1
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Franchini S, Mette F, Landoni G, Setti E, Ferrante L, Calcaterra B, Pagliula G, Barbieri A, Fontani D, Borio G, Citro M, Farolfi F, Suma G, Monti G, Colombo S, Dagna L, Rovere-Querini P, DE Cobelli F, Castagna A, Ciceri F, Zangrillo A, Tresoldi M, Secchi A, Etteri M. Gas-exchange deficit and systemic hypoperfusion in COVID-19 and non-COVID-19 young adult patients with pneumonia. Panminerva Med 2024; 66:27-35. [PMID: 35119247 DOI: 10.23736/s0031-0808.22.04562-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lung damage leading to gas-exchange deficit and sepsis leading to systemic hypoperfusion are well-known features of severe pneumonia. Although frequently described in COVID-19, their prognostic impact in COVID-19-related pneumonia versus COVID-19-unrelated pneumonia has never been compared. This study assesses fundamental gas-exchange and hemodynamic parameters and explores their prognostic impact in COVID-19 pneumonia and non-COVID-19 pneumonia. METHODS We prospectively evaluated arterial pO2/FiO2, alveolar to arterial O2 gradient, shock index, and serum lactate in 126 COVID-19 pneumonia patients, aged 18-65, presenting to the emergency department with acute, non-hypercapnic respiratory failure. As a control group we identified 1:1 age-, sex-, and pO2/FiO2-matched COVID-19-urelated pneumonia patients. Univariate and multivariable predictors of 30-day survival were identified in both groups. RESULTS COVID-19 patients showed lower arterial serum lactate concentration (P<0.001) and shock index (P<0.001) values as compared to non-COVID-19 patients. While we did not observe differences in lactate concentration or in shock index values in deceased vs. surviving COVID-19 patients (P=0.7 and P=0.6, respectively), non-COVID-19 deceased patients showed significantly higher lactate and shock index than non-COVID-19 survivors (P<0.001 and P=0.03). The pO2/FiO2 was the most powerful determinant of survival by Cox regression multivariate analysis in COVID-19 patients (P=0.006), while it was lactate in non-COVID-19 patients (P=0.001). CONCLUSIONS As compared to COVID19-unrelated pneumonia, COVID-19 pneumonia outcome seems more strictly correlated to the extent of lung damage, rather than to the systemic circulatory and metabolic derangements typical of sepsis.
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Affiliation(s)
- Stefano Franchini
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Francesca Mette
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Eleonora Setti
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Ferrante
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Calcaterra
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaia Pagliula
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Dario Fontani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgia Borio
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Citro
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Farolfi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Gloria Suma
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Monti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sergio Colombo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco DE Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Fabio Ciceri
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Antonio Secchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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2
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Pratesi C, Esposito D, Martini R, Novali C, Zaninelli A, Annese AL, Baggi P, Bellosta R, Bianchini Massoni C, Bonardelli S, Carriero S, Cervelli R, Chisci E, Cioni R, Corvino F, DE Cobelli F, Fanelli F, Fargion AT, Femia M, Freyrie A, Gaggiano A, Gallitto E, Gennai S, Giampalma E, Giurazza F, Grego F, Guazzarotti G, Ierardi AM, Kahlberg AL, Mascia D, Mezzetto L, Michelagnoli S, Nardelli F, Niola R, Lenti M, Perrone O, Piacentino F, Piffaretti G, Pulli R, Puntel G, Puppini G, Rossato D, Rossi M, Silingardi R, Sirignano P, Squizzato F, Tipaldi MA, Venturini M, Veraldi GF, Vizzuso A, Allievi S, Attisani L, Fino G, Ghirardini F, Manzo P, Migliari M, Steidler S, Miele V, Taurino M, Orso M, Cariati M. Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM). J Cardiovasc Surg (Torino) 2024; 65:49-63. [PMID: 38037721 DOI: 10.23736/s0021-9509.23.12809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended.
