidity and mortality.

Anesthesia Recovery Period↗

PubMed2005

Blunted inflammatory response to lipopolysaccharide endotracheal instillation due to thermal preconditioning.

AIM: Heat shock proteins (HSPs), induced by thermal stress, make the cells more resistant to following stress. We aimed to verify if rats heating reduces the production of TNF-alpha in a model of acute respiratory distress syndrome (ARDS). METHODS: We divided 34 Wistar rats in Group A and Group B. The rats of Group A received thermal shock and tracheal instillation of lipopolysaccharide (LPS), the rats of Group B only tracheal instillation of LPS. All the rats have been then subdivided in 6 subgroups sacrificed at different times after instillation of LPS: A30 and B30 at 30 min, A90 and B90 at 90 min and A180 and B180 at 180 min. We dosed the serum concentration of TNF-alpha and the values of every subgroup have been compared with the Student t-test. RESULTS: The serum concentration of TNF-alpha in the subgroup A90 resulted significantly lower than in the subgroup B90. CONCLUSIONS: The exposure to thermal stress resulting in the production of HSPs reduced the concentration of TNF-alpha in this model of ARDS.

Animals↗

PubMed2003

What is the role of streptogramins in intensive care?

The combination of two injectable streptogramins, quinupristin/dalfopristin, provides a new pharmacological choice proven to be therapeutically efficacious against most Gram-positive, multi-resistant microorganisms. They have been shown to be efficacious above all in critically ill patients hospitalized in intensive care who have unique alterations in homeostasis that makes tissue penetration of various pharmacological antimicrobials difficult. In cases of infection localized in difficult-to-treat sites, the combination with other drugs, such as cefepime, a glycopeptide or linezolid, is able to potentiate the action of the streptogramin with positive results which allow resolution of the illness. In this article, we review data from the literature on the use of quinupristin/dalfopristin in the treatment of Gram-positive, multi-resistant infections in critically ill patients.

Anti-Bacterial Agents↗

PubMed2003

Device-related infections in critically ill patients. Part I: Prevention of catheter-related bloodstream infections.

Antibiotic Prophylaxis↗

PubMed2003

Device-related infections in critically ill patients. Part II: Prevention of ventilator-associated pneumonia and urinary tract infections.

Device utilization in critically ill patients is responsible for a high risk of complications such as catheter-related bloodstream infections (CRBSI), ventilator-associated pneumonia (VAP) and urinary tract infections (UTI). In this article we will review the current status of data regarding the prevention of VAP and UTI. The results of the more recent (5 years) randomized controlled trials are reviewed and discussed. General recommendations include staff education and use of a surveillance program with a restrictive antibiotic policy. Adequate time must be allowed for hand washing and barrier precautions must always be used during device manipulation. Specific measures for VAP prevention are: 1) use of multi-use, closed-system suction catheters; 2) no routine change of the breathing circuit; 3) lubrication of the cuff of the endotracheal tube (ET) with a water-soluble gel; 4) maintenance of patient in semi-recumbent position to improve chest physiotherapy in intubated patients. Specific measures for UTI prevention include: 1) use of a catheter-valve instead of a standard drainage system; 2) use of a silver-alloy, hydro gel-coated latex urinary catheter instead of uncoated catheters. Biofilm represents a new variable: the capacity of bacteria to organize a biofilm on a device surface can explain the difficulty in preventing and eradicating an infection in a critically ill patient. More clinical trials are needed to verify the efficacy of prevention measures of ICU infections.

Anti-Bacterial Agents↗

PubMed2003

[What role for streptogramin in intensive therapy?].

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Anti-Bacterial Agents↗

PubMed2001

Glomerular permeability after surgical trauma in children: relationship between microalbuminuria and surgical stress score.

