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Search Results: 1 - 10 of 32227 matches for " Antonio Pesenti "
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Low tidal volume, high respiratory rate and auto-PEEP: the importance of the basics
Nicolò Patroniti, Antonio Pesenti
Critical Care , 2002, DOI: 10.1186/cc1883
Abstract: "... the wisdom of old men. They do not grow wise. They grow careful."A Farewell to Arms, Ernest HemingwayThe ARDSNet trial [1], which compared a low versus a high tidal volume (Vt) ventilation strategy, appears to have said the final word in the controversy surrounding the clinical relevance of ventilator-induced lung injury. That study indeed showed that patients with acute respiratory distress syndrome (ARDS) who were ventilated at 6 ml/kg benefited from a 22% reduction in mortality, as compared with the group ventilated with a Vt of 12 ml/kg. As always, and in spite of these important results, some aspects of the study design and speculation regarding the mechanisms involved generated some controversial interpretations [2345].Of those, a major interpretation of the ARDSNet findings pertains to the possible role of auto-PEEP (positive end-expiratory pressure) in causing the observed difference in mortality between low and high Vt strategies. The protocol allowed investigators to increase the respiratory rate in the low Vt group to 35 breaths/min, in order to minimize hypercapnia and respiratory acidosis – the major side effects of low Vt ventilation. A recent study conducted by de Durante and coworkers [4] demonstrated that the ventilatory settings employed in the ARDSNet low Vt group may generate an auto-PEEP of 5.8 ± 3 cmH2O. Based upon these data, those authors suggested that in the ARDSNet study, in spite of comparable external PEEP settings, total PEEP was substantially higher in the low Vt group, because the high respiratory rate generated a substantial auto-PEEP. It is possible to speculate that the observed difference in survival was more related to the difference in total PEEP than to the difference in Vt.Vieillard Baron and coworkers [5] recently investigated the effects of increasing respiratory rate from 15 to 30 breaths/min, while maintaining a constant plateau pressure (25 ≤ cmH2O). Those authors reported an auto-PEEP of 6.4 ± 2.7 cmH2O at 30 breath
Une défense et illustration du libéralisme.
Xavier Pesenti
EspacesTemps.net , 2007,
Abstract: Ce livre est le fruit d’une conférence simultanée de Monique Canto-Sperber et de Nicolas Tenzer devant le Collège de Philosophie. Le lecteur sera sans doute surpris du titre, qui peut para tre, par les temps-qui-courent , incongru. D’ailleurs, à quoi bon “sauver” le libéralisme, s’exclameraient certains, puisque nous sommes en plein dedans et qu’il ne semble pas si mal se porter ! . Critique évidemment trop simpliste, et qui tombe dès les premières pages, tant ...
Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO
Alberto Zangrillo, Giuseppe Biondi-Zoccai, Giovanni Landoni, Giacomo Frati, Nicolo Patroniti, Antonio Pesenti, Federico Pappalardo
Critical Care , 2013, DOI: 10.1186/cc12512
Abstract: CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus (updated January 2, 2012) were systematically searched. Studies reporting on 10 or more patients with H1N1 infection treated with ECMO were included. Baseline, procedural, outcome and validity data were systematically appraised and pooled, when appropriate, with random-effect methods.From 1196 initial citations, 8 studies were selected, including 1357 patients with confirmed/suspected H1N1 infection requiring intensive care unit admission, 266 (20%) of whom were treated with ECMO. Patients had a median SOFA score of 9, and had received mechanical ventilation before ECMO implementation for a median of 2 days. ECMO was implanted before inter-hospital patient transfer in 72% of cases and in most patients (94%) the veno-venous configuration was used. ECMO was maintained for a median of 10 days. Outcomes were highly variable among the included studies, with in-hospital or short-term mortality ranging between 8% and 65%, mainly depending on baseline patient features. Random-effect pooled estimates suggested an overall in-hospital mortality of 28% (95% confidence interval 18%-37%; I2=64%).ECMO is feasible and effective in patients with ALI due to H1N1 infection. Despite this, prolonged support (>1 week) is required in most cases, and subjects with severe comorbidities or multiorgan failure remain at high risk of in-hospital death.