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Affiliation(s)
- Carlo Pratesi
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Davide Esposito
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy -
| | - Romeo Martini
- Department of Angiology, San Martino Hospital, Belluno, Italy
| | - Claudio Novali
- Department of Vascular Surgery, GVM Maria Pia Hospital, Turin, Italy
| | | | - Antonio L Annese
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Paolo Baggi
- Department of Vascular Surgery, ASST Spedali Civili, Brescia, Italy
| | - Raffaello Bellosta
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | | | | | - Serena Carriero
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Cervelli
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Emiliano Chisci
- Department of Vascular Surgery, S. Giovanni di Dio Hospital, Florence, Italy
| | - Roberto Cioni
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Fabio Corvino
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Francesco DE Cobelli
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Fabrizio Fanelli
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Aaron T Fargion
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Marco Femia
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Antonio Freyrie
- Department of Vascular Surgery, University Hospital of Parma, Parma, Italy
| | - Andrea Gaggiano
- Department of Vascular Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Enrico Gallitto
- Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Stefano Gennai
- Department of Vascular Surgery, Baggiovara Hospital, Modena, Italy
| | - Emanuela Giampalma
- Department of Diagnostic and Interventional Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Francesco Giurazza
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Franco Grego
- Department of Vascular Surgery, University Hospital of Padua, Padua, Italy
| | - Giorgia Guazzarotti
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Anna M Ierardi
- Department of Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Daniele Mascia
- Department of Vascular Surgery, San Raffaele Hospital, Milan, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | | | - Floriana Nardelli
- Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
| | - Raffaella Niola
- Department of Diagnostic and Interventional Radiology, AORN Cardarelli, Naples, Italy
| | - Massimo Lenti
- Department of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Orsola Perrone
- Department of Diagnostic and Interventional Radiology, A.O.U. Pisana, Pisa, Italy
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Varese, Italy
| | | | - Raffaele Pulli
- Department of Vascular Surgery, Careggi University Hospital, Florence, Italy
| | - Gino Puntel
- Department of Diagnostic and Interventional Radiology, University Hospital of Verona, Verona, Italy
| | - Giovanni Puppini
- Department of Diagnostic and Interventional Radiology, University Hospital of Verona, Verona, Italy
| | - Denis Rossato
- Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
| | - Michele Rossi
- Department of Diagnostic and Interventional Radiology, Sant'Andrea University Hospital, Rome, Italy
| | | | | | | | - Marcello A Tipaldi
- Department of Diagnostic and Interventional Radiology, Sant'Andrea University Hospital, Rome, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Varese, Italy
| | - Gian F Veraldi
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | - Antonio Vizzuso
- Department of Diagnostic and Interventional Radiology, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Sara Allievi
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Attisani
- Department of Vascular Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - Gianluigi Fino
- Department of Vascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Paola Manzo
- Department of Vascular Surgery, Umberto I Mauriziano Hospital, Turin, Italy
| | - Mattia Migliari
- Department of Vascular Surgery, Baggiovara Hospital, Modena, Italy
| | - Stephanie Steidler
- Department of Diagnostic and Interventional Radiology, San Raffaele Hospital, Milan, Italy
| | - Vittorio Miele
- Department of Diagnostic and Interventional Radiology, Careggi University Hospital, Florence, Italy
| | - Maurizio Taurino
- Department of Vascular Surgery, Sant'Andrea University Hospital, Rome, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - Maurizio Cariati
- Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, Milan, Italy
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3
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Tresoldi M, Zangrillo A, Belletti A, Ramirez GA, Bozzolo E, Guzzo F, Marinosci A, Fominskiy EV, DA Prat V, Marmiere M, Palumbo D, Del Prete L, D'Amico F, Bellino C, Morando D, Saracino M, Ortalda A, Castelli E, Rocchi M, Baiardo Redaelli M, Scotti R, DI Terlizzi G, Azzolini ML, Guaschino G, Avitabile E, Borghi G, Soddu D, Dagna L, Landoni G, DE Cobelli F. Two-year multidisciplinary follow-up of COVID-19 patients requiring invasive and noninvasive respiratory support. Minerva Med 2023; 114:773-784. [PMID: 37021472 DOI: 10.23736/s0026-4806.22.08397-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND COVID-19 patients frequently develop respiratory failure requiring mechanical ventilation. Data on long-term survival of patients who had severe COVID-19 are insufficient. We assessed and compared two-year survival, CT imaging, quality of life, and functional recovery of COVID-19 ARDS patients requiring respiratory support with invasive (IMV) versus noninvasive ventilation (NIV). METHODS Patients with COVID-19 pneumonia admitted up to May 28th, 2020, who required IMV or NIV, and survived to hospital discharge were enrolled. Patients were contacted two years after discharge to assess vital status, functional, psychological, and cognitive outcomes using validated scales. Patients with persistent respiratory symptoms or high burden of residual lung damage at previous CT scan received a two-year chest CT scan. RESULTS Out of 61 IMV survivors, 98% were alive at two-year follow-up, and 52 completed the questionnaire. Out of 82 survivors receiving NIV only, 94% were alive at two years, and 47 completed the questionnaire. We found no major differences between invasively and noninvasively ventilated patients, with overall acceptable functional recovery. Among the 99 patients completing the questionnaire, 23 have more than moderate exertional dyspnea. Chest CT scans showed that 4 patients (all received IMV) had fibrotic-like changes. CONCLUSIONS Patients who received mechanical ventilation due to COVID-19 and were discharged from hospital had a 96% survival rate at the two-year follow-up. There was no difference in overall recovery and quality of life between patients who did and did not require IMV, although respiratory morbidity remains high.
