Endotracheal suctioning is an essential and frequently performed procedure for patients requiring... more Endotracheal suctioning is an essential and frequently performed procedure for patients requiring mechanical ventilation. Endotracheal suctioning should guarantee optimal oxygenation and avoidance of accumulation of secretions, leading to tube occlusion, increased work of breathing, atelectasis and pulmonary infections. Yet endotracheal suctioning may also have adverse effects, such as mucosal traumatic lesions, disturbances in cardiac rhythm, microbial contamination of the airway and the environment and ...
Background: Metabolic management of brain-death organ donors includes correction of the hormonal ... more Background: Metabolic management of brain-death organ donors includes correction of the hormonal perturbations that occur after cerebral death and impair circulatory function. Vasopressin is a hormone secreted by the posterior pituitary gland, which contributes to maintain systemic blood pressure by regulating urine secretion and small arteriole tonus. During brain death, the pituitary gland is damaged and hormone secretion rapidly ceases. Low-dose vasopressin increases systemic blood pressure and decreases the need for catecholamines in brain-dead organ donors but it is not available in many countries. Terlipressin is a synthetic analog of vasopressin characterized by greater selectivity for the V1 receptor than vasopressin. To date, the efficacy of terlipressin as a pressor agent in humans has been reported in a few studies. Method: Pharmacology and literature about the use of terlipressin in shock and in particularly in neurogenic shock following brain death is summarized and our personal experience is reported. Results and conclusion: Terlipressin is helpful in controlling severe hypotension; its use allowed to reduce the infusion rate of norepinephrine about 50% in two of three brain-death organ donors, but there are not yet enough data to define its therapeutic range and incidence of collateral effects on the grafts.
Background Metabolic management of brain-death organ donors includes correction of the hormonal p... more Background Metabolic management of brain-death organ donors includes correction of the hormonal perturbations that occur after cerebral death and impair circulatory function. Vasopressin is a hormone secreted by the posterior pituitary gland, which contributes to maintain systemic blood pressure by regulating urine secretion and small arteriole tonus. During brain death, the pituitary gland is damaged and hormone secretion rapidly ceases. Low-dose vasopressin increases systemic blood pressure and decreases the need for ...
At 5:30 pm on December 17, 2010, shortly after a power failure, smoke filled the Intensive Care U... more At 5:30 pm on December 17, 2010, shortly after a power failure, smoke filled the Intensive Care Unit (ICU) of Federico II University Hospital in Naples, Italy, triggering the hospital emergency alarm system. Immediately, staff began emergency procedures and alerted rescue teams. All patients were transferred without harm. The smoke caused pharyngeal and conjunctival irritation in some staff members. After a brief investigation, firefighters discovered the cause of the fire was a failure of the Uninterruptible Power Supply (UPS).
IntroductionMedia sensationalism on the H1N1 outbreak may have influenced decisional processes an... more IntroductionMedia sensationalism on the H1N1 outbreak may have influenced decisional processes and clinical diagnosis.Case PresentationWe report two cases of patients who presented in 2009 with coexisting H1N1 virus and Legionella infections: a 69-year-old Caucasian man and a 71-year-old Caucasian woman. In our cases all the signs and symptoms, including vomiting, progressive respiratory disease leading to respiratory failure, refractory hypoxemia, leukopenia, lymphopenia, thrombocytopenia, and elevated levels of creatine kinase and hepatic aminotransferases, were consistent with critical illness due to 2009 H1N1 virus infection. Other infectious disorders may mimic H1N1 viral infection especially Legionnaires' disease. Because the swine flu H1N1 pandemic occurred in Autumn in Italy, Legionnaires disease was to be highly suspected since the peak incidence usually occurs in early fall. We do think that our immediate suspicion of Legionella infection based on clinical history and X-ray abnormalities was fundamental for a successful resolution.ConclusionOur two case reports suggest that patients with H1N1 should be screened for Legionella, which is not currently common practice. This is particularly important since the signs and symptoms of both infections are similar.
Endotracheal suctioning is an essential and frequently performed procedure for patients requiring... more Endotracheal suctioning is an essential and frequently performed procedure for patients requiring mechanical ventilation. Endotracheal suctioning should guarantee optimal oxygenation and avoidance of accumulation of secretions, leading to tube occlusion, increased work of breathing, atelectasis and pulmonary infections. Yet endotracheal suctioning may also have adverse effects, such as mucosal traumatic lesions, disturbances in cardiac rhythm, microbial contamination of the airway and the environment and ...
Background Metabolic management of brain-death organ donors includes correction of the hormonal p... more Background Metabolic management of brain-death organ donors includes correction of the hormonal perturbations that occur after cerebral death and impair circulatory function. Vasopressin is a hormone secreted by the posterior pituitary gland, which contributes to maintain systemic blood pressure by regulating urine secretion and small arteriole tonus. During brain death, the pituitary gland is damaged and hormone secretion rapidly ceases.
