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Longhitano Y, Bottinelli M, Pappalardo F, Maj G, Audo A, Srejic U, Rasulo FA, Zanza C. Electrocardiogram alterations in non-traumatic brain injury: a systematic review. J Clin Monit Comput 2024; 38:407-414. [PMID: 37736801 DOI: 10.1007/s10877-023-01075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/01/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
The presence of abnormal electrocardiograms in individuals without known organic heart disease is one of the most common manifestations of cardiac dysfunction occurring during acute non traumatic brain injury. The primary goal of the present review is to provide an overview of the available data and literature regarding the presence of new-onset electrocardiographic (ECG) alterations in acute non traumatic brain injury. The secondary aim is to identify the incidence of ECG alterations and consider the prognostic significance of new-onset ECG changes in this setting. To do so, English language articles from January 2000 to January 2022 were included from PubMed using the following keywords: "electrocardiogram and subarachnoid hemorrhage", "electrocardiogram and intracranial hemorrhage", "Q-T interval and subarachnoid hemorrhage ", "Q-T interval and intracranial bleeding ", "Q-T interval and intracranial hemorrhage", and "brain and heart- interaction in stroke". Of 3162 papers, 27 original trials looking at electrocardiogram alterations in acute brain injury were included following the PRISMA guideline. ECG abnormalities associated with acute brain injury could potentially predict poor patient outcomes. They could even herald the future development of neurogenic pulmonary edema (NPE), delayed cerebral ischemia (DCI), and even in-hospital death. In particular, patients with SAH are at increased risk of having severe ventricular dysrhythmias. These may contribute to a high mortality rate and to poor functional outcome at 3 months. The current data on ECG QT dispersion and mortality appear less clearly associated. While some patients demonstrated poor outcomes, others showed no relationship with poor outcomes or increased in-hospital mortality. Observing ECG alterations carefully after cerebral damage is important in the critical care of these patients as it can expose preexisting myocardial disease and change prognosis.
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Affiliation(s)
- Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria Bottinelli
- Department of Anesthesiology and Intensive Care, "Maggiore Della Carità" University Hospital, Corso Mazzini18, 28100, Novara, Italy
| | - Federico Pappalardo
- Department of Cardiac Anesthesiology, AON SS. Antonio E Biagio E Cesare Arrigo H, Alessandria, Italy
| | - Giulia Maj
- Department of Cardiac Anesthesiology, AON SS. Antonio E Biagio E Cesare Arrigo H, Alessandria, Italy
| | - Andrea Audo
- Department of Cardiac Surgery, AON SS. Antonio E Biagio E Cesare Arrigo H, Alessandria, Italy
| | - Una Srejic
- Department of Anesthesiology, Pain Medicine, and Critical Care, University of California, San Diego, USA
| | - Frank Anthony Rasulo
- Department of Anesthesiology, Pain Medicine, and Critical Care, Spedali Civili, University of Brescia, Brescia, Italy
| | - Christian Zanza
- Italian Society of Pre-Hospital Emergency Medicine (SIS-118), Consultant in Anesthesia and Critical Care and Consultant in Internal and Emergency Medicine, Taranto, EU, Italy.
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Saviano A, Perotti C, Zanza C, Longhitano Y, Ojetti V, Franceschi F, Bellou A, Piccioni A, Jannelli E, Ceresa IF, Savioli G. Blood Transfusion for Major Trauma in Emergency Department. Diagnostics (Basel) 2024; 14:708. [PMID: 38611621 PMCID: PMC11011783 DOI: 10.3390/diagnostics14070708] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 02/08/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Severe bleeding is the leading cause of death in patients with major trauma admitted to the emergency department. It is estimated that about 50% of deaths happen within a few minutes of the traumatic event due to massive hemorrhage; 30% of deaths are related to neurological dysfunction and typically happen within two days of trauma; and approximately 20% of patients died of multiorgan failure and sepsis within days to weeks of the traumatic event. Over the past ten years, there has been an increased understanding of the underlying mechanisms and pathophysiology associated with traumatic bleeding leading to improved management measures. Traumatic events cause significant tissue damage, with the potential for severe blood loss and the release of cytokines and hormones. They are responsible for systemic inflammation, activation of fibrinolysis pathways, and consumption of coagulation factors. As the final results of this (more complex in real life) cascade, patients can develop tissue hypoxia, acidosis, hypothermia, and severe coagulopathy, resulting in a rapid deterioration of general conditions with a high risk of mortality. Prompt and appropriate management of massive bleeding and coagulopathy in patients with trauma remains a significant challenge for emergency physicians in their daily clinical practice. Our review aims to explore literature studies providing evidence on the treatment of hemorrhage with blood support in patients with trauma admitted to the Emergency Department with a high risk of death. Advances in blood transfusion protocols, along with improvements in other resuscitation strategies, have become one of the most important issues to face and a key topic of recent clinical research in this field.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (A.S.); (F.F.)
| | - Cesare Perotti
- Division of Immunohaematology and Transfusion, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Christian Zanza
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA;
- Department of Emergency Medicine-Emergency Medicine Residency Program, Humanitas University-Research Hospital, 20089 Rozzano, Italy
| | | | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (A.S.); (F.F.)
- Università Cattolica, 00168 Roma, Italy; (V.O.); (A.P.)
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
- Institute of Sciences in Emergency Medicine, Department of Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | | | - Eugenio Jannelli
- Department of Orthopedics and Traumatology, Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | | | - Gabriele Savioli
- Department of Emergency Medicine, Fondazione Policlinico San Matteo, 27100 Pavia, Italy
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Magon F, Longhitano Y, Savioli G, Piccioni A, Tesauro M, Del Duca F, Napoletano G, Volonnino G, Maiese A, La Russa R, Di Paolo M, Zanza C. Point-of-Care Ultrasound (POCUS) in Adult Cardiac Arrest: Clinical Review. Diagnostics (Basel) 2024; 14:434. [PMID: 38396471 PMCID: PMC10887671 DOI: 10.3390/diagnostics14040434] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 12/30/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Point-of-Care Ultrasound (POCUS) is a rapid and valuable diagnostic tool available in emergency and intensive care units. In the context of cardiac arrest, POCUS application can help assess cardiac activity, identify causes of arrest that could be reversible (such as pericardial effusion or pneumothorax), guide interventions like central line placement or pericardiocentesis, and provide real-time feedback on the effectiveness of resuscitation efforts, among other critical applications. Its use, in addition to cardiovascular life support maneuvers, is advocated by all resuscitation guidelines. The purpose of this narrative review is to summarize the key applications of POCUS in cardiac arrest, highlighting, among others, its prognostic, diagnostic, and forensic potential. We conducted an extensive literature review utilizing PubMed by employing key search terms regarding ultrasound and its use in cardiac arrest. Apart from its numerous advantages, its limitations and challenges such as the potential for interruption of chest compressions during image acquisition and operator proficiency should be considered as well and are discussed herein.
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Affiliation(s)
- Federica Magon
- Department of Anesthesia and Critical Care, Bicocca University of Milano, 20126 Milano, Italy;
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Gabriele Savioli
- Departement of Emergency, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Gemelli Hospital, Catholic University of Rome, 00168 Rome, Italy;
| | - Manfredi Tesauro
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Gianpietro Volonnino
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Christian Zanza
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
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Conti E, Cascio ND, Paluan P, Racca G, Longhitano Y, Savioli G, Tesauro M, Leo R, Racca F, Zanza C. Pregnancy Arrhythmias: Management in the Emergency Department and Critical Care. J Clin Med 2024; 13:1095. [PMID: 38398407 PMCID: PMC10888682 DOI: 10.3390/jcm13041095] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 01/18/2024] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Pregnancy is closely associated with an elevated risk of arrhythmias, constituting the predominant cardiovascular complication during this period. Pregnancy may induce the exacerbation of previously controlled arrhythmias and, in some instances, arrhythmias may present for the first time in pregnancy. The most important proarrhythmic mechanisms during pregnancy are the atrial and ventricular stretching, coupled with increased sympathetic activity. Notably, arrhythmias, particularly those originating in the ventricles, heighten the likelihood of syncope, increasing the potential for sudden cardiac death. The effective management of arrhythmias during the peripartum period requires a comprehensive, multidisciplinary approach from the prepartum to the postpartum period. The administration of antiarrhythmic drugs during pregnancy necessitates meticulous attention to potential alterations in pharmacokinetics attributable to maternal physiological changes, as well as the potential for fetal adverse effects. Electric cardioversion is a safe and effective intervention during pregnancy and should be performed immediately in patients with hemodynamic instability. This review discusses the pathophysiology of arrythmias in pregnancy and their management.
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Affiliation(s)
- Elena Conti
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, 10128 Turin, Italy; (E.C.); (N.D.C.); (P.P.); (F.R.)
| | - Nunzio Dario Cascio
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, 10128 Turin, Italy; (E.C.); (N.D.C.); (P.P.); (F.R.)
| | - Patrizia Paluan
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, 10128 Turin, Italy; (E.C.); (N.D.C.); (P.P.); (F.R.)
| | - Giulia Racca
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, 10128 Turin, Italy; (E.C.); (N.D.C.); (P.P.); (F.R.)
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Emergency Medicine—Emergency Medicine Residency Program, Humanitas University-Research Hospital, 20089 Rozzano, Italy
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Manfredi Tesauro
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Roberto Leo
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Fabrizio Racca
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, 10128 Turin, Italy; (E.C.); (N.D.C.); (P.P.); (F.R.)
| | - Christian Zanza
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Saviano A, Petruzziello C, Zanza C, Candelli M, Gabrielli M, Migneco A, Franceschi F, Ojetti V. Role of Fecal Calprotectin in Patients Presenting to the Emergency Department with Abdominal Pain with or without Diarrhea or Rectal Bleeding. Rev Recent Clin Trials 2023:RRCT-EPUB-135647. [PMID: 37921137 DOI: 10.2174/0115748871259008231006071656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Abdominal pain is a frequent reason for admission to the Emergency Department. It may be a symptom of an underlying "organic" disease or a "functional" manifestation without an underlying anatomic or physiologic alteration. The evaluation of patients with abdominal pain is a challenge for the emergency physician and the selection of patients for second-level radiological examinations or endoscopic procedures is not always easy to perform. Faecal calprotectin could be a useful diagnostic marker to distinguish between "organic" or "functional" form and its determination could be helpful to select patients for further examinations in the context of an emergency setting. MATERIALS AND METHODS This is an observational and retrospective study on 146 patients with abdominal pain and/or diarrhea (with or without rectal bleeding) admitted to the Emergency Department of Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, who collected a fecal sample to evaluate fecal calprotectin. We evaluated and correlated the level of fecal calprotectin with the final diagnosis they received. RESULTS 50/146 patients (34,24%) received a diagnosis of acute diverticulitis, in particular, 14/50 (28%) were complicated and 36/50 (72%) were uncomplicated; 4/146 (2,7%) were cholangitis, 32/146 (21,9%) were colitis, 6/146 (4,1%) gastritis, 42/146 (28,7%), Irritable bowel syndrome and 12/146 (8,2%) Inflammatory bowel disease. For the differential diagnosis between Irriable or inflammatory bowel diseses, our study showed a VPP and a VPN of 100% meanwhile for the differential diagnosis between Acute complicated and uncomplicated diverticulitis, our study showed a VPP of 40% and a VPN of 84%. CONCLUSION In the emergency setting, faecal calprotectin could be a helpful marker to select patients with abdominal pain who need second-level radiological examinations or endoscopic procedures, guiding the emergency physician in the evaluation of such a complex and wideranging symptom.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome
| | - Carmine Petruzziello
- Department of Emergency Medicine-Ospedale San Carlo di Nancy GVM care and research, Rome
| | - Christian Zanza
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome
| | - Marcello Candelli
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome
| | - Maurizio Gabrielli
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome
| | - Alessio Migneco
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome
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Bonfichi A, Ceresa IF, Piccioni A, Zanza C, Longhitano Y, Boudi Z, Esposito C, Savioli G. A Lethal Combination of Delirium and Overcrowding in the Emergency Department. J Clin Med 2023; 12:6587. [PMID: 37892725 PMCID: PMC10607343 DOI: 10.3390/jcm12206587] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 08/28/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Delirium is a common public health concern that significantly impacts older patients admitted to the Emergency Department (ED). This condition is linked to adverse outcomes such as reduced long-term functionality, higher mortality rates, extended hospital stays, and increased medical costs. The identification of risk factors is crucial for the early recognition and management of delirium in ED patients. Aging, cognitive decline, polypharmacy, and sensory impairment are some of the most common general risk factors described in the literature. Although validated delirium assessment tools already exist, they are not practical for the fast-paced ED environment because of their extended evaluation period or specialized training request. Moreover, clear guidance is needed to select the most suitable tool for detecting delirium, balancing between the accuracy and the swiftness required in an overcrowded, high-stress, and understaffed healthcare setting. This narrative review aims to analyze the updated literature on delirium risk factors in older ED patients and focuses on the methods for better screening, managing, and treating this condition in the ED.
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Affiliation(s)
- Alessandra Bonfichi
- Department of Internal Medicine, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Iride Francesca Ceresa
- Department of Emergency Medicine, Humanitas University-Research Hospital, 20089 Rozzano, Italy; (I.F.C.); (Y.L.)
| | - Andrea Piccioni
- Department of Emergency, Fondazione Policlinico Universitario A. Gemelli, IRCCS Fondazione Policlinico San Matteo, 00168 Roma, Italy;
| | - Christian Zanza
- Italian Society of Pre-Hospital Emergency Medicine (SIS-118), 74121 Taranto, Italy;
| | - Yaroslava Longhitano
- Department of Emergency Medicine, Humanitas University-Research Hospital, 20089 Rozzano, Italy; (I.F.C.); (Y.L.)
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA
| | - Zoubir Boudi
- Department of Emergency Medicine, Dr Sulaiman Alhabib Hospital, Dubai 2542, United Arab Emirates;
| | - Ciro Esposito
- Nephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, Italy;
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
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Pescatori L, Taurone S, Ciccarelli A, Palmieri M, Serraino A, Artico M, Fornai F, Longhitano Y, Zanza C, Tesauro M, Savioli G, Miglietta S, Ciappetta P. Petroclival Clinoidal Folds and Arachnoidal Membranes of the Anteromedial Incisural Space: Clinical Anatomy for Neuro Critical Care. Diagnostics (Basel) 2023; 13:3203. [PMID: 37892024 PMCID: PMC10605941 DOI: 10.3390/diagnostics13203203] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 09/11/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
A systematic and narrative literature review was performed, focusing attention on the anatomy of the area located at the junction of the sphenoid and the basal portion of the temporal bone (petrous bone, petrous apex, upper petro-clival region) encircled by the free edge of the tentorium, the insertion of the tentorium itself to the petrous apex and the anterior and posterior clinoid processes that give rise to three distinct dural folds or ligaments: the anterior petroclinoid ligament, the posterior petroclinoid ligament and the interclinoid ligament. These dural folds constitute the posterior portion of the roof of the cavernous sinus denominated "the oculomotor triangle". The main purpose of this review study was to describe this anatomical region, particularly in the light of the relationships between the anterior margin of the free edge of the tentorium and the above-mentioned components of the sphenoid and petrous bone.
