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Tabah A, Buetti N, Staiquly Q, Ruckly S, Akova M, Aslan AT, Leone M, Conway Morris A, Bassetti M, Arvaniti K, Lipman J, Ferrer R, Qiu H, Paiva JA, Povoa P, De Bus L, De Waele J, Zand F, Gurjar M, Alsisi A, Abidi K, Bracht H, Hayashi Y, Jeon K, Elhadi M, Barbier F, Timsit JF, Pollock H, Margetts B, Young M, Bhadange N, Tyler S, Ledtischke A, Finnis M, Ledtischke A, Finnis M, Dwivedi J, Saxena M, Biradar V, Soar N, Sarode V, Brewster D, Regli A, Weeda E, Ahmed S, Fourie C, Laupland K, Ramanan M, Walsham J, Meyer J, Litton E, Palermo AM, Yap T, Eroglu E, Attokaran AG, Jaramillo C, Nafees KMK, Rashid NAHA, Walid HAMI, Mon T, Moorthi PD, Sudhirchandra S, Sridharan DD, Haibo Q, Jianfeng X, Wei-Hua L, Zhen W, Qian C, Luo J, Chen X, Wang H, Zhao P, Zhao J, Wusi Q, Mingmin C, Xu L, Yin C, Wang R, Wang J, Yin Y, Zhang M, Ye J, Hu C, Zhou S, Huang M, Yan J, Wang Y, Qin B, Ye L, Weifeng X, Peije L, Geng N, Hayashi Y, Karumai T, Yamasaki M, Hashimoto S, Hosokawa K, Makino J, Matsuyoshi T, Kuriyama A, Shigemitsu H, Mishima Y, Nagashima M, Yoshida H, Fujitani S, Omori K, Rinka H, Saito H, Atobe K, Kato H, Takaki S, Hasan MS, Jamaluddin MFH, Pheng LS, Visvalingam S, Liew MT, Wong SLD, Fong KK, Rahman HBA, Noor ZM, Tong LK, Azman AH, Mazlan MZ, Ali S, Jeon K, Lee SM, Park S, Park SY, Lim SY, Goh QY, Ng SY, Lie SA, Kwa ALH, Goh KJ, Li AY, Ong CYM, Lim JY, Quah JL, Ng K, Ng LXL, Yeh YC, Chou NK, Cia CT, Hu TY, Kuo LK, Ku SC, Wongsurakiat P, Apichatbutr Y, Chiewroongroj S, Nadeem R, Houfi AE, Alsisi A, Elhadidy A, Barsoum M, Osman N, Mostafa T, Elbahnasawy M, Saber A, Aldhalia A, Elmandouh O, Elsayed A, Elbadawy MA, Awad AK, Hemead HM, Zand F, Ouhadian M, Borsi SH, Mehraban Z, Kashipazha D, Ahmadi F, Savaie M, Soltani F, Rashidi M, Baghbanian R, Javaherforoosh F, Amiri F, Kiani A, Zargar MA, Mahmoodpoor A, Aalinezhad F, Dabiri G, Sabetian G, Sarshad H, Masjedi M, Tajvidi R, Tabatabaei SMN, Ahmed AK, Singer P, Kagan I, Rigler M, Belman D, Levin P, Harara B, Diab A, Abilama F, Ibrahim R, Fares A, Buimsaedah A, Gamra M, Aqeelah A, AliAli AM, Homaidan AGS, Almiqlash B, Bilkhayr H, Bouhuwaish A, Taher AS, Abdulwahed E, Abousnina FA, Hdada AK, Jobran R, Hasan HB, Hasan RSB, Serghini I, Seddiki R, Boukatta B, Kanjaa N, Mouhssine D, Wajdi MA, Dendane T, Zeggwagh AA, Housni B, Younes O, Hachimi A, Ghannam A, Belkhadir Z, Amro S, Jayyab MA, Hssain AA, Elbuzidi A, Karic E, Lance M, Nissar S, Sallam H, Elrabi O, Almekhlafi GA, Awad M, Aljabbary A, Chaaban MK, Abu-Sayf N, Al-Jadaan M, Bakr L, Bouaziz M, Turki O, Sellami W, Centeno P, Morvillo LN, Acevedo JO, Lopez PM, Fernández R, Segura M, Aparicio DM, Alonzo MI, Nuccetelli Y, Montefiore P, Reyes LF, Reyes LF, Ñamendys-Silva SA, Romero-Gonzalez JP, Hermosillo M, Castillo RA, Leal JNP, Aguilar CG, Herrera MOG, Villafuerte MVE, Lomeli-Teran M, Dominguez-Cherit JG, Davalos-Alvarez A, Ñamendys-Silva SA, Sánchez-Hurtado L, Tejeda-Huezo B, Perez-Nieto OR, Tomas ED, De Bus L, De Waele J, Hollevoet I, Denys W, Bourgeois M, Vanderhaeghen SFM, Mesland JB, Henin P, Haentjens L, Biston P, Noel C, Layos N, Misset B, De Schryver N, Serck N, Wittebole X, De Waele E, Opdenacker G, Kovacevic P, Zlojutro B, Custovic A, Filipovic-Grcic I, Radonic R, Brajkovic AV, Persec J, Sakan S, Nikolic M, Lasic H, Leone M, Arbelot C, Timsit JF, Patrier J, Zappela N, Montravers P, Dulac T, Castanera J, Auchabie J, Le Meur A, Marchalot A, Beuzelin M, Massri A, Guesdon C, Escudier E, Mateu P, Rosman J, Leroy O, Alfandari S, Nica A, Souweine B, Coupez E, Duburcq T, Kipnis E, Bortolotti P, Le Souhaitier M, Mira JP, Garcon P, Duprey M, Thyrault M, Paulet R, Philippart F, Tran M, Bruel C, Weiss E, Janny S, Foucrier A, Perrigault PF, Djanikian F, Barbier F, Gainnier M, Bourenne J, Louis G, Smonig R, Argaud L, Baudry T, Dessap AM, Razazi K, Kalfon P, Badre G, Larcher R, Lefrant JY, Roger C, Sarton B, Silva S, Demeret S, Le Guennec L, Siami S, Aparicio C, Voiriot G, Fartoukh M, Dahyot-Fizelier C, Imzi N, Klouche K, Bracht H, Hoheisen S, Bloos F, Thomas-Rueddel D, Petros S, Pasieka B, Dubler S, Schmidt K, Gottschalk A, Wempe C, Lepper P, Metz C, Viderman D, Ymbetzhanov Y, Mugazov M, Bazhykayeva Y, Kaligozhin Z, Babashev B, Merenkov Y, Temirov T, Arvaniti K, Smyrniotis D, Psallida V, Fildisis G, Soulountsi V, Kaimakamis E, Iasonidou C, Papoti S, Renta F, Vasileiou M, Romanou V, Koutsoukou V, Matei MK, Moldovan L, Karaiskos I, Paskalis H, Marmanidou K, Papanikolaou M, Kampolis C, Oikonomou M, Kogkopoulos E, Nikolaou C, Sakkalis A, Chatzis M, Georgopoulou M, Efthymiou A, Chantziara V, Sakagianni A, Athanasa Z, Papageorgiou E, Ali F, Dimopoulos G, Almiroudi MP, Malliotakis P, Marouli D, Theodorou V, Retselas I, Kouroulas V, Papathanakos G, Montrucchio G, Sales G, De Pascale G, Montini LM, Carelli S, Vargas J, Di Gravio V, Giacobbe DR, Gratarola A, Porcile E, Mirabella M, Daroui I, Lodi G, Zuccaro F, Schlevenin MG, Pelosi P, Battaglini D, Cortegiani A, Ippolito M, Bellina D, Di Guardo A, Pelagalli L, Covotta M, Rocco M, Fiorelli S, Cotoia A, Rizzo AC, Mikstacki A, Tamowicz B, Komorowska IK, Szczesniak A, Bojko J, Kotkowska A, Walczak-Wieteska P, Wasowska D, Nowakowski T, Broda H, Peichota M, Pietraszek-Grzywaczewska I, Martin-Loeches I, Bisanti A, Cartoze N, Pereira T, Guimarães N, Alves M, Marques AJP, Pinto AR, Krystopchuk A, Teresa A, de Figueiredo AMP, Botelho I, Duarte T, Costa V, Cunha RP, Molinos E, da Costa T, Ledo S, Queiró J, Pascoalinho D, Nunes C, Moura JP, Pereira É, Mendes AC, Valeanu L, Bubenek-Turconi S, Grintescu IM, Cobilinschi C, Filipescu DC, Predoi CE, Tomescu D, Popescu M, Marcu A, Grigoras I, Lungu O, Gritsan A, Anderzhanova A, Meleshkina Y, Magomedov M, Zubareva N, Tribulev M, Gaigolnik D, Eremenko A, Vistovskaya N, Chukina M, Belskiy V, Furman M, Rocca RF, Martinez M, Casares V, Vera P, Flores M, Amerigo JA, Arnillas MPG, Bermudez RM, Armestar F, Catalan B, Roig R, Raguer L, Quesada MD, Santos ED, Gomà G, Ubeda A, Salgado DM, Espina LF, Prieto EG, Asensio DM, Rodriguez DM, Maseda E, De La Rica AS, Ayestaran JI, Novo M, Blasco-Navalpotro MA, Gallego AO, Sjövall F, Spahic D, Svensson CJ, Haney M, Edin A, Åkerlund J, De Geer L, Prazak J, Jakob S, Pagani J, Abed-Maillard S, Akova M, Aslan AT, Timuroglu A, Kocagoz S, Kusoglu H, Mehtap S, Ceyhun S, Altintas ND, Talan L, Kayaaslan B, Kalem AK, Kurt I, Telli M, Ozturk B, Erol Ç, Demiray EKD, Çolak S, Akbas T, Gundogan K, Sari A, Agalar C, Çolak O, Baykam NN, Akdogan OO, Yilmaz M, Tunay B, Cakmak R, Saltoglu N, Karaali R, Koksal I, Aksoy F, Eroglu A, Saracoglu KT, Bilir Y, Guzeldag S, Ersoz G, Evik G, Sungurtekin H, Ozgen C, Erdoğan C, Gürbüz Y, Altin N, Bayindir Y, Ersoy Y, Goksu S, Akyol A, Batirel A, Aktas SC, Morris AC, Routledge M, Morris AC, Ercole A, Antcliffe D, Rojo R, Tizard K, Faulkner M, Cowton A, Kent M, Raj A, Zormpa A, Tinaslanidis G, Khade R, Torlinski T, Mulhi R, Goyal S, Bajaj M, Soltan M, Yonan A, Dolan R, Johnson A, Macfie C, Lennard J, Templeton M, Arias SS, Franke U, Hugill K, Angell H, Parcell BJ, Cobb K, Cole S, Smith T, Graham C, Cerman J, Keegan A, Ritzema J, Sanderson A, Roshdy A, Szakmany T, Baumer T, Longbottom R, Hall D, Tatham K, Loftus S, Husain A, Black E, Jhanji S, Baikady RR, Mcguigan P, Mckee R, Kannan S, Antrolikar S, Marsden N, Torre VD, Banach D, Zaki A, Jackson M, Chikungwa M, Attwood B, Patel J, Tilley RE, Humphreys MSK, Renaud PJ, Sokhan A, Burma Y, Sligl W, Baig N, McCoshen L, Kutsogiannis DJ, Sligl W, Thompson P, Hewer T, Rabbani R, Huq SMR, Hasan R, Islam MM, Gurjar M, Baronia A, Kothari N, Sharma A, Karmakar S, Sharma P, Nimbolkar J, Samdani P, Vaidyanathan R, Rubina NA, Jain N, Pahuja M, Singh R, Shekhar S, Muzaffar SN, Ozair A, Siddiqui SS, Bose P, Datta A, Rathod D, Patel M, Renuka MK, Baby SK, Dsilva C, Chandran J, Ghosh P, Mukherjee S, Sheshala K, Misra KC, Yakubu SY, Ugwu EM, Olatosi JO, Desalu I, Asiyanbi G, Oladimeji M, Idowu O, Adeola F, Mc Cree M, Karar AAA, Saidahmed E, Hamid HKS. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study. Intensive Care Med 2023; 49:178-190. [PMID: 36764959 PMCID: PMC9916499 DOI: 10.1007/s00134-022-06944-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/23/2022] [Indexed: 02/12/2023]
Abstract
PURPOSE In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. METHODS We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. RESULTS 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. CONCLUSIONS HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.
