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Orso D, Federici N, Lio C, Mearelli F, Bove T. Hemodynamic goals in sepsis and septic shock resuscitation: An umbrella review of systematic reviews and meta-analyses with trial sequential analysis. Aust Crit Care 2024:S1036-7314(24)00059-6. [PMID: 38609748 DOI: 10.1016/j.aucc.2024.03.005] [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: 09/09/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE The objective of this study was to verify whether any parameter among those used as the target for haemodynamic optimisation (e.g., mean arterial pressure, central venous oxygen saturation, systolic or diastolic dysfunction, CO2 gap, lactates, right ventricular dysfunction, and PvaCO2/CavO2 ratio) is correlated with mortality in an undifferentiated population with sepsis or septic shock. METHODS An umbrella review, searching MEDLINE, the Cochrane Database of Systematic Reviews, Health Technology Assessment Database, and the JBI Database of Systematic Reviews and Implementation Reports, was performed. We included systematic reviews and meta-analyses enrolling a population of unselected patients with sepsis or septic shock. The main outcome was mortality. Two authors conducted data extraction and risk-of-bias assessments independently. We used a random-effects model to pool binary and continuous data and summarised estimates of effect using equivalent odds ratios (eORs). We used the ROBIS tool to assess risk of bias and the assessment of multiple systematic reviews 2 score to assess global quality. DATA SYNTHESIS 17 systematic reviews and meta-analyses (15 828 patients) were included in the quantitative analysis. Diastolic dysfunction (eOR: 1.42; 95% confidence interval [CI]: 1.14-1.76), PvaCO2/CavO2 ratio (eOR: 2.15; 95% CI: 1.37-3.37), and CO2 gap (eOR: 1.86; 95% CI: 1.07-3.25) showed a significant correlation with mortality. Lactates were the parameter with highest inconsistency (I2 = 92%). Central venous oxygen saturation and right ventricle dysfunction showed significant statistical excess test of significance (p-value = 0.009 and 0.005, respectively). None of the considered parameters showed statistically significant publication bias. CONCLUSIONS According to this umbrella review, diastolic dysfunction is the haemodynamic variable that is most closely linked to the prognosis of septic patients. The PvaCO2/CavO2 ratio and the CO2gap are significantly related to the mortality of septic patients, but the poor quality of evidence or the low number of cases, studied so far, limit their clinical applicability. CLINICAL TRIAL REGISTRATION PROSPERO: International prospective register of systematic reviews, 2023, CRD42023432813 (Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023432813).
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Affiliation(s)
- Daniele Orso
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy.
| | - Nicola Federici
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Cristina Lio
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy; Department of Medical Sciences (DAME), University of Udine, Udine, Italy
| | - Filippo Mearelli
- Department of Internal Medicine, ASUGI University Hospital of Trieste, Trieste, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy; Department of Medical Sciences (DAME), University of Udine, Udine, Italy
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Guglielmo N, Orso D. Cardiac Perforation After Pacemaker Placement in a Male Patient in His 80s. JAMA Cardiol 2024; 9:304. [PMID: 38170532 DOI: 10.1001/jamacardio.2023.4966] [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: 01/05/2024]
Abstract
This case report describes a diagnosis of cardiac perforation secondary to pacemaker placement in a male patient in his 80s who presented with pulsing chest pain.
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Affiliation(s)
- Nicola Guglielmo
- Department of Emergency Medicine, ASUFC Presidio Ospedaliero di Latisana, Latisana, Italy
| | - Daniele Orso
- Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Udine, Italy
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Orso D, Molinari C, Bacchetti G, Zanini V, Montanar V, Copetti R, Guglielmo N, Bove T. Correlation and Agreement Between the CO2 Gap Obtained From Peripheral Venous Blood and From Mixed Venous Blood in Mechanically Ventilated Septic Patients. Semin Cardiothorac Vasc Anesth 2024; 28:18-27. [PMID: 38037887 DOI: 10.1177/10892532231219917] [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] [Indexed: 12/02/2023]
Abstract
BACKGROUND Venous-arterial CO2 difference (Pv-aCO2) is a valuable marker that can identify a subset of patients in shock with inadequate cardiac output to meet tissue metabolic requirements. Some authors have found that Pv-aCO2 levels calculated from mixed vs central venous blood demonstrate a linear relationship. The purpose of this study is to determine whether there is a linear relationship between Pv-aCO2 obtained with peripheral venous blood (Pv-aCO2p) and with mixed venous blood, and the agreement between the 2 measures. METHODS This was a prospective, single-center, observational clinical study enrolling mechanically ventilated patients in septic shock during the first 24 hours following admission to the intensive care unit. RESULTS The Bravais-Pearson r-coefficient between Pv-aCO2 and Pv-aCO2p was .70 in 38 determinations (95%CI .48-.83; P-value = 1.25 x 10^-6). The Bland-Altman bias was 4.11 mmHg (95%CI 2.82-5.39), and the repeatability coefficient was 11.05. Using the Taffe approach, the differential and proportional biases were 2.81 (95%CI .52-5.11) and 1.29 (95%CI .86-1.72), respectively. CONCLUSION There was linear correlation between Pv-aCO2p and Pv-aCO2 in mechanically ventilated patients with septic shock. The bias showed a gradual increase in high Pv-aCO2 values in an upward trend.
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Affiliation(s)
- Daniele Orso
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
| | - Chiara Molinari
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
| | - Giacomo Bacchetti
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
| | - Victor Zanini
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
| | - Valentina Montanar
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
| | - Roberto Copetti
- Department of Emergency Medicine, Community Hospital of Latisana, Latisana, Italy
| | - Nicola Guglielmo
- Department of Emergency Medicine, Community Hospital of Latisana, Latisana, Italy
| | - Tiziana Bove
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
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Orso D, Furlanis G, Romanelli A, Gheller F, Tecchiolli M, Cominotto F. Risk Factors Analysis for 90-Day Mortality of Adult Patients with Mild Traumatic Brain Injury in an Italian Emergency Department. Geriatrics (Basel) 2024; 9:23. [PMID: 38525740 PMCID: PMC10961819 DOI: 10.3390/geriatrics9020023] [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: 12/11/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose: The most prominent risk factors for mortality after mild traumatic brain injury (TBI) have not been established. This study aimed to establish risk factors related to 90-day mortality after a traumatic event. Methods: A retrospective cohort study on adult patients entering the Emergency Department of the University Hospital of Trieste for mild TBI from 1 January 2020 to 31 December 2020 was conducted. Results: The final population was 1221 patients (median age of 78 years). The 90-day mortality rate was 7% (90 patients). In the Cox regression model (likelihood ratio 110.9; p < 2 × 10-16), the variables that significantly correlated to 90-day mortality were age (less than 75 years old is a protective factor, HR 0.29 [95%CI 0.16-0.54]; p < 0.001); chronic liver disease (HR 4.59 [95%CI 2.56-8.24], p < 0.001); cognitive impairment (HR 2.76 [95%CI 1.78-4.27], p < 0.001); intracerebral haemorrhage (HR 15.38 [95%CI 6.13-38.63], p < 0.001); and hospitalization (HR 2.56 [95%CI 1.67-3.92], p < 0.001). Cardiovascular disease (47% vs. 11%; p < 0.001) and cognitive impairment (36% vs. 10%; p < 0.001) were more prevalent in patients over 75 years of age than the rest of the population. Conclusions: In our cohort of patients with mild TBI, 90-day mortality was low but not negligible. The risk factors associated with 90-day mortality included age, history of chronic liver disease, and cognitive impairment, as well as evidence of intracerebral hemorrhage and hospitalization. The mortality of the sub-population of older patients was likely to be linked to cardiovascular comorbidities and neurodegenerative diseases.
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Affiliation(s)
- Daniele Orso
- Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Via Pozzuolo 330, 33100 Udine, Italy
| | - Giulia Furlanis
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Alice Romanelli
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Federica Gheller
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Marzia Tecchiolli
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
| | - Franco Cominotto
- Department of Emergency Medicine, ASUGI University Hospital of Trieste, 34100 Trieste, Italy; (G.F.); (F.C.)
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Dottore B, Meroi F, Tomasino S, Orso D, Comuzzi M, Vernaccini N, Vetrugno L, Intini S, Bove T. Pediatric ultrasound-guided dorsal penile nerve block and sedation in spontaneous breathing: a prospective observational study. Front Med (Lausanne) 2023; 10:1268594. [PMID: 38116040 PMCID: PMC10729315 DOI: 10.3389/fmed.2023.1268594] [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: 07/28/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023] Open
Abstract
Background Worldwide, one of the most common surgical procedures in the pediatric population is circumcision. There is no consent on the best anesthesiologic approach. This study aimed to investigate ultrasound-guided dorsal penile nerve block (DPNB) plus sedation in spontaneous breathing as a time-saving, safe, effective, and opioid-sparing technique. Aims The primary outcome was the assessment of the time from the end of surgery and the discharge to the post-anesthesia care unit. Secondary outcomes were to evaluate the cumulative dosages of opioids, differences in pain levels between the two groups, and complications at the awakening, 4 h and 72 h after surgery, respectively. Methods This was a prospective study with a retrospective control group, approved by the Friuli-Venezia Giulia Ethics Committee. Children in the intervention group received an ultrasound-guided DPNB under sedation and spontaneous breathing. With the probe positioned transversally at the base of the penis using an in-plane approach with a modified technique, local anesthetic was injected under the deep fascia of the penis. Results We recruited 70 children who underwent circumcision at the University Hospital of Udine, Italy, from 1 January 2016 to 1 October 2021: 35 children in the ultrasound-guided DPNB group and 35 children in the control group. Children who received ultrasound-guided DPNB had a statistically significant lower time to discharge from the operating room, did not require mechanical ventilation, maintained spontaneous breathing at all times, received fewer opioids, had lower mean intraoperative arterial pressures, and lower pain levels immediately after surgery. Conclusion Ultrasound-guided DPNB associated with sedation and spontaneous breathing is a time-saving, opioid-sparing, safe, and effective strategy for the management of intraoperative and postoperative pain in children undergoing circumcision.Clinical trial registration: ClinicalTrial.gov (NCT04475458, 17 July 2020).
