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72 results on '"Bombino A"'

1. Factores de riesgo asociados a la conducta suicida en adultos

Author

Jim Alex González-Consuegra, Mayara Jiménez-Rodríguez, María Caridad Bécquer-Bombino, and Yasmin García-Gutiérrez

Subjects
Factores de riesgo, conducta suicida, intentos suicidas, suicidio, Medicine
Abstract

Introducción: La conducta suicida se define como todo acto cometido en perjuicio propio de quien lo ejecuta, independientemente del grado de letalidad. Objetivo: Identificar los factores de riesgo asociados a la conducta suicida en adultos pertenecientes al área urbana del municipio Fomento. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal, en el período comprendido entre enero de 2021 y diciembre de 2022. La población estuvo conformada por 40 pacientes, se realizó un muestreo aleatorio simple seleccionando una muestra de 31 adultos expuestos a factores de riesgo que tuvieron intentos suicidas. Se estudiaron las variables, edad, sexo, estado civil, nivel de escolaridad y entre los factores de riesgo: la depresión, los trastornos de la personalidad , el consumo de alcohol y otras drogas, así como situaciones estresantes de la vida cotidiana relacionados con el trabajo , la sociedad y el hogar. Para la recopilación de la información se utilizó la encuesta, la observación y análisis documental. Los resultados se presentaron a través de tablas y se utilizó el cálculo porcentual. Resultados: El sexo femenino, el grado de escolaridad preuniversitario y las edades entre 19 y 29 años fueron los más relacionados con la conducta suicida. En su mayoría estaban casados y se destacó como principal factor de riesgo las situaciones estresantes de la vida cotidiana (83,87%) seguida de la depresión (35,48 %). Conclusiones: Los principales factores de riesgo asociados a la conducta suicida en la población estudiada son las situaciones estresantes de la vida cotidiana y la depresión.

Published
2024

2. Application of Natural and Traditional Medicine in four polyclinics in Pinar del Río

Author

Irene Alvarez Alonzo, Maria de la Caridad Casanova Moreno, Raúl Daniel Lagar Martínez, Margarita Gonzalez Tapia, and Luis Vivas Bombino

Subjects
terapéutica, atención primaria de salud, medicina tradicional, fitoterapia, medicina china tradicional., Medicine, Medicine (General), R5-920
Abstract

Introduction: Natural and Traditional Medicine allows professionals to broaden the scientific scope in an integrative way, showing their performance in the health areas of Pinar del Río. Objective: to identify the elements that limits the practice of therapeutic modalities of Natural and Traditional Medicine at primary health care in Pinar del Río municipality. Methods: a descriptive observational study was conducted between May 2016 and July 2017 in the four polyclinics of the municipality of Pinar del Río. The study target group included the doctors and professors of the Basic Work Team (U=1 006). The collection of sample was conducted through cases by authority criteria, and within these by simple random cases, sample (n=234). Results: Comprehensive Medicine Specialists with more than five years of experience predominated, 30.3 % do not applied Natural and Traditional Medicine, 67.9 % considered it useful, 58.8% recognized its effectiveness, phytotherapy prevailed (69.6 %). Conclusion: the application of Natural and Traditional Medicine still demands a priority by the professionals in the primary health care as an alternative to its application, a not minor part expresses not to make use of it, everything indicates that it is an element not to be left to the spontaneity taking care of the scientific and ethical aspects of its necessary prescription as therapeutic modalities.

Published
2019

5. La evaluación profesoral como fortaleza para el desarrollo docente

Author

María Mayra Hernández Cubilla and Luis Vivas Bombino

Subjects
Medicine, Medicine (General), R5-920
Abstract

La evaluación profesoral está dirigida al alcance de la idoneidad ética y pedagógica en el grado de cumplimien­to del encargo social en la creación, desarrollo y transmi­sión de la ciencia, la técnica, la cultura y su extensión en el medio social; precisa de un directivo preparado para llevar a cabo este proceso de dirección en los departa­mentos y facultades de la institución universitaria.

Published
2018

7. COVID‐19‐associated immune‐mediated encephalitis mimicking acute‐onset Creutzfeldt‐Jakob disease

Author

Simone Beretta, Michela Bombino, Giuseppe Citerio, Roberto Rona, Jacopo C. DiFrancesco, A. Patruno, Fabio Moda, Graziella Bogliun, Andrea Stabile, Giuseppe Foti, Carlo Ferrarese, Cristina Capraro, Francesca Andreetta, Paola Cavalcante, Claudia Balducci, Beretta, S, Stabile, A, Balducci, C, Difrancesco, J, Patruno, A, Rona, R, Bombino, M, Capraro, C, Andreetta, F, Cavalcante, P, Moda, F, Citerio, G, Foti, G, Bogliun, G, and Ferrarese, C

Subjects
Pathology, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Neurosciences. Biological psychiatry. Neuropsychiatry, Disease, Electroencephalography, Immune system, COVID‐19, Aphasia, mental disorders, medicine, RC346-429, medicine.diagnostic_test, Case Study, business.industry, General Neuroscience, medicine.disease, Hyperintensity, nervous system diseases, encephalitsi, Neurology (clinical), Neurology. Diseases of the nervous system, medicine.symptom, business, Myoclonus, Encephalitis, RC321-571
Abstract

We report a subtype of immune‐mediated encephalitis associated with COVID‐19, which closely mimics acute‐onset sporadic Creutzfeldt–Jakob disease. A 64‐year‐old man presented with confusion, aphasia, myoclonus, and a silent interstitial pneumonia. He tested positive for SARS‐CoV‐2. Cognition and myoclonus rapidly deteriorated, EEG evolved to generalized periodic discharges and brain MRI showed multiple cortical DWI hyperintensities. CSF analysis was normal, except for a positive 14‐3‐3 protein. RT‐QuIC analysis was negative. High levels of pro‐inflammatory cytokines were present in the CSF and serum. Treatment with steroids and intravenous immunoglobulins produced EEG and clinical improvement, with a good neurological outcome at a 6‐month follow‐up.

Published
2021

9. ECMO for COVID-19 patients in Europe and Israel

Author

Lorusso, Roberto, Combes, Alain, Coco, Valeria Lo, De Piero, Maria Elena, Belohlavek, Jan, Delnoij, Thijs, van der Horst, Iwan, Miranda, Dinis Reis, van der Linden, Marcel, van der Heijden, JJ, Scholten, Erik, van Belle-van Haren, Nicole, Lagrand, Wim, de Jong, Sytse, Candura, Dario, Maas, Jacinta, van den Berg, MJ van Gijlswijk, Malfertheiner, Maximilian, Dreier, Esther, Mueller, Thomas, Boeken, Udo, Akhyari, Payam, Lichtenberg, Artur, Saeed, Diyar, Thiele, Holger, Baumgaertel, Matthias, Schmitto, Jan D, Mariani, Silvia, Thielmann, Matthias, Brenner, Thorsten, Benk, Cristoph, Czerny, Martin, Kalbhenn, Johannes, Maier, Sven, Schibilsky, David, Staudacher, Dawid L, Henn, Philipp, Iuliu, Torje, Muellenbach, Ralf, Reyher, Christian, Rolfes, Caroline, Zacharowski, Kai, Lotz, Gosta, Sonntagbauer, Michael, Kersten, Alexander, Karagiannidis, Christian, Schafer, Simone, Fichte, Julia, Hopf, Hans-Bernd, Samalavicius, Robertas, Lorini, Luca, Ghitti, Davide, Grazioli, Lorenzo, Loforte, Antonio, Baiocchi, Massimo, Checco, Erika Dal, Pacini, Davide, Meani, Paolo, Cappai, Antioco, Russo, Claudio Francesco, Bottiroli, Maurizio, Mondino, Michele, Ranucci, Marco, Fina, Dario, Ballotta, Andrea, Scandroglio, Anna Mara, Zangrillo, Alberto, Pieri, Marina, Nardelli, Pasquale, Fominskiy, Evgeny, Landoni, Giovanni, Fanelli, Vito, Brazzi, Luca, Montrucchio, Giorgia, Sales, Gabriele, Simonetti, Umberto, Urbino, Rosario, Livigni, Sergio, Degani, Antonella, Raffa, Giuseppe, Pilato, Michele, Martucci, Gennaro, Arcadipane, Antonio, Chiarini, Giovanni, Latronico, Nicola, Cattaneo, Sergio, Puglia, Carmine, Reina, Gianfranco, Sponga, Sandro, Livi, Ugolino, Foti, Giuseppe, Giani, Marco, Rona, Roberto, Avalli, Leonello, Bombino, Michela, Costa, Maria Cristina, Carozza, Roberto, Donati, Abele, Piciche, Marco, Favaro, Alessandro, Salvador, Loris, Danzi, Vinicio, Zanin, Anita, Condello, Ignazio, Fiore, Flavio, Moscarelli, Marco, Nasso, Giuseppe, Speziale, Giuseppe, Sandrelli, Luca, Montalto, Andrea, Musumeci, Francesco, Circelli, Alessandro, Gamberini, Emiliano, Russo, Emanuele, Benni, Marco, Agnoletti, Vanni, Rociola, Ruggero, Milano, Aldo D, Grasso, Salvatore, Civita, Antonio, Murgolo, Francesco, Pilato, Emanuele, Comentale, Giuseppe, Montisci, Andrea, Alessandri, Francesco, Tosi, Antonella, Pugliese, Francesco, Carelli, Simone, Grieco, Domenico Luca, Antonelli, Massimo, Ramoni, Enrico, Di Nardo, Matteo, Maisano, Francesco, Bettex, Dominique, Weber, Alberto, Grunenfelder, Jurg, Consiglio, Jolanda, Hansjoerg, Jenni, Haenggi, Matthias, Agus, Gianluca, Doeble, Thomas, Zenklusen, Urs, Bechtold, Xavier, Stockman, Bernard, De Backer, Daniel, Giglioli, Simone, Meyns, Bart, Vercaemst, Leen, Herman, Greet, Meersseman, Philippe, Vandenbriele, Christophe, Dauwe, Dieter, Vlasselaers, Dirk, Raes, Matthias, Debeuckelaere, Gerdy, Rodrigus, Inez, Biston, Patrick, Piagnerelli, Michael, Peperstraete, Harlinde, Germay, Olivier, Vandewiele, Korneel, Vandeweghe, Dimitri, Witters, Ine, Havrin, Sven, Bourgeois, Marc, Taccone, Fabio Silvio, Nobile, Leda, Lheureux, Olivier, Brasseur, Alexandre, Creteur, Jacques, Defraigne, Jean-Olivier, Misset, Benoit, Courcelle, Romain, Timmermans, Philippe, Lehaen, Jeroen, Frederik, Bonte, Riera, Jordi, Castro, Miguel angel, Gallart, Elisabet, Martinez-Martinez, Maria, Argudo, Eduard, Garcia-de-Acilu, Marina, de Pablo Sanchez, Raul, Ortiz, Aaron Blandino, Cabanes, Mari-Paz Fuset, Higa, Karina Osorio, Cassina, Albert Miralles, Berbel, Daniel Ortiz, Sanchez-Salado, Jose Carlos, Arnau, Blasco-Lucas, de Gopegui, Pablo Ruiz, Ricart, Pilar, Sandoval, Elena, Veganzones, Javier, Millan, Pablo, de la Sota, Perez, Santa Teresa, Patricia, Alcantara, Sara, Alvarez, Jorge Duerto, Gonzalez, Anxela Vidal, Lopez, Marta, Gordillo, Antonio, Naranjo-Izurieta, Jose, Costa, Ricardo Gimeno, Albacete Moreno, Carlos L, de Ayala, Jose angel, Blanco-Schweizer, Pablo, Andres, Nicolas Hidalgo, Boado, Victoria, Martinez, Jose Maria Nunez, Casal, Vanesa Gomez, Garcia, Esperanza Fernandez, Martin-Villen, Luis, Climent, Joaquin Colomina, Pinto, Luis F, Leprince, Pascal, Lebreton, Guillaume, Juvin, Charles, Schmidt, Matthieu, Pineton, Marc, Folliguet, Thierry, Saiydoun, Gabriel, Gaudard, Philippe, Colson, Pascal, Obadia, Jean-Francois, Pozzi, Matteo, Fellahi, Jean Luc, Yonis, Hodane, Richard, Jean Christophe, Parasido, Alessandro, Verhoye, Jean-Philippe, Flecher, Erwan, Ajrhourh, Lucrezia, Nesseler, Nicolas, Mansour, Alexandre, Guinot, Pierre-Gregoire, Zarka, Jonathan, Besserve, Patricia, Makhoul, Maged, Bolotin, Gil, Kassif, Yigal, Soufleris, Dimitros, Schellongowski, Peter, Bonaros, Nikolaos, Krapf, Christoph, Ebert, Kathrin, Mair, Peter, Kothleutner, Florian, Kowalewsky, Mariusz, Christensen, Steffen, Pedersen, Finn Moller, Balik, Martin, Blaha, Jan, Lips, Michal, Otahal, Michal, Camporota, Luigi, Daly, Kathleen, Agnew, Nicola, Barker, Julian, Head, Laura, Garcia, Miguel, Ledot, Stephane, Aquino, Verna, Lewis, Rebecca, Worthy, Jennifer, Noor, Hamza, Scott, Ian, O'Brien, Serena, Conrick-Martin, Ian, Carton, Edmund, Gillon, Stuart, Flemming, Lucy, Broman, Lars Mikael, Grins, Edgars, Ketskalo, Michail, Tsarenko, Sergey, Popugaev, Konstantin, Minin, Sergei, Kornilov, Igor, Skopets, Alexander, Kornelyuk, Roman, Turchaninov, Alexandr, Gorjup, Vojka, Shelukhin, Daniil, Dsouki, Youssef El, Sargin, Murat, Kaygin, Mehmet Ali, Liana, Shestakova, Puss, Severin, Soerensen, Gro, Magnus, Rosen, Kanetoft, Mikael, Watson, Pia, Redfors, Bengt, Krenner, Niklas, Velia Antonini, M, Barrett, Nicholas A, Belliato, Mirko, Davidson, Mark, Finney, Simon, Fowles, Jo-Anne, Halbe, Maximilian, Hennig, Felix, Jones, Tim, Pinto, Luis, Smith, Jonathan, Roeleveld, Peter, Swol, Justyna, Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Cardiovascular Research Institute Maastricht (CARIM), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), First Faculty of Medicine Charles University [Prague], Intensive Care Medicine, AII - Inflammatory diseases, ANS - Neuroinfection & -inflammation, EuroECMO COVID-19 Working Group, Euro-ELSO Steering Committee, Lorusso, Roberto, Combes, Alain, Coco, Valeria Lo, De Piero, Maria Elena, Belohlavek, Jan (EuroECMO COVID-19, Workinggroup, Euro-ELSO Steering, Committee), Zangrillo, A, Landoni, G, CTC, MUMC+: MA Med Staf Spec CTC (9), RS: Carim - V04 Surgical intervention, MUMC+: MA Alg Ond Onderz CTC (9), Lorusso, R, Combes, A, Coco, V, De Piero, M, Belohlavek, J, Delnoij, T, van der Horst, I, Miranda, D, van der Linden, M, van der Heijden, J, Scholten, E, van Belle-van Haren, N, Lagrand, W, de Jong, S, Candura, D, Maas, J, van den Berg, M, Malfertheiner, M, Dreier, E, Mueller, T, Boeken, U, Akhyari, P, Lichtenberg, A, Saeed, D, Thiele, H, Baumgaertel, M, Schmitto, J, Mariani, S, Thielmann, M, Brenner, T, Benk, C, Czerny, M, Kalbhenn, J, Maier, S, Schibilsky, D, Staudacher, D, Henn, P, Iuliu, T, Muellenbach, R, Reyher, C, Rolfes, C, Zacharowski, K, Lotz, G, Sonntagbauer, M, Kersten, A, Karagiannidis, C, Schafer, S, Fichte, J, Hopf, H, Samalavicius, R, Lorini, L, Ghitti, D, Grazioli, L, Loforte, A, Baiocchi, M, Checco, E, Pacini, D, Meani, P, Cappai, A, Russo, C, Bottiroli, M, Mondino, M, Ranucci, M, Fina, D, Ballotta, A, Scandroglio, A, Pieri, M, Nardelli, P, Fominskiy, E, Fanelli, V, Brazzi, L, Montrucchio, G, Sales, G, Simonetti, U, Urbino, R, Livigni, S, Degani, A, Raffa, G, Pilato, M, Martucci, G, Arcadipane, A, Chiarini, G, Latronico, N, Cattaneo, S, Puglia, C, Reina, G, Sponga, S, Livi, U, Foti, G, Giani, M, Rona, R, Avalli, L, Bombino, M, Costa, M, Carozza, R, Donati, A, Piciche, M, Favaro, A, Salvador, L, Danzi, V, Zanin, A, Condello, I, Fiore, F, Moscarelli, M, Nasso, G, Speziale, G, Sandrelli, L, Montalto, A, Musumeci, F, Circelli, A, Gamberini, E, Russo, E, Benni, M, Agnoletti, V, Rociola, R, Milano, A, Grasso, S, Civita, A, Murgolo, F, Pilato, E, Comentale, G, Montisci, A, Alessandri, F, Tosi, A, Pugliese, F, Carelli, S, Grieco, D, Antonelli, M, Ramoni, E, Di Nardo, M, Maisano, F, Bettex, D, Weber, A, Grunenfelder, J, Consiglio, J, Hansjoerg, J, Haenggi, M, Agus, G, Doeble, T, Zenklusen, U, Bechtold, X, Stockman, B, De Backer, D, Giglioli, S, Meyns, B, Vercaemst, L, Herman, G, Meersseman, P, Vandenbriele, C, Dauwe, D, Vlasselaers, D, Raes, M, Debeuckelaere, G, Rodrigus, I, Biston, P, Piagnerelli, M, Peperstraete, H, Germay, O, Vandewiele, K, Vandeweghe, D, Witters, I, Havrin, S, Bourgeois, M, Taccone, F, Nobile, L, Lheureux, O, Brasseur, A, Creteur, J, Defraigne, J, Misset, B, Courcelle, R, Timmermans, P, Lehaen, J, Frederik, B, Riera, J, Castro, M, Gallart, E, Martinez-Martinez, M, Argudo, E, Garcia-de-Acilu, M, de Pablo Sanchez, R, Ortiz, A, Cabanes, M, Higa, K, Cassina, A, Berbel, D, Sanchez-Salado, J, Arnau, B, de Gopegui, P, Ricart, P, Sandoval, E, Veganzones, J, Millan, P, de la Sota, P, Santa Teresa, P, Alcantara, S, Alvarez, J, Gonzalez, A, Lopez, M, Gordillo, A, Naranjo-Izurieta, J, Costa, R, Albacete Moreno, C, de Ayala, J, Blanco-Schweizer, P, Andres, N, Boado, V, Martinez, J, Casal, V, Garcia, E, Martin-Villen, L, Climent, J, Pinto, L, Leprince, P, Lebreton, G, Juvin, C, Schmidt, M, Pineton, M, Folliguet, T, Saiydoun, G, Gaudard, P, Colson, P, Obadia, J, Pozzi, M, Fellahi, J, Yonis, H, Richard, J, Parasido, A, Verhoye, J, Flecher, E, Ajrhourh, L, Nesseler, N, Mansour, A, Guinot, P, Zarka, J, Besserve, P, Makhoul, M, Bolotin, G, Kassif, Y, Soufleris, D, Schellongowski, P, Bonaros, N, Krapf, C, Ebert, K, Mair, P, Kothleutner, F, Kowalewsky, M, Christensen, S, Pedersen, F, Balik, M, Blaha, J, Lips, M, Otahal, M, Camporota, L, Daly, K, Agnew, N, Barker, J, Head, L, Garcia, M, Ledot, S, Aquino, V, Lewis, R, Worthy, J, Noor, H, Scott, I, O'Brien, S, Conrick-Martin, I, Carton, E, Gillon, S, Flemming, L, Broman, L, Grins, E, Ketskalo, M, Tsarenko, S, Popugaev, K, Minin, S, Kornilov, I, Skopets, A, Kornelyuk, R, Turchaninov, A, Gorjup, V, Shelukhin, D, Dsouki, Y, Sargin, M, Kaygin, M, Liana, S, Puss, S, Soerensen, G, Magnus, R, Kanetoft, M, Watson, P, Redfors, B, Krenner, N, Velia Antonini, M, Barrett, N, Belliato, M, Davidson, M, Finney, S, Fowles, J, Halbe, M, Hennig, F, Jones, T, Smith, J, Roeleveld, P, Swol, J, Lorusso R., Combes A., Coco V.L., De Piero M.E., and Belohlavek J, EuroECMO COVID-19 WorkingGroup, and Euro-ELSO Steering Committee, Pacini D

