Sergio Boncinelli

Non-Contact Detection of Breathing Using a Microwave Sensor

In this paper the use of a continuous-wave microwave sensor as a non-contact tool for quantitative measurement of respiratory tidal volume has been evaluated by experimentation in seventeen healthy volunteers. The sensor working principle is reported and several causes that can affect its response are analyzed. A suitable data processing has been devised able to reject the majority of breath measurements taken under non suitable conditions. Furthermore, a relationship between microwave sensor measurements and volume inspired and expired at quiet breathing (tidal volume) has been found.

The increase of endothelial progenitor cells in the peripheral blood: a new parameter for detecting onset and severity of sepsis.

Sepsis is a clinical syndrome characterized by non-specific inflammatory response with evidence of profound changes in the function and structure of endothelium. Recent evidence suggests that vascular maintenance, repair and angiogenesis are in part mediated by recruitment from bone marrow (BM) of endothelial progenitor cells (EPCs). In this study we were interested in whether EPCs are increasingly mobilized during sepsis and if this mobilization is associated with sepsis severity. Our flow cytometry data demonstrate that in the CD34+ cell gate the number of EPCs in the blood of patients with sepsis had a four-fold increase (45 ± 4.5% p<0.001) compared to healthy controls (12 ± 3.6%) and that this increase was already evident at 6 hours from diagnosis (40.6 ± 4.2%), reaching its maximum at 72 hours. Also the percentage of cEPCs identified in the patients with sepsis (35 ± 4.6% of the CD34+ cell) was statistically different (p<0.001) compared to that found in the blood of patients with severe sepsis (75 ± 4.9%). In addition, we proved that at six hours after sepsis diagnosis, VEGF, CXCL8 and CXCL12 serum levels were significantly higher in septic patients compared to healthy volunteers 559 ± 82.14 pg/ml vs 2.9 ± 0.6 (p<0.0001), 189.8 ± 67.3 pg/ml 15 vs 11.9 ± 1.6 (p=0.014) and 780.5 ± 106.5 pg/ml; vs 190.2 ± 71.4 (p < 0.001). Our data suggest that the cEPC evaluation in peripheral blood, even at early times of diagnosis, in patients with sepsis can be envisaged as a valuable parameter to confirm diagnosis and suggest further prognosis.

Opioid-free analgesia by continuous psoas compartment block after total hip arthroplasty. A randomized study

Background and objective Adequate analgesia is needed after total hip arthroplasty to control pain at rest and during rehabilitation. Our aim was to compare, in a randomized study, the efficacy of two analgesia regimens in control of postoperative pain after total hip arthroplasty: opioid‐free continuous psoas compartment block vs. an opioid/non‐steroidal anti‐inflammatory drugs continuous intravenous infusion. Methods In all, 73 patients (ASA I–III), aged 61–82 yr, undergoing total hip arthroplasty were prospectively enrolled in a single‐blind randomized trial. Patients were allocated either to the study group (Group A, n = 37) or to the control group (Group B, n = 36). Patients in Group A underwent preoperative placement of a catheter in the psoas compartment and, 30 min before the end of surgery, the catheter was primed with a loading dose of 0.75% ropivacaine (0.4 mL kg−1) followed by a continuous infusion of 10 mL h−1 ropivacaine 0.2% for 48 h. Patients in Group B received, from 1 h before the end of surgery, a continuous intravenous infusion of 0.1% morphine and 0.12% ketorolac at 2 mL h−1 for 48 h. Both groups received spinal anaesthesia for surgery. Pain scores at rest and after mobilization, amount of rescue analgesia, nausea/vomiting and haemodynamic parameters were recorded. Results In Group A, median pain scores were very low during the whole study duration both at rest and during physiotherapy in comparison to Group B. Less rescue analgesia was needed and less nausea and vomiting was observed in Group A. Conclusions Opioid‐free continuous psoas compartment block seems to be an appropriate and reliable technique in providing effective postoperative analgesia at rest and during physiotherapy after total hip arthroplasty when compared to intravenous morphine/ketorolac infusion.

Role of patient posture during puncture on successful unilateral spinal anaesthesia in outpatient lower abdominal surgery

Background and objective: Unilateral spinal anaesthesia is a useful anaesthesia technique in lower abdominal surgery, especially in an outpatient setting. Patient posture is pivotal in the achievement of unilateral anaesthesia. Nevertheless, no studies have elucidated the influence of patient posture during the anaesthetic injection on unilaterality. Thus, the aim was to compare the effect of patient posture, during the induction phase of spinal anaesthesia, on block characteristics. Methods: Eighty patients, ASA I–II, scheduled for unilateral hernioplasty were randomized into two groups. Anaesthesia was performed in lateral position in Group 1 (G1) with operative side down and in sitting position in Group 2 (G2) whose patients were then immediately turned on their lateral side. All patients were maintained for 20 min in lateral position with their operative side down. Hyperbaric bupivacaine 1% 10 mg were used. Results: Unilateral anaesthesia was seen in 80% (32/40) and 12.5% (5/40) of G1 and G2, respectively. The readiness for surgery was faster in G1 (P < 0.0001). The motor block in the non‐operative side was stronger in G2 (P < 0.0001). The offset of sensory block was faster in G1 (P = 0.0001). The offset of motor block was slower in G1 (P = 0.0008). The time for voiding was shorter in G1, although not significant. Conclusions: Lateral posture during the induction of spinal anaesthesia is pivotal for a higher success of unilateral block, a fast readiness to surgery, and a fast recovery. Therefore, this technique can be considered feasible and time‐saving for lower abdominal surgery.

