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Search Results: 1 - 10 of 2849 matches for " Adriano Peris "
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Unexpected Hypertensive Pneumothorax after Digestive Upper Endoscopy: A Case Report  [PDF]
Giovanni Zagli, Rosario Spina, Stefano Batacchi, Giancarlo Freschi, Manlio Acquafresca, Antonio Taddei, Adriano Peris
Open Journal of Anesthesiology (OJAnes) , 2012, DOI: 10.4236/ojanes.2012.24041
Abstract: We report an unexpected massive left pneumothorax at the end of a digestive upper endoscopy without evidences of perforation or airway over-pressure. The possible air passage through a diaphragmatic failing is discussed.
Cardiopulmonary resuscitation after traumatic cardiac arrest - there are survivors: registries must speak about it
Adriano Peris, Simona Biondi, Giovanni Zagli
Critical Care , 2012, DOI: 10.1186/cc11348
Abstract: In our experience, cardiac arrest due to major trauma can also require extracorporeal life support (ECLS) [2]. At our tertiary referral hospital (Careggi Teaching Hospital, Florence, Italy), an ECLS algorithm-guided program has been extended to major trauma since 2009. Since then, 20 trauma patients (mean ± standard deviation age 46 ± 22 years, Injury Severity Score 57 ± 17) underwent either veno-arterial ECLS (15/20 patients) or veno-venous ECLS (5/20 patients). In 10 out of 20 trauma patients, veno-arterial ECLS was established during CPR for in-hospital cardiac arrest. This subgroup of trauma patients had severe injuries (mean Injury Severity Score 58.3 ± 15.4), frequently head injuries (70%) and a shock state (70%). Cardiac arrest occurred in six patients within 6 hours from the traumatic event, in one patient after 8 hours and in three patients after 24 hours. The overall mortality rate was 80%.Our data highlight that the lack of data from registries does not support operators in decision-making on post-traumatic cardiac arrest.Jan-Thorsten Gr?sner and Rolf LeferingThe letter of Peris and colleagues suggests including ECLS in the treatment algorithm for severely injured patients with CPR. We support any initiative to improve the outcome of severely injured patients, especially those with CPR, since their survival rates are usually underestimated as being close to zero. Our results show that on average seven out of 100 patients survive, at least two patients with a good outcome. This may serve as a benchmark for future research.However, the fact that our two registries were initially established for different purposes does not necessarily exclude their appropriateness for this joint research project. Although not based on a single patient group, the relative results from each registry that we combined, such as return of spontaneous circulation rates or survival rates, are valid and similar to published rates (for example, a 7.6% survival rate [3]).CPR: cardiopul
Power injectable peripherally inserted central catheters in the ICU: not only a question of flow
Manuela Bonizzoli, Stefano Batacchi, Giovanni Zagli, Adriano Peris
Critical Care , 2012, DOI: 10.1186/cc11258
Abstract: The study population consisted of adult and pediatric patients in whom power injectable PICCs were used, but the authors did not clarify whether every patient admitted to the intensive care unit (ICU) was automatically eligible for the placement of a PICC (a table summarizing population characteristics would help). To give important suggestions (for example, training and resource allocation) to those centers that are developing programs to improve the management of central venous catheters (CVCs), it would be interesting to know the total number of venous catheters inserted in the same period of the study.Pittiruti and colleagues reported a virtual absence of deep vein thrombosis but only of symptomatic thrombosis. Ultrasound examination is performed only in the presence of clinical symptoms of suspected thrombosis. So the low incidence of symptomatic thrombosis is similar to that documented in a recent study from our group [2], and a higher asymptomatic thrombosis incidence documented by ultrasonography surveillance cannot be ruled out. The precise selection of the ratio of inner diameter of the vein to the outer diameter of the catheter could justify the good results obtained and should ensure the maintenance of a residual venous flow suitable to prevent pericatheter thrombosis.Mauro Pittiruti and Giancarlo