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Affiliation(s)
- Lorenzo Pescatori
- Department of Neurosurgery, S. Eugenio Hospital of Rome, 00144 Rome, Italy
| | - Samanta Taurone
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Antonello Ciccarelli
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Mauro Palmieri
- Human Neurosciences Department, A.U.O. “Policlinico Umberto I” Neurosurgery Division, Sapienza University, 00185 Rome, Italy (A.S.)
| | - Alessandra Serraino
- Human Neurosciences Department, A.U.O. “Policlinico Umberto I” Neurosurgery Division, Sapienza University, 00185 Rome, Italy (A.S.)
| | - Marco Artico
- Department of Sensory Organs, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Francesco Fornai
- IRCCS Neuromed, 86077 Pozzilli, Italy;
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Department of Emergency Medicine, Humanitas University Hospital, 20089 Rozzano, Italy
| | - Christian Zanza
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Manfredi Tesauro
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Selenia Miglietta
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, “Sapienza” University of Rome, 00185 Rome, Italy;
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Racca F, Longhitano Y, Zanza C, Balzanelli MG, Draisci G, Stoia PA, Gollo E, Maio M, Grattarola C, Astuto M, Ciccarelli A, Racca G, Romenskaya T, Giordano B, Serraino A, Sansone VAM, Gregoretti C, Conti G, Piccolella F, Vaschetto R. Peri-partum respiratory management of pregnant women with neuro-muscular disorders: a prospective observational study (IT-NEUMA-Pregn study). BMC Anesthesiol 2023; 23:342. [PMID: 37833635 PMCID: PMC10571352 DOI: 10.1186/s12871-023-02307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/08/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Pregnant women with neuromuscular diseases (NMDs) often display respiratory muscle impairment which increases the risk for pulmonary complications (PCs). The aim of this study was to identify pregnant NMDs patients with pulmonary risk factors and to apply in these women non-invasive ventilation (NIV) combined with mechanical insufflation-exsufflation (MI-E) in the peri-partum period. METHODS We conducted a multicenter observational study on women with NMDs undergoing cesarean section or spontaneous labor in a network of 7 national hospitals. In these subjects we applied a protocol for screening and preventing PCs, and we evaluated PCs rate, maternal and neonatal outcome. RESULTS Twenty-four patients out of the 94 enrolled pregnant women were at risk for PCs and were trained or retrained to use NIV and/or MI-E before delivery. After delivery, 17 patients required NIV with or without MI-E. Despite nine out of the 24 women at pulmonary risk developed postpartum PCs, none of them needed reintubation nor tracheostomy. In addition, the average birth weight and Apgar score were normal. Only one patient without pulmonary risk factors developed postpartum PCs. CONCLUSION This study showed the feasibility of applying a protocol for screening and treating pregnant NMDs women with pulmonary risk. Despite a PCs rate of 37% was observed in these patients, maternal and neonatal outcome were favorable.
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Affiliation(s)
- Fabrizio Racca
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christian Zanza
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Post Graduate School of Geriatric Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | | | - Gaetano Draisci
- Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Augusto Stoia
- Anesthesiology and Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda Ca'Granda, Milan, Italy
| | - Evelina Gollo
- Department of Anesthesiology and Intensive Care A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Mariella Maio
- Department of Anesthesiology and Intensive Care A.O.U. Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Claudia Grattarola
- Anesthesiology and Intensive Care Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Marinella Astuto
- Dipartimento Chirurgia Generale e Specialità Medico Chirurgiche, A.O.Universitaria "Policlinico-Vittorio Emanuele", Università Degli Studi Di Catania, Catania, Italy
| | - Antonello Ciccarelli
- Department of Movement, Human, and Health Sciences - Division of Health Sciences, University of Rome "Foro Italico, Rome, Italy
| | - Giulia Racca
- Division of Anesthesia and Critical Care Medicine, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Tatsiana Romenskaya
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Benedetta Giordano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Valeria Ada Maria Sansone
- The NEMO Clinical Center in Milan, Neurorehabilitation Unit, University of Milan- ERN for Neuromuscular Diseases, Milan, Italy
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Fondazione Istituto "G. Giglio" Cefalù, Palermo, Italy
| | - Giorgio Conti
- Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabio Piccolella
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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9
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Zanza C, Saglietti F, Tesauro M, Longhitano Y, Savioli G, Balzanelli MG, Romenskaya T, Cofone L, Pindinello I, Racca G, Racca F. Cardiogenic Pulmonary Edema in Emergency Medicine. Adv Respir Med 2023; 91:445-463. [PMID: 37887077 PMCID: PMC10604083 DOI: 10.3390/arm91050034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/05/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
Cardiogenic pulmonary edema (CPE) is characterized by the development of acute respiratory failure associated with the accumulation of fluid in the lung's alveolar spaces due to an elevated cardiac filling pressure. All cardiac diseases, characterized by an increasing pressure in the left side of the heart, can cause CPE. High capillary pressure for an extended period can also cause barrier disruption, which implies increased permeability and fluid transfer into the alveoli, leading to edema and atelectasis. The breakdown of the alveolar-epithelial barrier is a consequence of multiple factors that include dysregulated inflammation, intense leukocyte infiltration, activation of procoagulant processes, cell death, and mechanical stretch. Reactive oxygen and nitrogen species (RONS) can modify or damage ion channels, such as epithelial sodium channels, which alters fluid balance. Some studies claim that these patients may have higher levels of surfactant protein B in the bloodstream. The correct approach to patients with CPE should include a detailed medical history and a physical examination to evaluate signs and symptoms of CPE as well as potential causes. Second-level diagnostic tests, such as pulmonary ultrasound, natriuretic peptide level, chest radiograph, and echocardiogram, should occur in the meantime. The identification of the specific CPE phenotype is essential to set the most appropriate therapy for these patients. Non-invasive ventilation (NIV) should be considered early in the treatment of this disease. Diuretics and vasodilators are used for pulmonary congestion. Hypoperfusion requires treatment with inotropes and occasionally vasopressors. Patients with persistent symptoms and diuretic resistance might benefit from additional approaches (i.e., beta-agonists and pentoxifylline). This paper reviews the pathophysiology, clinical presentation, and management of CPE.
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Affiliation(s)
- Christian Zanza
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Francesco Saglietti
- Department of Emergency and Critical Care, Santa Croce and Carle Hospital, 12100 Cuneo, Italy
| | - Manfredi Tesauro
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Emergency Medicine, Humanitas University Hospital, 20089 Rozzano, Italy
| | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | | | - Tatsiana Romenskaya
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy
| | - Luigi Cofone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (L.C.); (I.P.)
| | - Ivano Pindinello
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (L.C.); (I.P.)
| | - Giulia Racca
- Division of Anesthesia and Critical Care Medicine, AO Ordine Mauriziano, 10128 Turin, Italy; (G.R.)
| | - Fabrizio Racca
- Division of Anesthesia and Critical Care Medicine, AO Ordine Mauriziano, 10128 Turin, Italy; (G.R.)
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10
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Zanza C, Saglietti F, Giamello JD, Savioli G, Biancone DM, Balzanelli MG, Giordano B, Trompeo AC, Longhitano Y. Effectiveness of Intranasal Analgesia in the Emergency Department. Medicina (Kaunas) 2023; 59:1746. [PMID: 37893464 PMCID: PMC10608673 DOI: 10.3390/medicina59101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency physician, but it is frequently under-treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the standard methods for administering acute pain relief. Firstly, we compared the safety and efficacy of IN analgesia to other conventional routes of analgesia to assess if IN analgesia may be an alternative for the management of acute pain in ED. Secondly, we analyzed the incidence and severity of adverse events (AEs) and rescue analgesia required. We performed a narrative review-based keywords in Pubmed/Medline, Scopus, EMBASE, the Cochrane Library, and Controlled Trials Register, finding only twenty randomized Clinical trials eligible in the timeline 1992-2022. A total of 2098 patients were analyzed and compared to intravenous analgesia, showing no statistical difference in adverse effects. In addition, intranasal analgesia also has a rapid onset and quick absorption. Fentanyl and ketamine are two intranasal drugs that appear promising and may be taken simply and safely while providing effective pain relief. Intravenous is simple to administer, non-invasive, rapid onset, and quick absorption; it might be a viable choice in a variety of situations to reduce patient suffering or delays in pain management.
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Affiliation(s)
- Christian Zanza
- Italian Society of Prehospital Emergency Medicine-SIS 118-Taranto, 74121 Taranto, Italy
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Francesco Saglietti
- Department of Anesthesia and Critical Care, Santa Croce and Carle Hospital, 12100 Cuneo, Italy
| | | | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | | | | | - Benedetta Giordano
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Roma, Italy
| | - Anna Chiara Trompeo
- Department of Anesthesia and Critical Care, AOU Città della Scienza e della Salute, 10126 Torino, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA
- Department of Emergency Medicine, Humanitas University, 20089 Milan, Italy
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11
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Saviano A, Zanza C, Longhitano Y, Ojetti V, Franceschi F, Bellou A, Voza A, Ceresa IF, Savioli G. Current Trends for Delirium Screening within the Emergency Department. Medicina (Kaunas) 2023; 59:1634. [PMID: 37763753 PMCID: PMC10537118 DOI: 10.3390/medicina59091634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
Delirium is an acute neurological disorder that involves attention and cognition. It is associated with a high risk of morbidity and mortality among older people (>65 years old). In the context of the Emergency Department (ED), it is frequently experienced by patients but often not recognized. Literature studies have identified some screening instruments for an initial evaluation of delirium. Most of these tools have not been validated yet in the context of emergencies, but, in other settings, they were very useful for assessing and maximizing the recognition of this condition among older patients. We conducted a review of the literature, including randomized control trials, clinical and observational studies, and research studies published in recent years, confirming that most of the screening tools for delirium used in the intensive care unit (ICU) or the geriatric department have not been tested in the ED, and the ideal timing and form of the delirium assessment process for older adults have not been defined yet. The aim of our review is to summarize the updated evidence about the screening tools for delirium in the context of the ED, due to the fact that overcrowding of the ED and the stressful condition of emergency situations (that contribute to the onset of delirium) could expose older patients to a high risk of complications and mortality if delirium is not promptly recognized. In conclusion, we support the evidence that delirium is a current and real condition that emergency physicians have to face daily, and we are aware that more research is needed to explore this field in order to improve the overall outcomes of older patients admitted to the ED.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
| | - Christian Zanza
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Yaroslava Longhitano
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Veronica Ojetti
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Francesco Franceschi
- Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Abdelouahab Bellou
- Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Emergency Medicine, School of Medicine, Wayne State University, Detroit, MI 48201, USA
| | - Antonio Voza
- Emergency Department, Humanitas University, Via Rita Levi Montalcini 4, 20089 Milan, Italy
| | - Iride Francesca Ceresa
- Emergency Room and Internal Medicine, Istituti Clinici di Pavia e Vigevano, Gruppo San Donato, 27029 Milan, Italy
| | - Gabriele Savioli
- Department of Emergency Medicine, Fondazione Policlinico San Matteo, 27100 Pavia, Italy
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12
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Piccioni A, Valletta F, Franza L, Rosa F, Manca F, Zanza C, Savioli G, Gasbarrini A, Covino M, Franceschi F. Evaluation of procalcitonin in hemorrhagic shock: a pilot study. Clin Ter 2023; 174:432-435. [PMID: 37674453 DOI: 10.7417/ct.2023.2461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Abstract An increased secretion of procalcitonin (PCT) is primarily due to systemic inflammation of bacterial origin, as PCT is used to diagnose and manage sepsis. However, other conditions can induce high plasma levels of PCT, and hemorrhagic shock may be one of these as we found in clinical practice. The aim of this pilot, observational and prospective study was to investigate the role of PCT in hemorrhagic shock and if it could help in distinguishing between different types of shock. We enrolled 15 patients who entered the shock room of our Emergency Department (ED) with a diagnosis of hemodynamic shock, defined as hypotension (systolic blood pressure < 90 mmHg, or medial arterial pressure < 65 mmHg), and/or elevated lactate level (> 2 mmol/L), with one or more signs of cerebral or systemic hypoperfusion. For all the patients we dosed PCT at the time of admission, and we collected them into three different groups - septic, hemorrhagic and mixed shock - based on clinical presentation and laboratory and instrumental examination. First results did not show a significant increase of PCT in patients with hemorrhagic shock alone (average 0.12 ± 0.07 ng/mL), while PCT levels were similarly high in those with septic and mixed shock (17.63 ± 32.16 and 24.62 ± 33.02 respectively). PCT is not a marker of bleeding shock and does not help in distinguishing if bleeding or sepsis have the major impact on hemodynamics in those with mixed shock. However, patients with sepsis usually access the ED a few days after the initial infectious and inflammatory process has begun, while those with a major bleeding ask for intervention at the very first beginning. Thus, it may be helpful to see is PCT levels rise after some time from the bleeding start, or to investigate a different biomarker that rises earlier in course of systemic disfunction, such as presepsin. Finally, we also aimed at investigating if PCT levels would show any correlation with age of patients, regardless of the type of shock: results provided an higher PCT in individuals ≥ 80 years old, than in those < 80 years old.
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Affiliation(s)
- A Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Valletta
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Franza
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Rosa
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Manca
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Zanza
- Foundation "Ospedale Alba-Bra Onlus", Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno Italy
| | - G Savioli
- Department of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, Pavia, Italy
| | - A Gasbarrini
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Covino
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Gri N, Longhitano Y, Zanza C, Monticone V, Fuschi D, Piccioni A, Bellou A, Esposito C, Ceresa IF, Savioli G. Acute Oncologic Complications: Clinical-Therapeutic Management in Critical Care and Emergency Departments. Curr Oncol 2023; 30:7315-7334. [PMID: 37623012 PMCID: PMC10453099 DOI: 10.3390/curroncol30080531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/07/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction. It is now known that cancer is a major public health problem; on the other hand, it is less known, or rather, often underestimated, that a significant percentage of cancer patients will experience a cancer-related emergency. These conditions, depending on the severity, may require treatment in intensive care or in the emergency departments. In addition, it is not uncommon for a tumor pathology to manifest itself directly, in the first instance, with a related emergency. The emergency unit proves to be a fundamental and central unit in the management of cancer patients. Many cancer cases are diagnosed in the first instance as a result of symptoms that lead the patient's admittance into the emergency room. Materials and Methods. This narrative review aims to analyze the impact of acute oncological cases in the emergency setting and the role of the emergency physician in their management. A search was conducted over the period January 1981-April 2023 using the main scientific platforms, including PubMed, Scopus, Medline, Embase and Google scholar, and 156 papers were analyzed. Results. To probe into the main oncological emergencies and their management in increasingly overcrowded emergency departments, we analyzed the following acute pathologies: neurological emergencies, metabolic and endocrinological emergencies, vascular emergencies, malignant effusions, neutropenic fever and anemia. Discussion/Conclusions. Our analysis found that a redefinition of the emergency department connected with the treatment of oncology patients is necessary, considering not only the treatment of the oncological disease in the strict sense, but also the comorbidities, the oncological emergencies and the palliative care setting. The need to redesign an emergency department that is able to manage acute oncological cases and end of life appears clear, especially when this turns out to be related to severe effects that cannot be managed at home with integrated home care. In conclusion, a redefinition of the paradigm appears mandatory, such as the integration between the various specialists belonging to oncological medicine and the emergency department. Therefore, our work aims to provide what can be a handbook to detect, diagnose and treat oncological emergencies, hoping for patient management in a multidisciplinary perspective, which could also lead to the regular presence of an oncologist in the emergency room.
