1
|
Musto E, Gambardella ML, Perulli M, Quintiliani M, Veredice C, Verdolotti T, Berté G, Leoni C, Onesimo R, Pulitanò SM, Tartaglia M, Zampino G, Contaldo I, Battaglia DI. Status epilepticus in BRAF-related cardio-facio-cutaneous syndrome: Focus on neuroimaging clues to physiopathology. Epilepsia Open 2024; 9:258-267. [PMID: 37943120 PMCID: PMC10839340 DOI: 10.1002/epi4.12864] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 11/06/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE Cardio-facio-cutaneous syndrome (CFC) is a genetic disorder due to variants affecting genes coding key proteins of the Ras/MAPK signaling pathway. Among the different features of CFC, neurological involvement, including cerebral malformations and epilepsy, represents a common and clinically relevant aspect. Status epilepticus (SE) is a recurrent feature, especially in a specific subgroup of CFC patients with developmental and epileptic encephalopathy (DEE) and history of severe pharmacoresistant epilepsy. Here we dissect the features of SE in CFC patients with a particular focus on longitudinal magnetic resonance imaging (MRI) findings to identify clinical-radiological patterns and discuss the underlying physiopathology. METHODS We retrospectively analyzed clinical, electroencephalogram (EEG), and MRI data collected in a single center from a cohort of 23 patients with CFC carrying pathogenic BRAF variants who experienced SE during a 5-year period. RESULTS Seven episodes of SE were documented in 5 CFC patients who underwent EEG and MRI at baseline. MRI was performed during SE/within 72 hours from SE termination in 5/7 events. Acute/early post-ictal MRI findings showed heterogenous abnormalities: restricted diffusion in 2/7, focal area of pcASL perfusion change in 2/7, focal cortical T2/FLAIR hyperintensity in 2/7. Follow-up images were available for 4/7 SE. No acute changes were detected in 2/7 (MRI performed 4 days after SE termination). SIGNIFICANCE Acute focal neuroimaging changes concomitant with ictal EEG focus were present in 5/7 episodes, though with different findings. The heterogeneous patterns suggest different contributing factors, possibly including the presence of focal cortical malformations and autoinflammation. When cytotoxic edema is revealed by MRI, it can be followed by permanent structural damage, as already observed in other genetic conditions. A better understanding of the physiopathology will provide access to targeted treatments allowing to prevent long-term adverse neurological outcome. PLAIN LANGUAGE SUMMARY Cardio-facio-cutaneous syndrome is a genetic disorder that often causes prolonged seizures known as status epilepticus. This study has a focus on electroclinical and neuroimaging patterns in patients with cardio-facio-cutaneous syndrome. During these status epilepticus episodes, we found different abnormal brain imaging patterns in patients, indicating various causes like brain malformations and inflammation. Understanding these patterns could help doctors find specific treatments, protecting cardio-facio-cutaneous syndrome patients from long-term brain damage.
Collapse
Affiliation(s)
- Elisa Musto
- Department of Life Sciences and Public HealthUniversità Cattolica del Sacro CuoreRomeItaly
- Neurology, Epilepsy and Movement Disorders, Full member of European Reference Network EpiCAREBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Maria Luigia Gambardella
- Child Neurology and Psychiatric Unit, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Marco Perulli
- Department of Life Sciences and Public HealthUniversità Cattolica del Sacro CuoreRomeItaly
- Child Neurology and Psychiatric Unit, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Michela Quintiliani
- Child Neurology and Psychiatric Unit, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Chiara Veredice
- Child Neurology and Psychiatric Unit, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Tommaso Verdolotti
- Radiology and Neuroradiology Unit, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Giovanna Berté
- Radiology and Neuroradiology Unit, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Chiara Leoni
- Center for Rare Disease and Congenital Defects, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Roberta Onesimo
- Center for Rare Disease and Congenital Defects, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Silvia Maria Pulitanò
- Pediatric Intensive Care Unit Trauma Center Pediatric, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Marco Tartaglia
- Molecular Genetics and Functional Genomics, Ospedale Pediatrico Bambino GesùIRCCSRomeItaly
| | - Giuseppe Zampino
- Department of Life Sciences and Public HealthUniversità Cattolica del Sacro CuoreRomeItaly
- Center for Rare Disease and Congenital Defects, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Ilaria Contaldo
- Child Neurology and Psychiatric Unit, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| | - Domenica Immacolata Battaglia
- Department of Life Sciences and Public HealthUniversità Cattolica del Sacro CuoreRomeItaly
- Child Neurology and Psychiatric Unit, Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly
| |
Collapse
|
2
|
Putzulu R, Romano A, Mancino A, Corbingi A, Massini G, Mastrangelo S, Pulitanò SM, Piastra M, Pittiruti M, Ruggiero A, Piccirillo N. Successful stem cell collection for atypical teratoid rhabdoid tumor in an extremely low-body weight child: A case report. J Clin Apher 2023. [PMID: 36861176 DOI: 10.1002/jca.22044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/13/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