Subjects
2019-20 coronavirus outbreak, medicine.medical_specialty, Letter, Coronavirus disease 2019 (COVID-19), Pain medicine, medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), [SDV]Life Sciences [q-bio], MEDLINE, 610 Medicine & health, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, covid, ecmo, respiratory failure, 0302 clinical medicine, Critical Care Medicine, General & Internal Medicine, Anesthesiology, medicine, Extracorporeal membrane oxygenation, Humans, Israel, ComputingMilieux_MISCELLANEOUS, Science & Technology, business.industry, COVID-19, 030208 emergency & critical care medicine, 3. Good health, Europe, Emergency medicine, Human medicine, ECMO, business, Life Sciences & Biomedicine, Human
Abstract

ispartof: INTENSIVE CARE MEDICINE vol:47 issue:3 pages:344-348 ispartof: location:United States status: published

Published
2021
Full Text
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10. Síndrome de lipodistrofia

Author

Tamara González Gutiérrez, Luis Vivas Bombino, and Margarita González Tapia

Subjects
Síndrome de lipodistrofia asociada a VIH, VIH-sida, Terapia antirretroviral altamente activa, Linfocitos T CD4-positivos, Medicine, Medicine (General), R5-920
Abstract

Introducción: la morbilidad y la mortalidad relacionadas con el VIH se han reducido ostensiblemente después del inicio de la era de la terapia antirretroviral de alta eficacia. La prevalencia de lipodistrofia en pacientes con la terapia antirretroviral es muy variable, los cambios pueden ser clínicamente sutiles al inicio, con signos de lipohipertrofia central y lipoatrofia periférica en los primeros estadios. Cuando la lipoatrofia afecta la cara y/o la grasa se acumula en la región cervicodorsal (joroba de búfalo), se considera lipodistrofia en estadios avanzados. Caso clínico: en la actual investigación se hace la presentación de un caso clínico, paciente femenina, piel negra de 43 años de edad que se diagnostica seropositiva al VIH en el mes de julio de 1999. Después de varios años de tratamiento, se comenzaron a observar cambios de la composición corporal de esta paciente con signos evidentes de lipodistrofia. Conclusiones: el síndrome de lipodistrofia se presenta como efecto adverso de la terapia antirretroviral en pacientes con sida provocando alteraciones morfológicas y metabólicas que afectan la adherencia al tratamiento. Las repercusiones estéticas provocan alteraciones psicológicas que afectan directamente a estos sujetos en las áreas afectiva, social y laboral. Se hace necesaria la realización de más estudios que permitan obtener mayores evidencias sobre este síndrome. De vital importancia resulta la adecuada evaluación de los pacientes seropositivos al VIH que consumen terapia antirretroviral por los profesionales de la salud, para lograr la identificación temprana del síndrome de lipodistrofia y aplicar métodos oportunos de tratamiento.

Published
2014

11. Comportamiento del ingreso en el hogar en un área de salud Behavior of home admissions in a health area

Author

Noelvis Ramírez Pérez, Mirta Jiménez Pacheco, Jeidy Morejón Jiménez, Luis Viva Bombino, and Dianelis María Silva Sánchez

Subjects
Atención primaria de salud, Atención domiciliaria de salud, Sistemas de salud, Primary health care, Home nursing, Health systems, Medicine, Medicine (General), R5-920
Abstract

Introducción: un método de asistencia muy frecuente en la comunidad es el ingreso en hogar. Objetivo: caracterizar el ingreso en el hogar en el área de salud perteneciente al Policlínico Universitario Hermanos Cruz de Pinar del Río del 2006 al 2010. Material y método: se realizó una investigación transversal y retrospectiva, la información se obtuvo del departamento de estadística del policlínico. El universo de pacientes reportados fue de 6427 en este periodo, coincidiendo con la muestra estudio, los datos obtenidos se recopilaron en una planilla de datos y fueron analizados por año y grupo de edades, enfermedades más frecuentes que afectaron a estos pacientes, su estadía y el ahorro porcentual que representó para el estado, pacientes que fueron remitidos y cuantos fallecieron durante su ingreso en el hogar. Resultados: la causa más frecuente de ingreso en el hogar en el área estudiada fueron las infecciones respiratorias con 3709 (57,70 %), seguidas de otras 2847(45,16 %) y las afecciones del embarazo 1478 (22,99 %). El grupo de edades más afectado fue el de 19 a 59 años 3024(47,05 %). Resultó ser el año 2009 aquel en el que predominaron los ingresos en el hogar 3024(67,05 %) fallecidos 38 (0,59 %) y remitidos 59 (0,91 %). Conclusiones: el ingreso en el hogar en nuestra área de salud se caracterizó por un elevado número de pacientes con afecciones respiratorias, aquellos que se encontraron entre 19 y 59 años fue el grupo de edades que más necesitó este servicio que también se utilizó más durante el año 2009.Introduction: home admission is a method of a very frequent assistance in the community. Objective: to characterize home admissions at “Hermanos Cruz” Outpatient Clinic, Pinar del Rio from 2006-2010. Material and Method: a cross-sectional and retrospective research was conducted collecting the information from the statistics department of the outpatient clinic. The target group was comprised of 6427 patients in this period, which coincided with the sample of study; data were collected in a table of records and analyzed per year and age bracket, most frequent diseases the patients suffered from, stay and saving percentages to the country, patients referred and death rates during home admissions. Results: respiratory infections 3709 (57,70%), followed by other health disorders 2847 (45,16%) along with pregnancy affections 1478 (22,99%) were the most frequent causes of home admissions. The most affected group of patients was between 19 and 59 years old 3042 (47,05%). During 2009 home admissions prevailed 3024 (67,05%), 38 patients died (0,59%) and 59 were referred (0,91%). Conclusions: home admissions at “Hermanos Cruz” health area showed a high number of patients suffering from respiratory infections, those between 19-59 years old needed more home admission services, year 2009 showed the highest statistics.

Published
2013

12. A propósito de la carta al editor 'El método clínico desde el proceso de formación'

Author

Luis Vivas Bombino and Margarita Gonzalez Tapia

Subjects
Medicine, Medicine (General), R5-920
Abstract

De gran valor resulta la aparición en la Revista Electrónica Dr. Zoilo E. Marinello Vidaurreta, de Las Tunas, Vol. 41, número 7 de julio 2016, ISSN 1029-3027 | RNPS 1824, de la carta al editor “El método clínico desde el proceso de formación”, tanto por el significado que tiene para el desarrollo científico de nuestros profesionales; así como, en la formación de estudiantes de Medicina y el futuro médico revolucionario.Varios especialistas asumen que el método clínico es reconocido en documentos metodológicos rectores de la formación del médico general integral básico, como el principal método de enseñanza en la mayoría de las asignaturas del ciclo clínico de la carrera de Medicina. Sin embargo, las disciplinas y asignaturas del ciclo básico también contribuyen a la adquisición de las habilidades necesarias para que los estudiantes apliquen satisfactoriamente el método clínico durante el proceso de formación profesional.

Published
2016

13. Tuberculosis pulmonar y tabaquismo en la Atención Primaria de Salud Pulmonary tuberculosis and Smoking in Primary Health Care

Author

Margarita González Tapia and Luis Vivas Bombino

Subjects
Tuberculosis pulmonar, Tabaquismo, Pulmonary tuberculosis, Smoking, Medicine, Medicine (General), R5-920
Abstract

Introducción: la tuberculosis es la enfermedad infecciosa humana más importante que existe en el mundo, a pesar de los esfuerzos que se han invertido para su control en la última década. Objetivo: determinar las características clínico epidemiológicas de la tuberculosis pulmonar y la relación del tabaquismo, en los pacientes diagnosticados en el municipio de Pinar del Río. Material y Método: se realizó un estudio descriptivo, de corte transversal desde enero de 2010 hasta diciembre del año 2011 en el municipio de Pinar del Río. El universo de estudio lo constituyó el total de pacientes con el diagnóstico de tuberculosis pulmonar en el municipio de Pinar del Río durante los años 2010-2011. La muestra quedó conformada por el universo de pacientes diagnosticados, un total de 45. Se revisaron las historias clínicas de los pacientes, encuestas epidemiológicas registradas en el departamento de estadística de la "Unidad Municipal de Higiene y Epidemiologia" de Pinar del Río. Se aplicó una encuesta que constituyó la fuente primaria, que incluyó variables cualitativas y cuantitativas. Resultados: el grupo de edad más afectado fue el de 25-59 años predominando el sexo masculino. La sintomatología predominante fue la tos con expectoración de más de 14 días. Todos eran casos nuevos, 9 de ellos fumadores existiendo un retraso en la desaparición de los síntomas en estos pacientes fumadores. Conclusiones: se debe incrementar los conocimientos sobre el comportamiento de tuberculosis y su relación con el tabaquismo en el municipio de Pinar del Río.Introduction:the most studied human contagious disease worldwide is tuberculosis, during the last decade efforts have been devoted to control and avoid more infestations. Objective: to determine the clinical-epidemiological characteristics of pulmonary tuberculosis and its association with smoking in patients who were diagnosed in Pinar del Rio municipality. Material and Method: a descriptive, cross-sectional study was carried out from January 2010 to December 2011 in Pinar del Rio municipality. The target group involved the total of patients having the diagnosis of pulmonary tuberculosis in Pinar del Rio municipality during 2010-2011. The sample was comprised of 45 patients. Clinical charts of patients, epidemiological surveys recorded in the Statistics Department of the "Municipal Hygiene and Epidemiology Unit" in Pinar del Rio were reviewed. A survey that constituted the primary source of information was applied which included qualitative and quantitative variables. Results: the most affected group of ages was from 25-59 years old, prevailing male sex. Predominant symptoms included cough and expectoration for more than 14 days. All of the cases were new, 9 of them smokers; observing a delay in the disappearance of symptoms for these patients. Conclusions: knowledge of tuberculosis behavior and its association with smoking should be increased in Pinar del Rio municipality.

Published
2012

14. Tuberculosis en el puerperio. Presentación de un caso Tuberculosis in Primary Health Care. A case report

Author

Margarita González Tapia, Luis Vivas Bombino, Neptaly Pérez Moreno, Luis Enrique Pérez Moreno, and Rubén Posada Loriga

Subjects
Medicine, Medicine (General), R5-920
Abstract

Se presenta un caso de tuberculosis del área de salud del Policlínico Universitario "Raúl Sánchez". Se trata de una gestante de 19 años de edad, de color de la piel negra, adolescente, fumadora y con antecedentes de salud; transcurre además con un embarazo con sintomatología respiratoria. En el proceso de atención sus síntomas se interpretan como proceso bronco neumónico, un cuadro que empeora a los 20 días de parida y es ingresada en cuidados intensivos. Se le realiza la radiografía de tórax. La imagen realizada resulta sugestiva de una neumonía y se le indica tratamiento con antibióticos. Al no mejorar el cuadro respiratorio se interconsulta con neumología y se le diagnóstica tuberculosis pulmonar, se inicia tratamiento con la consiguiente mejoría de la paciente hasta su alta.A 19-year old, black, pregnant, smoker adolescent suffering from tuberculosis and having health history of respiratory symptoms was attended at "Raul Sanchez" University Outpatient Clinic. During health assistance the symptoms were interpreted as a bronchopneumonia process, clinical manifestations worsened 20 days after the delivery and she was admitted in Intensive Care Unit. Thoracic images suggested a pneumonia and antibiotic therapy was indicated. As the patient did not show respiratory improvements she was referred to the pulmonologist where pulmonary tuberculosis was diagnosed. The patient started the treatment observing a subsequent good progress up to the hospital discharge.

Published
2012

15. Parámetros ventilatorios en las maternas distresadas, de la provincia de Matanzas. Enero 2006 a mayo 2008 Ventilatory parameters in distressed pregnant women of the province of Matanzas in the period January 2006-May 2008

Author

Carlos Alberto de la Vega Cums, Idalmis Rodríguez Rivero, Denia Bombino López, Lázaro M Menéndez San Martí, and Juan C Fadraga González

Subjects
síndrome de dificultad respiratoria, adulto, letalidad, respiración artificial, mortalidad materna, lesión pulmonar, respiratory distress syndrome, adult, lethality, respiration artificial, maternal mortality, lung injury, Medicine
Abstract

Aunque la ocurrencia de síndrome de dificultad respiratoria aguda/daño pulmonar agudo durante el embarazo es infrecuente, su letalidad es elevada y ha sido reportado como un factor importante en la mortalidad materna. Por ello, se realizó un estudio observacional, analítico, de tipo transversal, en el universo de 17 pacientes maternas que ingresaron en las salas de terapia intensiva de los hospitales que atienden este tipo de casos en la provincia, los cuales son: Hospital Territorial Docente Julio M. Arístegui Villamil, de Cárdenas, y el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez, de Matanzas, por presentar síndrome de dificultad respiratoria aguda/daño pulmonar agudo, durante el período 1 de enero de 2006 al 31 de mayo de 2008, con el objetivo de investigar los aspectos clínicos y ventilatorios del distréss respiratorio de la materna crítica. El instrumento de recolección de la información fueron las historias clínicas y los protocolos de necropsias de las fallecidas. Se estudiaron variables ventilatorias y clínicas. El procesamiento estadístico se realizó en el Programa EPI INFO 06. Se determinaron porcentajes, media y desviación estándar con un intervalo de confianza del 95 % y significación estadística de P < 0,05. Entre los principales resultados se destacaron: predominio de las pacientes con síndrome de dificultad respiratoria aguda sobre las que tenían daño pulmonar agudo; el manejo de la ventilación mecánica basado en los principios de ventilación protectiva; en la mayoría de los casos se utilizaron valores de presión positiva al final de la expiración (PEEP) bajos; en las pacientes con daño pulmonar directo estos fueron más elevados; el volumen tidal (Vt) permaneció igual.Although the occurrence of the syndrome of acute respiratory difficulty/acute pulmonary damage during pregnancy is infrequent, its lethality is high and it has been reported as an important factor in maternal mortality. Therefore, an observational, analytic, cross-sectional study was carried out in the universe of 17 pregnant women who entered the intensive care services of the hospitals where this kind of cases are treated in the province: Teaching Territorial Hospital Julio M. Arístegui Villamil, of Cardenas, and the University Clinical Surgical Hospital Comandante Faustino Pérez, of Matanzas, presenting syndrome of acute respiratory difficulty/acute pulmonary damage, during the period from January 1 st 2006 to May 31 st 2008, with the objective of investigating the clinical and ventilatory aspects of the respiratory distress in critical pregnant women. The clinical records and the necropsy protocols of the deceased ones were the instrument for data collection. We studied clinical and ventilatory variables. The statistic processing was made in the program EPINFO 06. We determined percentages, average and standard deviation with a confidence interval of 95 % and a statistic significance of P < 0, 05. Among the main results we can call attention to: the predominance of the patients with syndrome of acute respiratory difficulty over those who presented acute pulmonary damage; the mechanical ventilation usage based on the principles of the protective ventilation; the usage of low positive end/expiratory pressure (PEEP) values in most of the cases; the higher positive end/expiratory pressure values in patients with direct pulmonary damage; the tidal volume (Vt) stayed the same.