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Affiliation(s)
- Nicole Gri
- Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Christian Zanza
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Valentina Monticone
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Italy
| | - Damiano Fuschi
- Department of Italian and Supranational Public Law, School of Law, University of Milan, 20122 Milan, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri, University of Pavia, 27100 Pavia, Italy
| | | | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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14
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Rocca E, Zanza C, Longhitano Y, Piccolella F, Romenskaya T, Racca F, Savioli G, Saviano A, Piccioni A, Mongodi S. Lung Ultrasound in Critical Care and Emergency Medicine: Clinical Review. Adv Respir Med 2023; 91:203-223. [PMID: 37218800 DOI: 10.3390/arm91030017] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 02/28/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023]
Abstract
Lung ultrasound has become a part of the daily examination of physicians working in intensive, sub-intensive, and general medical wards. The easy access to hand-held ultrasound machines in wards where they were not available in the past facilitated the widespread use of ultrasound, both for clinical examination and as a guide to procedures; among point-of-care ultrasound techniques, the lung ultrasound saw the greatest spread in the last decade. The COVID-19 pandemic has given a boost to the use of ultrasound since it allows to obtain a wide range of clinical information with a bedside, not harmful, repeatable examination that is reliable. This led to the remarkable growth of publications on lung ultrasounds. The first part of this narrative review aims to discuss basic aspects of lung ultrasounds, from the machine setting, probe choice, and standard examination to signs and semiotics for qualitative and quantitative lung ultrasound interpretation. The second part focuses on how to use lung ultrasound to answer specific clinical questions in critical care units and in emergency departments.
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Affiliation(s)
- Eduardo Rocca
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Christian Zanza
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Fabio Piccolella
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Tatsiana Romenskaya
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Fabrizio Racca
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
- Department of Anesthesia and Critical Care Medicine, AO Mauriziano Hospital, University of Turin, 10124 Turin, Italy
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Angela Saviano
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS University of Catholic of Sacred Heart, 00168 Rome, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS University of Catholic of Sacred Heart, 00168 Rome, Italy
| | - Silvia Mongodi
- Department of Anesthesia and Intensive Care Medicine, Critical Care Unit-1, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy
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15
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Bolgeo T, Maconi A, Gardalini M, Gatti D, Di Matteo R, Lapidari M, Longhitano Y, Savioli G, Piccioni A, Zanza C. The Role of Cold Atmospheric Plasma in Wound Healing Processes in Critically Ill Patients. J Pers Med 2023; 13:jpm13050736. [PMID: 37240907 DOI: 10.3390/jpm13050736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Critically ill patients are at risk of skin wounds, which reduce their quality of life, complicate their pharmacological regimens, and prolong their hospital stays in intensive care units (ICUs), while also increasing overall mortality and morbidity rates. Cold atmospheric plasma (CAP) has been proposed as a viable option for many biological and medical applications, given its capacity to reduce wound bacterial contamination and promote wound healing. The aim of this narrative review is to describe how CAP works and its operating mechanisms, as well as reporting its possible applications in critical care settings. The success of CAP in the treatment of wounds, in particular, bedsores or pressure sores, presents an innovative path in the prevention of nosocomial infections and an opportunity of reducing the negative implications of these diseases for the NHS. This narrative review of the literature was conducted following the 'Scale for the Assessment of Narrative Review Articles' (SANRA) methodology. Previous literature highlights three biological effects of plasma: inactivation of a wide range of microorganisms, including those that are multi-drug-resistant; increased cell proliferation and angiogenesis with a shorter period of plasma treatment; and apoptosis stimulation with a longer and more intensive treatment. CAP is effective in many areas of the medical field, with no significant adverse effects on healthy cells. However, its use can produce potentially serious side effects and should, therefore, be used under expert supervision and in appropriate doses.
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Affiliation(s)
- Tatiana Bolgeo
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Antonio Maconi
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Menada Gardalini
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Denise Gatti
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Roberta Di Matteo
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Marco Lapidari
- Department of Vascular Surgery, St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Gabriele Savioli
- Department of Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Christian Zanza
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
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Piccioni A, Niccolai E, Rozzi G, Spaziani G, Zanza C, Candelli M, Covino M, Gasbarrini A, Franceschi F, Amedei A. Familial Hypercholesterolemia and Acute Coronary Syndromes: The Microbiota-Immunity Axis in the New Diagnostic and Prognostic Frontiers. Pathogens 2023; 12:pathogens12040627. [PMID: 37111513 PMCID: PMC10142551 DOI: 10.3390/pathogens12040627] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Familial hypercholesterolemia is a common genetic disorder with a propensity towards early onset of atherosclerotic cardiovascular disease (CVD). The main goal of therapy is to reduce the LDL cholesterol and the current treatment generally consists of statin, ezetimibe and PCSK9 inhibitors. Unfortunately, lowering LDL cholesterol may be difficult for many reasons such as the variation of response to statin therapy among the population or the high cost of some therapies (i.e., PCSK9 inhibitors). In addition to conventional therapy, additional strategies may be used. The gut microbiota has been recently considered to play a part in chronic systemic inflammation and hence in CVD. Several studies, though they are still preliminary, consider dysbiosis a risk factor for various CVDs through several mechanisms. In this review, we provide an update of the current literature about the intricate relation between the gut microbiota and the familial hypercholesterolemia.
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Affiliation(s)
- Andrea Piccioni
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, 00168 Roma, Italy
| | - Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Gloria Rozzi
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, 00168 Roma, Italy
| | - Giacomo Spaziani
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, 00168 Roma, Italy
| | - Christian Zanza
- Foundation "Ospedale Alba-Bra Onlus", Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Marcello Candelli
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, 00168 Roma, Italy
| | - Marcello Covino
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, 00168 Roma, Italy
| | - Antonio Gasbarrini
- Medical and Surgical Science Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, 00168 Roma, Italy
| | - Francesco Franceschi
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, 00168 Roma, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
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Savioli G, Ceresa IF, Bressan MA, Piccini GB, Varesi A, Novelli V, Muzzi A, Cutti S, Ricevuti G, Esposito C, Voza A, Desai A, Longhitano Y, Saviano A, Piccioni A, Piccolella F, Bellou A, Zanza C, Oddone E. Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding-The CREONTE (Crowding and RE-Organization National TriagE) Study Group. Medicina (Kaunas) 2023; 59:medicina59040781. [PMID: 37109739 PMCID: PMC10143416 DOI: 10.3390/medicina59040781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Triage systems help provide the right care at the right time for patients presenting to emergency departments (EDs). Triage systems are generally used to subdivide patients into three to five categories according to the system used, and their performance must be carefully monitored to ensure the best care for patients. Materials and Methods: We examined ED accesses in the context of 4-level (4LT) and 5-level triage systems (5LT), implemented from 1 January 2014 to 31 December 2020. This study assessed the effects of a 5LT on wait times and under-triage (UT) and over-triage (OT). We also examined how 5LT and 4LT systems reflected actual patient acuity by correlating triage codes with severity codes at discharge. Other outcomes included the impact of crowding indices and 5LT system function during the COVID-19 pandemic in the study populations. Results: We evaluated 423,257 ED presentations. Visits to the ED by more fragile and seriously ill individuals increased, with a progressive increase in crowding. The length of stay (LOS), exit block, boarding, and processing times increased, reflecting a net raise in throughput and output factors, with a consequent lengthening of wait times. The decreased UT trend was observed after implementing the 5LT system. Conversely, a slight rise in OT was reported, although this did not affect the medium-high-intensity care area. Conclusions: Introducing a 5LT improved ED performance and patient care.
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Affiliation(s)
- Gabriele Savioli
- Department of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Maria Antonietta Bressan
- Department of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Angelica Varesi
- Faculty of Medicine, University of Pavia, 27100 Pavia, Italy
| | - Viola Novelli
- Health Department, University of Pavia, 27100 Pavia, Italy
| | - Alba Muzzi
- Health Department, University of Pavia, 27100 Pavia, Italy
| | - Sara Cutti
- Health Department, University of Pavia, 27100 Pavia, Italy
| | | | - Ciro Esposito
- Nephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, Italy
| | - Antonio Voza
- Emergency Department, Humanitas University, Via Rita Levi Montalcini 4, 20089 Milan, Italy
| | - Antonio Desai
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Intensive Care Medicine-AON Antonio, Biagio e Cesare Arrigo, 15100 Alessandria, Italy
| | - Angela Saviano
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy
| | - Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy
| | - Fabio Piccolella
- Department of Anesthesiology and Intensive Care Medicine-AON Antonio, Biagio e Cesare Arrigo, 15100 Alessandria, Italy
| | - Abdel Bellou
- Institute of Sciences in Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Christian Zanza
- Department of Anesthesiology and Intensive Care Medicine-AON Antonio, Biagio e Cesare Arrigo, 15100 Alessandria, Italy
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
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Messina A, Longhitano Y, Zanza C, Calabrò L, Villa F, Cammarota G, Sanfilippo F, Cecconi M, Robba C. Cardiac dysfunction in patients affected by subarachnoid haemorrhage affects in-hospital mortality: A systematic review and metanalysis. Eur J Anaesthesiol 2023; 40:442-449. [PMID: 37052065 DOI: 10.1097/eja.0000000000001829] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Subarachnoid haemorrhage (SAH) is a life-threatening condition with associated brain damage. Moreover, SAH is associated with a massive release of catecholamines, which may promote cardiac injury and dysfunction, possibly leading to haemodynamic instability, which in turn may influence a patient's outcome. OBJECTIVES To study the prevalence of cardiac dysfunction (as assessed by echocardiography) in patients with SAH and its effect on clinical outcomes. DESIGN Systematic review of observational studies. DATA SOURCES We performed a systematic search over the last 20 years on MEDLINE and EMBASE databases. ELIGIBILITY CRITERIA Studies reporting echocardiography findings in adult patients with SAH admitted to intensive care. Primary outcomes were in-hospital mortality and poor neurological outcome according to the presence or absence of cardiac dysfunction. RESULTS We included a total of 23 studies (4 retrospective) enrolling 3511 patients. The cumulative frequency of cardiac dysfunction was 21% (725 patients), reported as regional wall motion abnormality in the vast majority of studies (63%). Due to the heterogeneity of clinical outcome data reporting, a quantitative analysis was carried out only for in-hospital mortality. Cardiac dysfunction was associated with a higher in-hospital mortality [odds ratio 2.69 (1.64 to 4.41); P < 0.001; I2 = 63%]. The GRADE of evidence assessment resulted in very low certainty of evidence. CONCLUSION About one in five patients with SAH develops cardiac dysfunction, which seems to be associated with higher in-hospital mortality. The consistency of cardiac and neurological data reporting is lacking, reducing the comparability of the studies in this field.
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Affiliation(s)
- Antonio Messina
- From the IRCCS Humanitas Research Hospital, Rozzano (AM, LC, FV, MC), Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (AM, MC), Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA (YL, CZ), IRCCS Ospedale Policlinico San Martino (CR), Dipartimento di Medicina E Chirurgia, Universita' Degli Studi di Perugia, Perugia (GC) and Department of Anaesthesia and Intensive Care, A.O.U. 'Policlinico-San Marco', Catania, Italy (FS)
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Zanza C, Romenskaya T, Racca F, Rocca E, Piccolella F, Piccioni A, Saviano A, Formenti-Ujlaki G, Savioli G, Franceschi F, Longhitano Y. Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness. Int J Mol Sci 2023; 24:ijms24087118. [PMID: 37108280 PMCID: PMC10138568 DOI: 10.3390/ijms24087118] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 02/24/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
Trauma remains one of the leading causes of death in adults despite the implementation of preventive measures and innovations in trauma systems. The etiology of coagulopathy in trauma patients is multifactorial and related to the kind of injury and nature of resuscitation. Trauma-induced coagulopathy (TIC) is a biochemical response involving dysregulated coagulation, altered fibrinolysis, systemic endothelial dysfunction, platelet dysfunction, and inflammatory responses due to trauma. The aim of this review is to report the pathophysiology, early diagnosis and treatment of TIC. A literature search was performed using different databases to identify relevant studies in indexed scientific journals. We reviewed the main pathophysiological mechanisms involved in the early development of TIC. Diagnostic methods have also been reported which allow early targeted therapy with pharmaceutical hemostatic agents such as TEG-based goal-directed resuscitation and fibrinolysis management. TIC is a result of a complex interaction between different pathophysiological processes. New evidence in the field of trauma immunology can, in part, help explain the intricacy of the processes that occur after trauma. However, although our knowledge of TIC has grown, improving outcomes for trauma patients, many questions still need to be answered by ongoing studies.
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Affiliation(s)
- Christian Zanza
- Department of Anesthesia and Critical Care, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Tatsiana Romenskaya
- Department of Physiology and Pharmacology, Sapienza University of Rome, P. le A. Moro 5, 00185 Rome, Italy
| | - Fabrizio Racca
- Department of Anesthesia and Critical Care, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Eduardo Rocca
- Department of Anesthesia and Critical Care, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Fabio Piccolella
- Department of Anesthesia and Critical Care, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Angela Saviano
- Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - George Formenti-Ujlaki
- Department of Surgery, San Carlo Hospital, ASST Santi Paolo and Carlo, 20142 Milan, Italy
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, Polyclinic Agostino Gemelli/IRCCS, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
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20
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Cicchinelli S, Rosa F, Manca F, Zanza C, Ojetti V, Covino M, Candelli M, Gasbarrini A, Franceschi F, Piccioni A. The Impact of Smoking on Microbiota: A Narrative Review. Biomedicines 2023; 11:biomedicines11041144. [PMID: 37189762 DOI: 10.3390/biomedicines11041144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 05/17/2023] Open
Abstract
Cigarette smoke is a classic risk factor for many diseases. The microbiota has been recently indicated as a new, major player in human health. Its deregulation-dysbiosis-is considered a new risk factor for several illnesses. Some studies highlight a cross-interaction between these two risk factors-smoke and dysbiosis-that may explain the pathogenesis of some diseases. We searched the keywords "smoking OR smoke AND microbiota" in the title of articles on PubMed®, UptoDate®, and Cochrane®. We included articles published in English over the last 25 years. We collected approximately 70 articles, grouped into four topics: oral cavity, airways, gut, and other organs. Smoke may impair microbiota homeostasis through the same harmful mechanisms exerted on the host cells. Surprisingly, dysbiosis and its consequences affect not only those organs that are in direct contact with the smoke, such as the oral cavity or the airways, but also involve distant organs, such as the gut, heart, vessels, and genitourinary tract. These observations yield a deeper insight into the mechanisms implicated in the pathogenesis of smoke-related diseases, suggesting a role of dysbiosis. We speculate that modulation of the microbiota may help prevent and treat some of these illnesses.
