Efficacy of non-invasive mechanical ventilation in the general ward in patients with chronic obstructive pulmonary disease admitted for hypercapnic acute respiratory failure and pH < 7.35: a feasibility pilot study.

AIM: To date non-invasive (NIV) mechanical ventilation use is not recommended in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) and pH < 7.30 outside a 'protected environment'. We assessed NIV efficacy and feasibility in improving arterial blood gases (ABG) and in-hospital outcome in patients with ARF and severe respiratory acidosis (RA) admitted to an experienced rural medical ward. METHODS: This paper is a prospective pilot cohort study conducted in the General Medicine Ward of Budrio's District Hospital. Two hundred and seventy-two patients with ARF were admitted to our Department, 112, meeting predefined inclusion criteria (pH < 7.35, PaCO2 > 45 mmHg). Patients were divided according to the severity of acidosis into: group A (pH < 7.26), group B (7.26 ≤ pH < 7.30) and group C (7.30 ≤ pH < 7.35). ABG were assessed at admission, at 2-6 h, 24 h, 48 h and at discharge. RESULTS: Group A included 55 patients (24 men, mean age: 80.8 ± 8.3 years), group B 31 (12 men, mean age: 80.3 ± 9.4 years) and group C 26 (15 men, mean age: 78.6 ± 9.9 years). ABG improved within the first hours in 92/112 (82%) patients, who were all successfully discharged. Eighteen percent (20/112) of the patients died during the hospital stay, no significant difference emerged in mortality rate (MR) within the groups (23%, 16% and 8%, for groups A, B and C, respectively) and between patients with or without pneumonia: 8/29 (27%) versus 12/83 (14%). On multivariable analysis, only age and Glasgow Coma Scale had an impact on the clinical outcome. CONCLUSION: In a non-'highly protected' environment such as an experienced medical ward of a rural hospital, NIV is effective not only in patients with mild, but also with severe forms of RA. MR did not vary according to the level of initial pH.

[Percutaneous pulmonary valvuloplasty. Immediate results and a follow-up: clinical, Doppler and hemodynamic evaluation]. / Valvuloplastica polmonare percutanea. Risultati immediati e follow-up: valutazione clinica, Doppler ed emodinamica.

The purpose of this investigation was to evaluate the efficacy and follow-up results of balloon dilation angioplasty for valvular pulmonary stenosis. Percutaneous dilation was performed on 25 patients with pulmonary stenosis (aged 1 month to 69 years, mean = 15 years). In all cases, a single balloon was used. The pressure gradients across the pulmonary valve were estimated by continuous wave Doppler (CWD) and catheterization before and after dilation. The peak systolic gradients obtained by both techniques both pre- and post-angioplasty were compared. There was good linear correlation between the catheter pressure gradient and the pressure gradient estimated by Doppler (r = 0.78). The mean pre-angioplasty gradient of 82 +/- 33 mmHg (range 40-180) was reduced to 29 +/- 12 mmHg (range 17-50). The mean right ventricular systolic pressure of 110 +/- 33 mmHg decreased to 52 +/- 13 mmHg post-angioplasty. An excellent linear correlation was found between the pre-dilation gradient and the right ventricular systolic pressure drop (r = 0.94). During the procedures no complications were noted, 30 hours after dilation a 6 months old child suffered of stroke with transient hemiparesis. Follow-up pressure gradient estimations by Doppler echocardiogram were obtained in all patients between 3 months and 42 months (mean = 12.4 months); in 4 cases the catheterization was performed. Mean follow-up gradient was 33 +/- 11 mmHg (range 15-55). In a 18 months old child was detected a severe pulmonary restenosis 12 months after dilation; a second successful dilation was performed.(ABSTRACT TRUNCATED AT 250 WORDS)

[The need for invasive diagnostic investigations (coronaro-ventriculography), interventions using extracorporeal circulation and coronary angioplasty in a defined population of Emilia-Romagna]. / Fabbisogno di indagini diagnostiche cruente (coronaro-ventricolografie), di interventi in CEC e di angioplastiche coronariche in un campione definito di popolazione dell'Emilia-Romagna.

Working on a limited and controlled population of 100,000 living in the territory of Imola, in northern Italy, we tried to determine the need for coronary arteriography examinations, CABG interventions and PTCA procedures (similarly to the 1980 Minnesota survey). Indications for diagnosis or treatment were made according to agreement criteria of published data in 1990. In the 3 year time (1989-91) of this survey, indication to coronary arteriography was done in 433 pts. (367 atherosclerotic, 58 valvular and 8 with other etiologies). 57.7% (250/433) of the pts. were treated with CABG or PTCA, and 42.3% (202/433) were treated medically. Of the 367 pts. documented as having coronary ischemia, 54.5% had further invasive therapy: 35.4% CABG and 19% PTCA. For a population of 100,000 annual need has been estimated as follows: 145 catheterization procedures (99% coronary arteriography), 60 extracorporeal circulation procedures, and 24 PTCA interventions. Comparing programming estimates done by the national Health System for the needs of a population group in Northern Italy, it is clear that they are underestimating the real needs by 50%, and such an important underestimation implies important and pressing considerations for the future planning of the health care of this important pathology.