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Biomedical subjects

F Rubini

Publications and source records attributed to F Rubini.

At least 19 recordsLinked to original sources
PubMed1995

Elevated static compliance of the total respiratory system: early predictor of weaning unsuccess in severed COPD patients mechanically ventilated.

OBJECTIVE: To assess in a group of COPD patients mechanically ventilated for an episode of acute respiratory failure the respiratory mechanics with a simple and non invasive method at the bedside in order to evaluate if these parameters may be predictive of weaning failure or success. DESIGN: A prospective study. SETTING: Intensive care and intermediate intensive care units. PATIENTS: 23 COPD patients ventilated for acute respiratory failure and studied within 24 hours from intubation. METHODS: Using end-expiratory and end-inspiratory airway occlusion technique, we measured PEEPi, static compliance of the respiratory system (Crs, st) maximum respiratory resistance (Rrsmax) and minimum respiratory resistance (Rrsmin). MEASUREMENTS AND RESULTS: The weaned group (A) and the not weaned group (B) were not different regarding to static PEEPi (group A 8.5 +/- 4.0 vs group B 8.9 +/- 2.6 cmH2O), TO Rrsmax (22.4 +/- 5.3 versus 22.2 +/- 9.0 cmH2O/1/s) and to Rrsmin (17.6 +/- 5.5 versus 17.9 +/- 8.0 cmH2O/1/s), while a significant difference (p < 0.001) has been found in Cst, rs (62.7 +/- 17.% versus 111.6 +/- 18.0 ml/cm H2O). The threshold value of 88.5 ml/cmH2O was identified by discriminant analysis and provided the best separation between the two groups, with a sensitivity of 0.85 and a specificity of 0.87. CONCLUSION: Cst, rs measured non invasively in the first 24 h from intubation, provided a good separation between the patients who were successfully weaned and those who failed.

Acute Disease↗
PubMed1995

Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success.

BACKGROUND: Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. METHODS: Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one as successful (78%) or unsuccessful (22%) according to survival and to the need for endotracheal intubation. RESULTS: Pneumonia was the cause of acute respiratory failure in 38% of the unsuccessful episodes but only in 9% of the successful ones. Success with non-invasive mechanical ventilation was associated with less severely abnormal baseline clinical and functional parameters, and with less severe levels of acidosis assessed during an initial trial of non-invasive mechanical ventilation. CONCLUSIONS: The severity of the episode of acute respiratory failure as assessed by clinical and functional compromise, and the level of acidosis and hypercapnia during an initial trial of non-invasive mechanical ventilation, have an influence on the likelihood for success with non-invasive mechanical ventilation and may prove to be useful in deciding whether to continue with this treatment.

Aged↗
PubMed1994

Acute effect of corticosteroids on respiratory mechanics in mechanically ventilated patients with chronic airflow obstruction and acute respiratory failure.

We assessed the short-term effect of steroids on respiratory mechanics in eight mechanically ventilated patients with chronic airflow obstruction (CAO) and hypercapnic respiratory failure. Airflow (V), airway pressure (Paw), and changes in pulmonary volume were measured using a conventional ventilator. End-expiratory and end-inspiratory airway occlusions were performed to assess intrinsic PEEP (PEEPi), static compliance of total respiratory system (Cstrs), maximum inspiratory resistance (Rrsmax), and minimum inspiratory resistance (Rrsmin). These parameters were recorded at control, 30 min after saline, and 90 min after steroid (methylprednisolone 0.8 mg/kg intravenous) administration. No significant changes were found in respiratory mechanics after administration of saline. Steroids induced a significant decrease (p < 0.01) in inspiratory resistance (Rrsmax from 20.3 +/- 8.6 cm H2O/L/s (control) to 15.3 +/- 6.1 (90 min) and Rrsmin from 16.2 +/- 8.0 (control) to 11.9 +/- 6.5 (90 min), with no significant reduction in Paw and Cstrs. The PEEPi, reflecting pulmonary dynamic hyperinflation, was also significantly reduced (-16% from control). We conclude that in mechanically ventilated CAO patients, steroids may be useful in improving respiratory mechanics and therefore in providing better conditions for weaning from mechanical ventilation.