Anaesthesiological strategies in elective craniotomy: randomized, equivalence, open trial – The NeuroMorfeo trial
Giuseppe Citerio, Maria Grazia Franzosi, Roberto Latini, Serge Masson, Simona Barlera, Stefano Guzzetti, Antonio Pesenti
Trials , 2009, DOI: 10.1186/1745-6215-10-19
Abstract: This trial, named NeuroMorfeo, aims to assess the equivalence between volatile and intravenous anaesthetics for neurosurgical procedures.NeuroMorfeo is a multicenter, randomized, open label, controlled trial, based on an equivalence design. Patients aged between 18 and 75 years, scheduled for elective craniotomy for supratentorial lesion without signs of intracranial hypertension, in good physical state (ASA I-III) and Glasgow Coma Scale (GCS) equal to 15, are randomly assigned to one of three anaesthesiological strategies (two VA arms, sevoflurane + fentanyl or sevoflurane + remifentanil, and one IA, propofol + remifentanil). The equivalence between intravenous and volatile-based neuroanaesthesia will be evaluated by comparing the intervals required to reach, after anaesthesia discontinuation, a modified Aldrete score ≥ 9 (primary end-point). Two statistical comparisons have been planned:1) sevoflurane + fentanyl vs. propofol + remifentanil;2) sevoflurane + remifentanil vs. propofol + remifentanil.Secondary end-points include: an assessment of neurovegetative stress based on (a) measurement of urinary catecholamines and plasma and urinary cortisol and (b) estimate of sympathetic/parasympathetic balance by power spectrum analyses of electrocardiographic tracings recorded during anaesthesia; intraoperative adverse events; evaluation of surgical field; postoperative adverse events; patient's satisfaction and analysis of costs.411 patients will be recruited in 14 Italian centers during an 18-month period.We presented the development phase of this anaesthesiological on-going trial. The recruitment started December 4th, 2007 and up to 4th, December 2008, 314 patients have been enrolled.Anaesthesia for neurosurgical procedures should ideally provide optimal surgical conditions while maintaining appropriate cerebral oxygen supply and stable systemic haemodynamics. Rapid emergence from anaesthesia is also desirable to allow a quick neurological examination at the end of pro
Hippocrates, the τεχνη, the individuals and the institutions
Massimo Pesenti Campagnoni
Emergency Care Journal , 2007, DOI: 10.4081/ecj.2007.1.11
Abstract: Not available
Engineering of Fuel Plates on Uranium-Molybdenum Monolithic: Critical Issues  [PDF]
Jaime Lisboa, Jorge Marin, Mario Barrera, Héctor Pesenti
World Journal of Nuclear Science and Technology (WJNST) , 2015, DOI: 10.4236/wjnst.2015.54027
Abstract: Engineering of nuclear fuels using monolithic plates of uranium-molybdenum and Al-6061 cladding is the current challenge for research and test reactors. The main drawback of the manufacture of monolithic nuclear fuel was analyzed using two surface coating methods: aluminum sputtering and transient liquid phase bonding (TLPB). Coating was done with a commercial alloy of Al-Si (R-4047). These techniques were used to improve the metallurgical bonding between the UMo and the cladding by rolling. Finally, design parameters and manufacture of UMo plate fuels were established. Mechanical tests were used to characterize the plates, resulting in UTS values of about 700 and 1000 MPa for the UMo alloys. These results are complemented with metrological analyses, X-Ray diffraction (XRD), thermal analyses, and metallography. X-rays and ultrasound scanners were used to monitor bonding and the co-rolling effects. These initial results show the main obstacles to the engineering development of UMo monolithic plate fuels with Al-6061 cladding, and these are discussed herein.
Surgical site infections following colorectal cancer surgery: a randomized prospective trial comparing common and advanced antimicrobial dressing containing ionic silver
Roberto Biffi, Luca Fattori, Emilio Bertani, Davide Radice, Nicole Rotmensz, Pasquale Misitano, Sabine Cenciarelli, Antonio Chiappa, Liliana Tadini, Marina Mancini, Giovanni Pesenti, Bruno Andreoni, Angelo Nespoli
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-94
Abstract: Adults undergoing elective colorectal cancer surgery at two university-affiliated hospitals were randomly assigned to have the surgical incision dressed with Aquacel? Ag Hydrofiber dressing or a common dressing. To blind the patient and the nursing and medical staff to the nature of the dressing used, scrub nurses covered Aquacel? Ag Hydrofiber with a common wound dressing in the experimental arm, whereas a double common dressing was applied to patients of control group. The primary end-point of the study was the occurrence of any surgical-site infection within 30?days of surgery.A total of 112 patients (58 in the experimental arm and 54 in the control group) qualified for primary end-point analysis. The characteristics of the patient population and their surgical procedures were similar. The overall rate of surgical-site infection was lower in the experimental group (11.1% center 1, 17.5% center 2; overall 15.5%) than in controls (14.3% center 1, 24.2% center 2, overall 20.4%), but the observed difference was not statistically significant (P?=?0.451), even with respect to surgical-site infection grade 1 (superficial) versus grades 2 and 3, or grade 1 and 2 versus grade 3.This randomized trial did not confirm a statistically significant superiority of Aquacel? Ag Hydrofiber dressing in reducing surgical-site infection after elective colorectal cancer surgery.Clinicaltrials.gov: NCT00981110
Anaphylaxis management in ER
Paolo Borrelli,Massimo Pesenti Campagnoni
Emergency Care Journal , 2006, DOI: 10.4081/ecj.2006.3.9
Abstract: Anaphylaxis is a severe life threatening generalized or systemic hypersensitivity reaction that can affect all ages. The reaction originates from the discharge of chemical mediators released by either mast cells or by basophils activated after an allergic reaction or without any direct action of the immune system. Anaphylaxis usually develops gradually most often starting with skin manifestations and itching to a multiple organ reaction often dominated by severe asthma and culminating in hypotension and shock. In this work two clinical cases are presented. They are meant both to suggest the best therapy on the ground of evidence based medicine and to counsel the patient after his discharge.
Planning the beautiful exit or building the environmental well being?
Eusebio Balocco,Massimo Pesenti Campagnoni
Emergency Care Journal , 2009, DOI: 10.4081/ecj.2009.6.4
Abstract: Not available
Protestant ethics in ER nurses and doctors' training. Some acquisitions and considerations before and after a training course
Massimo Pesenti Campagnoni,Eusebio Balocco
Emergency Care Journal , 2007, DOI: 10.4081/ecj.2007.6.24
Abstract: The article explores some of the preliminary reasons for and effects of a training course on “Institutional, organisational and professional identification processes”, carried out at Aosta local Health Authority Accident and Emergency Dept. The article is based on the analysis of a number of critical points that emerged ex ante, in itinere ed ex post regarding a complex and rarely examined topic, focusing on how training makes it possible to explore latent aspects of the organisation. The use of an appropriate methodology has revealed explicit requests for greater attention to typically organisational aspects, which are typically neglected in the Public Services. The hypothesis put forward is that the same dimensions could provide a focus for research and productive application. The article suggests that methodologies and instruments developed in the public sector achieved an adequate degree of managerial knowledge to be “translated” into a National Health Service Accident and Emergency Department setting.
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