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Hemodynamic changes acutely determined by primary PCI in STEMI patients evaluated with a minimally invasive method

World Journal of Cardiovascular Diseases 2013年第4期3卷 69-72页

作者： Cristina Giglioli Omar Tujjar emanuele cecchi Daniele Landi Marco Chiostri Serafina Valente Giorgio Jacopo Baldereschi Francesco Meucci Gian Franco Gensini Salvatore Mario Romano Department of Critical Care and Surgery Unit of Internal Medicine and Cardiology University of Florence Italy Department of Heart and Vessels Azienda Ospedaliero-Universitaria Careggi Florence Italy

Objective: Few studies are available on the hemodynamic changes acutely determined by Primary Percutaneous Coronary Intervention (PCI) in ST-Elevation Myocardial Infarction (STEMI) patients, probably for the difficult evaluation of hemodynamic variables in this acute setting. Therefore, the paper is to evaluate the variations of several hemodynamic parameters determined by PCI using PRAM (Pressure Recording Analytical Method), minimally invasive hemodynamic monitoring. Methods: We analyzed in 20 STEMI patients submitted to PCI several hemodynamic variables, assessed with PRAM from radial/ femoral artery, 3-minute before PCI and at endprocedure. Variables measures were: systolic, diastolic, dicrotic and mean arterial pressures;heart rate (HR);stroke volume (SV);systemic vascular resistance (SVR);dP/dtmax;cardiac cycle efficiency (CCE). Results: In our patients HR, SVR and dP/dtmax decreased significantly (85 ± 6.3 to 77 ± 4.5, p = 0.002;1738 ± 241 to 1450 ± 253, p = 0.022;1.22 ± 0.11 to 1.11 ± 0.12, p = 0.007, respectively) while CCE and SV increased significantly (?0.25 ± 0.23 to ?0.01 ± 0.12,

关键词： STEMI Primary PCI Hemodynamic Monitoring Cardiac Output

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Challenges of Improving Intensive Care Medicine in Eritrea: Impact of an Italian Cooperative Project of Educational and Clinical Support

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Open Journal of Anesthesiology 2013年第7期3卷 315-319页

作者： Valentina Anichini Giovanni Zagli Hagos Goitom Giovanni Cianchi Andrea cecchi Lucia Perretta emanuele Bigazzi Barbara Gazzini Simone Proietti Alessandro Di Filippo Simone Toccafondi Gianfranco Gensini Giancarlo Berni Adriano Peris Anesthesia and Intensive Care Unit of Emergency Department Careggi Teaching Hospital Florence Italy Anesthesia and Intensive Care Faculty of Medicine University of Florence Florence Italy Department Intensive Care Unit Orotta National Referral Hospital Asmara Eritrea Department of Critical Care Medicine and Surgery Careggi Teaching Hospital Florence Italy First Aid of Emergency Department Careggi Teaching Hospital Florence Italy Tuscany Region Sanitary System Florence Italy.

Intensive care in Africa is available only in teaching or referral hospitals. Here we report the experience of a multidisciplinary collaboration between physicians and nurses of the Emergency Department (First Aid and Intensive Care Unit) of a tertiary referral hospital (Careggi Teaching Hospital, Florence, IT) and physicians and nurses of Orotta National referral Hospital in Asmara, Eritrea. The project was aimed at performing clinical assistance and training on the job to the local staff to improve the standard of care in the local Emergency Department. The duration of the project was initially planned to be 30 months, but unfortunately it was interrupted after 18 months because of lack of funds. The Italian staff was composed of two physicians and two nurses per period. To monitor local ICU activity, a retrospective survey of 36 months was performed. During the 36 months of data collection, 1169 patients were admitted to the ICU. Intra-ICU mortality rate resulted comparable before, during, and after Italian presence. On the contrary, the 28-day mortality resulted significantly lower bo th during and after the Italian stay. After project interruption, the Italian staff maintained contact with the Eritrean ICU personnel, who were invited to attend the Italian ICU for one month per year, and collected information about Orotta ICU activities.

关键词： Intensive Care Unit Developing Countries MEWS

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