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Affiliation(s)
- Bruno Dottore
- Azienda Sanitaria Integrata Friuli Centrale (ASUFC), Hospital of Palmanova, Italy Anesthesia and Intensive Care Service, Palmanova, Italy
| | - Francesco Meroi
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
| | - Serena Tomasino
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
| | - Daniele Orso
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
| | - Matteo Comuzzi
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
| | - Nicola Vernaccini
- Department of General Surgery, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesia and Intensive Care, University of Chieti-Pescara, Chieti, Italy
| | - Sergio Intini
- Department of General Surgery, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, General Surgery Clinic, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
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Venturini S, Orso D, Cugini F, Villalta D, Tonizzo M, Grembiale A, Zanier A, Cecco S, Callegari A, Duranti S, Del Fabro G, Crapis M. Mortality predictors in hospitalised COVID-19 patients and the role of anti-SARS-CoV-2 IgG antibodies and remdesivir. Infez Med 2023; 31:215-224. [PMID: 37283645 PMCID: PMC10241404 DOI: 10.53854/liim-3102-10] [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: 02/02/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023]
Abstract
Background In a pre-vaccination era serologic tests may be used to evaluate the seroprevalence and efficacy of containment strategies applied to the community. Subsequently, SARS-CoV-2 vaccination has successfully reduced hospitalization and admission to intensive care. The role of antiviral treatment for COVID-19 remains debated. Objective We investigated the effect of SARS-CoV-2 IgG Spike (S) antibody responses in hospitalized patients on 30-day mortality. Finally, we assessed whether other predictive factors affected mortality after 30 days. Methods Observational study on COVID-19 patients admitted from October 1, 2021, to January 30, 2022. Results 520 patients were studied; 108 died at the 30-day follow-up (21%). A borderline significance for mortality was observed in favour of the high antibody titer group (24% vs 17%, p=0.05). From the univariate Cox regression analysis, a high IgG-S titer was significantly correlated to lower 30-day mortality (p=0.04, HR: 0.7; 95%CI: 0.44-0.98). The administration of remdesivir (p=0.01) and the age <65 years (p=2.3e-05) were found to be protective for the considered outcome (respectively, HR: 0.5, 95%CI: 0.34-0.86, and HR: 0.1, 95%CI: 0.04-0.30). Conclusions S-antibodies and remdesivir could play a protecting role in increasing the survival of hospitalized COVID-19 patients who are not suffering from a critical disease. Advanced age is a risk factor for poor outcomes among infected people.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone,
Italy
| | - Daniele Orso
- Department of Anesthesia and Intensive Care, ASUFC “Santa Maria della Misericordia” University Hospital of Udine, Udine,
Italy
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Hospital of San Daniele, Udine,
Italy
| | - Danilo Villalta
- Immunology and Allergy Unit, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone,
Italy
| | - Maurizio Tonizzo
- Department of Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone,
Italy
| | - Alessandro Grembiale
- Department of Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone,
Italy
| | - Ada Zanier
- Department of Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone,
Italy
| | - Serena Cecco
- Department of Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone,
Italy
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone,
Italy
| | - Silvia Duranti
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone,
Italy
| | - Giovanni Del Fabro
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone,
Italy
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Pordenone,
Italy
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Orso D, Santangelo S, Guglielmo N, Bove T, Cilenti F, Cristiani L, Copetti R. Bayesian Network Meta-analysis of Randomized Controlled Trials on the Efficacy of Antiarrhythmics in the Pharmacological Cardioversion of Paroxysmal Atrial Fibrillation. Am J Cardiovasc Drugs 2023:10.1007/s40256-023-00586-5. [PMID: 37233967 DOI: 10.1007/s40256-023-00586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Since atrial fibrillation (AF) is one of the major arrhythmias managed in hospitals worldwide, it has a major impact on public health. The guidelines agree on the desirability of cardioverting paroxysmal AF episodes. This meta-analysis aims to answer the question of which antiarrhythmic agent is most effective in cardioverting a paroxysmal AF. MATERIALS AND METHODS A systematic review and Bayesian network meta-analysis, searching MEDLINE, Embase, and CINAHL, were performed, including randomized controlled trials (RCTs) enrolling a population of unselected adult patients with a paroxysmal AF that compared at least two pharmacological regimes to restore the sinus rhythm or a cardioversion agent against a placebo. The main outcome was efficacy in restoring sinus rhythm. RESULTS Sixty-one RCTs (7988 patients) were included in the quantitative analysis [deviance information criterion (DIC) 272.57; I2 = 3%]. Compared with the placebo, the association verapamil-quinidine shows the highest SUCRA rank score (87%), followed by antazoline (86%), vernakalant (85%), tedisamil at high dose (i.e., 0.6 mg/kg; 80%), amiodarone-ranolazine (80%), lidocaine (78%), dofetilide (77%), and intravenous flecainide (71%). Taking into account the degree of evidence of each individual comparison between pharmacological agents, we have drawn up a ranking of pharmacological agents from the most effective to the least effective. CONCLUSIONS In comparing the antiarrhythmic agents used to restore sinus rhythm in the case of paroxysmal AF, vernakalant, amiodarone-ranolazine, flecainide, and ibutilide are the most effective medications. The verapamil-quinidine combination seems promising, though few RCTs have studied it. The incidence of side effects must be taken into account in the choice of antiarrhythmic in clinical practice. CLINICAL TRIAL REGISTRATION PROSPERO: International prospective register of systematic reviews, 2022, CRD42022369433 (Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022369433 ).
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Affiliation(s)
- Daniele Orso
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Via Colugna 50, 33100, Udine, Italy.
- Department of Medical Sciences (DAME), University of Udine, Via Colugna 50, 33100, Udine, Italy.
| | - Sara Santangelo
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
- Department of Medical Sciences (DAME), University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Nicola Guglielmo
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
- Department of Medical Sciences (DAME), University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Francesco Cilenti
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
| | - Lorenzo Cristiani
- Department of Pre-hospital and Retrieval Medicine, Regional Health Emergency Operational Structure (SORES), Palmanova, Italy
| | - Roberto Copetti
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
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Vetrugno L, Mojoli F, Boero E, Berchialla P, Bignami EG, Orso D, Cortegiani A, Forfori F, Corradi F, Cammarota G, De Robertis E, Mongodi S, Chiumello D, Poole D, Ippolito M, Biasucci DG, Persona P, Bove T, Ball L, Pelosi P, Navalesi P, Antonelli M, Corcione A, Giarratano A, Petrini F. Level of Diffusion and Training of Lung Ultrasound during the COVID-19 Pandemic - A National Online Italian Survey (ITALUS) from the Lung Ultrasound Working Group of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI). Ultraschall Med 2022; 43:464-472. [PMID: 34734405 PMCID: PMC9534595 DOI: 10.1055/a-1634-4710] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE The goal of this survey was to describe the use and diffusion of lung ultrasound (LUS), the level of training received before and during the COVID-19 pandemic, and the clinical impact LUS has had on COVID-19 cases in intensive care units (ICU) from February 2020 to May 2020. MATERIALS AND METHODS The Italian Lung Ultrasound Survey (ITALUS) was a nationwide online survey proposed to Italian anesthesiologists and intensive care physicians carried out after the first wave of the COVID-19 pandemic. It consisted of 27 questions, both quantitative and qualitative. RESULTS 807 responded to the survey. The median previous LUS experience was 3 years (IQR 1.0-6.0). 473 (60.9 %) reported having attended at least one training course on LUS before the COVID-19 pandemic. 519 (73.9 %) reported knowing how to use the LUS score. 404 (52 %) reported being able to use LUS without any supervision. 479 (68.2 %) said that LUS influenced their clinical decision-making, mostly with respect to patient monitoring. During the pandemic, the median of patients daily evaluated with LUS increased 3-fold (p < 0.001), daily use of general LUS increased from 10.4 % to 28.9 % (p < 0.001), and the daily use of LUS score in particular increased from 1.6 % to 9.0 % (p < 0.001). CONCLUSION This survey showed that LUS was already extensively used during the first wave of the COVID-19 pandemic by anesthesiologists and intensive care physicians in Italy, and then its adoption increased further. Residency programs are already progressively implementing LUS teaching. However, 76.7 % of the sample did not undertake any LUS certification.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Italy
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Italy, Udine, Italy
- Correspondence Dr. Luigi Vetrugno Department of Medicine, University of UdineVia Colugna 5033100 UdineItaly+39/4 32/55 95 01
| | - Francesco Mojoli
- Anesthesiology, Intensive Care and Pain Medicine, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
- Anesthesia and Intensive Care, University Hospital of Pavia, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care, Hospital Saint-Giovanni Bosco Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin Faculty of Medicine and Surgery, Torino, Italy
| | - Elena Giovanna Bignami
- Department of Medicine and Surgery, University of Parma Department of Medicine and Surgery, Parma, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine Department of Biological and Medical Sciences, Udine, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Gianmaria Cammarota
- Department of Medicine and Surgery, University of Perugia School of Medicine and Surgery, Perugia, Italy
| | - Edoardo De Robertis
- Department of Medicine and Surgery, University of Perugia Department of Medicine, Perugia, Italy
| | - Silvia Mongodi
- Anesthesiology and Intensive Care, University Hospital of Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
| | - Davide Chiumello
- Department of Anesthesiology and Intensive Care, University of Milan, Milano, Italy
| | - Daniele Poole
- Anesthesia and Intensive Care Operative Unit, Hospital Saint-Martinus, Belluno, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Daniele Guerino Biasucci
- Department of Anesthesia and Intensive Care, University Hospital Agostino Gemelli Department of Surgical and Medical Sciences, Rome, Italy
| | - Paolo Persona
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy, Padua, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Italy, Udine, Italy
- Department of Medicine, University of Udine Department of Biological and Medical Sciences, Udine, Italy
| | - Lorenzo Ball
- Department of Anesthesia and Intensive Care, University of Genoa School of Medical and Pharmaceutical Sciences, Genova, Italy
| | - Paolo Pelosi
- Department of Anesthesia and Intensive Care, University of Genoa School of Medical and Pharmaceutical Sciences, Genova, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy, Padua, Italy
| | - Massimo Antonelli
- Department of Anesthesia and Intensive Care, University Hospital Agostino Gemelli Department of Surgical and Medical Sciences, Rome, Italy
| | - Antonio Corcione
- Unit of Anaesthesia and intensive Care, Monaldi Hospital Naples, Italy, Naples, Italy
| | - Antonino Giarratano
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
| | - Flavia Petrini
- Anesthesia, Intensive Care and Pain Management, President Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), Rome Italy, Rome, Italy
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9
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Venturini S, Orso D, Cugini F, Martin F, Boccato C, De Santi L, Pontoni E, Tomasella S, Nicotra F, Grembiale A, Tonizzo M, Grazioli S, Fossati S, Callegari A, del Fabro G, Crapis M. Home management of COVID-19 symptomatic patients: a safety study on COVID committed home medical teams. Infez Med 2022; 30:412-417. [PMID: 36148166 PMCID: PMC9448320 DOI: 10.53854/liim-3003-9] [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: 04/09/2022] [Accepted: 06/07/2022] [Indexed: 06/16/2023]
Abstract
To reduce the overburden in the hospital, during the COVID-19 pandemic, some "COVID Committed Home Medical Teams" (CCHTs) were created in Italy. These units consist of a small pool of general practitioners who aim to evaluate all patients with COVID-19 who require a medical examination directly at home. After the first visit (which can end with patient hospitalisation or home management), CCHTs periodically monitor the patients' clinical conditions and vital signs (usually a revaluation every 24-48 hours, except for a sudden worsening). However, this strategy - which reduces the pressure on hospitals - has never been evaluated for patient safety. Our study aims to determine whether a home-based monitoring and treatment strategy for non-severe COVID-19 patients was safe as direct hospital admission by the emergency department. We conducted a retrospective observational study about 1,182 patients admitted to the hospital for COVID-19 between September 2020 and April 2021, confronting in-hospital and 30-day mortality in both CCHT-referred (n=275) and directly admitted by emergency department (n=907). Patients assessed by the CCHT had lower in-hospital and 30-day mortality (18% vs 28%, p=0.001; and 20% vs 30%, p=0.002); but, in the propensity score matching comparison, there was no characteristic between the two groups turned out significantly different. CCHT did not correlate with in-hospital or 30-day mortality. CCHT is a safe strategy to reduce hospital overburden for COVID-19 during pandemic surges.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Daniele Orso
- Department of Anesthesia and Intensive Care, ASUFC “Santa Maria della Misericordia” University Hospital of Udine, Italy
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Hospital of San Daniele, Udine, Italy
| | - Francesco Martin
- Committed Home Medical Teams; ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Cecilia Boccato
- Committed Home Medical Teams; ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Laura De Santi
- Department of Emergency Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Elisa Pontoni
- Department of Emergency Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Silvia Tomasella
- Department of Emergency Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Fabrizio Nicotra
- Department of Emergency Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Alessandro Grembiale
- Department of Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Silvia Grazioli
- Department of Medicine, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Sara Fossati
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Giovanni del Fabro
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO “Santa Maria degli Angeli” Hospital of Pordenone, Italy
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10
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Vetrugno L, Orso D, Corradi F, Zani G, Spadaro S, Meroi F, D’Andrea N, Bove T, Cammarota G, De Robertis E, Ferrari S, Guarnieri M, Ajuti M, Fusari M, Grieco DL, Deana C, Boero E, Franchi F, Scolletta S, Maggiore SM, Forfori F. Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study. Respir Res 2022; 23:210. [PMID: 35989352 PMCID: PMC9392990 DOI: 10.1186/s12931-022-02138-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction (DTF) could provide corroborating information for weaning COVID-19 patients from mechanical ventilation.