Female↗
PubMed1994

Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days.

We studied survival and failure or success of weaning from mechanical ventilation (MV) in 42 consecutive chronic obstructive pulmonary disease (COPD) patients requiring prolonged MV (more than 21 days) after an episode of acute respiratory failure requiring admission to our Intermediate Intensive Care Unit (IICU). Parameters including arterial blood gases, pulmonary function tests, respiratory muscle force, neuromuscular drive, and nutritional status were recorded during a phase of clinical stability, in order to identify the features related to survival and weaning. All the patients were submitted to a comprehensive rehabilitation programme. Successful weaning from MV was defined as complete respiratory autonomy for at least 48 h. Twenty three patients were successfully weaned from MV after an average period of 44 days (Group A), requiring no further MV during their stay in hospital, whilst the remaining 19 patients were not able to be disconnected from the ventilator (Group B). The discriminant analysis showed that weaning from MV was significantly associated with arterial carbon dioxide tension (PaCO2), neuromuscular drive (P0.1), maximal inspiratory pressure (MIP), arterial oxygen tension (PaO2), the ratio of respiratory frequency to tidal volume (f/VT) and the serum protein level. Other pulmonary function tests (forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC), anthropometric data, nutritional status, number of pulmonary exacerbations during MV and evidence of cor pulmonale, were similar in the two groups. The discriminant equation considering PaCO2 and MIP could separate the two groups with an accuracy of 84%. The overall survival at 2 yrs was 40%; in Group B it was significantly lower than in Group A (22 vs 68%). Most of the deaths occurred within the first 120 days after intubation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Ventilatory techniques during weaning.

Ventilatory techniques are only a part of the weaning process, that also includes medical therapy, physiokinesitherapy, nutrition, psychological support and nursing. Traditional ventilatory techniques used in weaning are: T-piece trials (alternated with assist-control ventilation (ACV)), pressure support ventilation (PSV), intermittent mandatory ventilation (IMV) and continuous positive airway pressure (CPAP) ventilation. None of these techniques has been demonstrated to be better than the others, and the physician must be prepared--to try alternate strategies according to the kind of patient. Noninvasive mechanical ventilation (NIMV) can be successfully used in weaning from invasive mechanical ventilation. Furthermore, NIMV by nasal or facial mask has been successfully used in the treatment of acute respiratory failure (ARF) due to various pathologies. In these cases, the weaning trial has an immediate beginning, since noninvasive ventilation is performed alternatively with spontaneous breathing after the early phase of ARF.

Humans↗
PubMed1994

Weaning and outcome from mechanical ventilation.

Weaning means the ability of a patient to breath spontaneously after mechanical ventilation. In chronic obstructive pulmonary disease (COPD) patients, inability to tolerate discontinuation of mechanical ventilation is reported to have an incidence of 25-60%. It is, therefore, important to employ simple parameters able to predict weaning success, since, in the case of failure, the validation of predictive indices of weaning may also contribute to the decision of whether or not these patients should eventually enter a programme of home ventilation. Among other indices employed, respiratory frequency/tidal volume (f/VT) ratio, compliance, rate, oxygenation and pressure (CROP) index, mouth occlusion pressure (P0.1) and static compliance of the respiratory system have been shown to be quite accurate. The survival at one year of these patients requiring mechanical ventilation ranges 34-49%. Indeed, there is a particular subset of COPD patients in whom mechanical ventilation is prolonged due to the severity of their pathology. We studied 42 of these patients requiring mechanical ventilation for more than 21 days, to assess with simple parameters (arterial blood gases, pulmonary function tests, respiratory muscle force, P0.1, nutritional status) their potential for weaning and their survival at 2 yrs. Using discriminant analysis, and employing an equation comprising maximal inspiratory pressure (MIP) and arterial carbon dioxide tension (PaCO2), we were able to predict the patients able or unable to be weaned with an accuracy of almost 85%.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1994

Noninvasive mechanical ventilation in the treatment of acute respiratory failure due to infectious complications of lung transplantation.