The use of peripheral blood hematopoietic stem cells for bone marrow reconstitution after myeloablative therapy is well established in children with malignant disorders. However, the peripheral blood hematopoietic stem cells collection in very low-body weight (≤10 kg) children remains a significant challenge because of technical and clinical issues. A male newborn affected by atypical teratoid rhabdoid tumor, diagnosed prenatally, received two cycles of chemotherapy following surgical resection. After an interdisciplinary discussion, it was decided to intensify the treatment with high-dose chemotherapy followed by autologous stem cell transplantation. After 7 days of G-CSF administration the patient underwent hematopoietic progenitor cells-apheresis collection. The procedure was performed in the pediatric intensive care unit, using two central venous catheters and Spectra Optia device. The cell collection procedure was completed in 200 min, during which time 3.9 total blood volumes were processed. During apheresis we did not observe electrolyte alterations. No adverse events were recorded during or immediately following the cell collection procedure. Our report describes the feasibility of performing large volume leukapheresis without complications in an extremely low-body weight patient weighing 4.5 kg using the Spectra Optia apheresis device. No catheter-related problems occurred, and apheresis was completed without any adverse event. In conclusion, we believe that very low-body weight pediatric patients need a multidisciplinary approach to manage central venous access, hemodynamic monitoring, cell collection, prevention of metabolic complications to improve safety, feasibility, and efficiency of stem cell collection procedures.
Collapse
Affiliation(s)
- Rossana Putzulu
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Largo A. Gemelli, Rome, Italy
| | - Alberto Romano
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Agostino Gemelli IRCCS, Largo A. Gemelli, Rome, Italy
| | - Aldo Mancino
- Pediatric Intensive Care Unit and Pediatric Trauma Centre, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, Rome, Italy
| | - Andrea Corbingi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Largo A. Gemelli, Rome, Italy
| | - Giuseppina Massini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Largo A. Gemelli, Rome, Italy
| | - Stefano Mastrangelo
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Agostino Gemelli IRCCS, Largo A. Gemelli, Rome, Italy.,Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Rome, Italy
| | - Silvia Maria Pulitanò
- Pediatric Intensive Care Unit and Pediatric Trauma Centre, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, Rome, Italy.,Pediatric Intensive Care Unit and Pediatric Trauma Centre, Catholic University of the Sacred Heart of Rome, Largo A. Gemelli, Rome, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit and Pediatric Trauma Centre, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, Rome, Italy.,Pediatric Intensive Care Unit and Pediatric Trauma Centre, Catholic University of the Sacred Heart of Rome, Largo A. Gemelli, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Rome, Italy
| | - Antonio Ruggiero
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Agostino Gemelli IRCCS, Largo A. Gemelli, Rome, Italy.,Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Rome, Italy
| | - Nicola Piccirillo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, Largo A. Gemelli, Rome, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Rome, Italy
| |
Collapse
|
3
|
Rosati A, L'Erario M, Bianchi R, Olivotto S, Battaglia DI, Darra F, Biban P, Biggeri A, Catelan D, Danieli G, Mondardini MC, Cordelli DM, Amigoni A, Cesaroni E, Conio A, Costa P, Lombardini M, Meleleo R, Pugi A, Tornaboni EE, Santarone ME, Vittorini R, Sartori S, Marini C, Vigevano F, Mastrangelo M, Pulitanò SM, Izzo F, Fusco L. KETASER01 protocol: What went right and what went wrong. Epilepsia Open 2022; 7:532-540. [PMID: 35833327 PMCID: PMC9436287 DOI: 10.1002/epi4.12627] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Objective To discuss the results of the KETASER01 trial and the reasons for its failure, particularly in view of future studies. Methods KETASER01 is a multicenter, randomized, controlled, open‐label, sequentially designed, non‐profit Italian study that aimed to assess the efficacy of ketamine compared with conventional anesthetics in the treatment of refractory convulsive status epilepticus (RCSE) in children. Results During the 5‐year recruitment phase, a total of 76 RCSEs treated with third‐line therapy were observed in five of the 10 participating Centers; only 10 individuals (five for each study arm; five females, mean age 6.5 ± 6.3 years) were enrolled in the KETASER01 study. Two of the five patients (40%) in the experimental arm were successfully treated with ketamine and two of the five (40%) children in the control arm, where successfully treated with thiopental. In the remaining six (60%) enrolled patients, RCSE was not controlled by the randomized anesthetic(s). Significance The KETASER01 study was prematurely halted due to low eligibility of patients and no successful recruitment. No conclusions can be drawn regarding the objectives of the study. Here, we discuss the KETASER01 results and critically analyze the reasons for its failure in view of future trials.