Methods
This was an observational, pragmatic, cross-section, multicenter study in 6 Italian intensive care units. DTF was assessed in COVID-19 patients undergoing weaning from mechanical ventilation from 1st March 2020 to 30th June 2021. Primary aim was to evaluate whether DTF is a predictive factor for weaning failure.
Results
Fifty-seven patients were enrolled, 25 patients failed spontaneous breathing trial (44%). Median length of invasive ventilation was 14 days (IQR 7–22). Median DTF within 24 h since the start of weaning was 28% (IQR 22–39%), RASS score (− 2 vs − 2; p = 0.031); Kelly-Matthay score (2 vs 1; p = 0.002); inspiratory oxygen fraction (0.45 vs 0.40; p = 0.033). PaO2/FiO2 ratio was lower (176 vs 241; p = 0.032) and length of intensive care stay was longer (27 vs 16.5 days; p = 0.025) in patients who failed weaning. The generalized linear regression model did not select any variables that could predict weaning failure. DTF was correlated with pH (RR 1.56 × 1027; p = 0.002); Kelly-Matthay score (RR 353; p < 0.001); RASS (RR 2.11; p = 0.003); PaO2/FiO2 ratio (RR 1.03; p = 0.05); SAPS2 (RR 0.71; p = 0.005); hospital and ICU length of stay (RR 1.22 and 0.79, respectively; p < 0.001 and p = 0.004).
Conclusions
DTF in COVID-19 patients was not predictive of weaning failure from mechanical ventilation, and larger studies are needed to evaluate it in clinical practice further.
Registered: ClinicalTrial.gov (NCT05019313, 24 August 2021).
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11
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Venturini S, Avolio M, Fossati S, Callegari A, De Rosa R, Basso B, Zanusso C, Orso D, Cugini F, Crapis M. Antimicrobial Stewardship in the Covid-19 Pandemic. Hosp Pharm 2022; 57:416-418. [PMID: 35898252 PMCID: PMC9310298 DOI: 10.1177/00185787221075190] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
During COVID-19 pandemic, implementing and maintaining an antimicrobial stewardship protocol obtained both low rates of MDR microorganisms and low antimicrobial use in an 800-bed hospital network in northern Italy. Infectious diseases specialist consulting was crucial to maintain this protocol active.
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Affiliation(s)
- Sergio Venturini
- Santa Maria degli Angeli Hospital Pordenone, Pordenone, Friuli-Venezia Giulia, Italy
| | - Manuela Avolio
- Santa Maria degli Angeli Hospital Pordenone, Pordenone, Friuli-Venezia Giulia, Italy
| | - Sara Fossati
- Santa Maria degli Angeli Hospital Pordenone, Pordenone, Friuli-Venezia Giulia, Italy
| | - Astrid Callegari
- Santa Maria degli Angeli Hospital Pordenone, Pordenone, Friuli-Venezia Giulia, Italy
| | - Rita De Rosa
- Santa Maria degli Angeli Hospital Pordenone, Pordenone, Friuli-Venezia Giulia, Italy
| | - Barbara Basso
- Santa Maria degli Angeli Hospital Pordenone, Pordenone, Friuli-Venezia Giulia, Italy
| | - Chiara Zanusso
- Santa Maria degli Angeli Hospital Pordenone, Pordenone, Friuli-Venezia Giulia, Italy
| | - Daniele Orso
- Santa Maria della Misericordia University Hospital, Udine, Friuli-Venezia Giulia, Italy
| | | | - Massimo Crapis
- Santa Maria degli Angeli Hospital Pordenone, Pordenone, Friuli-Venezia Giulia, Italy
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12
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Dell'Aquila P, Raimondo P, Racanelli V, De Luca P, De Matteis S, Pistone A, Melodia R, Crudele L, Lomazzo D, Solimando AG, Moschetta A, Vacca A, Grasso S, Procacci V, Orso D, Vetrugno L. Integrated lung ultrasound score for early clinical decision-making in patients with COVID-19: results and implications. Ultrasound J 2022; 14:21. [PMID: 35648278 PMCID: PMC9156837 DOI: 10.1186/s13089-022-00264-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 09/14/2021] [Accepted: 03/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background and objectives Lung Ultrasound Score (LUS) identifies and monitors pneumonia by assigning increasing scores. However, it does not include parameters, such as inferior vena cava (IVC) diameter and index of collapse, diaphragmatic excursions and search for pleural and pericardial effusions. Therefore, we propose a new improved scoring system, termed “integrated” lung ultrasound score (i-LUS) which incorporates previously mentioned parameters that can help in prediction of disease severity and survival, choice of oxygenation mode/ventilation and assignment to subsequent areas of care in patients with COVID-19 pneumonia. Methods Upon admission at the sub-intensive section of the emergency medical department (SEMD), 143 consecutively examined COVID-19 patients underwent i-LUS together with all other routine analysis. A database for anamnestic information, laboratory data, gas analysis and i-LUS parameters was created and analyzed. Results Of 143 enrolled patients, 59.4% were male (mean age 71 years) and 40.6% female. (mean age 79 years: p = 0.005). Patients that survived at 1 month had i-LUS score of 16, which was lower than that of non-survivors (median 20; p = 0.005). Survivors had a higher PaO2/FiO2 (median 321.5) compared to non-survivors (median 229, p < 0.001). There was a correlation between i-LUS and PaO2/FiO2 ratio (rho:-0.4452; p < 0.001), PaO2/FiO2 and survival status (rho:-0.3452; p < 0.001), as well as i-LUS score and disease outcome (rho:0.24; p = 0.005). In non-survivors, the serum values of different significant COVID indicators were severely expressed. The i-LUS score was higher (median 20) in patients who required non-invasive ventilation (NIV) than in those treated only by oxygen therapy (median 15.42; p = 0.003). The odds ratio for death outcome was 1.08 (confidence interval 1.02–1.15) for each point increased. At 1-month follow-up, 65 patients (45.5%) died and 78 (54.5%) survived. Patients admitted to the high critical ward had higher i-LUS score than those admitted to the low critical one (p < 0.003). Conclusions i-LUS could be used as a helpful clinical tool for early decision-making in patients with COVID-19 pneumonia. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00264-8.
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Affiliation(s)
- Paola Dell'Aquila
- Emergency Department, Teaching Hospital Policlinico di Bari, Bari, Italy
| | - Pasquale Raimondo
- Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
| | - Vito Racanelli
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine "Guido Baccelli, University of Bari Medical School, Bari, Italy.
| | - Paola De Luca
- Emergency Department, Teaching Hospital Policlinico di Bari, Bari, Italy
| | - Sandra De Matteis
- Emergency Department, Teaching Hospital Policlinico di Bari, Bari, Italy
| | - Antonella Pistone
- Emergency Department, Teaching Hospital Policlinico di Bari, Bari, Italy
| | - Rosa Melodia
- Emergency Department, Teaching Hospital Policlinico di Bari, Bari, Italy
| | - Lucilla Crudele
- Emergency Department, Teaching Hospital Policlinico di Bari, Bari, Italy
| | - Daniela Lomazzo
- Emergency Department, Teaching Hospital Policlinico di Bari, Bari, Italy
| | - Antonio Giovanni Solimando
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine "Guido Baccelli, University of Bari Medical School, Bari, Italy
| | - Antonio Moschetta
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine "Guido Baccelli, University of Bari Medical School, Bari, Italy
| | - Salvatore Grasso
- Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
| | - Vito Procacci
- Emergency Department, Teaching Hospital Policlinico di Bari, Bari, Italy
| | - Daniele Orso
- Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
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13
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Orso D, Scapol S, Bove T. Is extracorporeal life support evidence-based medicine? Not yet. Artif Organs 2022; 46:1446-1447. [PMID: 35435258 DOI: 10.1111/aor.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Udine, Italy
| | - Sara Scapol
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Udine, Italy
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14
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Vetrugno L, Meroi F, Orso D, D’Andrea N, Marin M, Cammarota G, Mattuzzi L, Delrio S, Furlan D, Foschiani J, Valent F, Bove T. Can Lung Ultrasound Be the Ideal Monitoring Tool to Predict the Clinical Outcome of Mechanically Ventilated COVID-19 Patients? An Observational Study. Healthcare (Basel) 2022; 10:healthcare10030568. [PMID: 35327046 PMCID: PMC8955357 DOI: 10.3390/healthcare10030568] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role is still controversial. Methods: A retrospective observational study on 103 COVID-19 patients with respiratory failure that were assessed with an LUS score at intensive care unit (ICU) admission and discharge in a tertiary university COVID-19 referral center. Results: The deceased patients had a higher LUS score at admission than the survivors (25.7 vs. 23.5; p-value = 0.02; cut-off value of 25; Odds Ratio (OR) 1.1; Interquartile Range (IQR) 1.0−1.2). The predictive regression model shows that the value of LUSt0 (OR 1.1; IQR 1.0–1.3), age (OR 1.1; IQR 1.0−1.2), sex (OR 0.7; IQR 0.2−3.6), and days in spontaneous breathing (OR 0.2; IQR 0.1–0.5) predict the risk of death for COVID-19 patients (Area under the Curve (AUC) 0.92). Furthermore, the surviving patients showed a significantly lower difference between LUS scores at admission and discharge (mean difference of 1.75, p-value = 0.03). Conclusion: Upon entry into the ICU, the LUS score may play a prognostic role in COVID-19 patients with ARDS. Furthermore, employing the LUS score as a monitoring tool allows for evaluating the patients with a higher probability of survival.
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Affiliation(s)
- Luigi Vetrugno
- Dipartimento di Scienze, Orali e Biotecnologiche, Università degli Studi “G. d’Annunzio”, 66100 Chieti, Italy;
| | - Francesco Meroi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
- Correspondence:
| | - Daniele Orso
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Natascia D’Andrea
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Matteo Marin
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Gianmaria Cammarota
- Division of Anesthesia, Analgesia and Intensive Care, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Lisa Mattuzzi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Silvia Delrio
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Davide Furlan
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Jonathan Foschiani
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Francesca Valent
- Clinical and Evaluational Epidemiologic Service, Department of Governance, Local Health Authority, 38123 Trento, Italy;
| | - Tiziana Bove
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
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15
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Di Gioia CC, Artusi N, Xotta G, Bonsano M, Sisto UG, Tecchiolli M, Orso D, Cominotto F, Amore G, Meduri S, Copetti R. Lung ultrasound in ruling out COVID-19 pneumonia in the ED: a multicentre prospective sensitivity study. Emerg Med J 2022; 39:199-205. [PMID: 34937709 PMCID: PMC8704061 DOI: 10.1136/emermed-2020-210973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/13/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Early diagnosis of COVID-19 has a crucial role in confining the spread among the population. Lung ultrasound (LUS) was included in the diagnostic pathway for its high sensitivity, low costs, non-invasiveness and safety. We aimed to test the sensitivity of LUS to rule out COVID-19 pneumonia (COVIDp) in a population of patients with suggestive symptoms. METHODS Multicentre prospective observational study in three EDs in Northeastern Italy during the first COVID-19 outbreak. A convenience sample of 235 patients admitted to the ED for symptoms suggestive COVIDp (fever, cough or shortness of breath) from 17 March 2020 to 26 April 2020 was enrolled. All patients underwent a sequential assessment involving: clinical examination, LUS, CXR and arterial blood gas. The index test under investigation was a standardised protocol of LUS compared with a pragmatic composite reference standard constituted by: clinical gestalt, real-time PCR test, radiological and blood gas results. Of the 235 enrolled patients, 90 were diagnosed with COVIDp according to the reference standard. RESULTS Among the patients with suspected COVIDp, the prevalence of SARS-CoV-2 was 38.3%. The sensitivity of LUS for diagnosing COVIDp was 85.6% (95% CI 76.6% to 92.1%); the specificity was 91.7% (95% CI 86.0% to 95.7%). The positive predictive value and the negative predictive value were 86.5% (95%CI 78.8% to 91.7%) and 91.1% (95% CI 86.1% to 94.4%) respectively. The diagnostic accuracy of LUS for COVIDp was 89.4% (95% CI 84.7% to 93.0%). The positive likelihood ratio was 10.3 (95% CI 6.0 to 17.9), and the negative likelihood ratio was 0.16 (95% CI 0.1 to 0.3). CONCLUSION In a population with high SARS-CoV-2 prevalence, LUS has a high sensitivity (and negative predictive value) enough to rule out COVIDp in patients with suggestive symptoms. The role of LUS in diagnosing patients with COVIDp is perhaps even more promising. Nevertheless, further research with adequately powered studies is needed. TRIAL REGISTRATION NUMBER NCT04370275.