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Affiliation(s)
- Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Guzzo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny V Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina DA Prat
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marilena Marmiere
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lidia Del Prete
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo D'Amico
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Bellino
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Deodata Morando
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Saracino
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Castelli
- Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Rocchi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Baiardo Redaelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaetano DI Terlizzi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria L Azzolini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Giulia Guaschino
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emma Avitabile
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Borghi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Soddu
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco DE Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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4
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Ramirez GA, Bozzolo EP, Gobbi A, Castelli E, Centurioni C, DI Meo M, Della Torre E, DI Scala F, Morgillo A, Marinosci A, Miglio M, Scarpellini P, Tassan Din C, Castiglioni B, Oltolini C, Ripa M, DI Terlizzi G, DA Prat V, Damanti S, Scotti R, DI Lucca G, Baiardo Redaelli M, Plumari VP, Moizo E, Carcó F, Silvani P, DE Cobelli F, Landoni G, Tresoldi M. Outcomes of non-invasive ventilation as the ceiling of treatment in patients with COVID-19. Panminerva Med 2021; 64:506-516. [PMID: 33860653 DOI: 10.23736/s0031-0808.21.04280-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Non-invasive mechanical ventilation (NIV) is effective for symptom relief and respiratory support in patients with respiratory insufficiency, severe comorbidities and no indication to intubation. Experience with NIV as the ceiling of treatment in severely compromised novel coronavirus disease (COVID-19) patients is lacking. METHODS We evaluated 159 patients with COVID-19-related acute respiratory syndrome (ARDS), 38 of whom with NIV as the ceiling of treatment, admitted to an ordinary ward and treated with continuous positive airway pressure (CPAP) and respiratory physiotherapy. Treatment failure and death were correlated with clinical and laboratory parameters in the whole cohort and in patients with NIV as the ceiling of treatment. RESULTS Patients who had NIV as the ceiling of treatment were elderly, with a low BMI and a high burden of comorbidities, showed clinical and laboratory signs of multi-organ insufficiency on admission and of rapidly deteriorating vital signs during the first week of treatment. NIV failure occurred overall in 77 (48%) patients, and 27/38 patients with NIV as the ceiling of treatment died. Congestive heart failure, chronic benign haematological diseases and inability/refusal to receive respiratory physiotherapy were independently associated to NIV failure and mortality. Need for increased positive end-expiratory pressures and low platelets were associated with NIV failure. Death was associated to cerebrovascular disease, need for CPAP cycles longer than 12h and, in the subgroup of patients with NIV as the ceiling of treatment, was heralded by vital sign deterioration within 48 h. CONCLUSIONS NIV and physiotherapy are a viable treatment option for patients with severe COVID-19 and severe comorbidities.
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Affiliation(s)
- Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy - .,Vita-Salute San Raffaele University, Milan, Italy -
| | - Enrica P Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Agnese Gobbi
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Castelli
- Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Clarissa Centurioni
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mattia DI Meo
- Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuel Della Torre
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Flavia DI Scala
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Morgillo
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Paolo Scarpellini
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Tassan Din
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Castiglioni
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ripa
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaetano DI Terlizzi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina DA Prat
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe DI Lucca
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Baiardo Redaelli
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina P Plumari
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Moizo
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Carcó
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Silvani
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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5
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Nini A, Muttin F, Cianflone F, Carenzi C, Luciano R, Catena M, Larcher A, Salvioni M, Cazzaniga W, Pederzoli F, Matloob R, Colombo R, Paganelli M, Salonia A, Briganti A, Doglioni C, Zangrillo A, DE Cobelli F, Rigatti P, Freschi M, Cornero G, Nicoletti R, Aldrighetti L, Montorsi F, Capitanio U, Bertini R. Perioperative and oncologic outcomes of open radical nephrectomy and inferior vena cava thrombectomy with liver mobilization and Pringle maneuver for Mayo III level tumor thrombus: single institution experience. Minerva Urol Nephrol 2020; 73:746-753. [PMID: 33242949 DOI: 10.23736/s2724-6051.20.03844-8] [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: 11/08/2022]
Abstract
BACKGROUND Scarce data are available regarding the technique and outcomes for patients with RCC and Mayo III caval thrombi. The aim of this study was to report surgical and oncological outcomes of RCC patients with Mayo III thrombi treated with radical nephrectomy and thrombectomy after liver mobilization (LM) and Pringle maneuver (PM). METHODS Retrospective analysis of surgical technique, outcomes and cancer control in 19 patients undergoing LM and PM in a single tertiary care institution were analyzed. RESULTS Overall, 78% of the patients had performance status ECOG 1 and 58% had a Comorbidity Index >2. Median surgical time was 305 minutes (IQR 264-440). Intraoperative complications were reported for 39% of patients and postoperative complications for 58% (only grade 1 and 2). Intensive Care Unit support was necessary in 16% of the cases. Median length of hospital stay was 9 days (IQR: 7-11). Thirty- and 90-day mortality were 5% and 15%. Two-year overall survival and cancer-specific survival were 60% and 62%, respectively. CONCLUSIONS We reported surgical techniques, intra- and perioperative complications and follow-up in the largest cohort of RCC patients requiring LM and PM.
