[Latex allergy. Preventive measures in health care workers: a comparison of Italian experiences]. / Allergia a latice. Approcci preventivi nelle Aziende Sanitarie: esperienze italiane a confronto. Risultati preliminari di un'indagine trasversale.

BACKGROUND: We have performed a transversal study in different Italian Regions to underline the problem related to natural latex allergy. OBJECTIVES: The aim of the study was to determine the glove use on the basis of the materials gloves were made of, to identify the departments and the qualifications mainly interested in the latex allergy problem, to check the required features for gloves and other rubber devices at the moment of the purchase, as well as the presence of guidelines, of training and information activities for health care workers and procedures for sensitized patients. METHODS: We sent a questionnaire to the local public Health Authorities (HA) in different Italian Regions. RESULTS: Number and regional distribution of the answers received back did not have statistical significance. Anyway, from the elaboration of the data it has been possible to obtain some interesting observations on both a theoretical and an operational level. The results showed: a) the level of interest and attention to the latex allergy problem has increased a lot recently; b) there is a high use of latex gloves (>50% of HA), in particular in surgical and intensive care departments; c) there are differences on an operational level between HA, also between HA that are in the same Italian Region. It resulted a widespread delay in the replacement of latex devices (e.g. urinary and intravenous catheters) with devices made of alternative materials. However, we found a growing attention towards the procedures related to the purchase of gloves, towards the adoption of guidelines about the use of gloves and towards the training and the information of health care workers. CONCLUSIONS: From this study it has emerged clear the need of Italian HA to focus on the prevention of latex allergy, goal already obtained in a few, almost isolated, realities.

The ability of PiCCO versus LiDCO variables to detect changes in cardiac index: a prospective clinical study.

BACKGROUND: Both PiCCO and LiDCO can provide dynamic preload parameters, pulse pressure variation (PPV) and stroke volume variation (SVV). The PiCCO device also provides a measure of intrathoracic blood volume index (ITBVI). We investigated the agreement between SVV and PPV, as well as the reliability of LiDCO- and PiCCO-measured SVV, PPV and ITBVI, in detecting fluid responsiveness before and after fluid challenge (FC). METHODS: We performed a prospective clinical study in University Hospital ICU. Nine adult ICU patients with cardiovascular instability were enrolled in the study. All patients were sedated and mechanically ventilated with intermittent positive pressure ventilation. The PiCCO and LiDCO systems were both connected to each patient. The PiCCO pulse waveform system was joined by a 5-French (Fr) thermistor-tipped arterial catheter inserted into the femoral artery. LiDCO measurements were performed through radial artery pulse contour analysis. Fluid challenge was performed using a rapid infusion of 7 mL/kg of 6% hydroxyethylstarch over 30 min. RESULTS: Measurements of CI, ITBVI, SVV, and PVV were made using both techniques before and after FC. Pre-FC cardiac index (CI) measurements were similar with both devices, although the reading was higher after FC with the PiCCO device (P<0.001). The correlation coefficient between PiCCO-CI and LiDCO-CI was 0.85 (95% CI: 0.69 to 0.93; P<0.001); for P-PPV and L-PPV, it was 0.74 (95% CI: 0.49 to 0.88; P<0.001). Only ITBV had a significant correlation with LiDCO-CI or PiCCO-CI. CONCLUSION: We found a narrow bias but less accurate precision in cardiac index values measured by a radial artery-site LiDCO catheter and a femoral artery-site PiCCO catheter, with poor agreement between radial and femoral-derived SVV and PPV measurements. ITBVI proved to be the best predictor of fluid responsiveness. The SVV does not seem to be reliable for preload optimization in ICU patients.

Fluid challenge in patients submitted to spinal block.

AIM: The practice of routinely prehydrating patients by infusing a colloid solution for prevention of spinal anesthesia-induced hypotension has been challenged recently. The aim of the study was to evaluate the influence of a 15 mL/kg pre-emptive bolus of colloids (6% hydroxyhethyl starch) on heart rate (HR), mean arterial blood pressure (MAP), cardiac index (CI) in patients submitted to subarachnoid block with hyperbaric bupivacaine 0.5%, 0.2 mg/kg for orthopedic surgery of the lower limb. METHODS: Patients were monitored by a Model Flow method. Forty patients (ASA I-II) scheduled to undergo to spinal anesthesia for elective orthopedic surgery of the lower limb were enrolled in the study. The 20 patients in Group A were treated with a preanesthetic infusion of 15 mL/kg of hydroxyhaethyl starch 6%, Group B (20 untreated patients) was the control group. HR, MAP, CI were collected at T0 (first relevation); T1 (after 5 min from the spinal block); T2 (after 10 min); T3 (after 15 min); T4 (after 20 min); T5 (after 25 min); T6 (after 30 min); T7 (after 35 min). RESULTS: Our data show that MAP value is higher in treated patients than in control group (ANOVA: P<0.001) and at T1 in Group B MAP was lower than at T0 (P<0.05). HR and CI trend appear similar in the 2 groups. Our results show that heart rate is not affected by colloid infusion. This may be due to the substantial cardiovascular stability of the selective spinal anesthesia, which does not activate a clinical relevant compensatory vagal effect. Fluid prehydration would expand the vascular space and hence compensate for the reduction in systemic vascular resistance, although MAP reduction following the induction of spinal anesthesia is present in both treated and control groups. CONCLUSION: Our data show that despite to fluid challenge, we could not prevent MAP decrease in Group A, even if it is more marked in Group B.

Regulatory volume decrease in nematocytes isolated from acontia of Aiptasia diaphana.

Regulatory volume decrease (RVD) and the mechanisms of its regulation were investigated in microbasic mastigophore nematocytes isolated from the acontia of Aiptasia diaphana (Coelenterates, Cnidaria), a marine species that can be exposed to considerable changes in osmotic pressure. Exposure of isolated cells to a 35% hypoosmotic shock lead to the expected osmotic swelling followed by a rapid RVD. RVD was blocked if Ca2+ influx was prevented either by applying a Ca2+-free medium or by treating the cells with Gd3+. Furthermore, the calmodulin action inhibitor trifluoperazine (TFP), prevented RVD and also caused a larger swelling than that induced by preventing Ca2+ influx. Treatment of nematocytes with quinine completely blocked the RVD. Such an effect was prevented by gramicidine. A partial inhibition of RVD was caused by treatment with 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS). It is concluded that: i) the nematocytes regulate volume under hypoosmotic shock; ii) the regulatory mechanisms consist mainly in increased conductance to K+, and consequently, of Cl-, and, to a lesser extent, in H+/K+-Cl-/HCO3- exchange, and iii) the ionic fluxes are triggered by increased [Ca2+]i with the possible involvement of calmodulin.