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Affiliation(s)
- Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia. .,Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Université de Paris, INSERM, IAME UMR 1137, 75018, Paris, France
| | | | - Stéphane Ruckly
- Université de Paris, INSERM, IAME UMR 1137, 75018, Paris, France.,ICUREsearch, Biometry, 38600, Fontaine, France
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdullah Tarik Aslan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.,Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK.,JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Jeffrey Lipman
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Nimes University Hospital, University of Montpellier, Nimes, France.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - José-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal.,Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Infection and Sepsis ID Group, Porto, Portugal
| | - Pedro Povoa
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark.,Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Liesbet De Bus
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan De Waele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Farid Zand
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | - Adel Alsisi
- ICU Department, Prime Hospital, Dubai, United Arab Emirates.,Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khalid Abidi
- Medical ICU, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hendrik Bracht
- Central Interdisciplinary Emergency Medicine, University Hospital Ulm, Ulm, Germany
| | - Yoshiro Hayashi
- Department of Intensive Care Medicine, Kameda General Hospital, Kamogawa, Japan
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - François Barbier
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, 14, avenue de L'Hôpital, 45100, Orléans, France
| | - Jean-François Timsit
- Université Paris-Cité, INSERM, IAME UMR 1137, 75018, Paris, France.,Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Omdurman maternity hospitalrue Henri Huchard, 75877, Paris Cedex, France
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Cortegiani A, Tripodi VF, Castioni CA, Esposito C, Galdieri N, Monzani R, Rispoli M, Simonini A, Torrano V, Giarratano A, Gratarola A. Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement. J Anesth Analg Crit Care 2022. [PMCID: PMC9214464 DOI: 10.1186/s44158-022-00058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background The appropriate timing of surgery and perioperative management of patients with previous SARS-CoV-2 infection are open issues. The purpose of this document is to support the clinical decision-making process regarding the patient with previous Sars-CoV-2 infection to undergo elective surgery. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient’s surgical process. Methods The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) selected 11 experts to reach a consensus on key aspects of this theme in adult and pediatric population. The methods of this process document were in accordance to the principles of rapid review of the scientific literature and modified Delphi method. The experts produced statements and supporting reasons in the form of an informative text. The overall list of statements was subjected to a vote in order to express the degree of consent. Results Patients should not undergo elective surgery within 7 weeks of infection unless there is the risk of a negative evolution of the disease. To mitigate the risk of postsurgical mortality, a multidisciplinary approach seemed useful in addition to the use of validated algorithms to estimate the risk of perioperative morbidity and mortality; the risk related to SARS-CoV-2 infection should be added. The risk of potential nosocomial contagion from a positive patients should also be considered when deciding to proceed with surgery. Most of the evidence came from previous SARS-CoV-2 variants, so the evidence should be considered indirect. Conclusion A balanced preoperative multidisciplinary risk–benefit evaluation is needed in patients with previous infection by SARS-CoV-2 for elective surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s44158-022-00058-3.
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Coccolini F, Corradi F, Sartelli M, Coimbra R, Kryvoruchko IA, Leppaniemi A, Doklestic K, Bignami E, Biancofiore G, Bala M, Marco C, Damaskos D, Biffl WL, Fugazzola P, Santonastaso D, Agnoletti V, Sbarbaro C, Nacoti M, Hardcastle TC, Mariani D, De Simone B, Tolonen M, Ball C, Podda M, Di Carlo I, Di Saverio S, Navsaria P, Bonavina L, Abu-Zidan F, Soreide K, Fraga GP, Carvalho VH, Batista SF, Hecker A, Cucchetti A, Ercolani G, Tartaglia D, Galante JM, Wani I, Kurihara H, Tan E, Litvin A, Melotti RM, Sganga G, Zoro T, Isirdi A, De'Angelis N, Weber DG, Hodonou AM, tenBroek R, Parini D, Khan J, Sbrana G, Coniglio C, Giarratano A, Gratarola A, Zaghi C, Romeo O, Kelly M, Forfori F, Chiarugi M, Moore EE, Catena F, Malbrain MLNG. Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines. World J Emerg Surg 2022; 17:50. [PMID: 36131311 PMCID: PMC9494880 DOI: 10.1186/s13017-022-00455-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/16/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. MATERIAL AND METHODS An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. CONCLUSION Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy.
