Giovanna Occhipinti was born in 1978, performed her medical school in Catania from 1997 to 2003 and finished her specialization school in Belgium at ERASME Hospital having Daniel De Backer as Coauthor of her final thesis: “Effect of fluids challenge on microcirculation” in 2007. Since than she worked as Intensivist at Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), Palermo, Italy, as clinician and preclinical researcher. Currently she is senior attending in critical care medicine at IsMeTT, involved in ECMO (extra corporeal membrane ossigenation) assistance for end stage heart and lung failure and extra hospital transfer on ECMO support by ambulance and helicopter. In IsMeTT, she is involved also in clinical study about protective mechanical ventilation during ARDS and different type of anticoagulation used during extracorporeal assistance. She was also involved as local investigator in the Lung Safe Study.
Extracorporeal Membrane Oxygenation (ECMO) has been shown to be very effective in treating ARDS patients during the 2009 H1N1 pandemic 1 and, since then, its use as salvage therapy in case of severe ARDS not responsive to conventional therapy has become more and more common, overwhelming many of the limitations once considered as insurmountable. Successful use of ECMO in immunocompromised patients has been reported but it remains controversial because of the high mortality rate linked to the compromised immune response. ARDS occurrence in HIV infected patients is burden by an extremely high mortality rate, especially before Highly Active Antiretroviral Therapy (HAART) introduction. HAART has profoundly changed the course of HIV infection significantly reducing the rate of opportunistic infections; nevertheless the need of ICU care among HIV patients remained almost unchanged (4-12%) and respiratory impairment is the most common indication.2,3 Recent studies cite that clinical outcomes for HIV-1-infected patients admitted to the ICU are comparable with that for critically ill HIV-uninfected patients and HIV-1 infection was not associated with increased mortality in patients with ARDS. Up to now HIV seropositivity has been considered a contraindication to ECMO and only anecdotic cases have been reported with variable outcomes. We report two cases of Pnumocystis jiorvecii pneumonia as AIDS exordium opportunistic infection. Both evolved to severe ARDS and were successfully treated with VV ECMO support.
Shun Huang has her expertise in evaluation and passion in improving the Chinese medicine especially acupuncture. Her open and contextual evaluation model based on responsive constructivists creates new pathways for improving perioperative analgesia. She has built this model after years of experience in research, evaluation, teaching and administration both in hospital and education institutions. The investigation is based on transcutaneous electric acupoint stimulation which is a methodology that utilizes the acupoints effects to patients for improving the recovery of them.
Objective: To investigate the specific effects of different frequencies of transcutaneous electrical acupoints stimulation (TEAS) on perioperative anesthetic dosage, recovery, complications, and prognosis in patients who underwent video-assisted thoracic surgical (VATS) lobectomy. Methods: 80 patients with no previous experience of TEAS or acupuncture undergoing VATS lobectomy were randomly assigned into four groups: control, 2/100Hz, 2Hz and 100Hz groups. The experimental group received TEAS for 30 minutes right before induction, during the entire intraoperative period, for another 30 minutes at 24 and 48 hours after surgery respectively. TEAS were given over acupoints Neiguan(PC6), Hegu(LI4), Lieque(LU7) and Quchi (LI11) sick-laterally. The control group received zero frequency of TEAS, while the 2/100Hz, 2Hz and 100Hz groups used 2/100Hz, 2Hz and 100Hz stimuli frequency respectively. Anesthetic dosage, blood gas analysis results, lung function indexes such as FEV1 and FVC, post anesthesia care unit (PACU) status, postoperative complications, and quality of life scores were collected and analyzed statistically. Results: Intraoperative opioid consumption was significantly decreased in 2/100Hz group (vs Con p≤0.001, vs 2Hz p≤0.001, vs 100Hz p=0.026). During one-lung ventilation arterial oxygen partial pressure (PaO2) showed slower decreasing pattern in 2/100Hz group (vs Con p=0.042). Moreover, 2/100Hz group showed shorter extubation time (vs Con p=0.038), lower VAS score (vs Con p=0.047) and shorter PACU stay time (vs Con p=0.043) right after surgery. Meanwhile 100Hz group revealed a reduced incidence of postoperative nausea and vomiting (PONV) (vs Con p=0.044). Conclusions: TEAS are a safe and non-invasive adjunctive intervention in the anesthesia management for patients undergoing VATS lobectomy. TEAS at 2/100Hz is more potent in decreasing intraoperative opioid dosage and slowing down PaO2 decrease during one-lung ventilation. It can also effectively decrease the pain score and extubation and PACU stay time right after surgery. 100Hz TEAS can decrease the morbidity of PONV.