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Vetrugno L, Deana C, Spadaro S, Cammarota G, Grieco DL, Tullio A, Bove T, Di Loreto C, Maggiore SM, Orsaria M, Study Group D. Diaphragmatic morphological post-mortem findings in critically ill COVID-19 patients: an observational study. Monaldi Arch Chest Dis 2024. [PMID: 38656318 DOI: 10.4081/monaldi.2024.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Our study investigates the post-mortem findings of the diaphragm's muscular structural changes in mechanically ventilated COVID-19 patients. Diaphragm samples of the right side from 42 COVID-19 critically ill patients were analyzed and correlated with the type and length of mechanical ventilation (MV), ventilatory parameters, prone positioning, and use of sedative drugs. The mean number of fibers was 550±626. The cross-sectional area was 4120±3280 μm2, while the muscular fraction was 0.607±0.126. The overall population was clustered into two distinct populations (clusters 1 and 2). Cluster 1 showed a lower percentage of slow myosin fiber and higher fast fiber content than cluster 2, 68% versus 82%, p<0.00001, and 29.8% versus 18.8%, p=0.00045 respectively. The median duration of MV was 180 (41-346) hours. In cluster 1, a relationship between assisted ventilation and fast myosin fiber percentage (R2=-0.355, p=0.014) was found. In cluster 2, fast fiber content increased with increasing the length of the controlled MV (R2=0.446, p=0.006). A high grade of fibrosis was reported. Cluster 1 was characterized by fibers' atrophy and cluster 2 by hypertrophy, supposing different effects of ventilation on the diaphragm but without excluding a possible direct viral effect on diaphragmatic fibers.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti Pescara, Chieti; Department of Anesthesiology, Critical Care Medicine and Emergency, Annunziata Hospital, Chieti.
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine.
| | - Savino Spadaro
- Department of Translational Medicine, University of Ferrara; Intensive Care Unit, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara.
| | - Gianmaria Cammarota
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara; Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara.
| | - Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome.
| | - Annarita Tullio
- Health Integrated Agency Friuli Centrale, Academic Hospital of Udine.
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine; Department of Medicine, University of Udine.
| | - Carla Di Loreto
- Department of Medicine, University of Udine; Institute of Anatomic Pathology, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine.
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, Annunziata Hospital, Chieti; Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti.
| | - Maria Orsaria
- Institute of Anatomic Pathology, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine.
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Orso D, Federici N, Lio C, Mearelli F, Bove T. Hemodynamic goals in sepsis and septic shock resuscitation: An umbrella review of systematic reviews and meta-analyses with trial sequential analysis. Aust Crit Care 2024:S1036-7314(24)00059-6. [PMID: 38609748 DOI: 10.1016/j.aucc.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE The objective of this study was to verify whether any parameter among those used as the target for haemodynamic optimisation (e.g., mean arterial pressure, central venous oxygen saturation, systolic or diastolic dysfunction, CO2 gap, lactates, right ventricular dysfunction, and PvaCO2/CavO2 ratio) is correlated with mortality in an undifferentiated population with sepsis or septic shock. METHODS An umbrella review, searching MEDLINE, the Cochrane Database of Systematic Reviews, Health Technology Assessment Database, and the JBI Database of Systematic Reviews and Implementation Reports, was performed. We included systematic reviews and meta-analyses enrolling a population of unselected patients with sepsis or septic shock. The main outcome was mortality. Two authors conducted data extraction and risk-of-bias assessments independently. We used a random-effects model to pool binary and continuous data and summarised estimates of effect using equivalent odds ratios (eORs). We used the ROBIS tool to assess risk of bias and the assessment of multiple systematic reviews 2 score to assess global quality. DATA SYNTHESIS 17 systematic reviews and meta-analyses (15 828 patients) were included in the quantitative analysis. Diastolic dysfunction (eOR: 1.42; 95% confidence interval [CI]: 1.14-1.76), PvaCO2/CavO2 ratio (eOR: 2.15; 95% CI: 1.37-3.37), and CO2 gap (eOR: 1.86; 95% CI: 1.07-3.25) showed a significant correlation with mortality. Lactates were the parameter with highest inconsistency (I2 = 92%). Central venous oxygen saturation and right ventricle dysfunction showed significant statistical excess test of significance (p-value = 0.009 and 0.005, respectively). None of the considered parameters showed statistically significant publication bias. CONCLUSIONS According to this umbrella review, diastolic dysfunction is the haemodynamic variable that is most closely linked to the prognosis of septic patients. The PvaCO2/CavO2 ratio and the CO2gap are significantly related to the mortality of septic patients, but the poor quality of evidence or the low number of cases, studied so far, limit their clinical applicability. CLINICAL TRIAL REGISTRATION PROSPERO: International prospective register of systematic reviews, 2023, CRD42023432813 (Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023432813).
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Affiliation(s)
- Daniele Orso
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy.
| | - Nicola Federici
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Cristina Lio
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy; Department of Medical Sciences (DAME), University of Udine, Udine, Italy
| | - Filippo Mearelli
- Department of Internal Medicine, ASUGI University Hospital of Trieste, Trieste, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy; Department of Medical Sciences (DAME), University of Udine, Udine, Italy
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Orso D, Molinari C, Bacchetti G, Zanini V, Montanar V, Copetti R, Guglielmo N, Bove T. Correlation and Agreement Between the CO2 Gap Obtained From Peripheral Venous Blood and From Mixed Venous Blood in Mechanically Ventilated Septic Patients. Semin Cardiothorac Vasc Anesth 2024; 28:18-27. [PMID: 38037887 DOI: 10.1177/10892532231219917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND Venous-arterial CO2 difference (Pv-aCO2) is a valuable marker that can identify a subset of patients in shock with inadequate cardiac output to meet tissue metabolic requirements. Some authors have found that Pv-aCO2 levels calculated from mixed vs central venous blood demonstrate a linear relationship. The purpose of this study is to determine whether there is a linear relationship between Pv-aCO2 obtained with peripheral venous blood (Pv-aCO2p) and with mixed venous blood, and the agreement between the 2 measures. METHODS This was a prospective, single-center, observational clinical study enrolling mechanically ventilated patients in septic shock during the first 24 hours following admission to the intensive care unit. RESULTS The Bravais-Pearson r-coefficient between Pv-aCO2 and Pv-aCO2p was .70 in 38 determinations (95%CI .48-.83; P-value = 1.25 x 10^-6). The Bland-Altman bias was 4.11 mmHg (95%CI 2.82-5.39), and the repeatability coefficient was 11.05. Using the Taffe approach, the differential and proportional biases were 2.81 (95%CI .52-5.11) and 1.29 (95%CI .86-1.72), respectively. CONCLUSION There was linear correlation between Pv-aCO2p and Pv-aCO2 in mechanically ventilated patients with septic shock. The bias showed a gradual increase in high Pv-aCO2 values in an upward trend.
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Affiliation(s)
- Daniele Orso
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
| | - Chiara Molinari
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
| | - Giacomo Bacchetti
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
| | - Victor Zanini
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
| | - Valentina Montanar
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
| | - Roberto Copetti
- Department of Emergency Medicine, Community Hospital of Latisana, Latisana, Italy
| | - Nicola Guglielmo
- Department of Emergency Medicine, Community Hospital of Latisana, Latisana, Italy
| | - Tiziana Bove
- Anaesthesia and Intensive Care Medicine Department, ASUFC University Hospital of Udine and Department of Medical Science (DAME), University of Udine, Udine, Italy
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Dottore B, Meroi F, Tomasino S, Orso D, Comuzzi M, Vernaccini N, Vetrugno L, Intini S, Bove T. Pediatric ultrasound-guided dorsal penile nerve block and sedation in spontaneous breathing: a prospective observational study. Front Med (Lausanne) 2023; 10:1268594. [PMID: 38116040 PMCID: PMC10729315 DOI: 10.3389/fmed.2023.1268594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023] Open
Abstract
Background Worldwide, one of the most common surgical procedures in the pediatric population is circumcision. There is no consent on the best anesthesiologic approach. This study aimed to investigate ultrasound-guided dorsal penile nerve block (DPNB) plus sedation in spontaneous breathing as a time-saving, safe, effective, and opioid-sparing technique. Aims The primary outcome was the assessment of the time from the end of surgery and the discharge to the post-anesthesia care unit. Secondary outcomes were to evaluate the cumulative dosages of opioids, differences in pain levels between the two groups, and complications at the awakening, 4 h and 72 h after surgery, respectively. Methods This was a prospective study with a retrospective control group, approved by the Friuli-Venezia Giulia Ethics Committee. Children in the intervention group received an ultrasound-guided DPNB under sedation and spontaneous breathing. With the probe positioned transversally at the base of the penis using an in-plane approach with a modified technique, local anesthetic was injected under the deep fascia of the penis. Results We recruited 70 children who underwent circumcision at the University Hospital of Udine, Italy, from 1 January 2016 to 1 October 2021: 35 children in the ultrasound-guided DPNB group and 35 children in the control group. Children who received ultrasound-guided DPNB had a statistically significant lower time to discharge from the operating room, did not require mechanical ventilation, maintained spontaneous breathing at all times, received fewer opioids, had lower mean intraoperative arterial pressures, and lower pain levels immediately after surgery. Conclusion Ultrasound-guided DPNB associated with sedation and spontaneous breathing is a time-saving, opioid-sparing, safe, and effective strategy for the management of intraoperative and postoperative pain in children undergoing circumcision.Clinical trial registration: ClinicalTrial.gov (NCT04475458, 17 July 2020).
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Affiliation(s)
- Bruno Dottore
- Azienda Sanitaria Integrata Friuli Centrale (ASUFC), Hospital of Palmanova, Italy Anesthesia and Intensive Care Service, Palmanova, Italy
| | - Francesco Meroi
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
| | - Serena Tomasino
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
| | - Daniele Orso
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
| | - Matteo Comuzzi
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
| | - Nicola Vernaccini
- Department of General Surgery, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesia and Intensive Care, University of Chieti-Pescara, Chieti, Italy
| | - Sergio Intini
- Department of General Surgery, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, General Surgery Clinic, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Udine, Italy
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Monti G, Konkayev A, Carta S, Bradic N, Bruni A, Kotani Y, Guarracino F, Redkin I, Biondi-Zoccai G, Benedetto U, D'Ascenzo F, Garofalo E, Baiardo Redaelli M, Brizzi G, Forfori F, Borghi G, Scapol S, Momesso E, Cuffaro R, Boffa N, Rauch S, D'Amico F, Montrucchio G, Pace MC, Galbiati C, Bosso S, Savelli F, Giardina G, Silvetti S, Tripodi VF, Labanca R, Lembo R, Marmiere M, Marzaroli M, Nakhnoukh C, Valsecchi D, Finco G, Agrò FE, Bove T, Corradi F, Longhini F, Landoni G, Bellomo R, Zangrillo A. High dose esomeprazole as an anti-inflammatory agent in sepsis: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 133:107319. [PMID: 37625587 DOI: 10.1016/j.cct.2023.107319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Sepsis is caused by dysregulated immune responses due to infection and still presents high mortality rate and limited efficacious therapies, apart from antibiotics. Recent evidence suggests that very high dose proton pump inhibitors might regulate major sepsis mediators' secretion by monocytes, which might attenuate excessive host reactions and improve clinical outcomes. This effect is obtained with doses which are approximately 50 times higher than prophylactic esomeprazole single daily administration and 17 times higher than the cumulative dose of a three day prophylaxis. We aim to perform a randomized trial to investigate if high dose esomeprazole reduces organ dysfunction in patients with sepsis or septic shock. METHODS This study, called PPI-SEPSIS, is a multicenter, randomized, double blind, placebo-controlled clinical trial on critically ill septic patients admitted to the emergency department or intensive care unit. A total of 300 patients will be randomized to receive high dose esomeprazole (80 mg bolus followed by 12 mg/h for 72 h and a second 80 mg bolus 12 h after the first one) or equivolume placebo (sodium chloride 0.9%), with 1:1 allocation. The primary endpoint of the study will be mean daily Sequential Organ Failure Assessment (SOFA) score over 10 days. Secondary outcomes will include antibiotic-free days, single organ failure severity, intensive care unit-free days at day 28, and mortality. DISCUSSION This trial aims to test the efficacy of high dose esomeprazole to reduce acute organ dysfunction in patients with septic shock. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov with the trial identification NCT03452865 in March 2018.
