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Bottari G, Caruso M, Paionni E, De Luca M, Romani L, Pisani M, Grandin A, Gargiullo L, Zampini G, Gagliardi C, Fegatelli DA, Vestri A, Lancella L, Porzio O, Muda AO, Villani A, Atti MCD, Raponi M, Cecchetti C. Accuracy of Pancreatic Stone Protein for diagnosis of sepsis in children admitted to pediatric intensive care or high-dependency care: a pilot study. Ital J Pediatr 2023; 49:134. [PMID: 37805604 PMCID: PMC10559422 DOI: 10.1186/s13052-023-01540-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Pancreatic Stone Protein (PSP) is one of the most promising diagnostic and prognostic markers. The aim of the study was to assess the accuracy of PSP, compared to C-Reactive Protein (CRP), and Procalcitonin (PCT) for sepsis diagnosis in pediatric patients. Furthermore, we explored the correlation of PSP levels with sepsis severity and organ failure measured with PELOD-2 score. METHODS Forty pediatric patients were enrolled following admission to pediatric intensive care, high dependency care or pediatric ward. PSP blood levels were measured in Emergency Department (nanofluidic point-of-care immunoassay; abioSCOPE, Abionic SA, Switzerland) on day 1, 2, 3, 5 and 7 from the onset of the clinical signs and symptoms of sepsis or SIRS. Inclusion criteria were: 1) patient age (1 month to 18 years old), 2) signs and symptoms of SIRS, irrespective of association with organ dysfunction. Exclusion criteria were: 1) hemato-oncological diseases and/or immunodeficiencies, 2) pancreatic diseases. RESULTS Septic patients showed higher PSP levels than those with non-infectious systemic inflammation. The optimal cut-off in diagnosis of sepsis for PSP at day 1 was 167 ng/ml resulted in a sensitivity of 59% (95% IC 36%-79%) and a specificity of 83% (95% IC 58%-96%) with an AUC of 0.636 for PSP in comparison to AUC of 0.722 for PCT and 0.503 for C-RP. ROC analysis for outcome (survival versus no survival) has showed AUC 0.814 for PSP; AUC 0.814 for PCT; AUC of 0.657 for C-RP. CONCLUSIONS PSP could distinguish sepsis from non-infectious systemic inflammation; however, our results need to be confirmed in larger pediatric population.
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Affiliation(s)
- Gabriella Bottari
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCSS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Mariangela Caruso
- Department of Anesthesia and Intensive Care, Catholic University of Rome, Residency School of Anesthesia and Intensive Care, Catholic University, Rome, Italy
| | - Emanuel Paionni
- Clinical Laboratory Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maia De Luca
- Infectious Disease Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Lorenza Romani
- Infectious Disease Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Mara Pisani
- Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annalisa Grandin
- General Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Livia Gargiullo
- General Pediatric and Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCSS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Chiara Gagliardi
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCSS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy
| | - Laura Lancella
- Infectious Disease Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Ottavia Porzio
- Clinical Laboratory Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Onetti Muda
- Clinical Laboratory Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Scientific Direction, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Disease Unit, Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marta Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit-Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Corrado Cecchetti
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCSS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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Roversi M, Martini M, Musolino A, Pisani M, Zampini G, Genuini L, Bottari G, Di Nardo M, Stoppa F, Marano M. Drug self-poisoning in adolescents: A report of 267 cases. Toxicol Rep 2023; 10:680-685. [PMID: 37304378 PMCID: PMC10247951 DOI: 10.1016/j.toxrep.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction The current study aims at describing a sample of adolescents admitted to a tertiary referral pediatric hospital for drug self-poisoning and to identify variables that could explain and predict a higher severity of intoxication. Methods We retrospectively reviewed the cases of drug self-poisoning in adolescents admitted to the Bambino Gesù Children's Hospital between January 2014 and June 2022 requiring consultation by the local Pediatric Poison Control Center (PPCC). We reported the type and class of drug ingested and correlated the clinical characteristics of the patients with their Poison Severity Score. Results The data of 267 patients were reported. Most patients were female (85.8 %), with a median age of 15.8 years at presentation. Half of the patients were symptomatic at admission (44.2 %), and most had at least one psychiatric comorbidity (71.1 %). Most patients were hospitalized (79.6 %), 16.6 % of cases required antidote administration and a minority required intensive care. Most patients received a PSS score of 0 (59.6 %). The most frequently ingested drug was acetaminophen (28.1 %) followed by ibuprofen (10.1 %) and aripiprazole (10.1 %). Antipsychotics as a class were the most abused drugs (33.1 %). The correlation of clinical variables with the PSS showed that older and male patients were more prone to be severely intoxicated. Conclusions This single-center study identifies the most commonly ingested drugs in a large sample of adolescents with voluntary drug self-poisoning, also showing that older and male patients are more susceptible to severe intoxication.