| | | | | | - Raul Coimbra
- Trauma Surgery Department, Riverside University Health System Medical Center, Loma Linda, CA, USA
| | - Igor A Kryvoruchko
- Department of Surgery No2, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Ari Leppaniemi
- General Surgery Department, Helsinki University Hospital, Helsinki, Finland
| | - Krstina Doklestic
- Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Elena Bignami
- ICU Department, Parma University Hospital, Parma, Italy
| | | | - Miklosh Bala
- Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Ceresoli Marco
- General Surgery Department, Monza University Hospital, Monza, Italy
| | - Dimitris Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Walt L Biffl
- Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Paola Fugazzola
- General Surgery Department, Pavia University Hospital, Pavia, Italy
| | | | | | | | - Mirco Nacoti
- ICU Department Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Timothy C Hardcastle
- Trauma and Burn Service, Inkosi Albert Luthuli Central Hospital, Mayville, Durban, South Africa
| | - Diego Mariani
- General Surgery Department, Legnano Hospital, Legnano, Milano, Italy
| | - Belinda De Simone
- Emergency and Colorectal Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France
| | - Matti Tolonen
- Emergency Surgery, HUS Helsinki University Hospital, Meilahti Tower Hospital, Helsinki, Finland
| | - Chad Ball
- Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Salomone Di Saverio
- General Surgery Department, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy
| | - Pradeep Navsaria
- Trauma Center, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Luigi Bonavina
- General Surgery Department, San Donato Hospital, Milan, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | - Andreas Hecker
- General Surgery, Giessen University Hospital, Giessen, Germany
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, General Surgery of the Morgagni - Pierantoni Hospital, Forlì, Italy
| | - Dario Tartaglia
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | - Joseph M Galante
- General Surgery Department, UCLA Davis University Hospital, Los Angeles, CA, USA
| | - Imtiaz Wani
- General Surgery Department, Government Gousiua Hospital, Srinagar, India
| | - Hayato Kurihara
- Emergency and Trauma Surgery Department, Milano University Hospital, Milan, Italy
| | - Edward Tan
- Emergency Department, Nijmegen Hospital, Nijmegen, The Netherlands
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | | | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tamara Zoro
- ICU Department, Pisa University Hospital, Pisa, Italy
| | | | - Nicola De'Angelis
- Service de Chirurgie Digestive Et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Adrien M Hodonou
- Faculty of Medicine of Parakou, University of Parakou, Parakou, Benin
| | - Richard tenBroek
- General Surgery Department, Nijmegen Hospital, Nijmegen, The Netherlands
| | - Dario Parini
- General Surgery Department, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Jim Khan
- University of Portsmouth, Portsmouth Hospitals University NHS Trust UK, Portsmouth, UK
| | | | | | | | | | - Claudia Zaghi
- General, Emergency and Trauma Surgery Department, Vicenza Hospital, Vicenza, Italy
| | - Oreste Romeo
- Trauma and Surgical Critical Care, East Medical Center Drive, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | | | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124, Pisa, Italy
| | | | - Fausto Catena
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Manu L N G Malbrain
- First Department Anaesthesiology Intensive Therapy, Medical University Lublin, Lublin, Poland.,International Fluid Academy, Lovenjoel, Belgium
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Filauro M, Mora F, Vallin A, Della Casa P, Arceri C, Gratarola A, Peretti G. Evone® Flow controlled ventilation: a new device for laryngotracheal surgery. Acta Otorhinolaryngol Ital 2022; 42:189-193. [PMID: 35612512 PMCID: PMC9132004 DOI: 10.14639/0392-100x-n1834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022]
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Bassetti M, Giacobbe DR, Bruzzi P, Barisione E, Centanni S, Castaldo N, Corcione S, De Rosa FG, Di Marco F, Gori A, Gramegna A, Granata G, Gratarola A, Maraolo AE, Mikulska M, Lombardi A, Pea F, Petrosillo N, Radovanovic D, Santus P, Signori A, Sozio E, Tagliabue E, Tascini C, Vancheri C, Vena A, Viale P, Blasi F. Clinical Management of Adult Patients with COVID-19 Outside Intensive Care Units: Guidelines from the Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP). Infect Dis Ther 2021; 10:1837-1885. [PMID: 34328629 PMCID: PMC8323092 DOI: 10.1007/s40121-021-00487-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP) constituted an expert panel for developing evidence-based guidance for the clinical management of adult patients with coronavirus disease 2019 (COVID-19) outside intensive care units. METHODS Ten systematic literature searches were performed to answer ten different key questions. The retrieved evidence was graded according to the Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). RESULTS AND CONCLUSION The literature searches mostly assessed the available evidence on the management of COVID-19 patients in terms of antiviral, anticoagulant, anti-inflammatory, immunomodulatory, and continuous positive airway pressure (CPAP)/non-invasive ventilation (NIV) treatment. Most evidence was deemed as of low certainty, and in some cases, recommendations could not be developed according to the GRADE system (best practice recommendations were provided in similar situations). The use of neutralizing monoclonal antibodies may be considered for outpatients at risk of disease progression. For inpatients, favorable recommendations were provided for anticoagulant prophylaxis and systemic steroids administration, although with low certainty of evidence. Favorable recommendations, with very low/low certainty of evidence, were also provided for, in specific situations, remdesivir, alone or in combination with baricitinib, and tocilizumab. The presence of many best practice recommendations testified to the need for further investigations by means of randomized controlled trials, whenever possible, with some possible future research directions stemming from the results of the ten systematic reviews.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy.
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy.
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Paolo Bruzzi
- Clinical Epidemiology Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Emanuela Barisione
- Interventional Pulmonology, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Stefano Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Nadia Castaldo
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Guido Granata
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Angelo Gratarola
- Department of Emergency and Urgency, San Martino Policlinico Hospital, IRCCS, Genoa, Italy
| | | | - Malgorzata Mikulska
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- SSD Clinical Pharmacology Unit, University Hospital, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
- Infection Control and Infectious Disease Service, University Hospital "Campus-Biomedico", Rome, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Emanuela Sozio
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - Elena Tagliabue
- Interventional Pulmonology, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Carlo Tascini
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases-University Hospital "Policlinico G. Rodolico", Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Infectious Diseases Unit, University Hospital IRCCS Policlinico Sant'Orsola, Bologna, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
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Sartini S, Massobrio L, Cutuli O, Campodonico P, Bernini C, Sartini M, Cristina ML, Castellani L, Ceschi L, Spadaro M, Gratarola A, Barbera P. Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study. Int J Environ Res Public Health 2021; 18:11534. [PMID: 34770046 PMCID: PMC8582831 DOI: 10.3390/ijerph182111534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 12/21/2022]
Abstract
COVID-19 respiratory failure is a life-threatening condition. Oxygenation targets were evaluated in a non-ICU setting. In this retrospective, observational study, we enrolled all patients admitted to the University Hospital of Genoa, Italy, between 1 February and 31 May 2020 with an RT-PCR positive for SARS-CoV-2. PaO2, PaO2/FiO2 and SatO2% were collected and analyzed at time 0 and in case of admission, patients who required or not C-PAP (groups A and B) were categorized. Each measurement was correlated to adverse outcome. A total of 483 patients were enrolled, and 369 were admitted to hospital. Of these, 153 required C-PAP and 266 had an adverse outcome. Patients with PaO2 <60 and >100 had a higher rate of adverse outcome at time 0, in groups A and B (OR 2.52, 3.45, 2.01, respectively). About the PaO2/FiO2 ratio, the OR for < 300 was 3.10 at time 0, 4.01 in group A and 4.79 in group B. Similar odds were found for < 200 in any groups and < 100 except for group B (OR 11.57). SatO2 < 94% showed OR 1.34, 3.52 and 19.12 at time 0, in groups A and B, respectively. PaO2 < 60 and >100, SatO2 < 94% and PaO2/FiO2 ratio < 300 showed at least two- to three-fold correlation to adverse outcome. This may provide simple but clear targets for clinicians facing COVID-19 respiratory failure in a non ICU-setting.
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Affiliation(s)
- Stefano Sartini
- Emergency Medicine Department, San Martino Policlinic University Hospital, 16132 Genoa, Italy; (S.S.); (L.M.); (O.C.); (P.C.); (C.B.); (P.B.)
| | - Laura Massobrio
- Emergency Medicine Department, San Martino Policlinic University Hospital, 16132 Genoa, Italy; (S.S.); (L.M.); (O.C.); (P.C.); (C.B.); (P.B.)
| | - Ombretta Cutuli
- Emergency Medicine Department, San Martino Policlinic University Hospital, 16132 Genoa, Italy; (S.S.); (L.M.); (O.C.); (P.C.); (C.B.); (P.B.)
| | - Paola Campodonico
- Emergency Medicine Department, San Martino Policlinic University Hospital, 16132 Genoa, Italy; (S.S.); (L.M.); (O.C.); (P.C.); (C.B.); (P.B.)
| | - Cristina Bernini
- Emergency Medicine Department, San Martino Policlinic University Hospital, 16132 Genoa, Italy; (S.S.); (L.M.); (O.C.); (P.C.); (C.B.); (P.B.)
| | - Marina Sartini
- Department of Health Sciences, University of Genova, 16132 Genoa, Italy;
- Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genoa, Italy
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, 16132 Genoa, Italy;
- Hospital Hygiene, E.O. Ospedali Galliera, 16128 Genoa, Italy
| | - Luca Castellani
- Emergency Medicine Post-Graduate School, University of Genoa, 16132 Genoa, Italy; (L.C.); (L.C.); (M.S.)
| | - Ludovica Ceschi
- Emergency Medicine Post-Graduate School, University of Genoa, 16132 Genoa, Italy; (L.C.); (L.C.); (M.S.)
| | - Marzia Spadaro
- Emergency Medicine Post-Graduate School, University of Genoa, 16132 Genoa, Italy; (L.C.); (L.C.); (M.S.)
| | - Angelo Gratarola
- Division of Anesthesia and Intensive Care, San Martino Policlinic University Hospital, 16132 Genoa, Italy;
| | - Paolo Barbera
- Emergency Medicine Department, San Martino Policlinic University Hospital, 16132 Genoa, Italy; (S.S.); (L.M.); (O.C.); (P.C.); (C.B.); (P.B.)
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Benenati S, Vercellino M, Avenoso D, Crimi G, Macchione A, Giachero C, Balbi M, Della Bona R, Gnecco G, Baronetto A, Ricci D, Buscaglia G, Palombo D, Gratarola A, Santini F, Porto I. [Management of cardiogenic shock: a proposal for a shared protocol]. G Ital Cardiol (Rome) 2021; 22:29S-38S. [PMID: 34590622 DOI: 10.1714/3675.36614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiogenic shock (CS) is a complex and relatively rare disease. Whilst its mortality remains unacceptably high, a multidisciplinary approach based on pre-established and shared protocols may improve prognosis and ensure appropriate resource allocation. Comprehensive hemodynamic assessment and monitoring as well as tailored, goal-directed medical therapy are part of an optimal management. Moreover, mechanical support devices may be helpful as they sustain hemodynamics to a greater extent as compared to inotropes and vasopressors, while lacking their cardiotoxic effects. Therefore, they are increasingly used in CS patients. In 2019, a new protocol for the management of patients with CS was adopted at the Ospedale Policlinico San Martino (HSM) in Genoa, Italy. Following in the footsteps of similar international experiences, the HSM protocol aims at streamlining the management of these high-risk patients improving the cooperation among healthcare specialists, and also addressing the key issues of mechanical support device implantation and appropriate referral for palliative care.