ScoppettuoloBonizzoli and colleagues address two very relevant issues: the appropriate indication of PICCs in the ICU and concern about their thrombotic risk. In regard to the first aspect, it is important to note that we reported our initial experience with a new venous access device by a retrospective investigation. In the first year (2010), 65 power injectable PICCs were inserted in our adult ICU patients [1], but in 2011, their number has almost doubled (118). Given that approximately 900 standard CVCs are inserted each year in our ICU (excluding Swan-Ganz and dialysis catheters), the use of the PICC as a central line is steadily increasing. However, since
Treatment of Fournier's Gangrene with Combination of Vacuum-Assisted Closure Therapy, Hyperbaric Oxygen Therapy, and Protective Colostomy
Giovanni Zagli,Giovanni Cianchi,Sara Degl'Innocenti,Jessyca Parodo,Lorenzo Bonetti,Paolo Prosperi,Adriano Peris
Case Reports in Anesthesiology , 2011, DOI: 10.1155/2011/430983
Abstract: Fournier's gangrene is a rare process which affects soft tissue in the genital and perirectal area. It can also progress to all different stages of sepsis, and abdominal compartment syndrome can be one of its complications. Two patients in septic shock due to Fournier gangrene were admitted to the Intensive Care Unit of Emergency Department. In both cases, infection started from the scrotum and the necrosis quickly involved genitals, perineal, and inguinal regions. Patients were treated with surgical debridement, protective colostomy, hyperbaric oxygen therapy, and broad-spectrum antibacterial chemotherapy. Vacuum-assisted closure (VAC) therapy was applied to the wound with the aim to clean, decontaminate, and avoid abdominal compartmental syndrome development. Both patients survived and were discharged from Intensive Care Unit after hyperbaric oxygen therapy cycles and abdominal closure.
Time needed to achieve completeness and accuracy in bedside lung ultrasound reporting in Intensive Care Unit
Lorenzo Tutino, Giovanni Cianchi, Francesco Barbani, Stefano Batacchi, Rita Cammelli, Adriano Peris
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-44
Abstract: Intensivists were trained for LUS following a teaching programme. From April 2008, an electronic sheet was designed and introduced in ICU database in order to uniform LUS examination reporting. A mark from 0 to 24 has been given for each exam by two senior intensivists not involved in the survey. The mark assigned was based on completeness of a precise reporting scheme, concerning the main finding of LUS. A cut off of 15 was considered sufficiency.The study comprehended 12 months of observations and a total of 637 LUS. Initially, although some improvement in the reports completeness, still the accuracy and precision of examination reporting was below 15. The time required to reach a sufficient quality was 7 months. A linear trend in physicians progress was observed.The uniformity in teaching programme and examinations reporting system permits to improve the level of completeness and accuracy of LUS reporting, helping physicians in following lung pathology evolution.Bedside lung ultrasound can provide accurate information on lung status in critically ill patients in Intensive Care Unit (ICU) [1,2], and the important role of defining standards in critical care ultrasonography has been recently discussed [3].Before April 2008, in the ICU of Emergency Department (Careggi Teaching Hospital, Florence, IT), bedside Lung Ultrasound (LUS) was only performed as support of invasive device positioning (central venous catheter, chest drainage), and for quantification of pleural effusions.After April 2008, trained intensivists started to use bedside LUS on a daily basis in order to make diagnosis, to monitor chest pathologies and to improve pulmonary patterns interpretation. The present study describes the accuracy and quality curve of the LUS reporting during its method implementation.The study was performed in a 10-beds ICU. The ICU was equipped with two MyLab 30 CV (ESAOTE, Genova, IT) with multifrequency Convex and Linear probes. From April 2008 to April 2009, 397 patients ad
H3N2 Virus as Causative Agent of ARDS Requiring Extracorporeal Membrane Oxygenation Support
Adriano Peris,Giovanni Zagli,Pasquale Bernardo,Massimo Bonacchi,Morena Cozzolino,Lucia Perretta,Alberta Azzi,Giovanni Cianchi
Case Reports in Medicine , 2014, DOI: 10.1155/2014/560208