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Affiliation(s)
- Marco Roversi
- Clinical Trial Area, Development and Implementation of Drugs, Vaccines, and Medical Devices for pediatric use, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Matteo Martini
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Musolino
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Leonardo Genuini
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Gabriella Bottari
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Marano
- Pediatric Poison Control Centre, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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3
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Romolini G, Gambucci M, Ricciarelli D, Tarpani L, Zampini G, Latterini L. Photocatalytic activity of silica and silica-silver nanocolloids based on photo-induced formation of reactive oxygen species. Photochem Photobiol Sci 2021; 20:1161-1172. [PMID: 34449077 DOI: 10.1007/s43630-021-00089-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/08/2021] [Indexed: 12/23/2022]
Abstract
Semiconductor nanomaterials are often proposed as photocatalysts for wastewater treatment; silica nanomaterials are still largely unexploited because their photocatalytic performances need improvements, especially under visible light. The present study is a proof-of-concept that amorphous silica colloids once submitted to the proper surface modifications change into an efficient photocatalyst even under low-energy illumination source. For this reason, silica-based colloidal nanomaterials, such as bare (SiO2 NPs), aminated (NH2-SiO2 NPs), and Ag NPs-decorated (Ag-SiO2 NPs) silica, are tested as photocatalysts for the degradation of 9-anthracenecarboxylic acid (9ACA), taken as a model aromatic compound. Interestingly, upon irradiation at 313 nm, NH2-SiO2 NPs induce 9ACA degradation, and the effect is even improved when Ag-SiO2 NPs are used. On the other hand, irradiation at 405 nm activates the plasmon of Ag-SiO2 NPs photocatalyst, providing a faster and more efficient photodegradation. The photodegradation experiments are also performed under white light illumination, employing a low-intensity fluorescent lamp, confirming satisfying efficiencies. The catalytic effect of SiO2-based nanoparticles is thought to originate from photo-excitable surface defects and Ag NP plasmons since the catalytic degradation takes place only when the 9ACA is adsorbed on the surface. In addition, the involvement of reactive oxygen species was demonstrated through a scavenger use, obtaining a yield of 17%. In conclusion, this work shows the applicability of silica-based nanoparticles as photocatalysts through the involvement of silica surface defects, confirming that the silica colloids can act as photocatalysts under irradiation with monochromatic and white light. Silica and Ag-decorated silica colloids photosensitize the formation of Reactive Oxygen Species with 17% efficiencies. ROS are able to oxidase aromatic pollutants chemi-adsorbed on the surface of the colloids. Silica-silver nanocomposites present a photocatalytic activity useful to degrade aromatic compounds.
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Affiliation(s)
- G Romolini
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via Elce di Sotto 8, 06123, Perugia, Italy.,Chem & Tech, Molecular Imaging and Photonics, KULeuven, Celestijnenlaan 200 F, B-3001, Leuven, Belgium
| | - M Gambucci
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via Elce di Sotto 8, 06123, Perugia, Italy
| | - D Ricciarelli
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via Elce di Sotto 8, 06123, Perugia, Italy
| | - L Tarpani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via Elce di Sotto 8, 06123, Perugia, Italy
| | - G Zampini
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via Elce di Sotto 8, 06123, Perugia, Italy.
| | - L Latterini
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Via Elce di Sotto 8, 06123, Perugia, Italy.