Collapse
Affiliation(s)
- Anna Rosati
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Italy
| | - Manuela L'Erario
- Intensive Care Unit, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Roberto Bianchi
- Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Olivotto
- Pediatric Neurology Unit, Children's Hospital Vittore Buzzi, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Francesca Darra
- Child Neuropsychiatry Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Italy
| | - Paolo Biban
- Department of Neonatal and Pediatric Intensive Care, University Hospital, Verona, Italy
| | - Annibale Biggeri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Dolores Catelan
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Giacomo Danieli
- Department of Statistics, Computer Science, Applications G. Parenti, University of Florence, Italy
| | - Maria Cristina Mondardini
- Department of Pediatric Anesthesia and Intensive Care, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Duccio Maria Cordelli
- IRCCS Institute of Neurological Sciences of Bologna, UOC Neuropsychiatry of the Pediatric Age, Bologna, Italy
| | - Angela Amigoni
- Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - Elisabetta Cesaroni
- Child Neuropsychiatry Unit, Polytechnic University of the Marche, Ancona, Italy
| | - Alessandra Conio
- Pediatric Intensive Care Unit, Health and Science City Hospital-University of Turin, Italy
| | - Paola Costa
- Department of Neuropsychiatry Ward, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Martina Lombardini
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Italy
| | - Rosanna Meleleo
- Intensive Care Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessandra Pugi
- Clinical Trial Office Meyer Children's Hospital-University of Florence, Italy
| | - Elena Eve Tornaboni
- Clinical Trial Office Meyer Children's Hospital-University of Florence, Italy
| | | | - Roberta Vittorini
- Child and Adolescence Neuropsychiatry Unit, Health and Science City Hospital-University of Turin, Italy
| | - Stefano Sartori
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - Carla Marini
- Child Neuropsychiatry Unit, Polytechnic University of the Marche, Ancona, Italy
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Mastrangelo
- Pediatric Neurology Unit, Children's Hospital Vittore Buzzi, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Francesca Izzo
- Pediatric Intensive Care Unit, Children's Hospital Vittore Buzzi, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Lucia Fusco
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
4
|
Perulli M, Cicala G, Turrini I, Musto E, Quintiliani M, Gambardella ML, Pulitanò SM, Bompard S, Staccioli S, Carmillo L, Di Sante G, Ria F, Veredice C, Contaldo I, Battaglia D. Fighting autoinflammation in FIRES: The role of interleukins and early immunomodulation. Epilepsy Behav Rep 2022; 18:100531. [PMID: 35356746 PMCID: PMC8958320 DOI: 10.1016/j.ebr.2022.100531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 01/11/2023] Open
|
5
|
Gatto A, Pulitanò SM, Conti G, Soave PM, Di Sarno L, Chiaretti A. Botulism during SARS-CoV-2 pandemic: The importance of differential diagnoses. Anaerobe 2021; 70:102389. [PMID: 34051376 PMCID: PMC8149469 DOI: 10.1016/j.anaerobe.2021.102389] [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: 03/04/2021] [Revised: 04/23/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
Botulism is a neuroparalytic syndrome caused by a neurotoxin produced by Clostridium botulinum. We describe a patient with neurological symptoms associated with intoxication by Clostridium botulinum and infection by SARSCoV2. This report underlines that it is mandatory, even in case of SARS-CoV-2 positivity, to investigate all the causes of a clinical pattern.