OBJECTIVES: To determine whether there is an increase of urinary albumin during and after surgical trauma and investigate a possible relationship between microalbuminuria and the severity of surgical stress. DESIGN: Prospective study. SETTING: University hospital pediatric intensive care unit. PATIENTS: Forty consecutive children scheduled for elective surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Microalbuminuria/urinary creatinine ratio (MACR) was measured before, during, and after elective moderate or major surgical procedures. The Oxford Surgical Stress Score (SSS) was determined for each patient at the end of the operation, and its relationship with maximum deviation of MACR from baseline values was investigated. MACR showed a progressive increase during surgery and a decrease afterward, reaching preoperative values in most cases within 24 hrs after the end of surgery. There was a significant correlation between the increase in MACR and severity of the surgical trauma as measured by SSS. Two patients showed a rise in MACR after the initial postoperative normalization before clinical appearance of a surgical complication and one patient showed a persistent rise in MACR before clinical appearance of a septic complication. None of the other patients showed any rise in MACR after postoperative normalization, and they all had an uneventful recovery. CONCLUSIONS: MACR rises during and after major or moderate elective surgery in children. There is a significant positive correlation between severity of surgical trauma and capillary permeability in pediatric patients. Microalbuminuria, as an index of capillary permeability, may be an early sign of incipient complications and assist in the identification of those patients whose condition will deteriorate. The test is a cheap, blood-sparing, easy-to-perform bedside procedure that may have a useful role in clinical practice for evaluating the effect of surgical trauma on capillary permeability in children.

Albuminuria↗

PubMed2000

Microalbuminuria as an early index of impairment of glomerular permeability in postoperative septic patients.

OBJECTIVE: To evaluate whether microalbuminuria increases in post-operative patients developing sepsis, and whether it is correlated to the sepsis severity score (SOFA) and the PaO2/FIO2 ratio. DESIGN: Prospective study. SETTING: University intensive care unit. PATIENT POPULATION: Fifty-five postoperative ASA II-III patients admitted to the ICU after major abdominal or vascular surgery. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Urine collection and measurement of microalbuminuria and urinary creatinine on admission and again as soon as sepsis developed or at the end of the study (72 h after admission). Results are expressed as the microalbuminuria/creatinine ratio (MACR). The MACR significantly increased as soon as sepsis (defined according to the ACPP/SCCM Consensus Conference) appeared. The MACR positively correlated to the SOFA score, but had no relation to the PaO2/FIO2 ratio. Patients not developing sepsis did not show any increase in the MACR during the study period. CONCLUSIONS: Post-operative patients developing sepsis, unlike those with an uncomplicated postoperative evolution, showed an increase in glomerular permeability which was revealed by MACR. The increase in the MACR was positively correlated to the increase in SOFA score, while it had no relation to the PaO2/FIO2 ratio.

Aged↗

PubMed2000

Videolaparoscopic cholecystectomy induces a hemostasis activation of lower grade than does open surgery.

BACKGROUND: Tissue injury after trauma and surgery may induce alterations in blood coagulation and fibrinolysis, and the hypercoagulable state observed after surgery can be associated with the risk of postoperative thromboembolic complications. Recently, videolaparoscopic (VLPS) cholecystectomy has been introduced, and its advantages over the open procedure seem related to the reduced surgical trauma. The aim of this study was to investigate hemostatic system alterations in patients who undergo open and VLPS cholecystectomy. METHODS: Fibrinogen, prothrombin fragment F1+2, D-dimer, and plasminogen activator inhibitor type-1 (PAI-1) activity was determined in 10 patients who underwent open (group A) and 10 patients who underwent VLPS cholecystectomy (group B), respectively. Blood samples were obtained the day of surgery in the morning (B1), after anesthesia (A1), 1 hour after the start of surgery (S1), then 30 min (E.05) and 24 h (E.24) after the surgery. RESULTS: No significant differences were observed in baseline values between groups A and B for the parameters investigated. At 24 h after surgery, fibrinogen increased significantly (p < 0.05) in group A and also was significantly higher than in group B (p < 0.05). In group A, a marked increase in F1+2 levels (p < 0.01) was observed in all the samples, with the maximum values on the first day after surgery (3.7 nmol/l; 1.2-6.0 nmol/l), whereas in group B, a slight but significant increase in F1+2 levels (2.1 nmol/l; 1.1-3.9 nmol/l; p < 0.01) was observed only 30 min after the end of surgery. In both groups A and B, D-dimer markedly increased after surgery, without statistical significant differences between the two groups at any time. The PAI-1 activity plasma levels remained in the normal range during and after surgery in both groups. CONCLUSIONS: These results indicate that VLPS surgery induces an activation of the clotting system that, although of low degree and short duration, can lead to a transient prothrombotic state.