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Affiliation(s)
- Sara Cicchinelli
- Department of Emergency, Ospedale SS. Filippo e Nicola, 67051 Avezzano, Italy
| | - Federico Rosa
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Federica Manca
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Christian Zanza
- Department of Anesthesia, Critical Care, and Emergency Medicine, Ospedale Michele e Pietro Ferrero, 12060 Cuneo, Italy
| | - Veronica Ojetti
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Department of Internal Medicine, Ospedale San Carlo di Nancy, 00165 Rome, Italy
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Division of Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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21
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Saviano A, Brigida M, Petruzziello C, Zanza C, Candelli M, Morabito Loprete MR, Saleem F, Ojetti V. Intestinal Damage, Inflammation and Microbiota Alteration during COVID-19 Infection. Biomedicines 2023; 11:biomedicines11041014. [PMID: 37189632 DOI: 10.3390/biomedicines11041014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Background: The virus SARS-CoV-2 is responsible for respiratory disorders due to the fact that it mainly infects the respiratory tract using the Angiotensin-converting enzyme 2 (ACE2) receptors. ACE2 receptors are also highly expressed on intestinal cells, representing an important site of entry for the virus in the gut. Literature studies underlined that the virus infects and replicates in the gut epithelial cells, causing gastrointestinal symptoms such as diarrhea, abdominal pain, nausea/vomiting and anorexia. Moreover, the SARS-CoV-2 virus settles into the bloodstream, hyperactivating the platelets and cytokine storms and causing gut–blood barrier damage with an alteration of the gut microbiota, intestinal cell injury, intestinal vessel thrombosis leading to malabsorption, malnutrition, an increasing disease severity and mortality with short and long-period sequelae. Conclusion: This review summarizes the data on how SARS-CoV-2 effects on the gastrointestinal systems, including the mechanisms of inflammation, relationship with the gut microbiota, endoscopic patterns, and the role of fecal calprotectin, confirming the importance of the digestive system in clinical practice for the diagnosis and follow-up of SARS-CoV-2 infection.
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22
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Racca F, Longhitano Y, Zanza C, Draisci G, Stoia PA, Gollo E, Maio M, Grattarola C, Astuto M, Vaschetto R, Sansone VAM, Conti G, Gregoretti C. Peri-Partum respiratory management in neuro-muscular disorders (IT-NEUMA-Pregn study): A proposal by an italian panel and a call for an international collaboration. Pulmonology 2023:S2531-0437(23)00041-7. [PMID: 36907810 DOI: 10.1016/j.pulmoe.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/18/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Affiliation(s)
- F Racca
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, Via Venezia, 16, 15121 Alessandria, Italy, EU
| | - Y Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - C Zanza
- Department of Integrated Research and Innovation Activities, Service of Translational Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, Alessandria, Italy.
| | - G Draisci
- Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P A Stoia
- Anesthesiology and Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda Ca'Granda, Milan, Italy
| | - E Gollo
- Department of Anesthesiology, Intensive Care A.O.U, Città della Salute e della Scienza di Torino C.so Bramante 88/90, 10126 Torino, Italy
| | - M Maio
- Department of Anesthesiology, Intensive Care A.O.U, Città della Salute e della Scienza di Torino C.so Bramante 88/90, 10126 Torino, Italy
| | - C Grattarola
- Anesthesiology and Intensive Care Unit, Istituto Giannina Gaslini, Genova, Italy
| | - M Astuto
- Dipartimento Chirurgia Generale e Specialità Medico Chirurgiche, A.O.Universitaria "Policlinico-Vittorio Emanuele", Università degli Studi di Catania, Italy
| | - R Vaschetto
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - V A M Sansone
- The NEMO Clinical Center in Milan, Neurorehabilitation Unit, University of Milan, ERN for Neuromuscular Diseases, Milano, Italy
| | - G Conti
- Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy; Fondazione Istituto "G. Giglio" Cefalù, Palermo, Italy
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23
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Saviano A, Zanza C, Longhitano Y, Nista EC, Franceschi F, Ojetti V. Effects of functional foods, nutraceuticals, and herbal products on pancreas. Chin Med J (Engl) 2023; 136:619-620. [PMID: 36804460 PMCID: PMC10106171 DOI: 10.1097/cm9.0000000000002396] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Christian Zanza
- Foundation “Ospedale Alba-Bra” and Department of Anesthesia, Critical Care and Emergency Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Enrico Celestino Nista
- Department of Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Veronica Ojetti
- Department of Emergency Medicine, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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24
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Zanza C, Romenskaya T, Zuliani M, Piccolella F, Bottinelli M, Caputo G, Rocca E, Maconi A, Savioli G, Longhitano Y. Acute Traumatic Pain in the Emergency Department. Diseases 2023; 11:diseases11010045. [PMID: 36975594 PMCID: PMC10046963 DOI: 10.3390/diseases11010045] [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] [Received: 12/05/2022] [Revised: 02/01/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Trauma is a major cause of mortality throughout the world. Traumatic pain—acute, sudden, or chronic—is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. Patients’ perceptions of pain assessment and management have become an important criterion and relevant outcome measure for healthcare institutions. Several studies show that 60–70% of ER patients experience pain, and more than half of them express a feeling of sorrow, which can be moderate or severe, at triage. The few studies that have analyzed how pain is assessed and managed in these departments agree that approximately 70% of patients receive no analgesia or receive it with remarkable delay. Specifically, less than half of the patients receive treatment for pain during admission and 60% of discharged patients have higher intensity pain than at admission. Trauma patients are also the ones who most commonly report low satisfaction with pain management. Associated with this lack of satisfaction, we can describe the poor use of tools for measuring and recording pain, poor communication among caregivers, inadequate training in pain assessment and management, and widespread misconceptions among nurses about the reliability of patients’ estimation of pain. The aim of this article is to review the scientific literature to explore the methodologies of pain management in trauma patients attending the emergency room and analyzing their weaknesses as a starting point to improve the approach to this, unfortunately too often, underestimated issue. A literature search was performed using the major databases to identify relevant studies in indexed scientific journals. The literature showed that the multimodal approach in trauma patients is the best approach to pain management. It is becoming increasingly crucial to manage the patient on multiple fronts. Drugs acting on different pathways can be administered together at lower doses, minimizing risks. Every emergency department must have staff trained in the assessment and immediate management of pain symptoms as this allows the reduction of mortality and morbidity and shortens hospital stays, contributing to early mobilization, reduced hospital costs, and enhanced patient satisfaction and quality of life.
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Affiliation(s)
- Christian Zanza
- Department of Integrated Research and Innovation Activities, Unit of Translational Medicine AON SS, Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
- Correspondence:
| | - Tatsiana Romenskaya
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy
| | - Marta Zuliani
- Department of Integrated Research and Innovation Activities, Unit of Translational Medicine AON SS, Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Fabio Piccolella
- Department of Integrated Research and Innovation Activities, Unit of Translational Medicine AON SS, Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Maria Bottinelli
- Department of Integrated Research and Innovation Activities, Unit of Translational Medicine AON SS, Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Giorgia Caputo
- Department of Integrated Research and Innovation Activities, Unit of Translational Medicine AON SS, Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Eduardo Rocca
- Department of Integrated Research and Innovation Activities, Unit of Translational Medicine AON SS, Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Antonio Maconi
- Department of Integrated Research and Innovation Activities, Unit of Translational Medicine AON SS, Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
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Abenavoli L, Aquila I, Sacco MA, Procopio AC, Cinaglia P, Zanza C, Longhitano Y, Arena V, Fagoonee S, Ricci P, Luzza F. Liver injury associated with high value of D-dimer plasmatic level in COVID-19 patients. Minerva Gastroenterol (Torino) 2023; 69:141-148. [PMID: 35470356 DOI: 10.23736/s2724-5985.22.03189-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causal agent of the coronavirus disease (COVID-19), has infected millions of people worldwide. Currently, the scientific community debates on the direct viral responsibility of liver damage or whether the observed changes are secondary manifestations of systemic inflammation triggered by COVID-19. The hepatic involvement is associated with worse clinical outcomes and higher risk of COVID-19 related morbidity and mortality. Furthermore, SARS-CoV-2 infection may predispose patients to thrombotic disease due to excessive inflammation, platelet activation, and endothelial dysfunction. METHODS In this paper, we reported a cross-sectional analysis of five patients affected by a severe form of COVID-19, who died between April 11 and May 1, 2020. Each patient has been subjected to a medico-legal autopsy in which both gross and histological liver changes were evaluated, as well as the correlation with the related coagulation profile. RESULTS In three cases of our cohort, the thromboembolism was recognized as cause of death. Furthermore, a significant statistical difference between D-dimer values at hospital admission and death among enrolled patients (P=0.033), was evaluated. No patient has recorded a pre-existing liver disease. CONCLUSIONS Our results support the evidence that hepatic damage in subjects with severe form of COVID-19 is related to the changes in coagulative and fibrinolytic pathways. Hence, the evaluation of D-dimer blood levels may be useful in clinical practice to predict the involvement of the liver and the prognosis of these patients. This data highlights the fundamental role of coagulation balance in subjects with advanced form of COVID-19.
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Affiliation(s)
- Ludovico Abenavoli
- Department of Health Sciences, Magna Grecia University, Catanzaro, Italy -
| | - Isabella Aquila
- Department of Surgical and Medical Sciences, Magna Grecia University, Catanzaro, Italy
| | - Matteo A Sacco
- Department of Surgical and Medical Sciences, Magna Grecia University, Catanzaro, Italy
| | - Anna C Procopio
- Department of Health Sciences, Magna Grecia University, Catanzaro, Italy
| | - Pietro Cinaglia
- Department of Health Sciences, Magna Grecia University, Catanzaro, Italy
| | - Christian Zanza
- Department of Emergency, Anesthesia and Critical Care, Foundation "Ospedale Alba-Bra", Michele and Pietro Ferrero Hospital, Verduno, Cuneo, Italy
| | - Yaroslava Longhitano
- Department of Emergency Medicine, Section of Anesthesia and Critical Care, St Giacomo Hospital, Novi Ligure, Alessandria, Italy
| | - Vincenzo Arena
- Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, Turin, Italy
| | - Pietrantonio Ricci
- Department of Surgical and Medical Sciences, Magna Grecia University, Catanzaro, Italy
| | - Francesco Luzza
- Department of Health Sciences, Magna Grecia University, Catanzaro, Italy
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Longhitano Y, Zanza C. The Second Part of Current Route of Neuro-Critical Care. Rev Recent Clin Trials 2023; 18:2. [PMID: 36960650 DOI: 10.2174/157488711801230222095341] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/24/2023]
Affiliation(s)
- Yaroslava Longhitano
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Christian Zanza
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Foundation of "Ospedale Alba-Bra" and Department of Emergency Medicine, Anaesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy
- Foundation of "Ospedale Alba-Bra" and Department of Emergency Medicine, Anaesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy
- Department Of Emergency Medicine - Fondazione, Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
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Romenskaya T, Longhitano Y, Piccolella F, Berger JM, Artico M, Taurone S, Maconi A, Saviano A, Caramuta M, Savioli G, Zanza C. Cerebral Vasospasm: Practical Review of Diagnosis and Management. Rev Recent Clin Trials 2023; 18:12-18. [PMID: 35950252 DOI: 10.2174/1574887117666220810121048] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 02/03/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cerebral vasospasm is one of the frequent complications that can occur following subarachnoid hemorrhage (SAH). With new protocols in the management of SAH, the combined risk of death and long-term disability have been reduced by about 10% compared with the past. OBJECTIVE This work aims to report the latest updates on the vasospasm developing after the SAH in patients in the ICU department. In this short review, we reviewed the latest scientific findings on the mechanisms of vasospasm, and in addition, we considered it necessary to review the literature to report the tools for early diagnosis of vasospasm and the best treatment strategies to prevent the negative outcome in patients admitted to ICU. AIM The aim of this narrative review is to report the main characteristics of vasospasm, new diagnostic methods, and, especially, more effective treatment of vasospasm. MATERIALS AND METHODS The peer-reviewed articles analyzed were selected from PubMed, Google scholar, Embase, and Scopus databases published in the previous 20 years using the keywords "vasospasm", "vasospasm diagnosis", "vasospasm and SAH", "vasospasm treatment", and nontraumatic brain injury. Among the 78 papers identified, 43 articles were selected; after the title - abstract examination and removing the duplicates, only 31 articles were examined. RESULTS Vasospasm can be classified according to clinical (asymptomatic vs. symptomatic) and diagnostic (angiographic vs. ultrasound) methods. Various procedures such as TCD and CT perfusion are used for early diagnosis and close monitoring of this condition. The treatment of vasospasm consists of both prevention (nimodipine, statitis, and magnesium sulphate) and active treatment (mainly endovascular). CONCLUSION As the review shows, vasospasm is a complication of SAH, a complication that is difficult to recognize early and treat with the best outcome. However, with the equipment we have, it has been possible to improve the outcome, even if it is still not ideal, in patients who develop vasospasm. Several studies are in the final stages to improve the outcome of this unfortunately frequent condition.