Patients that have undergone lung and heart-lung transplantation may contract severe respiratory infections, often leading to acute respiratory failure requiring mechanical ventilation. Endotracheal intubation may induce infectious complications of the respiratory tract, which can be avoided by noninvasive modes of ventilation. We describe the use of noninvasive modes of ventilation in three cases of acute respiratory failure induced by infectious complication of lung and heart-lung transplantation. In two cases endotracheal intubation was avoided and treatment was successful.

Acute Disease↗
PubMed1994

[Nasal pressure support ventilation (NPSV) in a case of Pneumocystis carinii pneumonia in single-lung transplantation].

In patients who underwent lung transplantation one of the primary determinants of patient survival is infection. Contributing factors in the development of pneumonia include immunosuppression and alterations in the natural lung defense mechanism induced by transplantation. We describe a case of a Pneumocystis carinii pneumonia occurring in the recipient of single lung transplantation for interstitial lung disease four months after surgery. The patient developed severe acute respiratory failure (ARF) requiring mechanical ventilation. Because of the increased infectious risk, tracheal intubation was avoided and pressure support ventilation was performed by the nasal route (NPSV) with PEEP (PS: 16 cm H2O PEEP: 8 cm H2O). NPSV and PEEP were applied 20-22 hours/day in the first 4 days, thereafter 2 to 6 hours 3 times a day, together with medical therapy. This treatment was performed for 15 days. This mode of ventilation was well tolerated and was successful. We conclude that NPSV may be useful in the treatment of ARF in patients with lung transplantation, particularly to avoid invasive mechanical ventilation related infectious complications.

Humans↗
PubMed1993

Non-invasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COLD patients.

OBJECTIVE: 1) To compare the clinical usefulness of both non-invasive pressure support ventilation (NPSV) and non-invasive intermittent positive pressure ventilation in assist-control (A/C) mode (NIPPV) in chronic obstructive lung disease (COLD) patients with acute hypercapnic respiratory failure: 2) to compare retrospectively the usefulness of non-invasive mechanical ventilation (NMV) with standard medical therapy alone. DESIGN: Prospective randomized retrospective study. SETTING: 2 Respiratory intermediate intensive units. PATIENTS: 29 COLD patients (age: 62 +/- 8 years) with chronic respiratory failure were hospitalized in a department for rehabilitation during acute relapses of their disease. They were transferred to our intermediate intensive care unit (IICU) and submitted randomly to either NPSV (16 patients) or NIPPV (13 patients). MEASUREMENTS AND RESULTS: Blood gas analysis, dynamic flows, clinical variables, success rate, time of ventilation, side effects and subjective score of compliance to therapy. Therapy was considered successful when endotracheal intubation was avoided and patients were returned to their condition prior to exacerbation. No statistically significant difference was found between NPSV and NIPPV in success rate (NPSV 87.5%; NIPPV 77%) or in time of ventilation (NPSV: 69 +/- 49; NIPPV: 57 +/- 49 h). A better compliance to non-invasive mechanical ventilation (NMV) was found in NPSV patients than in NIPPV patients; side effects were observed less frequently in the NPSV group. Comparison of the success rate of NMV was retrospectively performed with 35 control COLD patients with chronic respiratory insufficiency who had undergone an acute relapse of their disease in the 2 years preceding the institution of the IICU and had been treated with oxygen and medical therapy alone. Patients submitted to NMV showed a greater success rate than control (82 versus 54%) after a period of ventilation ranging from 4-216 h. CONCLUSION: Non-invasive mechanical ventilation performed either by NPSV or NIPPV may improve the outcome of acute exacerbations of COLD, as compared to medical therapy alone. NPSV seems to be more acceptable to patients in comparison with NIPPV.

