Showing papers by "Giorgio Conti published in 2008"

Interleukin-6 and nerve growth factor upregulation correlates with improved outcome in children with severe traumatic brain injury

Abstract: Aims Secondary brain damage after traumatic brain injury (TBI) involves neuro-inflammatory mechanisms that are mainly dependent on the intracerebral production of cytokines Interleukin 6 (IL-6) may have a role both in the pathogenesis of neuronal damage and in the recovery mechanisms of injured neurons through the modulation of nerve growth factor (NGF) biosynthesis However, the relationship between IL-6 and NGF expression and the severity and outcome of TBI remains controversial We have conducted a prospective observational clinical study to determine whether the concentration of IL-6 and NGF in the cerebrospinal fluid (CSF) of children with TBI correlates with the severity of the injury and neurologic outcome of patients Methods CSF samples were collected from 29 children at 2 (Time T1) and 48 hours (Time T2) after severe TBI, and from 31 matched controls TBI severity was evaluated by Glasgow Coma Scale (GCS) and neurologic outcome by Glasgow Outcome Score (GOS) CSF concentrations of IL-6 and NGF were measured by immunoenzymatic assays Results Early NGF concentrations (T1) correlated significantly with head injury severity, whereas no correlation was found between GCS and IL-6 Furthermore, IL-6 and NGF upregulation after injury was associated with better neurologic outcomes Conclusions Based on these findings, we showed that NGF expression is a useful marker of brain damage following severe TBI Moreover, the early upregulation of both IL-6 and NGF correlates with a favourable neurologic outcome and may reflect an endogenous attempt at neuroprotection against biochemical and molecular cascades triggered by traumatic insult

Secretory phospholipase A2 and neonatal respiratory distress: pilot study on broncho-alveolar lavage

Abstract: Purposes Secretory phospholipase A2 hydrolyzes phosphoglycerides and it has been shown to be involved in alveolar inflammation and surfactant degradation. It plays an important role in acute lung injury but it has never been studied in newborn infants. We were aimed to investigate the phospholipase A2 activity in neonatal lung injury and its relationship with ventilatory findings.

Comparative evaluation of different helmets on patient–ventilator interaction during noninvasive ventilation

Abstract: R. Costa ( ) · G. Spinazzola · F. Cavaliere · M. Antonelli · R. Proietti · G. Conti Universita Cattolica del Sacro Cuore, Department of Anesthesiology and Intensive Care Medicine, Rome, Italy e-mail: roberta.costa@rm.unicatt.it P. Navalesi Universita Cattolica del Sacro Cuore, Dipartimento di Anestesia e Rianimazione, Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche, Campobasso, Italy

Blood loss and short-term outcome of infants undergoing brain tumour removal.

Abstract: Objective To evaluate perioperative management, early outcomes and hemocoagulative disorders in infants up to 1 year old, undergoing neurosurgery for brain tumors removal. Design Retrospective evaluation of prospectively collected data regarding all infants aged <1 year admitted to PICU from 1994 to 2004, following intracranial mass removal. Interventions none. Setting University Hospital PICU in a tertiary neurosurgical referral centre. Patients and participants All eligible infants were enrolled in the study. Population was constituted by 43 infants and subdivided in two groups, according to their intra-operative blood loss. Babies having blood loss exceeding the preoperative estimated volemia were classified in group A; the remaining babies were included in group B. Results Intraoperative transfusions, PICU length of stay, need for post-operative mechanical ventilation and cardiovascular support were all significantly higher in group A than in group B. No early postoperative mortality occurred. ROC analysis and multiple logistic regression showed the age as the only variable independently associated with blood loss exceeding preoperative volemia (cut-off 60.3 days; OR = 0.11, CI 0.02–0.55, sensitivity 82.4%; specificity 67%). Postoperatively, platelet count, prothrombin activity and fibrinogen resulted significantly depressed in group A, representing a dilutional coagulopathy. A marked dispersion of aPTT values was recorded in group B, where most infants exhibit aPTT shortening, suggesting a hypercoagulability status. Three episodes of clinical disseminated intravascular coagulation (DIC) were registered in group B. Conclusions We illustrated the relationships between intraoperative blood loss, transfusions and haemostatic impairment in babies following brain tumor removal. Youngest infants had the higher risk to experience hemocoagulative disorders. These infants showed significantly higher impact on the global PICU burden of care, as represented by the need of mechanical ventilation, cardiovascular support and PICU length of stay.

Year in review in Intensive Care Medicine, 2007. III. Ethics and legislation, health services research, pharmacology and toxicology, nutrition and paediatrics

Abstract: Year in review in Intensive Care Medicine, 2007. III. Ethics and legislation, health services research, pharmacology and toxicology, nutrition and paediatrics

Noninvasive ventilation in large postoperative flail chest.

Abstract: An 11-year-old male developed a severe respiratory failure due to a iatrogenic flail chest following a surgery for removing a large chest wall area. A rare Ewing sarcoma was histologically diagnosed and intensive chemotherapy was administered. Postoperatively, because of the failure in ventilation weaning, the patient was electively extubated and noninvasive positive pressure ventilation through face-mask was provided. Respiratory support avoided asynchronous paradoxical movements and achieved pneumatic stabilization. Clinical and respiratory improvement allowed a successful weaning from ventilator. Pediatr Blood Cancer 2008;51:831–833. © 2008 Wiley-Liss, Inc.