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Affiliation(s)
- Tatsiana Romenskaya
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
- Department of Research and Innovation-Research Training Innovation Infrastructure, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Yaroslava Longhitano
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
- Department of Research and Innovation-Research Training Innovation Infrastructure, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Foundation of "Ospedale Alba-Bra"" Verduno, Italy
- Department of Emergency Medicine, Anesthesia, and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy
- Department of Anesthesiology, Keck Medical School of University of Southern California, LA, CA 90033, USA
| | - Fabio Piccolella
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Jack Marshall Berger
- Department of Anesthesiology, Keck Medical School of University of Southern California, LA, CA 90033, USA
| | - Marco Artico
- Department of Anesthesiology, Keck Medical School of University of Southern California, LA, CA 90033, USA
| | - Samanta Taurone
- Department of Sensory Organs- Sapienza University of Rome, Rome, Italy
| | - Antonio Maconi
- Department of Research and Innovation-Research Training Innovation Infrastructure, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Angela Saviano
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS, University of Catholic of Sacred Heart, Rome, Italy
| | - Michela Caramuta
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS, University of Catholic of Sacred Heart, Rome, Italy
| | - Gabriele Savioli
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Christian Zanza
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
- Department of Research and Innovation-Research Training Innovation Infrastructure, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Foundation of "Ospedale Alba-Bra"" Verduno, Italy
- Department of Emergency Medicine, Anesthesia, and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy
- Department of Sensory Organs- Sapienza University of Rome, Rome, Italy
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS, University of Catholic of Sacred Heart, Rome, Italy
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28
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Racca F, Geraci C, Cremascoli L, Ruvolo D, Piccolella F, Romenskaya T, Longhitano Y, Martuscelli E, Saviano A, Savioli G, Zanza C. Invasive Mechanical Ventilation in Traumatic Brain Injured Patients with Acute Respiratory Failure. Rev Recent Clin Trials 2023; 18:3-11. [PMID: 36043786 DOI: 10.2174/1574887117666220826164723] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 11/19/2021] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
Abstract
Patients with severe traumatic brain injury (TBI) need to be admitted to intensive care (ICU) because they require invasive mechanical ventilation (IMV) due to reduced consciousness resulting in loss of protective airway reflexes, reduced ability to cough and altered breathing control. In addition, these patients can be complicated by pneumonia and acute distress syndrome (ARDS). IMV allows these patients to be sedated, decreasing intracranial pressure and ensuring an adequate oxygen delivery and tight control of arterial carbon dioxide tension. However, IMV can also cause dangerous effects on the brain due to its interaction with intrathoracic and intracranial compartments. Moreover, when TBI is complicated by ARDS, the setting of mechanical ventilation can be very difficult as ventilator goals are often different and in conflict with each other. Consequently, close brain and respiratory monitoring is essential to reduce morbidity and mortality in mechanically ventilated patients with severe TBI and ARDS. Recently, recommendations for the setting of mechanical ventilation in patients with acute brain injury (ABI) were issued by the European Society of Intensive Care Medicine (ESICM). However, there is insufficient evidence regarding ventilation strategies for patients with ARDS associated with ABI. The purpose of this paper is to analyze in detail respiratory strategies and targets in patients with TBI associated with ARDS.
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Affiliation(s)
- Fabrizio Racca
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Cristina Geraci
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Luca Cremascoli
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Domenico Ruvolo
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Piccolella
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Tatsiana Romenskaya
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Yaroslava Longhitano
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Foundation of "Ospedale Alba-Bra", Department of Emergency Medicine, Anaesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Ermelinda Martuscelli
- Department of Emergency Medicine and Anesthesia and Critical Care, San Giacomo Hospital, Novi Ligure (AL), Italy
| | - Angela Saviano
- Department Of Emergency Medicine - Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Gabriele Savioli
- Clinical Echocardiography and Urgency Ultrasound, Emergency Medicine, Fondazione IRCCS San Matteo, 27100 Pavia, Italy
| | - Christian Zanza
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Foundation of "Ospedale Alba-Bra", Department of Emergency Medicine, Anaesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy
- Department Of Emergency Medicine - Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
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Saviano A, Petruzziello C, Riccioni ME, Di Pumpo M, Petrucci M, Brigida M, Zanza C, Candelli M, Franceschi F, Ojetti V. Lower Gastrointestinal Bleeding in the Emergency Department: High- Volume vs. Low-Volume Peg Bowel Preparation for Colonoscopy: A Randomized Trial. Rev Recent Clin Trials 2023; 18:76-81. [PMID: 36089784 DOI: 10.2174/1574887117666220908152754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lower Gastrointestinal Bleeding (LGIB) is a common cause of admission to the Emergency Department (ED). Early colonoscopy is the exam of choice for evaluating LGIB, and an adequate colon cleansing is essential. High-volume solution 4L-PEG is largely used, but it has some limitations. Low-volume solution 2L-PEG may improve patient's tolerability and compliance, reducing the time of administration and speeding up the exam. PATIENTS AND METHODS We conducted a randomized 1:1, prospective observational monocentric study in 228 patients (144M/84F) with LGIB. 121 (69M/52F) received the High-Volume, while 107 (75M/32F) received Low-Volume. They completed a "satisfaction questionnaire" (taste and smell, mood, time of taking, general experience). We collected the results of the Boston Bowel Preparation Scale (BBPS) and the final diagnosis. The study was retrospectively registered on clinicaltrial.gov with protocol number NCT0536 2227. RESULTS A mean value of BBPS 6,3 was achieved by both groups (p=0.57). Regarding smell, taste, mood and time of taking (1 to 5), we do not find any statistically differences. The overall satisfaction between the two preparations was 2.90 for low-volume compared to 3.17 for Highvolume (p=0.06). No side effects were reported. The proportion of patients without an evident source of bleeding was higher in High volume preparations compared to Low-volume (39% vs. 30%, respectively). CONCLUSION Low volume bowel preparation showed the same efficacy and tolerability with better satisfaction compared with high volume. Low-volume could represent an effective and more desirable preparation for patients in the ED.
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Affiliation(s)
- Angela Saviano
- Emergency Department, Fondazione Policlinico A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmine Petruzziello
- Emergency Department, Ospedale San Carlo di Nancy GVM Care & Research, Rome, Italy
| | - Maria Elena Riccioni
- Endoscopy Unit, Fondazione Policlinico A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marcello Di Pumpo
- Section of Hygiene, University Department of Health Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Petrucci
- Emergency Department, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Mattia Brigida
- Emergency Department, Fondazione Policlinico A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christian Zanza
- Department of Emergency Medicine-Section of Anesthesia and Critical Care-Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Marcello Candelli
- Emergency Department, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Veronica Ojetti
- Emergency Department, Fondazione Policlinico A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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30
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Racca F, Sansone VA, Ricci F, Filosto M, Pedroni S, Mazzone E, Longhitano Y, Zanza C, Ardissone A, Adorisio R, Berardinelli A, Bondone C, Briani C, Cairello F, Carraro E, Comi GP, Crescimanno G, D’Amico A, Deiaco F, Fabiano A, Franceschi F, Mancuso M, Massè A, Messina S, Mongini T, Moroni I, Moscatelli A, Musumeci O, Navalesi P, Nigro G, Origo C, Panicucci C, Pane M, Pavone M, Pedemonte M, Pegoraro E, Piastra M, Pini A, Politano L, Previtali S, Rao F, Ricci G, Toscano A, Wolfler A, Zoccola K, Sancricca C, Nigro V, Trabacca A, Vianello A, Bruno C. Emergencies cards for neuromuscular disorders 1 st Consensus Meeting from UILDM - Italian Muscular Dystrophy Association Workshop report. Acta Myol 2022; 41:135-177. [PMID: 36793651 PMCID: PMC9896597 DOI: 10.36185/2532-1900-081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/20/2022] [Indexed: 02/17/2023]
Abstract
Acute hospitalisation may be required to support patients with Neuromuscular disorders (NMDs) mainly experiencing respiratory complications, swallowing difficulties, heart failure, urgent surgical procedures. As NMDs may need specific treatments, they should be ideally managed in specialized hospitals. Nevertheless, if urgent treatment is required, patients with NMD should be managed at the closest hospital site, which may not be a specialized centre where local emergency physicians have the adequate experience to manage these patients. Although NMDs are a group of conditions that can differ in terms of disease onset, progression, severity and involvement of other systems, many recommendations are transversal and apply to the most frequent NMDs. Emergency Cards (EC), which report the most common recommendations on respiratory and cardiac issues and provide indications for drugs/treatments to be used with caution, are actively used in some countries by patients with NMDs. In Italy, there is no consensus on the use of any EC, and a minority of patients adopt it regularly in case of emergency. In April 2022, 50 participants from different centres in Italy met in Milan, Italy, to agree on a minimum set of recommendations for urgent care management which can be extended to the vast majority of NMDs. The aim of the workshop was to agree on the most relevant information and recommendations regarding the main topics related to emergency care of patients with NMD in order to produce specific ECs for the 13 most frequent NMDs.
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Affiliation(s)
- Fabrizio Racca
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy,Correspondence Fabrizio Racca Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, via Venezia 16, 15121 Alessandria, Italy E-mail:
| | - Valeria A. Sansone
- Neurorehabilitation Unit, the NeMO Clinical Center in Milan, University of Milan, Milan, Italy
| | - Federica Ricci
- Division of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Stefania Pedroni
- Neuromuscular Omnicentre (NeMO), Fondazione Serena Onlus, Milan, Italy
| | - Elena Mazzone
- Paediatric Neurology and NeMO Center, Catholic University and Policlinico Gemelli, Rome, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Christian Zanza
- Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Anna Ardissone
- Child Neurology Unit, Department of Pediatric Neuroscience Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Rachele Adorisio
- Bambino Gesù Hospital and Research Institute- ERN GUARD Heart, Rome, Italy
| | | | - Claudia Bondone
- Pediatric Emergency Department, University Hospital “Città della Salute e della Scienza di Torino”, Turin, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Francesca Cairello
- Pediatric and Pediatric Emergency Unit, Pediatric Cardiology Service AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Elena Carraro
- Neuromuscular Omnicentre (NeMO), Fondazione Serena Onlus, Milan, Italy
| | - Giacomo P. Comi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy; Dino Ferrari Center, University of Milan, Milan, Italy
| | - Grazia Crescimanno
- Italian National Research Council, Institute for Biomedical Research and Innovation, Palermo, Italy; Regional Center for prevention and treatment of respiratory complications of rare genetic neuromuscular diseases, Villa Sofia-Cervello Hospital Palermo, Italy
| | - Adele D’Amico
- Neuromuscular and Neurodegenerative Unit, Department of Neurosciences. Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Fabio Deiaco
- Paediatric Emergency Department, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessia Fabiano
- Pneumology Unit Azienda USL Romagna Infermi Hospital, Rimini, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine Neurological Institute, University of Pisa, Pisa, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, Turin, Italy
| | - Sonia Messina
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Tiziana Mongini
- Neuromuscular Unit, Department of Neurosciences RLM, University of Turin, Turin, Italy
| | - Isabella Moroni
- Child Neurology Unit, Department of Pediatric Neuroscience Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Moscatelli
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Gerardo Nigro
- Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carlo Origo
- Pediatric Orthopedic and Traumatology Unit Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Chiara Panicucci
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marika Pane
- Paediatric Neurology and NeMO Center, Catholic University and Policlinico Gemelli, Rome, Italy
| | - Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Pediatric Hospital Bambino Gesù Research Institute, Rome, Italy
| | - Marina Pedemonte
- Pediatric Neurology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Marco Piastra
- Pediatric Anesthesiology and Intensive Care Unit, Università Cattolica, Rome, Italy
| | - Antonella Pini
- Pediatric Neuromuscular Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Luisa Politano
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy and Gaetano Torre for Muscular Dystrophy Association, Naples, Italy
| | | | - Fabrizio Rao
- Neuromuscular Omnicentre (NeMO), Fondazione Serena Onlus La Colletta Hospital, Arenzano (GE), Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine Neurological Institute, University of Pisa, Pisa, Italy
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Andrea Wolfler
- Neonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Khristian Zoccola
- Pediatric Orthopedic and Traumatology Unit Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Vincenzo Nigro
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Trabacca
- Scientific Institute IRCCS “E. Medea”, Unit for Severe disabilities in developmental age and young adults. (Developmental Neurology and Neurorehabilitation), Brindisi, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health - DINOGMI, University of Genoa, Genoa, Italy
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31
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Rasulo FA, Badenes R, Longhitano Y, Racca F, Zanza C, Marchesi M, Piva S, Beretta S, Nocivelli GP, Matta B, Cunningham D, Cattaneo S, Savioli G, Franceschi F, Robba C, Latronico N. Excessive Sedation as a Risk Factor for Delirium: A Comparison between Two Cohorts of ARDS Critically Ill Patients with and without COVID-19. Life (Basel) 2022; 12:life12122031. [PMID: 36556396 PMCID: PMC9781164 DOI: 10.3390/life12122031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/26/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Excessive sedation is associated with poor outcome in critically ill acute respiratory distress syndrome (ARDS) patients. Whether this prognostic effect varies among ARDS patients with and without COVID-19 has yet to be determined. We compared the prognostic value of excessive sedation—in terms of delirium, length of stay in intensive care unit (ICU-LOS) and ICU mortality—between COVID-19 and non-COVID-19 critically ill ARDS patients. This was a second analysis of prospectively collected data in four European academic centers pertaining to 101 adult critically ill ARDS patients with and without COVID-19 disease. Depth of sedation (DOS) and delirium were monitored through processed electroencephalogram (EEG) and the Confusion Assessment Method for ICU (CAM-ICU). Our main exposure was excessive sedation and how it relates to the presence of delirium, ICU-LOS and ICU mortality. The criterion for excessive sedation was met in 73 (72.3%) patients; of these, 15 (82.2%) and 58 (69.1%) were in non-COVID-19 and COVID-19 ARDS groups, respectively. The criteria of delirium were met in 44 patients (60.3%). Moreover, excessive sedation was present in 38 (86.4%) patients with delirium (p < 0.001). ICU death was ascertained in 41 out of 101 (41.0%) patients; of these, 37 (90.2%) had excessive sedation (p < 0.001). The distribution of ICU-LOS among excessive-sedated and non-sedated patients was 22 (16−27) vs. 14 (10.5−19.5) days (p < 0.001), respectively. In a multivariable framework, excessive sedation was independently associated with the development of delirium (p = 0.001), increased ICU mortality (p = 0.009) and longer ICU-LOS (p = 0.000), but only in COVID-19 ARDS patients. Independent of age and gender, excessive sedation might represent a risk factor for delirium in COVID-19 ARDS patients. Similarly, excessive sedation shows to be an independent predictor of ICU-LOS and ICU mortality. The use of continuous EEG-based depth of sedation (DOS) monitoring and delirium assessment in critically ill COVID-19 patients is warranted.