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Affiliation(s)
- Alessandro Nini
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy.,Department of Urology and Pediatric Urology, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Fabio Muttin
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Cianflone
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Cristina Carenzi
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberta Luciano
- Unit of Pathology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Catena
- Unit of Hepatobiliary Surgery, Department of General Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Larcher
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Salvioni
- Unit of Radiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Walter Cazzaniga
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Filippo Pederzoli
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rayan Matloob
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Renzo Colombo
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michele Paganelli
- Unit of Hepatobiliary Surgery, Department of General Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Briganti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudio Doglioni
- Unit of Pathology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Unit of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco DE Cobelli
- Unit of Radiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizio Rigatti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Freschi
- Unit of Pathology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Guglielmo Cornero
- Unit of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Nicoletti
- Unit of Radiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Aldrighetti
- Unit of Hepatobiliary Surgery, Department of General Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Umberto Capitanio
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberto Bertini
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy - .,Unit of Urology, Division of Experimental Oncology, IRCCS San Raffaele Hospital, Milan, Italy
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6
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Melissano G, Mascia D, Atique Gabriel S, Bertoglio L, Venturini M, DE Cobelli F, Del Maschio A, Chiesa R. Hepatic artery aneurysms: open and endovascular repair. J Cardiovasc Surg (Torino) 2016; 59:95-100. [PMID: 27153369 DOI: 10.23736/s0021-9509.16.09220-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND During the last decade endovascular treatment has emerged as an important alternative to open surgical repair because of its reduced invasiveness. Results of both modalities are evaluated in this study. METHODS A retrospective review of 26 patients (18 males and 8 females; mean age: 62±9 years) who underwent surgical open repair of hepatic artery aneurysm (HAA) between 1998 and 2015 was performed. Indications to open or endovascular procedure was based on aneurysm size, anatomical features and operative risk. RESULTS Aneurysm size ranged between 2 and 17 cm (mean value: 3.3 cm). Endovascular treatment was performed in 9 patients (34.6%) while open repair in 17 (65.4%). Endovascular procedures included 5 (55.5%) coils embolization and 4 (44.5%) endograft exclusion. Open repair included 9 (53%) aneurysmectomies with end-to-end anastomosis, 7 (41.1%) aneurysmectomies and bypass grafting and 1 (5.9%) simple ligation. In the surgical group, one case of respiratory insufficiency and one myocardial infarction were observed. A 7 cm pseudoaneurysm was found during follow-up for a hepatic artery aneurysm treated 8 years before: the patient underwent re-laparotomy and artery ligation. In the endovascular group, a stent-graft thrombosis occurred and one case of aneurysm reperfusion after coils embolization was found at 48 months follow-up: both patients were treated by means of surgical conversion with aorto-hepatic bypass. CONCLUSIONS Endovascular and open repair are both effective in the treatment of HAA. Type of treatment selection is individualized based on patients' clinical status, aneurysm location and the presence of hepatic collateral circulation.
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Affiliation(s)
- Germano Melissano
- Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy -
| | - Daniele Mascia
- Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Sthefano Atique Gabriel
- Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Bertoglio
- Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Venturini
- Unit of Angiography, Department of Radiology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco DE Cobelli
- Unit of Angiography, Department of Radiology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Del Maschio
- Unit of Angiography, Department of Radiology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Unit of Vascular Surgery, Cardio-Thoracic Department, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
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