Collapse
Affiliation(s)
- Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Silvia Maria Pulitanò
- Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit, Catholic University of Rome, Rome, Italy.
| | - Giorgio Conti
- Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit, Catholic University of Rome, Rome, Italy.
| | - Paolo Maurizio Soave
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Catholic University, Roma, Italy.
| | - Lorenzo Di Sarno
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| |
Collapse
|
6
|
Chiaretti A, Pittiruti M, Sassudelli G, Conti G, Rossi M, Pulitanò SM, Mancino A, Pusateri A, Gatto A, Tosi F. Comparison between sedation room and operating room in central venous catheter positioning in children. J Vasc Access 2020; 22:184-188. [PMID: 32564667 DOI: 10.1177/1129729820932415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/15/2023] Open
Abstract
BACKGROUND Placement of central venous access devices is a clinical procedure associated with some risk of adverse events and with a relevant cost. Careful choice of the device, appropriate insertion technique, and proper management of the device are well-known strategies commonly adopted to achieve an optimal clinical result. However, the environment where the procedure takes place may have an impact on the overall outcome in terms of safety and cost-effectiveness. METHODS We carried out a retrospective analysis on pediatric patients scheduled for a major neurosurgical operation, who required a central venous access device in the perioperative period. We divided the patients in two groups: in group A the central venous access device was inserted in the operating room, while in group B the central venous access device was inserted in the sedation room of our Pediatric Intensive Care Unit. We compared the two groups in terms of safety and cost-effectiveness. RESULTS We analyzed 47 central venous access devices in 42 children. There were no insertion-related complications. Only one catheter-related bloodstream infection was recorded, in group A. However, the costs related to central venous access device insertion were quite different: €330-€540 in group A versus €105-€135 in group B. CONCLUSION In the pediatric patient candidate to a major neurosurgical operation, preoperative insertion of the central venous access device in the sedation room rather than in the operating room is less expensive and equally safe.
Collapse
Affiliation(s)
- Antonio Chiaretti
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giovanni Sassudelli
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Marco Rossi
- Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Silvia Maria Pulitanò
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Aldo Mancino
- Pediatric Intensive Care Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Angela Pusateri
- Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Antonio Gatto
- Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Federica Tosi
- Department of Anesthesia and Pain Therapy, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| |
Collapse
|
7
|
Mistraletti G, Mezzetti A, Anania S, Ionescu Maddalena A, Del Negro S, Giusti GD, Gili A, Iacobone E, Pulitanò SM, Conti G, Bocci MG. Improving communication toward ICU families to facilitate understanding and reduce stress. Protocol for a multicenter randomized and controlled Italian study. Contemp Clin Trials 2019; 86:105847. [PMID: 31525488 DOI: 10.1016/j.cct.2019.105847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/25/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Families of ICU patients have a pressing need for information: they find themselves suddenly in a complex technical environment often because of a life-threatening illness of a loved one. Some evidence suggests that specific communication tools (like websites or brochures) could improve the experience of ICU families. DESIGN Randomized, multicenter, stepped wedge trial for large-scale assessment of the effectiveness of a multitasking intervention to improve communication with families of critically ill patients. MAIN OUTCOME correct understanding of the prognosis. SECONDARY OUTCOMES correct understanding of medical treatments, prevalence of anxiety, depression and post-traumatic stress symptoms in the first ICU week. Prevalence of PTSD 6 months from ICU discharge. Empathy and burnout among ICU staff. Prevalence of refusals for tissues/organ donation, and medical claims. SUBJECTS 2100 ICU relatives of critically ill patients. INTERVENTIONS The intervention employs specific tools especially designed to raise the correctness of information and to improve the quality of communication: a website presenting the ICU world and justifying the relatives' emotions, with a webpage specifically dedicated to each participating ICU; a standard brochure; eight posters for the families' waiting room and a signboard for the ICU door. MEASUREMENTS AND MAIN RESULTS The study plans to assess these materials in up to 300 Italian ICUs that will participate, according to a five waves program, each one with randomized starting order. This way the effect of the intervention will be evaluated simultaneously. CONCLUSION This is an educational study, aiming to spread good medical practices, while also verifying their real effectiveness in a large number of ICUs. TRIAL REGISTRATION NUMBER NCT03438175.
Collapse
Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy; SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy.
| | - Andrea Mezzetti
- AUSL Toscana Centro, SOS 118 Emergenza Territoriale, Empoli, Italy
| | - Stefania Anania
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | - Alessandra Ionescu Maddalena
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Silvia Del Negro
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | | | - Alessio Gili
- Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Italy
| | - Emanuele Iacobone
- SAR, Dipartimento Emergenza-Urgenza, AV3 Ospedale di Macerata, ASUR Marche, Italy
| | - Silvia Maria Pulitanò
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giorgio Conti
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Grazia Bocci
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| |
Collapse
|
8
|
De Marco EA, Merli L, Taddei A, Pulitanò SM, Manzoni C, Nanni L. Late-presenting right congenital diaphragmatic hernia with severe hypotrophy of the right lobe of the liver. Int J Surg Case Rep 2015; 17:28-30. [PMID: 26519813 PMCID: PMC4701755 DOI: 10.1016/j.ijscr.2015.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/23/2015] [Accepted: 10/09/2015] [Indexed: 12/03/2022] Open
Abstract
We report an absolute novelty in the extant scientific literature. Usually congenital diaphragmatic hernia is prenatally diagnosed. This is an autoptic finding of the co-existence of right congenital diaphragmatic hernia and important hypotrophy of the right lobe of the liver. We suggest to suspect the presence of congenital diaphragmatic hernia in fetus with disparity in right and left liver lobe at prenatal ultrasound.