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Affiliation(s)
- Frank Anthony Rasulo
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari, School of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Yaroslava Longhitano
- Department of Anesthesia and Critical Care Medicine—AON St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
- Foundation of “Ospedale Alba-Bra Onlus”—Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Fabrizio Racca
- Department of Anesthesia and Critical Care Medicine—AON St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Christian Zanza
- Department of Anesthesia and Critical Care Medicine—AON St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
- Foundation of “Ospedale Alba-Bra Onlus”—Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS—University of Catholic of Sacred Heart, 30149 Rome, Italy
- Correspondence: ; Tel.: +39-334-326-1277
| | - Mattia Marchesi
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy
| | - Simone Piva
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy
| | - Silvia Beretta
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy
| | - Gian Piero Nocivelli
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy
| | - Basil Matta
- Department of Anaesthesia and Intensive Care, Addenbrookes NHS Hospital, Cambridge University, Cambridge CB39DF, UK
| | - Daniel Cunningham
- Department of Anaesthesia and Intensive Care, Addenbrookes NHS Hospital, Cambridge University, Cambridge CB39DF, UK
| | - Sergio Cattaneo
- Division of Cardio-Thoracic Intensive Care, Spedali Civili Hospital, 25121 Brescia, Italy
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
- PhD Program in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS—University of Catholic of Sacred Heart, 30149 Rome, Italy
| | - Chiara Robba
- Policlinico San Martino, Department of Surgical Sciences and Diagnostic Integrated, University of Genoa, 16100 Genoa, Italy
| | - Nicola Latronico
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University Hospital, 25121 Brescia, Italy
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Angelini L, Gioulis E, Civitareale N, Granata A, Zanza C, Longhitano Y, Zago A, Machin P, Canal F, Serao A, Piccoli G, Valerio S. Assessment of Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography (CT) diagnostic accuracy in the evaluation of challenging cystic renal masses. J Ultrasound 2022; 25:905-913. [PMID: 35460506 PMCID: PMC9705654 DOI: 10.1007/s40477-022-00683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/05/2021] [Accepted: 03/28/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To assess the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) and computed tomography (CT) within Bosniak IIF/III categories. METHODS After cystic renal mass diagnosis by contrast-enhanced CT, all patients with Bosniak score ≥ II also underwent CEUS between March 2017 and March 2019. Their exams were retrospectively analyzed. One experienced uro-radiologist performed every CEUS and reviewed the exams according to the EFSUMB 2020 Position Statement, while blinded to clinical data. CT Bosniak scores were retrospectively given blindly by two uro-radiologists (CT 1 and CT 2). We compared CEUS, CT 1 and CT 2 scores to clinical findings and histological tests. Clinical performance characteristics and area under the receiver operating characteristic (ROC) curves (AUCs) were determined separately for CEUS and CT, and then compared. RESULTS 101 cystic masses were analyzed. In Bosniak categories IIF and III, the AUCs were 0.854 for CT 1, 0.779 for CT 2, and 0.746 for CEUS. CONCLUSION Despite some statistical limitations, this study confirms that among cystic renal masses, those classified as Bosniak IIF and III are the most difficult to assess. The diagnostic performances of CEUS and CT are similar within this group. However, in experienced hands, CEUS could be valuable in further evaluation of ambiguous cystic masses, and in more ductile, safer, and cost-effective surveillance of those classified as Bosniak IIF and III. When challenging cystic renal masses occur, CEUS is a useful tool for clinical management and for the follow-up of non-surgical lesions.
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Affiliation(s)
- Lorenzo Angelini
- Department of Surgery, Section of Urology, SS Antonio and Biagio and Cesare Arrigo Hospital, Via Venezia, 16, 15121, Alessandria, Italy.
| | - Eugenio Gioulis
- Department of Radiology, Conegliano Hospital, Conegliano, Italy
| | | | - Antonio Granata
- Nephrology and Dialysis Unit, Emergency Hospital "Cannizzaro", Catania, Italy
| | - Christian Zanza
- Department of Emergency Medicine, Anesthesia and Critical Care, Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Yaroslava Longhitano
- Department of Anesthesia and Critical Care, SS Antonio and Biagio and Cesare Arrigo Hospital, Alessandria, Italy
| | - Angelica Zago
- Department of Radiology, Conegliano Hospital, Conegliano, Italy
| | | | - Fabio Canal
- Department of Pathology, Conegliano Hospital, Conegliano, Italy
| | - Armando Serao
- Department of Surgery, Section of Urology, SS Antonio and Biagio and Cesare Arrigo Hospital, Via Venezia, 16, 15121, Alessandria, Italy
| | | | - Salvatore Valerio
- Department of Surgery, Section of Urology, Conegliano Hospital, Conegliano, Italy
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Zanza C, Facelli V, Romenskaya T, Bottinelli M, Caputo G, Piccioni A, Franceschi F, Saviano A, Ojetti V, Savioli G, Longhitano Y. Lactic Acidosis Related to Pharmacotherapy and Human Diseases. Pharmaceuticals (Basel) 2022; 15:ph15121496. [PMID: 36558947 PMCID: PMC9787936 DOI: 10.3390/ph15121496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/02/2022] Open
Abstract
Lactic acidosis represents one of the most common conditions that can compromise the health of intensive care unit (ICU) patients, increasing the mortality of patients with high levels of Lactate who do not receive a proper treatment within the first 6 h of hospitalization. There are two enantiomers of lactic acid: L-lactic acid (when the concentration increases, it can lead to a state of severe acidemia risking cardiovascular collapse, causing an increase in mortality in ICU patients) and D lactic acid (produced in the human organism by microbiota and its production increases during some pathological status). Generally, increased levels of serum lactic acid could be due to numerous factors, including hypoxia (caused for example by septic/cardiogenic/hypovolemic or obstructive shock), specific pathologies (e.g., liver disease), use of some drugs (e.g., metformin), presence of toxins, and trauma. Since the underlying cause could be fatal for the ICU patient, it is important to understand the root of this clinical status with a view to correct it and prevent the risk of a poor clinical outcome. Prevention and early treatment are the keys to control the negative clinical consequences. The aim of this review is to revise the scientific literature for further confirmation about the importance of early identification of acidotic statuses and to underline how an early diagnosis can prevent the worst clinical outcome, especially for ICU patients who are more fragile compared to the general population.
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Affiliation(s)
- Christian Zanza
- Foundation “Ospedale Alba-Bra Onlus,” Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital,12060 Verduno, Italy
- Department of Emergency Medicine, Policlinico Agostino Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-334-326-1277
| | - Valentina Facelli
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera “SS Antonio e Biagio e C. Arrigo”, 15121 Alessandria, Italy
| | - Tastiana Romenskaya
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Bottinelli
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera “SS Antonio e Biagio e C. Arrigo”, 15121 Alessandria, Italy
| | - Giorgia Caputo
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera “SS Antonio e Biagio e C. Arrigo”, 15121 Alessandria, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Policlinico Agostino Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, Policlinico Agostino Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Angela Saviano
- Department of Emergency Medicine, Policlinico Agostino Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Veronica Ojetti
- Department of Emergency Medicine, Policlinico Agostino Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Yaroslava Longhitano
- Foundation “Ospedale Alba-Bra Onlus,” Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital,12060 Verduno, Italy
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliera “SS Antonio e Biagio e C. Arrigo”, 15121 Alessandria, Italy
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Piccioni A, Rosa F, Manca F, Pignataro G, Zanza C, Savioli G, Covino M, Ojetti V, Gasbarrini A, Franceschi F, Candelli M. Gut Microbiota and Clostridium difficile: What We Know and the New Frontiers. Int J Mol Sci 2022; 23:ijms232113323. [PMID: 36362106 PMCID: PMC9657115 DOI: 10.3390/ijms232113323] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/29/2022] [Revised: 10/25/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Our digestive system, particularly our intestines, harbors a vast amount of microorganisms, whose genetic makeup is referred to as the microbiome. Clostridium difficile is a spore-forming Gram-positive bacterium, which can cause an infection whose symptoms range from asymptomatic colonization to fearsome complications such as the onset of toxic megacolon. The relationship between gut microbiota and Clostridium difficile infection has been studied from different perspectives. One of the proposed strategies is to be able to specifically identify which types of microbiota alterations are most at risk for the onset of CDI. In this article, we understood once again how crucial the role of the human microbiota is in health and especially how crucial it becomes, in the case of its alteration, for the individual's disease. Clostridium difficile infection is an emblematic example of how a normal and physiological composition of the human microbiome can play a very important role in immune defense against such a fearsome disease.
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Affiliation(s)
- Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Federico Rosa
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Federica Manca
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulia Pignataro
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Christian Zanza
- Foundation of Ospedale Alba-Bra, Department of Anesthesia, Critical Care and Emergency Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Gabriele Savioli
- Emergency Department, Policlinico Universitario San Matteo, IRCCS, 27100 Pavia, Italy
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Veronica Ojetti
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
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Affiliation(s)
- Yaroslava Longhitano
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Christian Zanza
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.,Foundation of "Ospedale Alba-Bra" and Department of Emergency Medicine, Anaesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy.,Department Of Emergency Medicine - Fondazione, Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
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Savioli G, Zanza C, Longhitano Y, Nardone A, Varesi A, Ceresa IF, Manetti AC, Volonnino G, Maiese A, La Russa R. Heat-Related Illness in Emergency and Critical Care: Recommendations for Recognition and Management with Medico-Legal Considerations. Biomedicines 2022; 10:biomedicines10102542. [PMID: 36289804 PMCID: PMC9599879 DOI: 10.3390/biomedicines10102542] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/19/2022] [Revised: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022] Open
Abstract
Hyperthermia is an internal body temperature increase above 40.5 °C; normally internal body temperature is kept constant through natural homeostatic mechanisms. Heat-related illnesses occur due to exposure to high environmental temperatures in conditions in which an organism is unable to maintain adequate homeostasis. This can happen, for example, when the organism is unable to dissipate heat adequately. Heat dissipation occurs through evaporation, conduction, convection, and radiation. Heat disease exhibits a continuum of signs and symptoms ranging from minor to major clinical pictures. Minor clinical pictures include cramps, syncope, edema, tetany, and exhaustion. Major clinical pictures include heatstroke and life-threatening heat stroke and typically are expressed in the presence of an extremely high body temperature. There are also some categories of people at greater risk of developing these diseases, due to exposure in particular geographic areas (e.g., hot humid environments), to unchangeable predisposing conditions (e.g., advanced age, young age (i.e., children), diabetes, skin disease with reduced sweating), to modifiable risk factors (e.g., alcoholism, excessive exercise, infections), to partially modifiable risk factors (obesity), to certain types of professional activity (e.g., athletes, military personnel, and outdoor laborers) or to the effects of drug treatment (e.g., beta-blockers, anticholinergics, diuretics). Heat-related illness is largely preventable.
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Affiliation(s)
- Gabriele Savioli
- Emergency Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Doctoral Program Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Christian Zanza
- Foundation “Ospedale Alba-Bra”, Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
- Correspondence:
| | - Yaroslava Longhitano
- Foundation “Ospedale Alba-Bra”, Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Alba Nardone
- Department of Internal Medicine, Università degli Studi of Pavia, 27100 Pavia, Italy
| | - Angelica Varesi
- Department of Internal Medicine, Università degli Studi of Pavia, 27100 Pavia, Italy
| | | | - Alice Chiara Manetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Gianpietro Volonnino
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Aniello Maiese
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
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Saviano A, Candelli M, Zanza C, Piccioni A, Migneco A, Ojetti V. Gastrointestinal Involvement in Extra-Digestive Disease: Which Is the Role of Fecal Calprotectin? Medicina (Kaunas) 2022; 58:medicina58101384. [PMID: 36295545 PMCID: PMC9608771 DOI: 10.3390/medicina58101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/08/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022]
Abstract
Fecal calprotectin (FC) is a very sensitive marker of inflammation of the gastrointestinal tract. Its clinical utility can be appreciated in both intestinal and extraintestinal diseases. Recent evidence suggests a link between intestinal inflammation and dermatological, rheumatic and neurological diseases. This review focuses on the role of FC in non-gastrointestinal disease, such as rheumatic, dermatologic, neurologic and last but not least SARS-CoV-2 infection.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Christian Zanza
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Alessio Migneco
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Veronica Ojetti
- Department of Internal Medicine, Ospedale San Carlo di Nancy, 00165 Rome, Italy
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS University of Catholic of Sacred Heart, 00168 Rome, Italy
- Correspondence:
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Gilardi E, Pomero F, Ravera E, Piccioni A, Santoro MC, Bonadia N, Carnicelli A, Di Maurizio L, Sabia L, Longhitano Y, Saviano A, Ojetti V, Savioli G, Zanza C, Franceschi F. Intravenous Magnesium Sulfate Reduces the Need for Antiarrhythmics during Acute-Onset Atrial Fibrillation in Emergency and Critical Care. J Clin Med 2022; 11:jcm11195527. [PMID: 36233391 PMCID: PMC9570780 DOI: 10.3390/jcm11195527] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Several studies have suggested the potential role of Magnesium Sulfate (MgSO4) for the treatment of Atrial Fibrillation (AF) but, in clinical practice, the use of magnesium is not standardized although it is largely used for the treatment of supraventricular arrhythmias. Objectives. We evaluated the role of MgSO4 infusion in association with flecainide in cardioversion of patients presenting in ED with symptomatic AF started less than 48 h before. We retrospectively searched for all patients presented in ED from 1 January 2019 to 31 December 2019 requiring pharmacological cardioversion with flecainide 2 mg/kg. Ninety-seven patients met these criteria, 46 received the administration of intravenous MgSO4 2 gr (Group A), and 51 did not (Group B). Among the 97 patients, the overall cardioversion rate was 85.6%, 91.3% in Group A and 80.4% in Group B. In 27 patients out of 97, the Flecainide was not administered because of spontaneous restoration of sinus rhythm of 9 pts (Group B) and 18 pts (Group A). We also found a statistical significance in the HR at the time of cardioversion between Group A (77.8 ± 19.1 bpm) and Group B (87 ± 21.7 bpm). No complications emerged. The association between MgSO4 and Flecainide has not yielded statistically significant results. However, in consideration of its high safety profile, MgSO4 administration may play a role in ED cardioversion of acute onset AF, reducing the need for antiarrhythmic medications and electrical cardioversion procedures, relieving symptoms reducing heart rate, and reducing the length of stay in the ED.
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Affiliation(s)
- Emanuele Gilardi
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Fulvio Pomero
- Department of Internal Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Enrico Ravera
- Foundation of “Ospedale Alba-Bra”, Department of Emergency Medicine, Anaesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Michele Cosimo Santoro
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Nicola Bonadia
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Annamaria Carnicelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Luca Di Maurizio
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Luca Sabia
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Yaroslava Longhitano
- Foundation of “Ospedale Alba-Bra”, Department of Emergency Medicine, Anaesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Veronica Ojetti
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Christian Zanza
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
- Department of Internal Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
- Foundation of “Ospedale Alba-Bra”, Department of Emergency Medicine, Anaesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
- Correspondence:
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
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Piccioni A, Vaccaro V, Manca F, Nonno C, Zanza C, Savioli G, Candelli M, Covino M, Franceschi F. Management of maxillary artery pseudoaneurysm in Emergency Department: a narrative review. Clin Ter 2022; 173:496-499. [PMID: 36155736 DOI: 10.7417/ct.2022.2468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Tooth extraction is a common procedure that is performed routinely and is associated with very few risks. The formation of a pseudoaneurysm as a direct result of tooth extraction has not been widely reported in published studies; it is more frequent as a complication of orthognathic surgery (1). The purpose of this paper is to describe the literature of maxillary artery pseudoaneurysm and its diagnosis and treatment in the Emer-gency Department. The search engine we used is Pubmed. 39 studies were analyzed; mainly, they were case reports. In this study, we will analyze the cases of pseudoaneurysm formation following dental extraction and orthognotia surgery which are reported in literature.