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Affiliation(s)
- Carmine Cristiano Di Gioia
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Nicola Artusi
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Giovanni Xotta
- Department of Emergency Medicine, University of Verona, Verona, Veneto, Italy
| | - Marco Bonsano
- Department of Emergency Medicine, Barts Health NHS Trust, London, UK
| | - Ugo Giulio Sisto
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Marzia Tecchiolli
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Friuli-Venezia Giulia, Italy
| | - Franco Cominotto
- Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy
| | - Giulia Amore
- Department of Emergency Medicine, Ospedale Civile di Latisana, Latisana, Friuli-Venezia Giulia, Italy
| | - Stefano Meduri
- Department of Radiology, Ospedale Civile di Latisana, Latisana, Friuli-Venezia Giulia, Italy
| | - Roberto Copetti
- Department of Emergency Medicine, Ospedale Civile di Latisana, Latisana, Friuli-Venezia Giulia, Italy
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16
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Orso D, Scapol S, Dogareschi T, Spasiano A, Driul L, Bove T. Correlation between epidural analgesia and type of delivery in the low Robson score classes: a registry based-cohort study. Minerva Anestesiol 2022; 88:525-526. [PMID: 35199976 DOI: 10.23736/s0375-9393.21.16356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy -
| | - Sara Scapol
- Department of Medicine, University of Udine, Udine, Italy
| | - Teresa Dogareschi
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Santa Maria della Misericordia Hospital of Udine, Udine, Italy
| | - Alessandra Spasiano
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Santa Maria della Misericordia Hospital of Udine, Udine, Italy
| | - Lorenza Driul
- Department of Medicine, University of Udine, Udine, Italy.,Department of Obstetrics and Gynaecology, ASUFC Santa Maria della Misericordia Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Santa Maria della Misericordia Hospital of Udine, Udine, Italy
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17
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Vetrugno L, Sala A, Orso D, Meroi F, Fabbro S, Boero E, Valent F, Cammarota G, Restaino S, Vizzielli G, Girometti R, Merelli M, Tascini C, Bove T, Driul L. Lung Ultrasound Signs and Their Correlation With Clinical Symptoms in COVID-19 Pregnant Women: The "PINK-CO" Observational Study. Front Med (Lausanne) 2022; 8:768261. [PMID: 35127744 PMCID: PMC8814327 DOI: 10.3389/fmed.2021.768261] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/10/2021] [Indexed: 12/21/2022] Open
Abstract
Objective To analyze the application of lung ultrasound (LUS) diagnostic approach in obstetric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and compare LUS score and symptoms of the patients. Design A single-center observational retrospective study from October 31, 2020 to March 31, 2021. Setting Department of Ob/Gyn at the University-Hospital of Udine, Italy. Participants Pregnant women with SARS-CoV-2 diagnosed with reverse transcription-PCR (RT-PCR) swab test were subdivided as symptomatic and asymptomatic patients with COVID-19. Exposure Lung ultrasound evaluation both through initial evaluation upon admission and through serial evaluations. Main Outcome Reporting LUS findings and LUS score characteristics. Results Symptomatic patients with COVID-19 showed a higher LUS (median 3.5 vs. 0, p < 0.001). LUS was significantly correlated with COVID-19 biomarkers as C-reactive protein (CPR; p = 0.011), interleukin-6 (p = 0.013), and pro-adrenomedullin (p = 0.02), and inversely related to arterial oxygen saturation (p = 0.004). The most frequent ultrasound findings were focal B lines (14 vs. 2) and the light beam (9 vs. 0). Conclusion Lung ultrasound can help to manage pregnant women with SARS-CoV-2 infection during a pandemic surge. Study Registration ClinicalTrials.gov, NCT04823234. Registered on March 29, 2021.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Alessia Sala
- Department of Medicine, University of Udine, Udine, Italy.,Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Francesco Meroi
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | | | - Enrico Boero
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Francesca Valent
- Department of Epidemiology and Public Health, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care Medicine, University of Perugia, Perugia, Italy
| | - Stefano Restaino
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Giuseppe Vizzielli
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Rossano Girometti
- Department of Medicine, University of Udine, Udine, Italy.,Department of Radiology, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Maria Merelli
- Department of Infectious Diseases, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy.,Department of Infectious Diseases, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Lorenza Driul
- Department of Medicine, University of Udine, Udine, Italy.,Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
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18
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Orso D. The "one-size-fits-all" management of sepsis is a dismissal of clinical judgment. Eur J Emerg Med 2022; 29:12-13. [PMID: 34932029 DOI: 10.1097/mej.0000000000000893] [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] [Indexed: 11/26/2022]
Affiliation(s)
- Daniele Orso
- Department of Medical Sciences (DAME), University of Udine, Italy
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Italy
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19
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Rovida S, Orso D, Naeem S, Vetrugno L, Volpicelli G. Lung ultrasound in blunt chest trauma: A clinical review. Ultrasound 2022; 30:72-79. [PMID: 35173781 PMCID: PMC8841950 DOI: 10.1177/1742271x21994604] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/24/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Bedside lung sonography is recognized as a reliable diagnostic modality in trauma settings due to its ability to detect alterations both in lung parenchyma and in pleural cavities. In severe blunt chest trauma, lung ultrasound can identify promptly life-threatening conditions which may need direct intervention, whereas in minor trauma, lung ultrasound contributes to detection of acute pathologies which are often initially radio-occult and helps in the selection of those patients that might need further investigation. TOPIC DESCRIPTION We did a literature search on databases EMBASE, PubMed, SCOPUS and Google Scholar using the terms 'trauma', 'lung contusion', 'pneumothorax', 'hemothorax' and 'lung ultrasound'. The latest articles were reviewed and this article was written using the most current and validated information. DISCUSSION Lung ultrasound is quite accurate in diagnosing pneumothorax by using a combination of four sonographic signs; absence of lung sliding, B-lines, lung pulse and presence of lung point. It provides a rapid diagnosis in hemodynamically unstable patients. Lung contusions and hemothorax can be diagnosed and assessed with lung ultrasound. Ultrasound is also very useful for evaluating rib and sternal fractures and for imaging the pericardium for effusion and tamponade. CONCLUSION Bedside lung ultrasound can lead to rapid and accurate diagnosis of major life-threatening pathologies in blunt chest trauma patients.
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Affiliation(s)
- Serena Rovida
- Department of Emergency Medicine, Royal London Hospital, Barts
Health NHS Trust, London, UK,Serena Rovida, Department of Emergency
Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy
| | - Salman Naeem
- Department of Emergency Medicine, Royal London Hospital, Barts
Health NHS Trust, London, UK
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy,Department of Anesthesia and Intensive Care Medicine, “Santa
Maria della Misericordia” Hospital, ASUFC Udine, Italy
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University
Hospital, Torino, Italy
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20
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Castelletto S, Amore G, Giudice CA, Orso D, Copetti R. A Preliminary Investigation on the “Swinging Kidney”: A Sonographic Sign Useful for Diagnosing Renal Colic. Journal of Diagnostic Medical Sonography 2022. [DOI: 10.1177/87564793211073693] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: During acute renal colic due to nephrolithiasis, a new sonographic diagnostic sign was noted, called “a swinging kidney.” This term was given due to a characteristic anteroposterior “rolling” movement of the kidney. A preliminary investigation was conducted to evaluate the correlation between this new diagnostic sign and nephrolithiasis. Materials and Methods: An exploratory observational investigation was conducted on adult patients who accessed an emergency medicine department, with acute renal colic, between June 1, 2019, and October 31, 2019. Results: Thirty-seven patients were enrolled. The “swinging kidney” was present in 26 cases (70%). This sign was correlated with a stone’s diameter of less than 10 mm (χ2: 4.68; P = .031), and with a stone localization in the juxtavesical ureter tract site (χ2: 10.83; P = .029). Spontaneously stone expulsion was correlated with the presence of the “swinging kidney” (χ2: 4.66; P = .031); with the minor degree of hydronephrosis (χ2: 16.82; P = .0008), and with a distal localization of the stone (χ2: 25.11; P = 1:47 × 10−5). Conclusion: The “swinging kidney” may be a promising diagnostic sign that could be useful in diagnosing nephrolithiasis besides the other indirect sonographic signs. This new diagnostic sign could have a prognostic role.
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Affiliation(s)
- Silvia Castelletto
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
| | - Giulia Amore
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
| | - Caterina Anna Giudice
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Roberto Copetti
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
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21
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Furlan D, Deana C, Orso D, Licari M, Cappelletto B, DE Monte A, Vetrugno L, Bove T. Perioperative management of spinal cord injury: the anesthesiologist's point of view. Minerva Anestesiol 2021; 87:1347-1358. [PMID: 34874136 DOI: 10.23736/s0375-9393.21.15753-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) is one of the most devastating events a person can experience. It may be life-threatening or result in long-term disability. This narrative review aims to delineate a systematic step-wise airways, breathing, circulation and disability (ABCD) approach to perioperative patient management during spinal cord surgery in order to fill some of the gaps in our current knowledge. METHODS We performed a comprehensive review of the literature regarding the perioperative management of traumatic spinal injuries from May 15, 2020, to December 13, 2020. We consulted the PubMed and Embase database libraries. RESULTS Videolaryngoscopy supplements the armamentarium available for airway management. Optical fiberscope use should be evaluated when intubating awake patients. Respiratory complications are frequent in the acute phase of traumatic spinal injury, with an estimated incidence of 36-83%. Early tracheostomy can be considered for expected difficult weaning from mechanical ventilation. Careful intraoperative management of administered fluids should be pursued to avoid complications from volume overload. Neuromonitoring requires investments in staff training and cooperation, but better outcomes have been obtained in centers where it is routinely applied. The prone position can cause rare but devastating complications, such as ischemic optic neuropathy; thus, the anesthetist should take the utmost care in positioning the patient. CONCLUSIONS A one-size fit all approach to spinal surgery patients is not applicable due to patient heterogeneity and the complexity of the procedures involved. The neurologic outcome of spinal surgery can be improved, and the incidence of complications reduced with better knowledge of patient-specific aspects and individualized perioperative management.
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Affiliation(s)
- Davide Furlan
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Maurizia Licari
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Barbara Cappelletto
- Section of Spine and Spinal Cord Surgery, Department of Neurological Sciences, ASUFC University Hospital of Udine, Udine, Italy
| | - Amato DE Monte
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine (DAME), University of Udine, Udine, Italy - .,Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
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22
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Vetrugno L, Mojoli F, Cortegiani A, Bignami EG, Ippolito M, Orso D, Corradi F, Cammarota G, Mongodi S, Boero E, Iacovazzo C, Vargas M, Poole D, Biasucci DG, Persona P, Bove T, Ball L, Chiumello D, Forfori F, de Robertis E, Pelosi P, Navalesi P, Giarratano A, Petrini F. Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO). J Anesth Analg Crit Care 2021. [PMCID: PMC8611396 DOI: 10.1186/s44158-021-00015-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s44158-021-00015-6.