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Affiliation(s)
- Stefano Benenati
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi, Genova
| | - Matteo Vercellino
- U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Davide Avenoso
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi, Genova
| | - Gabriele Crimi
- U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Andrea Macchione
- U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Corinna Giachero
- U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Manrico Balbi
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi, Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Roberta Della Bona
- U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Giovanni Gnecco
- U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Andrea Baronetto
- U.O.C. Cardiochirurgia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Davide Ricci
- U.O.C. Cardiochirurgia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Giuseppe Buscaglia
- Dipartimento di Cardioanestesia e Terapia Intensiva, Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Domenico Palombo
- Unità di Chirurgia Vascolare ed Endovascolare, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Angelo Gratarola
- Dipartimento di Emergenza e Urgenza, Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Francesco Santini
- U.O.C. Cardiochirurgia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
| | - Italo Porto
- Cattedra di Malattie Cardiovascolari, Dipartimento di Medicina Interna (DIMI), Università degli Studi, Genova - U.O. Cardiologia, Dipartimento Cardio-Toraco-Vascolare (DICATOV), Ospedale Policlinico San Martino IRCCS - IRCCS Cardiovascular Network, Genova
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Bonsignore A, Bragazzi NL, Basile C, Pelosi P, Gratarola A, Bonatti G, Patroniti N, Ciliberti R. Development and Validation of a Questionnaire investigating the Knowledge, Attitudes and Practices of Healthcare Workers in the Field of Anesthesiology concerning the Italian Law on Advance Healthcare Directives: a Pilot Study. Acta Biomed 2021; 92:e2021092. [PMID: 34487082 PMCID: PMC8477106 DOI: 10.23750/abm.v92i4.11314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
Advance healthcare directives are legal documents, in which the patient, foreseeing a potential loss of capacity and autonomy, makes in advance decisions regarding future care and, in particular, end-of-life arrangements. In Italy, advance healthcare directives are regulated by the Law 219 of 22 December 2017. Objectives of the study were: i) to develop and validate a questionnaire dedicated to evaluate the knowledge of the Law in a sample of 98 anesthesiologists, and ii) to shed light on the process of health-related decision-making and its determinants (age, gender, doctor/training resident, religious beliefs). A second part of the survey not analyzed in the present study, aimed to assess, through two simulated clinical scenarios, how patient' directives, relatives and the medical staff could influence physicians' clinical decision. Overall Cronbach's alpha coefficient of the questionnaire resulted 0.83. Three factors explaining up to 38.4% of total variance (communication and relationship with the patient; critical life-threatening situations and binding nature of the advance directive for the physician; and involvement of patients). Most of the doctors (58.7%) did not fully know the recent legislative provision. The lack of knowledge is critical in view of the specificity of the clinical area investigated (anesthesiology and intensive care), which has to cope with ethical issues. An adequate revision and implementation of the traditional curricula could help medical students and trainees develop the aptitudes and skills needed in their future profession.
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Dentone C, Vena A, Loconte M, Grillo F, Brunetti I, Barisione E, Tedone E, Mora S, Di Biagio A, Orsi A, De Maria A, Nicolini L, Ball L, Giacobbe DR, Magnasco L, Delfino E, Mastracci L, Mangerini R, Taramasso L, Sepulcri C, Pincino R, Bavastro M, Cerchiaro M, Mikulska M, Bruzzone B, Icardi G, Frisoni P, Gratarola A, Patroniti N, Pelosi P, Bassetti M. Bronchoalveolar lavage fluid characteristics and outcomes of invasively mechanically ventilated patients with COVID-19 pneumonia in Genoa, Italy. BMC Infect Dis 2021; 21:353. [PMID: 33858331 PMCID: PMC8049078 DOI: 10.1186/s12879-021-06015-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The primary objective of the study is to describe the cellular characteristics of bronchoalveolar lavage fluid (BALF) of COVID-19 patients requiring invasive mechanical ventilation; the secondary outcome is to describe BALF findings between survivors vs non-survivors. MATERIALS AND METHODS Patients positive for SARS-CoV-2 RT PCR, admitted to ICU between March and April 2020 were enrolled. At ICU admission, BALF were analyzed by flow cytometry. Univariate, multivariate and Spearman correlation analyses were performed. RESULTS Sixty-four patients were enrolled, median age of 64 years (IQR 58-69). The majority cells in the BALF were neutrophils (70%, IQR 37.5-90.5) and macrophages (27%, IQR 7-49) while a minority were lymphocytes, 1%, TCD3+ 92% (IQR 82-95). The ICU mortality was 32.8%. Non-survivors had a significantly older age (p = 0.033) and peripheral lymphocytes (p = 0.012) were lower compared to the survivors. At multivariate analysis the percentage of macrophages in the BALF correlated with poor outcome (OR 1.336, CI95% 1.014-1.759, p = 0.039). CONCLUSIONS In critically ill patients, BALF cellularity is mainly composed of neutrophils and macrophages. The macrophages percentage in the BALF at ICU admittance correlated with higher ICU mortality. The lack of lymphocytes in BALF could partly explain a reduced anti-viral response.
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Affiliation(s)
- Chiara Dentone
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
| | - Antonio Vena
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Maurizio Loconte
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Federica Grillo
- Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Emanuela Barisione
- Interventional Pulmonology Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Elisabetta Tedone
- Flow Cytometry Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Andrea De Maria
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Laura Nicolini
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Laura Magnasco
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Emanuele Delfino
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Luca Mastracci
- Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Rosa Mangerini
- Flow Cytometry Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Chiara Sepulcri
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Rachele Pincino
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Martina Bavastro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matteo Cerchiaro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Paolo Frisoni
- Department of Anesthesia and Resuscitation, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Angelo Gratarola
- Department of Anesthesia and Resuscitation, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Nicolò Patroniti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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10
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Bozzano F, Dentone C, Perrone C, Di Biagio A, Fenoglio D, Parodi A, Mikulska M, Bruzzone B, Giacobbe DR, Vena A, Taramasso L, Nicolini L, Patroniti N, Pelosi P, Gratarola A, De Palma R, Filaci G, Bassetti M, De Maria A. Extensive activation, tissue trafficking, turnover and functional impairment of NK cells in COVID-19 patients at disease onset associates with subsequent disease severity. PLoS Pathog 2021; 17:e1009448. [PMID: 33861802 PMCID: PMC8081333 DOI: 10.1371/journal.ppat.1009448] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/28/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023] Open
Abstract
The SARS-CoV-2 infection causes severe respiratory involvement (COVID-19) in 5-20% of patients through initial immune derangement, followed by intense cytokine production and vascular leakage. Evidence of immune involvement point to the participation of T, B, and NK cells in the lack of control of virus replication leading to COVID-19. NK cells contribute to early phases of virus control and to the regulation of adaptive responses. The precise mechanism of NK cell dysregulation is poorly understood, with little information on tissue margination or turnover. We investigated these aspects by multiparameter flow cytometry in a cohort of 28 patients hospitalized with early COVID-19. Relevant decreases in CD56brightCD16+/- NK subsets were detected, with a shift of circulating NK cells toward more mature CD56dimCD16+KIR+NKG2A+ and "memory" KIR+CD57+CD85j+ cells with increased inhibitory NKG2A and KIR molecules. Impaired cytotoxicity and IFN-γ production were associated with conserved expression of natural cytotoxicity receptors and perforin. Moreover, intense NK cell activation with increased HLA-DR and CD69 expression was associated with the circulation of CD69+CD103+ CXCR6+ tissue-resident NK cells and of CD34+DNAM-1brightCXCR4+ inflammatory precursors to mature functional NK cells. Severe disease trajectories were directly associated with the proportion of CD34+DNAM-1brightCXCR4+ precursors and inversely associated with the proportion of NKG2D+ and of CD103+ NK cells. Intense NK cell activation and trafficking to and from tissues occurs early in COVID-19, and is associated with subsequent disease progression, providing an insight into the mechanism of clinical deterioration. Strategies to positively manipulate tissue-resident NK cell responses may provide advantages to future therapeutic and vaccine approaches.
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Affiliation(s)
- Federica Bozzano
- Division of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
| | - Chiara Dentone
- Division of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
| | - Carola Perrone
- Centre of Excellence for Biomedical Research and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Division of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Daniela Fenoglio
- Centre of Excellence for Biomedical Research and Department of Internal Medicine, University of Genoa, Genoa, Italy
- Biotherapy Unit, Policlinico San Martino Hospital, Genoa, Italy
| | - Alessia Parodi
- Centre of Excellence for Biomedical Research and Department of Internal Medicine, University of Genoa, Genoa, Italy
- Biotherapy Unit, Policlinico San Martino Hospital, Genoa, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, Policlinico San Martino Hospital, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Division of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Antonio Vena
- Division of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
| | - Lucia Taramasso
- Division of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
| | - Laura Nicolini
- Division of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
| | - Nicolò Patroniti
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Angelo Gratarola
- Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Raffaele De Palma
- Internal Medicine Unit, Clinical Immunology and Translational Medicine, Policlinico San Martino Hospital, Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Italy
| | - Gilberto Filaci
- Biotherapy Unit, Policlinico San Martino Hospital, Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Andrea De Maria
- Division of Infectious Diseases, Policlinico San Martino Hospital, Genoa, Italy
- Centre of Excellence for Biomedical Research and Department of Internal Medicine, University of Genoa, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
- * E-mail:
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11
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Valente R, Di Domenico S, Mascherini M, Santori G, Papadia F, Orengo G, Gratarola A, Cafiero F, De Cian F. A new model to prioritize waiting lists for elective surgery under the COVID-19 pandemic pressure. Br J Surg 2021; 108:e12-e14. [PMID: 33640936 PMCID: PMC7799261 DOI: 10.1093/bjs/znaa028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 11/14/2022]
Affiliation(s)
- R Valente
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy.,Division of Surgery and Interventional Science, University College London, London, UK
| | - S Di Domenico
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
| | - M Mascherini
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
| | - G Santori
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - F Papadia
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - G Orengo
- Hospital Leadership Department, Policlinico San Martino, Genoa, Italy
| | - A Gratarola
- Department of Emergency, Anaesthesia and Intensive Care, Policlinico San Martino, Genoa, Italy
| | - F Cafiero
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy.,Regional Inter-Trust Surgical Departments, Regional Healthcare Trust, Liguria Region Health Administration, Italy
| | - F De Cian
- Department of Surgery, Policlinico San Martino, Largo Rosanna Benzi, 10, 16132 Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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12
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Mantica G, Riccardi N, Terrone C, Gratarola A. Non-COVID-19 admissions to the emergency department during the pandemic second wave in Italy: What is changed from the first wave? Am J Emerg Med 2020; 45:625-626. [PMID: 33303298 PMCID: PMC7690299 DOI: 10.1016/j.ajem.2020.11.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genova, Italy.