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Marano M, Rossi F, Ravà L, Khalil Ramla M, Pisani M, Bottari G, Genuini L, Zampini G, Nunziata J, Reale A, Barbieri MA, Celeani F, Di Nardo M, Cecchetti C, Stoppa F, Villani A, Raponi M, Livadiotti S, Pontrelli G. Acute toxic exposures in children: analysis of a three year registry managed by a Pediatric poison control Center in Italy. Ital J Pediatr 2021; 47:125. [PMID: 34078407 PMCID: PMC8170623 DOI: 10.1186/s13052-021-01071-y] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Acute pediatric poisoning is an emerging health and social problem. The aim of this study is to describe the characteristics of a large pediatric cohort exposed to xenobiotics, through the analysis of a Pediatric Poison Control Center (PPCc) registry. Methods This study, conducted in the Pediatric Hospital Bambino Gesù of Rome, a reference National Pediatric Hospital, collected data of children whose parents or caregivers contacted the PPCc by phone (group “P”), or who presented to the Emergency Department (group “ED”), during the three-year period 2014–2016. Data were prospectively and systematically collected in a pre-set electronic registry. Comparisons among age groups were performed and multivariable logistic regression models used to investigate associations with outcomes (hospital referral for “P”, and hospital admission for “ED”group). Results We collected data of 1611 children on group P and 1075 on group ED. Both groups were exposed to both pharmaceutical and non-pharmaceutical agents. Pharmaceutical agent exposure increased with age and the most common route of exposure was oral. Only 10% among P group were symptomatic children, with gastrointestinal symptoms. Among the ED patients, 30% were symptomatic children mostly with gastrointestinal (55.4%) and neurologic symptoms (23.8%). Intentional exposure (abuse substance and suicide attempt), which involved 7.7% of patients, was associated with older age and Hospital admission. Conclusions Our study describes the characteristics of xenobiotics exposures in different paediatric age groups, highlighting the impact of both pharmacological and intentional exposure. Furthermore, our study shows the utility of a specific PPCc, either through Phone support or by direct access to ED. PPCc phone counselling could avoid unnecessary access to the ED, a relevant achievement, particularly in the time of a pandemic.
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Affiliation(s)
- M Marano
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy. .,Paediatric Clinical Toxicology Centre, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.
| | - F Rossi
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Palidoro, Italy
| | - L Ravà
- Epidemiology Unit and Biostatistics, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M Khalil Ramla
- Paediatric Clinical Toxicology Centre, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M Pisani
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - G Bottari
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - L Genuini
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - G Zampini
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - J Nunziata
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - A Reale
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M A Barbieri
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Palidoro, Italy
| | - F Celeani
- Information Systems Department, General direction Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M Di Nardo
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - C Cecchetti
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - F Stoppa
- DEA Paediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - A Villani
- Emergency Department, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - M Raponi
- Medical Direction, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - S Livadiotti
- Clinical Trials Centre, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - G Pontrelli
- Clinical Trials Centre, University Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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5
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Marano M, Pisani M, Zampini G, Pontrelli G, Roversi M. Acute Exposure to European Viper Bite in Children: Advocating for a Pediatric Approach. Toxins (Basel) 2021; 13:toxins13050330. [PMID: 34063282 PMCID: PMC8170888 DOI: 10.3390/toxins13050330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Viper bite is an uncommon but serious cause of envenoming in Europe, especially in children. Our study aim is to better describe and analyze the clinical course and treatment of viper bite envenoming in a pediatric population. We retrospectively reviewed 24 cases of pediatric viper bites that were admitted to the Pediatric Emergency Department and the Pediatric Intensive Care Unit of the Bambino Gesù Children Hospital in Rome between 2000 and 2020. Epidemiological characteristics of the children, localization of the bite, clinical and laboratory findings, and treatment approaches were evaluated. The median age of the patients was 4.2 years, with male predominance. Most cases of viper bite occurred in the late summer. Most patients required admission to the ward for prolonged observation. The most common presenting signs were pain, local oedema, and swelling. Patients with a high severity score also had a significantly higher white blood cell count and an increase of INR, LDH, and CRP levels. No fatality was reported. Viper bite envenomation is a rare pediatric medical emergency in Italy but may sometimes be severe. A new pediatric severity score may be implemented in the screening of children with viper bites to favor a selective and prompt administration of antivenom.