Endotracheal suctioning is an essential and frequently performed procedure for patients requiring... more Endotracheal suctioning is an essential and frequently performed procedure for patients requiring mechanical ventilation. Endotracheal suctioning should guarantee optimal oxygenation and avoidance of accumulation of secretions, leading to tube occlusion, increased work of breathing, atelectasis and pulmonary infections. Yet endotracheal suctioning may also have adverse effects, such as mucosal traumatic lesions, disturbances in cardiac rhythm, microbial contamination of the airway and the environment and ...
Background: Metabolic management of brain-death organ donors includes correction of the hormonal ... more Background: Metabolic management of brain-death organ donors includes correction of the hormonal perturbations that occur after cerebral death and impair circulatory function. Vasopressin is a hormone secreted by the posterior pituitary gland, which contributes to maintain systemic blood pressure by regulating urine secretion and small arteriole tonus. During brain death, the pituitary gland is damaged and hormone secretion rapidly ceases. Low-dose vasopressin increases systemic blood pressure and decreases the need for catecholamines in brain-dead organ donors but it is not available in many countries. Terlipressin is a synthetic analog of vasopressin characterized by greater selectivity for the V1 receptor than vasopressin. To date, the efficacy of terlipressin as a pressor agent in humans has been reported in a few studies. Method: Pharmacology and literature about the use of terlipressin in shock and in particularly in neurogenic shock following brain death is summarized and our personal experience is reported. Results and conclusion: Terlipressin is helpful in controlling severe hypotension; its use allowed to reduce the infusion rate of norepinephrine about 50% in two of three brain-death organ donors, but there are not yet enough data to define its therapeutic range and incidence of collateral effects on the grafts.
Background Metabolic management of brain-death organ donors includes correction of the hormonal p... more Background Metabolic management of brain-death organ donors includes correction of the hormonal perturbations that occur after cerebral death and impair circulatory function. Vasopressin is a hormone secreted by the posterior pituitary gland, which contributes to maintain systemic blood pressure by regulating urine secretion and small arteriole tonus. During brain death, the pituitary gland is damaged and hormone secretion rapidly ceases. Low-dose vasopressin increases systemic blood pressure and decreases the need for ...
At 5:30 pm on December 17, 2010, shortly after a power failure, smoke filled the Intensive Care U... more At 5:30 pm on December 17, 2010, shortly after a power failure, smoke filled the Intensive Care Unit (ICU) of Federico II University Hospital in Naples, Italy, triggering the hospital emergency alarm system. Immediately, staff began emergency procedures and alerted rescue teams. All patients were transferred without harm. The smoke caused pharyngeal and conjunctival irritation in some staff members. After a brief investigation, firefighters discovered the cause of the fire was a failure of the Uninterruptible Power Supply (UPS).
IntroductionMedia sensationalism on the H1N1 outbreak may have influenced decisional processes an... more IntroductionMedia sensationalism on the H1N1 outbreak may have influenced decisional processes and clinical diagnosis.Case PresentationWe report two cases of patients who presented in 2009 with coexisting H1N1 virus and Legionella infections: a 69-year-old Caucasian man and a 71-year-old Caucasian woman. In our cases all the signs and symptoms, including vomiting, progressive respiratory disease leading to respiratory failure, refractory hypoxemia, leukopenia, lymphopenia, thrombocytopenia, and elevated levels of creatine kinase and hepatic aminotransferases, were consistent with critical illness due to 2009 H1N1 virus infection. Other infectious disorders may mimic H1N1 viral infection especially Legionnaires' disease. Because the swine flu H1N1 pandemic occurred in Autumn in Italy, Legionnaires disease was to be highly suspected since the peak incidence usually occurs in early fall. We do think that our immediate suspicion of Legionella infection based on clinical history and X-ray abnormalities was fundamental for a successful resolution.ConclusionOur two case reports suggest that patients with H1N1 should be screened for Legionella, which is not currently common practice. This is particularly important since the signs and symptoms of both infections are similar.
Endotracheal suctioning is an essential and frequently performed procedure for patients requiring... more Endotracheal suctioning is an essential and frequently performed procedure for patients requiring mechanical ventilation. Endotracheal suctioning should guarantee optimal oxygenation and avoidance of accumulation of secretions, leading to tube occlusion, increased work of breathing, atelectasis and pulmonary infections. Yet endotracheal suctioning may also have adverse effects, such as mucosal traumatic lesions, disturbances in cardiac rhythm, microbial contamination of the airway and the environment and ...
Background Metabolic management of brain-death organ donors includes correction of the hormonal p... more Background Metabolic management of brain-death organ donors includes correction of the hormonal perturbations that occur after cerebral death and impair circulatory function. Vasopressin is a hormone secreted by the posterior pituitary gland, which contributes to maintain systemic blood pressure by regulating urine secretion and small arteriole tonus. During brain death, the pituitary gland is damaged and hormone secretion rapidly ceases.
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