| | - Niccolò Riccardi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Valpolicella di Negrar, Verona, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genova, Italy
| | - Angelo Gratarola
- Division of Anesthesia and Intensive Care, San Martino Policlinic Hospital, IRCCS for Oncology, Genoa, Italy
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13
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Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, Pelosi P, Patroniti NA, De Lucia A, Orengo G, Gratarola A, Verda M, Cittadini G, Mastracci L, Fiocca R. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch 2020; 478:471-485. [PMID: 32989525 PMCID: PMC7521863 DOI: 10.1007/s00428-020-02934-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/19/2020] [Accepted: 09/18/2020] [Indexed: 12/24/2022]
Abstract
Data on the pathology of COVID-19 are scarce; available studies show diffuse alveolar damage; however, there is scarce information on the chronologic evolution of COVID-19 lung lesions. The primary aim of the study is to describe the chronology of lung pathologic changes in COVID-19 by using a post-mortem transbronchial lung cryobiopsy approach. Our secondary aim is to correlate the histologic findings with computed tomography patterns. SARS-CoV-2-positive patients, who died while intubated and mechanically ventilated, were enrolled. The procedure was performed 30 min after death, and all lung lobes sampled. Histopathologic analysis was performed on thirty-nine adequate samples from eight patients: two patients (illness duration < 14 days) showed early/exudative phase diffuse alveolar damage, while the remaining 6 patients (median illness duration—32 days) showed progressive histologic patterns (3 with mid/proliferative phase; 3 with late/fibrotic phase diffuse alveolar damage, one of which with honeycombing). Immunohistochemistry for SARS-CoV-2 nucleocapsid protein was positive predominantly in early-phase lesions. Histologic patterns and tomography categories were correlated: early/exudative phase was associated with ground-glass opacity, mid/proliferative lesions with crazy paving, while late/fibrous phase correlated with the consolidation pattern, more frequently seen in the lower/middle lobes. This study uses an innovative cryobiopsy approach for the post-mortem sampling of lung tissues from COVID-19 patients demonstrating the progression of fibrosis in time and correlation with computed tomography features. These findings may prove to be useful in the correct staging of disease, and this could have implications for treatment and patient follow-up.
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Affiliation(s)
- Emanuela Barisione
- Interventional Pulmonology Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Federica Grillo
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Lorenzo Ball
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
- Anesthesia and Intensive Care Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Rita Bianchi
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Marco Grosso
- Interventional Pulmonology Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Patrizia Morbini
- Unit of Pathology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pelosi
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
- Anesthesia and Intensive Care Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Nicolò Antonino Patroniti
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
- Anesthesia and Intensive Care Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Arduino De Lucia
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Giovanni Orengo
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Angelo Gratarola
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Marta Verda
- Radiology, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Giuseppe Cittadini
- General Radiology, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Luca Mastracci
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy.
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy.
| | - Roberto Fiocca
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
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14
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Mikulska M, Nicolini LA, Signori A, Di Biagio A, Sepulcri C, Russo C, Dettori S, Berruti M, Sormani MP, Giacobbe DR, Vena A, De Maria A, Dentone C, Taramasso L, Mirabella M, Magnasco L, Mora S, Delfino E, Toscanini F, Balletto E, Alessandrini AI, Baldi F, Briano F, Camera M, Dodi F, Ferrazin A, Labate L, Mazzarello G, Pincino R, Portunato F, Tutino S, Barisione E, Bruzzone B, Orsi A, Schenone E, Rosseti N, Sasso E, Da Rin G, Pelosi P, Beltramini S, Giacomini M, Icardi G, Gratarola A, Bassetti M. Tocilizumab and steroid treatment in patients with COVID-19 pneumonia. PLoS One 2020; 15:e0237831. [PMID: 32817707 PMCID: PMC7440633 DOI: 10.1371/journal.pone.0237831] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/02/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) can lead to respiratory failure due to severe immune response. Treatment targeting this immune response might be beneficial but there is limited evidence on its efficacy. The aim of this study was to determine if early treatment of patients with COVID-19 pneumonia with tocilizumab and/or steroids was associated with better outcome. METHODS This observational single-center study included patients with COVID-19 pneumonia who were not intubated and received either standard of care (SOC, controls) or SOC plus early (within 3 days from hospital admission) anti-inflammatory treatment. SOC consisted of hydroxychloroquine 400mg bid plus, in those admitted before March 24th, also darunavir/ritonavir. Anti-inflammatory treatment consisted of either tocilizumab (8mg/kg intravenously or 162mg subcutaneously) or methylprednisolone 1 mg/kg for 5 days or both. Failure was defined as intubation or death, and the endpoints were failure-free survival (primary endpoint) and overall survival (secondary) at day 30. Difference between the groups was estimated as Hazard Ratio by a propensity score weighted Cox regression analysis (HROW). RESULTS Overall, 196 adults were included in the analyses. They were mainly male (67.4%), with comorbidities (78.1%) and severe COVID-19 pneumonia (83.7%). Median age was 67.9 years (range, 30-100) and median PaO2/FiO2 200 mmHg (IQR 133-289). Among them, 130 received early anti-inflammatory treatment with: tocilizumab (n = 29, 22.3%), methylprednisolone (n = 45, 34.6%), or both (n = 56, 43.1%). The adjusted failure-free survival among tocilizumab/methylprednisolone/SOC treated patients vs. SOC was 80.8% (95%CI, 72.8-86.7) vs. 64.1% (95%CI, 51.3-74.0), HROW 0.48, 95%CI, 0.23-0.99; p = 0.049. The overall survival among tocilizumab/methylprednisolone/SOC patients vs. SOC was 85.9% (95%CI, 80.7-92.6) vs. 71.9% (95%CI, 46-73), HROW 0.41, 95%CI: 0.19-0.89, p = 0.025. CONCLUSION Early adjunctive treatment with tocilizumab, methylprednisolone or both may improve outcomes in non-intubated patients with COVID-19 pneumonia.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- * E-mail:
| | - Laura Ambra Nicolini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genova, Italy
| | - Antonio Di Biagio
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Sepulcri
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Chiara Russo
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Silvia Dettori
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Marco Berruti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Maria Pia Sormani
- Section of Biostatistics, Department of Health Sciences, University of Genova, Genova, Italy
| | - Daniele Roberto Giacobbe
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea De Maria
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Dentone
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Taramasso
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Mirabella
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Magnasco
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Emanuele Delfino
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federica Toscanini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Balletto
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Ida Alessandrini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Baldi
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Federica Briano
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Marco Camera
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ferdinando Dodi
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Ferrazin
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Labate
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Giovanni Mazzarello
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rachele Pincino
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Federica Portunato
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Stefania Tutino
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Emanuela Barisione
- Interventional Pulmonology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Orsi
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Eva Schenone
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nirmala Rosseti
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisabetta Sasso
- Pharmacy Complex Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giorgio Da Rin
- Medicine Laboratory, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Genova, Italy
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Sabrina Beltramini
- Pharmacy Complex Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Giancarlo Icardi
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Angelo Gratarola
- Department of Emergency and Urgency, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Mantica G, Riccardi N, Terrone C, Gratarola A. Re: Letter to the editor of Public Health in response to 'Non-COVID-19 visits to emergency departments during the pandemic: the impact of fear'. Public Health 2020; 186:17. [PMID: 32739666 PMCID: PMC7357536 DOI: 10.1016/j.puhe.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Affiliation(s)
- G Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genova, Italy.
| | - N Riccardi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Valpolicella di Negrar, Verona, Italy
| | - C Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genova, Italy
| | - A Gratarola
- Division of Anesthesia and Intensive Care, San Martino Policlinic Hospital, IRCCS for Oncology, Genoa, Italy
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Mantica G, Riccardi N, Terrone C, Gratarola A. Non-COVID-19 visits to emergency departments during the pandemic: the impact of fear. Public Health 2020; 183:40-41. [PMID: 32417567 PMCID: PMC7203034 DOI: 10.1016/j.puhe.2020.04.046] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genova, Italy.
| | - Niccolò Riccardi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Valpolicella di Negrar, Verona, Italy
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genova, Italy
| | - Angelo Gratarola
- Division of Anesthesia and Intensive Care, San Martino Policlinic Hospital, IRCCS for Oncology, Genoa, Italy
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Langiano N, Fiorelli S, Deana C, Baroselli A, Bignami EG, Matellon C, Pompei L, Tornaghi A, Piccioni F, Orsetti R, Coccia C, Sacchi N, D'Andrea R, Brazzi L, Franco C, Accardo R, Di Fuccia A, Baldinelli F, De Negri P, Gratarola A, Angeletti C, Pugliese F, Micozzi MV, Massullo D, Della Rocca G. Airway management in anesthesia for thoracic surgery: a "real life" observational study. J Thorac Dis 2019; 11:3257-3269. [PMID: 31559028 DOI: 10.21037/jtd.2019.08.57] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background One-lung ventilation (OLV) in thoracic anesthesia is required to provide good surgical exposure. OLV is commonly achieved through a double lumen tube (DLT) or a bronchial blocker (BB). Malposition is a relevant issue related to these devices use. No prospective studies with adequately large sample size have been performed to evaluate the malposition rate of DLTs and BBs. Methods A total of 2,127 patients requiring OLV during thoracic surgery were enrolled. The aim of this multicenter prospective observational study performed across 26 academic and community hospitals is to evaluate intraoperative malposition rate of DLTs and BBs. We also aim to assess: which device is the most used to achieve OLV, the frequency of bronchoscope (BRO) use, the incidence rate of desaturation during OLV and the role of other factors that can correlate to this event, and incidence of difficult airway. Results Malposition rate for DLTs was 14%, for BBs 33%. DLTs were used in 95% of patients and BBs in 5%. Mean positioning time was shorter for DLT than BB (156±230 vs. 321±290 s). BRO was used in 54% of patients to check the correct positioning of the DLT. Desaturation occurred in 20% of all cases during OLV achieved through a DLT. Predicting factors of desaturation were dislocation (OR 2.03) and big size of DLT (OR 1.15). BRO use (OR 0.69) and left surgical side (OR 0.41) proved to be protective factors. Difficult airway prevalence was 16%; 10.8% predicted and 5.2% unpredicted. Conclusions DLT has a low malpositioning rate and is the preferred device to achieve OLV. BRO use recorded was unexpectedly low. The possibility of encountering a difficult airway is frequent, with an overall prevalence of 16%. Risk factors of desaturation are malposition and increased size of DLT. Left procedures and BRO use could lead to fewer episodes of desaturation.