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Affiliation(s)
- Marco Marano
- Pediatric Intensive Care Unit, Pediatric Clinical Toxicology Center, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.M.); (G.Z.)
| | - Mara Pisani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Giorgio Zampini
- Pediatric Intensive Care Unit, Pediatric Clinical Toxicology Center, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.M.); (G.Z.)
| | - Giuseppe Pontrelli
- Clinical Trial Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Marco Roversi
- Clinical Trial Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Correspondence:
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Di Nardo M, Boldrini F, Broccati F, Cancani F, Satta T, Stoppa F, Genuini L, Zampini G, Perdichizzi S, Bottari G, Fischer M, Gawronski O, Bonetti A, Piermarini I, Recchiuti V, Leone P, Rossi A, Tabarini P, Biasucci D, Villani A, Raponi M, Cecchetti C, Choong K. The LiberAction Project: Implementation of a Pediatric Liberation Bundle to Screen Delirium, Reduce Benzodiazepine Sedation, and Provide Early Mobilization in a Human Resource-Limited Pediatric Intensive Care Unit. Front Pediatr 2021; 9:788997. [PMID: 34956989 PMCID: PMC8692861 DOI: 10.3389/fped.2021.788997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Delirium, bed immobilization, and heavy sedation are among the major contributors of pediatric post-intensive care syndrome. Recently, the Society of Critical Care Medicine has proposed the implementation of daily interventions to minimize the incidence of these morbidities and optimize children functional outcomes and quality of life. Unfortunately, these interventions require important clinical and economical efforts which prevent their use in many pediatric intensive care units (PICU). Aim: First, to evaluate the feasibility and safety of a PICU bundle implementation prioritizing delirium screening and treatment, early mobilization (<72 h from PICU admission) and benzodiazepine-limited sedation in a human resource-limited PICU. Second, to evaluate the incidence of delirium and describe the early mobilization practices and sedative drugs used during the pre- and post-implementation periods. Third, to describe the barriers and adverse events encountered during early mobilization. Methods: This observational study was structured in a pre- (15th November 2019-30th June 2020) and post-implementation period (1st July 2020-31st December 2020). All patients admitted in PICU for more than 72 h during the pre and post-implementation period were included in the study. Patients were excluded if early mobilization was contraindicated. During the pre-implementation period, a rehabilitation program including delirium screening and treatment, early mobilization and benzodiazepine-sparing sedation guidelines was developed and all PICU staff trained. During the post-implementation period, delirium screening with the Connell Assessment of Pediatric Delirium scale was implemented at bedside. Early mobilization was performed using a structured tiered protocol and a new sedation protocol, limiting the use of benzodiazepine, was adopted. Results: Two hundred and twenty-five children were enrolled in the study, 137 in the pre-implementation period and 88 in the post-implementation period. Adherence to delirium screening, benzodiazepine-limited sedation and early mobilization was 90.9, 81.1, and 70.4%, respectively. Incidence of delirium was 23% in the post-implementation period. The median cumulative dose of benzodiazepines corrected for the total number of sedation days (mg/kg/sedation days) was significantly lower in the post-implementation period compared with the pre-implementation period: [0.83 (IQR: 0.53-1.31) vs. 0.74 (IQR: 0.55-1.16), p = 0.0001]. The median cumulative doses of fentanyl, remifentanil, and morphine corrected for the total number of sedation days were lower in the post-implementation period, but these differences were not significant. The median number of mobilizations per patient and the duration of each mobilization significantly increased in the post-implementation period [3.00 (IQR: 2.0-4.0) vs. 7.00 (IQR: 3.0-12.0); p = 0.004 and 4 min (IQR: 3.50-4.50) vs. 5.50 min (IQR: 5.25-6.5); p < 0.0001, respectively]. Barriers to early mobilization were: disease severity and bed rest orders (55%), lack of physicians' order (20%), lack of human resources (20%), and lack of adequate devices for patient mobilization (5%). No adverse events related to early mobilization were reported in both periods. Duration of mechanical ventilation and PICU length of stay was significantly lower in the post-implementation period as well as the occurrence of iatrogenic withdrawal syndrome. Conclusion: This study showed that the implementation of a PICU liberation bundle prioritizing delirium screening and treatment, benzodiazepine-limited sedation and early mobilization was feasible and safe even in a human resource-limited PICU. Further pediatric studies are needed to evaluate the clinical impact of delirium, benzodiazepine-limited sedation and early mobilization protocols on patients' long-term functional outcomes and on hospital finances.