Published
2011

16. Evolution Over Time of Ventilatory Management and Outcome of Patients With Neurologic Disease

Author

Tejerina E. E., Pelosi P., Robba C., Penuelas O., Muriel A., Barrios D., Frutos-Vivar F., Raymondos K., Du B., Thille A. W., Rios F., Gonzalez M., Del-Sorbo L., Marin M. D. C., Valle Pinheiro B., Soares M. A., Nin N., Maggiore S. M., Bersten A., Amin P., Cakar N., Young Suh G., Abroug F., Jibaja M., Matamis D., Ali Zeggwagh A., Sutherasan Y., Anzueto A., Esteban A, Fernando Ríos, Damian Violi, Marisol Rodríguez-Goñi, Roger Lamoglie, Fernando Villarejo, Norberto Tiribelli, Santiago Ilutovich, Matías Brizuela, Mariana Monllau, Fernando Saldarini, Silvina Borello, Alberto Marino, Mauricio Vinzio, Karina Bonasegla, Julián Hernández, María Belén Yapur, María Eugenia González, Sebastián E Mare, Judith Sagardía, Marco Bezzi, Cecilia Pereyra, Julian Strati, Daniel Vargas, Claudia Diaz, Pablo Gómez, Marcelo Palavecino, Graciela Elizabeth, Aguilera García, M Eugenia, Luis Pablo Cardonnet, Lisandro Betttini, Hernán Nuñez, Lucas Vallejo, Fernando Fernández, Jorge Arroyo, Daniel Duarte, Gerardo Filippa, Cayetano Galetti, Hernan Nunia, Fernando Lambert, Elisa Estenssoro, Marina Busico, Javier Horacio Álvarez, Alejandro Raimondi, Gustavo Badariotti, Martín Lugaro, Fernando Lipovestky, Alan Javier Zazu, Hugo Capponcelli, Patricia Vogl, Cristina Orlandi, Alejandro Gómez, Gustavo Jannello, Alejandro Risso, Leticia Rapetti, Guillermo Chiappero, Juan Domingo Fernández, Rodrigo E Gómez-Paz, Marcos Juan Zec, Pascual Valdez, Jorgelina Guyon, Ariel Chena, Sergio Lasdica, Martin Deheza, Schimdt Alejandra, Francisco Criado, Norma Beatriz Márquez, Pablo Desmery, José Luis Scapellato, Gonzalo Javier Ríos, Cristian Casabella, Jasmin Board, Andrew Davies, Andrew Bersten, Elisha Matheson, Amy Waters, John Santamaria, Jennifer Holmes, Cartan Costello, Manoj K Saxena, John Myburgh, Ellen Kinkel, Forbes McGain, Claire Cattigan, Allison Bone, Ian Seppelt, Leonie Weisbrodt, Cheryl Cuzner, Christopher MacIsaac, Deborah Barge, Tania Caf, Cameron Knott, Graeme Duke, Imogen Mitchell, Helen Rodgers, Rachel Whyte, Elisha Fulton, Alistair Nichol, Hergen Buscher, Priya Nair, Claire Reynolds, Simon J G Hockley, Ian Moore, Katherine Davidson, David Milliss, Raju Pusapati, Helen Wong, Jason Fletcher, Julie Smith, Paul Goldrick, Dianne Stephens, Jane Thomas, Anders Aneman, Sutrisno Gunawan, Tom Cowlam, George Lukas, Rick McAllister, Minka Springham, Joanne Sutton, Jeff Presneill, Tony Sutherland, Dianne Hill, Howard Connor, Jenny Dennett, Tim Coles, Freddy Sandy, Sando Chavarria, Marcelo Choque, Ronald Pairumani, Juan Guerra, Marco Antônio Soares Reis, José Carlos Versiani, Eduardo Fonseca Sad, Maria Aparecida Braga, Dinalva Aparecida Gomes, Fernando Antônio Botoni, Maurício Meireles Góes, Frederico Costa Val Barros, Rogério de Castro Pereira, Hugo Urbano, Valéria de Carvalho Magela, Aline Camile Yehia, Bruno Bonaccorsi Fernandino, Marco Antônio Ribeiro Leão, Rovílson Lara, Rubens Altair Amaral de Pádua, Janine Dias Alves, Aloísio Marques do Nascimento, Bruno do Valle Pinheiro, Carlos Alberto Studart Gomes, Marcelo Alcântara Holanda, Frederico Rodrigues Anselmo, Niall Ferguson, Neill Adhikari, Robert Fowler, Cheromi Sittambalam, Mehar-Un-Nisa Raja, Nicole Marinoff, Lauralyn McIntryre, Shawna Reddie, Laura Jones, Irene Watpool, Jeffrey Singh, Madison Dennis, Andrea Matte, Marc Lipkus, Ryan Albert, Andrew Steel, Emily Stern, Michael Miletin, Antonio Raso, Robyn Klages, Jan Friedrich, Orla Smith, Laura Wilson, Deborah Cook, Mark Bailey, Sangeeta Mehta, Stephen Lapinsky, Hannah Mathers, Cheryl Ethier, Stephanie Lubchansky, Samer Haj-Bakri, Dietrich Henzler, Lisa Julien, Luis Soto-Román, Juan Carlos Maurelia, César Antonio Maquilon, Luis Soto-Germani, Bin Du, Yan Kang, Bo Wang, Fachun Zhou, Fang Xu, Haibo Qiu, Yi Yang, Qingyuan Zhan, Bing Sun, Zhenjie Hu, Bin Yu, Xi Zhu, Yu Bai, Gang Li, Yi Li, Geng Zhang, Jianbiao Meng, Xiaobo Huang, Hong Pu, Daxing Yu, Chuanyun Qian, Wei Zhang, Yongjie Yin, Debiao Song, Yunxuan Yue, Zhengxuan Lv, Chengmin Yu, Qunmei Yao, Xue Wang, Yuan Xu, Wei He, Mian Chen, Zhihua Hu, Dongpo Jiang, Jian Huang, Wei Yu, Juanxian Gu, Yangong Chao, Zhixiang Li, Zhicheng Zhang, Wanxia Li, Zhenyang He, Jianguo Li, Chang Liu, Tiehe Qin, Shouhong Wang, Feng Li, Jun Jin, Jianhong Fu, Hongyang Xu, Hongyuan Lin, Jianying Guo, Yalin Liu, Jinghua Wang, Maoqin Li, Jiaqiong Li, Lei Chen, Qing Song, Liang Pan, Xianyao Wan, Jiuzhi Zhang, Weihai Yao, Yuhong Guo, Pang Wing Yan, Kelly Choy, Kwan Ming Chit, Patricia Leung, Chau Chin Man, Marco González, Ricardo Buitrago, Marcela Granados, Guillermo Ortiz, Cesar Enciso, Mario Gómez, Bladimir Alejandro Gil, Juan Pablo Sedano, Luis Fernando Castro Castro, Carlo Alberto Acosta, Marco Gonzalez, Francisco Molina, Camilo Pizarro, Mario Villabon, Carmelo Dueñas, Carlos Andrés Díaz, Nelson Fonseca, Rubén Camargo, Juan David Uribe, Hans-Henrik Bülow, Simona Beniczky, Jens Brushoj, Mikkel Præst, Birgitte Viebaek, Sine Wichman, Anette Mortensen, Susanne Andi Iversen, Bo Broberg, Edgard Luna, Manuel Jibaja, Leonardo Pazmiño, Katty Trelles, Fabricio Picoita, Gustavo Paredes, Vanesa Ramírez, Guillermo Falconí, Cristian Cevallos, Boris Villamagua, Marco Escobar, Freddy Sánchez, Miguel Llano, Miguel Lazcano, Ramiro Puetate, José Miguel Guerrero, Mijail Játiva, Myriam Montalvo, Franklin Villegas, Luis González Zambrano, Ronnie Mantilla, Gina Quinde, Andrea Gimenez, Luis Gonzalez Mosquera, Henry Caballero, María Fernanda García, Marcelo Ochoa, Soraya Puertas, Jackeline Coello, Mario Acosta, Medhat Soliman, Arnaud W Thille, Achille Kouatchet, Alain Mercat, Laurent Brochard, François Collet, Guillaume Marcotte, Pascal Beuret, Jean-Christophe M Richard, Gaëtan Bedunaeu, Pierre-Gildas Guitard, Fabien Soulis, Frédéric Bellec, Philippe Berger, Dorothée Carpentier, Benoit Veber, Salem Ould Zein, Géraldine Dessertaine, C Canevet, Fabien Grelon, Konstantinos Raymondos, Rolf Dembinski, Rolf Rossaint, Steffen Weber-Carstens, Christian Putensen, Maximillian Ragaller, Michael Quintel, Winfried Schubert, Thomas Bein, Heinrich Paulus, Walter Brandt, Lutz Pfeiffer, Silke Frenzel, Thoralf Kerner, P Kruska, Leila Eckholt, Joachim Hartung, Harald Fritz, Monika Holler, Johannes Busch, Andreas Viehöfer, Jens Buettner, Jörn Schlechtweg, Achim Lunkeit, Roland Schneider, Maria Wussow, Nils Marquardt, Christian Frenkel, Falk Hildebrandt, Tumbass Volker, Thomas Lipp, Cezar Mihailescu, Thomas Moellhoff, Thomas Steinke, Oliver Franke, Marcus Ruecker, Markus Schappacher, Steffen Appel, Heinz Kerger, Andreas Schwartz, Jan Dittmann, Jörg Haberkorn, Wolfgang Baier, Walter Seyde, Dimitros Matamis, Eleni Antoniadou, Pertsas Evangelos, Maria Giannakou, Zoltan Szentkereszty, Zsolt Molnar, Pravin Amin, Farhad N Kapadia, Nagarajan Ramakrishnan, Deepak Govil, Anitha Shenoy, Umesh G, Samir Sahu, Sheila Nainan Myatra, Subhash Kumar Todi, Sanjay Dhanuka, Mayur Patel, P Samaddar, Dhruva Chaudhry, Vivek Joshi, Srinivas Samavedam, Ankur Devendra Bhavsar, Prachee Sathe, Sujoy Mukherjee, Salvatore Maurizio Maggiore, Francesco Idone, Federica Antonicelli, Paolo Navalesi, Rosanna Vaschetto, Arianna Boggero, Rosalba Tufano, Michele Iannuzzi, Edoardo De Robertis, Romano Tetamo, Andrea Neville Cracchiolo, Antonio Braschi, Francesco Mojoli, Ilaria Curro', Mirko Belliato, Chiara Verga, Marta Ferrari, Erika Mannelli, Valerio Mangani, Giorgio Tulli, Francesca Frigieri, Armando Pedulla', Monica Rocco, Giorgia Citterio, Di Russo, Gaetano Perchiazzi, Loredana Pitagora, Antonio Pesenti, Michela Bombino, Davide Chiumello, Federica Tallarini, Serena Azzari, Antonina Pigna, Ivano Aprile, Marco Adversi, Antonio Corcione, Marianna Esposito, Annunziata Mattei, Vito Marco Ranieri, Rosario Urbino, Ilaria Maria Mastromauro, Antonino Giarratano, Maurizio Raineri Santi, Ambrogio Sansone, Younsuck Koh, Moo Suk Park, Je Hyeong Kim, Kyung Chan Kim, Hye Sook Choi, Yun Seong Kim, Jin Hwa Lee, Myung-Goo Lee, Won-Yeon Lee, Jin Young An, Gee Young Suh, Ki-Suck Jung, Asisclo J Villagómez Ortiz, César Cruz Lozano, Zalatiel Maycotte Luna, José Francisco López Baca, José Elizalde, Guillermo Cueto Robledo, Mario Alonso Treviño Salinas, Ricardo Martinez Zubieta, Claudia Olvera-Guzman, Marco Montes De Oca, Silvio A Ñamendys-Silva, José Salvador Martínez Cano, Jose Angel Baltazar Torres, Gustavo Morales Muñoz, Antonio Villa Delgado, Javier Ladape Martinez, Amine Ali Zeggwagh, Tarek Dendane, Abderrahim Azzouzi, Ahmed Sbihi, Wajdi Maazouzi, Mourad Amor, Charki Haimeur, Michael A Kuiper, Matty Koopmans, Uli Strauch, Dennis Bergmans, Serge Heines, Sylvia den Boer, Bas M Kors, Peter van der Voort, Paul J Dennesen, Bert Beishuizen, Ingrid van den Hul, Erna Alberts, Harry P P M Gelissen, Eduard Bootsma, Auke Reidinga, Kim Heus, Diane Mackle, Paul Young, Rachael Parke, Eileen Gilder, Jodi Brown, Lynette Newby, Catherine Simmonds, Jan Mehrtens, Seton Henderson, Tony Williams, Judi Tai, Chantal Hogan, Mary La Pine, John Durning, Sheree Gare, Troy Browne, Shirley Nelson, Jennifer Goodson, Julio Osorio, Chabu Coronado, Rollin Roldán Mori, Rosa Luz López Martínez, Adam Mikstacki, Barbara Tamowicz, Rui Moreno, Eduardo Almeida, Joana Silvestre, Heloisa Castro, Irene Aragão, Susana Alves Ferreira, Nelson Barros, Filomena Faria, Carlos André Correia Casado, Fausto Fialho Moura, Paulo Marcal, Ricardo Matos, Edward Nicolayenko, Mikhail Kirov, Andrey Yaroshetskiy, Andrei Piontek, Valery Subbotin, Yaseen Arabi, Olivia Dulfo, Chafrina Marie Olay, Edgardo E Tabhan, Nicolas Nin, Alfonso Muñoz, César Aragón, Ana Villagrá, Ainhoa Rosselló, Joan Maria Raurich, María Garitacelaya, Miguel Ángel González-Gallego, Francisco Ortuño, Miguel Fernández-Vivas, David Freire, Francisco Guerrero, Francisco Manzano, Juan Carlos, Alfredo Padrón, Pedro Rosa, Rafael Morales, Liliana Caipe, Maurizio Bottiroli, José María Nicolás, Marta Ugalde, Javier Ruiz, Lucia Capilla, Guillermo Muñiz, Jesús Sánchez-Ruiz, Javier Cebrián, Begoña Balerdi, Elena Parreño, Alvaro van Bommel, César Pérez-Calvo, Irene Dot, Javier Blanco, Raquel Manzanedo, José J Blanco, Daniel Fontaneda, Raúl González, Javier Díaz Domínguez, Alfonso Moreno, Antonio Reyes, Ian Carrasco, Itziar Mintegui, Rosa Sebastián, Javier García-Alonso, Carolina Lorencio, Josep Maria Sirvent, Patricia Jimeno, Miguel León, Pedro Galdos, Nuria Alonso, Julia López-Díaz, María Victoria de la Torre, Jorge Vidal Hernández, Nicolás Zamboschi, Francisco Lucena, Gemma Rialp, Raquel Montoiro, Victoria Goñi, María Ángeles Pena, Antonio Maestre, Marc Fabra, Jacinto Baena, Eva Benveniste, Susana Temprano, Jesús Sánchez, Carmen Campos, Sara Cabañes, María Elena Pérez-Losada, José Claudio Leo, Enrique Piacentini, María Del Carmen de la Torre, Laura Álvarez-Montero, Fernando Sánchez, Antonio Viñuales, Bernabé Álvarez, Javier Castañeda, Ángela Alonso, María Isabel Ruiz, Pedro Jesús Domínguez, Marcos Delgado, Eugenio Palazón, Antonio García-Jiménez, Rosa Álvaro, Clara Laplaza Eva Regidor, Enrique Maraví, José María Quiroga, Amalia Martínez de la Gandara, Cecilia Carbayo, María Luisa Navarrete, Manuel Valledor, Raquel Yano, José María Gutiérrez, Javier González-Robledo, Amparo Ferrandiz, Alberto Belenguer, Lidón Mateu, Laura Sayagues, María José Tolón, Nieves Franco, Elena Gallego, Félix Lacoma, Patricia Albert, Vicente Arraez, Mar Gobernado, Susana Moradillo, Carolina Gímenez-Esparza, Teresa Sánchez de Dios, Carlos Marian Crespo, Cecilia Hermosa, Federico Gordo, Genis Carrasco, María Ángeles Alonso, Alejandro Algora, Raúl de Pablo, Sofía García, Ana Carolina Caballero, José María Montón, Teresa Mut, Eva Manteiga, Alejandro de la Serna, Ana Esther Trujillo, Rafael Blancas, Inmaculada Vallverdú, José Manuel Serrano, Miquel Ferrer, Juan Diego Jiménez, Carlos Gallego, Dolores Vila, Luis Marina, Valentín Parra, Juan Ramón Cortés, Chen Chin-Ming, Ai-Chin Cheng, Fekri Abroug, Besbes Mohamed, Imed Chouchene, Mounir Bouaziz, Stambouli Neji, Islem Ouanes, Ayed Samia, Nahit Cakar, Ismail Kati, Ali Aydım Altunkan, Remzi Iscimen, Zafer Dogan, Bilge Çetin, Tayfun Adanir, Sabriye Guvenc, Unase Büyükkoçak, Antonio Anzueto, Ashley Ellis, Gary Kinasewitz, Allan Walkey, Phil Alkana, Gregory A Schmidt, Susan Gillen, Kathleen Lilli, Jennifer Twombley, Denice Wells, Larry Welder, Alejandro Arroliga, Alfredo Vasquez-Sandoval, Vincent John Scott, Craig Cernosek, Christopher Spradley, Dimple Tejwani, Sindhaghatta Venkatram, Gilda Diaz-Fuentes, Amber Monson, Anthony Saleh, Madhav Gudi, George Liziamma, Mohamed A Saad, Crissie De Spirito, Bryan Beatty, Samir Vermani, Crissie Despirito, Zaza Cohen, Amee Patrawalla, Samir Abdelhadi, Rupesh Vakil, Steven Y Chang, Brian Sherman, Rosanna Del Giudice, John Oropell, Timothy D Girard, Cayce Strength, Joyce Okahashi, Leanne Boehm, Matthew Kirchner, Erwin J Oei, Sebastian Circo, Nelson Medina, Mohammed Al-Jagbeer, V J Cardenas Jr, Smyth Smith, Shelby Sutton, Marcela Canola-Mazo, Tim Houlihan, Yogeet Kaur, Travis Parry, Craig A Piquette, Kerry Canady, Rahul Nanchal, Dana K Soetaert, Maria Del Mar Torres-Perez, Carlos Robles-Arias, William Rodriguez-Cintron, Mark Tidswell, Jennifer Germain, Lori-Ann Kozikowski, Erin Braden, Geneva Tatem, Javier Hurtado, Alberto Deicas, Daniel Weiss, Marta Beron, Román Garrido, Cristina Santos, Mario Cancela, Raúl Lombardi, Pedro Alzugaray, Jorge Gerez, Silvia Mareque, Graciela Franca, Oscar Cluzet, Edgardo Nuñez, Julio Pontet, Sergio Cáceres, Elias Caragna, Alberto Soler, Frank Torres, Gastón Pittini, Gabriel D Empaire, Stevens Salva, Fernando Pérez, Clara Pacheco, Zoraida Parra, Ingrid Von der Osten, Luis Williams, José Salinas, Do Danh Quynh, Pham Thi Van Anh, Nguyen Huu Hoang, Nghuyen Ba Tuan, RS: NUTRIM - R2 - Liver and digestive health, MUMC+: MA Arts Assistenten IC (9), Intensive Care, MUMC+: MA Medische Staf IC (9), Tejerina E.E., Pelosi P., Robba C., Penuelas O., Muriel A., Barrios D., Frutos-Vivar F., Raymondos K., Du B., Thille A.W., Rios F., Gonzalez M., Del-Sorbo L., Marin M.D.C., Valle Pinheiro B., Soares M.A., Nin N., Maggiore S.M., Bersten A., Amin P., Cakar N., Young Suh G., Abroug F., Jibaja M., Matamis D., Ali Zeggwagh A., Sutherasan Y., Anzueto A., Esteban A, and Fernando Ríos, Damian Violi, Marisol Rodríguez-Goñi, Roger Lamoglie, Fernando Villarejo, Norberto Tiribelli, Santiago Ilutovich, Matías Brizuela, Mariana Monllau, Fernando Saldarini, Silvina Borello, Alberto Marino, Norberto Tiribelli, Mauricio Vinzio, Karina Bonasegla, Julián Hernández, María Belén Yapur, María Eugenia González, Sebastián E Mare, Judith Sagardía, Marco Bezzi, Cecilia Pereyra, Julian Strati, Daniel Vargas, Claudia Diaz, Pablo Gómez, Marcelo Palavecino, Graciela Elizabeth, Aguilera García, M Eugenia, Luis Pablo Cardonnet, Lisandro Betttini, Hernán Nuñez, Lucas Vallejo, Fernando Fernández, Jorge Arroyo, Daniel Duarte, Gerardo Filippa, Cayetano Galetti, Hernan Nunia, Fernando Lambert, Elisa Estenssoro, Marina Busico, Fernando Villarejo, Javier Horacio Álvarez, Alejandro Raimondi, Gustavo Badariotti, Martín Lugaro, Fernando Lipovestky, Alan Javier Zazu, Hugo Capponcelli, Patricia Vogl, Cristina Orlandi, Alejandro Gómez, Gustavo Jannello, Alejandro Risso, Leticia Rapetti, Guillermo Chiappero, Juan Domingo Fernández, Rodrigo E Gómez-Paz, Marcos Juan Zec, Pascual Valdez, Jorgelina Guyon, Ariel Chena, Sergio Lasdica, Martin Deheza, Schimdt Alejandra, Francisco Criado, Norma Beatriz Márquez, Pablo Desmery, José Luis Scapellato, Gonzalo Javier Ríos, Cristian Casabella, Jasmin Board, Andrew Davies, Andrew Bersten, Elisha Matheson, Amy Waters, John Santamaria, Jennifer Holmes, Cartan Costello, Manoj K Saxena, John Myburgh, Ellen Kinkel, Forbes McGain, Claire Cattigan, Allison Bone, Ian Seppelt, Leonie Weisbrodt, Cheryl Cuzner, Christopher MacIsaac, Deborah Barge, Tania Caf, Cameron Knott, Graeme Duke, Imogen Mitchell, Helen Rodgers, Rachel Whyte, Elisha Fulton, Jasmin Board, Andrew Davies, Alistair Nichol, Hergen Buscher, Priya Nair, Claire Reynolds, Simon J G Hockley, Ian Moore, Katherine Davidson, David Milliss, Raju Pusapati, Helen Wong, Jason Fletcher, Julie Smith, Paul Goldrick, Dianne Stephens, Jane Thomas, Anders Aneman, Sutrisno Gunawan, Tom Cowlam, George Lukas, Rick McAllister, Minka Springham, Joanne Sutton, Jeff Presneill, Tony Sutherland, Dianne Hill, Howard Connor, Jenny Dennett, Tim Coles, Freddy Sandy, Sando Chavarria, Marcelo Choque, Ronald Pairumani, Juan Guerra, Marco Antônio Soares Reis, José Carlos Versiani, Eduardo Fonseca Sad, Maria Aparecida Braga, Dinalva Aparecida Gomes, Fernando Antônio Botoni, Maurício Meireles Góes, Frederico Costa Val Barros, Rogério de Castro Pereira, Hugo Urbano, Valéria de Carvalho Magela, Aline Camile Yehia, Bruno Bonaccorsi Fernandino, Marco Antônio Ribeiro Leão, Rovílson Lara, Rovílson Lara, Rubens Altair Amaral de Pádua, Janine Dias Alves, Aloísio Marques do Nascimento, Bruno do Valle Pinheiro, Carlos Alberto Studart Gomes, Marcelo Alcântara Holanda, Frederico Rodrigues Anselmo, Niall Ferguson, Neill Adhikari, Robert Fowler, Cheromi Sittambalam, Mehar-Un-Nisa Raja, Nicole Marinoff, Lauralyn McIntryre, Shawna Reddie, Laura Jones, Irene Watpool, Jeffrey Singh, Madison Dennis, Andrea Matte, Marc Lipkus, Ryan Albert, Andrew Steel, Emily Stern, Michael Miletin, Antonio Raso, Robyn Klages, Jan Friedrich, Orla Smith, Laura Wilson, Deborah Cook, Mark Bailey, Sangeeta Mehta, Stephen Lapinsky, Hannah Mathers, Cheryl Ethier, Stephanie Lubchansky, Samer Haj-Bakri, Dietrich Henzler, Lisa Julien, Luis Soto-Román, Juan Carlos Maurelia, César Antonio Maquilon, Luis Soto-Germani, Bin Du, Yan Kang, Bo Wang, Fachun Zhou, Fang Xu, Haibo Qiu, Yi Yang, Qingyuan Zhan, Bing Sun, Zhenjie Hu, Bin Yu, Xi Zhu, Yu Bai, Gang Li, Yi Li, Geng Zhang, Jianbiao Meng, Xiaobo Huang, Hong Pu, Bin Du, Daxing Yu, Chuanyun Qian, Wei Zhang, Yongjie Yin, Debiao Song, Yunxuan Yue, Zhengxuan Lv, Chengmin Yu, Qunmei Yao, Xue Wang, Yuan Xu, Wei He, Mian Chen, Zhihua Hu, Dongpo Jiang, Jian Huang, Wei Yu, Juanxian Gu, Yangong Chao, Zhixiang Li, Zhicheng Zhang, Wanxia Li, Zhenyang He, Jianguo Li, Chang Liu, Tiehe Qin, Shouhong Wang, Feng Li, Jun Jin, Jianhong Fu, Hongyang Xu, Hongyuan Lin, Jianying Guo, Yalin Liu, Jinghua Wang, Maoqin Li, Jiaqiong Li, Lei Chen, Qing Song, Liang Pan, Xianyao Wan, Jiuzhi Zhang, Weihai Yao, Yuhong Guo, Pang Wing Yan, Kelly Choy, Kwan Ming Chit, Patricia Leung, Chau Chin Man, Marco González, Ricardo Buitrago, Marcela Granados, Guillermo Ortiz, Cesar Enciso, Mario Gómez, Bladimir Alejandro Gil, Juan Pablo Sedano, Luis Fernando Castro Castro, Carlo Alberto Acosta, Marco Gonzalez, Francisco Molina, Camilo Pizarro, Mario Villabon, Carmelo Dueñas, Carlos Andrés Díaz, Nelson Fonseca, Rubén Camargo, Juan David Uribe, Hans-Henrik Bülow, Simona Beniczky, Jens Brushoj, Mikkel Præst, Birgitte Viebaek, Sine Wichman, Anette Mortensen, Susanne Andi Iversen, Bo Broberg, Edgard Luna, Manuel Jibaja, Leonardo Pazmiño, Katty Trelles, Fabricio Picoita, Gustavo Paredes, Vanesa Ramírez, Guillermo Falconí, Cristian Cevallos, Boris Villamagua, Marco Escobar, Freddy Sánchez, Miguel Llano, Miguel Lazcano, Ramiro Puetate, José Miguel Guerrero, Mijail Játiva, Myriam Montalvo, Franklin Villegas, Luis González Zambrano, Ronnie Mantilla, Gina Quinde, Andrea Gimenez, Luis Gonzalez Mosquera, Henry Caballero, María Fernanda García, Marcelo Ochoa, Soraya Puertas, Jackeline Coello, Mario Acosta, Medhat Soliman, Arnaud W Thille, Achille Kouatchet, Alain Mercat, Laurent Brochard, François Collet, Guillaume Marcotte, Pascal Beuret, Jean-Christophe M Richard, Gaëtan Bedunaeu, Pierre-Gildas Guitard, Fabien Soulis, Frédéric Bellec, Philippe Berger, Dorothée Carpentier, Benoit Veber, Salem Ould Zein, Géraldine Dessertaine, C Canevet, Fabien Grelon, Konstantinos Raymondos, Rolf Dembinski, Rolf Rossaint, Steffen Weber-Carstens, Christian Putensen, Maximillian Ragaller, Michael Quintel, Winfried Schubert, Thomas Bein, Heinrich Paulus, Walter Brandt, Lutz Pfeiffer, Silke Frenzel, Thoralf Kerner, P Kruska, Leila Eckholt, Joachim Hartung, Harald Fritz, Monika Holler, Johannes Busch, Andreas Viehöfer, Jens Buettner, Jörn Schlechtweg, Achim Lunkeit, Roland Schneider, Maria Wussow, Nils Marquardt, Christian Frenkel, Falk Hildebrandt, Tumbass Volker, Thomas Lipp, Cezar Mihailescu, Thomas Moellhoff, Thomas Steinke, Oliver Franke, Marcus Ruecker, Markus Schappacher, Steffen Appel, Heinz Kerger, Andreas Schwartz, Jan Dittmann, Jörg Haberkorn, Wolfgang Baier, Walter Seyde, Dimitros Matamis, Eleni Antoniadou, Pertsas Evangelos, Maria Giannakou, Zoltan Szentkereszty, Zsolt Molnar, Pravin Amin, Farhad N Kapadia, Nagarajan Ramakrishnan, Deepak Govil, Anitha Shenoy, Umesh G, Samir Sahu, Sheila Nainan Myatra, Subhash Kumar Todi, Sanjay Dhanuka, Mayur Patel, P Samaddar, Dhruva Chaudhry, Vivek Joshi, Srinivas Samavedam, Ankur Devendra Bhavsar, Prachee Sathe, Sujoy Mukherjee, Salvatore Maurizio Maggiore, Francesco Idone, Federica Antonicelli, Paolo Navalesi, Rosanna Vaschetto, Arianna Boggero, Rosalba Tufano, Michele Iannuzzi, Edoardo De Robertis, Romano Tetamo, Andrea Neville Cracchiolo, Antonio Braschi, Francesco Mojoli, Ilaria Curro', Mirko Belliato, Chiara Verga, Marta Ferrari, Erika Mannelli, Valerio Mangani, Giorgio Tulli, Francesca Frigieri, Armando Pedulla', Monica Rocco, Giorgia Citterio, Di Russo, Gaetano Perchiazzi, Loredana Pitagora, Antonio Pesenti, Michela Bombino, Davide Chiumello, Federica Tallarini, Serena Azzari, Antonina Pigna, Ivano Aprile, Marco Adversi, Antonio Corcione, Marianna Esposito, Annunziata Mattei, Vito Marco Ranieri, Rosario Urbino, Ilaria Maria Mastromauro, Antonino Giarratano, Maurizio Raineri Santi, Ambrogio Sansone, Younsuck Koh, Moo Suk Park, Je Hyeong Kim, Kyung Chan Kim, Hye Sook Choi, Yun Seong Kim, Jin Hwa Lee, Myung-Goo Lee, Won-Yeon Lee, Jin Young An, Gee Young Suh, Ki-Suck Jung, Asisclo J Villagómez Ortiz, César Cruz Lozano, Zalatiel Maycotte Luna, José Francisco López Baca, José Elizalde, Guillermo Cueto Robledo, Mario Alonso Treviño Salinas, Ricardo Martinez Zubieta, Claudia Olvera-Guzman, Marco Montes De Oca, Silvio A Ñamendys-Silva, José Salvador Martínez Cano, Jose Angel Baltazar Torres, Gustavo Morales Muñoz, Antonio Villa Delgado, Javier Ladape Martinez, Amine Ali Zeggwagh, Tarek Dendane, Abderrahim Azzouzi, Ahmed Sbihi, Wajdi Maazouzi, Mourad Amor, Charki Haimeur, Michael A Kuiper, Matty Koopmans, Uli Strauch, Dennis Bergmans, Serge Heines, Sylvia den Boer, Bas M Kors, Peter van der Voort, Paul J Dennesen, Bert Beishuizen, Ingrid van den Hul, Erna Alberts, Harry P P M Gelissen, Eduard Bootsma, Auke Reidinga, Jasmin Board, Andrew Davies, Kim Heus, Diane Mackle, Paul Young, Rachael Parke, Eileen Gilder, Jodi Brown, Lynette Newby, Catherine Simmonds, Jan Mehrtens, Seton Henderson, Tony Williams, Judi Tai, Chantal Hogan, Mary La Pine, John Durning, Sheree Gare, Troy Browne, Shirley Nelson, Jennifer Goodson, Julio Osorio, Chabu Coronado, Rollin Roldán Mori, Rosa Luz López Martínez, Adam Mikstacki, Barbara Tamowicz, Rui Moreno, Eduardo Almeida, Joana Silvestre, Heloisa Castro, Irene Aragão, Susana Alves Ferreira, Nelson Barros, Filomena Faria, Carlos André Correia Casado, Fausto Fialho Moura, Paulo Marcal, Ricardo Matos, Edward Nicolayenko, Mikhail Kirov, Andrey Yaroshetskiy, Andrei Piontek, Valery Subbotin, Yaseen Arabi, Olivia Dulfo, Chafrina Marie Olay, Edgardo E Tabhan, Nicolas Nin, Alfonso Muñoz, César Aragón, Ana Villagrá, Ainhoa Rosselló, Joan Maria Raurich, María Garitacelaya, Miguel Ángel González-Gallego, Francisco Ortuño, Miguel Fernández-Vivas, David Freire, Francisco Guerrero, Francisco Manzano, Juan Carlos, Alfredo Padrón, Pedro Rosa, Rafael Morales, Liliana Caipe, Maurizio Bottiroli, José María Nicolás, Marta Ugalde, Javier Ruiz, Lucia Capilla, Guillermo Muñiz, Jesús Sánchez-Ruiz, Javier Cebrián, Begoña Balerdi, Elena Parreño, Alvaro van Bommel, César Pérez-Calvo, Irene Dot, Javier Blanco, Raquel Manzanedo, José J Blanco, Daniel Fontaneda, Raúl González, Javier Díaz Domínguez, Alfonso Moreno, Antonio Reyes, Ian Carrasco, Itziar Mintegui, Rosa Sebastián, Javier García-Alonso, Carolina Lorencio, Josep Maria Sirvent, Patricia Jimeno, Miguel León, Pedro Galdos, Nuria Alonso, Julia López-Díaz, María Victoria de la Torre, Jorge Vidal Hernández, Nicolás Zamboschi, Francisco Lucena, Gemma Rialp, Raquel Montoiro, Victoria Goñi, María Ángeles Pena, Antonio Maestre, Marc Fabra, Jacinto Baena, Eva Benveniste, Susana Temprano, Jesús Sánchez, Carmen Campos, Sara Cabañes, María Elena Pérez-Losada, José Claudio Leo, Enrique Piacentini, María Del Carmen de la Torre, Laura Álvarez-Montero, Fernando Sánchez, Antonio Viñuales, Bernabé Álvarez, Javier Castañeda, Ángela Alonso, María Isabel Ruiz, Pedro Jesús Domínguez, Marcos Delgado, Eugenio Palazón, Antonio García-Jiménez, Rosa Álvaro, Clara Laplaza Eva Regidor, Enrique Maraví, José María Quiroga, Amalia Martínez de la Gandara, Cecilia Carbayo, María Luisa Navarrete, Manuel Valledor, Raquel Yano, José María Gutiérrez, Javier González-Robledo, Amparo Ferrandiz, Alberto Belenguer, Lidón Mateu, Laura Sayagues, María José Tolón, Nieves Franco, Elena Gallego, Félix Lacoma, Patricia Albert, Vicente Arraez, Mar Gobernado, Susana Moradillo, Carolina Gímenez-Esparza, Teresa Sánchez de Dios, Carlos Marian Crespo, Cecilia Hermosa, Federico Gordo, Genis Carrasco, María Ángeles Alonso, Alejandro Algora, Raúl de Pablo, Sofía García, Ana Carolina Caballero, José María Montón, Teresa Mut, Eva Manteiga, Alejandro de la Serna, Ana Esther Trujillo, Rafael Blancas, Inmaculada Vallverdú, José Manuel Serrano, Miquel Ferrer, Juan Diego Jiménez, Carlos Gallego, Dolores Vila, Luis Marina, Valentín Parra, Juan Ramón Cortés, Chen Chin-Ming, Ai-Chin Cheng, Fekri Abroug, Besbes Mohamed, Imed Chouchene, Mounir Bouaziz, Stambouli Neji, Islem Ouanes, Ayed Samia, Nahit Cakar, Ismail Kati, Ali Aydım Altunkan, Remzi Iscimen, Zafer Dogan, Bilge Çetin, Tayfun Adanir, Sabriye Guvenc, Unase Büyükkoçak, Antonio Anzueto, Ashley Ellis, Gary Kinasewitz, Allan Walkey, Phil Alkana, Gregory A Schmidt, Susan Gillen, Kathleen Lilli, Jennifer Twombley, Denice Wells, Larry Welder, Alejandro Arroliga, Alfredo Vasquez-Sandoval, Vincent John Scott, Craig Cernosek, Christopher Spradley, Dimple Tejwani, Sindhaghatta Venkatram, Gilda Diaz-Fuentes, Amber Monson, Anthony Saleh, Madhav Gudi, George Liziamma, Mohamed A Saad, Crissie De Spirito, Bryan Beatty, Samir Vermani, Crissie Despirito, Zaza Cohen, Amee Patrawalla, Samir Abdelhadi, Rupesh Vakil, Steven Y Chang, Brian Sherman, Rosanna Del Giudice, John Oropell, Timothy D Girard, Cayce Strength, Joyce Okahashi, Leanne Boehm, Matthew Kirchner, Ashley Ellis, Gary Kinasewitz, Erwin J Oei, Sebastian Circo, Nelson Medina, Mohammed Al-Jagbeer, V J Cardenas Jr, Smyth Smith, Shelby Sutton, Marcela Canola-Mazo, Tim Houlihan, Yogeet Kaur, Travis Parry, Craig A Piquette, Kerry Canady, Rahul Nanchal, Dana K Soetaert, Maria Del Mar Torres-Perez, Carlos Robles-Arias, William Rodriguez-Cintron, Mark Tidswell, Jennifer Germain, Lori-Ann Kozikowski, Erin Braden, Geneva Tatem, Javier Hurtado, Alberto Deicas, Daniel Weiss, Marta Beron, Román Garrido, Cristina Santos, Mario Cancela, Raúl Lombardi, Pedro Alzugaray, Jorge Gerez, Silvia Mareque, Graciela Franca, Oscar Cluzet, Edgardo Nuñez, Julio Pontet, Sergio Cáceres, Elias Caragna, Alberto Soler, Frank Torres, Gastón Pittini, Gabriel D Empaire, Stevens Salva, Fernando Pérez, Clara Pacheco, Zoraida Parra, Ingrid Von der Osten, Luis Williams, José Salinas, Do Danh Quynh, Pham Thi Van Anh, Nguyen Huu Hoang, Nghuyen Ba Tuan