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Affiliation(s)
- Nicola Langiano
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Silvia Fiorelli
- Department of Anesthesiology and Intensive care, Sapienza University of Rome, Rome, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Antonio Baroselli
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carola Matellon
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
| | - Livia Pompei
- UOC Anesthesia and ICM 1. Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Anna Tornaghi
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Piccioni
- Department of Anesthesia, Intensive Care and Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Remo Orsetti
- Anesthesia and ICM DPT of Pulmonary Diseases, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | | | - Noemi Sacchi
- School of Anesthesia and Intensive Care, University of Milan, Milan, Italy
| | - Rocco D'Andrea
- U.O. Anesthesia and ICM. A.U.O. Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Luca Brazzi
- AOU "Città della Salute e della Scienza" di Turin, University of Turin, Turin, Italy
| | - Carlo Franco
- AOU "Città della Salute e della Scienza" di Turin, University of Turin, Turin, Italy
| | - Rosanna Accardo
- Division of Anesthesia, Department of Anesthesia, Endoscopy and Cardiology, Istituto Nazionale Tumori "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - Antonio Di Fuccia
- UOC Anesthesia and Postoperative ICM, Cardarelli Hospital, Naples, Italy
| | | | - Pasquale De Negri
- Department of Anesthesia, Intensive Care and Pain Medicine. IRCCS Centro di Riferimento Oncologico della Basilicata/OECI Clinical Cancer Center - Rionero in Vulture, Potenza, Italy
| | | | - Chiara Angeletti
- Operative Unit of Anesthesiology, Intensive Care and Pain Medicine, Civil Hospital G. Mazzini of Teramo, Teramo, Italy. Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Pugliese
- UOD Anesthesia and ICM of Organ Transplantation, DPT Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Marco Valerio Micozzi
- Department of Anesthesiology and Intensive care, Sapienza University of Rome, Rome, Italy
| | - Domenico Massullo
- Department of Anesthesiology and Intensive care, Sapienza University of Rome, Rome, Italy
| | - Giorgio Della Rocca
- Department of Anesthesia and Intensive Care, University of Udine, Academic Hospital "S. M. della Misericordia", Udine, Italy
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18
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Funcke S, Saugel B, Koch C, Schulte D, Zajonz T, Sander M, Gratarola A, Ball L, Pelosi P, Spadaro S, Ragazzi R, Volta CA, Mencke T, Zitzmann A, Neukirch B, Azparren G, Giné M, Moral V, Pinnschmidt HO, Díaz-Cambronero O, Estelles MJA, Velez ME, Montañes MV, Belda J, Soro M, Puig J, Reuter DA, Haas SA. Individualized, perioperative, hemodynamic goal-directed therapy in major abdominal surgery (iPEGASUS trial): study protocol for a randomized controlled trial. Trials 2018; 19:273. [PMID: 29743101 PMCID: PMC5944092 DOI: 10.1186/s13063-018-2620-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/28/2018] [Indexed: 01/04/2023] Open
Abstract
Background Postoperative morbidity and mortality in patients undergoing surgery is high, especially in patients who are at risk of complications and undergoing major surgery. We hypothesize that perioperative, algorithm-driven, hemodynamic therapy based on individualized fluid status and cardiac output optimization is able to reduce mortality and postoperative moderate and severe complications as a major determinant of the patients’ postoperative quality of life, as well as health care costs. Methods/design This is a multi-center, international, prospective, randomized trial in 380 patients undergoing major abdominal surgery including visceral, urological, and gynecological operations. Eligible patients will be randomly allocated to two treatment arms within the participating centers. Patients of the intervention group will be treated perioperatively following a specific hemodynamic therapy algorithm based on pulse-pressure variation (PPV) and individualized optimization of cardiac output assessed by pulse-contour analysis (ProAQT© device; Pulsion Medical Systems, Feldkirchen, Germany). Patients in the control group will be treated according to standard local care based on established basic hemodynamic treatment. The primary endpoint is a composite comprising the occurrence of moderate or severe postoperative complications or death within 28 days post surgery. Secondary endpoints are: (1) the number of moderate and severe postoperative complications in total, per patient and for each individual complication; (2) the occurrence of at least one of these complications on days 1, 3, 5, 7, and 28 in total and for every complication; (3) the days alive and free of mechanical ventilation, vasopressor therapy and renal replacement therapy, length of intensive care unit, and hospital stay at day 7 and day 28; and (4) mortality and quality of life, assessed by the EQ-5D-5L™ questionnaire, after 6 months. Discussion This is a large, international randomized controlled study evaluating the effect of perioperative, individualized, algorithm-driven ,hemodynamic optimization on postoperative morbidity and mortality. Trial registration Trial registration: NCT03021525. Registered on 12 January 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2620-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Funcke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Koch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Dagmar Schulte
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Thomas Zajonz
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Universitätsklinikum Giessen und Marburg GmbH, 35392, Giessen, Germany
| | - Angelo Gratarola
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Savino Spadaro
- Department of Anesthesia and Intensive Care, University of Ferrara, Sant Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Riccardo Ragazzi
- Department of Anesthesia and Intensive Care, University of Ferrara, Sant Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Carlo Alberto Volta
- Department of Anesthesia and Intensive Care, University of Ferrara, Sant Anna Hospital, Via Aldo Moro, 8, 44121, Ferrara, Italy
| | - Thomas Mencke
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Amelie Zitzmann
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Benedikt Neukirch
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Gonzalo Azparren
- Department of Anesthesiology, Hospital Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
| | - Marta Giné
- Department of Anesthesiology, Hospital Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
| | - Vicky Moral
- Department of Anesthesiology, Hospital Santa Creu i Sant Pau, C/ Mas Casanovas 90, 08041, Barcelona, Spain
| | - Hans Otto Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Oscar Díaz-Cambronero
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Maria Jose Alberola Estelles
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Marisol Echeverri Velez
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Maria Vila Montañes
- Department of Anaesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politecnic La Fe, Instituto de Investigación Sanitaria La Fe (IIS laFe), Valencia, Spain
| | - Javier Belda
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Marina Soro
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Jaume Puig
- Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibañez 17, 46010, Valencia, Spain
| | - Daniel Arnulf Reuter
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Sebastian Alois Haas
- Department of Anesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18057, Rostock, Germany.
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Vargas M, Sutherasan Y, Brunetti I, Micalizzi C, Insorsi A, Ball L, Folentino M, Sileo R, De Lucia A, Cerana M, Accattatis A, De Lisi D, Gratarola A, Mora F, Peretti G, Servillo G, Pelosi P. Mortality and long-term quality of life after percutaneous tracheotomy in Intensive Care Unit: a prospective observational study. Minerva Anestesiol 2018; 84:1024-1031. [PMID: 29338144 DOI: 10.23736/s0375-9393.18.12133-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Quality of life and mortality after percutaneous dilatational tracheotomy (PDT) has been poorly investigated. The aims of this study were to evaluate the independent risk factors for Intensive Care Unit (ICU) mortality and investigate quality of life over the first year after PDT in critically ill patients. METHODS This was a prospective, single-center, cohort study performed in a tertiary care University Hospital, enrolling consecutive ICU patients requiring elective PDT, collecting data during the tracheotomy procedure and the ICU stay. Follow-up was performed at three, six and twelve months after PDT. The medical interview included the Euro Quality of Life questionnaire comprising five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). RESULTS A total of 137 patients were included in the study. In the multivariate analysis, ICU mortality was independently associated with age (OR 1.089; P=0.003) and SAPS II (OR 1.047; P=0.003), and inversely with neurologic disease (OR 0.162; P=0.004). Mortality increased over time (ICU mortality 26.7%; in-hospital mortality 43.1%; 3-months mortality 47.4%; 6-months mortality 61.3%; and 1-year mortality 70.8%; P=0.0001). Tracheostomized patients due to respiratory disease had a higher ICU mortality (50%) compared to those with neurological disease (13.6%). quality of life (QoL) of tracheostomized patients was severely compromised at 3-months (QoL: 17, 15-19), 6-months (QoL: 17; 16-19), while moderately compromised at 1-year (QoL: 13; 9-16). A subgroup analysis showed better QoL at 3-months, 6-months and 1-year in respiratory compared to neurological tracheostomized patients (P=0.01). CONCLUSIONS Patients baseline characteristics and indication for PDT procedure are important determinants of in-ICU mortality and QoL in tracheostomized patients.