Abstract: Pandemic influenza virus A(H1N1) 2009 was associated with a higher risk of viral pneumonia in comparison with seasonal influenza viruses. The influenza season 2011-2012 was characterized by the prevalent circulation of influenza A(H3N2) viruses. Whereas most H3N2 patients experienced mild, self-limited influenza-like illness, some patients were at increased risk for influenza complications because of age or underlying medical conditions. Cases presented were patients admitted to the Intensive Care Unit (ICU) of ECMO referral center (Careggi Teaching Hospital, Florence, Italy). Despite extracorporeal membrane oxygenation treatment (ECMO), one patient with H3N2-induced ARDS did not survive. Our experience suggests that viral aetiology is becoming more important and hospitals should be able to perform a fast differential diagnosis between bacterial and viral aetiology. 1. Introduction Influenza viruses represent an important cause of severe lower respiratory disease. Pandemic influenza virus A(H1N1) 2009 was associated with a higher risk of viral pneumonia in comparison with seasonal influenza viruses [1, 2]. During the pandemic and the following influenza epidemic season 2010-2011, this led to an increased frequency of hospitalization in Intensive Care Units (ICUs) and of Acute Respiratory Distress Syndrome (ARDS) that is the most severe type of acute lung injury. The influenza season 2011-2012 was characterized by the prevalent circulation of influenza A(H3N2) viruses. Whereas most H3N2 patients experienced mild, self-limited influenza-like illness, some patients were at increased risk for influenza complications because of age or underlying medical conditions. Here we show our experience of treating two cases of adult patient with ARDS due to H3N2 pneumonia treated with venovenous extracorporeal membrane oxygenation (ECMO). 2. Methods 2.1. Setting The patients were admitted to the Intensive Care Unit (ICU) of Careggi Teaching Hospital (Florence, Italy) as ECMO Referral Center in season 2011-2012. Data were collected from ICU databases and the Italian Group for the Evaluation of Interventions in Intensive Care Medicine database (GiViTI Margherita Project, Istituto Mario Negri, Bergamo, Italy). Table 1 summarized baseline and clinical characteristic of patients. Internal Review Board approved the study and informed consent for data publication was obtained. Table 1: Clinical characteristic of H3N2-pneumonia patients. 2.2. Ventilation Strategies and Extracorporeal Membrane Oxygenation (ECMO) ECMO was used to support the respiratory function after the
Challenges of Improving Intensive Care Medicine in Eritrea: Impact of an Italian Cooperative Project of Educational and Clinical Support  [PDF]
Valentina Anichini, Giovanni Zagli, Hagos Goitom, Giovanni Cianchi, Andrea Cecchi, Lucia Perretta, Emanuele Bigazzi, Barbara Gazzini, Simone Proietti, Alessandro Di Filippo, Simone Toccafondi, Gianfranco Gensini, Giancarlo Berni, Adriano Peris
Open Journal of Anesthesiology (OJAnes) , 2013, DOI: 10.4236/ojanes.2013.37069
Abstract:

Intensive care in Africa is available only in teaching or referral hospitals. Here we report the experience of a multidisciplinary collaboration between physicians and nurses of the Emergency Department (First Aid and Intensive Care Unit) of a tertiary referral hospital (Careggi Teaching Hospital, Florence, IT) and physicians and nurses of Orotta National referral Hospital in Asmara, Eritrea. The project was aimed at performing clinical assistance and training on the job to the local staff to improve the standard of care in the local Emergency Department. The duration of the project was initially planned to be 30 months, but unfortunately it was interrupted after 18 months because of lack of funds. The Italian staff was composed of two physicians and two nurses per period. To monitor local ICU activity, a retrospective survey of 36 months was performed. During the 36 months of data collection, 1169 patients were admitted to the ICU. Intra-ICU mortality rate resulted comparable before, during, and after Italian presence. On the contrary, the 28-day mortality resulted significantly lower bo th during and after the Italian stay. After project interruption, the Italian staff maintained contact with the Eritrean ICU personnel, who were invited to attend the Italian ICU for one month per year, and collected information about Orotta ICU activities.