Acute Disease↗
PubMed1993

Clinical and histological evaluation of interferon alfa-2b in the treatment of chronic hepatitis C.

In a study of 37 patients with hepatitis C (proved histologically) positive chronic hepatitis, a correlation was seen between clinical efficacy and histological improvement after treatment with interferon alfa-2b (3 million units (MU) three times a week for six months plus six months' follow up). Alanine aminotransferase activities became normal in 18 (48%) patients during treatment; at the end of follow up eight (45%) had a continued response to the treatment. Paired liver biopsy specimens showed marked improvements in Knodell index score and portal inflammation in these patients.

Adolescent↗
PubMed1993

Effect of nasal pressure support ventilation and external PEEP on diaphragmatic activity in patients with severe stable COPD.

Nasal pressure support ventilation (NPSV) has been shown to be useful in the treatment of acute and chronic pulmonary failure. However, little is known about respiratory muscle activity during NPSV in stable patients with COPD. The aim of this study was to test the effect of two levels (10 and 20 cm H2O) of NPSV on diaphragmatic activity, in a group of seven stable, severe COPD patients (FEV1 20 percent +/- 7 of pred, FEV1/FVC 35 percent) with hypercapnic respiratory insufficiency. Since these patients had an intrinsic PEEP (PEEPi) of 2.6 +/- 1.3 cm H2O, we also investigated the effect of adding 5 cm H2O external PEEP (PEEPe) during NPSV. Blood gases, ventilatory pattern by inductive plethysmography, integrated electromyogram of the diaphragm (Edi), transdiaphragmatic pressure (Pdi), and the diaphragmatic pressure time product (PTPdi) were recorded during randomized 15-min runs of both levels of NPSV with and without the addition of PEEPe. Minute ventilation did not change with the application of NPSV, but a significant decrease in breathing frequency with a parallel increase in tidal volume was observed, so that blood gas determinations improved at the higher levels of support. A marked statistically significant reduction in diaphragmatic activity, as assessed by a decrease in Pdi swings, PTPdi, and Edi, was detected at the levels of 10 and 20 cm H2O; a further significant decrease in these values was observed when PEEPe was added. PEEPi decreased significantly only with the application of PEEPe, resulting in a small increase in end-expiratory lung volume. We conclude that NPSV improves diaphragmatic function in patients with severe stable COPD; this effect may be enhanced by the applications of external PEEP.

Aged↗
PubMed1993

Transmission of HIV-associated tuberculosis to healthcare workers.

OBJECTIVE: A retrospective investigation was made to compare the occupational risk of tuberculosis in personnel assisting human immunodeficiency virus (HIV)-infected and uninfected subjects with active tuberculosis. DESIGN: We retrospectively reviewed 6 years of hospital activity in 3 units where HIV-infected patients with tuberculosis are hospitalized and in 2 units where non-HIV-infected tuberculosis patients are hospitalized. The risk of occupational tuberculosis in healthcare workers who assisted HIV-infected and non-HIV-infected patients with tuberculosis was investigated. PARTICIPANTS: The risk of occupational tuberculosis in healthcare workers was studied by considering the numbers of potential source cases (hospitalized patients with tuberculosis) in the two conditions investigated (HIV-positive and HIV-negative). Both potential source cases and cases of tuberculosis in healthcare workers had to be microbiologically proven in order to be considered. RESULTS: Seven cases of tuberculosis occurred in persons who cared for 85 HIV-infected subjects with tuberculosis, while only 2 cases occurred in staff members who took care of 1,079 HIV-negative tuberculosis patients over the same period (relative risk = 44.4; 95% confidence interval = 8.5-438). CONCLUSIONS: Tuberculosis seems no longer to be a neglectable risk in healthcare workers assisting patients with HIV infection. Further study is urgently needed to see whether such unexpectedly high dissemination of tuberculosis also is demonstrable in the community.

HIV Infections↗
PubMed1991

Comparative efficacy of ceftriaxone versus ceftazidime in the treatment of nosocomial lower respiratory tract infections.