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23
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Fantin A, Castaldo N, Vailati P, Morana G, Orso D, Vetrugno L, Patruno V. Pleural effusion aetiology, presentation, treatment and outcome in haematological diseases: a review. Acta Biomed 2021; 92:e2021268. [PMID: 34738567 PMCID: PMC8689299 DOI: 10.23750/abm.v92i5.11794] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/30/2021] [Indexed: 11/29/2022]
Abstract
Background and aim: Pleural effusions (PE) can complicate the course of hematologic disorders (HD) and may arise in the form of malignant PE or as a consequence of non-neoplastic complications. While a certain amount of data has been published regarding infectious and iatrogenic HD-associated PE (HPE), no comprehensive review regarding the other types of HPE has ever been conducted. To address this issue, we performed a systematic review of the literature regarding HPE, focusing on the clinical and chemical characteristics of PE, therapeutic approaches and ì outcomes at the one-year follow-up. Methods: We conducted our review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Overall, 283 manuscripts and 1216 cases were included. In summary, PE frequently signals an underlying HD, especially Hodgkin’s lymphoma and IgG4-related disease; it mainly consists of exudate, although chylothorax is diagnosed in some cases. Although cytological examination has a discrete diagnostic yield, it is generally insufficient to render a definitive diagnosis; pleural biopsy remains an important diagnostic means in such cases. Invasive diagnostic procedures are not frequently performed because of an increased risk of haemorrhagic complications. The majority of PE are resolved by means of systemic therapy. When local treatments are attempted, the most frequently adopted procedures are evacuative thoracentesis and indwelling chest tube placement. Conclusions: This review highlights the need for well-designed prospective studies comparing diagnostic means and therapeutic interventions for HPE to increase the quality of available data. (www.actabiomedica.it)
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Affiliation(s)
- Alberto Fantin
- Department of Pulmonology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - Nadia Castaldo
- Department of Pulmonology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy; Department of Infectious diseases, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy;.
| | - Paolo Vailati
- Department of Pulmonology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - Giuseppe Morana
- Department of Pulmonology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
| | - Daniele Orso
- Department of Medicine, University of Udine, via Colugna n° 50, 33100, Udine, Italy. .
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, via Colugna n° 50, 33100, Udine, Italy; Anesthesia and Intensive Care Medicine Department, ASUFC University-Hospital of Central Friuli, ASUFC, P.le S. Maria della Misericordia n° 15, 33100, Udine, Italy.
| | - Vincenzo Patruno
- Department of Pulmonology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
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24
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Deana C, Vetrugno L, Tonizzo A, Orso D, Piani T, Bove T, De Monte A. Drug Supply During COVID-19 Pandemic: Remember Not to Run With Your Tank Empty. Hosp Pharm 2021; 56:405-407. [PMID: 34720135 DOI: 10.1177/0018578720931749] [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] [Indexed: 11/17/2022]
Affiliation(s)
- Cristian Deana
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luigi Vetrugno
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,University of Udine, Udine, Italy
| | | | | | - Tommaso Piani
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Tiziana Bove
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,University of Udine, Udine, Italy
| | - Amato De Monte
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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25
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Vetrugno L, Divella M, Orso D, Deana C, Vaccher G, Drovandi P, Beltrame A, Causero A, Bove T. Tracheal lesion during shoulder surgery: a case report and systemic review of the literature. J Anesth Analg Crit Care 2021; 1:11. [PMID: 37386524 DOI: 10.1186/s44158-021-00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 07/01/2023]
Abstract
Pneumomediastinum (PNM) and pneumothorax (PNX) are documented complications of arthroscopic shoulder surgery (ATS). Plexus anesthetic block and tracheal lesions during endotracheal intubation are hypothesized to be the underlying risk factors; however, the actual evidence supporting this hypothesis is scarce.A case of bilateral laterocervical emphysema, subcutaneous edema, and signs of PNM after ATS performed under general anesthesia and supra-scapular nerve block is presented. An up-to-date systematic review of PNM/PNX during orthopedic surgery was performed, involving six databases: PubMed (1996-present), Embase (1974-present), Scopus (2004-present), SpringerLink (1950-present), Ovid Emcare (1995-present), and Google Scholar (2004-present).Twenty-five case studies met the eligibility criteria. In 24 cases, the patient underwent general anesthesia and orotracheal intubation; in 9 of these, a plexus anesthetic block was also performed. One case involved ATS under plexus anesthetic block only. In 10 cases, the diagnostic finding was PNM. In 5 cases, the diagnostic finding was associated with PNX. PNX was detected in 17 cases. In 2 cases, SE was found in the absence of any evidence of either PNM or PNX. A tracheal lesion was identified in 3 cases.Endotracheal intubation and loco-regional anesthesia are not the only predisposing risk factors at play in the pathogenesis of PNM/PNX. Rather, multi-factorial pathogenesis seems more probable, necessitating that specific attention is paid during ATS to the change in patient position on the operating bed, to any slipping of the endotracheal tube, to patient monitoring whilst under the drapes, and to the cuff pressure. PROSPERO registration number: CRD42021260370.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Michele Divella
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Cristian Deana
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Giulia Vaccher
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Pietro Drovandi
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Alessandro Beltrame
- Orthopedic and Trauma Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Araldo Causero
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Orthopedic and Trauma Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
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26
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Orso D, Mattuzzi L, Scapol S, Delrio S, Vetrugno L, Bove T. Phlegmasia cerulea dolens superimposed on disseminated intravascular coagulation in COVID-19. Acta Biomed 2021; 92:e2021101. [PMID: 34487073 PMCID: PMC8477088 DOI: 10.23750/abm.v92i4.11478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/21/2021] [Indexed: 01/10/2023]
Abstract
COVID-19 infection has several cardiovascular implications, and coagulopathy is a common abnormality in these patients, often coupled with elevated plasma fibrinogen and D-dimer levels, contributing to adverse outcomes. Phlegmasia cerulea dolens (PCD) is a rare manifestation of deep vein thrombosis. It is life-threatening and can rapidly lead to venous gangrene of the extremity. Only a few cases of COVID-19 associated with PCD are reported in the literature, despite thromboembolism being the common paradigm between the two diseases. We present the case of a 64-year-old adult with acute severe COVID-19 pneumonia who developed PCD despite constantly elevated activated partial thromboplastin time and international normalized ratio. (www.actabiomedica.it)
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Dell'Aquila P, Raimondo P, Orso D, De Luca P, Pozzessere P, Parisi CV, Bove T, Vetrugno L, Grasso S, Procacci V. A simple prognostic score based on troponin and presepsin for COVID-19 patients admitted to the emergency department: a single-center pilot study. Acta Biomed 2021; 92:e2021233. [PMID: 34487072 PMCID: PMC8477102 DOI: 10.23750/abm.v92i4.11479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/22/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The need to determine prognostic factors that can predict a particularly severe or, conversely, the benign course of COVID-19 is particularly perceived in the Emergency Department (ED), considering the scarcity of resources for a conspicuous mass of patients. The aim of our study was to identify some predictors for 30-day mortality among some clinical, laboratory, and ultrasound variables in a COVID-19 patients population. METHODS Prospective single-center pilot study conducted in an ED of a University Hospital. A consecutive sample of confirmed COVID-19 patients with acute respiratory failure was enrolled from March 8th to April 15th, 2020. RESULTS 143 patients were enrolled. Deceased patients (n = 65) were older (81 vs. 61 years, p <0.001), and they had more frequently a history of heart disease, neurological disease, or chronic obstructive pulmonary disease (p-values = 0.026, 0.025, and 0.034, respectively) than survived patients. Troponin I and presepsin had a significant correlation with a worse outcome. Troponin achieved a sensitivity of 77% and a specificity of 82% for a cut-off value of 27.6 ng/L. The presepsin achieved a sensitivity of 54% and a specificity of 92% for a cut-off value of 871 pg/mL. CONCLUSION In a population of COVID-19 patients with acute respiratory failure in an ED, presepsin and troponin I are accurate predictors of 30-day mortality. Presepsin is highly specific and could permit the early identification of patients who could benefit from more intensive care as soon as they enter the ED. Further validation studies are needed to confirm this result.
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Affiliation(s)
- Paola Dell'Aquila
- Department of Emergency Medicine, University Hospital of Bari, Bari, Italy..
| | - Pasquale Raimondo
- Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Paola De Luca
- Department of Emergency Medicine, University Hospital of Bari, Bari, Italy..
| | - Pietro Pozzessere
- Department of Emergency Medicine, University Hospital of Bari, Bari, Italy..
| | - Carmen Vita Parisi
- Department of Emergency Medicine, University Hospital of Bari, Bari, Italy..
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy.
| | - Salvatore Grasso
- Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
| | - Vito Procacci
- Department of Emergency Medicine, University Hospital of Bari, Bari, Italy..
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Meroi F, Orso D, Vetrugno L, Bove T. Lung Ultrasound Score in Critically Ill COVID-19 Patients: A Waste of Time or a Time-Saving Tool? Acad Radiol 2021; 28:1323-1324. [PMID: 34275738 PMCID: PMC8275841 DOI: 10.1016/j.acra.2021.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Francesco Meroi
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Via Colugna n° 50, 33100 Udine, Italy.
| | - Daniele Orso
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Via Colugna n° 50, 33100 Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Via Colugna n° 50, 33100 Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Via Colugna n° 50, 33100 Udine, Italy
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Copetti R, Amore G, Giudice CA, Orso D, Cola S, Pillinini P, Rocco C, Cappello D, Dibenedetto AG, Meduri S. Lung Ultrasonography in Ruling Out COVID-19 Among Health Care Workers in Two Italian Emergency Departments: A Multicenter Study. Journal of Diagnostic Medical Sonography 2021. [DOI: 10.1177/87564793211037607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: The low sensitivity of the real-time reverse transcription-polymerase chain reaction (rRT-PCR) test on the nasopharyngeal swab for SARS-CoV2 virus could cause infections among health care professionals and could be a source of viral spread. The aim of this study was to verify whether lung ultrasonography (LUS) had a negative predictive value (NPV) high enough to rule out coronavirus disease 2019 (COVID-19) in a cohort of health care employees, working in emergency departments (EDs). Materials and Methods: A multicenter prospective observational study was conducted in two EDs in Northeast Italy. An adjudication committee established the definitive diagnosis of COVID-19. Results: A cohort was enrolled of 155 possible patient cases (two true positives). Twenty-one health care employees presented with suggestive symptoms for COVID-19. The rRT-PCR test was positive in one of the two patients. LUS was suggestive for COVID-19 pneumonia in four patients. The diagnostic accuracy of LUS was 98.7% (95% confidence interval [CI] = 95.4%–99.8%). The NPV was 100% (95% CI = 100%–100%). Conclusion: LUS has a high enough NPV for excluding a COVID-19-related pneumonia in a cohort of health care employees who were exposed to the SARS-CoV2 virus.