Subjects
Male, medicine.medical_treatment, pulmonary complications, RESPIRATORY-DISTRESS-SYNDROME, Critical Care and Intensive Care Medicine, CASE-FATALITY, 0302 clinical medicine, Risk Factors, Brain Injuries, Traumatic, Multicenter Studies as Topic, Hospital Mortality, Prospective Studies, Simplified Acute Physiology Score, Stroke, POPULATION, Age Factors, ANEURYSMAL SUBARACHNOID HEMORRHAGE, Middle Aged, Hemorrhagic Stroke, Intensive Care Units, Observational Studies as Topic, Anesthesia, Breathing, Female, medicine.symptom, Ventilator Weaning, Cohort study, Adult, TRAUMATIC BRAIN-INJURY, Pressure support ventilation, mechanical ventilation, prognosis factors, ACUTE LUNG INJURY, 03 medical and health sciences, medicine, Humans, Aged, Ischemic Stroke, Mechanical ventilation, Noninvasive Ventilation, business.industry, MORTALITY, neurologic patients, Organ dysfunction, 030208 emergency & critical care medicine, Length of Stay, medicine.disease, TRENDS, Respiration, Artificial, 030228 respiratory system, Etiology, NEUROCRITICAL CARE, Nervous System Diseases, Tracheotomy, business
Abstract

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease.

