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Background: The use of non-invasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF) due to H1N1 virus infection is controversial. In this multicenter study we aimed to assess the efficacy of NIV in avoiding endotracheal intubation (ETI) and to identify predictors of success or failure., Methods: In this prospective multicenter study, 98 patients with new pulmonary infiltrate(s) sustained by H1N1 virus and a PaO(2)/FiO2<300 were eligible for study; 38/98 required immediate ETI, while the others received NIV as a first line therapy; 13/60 patients failed NIV and were intubated after 5.8+5.5 hours from enrolment. The remaining 47/60 patients were successfully ventilated with NIV., Results: Hospital mortality was significantly higher in those patients who failed NIV vs. those who succeeded (53.8% vs. 2.1%; OR=0.52, P<0.001). ETI was associated with higher number of infectious complications, mainly sepsis and septic shock. The OR of having one of these events in the NIV failure group vs. NIV success was 16.7, P<0.001. According to logistic regression model, a SAPS II>29 and a PaO(2)/FIO(2)≤127 at admission and PaO2/FIO(2)≤149 after 1 hr of NIV were independently associated with the need for ETI., Conclusion: The early application of NIV, with the aim to avoid invasive ventilation, during the H1N1 pandemics was associated with an overall success rate of 47/98 (48%). Patients presenting at admission with an high SAPS II score and a low PaO(2)/FiO(2) ratio and/or unable to promptly correct gas exchange are at high risk of intubation and mortality.

This case report describes a case of acute necrotic-hemorrhagic pancreatitis complicated by Wernicke's encephalopathy (WE) and stresses the importance of a correct dietetic regimen. A 39-year-old Chinese male patient with negative remote pathological anamnesis was hospitalized in the Medical Department with a diagnosis of gallstones. The clinical course was complicated with the onset of acute pancreatitis. Enteral fasting was imposed with intravenous feeding without vitamin supplementation. The progressive worsening of the clinical, radiodiagnostic and laboratory profile combined with deterioration in the state of consciousness promoted, on the 36th day exploratory laparotomy revealed necrotic-hemorrhagic pancreatitis. The patient was, therefore, admitted to the Intensive Care Unit in a deep coma. The recent medical history, neurological examination, and encephalic computed tomography suggested a revealing diagnosis of WE combined with pancreatic encephalopathy.

In 1990, a survey of recommended infection control practices in ICUs was carried out in 11 European countries. At the European level, 1005 ICUs returned the questionnaire (response rate = 61.2%), while in Italy only 129 ICUs out of 289 answered (response rate = 45%). The survey showed that the diffusion of recommended infection control practices in Italian ICUs was similar to other European countries, even if infection control resources at the hospital level were scarce: a hospital infection control program was launched ad necessary resources were available in only 14% of the responding Italian ICUs.

The inhalation of foreign bodies gives rise to a symptom picture that will depend on the nature and size of the foreign body, its location in the airways, the age of the patient, and the presence of prior lung affections. Non-invasive removal of such bodies is often enough to resolve both acute and chronic symptomatologies. In view of the striking nature of the symptoms and the imminent risk of complications or exacerbation associated with the continued presence of foreign bodies and the therapeutic strategy to be adopted, many workers consider that treatment should be given in a suitable environment, with proper equipment and an experienced staff. Reference is made to a personal series collected at the Chieti and Bologna resuscitation centres in describing the criteria followed in the diagnosis and management of cases of recently inhaled or latent foreign bodies, and their parenchymal complications. Non-invasive management by means of direct bronchoscopy is advised in all cases except those in which the subsequent intervention of serious, evident and irreversible parenchymal alterations make surgery inevitable.