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1. Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis: The MERCY Randomized Clinical Trial

Author: Monti, Giacomo, Bradic, Nikola, Marzaroli, Matteo, Konkayev, Aidos, Fominskiy, Evgeny, Kotani, Yuki, Likhvantsev, Valery V, Momesso, Elena, Nogtev, Pavel, Lobreglio, Rosetta, Redkin, Ivan, Toffoletto, Fabio, Bruni, Andrea, Baiardo Redaelli, Martina, D'Andrea, Natascia, Paternoster, Gianluca, Scandroglio, Anna Mara, Gallicchio, Francesca, Ballestra, Mariano, Calabrò, Maria Grazia, Cotoia, Antonella, Perone, Romina, Cuffaro, Raffaele, Montrucchio, Giorgia, Pota, Vincenzo, Ananiadou, Sofia, Lembo, Rosalba, Musu, Mario, Rauch, Simon, Galbiati, Carola, Pinelli, Fulvio, Pasin, Laura, Guarracino, Fabio, Santarpino, Giuseppe, Agrò, Felice Eugenio, Bove, Tiziana, Corradi, Francesco, Forfori, Francesco, Longhini, Federico, Cecconi, Maurizio, Landoni, Giovanni, Bellomo, Rinaldo, Zangrillo, Alberto, Monti, Giacomo, Bradic, Nikola, Marzaroli, Matteo, Konkayev, Aido, Fominskiy, Evgeny, Kotani, Yuki, Likhvantsev, Valery V, Momesso, Elena, Nogtev, Pavel, Lobreglio, Rosetta, Redkin, Ivan, Toffoletto, Fabio, Bruni, Andrea, Baiardo Redaelli, Martina, D'Andrea, Natascia, Paternoster, Gianluca, Scandroglio, Anna Mara, Gallicchio, Francesca, Ballestra, Mariano, Calabrò, Maria Grazia, Cotoia, Antonella, Perone, Romina, Cuffaro, Raffaele, Montrucchio, Giorgia, Pota, Vincenzo, Ananiadou, Sofia, Lembo, Rosalba, Musu, Mario, Rauch, Simon, Galbiati, Carola, Pinelli, Fulvio, Pasin, Laura, Guarracino, Fabio, Santarpino, Giuseppe, Agrò, Felice Eugenio, Bove, Tiziana, Corradi, Francesco, Forfori, Francesco, Longhini, Federico, Cecconi, Maurizio, Landoni, Giovanni, Bellomo, Rinaldo, and Zangrillo, Alberto
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.
Published: 2023

2. Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis: The MERCY Randomized Clinical Trial

Author: Monti, Giacomo, Bradic, Nikola, Marzaroli, Matteo, Konkayev, Aidos, Fominskiy, Evgeny, Kotani, Yuki, Likhvantsev, Valery, Momesso, Elena, Nogtev, Pavel, Lobreglio, Rosetta, Redkin, Ivan, Toffoletto, Fabio, Bruni, Andrea, Baiardo Redaelli, Martina, D'Andrea, Natascia, Paternoster, Gianluca, Scandroglio, Anna Mara, Gallicchio, Francesca, Ballestra, Mariano, Calabrò, Maria Grazia, Cotoia, Antonella, Perone, Romina, Cuffaro, Raffaele, Montrucchio, Giorgia, Pota, Vincenzo, Ananiadou, Sofia, Lembo, Rosalba, Musu, Mario, Rauch, Simon, Galbiati, Carola, Pinelli, Fulvio, Pasin, Laura, Guarracino, Fabio, Santarpino, Giuseppe, Agrò, Felice Eugenio, Bove, Tiziana, Corradi, Francesco, Forfori, Francesco, Longhini, Federico, Cecconi, Maurizio, Landoni, Giovanni, Bellomo, Rinaldo, Zangrillo, Alberto, and MERCY Investigators
