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Background and Objectives: Transthoracic echocardiography may potentially be useful to obtain a prompt, accurate and non-invasive estimation of cardiac output. We evaluated whether non-cardiologist intensivists may obtain accurate and reproducible cardiac output determination in hemodynamically unstable mechanically ventilated patients., Methods: We studied 25 hemodynamically unstable mechanically ventilated intensive care unit patients with a pulmonary artery catheter in place. Cardiac output was calculated using the pulsed Doppler transthoracic echocardiography technique applied to the left ventricular outflow tract in apical 5 chamber view by two intensive care unit physicians who had received a basic Transthoracic Echocardiography training plus a specific training focused on Doppler, left ventricular outflow tract and velocity-time integral determination., Results: Cardiac output assessment by transthoracic echocardiography was feasible in 20 out of 25 enrolled patients (80%) and showed an excellent inter-operator reproducibility (Pearson correlation test r=0.987; Cohen's K=0.840). Overall, the mean bias was 0.03L.min -1 , with limits of agreement -0.52 and +0.57L.min -1 . The concordance correlation coefficient (ρ c ) was 0.986 (95% IC 0.966-0.995) and 0.995 (95% IC 0.986-0.998) for physician 1 and 2, respectively. The value of accuracy (C b ) of CO TTE measurement was 0.999 for both observers. The value of precision (ρ) of CO TTE measurement was 0.986 and 0.995 for observer 1 and 2, respectively., Conclusions: A specific training focused on Doppler and VTI determination added to the standard basic transthoracic echocardiography training allowed non-cardiologist intensive care unit physicians to achieve a quick, reproducible and accurate snapshot cardiac output assessment in the majority of mechanically ventilated intensive care unit patients., (Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.) more...

The effects of variation in odors and thickening agents on sensory properties and acceptability of a model custard dessert were investigated in normal weight and obese women. Subjects rated their liking and the intensity of sensory properties (sweetness, vanilla and butter flavors, and creaminess) of 3 block samples (the first varied in vanilla aroma, the second varied in butter aroma and the third varied in xanthan gum). Significant differences were found in acceptability and intensity ratings in relation to body mass index. The addition of butter aroma in the custard was the most effective way to elicit odor-taste, odor-flavor and odor-texture interactions in obese women. In this group, butter aroma, signaling energy dense products, increased the perception of sweetness, vanilla flavor and creaminess, which are all desirable properties in a custard, while maintaining a high liking degree. Understanding cross-modal interactions in relation to nutritional status is interesting in order to develop new food products with reduced sugar and fat, that are still satisfying for the consumer. This could have important implications to reduce caloric intake and tackle the obesity epidemic., (Copyright © 2016 Elsevier Ltd. All rights reserved.) more...

Variety within a meal is known to increase intake. However, intake of certain food items (e.g. vegetables) in children is consistently below recommendations, and increasing the consumption of such food would lead to health benefits. This study investigated how different levels of food variety influence children's acceptance. A total of 132 children, aged from 9 to 11 years, were exposed to vegetables, fruits and nut snacks during mid-morning break at school. Two different sets of stimuli were used in a within subject design: Classical Variety (CV), i.e. serving of different foods and Perceived Variety (PV), i.e. serving of the same food in different shapes. For each set, three levels of variety in the servings were tested: low, medium, and high. Intake and liking were determined for each serving set. ANOVA results showed that intake of CV set decreased according to the level of variety, whereas results of PV set only showed an increase of liking with increasing levels of variety. Adding more variations of products appeared to be less successful on consumption despite changing the liking of the products, may be because consumption is more affected by acceptability and familiarity for the stimuli than by variety., (Copyright © 2015 Elsevier Ltd. All rights reserved.) more...

This study investigated the effectiveness of the 'Food Dudes' school-based intervention consisting of rewards, peer-modeling and food exposure on food neophobia and the liking of fruits and vegetables (FV) in a large cohort of children. Five-hundred sixty children recruited from three schools were assigned to the experimental or control group. For 16 days, children in the experimental group watched motivational videos, were read letters to encourage them to eat FV and received a small reward for eating one portion of both a fruit and a vegetable. The control group was only provided with FV for the same time period. Food neophobia and liking were measured in both groups of children before and after the intervention, and a follow-up measurement was carried out 6 months later. The intervention was effective in reducing food neophobia and, most importantly, a persistent effect was observed 6 months after the intervention as children of the experimental group showed significantly lower neophobia scores than the control group. Additionally, the program was effective in increasing liking for both FV; however, this effect was maintained only for fruit after 6 months., (Copyright © 2014 Elsevier Ltd. All rights reserved.) more...