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Affiliation(s)
- Giacomo Monti
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Aidos Konkayev
- Astana Medical University, National Scientific Center of Traumatology and Orthopedia, Astana, Kazakhstan
| | - Sonia Carta
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Nikola Bradic
- University Hospital Dubrava, Zagreb, Croatia; University North, Varazdin, Croatia
| | - Andrea Bruni
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Yuki Kotani
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Kameda Medical Center, Kamogawa, Japan
| | | | - Ivan Redkin
- Federal Research and Clinical Center of Reanimatology and Rehabilitology, Moscow, Russia
| | | | | | - Fabrizio D'Ascenzo
- University of Turin, Turin, Italy; Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Giulia Brizzi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | - Sara Scapol
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Elena Momesso
- Ospedale San Donà di Piave, San Donà di Piave (VE), Italy
| | | | | | | | | | - Giorgia Montrucchio
- University of Turin, Turin, Italy; Città Della Salute e Della Scienza Hospital, Turin, Italy
| | | | | | | | | | | | | | | | - Rosa Labanca
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosalba Lembo
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | | | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy; University of Udine, Udine, Italy
| | | | - Federico Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Rinaldo Bellomo
- The University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Alberto Zangrillo
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Vetrugno L, Sala A, Deana C, Meroi F, Grandesso M, Maggiore SM, Isola M, De Martino M, Restaino S, Vizzielli G, Bove T, Driul L. Quality of life 1 year after hospital discharge in unvaccinated pregnant women with COVID-19 respiratory symptoms: a prospective observational study (ODISSEA-PINK study). Front Med (Lausanne) 2023; 10:1225648. [PMID: 37746068 PMCID: PMC10516577 DOI: 10.3389/fmed.2023.1225648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Little is known about Quality of Life within the first court of unvaccinated COVID-19 pregnant women exposed to the pandemic stressor. Primary aim of this study was to evaluate 1 year after hospital discharge HRQoL in a cohort of COVID-19 unvaccinated pregnant patients with COVID-19. Methods in this prospective observational study, all COVID-19 positive pregnant women at any gestational age, admitted to the Obstetric Department at the University Hospital of Udine, Italy, from 1 March 2020 to 1 March 2021, requiring or not oxygen supplementation due to SARS-CoV2 pneumonia were evaluated. Patients with a history of neurological or psychiatric disease, those with a previous abortion, and those who refused to provide written informed consent were excluded from the study. We investigated pregnant positive COVID-19 women Health-related quality of life (HRQoL) with the Short-Form Health Survey-36 (SF-36) and Post-traumatic Stress-Disorder (PTSD) with the Impact of Event Scale-Revised (IES-R). Results 62 pregnant women respected the inclusion criteria of the study, and data from 33 patients were analyzed. The mean age was 32 ± 6 years, with a median gestational age of 38 weeks [IQR 34-40]. 15.2% of patients required oxygen therapy through noninvasive respiratory support (with high flow nasal cannula) for a median of 9 days [IQR 6-12]. The median Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were 50.2 [IQR 46.7-53.7] and 56.0 [IQR 46.8-60.6] respectively. Ten patients out of 33 (30%) tested positive for PTSD. Maternal age, gestational age, and history of cardiac-pulmonary-kidney disease significantly affected HRQoL at multivariable analysis. Discussion In COVID-19 pregnant unvaccinated women some physical impairments reducing HRQoL are still present 1 year after hospital discharge. Previous medical history such as history of cardiac-pulmonary-kidney disease significantly affected HRQoL. Long and repeated follow-up should be pursued in this category of patients.Clinical trial registration:ClinicalTrials.gov, Identifier NCT04860687.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral, and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Alessia Sala
- Department of Medical Area (DAME), University of Udine, Udine, Italy
- Department of Obstetrics and Gynaecology, ASUFC, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Francesco Meroi
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Maria Grandesso
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy
| | - Miriam Isola
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Maria De Martino
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Stefano Restaino
- Department of Obstetrics and Gynaecology, ASUFC, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Giuseppe Vizzielli
- Department of Medical Area (DAME), University of Udine, Udine, Italy
- Department of Obstetrics and Gynaecology, ASUFC, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Tiziana Bove
- Department of Medical Area (DAME), University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Lorenza Driul
- Department of Medical Area (DAME), University of Udine, Udine, Italy
- Department of Obstetrics and Gynaecology, ASUFC, Ospedale Santa Maria Della Misericordia, Udine, Italy
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Cherchi V, Vetrugno L, Terrosu G, Deana C, Ventin M, Zanini V, Barbariol F, Pravisani R, Bove T, Risaliti A, Lorenzin D, Baccarani U. Association between artificial nutrition in brain dead donors and early allograft function in liver transplant recipients: an observational study. Clin Transplant 2023; 37:e15034. [PMID: 37212369 DOI: 10.1111/ctr.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/23/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The role of nutrition in donor after brain deaths (DBDs) has yet to be adequately discussed. The primary aim of this study was to investigate whether the nutritional intake in the 48 h before organ retrieval may play a role on the graft functional recovery assessed with Model for Early Allograft Function (MEAF) Score. METHODS Single-center retrospective study evaluating all liver transplants performed at the University Hospital of Udine from January 2010 to August 2020. Patients receiving grafts from DBD donors fed with artificial enteral nutrition in the 48 h prior to organ procurement (EN-group) or who did not (No-EN-group). Caloric debt was calculated using the difference between the calculated caloric needs and the effective calories delivered through enteral nutrition. RESULTS Livers from EN-group presented a lower mean MEAF score compared to the no-EN-group: 3.39 ± 1.46 versus 4.15 ± 1.51, respectively (p = .04). A positive correlation between caloric debt and the MEAF score was found within the overall population (r = .227, p = .043) as well as in EN-group (r = .306, p = .049). CONCLUSIONS Donor's nutritional intake in the final 48 h before organ procurement correlates with MEAF score, and nutrition probably plays a positive role on the functional recovery of the graft. Large future randomized controlled trials are needed to confirm this preliminary results.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Victor Zanini
- Department of Medicine, University of Udine, Udine, Italy
| | - Federico Barbariol
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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Monti G, Bradić N, Marzaroli M, Konkayev A, Fominskiy E, Kotani Y, Likhvantsev VV, Momesso E, Nogtev P, Lobreglio R, Redkin I, Toffoletto F, Bruni A, Baiardo Redaelli M, D’Andrea N, Paternoster G, Scandroglio AM, Gallicchio F, Ballestra M, Calabrò MG, Cotoia A, Perone R, Cuffaro R, Montrucchio G, Pota V, Ananiadou S, Lembo R, Musu M, Rauch S, Galbiati C, Pinelli F, Pasin L, Guarracino F, Santarpino G, Agrò FE, Bove T, Corradi F, Forfori F, Longhini F, Cecconi M, Landoni G, Bellomo R, Zangrillo A. Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis: The MERCY Randomized Clinical Trial. JAMA 2023; 330:141-151. [PMID: 37326473 PMCID: PMC10276329 DOI: 10.1001/jama.2023.10598] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
Importance Meropenem is a widely prescribed β-lactam antibiotic. Meropenem exhibits maximum pharmacodynamic efficacy when given by continuous infusion to deliver constant drug levels above the minimal inhibitory concentration. Compared with intermittent administration, continuous administration of meropenem may improve clinical outcomes. Objective To determine whether continuous administration of meropenem reduces a composite of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria compared with intermittent administration in critically ill patients with sepsis. Design, Setting, and Participants A double-blind, randomized clinical trial enrolling critically ill patients with sepsis or septic shock who had been prescribed meropenem by their treating clinicians at 31 intensive care units of 26 hospitals in 4 countries (Croatia, Italy, Kazakhstan, and Russia). Patients were enrolled between June 5, 2018, and August 9, 2022, and the final 90-day follow-up was completed in November 2022. Interventions Patients were randomized to receive an equal dose of the antibiotic meropenem by either continuous administration (n = 303) or intermittent administration (n = 304). Main Outcomes and Measures The primary outcome was a composite of all-cause mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. There were 4 secondary outcomes, including days alive and free from antibiotics at day 28, days alive and free from the intensive care unit at day 28, and all-cause mortality at day 90. Seizures, allergic reactions, and mortality were recorded as adverse events. Results All 607 patients (mean age, 64 [SD, 15] years; 203 were women [33%]) were included in the measurement of the 28-day primary outcome and completed the 90-day mortality follow-up. The majority (369 patients, 61%) had septic shock. The median time from hospital admission to randomization was 9 days (IQR, 3-17 days) and the median duration of meropenem therapy was 11 days (IQR, 6-17 days). Only 1 crossover event was recorded. The primary outcome occurred in 142 patients (47%) in the continuous administration group and in 149 patients (49%) in the intermittent administration group (relative risk, 0.96 [95% CI, 0.81-1.13], P = .60). Of the 4 secondary outcomes, none was statistically significant. No adverse events of seizures or allergic reactions related to the study drug were reported. At 90 days, mortality was 42% both in the continuous administration group (127 of 303 patients) and in the intermittent administration group (127 of 304 patients). Conclusions and Relevance In critically ill patients with sepsis, compared with intermittent administration, the continuous administration of meropenem did not improve the composite outcome of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. Trial Registration ClinicalTrials.gov Identifier: NCT03452839.
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Affiliation(s)
- Giacomo Monti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Nikola Bradić
- Clinical Department of Anesthesiology, Resuscitation and Intensive Medicine, University Hospital Dubrava, Zagreb, Croatia
- University North, Varazdin, Croatia
| | - Matteo Marzaroli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Aidos Konkayev
- National Scientific Center of Traumatology and Orthopedia named acad NBatpenov, Astana Medical University, Astana, Kazakhstan
| | - Evgeny Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Yuki Kotani
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Kameda Medical Center, Kamogawa, Japan
| | | | - Elena Momesso
- UOC Anestesia Rianimazione Ospedale San Donà di Piave, San Donà di Piave, Italy
| | - Pavel Nogtev
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Rosetta Lobreglio
- Department of Anesthesia, Intensive Care and Emergency, Citta della Salute e della Scienza University Hospital, Turin, Italy
| | - Ivan Redkin
- Federal Research and Clinical Center of Resuscitation and Rehabilitation, Moscow, Russia
| | - Fabio Toffoletto
- UOC Anestesia Rianimazione Ospedale San Donà di Piave, San Donà di Piave, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Martina Baiardo Redaelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Natascia D’Andrea
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | | | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Romina Perone
- Department of Cardio Thoracic and Vascular Surgery, Pineta Grande Hospital, Pineta Grande, Italy
| | - Raffaele Cuffaro
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Montrucchio
- Department of Anesthesia, Intensive Care and Emergency, Citta della Salute e della Scienza University Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Vincenzo Pota
- Università della Campania L. Vanvitelli, Napoli, Italy
| | | | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Musu
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari, Cagliari, Italy
- Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Simon Rauch
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of Merano, Merano, Italy
| | - Carola Galbiati
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fulvio Pinelli
- Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Laura Pasin
- Azienda Ospedale Università Padova, Padua, Italy
| | - Fabio Guarracino
- Dipartimento Anestesia e Rianimazione, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Santarpino
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
- GVM Care and Research, Department of Cardiac Surgery, Città di Lecce Hospital, Lecce, Italy
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Felice Eugenio Agrò
- Research Unit of Anesthesia and Intensive Care, Department of Medicine and Surgery, Università Campus Bio-Medico, Rome, Italy
- Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy
- Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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9
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Orso D, Santangelo S, Guglielmo N, Bove T, Cilenti F, Cristiani L, Copetti R. Bayesian Network Meta-analysis of Randomized Controlled Trials on the Efficacy of Antiarrhythmics in the Pharmacological Cardioversion of Paroxysmal Atrial Fibrillation. Am J Cardiovasc Drugs 2023:10.1007/s40256-023-00586-5. [PMID: 37233967 DOI: 10.1007/s40256-023-00586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Since atrial fibrillation (AF) is one of the major arrhythmias managed in hospitals worldwide, it has a major impact on public health. The guidelines agree on the desirability of cardioverting paroxysmal AF episodes. This meta-analysis aims to answer the question of which antiarrhythmic agent is most effective in cardioverting a paroxysmal AF. MATERIALS AND METHODS A systematic review and Bayesian network meta-analysis, searching MEDLINE, Embase, and CINAHL, were performed, including randomized controlled trials (RCTs) enrolling a population of unselected adult patients with a paroxysmal AF that compared at least two pharmacological regimes to restore the sinus rhythm or a cardioversion agent against a placebo. The main outcome was efficacy in restoring sinus rhythm. RESULTS Sixty-one RCTs (7988 patients) were included in the quantitative analysis [deviance information criterion (DIC) 272.57; I2 = 3%]. Compared with the placebo, the association verapamil-quinidine shows the highest SUCRA rank score (87%), followed by antazoline (86%), vernakalant (85%), tedisamil at high dose (i.e., 0.6 mg/kg; 80%), amiodarone-ranolazine (80%), lidocaine (78%), dofetilide (77%), and intravenous flecainide (71%). Taking into account the degree of evidence of each individual comparison between pharmacological agents, we have drawn up a ranking of pharmacological agents from the most effective to the least effective. CONCLUSIONS In comparing the antiarrhythmic agents used to restore sinus rhythm in the case of paroxysmal AF, vernakalant, amiodarone-ranolazine, flecainide, and ibutilide are the most effective medications. The verapamil-quinidine combination seems promising, though few RCTs have studied it. The incidence of side effects must be taken into account in the choice of antiarrhythmic in clinical practice. CLINICAL TRIAL REGISTRATION PROSPERO: International prospective register of systematic reviews, 2022, CRD42022369433 (Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022369433 ).
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Affiliation(s)
- Daniele Orso
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Via Colugna 50, 33100, Udine, Italy.
- Department of Medical Sciences (DAME), University of Udine, Via Colugna 50, 33100, Udine, Italy.
| | - Sara Santangelo
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
- Department of Medical Sciences (DAME), University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Nicola Guglielmo
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
- Department of Medical Sciences (DAME), University of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Francesco Cilenti
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
| | - Lorenzo Cristiani
- Department of Pre-hospital and Retrieval Medicine, Regional Health Emergency Operational Structure (SORES), Palmanova, Italy
| | - Roberto Copetti
- Department of Emergency Medicine, ASUFC Community Hospital of Latisana, Latisana, Italy
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10
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Auci E, Vetrugno L, Riccardi I, Vendramin I, Livi U, Bassi F, Bove T. Acute acquired immune thrombocytopenia after cardiac surgery: A challenging case. Ann Card Anaesth 2023; 26:90-93. [PMID: 36722595 PMCID: PMC9997465 DOI: 10.4103/aca.aca_37_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Thrombocytopenia is a common condition that recognizes an infinite number of possible causes, especially in specific settings like the one covered in this case report: the postoperative period of cardiac surgery. We report a case of an old male with multiple comorbidities who underwent a coronary angioplasty procedure and aortic valve replacement. He showed severe thrombocytopenia in the postoperative days. Differential diagnosis required a big effort, also for the experts in the field. Our goal was to aggressively treat the patient with prednisolone, platelets, and intravenous immunoglobulins to maximize the prognosis. Our patient developed no complications and was discharged successfully.