Subjects: Sepsis, Continuous vs Intermittent Meropenem, Critically Ill Patients
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
Published: 2023

3. A Bayesian reanalysis of the standard versus accelerated initiation of renal-replacement therapy in acute kidney injury (STARRT-AKI) trial

Author: Zampieri, Fernando G., da Costa, Bruno R., Vaara, Suvi T., Lamontagne, François, Rochwerg, Bram, Nichol, Alistair D., McGuinness, Shay, McAuley, Danny F., Ostermann, Marlies, Wald, Ron, Bagshaw, Sean M., Adhikari, Neill K. J., Bellomo, Rinaldo, Dreyfuss, Didier, Du, Bin, Gallagher, Martin P., Gaudry, Stéphane, Joannidis, Michael, Liu, Kathleen D., McAuley, Daniel F., McGuinness, Shay P., Palevsky, Paul M., Qiu, Haibo, Pettilä, Ville, Schneider, Antoine G., Smith, Orla M., Vaara, Suvi, Weir, Matthew, Eastwood, Glenn M., Peck, Leah, Young, Helen, Kruger, Peter, Laurie, Gordon, Saylor, Emma, Meyer, Jason, Venz, Ellen, Wetzig, Krista, French, Craig, McGain, Forbes, Mulder, John, Fennessy, Gerard, Koottayi, Sathyajith, Bates, Samantha, Towns, Miriam, Morgan, Rebecca, Tippett, Anna, Udy, Andrew, Mason, Chris, Licari, Elisa, Gantner, Dashiell, McClure, Jason, Nichol, Alistair, McCracken, Phoebe, Board, Jasmin, Martin, Emma, Vallance, Shirley, Young, Meredith, Vladic, Chelsey, McGloughlin, Steve, Gattas, David, Buhr, Heidi, Coles, Jennifer, Hutch, Debra, Wun, James, Cole, Louise, Whitehead, Christina, Lowrey, Julie, Masters, Kristy, Gresham, Rebecca, Campbell, Victoria, Gutierrez, David, Brailsford, Jane, Forbes, Loretta, Murray, Lauren, Maguire, Teena, NiChonghaile, Martina, Orford, Neil, Bone, Allison, Elderkin, Tania, Salerno, Tania, Chimunda, Tim, Fletcher, Jason, Broadfield, Emma, Porwal, Sanjay, Knott, Cameron, Boschert, Catherine, Smith, Julie, Richardson, Angus, Hill, Dianne, Duke, Graeme, Oziemski, Peter, Cegarra, Santiago, Chan, Peter, Welsh, Deborah, Hunter, Stephanie, Roodenburg, Owen, Dyett, John, Kokotsis, Nicos, Moser, Max, Yang, Yang, Padayachee, Laven, Vetro, Joseph, Gangopadhyay, Himangsu, Kaufman, Melissa, Ghosh, Angaj, Said, Simone, Patel, Alpesh, Bihari, Shailesh, Matheson, Elisha, Jin, Xia, Shrestha, Tapaswi, Schwartz, Kate, Cross, Rosalba, Cheung, Winston, Wong, Helen, Kol, Mark, Shah, Asim, Wang, Amanda