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Affiliation(s)
- Matteo Di Nardo
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Boldrini
- Unit of Clinical Psychology, Department of Neurological Sciences, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Broccati
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Federica Cancani
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Tiziana Satta
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesca Stoppa
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Leonardo Genuini
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giorgio Zampini
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Salvatore Perdichizzi
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gabriella Bottari
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Maximilian Fischer
- Pediatric Emergency Unit, Department of Medical and Surgical Sciences (DIMEC), St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Annamaria Bonetti
- Functional Rehab Unit, Neurorehabilitation and Robotics Department, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Irene Piermarini
- Respiratory Physiotherapy, Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Veronica Recchiuti
- Functional Rehab Unit, Neurorehabilitation and Robotics Department, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Paola Leone
- Respiratory Physiotherapy, Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Angela Rossi
- Unit of Clinical Psychology, Department of Neurological Sciences, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Paola Tabarini
- Unit of Clinical Psychology, Department of Neurological Sciences, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Daniele Biasucci
- Department of Emergency, Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alberto Villani
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Massimiliano Raponi
- Medical Directorate, Bambino Gesu' Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Corrado Cecchetti
- PICU, Children's Hospital Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Karen Choong
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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7
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Di Nardo M, Dalle Ore A, Testa G, Annich G, Piervincenzi E, Zampini G, Bottari G, Cecchetti C, Amodeo A, Lorusso R, Del Sorbo L, Kirsch R. Principlism and Personalism. Comparing Two Ethical Models Applied Clinically in Neonates Undergoing Extracorporeal Membrane Oxygenation Support. Front Pediatr 2019; 7:312. [PMID: 31417882 PMCID: PMC6682695 DOI: 10.3389/fped.2019.00312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/11/2019] [Indexed: 11/13/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a technology used to temporarily assist critically ill patients with acute and reversible life-threatening cardiac and/or respiratory failure. This technology can often be lifesaving but is also associated with several complications that may contribute to reduced survival. Currently, neonates supported with ECMO are complex and bear an increased risk of mortality. This means that clinicians must be particularly prepared not only to deal with complex clinical scenarios, but also ethical issues associated with ECMO. In particular, clinicians should be trained to handle unsuccessful ECMO runs with attention to high quality end of life care. Within this manuscript we will compare and contrast the application of two ethical frameworks, used in the authors' institutions (Toronto and Rome). This is intended to enhance a broader understanding of cultural differences in applied ethics which is useful to the clinician in an increasingly multicultural and diverse patient mix.
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Affiliation(s)
| | - Anna Dalle Ore
- Clinical Bioethics, Children's Hospital Bambino Gesù, Rome, Italy
| | | | - Gail Annich
- Department of Critical Care, The Hospital for Sick Children, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Antonio Amodeo
- Mechanical Assist Device and ECMO Unit, Children's Hospital Bambino Gesù, Rome, Italy
| | - Roberto Lorusso
- Department of Adult Cardiac Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,MSICU, Toronto General Hospital, Toronto, ON, Canada
| | - Roxanne Kirsch
- Department of Critical Care, The Hospital for Sick Children, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada
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Zampini G, Planas O, Marmottini F, Gulías O, Agut M, Nonell S, Latterini L. Morphology effects on singlet oxygen production and bacterial photoinactivation efficiency by different silica-protoporphyrin IX nanocomposites. RSC Adv 2017. [DOI: 10.1039/c7ra00784a] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Different silica-protoporphyrin IX (PpIX) nanocomposites have been synthesized to evaluate the dependence of singlet oxygen production and bacterial inactivation efficiency on the morphology of the nanomaterials.