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Affiliation(s)
- Elisabetta Auci
- Department of Anesthesia and Intensive Care Medicine, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Clinic, ASUFC "Santa Maria della Misericordia" University Hospital of Udine; Department of Medicine, University of Udine, Udine, Italy
| | - Ilaria Riccardi
- Department of Anesthesia and Intensive Care Medicine, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Igor Vendramin
- Department of Cardiothoracic Surgery, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Department of Cardiothoracic Surgery, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care Medicine, ASUFC "Santa Maria della Misericordia" University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Clinic, ASUFC "Santa Maria della Misericordia" University Hospital of Udine; Department of Medicine, University of Udine, Udine, Italy
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11
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Vetrugno L, Mojoli F, Boero E, Berchialla P, Bignami EG, Orso D, Cortegiani A, Forfori F, Corradi F, Cammarota G, De Robertis E, Mongodi S, Chiumello D, Poole D, Ippolito M, Biasucci DG, Persona P, Bove T, Ball L, Pelosi P, Navalesi P, Antonelli M, Corcione A, Giarratano A, Petrini F. Level of Diffusion and Training of Lung Ultrasound during the COVID-19 Pandemic - A National Online Italian Survey (ITALUS) from the Lung Ultrasound Working Group of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI). Ultraschall Med 2022; 43:464-472. [PMID: 34734405 PMCID: PMC9534595 DOI: 10.1055/a-1634-4710] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE The goal of this survey was to describe the use and diffusion of lung ultrasound (LUS), the level of training received before and during the COVID-19 pandemic, and the clinical impact LUS has had on COVID-19 cases in intensive care units (ICU) from February 2020 to May 2020. MATERIALS AND METHODS The Italian Lung Ultrasound Survey (ITALUS) was a nationwide online survey proposed to Italian anesthesiologists and intensive care physicians carried out after the first wave of the COVID-19 pandemic. It consisted of 27 questions, both quantitative and qualitative. RESULTS 807 responded to the survey. The median previous LUS experience was 3 years (IQR 1.0-6.0). 473 (60.9 %) reported having attended at least one training course on LUS before the COVID-19 pandemic. 519 (73.9 %) reported knowing how to use the LUS score. 404 (52 %) reported being able to use LUS without any supervision. 479 (68.2 %) said that LUS influenced their clinical decision-making, mostly with respect to patient monitoring. During the pandemic, the median of patients daily evaluated with LUS increased 3-fold (p < 0.001), daily use of general LUS increased from 10.4 % to 28.9 % (p < 0.001), and the daily use of LUS score in particular increased from 1.6 % to 9.0 % (p < 0.001). CONCLUSION This survey showed that LUS was already extensively used during the first wave of the COVID-19 pandemic by anesthesiologists and intensive care physicians in Italy, and then its adoption increased further. Residency programs are already progressively implementing LUS teaching. However, 76.7 % of the sample did not undertake any LUS certification.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Italy
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Italy, Udine, Italy
- Correspondence Dr. Luigi Vetrugno Department of Medicine, University of UdineVia Colugna 5033100 UdineItaly+39/4 32/55 95 01
| | - Francesco Mojoli
- Anesthesiology, Intensive Care and Pain Medicine, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
- Anesthesia and Intensive Care, University Hospital of Pavia, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care, Hospital Saint-Giovanni Bosco Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin Faculty of Medicine and Surgery, Torino, Italy
| | - Elena Giovanna Bignami
- Department of Medicine and Surgery, University of Parma Department of Medicine and Surgery, Parma, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine Department of Biological and Medical Sciences, Udine, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Gianmaria Cammarota
- Department of Medicine and Surgery, University of Perugia School of Medicine and Surgery, Perugia, Italy
| | - Edoardo De Robertis
- Department of Medicine and Surgery, University of Perugia Department of Medicine, Perugia, Italy
| | - Silvia Mongodi
- Anesthesiology and Intensive Care, University Hospital of Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
| | - Davide Chiumello
- Department of Anesthesiology and Intensive Care, University of Milan, Milano, Italy
| | - Daniele Poole
- Anesthesia and Intensive Care Operative Unit, Hospital Saint-Martinus, Belluno, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Daniele Guerino Biasucci
- Department of Anesthesia and Intensive Care, University Hospital Agostino Gemelli Department of Surgical and Medical Sciences, Rome, Italy
| | - Paolo Persona
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy, Padua, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Italy, Udine, Italy
- Department of Medicine, University of Udine Department of Biological and Medical Sciences, Udine, Italy
| | - Lorenzo Ball
- Department of Anesthesia and Intensive Care, University of Genoa School of Medical and Pharmaceutical Sciences, Genova, Italy
| | - Paolo Pelosi
- Department of Anesthesia and Intensive Care, University of Genoa School of Medical and Pharmaceutical Sciences, Genova, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy, Padua, Italy
| | - Massimo Antonelli
- Department of Anesthesia and Intensive Care, University Hospital Agostino Gemelli Department of Surgical and Medical Sciences, Rome, Italy
| | - Antonio Corcione
- Unit of Anaesthesia and intensive Care, Monaldi Hospital Naples, Italy, Naples, Italy
| | - Antonino Giarratano
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
| | - Flavia Petrini
- Anesthesia, Intensive Care and Pain Management, President Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), Rome Italy, Rome, Italy
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12
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Restaino S, Paparcura F, Giorgiutti C, Trojan D, Montagner G, Pengo G, Pividore G, Albanese R, Rampino E, Dogareschi T, Bove T, Titone F, Trovò M, Garganese G, Parodi PC, Scambia G, Driul L, Vizzielli G. Human amniotic membrane for myocutaneous dehiscence after a radical surgical treatment of vulvar cancer: A case report. Front Oncol 2022; 12:1009884. [PMID: 36212440 PMCID: PMC9539543 DOI: 10.3389/fonc.2022.1009884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background The application of the amniotic membrane could have a favourable effect on tissue repair and regeneration. We report the first case of implant of an amniotic membrane in a patient affected by myo-cutaneous dehiscence, after a radical surgical treatment for vulvar cancer. Methods We describe a case of a 74-years-old patient affected by vulvar cancer. After radiotherapy, the patient underwent to an anterior pelvic exenteration with uretero-ileo-cutaneostomy by Wallace, bilateral pelvic lymphadenectomy, omental biopsies, omental flap, bilateral inguinal lymphadenectomy, resection of ulcerated left inguinal lesion, reconstruction with left gracilis muscle flap and locoregional V-Y advancement flap. The patient developed a myo-cutaneous dehiscence. Two months after the surgery, following an accurate curettage of the wound and negative pressure therapy, a patch of human amniotic membrane was implanted. Results The surgical procedure was easy, feasible and did not require long operating room times. No intraoperative or postoperative complications occurred. The results obtained were encouraging with a marked improvement in the surgical wound. Conclusion the use of amniotic membranes was safely and easily performed to promote the healing of complicated surgical wounds.
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Affiliation(s)
- Stefano Restaino
- Department of Maternal and Child Health, Obstetrics and Gynecology Clinic, University Hospital of Udine, Udine, Italy
| | - Federico Paparcura
- Medical Area Department (Dipartimento di Area Medica, DAME), Università degli Studi di Udine, Udine, Italy
| | - Cristina Giorgiutti
- Medical Area Department (Dipartimento di Area Medica, DAME), Università degli Studi di Udine, Udine, Italy
| | - Diletta Trojan
- Fondazione Banca dei tessuti di Treviso Onlus, Treviso, Italy
| | | | - Giancarlo Pengo
- Surgical Video Production & Multimedia Medical – Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Roberta Albanese
- Dipartimento di Scienze Chirurgiche, Clinica di Chirurgia Plastica Ricostruttiva, Università degli Studi di Udine, Udine, Italy
| | - Emanuele Rampino
- Dipartimento di Scienze Chirurgiche, Clinica di Chirurgia Plastica Ricostruttiva, Università degli Studi di Udine, Udine, Italy
| | - Teresa Dogareschi
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Medical Area Department (Dipartimento di Area Medica, DAME), Università degli Studi di Udine, Udine, Italy
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Udine, Italy
| | - Francesca Titone
- Radiation Oncology Department, University Hospital of Udine, Udine, Italy
| | - Marco Trovò
- Radiation Oncology Department, University Hospital of Udine, Udine, Italy
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Pier Camillo Parodi
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Udine, Italy
| | - Giovanni Scambia
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Unità Operativa Complessa Ginecologia Oncologica, Roma, Italy
| | - Lorenza Driul
- Medical Area Department (Dipartimento di Area Medica, DAME), Università degli Studi di Udine, Udine, Italy
- *Correspondence: Lorenza Driul,
| | - Giuseppe Vizzielli
- Medical Area Department (Dipartimento di Area Medica, DAME), Università degli Studi di Udine, Udine, Italy
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13
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Vetrugno L, Orso D, Corradi F, Zani G, Spadaro S, Meroi F, D’Andrea N, Bove T, Cammarota G, De Robertis E, Ferrari S, Guarnieri M, Ajuti M, Fusari M, Grieco DL, Deana C, Boero E, Franchi F, Scolletta S, Maggiore SM, Forfori F. Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study. Respir Res 2022; 23:210. [PMID: 35989352 PMCID: PMC9392990 DOI: 10.1186/s12931-022-02138-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction (DTF) could provide corroborating information for weaning COVID-19 patients from mechanical ventilation.
Methods
This was an observational, pragmatic, cross-section, multicenter study in 6 Italian intensive care units. DTF was assessed in COVID-19 patients undergoing weaning from mechanical ventilation from 1st March 2020 to 30th June 2021. Primary aim was to evaluate whether DTF is a predictive factor for weaning failure.
Results
Fifty-seven patients were enrolled, 25 patients failed spontaneous breathing trial (44%). Median length of invasive ventilation was 14 days (IQR 7–22). Median DTF within 24 h since the start of weaning was 28% (IQR 22–39%), RASS score (− 2 vs − 2; p = 0.031); Kelly-Matthay score (2 vs 1; p = 0.002); inspiratory oxygen fraction (0.45 vs 0.40; p = 0.033). PaO2/FiO2 ratio was lower (176 vs 241; p = 0.032) and length of intensive care stay was longer (27 vs 16.5 days; p = 0.025) in patients who failed weaning. The generalized linear regression model did not select any variables that could predict weaning failure. DTF was correlated with pH (RR 1.56 × 1027; p = 0.002); Kelly-Matthay score (RR 353; p < 0.001); RASS (RR 2.11; p = 0.003); PaO2/FiO2 ratio (RR 1.03; p = 0.05); SAPS2 (RR 0.71; p = 0.005); hospital and ICU length of stay (RR 1.22 and 0.79, respectively; p < 0.001 and p = 0.004).
Conclusions
DTF in COVID-19 patients was not predictive of weaning failure from mechanical ventilation, and larger studies are needed to evaluate it in clinical practice further.
Registered: ClinicalTrial.gov (NCT05019313, 24 August 2021).
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14
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Deana C, Vetrugno L, Stefani F, Bassi F, Bove T. Transcranial Doppler in a child: A most valuable imaging modality. Ultrasound 2022; 30:167-172. [PMID: 35509297 PMCID: PMC9058393 DOI: 10.1177/1742271x21998059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/01/2021] [Indexed: 05/03/2023]
Abstract
Introduction Pediatric brain injury is a common cause of emergency department (ED) referral. Although severe traumatic brain damage is less frequent, it could be primarily managed by non-pediatric critical care physicians called in for advice. Clinical evaluation is important, but radiology is of particular value in the case of severe brain injury. Transcranial Doppler may help the physician through neuromonitoring. Case Report We report the case of a 3-year-old male child brought into the pediatric ED for a moderate head injury. His neurological status deteriorated rapidly, making endotracheal intubation and mechanical ventilation necessary. Computed tomography (CT) of the head revealed brain contusion and post-traumatic subarachnoidal hemorrhage. Discussion Transcranial Doppler was performed at the standard transtemporal evaluation window, and it showed normal vascularization of the entire anterior brain. This result permitted performance of the control CT scan to be postponed. In this case, basic knowledge of transcranial ultrasound proved to be useful, and we believe it could also be useful to other colleagues faced with similar situations even if they are not dedicated to pediatric critically ill patients. Conclusion Doppler ultrasound in the pediatric population is a valuable bedside tool. Together with clinical evaluation and radiology, it completes the set of techniques necessary for continuous neuromonitoring.
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Cristian Deana, Anesthesia and Intensive Care 1, Anesthesia and Intensive Care Department, Academic Hospital S. Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale S. M. della Misericordia, 15 - 33100 Udine, Italy.
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Medical Department, University of Udine, Udine, Italy
| | - Francesca Stefani
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Medical Department, University of Udine, Udine, Italy
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15
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Orso D, Scapol S, Bove T. Is extracorporeal life support evidence-based medicine? Not yet. Artif Organs 2022; 46:1446-1447. [PMID: 35435258 DOI: 10.1111/aor.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Udine, Italy
| | - Sara Scapol
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC University Hospital of Udine, Udine, Italy
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16
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Peghin M, Castaldo N, Tascini C, Bassetti M, Graziano E, Givone F, Savignano C, De Colle MC, Bove T, Pipan C, Loy M, Basso S, Cinque P, Gerevini S, Berastegui C, Hirsch HH, Grossi PA, Comoli P. Successful JC virus-targeted T-cell therapy for progressive multifocal leukoencephalopathy in a lung transplant recipient. J Heart Lung Transplant 2022; 41:991-996. [DOI: 10.1016/j.healun.2022.04.001] [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] [Received: 01/22/2022] [Revised: 03/08/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
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17
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Vetrugno L, Meroi F, Orso D, D’Andrea N, Marin M, Cammarota G, Mattuzzi L, Delrio S, Furlan D, Foschiani J, Valent F, Bove T. Can Lung Ultrasound Be the Ideal Monitoring Tool to Predict the Clinical Outcome of Mechanically Ventilated COVID-19 Patients? An Observational Study. Healthcare (Basel) 2022; 10:healthcare10030568. [PMID: 35327046 PMCID: PMC8955357 DOI: 10.3390/healthcare10030568] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background: During the COVID-19 pandemic, lung ultrasound (LUS) has been widely used since it can be performed at the patient’s bedside, does not produce ionizing radiation, and is sufficiently accurate. The LUS score allows for quantifying lung involvement; however, its clinical prognostic role is still controversial. Methods: A retrospective observational study on 103 COVID-19 patients with respiratory failure that were assessed with an LUS score at intensive care unit (ICU) admission and discharge in a tertiary university COVID-19 referral center. Results: The deceased patients had a higher LUS score at admission than the survivors (25.7 vs. 23.5; p-value = 0.02; cut-off value of 25; Odds Ratio (OR) 1.1; Interquartile Range (IQR) 1.0−1.2). The predictive regression model shows that the value of LUSt0 (OR 1.1; IQR 1.0–1.3), age (OR 1.1; IQR 1.0−1.2), sex (OR 0.7; IQR 0.2−3.6), and days in spontaneous breathing (OR 0.2; IQR 0.1–0.5) predict the risk of death for COVID-19 patients (Area under the Curve (AUC) 0.92). Furthermore, the surviving patients showed a significantly lower difference between LUS scores at admission and discharge (mean difference of 1.75, p-value = 0.03). Conclusion: Upon entry into the ICU, the LUS score may play a prognostic role in COVID-19 patients with ARDS. Furthermore, employing the LUS score as a monitoring tool allows for evaluating the patients with a higher probability of survival.