Published
2021
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17. Remdesivir Use in Patients Requiring Mechanical Ventilation due to COVID-19

Author

Lapadula, Giuseppe, Bernasconi, Davide Paolo, Bellani, Giacomo, Soria, Alessandro, Rona, Roberto, Bombino, Michela, Avalli, Leonello, Rondelli, Egle, Cortinovis, Barbara, Colombo, Enrico, Valsecchi, Maria Grazia, Migliorino, Guglielmo Marco, Bonfanti, Paolo, Foti, Giuseppe, Gambaro, Alessandra, Spolti, Anna, Beretta, Ilaria, Bisi, Luca, Cappelletti, Anna, Chiesa, Elisabetta, Cogliandro, Viola, Columpsi, Paola, Foresti, Sergio, Gustinetti, Giulia, Iannuzzi, Francesca, Pollastri, Ester, Rossi, Marianna, Sabbatini, Francesca, Squillace, Nicola, Ferlicca, Daniela, Mauri, Fabrizia, Giani, Marco, Pozzi, Matteo, Russotto, Vincenzo, Lapadula, G, Bernasconi, D, Bellani, G, Soria, A, Rona, R, Bombino, M, Avalli, L, Rondelli, E, Cortinovis, B, Colombo, E, Valsecchi, M, Migliorino, G, Bonfanti, P, and Foti, G

Subjects
Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, critically ill patients, antiviral treatment, coronavirus, remdesivir, 030204 cardiovascular system & hematology, intensive care unit, law.invention, Major Articles, 03 medical and health sciences, 0302 clinical medicine, COVID-19, SARS-CoV-2, Interquartile range, law, Medicine, 030212 general & internal medicine, Survival analysis, Mechanical ventilation, Proportional hazards model, business.industry, Hazard ratio, Intensive care unit, Infectious Diseases, AcademicSubjects/MED00290, Oncology, Anesthesia, Cohort, business
Abstract

Background Remdesivir has been associated with accelerated recovery of severe coronavirus disease 2019 (COVID-19). However, whether it is also beneficial in patients requiring mechanical ventilation is uncertain. Methods All consecutive intensive care unit (ICU) patients requiring mechanical ventilation due to COVID-19 were enrolled. Univariate and multivariable Cox models were used to explore the possible association between in-hospital death or hospital discharge, considered competing-risk events, and baseline or treatment-related factors, including the use of remdesivir. The rate of extubation and the number of ventilator-free days were also calculated and compared between treatment groups. Results One hundred thirteen patients requiring mechanical ventilation were observed for a median of 31 days of follow-up; 32% died, 69% were extubated, and 66% were discharged alive from the hospital. Among 33 treated with remdesivir (RDV), lower mortality (15.2% vs 38.8%) and higher rates of extubation (88% vs 60%), ventilator-free days (median [interquartile range], 11 [0–16] vs 5 [0–14.5]), and hospital discharge (85% vs 59%) were observed. Using multivariable analysis, RDV was significantly associated with hospital discharge (hazard ratio [HR], 2.25; 95% CI, 1.27–3.97; P = .005) and with a nonsignificantly lower mortality (HR, 0.73; 95% CI, 0.26–2.1; P = .560). RDV was also independently associated with extubation (HR, 2.10; 95% CI, 1.19–3.73; P = .011), which was considered a competing risk to death in the ICU in an additional survival model. Conclusions In our cohort of mechanically ventilated patients, RDV was not associated with a significant reduction of mortality, but it was consistently associated with shorter duration of mechanical ventilation and higher probability of hospital discharge, independent of other risk factors.

Published
2020

19. Association between Term Equivalent Brain Magnetic Resonance Imaging and 2-Year Outcomes in Extremely Preterm Infants: A Report from the Preterm Erythropoietin Neuroprotection Trial Cohort

Author

Dennis E. Mayock, Semsa Gogcu, Mihai Puia-Dumitrescu, Dennis W.W. Shaw, Jason N. Wright, Bryan A. Comstock, Patrick J. Heagerty, Sandra E. Juul, Rajan Wadhawan, Sherry E. Courtney, Tonya Robinson, Kaashif A. Ahmad, Ellen Bendel-Stenzel, Mariana Baserga, Edmund F. LaGamma, L. Corbin Downey, Raghavendra Rao, Nancy Fahim, Andrea Lampland, Ivan D. Frantz, Janine Khan, Michael Weiss, Maureen M. Gilmore, Robin K. Ohls, Jean Lowe, Nishant Srinivasan, Jorge E. Perez, Victor McKay, Billy Thomas, Nahed Elhassan, Sarah Mulkey, Vivek K. Vijayamadhavan, Neil Mulrooney, Bradley Yoder, Jordan S. Kase, Jennifer Check, Erin Osterholm, Thomas George, Michael Georgieff, Camilia R. Martin, Deirdre O'Reilly, Raye-Ann deRegnier, Nicolas Porta, Catalina Bazacliu, Frances Northington, Raul Chavez Valdez, Patel Saurabhkumar, Magaly Diaz-Barbosa, Todd Richards, John B. Feltner, Isabella Esposito, Stephanie Hauge, Samantha Nikirk, Amy Silvia, Bailey Clopp, Debbie Ott, Ariana Franco Mora, Pamela Hedrick, Vicki Flynn, Andrea Wyatt, Emilie Loy, Natalie Sikes, Melanie Mason, Jana McConnell, Tiffany Brown, Henry Harrison, Denise Pearson, Tammy Drake, Jocelyn Wright, Debra Walden, Annette Guy, Jennifer Nason, Morgan Talbot, Kristen Lee, Sarah Penny, Terri Boles, Melanie Drummond, Katy Kohlleppel, Charmaine Kathen, Brian Kaletka, Shania Gonzales, Cathy Worwa, Molly Fisher, Tyler Richter, Alexander Ginder, Brixen Reich, Carrie Rau, Manndi Loertscher, Laura Cole, Kandace McGrath, Kimberlee Weaver Lewis, Jill Burnett, Susan Schaefer, Karie Bird, Clare Giblin, Rita Daly, Kristi Lanier, Kelly Warden, Jenna Wassenaar, Jensina Ericksen, Bridget Davern, Mary Pat Osborne, Neha Talele, Evelyn Obregon, Tiglath Ziyeh, Molly Clarke, Rachel E. Wegner, Palak Patel, Molly Schau, Annamarie Russow, Kelly Curry, Lisa Barnhart, Charlamaine Parkinson, Sandra Beauman, Mary Hanson, Elizabeth Kuan, Conra Backstrom Lacy, Edshelee M. Galvis, Susana Bombino, Denise Martinez, Suzi Bell, Corrie Long, Christopher Nefcy, Mark A. Konodi, Phuong T. Vu, Adam Hartman, T. Michael O'Shea, Roberta Ballard, Mike O'Shea, Karl Kuban, and John Widness

Subjects
Male, Pediatrics, medicine.medical_specialty, Placebo, Bayley Scales of Infant Development, Article, Double-Blind Method, Medicine, Humans, Erythropoietin, Periventricular leukomalacia, business.industry, Infant, Newborn, Gestational age, Brain, Infant, Retinopathy of prematurity, medicine.disease, Neuroprotection, Intraventricular hemorrhage, Bronchopulmonary dysplasia, Neurodevelopmental Disorders, Child, Preschool, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Cohort, Female, business
Abstract

Objectives To compare the term equivalent brain magnetic resonance imaging (MRI) findings between erythropoietin (Epo) treated and placebo control groups in infants 240/7-276/7 weeks of gestational age and to assess the associations between MRI findings and neurodevelopmental outcomes at 2 years corrected age. Study design The association between brain abnormality scores and Bayley Scales of Infant Development, Third Edition at 2 years corrected age was explored in a subset of infants enrolled in the Preterm Erythropoietin Neuroprotection Trial. Potential risk factors for neurodevelopmental outcomes such as treatment assignment, recruitment site, gestational age, inpatient complications, and treatments were examined using generalized estimating equation models. Results One hundred ten infants were assigned to Epo and 110 to placebo groups. 27% of MRI scans were rated as normal, and 60%, 10%, and 2% were rated as having mild, moderate, or severe abnormality. Brain abnormality scores did not significantly differ between the treatment groups. Factors that increased the risk of higher brain injury scores included intubation; bronchopulmonary dysplasia; retinopathy of prematurity; opioid, benzodiazepine, or antibiotic treatment >7 days; and periventricular leukomalacia or severe intraventricular hemorrhage diagnosed on cranial ultrasound. Increased global brain abnormality and white matter injury scores at term equivalent were associated with reductions in cognitive, motor, and language abilities at 2 years of corrected age. Conclusions Evidence of brain injury on brain MRIs obtained at term equivalent correlated with adverse neurodevelopmental outcomes as assessed by the Bayley Scales of Infant and Toddler Development, Third Edition at 2 years corrected age. Early Epo treatment had no effect on the MRI brain injury scores compared with the placebo group.

Published
2021

20. A propósito del artículo: El proceso de formación de habilidades investigativas en estudiantes de Medicina mediante el método clínico

Author

Luis Vivas Bombino and Margarita Gonzalez Tapia

Subjects
Medicine, Medicine (General), R5-920
Abstract

Estimado Sr Director. De gran valor resulta la aparición en la Revista de Ciencias Médicas de Pinar del Río. Enero-febrero, 2016; vol. 20 (1) del artículo, tanto por el significado que tiene para el desarrollo científico de la provincia como en la formación del estudiantes de Medicina y el futuro médico revolucionario, como por el resultado de la investigación realizada por los autores, sobre la cual estamos muy a tono, aún más cuando conocemos la problemática. La enseñanza de la Medicina ha estado influenciada por el desarrollo de las ciencias médicas y el modelo de práctica médica imperante, lo cual ha constituido una guía en la conducción del proceso formativo del médico en sus diferentes épocas de manera que el modelo médico se convierte en la aspiración o guía del proceso formativo. Esta premisa conduce al docente a tener una correcta concepción de los modos de actuación que se pretende formar en el futuro egresado y del dominio del método clínico como vía para lograrlo, es decir, las etapas que se deben cumplir durante su aplicación, así como los aspectos que particularizan la aplicación de este método en la asignatura o disciplina que se trate sin olvidar las vías de que dispone el profesor para lograrlo. La incorrecta aplicación del método clínico debido a que la práctica médica ha otorgado prioridad al uso indebido de los procederes diagnósticos en detrimento del juicio clínico, constituye un problema, todo lo cual afecta también su enseñanza, ya que los docentes violentan las etapas establecidas para la aplicación de este método, el cual resulta fundamental para el estudio del paciente, además de ser útil para la formación de habilidades investigativas en estudiantes de la carrera de Medicina. Desde mediados del siglo pasado las ciencias médicas han tenido un gran desarrollo en la técnica, y de cierta manera los especialistas han sido “impulsados” por nuevos medios diagnósticos que con frecuencia superan su propia preparación. Esto pudiera llevar a la falsa idea de que en esta época de tanto adelanto tecnológico con sofisticados equipos de laboratorio clínico, de Microbiología y de imágenes, y de notable desarrollo en la Inmunología y la Genética, el interrogatorio, el examen físico minucioso, el diagnóstico de síntomas y signos, el planteamiento de síndromes y de entidades nosológicas en la cabecera del enfermo van resultando obsoletos y que el método científico aplicado al proceso salud-enfermedad, o sea, el método clínico resulta inadecuado. Considero se hace necesario incorporar de igual manera la enseñanza del método epidemiológico en la enseñanza de habilidades investigativas en los estudiantes, de esa forma contaríamos con una gran herramienta que constituye el método clínico y epidemiológico y ante los actuales perfiles de salud y enfermedad de la población cubana, resulta pertinente revisar algunos vínculos entre el método clínico y el método epidemiológico, que constituyen los métodos conductores para los procesos de revitalización o renovación del sistema de salud, para contribuir a los cambios que se requieren. La revitalización del método clínico, como parte de las transformaciones necesarias del Sistema Nacional de Salud cubano, requiere de incorporar el pensamiento epidemiológico al lenguaje práctico real en el desempeño de los profesionales en un nivel de desarrollo muy superior al actual, para convertir en acciones un discurso en ocasiones en franca obsolescencia, si se compara con los avances que poseen la Clínica y la Epidemiología.

Published
2016

21. Gastrointestinal colonization with multidrug-resistant Gram-negative bacteria during extracorporeal membrane oxygenation: effect on the risk of subsequent infections and impact on patient outcome

Author

Antonio Pesenti, Laura Alagna, Alessandra Bandera, Stefano De Falco, Andrea Gori, Giacomo Grasselli, Nicolò Patroniti, Vittorio Scaravilli, Michela Bombino, and Chiara Abbruzzese

Subjects
Colonization, ARDS, medicine.medical_specialty, Health care-associated infection, medicine.medical_treatment, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Extracorporeal membrane oxygenation, Medicine, 030212 general & internal medicine, Survival rate, Mechanical ventilation, 0303 health sciences, 030306 microbiology, business.industry, Research, Incidence (epidemiology), lcsh:Medical emergencies. Critical care. Intensive care. First aid, Retrospective cohort study, lcsh:RC86-88.9, medicine.disease, Multi-drug resistance, Retrospective study, Etiology, business
Abstract

Background In ICU patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G−) bacteria is a significant risk factor for the development of infections. In patients undergoing extracorporeal membrane oxygenation (ECMO), colonization by MDR bacteria and risk of subsequent nosocomial infections (NIs) have not been studied yet. The aim of this study is to evaluate the incidence, etiology, risk factors, impact on outcome of gastrointestinal colonization by MDR G− bacteria, and risk of subsequent infections in patients undergoing ECMO. Methods This is a retrospective analysis of prospectively collected data: 105 consecutive patients, treated with ECMO, were admitted to the ICU of an Italian tertiary referral center (San Gerardo Hospital, Monza, Italy) from January 2010 to November 2015. Rectal swabs for MDR G− bacteria were cultured at admission and twice a week. Only colonization and NIs by MDR G− bacteria were analyzed. Results Ninety-one included patients [48.5 (37–56) years old, 63% male, simplified acute physiology score II 37 (32–47)] underwent peripheral ECMO (87% veno-venous) for medical indications (79% ARDS). Nineteen (21%) patients were colonized by MDR G− bacteria. Male gender (OR 4.03, p = 0.029) and duration of mechanical ventilation (MV) before ECMO > 3 days (OR 3.57, p = 0.014) were associated with increased risk of colonization. Colonized patients had increased odds of infections by the colonizing germs (84% vs. 29%, p p = 0.002), MV (50 vs. 22 days, p p p = 0.480, OR 0.68). Infected patients had almost halved ICU survival (46% vs. 78%, p Conclusions In patients undergoing ECMO for respiratory and/or circulatory failure, colonization by MDR G− bacteria is frequent and associated with more the tenfold odds for subsequent infection. Those infections are associated with an increased risk of death.

Published
2019

22. Assessment of a Laboratory-Based SARS-CoV-2 Antibody Test Among Hemodialysis Patients: A Quality Improvement Initiative

Author

N. Queija, S. Zeig, K. Swanzy, J. L. Posada, Dena E. Cohen, J. A. Fernandez-Bombino, P. M. Teixeiro, Steven M. Brunelli, M. T. Lemont, L. Garcia-Mayol, M. J. Palecek, Gilbert Marlowe, Zain Mithani, M. A. Sosa, J. A. Giullian, Oliver Lenz, Gabriel Contreras, Mahesh Krishnan, Jair Munoz Mendoza, A. M. V. Miles, and J. S. Jeanty

Subjects
medicine.medical_specialty, biology, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, Arbitrary unit, Asymptomatic, Test (assessment), Internal medicine, Pandemic, medicine, biology.protein, Hemodialysis, Antibody, medicine.symptom, business, Dialysis
Abstract

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although tests to detect anti-SARS-CoV-2 antibodies have been developed, their sensitivity and specificity in hemodialysis patients have not been previously assessed.MethodsAs part of a quality improvement (QI) initiative, nasopharyngeal swabs and predialysis blood samples were collected on the same day from adult patients receiving routine hemodialysis care at clinics managed by a large dialysis organization in the greater Miami, Florida region (23 – 30 Apr 2020). Polymerase chain reaction (PCR) tests for SARS-CoV-2 and chemiluminescence immunoassays for anti-SARS-CoV2 antibodies were performed according to manufacturer-specified protocols.ResultsOf 715 participants in the QI initiative, 38 had symptomatology consistent with COVID-19 prior to or during the initiative. Among these, COVID-19 was PCR-confirmed in 14 and ruled out in 20, with the remaining 4 being inconclusive. Among the 34 patients with known COVID-19 status, the sensitivity and specificity of the antibody test were 57.1% and 85.0% when either antibody was considered. The remaining 677 patients had no record of symptoms consistent with COVID-19, nor any known exposure. Of these, 38 patients (5.6%) tested positive for anti-SARS-CoV-2 antibodies.ConclusionsThe operational characteristics of the laboratory-based antibody test make it sufficient to rule in, but not rule out, SARS-CoV-2 infection in the appropriate clinical circumstance. A substantial proportion of dialysis patients may have had asymptomatic SARS-CoV-2 infection.

Published
2020
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23. Life-threatening cardiogenic shock in a pediatric patient with SARS-CoV-2-associated myocarditis treated with remdesivir: a case description and report of similar cases from the Literature

Author

Giuseppe Lapadula, Silvia Molinari, Michela Bombino, Alessandro Cattoni, Roberto Panceri, Andrea Biondi, Lucia M.D. Colasanto, and Maria Luisa Melzi

Subjects
Pediatric patient, medicine.medical_specialty, Myocarditis, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Cardiogenic shock, medicine, Case description, Intensive care medicine, business, medicine.disease
Abstract

BackgroundChildren are relatively spared from Coronavirus disease 2019 (COVID-19), but some severe cases have been reported. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children may affect the cardiovascular system. We hereby report about a case of myocarditis evolving to cardiogenic shock in a SARS-CoV-2 positive child.Case presentationAn otherwise healthy 12-year-old patient was admitted with fever, vomiting, diarrhoea and drowsiness, without any respiratory symptoms. He was diagnosed with COVID-19 on nasopharyngeal swab. He developed hypotension and cardiogenic shock. Bedside echocardiography revealed left ventricular impairment with an ejection fraction (LVEF) below 25%. Plasmatic markers of myocardial injury were remarkably raised, as well as inflammatory biomarkers, including procalcitonin (highest recorded value: 66 ng/mL) and interleukin-6 (8209 pg/mL). The child was transferred to Intensive Care Unit and he was treated with catecholamine support, mechanical ventilation and empiric anti-infectious therapy, including broad spectrum antibiotics and the antiviral agent remdesivir. All additional microbiological investigations yielded negative results. We observed a gradual improvement of LVEF within 5 days. A cardiac magnetic resonance confirmed the suspicion of myocarditis. After 21 days of hospitalisation, the child was discharged without sequelae.ConclusionsOur hypothesis is that the child suffered from SARS-CoV-2-induced fulminant myocarditis, probably in the setting of cytokine release syndrome (CRS). The peculiarity of this SARS-CoV-2 infection is the presence of cardiac failure in a previously healthy child without a respiratory illness. The positive outcome is in line with published Literature about the overall better prognosis of COVID-19 children compared to adults. Remdesivir, an investigational antiviral therapy, may have played a role on the clinical improvement of the child.