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Affiliation(s)
- G. Zampini
- Department of Chemistry
- Biology and Biotechnology
- University of Perugia
- 06123 Perugia
- Italy
| | - O. Planas
- Institut Químic de Sarrià
- Universitat Ramon Llull
- Barcelona 08017
- Spain
| | - F. Marmottini
- Department of Chemistry
- Biology and Biotechnology
- University of Perugia
- 06123 Perugia
- Italy
| | - O. Gulías
- Institut Químic de Sarrià
- Universitat Ramon Llull
- Barcelona 08017
- Spain
| | - M. Agut
- Institut Químic de Sarrià
- Universitat Ramon Llull
- Barcelona 08017
- Spain
| | - S. Nonell
- Institut Químic de Sarrià
- Universitat Ramon Llull
- Barcelona 08017
- Spain
| | - L. Latterini
- Department of Chemistry
- Biology and Biotechnology
- University of Perugia
- 06123 Perugia
- Italy
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Di Somma S, Zampini G, Vetrone F, Soto-Ruiz KM, Magrini L, Cardelli P, Ronco C, Maisel A, Peacock FW. Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making. Clin Chem Lab Med 2015; 52:1401-7. [PMID: 24864300 DOI: 10.1515/cclm-2014-0267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/04/2014] [Indexed: 11/15/2022]
Abstract
Overcrowding of the emergency department (ED) is rapidly becoming a global challenge and a major source of concern for emergency physicians. The evaluation of cardiac biomarkers is critical for confirming diagnoses and expediting treatment decisions to reduce overcrowding, however, physicians currently face the dilemma of choosing between slow and accurate central-based laboratory tests, or faster but imprecise assays. With improvements in technology, point-of-care testing (POCT) systems facilitate the efficient and high-throughput evaluation of biomarkers, such as troponin (cTn), brain natriuretic peptide (BNP) and neutrophil gelatinase-associated lipocalin (NGAL). In this context, POCT may help ED physicians to confirm a diagnosis of conditions, such as acute coronary syndrome, heart failure or kidney damage. Compared with classic laboratory methods, the use of cTn, BNP, and NGAL POCT has shown comparable sensitivity, specificity and failure rate, but with the potential to provide prompt and accurate diagnosis, shorten hospital stay, and alleviate the burden on the ED. Despite this potential, the full advantages of rapid delivery results will only be reached if POCT is implemented within hospital standardized procedures and ED staff receive appropriate training.
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Di Somma S, Marino R, Zampini G, Magrini L, Ferri E, Shah K, Clopton P, Maisel AS. Predictive value for death and rehospitalization of 30-day postdischarge B-type natriuretic peptide (BNP) in elderly patients with heart failure. Sub-analysis of Italian RED Study. ACTA ACUST UNITED AC 2015; 53:507-13. [DOI: 10.1515/cclm-2013-0927] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 08/24/2014] [Indexed: 11/15/2022]
Abstract
AbstractOur aim was to determine if, in elderly heart failure (eHF) patients, serial B-type natriuretic peptide (BNP) assessments obtained during follow-up after hospital discharge could have prognostic utility for death and rehospitalizations. In eHF patients, BNP assessment at hospital discharge has been demonstrated to have a high prognostic value; however, its predictive role for future cardiovascular events in eHF patients, when assessed in the period after discharge, both for the correct timing and cut-off levels, has not been completely elucidated.This study is a monocentric subanalysis of the Italian RED (Rapid Emergency Department) study. We studied 180 consecutive patients admitted for acute HF through serial BNP assessments: at hospital arrival; at discharge; and at 30, 90, and 180 days follow-up outpatient visit.Both a BNP >400 pg/mL at 30 days after discharge and the percentage variation of BNP from discharge to 30 days (Δ%BNP), compared with a BNP at discharge >400 pg/mL, showed a higher area under the curve (AUC) and odds ratio (OR) in predicting events [AUC=0.842, p<0.0001; OR 7.9 (3.3–19.0), p<0.001 for 30 days BNP and AUC=0.851, p<0.0001; OR 9.5 (4.065–22.572), p<0.0001 for Δ%BNP compared with AUC=0.638, p<0.002; OR 2.4 (1.1–5.3), p=0.032 for BNP at discharge].In patients at a high risk for future events, BNP levels assessed 30 days after hospital discharge in the absence of signs and symptoms could be predictive of subsequent hospitalization and death. These patients should be considered for closer monitoring and treatment adjustment.