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Affiliation(s)
- Luigi Vetrugno
- Dipartimento di Scienze, Orali e Biotecnologiche, Università degli Studi “G. d’Annunzio”, 66100 Chieti, Italy;
| | - Francesco Meroi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
- Correspondence:
| | - Daniele Orso
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Natascia D’Andrea
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Matteo Marin
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Gianmaria Cammarota
- Division of Anesthesia, Analgesia and Intensive Care, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Lisa Mattuzzi
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Silvia Delrio
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Davide Furlan
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Jonathan Foschiani
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
| | - Francesca Valent
- Clinical and Evaluational Epidemiologic Service, Department of Governance, Local Health Authority, 38123 Trento, Italy;
| | - Tiziana Bove
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, 33100 Udine, Italy; (D.O.); (N.D.); (M.M.); (L.M.); (S.D.); (D.F.); (J.F.); (T.B.)
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18
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Vetrugno L, Cherchi V, Zanini V, Cotrozzi S, Ventin M, Terrosu G, Baccarani U, Bove T. Association between preoperative diastolic dysfunction and early allograft dysfunction after orthotopic liver transplantation: An observational study. Echocardiography 2022; 39:561-567. [PMID: 35224775 DOI: 10.1111/echo.15328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/30/2022] [Accepted: 02/16/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To investigate the association between the grade of diastolic dysfunction (DD) and the occurrence of early allograft dysfunction (EAD) in liver transplant patients following the new 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) guidelines. METHODS From January 2015 to December 2019, we retrospectively analyzed 83 patients who underwent orthotopic liver transplantation (OLTx) and their susceptibility to develop EAD according to the grade of preoperative DD. EAD was defined according to the criteria proposed by Olfhoff et al.; DD was defined with four parameters: E/A, e/e', Left Atrium volume, and Tricuspid Regurgitation velocity. RESULTS According to the ASE/EACVI guidelines grade II DD was detected in 20 patients (24.1%) undergoing OLTx. A statistically significant association was found between grade II DD and the occurrence of EAD (p-value < 0.003). The Kaplan-Meier analysis failed to find any significant difference between the survival probability, nevertheless at the end of a 90-day follow-up period, mortality showed a different trend in classes with more severe diastolic dysfunction. CONCLUSION According to the ASE/EACVI guidelines from 2016, patients with grade II DD seem to have a higher propensity to develop early allograft dysfunction EAD after OLTx. Our study advises a need for an urgent prospective multicenter study to elucidate the long-term outcomes of liver transplants patients with diastolic dysfunction.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral, and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Victor Zanini
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Marco Ventin
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy
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19
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Orso D, Scapol S, Dogareschi T, Spasiano A, Driul L, Bove T. Correlation between epidural analgesia and type of delivery in the low Robson score classes: a registry based-cohort study. Minerva Anestesiol 2022; 88:525-526. [PMID: 35199976 DOI: 10.23736/s0375-9393.21.16356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy -
| | - Sara Scapol
- Department of Medicine, University of Udine, Udine, Italy
| | - Teresa Dogareschi
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Santa Maria della Misericordia Hospital of Udine, Udine, Italy
| | - Alessandra Spasiano
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Santa Maria della Misericordia Hospital of Udine, Udine, Italy
| | - Lorenza Driul
- Department of Medicine, University of Udine, Udine, Italy.,Department of Obstetrics and Gynaecology, ASUFC Santa Maria della Misericordia Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Santa Maria della Misericordia Hospital of Udine, Udine, Italy
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20
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Auci E, Vendramin I, Barbariol F, Riccardi I, Gigante A, Baroselli A, Bove T, Bassi F, Vetrugno L, Livi U. Platelet Dysfunction in Cardiac Surgery: When is the Best Time to Assess It? An Observational Single Center Study. Semin Cardiothorac Vasc Anesth 2022; 26:8-14. [PMID: 35156440 DOI: 10.1177/10892532211064041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose. Cardiac surgery is characterized by a high risk of complications related to perioperative bleeding. Guidelines suggest the use of local algorithms based on perioperative point-of-care tests to assess and manage potential coagulation abnormalities. We investigated whether heparin reversal administration affects the adenosine-5-diphosphate (ADP) test values, thus identifying the earliest time point following cardio-pulmonary bypass that permits the promptest detection and treatment of potential platelet dysfunctions. Methods. This was a retrospective, single-center, observational study enrolling cardiac surgery patients requiring cardiac bypass. ADP-tests at 4 different time-points during surgery (T0: baseline, T1: at aortic de-clamping, T2: 10 minutes after protamine administration, and T3: at the end of surgery) were performed. Results. 63 patients undergoing elective cardiac surgery were studied. Baseline ADP-test values were almost constantly greater than intraoperative values, and end of surgery values were often greater than previous intraoperative values. The only difference that proved to be not statistically significant was between T1 and T2, with a clinically insignificant mean difference of -.2 U (95%CI of difference: -6.9 - 6.5 U). There was no correlation between the variation in ADP-test values pre- and post-protamine administration and the protamine-to-heparin ratio. Conclusion. The results of the present study support the hypothesis that the ADP-test could be performed early, at aortic de-clamping before protamine administration. This approach allows for the promptest assessment of a potential impairment in platelet function, and its timely correction.
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Affiliation(s)
| | | | | | | | | | | | - Tiziana Bove
- ASUFC University Hospital of Udine, Udine, Italy.,Department of Medicine, 9316University of Udine, Udine, Italy
| | - Flavio Bassi
- ASUFC University Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- ASUFC University Hospital of Udine, Udine, Italy.,Department of Medicine, 9316University of Udine, Udine, Italy
| | - Ugolino Livi
- ASUFC University Hospital of Udine, Udine, Italy.,Department of Medicine, 9316University of Udine, Udine, Italy
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21
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Vetrugno L, Sala A, Orso D, Meroi F, Fabbro S, Boero E, Valent F, Cammarota G, Restaino S, Vizzielli G, Girometti R, Merelli M, Tascini C, Bove T, Driul L. Lung Ultrasound Signs and Their Correlation With Clinical Symptoms in COVID-19 Pregnant Women: The "PINK-CO" Observational Study. Front Med (Lausanne) 2022; 8:768261. [PMID: 35127744 PMCID: PMC8814327 DOI: 10.3389/fmed.2021.768261] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/10/2021] [Indexed: 12/21/2022] Open
Abstract
Objective To analyze the application of lung ultrasound (LUS) diagnostic approach in obstetric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and compare LUS score and symptoms of the patients. Design A single-center observational retrospective study from October 31, 2020 to March 31, 2021. Setting Department of Ob/Gyn at the University-Hospital of Udine, Italy. Participants Pregnant women with SARS-CoV-2 diagnosed with reverse transcription-PCR (RT-PCR) swab test were subdivided as symptomatic and asymptomatic patients with COVID-19. Exposure Lung ultrasound evaluation both through initial evaluation upon admission and through serial evaluations. Main Outcome Reporting LUS findings and LUS score characteristics. Results Symptomatic patients with COVID-19 showed a higher LUS (median 3.5 vs. 0, p < 0.001). LUS was significantly correlated with COVID-19 biomarkers as C-reactive protein (CPR; p = 0.011), interleukin-6 (p = 0.013), and pro-adrenomedullin (p = 0.02), and inversely related to arterial oxygen saturation (p = 0.004). The most frequent ultrasound findings were focal B lines (14 vs. 2) and the light beam (9 vs. 0). Conclusion Lung ultrasound can help to manage pregnant women with SARS-CoV-2 infection during a pandemic surge. Study Registration ClinicalTrials.gov, NCT04823234. Registered on March 29, 2021.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Alessia Sala
- Department of Medicine, University of Udine, Udine, Italy.,Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Francesco Meroi
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | | | - Enrico Boero
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Francesca Valent
- Department of Epidemiology and Public Health, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care Medicine, University of Perugia, Perugia, Italy
| | - Stefano Restaino
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Giuseppe Vizzielli
- Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Rossano Girometti
- Department of Medicine, University of Udine, Udine, Italy.,Department of Radiology, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Maria Merelli
- Department of Infectious Diseases, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy.,Department of Infectious Diseases, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
| | - Lorenza Driul
- Department of Medicine, University of Udine, Udine, Italy.,Department of Gynecology and Obstetrics, ASUFC University-Hospital of Friuli Centrale, Udine, Italy
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22
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Lazzarotto A, Tel A, Vetrugno L, Cereser L, Sembronio S, Di Cosola M, Bove T, Robiony M. Pneumomediastinum, pneumothorax and subcutaneous emphysema after tracheostomy closure. When less is more. Acta Biomed 2022; 92:e2021368. [PMID: 35045064 PMCID: PMC10523032 DOI: 10.23750/abm.v92is1.11551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/28/2021] [Indexed: 06/14/2023]
Abstract
Pneumomediastinum is a threatening complication that might occur after tight surgical closure of tracheostomy is performed. Physiopathology of this condition is based on several factors, including direct trauma to the tracheal wall caused by surgical maneuvers or insufficient closure of soft tissue layers which do not seal air leakage. In this paper we explore this phenomenon by reporting the case of one patient undergoing surgical closure of tracheostomy after two weeks, who later developed subcutaneous emphysema followed by pneumomediastinum. Physiopatology is analyzed and management strategies for this condition are suggested based on our experience.
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Affiliation(s)
- Andrea Lazzarotto
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy..
| | - Alessandro Tel
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy..
| | - Luigi Vetrugno
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University of Udine, P.le Kolbe 4, 33100, Udine, Italy.
| | - Salvatore Sembronio
- Maxillofacial Surgery Department, Academic Hospital of Udine, Department of Medical Science, University of Udine, P.le Kolbe 4, 33100, Udine, Italy.
| | - Michele Di Cosola
- 4. Department of Clinical and Experimental Medicine, Riuniti University Hospital of Foggia, Viale Luigi Pinto 1, 71122, Foggia, Italy.
| | - Tiziana Bove
- 2. Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.
| | - Massimo Robiony
- a:1:{s:5:"en_US";s:114:"Chief of Maxillofacial Surgery Unit, Academic Hospital of Udine Department of Medical Sciences University of Udine";}.
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23
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Zangrillo A, Lomivorotov VV, Pasyuga VV, Belletti A, Gazivoda G, Monaco F, Nigro Neto C, Likhvantsev VV, Bradic N, Lozovskiy A, Lei C, Bukamal NAR, Silva FS, Bautin AE, Ma J, Yong CY, Carollo C, Kunstyr J, Wang CY, Grigoryev EV, Riha H, Wang C, El-Tahan MR, Scandroglio AM, Mansor M, Lembo R, Ponomarev DN, Bezerra FJL, Ruggeri L, Chernyavskiy AM, Xu J, Tarasov DG, Navalesi P, Yavorovskiy A, Bove T, Kuzovlev A, Hajjar LA, Landoni G. Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial. J Cardiothorac Vasc Anesth 2022; 36:2454-2462. [PMID: 35168907 DOI: 10.1053/j.jvca.2022.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/08/2021] [Accepted: 01/02/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). DESIGN A post hoc analysis of a randomized trial. SETTING Cardiac surgical operating rooms. PARTICIPANTS Patients undergoing elective, isolated CABG. INTERVENTIONS Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. MEASUREMENTS AND MAIN RESULTS A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p = 0.03). CONCLUSIONS An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.
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Affiliation(s)
- 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
| | - Vladimir V Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia; Department of Anesthesiology and Intensive Care, Novosibirsk State University, Novosibirsk, Russia
| | - Vadim V Pasyuga
- Department of Anesthesiology and Intensive Care, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, Russia
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gordana Gazivoda
- Department of Anaesthesia and Intensive Care, Cardiovascular Institute Dedinje, Belgrade, Serbia
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caetano Nigro Neto
- Anesthesia Section, Department of Cardiovascular Surgery, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Valery V Likhvantsev
- Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia; V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - Nikola Bradic
- Department of Cardiovascular Anesthesiology and Intensive Care Medicine, Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia; Department of Biomedical Sciences, University North, Varazdin, Croatia
| | - Andrey Lozovskiy
- Department of Anesthesia and Intensive Care, Ural Institute of Cardiology, Ekaterinburg, Russia
| | - Chong Lei
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Xi'an, Shaanxi, China
| | - Nazar A R Bukamal
- Cardiothoracic ICU and Anesthesia Department, Mohammed Bin Khalifa Cardiac Center, Riffa, Bahrain
| | | | - Andrey E Bautin
- Laboratory for Anesthesiology and Intensive Care, Almazov National Medical Research Center, Saint Petersburg, Russia
| | - Jun Ma
- Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chow Yen Yong
- Department of Anaesthesiology and Intensive Care, Hospital Pulau Pinang, Pulau Pinang, Malaysia
| | - Cristiana Carollo
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Jan Kunstyr
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic
| | - Chew Yin Wang
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Evgeny V Grigoryev
- Intensive Care Unit, Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Hynek Riha
- Cardiothoracic Anesthesiology and Intensive Care Medicine, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Chengbin Wang
- Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mohamed R El-Tahan
- Department of Anesthesiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marzida Mansor
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Dmitry N Ponomarev
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Francisco José Lucena Bezerra
- Anesthesia Section, Department of Cardiovascular Surgery, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Laura Ruggeri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexander M Chernyavskiy
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Junmei Xu
- Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Dmitry G Tarasov
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, Russian Federation
| | - Paolo Navalesi
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy; Department of Medicine, University of Padua, Padua, Italy
| | - Andrey Yavorovskiy
- Federal Research and Clinical Center of Resuscitation and Rehabilitation, Moscow, Russia
| | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC University-Hospital of Central Friuli, Udine, Italy
| | - Artem Kuzovlev
- V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - Ludhmila A Hajjar
- Department of Cardiopneumology, Instituto do Coração, Universidade de São Paulo, São Paulo, Brazil; Intensive Care Unit, Hospital SirioLibanes, São Paulo, Brazil
| | - 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.