Y., Endre, Zoltan, Bradford, Celia, Janin, Pierre, Finfer, Simon, Diel, Naomi, Gatward, Jonathan, Hammond, Naomi, Delaney, Anthony, Bass, Frances, Yarad, Elizabeth, Buscher, Hergen, Reynolds, Claire, Baker, Nerilee, Bellmann, Romuald, Peer, Andreas, Hasslacher, Julia, Koglberger, Paul, Klein, Sebastian, Zotter, Klemens, Brandtner, Anna, Finkenstedt, Armin, Ditlbacher, Adelheid, Hartig, Frank, Fries, Dietmar, Bachler, Mirjam, Schenk, Bettina, Wagner, Martin, Eller, Philipp, Staudinger, Thomas, Tiller, Esther, Schellongowski, Peter, Bojic, Andja, Hoste, Eric, Bracke, Stephanie, De Crop, Luc, Vermeiren, Daisy, Thome, Fernando, Chiella, Bianca, Fendt, Lucia, Antunes, Veronica, Lafrance, Jean-Philippe, D’Aragon, Frédérick, St-Arnaud, Charles, Mayette, Michael, Carbonnaeu, Élaine, Marchand, Joannie, Masse, Marie-Hélène, Ladouceur, Marilène, Turgeon, Alexis F., Lauzier, François, Bellemare, David, Francoeur, Charles Langis, LeBlanc, Guillaume, Guilbault, Gabrielle, Grenier, Stéphanie, Cloutier, Eve, Boivin, Annick, Delisle-Thibault, Charles, Giannakouros, Panagiota, Costerousse, Olivier, Cailhier, Jean-François, Carrier, François-Martin, Ghamraoui, Ali, Lebrasseur, Martine, Benettaib, Fatna, Salamé, Maya, Boumahni, Dounia, Sia, Ying Tung, Naud, Jean-François, Roy, Isabelle, Stelfox, Henry T., Ruddell, Stacey, Manns, Braden J., Duggan, Shelley, Carney, Dominic, Barchard, Jennifer, Whitlock, Richard P., Belley-Cote, Emilie, Savija, Nevena, Sabev, Alexandra, Campbell, Troy, Creary, Thais, Devereaux, Kelson, Brodutch, Shira, Rigatto, Claudio, Paunovic, Bojan, Mooney, Owen, Glybina, Anna, Harasemiw, Oksana, Di Nella, Michelle, Harmon, John, Mehta, Navdeep, Lakatos, Louis, Haslam, Nicole, Lellouche, Francois, Simon, Mathieu, Tung, Ying, Lizotte, Patricia, Bourchard, Pierre-Alexandre, Karachi, Tim, Millen, Tina, Muscedere, John, Maslove, David, Gordon Boyd, J., Sibley, Stephanie, Drover, John, Hunt, Miranda, Georgescu, Ilinca, Wax, Randy, Lenga, Ilan, Sridhar, Kavita, Steele, Andrew, Fusco, Kelly, Ghate, Taneera, Tolibas, Michael, Robinson, Holly, Weir, Matthew A., Taneja, Ravi, Ball, Ian M., Garg, Amit, Campbell, Eileen, Ovsenek, Athena, van Diepen, Sean, Baig, Nadia, Magder, Sheldon, Yao, Han, Alam, Ahsan, Campisi, Josie, MacIntyre, Erika, Rokosh, Ella, Scherr, Kimberly, Lapinsky, Stephen, Mehta, Sangeeta, Shah, Sumesh, Niven, Daniel J., Russell, Michael, Jim, Kym, Brown, Gillian, Oxtoby, Kerry, Hall, Adam, Benoit, Luc, Sokolowski, Colleen, Prasad, Bhanu, Rao, Jag, Giebel, Shelley, Kutsogiannis, Demetrios J., Thompson, Patricia, Thompson, Tayne, Cirone, Robert, Kavikondala, Kanthi, Soth, Mark, Clarke, France, Takaoka, Alyson, Mazer, David, Burns, Karen, Friedrich, Jan, Klein, David, Sandhu, Gyan, Santos, Marlene, Khalid, Imrana, Hodder, Jennifer, Dodek, Peter, Ayas, Najib, Alcuaz, Victoria, Suen, Gabriel, Rewa, Oleksa, Singh, Gurmeet, Norris, Sean, Gibson, Neil, Arias, Castro, Shami, Aysha, Pelletier, Celine, Zahirieh, Alireza, Amaral, Andre, Marinoff, Nicole, Kaur, Navjot, Perez, Adic, Wang, Jane, Haljan, Gregory, Condin, Christopher, McIntyre, Lauralyn, Gomes, Brigette, Porteous, Rebecca, Watpool, Irene, Hiremath, Swapnil, Clark, Edward, Herridge, Margaret