Seventy-two hospitalized patients with pneumonia or bacteremia were randomly allocated to receive ceftriaxone 2 g once daily i.v. or ceftazidime 2 g twice a day i.v. At the end of the study 60 patients were evaluable, 31 in the ceftazidime group and 29 in the ceftriaxone group. Thirty-four patients (ceftazidime = 15, ceftriaxone = 19) yielded one or more pathogens, of which 64% were gram-negative bacilli. Clinical cure or improvement was observed in 90% of patients in both groups. All 3 cases of bacteremia were cured. Three patients in each group failed to respond to the administered drug. Eradication of the pathogen(s) was observed in 82% of the ceftazidime group and in 86% of the ceftriaxone group. Two episodes of superinfection due to Pseudomonas aeruginosa were recorded in the ceftriaxone group, while Candida spp. was isolated from the sputum in 2 patients in the ceftazidime group. Three strains of P. aeruginosa (2 in the ceftazidime group, 1 in the ceftriaxone group) persisted despite the treatment. No side effects were seen except for skin rash in 2 patients receiving ceftazidime. Compliance was good in both groups, particularly with the once daily administration of ceftriaxone. Overall ceftriaxone and ceftazidime appear to be equally effective in the treatment of nosocomial pneumonia, with the exception of P. aeruginosa infection.

Adolescent↗
PubMed1991

[Contribution of the CT to a special technique of percutaneous lumbar anesthetic block].

The authors suggest the use of CT for the positioning of a permanent catheter, suitable for lumbar anesthetic block in painful lower limbs syndromes. This technique was employed on 12 patients suffering from vascular diseases of the lower limbs. CT allowed a good visualization of both bone structures and soft tissues, which are essential landmarks for catheter positioning. The catheter was inserted with its anterior end fixed to the anterior abdominal wall, which allowed the patient to manage its own treatment. In all cases we obtained marked symptoms regression, after 5 months of treatment. No such complications were observed as those report in literature. The main contraindication appeared to be the aneurysmatic dilatation of both aorta and iliac arteries.

Female↗
PubMed1990

[Hyperparathyroidism in patients with respiratory decompensation].

Eighteen patients aged between 55 and 65 and affected by respiratory insufficient were included in the study. Serum levels of PTH, total calcium, Ca++ and phosphorus were measured. Special attention was focused on PTH concentrations with in some case provedo to be above normal. Two hypotheses of pathogenesis are put forward. The first suggests that reduced Ca++ levels are responsible for anomalous PTH serum concentrations, whereas the second suggests that this role may be played by hypoxia. The latter would indirectly or directly affect parathyroids, either increasing PTH hyperincretion or slowing down the metabolism of the hormone by kidneys and liver which are in turn negatively affected by low blood oxygen tension.

Aged↗
PubMed1989

[Mechanical ventilation and pulmonary vascular resistance: comparison of IPPV, CPPV, CPAP, and PSV in decompensated chronic obstructive bronchopneumopathy with pulmonary hypertension].

Alterations of pulmonary vascular resistance were studied using four different methods of mechanical ventilation. A Servo Ventilator 900 C respirator was used for three of these techniques (IPPV, CPPV and PSV); CPAP was performed using a continuous-flow system because of the latter's advantages compared to demand-flow systems. Five patients (aged 64-75) affected by BPCO uncompensation and pulmonary hypertension (PAP 40 +/- 8 mmHg) were included in the study. A complete hemodynamic test was performed in each patient for each of the methods used by inserting a Swan-Ganz catheter through the right-hand internal jugular vein; intrapleural pressure were also measured using an esophageal balloon. The results of the study revealed a low level of tolerance to CPAP. Of the other methods, PSV was found to be particularly useful since it produced significant constant reductions of PVR and increased levels of CO compared to other techniques. These positive hemodynamic effects may be explained by the pattern of intrapleural pressures and the possibility of "self-adjustment" which this method allows.

Aged↗