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Zanini V, Vetrugno L, Ventin M, Cherchi V, Lugano M, Baccarani U, Bove T. Is the indocyanine green clearance test useful in viral acute liver failure? Maybe! Acta Biomed 2022; 93:e2022131. [PMID: 36043982 PMCID: PMC9534256 DOI: 10.23750/abm.v93i4.12067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Victor Zanini
- Department of Medicine, University of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Italy
| | - Marco Ventin
- Department of Medicine, University of Udine, Udine, Italy
| | - Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Manuela Lugano
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Italy
| | - Umberto Baccarani
- Department of Medicine, University of Udine, Udine, Italy, Department of Anesthesia and Intensive Care, University-Hospital of Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy, Department of Anesthesia and Intensive Care, University-Hospital of Udine, Italy
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25
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Furlan D, Deana C, Orso D, Licari M, Cappelletto B, DE Monte A, Vetrugno L, Bove T. Perioperative management of spinal cord injury: the anesthesiologist's point of view. Minerva Anestesiol 2021; 87:1347-1358. [PMID: 34874136 DOI: 10.23736/s0375-9393.21.15753-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) is one of the most devastating events a person can experience. It may be life-threatening or result in long-term disability. This narrative review aims to delineate a systematic step-wise airways, breathing, circulation and disability (ABCD) approach to perioperative patient management during spinal cord surgery in order to fill some of the gaps in our current knowledge. METHODS We performed a comprehensive review of the literature regarding the perioperative management of traumatic spinal injuries from May 15, 2020, to December 13, 2020. We consulted the PubMed and Embase database libraries. RESULTS Videolaryngoscopy supplements the armamentarium available for airway management. Optical fiberscope use should be evaluated when intubating awake patients. Respiratory complications are frequent in the acute phase of traumatic spinal injury, with an estimated incidence of 36-83%. Early tracheostomy can be considered for expected difficult weaning from mechanical ventilation. Careful intraoperative management of administered fluids should be pursued to avoid complications from volume overload. Neuromonitoring requires investments in staff training and cooperation, but better outcomes have been obtained in centers where it is routinely applied. The prone position can cause rare but devastating complications, such as ischemic optic neuropathy; thus, the anesthetist should take the utmost care in positioning the patient. CONCLUSIONS A one-size fit all approach to spinal surgery patients is not applicable due to patient heterogeneity and the complexity of the procedures involved. The neurologic outcome of spinal surgery can be improved, and the incidence of complications reduced with better knowledge of patient-specific aspects and individualized perioperative management.
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Affiliation(s)
- Davide Furlan
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Maurizia Licari
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Barbara Cappelletto
- Section of Spine and Spinal Cord Surgery, Department of Neurological Sciences, ASUFC University Hospital of Udine, Udine, Italy
| | - Amato DE Monte
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine (DAME), University of Udine, Udine, Italy - .,Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
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Montalto F, Ippolito M, Noto A, Madotto F, Gelardi F, Savatteri P, Giarratano A, Cortegiani A, Brescia F, Fabiani F, Zanier C, Nadalini E, Gambaretti E, Gabriele F, Astuto M, Murabito P, Sanfilippo F, Misseri G, Moscarelli A, Spadaro S, Bussolati E, Squadrani E, Villa G, D’Errico R, Cocci G, Lanini I, Mirabella L, Morelli A, Tullo L, Caggianelli G, Ball L, Iiriti M, Giordani F, Giardina M, Mazzeo AT, Grasselli G, Cattaneo E, Alongi S, Marenghi C, Marmiere M, Rocchi M, Turi S, Landoni G, Torrano V, Tinti G, Giorgi A, Fumagalli R, Salvo F, Blangetti I, Cascella M, Forte CA, Navalesi P, Montalbano M, Chiarelli V, Bonanno G, Ferrara FP, Pernice I, Catalisano G, Marino C, Presti G, Fricano DC, Fucà R, Palmeri di Villalba C, Strano MT, Caruso S, Scafidi A, Mazzarese V, Augugliaro E, Terranova V, Forfori F, Corradi F, Taddei E, Isirdi A, Pratesi G, Puccini F, Paternoster G, Barile A, Tescione M, Santacaterina I, Siclari EM, Tripodi VF, Vadalà M, Agrò FE, Pascarella G, Piliego C, Aceto P, De Pascale G, Dottarelli A, Romanò B, Russo A, Covotta M, Giorgerini V, Sardellitti F, Vitelli GM, Coluzzi F, Bove T, Vetrugno L. Emotional status and fear in patients scheduled for elective surgery during COVID-19 pandemic: a nationwide cross-sectional survey (COVID-SURGERY). J Anesth Analg Crit Care 2021. [PMCID: PMC8613518 DOI: 10.1186/s44158-021-00022-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Abstract
Background
Fragmented data exist on the emotional and psychological distress generated by hospital admission during the pandemic in specific populations of patients, and no data exists on patients scheduled for surgery. The aim of this multicentre nationwide prospective cross-sectional survey was to evaluate the impact of pandemic on emotional status and fear of SARS-CoV-2 contagion in a cohort of elective surgical patients in Italy, scheduled for surgery during the COVID-19 pandemic.
Results
Twenty-nine Italian centres were involved in the study, for a total of 2376 patients surveyed (mean age of 58 years ± 16.61; 49.6% males). The survey consisted of 28 total closed questions, including four study outcome questions. More than half of patients had at least one chronic disease (54%), among which cardiovascular diseases were the commonest (58%). The most frequent type of surgery was abdominal (20%), under general anaesthesia (64%). Almost half of the patients (46%) declared to be frightened of going to the hospital for routine checkups; 55% to be afraid of getting SARS-CoV-2 infection during hospitalization and 62% were feared of being hospitalised without seeing family members. Having an oncological disease and other patient-related, centre-related or perioperative factors were independently associated with an increased risk of fear of SARS-CoV-2 infection during hospitalization and of being hospitalised without seeing family members. A previous infection due to SARS-COV-2 was associated with a reduced risk of worse emotional outcomes and fear of SARS-CoV-2 infection during hospitalization. Patients who showed the most emotionally vulnerable profile (e.g. use of sleep-inducing drugs, higher fear of surgery or anaesthesia) were at higher risk of worse emotional status towards the hospitalization during COVID-19 pandemic. Being operated in hospitals with lower surgical volume and with COVID-19 wards was associated with worse emotional status and fear of contagion.
Conclusions
Additional fear and worse emotional status may be frequent in patients scheduled for elective surgery during COVID-19 pandemic. More than half of the participants to the survey were worried about not being able to receive family visits. Psychological support may be considered for patients at higher risk of psychological distress to improve perioperative wellbeing during the pandemic.
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Vetrugno L, Mojoli F, Cortegiani A, Bignami EG, Ippolito M, Orso D, Corradi F, Cammarota G, Mongodi S, Boero E, Iacovazzo C, Vargas M, Poole D, Biasucci DG, Persona P, Bove T, Ball L, Chiumello D, Forfori F, de Robertis E, Pelosi P, Navalesi P, Giarratano A, Petrini F. Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO). J Anesth Analg Crit Care 2021. [PMCID: PMC8611396 DOI: 10.1186/s44158-021-00015-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s44158-021-00015-6.
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Deana C, Vetrugno L, Tonizzo A, Orso D, Piani T, Bove T, De Monte A. Drug Supply During COVID-19 Pandemic: Remember Not to Run With Your Tank Empty. Hosp Pharm 2021; 56:405-407. [PMID: 34720135 DOI: 10.1177/0018578720931749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Cristian Deana
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luigi Vetrugno
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,University of Udine, Udine, Italy
| | | | | | - Tommaso Piani
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Tiziana Bove
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,University of Udine, Udine, Italy
| | - Amato De Monte
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Vetrugno L, Divella M, Orso D, Deana C, Vaccher G, Drovandi P, Beltrame A, Causero A, Bove T. Tracheal lesion during shoulder surgery: a case report and systemic review of the literature. J Anesth Analg Crit Care 2021; 1:11. [PMID: 37386524 DOI: 10.1186/s44158-021-00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 07/01/2023]
Abstract
Pneumomediastinum (PNM) and pneumothorax (PNX) are documented complications of arthroscopic shoulder surgery (ATS). Plexus anesthetic block and tracheal lesions during endotracheal intubation are hypothesized to be the underlying risk factors; however, the actual evidence supporting this hypothesis is scarce.A case of bilateral laterocervical emphysema, subcutaneous edema, and signs of PNM after ATS performed under general anesthesia and supra-scapular nerve block is presented. An up-to-date systematic review of PNM/PNX during orthopedic surgery was performed, involving six databases: PubMed (1996-present), Embase (1974-present), Scopus (2004-present), SpringerLink (1950-present), Ovid Emcare (1995-present), and Google Scholar (2004-present).Twenty-five case studies met the eligibility criteria. In 24 cases, the patient underwent general anesthesia and orotracheal intubation; in 9 of these, a plexus anesthetic block was also performed. One case involved ATS under plexus anesthetic block only. In 10 cases, the diagnostic finding was PNM. In 5 cases, the diagnostic finding was associated with PNX. PNX was detected in 17 cases. In 2 cases, SE was found in the absence of any evidence of either PNM or PNX. A tracheal lesion was identified in 3 cases.Endotracheal intubation and loco-regional anesthesia are not the only predisposing risk factors at play in the pathogenesis of PNM/PNX. Rather, multi-factorial pathogenesis seems more probable, necessitating that specific attention is paid during ATS to the change in patient position on the operating bed, to any slipping of the endotracheal tube, to patient monitoring whilst under the drapes, and to the cuff pressure. PROSPERO registration number: CRD42021260370.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Michele Divella
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Cristian Deana
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Giulia Vaccher
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Pietro Drovandi
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Alessandro Beltrame
- Orthopedic and Trauma Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Araldo Causero
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Orthopedic and Trauma Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
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30
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Langiano N, Brussa A, Riccardi I, Meroi F, Toso F, Cesselli D, Vetrugno L, Bove T. A Rare Cause of Respiratory Insufficiency in a 30-Year-Old Transgender Woman. Chest 2021; 160:e339-e342. [PMID: 34625180 DOI: 10.1016/j.chest.2021.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/22/2021] [Accepted: 05/24/2021] [Indexed: 10/20/2022] Open
Abstract
CASE PRESENTATION A 30-year-old transgender woman who was HIV positive presented to the ED with progressive severe dyspnea and hemoptysis that started 1 day earlier. The patient was undergoing antiretroviral therapy with emtricitabine-rilpivirine-tenofovir with good compliance and feminizing hormone therapy with cyproterone acetate. She was otherwise healthy and was not taking any other medications.
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Affiliation(s)
- Nicola Langiano
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Alessandro Brussa
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Ilaria Riccardi
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Francesco Meroi
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy; Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | - Francesco Toso
- Department of Radiology, University-Hospital of Udine, Udine, Italy
| | - Daniela Cesselli
- Department of Medicine, Institute of Pathology, University of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy; Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy; Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
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Vetrugno L, Cherchi V, Lorenzin D, De Lorenzo F, Ventin M, Zanini V, Terrosu G, Risaliti A, Baccarani U, Bove T. The Challenging Management of an Intracardiac Thrombus in a Liver Transplant Patient at the Reperfusion Phase: A Case Report and Brief Literature Review. Transplant Direct 2021; 7:e746. [PMID: 34476291 PMCID: PMC8405129 DOI: 10.1097/txd.0000000000001200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/25/2022] Open
Abstract
The exact origin of intracardiac thrombi formation during orthotopic liver transplant remains unknown. The altered balance between hypercoagulability, hypocoagulation, and endothelial dysfunction associated with end-stage liver disease is thought to play a pivotal role. Venous stasis, vascular clamping, and reperfusion could also contribute to clot formation. The incidence of intracardiac thrombi formation stands at 4.2%, associated with a mortality rate of 45.5%, and to date, no consensus exists regarding the best way to treat this complication. Intraoperative transesophageal echocardiography is the only effective method for diagnosing intracardiac thrombi formation early, while point-of-care coagulation testing could guide the coagulation management potentially improving patient outcomes.
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Italy, Udine, Italy
| | - Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Francesco De Lorenzo
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Medicine, University of Udine, Italy, Udine, Italy
| | - Victor Zanini
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Italy, Udine, Italy
| | - Giovanni Terrosu
- Department of Medicine, University of Udine, Italy, Udine, Italy.,General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Andrea Risaliti
- Department of Medicine, University of Udine, Italy, Udine, Italy
| | - Umberto Baccarani
- Department of Medicine, University of Udine, Italy, Udine, Italy.,General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Italy, Udine, Italy
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Orso D, Mattuzzi L, Scapol S, Delrio S, Vetrugno L, Bove T. Phlegmasia cerulea dolens superimposed on disseminated intravascular coagulation in COVID-19. Acta Biomed 2021; 92:e2021101. [PMID: 34487073 PMCID: PMC8477088 DOI: 10.23750/abm.v92i4.11478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/21/2021] [Indexed: 01/10/2023]
Abstract
COVID-19 infection has several cardiovascular implications, and coagulopathy is a common abnormality in these patients, often coupled with elevated plasma fibrinogen and D-dimer levels, contributing to adverse outcomes. Phlegmasia cerulea dolens (PCD) is a rare manifestation of deep vein thrombosis. It is life-threatening and can rapidly lead to venous gangrene of the extremity. Only a few cases of COVID-19 associated with PCD are reported in the literature, despite thromboembolism being the common paradigm between the two diseases. We present the case of a 64-year-old adult with acute severe COVID-19 pneumonia who developed PCD despite constantly elevated activated partial thromboplastin time and international normalized ratio. (www.actabiomedica.it)
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Dell'Aquila P, Raimondo P, Orso D, De Luca P, Pozzessere P, Parisi CV, Bove T, Vetrugno L, Grasso S, Procacci V. A simple prognostic score based on troponin and presepsin for COVID-19 patients admitted to the emergency department: a single-center pilot study. Acta Biomed 2021; 92:e2021233. [PMID: 34487072 PMCID: PMC8477102 DOI: 10.23750/abm.v92i4.11479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/22/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The need to determine prognostic factors that can predict a particularly severe or, conversely, the benign course of COVID-19 is particularly perceived in the Emergency Department (ED), considering the scarcity of resources for a conspicuous mass of patients. The aim of our study was to identify some predictors for 30-day mortality among some clinical, laboratory, and ultrasound variables in a COVID-19 patients population. METHODS Prospective single-center pilot study conducted in an ED of a University Hospital. A consecutive sample of confirmed COVID-19 patients with acute respiratory failure was enrolled from March 8th to April 15th, 2020. RESULTS 143 patients were enrolled. Deceased patients (n = 65) were older (81 vs. 61 years, p <0.001), and they had more frequently a history of heart disease, neurological disease, or chronic obstructive pulmonary disease (p-values = 0.026, 0.025, and 0.034, respectively) than survived patients. Troponin I and presepsin had a significant correlation with a worse outcome. Troponin achieved a sensitivity of 77% and a specificity of 82% for a cut-off value of 27.6 ng/L. The presepsin achieved a sensitivity of 54% and a specificity of 92% for a cut-off value of 871 pg/mL. CONCLUSION In a population of COVID-19 patients with acute respiratory failure in an ED, presepsin and troponin I are accurate predictors of 30-day mortality. Presepsin is highly specific and could permit the early identification of patients who could benefit from more intensive care as soon as they enter the ED. Further validation studies are needed to confirm this result.
