[The development of a bedside cart for the management of acute respiratory failure with non-invasive ventilation in Internal Medicine wards]. / Lo sviluppo di un carrello "bedside" per la gestione dell'insufficienza respiratoria acuta con ventilazione non invasiva nei reparti di Medicina Interna.

In order to improve the organization of a General Medical ward without a real critical care area and to optimize treatment of patients with acute respiratory failure, we developed a cart for non-invasive ventilation to be used at the patient bedside. In the rear panel, we set two i.v. drip poles used for i.v. therapy and to hold two Venturi-like flow generators for continuous positive airway pressure. On the top, two ventilators are present, a smaller one (domiciliary) and a bigger one (intensive care unit ventilator). In the front panel, there are 4 drawers called "blood - drugs", "oxygenation", "CPAP", "ventilation", in which all the devices for ventilation, oxygenation, aerosol and medical therapy are easily and quickly available. The management of acute respiratory failure is simpler, easier and safer with this cart: each necessary device is immediately available, and this avoids wasting time. This bedside non-invasive ventilation cart, as far as the cardiac emergency cart, can be useful in general medical wards lacking a critical care area in order to improve interventions in patients with acute respiratory failure.

[Continuous positive airway pressure in acute pulmonary edema. application in a general medical ward]. / Sistemi CPAP (Continuous Positive Airway Pressure) nell'edema polmonare acuto cardiogenico: loro impiego in Reparto di Medicina Interna.

BACKGROUND: The application of a Continuous Positive pressure to Patient's airway (CPAP) represents one of the most important respiratory treatments during Acute Respiratory Failure (ARF) due to Acute Cardiogenic Pulmonary Edema (ACPE). Thanks to its hemodynamic and ventilatory effects, CPAP improves clinical and gasanalytic parameters and lead to a decrease of mortality and need of intubation in these patients. CPAP can be applied with different devices: ventilators, Venturi-like flow generators and Boussignac's device. AIM: To verify and to compare effectiveness and tolerability of two different CPAP's devices (Venturi-like flow generator and Buossignac's device) in ARF due to ACPE. The study was performed in a General Medical Ward. MATERIALS AND METHODS: 20 patients with ARF due to ACPE were randomized in two group: the first group (10 patients) received CPAP with a Venturi-like flow generator, the second group (10 patients) with Boussignac's device. At the end of CPAP treatment each patient gave a score to tolerability. RESULTS: In each group we noted a significant (p<0.05) improvement in clinical and gasanalytic parameters since the first hour of treatment; these improvements were confirmed in following determinations and were not significantly different in the two group of patients. The Boussignac group showed a better tolerability. CONCLUSIONS: The two CPAP's devices resulted similar in term of effectiveness. Boussignac's device has shown a better tolerability: this characteristic, together with the simple use, should stimulate the diffusion of this device where a flow generator or a ventilator are not present (outside Intensive Care Units, for example in General Medical Wards).

Impaired alveolar gas exchange in acute pancreatitis.

We evaluated the alveolar-arterial oxygen difference (deltaA-a) and the ratio between PaO2 and the fractional concentration of inspired oxygen (P/F) in acute pancreatitis. Eleven patients had mild uncomplicated disease, six showed acute abdominal fluid collections, six had acute abdominal collections and asymptomatic x-ray lung involvement, three presented transient dyspneic episodes, and four had severe acute pancreatitis requiring prolonged oxygen therapy. In the uncomplicated disease, respiratory function was normal; in the six patients with abdominal collections only, deltaA-a increased by 50% and P/F decreased by 20-30%; in the six patients with abdominal collections and asymptomatic x-ray lung involvement, deltaA-a increased by 50-70% and P/F decreased by 40%; the three patients with dyspneic episodes showed a twofold increase in deltaA-a and a 40% decrease in P/F; the four patients with severe pancreatitis had a two- to threefold increase in deltaA-a and a 40-50% decrease in P/F. Hence respiratory function is normal only in uncomplicated pancreatitis; in the presence of complications, disturbance of gas exchange always occurs, requiring careful control and treatment.