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Affiliation(s)
- A Piccioni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - V Vaccaro
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - F Manca
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - C Nonno
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - C Zanza
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - G Savioli
- Emergency Department, Policlinico Universitario San Matteo, IRCCS, Pavia, Italy
| | - M Candelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M Covino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - F Franceschi
- Università Cattolica del Sacro Cuore, Roma, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Abenavoli L, Procopio AC, Cinaglia P, Zanza C, Grazie CD, Longhitano Y, Libicherova P, Luzza F. Clinical Patterns of Primary Biliary Cholangitis: Comparison Between Two European Case Series. Rev Recent Clin Trials 2022; 17:136-142. [PMID: 35718979 DOI: 10.2174/1574887117666220617095856] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 12/01/2021] [Revised: 03/22/2022] [Accepted: 04/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease characterized by progressive destruction of the intrahepatic bile ducts, followed by fibrous substitution of the ducts and potential evolution in cirrhosis. The geographical disparity in the prevalence of PBC suggests a possible role of environmental factors in developing the disease. We analyzed two groups of patients with different geographical prevalence. METHODS This study concerned the analysis of 14 Caucasian patients in two groups: ten patients enrolled in the Digestive Diseases Unit, University of Catanzaro (Italy), and four patients enrolled in the Department of Hepatology, University Hospital Kràlovskè Vinohrady of Prague (Czech Republic). The statistical analysis was performed using the software IBM SPSS (v. 20, Windows). RESULTS The Italian group showed a statistically significant difference in the total bilirubin values at diagnosis and during the last control (0.74±0.267 vs. 0.56±0.246; p-value: 0.013). Moreover, the comparison between the two groups showed a statistically significant difference in the serum albumin values at the time of the last control (4.6±0.231 vs. 4.15±0.532; p-value: 0.048). CONCLUSION Our data indicate an effective difference in the onset and clinical presentation between our two groups. More epidemiologic, prospective, and multicenter research projects are warranted to advance PBC knowledge in Europe.
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Affiliation(s)
- Ludovico Abenavoli
- Department of Health Sciences, University, Magna Graecia, Catanzaro Italy
| | | | - Pietro Cinaglia
- Department of Health Sciences, University, Magna Graecia, Catanzaro Italy
| | - Christian Zanza
- Ospedale Alba-Bra Onlus, Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno (CN), Italy
| | | | - Yaroslava Longhitano
- Ospedale Alba-Bra Onlus, Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno (CN), Italy
| | - Pavla Libicherova
- Department of Hepatology, Third Faculty of Medicine and University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Francesco Luzza
- Department of Health Sciences, University, Magna Graecia, Catanzaro Italy
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Fasano G, Pabon IM, Longhitano Y, Zanza C, Carlidi G, Ravera E, Della Selva A. Pembrolizumab-Related Side Effects: Acute Renal Failure and Severe Neurological Toxicity. Medicina (B Aires) 2022; 58:medicina58020209. [PMID: 35208533 PMCID: PMC8875589 DOI: 10.3390/medicina58020209] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/11/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
Abstract
Immunotherapy with immune checkpoint inhibitors represents nowadays a marked improvement in cancer treatment. Nevertheless, they can cause severe toxicities that put the patient at high risk, often requiring aggressive treatment. We present the case of a female patient who developed a severe immune-related adverse reaction to Pembrolizumab prescribed for melanoma treatment. Her array of symptoms, which presented a few days after last drug administration, consisted of severe neurological deficit, severe renal failure, polymyositis, and hyperthyroidism. Treatment required the immediate interruption of the trigger drug, infusion of high dose steroids, renal replacement therapy, plasmapheresis, and methimazole, as will be further discussed.
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Affiliation(s)
- Gabriele Fasano
- Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy; (G.F.); (I.M.P.); (Y.L.); (G.C.); (E.R.); (A.D.S.)
| | - Ingrid Marcela Pabon
- Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy; (G.F.); (I.M.P.); (Y.L.); (G.C.); (E.R.); (A.D.S.)
| | - Yaroslava Longhitano
- Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy; (G.F.); (I.M.P.); (Y.L.); (G.C.); (E.R.); (A.D.S.)
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
- Foundation of “Ospedale Alba-Bra”, 12060 Verduno, Italy
| | - Christian Zanza
- Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy; (G.F.); (I.M.P.); (Y.L.); (G.C.); (E.R.); (A.D.S.)
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
- Foundation of “Ospedale Alba-Bra”, 12060 Verduno, Italy
- Correspondence: ; Tel.: +39-3343261277
| | - Graziano Carlidi
- Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy; (G.F.); (I.M.P.); (Y.L.); (G.C.); (E.R.); (A.D.S.)
| | - Enrico Ravera
- Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy; (G.F.); (I.M.P.); (Y.L.); (G.C.); (E.R.); (A.D.S.)
- Foundation of “Ospedale Alba-Bra”, 12060 Verduno, Italy
| | - Andrea Della Selva
- Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy; (G.F.); (I.M.P.); (Y.L.); (G.C.); (E.R.); (A.D.S.)
- Foundation of “Ospedale Alba-Bra”, 12060 Verduno, Italy
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Savioli G, Alfano C, Zanza C, Bavestrello Piccini G, Varesi A, Esposito C, Ricevuti G, Ceresa IF. Dysbarism: An Overview of an Unusual Medical Emergency. Medicina (Kaunas) 2022; 58:104. [PMID: 35056412 PMCID: PMC8778177 DOI: 10.3390/medicina58010104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/18/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 02/03/2023]
Abstract
Dysbarism is a general term which includes the signs and symptoms that can manifest when the body is subject to an increase or a decrease in the atmospheric pressure which occurs either at a rate or duration exceeding the capacity of the body to adapt safely. In the following review, we take dysbarisms into account for our analysis. Starting from the underlying physical laws, we will deal with the pathologies that can develop in the most frequently affected areas of the body, as the atmospheric pressure varies when acclimatization fails. Manifestations of dysbarism range from itching and minor pain to neurological symptoms, cardiac collapse, and death. Overall, four clinical pictures can occur: decompression illness, barotrauma, inert gas narcosis, and oxygen toxicity. We will then review the clinical manifestations and illustrate some hints of therapy. We will first introduce the two forms of decompression sickness. In the next part, we will review the barotrauma, compression, and decompression. The last three parts will be dedicated to gas embolism, inert gas narcosis, and oxygen toxicity. Such an approach is critical for the effective treatment of patients in a hostile environment, or treatment in the emergency room after exposure to extreme physical or environmental factors.
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Affiliation(s)
- Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Claudia Alfano
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Christian Zanza
- “Ospedale Alba-Bra Onlus”—Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy;
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | | | - Angelica Varesi
- Department of Biology and Biotechnology, University of Pavia, 27100 Pavia, Italy;
| | - Ciro Esposito
- Unit of Nephrology and Dialysis, ICS Maugeri, University of Pavia, 27100 Pavia, Italy;
| | - Giovanni Ricevuti
- School of Pharmacy, Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy;
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Saviano A, Gayani G, Migneco A, Candelli M, Franceschi F, Ojetti V, Zanza C, Longhitano Y. The Gut Microbiota-Brain Axis in Acute Neurological Disease: Focus on Stroke. Rev Recent Clin Trials 2022; 17:240-244. [PMID: 35319389 DOI: 10.2174/1574887117666220321155508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/22/2021] [Revised: 12/27/2021] [Accepted: 01/11/2022] [Indexed: 01/15/2023]
Abstract
The gut microbiota is one of the great innovations of modern medicine. In the modern microbiota revolution era, more comprehensive and in-depth studies have been performed regarding the microbial gut communities and their impact on acute and chronic diseases, including those of the nervous system as acute neurological diseases. The microbiota has changed our knowledge of medical conditions; in particular, considering stroke (both ischemic and hemorrhagic), literature studies, experimental and clinical researches indicate that the individual's risk and outcomes are substantially impacted by the gut microbiota. The aim of our review article is to investigate and discuss the recent insights into the emerging role of this complex "gut microbiota-brain axis" in affecting some acute neurological diseases, such as stroke, responsible for a significant number of deaths worldwide. We performed electronic research on PubMed® and collected articles published in the last ten years, finding that changes in the gut microbiota composition could affect various aspects of stroke pathophysiology and individual predisposition, risk, and outcomes. Our review article suggests that there is a strong connection between the gut microbiota and the brain, both in health and in acute neurological diseases such as stroke. Investigating and exploring this relationship can be a challenge useful to learn more about this disabling/deadly condition, and it can be a useful tool to identify novel potential therapeutic approaches, improving an individual's outcomes and life.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
| | - Gunawardena Gayani
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
| | - Alessio Migneco
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
| | - Marcello Candelli
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Veronica Ojetti
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christian Zanza
- Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Foundation Ospedale Alba-Bra Onlus, Verduno (Cuneo), Italy
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Yaroslava Longhitano
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Siciliano V, Rosà T, Del Vecchio P, D'Angelillo A, Brigida M, Longhitano Y, Zanza C, Santoro MC, Candelli M, Franceschi F, Piccioni A. Viral Encephalitis in Adults: A Narrative Review. Rev Recent Clin Trials 2022; 17:259-267. [PMID: 34792015 DOI: 10.2174/1574887116666211118141117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/16/2021] [Revised: 06/14/2021] [Accepted: 09/22/2021] [Indexed: 02/08/2023]
Abstract
Viral infections of the central nervous system cause frequent hospitalization. The pathogenesis of viral encephalitis involves both the direct action of invading pathogens and the damage generated by the inflammatory reaction they trigger. The type of signs and symptoms presented by the patient depends on the severity and location of the ongoing inflammatory process. Most of the viral encephalitides are characterized by an acute development, fever, variable alterations in consciousness (confusion, lethargy, even coma), seizures (focal and generalized) and focal neurologic signs. The specific diagnosis of encephalitis is usually based on lumbar puncture. Cerebrospinal fluid examination should be performed in all patients unless absolutely contraindicated. Also, electroencephalogram and neuroimaging play a prominent role in diagnosis. Airway protection, ventilatory support, the management of raised intracranial pressure and correction of electrolyte disorders must be immediately considered in a patient with altered mental status. The only therapy strictly recommended is acyclovir in HSV encephalitis. The use of adjunctive glucocorticoids has poor-quality evidence in HSV, EBV, or VZV encephalitis. The role of antiviral therapy in other types of viral encephalitis is not well defined.
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Affiliation(s)
- Valentina Siciliano
- Department of Laboratory and Infectious Diseases, University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Rosà
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Pierluigi Del Vecchio
- Department of Laboratory and Infectious Diseases, University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - Anna D'Angelillo
- Department of Laboratory and Infectious Diseases, University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - Mattia Brigida
- Department of Systems Medicine, Unit of Gastroenterology, Tor Vergata University, Rome, Italy
| | - Yaroslava Longhitano
- Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Department of Anesthesia and Critical Care, Alessandria, Italy
| | - Christian Zanza
- Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Department of Anesthesia and Critical Care, Alessandria, Italy
- Foundation of "Nuovo Ospedale Alba-Bra" and Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital Verduno, Italy
- Department of Emergency Medicine, University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - Michele Cosimo Santoro
- Department of Emergency Medicine, University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - Marcello Candelli
- Department of Emergency Medicine, University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
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Ferrara M, Bertozzi G, Zanza C, Longhitano Y, Piccolella F, Lauritano CE, Volonnino G, Manetti AC, Maiese A, La Russa R. Traumatic Brain Injury and Gut Brain Axis: The Disruption of an Alliance. Rev Recent Clin Trials 2022; 17:268-279. [PMID: 35733301 DOI: 10.2174/1574887117666220622143423] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 11/18/2021] [Revised: 03/13/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) can be considered a "silent epidemic", causing morbidity, disability, and mortality in all age cohorts. Therefore, a greater understanding of the underlying pathophysiological intricate mechanisms and interactions with other organs and systems is necessary to intervene not only in the treatment but also in the prevention of complications. In this complex of reciprocal interactions, the complex brain-gut axis has captured a growing interest. SCOPE The purpose of this manuscript is to examine and systematize existing evidence regarding the pathophysiological processes that occur following TBI and the influences exerted on these by the brain-gut axis. LITERATURE REVIEW A systematic review of the literature was conducted according to the PRISMA methodology. On the 8th of October 2021, two independent databases were searched: PubMed and Scopus. Following the inclusion and exclusion criteria selected, 24 (12 from PubMed and 12 from Scopus) eligible manuscripts were included in the present review. Moreover, references from the selected articles were also updated following the criteria mentioned above, yielding 91 included manuscripts. DISCUSSION Published evidence suggests that the brain and gut are mutually influenced through four main pathways: microbiota, inflammatory, nervous, and endocrine. CONCLUSION These pathways are bidirectional and interact with each other. However, the studies conducted so far mainly involve animals. An autopsy methodological approach to corpses affected by traumatic brain injury or intestinal pathology could represent the keystone for future studies to clarify the complex pathophysiological processes underlying the interaction between these two main systems.
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Affiliation(s)
- Michela Ferrara
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, Rome, 00161, Italy
| | - Giuseppe Bertozzi
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Christian Zanza
- Foundation of "Ospedale Alba-Bra Onlus and Department of Anesthesia and Critical Care and Emergency Medicine- "Michele and Pietro Ferrero Hospital" Verduno, Cuneo, Italy
| | - Yaroslava Longhitano
- Department of Anesthesia and Critical Care - AON SS Antonio and Biagio and Cesare Arrigo Hospital- Alessandria, Italy
| | - Fabio Piccolella
- Department of Anesthesia and Critical Care - AON SS Antonio and Biagio and Cesare Arrigo Hospital- Alessandria, Italy
| | - Cristiano Ernesto Lauritano
- Department of Anesthesia and Critical Care - AON SS Antonio and Biagio and Cesare Arrigo Hospital- Alessandria, Italy
| | - Gianpietro Volonnino
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, Rome, 00161, Italy
| | - Alice Chiara Manetti
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, 56126, Italy
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Pisa, 56126, Italy
| | - Raffaele La Russa
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Italy
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Taurone S, Santarelli MT, De Santis E, Di Gioia C, Pompili E, Pellegrino F, Familiari P, Papa V, Zanza C, Coppola L, Familiari G, Artico M. Porcine coronary arteries: immunohistochemical profile of TNF-alpha, IL-1beta, TGF-beta1 and ICAM-1. Folia Morphol (Warsz) 2021; 82:119-126. [PMID: 34966995 DOI: 10.5603/fm.a2021.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 07/05/2021] [Revised: 10/15/2021] [Accepted: 11/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In our study we used immunohistochemical technique to demonstrate the presence of the cytokines tumour necrosis factor alpha (TNF-α), interleukin 1beta (IL-1β), transforming growth factor beta1 (TGF-β1) and intercellular adhesion molecule-1 (ICAM-1) in porcine coronaries even in physiological conditions. MATERIALS AND METHODS Inflammatory cytokines are polypeptide mediators which act as a communication signal between immune system cells and other types of cellsin different organs and tissues, both in human and pig coronary circulation. RESULTS Our results show that pro-inflammatory cytokines TNF-α, IL-1β, TGF-β1 and ICAM-1 are also present in the medium tunica of the coronary arteries under physiological conditions. These results may be compared with those found in coronary atherosclerosis, where the increase in TNF-α has a dramatic effect on the function of the left ventricle, and the high value of IL-1 correlates directly with the extent of myocardial necrosis. In our study we observe the damage and activation of endothelial cells; this induces endothelial dysfunction by accumulation and oxidation of low density lipoproteins (LDL). The formation of oxidized LDL could play a central role in the amplification of the inflammatory response causing an increased expression of pro-inflammatory cytokines which promotes leukocyte recruitment in the intimal layer. These leukocytes, after the adhesion to the endothelium, penetrate the intimate tunic. CONCLUSIONS Therefore inflammatory processes promote the onset and evolution of atheroma and the development of thrombotic complications.