Adult↗

PubMed2000

Protective effects of N-acetylcysteine and rutin on the lipid peroxidation of the lung epithelium during the adult respiratory distress syndrome.

This study investigates the effects of N-acetylcysteine (NAC) and rutin on the lung oxidative burden of patients with early adult respiratory distress syndrome (ARDS). The protection was evaluated by measuring expired ethane and malondialdehyde (MDA), and oxidized (GSSG) and reduced glutathione (GSH) in the epithelial lining fluid of 36 patients who developed ARDS less than 24 hours before enrollment in the study. The patients were randomly assigned to 3 groups, receiving 250 mL 5% dextrose in water (group 1), NAC 50 mg/kg body weight in 5% dextrose (group 2), and NAC 50 mg/kg + rutin 5 mg/kg in 5% dextrose (group 3). Ethane and MDA concentrations were significantly reduced in the treatment groups after day 6. GSH was 30% increased in the treatment groups. No significant variations were observed in the control group until day 9. The trial confirms that NAC and rutin are efficient in protecting the lungs of patients with ARDS.

APACHE↗

PubMed2000

The effect of glutathione and N-acetylcysteine on lipoperoxidative damage in patients with early septic shock.

Both the hyperproduction of oxygen free radicals (OFR) and the weakening of natural scavenging mechanisms have been implicated as contributors to multiple organ failure in septic shock. This study examined whether the antioxidants glutathione (GSH) and N-acetyl-L-cysteine (NAC) play a protective role against damage by OFR in early septic shock. We randomly entered 30 patients with septic shock into one of three groups within 24 h of diagnosis. All of the patients received septic shock therapy, including parenteral nutrition, antibiotics, and volume-expanding and inotropic agents. One group (Group B) also received 70 mg/kg/d of intravenous GSH, and a second group (Group C), 70 mg/kg/d of intravenous GSH and 75 mg/kg/d of intravenous NAC. The protection against OFR damage was evaluated by measuring expired ethane, plasma malondialdehyde, erythrocyte deformability, complement activation, and clinical scores at admission and on Days 3 and 5 of treatment. A significant decrease in peroxidative indexes was observed at Day 5 in Group B as compared with both the control group and basal values. The decrease in peroxidative indexes was even more marked in Group C. Clinical scores in this group were also significantly improved. In conclusion, the administration of high doses of NAC added to GSH significantly decreased the peroxidative stress of patients with septic shock.

APACHE↗

PubMed1999

Glomerular permeability and trauma: a correlation between microalbuminuria and Injury Severity Score.

OBJECTIVE: To determine if there is a correlation between an increase in glomerular permeability, the magnitude of trauma, and the severity of illness. DESIGN: Prospective study. SETTING: Two university hospital intensive care units. PATIENTS: Forty consecutive critically ill trauma patients admitted directly to the intensive care unit within 120 mins of their injuries. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For each patient, urine was collected from the time of admission until 7 am the next day. Within 48 hrs, only one sample of all urine collected (5 mL) was examined for microalbuminuria and urinary creatinine. Results were expressed as the microalbuminuria/urinary creatinine ratio (MACR). The mortality rate in the intensive care unit, Injury Severity Score at the moment of admission, Acute Physiology and Chronic Health Evaluation III score, and Simplified Acute Physiology Score in the first 24 hrs were calculated for each patient. The data were analyzed using the Pearson test for linear regression and Student's t-test. During the first 24 hrs after trauma, there was an increase of MACR (6.9 +/- 0.6 mg/mmol) above normal (reference range, <3 mg/mmol) that was positively correlated with Injury Severity Score (31.4 +/- 1.9; r2 = .73, p < .05). However, there was no correlation between MACR, Acute Physiology and Chronic Health Evaluation III score, Simplified Acute Physiology Score, and mortality rate. CONCLUSIONS: Patients with trauma show an increase in glomerular permeability during the first 24 hrs after injury. The magnitude of this increase is correlated with the extent of trauma but does not seem significant enough to be predictive of severity of illness and/or outcome.