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Affiliation(s)
- Paola Dell'Aquila
- Department of Emergency Medicine, University Hospital of Bari, Bari, Italy..
| | - Pasquale Raimondo
- Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Paola De Luca
- Department of Emergency Medicine, University Hospital of Bari, Bari, Italy..
| | - Pietro Pozzessere
- Department of Emergency Medicine, University Hospital of Bari, Bari, Italy..
| | - Carmen Vita Parisi
- Department of Emergency Medicine, University Hospital of Bari, Bari, Italy..
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy.
| | - Salvatore Grasso
- Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
| | - Vito Procacci
- Department of Emergency Medicine, University Hospital of Bari, Bari, Italy..
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Meroi F, Orso D, Vetrugno L, Bove T. Lung Ultrasound Score in Critically Ill COVID-19 Patients: A Waste of Time or a Time-Saving Tool? Acad Radiol 2021; 28:1323-1324. [PMID: 34275738 PMCID: PMC8275841 DOI: 10.1016/j.acra.2021.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Francesco Meroi
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Via Colugna n° 50, 33100 Udine, Italy.
| | - Daniele Orso
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Via Colugna n° 50, 33100 Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Via Colugna n° 50, 33100 Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, Via Colugna n° 50, 33100 Udine, Italy
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Cherchi V, Vetrugno L, Terrosu G, Zanini V, Ventin M, Pravisani R, Tumminelli F, Brollo PP, Boscolo E, Peressutti R, Lorenzin D, Bove T, Risaliti A, Baccarani U. Association between the donor to recipient ICG-PDR variation rate and the functional recovery of the graft after orthotopic liver transplantation: A case series. PLoS One 2021; 16:e0256786. [PMID: 34449820 PMCID: PMC8396715 DOI: 10.1371/journal.pone.0256786] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background Despite current advances in liver transplant surgery, post-operative early allograft dysfunction still complicates the patient prognosis and graft survival. The transition from the donor has not been yet fully understood, and no study quantifies if and how the liver function changes through its transfer to the recipient. The indocyanine green dye plasma disappearance rate (ICG-PDR) is a simple validated tool of liver function assessment. The variation rate between the donor and recipient ICG-PDR still needs to be investigated. Materials and methods Single-center retrospective study. ICG-PDR determinations were performed before graft retrieval (T1) and 24 hours after transplant (T2). The ICG-PDR relative variation rate between T1 and T2 was calculated to assess the graft function and suffering/recovering. Matched data were compared with the MEAF model of graft dysfunction. Objective To investigate whether the variation rate between the donor ICG-PDR value and the recipient ICG-PDR measurement on first postoperative day (POD1) can be associated with the MEAF score. Results 36 ICG-PDR measurements between 18 donors and 18 graft recipients were performed. The mean donor ICG-PDR was 22.64 (SD 6.35), and the mean receiver’s ICG-PDR on 1st POD was 17.68 (SD 6.60), with a mean MEAF value of 4.51 (SD 1.23). Pearson’s test stressed a good, linear inverse correlation between the ICG-PDR relative variation and the MEAF values, correlation coefficient -0.580 (p = 0.012). Conclusion The direct correlation between the donor to recipient ICG-PDR variation rate and MEAF was found. Measurements at T1 and T2 showed an up- or downtrend of the graft performance that reflect the MEAF values.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Victor Zanini
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Marco Ventin
- Department of Medicine, University of Udine, Udine, Italy
- * E-mail:
| | - Riccardo Pravisani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Francesco Tumminelli
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Pier Paolo Brollo
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Erica Boscolo
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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Driul L, Meroi F, Cecchini F, Sala A, Orso D, Padovani D, Rovida S, Dogareschi T, Vetrugno L, Bove T. COVID-19 pandemic in an Italian obstetric department: sharing our experience. Acta Biomed 2021; 92:e2021217. [PMID: 34212913 PMCID: PMC8343760 DOI: 10.23750/abm.v92i3.11098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK The outbreak of the novel coronavirus (or SARS-CoV 2) has significantly struck the healthcare system worldwide. Over the course of a few weeks, hospitals reorganized their internal structure entirely at any level of care, from the Emergency rooms to Departments, including all the medical specialties. METHODS In order to cope with the contingent state of emergency, the Gynecology and Obstetrics Unit of the University Hospital in Udine introduced new protocols and guidance for the usual standard of care, ensuring a safe environment for both healthcare providers and patients. RESULTS By a continuous update of scientific evidence, the department was able to increase capacity as well as maintain flexibility when a higher number of admissions was required. CONCLUSION We aimed to share our experience, which provided a relevant lesson about what to expect and how to prepare a referral center for high-risk pregnancy in response to a pandemic such as COVID-19.
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Affiliation(s)
- Lorenza Driul
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Francesco Meroi
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Fabiana Cecchini
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Alessia Sala
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Daniele Orso
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Diana Padovani
- Department of Medicine, University of Udine, Gynecology and Obstetrics Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Serena Rovida
- Royal London Hospital, Barts Trust NHS, Whitechapel Rd, Whitechapel, London E1 1FR, United Kingdom.
| | - Teresa Dogareschi
- University-Hospital of Udine, Department of Anesthesia and Intensive Care, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
| | - Tiziana Bove
- Department of Medicine, University of Udine, Anesthesia and Intensive Care Clinic, via Colugna n° 50, 33100 Udine, Italy.
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Divella M, Vetrugno L, Orso D, Federici N, Russo G, Bove T. Which regional anesthesia technique is the best for arthroscopic shoulder surgery in terms of postoperative outcomes? A comprehensive literature review. Eur Rev Med Pharmacol Sci 2021; 25:985-998. [PMID: 33577054 DOI: 10.26355/eurrev_202101_24668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The literature offers numerous reviews and meta-analyses assessing the different regional anesthesia techniques employed for arthroscopic shoulder surgery (ATS) in terms of diverse outcome parameters. Most have focused on analgesic efficacy in the limited post-operative period as their primary outcome. Indeed, the most up-to-date guidelines are based on the results of comparisons that focus on analgesic efficacy and analgesic drug consumption. However, a correlation has yet to be demonstrated between post-operative analgesia and functional recovery; indeed, the latter has received relatively less research attention concerning the anesthetic technique despite its clinical importance. Here, we aimed to identify the best loco-regional anesthetic technique for ATS, considering all the evaluation parameters considered to date. MATERIALS AND METHODS We performed a comprehensive literature review on ATS, searching for all the relative aspects of the regional anesthesia technique employed and the outcome parameters assessed. RESULTS From the literature, it is not clear which technique is better than the others. No single technique was revealed as being the absolute best, independent of the outcome parameter considered, which included: post-operative analgesic effect, speed of functional recovery, ease, and safety of execution. CONCLUSIONS The choice of anesthetic technique should be tailored to the patient and type of surgery. When comparing one type of loco-regional anesthesia against another, in addition to analgesic efficacy, a whole plethora of aspects need to be considered (i.e., feasibility, complications, contribution to functional recovery, etc.).
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Affiliation(s)
- M Divella
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.
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Cammarota G, Vaschetto R, Azzolina D, De Vita N, Olivieri C, Ronco C, Longhini F, Bruni A, Colombo D, Pissaia C, Prato F, Maestrone C, Maestrone M, Vetrugno L, Bove T, Lemut F, Taretto E, Locatelli A, Barzaghi N, Cerrano M, Ravera E, Zanza C, Selva AD, Blangetti I, Salvo F, Racca F, Longhitano Y, Boscolo A, Sguazzotti I, Bonato V, Grossi F, Crimaldi F, Perucca R, Boniolo E, Verdina F, Vignazia GL, Santangelo E, Tarquini R, Zanoni M, Messina A, Marin M, Bacigalupo P, Sileci G, Sella N, De Robertis E, Corte FD, Navalesi P. Early extubation with immediate non-invasive ventilation versus standard weaning in intubated patients for coronavirus disease 2019: a retrospective multicenter study. Sci Rep 2021; 11:13418. [PMID: 34183764 PMCID: PMC8239031 DOI: 10.1038/s41598-021-92960-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/16/2021] [Indexed: 12/12/2022] Open
Abstract
In patients intubated for hypoxemic acute respiratory failure (ARF) related to novel coronavirus disease (COVID-19), we retrospectively compared two weaning strategies, early extubation with immediate non-invasive ventilation (NIV) versus standard weaning encompassing spontaneous breathing trial (SBT), with respect to IMV duration (primary endpoint), extubation failures and reintubations, rate of tracheostomy, intensive care unit (ICU) length of stay and mortality (additional endpoints). All COVID-19 adult patients, intubated for hypoxemic ARF and subsequently extubated, were enrolled. Patients were included in two groups, early extubation followed by immediate NIV application, and conventionally weaning after passing SBT. 121 patients were enrolled and analyzed, 66 early extubated and 55 conventionally weaned after passing an SBT. IMV duration was 9 [6-11] days in early extubated patients versus 11 [6-15] days in standard weaning group (p = 0.034). Extubation failures [12 (18.2%) vs. 25 (45.5%), p = 0.002] and reintubations [12 (18.2%) vs. 22 (40.0%) p = 0.009] were fewer in early extubation compared to the standard weaning groups, respectively. Rate of tracheostomy, ICU mortality, and ICU length of stay were no different between groups. Compared to standard weaning, early extubation followed by immediate NIV shortened IMV duration and reduced the rate of extubation failure and reintubation.
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Affiliation(s)
- Gianmaria Cammarota
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy.