An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest

We describe a case of more than 5 h cardiac arrest in a 60-year-old patient who underwent general anesthesia for a urologic operation. Before extubation, the patient suddenly developed ventricular fibrillation, pulseless ventricular tachycardia and asystole which was immediately treated by advanced life support (ALS) measures. Thirty minutes later seizures developed and were controlled by 200 mg of thiopentone and 10 mg of diazepam. A pattern of ventricular tachycardia, coarse ventricular fibrillation and asystole lasted for nearly 120 min. Termination of resuscitation maneuvers was considered, but long-term life support was continued for 5 h. After this time, peripheral pulses, with a supraventricular tachycardia-like rhythm and regular spontaneous breathing reappeared. Seven hours later, the patient had a Glasgow Coma Scale (GCS) of 5, dilated unresponsive, absence of pupils, and a systolic arterial pressure of 100 mmHg. He was then transferred to intensive care unit (ICU). The morning after, the patient was awake, responded to simple orders, breathing spontaneously, and free from sensomotor deficit. He was, therefore, extubated. Subsequently, other episodes of transitory ST-line upper wave followed by ventricular fibrillation appeared, suggesting Prinzmetal angina. This was successfully treated by percutaneous coronary angioplasty. The first electroencephalogram recorded the day after cardiac arrest showed a mild widespread background slowing. An electroencephalogram 6 days later showed a return to alpha rhythm with only mild theta-wave abnormalities. Four weeks after the first cardiac arrest the patient was discharged. This is an exceptional experience compared with the others reported. We believe that all the efforts must not be given up when such an event occurs during anesthesia and there are optimal conditions for resuscitation maneuvers.

Correlation Between Markers of TH2-Oriented Response and SOFA Score in Sepsis

A shift from Th1- to Th2-type cell immune response has been suggested to occur during sepsis, contributing to cell-mediated immunity suppression and to poor prognosis. The aim was to study the relationship between old and new Th2 markers and the clinical outcome of sepsis. 30 critically ill patients with sepsis for � 48 hours were enrolled in a pro- spective clinical study. Blood samples were collected at the enrolment, at the 5 th and 10 th day. Serum levels of total IgE and soluble chemokines related to Th1- and Th2 responses were evaluated. The percentages and absolute number of CD4+ and CD8+Tcells as well as CRTH2+Tcell subsets were detected by flow cytometry. Sepsis severity was assessed with SOFA score. The mean values of total IgE in septic patients were significantly higher than in controls(p<0.01). Moreover, IgE levels of septic patients who died were higher than those of survived patients(p<0.05). It has been found that IgE levels directly and RANTES inversely correlated with SOFA score at different time points(p<0.01). A significant correlation between the percentages of CRTH2+/CD4+(but not CRTH2+/CD8+)T cells and SOFA at different time points was observed(p<0.05). The direct correlation between total IgE, the percentages of circulating CRTh2+CD4+T cells and the clinical outcome suggests that clinical worsening of sepsis is closely linked to the shift towards a predominant less protective Th2 phenotype. Although these are preliminary results, the longitudinal analysis of these parameters during the disease could be proposed as useful prognostic tools in sepsis.

Erratum to “An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest”

Erratum Erratum to ‘‘An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest’’ [Resuscitation 48 (2001) 175–180] Lea Poala Fabbri *, Maria Nucera , Aureliano Becucci , Antonello Grippo , Francesco Venneri , Vismara Merciai , Sergio Boncinelli a a Department of Pathophysiology, Unit of Anaesthesiology and Intensi e care, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. b Department of Internal Medicine, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. c Department of Neurological Sciences, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. Received 1 February 2000; received in revised form 22 August 2000; accepted 22 August 2000 www.elsevier.com/locate/resuscitation

Erratum: An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest (Resuscitation (2001) 48 (175-180) PII: S0300957200003270)

Erratum Erratum to ‘‘An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest’’ [Resuscitation 48 (2001) 175–180] Lea Poala Fabbri *, Maria Nucera , Aureliano Becucci , Antonello Grippo , Francesco Venneri , Vismara Merciai , Sergio Boncinelli a a Department of Pathophysiology, Unit of Anaesthesiology and Intensi e care, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. b Department of Internal Medicine, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. c Department of Neurological Sciences, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. Received 1 February 2000; received in revised form 22 August 2000; accepted 22 August 2000 www.elsevier.com/locate/resuscitation

ErratumErratum to “An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest”: [Resuscitation 48 (2001) 175–180]

Erratum Erratum to ‘‘An exceptional case of complete neurologic recovery after more than 5-h cardiac arrest’’ [Resuscitation 48 (2001) 175–180] Lea Poala Fabbri *, Maria Nucera , Aureliano Becucci , Antonello Grippo , Francesco Venneri , Vismara Merciai , Sergio Boncinelli a a Department of Pathophysiology, Unit of Anaesthesiology and Intensi e care, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. b Department of Internal Medicine, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. c Department of Neurological Sciences, Uni ersity of Florence, Viale Morgagni 85, 50134 Florence, Italy. Received 1 February 2000; received in revised form 22 August 2000; accepted 22 August 2000 www.elsevier.com/locate/resuscitation

A New Model of Mobile Intensive Care Unit

For some time emergency ambulances have been in operation in Italy. In spite of their modern equipment, these ambulances often turn out to be unsuitable for a comfortable journey and do not have satisfactory working conditions. This is due to the lack of up-to-date standards for vehicles and equipment.