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Affiliation(s)
- S Taurone
- Department of Sensory Organs, Sapienza University of Rome, Italy.
| | - M T Santarelli
- Department of Sensory Organs, Sapienza University of Rome, Italy
| | - E De Santis
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Italy
| | - C Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Italy
| | - E Pompili
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Italy
| | - F Pellegrino
- UOC of Pathology, Sandro Pertini Hospital, Rome, Italy, Italy
| | - P Familiari
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - V Papa
- Department of Motor Sciences and Wellness, University of Naples "Parthenope", Naples, Italy
| | - C Zanza
- Department of Emergency Medicine, Foundation of Policlinico Agostino Gemelli-IRCCS, Catholic University of Sacred Heart, Rome, Italy.,Department of Anaesthesia and Critical Care, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.,Foundation Ospedale Alba-Bra and Department of Anaesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, Verduno, Italy
| | - L Coppola
- UOC of Pathology, Sandro Pertini Hospital, Rome, Italy, Italy
| | - G Familiari
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Italy
| | - M Artico
- Department of Sensory Organs, Sapienza University of Rome, Italy
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Longhitano Y, Iannuzzi F, Bonatti G, Zanza C, Messina A, Godoy D, Dabrowski W, Xiuyun L, Czosnyka M, Pelosi P, Badenes R, Robba C. Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic Review. Front Neurol 2021; 12:732176. [PMID: 34899560 PMCID: PMC8660115 DOI: 10.3389/fneur.2021.732176] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 06/28/2021] [Accepted: 10/11/2021] [Indexed: 01/12/2023] Open
Abstract
Introduction: Cerebral autoregulation (CA) plays a fundamental role in the maintenance of adequate cerebral blood flow (CBF). CA monitoring, through direct and indirect techniques, may guide an appropriate therapeutic approach aimed at improving CBF and reducing neurological complications; so far, the role of CA has been investigated mainly in brain-injured patients. The aim of this study is to investigate the role of CA in non-brain injured patients. Methods: A systematic consultation of literature was carried out. Search terms included: “CA and sepsis,” “CA and surgery,” and “CA and non-brain injury.” Results: Our research individualized 294 studies and after screening, 22 studies were analyzed in this study. Studies were divided in three groups: CA in sepsis and septic shock, CA during surgery, and CA in the pediatric population. Studies in sepsis and intraoperative setting highlighted a relationship between the incidence of sepsis-associated delirium and impaired CA. The most investigated setting in the pediatric population is cardiac surgery, but the role and measurement of CA need to be further elucidated. Conclusion: In non-brain injured patients, impaired CA may result in cognitive dysfunction, neurological damage, worst outcome, and increased mortality. Monitoring CA might be a useful tool for the bedside optimization and individualization of the clinical management in this group of patients.
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Affiliation(s)
- Yaroslava Longhitano
- Department of Anesthesiology and Critical Care, AO St. Antonio, Biagio and Cesare Arrigo, Alessandria, Italy
| | - Francesca Iannuzzi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giulia Bonatti
- Anesthesia and Intensive Care, Gaslini Hospital, Genova, Italy
| | - Christian Zanza
- Foundation of "Nuovo Ospedale Alba-Bra" and Department of Emergency Medicine, Anesthesia and Critical Care Division, Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Antonio Messina
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Daniel Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, 2 Intensive Care Unit, Hospital Carlos Malbran, Catamarca, Argentina
| | | | - Li Xiuyun
- Department of Anesthesiology & Critical Care Medicine, John Hopkins University, Baltimore, MD, United States
| | - Marek Czosnyka
- Brain Physics Laboratory, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.,Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, Department of Surgery, University of Valencia, Valencia, Spain
| | - Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.,Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
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Racca F, Longhitano Y, Wolfler A, Carfagna F, Grattarola C, Serio P, Sbaraglia F, Amigoni A, Savron F, Caramelli F, Montagnini L, Astuto M, Gallo E, Zanza C, Vaschetto R, Conti G. Perioperative management of children with neuromuscular disorders based on a common protocol: A prospective, national study in Italy. Acta Anaesthesiol Scand 2021; 65:1195-1204. [PMID: 33963537 DOI: 10.1111/aas.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 12/22/2020] [Revised: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with neuromuscular diseases (NMDs) often display respiratory muscle weakness which increases the risk of postoperative pulmonary complications (PPCs) after general anaesthesia. Non-invasive ventilation (NIV) associated with mechanical insufflation-exsufflation (MI-E) can reduce the incidence and severity of PPCs. The aim of this study was to report our experience with a shared perioperative protocol that consists in using NIV combined with MI-E to improve the postoperative outcome of NMD children (IT-NEUMA-Ped). METHOD We conducted a multicentre, observational study on 167 consecutive paediatric patients with NMDs undergoing anaesthesia from December 2015 to December 2018 in a network of 13 Italian hospitals. RESULTS We found that 89% of the 167 children (mean age 8 years old) were at high risk of PPCs, due to the presence of at least one respiratory risk factor. In particular, 51% of them had preoperative ventilatory support dependence. Only 14 (8%) patients developed PPCs, and only two patients needed tracheostomy. Average hospital length of stay (LOS) was 6 (2-14) days. The study population was stratified according to preoperative respiratory devices dependency and invasiveness of the procedure. Patients with preoperative ventilatory support dependence showed significantly higher intensive care unit (ICU) admission rate and longer hospital LOS. CONCLUSION Disease severity seems to be more related to the outcome of this population than invasiveness of procedures. NIV combined with MI-E can help in preventing and resolve PPCs.
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Affiliation(s)
- Fabrizio Racca
- Department of Anaesthesiology and Intensive Care Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo Alessandria Italy
| | - Yaroslava Longhitano
- Department of Anaesthesiology and Intensive Care Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo Alessandria Italy
| | - Andrea Wolfler
- Department of Anaesthesiology and Intensive Care Vittore Buzzi Children's Hospital Milan Italy
| | - Fabio Carfagna
- Department of Translational Medicine University of Eastern Piedmont Amedeo Avogadro School of Medicine Novara Italy
| | - Claudia Grattarola
- Department of Anaesthesiology and Intensive Care Unit Istituto Giannina Gaslini Genova Italy
| | - Paola Serio
- Department of Paediatric Anaesthesia and Intensive Care Meyer Children Hospital Florence Italy
| | - Fabio Sbaraglia
- Department of Emergency Medicine, Anaesthesia and Intensive Care University Hospital Agostino Gemelli IRCCS Rome Italy
| | - Angela Amigoni
- Paediatric Intensive Care Unit Department of Woman's and Child's Health University Hospital of Padova Padua Italy
| | - Fabio Savron
- Department of Anaesthesia and Intensive Care Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” Trieste Italy
| | - Fabio Caramelli
- Department of Anaesthesia and Intensive Care University of Bologna Hospital of Bologna Sant'Orsola‐Malpighi Polyclinic Bologna Italy
| | - Luigi Montagnini
- Department of Anaesthesiology and Intensive Care Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo Alessandria Italy
| | - Marinella Astuto
- Dipartimento Chirurgia Generale e Specialità Medico Chirurgiche A.O.Universitaria “Policlinico‐Vittorio Emanuele”Università degli Studi di Catania Catania Italy
| | - Elisa Gallo
- Department of Translational Medicine University of Eastern Piedmont Amedeo Avogadro School of Medicine Novara Italy
| | - Christian Zanza
- Department of Anaesthesiology and Intensive Care Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo Alessandria Italy
- Foundation of “Nuovo Ospedale Alba‐Bra” Department of Emergency Medicine, Anaesthesia and Critical Care Medicine Michele and Pietro Ferrero Hospital Verduno Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine University of Eastern Piedmont Amedeo Avogadro School of Medicine Novara Italy
| | - Giorgio Conti
- Department of Emergency Medicine, Anaesthesia and Intensive Care University Hospital Agostino Gemelli IRCCS Rome Italy
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Piccioni A, Saviano A, Cicchinelli S, Franza L, Rosa F, Zanza C, Santoro MC, Candelli M, Covino M, Nannini G, Amedei A, Franceschi F. Microbiota and Myopericarditis: The New Frontier in the Car-Diological Field to Prevent or Treat Inflammatory Cardiomyo-Pathies in COVID-19 Outbreak. Biomedicines 2021; 9:biomedicines9091234. [PMID: 34572420 PMCID: PMC8468627 DOI: 10.3390/biomedicines9091234] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 02/05/2023] Open
Abstract
Myopericarditis is an inflammatory heart condition involving the pericardium and myocardium. It can lead to heart failure, dilated cardiomyopathy, arrhythmia and sudden death. Its pathogenesis is mainly mediated by viral infections but also can be induced by bacterial infections, toxic substances and immune mediated disorders. All these conditions can produce severe inflammation and myocardial injury, often associated with a poor prognosis. The specific roles of these different pathogens (in particular viruses), the interaction with the host, the interplay with gut microbiota, and the immune system responses to them are still not completely clear and under investigation. Interestingly, some research has demonstrated the contribution of the gut microbiota, and its related metabolites (some of which can mimic the cardiac myosin), in cardiac inflammation and in the progression of this disease. They can stimulate a continuous and inadequate immune response, with a subsequent myocardial inflammatory damage. The aim of our review is to investigate the role of gut microbiota in myopericarditis, especially for the cardiovascular implications of COVID-19 viral infection, based on the idea that the modulation of gut microbiota can be a new frontier in the cardiological field to prevent or treat inflammatory cardiomyopathies.
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Affiliation(s)
- Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
- Correspondence:
| | - Sara Cicchinelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Laura Franza
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Federico Rosa
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Christian Zanza
- Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, Foundation Nuovo-Ospedale Alba-Bra, 12060 Verduno, Italy;
| | - Michele Cosimo Santoro
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy; (G.N.); (A.A.)
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy; (G.N.); (A.A.)
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario, Università Cattolica del Sacro Cuore, 00168 Roma, Italy; (A.P.); (S.C.); (L.F.); (F.R.); (M.C.S.); (M.C.); (M.C.); (F.F.)
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50
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Zanza C, Romenskaya T, Thangathurai D, Ojetti V, Saviano A, Abenavoli L, Robba C, Cammarota G, Franceschi F, Piccioni A, Longhitano Y. Microbiome in Critical illness: An Unconventional and Unknown Ally. Curr Med Chem 2021; 29:3179-3188. [PMID: 34525908 DOI: 10.2174/0929867328666210915115056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/10/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The digestive tract represents an interface between the external environment and the body where the interaction of a complex polymicrobial ecology has an important influence on health and disease. The physiological mechanisms that are altered during the hospitalization and in the intensive care unit (ICU) contribute to the pathobiota's growth. Intestinal dysbiosis occurs within hours of being admitted to ICU. This may be due to different factors, such as alterations of normal intestinal transit, administration of variuos medications or alterations in the intestinal wall which causes a cascade of events that will lead to the increase of nitrates and decrease of oxygen concentration, liberation of free radicals. OBJECTIVE This work aims to report the latest updates on the microbiota's contribution to developing sepsis in patients in the ICU department. In this short review were reviewed the latest scientific findings on the mechanisms of intestinal immune defenses performed both locally and systemically. In addition, we considered it necessary to review the literature to report the current best treatment strategies to prevent the infection spread which can bring systemic infections in patients admitted to ICU. MATERIAL AND METHODS This review has been written to answer at three main questions: what are the main intestinal flora's defense mechanisms that help us to prevent the risk of developing systemic diseases on a day-to-day basis? What are the main dysbiosis' systemic abnormalities? What are the modern strategies that are used in the ICU patients to prevent the infection spread? Using the combination of following keywords: microbiota and ICU, ICU and gut, microbiota and critical illness, microbiota and critical care, microbiota and sepsis, microbiota and infection, gastrointestinal immunity,in the Cochrane Controlled Trials Register, the Cochrane Library, medline and pubmed, google scholar, ovid/wiley. Finally, we reviewed and selected 72 articles. We also consulted the site ClinicalTrials.com to find out studies that are recently conducted or ongoing. RESULTS The critical illness can alter intestinal bacterial flora leading to homeostasis disequilibrium. Despite numerous mechanisms, such as epithelial cells with calciform cells that together build a mechanical barrier for pathogenic bacteria, the presence of mucous associated lymphoid tissue (MALT) which stimulates an immune response through the production of interferon-gamma (IFN-y) and THN-a or by stimulating lymphocytes T helper-2 produces anti-inflammatory cytokines. But these defenses can be altered following a hospitalization in ICU and lead to serious complications such as acute respiratory distress syndrome (ARDS), health care associated pneumonia (HAP) and ventilator associated pneumonia (VAP), Systemic infection and multiple organ failure (MOF), but also in the development of coronary artery disease (CAD). In addition, the microbiota has a significant impact on the development of intestinal complications and the severity of the SARS-COVID-19 patients. CONCLUSION The microbiota is recognized as one of the important factors that can worsen the clinical conditions of patients who are already very frailty in intensive care unit. At the same time, the microbiota also plays a crucial role in the prevention of ICU associated complications. By using the resources, we have available, such as probiotics, symbiotics or fecal microbiota transplantation (FMT), we can preserve the integrity of the microbiota and the GUT, which will later help maintain homeostasis in ICU patients.
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Affiliation(s)
- Christian Zanza
- Department of Emergency Medicine Division, Policlinico Gemelli/IRCCS- University of Catholic of Sacred Heart, Rome. Italy
| | - Tatsiana Romenskaya
- Department of Anesthesia and Critical Care Medicine - AON St. Antonio and Biagio and Cesare Arrigo Hospital, Alessandria. Italy
| | - Duraiyah Thangathurai
- Department of Anesthesiology - Keck Medical School of University of Southern California, Los Angeles. United States
| | - Veronica Ojetti
- Department of Emergency Medicine Division, Policlinico Gemelli/IRCCS- University of Catholic of Sacred Heart, Rome. Italy
| | - Angela Saviano
- Department of Emergency Medicine Division, Policlinico Gemelli/IRCCS- University of Catholic of Sacred Heart, Rome. Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University "Magna Graecia", Catanzaro. Italy
| | - Chiara Robba
- Department of Surgical Sciences and Diagnostic Integrated, University of Genoa. Italy
| | - Gianmaria Cammarota
- Department of Medicine and Surgery, Section of Anaesthesia, Analgesia, and Intensive Care, University of Perugia, Perugia. Italy
| | - Francesco Franceschi
- Department of Emergency Medicine Division, Policlinico Gemelli/IRCCS- University of Catholic of Sacred Heart, Rome. Italy
| | - Andrea Piccioni
- Department of Emergency Medicine Division, Policlinico Gemelli/IRCCS- University of Catholic of Sacred Heart, Rome. Italy
| | - Yaroslava Longhitano
- Foundation of "Ospedale Alba-Bra" and Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno. Italy
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