| | - Rosanna Vaschetto
- Department of Anesthesia and Intensive Care, AAzienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
- Translational Medicine Department, Università "del Piemonte Orientale", Novara, Italy
| | - Danila Azzolina
- Translational Medicine Department, Università "del Piemonte Orientale", Novara, Italy
| | - Nello De Vita
- Translational Medicine Department, Università "del Piemonte Orientale", Novara, Italy
| | - Carlo Olivieri
- Anesthesia and Intensive Care, Ospedale Sant'Andrea", Vercelli, Italy
| | - Chiara Ronco
- Anesthesia and Intensive Care, Ospedale Sant'Andrea", Vercelli, Italy
| | - Federico Longhini
- Department of Medical and Surgical Science, Università "Magna Graecia", Catanzaro, Italy
| | - Andrea Bruni
- Department of Medical and Surgical Science, Università "Magna Graecia", Catanzaro, Italy
| | - Davide Colombo
- Department of Anesthesia and Critical Care, Ospedale "Ss. Trinità", Borgomanero, Italy
| | - Claudio Pissaia
- Department of Anesthesia and Critical Care, Ospedale "degli Infermi", Biella, Italy
| | - Federico Prato
- Department of Anesthesia and Critical Care, Ospedale "degli Infermi", Biella, Italy
| | - Carlo Maestrone
- Department of Anesthesia and Critical Care, Presidio Ospedaliero Domodossola e Verbania "ASL VCO", Domodossola-Verbania, Italy
| | - Matteo Maestrone
- Department of Anesthesia and Critical Care, Presidio Ospedaliero Domodossola e Verbania "ASL VCO", Domodossola-Verbania, Italy
| | - Luigi Vetrugno
- Department of Medicine, Anesthesia and Intensive Care Clinic, Università di Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, Anesthesia and Intensive Care Clinic, Università di Udine, Udine, Italy
| | - Francesco Lemut
- Department of Anesthesia and Critical Care, Ospedale "Monsignor Giovanni Galliano", Acqui Terme, Italy
| | - Elisa Taretto
- Department of Anesthesia and Critical Care, Ospedale "Monsignor Giovanni Galliano", Acqui Terme, Italy
| | - Alessandro Locatelli
- Department of Anesthesia and Critical Care, Azienda Ospedaliera "Santa Croce e Carle", Cuneo, Italy
| | - Nicoletta Barzaghi
- Department of Anesthesia and Critical Care, Azienda Ospedaliera "Santa Croce e Carle", Cuneo, Italy
| | - Martina Cerrano
- Department of Anesthesia and Critical Care, Azienda Ospedaliera "Santa Croce e Carle", Cuneo, Italy
| | - Enrico Ravera
- Department of Emergency Medicine-Anesthesia and Critical Care-Michele, Pietro Ferrero Hospital, Verduno, Italy
| | - Christian Zanza
- Department of Emergency Medicine-Anesthesia and Critical Care-Michele, Pietro Ferrero Hospital, Verduno, Italy
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Della Selva
- Department of Emergency Medicine-Anesthesia and Critical Care-Michele, Pietro Ferrero Hospital, Verduno, Italy
| | - Ilaria Blangetti
- Department of Anesthesia and Intensive Care, Ospedale "Regina Montis Regalis", Mondovì, Italy
| | - Francesco Salvo
- Department of Anesthesia and Intensive Care, Ospedale "Regina Montis Regalis", Mondovì, Italy
| | - Fabrizio Racca
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Yaroslava Longhitano
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Annalisa Boscolo
- Anesthesia and Intensive Care Unit, Ospedale Universitario di Padova, Padova, Italy
| | - Ilaria Sguazzotti
- Department of Anesthesia and Intensive Care, AAzienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Valeria Bonato
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesca Grossi
- Department of Anesthesia and Intensive Care, AAzienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Federico Crimaldi
- Translational Medicine Department, Università "del Piemonte Orientale", Novara, Italy
| | - Raffaella Perucca
- Department of Anesthesia and Intensive Care, AAzienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Ester Boniolo
- Translational Medicine Department, Università "del Piemonte Orientale", Novara, Italy
| | - Federico Verdina
- Translational Medicine Department, Università "del Piemonte Orientale", Novara, Italy
| | - Gian Luca Vignazia
- Department of Anesthesia and Intensive Care, AAzienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Erminio Santangelo
- Translational Medicine Department, Università "del Piemonte Orientale", Novara, Italy
| | - Riccardo Tarquini
- Translational Medicine Department, Università "del Piemonte Orientale", Novara, Italy
| | - Marta Zanoni
- Department of Anesthesia and Intensive Care, AAzienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
| | - Antonio Messina
- Humanitas, Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Matteo Marin
- Department of Medicine, Anesthesia and Intensive Care Clinic, Università di Udine, Udine, Italy
| | - Paola Bacigalupo
- Department of Anesthesia and Critical Care, Ospedale "Monsignor Giovanni Galliano", Acqui Terme, Italy
| | - Graziana Sileci
- Department of Anesthesia and Critical Care, Ospedale "Monsignor Giovanni Galliano", Acqui Terme, Italy
| | - Nicolò Sella
- Department of Medicine-DIMED, Università di Padova, Padova, Italy
| | - Edardo De Robertis
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | - Francesco Della Corte
- Department of Anesthesia and Intensive Care, AAzienda Ospedaliero Universitaria "Maggiore della Carità", Novara, Italy
- Translational Medicine Department, Università "del Piemonte Orientale", Novara, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, Ospedale Universitario di Padova, Padova, Italy
- Department of Medicine-DIMED, Università di Padova, Padova, Italy
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Venturini S, Cugini F, Orso D, Crapis M, Fossati S, Callegari A, Pontoni E, De Santi L, Arcidiacono D, Lugano M, Vetrugno L, Bove T. Acute kidney injury and single-dose administration of aminoglycoside in the Emergency Department: a comparison through propensity score matching. G Ital Nefrol 2021; 38:38-03-2021-07. [PMID: 34169695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: According to the Surviving Sepsis Campaign, aminoglycosides (AG) can be administered together with a β-lactam in patients with septic shock. Some authors propose administering a single dose of an AG combined with a β-lactam antibiotic in septic patients to extend the spectrum of antibiotic therapy. The aim of this study has been to investigate whether a single shot of AG when septic patients present at the Emergency Department (ED) is associated with acute kidney injury (AKI). Methods: We retrospectively enrolled patients based on a 3-year internal registry of septic patients visited in the Emergency Department (ED) of Pordenone Hospital. We compared the patients treated with a single dose of gentamicin (in addition to the β-lactam) and those who had not been treated to verify AKI incidence. Results: 355 patients were enrolled. The median age was 71 years (IQR 60-78). Less than 1% of the patients had a chronic renal disease. The most frequent infection source was the urinary tract (31%), followed by intra-abdominal and lower respiratory tract infections (15% for both). 131 patients received gentamicin. Unmatched data showed a significant difference between the two groups in AKI (79/131, 60.3% versus 102/224, 45.5%; p=0.010) and in infectious disease specialist's consultation (77/131, 59% versus 93/224, 41.5%; p=0.002). However, after propensity score matching, no significant difference was found. Conclusion: Our experience shows that a single-shot administration of gentamicin upon admission to the ED does not determine an increased incidence of AKI in septic patients.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO Hospital of Pordenone, Pordenone, Italy
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Hospital of San Daniele, San Daniele (UD), Italy
| | - Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO Hospital of Pordenone, Pordenone, Italy
| | - Sara Fossati
- Department of Infectious Diseases, ASFO Hospital of Pordenone, Pordenone, Italy
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO Hospital of Pordenone, Pordenone, Italy
| | - Elisa Pontoni
- Department of Emergency Medicine, ASFO Hospital of Pordenone, Pordenone, Italy
| | - Laura De Santi
- Department of Emergency Medicine, ASFO Hospital of Pordenone, Pordenone, Italy
| | | | - Manuela Lugano
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Udine, Italy
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Vetrugno L, Boero E, Bignami E, Cortegiani A, Raineri SM, Spadaro S, Moro F, D’Incà S, D’Orlando L, Agrò FE, Bernardinetti M, Forfori F, Corradi F, Pregnolato S, Mosconi M, Bellini V, Franchi F, Mongelli P, Leonardi S, Giuffrida C, Tescione M, Bruni A, Garofalo E, Longhini F, Cammarota G, De Robertis E, Giglio G, Urso F, Bove T. Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP). Ultrasound J 2021; 13:30. [PMID: 34100124 PMCID: PMC8184059 DOI: 10.1186/s13089-021-00230-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of "indirect" and "direct" cardiac and pulmonary lung ultrasound signs. METHODS LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns-each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. CONCLUSIONS Lung ultrasound (LU), as a tool within the anesthesiologist's armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
- University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100 Udine, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S), University of Palermo, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Santi Maurizio Raineri
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S), University of Palermo, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Savino Spadaro
- Department of translational medicine, Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Federico Moro
- Department of translational medicine, Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy
| | - Stefano D’Incà
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
| | - Loris D’Orlando
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
| | - Felice Eugenio Agrò
- Department of Medicine, Unit of Anesthesia Intensive Care Pain Management, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Mattia Bernardinetti
- Department of Medicine, Unit of Anesthesia Intensive Care Pain Management, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Anesthesia and Intensive Care, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Sandro Pregnolato
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mario Mosconi
- Orthopedics and Traumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Bellini
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federico Franchi
- Department of Medicine, Surgery and Neuroscience, Anesthesiology and Intensive Care, University of Siena, Siena, Italy
| | - Pierpaolo Mongelli
- Department of Medicine, Surgery and Neuroscience, Anesthesiology and Intensive Care, University of Siena, Siena, Italy
| | | | | | - Marco Tescione
- Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Gianmaria Cammarota
- Section of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Edoardo De Robertis
- Section of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giuseppe Giglio
- University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100 Udine, Italy
| | - Felice Urso
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Via Colugna no. 50, 33100 Udine, Italy
- University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100 Udine, Italy
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Guarracino F, Vetrugno L, Forfori F, Corradi F, Orso D, Bertini P, Ortalda A, Federici N, Copetti R, Bove T. Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach. J Cardiothorac Vasc Anesth 2021; 35:1866-1874. [PMID: 32624431 PMCID: PMC7289113 DOI: 10.1053/j.jvca.2020.06.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
Abstract
Lung ultrasound (LU) has a multitude of features and capacities that make it a useful medical tool to assist physicians contending with the pandemic spread of novel coronavirus disease-2019 (COVID-19) caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, an LU approach to patients with suspected COVID-19 is being implemented worldwide. In noncritical COVID-19 patients, 2 new LU signs have been described and proposed, the "waterfall" and the "light beam" signs. Both signs have been hypothesized to increase the diagnostic accuracy of LU for COVID-19 interstitial pneumonia. In critically ill patients, a distinct pattern of LU changes seems to follow the disease's progression, and this information can be used to guide decisions about when a patient needs to be ventilated, as occurs in other disease states similar to COVID-19. Furthermore, a new algorithm has been published, which enables the automatic detection of B-lines as well as quantification of the percentage of the pleural line associated with lung disease. In COVID-19 patients, a direct involvement of cardiac function has been demonstrated, and ventilator-induced diaphragm dysfunction might be present due to the prolonged mechanical ventilation often involved, as reported for similar diseases. For this reason, cardiac and diaphragm ultrasound evaluation are highly important. Last but not least, due to the thrombotic tendency of COVID-19 patients, particular attention also should be paid to vascular ultrasound. This review is primarily devoted to the study of LU in COVID-19 patients. The authors explain the significance of its "light and shadows," bearing in mind the context in which LU is being used-the emergency department and the intensive care setting. The use of cardiac, vascular, and diaphragm ultrasound is also discussed, as a comprehensive approach to patient care.
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Affiliation(s)
- Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Luigi Vetrugno
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy.
| | - Francesco Forfori
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Daniele Orso
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
| | - Pietro Bertini
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Federici
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
| | - Roberto Copetti
- Emergency Department, Azienda Sanitaria Universitaria Friuli Centrale, Latisana General Hospital, Latisana, Italy
| | - Tiziana Bove
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
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Cherchi V, Vetrugno L, Zanini V, Pravisani R, Ventin M, Lorenzin D, Adani GL, Clocchiatti L, Boscolo E, Vit A, Sponza M, D'Alì L, Di Loreto C, Bove T, Terrosu G, Risaliti A, Baccarani U. Association between indocyanine green clearance test and ischemic type biliary lesions within one year after orthotopic liver transplantation. Gastroenterol Hepatol 2021; 44:687-695. [PMID: 34023468 DOI: 10.1016/j.gastrohep.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ischemic type biliary lesions (ITBLs), a particular subset of non-anastomotic biliary strictures (NAS), are characterized by intra and extrahepatic strictures that occur in the absence of either hepatic artery thrombosis or stenosis. When they occur within the first year after liver transplantation their development is mostly related to ischemia-reperfusion injury (IRI). The indocyanine green plasma disappearance rate (ICG-PDR) might be able to predict the probability of IRI-induced graft damage after liver transplantation. OBJECTIVE Our aim was to evaluate the association between ICG-PDR and the occurrence of ITBLs. Secondly, we searched for evidence of IRI in patients presenting ITBLs. METHODS This retrospective single-center observational study assessed a cohort of 60 liver transplant patients. Each patient underwent ICG-PDR on the 1st postoperative day. ITBLs were identified by means of either cholangiography or magnetic resonance imaging evidence of a deformity and narrowing of the biliary tree in the absence of hepatic artery thrombosis/stenosis. RESULTS ITBLs were discovered in 10 patients out of 60 liver recipients (16.67%) within one year after transplantation. A low ICG-PDR value was found to be a significant predictive factor for ITBL development, with an OR of 0.87 and a 95% CI of 0.77-0.97. Liver biopsies were performed in 56 patients presenting unexplained abnormal liver function test results. A statistically significant association was found between the development of ITBLs and anatomopathological evidence of IRI. LIMITATIONS Retrospective, single-center study. CONCLUSIONS The findings from this study show a relationship between low ICG-PDR values on first post-operative-day and the occurrence of ITBLs within 1 year after transplantation.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy; Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Victor Zanini
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy; Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Riccardo Pravisani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Marco Ventin
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy.
| | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Gian Luigi Adani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Lucrezia Clocchiatti
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Erica Boscolo
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Alessandro Vit
- Division of Vascular and Interventional Radiology, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Massimo Sponza
- Division of Vascular and Interventional Radiology, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Lorenzo D'Alì
- Anatomic Pathology Institute, ASUFC University Hospital, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Carla Di Loreto
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy; Anatomic Pathology Institute, ASUFC University Hospital, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy; Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Andrea Risaliti
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
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Barbariol F, Deana C, Lucchese F, Cataldi G, Bassi F, Bove T, Vetrugno L, De Monte A. Evaluation of Drug Wastage in the Operating Rooms and Intensive Care Units of a Regional Health Service. Anesth Analg 2021; 132:1450-1456. [PMID: 33667211 DOI: 10.1213/ane.0000000000005457] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pharmacological treatments for critical processes in patients need to be initiated as rapidly as possible; for this reason, it is a standard of care to prepare the main anesthesia and emergency drugs in advance. As a result, 20%-50% of the prepared drugs remain unused and are then discarded. Decreasing waste by optimizing drug use is an attractive strategy for meeting both cost containment and environmental sustainability. The primary end point of this study was to measure the actual amount of drug wastage in the operating rooms (ORs) and intensive care units (ICUs) of a Regional Health Service (RHS). The secondary end point was to analyze and estimate the economic implications of this waste for the Health Service and to suggest possible measures to reduce it. METHODS This prospective observational multicenter study was conducted across 12 hospitals, all of which belong to the same RHS in the north-east of Italy. Data collection took place in March 2018 and included patients admitted to ICUs, emergency areas, and ORs of the participating hospitals. Data concerning drug preparation and administration were collected for all consecutive patients, independent of case types and of whether operations were scheduled or unscheduled. Drug wastage was defined as follows: drugs prepared in ready-to-use syringes but not administered at all and discarded untouched. We then estimated the costs of wasted drugs for a 1-year period using the data from this study and the yearly regional pharmacy orders of drugs provided to the ORs and ICUs. We also performed a sensitivity analysis to validate the robustness of our assumptions and qualitative conclusions. RESULTS We collected data for a total of 13,078 prepared drug syringes. Drug wastage varied from 7.8% (Urapidil, an alpha-1 antagonist antihypertensive) to 85.7% (epinephrine) of prepared syringes, with an overall mean wastage rate of 38%. The estimated yearly waste was 139,531 syringes, for a total estimated financial cost of €78,060 ($92,569), and an additional quantity of medical waste amounting to 4968 kg per year. The total provider time dedicated to the preparation of unused drugs was predicted to be 1512 working hours per year. CONCLUSIONS The overall extent of drug wastage in ORs and ICUs is concerning. Interventions aimed at minimizing waste-related costs and improving the environmental sustainability of our practice are paramount. Effort should be put into designing a more efficient workflow that reduces this waste while providing for the emergency availability of these medications in the OR and ICU.