Published
2020
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24. The Impact of Erythropoietin on Short- and Long-Term Kidney-Related Outcomes in Neonates of Extremely Low Gestational Age. Results of a Multicenter, Double-Blind, Placebo-Controlled Randomized Clinical Trial

Author

David J. Askenazi, Patrick J. Heagerty, Robert H. Schmicker, Patrick Brophy, Sandra E. Juul, Stuart L. Goldstein, Sangeeta Hingorani, Bryan A. Comstock, Rajan Wadhawan, Dennis E. Mayock, Sherry E. Courtney, Tonya Robinson, Kaashif A. Ahmad, Ellen Bendel-Stenzel, Mariana Baserga, Edmund F. LaGamma, L. Corbin Downey, Raghavendra Rao, Nancy Fahim, Andrea Lampland, Ivan D. Frantz, Janine Y. Khan, Michael Weiss, Maureen M. Gilmore, Robin Ohls, Nishant Srinivasan, Jorge E. Perez, Victor McKay, Phuong T. Vu, Billy Thomas, Nahed Elhassan, Sarah Mulkey, Philip Dydynski, Vivek K. Vijayamadhavan, Neil Mulrooney, Bradley Yoder, Jordan S. Kase, Jennifer Check, Semsa Gogcu, Erin Osterholm, Sara Ramel, Catherine Bendel, Cheryl Gale, Thomas George, Michael Georgieff, Tate Gisslen, Sixto Guiang, Anne Hall, Dana Johnson, Katie Pfister, Heather Podgorski, Kari Roberts, Erin Stepka, Melissa Engel, Heidi Kamrath, Johannah Scheurer, Angela Hanson, Katherine Satrom, Susan Pfister, Ann Simones, Erin Plummer, Elizabeth Zorn, Camilia R. Martin, Deirdre O'Reilly, Nicolas Porta, Catalina Bazacliu, Jonathan Williams, Dhanashree Rajderkar, Frances Northington, Raul Chavez Valdez, Sandra Beauman, Patel Saurabhkumar, Magaly Diaz-Barbosa, Arturo Serize, Jorge Jordan, Debbie Ott, Ariana Franco Mora, Pamela Hedrick, Vicki Flynn, Amy Silvia, Bailey Clopp, John B. Feltner, Isabella Esposito, Stephanie Hauge, Samantha Nikirk, Andrea Purnell, Emilie Loy, Natalie Sikes, Melanie Mason, Jana McConnell, Tiffany Brown, Henry Harrison, Denise Pearson, Tammy Drake, Jocelyn Wright, Debra Walden, Annette Guy, Jennifer Nason, Morgan Talbot, Kristen Lee, Sarah Penny, Terri Boles, Melanie Drummond, Katy Kohlleppel, Charmaine Kathen, Brian Kaletka, Shania Gonzales, Cathy Worwa, Molly Fisher, Tyler Richter, Alexander Ginder, Brixen Reich, Carrie Rau, Manndi Loertscher, Laura Bledsoe, Kandace McGrath, Kimberlee Weaver Lewis, Jill Burnett, Susan Schaefer, Karie Bird, Clare Giblin, Rita Daly, Kristi Lanier, Kelly Warden, Jenna Wassenaar, Jensina Ericksen, Bridget Davern, Mary Pat Osborne, Brittany Gregorich, Neha Talele, Evelyn Obregon, Tiglath Ziyeh, Molly Clarke, Rachel E. Wegner, Palak Patel, Molly Schau, Annamarie Russow, Kelly Curry, Susan Sinnamon, Lisa Barnhart, Charlamaine Parkinson, Mary Hanson, Elizabeth Kuan, Conra Backstrom Lacy, Edshelee M. Galvis, Susana Bombino, Denise Martinez, Suzi Bell, Corrie Long, Cathy Longa, Michael Westerveld, Stacy McConkey, Anne Hay, Niranjana Natarajan, Shari Gaudette, Sarah Cobb, Gregory Sharp, Elizabeth Schumacher, Leslie Schuschke, Charlotte Frey, Mario Fierro, Lois Gilmore, Pamela Lundequam, Ronald Hoekstra, Anastasia Ketko, Nina Perdue, Sean Cunningham, Kelly Stout, Becky Hall, Galina Morshedzadeh, Betsy Ostrander, Sarah Winter, Lauren Cox, Matthew A. Rainaldi, Sarah Hensley, Melissa Morris, Dia Roberts, Melissa Tuttle, Christopher Boys, Solveig Hultgren, Elizabeth I. Pierpont, Tom George, Kelly E. King, Katherine Bataglia, Cathy Neis, Mark Bergeron, Cristina Miller, Cara Accomando, Jennifer Anne Gavin, Elizabeth Maczek, Susan Marakovitz, Aimee Knorr, Vincent C. Smith, Jane E. Stewart, Marie Weissbourd, Raye-Ann deRegnier, Nana Matoba, Shelly C. Heaton, Erika M. Cascio, Janet Brady, Suman Ghosh, Jessica Ditto, Mary Leppert, Jean Lowe, Janell Fuller, Tara DuPont, Pamela Kloska, Saurabh Patel, Lauren Carbonell, Anna Maria Patino-Fernandez, Carmen de Lerma, Kelly McDonough, Maiana De Cortada, Lacy Chavis, Jane Shannon, Mark A. Konodi, Christopher Nefcy, Karl C.K. Kuban, Jean R. Lowe, T. Michael O'Shea, Manjiri Dighe, Todd Richards, Dennis W.W. Shaw, Colin Studholme, Christopher M. Traudt, Roberta Ballard, Adam Hartman, Scott Janis, T. Robin Ohls, Michael O'Shea, Ronnie Guillet, M. Bethany Ball, Hannah Glass, Ben Saville, and Michael Schreiber

Subjects
Male, medicine.medical_specialty, Renal function, Gestational Age, Infant, Premature, Diseases, Placebo, Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Double-Blind Method, law, 030225 pediatrics, Internal medicine, medicine, Albuminuria, Humans, 030212 general & internal medicine, Renal Insufficiency, Chronic, Erythropoietin, business.industry, Acute kidney injury, Infant, Newborn, Gestational age, Acute Kidney Injury, medicine.disease, Recombinant Proteins, Blood pressure, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Hypertension, Female, medicine.symptom, business, medicine.drug, Glomerular Filtration Rate
Abstract

OBJECTIVE: To evaluate whether extremely low gestational age neonates (ELGANs) randomized to erythropoietin have better or worse kidney-related outcomes during hospitalization and at 22–26 months corrected gestational age (cGA) compared with those randomized to placebo. STUDY DESIGN: We performed an ancillary study to a multicenter double-blind, placebo-controlled randomized clinical trial of erythropoietin in ELGANs. RESULTS: The prevalence of severe (stage 2 or 3) acute kidney injury (AKI) was 18.2%. We did not find a statistically significant difference between those randomized to erythropoietin vs. placebo for in-hospital primary (severe AKI) or secondary outcomes (any AKI and serum creatinine [SCr]/ cystatin C values at days 0, 7, 9 and 14). At 22–26 months cGA, 16% of the cohort had an estimated glomerular filtration rate (eGFR) 30 mg/g, 23% had a systolic blood pressure (SBP) >95(th) percentile for age, and 40% had a diastolic blood pressure (DBP) >95(th) percentile for age. SBP >90(th) percentile occurred less often among recipients of erythropoietin (p95(th) percentile or DBP >90(th) or >95(th) percentiles. CONCLUSIONS: ELGANs have high rates of in-hospital AKI and kidney-related problems at 22–26 months cGA. Recombinant erythropoietin (rhEpo) may protect ELGANs against long-term elevated SBP, but does not appear to protect from AKI, low eGFR, albuminuria or elevated DBP at 22–26 months cGA.

Published
2020

25. Intuitive Real-Time Multidimensional Diagnostic Sonographic Image Optimization Technology

Author

Leonardo Forzoni, Luca Bombino, Giampaolo Borreani, Carlo Biagini, and Roberto Pesce

Subjects
0209 industrial biotechnology, Pathology, medicine.medical_specialty, Radiological and Ultrasound Technology, business.industry, 030208 emergency & critical care medicine, 02 engineering and technology, Image (mathematics), 03 medical and health sciences, 020901 industrial engineering & automation, 0302 clinical medicine, Operator (computer programming), Diagnostic medical sonography, Medicine, Radiology, Nuclear Medicine and imaging, Computer vision, Artificial intelligence, business
Abstract

Diagnostic medical sonography (DMS) is an operator and patient dependent examination where anatomical and hemodynamic analysis settings have to be adjusted in real-time while scanning. Several techniques were developed so far to perform the DMS acquisition and post processing adjustments quickly and to maximize their easiness. A new easyMode Technology was recently implemented in order to drastically simplify the operator system setup to only three macro-parameters related to the desired effect in terms of: resolution/penetration, contrast/soft, smooth/sharp. A multidimensional algorithm varies simultaneously several internal system parameters to modify the image in the direction of the macro-parameter varied by the user. No prior knowledge of ultrasound physics or technology is required to adjust the macro-parameter, the effects of which are directly visible on the sonographic image in real-time (for instance, to optimize the level of smoothness with respect to sonographic image contrast). The aim of the easyMode is to increase productivity, reduce sonographer’s work-related musculoskeletal disorders due to extensive use of the ultrasound system control panel, and increase diagnostic confidence based on the intuitive optimization of the sonographer’s desired effect, instead of an engineering approach to real-time scanning optimization.

Published
2017
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26. Nosocomial infections during extracorporeal membrane oxygenation: Incidence, etiology, and impact on patients' outcome

Author

Antonio Pesenti, Andrea Gori, Stefano Biffi, Michela Bombino, Luca Bisi, Vittorio Scaravilli, Nicolò Patroniti, Stefano Di Bella, Giacomo Grasselli, Laura Alagna, Anna Maria Peri, Grasselli, G., Scaravilli, V., Di Bella, S., Biffi, S., Bombino, M., Patroniti, N., Bisi, L., Peri, A. M., Pesenti, A., Gori, A., and Alagna, L.

Subjects
Male, medicine.medical_treatment, retrospective study, Drug Resistance, Bacteremia, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, intensive care unit, law.invention, 0302 clinical medicine, Retrospective Studie, law, Risk Factors, Drug Resistance, Multiple, Bacterial, Age Factor, health care-associated infection, Child, Cross Infection, Incidence (epidemiology), Incidence, Age Factors, Bacterial, Pneumonia, Ventilator-Associated, Middle Aged, Intensive care unit, Intensive Care Units, Ventilator-Associated, Italy, extracorporeal membrane oxygenation, multidrug resistance, Adolescent, Adult, Catheter-Related Infections, Child, Preschool, Extracorporeal Membrane Oxygenation, Female, Humans, Length of Stay, Retrospective Studies, Urinary Tract Infections, Young Adult, Multiple, Human, medicine.medical_specialty, Intensive Care Unit, Extracorporeal, 03 medical and health sciences, medicine, Extracorporeal membrane oxygenation, Intensive care medicine, Preschool, Catheter-Related Infection, business.industry, Risk Factor, 030208 emergency & critical care medicine, Retrospective cohort study, Pneumonia, medicine.disease, Urinary Tract Infection, Emergency medicine, Etiology, business
Abstract

OBJECTIVE: To study incidence, type, etiology, risk factors, and impact on outcome of nosocomial infections during extracorporeal membrane oxygenation. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Italian tertiary referral center medical-surgical ICU. PATIENTS: One hundred five consecutive patients who were treated with extracorporeal membrane oxygenation from January 2010 to November 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Ninety-two patients were included in the analysis (48.5 [37-56] years old, simplified acute physiology score II 37 [32-47]) who underwent peripheral extracorporeal membrane oxygenation (87% veno-venous) for medical indications (78% acute respiratory distress syndrome). Fifty-two patients (55%) were infected (50.4 infections/1,000 person-days of extracorporeal membrane oxygenation). We identified 32 ventilator-associated pneumonia, eight urinary tract infections, five blood stream infections, three catheter-related blood stream infections, two colitis, one extracorporeal membrane oxygenation cannula infection, and one pulmonary-catheter infection. G+ infections (35%) occurred earlier compared with G- (48%) (4 [2-10] vs. 13 [7-23] days from extracorporeal membrane oxygenation initiation; p < 0.001). Multidrug-resistant organisms caused 56% of bacterial infections. Younger age (2-35 years old) was independently associated with higher risk for nosocomial infections. Twenty-nine patients (31.5%) died (13.0 deaths/1,000 person-days of extracorporeal membrane oxygenation). Infected patients had higher risk for death (18 vs. 8 deaths/1,000 person-days of extracorporeal membrane oxygenation; p = 0.037) and longer ICU stay (32.5 [19.5-78] vs. 19 [10.5-27.5] days; p = 0.003), mechanical ventilation (36.5 [20-80.5] vs. 16.5 [9-25.5] days; p < 0.001), and extracorporeal membrane oxygenation (25.5 [10.75-54] vs. 10 [5-13] days; p < 0.001). Older age (> 50 years old), reason for connection different from acute respiratory distress syndrome, higher simplified acute physiology score II, diagnosis of ventilator-associated pneumonia, and infection by multidrug-resistant bacteria were independently associated to increased death rate. CONCLUSIONS: Infections (especially ventilator-associated pneumonia) during extracorporeal membrane oxygenation therapy are common and frequently involve multidrug-resistant organisms. In addition, they have a negative impact on patients' outcomes.

Published
2017

27. ECMO for intractable status asthmaticus following atracurium

Author

Antonio Pesenti, Michela Bombino, Vittorio Scaravilli, Annalisa Benini, Uta Emmig, Nicolò Patroniti, Giacomo Grasselli, Alberto Zanella, and Daniele Ceriani

Subjects
Adult, Nephrology, medicine.medical_specialty, medicine.medical_treatment, Status Asthmaticus, Biomedical Engineering, Medicine (miscellaneous), Bronchial spasm, Bronchospasm, Hypercapnia, Biomaterials, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Internal medicine, medicine, Extracorporeal membrane oxygenation, Humans, Anaphylaxis, business.industry, Respiratory insufficiency, Atracurium, Female, Neuromuscular Nondepolarizing Agents, Respiratory Insufficiency, Cardiology and Cardiovascular Medicine, Thyroidectomy, 030208 emergency & critical care medicine, medicine.disease, Cardiac surgery, Surgery, surgical procedures, operative, Anesthesia, Hypercapnic Acidosis, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Intraoperative allergic reactions are rare but serious events associated with increased morbidity and mortality. We report the salvage of intraoperative anaphylaxis leading to extreme hypercapnic respiratory failure by veno-venous extracorporeal membrane oxygenation (ECMO). A 38-year-old woman undergoing thyroidectomy developed intractable bronchospasm after administration of atracurium, leading to extreme hypercapnic respiratory failure (PaCO2 > 250 mmHg, pH 6.773). After the failure of conventional medical therapy and ventilatory optimization, the patient was connected to a veno-venous ECMO circuit. PaCO2 of 45.6 mmHg and pH of 7.25 were achieved in 1 h, by slowly increasing sweep gas flows up to 3.5 L/min and using continuous end-tidal CO2 monitoring to gauge the procedure. After extubation and disconnection from ECMO, the patient was discharged on the 6th day without sequelae. Rapid reversal of extreme hypercapnic acidosis by ECMO was feasible, without any neurologic sequelae. Veno-venous ECMO support may be a valuable option for the salvage of intraoperative anaphylaxis.

Published
2016
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28. Six-Month outcome of immunocompromised patients with severe acute respiratory distress syndrome rescued by extracorporeal membrane oxygenation. An international multicenter retrospective study

Author

Matthieu Schmidt, Peter Schellongowski, Nicolò Patroniti, Fabio Silvio Taccone, Dinis Reis Miranda, Jean Reuter, Helène Prodanovic, Marc Pierrot, Amandine Dorget, Sunghoon Park, Martin Balik, Alexandre Demoule, Ilaria Alice Crippa, Alain Mercat, Philipp Wohlfarth, Romain Sonneville, Alain Combes, Lila Bouadma, Jean-Francois Timsit, Alexandre Brasseur, Olivier Lheureux, Jacques Creteur, Philippe Lemaitre, Xavier Bechtold, Gerdy Debeuckelaere, Franky Partipilo, Robert van Thiel, Corstiaan den Uil, Jan Rulisek, Petr Kopecky, Jan Kunstyr, Michela Bombino, Jonata Pizzagalli, Alessandra Ponti, Antonio Pesenti, Hyoung Soo Kim, Charles-Edouard Luyt, Nicolas Bréchot, Guillaume Hékimian, Sébastien Besset, Maxime Coutrot, Ania Nieszkowska, Simon Bourcier, Guillaume Lebreton, Pascal Leprince, Julien Mayaux, Hélène Prodanovic, Andja Bojic, Nina Buchtele, Alexander Hermann, Peter Jaksch, Oliver Robak, Wolfgang R. Sperr, Thomas Staudinger, International ECMO Network (ECMONet), REVA Research Network, IDEA Study Group, Schmidt, M, Schellongowski, P, Patroniti, N, Taccone, F, Reis Miranda, D, Reuter, J, Prodanovic, H, Pierrot, M, Dorget, A, Park, S, Balik, M, Demoule, A, Crippa, I, Mercat, A, Wohlfarth, P, Sonneville, R, and Combes, A

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Acute respiratory distress, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Immunocompromised Host, 0302 clinical medicine, Internal medicine, medicine, Extracorporeal membrane oxygenation, extracorporeal membrane oxygenation, acute respiratory distress syndrome, immunodeficiency, outcome, hematological malignancies, Humans, hematological malignancies, Immunodeficiency, Retrospective Studies, Respiratory Distress Syndrome, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, Original Articles, extracorporeal membrane oxygenation, acute respiratory distress syndrome, medicine.disease, Respiration, Artificial, 3. Good health, surgical procedures, operative, 030228 respiratory system, outcome, Human medicine, business, immunodeficiency
Abstract

Rationale: Because encouraging rates for hospital and long-term survival of immunocompromised patients in ICUs have been described, these patients are more likely to receive invasive therapies, like extracorporeal membrane oxygenation (ECMO). Objectives: To report outcomes of immunocompromised patients treated with ECMO for severe acute respiratory distress syndrome (ARDS) and to identify their pre-ECMO predictors of 6-month mortality and main ECMO-related complications. Methods: Retrospective multicenter study in 10 international ICUs with high volumes of ECMO cases. Immunocompromised patients, defined as having hematological malignancies, active solid tumor, solid-organ transplant, acquired immunodeficiency syndrome, or long-term or high-dose corticosteroid or immunosuppressant use, and severe ECMO-treated ARDS, from 2008 to 2015 were included. Measurements and Main Results: We collected demographics, clinical data, ECMO-related complications, and ICU- and 6 month–outcome data for 203 patients (median Acute Physiology and Chronic Health Evaluation II score, 28 [25th–75th percentile, 20–33]; age, 51 [38–59] yr; Pa(O(2))/Fi(O(2)), 60 [50–82] mm Hg before ECMO) who fulfilled our inclusion criteria. Six-month survival was only 30%, with a respective median ECMO duration and ICU stay of 8 (5–14) and 25 (16–50) days. Patients with hematological malignancies had significantly poorer outcomes than others (log-rank P = 0.02). ECMO-related major bleeding, cannula infection, and ventilator-associated pneumonia were frequent (36%, 10%, and 50%, respectively). Multivariate analyses retained fewer than 30 days between immunodeficiency diagnosis and ECMO cannulation as being associated with lower 6-month mortality (odds ratio, 0.32 [95% confidence interval, 0.16–0.66]; P = 0.002), and lower platelet count, higher Pco(2), age, and driving pressure as independent pre-ECMO predictors of 6-month mortality. Conclusions: Recently diagnosed immunodeficiency is associated with a much better prognosis in ECMO-treated severe ARDS. However, low 6-month survival of our large cohort of immunocompromised patients supports restricting ECMO to patients with realistic oncological/therapeutic prognoses, acceptable functional status, and few pre-ECMO mortality-risk factors.