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Affiliation(s)
- Roberto Copetti
- Department of Emergency Medicine, ASUFC Latisana Community Hospital, Latisana, Italy
| | - Giulia Amore
- Department of Emergency Medicine, ASUFC Latisana Community Hospital, Latisana, Italy
| | - Caterina Anna Giudice
- Department of Emergency Medicine, ASUFC Latisana Community Hospital, Latisana, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Silvia Cola
- Department of Emergency Medicine, ASUFC Latisana Community Hospital, Latisana, Italy
| | - Pierpaolo Pillinini
- Department of Emergency Medicine, ASUFC “Sant’Antonio Abate” Tolmezzo Community Hospital, Tolmezzo, Italy
| | - Chiara Rocco
- Department of Emergency Medicine, ASUFC “Sant’Antonio Abate” Tolmezzo Community Hospital, Tolmezzo, Italy
| | - Dario Cappello
- Department of Emergency Medicine, ASUFC “Sant’Antonio Abate” Tolmezzo Community Hospital, Tolmezzo, Italy
| | - Alessia Geneve Dibenedetto
- Department of Emergency Medicine, ASUFC “Sant’Antonio Abate” Tolmezzo Community Hospital, Tolmezzo, Italy
| | - Stefano Meduri
- Department of Radiology, ASUFC Latisana Community Hospital, Latisana, Italy
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Orso D, Guglielmo N, Cugini F. Emergency department intensive care units in a country with a fledgling specialty in emergency medicine as in Italy. Emerg Med J 2021; 38:939. [PMID: 34289967 DOI: 10.1136/emermed-2021-211825] [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] [Accepted: 07/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Daniele Orso
- Department of Anesthesia and Intensive Care Medicine, Udine University Health Integrated Agency, Udine, Friuli-Venezia Giulia, Italy
| | - Nicola Guglielmo
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana (UD), Italy
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Community Hospital of San Daniele del Friuli, San Daniele del Friuli (UD), Italy
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Driul L, Meroi F, Cecchini F, Sala A, Orso D, Padovani D, Rovida S, Dogareschi T, Vetrugno L, Bove T. COVID-19 pandemic in an Italian obstetric department: sharing our experience. Acta Biomed 2021; 92:e2021217. [PMID: 34212913 PMCID: PMC8343760 DOI: 10.23750/abm.v92i3.11098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The outbreak of the novel coronavirus (or SARS-CoV 2) has significantly struck the healthcare system worldwide. Over the course of a few weeks, hospitals reorganized their internal structure entirely at any level of care, from the Emergency rooms to Departments, including all the medical specialties. METHODS In order to cope with the contingent state of emergency, the Gynecology and Obstetrics Unit of the University Hospital in Udine introduced new protocols and guidance for the usual standard of care, ensuring a safe environment for both healthcare providers and patients. RESULTS By a continuous update of scientific evidence, the department was able to increase capacity as well as maintain flexibility when a higher number of admissions was required. CONCLUSION We aimed to share our experience, which provided a relevant lesson about what to expect and how to prepare a referral center for high-risk pregnancy in response to a pandemic such as COVID-19.
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Affiliation(s)
- Lorenza Driul
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Francesco Meroi
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Fabiana Cecchini
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Alessia Sala
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Daniele Orso
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Diana Padovani
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Serena Rovida
- Royal London Hospital, Barts Trust NHS, Whitechapel Rd, Whitechapel, London E1 1FR, United Kingdom.
| | - Teresa Dogareschi
- University-Hospital of Udine, Department of Anesthesia and Intensive Care, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Tiziana Bove
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
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Divella M, Vetrugno L, Orso D, Federici N, Russo G, Bove T. Which regional anesthesia technique is the best for arthroscopic shoulder surgery in terms of postoperative outcomes? A comprehensive literature review. Eur Rev Med Pharmacol Sci 2021; 25:985-998. [PMID: 33577054 DOI: 10.26355/eurrev_202101_24668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The literature offers numerous reviews and meta-analyses assessing the different regional anesthesia techniques employed for arthroscopic shoulder surgery (ATS) in terms of diverse outcome parameters. Most have focused on analgesic efficacy in the limited post-operative period as their primary outcome. Indeed, the most up-to-date guidelines are based on the results of comparisons that focus on analgesic efficacy and analgesic drug consumption. However, a correlation has yet to be demonstrated between post-operative analgesia and functional recovery; indeed, the latter has received relatively less research attention concerning the anesthetic technique despite its clinical importance. Here, we aimed to identify the best loco-regional anesthetic technique for ATS, considering all the evaluation parameters considered to date. MATERIALS AND METHODS We performed a comprehensive literature review on ATS, searching for all the relative aspects of the regional anesthesia technique employed and the outcome parameters assessed. RESULTS From the literature, it is not clear which technique is better than the others. No single technique was revealed as being the absolute best, independent of the outcome parameter considered, which included: post-operative analgesic effect, speed of functional recovery, ease, and safety of execution. CONCLUSIONS The choice of anesthetic technique should be tailored to the patient and type of surgery. When comparing one type of loco-regional anesthesia against another, in addition to analgesic efficacy, a whole plethora of aspects need to be considered (i.e., feasibility, complications, contribution to functional recovery, etc.).
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Affiliation(s)
- M Divella
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.
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Venturini S, Cugini F, Orso D, Crapis M, Fossati S, Callegari A, Pontoni E, De Santi L, Arcidiacono D, Lugano M, Vetrugno L, Bove T. Acute kidney injury and single-dose administration of aminoglycoside in the Emergency Department: a comparison through propensity score matching. G Ital Nefrol 2021; 38:38-03-2021-07. [PMID: 34169695] [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: 06/13/2023]
Abstract
Purpose: According to the Surviving Sepsis Campaign, aminoglycosides (AG) can be administered together with a β-lactam in patients with septic shock. Some authors propose administering a single dose of an AG combined with a β-lactam antibiotic in septic patients to extend the spectrum of antibiotic therapy. The aim of this study has been to investigate whether a single shot of AG when septic patients present at the Emergency Department (ED) is associated with acute kidney injury (AKI). Methods: We retrospectively enrolled patients based on a 3-year internal registry of septic patients visited in the Emergency Department (ED) of Pordenone Hospital. We compared the patients treated with a single dose of gentamicin (in addition to the β-lactam) and those who had not been treated to verify AKI incidence. Results: 355 patients were enrolled. The median age was 71 years (IQR 60-78). Less than 1% of the patients had a chronic renal disease. The most frequent infection source was the urinary tract (31%), followed by intra-abdominal and lower respiratory tract infections (15% for both). 131 patients received gentamicin. Unmatched data showed a significant difference between the two groups in AKI (79/131, 60.3% versus 102/224, 45.5%; p=0.010) and in infectious disease specialist's consultation (77/131, 59% versus 93/224, 41.5%; p=0.002). However, after propensity score matching, no significant difference was found. Conclusion: Our experience shows that a single-shot administration of gentamicin upon admission to the ED does not determine an increased incidence of AKI in septic patients.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO Hospital of Pordenone, Pordenone, Italy
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Hospital of San Daniele, San Daniele (UD), Italy
| | - Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO Hospital of Pordenone, Pordenone, Italy
| | - Sara Fossati
- Department of Infectious Diseases, ASFO Hospital of Pordenone, Pordenone, Italy
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO Hospital of Pordenone, Pordenone, Italy
| | - Elisa Pontoni
- Department of Emergency Medicine, ASFO Hospital of Pordenone, Pordenone, Italy
| | - Laura De Santi
- Department of Emergency Medicine, ASFO Hospital of Pordenone, Pordenone, Italy
| | | | - Manuela Lugano
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy
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Guarracino F, Vetrugno L, Forfori F, Corradi F, Orso D, Bertini P, Ortalda A, Federici N, Copetti R, Bove T. Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach. J Cardiothorac Vasc Anesth 2021; 35:1866-1874. [PMID: 32624431 PMCID: PMC7289113 DOI: 10.1053/j.jvca.2020.06.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
Abstract
Lung ultrasound (LU) has a multitude of features and capacities that make it a useful medical tool to assist physicians contending with the pandemic spread of novel coronavirus disease-2019 (COVID-19) caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, an LU approach to patients with suspected COVID-19 is being implemented worldwide. In noncritical COVID-19 patients, 2 new LU signs have been described and proposed, the "waterfall" and the "light beam" signs. Both signs have been hypothesized to increase the diagnostic accuracy of LU for COVID-19 interstitial pneumonia. In critically ill patients, a distinct pattern of LU changes seems to follow the disease's progression, and this information can be used to guide decisions about when a patient needs to be ventilated, as occurs in other disease states similar to COVID-19. Furthermore, a new algorithm has been published, which enables the automatic detection of B-lines as well as quantification of the percentage of the pleural line associated with lung disease. In COVID-19 patients, a direct involvement of cardiac function has been demonstrated, and ventilator-induced diaphragm dysfunction might be present due to the prolonged mechanical ventilation often involved, as reported for similar diseases. For this reason, cardiac and diaphragm ultrasound evaluation are highly important. Last but not least, due to the thrombotic tendency of COVID-19 patients, particular attention also should be paid to vascular ultrasound. This review is primarily devoted to the study of LU in COVID-19 patients. The authors explain the significance of its "light and shadows," bearing in mind the context in which LU is being used-the emergency department and the intensive care setting. The use of cardiac, vascular, and diaphragm ultrasound is also discussed, as a comprehensive approach to patient care.
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Affiliation(s)
- Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Luigi Vetrugno
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy.
| | - Francesco Forfori
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Daniele Orso
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
| | - Pietro Bertini
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Federici
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
| | - Roberto Copetti
- Emergency Department, Azienda Sanitaria Universitaria Friuli Centrale, Latisana General Hospital, Latisana, Italy
| | - Tiziana Bove
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
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Venturini S, Orso D, Cugini F, Crapis M, Fossati S, Callegari A, Pellis T, Tomasello DC, Tonizzo M, Grembiale A, D'Andrea N, Vetrugno L, Bove T. Artificial neural network model from a case series of COVID-19 patients: a prognostic analysis. Acta Biomed 2021; 92:e2021202. [PMID: 33988146 PMCID: PMC8182608 DOI: 10.23750/abm.v92i2.11086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM There is a need to determine which clinical variables predict the severity of COVID-19. We analyzed a series of critically ill COVID-19 patients to see if any of our dataset's clinical variables were associated with patient outcomes. METHODS We retrospectively analyzed the data of COVID-19 patients admitted to the ICU of the Hospital in Pordenone from March 11, 2020, to April 17, 2020. Patients' characteristics of survivors and deceased groups were compared. The variables with a different distribution between the two groups were implemented in a generalized linear regression model (LM) and in an Artificial Neural Network (NN) model to verify the "robustness" of the association with mortality. RESULTS In the considered period, we reviewed the data of 22 consecutive patients: 8 died. The causes of death were a severe respiratory failure (3), multi-organ failure (1), septic shock (1), pulmonary thromboembolism (2), severe hemorrhage (1). Lymphocyte and the platelet count were significantly lower in the group of deceased patients (p-value 0.043 and 0.020, respectively; cut-off values: 660/mm3; 280,000/mm3, respectively). Prothrombin time showed a statistically significant trend (p-value= 0.065; cut-off point: 16.8/sec). The LM model (AIC= 19.032), compared to the NN model (Mean Absolute Error, MAE = 0.02), was substantially alike (MSE 0.159 vs. 0.136). CONCLUSIONS In the context of critically ill COVID-19 patients admitted to ICU, lymphocytopenia, thrombocytopenia, and lengthening of prothrombin time were strictly correlated with higher mortality. Additional clinical data are needed to be able to validate this prognostic score.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Hospital of San Daniele, Udine, Italy.
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Sara Fossati
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Tommaso Pellis
- Department of Anesthesia and Intensive Care, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Dario Carmelo Tomasello
- Department of Anesthesia and Intensive Care, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Maurizio Tonizzo
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Alessandro Grembiale
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Natascia D'Andrea
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
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Deana C, Rovida S, Orso D, Bove T, Bassi F, De Monte A, Vetrugno L. Learning from the Italian experience during COVID-19 pandemic waves: be prepared and mind some crucial aspects. Acta Biomed 2021; 92:e2021097. [PMID: 33988143 PMCID: PMC8182622 DOI: 10.23750/abm.v92i2.11159] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
COVID-19 pandemic has rapidly spread worldwide causing a serious challenge to the global medical community. Italy was struck hard during the first wave earlier this year and several weaknesses as well as general unpreparedness of the national healthcare system were acknowledged. Learning essential lessons from the past, we realized how implementing contingency response measures, human resources and social dynamics could have changed the outcome if promptly adopted. This review translates the previous experience into strategic actions that has to be considered when developing appropriate national and regional operational plans to respond to a pandemic.
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Affiliation(s)
| | - Serena Rovida
- 2Department of Anesthesia and Intensive Care Unit, Saint Bartholomew's Hospital, Barts NHS Trust, London, UK..
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy..
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy..
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Amato De Monte
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy..