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Affiliation(s)
- Federico Barbariol
- From the Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, Udine, Italy
| | - Cristian Deana
- From the Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, Udine, Italy
| | - Francesca Lucchese
- From the Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, Udine, Italy
| | - Giuseppe Cataldi
- Department of Anesthesia and Intensive Care Medicine, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy
| | - Flavio Bassi
- From the Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Medicine, University of Udine, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Medicine, University of Udine, University-Hospital of Udine, Udine, Italy
| | - Amato De Monte
- From the Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, Udine, Italy
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Venturini S, Orso D, Cugini F, Crapis M, Fossati S, Callegari A, Pellis T, Tomasello DC, Tonizzo M, Grembiale A, D'Andrea N, Vetrugno L, Bove T. Artificial neural network model from a case series of COVID-19 patients: a prognostic analysis. Acta Biomed 2021; 92:e2021202. [PMID: 33988146 PMCID: PMC8182608 DOI: 10.23750/abm.v92i2.11086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM There is a need to determine which clinical variables predict the severity of COVID-19. We analyzed a series of critically ill COVID-19 patients to see if any of our dataset's clinical variables were associated with patient outcomes. METHODS We retrospectively analyzed the data of COVID-19 patients admitted to the ICU of the Hospital in Pordenone from March 11, 2020, to April 17, 2020. Patients' characteristics of survivors and deceased groups were compared. The variables with a different distribution between the two groups were implemented in a generalized linear regression model (LM) and in an Artificial Neural Network (NN) model to verify the "robustness" of the association with mortality. RESULTS In the considered period, we reviewed the data of 22 consecutive patients: 8 died. The causes of death were a severe respiratory failure (3), multi-organ failure (1), septic shock (1), pulmonary thromboembolism (2), severe hemorrhage (1). Lymphocyte and the platelet count were significantly lower in the group of deceased patients (p-value 0.043 and 0.020, respectively; cut-off values: 660/mm3; 280,000/mm3, respectively). Prothrombin time showed a statistically significant trend (p-value= 0.065; cut-off point: 16.8/sec). The LM model (AIC= 19.032), compared to the NN model (Mean Absolute Error, MAE = 0.02), was substantially alike (MSE 0.159 vs. 0.136). CONCLUSIONS In the context of critically ill COVID-19 patients admitted to ICU, lymphocytopenia, thrombocytopenia, and lengthening of prothrombin time were strictly correlated with higher mortality. Additional clinical data are needed to be able to validate this prognostic score.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Hospital of San Daniele, Udine, Italy.
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Sara Fossati
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Tommaso Pellis
- Department of Anesthesia and Intensive Care, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Dario Carmelo Tomasello
- Department of Anesthesia and Intensive Care, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Maurizio Tonizzo
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Alessandro Grembiale
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Natascia D'Andrea
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
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Deana C, Rovida S, Orso D, Bove T, Bassi F, De Monte A, Vetrugno L. Learning from the Italian experience during COVID-19 pandemic waves: be prepared and mind some crucial aspects. Acta Biomed 2021; 92:e2021097. [PMID: 33988143 PMCID: PMC8182622 DOI: 10.23750/abm.v92i2.11159] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
COVID-19 pandemic has rapidly spread worldwide causing a serious challenge to the global medical community. Italy was struck hard during the first wave earlier this year and several weaknesses as well as general unpreparedness of the national healthcare system were acknowledged. Learning essential lessons from the past, we realized how implementing contingency response measures, human resources and social dynamics could have changed the outcome if promptly adopted. This review translates the previous experience into strategic actions that has to be considered when developing appropriate national and regional operational plans to respond to a pandemic.
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Affiliation(s)
| | - Serena Rovida
- 2Department of Anesthesia and Intensive Care Unit, Saint Bartholomew's Hospital, Barts NHS Trust, London, UK..
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy..
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy..
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Amato De Monte
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy..
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46
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Cherchi V, Baccarani U, Vetrugno L, Pravisani R, Bove T, Meroi F, Terrosu G, Adani GL. Early Graft Dysfunction Following Kidney Transplantation: Can Thermographic Imaging Play a Predictive Role? Semin Cardiothorac Vasc Anesth 2021; 25:196-199. [PMID: 33840293 DOI: 10.1177/10892532211007270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The shortage of organs and the growing need for them over recent years have led to the adoption of less stringent donor acceptance criteria, resulting in the approval of marginal organs for transplant, especially from elderly donors. This implies a higher risk of graft dysfunction, a higher frequency of immunological and vascular complications, and shorter graft survival. Several strategies have been implemented in clinical practice to assess graft quality and suitability for transplantation. We have started to test the prospective intraoperative use of thermo-vision cameras during graft reperfusion. Images were acquired using the FLIR One Pro thermo-vision camera for android devices. We hypothesized that thermal images would give a better perspective about the quality of arterial perfusion and graft revascularization of the renal cortex. Thermo-vision cameras provide an easy-to-use, noninvasive, cost-effective tool for the global assessment of kidney graft cortical microcirculation in the immediate post-reperfusion period, providing additional data on the immediate viability and function of a graft.
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Affiliation(s)
- Vittorio Cherchi
- Azienda Sanitaria Universitaria Friuli Centrale, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- Azienda Sanitaria Universitaria Friuli Centrale, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Luigi Vetrugno
- Azienda Sanitaria Universitaria Friuli Centrale, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Riccardo Pravisani
- Azienda Sanitaria Universitaria Friuli Centrale, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Tiziana Bove
- Azienda Sanitaria Universitaria Friuli Centrale, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Francesco Meroi
- Azienda Sanitaria Universitaria Friuli Centrale, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Giovanni Terrosu
- Azienda Sanitaria Universitaria Friuli Centrale, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Gian Luigi Adani
- Azienda Sanitaria Universitaria Friuli Centrale, University-Hospital of Udine, Udine, Italy
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47
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Venturini S, Orso D, Cugini F, Crapis M, Fossati S, Callegari A, Pellis T, Tonizzo M, Grembiale A, Rosso A, Tamburrini M, D'Andrea N, Vetrugno L, Bove T. Classification and analysis of outcome predictors in non-critically ill COVID-19 patients. Intern Med J 2021; 51:506-514. [PMID: 33835685 PMCID: PMC8250466 DOI: 10.1111/imj.15140] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
Background Early detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐infected patients who could develop a severe form of COVID‐19 must be considered of great importance to carry out adequate care and optimise the use of limited resources. Aims To use several machine learning classification models to analyse a series of non‐critically ill COVID‐19 patients admitted to a general medicine ward to verify if any clinical variables recorded could predict the clinical outcome. Methods We retrospectively analysed non‐critically ill patients with COVID‐19 admitted to the general ward of the hospital in Pordenone from 1 March 2020 to 30 April 2020. Patients' characteristics were compared based on clinical outcomes. Through several machine learning classification models, some predictors for clinical outcome were detected. Results In the considered period, we analysed 176 consecutive patients admitted: 119 (67.6%) were discharged, 35 (19.9%) dead and 22 (12.5%) were transferred to intensive care unit. The most accurate models were a random forest model (M2) and a conditional inference tree model (M5) (accuracy = 0.79; 95% confidence interval 0.64–0.90, for both). For M2, glomerular filtration rate and creatinine were the most accurate predictors for the outcome, followed by age and fraction‐inspired oxygen. For M5, serum sodium, body temperature and arterial pressure of oxygen and inspiratory fraction of oxygen ratio were the most reliable predictors. Conclusions In non‐critically ill COVID‐19 patients admitted to a medical ward, glomerular filtration rate, creatinine and serum sodium were promising predictors for the clinical outcome. Some factors not determined by COVID‐19, such as age or dementia, influence clinical outcomes.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Hospital of San Daniele, Udine, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Sara Fossati
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Tommaso Pellis
- Department of Anesthesia and Intensive Care, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Alessandro Grembiale
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Alessia Rosso
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Mario Tamburrini
- Department of Pneumology, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Natascia D'Andrea
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy
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Vetrugno L, Bignami E, Deana C, Bassi F, Vargas M, Orsaria M, Bagatto D, Intermite C, Meroi F, Saglietti F, Sartori M, Orso D, Robiony M, Bove T. Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports. Scand J Trauma Resusc Emerg Med 2021; 29:47. [PMID: 33712051 PMCID: PMC7953582 DOI: 10.1186/s13049-021-00861-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background The incidence of cerebral fat embolism (CFE) ranges from 0.9–11%, with a mean mortality rate of around 10%. Although no univocal explanation has been identified for the resulting fat embolism syndrome (FES), two hypotheses are widely thought: the ‘mechanical theory’, and the ‘chemical theory’. The present article provides a systematic review of published case reports of FES following a bone fracture. Methods We searched MEDLINE, Web of Science and Scopus to find any article related to FES. Inclusion criteria were: trauma patients; age ≥ 18 years; and the clinical diagnosis of CFE or FES. Studies were excluded if the bone fracture site was not specified. Results One hundred and seventy studies were included (268 cases). The male gender was most prominent (81.6% vs. 18.4%). The average age was 33 years (±18). The mean age for males (29 ± 14) was significantly lower than for females (51 ± 26) (p < 0.001). The femur was the most common fracture site (71% of cases). PFO was found in 12% of all cases. Univariate and multivariate regression analyses showed the male gender to be a risk factor for FES: RR 1.87 and 1.41, respectively (95%CI 1.27–2.48, p < 0.001; 95%CI 0.48–2.34, p < 0.001). Conclusions FES is most frequent in young men in the third decades of life following multiple leg fractures. FES may be more frequent after a burst fracture. The presence of PFO may be responsible for the acute presentation of cerebral embolisms, whereas FES is mostly delayed by 48–72 h. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00861-x.
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. .,Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.
| | - Elena Bignami
- Department of Medicine and Surgery, Unit of Anesthesiology, Parma University Hospital, Parma, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Unit 1, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Unit 2, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Orsaria
- Department of Medicine, Surgical Pathology Section, University of Udine, Udine, Italy
| | - Daniele Bagatto
- Department of Diagnostic Imaging, Neuroradiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Cristina Intermite
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | - Francesco Meroi
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | | | - Marco Sartori
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | - Daniele Orso
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | - Massimo Robiony
- Department of Medicine, Maxillofacial Surgery, University of Udine, Udine, Italy.,Azienda Sanitaria Universitaria Friuli Centrale, Maxillofacial Surgery, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
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49
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Marin M, Orso D, Federici N, Vetrugno L, Bove T. D-dimer specificity and clinical context: an old unlearned story. Crit Care 2021; 25:101. [PMID: 33691711 PMCID: PMC7944469 DOI: 10.1186/s13054-021-03532-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/04/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matteo Marin
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Italy. .,Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Via Colugna 50, 33100, Udine, Italy.
| | - Nicola Federici
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
| | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC Hospital of Udine, Via Colugna 50, 33100, Udine, Italy
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50
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Monti G, Galbiati C, Toffoletto F, Calabrò MG, Colombo S, Ferrara B, Giardina G, Lembo R, Marzaroli M, Moizo E, Mucci M, Pasculli N, Plumari VP, Scandroglio AM, Tozzi M, Momesso E, Boffa N, Lobreglio R, Montrucchio G, Guarracino F, Benedetto U, Biondi-Zoccai G, D'Ascenzo F, D'Andrea N, Paternoster G, Ananiadou S, Ballestra M, De Sio A, Pota V, Cotoia A, Della Selva A, Bruni A, Iapichino G, Bradić N, Corradi F, Gemma M, Nogtev P, Petrova M, Agrò FE, Cabrini L, Forfori F, Likhvantsev V, Bove T, Finco G, Landoni G, Zangrillo A. Continuous infusion versus intermittent administration of meropenem in critically ill patients (MERCY): A multicenter randomized double-blind trial. Rationale and design. Contemp Clin Trials 2021; 104:106346. [PMID: 33684595 DOI: 10.1016/j.cct.2021.106346] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/09/2021] [Accepted: 03/03/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Meropenem is a β-lactam, carbapenem antibacterial agent with antimicrobial activity against gram-negative, gram-positive and anaerobic micro-organisms and is important in the empirical treatment of serious infections in Intensive Care Unit (ICU) patients. Multi-drug resistant gram-negative organisms, coupled with scarcity of new antibiotic classes, forced healthcare community to optimize the therapeutic potential of available antibiotics. Our aim is to investigate the effect of continuous infusion of meropenem against bolus administration, as indicated by a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens in a population of ICU patients. DESIGN Double blind, double dummy, multicenter randomized controlled trial (1:1 allocation ratio). SETTING Tertiary and University hospitals. INTERVENTIONS 600 ICU patients with sepsis or septic shock, needing by clinical judgment antibiotic therapy with meropenem, will be randomized to receive a continuous infusion of meropenem 3 g/24 h or an equal dose divided into three daily boluses (i.e. 1g q8h). MEASUREMENTS The primary endpoint will be a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens. Secondary endpoints will be death from any cause at day 90, antibiotic-free days at day 28, ICU-free days at day 28, cumulative SOFA-free (Sequential Organ Failure Assessment) score from randomization to day 28 and the two, separate, components of the primary endpoint. We expect a primary outcome reduction from 52 to 40% in the continuous infusion group. CONCLUSIONS The trial will provide evidence for choosing intermittent or continuous infusion of meropenem for critically ill patients with multi-drug resistant gram-negative infections.
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Affiliation(s)
- Giacomo Monti
- IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | | | | | | | | | | | | | - Rosalba Lembo
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Elena Moizo
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Milena Mucci
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | - Elena Momesso
- Azienda ULSS 4 Veneto Orientale, San Donà di Piave (VE), Italy
| | - Nicoletta Boffa
- Azienda ULSS 4 Veneto Orientale, San Donà di Piave (VE), Italy
| | | | | | | | - Umberto Benedetto
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | | | | | | | | | - Sofia Ananiadou
- ASST Cremona - Presidio Ospedaliero di Cremona, Cremona, Italy
| | | | | | - Vincenzo Pota
- Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | | | | | | | | | | | - Francesco Corradi
- Azienda Ospedaliero - Universitaria Pisana, Pisa, Italy; Ente Ospedaliero Ospedali Galliera, Genova, Italy; Università di Pisa, Pisa, Italy
| | - Marco Gemma
- ASST Fatebenefratelli Sacco - Ospedale Fatebenefratelli e Oftalmico, Milan, Italy
| | - Pavel Nogtev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Marina Petrova
- Federal Research and Clinical Center of Resuscitation and Rehabilitation, Moscow, Russia
| | | | - Luca Cabrini
- ASST dei Sette Laghi - Ospedale di Circolo e Fondazione Macchi di Varese, Varese, Italy; Università degli Studi dell'Insubria, Varese, Italy
| | - Francesco Forfori
- Azienda Ospedaliero - Universitaria Pisana, Pisa, Italy; Università di Pisa, Pisa, Italy
| | - Valery Likhvantsev
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Federal Research and Clinical Center of Resuscitation and Rehabilitation, Moscow, Russia
| | - Tiziana Bove
- Università degli Studi di Udine, Udine, Italy; Azienda Sanitaria Universitaria Friuli Centrale - Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy
| | | | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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