Successful resuscitation of unexpected neonatal hemorrhagic shock due to massive feto-maternal hemorrhage.

Abstract: SIR— Massive feto-maternal hemorrhage (MFH) resulting in neonatal shock is an exceptional event. MFH is defined as the loss of over 150 ml of blood and clinical manifestations strictly depend on the lost blood volume (1). The difficult prenatal diagnosis makes such cases an unexpected challenge. Few cases of MFH-surviving neonates have been reported with high mortality and morbidity (1,2). Immediate volume replacement is the last phase of the Neonatal Resuscitation Program algorithm and is crucial to achieve a good outcome, even if its usefulness can be low (2) and anemia correction may cause fluid overload (3). Detailed descriptions of successful resuscitation in such cases are lacking: we report a case of MFHrelated hemorrhagic shock with good outcome. A male neonate weighting 3 kg was born at 38 weeks after an uneventful pregnancy. Cardiotocogram performed 12 h before delivery showed A-pattern with poor variability. The woman was admitted to the hospital and monitoring was repeated every 3 h showing no differences. Twelve hours after, cardiotocography suddenly became sinusoidal with heart rate of 150 bÆmin and no areas of normal fetal heart rate variability. Emergency caesarean section was performed and the neonate appeared extremely pale with an heart rate of 100 bÆmin, but with vigorous breathing efforts. Apgar score was 7 ⁄ 6, at 1¢ ⁄ 5¢. At 5¢ breathing became superficial, heart rate decreased to 80 bÆmin, oxygen saturation was not measurable and 3 ⁄ 6 systolic murmur was present. Arterial gas analysis showed hypoxia and metabolic acidosis (pH: 7.22; base excess:-7;PaO2:30;PaCO2:48) and 100% oxygen was started by face mask. Although no visible bleeding was noticed, hemoglobin level was 3.1 grÆdl, hematocrit was 10.5% and mean arterial pressure was 20 mmHg. Blood bank was alerted for an emergency transfusion. At 15¢ the neonate was intubated and intermittent positive pressure ventilation was started with peak 20 cmH2O, PEEP 4 cmH2O, rate 40 and FiO2 100%. Umbilical vein was quickly cannulated and central venous pressure was 3 cmH2O. While waiting for the blood, 30 ml of normal saline were rapidly administered, followed by 5 ml of NaHCO3. At 25¢, 30 ml of packed red cell were administered in 15¢. After that, FiO2 decreased to 60% and arterial pressure increased to 30 mmHg. Abdominal ⁄ head ultrasound and chest X-rays where then emergently performed and failed to prove any internal hemorrhage. At 1 h, continuous infusion of 30 ml packed red cells was started through peripheral vein and after 4 h hemoglobin raised to 7.3 grÆdl. During the following 24 h standard fluid intake was provided. Another transfusion was performed with 60 ml of highly concentrated packed red cells which led hemoglobin to reach 12 gÆdl. The baby was successfully extubated at 30 h and weaned from oxygen after 4 days. Diuresis was »2.0 mlÆkgÆh, in the first days of life. A detailed analysis of hemodinamic situation was performed (Figure 1). Red cell volume has been estimated using the Kearney’s formula: (4)

Year in review in Intensive Care Medicine, 2007. II. Haemodynamics, pneumonia, infections and sepsis, invasive and non-invasive mechanical ventilation, acute respiratory distress syndrome

Abstract: Year in review in Intensive Care Medicine, 2007. II. Haemodynamics, pneumonia, infections and sepsis, invasive and non-invasive mechanical ventilation, acute respiratory distress syndrome

La tomografia assiale computerizzata spirale ad alta definizione ha cambiato la gestione del paziente con embolia polmonare acuta

Abstract: Pulmonary embolism (PE) is a common condition carrying a significant degree of mortality if not di- agnosed early. The diagnosis of PE is challenging, because of the non-specific nature of its clinical fea- tures. For many years the diagnostic strategies for PE have mainly involved ventilation/perfusion lung scan as the chief diagnostic procedure, often associated with a few clinical models of pre-test proba- bility and the D-dimer test. These modalities of diagnosing PE, though quite satisfactory in various clinical settings, show several limitations, the most important one being the high rate of non-diagnos- tic procedures. The introduction of computed tomography (CT) has changed the diagnostic strategies and has become the main diagnostic procedure for diagnosing PE. CT is undergoing a rapid techno- logical upgrade, which will open in the near future new frontiers in the diagnosis of PE. Nonetheless, CT carries a number of limitations, which should be carefully identified. This article reviews the ev- idences on both the traditional and newer diagnostic strategies for PE, outlines their strengths and weaknesses and describes future applications of CT for diagnosing PE.

Year in review in Intensive Care Medicine, 2007. I. Experimental studies. Clinical studies: brain injury and neurology, renal failure and endocrinology

Abstract: Year in review in Intensive Care Medicine, 2007. I. Experimental studies. Clinical studies : brain injury and neurology, renal failure and endocrinology