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Affiliation(s)
- Maria Vargas
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy - .,Department of Neurosciences, Reproductive and Odonthostomatologic Sciences, "Federico II" University, Naples, Italy -
| | - Yuda Sutherasan
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Iole Brunetti
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Camilla Micalizzi
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Angelo Insorsi
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Marta Folentino
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Rosanna Sileo
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Arduino De Lucia
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Manuela Cerana
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Alessandro Accattatis
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Domenico De Lisi
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Angelo Gratarola
- Division of Anesthesia and Intensive Care, San Martino Policlinic Hospital, IRCCS for Oncology, Genoa, Italy
| | - Francesco Mora
- Department of Otorhinolaryngology, Head and Neck Surgery, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odonthostomatologic Sciences, "Federico II" University, Naples, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, San Martino Policlinic Hospital, IRCCS for Oncology, University of Genoa, Genoa, Italy
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Del Bono V, Giacobbe DR, Marchese A, Parisini A, Fucile C, Coppo E, Marini V, Arena A, Molin A, Martelli A, Gratarola A, Viscoli C, Pelosi P, Mattioli F. Meropenem for treating KPC-producing Klebsiella pneumoniae bloodstream infections: Should we get to the PK/PD root of the paradox? Virulence 2017; 8:66-73. [PMID: 27430122 PMCID: PMC5963200 DOI: 10.1080/21505594.2016.1213476] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/14/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022] Open
Abstract
The objective of this study was to assess the achievement of pharmacokinetic/pharmacodynamic (PK/PD) targets of meropenem (MEM) in critically-ill patients with bloodstream infections (BSI) due to Klebsiella pneumoniae-carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) with MEM minimum inhibitory concentrations (MICs) ≥16 mg/L. Nineteen critically-ill patients with KPC-Kp BSI were given combination therapy including MEM, tigecycline, plus colistin or gentamicin (according to susceptibility testing). MEM was administered as an extended 3-hour infusion of 2 g every 8 hours, or adjusted according to renal function. MEM plasma concentrations were determined by high-performance liquid chromatography. PK/PD targets for MEM were defined as T > 40% 1×MIC and T > 40% 4×MIC. Possible synergisms between MEM and coadministered agents were assessed by time-kill assays based on plasma levels for MEM and on fixed plasma concentrations for the other agents. In none of 19 patients MEM reached any PK/PD target. The actual MEM MICs were 256, 512, and 1024 mg/L in 1, 3, and 15 isolates, respectively. However, theoretically, the PK/PD target of T > 40% 1×MIC could have been achieved in 95%, 68%, 32% and 0% of the isolates for MIC equal to 8, 16, 32, and 64 mg/L, respectively. No synergisms were observed between MEM and coadministered agents. In conclusion, high-dose MEM failed to reach PK/PD targets in 19 patients with BSI due to KPC-Kp with very high MEM MICs. On a theoretical basis, our results suggest a possible usefulness of MEM against resistant blood isolates with MICs up to 32 mg/L.
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Affiliation(s)
- Valerio Del Bono
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Anna Marchese
- Unità di Microbiologia, DIPSE, DISC, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Andrea Parisini
- Centro ortopedico di Quadrante, Ospedale Madonna del Popolo, Omegna, Italy
| | - Carmen Fucile
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Erika Coppo
- Unità di Microbiologia, DIPSE, DISC, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Valeria Marini
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Antonio Arena
- U.O. Anestesia e Rianimazione, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Alexandre Molin
- U.O. Anestesia e Terapia Intensiva, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Antonietta Martelli
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Angelo Gratarola
- U.O. Anestesia e Rianimazione, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Claudio Viscoli
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Paolo Pelosi
- U.O. Anestesia e Terapia Intensiva, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
- Anestesia e Terapia Intensiva, DISC, Università di Genova, Genova, Italy
| | - Francesca Mattioli
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
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21
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Ball L, Pellerano G, Corsi L, Giudici N, Pellegrino A, Cannata D, Santori G, Palombo D, Pelosi P, Gratarola A. Continuous epidural versus wound infusion plus single morphine bolus as postoperative analgesia in open abdominal aortic aneurysm repair: a randomized non-inferiority trial. Minerva Anestesiol 2016; 82:1296-1305. [PMID: 27575452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND We compared a bundle of interventions including wound infiltration and continuous infusion with local anesthetics plus a single morphine bolus (CWI-M) with continuous epidural infusion (CEI) as postoperative analgesia. METHODS Fifty-one adults undergoing open abdominal aortic aneurysm repair were randomized in this non-inferiority open-label trial. In the CEI group, patients received thoracic epidural levobupivacaine 0.12% plus sufentanil 0.4 µg/mL infusion for 48 hours. In the CWI-M group, the wound was infiltrated with 10 mL levobupivacaine 0.5%, patients received a morphine bolus before the end of anesthesia and levobupivacaine 0.25% infusion through two multi-holed pre-peritoneal catheters for 48 hours. Systemic morphine was administered as rescue in both groups. The primary endpoint was the mean Numeric Rating Scale score in the first 48 hours after surgery. RESULTS Mean NRS was 1.7 (95% CI: from 1.2 to 2.2) in the CEI and 2.2 (95% CI: from 1.7 to 2.7) in the CWI-M group, the 90% CI of difference was from -0.1 to 1.1, not including the non-inferiority margin of 1.3. The cumulative rescue morphine dose per patient was higher in CWI-M than in CEI group (3.7±4.4 vs. 0.8±2.4 mg, P=0.006); moreover, NRS at arousal was higher in CWI-M (P=0.003). No differences were observed in postoperative hemodynamic parameters, recovery-related outcomes, length of stay nor complications. CONCLUSIONS CWI-M was comparable to CEI in in postoperative pain control, but it was associated with higher need of rescue systemic opiates and with a worse early pain control.
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Affiliation(s)
- Lorenzo Ball
- Department of Surgery and Integrated Diagnostics, San Martino Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy -
| | - Giulia Pellerano
- Department of Surgery and Integrated Diagnostics, San Martino Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy
| | - Laura Corsi
- Department of Anesthesia and Resuscitation, San Martino Hospital and Institute for Research and Care, Genoa, Italy
| | - Nadia Giudici
- Department of Anesthesia and Resuscitation, San Martino Hospital and Institute for Research and Care, Genoa, Italy
| | - Anna Pellegrino
- Department of Anesthesia and Resuscitation, San Martino Hospital and Institute for Research and Care, Genoa, Italy
| | - Daniela Cannata
- Department of Anesthesia and Resuscitation, San Martino Hospital and Institute for Research and Care, Genoa, Italy
| | - Gregorio Santori
- Department of Surgery and Integrated Diagnostics, San Martino Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy
| | - Domenico Palombo
- Department of Surgery and Integrated Diagnostics, San Martino Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgery and Integrated Diagnostics, San Martino Hospital and Institute for Research and Care, University of Genoa, Genoa, Italy
| | - Angelo Gratarola
- Department of Anesthesia and Resuscitation, San Martino Hospital and Institute for Research and Care, Genoa, Italy
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22
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Rognoni A, Bertolazzi M, Peron M, Macciò S, Cameroni GT, Gratarola A, Rognoni G. Electrocardiographic changes in a rare case of flecainide poisoning: a case report. Cases J 2009; 2:9137. [PMID: 20062654 PMCID: PMC2803934 DOI: 10.1186/1757-1626-2-9137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 12/03/2009] [Indexed: 11/25/2022]
Abstract
Flecainide is a class Ic anti - arrhythmic drug with sodium channel blocking activities. We report a case of a 57 year - old woman who attempted a suicide by ingesting approximately 1,8 gr of flecainide. On the surface electrocardiogram this results in a large QRS complex and in prolongation of the QTc interval. Overdose with a class Ic drug is very uncommon, its management is difficult and the mortality high. Because of a hemodynamic instability and in addition to supportive care and antidysrhythmics, she was treated with a high dose of sodium bicarbonate in hypertonic solution; after this infusion the patient's QRS progressive narrowed. In conclusion, sodium bicarbonate may be useful in the treatment of widened QRS and to stabilize a overdose of class Ic anti - arrhythmic drugs.
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Affiliation(s)
- Andrea Rognoni
- Department of Cardiology, Sant'Andrea Hospital, Corso Mario Abbiate 21, 13100, Vercelli, Italy
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23
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Zanaboni S, Krauss B, Buscaglia R, Montagnini C, Gratarola A, Gualino J, Colombo R, Della Corte F. Changes in respiratory and hemodynamic parameters during low-dose propofol sedation in combination with regional anesthesia for herniorrhaphy and genitourinary surgery in children. Paediatr Anaesth 2007; 17:934-41. [PMID: 17767628 DOI: 10.1111/j.1460-9592.2007.02299.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Spontaneous vs mechanical ventilation during propofol sedation has been a subject of debate. We evaluated the safety of low-dose propofol sedation as an adjunct to regional anesthesia during herniorrhaphy and genitourinary surgery in infants and children. METHODS The study was conducted in a prospective, nonrandomized manner using a consecutive sample of 62 American Society of Anesthesiologists physical status class I patients between 5 months to 11 years of age in the surgery unit of an urban University Hospital. Propofol sedation (4-8 mg x kg(-1) x h(-1) continuous infusion) was used with regional anesthesia (caudal, ilioinguinal/iliohypogastric nerve or penile block with 0.2-0.375% ropivacaine). All children were spontaneously breathing without an anesthesia circuit. Respiratory and hemodynamic parameters were continuously recorded on all patients. One-way analysis of variance (ANOVA) for repeated measurements was used to analyze changes in respiratory and hemodynamic parameters during the procedure. RESULTS Spontaneous ventilation was maintained in all patients with minimal changes in hemodynamic parameters. Heart rate, mean arterial pressure, and P(E)CO(2) remained stable throughout the study period: 23/62 (37%) patients exhibited signs of developing intrinsic endexpiratory pressure (PEEPi) or the presence of PEEPi because of progressive reduction of expiratory time. CONCLUSIONS Low-dose propofol sedation in combination with regional anesthesia for elective herniorrhaphy and genitourinary surgery in children maintains spontaneous ventilation and has minimal effects on hemodynamic parameters for sedation lasting <1 h. The presence of PEEPi is a relative contraindication to the use of this regimen in children with asthma or history of upper airway infections.
