Tracheostomy in Intensive Care Unit: a national survey in Italy.

BACKGROUND: The aim of the present study was to evaluate the frequency of different techniques, indications, timing, as well as procedural features, sedation and ventilation protocols, early and late complications of tracheostomy in Intensive Care Unit (ICU). METHODS: This was a retrospective survey on data collected in 2011. A questionnaire was mailed to all members of the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI). RESULTS: We included in the analysis 131 questionnaires. We found that: 1) Ciaglia Blue-Rhino® (CBR) was the most commonly used tracheostomy (32.8%; N.=1953) and the main indication was prolonged mechanical ventilation (58.8%; N.=77); 2) tracheostomy was performed between 7-15 days (71.8%; N.=94) from ICU admission by a dedicated team (62.6%; N.=82) involving more than one intensive care physician and a nurse; 3) tracheostomy was frequently guided by fiberoptic bronchoscope (93.1%, N.=122) while neck ultrasounds were used as a screening procedure to assess at-risk structure often in presence of pathological anatomical structures (68.7%; N.=90); 4) ventilation protocol and sedation-analgesia-neuromuscular blocking protocol were available in 83.2% and 58.8% of ICUs, respectively; 5) minor bleeding controlled by compression was the most common early and late complication. CONCLUSION: Percutaneous tracheostomy is well established in Italian ICUs and CBR is the most popular technique performed in patients requiring prolonged mechanical ventilation. Tracheostomy is usually performed by a dedicated team using a specific sedation-analgesia-neuromuscular blocking and ventilation protocol, guided by fiberoptic bronchoscope and/or neck ultrasounds. Bleeding controlled by compression was the most common early and late complication.

[Technic of multiple procurement from donor cadavers (observations on 19 cases)]. / La technica di prelievo multiplo da donatore cadavere (osservazioni su 19 casi).

Several procedures for multiple cadaveric organ procurement have been developed for the recent growth of transplantation of extrarenal organs. These techniques permit removal of the kidneys, liver, pancreas and heart from the same donor without jeopardy to the kidneys above all. At the Department of Surgery - Section Transplantation of the University of Genoa in 1983 and 1984 19 multiple organ harvesting have been carried out. The kidneys were transplanted at our Center or at other Nit Center. Two patients received segmental pancreatic allograft. Two livers were sent to other Italian and European Centers and successfully transplanted.