APACHE↗

PubMed1998

Endotoxin-mediated intestinal damage: protective effect of capsaicin in the rat.

BACKGROUND: Endotoxin provokes the disruption of intestinal mucosal architecture. To investigate whether afferent fibers of the enteric nervous system are involved in this damage, we have used capsaicin to induce a selective, long-lasting degeneration of these fibers in the rat. METHODS: The rats were divided in two groups, receiving subcutaneously either capsaicin or its vehicle. After 10 days the rats from each group were injected with nonlethal doses of endotoxin or with saline. The next day all the animals were killed, and the jejunum and ascending colon were collected for light and scanning electron microscopy analysis; morphometric analysis of jejunal villus height was also performed. RESULTS: The rats receiving endotoxin but not pretreated with capsaicin had severe morphologic alterations and a significant reduction in villus height. In contrast, the rats pretreated with capsaicin and then with endotoxin showed a preserved mucosa with normal mean villus height. CONCLUSIONS: Capsaicin pretreatment is able to prevent endotoxin-induced damage of intestinal mucosa; this result seems to indicate that afferent fibers of the enteric nervous system are involved in the pathogenesis of this damage.

Animals↗

PubMed1995

Peri-operative assessment of glomerular permeability.

Surgical trauma may provoke an increase in glomerular permeability. Microalbuminuria is a subclinical increase in urinary albumin ranging from 20 to 300 mg..-1. This cannot be measured with routine laboratory tests and is estimated by radioimmunoassay. It has been proposed that microalbuminuria, an expression of increased glomerular permeability, serves to reflect a generalised increase in systemic vascular permeability. In this study the degree of microalbuminuria (expressed as microalbuminuria/creatinine ratio to correct for dilutional changes) has been measured in two groups of patients undergoing either videolaparoscopic surgery (group A) or conventional, open, abdominal surgery (group B). The anaesthetic technique was standardised and the duration of surgery similar in the two groups. A significant increase (p < 0.01) in the microalbuminuria/urinary creatinine ratio occurred in patients undergoing open abdominal surgery (group B). This alteration appeared 2 h after surgery but had disappeared 24 h after the end of the operation. During surgery, there was a direct relationship between glomerular permeability and the severity of the surgical insult.

Abdomen↗

PubMed1995

Therapeutic use of albumin.

The clinical use of albumin solutions is a controversial issue, that involves albumin as a volume plasma expander, a supplement of total parenteral nutrition and a substance with pharmacological properties. The aim of this review is to show the present role of albumin in the clinical setting. We reviewed experimental and clinical data collected by the Medline System and the bibliographies of relevant articles. Experimental studies were selected on the basis of their historical value and applicability (hypothetical use, correct use) to the clinical setting. At present, it is possible to assert that: a) exogenous albumin is not an ideal colloid; b) the effects on plasma volume expansion are not entirely predictable, especially in pathologic states accompanied by leaky capillary membranes; c) albumin supplementation shows no benefit on many kinds of tissue edema; d) the supplementation of albumin has no influence on outcome. It is possible to demonstrate the role of albumin as a substance with unique properties that make it useful, but further experimental and clinical data will be necessary and represent new areas for future exploration. Given the protein's cost, the routine use of albumin does not appear to be justified, until new data indicate otherwise.

Albumins↗