Aim: We investigated the relationship between taste sensitivity, nutritional status and metabolic syndrome and possible implications on weight loss dietary program., Methods: Sensitivity for bitter, sweet, salty and sour tastes was assessed by the three-Alternative-Forced-Choice method in 41 overweight (OW), 52 obese (OB) patients and 56 normal-weight matched controls. OW and OB were assessed also for body composition (by impedence), resting energy expenditure (by indirect calorimetry) and presence of metabolic syndrome (MetS) and were prescribed a weight loss diet. Compliance to the weight loss dietary program was defined as adherence to control visits and weight loss ≥ 5% in 3 mo., Results: Sex and age-adjusted multiple regression models revealed a significant association between body mass index (BMI) and both sour taste (P < 0.05) and global taste acuity score (GTAS) (P < 0.05), with lower sensitivity with increasing BMI. This trend in sensitivity for sour taste was also confirmed by the model refitted on the OW/OB group while the association with GTAS was marginally significant (P = 0.06). MetS+ subjects presented higher thresholds for salty taste when compared to MetS- patients while no significant difference was detected for the other tastes and GTAS. As assessed by multiple regression model, the association between salty taste and MetS appeared to be independent of sex, age and BMI. Patients continuing the program (n = 37) did not show any difference in baseline taste sensitivity when compared to drop-outs (n = 29). Similarly, no significant difference was detected between patients reporting and not reporting a weight loss ≥ 5% of the initial body weight. No significant difference in taste sensitivity was detected even after dividing patients on the basis of nutritional (OW and OB) or metabolic status (MetS+ and MetS-)., Conclusion: There is no cause-effect relationship between overweight and metabolic derangements. Taste thresholds assessment is not useful in predicting the outcome of a diet-induced weight loss program. more...

A 22-year-old insulin-dependent diabetic male was admitted for diabetic ketoacidosis. He developed hospital-acquired pneumonia (HAP) for which empirical antibiotic and antifungal therapy was started on the ward. On day 6, clinical and laboratory findings worsened, and bronchoalveolar lavage (BAL) was performed. Serum real time-polymerase chain reaction (RT-PCR) indicated invasive pulmonary aspergillosis (IPA) and led to antifungal therapy being initiated 48 hours before the results of the BAL culture were available. Despite early appropriate antifungal therapy, however, the patient died on day 22 while being supported by venovenous extracorporeal membrane oxygenation. more...

Recently, several studies have been performed to better outline the pathophysiology of acute respiratory failure and evaluate the therapeutic profile of different modes of ventilation and ventilator settings. Here we briefly report those we consider most relevant for daily intensive care unit clinical practice. more...

Objective: Neurally adjusted ventilatory assist (NAVA) is a new mode wherein the assistance is provided in proportion to diaphragm electrical activity (EAdi). We assessed the physiologic response to varying levels of NAVA and pressure support ventilation (PSV)., Setting: ICU of a University Hospital., Patients: Fourteen intubated and mechanically ventilated patients. DESIGN AND PROTOCOL: Cross-over, prospective, randomized controlled trial. PSV was set to obtain a VT/kg of 6-8 ml/kg with an active inspiration. NAVA was matched with a dedicated software. The assistance was decreased and increased by 50% with both modes. The six assist levels were randomly applied., Measurements: Arterial blood gases (ABGs), tidal volume (VT/kg), peak EAdi, airway pressure (Paw), neural and flow-based timing. Asynchrony was calculated using the asynchrony index (AI)., Results: There was no difference in ABGs regardless of mode and assist level. The differences in breathing pattern, ventilator assistance, and respiratory drive and timing between PSV and NAVA were overall small at the two lower assist levels. At the highest assist level, however, we found greater VT/kg (9.1 +/- 2.2 vs. 7.1 +/- 2 ml/kg, P < 0.001), and lower breathing frequency (12 +/- 6 vs. 18 +/- 8.2, P < 0.001) and peak EAdi (8.6 +/- 10.5 vs. 12.3 +/- 9.0, P < 0.002) in PSV than in NAVA; we found mismatch between neural and flow-based timing in PSV, but not in NAVA. AI exceeded 10% in five (36%) and no (0%) patients with PSV and NAVA, respectively (P < 0.05)., Conclusions: Compared to PSV, NAVA averted the risk of over-assistance, avoided patient-ventilator asynchrony, and improved patient-ventilator interaction. more...