Introduction Congenital diaphragmatic hernia (CDH) presenting after 30 days of life is unusual and has a variant pattern of presentation. Presentation of case We present a death case occurred to a 34-days-old infant. The infant arrived to our emergency department in cardiac arrest after having suffered from intermittent acute abdominal pain. Autopsy confirmed the presence of a right CDH, with herniation of the right lobe of the liver into the thorax. Discussion Most of the cases of CDH are diagnosed prenatally or in the neonatal period. However, some patients do not develop symptoms until after the neonatal period. The relevance of our case is the co-existence of right CDH and important hypotrophy of the right lobe of the liver. Conclusions Evidence of this phenomenon represents an absolute novelty in the extant scientific literature. Even if rare, we suggest to suspect the presence of CDH in fetus with disparity in right and left liver lobe at prenatal ultrasound.
Collapse
Affiliation(s)
- E A De Marco
- Pediatric Surgery Unit, Catholic University of Sacred Heart Medical School, Largo Francesco Vito 1, 00168 Rome, Italy.
| | - L Merli
- Pediatric Surgery Unit, Catholic University of Sacred Heart Medical School, Largo Francesco Vito 1, 00168 Rome, Italy
| | - A Taddei
- Pediatric Surgery Unit, Catholic University of Sacred Heart Medical School, Largo Francesco Vito 1, 00168 Rome, Italy
| | - S M Pulitanò
- Pediatric Intensive Care Unit, Catholic University of Sacred Heart Medical School, Largo Francesco Vito 1, 00168 Rome, Italy
| | - C Manzoni
- Pediatric Surgery Unit, Catholic University of Sacred Heart Medical School, Largo Francesco Vito 1, 00168 Rome, Italy
| | - L Nanni
- Pediatric Surgery Unit, Catholic University of Sacred Heart Medical School, Largo Francesco Vito 1, 00168 Rome, Italy
| |
Collapse
|
9
|
Cipriani F, Mancino A, Pulitanò SM, Piastra M, Conti G. A cannabinoid-intoxicated child treated with dexmedetomidine: a case report. J Med Case Rep 2015; 9:152. [PMID: 26138711 PMCID: PMC4490763 DOI: 10.1186/s13256-015-0636-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 02/02/2015] [Accepted: 06/15/2015] [Indexed: 01/23/2023] Open
Abstract
Introduction In the last 20 years, the rate of exposure to marijuana has increased dramatically, even in the pediatric population. Effects of intoxication are variable, more severe neurological symptoms can be observed following ingestion, thus hospital or intensive care unit admission is often required. Usually cannabinoids intoxicated patients are treated with administration of benzodiazepines or opioids, accepting the related risk of intubation and mechanical ventilation. Dexmedetomidine is a highly selective α2-adrenergic receptor agonist, with no effect on the respiratory drive and pattern and produces a good level of sedation, allowing to avoid the administration of other sedatives. To our knowledge, this is the first reported case of dexmedetomidine use to support a cannabis intoxicated patient. Case presentation A 19-month-old Caucasian boy was presented to our emergency department. At the time of his arrival, he was somnolent with paroxysms of agitation, breathing spontaneously and hemodynamically stable. The results of all investigations were negative, but the result of the immunochemical screening of his urine was positive for Δ9-tetrahydrocannabinol. The patient was admitted to the pediatric intensive care unit and treated with a continuous infusion of dexmedetomidine. Conclusions Dexmedetomidine is a fairly safe and effective antidote for pediatric marijuana or natural cannabinoid exposures. Its properties and potential to allow for “cooperative” sedation make it a more attractive choice with fewer side effects than benzodiazepines or opioids.
Collapse
Affiliation(s)
- Flora Cipriani
- Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy.
| | - Aldo Mancino
- Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy.
| | - Silvia Maria Pulitanò
- Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy.
| | - Marco Piastra
- Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy.
| | - Giorgio Conti
- Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy.
| |
Collapse
|