Low central venous saturation predicts poor outcome in patients with brain injury after major trauma: a prospective observational study
Alessandro Di Filippo, Chiara Gonnelli, Lucia Perretta, Giovanni Zagli, Rosario Spina, Marco Chiostri, Gian Gensini, Adriano Peris
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2009, DOI: 10.1186/1757-7241-17-23
Abstract: This prospective, non-controlled study, carried out between April 2006 and March 2008, was performed in a higher level Trauma Center in Florence (Italy). In the study period, 121 patients affected by major brain injury after major trauma were recruited. Inclusion criteria were: 1. Glasgow Coma Scale (GCS) score ≤ 13; 2. an Injury Severity Score (ISS) ≥ 15. Exclusion criteria included: 1. pregnancy; 2. age < 14 years; 3. isolated head trauma; 4. death within the first 24 hours from the event; 5. the lack of ScvO2 monitoring within 2 hours from the trauma. Demographic and clinical data were collected, including Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Simplified Acute Physiologic Score II (SAPS II), Marshall score. The worst values of lactate and ScvO2 within the first 24 hours from trauma, ICU length of stay (LOS), and 28-day mortality were recorded.Patients who deceased within 28 days showed higher age (53 ± 16.6 vs 43.8 ± 19.6, P = 0.043), ISS core (39.3 ± 14 vs 30.3 ± 10.1, P < 0.001), AIS score for head/neck (4.5 ± 0.7 vs 3.4 ± 1.2, P = 0.001), SAPS II score (51.3 ± 14.1 vs 42.5 ± 15, P = 0.014), Marshall Score (3.5 ± 0.7 vs 2.3 ± 0.7, P < 0.001) and arterial lactate concentration (3.3 ± 1.8 vs 6.7 ± 4.2, P < 0.001), than survived patients, whereas ScvO2 resulted significantly lower (66.7% ± 11.9 vs 70.1% ± 8.9 vs, respectively; P = 0.046). Patients with ScvO2 values ≤ 65% also showed higher 28-days mortality rate (31.3% vs 13.5%, P = 0.034), ICU LOS (28.5 ± 15.2 vs 16.6 ± 13.8, P < 0.001), and total hospital LOS (45.1 ± 20.8 vs 33.2 ± 24, P = 0.046) than patients with ScvO2 > 65%.ScvO2 value less than 65%, measured in the first 24 hours after admission in patients with major trauma and head injury, was associated with higher mortality and prolonged hospitalization.Organ and tissue damages caused by a trauma impact lead to the development of systemic inflammatory response syndrome (SIRS) [1]. The local and systemic release of inflammation medi
Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria
Marco Ciapetti, Alessandro Circelli, Giovanni Zagli, Maria Migliaccio, Rosario Spina, Alessandro Alessi, Manlio Acquafresca, Marco Bartolini, Adriano Peris
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-61
Abstract: Trauma patients consecutively admitted to Intensive Care Unit (ICU) from Jan 2008 to Oct 2009 were considered for the study. Memphis criteria comprehend: basilar skull fracture with involvement of the carotid canal, cervical spine fracture, neurological exam not explained by brain imaging, Horner's syndrome, LeFort II-III fractures, and neck soft tissue injury. As single criteria modification, we included all patients with petrous bone fracture, even without carotid canal involvement. In all patients at risk of BCVI, 64-slice angio-CT-scans was performed.During the study period, 266 patients were admitted to the ICU for blunt major trauma. Among them, 162 presented traumatic brain injury or cervical spine fracture. In accordance with the proposed modified-Memphis criteria, 53 patients showed risk factors for BCVI compared to 45 using the original Memphis criteria. Among the 53 patients, 6 resulted as having carotid lesions (2.2% of all blunt major traumas; one patient more than when using Memphis criteria). Anticoagulant therapy with low molecular weight heparin was administered in all patients. No stroke or hemorrhagic complications occurred. Clinical examination at 6-months showed no central neurological deficit.A modification of a single criteria of Memphis screening protocol might permit the identification of a higher percentage of BCVI. Limited by sample size, this study needs to be validated.The incidence of Blunt Cerebrovascular Injuries (BCVI) varies from 0.5% to 1% of all admissions for blunt trauma, but this relatively small percentage of patients is affected by a stroke rate ranging from 25% to 58% and a mortality rate ranging from 31% to 59% [1-5].Although BCVIs are related to severe complications and high mortality rate, controversy exists in literature when defining the patient at risk for these injuries. Four-vessel angiography has been considered the gold standard diagnostic test for the presence of BCVI for a long time. With the increasing availabil
Mots fantasmes en el català medieval
Antoni Peris
Llengua & Literatura , 2003, DOI: 10.2436/l&l.vi.1414
Abstract:
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