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Venturini S, Orso D, Cugini F, Crapis M, Fossati S, Callegari A, Pellis T, Tonizzo M, Grembiale A, Rosso A, Tamburrini M, D'Andrea N, Vetrugno L, Bove T. Classification and analysis of outcome predictors in non-critically ill COVID-19 patients. Intern Med J 2021; 51:506-514. [PMID: 33835685 PMCID: PMC8250466 DOI: 10.1111/imj.15140] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
Background Early detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐infected patients who could develop a severe form of COVID‐19 must be considered of great importance to carry out adequate care and optimise the use of limited resources. Aims To use several machine learning classification models to analyse a series of non‐critically ill COVID‐19 patients admitted to a general medicine ward to verify if any clinical variables recorded could predict the clinical outcome. Methods We retrospectively analysed non‐critically ill patients with COVID‐19 admitted to the general ward of the hospital in Pordenone from 1 March 2020 to 30 April 2020. Patients' characteristics were compared based on clinical outcomes. Through several machine learning classification models, some predictors for clinical outcome were detected. Results In the considered period, we analysed 176 consecutive patients admitted: 119 (67.6%) were discharged, 35 (19.9%) dead and 22 (12.5%) were transferred to intensive care unit. The most accurate models were a random forest model (M2) and a conditional inference tree model (M5) (accuracy = 0.79; 95% confidence interval 0.64–0.90, for both). For M2, glomerular filtration rate and creatinine were the most accurate predictors for the outcome, followed by age and fraction‐inspired oxygen. For M5, serum sodium, body temperature and arterial pressure of oxygen and inspiratory fraction of oxygen ratio were the most reliable predictors. Conclusions In non‐critically ill COVID‐19 patients admitted to a medical ward, glomerular filtration rate, creatinine and serum sodium were promising predictors for the clinical outcome. Some factors not determined by COVID‐19, such as age or dementia, influence clinical outcomes.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Hospital of San Daniele, Udine, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Sara Fossati
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Tommaso Pellis
- Department of Anesthesia and Intensive Care, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Alessandro Grembiale
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Alessia Rosso
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Mario Tamburrini
- Department of Pneumology, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Natascia D'Andrea
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
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Vetrugno L, Bignami E, Deana C, Bassi F, Vargas M, Orsaria M, Bagatto D, Intermite C, Meroi F, Saglietti F, Sartori M, Orso D, Robiony M, Bove T. Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports. Scand J Trauma Resusc Emerg Med 2021; 29:47. [PMID: 33712051 PMCID: PMC7953582 DOI: 10.1186/s13049-021-00861-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/01/2020] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background The incidence of cerebral fat embolism (CFE) ranges from 0.9–11%, with a mean mortality rate of around 10%. Although no univocal explanation has been identified for the resulting fat embolism syndrome (FES), two hypotheses are widely thought: the ‘mechanical theory’, and the ‘chemical theory’. The present article provides a systematic review of published case reports of FES following a bone fracture. Methods We searched MEDLINE, Web of Science and Scopus to find any article related to FES. Inclusion criteria were: trauma patients; age ≥ 18 years; and the clinical diagnosis of CFE or FES. Studies were excluded if the bone fracture site was not specified. Results One hundred and seventy studies were included (268 cases). The male gender was most prominent (81.6% vs. 18.4%). The average age was 33 years (±18). The mean age for males (29 ± 14) was significantly lower than for females (51 ± 26) (p < 0.001). The femur was the most common fracture site (71% of cases). PFO was found in 12% of all cases. Univariate and multivariate regression analyses showed the male gender to be a risk factor for FES: RR 1.87 and 1.41, respectively (95%CI 1.27–2.48, p < 0.001; 95%CI 0.48–2.34, p < 0.001). Conclusions FES is most frequent in young men in the third decades of life following multiple leg fractures. FES may be more frequent after a burst fracture. The presence of PFO may be responsible for the acute presentation of cerebral embolisms, whereas FES is mostly delayed by 48–72 h. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00861-x.
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. .,Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.
| | - Elena Bignami
- Department of Medicine and Surgery, Unit of Anesthesiology, Parma University Hospital, Parma, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Unit 1, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Unit 2, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Orsaria
- Department of Medicine, Surgical Pathology Section, University of Udine, Udine, Italy
| | - Daniele Bagatto
- Department of Diagnostic Imaging, Neuroradiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Cristina Intermite
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | - Francesco Meroi
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | | | - Marco Sartori
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | - Daniele Orso
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | - Massimo Robiony
- Department of Medicine, Maxillofacial Surgery, University of Udine, Udine, Italy.,Azienda Sanitaria Universitaria Friuli Centrale, Maxillofacial Surgery, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
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Marin M, Orso D, Federici N, Vetrugno L, Bove T. D-dimer specificity and clinical context: an old unlearned story. Crit Care 2021; 25:101. [PMID: 33691711 PMCID: PMC7944469 DOI: 10.1186/s13054-021-03532-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/04/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matteo Marin
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Italy. .,Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Via Colugna 50, 33100, Udine, Italy.
| | - Nicola Federici
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
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40
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Orso D, Vetrugno L, Bove T. Ventilation During Cardiac Arrest and After Return of Spontaneous Circulation: More than a Family Affair . . . the Truth Will Be in the Details. Respir Care 2021; 66:539. [PMID: 33632793 PMCID: PMC9994070 DOI: 10.4187/respcare.08814] [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] [Indexed: 11/05/2022]
Affiliation(s)
- Daniele Orso
- Department of Medicine University of Udine Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Clinic ASUFC University Hospital Santa Maria della Misericordia Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Clinic ASUFC University Hospital Santa Maria della Misericordia Udine, Italy
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Abstract
Ventilation during chest compressions can lead to an increase in peak inspiratory pressure. High inspiratory pressure can raise the risk of injury to the respiratory system and make it challenging to deliver the required tidal volume. The utilization of mechanical devices for chest compression has exacerbated this challenge. The aim of this narrative review was to summarize the different mechanical ventilation strategies applied during mechanical cardiopulmonary resuscitation (CPR). To this end, we searched the PubMed and BioMed Central databases from inception to January 2020, using the search terms "mechanical ventilation," "cardiac arrest," "cardiopulmonary resuscitation," "mechanical cardiopulmonary resuscitation," and their related terms. We included all studies (human clinical or animal-based research studies, as well as studies using simulation models) to explore the various ventilation settings during mechanical CPR. We identified 842 relevant articles on PubMed and 397 on BioMed Central; a total of 38 papers were judged to be specifically related to the subject of this review. Of this sample, 17 studies were conducted on animal models, 6 considered a simulated scenario, 13 were clinical studies (5 of which were retrospective), and 2 studies constituted literature review articles. The main finding arising from the assessment of these publications is that a high [Formula: see text] must be guaranteed during CPR. Low-grade evidence suggests turning off inspiratory triggering and applying PEEP ≥ 5 cm H2O. The analysis also revealed that many uncertainties persist regarding the ideal choice of ventilation mode, tidal volume, the ventilation rate setting, and the inspiratory:expiratory ratio. None of the current international guidelines indicate the "best" mechanical ventilation strategy to apply during mechanical CPR. We propose an operating algorithm worthy of future discussion and study. Future studies specifically addressing the topics covered in this review are required.
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Affiliation(s)
- Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy.
- Department of Anesthesia and Intensive Care Clinic, ASUFC University Hospital Santa Maria della Misericordia, Udine, Italy
| | | | - Matteo Borselli
- Department of Emergency Medicine, Azienda Usl Toscana Sud-Est, Grosseto, Italy
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, Sant'Anna Hospital, Ferrara, Italy
| | - Gianmaria Cammarota
- Department of Anaesthesia and General Intensive Care, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care Clinic, ASUFC University Hospital Santa Maria della Misericordia, Udine, Italy
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Orso D, Vetrugno L, Federici N, D'Andrea N, Bove T. Endotracheal intubation to reduce aspiration events in acutely comatose patients: a systematic review. Scand J Trauma Resusc Emerg Med 2020; 28:116. [PMID: 33303004 PMCID: PMC7726605 DOI: 10.1186/s13049-020-00814-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/04/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background It is customary to believe that a patient with a Glasgow Coma Scale (GCS) score less than or equal to 8 should be intubated to avoid aspiration. We conducted a systematic review to establish if patients with GCS ≤ 8 for trauma or non-traumatic emergencies and treated in the acute care setting (e.g., Emergency Department or Pre-hospital environment) should be intubated to avoid aspiration or aspiration pneumonia/pneumonitis, and consequently, reduce mortality. Methods We searched six databases, Pubmed, Embase, Scopus, SpringerLink, Cochrane Library, and Ovid Emcare, from April 15th to October 14th, 2020, for studies involving low GCS score patients of whom the risk of aspiration and related complications was assessed. Results Thirteen studies were included in the final analysis (7 on non-traumatic population, 4 on trauma population, 1 pediatric and 1 adult mixed case studies). For the non-traumatic cases, two prospective studies and one retrospective study found no difference in aspiration risk between intubated and non-intubated patients. Two retrospective studies reported a reduction in the risk of aspiration in the intubated patient group. For traumatic cases, the study that considered the risk of aspiration did not show any differences between the two groups. A study on adult mixed cases found no difference in the incidence of aspiration among intubated and non-intubated patients. A study on pediatric patients found increased mortality for intubated versus non-intubated non-traumatic patients with a low GCS score. Conclusion Whether intubation results in a reduction in the incidence of aspiration events and whether these are more frequent in patients with low GCS scores are not yet established. The paucity of evidence on this topic makes clinical trials justifiable and necessary. Trial registration Prospero registration number: CRD42020136987. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-020-00814-w.
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Affiliation(s)
- Daniele Orso
- Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100, Udine, Italy. .,Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital "Santa Maria della Misericordia" of Udine, Udine, Italy.
| | - Nicola Federici
- Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100, Udine, Italy
| | - Natascia D'Andrea
- Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, P.le S. Maria della Misericordia 15, 33100, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital "Santa Maria della Misericordia" of Udine, Udine, Italy
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43
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Corradi F, Vetrugno L, Orso D, Bove T, Schreiber A, Boero E, Santori G, Isirdi A, Barbieri G, Forfori F. Diaphragmatic thickening fraction as a potential predictor of response to continuous positive airway pressure ventilation in Covid-19 pneumonia: A single-center pilot study. Respir Physiol Neurobiol 2020; 284:103585. [PMID: 33197604 PMCID: PMC7664482 DOI: 10.1016/j.resp.2020.103585] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 08/14/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In a variable number of Covid-19 patients with acute respiratory failure, non-invasive breathing support strategies cannot provide adequate oxygenation, thus making invasive mechanical ventilation necessary. Factors predicting this unfavorable outcome are unknown, but we hypothesized that diaphragmatic weakness may contribute. METHODS We prospectively analyzed the data of 27 consecutive patients admitted to the general Intensive Care Unit (ICU) from March 19, 2020, to April 20, 2020 and submitted to continuous positive airway pressure (CPAP) before considering invasive ventilation. Diaphragmatic thickening fraction (DTF) inferred by ultrasound was determined before applying CPAP. RESULTS Eighteen patients recovered with CPAP, whereas nine required invasive mechanical ventilation with longer stay in ICU (p < 0.001) and hospital (p = 0.003). At univariate logistic regression analysis, CPAP failure was significantly associated with low DTF [β: -0.396; OR: 0.673; p < 0.001] and high respiratory rate [β: 0.452; OR: 1.572; p < 0.001] but only DTF reached statistical significance at multivariate analysis [β: -0.384; OR: 0.681; p < 0.001]. The DTF best threshold predicting CPAP failure was 21.4 % (AUC: 0.944; sensitivity: 94.4 %, specificity: 88.9 %). CONCLUSIONS In critically ill patients with Covid-19 respiratory failure admitted to ICU, a reduced DTF could be a potential predictor of CPAP failure and requirement of invasive ventilation.