Published
2018

29. A mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation support

Author

P. Cadringher, Antonio Pesenti, Domenico Salerno, Giacomo Grasselli, Federico Magni, Vittorio Scaravilli, Luigi Castagna, Marco Giani, Alberto Zanella, Nicolò Patroniti, Michela Bombino, Eleonora Carlesso, Zanella, A, Salerno, D, Scaravilli, V, Giani, M, Castagna, L, Magni, F, Carlesso, E, Cadringher, P, Bombino, M, Grasselli, G, Patroniti, N, and Pesenti, A

Subjects
Male, Cardiac output, medicine.medical_treatment, Hemodynamics, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Oxygen, Decision Support Technique, 0302 clinical medicine, Theoretical, Retrospective Studie, Models, Theoretical model, Oximetry, Blood circulation, Extracorporeal circulation, Extracorporeal membrane oxygenation, Oxygen consumption, Theoretical models, Adult, Decision Support Techniques, Female, Humans, Hypoxia, Middle Aged, Models, Biological, Models, Theoretical, Partial Pressure, Retrospective Studies, Software, Cardiac Output, Extracorporeal Membrane Oxygenation, Oxygen Consumption, Anesthesia, Human, chemistry.chemical_element, Extracorporeal, 03 medical and health sciences, medicine, Hemodynamic, business.industry, Blood flow, Oxygenation, Biological, 030228 respiratory system, chemistry, business
Abstract

Purpose To develop a mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation (vv-ECMO). Material and methods Total oxygen consumption, cardiac output, blood flow, recirculation, intrapulmonary shunt, hemoglobin, natural lung, and membrane lung oxygen fractions were chosen as inputs. Content, partial pressure, and hemoglobin saturation of oxygen in arterial, venous, pulmonary, and extracorporeal blood were outputs. To assess accuracy and predictive power of the model, we retrospectively analyzed data of 25 vv-ECMO patients. We compiled 2 software (with numerical, 2D and 3D graphical outputs) to study the impact of each variable on oxygenation. Results The model showed high accuracy and predictive power. Raising blood flow and oxygen fraction to the membrane lung or reducing total oxygen consumption improves arterial and venous oxygenation, especially in severe cases; raising oxygen fraction to the natural lung improves oxygenation only in milder cases; raising hemoglobin always improves oxygenation, especially in the venous district; recirculation fraction severely impairs oxygenation. In severely ill patients, increasing cardiac output worsens arterial oxygenation but enhances venous oxygenation. Oxygen saturation of ECMO inlet is critical to evaluate the appropriateness of oxygen delivery. Conclusions The model with the software can be a useful teaching tool and a valuable decision-making aid for the management of hypoxic patients supported by vv-ECMO.

Published
2016

30. Effectiveness of using a new polyurethane foam multi-layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: A pragmatic randomised controlled trial

Author

Arianna Vitulli, Pina Gallerani, Alfredo Amodeo, Caterina Bombino, Patrizia Taddia, Fabio D'Alessandro, Cristiana Forni, Sandra Mini, Andrea Bolzon, Laura Rocchegiani, Guglielmo Celli, Rossana Genco, and Teresa Notarnicola

Subjects
Male, medicine.medical_specialty, Sacrum, Polyurethanes, Dermatology, Occlusive Dressings, pressure ulcer prevention, law.invention, 030207 dermatology & venereal diseases, 03 medical and health sciences, Health services, 0302 clinical medicine, Randomized controlled trial, law, medicine, Humans, 030212 general & internal medicine, Multi layer, polyurethane foam dressing, Aged, High rate, Aged, 80 and over, Pressure Ulcer, Hip fracture, business.industry, Hip Fractures, Original Articles, medicine.disease, Surgery, Occlusive dressing, Treatment Outcome, hip fracture, Relative risk, Female, Original Article, business
Abstract

Hip fractures in the elderly are a serious problem for the health service due to the high rate of complications. One of these complications is pressure ulcers that, according to the literature, occur in 8.8% to 55% of patients and mainly arise in the sacral area. The present randomised controlled trial tests whether applying a new innovative multi-layer polyurethane foam dressing (ALLEVYN LIFE™), reduces the onset of pressure ulcers in the sacral area. From March to December 2016, 359 fragility hip fracture patients were randomly divided into 2 groups: 182 in the control group and 177 in the experimental group. Pressure ulcers occurred overall in 36 patients (10%): 8 patients (4.5%) in the experimental group compared to 28 (15.4%) in the control group: P = 0.001, relative risk 0.29 (95% CI 0.14-0.61) with NNT of 9 (95% CI 6-21). In the experimental group the onset of pressure ulcers occurred on average on the 6th day compared to the 4th day in the control group (HR 4.4). Using polyurethane foam is effective at reducing the rate of pressure ulcers in the sacrum in elderly patients with hip fracture. The adhesiveness of this device also enables costs to be kept down.

Published
2017

31. Partial or Total Extracorporeal Support

Author

Nicolò Patroniti, Stefano Isgrò, and Michela Bombino

Subjects
medicine.medical_specialty, ARDS, business.industry, medicine.medical_treatment, Blood flow, Oxygenation, medicine.disease, Extracorporeal, Artificial lung, surgical procedures, operative, Blood pressure, Internal medicine, Extracorporeal membrane oxygenation, medicine, Cardiology, business, Venous return curve
Abstract

Extracorporeal membrane oxygenation (ECMO) is one of the terms used to describe a number of different techniques used for prolonged cardiac and/or respiratory support. During ECMO a fraction of the patient venous return is diverted through an artificial lung for gas exchange (oxygenation and CO2 removal) and then returned to the patient. Depending on the returning vessel (venous or arterial), ECMO can be used for cardiac (veno-arterial bypass (VA-ECMO)) or respiratory support. For respiratory support blood can be drained either from a venous vessel (veno-venous ECMO (VV-ECMO)) or from an arterial vessel (arteriovenous bypass (AV-ECMO)). During VV and VA-ECMO, the blood is withdrawn from the patient through the action of a pump, whereas during AV-ECMO, the blood flow is driven by the patient’s arterial pressure. For respiratory support in ARDS patients, VV-ECMO represents the simplest and more rational choice [1]. Depending on the extracorporeal blood flow (ECBF), VV-ECMO can be used to support both oxygenation and CO2 removal (ECBF 3–7 l/min, total extracorporeal support) or to provide mainly CO2 removal (ECBF 0.5–2.5 l/min, partial extracorporeal support). This chapter will focus mainly on the application of VV-ECMO in ARDS patient.

Published
2017
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32. Pentraxin 3 in acute respiratory distress syndrome: An early marker of severity*

Author

Nicolò Patroniti, Antonio Pesenti, Giacomo Bellani, Tommaso Mauri, Alberto Mantovani, Giuseppe Peri, Andrea Coppadoro, Michela Bombino, Mauri, T, Coppadoro, A, Bellani, G, Bombino, M, Patroniti, N, Peri, G, Mantovani, A, and Pesenti, A

Subjects
medicine.medical_specialty, Resuscitation, Acute respiratory distress syndrome, Inflammation, Marker, Multiple organ failure, Outcome, Pentraxin 3, Sepsis, Critical Care and Intensive Care Medicine, Lung injury, Pentraxi 3, Gastroenterology, Interquartile range, Internal medicine, Intensive care, Medicine, MED/41 - ANESTESIOLOGIA, Respiratory distress, Pentraxins, biology, business.industry, Respiratory disease, medicine.disease, Immunology, biology.protein, business
Abstract

OBJECTIVE: Pentraxin 3 is a fluid phase receptor involved in innate immunity. It belongs to the Pentraxins family, as C-reactive protein does. Pentraxin 3 is produced by a variety of tissue cells, whereas only the liver produces C-reactive protein. Pentraxin 3 plays a unique role in the regulation of inflammation. Acute lung injury and acute respiratory distress syndrome are characterized by an important inflammatory reaction. We investigated the role of pentraxin 3 as a marker of severity and outcome predictor of acute lung injury and acute respiratory distress syndrome. DESIGN: We measured circulating pentraxin 3 and C-reactive protein levels within 24 hrs from intubation (day 1), after 24 hrs from the first sample, then every 3 days for the first month and then once a week, until discharge from the intensive care unit. Pentraxin 3 was also measured in bronchoalveolar lavages, performed when clinically indicated. SETTING: One university medical center general intensive care unit. PATIENTS: The study included 21 patients affected by acute lung injury and acute respiratory distress syndrome (1994 Consensus Conference criteria). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Pentraxin 3 plasma levels were high with a peak on the first day (median 71.05 ng/mL, interquartile range 52.37-117.38 ng/mL, normal values

Published
2008
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33. Percutaneous Bridge to Heart Transplantation by Venoarterial ECMO and Transaortic Left Ventricular Venting

Author

Luciano Gattinoni, V. Colombo, F. Rossi, Antonio Pesenti, G. Osculati, M. Bombino, P. Ferrazzi, M. Borelli, Roberto Fumagalli, Fumagalli, R, Bombino, M, Borelli, M, Rossi, F, Colombo, V, Osculati, G, Ferrazzi, P, Pesenti, A, and Gattinoni, L

Subjects
Adult, Male, Aortic valve, Cardiac Catheterization, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Shock, Cardiogenic, 030232 urology & nephrology, Biomedical Engineering, Medicine (miscellaneous), Bioengineering, Femoral artery, 030204 cardiovascular system & hematology, Biomaterials, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Percutaneous bridge, heart transplantation, venoarterial, ECMO, transaortic, left ventricular venting, Internal medicine, medicine.artery, Preoperative Care, medicine, Humans, Heart transplantation, business.industry, Cardiogenic shock, General Medicine, medicine.disease, Pulmonary edema, Surgery, Life Support Care, Catheter, medicine.anatomical_structure, Ventricle, Cardiology, Heart Transplantation, business
Abstract

We report a case in which life support for cardiogenic shock was achieved by a nonpulsatile venoarterial bypass, and left ventricular decompression was obtained by a catheter placed percutaneously through the aortic valve into the left ventricle. The blood drained from the left ventricle was pumped into the femoral artery. The normalization of left heart filling pressures allowed the resolution of pulmonary edema, and the patient underwent a successful heart transplantation following 7 days of mechanical cardiocirculatory support. © Wichtig Editore, 2004.

Published
2004
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34. Alveolar pentraxin 3 as an early marker of microbiologically confirmed pneumonia: a threshold-finding prospective observational study

Author

Edward A. Bittner, Paolo Brambilla, Marina Sironi, Tommaso Mauri, Alberto Mantovani, Barbara Bottazzi, Ulrich Schmidt, Andrea Coppadoro, Antonio Pesenti, Michela Bombino, Carla Fornari, Lorenzo Berra, Vanessa Zambelli, Giacomo Bellani, Mauri, T, Coppadoro, A, Bombino, M, Bellani, G, Zambelli, V, Fornari, C, Berra, L, Bittner, E, Schmidt, U, Sironi, M, Bottazzi, B, Brambilla, P, Mantovani, A, and Pesenti, A

Subjects
Adult, Calcitonin, Male, medicine.medical_specialty, Calcitonin Gene-Related Peptide, Pneumonia, Viral, Critical Care and Intensive Care Medicine, Sensitivity and Specificity, Gastroenterology, Procalcitonin, Diagnosis, Differential, Intensive care, Internal medicine, Pneumonia, Bacterial, medicine, Humans, Prospective Studies, Protein Precursors, Prospective cohort study, Aged, Univariate analysis, medicine.diagnostic_test, biology, business.industry, Research, C-reactive protein, Bacterial pneumonia, Middle Aged, medicine.disease, Respiration, Artificial, respiratory tract diseases, Intensive Care Units, Serum Amyloid P-Component, Pneumonia, C-Reactive Protein, Bronchoalveolar lavage, ROC Curve, Immunology, biology.protein, Female, business, Bronchoalveolar Lavage Fluid, Biomarkers, Pentraxin 3, pneumonia
Abstract

Introduction Timely diagnosis of pneumonia in intubated critically ill patients is rather challenging. Pentraxin 3 (PTX3) is an acute-phase mediator produced by various cell types in the lungs. Animal studies have shown that, during pneumonia, PTX3 participates in fine-tuning of inflammation (for example, microbial clearance and recruitment of neutrophils). We previously described an association between alveolar PTX3 and lung infection in a small group of intubated patients. The aim of the present study was to determine a threshold level of alveolar PTX3 with elevated sensitivity and specificity for microbiologically confirmed pneumonia. Methods We recruited 82 intubated patients from two intensive care units (San Gerardo Hospital, Monza, Italy, and Massachusetts General Hospital, Boston, MA, USA) undergoing bronchoalveolar lavage (BAL) as per clinical decision. We collected BAL fluid and plasma samples, together with relevant clinical and microbiological data. We assayed PTX3 and soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) in BAL fluid and PTX3, sTREM-1, C-reactive protein (CRP) and procalcitonin (PCT) in plasma. Two blinded independent physicians reviewed patient data to confirm pneumonia. We determined the PTX3 threshold in BAL fluid for pneumonia and compared it to other biomarkers. Results Microbiologically confirmed pneumonia of bacterial (n =12), viral (n =4) or fungal (n =8) etiology was diagnosed in 24 patients (29%). PTX3 levels in BAL fluid predicted pneumonia with an area under the receiving operator curve of 0.815 (95% CI =0.710 to 0.921, P

Published
2014

35. Torsade de Pointes due to Methadone Use in a Patient with HIV and Hepatitis C Coinfection

Author

Gerald Hollander, Gabriel Bombino, Bernard Topi, Xixi Amley, Chaim Gitelis, Jinu John, and Joydeep Ghosh

Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system, Pediatrics, medicine.medical_specialty, business.industry, Human immunodeficiency virus (HIV), MEDLINE, Case Report, Hepatitis C, medicine.disease_cause, medicine.disease, Multiple factors, lcsh:RC666-701, medicine, Coinfection, Cardiology and Cardiovascular Medicine, business, Methadone, medicine.drug
Abstract

We present a case of Torsade de Pointes secondary to multiple factors including patient susceptibility and iatrogenic influences. Contributing causes are presented, and the approach to treatment is discussed.

Published
2010
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36. Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: the ECMOnet score

Author

Pappalardo F, Pieri M, Greco T, Patroniti N, Pesenti A, Arcadipane A, Ranieri VM, Gattinoni L, Landoni G, Holzgraefe B, Beutel G, Zangrillo A, Italian E.C.M.O.n.e.t. Scandroglio AM, Calabrò MG, Bove T, De Bonis M, Foti G, Bombino M, Peris A, Cianchi G, Pasquini A, Braschi A, Mojoli F, Zanierato M, Iotti GA, Belliato M, Carnevale L, Terragni P, Urbino R, Del Sorbo L, Fanelli V, Panarello G, Antonelli M, Bello G, Maviglia R, Lissoni A, Crotti S, Pietropaoli P, Rocco M, Morelli A, Frascaroli G, Caramelli F, Bruno F, Grasso S, Lorini L, Ori C., TUFANO, ROSALBA, IANNUZZI, MICHELE, Pappalardo, F, Pieri, M, Greco, T, Patroniti, N, Pesenti, A, Arcadipane, A, Ranieri, V, Gattinoni, L, Landoni, G, Holzgraefe, B, Beutel, G, Zangrillo, A, Lorini, F, Ranieri, Vm, Federico Pappalardo, Marina Pieri, Teresa Greco, Nicolò Patroniti, Antonio Pesenti, Antonio Arcadipane, V. Marco Ranieri, Luciano Gattinoni, Giovanni Landoni, Bernhard Holzgraefe, Gernot Beutel, Alberto Zangrillo, Scandroglio AM, Italian E. C. M. O. n. e. t., Calabrò, Mg, Bove, T, De Bonis, M, Foti, G, Bombino, M, Peris, A, Cianchi, G, Pasquini, A, Braschi, A, Mojoli, F, Zanierato, M, Iotti, Ga, Belliato, M, Carnevale, L, Terragni, P, Urbino, R, Del Sorbo, L, Fanelli, V, Panarello, G, Antonelli, M, Bello, G, Maviglia, R, Lissoni, A, Crotti, S, Pietropaoli, P, Rocco, M, Morelli, A, Frascaroli, G, Caramelli, F, Tufano, Rosalba, Iannuzzi, Michele, Bruno, F, Grasso, S, Lorini, L, and Ori, C.

Subjects
Adult, Male, medicine.medical_specialty, ARDS, medicine.medical_treatment, ECMO -ARDS - H1N1, venovenous extracorporeal membrane oxygenation (VV ECMO), H1N1 virus, Critical Care and Intensive Care Medicine, Risk Assessment, Veins, Cohort Studies, Influenza A Virus, H1N1 Subtype, Acute respiratory distress syndrome, ECMO, Extracorporeal membrane oxygenation, Mortality, Multiple organ failure, Female, Humans, Influenza, Human, Prospective Studies, Respiratory Distress Syndrome, Adult, Survival Rate, Extracorporeal Membrane Oxygenation, Anesthesiology, Influenza A Virus, Medicine, H1N1 Subtype, MED/41 - ANESTESIOLOGIA, Intensive care medicine, Prospective cohort study, Survival rate, Respiratory Distress Syndrome, business.industry, medicine.disease, Influenza, ECMO: H1N1, Pneumonia, surgical procedures, operative, Respiratory failure, business, Cohort study, Human
Abstract

PURPOSE: The decision to start venovenous extracorporeal membrane oxygenation (VV ECMO) is commonly based on the severity of respiratory failure, with little consideration of the extrapulmonary organ function. The aim of the study was to identify predictors of mortality and to develop a score allowing a better stratification of patients at the time of VV ECMO initiation. METHODS: This was a prospective multicenter cohort study on 60 patients with influenza A (H1N1)-associated respiratory distress syndrome participating in the Italian ECMOnet data set in the 2009 pandemic. Criteria for ECMO institution were standardized according to national guidelines. RESULTS: The survival rate in patients treated with ECMO was 68%. Significant predictors of death before ECMO institution by multivariate analysis were hospital length of stay before ECMO institution (OR=1.52, 95% CI 1.12-2.07, p=0.008); bilirubin (OR=2.32, 95% CI 1.52-3.52, p&nbsp

Published
2013

37. Assessment of the effects of check-dams on riparian vegetation in the mediterranean environment: A methodological approach and example application

Author

Giuseppe Bombino, Vincenzo Tamburino, and Santo Marcello Zimbone

Subjects
Canopy, Hydrology, geography, Environmental Engineering, geography.geographical_feature_category, Management, Monitoring, Policy and Law, Habitat, Vegetation type, medicine, Environmental science, medicine.symptom, Transect, Vegetation (pathology), Nature and Landscape Conservation, Riparian zone, Check dam, Global biodiversity
Abstract

The paper illustrates some criteria for the assessment of the direct effects of check-dams on riparian vegetation. The paper develops a methodology to investigate such effects, which requires the preliminary identification of homogeneous torrent reaches in which a sample of existing check-dams is identified for study. Transects, subdivided into sample areas, are located immediately upstream and downstream of check-dams and in control zones. At these transects vegetation parameters (number of species, canopy cover of each species and vegetation layer, height of each vegetation layers, vegetation type, biological forms and ecological groups) are surveyed. Two new parameters (global canopy cover and weighted canopy height) are proposed to give synthetic information on the global development of vegetation. The features of transects close to check-dams are compared with those of control transects. The methodology is applied to two calabrian torrents. An influence of check-dams is found especially in the lower torrent reaches, with a longitudinal diversification of vegetation types and the creation, either immediately up or downstream, of habitats characterized by new biological and ecological formations.

