Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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Pneumonia is common in those patients placed in intensive care units, especially in mechanically ventilated patients. The high mortality rate of ventilator-associated pneumonia requires a rapid initiation of the appropriate antibiotic treatment. ⋯ Such conditions include pulmonary haemorrhages, acute eosinophilic pneumonia, malignancy, drug-induced toxicity, adult respiratory distress syndrome and cardiogenic pulmonary oedema. It is important to distinguish these conditions from pneumonia because the management and prognosis of these entities is quite different.
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Monaldi Arch Chest Dis · Jan 2004
Case ReportsAcute eosinophilic pneumonia with respiratory failure: a case likely triggered by cigarette smoking.
The authors report a case of acute respiratory failure that fulfils the diagnostic criteria for acute eosinophilic pneumonia. Bronchoalveolar lavage eosinophilia and eosinophilic lung diseases are also discussed. The pathogenetic events, including the role of IL-5, eotaxin 1 and 2 and VEGF are emphasised.
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Monaldi Arch Chest Dis · Jan 2004
Ethics, attitude and practice in end-of-life care decision: an European perspective.
Only in the last decade in Europe has there been increased attention dedicated to the end-of-life care in the hospital, especially in the Intensive Care Unit (ICU). The definitions of the potential decision are extremely important. Withholding is a planned decision not to institute therapies that were otherwise warranted, Withdrawal is the discontinuation of treatments that had been started, Terminal sedation consists of pain and symptom treatment with the possible side effect of shortening life, while Euthanasia means that a doctor is intentionally killing a person who is suffering unbearably and hopelessly at the latter's explicit informed request. ⋯ Only <15% of ICU patients retain decision making capacity, allowing the impossibility of discussing the decision with them. It is rare that the patient's family is involved in the decision and when such case does arise, the relatives rate the communication with hospital staff poor. The "shared decision" taken together by physicians, nurses, and the patient's family may be the best approach for end-of-life decision, therefore common European guidelines are needed.
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In this study, the presence of microalbuminuria in patients with chronic obstructive pulmonary disease (COPD) in whom no proteinuria was determined by conventional methods, has been studied taking into account the possible relationship between microalbuminuria and respiratory parameters and their predictive role on mortality. ⋯ In a quite large number of patients with COPD in whom no proteinuria were determined by conventional methods, especially at the time of exacerbation, microalbuminuria could be seen. Microalbuminuria was related with hypoxemia but has no predictive role on mortality.