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Di Somma S, Marino R, Zampini G, Magrini L, Ferri E, Shah K, Clopton P, Maisel AS. Predictive value for death and rehospitalization of 30-day postdischarge B-type natriuretic peptide (BNP) in elderly patients with heart failure. Sub-analysis of Italian RED Study. Clin Chem Lab Med 2014. [PMID: 25252752 DOI: 10.1515/cclm-2013–0927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Our aim was to determine if, in elderly heart failure (eHF) patients, serial B-type natriuretic peptide (BNP) assessments obtained during follow-up after hospital discharge could have prognostic utility for death and rehospitalizations. In eHF patients, BNP assessment at hospital discharge has been demonstrated to have a high prognostic value; however, its predictive role for future cardiovascular events in eHF patients, when assessed in the period after discharge, both for the correct timing and cut-off levels, has not been completely elucidated. METHODS This study is a monocentric subanalysis of the Italian RED (Rapid Emergency Department) study. We studied 180 consecutive patients admitted for acute HF through serial BNP assessments: at hospital arrival; at discharge; and at 30, 90, and 180 days follow-up outpatient visit. RESULTS Both a BNP >400 pg/mL at 30 days after discharge and the percentage variation of BNP from discharge to 30 days (Δ%BNP), compared with a BNP at discharge >400 pg/mL, showed a higher area under the curve (AUC) and odds ratio (OR) in predicting events [AUC=0.842, p<0.0001; OR 7.9 (3.3-19.0), p<0.001 for 30 days BNP and AUC=0.851, p<0.0001; OR 9.5 (4.065-22.572), p<0.0001 for Δ%BNP compared with AUC=0.638, p<0.002; OR 2.4 (1.1-5.3), p=0.032 for BNP at discharge]. CONCLUSIONS In patients at a high risk for future events, BNP levels assessed 30 days after hospital discharge in the absence of signs and symptoms could be predictive of subsequent hospitalization and death. These patients should be considered for closer monitoring and treatment adjustment.
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Russo V, Navarin S, Zampini G, Magrini L, Mann C, Muiesan ML, De Caterina R, Yılmaz MB, Beton O, Monzani V, Kubica J, Müller C, Di Somma S. Management of atrial fibrillation in the Emergency Department: current approach and future expectations. Eur Rev Med Pharmacol Sci 2013; 17:3132-3147. [PMID: 24338454] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac dysrhythmia and occurs in 3.3%-10% of emergency admissions. It is frequently quoted for people over the age of 75, but the cases of AF in young subjects without structural heart disease are also increasing, therefore, leading to the evaluation of "lonely atrial fibrillation" as a new challenge for the clinician. The first diagnosis and treatment often occur in the emergency room and the emergency physician has therefore to evaluate the initial step towards the therapeutic decisions. Although international standard guidelines are available, AF treatment in the Emergency Department (ED) is still heterogeneous in terms of the management strategy chosen. There are two main strategies for the management of AF: rate and rhythm control. Moreover, antithrombotic treatment is pivotal in AF to prevent cardioembolic stroke and it is considered a primary objective after an accurate assessment of antithrombotic treatment risks and benefits. The introduction of innovative echocardiographic approach, directly in ED, seems to improve the management and risk stratification of patients with AF. This review aims to provide an overview about the current approach and the future expectations in the management of AF in ED. This manuscript represents a synopsis of the lectures on AF management in the ED of the Third Italian GREAT Network Congress, that was hold in Rome, 15-19 October 2012. We decided to use only the most relevant references for each contribution as suggested by each participant at this review.
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Affiliation(s)
- V Russo
- Emergency Medicine Department, Sant'Andrea Hospital, School of Medicine and Psychology, "Sapienza" University Rome, Rome, Italy.
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Zampini G, Shah KS, Magrini L, Maisel AS, DiSomma S. Italian RED Study Sub-Analysis: 30-Day Post-Discharge BNP Levels Predict 6-Month All-Cause Mortality and Cardiac Events. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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