Published
2006
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38. Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: 5-year experience

Author

Nicolò Patroniti, Michela Bombino, Alberto Zanella, Stefano Isgrò, Manuela Milan, Antonio Pesenti, R. Marcolin, Giuseppe Foti, Isgro', S, Patroniti, N, Bombino, M, Marcolin, R, Zanella, A, Milan, M, Foti, G, and Pesenti, A

Subjects
Male, ARDS, Time Factors, medicine.medical_treatment, Treatment outcome, Ambulances, Medicine (miscellaneous), Tertiary care, Severity of Illness Index, Anoxia, Retrospective Studie, Risk Factors, Hypoxia, Patient transfer, Lung, Referral and Consultation, Respiratory Distress Syndrome, General Medicine, Equipment Design, Middle Aged, Treatment Outcome, Severe acute respiratory syndrome, Italy, Anesthesia, Child, Preschool, Female, Severe hypoxia, Human, Adult, Patient Transfer, medicine.medical_specialty, Time Factor, Biomedical Engineering, Bioengineering, Acute respiratory distress, Hospitals, General, Risk Assessment, Ambulance, Transportation of patients, Mobile emergency units, Biomaterials, Extracorporeal Membrane Oxygenation, Severity of illness, medicine, Extracorporeal membrane oxygenation, Humans, MED/41 - ANESTESIOLOGIA, Intensive care medicine, Aged, Retrospective Studies, business.industry, Risk Factor, Respiratory Distress Syndrome, Adult, Retrospective cohort study, medicine.disease, business, Program Evaluation
Abstract

Purpose Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal Membrane Oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO transportation program was instituted in 2004; here we report results after 5 years of activity. Methods This is a clinical observational study. Criteria for ECMO center activation were: potentially reversibile respiratory failure, PaO2 2 >0.6 for >12 hours, PEEP >5 cmH20, Lung Injury Score (LIS) ≥3 or respiratory acidosis with pH Results Sixteen patients were possible candidates for ECMO transfer. Two patients were excluded while 14 (mean±SD, age 35.4±18.6, SOFA 8.4±3.7, Oxygenation Index 43.7±13.4) were transported to our institution (distance covered 102±114 km, global duration of transport 589±186 minutes). Two patients improved after iNO-trial and were transferred and subsequently managed without ECMO. The remaining 12 patients were transferred on veno-venous ECMO with extracorporeal blood flow 2.7±1 L·min−1, gas flow 3.8±1.8 L·min−1, and FiO2 1. Data were recorded 30 minutes before and 60 minutes after initiation of ECMO. ECMO improved PCO2 (75±23 vs. 53±9 mmHg, p−1, p2O, pConclusions ECMO effectively enabled high-risk ground transfer of severely hypoxic patients.

Published
2011

39. Bronchopleural Fistulae and Pulmonary Ossification in Posttraumatic Acute Respiratory Distress Syndrome: Successful Treatment With Extracorporeal Support

Author

Antonio Pesenti, Stefano Isgrò, Giacomo Grasselli, Michela Bombino, Nicolò Patroniti, Giuseppe Foti, Bombino, M, Patroniti, N, Foti, G, Isgro', S, Grasselli, G, and Pesenti, A

Subjects
Adult, Male, medicine.medical_specialty, ARDS, medicine.medical_treatment, Biophysics, Biomedical Engineering, Bioengineering, Acute respiratory distress, Pulmonary ossification, Extracorporeal, Extracorporeal carbon dioxide removal, Biomaterials, Extracorporeal Membrane Oxygenation, Humans, Medicine, Medicine (all), MED/41 - ANESTESIOLOGIA, Lung, Mechanical ventilation, Respiratory Distress Syndrome, business.industry, Respiration, Accidents, Traffic, Respiratory Distress Syndrome, Adult, General Medicine, Carbon Dioxide, medicine.disease, Respiration, Artificial, Biomaterial, medicine.anatomical_structure, Biophysic, Anesthesia, Breathing, Radiology, Bronchial Fistula, business, Human
Abstract

We report a case of severe posttraumatic acute respiratory distress syndrome (ARDS) complicated by bronchopleural fistulae (BPF). The stiff ARDS lung and huge air leaks from BPF resulted in the failure of different protective mechanical ventilation strategies to provide viable gas exchange. Lung rest, achieved by extracorporeal carbon dioxide removal (ECCO₂R), allowed weaning from mechanical ventilation, closure of BPF, and resumption of spontaneous breathing.

Published
2011

40. Elevated plasma and alveolar levels of soluble receptor for advanced glycation endproducts are associated with severity of lung dysfunction in ARDS patients

Author

Giacomo Bellani, Nicolò Patroniti, Alberto Mantovani, Michela Bombino, Andrea Pradella, Serge Masson, Antonio Pesenti, Andrea Coppadoro, Roberto Latini, Tommaso Mauri, Sonia Valentino, Mauri, T, Masson, S, Pradella, A, Bellani, G, Coppadoro, A, Bombino, M, Valentino, S, Patroniti, N, Mantovani, A, Pesenti, A, and Latini, R

Subjects
Male, Genetics and Molecular Biology (all), ARDS, Receptor for Advanced Glycation End Products, Severity of Illness Index, Biochemistry, Gastroenterology, Pentraxin 3, law.invention, law, Receptors, Immunologic, Diffuse alveolar damage, Respiratory Distress Syndrome, medicine.diagnostic_test, Medicine (all), General Medicine, Middle Aged, respiratory system, Intensive care unit, Pathophysiology, Respiratory Function Tests, Serum Amyloid P-Component, C-Reactive Protein, medicine.anatomical_structure, Female, medicine.symptom, Bronchoalveolar Lavage Fluid, medicine.medical_specialty, Inflammation, Lung injury, General Biochemistry, Genetics and Molecular Biology, Severity, Internal medicine, medicine, Humans, MED/41 - ANESTESIOLOGIA, Aged, Soluble receptor for advanced glycation endproducts, Lung, business.industry, Acute lung injury/acute respiratory distress syndrome, Marker, Biochemistry, Genetics and Molecular Biology (all), medicine.disease, respiratory tract diseases, Surgery, Pulmonary Alveoli, Bronchoalveolar lavage, Soluble receptor for advanced glycation endproduct, business, Biomarkers
Abstract

Acute lung injury and acute respiratory distress syndrome (ALI/ARDS) are severe forms of bilateral lung inflammation with poor clinical outcomes. However, the pathophysiology of ALI/ARDS remains largely obscure. Soluble receptor for advanced glycation endproducts (sRAGE) plays a key regulatory role during the acute phase of inflammation, and baseline plasma levels of sRAGE were recently found to be associated with severity of ALI/ARDS. We analyzed, in ALI/ARDS patients, plasma and alveolar levels of sRAGE over time and the association with severity of lung injury. We enrolled 21 ALI/ARDS patients admitted to our intensive care unit (ICU) and assayed plasma sRAGE on the first 2 days after diagnosis, every three days for the first month and then once a week, until ICU discharge or death. We also measured sRAGE levels in bronchoalveolar lavage fluids, obtained when clinically indicated. At each sampling time, we recorded physiological and clinical data of the patients. Plasma sRAGE levels peaked at day 1 and decreased over time. When all samples were considered, plasma and alveolar sRAGE levels were significantly higher in patients with worse oxygenation and higher need for ventilatory support (i.e., patients with more severe lung dysfunction). Moreover, the presence of lung infection yielded higher alveolar sRAGE levels. In conclusion, we show that the plasma and alveolar levels of sRAGE in ALI/ARDS patients are correlated to lung injury severity and to lung infection. Our findings may, in time, lead to the development of more effective therapies against ALI/ARDS. © 2010 Tohoku University Medical Press.

Published
2010

41. Percutaneous Cannulation: Indication, Technique, and Complications

Author

Michela Bombino, R. Marcolin, Maurizio Migliari, and Leonello Avalli

Subjects
medicine.medical_specialty, Percutaneous, Surgical approach, business.industry, Vascular access, Systemic circulation, Cannula, Intensive care unit, law.invention, Surgery, Key point, surgical procedures, operative, law, Anesthesia, Medicine, business, Internal jugular vein
Abstract

Vascular access to systemic circulation is the key point for ECMO institution. In the pioneering years, the surgical approach was the rule both for central and peripheral cannulation in V-A or V-V ECMO. In the early 1990s, the availability of new thin-walled spring-wired reinforced cannulas opened the era of percutaneous cannulation technique, which shortly became the first choice for ECMO peripheral cannulation. Benefits of percutaneous cannulation versus the surgical technique are a reduced procedural time, decreased bleeding complications, and easy decannulation without the need of vessel repair. Percutaneous placement of cannulas can be done at any bedside in the hospital, intensive care unit, emergency room, and catheterization laboratory or intraoperatively. We will review cannula implantation and explantation techniques for V-V and V-A ECMO and discuss the vascular complications that can ensue during and after the procedure and their possible solutions.

Published
2014
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42. Patient Care During ECMO

Author

Nicolò Patroniti, Sara Redaelli, and Michela Bombino

Subjects
medicine.medical_specialty, Do no harm, Abdominal compartment syndrome, business.industry, Sedation, medicine.disease, Patient care, Nursing care, surgical procedures, operative, Pneumothorax, Care plan, medicine, Bowel function, medicine.symptom, Intensive care medicine, business
Abstract

Patient care during ECMO includes daily nursing and a careful head-to-toe examination to assess organ functions, reveal actual problems and draw the daily care plan. Nursing care should take into account the risks related to anticoagulation and the presence of ECMO equipment. Neurological evaluation, need and depth of sedation, assessment of effective protective ventilation and timing for weaning, haemodynamic assessment, infective status, bowel function and nutritional support and hepatic and renal function are the key points in the standard head-to-toe examination of the ECMO patients. The complex interaction between the patient and the ECMO apparatus must be accounted during the evaluation. Finally, complications such as bleeding and pneumothorax should be promptly recognised and treated; to minimise the risk of bleeding, a “do no harm” approach must be used avoiding unnecessary invasive procedures.

Published
2014
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43. Alveolar Pentraxin 3 (PTX3) Levels And Diagnosis Of Pneumonia In Critically Ill Patients: A Multicenter Study

Author

Antonio Pesenti, Lorenzo Berra, Nicolò Patroniti, Ivan Cuccovillo, Andrea Coppadoro, Giacomo Bellani, Andrea Pradella, Ulrich Schmidt, Edward A. Bittner, Michela Bombino, Alberto Mantovani, Ashees Kumar, and Tommaso Mauri

Subjects
Pneumonia, medicine.medical_specialty, Multicenter study, Critically ill, business.industry, Medicine, PTX3, business, medicine.disease, Intensive care medicine, Pentraxin-3
Published
2012
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44. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome

Author

Mary R. Suchyta, Lindell K. Weaver, Michela Bombino, Thomas D. East, E. Beck, James F. Orme, Samuel Butler, Nathan C. Dean, Nathan L. Pace, Dean F. Sittig, Alan H. Morris, Barbara Hoffmann, C. Jane Wallace, Hayo Becks, Frank Thomas, Ronald L. Menlove, James Pearl, Terry P. Clemmer, Brad Rasmusson, and Stephen Bohm

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, ARDS, Randomization, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Extracorporeal, law.invention, Positive-Pressure Respiration, Extracorporeal Membrane Oxygenation, Randomized controlled trial, law, Co2 removal, Humans, Medicine, Inverse ratio ventilation, Life Tables, Hospital Costs, Intensive care medicine, Survival rate, Mechanical ventilation, Respiratory Distress Syndrome, Respiratory distress, business.industry, Carbon Dioxide, Length of Stay, medicine.disease, Combined Modality Therapy, Respiration, Artificial, Survival Analysis, Surgery, Survival Rate, Treatment Outcome, Emergency medicine, Female, business
Abstract

The impact of a new therapy that includes pressure-controlled inverse ratio ventilation followed by extracorporeal CO2 removal on the survival of patients with severe ARDS was evaluated in a randomized controlled clinical trial. Computerized protocols generated around-the-clock instructions for management of arterial oxygenation to assure equivalent intensity of care for patients randomized to the new therapy limb and those randomized to the control, mechanical ventilation limb. We randomized 40 patients with severe ARDS who met the ECMO entry criteria. The main outcome measure was survival at 30 days after randomization. Survival was not significantly different in the 19 mechanical ventilation (42%) and 21 new therapy (extracorporeal) (33%) patients (p = 0.8). All deaths occurred within 30 days of randomization. Overall patient survival was 38% (15 of 40) and was about four times that expected from historical data (p = 0.0002). Extracorporeal treatment group survival was not significantly different from other published survival rates after extracorporeal CO2 removal. Mechanical ventilation patient group survival was significantly higher than the 12% derived from published data (p = 0.0001). Protocols controlled care 86% of the time. Average PaO2 was 59 mm Hg in both treatment groups. Intensity of care required to maintain arterial oxygenation was similar in both groups (2.6 and 2.6 PEEP changes/day; 4.3 and 5.0 FIO2 changes/day). We conclude that there was no significant difference in survival between the mechanical ventilation and the extracorporeal CO2 removal groups. We do not recommend extracorporeal support as a therapy for ARDS. Extracorporeal support for ARDS should be restricted to controlled clinical trials.

Published
1994
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47. Pentraxin 3 levels from bronchoalveolar lavage of critically ill patients predict lung infection

Author

Tommaso Mauri, Giacomo Bellani, Antonio Pesenti, I Cuccovillo, Daniela Ferlicca, Michela Bombino, Andrea Pradella, Alberto Mantovani, Nicolò Patroniti, and A Confalonieri

Subjects
medicine.medical_specialty, Microbiological culture, medicine.diagnostic_test, Critically ill, business.industry, Lung infection, PTX3, Acute respiratory distress, Gold standard (test), respiratory system, Critical Care and Intensive Care Medicine, Gastroenterology, respiratory tract diseases, Bronchoalveolar lavage, Internal medicine, Poster Presentation, medicine, Intensive care medicine, business, Pentraxin-3
Abstract

Timely diagnosis of lung infection in critically ill patients is key to guide therapy and avoid futile antibiotic prescription. The gold standard for diagnosis is microbiological culture of bronchoalveolar lavage fluid (BALf). However, it takes up to 48 hours to disclose results. Pentraxin 3 (PTX3) is an acute phase mediator of infection that can be assayed in a few hours. We described a relationship between BALf PTX3 presence and lung infection in acute respiratory distress syndrome patients. The aim of this study was to validate BALf PTX3 as an early marker of lung infection in critically ill patients.

Published
2011
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48. Positive end-expiratory pressure improves oxygenation inducing ventral-to-dorsal tidal ventilation redistribution: an electrical impedance tomography study

Author

Giuseppe Foti, Nicolò Patroniti, Giacomo Bellani, Antonio Pesenti, Tommaso Mauri, Andrea Pradella, Alice Grassi, Michela Bombino, and Paola Tagliabue

Subjects
Dorsum, medicine.medical_specialty, business.industry, Oxygenation, respiratory system, Lung injury, Critical Care and Intensive Care Medicine, respiratory tract diseases, Surgery, Internal medicine, Poster Presentation, Cardiology, Medicine, Lung volumes, business, Electrical impedance tomography, Positive end-expiratory pressure, circulatory and respiratory physiology
Abstract

Positive end-expiratory pressure (PEEP) improves oxygenation in acute lung injury (ALI) patients by increasing end-expiratory lung volume (EELV). Electrical impedance tomography (EIT) is a relatively new non-invasive bedside method to monitor regional distribution of tidal ventilation and EELV changes, validated in preclinical studies. We tested EIT as a monitor of PEEP-induced tidal redistribution and EELV changes in ALI patients, and the relationship between EIT parameters and oxygenation.

Published
2011
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49. Electrical impedance tomography to monitor regional tidal ventilation at different pressure support levels

Author

Nicolò Patroniti, Giacomo Bellani, Antonio Pesenti, Tommaso Mauri, Paola Tagliabue, Michela Bombino, Giuseppe Foti, and A Confalonieri

Subjects
Mechanical ventilation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Dependent lung, respiratory system, Lung injury, Assisted ventilation, Critical Care and Intensive Care Medicine, respiratory tract diseases, Internal medicine, Poster Presentation, medicine, Cardiology, In patient, Intensive care medicine, business, Electrical impedance tomography
Abstract

Implementation of assisted mechanical ventilation in acute lung injury (ALI) patients may decrease ventilator-induced lung injury by redistribution of tidal ventilation towards dependent lung regions. Up to now, tidal ventilation regional distribution has been measured by expensive and complicated methods, not readily available at the bedside. Electrical impedance tomography (EIT) is a relatively new non-invasive bedside method to monitor tidal ventilation distribution, validated in preclinical studies. We verified the feasibility of using EIT to monitor tidal ventilation regional distribution in patients undergoing assisted ventilation and we describe the effect of different pressure support levels on regional ventilation.

Published
2011
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50. Plasma And Alveolar Fluid Levels Of Receptor For Advanced Glycation Endproducts (RAGE) Are Associated With Severity Of ARDS

Author

Andrea Pradella, Nicolò Patroniti, Giacomo Bellani, Roberto Latini, Antonio Pesenti, Serge Masson, Marco Giani, Tommaso Mauri, Andrea Coppadoro, and Michela Bombino

Subjects
ARDS, medicine.medical_specialty, Endocrinology, business.industry, Internal medicine, medicine, medicine.disease, business, Receptor, Advanced Glycation Endproducts, RAGE (receptor)
Published
2010
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