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Affiliation(s)
- Silvio Zanaboni
- Anesthesiology and Intensive Care Unit, Università del Piemonte Orientale, Novara, Italy.
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24
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Biamino C, Gratarola A, Gontero P, Kocjancic E, Frea B, Corte FD. Complications of Irrigations Solutions during Transurethral Resection of the Prostate in Spinal Anesthesia. Urologia 2005. [DOI: 10.1177/039156030507200126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perspective study in order to estimate the incidence of TURP-Syndrome, in spinal anesthesia (SA) with volemic expansion with sodium chloride solution 0.9 % vs 3%. Materials and Methods Two groups (gr) of patients (pt) A (n=20) and B (n=20) in SA have received like respective 500 ml of NaCl 0.9% and 250 ml. of NaCl 3%. The bladder was irrigated with a solution containing 1.5% glycine (1). We estimated: weight of prostate adenoma and weight of removed tessue, Sodium (Na) preop - intraop - postop. and after 24 hours, Ammonium (NH4+) pre - postop, volumes (V) of dropped solutions, V of dropped glycine (gl), operation time, core body temperature intraop and postop, mental state intra and postop., osmolarity. Results We found no significant difference in weight of adenoma and removed tessue. We have not observed any differences in the V of infusive solutions in the periop. We have not observed any difference in the values of Na preop. and postop, in those of NH4+ preop and postop, in operation time and in the V of gl. During procedure 5 pz. (S group) showed: visual disturbances, mental confusion (TURP-Syndrome) and hypertention (2). No pz. have any Na and NH4+ intraop.values altered. Time of TURP appeared bigger in non symptomatic patients (69 mn gr S. vs 48.43 gr.A and 47.26 gr. B). The V of instilled gl. has appeared meaningfully more elevated in gr. S (21.4 / vs 12 in gr.A and 12.31 in gr. B). The Na and NH4+ postop., Na after 24 hours and core body temperature have turned out statistically omogenee in all pt. In the 5 symptomatic pt the osmolarity values entered in normality ranges and they did not show differences between the groups considered. Conclusions We have not noticed any differences in using of the NaCl solution 0.9% versus NaCl 3% like volemic prefilling; the symptomatic patients have endured one longer procedure and greater amount of irrigating solution; their values of Na and NH4+ were in the limits of the normality; for this reasons perhaps the cause of symptoms in our patients would be searched in direct toxicity of glycine as inhibitory neurotrasmitter in CNS.
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Affiliation(s)
- C. Biamino
- SCDU Anestesia e Rianimazione, Università del Piemonte Orientale, Novara
| | - A. Gratarola
- SCDU Anestesia e Rianimazione, Università del Piemonte Orientale, Novara
| | - P. Gontero
- Divisione di Urologia Az. Ospedaliera “Maggiore della Carità”, Università del Piemonte Orientale, Novara
| | - E. Kocjancic
- Divisione di Urologia Az. Ospedaliera “Maggiore della Carità”, Università del Piemonte Orientale, Novara
| | - B. Frea
- Divisione di Urologia Az. Ospedaliera “Maggiore della Carità”, Università del Piemonte Orientale, Novara
| | - F. Della Corte
- SCDU Anestesia e Rianimazione, Università del Piemonte Orientale, Novara
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25
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Pelosi G, Gratarola A, Pissaia C, Mendola C, Bellomo G. Total intravenous anesthesia with propofol and remifentanil for elective non-cardiac surgery. Minerva Anestesiol 1999; 65:791-8. [PMID: 10634052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Remifentanil is a highly effective mu opioid agonist with predictable pharmacokinetics and a close concentration-effect relationship. Moreover, studies on anesthetic drugs interactions show that optimal propofol concentrations decrease more significantly with remifentanil as compared with other opioids and recovery appears to be much faster than when propofol is combined with other opioids combinations. This intervention study was designed to evaluate the efficacy of propofol combined with remifentanil in elective non cardiac inpatient surgery. METHODS N. 405 patients undergoing intraperitoneal, head-neck, intrathoracic, major orthopaedics, breast and major vascular surgery received: remifentanil (1 microgram.kg-1 at induction; 0.50 microgram.kg-1.min-1 at laryngoscopy; 0.25 microgram.kg-1.min-1 at skin incision; 0.25-0.30 microgram.kg-1.min1 from skin incision to end of skin suture) and propofol (0.5-1 mg.kg-1 at induction; 5 mg.kg-1.h-1 at laryngoscopy; 5 mg.kg-1.h-1 at skin incision and 5 mg.kg1.h1 thereafter). Intraoperative end-points included somatic responses, tachycardia and hypertension to laryngoscopy and surgery. Incidence of intraoperative bradycardia, hypotension and muscle rigidity were also recorded. Postoperative end-points included Aldrete score > or = 9, pain immediately following emergence and PONV. RESULTS Propofol-remifentanil combination effectively controlled responses to laryngoscopy and surgical stress. Drug related adverse events were transient bradycardia (< 50 bpm) and hypotension (SBP < or = 80 mmHg) respectively: at prelaryngoscopy 11.60-1.48% and at pre-skin incision 10.61-0.98%. N. 365 patients were discharged from PACU and the median time to first Aldrete score > or = 9 was 22.3 min. The most frequent postoperative event was shivering recorded in n. 46 patients (12%). Postoperative analgesic medication was requested by n. 16 patients (4.4%) and PONV was noted in n. 6 patients (1.6%). CONCLUSIONS When combined with propofol, remifentanil effectively provided for profound analgesia during surgery, stable anesthetic conditions, simplicity of use and predictable recovery.
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Affiliation(s)
- G Pelosi
- Department of Anesthesiology and Intensive Care, University of Eastern Piedmont School of Medicine, Novara
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26
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Gratarola A, Mameli MC, Pelosi G. Total intravenous anaesthesia in Charcot-Marie-Tooth disease. Case report. Minerva Anestesiol 1998; 64:357-60. [PMID: 9796246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A Total Intravenous Anaesthesia (TIVA) protocol in a case of hereditary motor-sensory neuropathy Charcot-Marie-Tooth disease in three consecutive orthopaedic surgical procedures is described. History, physical examination and sural nerve fascicular biopsy findings are reported. Problems related to the perioperative anaesthesiological management in peripheral neuropathies are discussed. Propofol and fentanyl without muscle relaxants, proved to be a safe technique, fast at reaching the level of surgical anaesthesia required, manageable for maintenance and rapidly reversible.
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Affiliation(s)
- A Gratarola
- Department of Medical Sciences of Novara, University of Turin
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27
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Pelosi G, Gratarola A, Pissaia C. [Nausea and postoperative vomiting]. Minerva Anestesiol 1995; 61:1-35. [PMID: 7617243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G Pelosi
- Cattedra di Anestesiologia e Rianimazione, Facoltà di Medicina e Chirurgia di Novara, Università degli Studi di Torino
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28
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Fregonara M, Gratarola A, Pissaia C, Panzarasa G. [Neuroanesthesia during carotid thromboendarterectomy interventions]. Minerva Anestesiol 1992; 58:189-92. [PMID: 1620446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The paper describes two techniques of anesthesia used during carotid thromboendarteriectomy surgery. The first technique utilises a mixture of O2-N2O, isofluorane and fentanyl as analgesic; the halogenate compound is not administered during carotis clamping and fentanyl is used for maintenance. The second technique is predominantly intravenous and utilises differing doses of propofol during the entire operation with fentanyl as an analgesic. The two techniques are comparable in terms of management and efficacy; the use of ECG monitoring is vital to identify possible intraoperative cerebral ischemic phenomena.
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Affiliation(s)
- M Fregonara
- I Servizio di Anestesia e Rianimazione, Ospedale Maggiore della Carità, Novara
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29
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Pissaia C, Fregonara M, Gratarola A, Rossitto C, Mazzoli R, Pelosi G, Di Stanislao F. [Nitrous oxide/oxygen versus air/oxygen in neuroanesthesia]. Minerva Anestesiol 1991; 57:1010-1. [PMID: 1961451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- C Pissaia
- Sede di Novara, I. Servizio di Anestesia e rianimazione, Universita di Torino
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30
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Gratarola A, Pissaia C, Mameli MC, Mazzoli R, Pelosi G. [Ventricular pre-excitation syndrome: anesthesiologic aspects]. Minerva Anestesiol 1991; 57:117-21. [PMID: 1922858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Two cases of pre-excitation syndrome are reported and the anaesthesiological management adopted is discussed. After a brief overview of the pathophysiology of the syndrome relative indications and contraindications of the main anaesthetic drugs and volatile agents are analyzed. The high incidence of perioperative atrial fibrillation, atrial flutter or supraventricular tachycardia and the importance of maintaining sinus rhythm is recalled. The task confronting the anaesthetist is to ensure an adequate level of anaesthesia during induction and maintenance while carefully selecting specific drugs associated with minor cardiovascular side effects. In the Authors' experience benzodiazepines, fentanyl, vecuronium and isoflurane have proved to be the most adequate choice for this type of patient.
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Affiliation(s)
- A Gratarola
- I Servizio di Anestesia e Rianimazione, Università degli Studi di Torino, Ospedale Maggiore della Carità - Novara
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