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Affiliation(s)
- Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy; Department of Anesthesiology. Ente Ospedaliero Ospedali Galliera, Genova, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria Della Misericordia University Hospital of Udine, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria Della Misericordia University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria Della Misericordia University Hospital of Udine, Udine, Italy
| | - Annia Schreiber
- Interdepartmental Division of Critical Care, University of Toronto, Unity Health Toronto (St Michael's Hospital) and the Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Enrico Boero
- Dipartimento di Scienze Chirurgiche, Università Degli Studi di Torino, Turin, Italy
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Isirdi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
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44
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Vetrugno L, Bove T, Orso D, Bassi F, Boero E, Ferrari G. Lung Ultrasound and the COVID-19 "Pattern": Not All That Glitters Today Is Gold Tomorrow. J Ultrasound Med 2020; 39:2281-2282. [PMID: 32383793 PMCID: PMC7272952 DOI: 10.1002/jum.15327] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 05/08/2023]
Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, Anesthesia and Intensive Care ClinicUniversity of UdineUdineItaly
- Department of Anesthesia and Intensive CareUniversity Hospital of UdineUdineItaly
| | - Tiziana Bove
- Department of Medicine, Anesthesia and Intensive Care ClinicUniversity of UdineUdineItaly
- Department of Anesthesia and Intensive CareUniversity Hospital of UdineUdineItaly
| | - Daniele Orso
- Department of Medicine, Anesthesia and Intensive Care ClinicUniversity of UdineUdineItaly
| | - Flavio Bassi
- Department of Anesthesia and Intensive CareUniversity Hospital of UdineUdineItaly
| | - Enrico Boero
- Department of Anesthesia and Intensive CareSan Giovanni Bosco HospitalTorinoItaly
| | - Giovanni Ferrari
- S. C. Pneumologia ad Indirizzo Semi Intensivo, Azienda Ospedaliera Ordine MaurizianoTorinoItaly
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Copetti R, Amore G, Di Gioia CC, Orso D. First comes the A, then the B: what we learned from the COVID-19 outbreak. Eur J Intern Med 2020; 80:108-110. [PMID: 32620500 PMCID: PMC7321044 DOI: 10.1016/j.ejim.2020.06.031] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/20/2020] [Accepted: 06/25/2020] [Indexed: 11/20/2022]
Abstract
The SARS-CoV-2 epidemic, which has spread to many countries around the world, has hit Europe particularly hard. From our point of view, in a rural emergency department (with an annual patient census of around 25,000) in northeastern Italy, it is necessary to preserve the hospital and prevent it from becoming an outbreak of infection. In our experience, we reevaluated the negative predictive value of lung ultrasound to rule out lung involvement. Since severe acute respiratory failure appears to be the leading cause of death for COVID-19 patients, it is essential to focus on this clinical feature. We currently believe that a patient suspected of COVID-19, if he has a normal ultrasound examination (a so-called "A-profile"), can be discharged home to continue isolation and be treated without being hospitalized.
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Affiliation(s)
- Roberto Copetti
- Department of Emergency Medicine, ASUFC Latisana Community Hospital, Latisana (UD), Italy
| | - Giulia Amore
- Department of Emergency Medicine, ASUFC Latisana Community Hospital, Latisana (UD), Italy
| | | | - Daniele Orso
- Anesthesia and Intensive Care Medicine, Department of Medicine, University of Udine, Udine, Italy..
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Spasiano A, Barbarino C, Marangone A, Orso D, Trillò G, Giacomello R, Bove T, Della Rocca G. Early thromboelastography in acute traumatic coagulopathy: an observational study focusing on pre-hospital trauma care. Eur J Trauma Emerg Surg 2020; 48:431-439. [PMID: 32929548 PMCID: PMC8825617 DOI: 10.1007/s00068-020-01493-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/04/2020] [Indexed: 01/20/2023]
Abstract
Background Major brain injury and uncontrolled blood loss remain the primary causes of early trauma-related mortality. One-quarter to one-third of trauma patients exhibit trauma-induced coagulopathy (TIC). Thromboelastometry (ROTEM) and thrombelastography (TEG) are valuable alternatives to standard coagulation testing, providing a more comprehensive overview of the coagulation process. Purpose Evaluating thromboelastographic profile, the incidence of fibrinolysis (defined as Ly30 > 3%) in severe trauma patients, and factors influencing pathological coagulation pattern. Methods Prospective observational 2 years cohort study on severe trauma patients assisted by Helicopter Emergency Medical System (HEMS) and Level 1 Trauma Center, in a tertiary referral University Hospital. Results Eighty three patients were enrolled, mean NISS (new injury severity score) 36 (± 13). Mean R value decreased from 7.25 (± 2.6) to 6.19 (± 2.5) min (p < 0.03); 48 (60%) patients had a reduction in R from T0 to T1. In NISS 25–40 and NISS > 40 groups, changes in R value increased their significance (p = 0.04 and p < 0.03, respectively). Pathological TEG was found in 71 (88.8%) patients at T0 and 74 (92.5%) at T1. Hypercoagulation was present in 57 (71.3%) patients at T0, and in 66(82.5%) at T1. 9 (11.3%) patients had hyperfibrinolysis at T0, 7 (8.8%) patients at T1. Prevalence of StO2 < 75% at T0 was greater in patients whose TEG worsened (7 patients, 46.7%) against whose TEG remained stable or improved (8 patients, 17.4%) from T0 to T1 (p = 0.02). 48 (57.8%) patients received < 1000 mL of fluids, while 35 (42.2%) received ≥ 1000 mL. The first group had fewer patients with hypercoagulation (20, 41.6%) than the second (6, 17.6%) at T1 (p < 0.03). No differences were found for same TEG pattern at T0, nor other TEG pattern. Conclusion Our population is representative of a non-hemorrhagic severe injury subgroup. Almost all of our trauma population had coagulation abnormalities immediately after the trauma; pro-coagulant changes were the most represented regardless of the severity of injury. NISS appears to affect only R parameter on TEG. Hyperfibrinolysis has been found in a low percentage of patients. Hypoperfusion parameters do not help to identify patients with ongoing coagulation impairment. Small volume resuscitation and mild hypotermia does not affect coagulation, at least in the early post-traumatic phase. Electronic supplementary material The online version of this article (10.1007/s00068-020-01493-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessandra Spasiano
- Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Cristina Barbarino
- Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Anna Marangone
- Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy.
| | - Daniele Orso
- Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Giulio Trillò
- HEMS Division, Department of Anesthesia and Intensive Care Medicine, ASUFC Udine, 33100, Udine, Italy
| | - Roberta Giacomello
- Department of Laboratory Medicine, Institute of Clinical Pathology, University of Udine, ASUFC Udine, 33100, Udine, Italy
| | - Tiziana Bove
- Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Giorgio Della Rocca
- Anesthesiology and Intensive Care Medicine, Department of Medicine, University of Udine, ASUFC Udine, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy
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47
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Delrio S, Vetrugno L, Orso D, Deana C, D'Andrea N, Bove T. Lung ultrasound signs and cytokine profile in Covid-19 patients: a case series. Eur Rev Med Pharmacol Sci 2020; 24:8632-8634. [PMID: 32964950 DOI: 10.26355/eurrev_202009_22799] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- S Delrio
- Department of Medicine, University of Udine, Udine, Italy.
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48
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Copetti R, Cominotto F, Meduri S, Orso D. The "Survived Lung:" An Ultrasound Sign of "Bubbly Consolidation" Pulmonary Infarction. Ultrasound Med Biol 2020; 46:2546-2550. [PMID: 32507699 DOI: 10.1016/j.ultrasmedbio.2020.04.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 09/24/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
Since the presence of "bubbly consolidation" (central lucencies) on a multi-slice computed tomography pulmonary angiography (MCTPA) is one of the highly specific imaging appearances of infarct secondary to pulmonary embolism, we investigated the ultrasound characteristics of these infarctions. In this study, 118 patients with MCTPA diagnosis of acute pulmonary embolism were enrolled. Pulmonary infarctions were detected in 21 patients (17.7%), of which 10 (47.6%) showed the typical appearance of bubbly consolidation on MCTPA. Lung ultrasound (LUS) was performed to evaluate the characteristics of the infarcts highlighted by MCTPA. The bubbly consolidations showed a very peculiar echographic aspect represented by a triangular hypoechoic consolidation with sharp margins, the absence of air bronchograms and a mostly central roundish hyperechoic area. Air lucencies within a pulmonary infarct is hypothesized to represent the coexistence of aerated non-infarcted lung with the infarcted lung in the same lobule. The ultrasound appearance confirms this hypothesis, so we named the roundish hyperechoic area the "survived lung." This picture was found in all patients with a diagnosis of bubbly consolidation on MCTPA (100%). Χ2 between MCTPA and LUS regarding the bubbly consolidation diagnosis is 17.18 (df = 1; p value = 0.00003). Bubbly consolidations show a very typical appearance on LUS. Their detection suggests further investigations (MCTPA or point-of-care multi-organ ultrasonography).
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Affiliation(s)
- Roberto Copetti
- Department of Emergency Medicine, University Hospital of Cattinara, Trieste, Italy
| | - Franco Cominotto
- Department of Emergency Medicine, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Stefano Meduri
- Radiology Department, Latisana/Palmanova Hospitals, Latisana (UD), Italy
| | - Daniele Orso
- Anesthesiology and Intensive Care Medicine Division, Department of Medicine, ASUIUD University Hospital of Udine, Udine, Italy.
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Vetrugno L, Orso D, Deana C, Bassi F, Bove T. COVID-19 Diagnostic Imaging: Caution Need Before the End of the Game. Acad Radiol 2020; 27:1331. [PMID: 32593539 PMCID: PMC7305904 DOI: 10.1016/j.acra.2020.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/25/2022]
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Vetrugno L, Baciarello M, Bignami E, Bonetti A, Saturno F, Orso D, Girometti R, Cereser L, Bove T. The "pandemic" increase in lung ultrasound use in response to Covid-19: can we complement computed tomography findings? A narrative review. Ultrasound J 2020; 12:39. [PMID: 32785855 PMCID: PMC7422672 DOI: 10.1186/s13089-020-00185-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease of 2019 (COVID-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has rapidly spread to a global pandemic in March 2020. This emergency condition has been putting a severe strain on healthcare systems worldwide, and a prompt, dynamic response is instrumental in its management. While a definite diagnosis is based on microbiological evidence, the relationship between lung ultrasound (LU) and high-resolution computed tomography (HRCT) in the diagnosis and management of COVID-19 is less clear. Lung ultrasound is a point-of-care imaging tool that proved to be useful in the identification and severity assessment of different pulmonary conditions, particularly in the setting of emergency and critical care patients in intensive care units; HRCT of the thorax is regarded as the mainstay of imaging evaluation of lung disorders, enabling characterization and quantification of pulmonary involvement. Aims of this review are to describe LU and chest HRCT main imaging features of COVID-19 pneumonia, and to provide state-of-the-art insights regarding the integrated role of these techniques in the clinical decision-making process of patients affected by this infectious disease.
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Affiliation(s)
- Luigi Vetrugno
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Marco Baciarello
- Anesthesia, Critical Care and Pain Medicine Unit, Department of Medicine and Surgery, University of Parma, Viale Gramsci, 14, 431236, Parma, Italy.
| | - Elena Bignami
- Anesthesia, Critical Care and Pain Medicine Unit, Department of Medicine and Surgery, University of Parma, Viale Gramsci, 14, 431236, Parma, Italy
| | - Andrea Bonetti
- Anesthesia, Critical Care and Pain Medicine Unit, Department of Medicine and Surgery, University of Parma, Viale Gramsci, 14, 431236, Parma, Italy
| | - Francesco Saturno
- Anesthesia, Critical Care and Pain Medicine Unit, Department of Medicine and Surgery, University of Parma, Viale Gramsci, 14, 431236, Parma, Italy
| | - Daniele Orso
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Tiziana Bove
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine, Italy
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