S., Backhouse, Felicity, Elizabeth Wilcox, M., Walczak, Karolina, Ki, Vincent, Sharman, Asheer, Romano, Martin, Noel Gibney, R. T., Romanovsky, Adam S., McCoshen, Lorena, Wood, Gordon, Ovakim, Daniel, Auld, Fiona, Carney, Gayle, Duan, Meili, Ji, Xiaojun, Guo, Dongchen, Qi, Zhili, Lin, Jin, Zhang, Meng, Dong, Lei, Liu, Jingfeng, Liu, Pei, Zhi, Deyuan, Bai, Guoqiang, Qiu, Yu, Yang, Ziqi, Bai, Jing, Liu, Zhuang, Zhuang, Haizhou, Wang, Haiman, Li, Jian, Zhao, Mengya, Zhou, Xiao, Shi, Xianqing, Ye, Baning, Liu, Manli, Wu, Jing, Fu, Yongjian, Long, Dali, Pan, Yu, Wang, Jinlong, Mei, Huaxian, Zhang, Songsong, Wen, Mingxiang, Yang, Enyu, Mu, Sijie, Li, Jianquan, Hu, Tingting, Qin, Bingyu, Li, Min, Wang, Cunzhen, Dong, Xin, Wang, Kaiwu, Wang, Haibo, Yang, Jianxu, Wang, Chuanyao, Wang, Dongxin, Li, Nan, Yu, Zhui, Xu, Song, Yao, Lan, Hou, Guo, Liu, Zhou, Lu, Liping, Lian, Yingtao, Wang, Chunting, Zhang, Jichen, Ding, Ruiqi, Qi, Guoqing, Wang, Qizhi, Wang, Peng, Meng, Zhaoli, Chen, Man, Hu, Xiaobo, He, Xiandi, Zhao, Shibing, Hang, Lele, Li, Rui, Qin, Suhui, Lu, Kun, Dun, Shijuan, Liu, Cheng, Zhou, Qi, Chen, Zhenzhen, Mei, Jing, Zhang, Minwei, Xu, Hao, Lin, Jincan, Shi, Qindong, Fu, Lijuan, Zeng, Qinjing, Ma, Hongye, Yan, Jinqi, Gao, Lan, Liu, Hongjuan, Zhang, Lei, Li, Hao, He, Xiaona, Fan, Jingqun, Guo, Litao, Liu, Yu, Wang, Xue, Sun, Jingjing, Liu, Zhongmin, Yang, Juan, Ding, Lili, Sheng, Lulu, Liu, Xingang, Yan, Jie, Wang, Quihui, Wang, Yifeng, Zhao, Dan, Zhao, Shuangping, Hu, Chenghuan, Li, Jing, Deng, Fuxing, Qui, Haibo, Yang, Yi, Mo, Min, Pan, Chun, Wu, Changde, Huang, Yingzi, Huang, Lili, Liu, Airan, Korhonen, Anna-Maija, Törnblom, Sanna, Sutinen, Sari, Pettilä, Leena, Heinonen, Jonna, Lappi, Eliria, Suhonen, Taria, Karlsson, Sari, Hoppu, Sanna, Jalkanen, Ville, Kuitunen, Anne, Levoranta, Markus, Långsjö, Jaakko, Ristimäki, Sanna, Malila, Kaisa, Wootten, Anna, Varila, Simo, Järvisalo, Mikko J., Inkinen, Outi, Kentala, Satu, Leivo, Keijo, Haltia, Paivi, Ricard, Jean-Damien, Messika, Jonathan, Tiagarajah, Abirami, Emery, Malo, Dechanet, Aline, Gernez, Coralie, Roux, Damien, Martin-Lefevre, Laurent, Fiancette, Maud, Vinatier, Isabelle, Lacherade, Jean Claude, Colin, Gwenhaël, Lebert, Christine, Azais, Marie-Ange, Yehia, Aihem, Pouplet, Caroline, Lagarrigue, Matthieu Henry, Seguin, Amélie, Crosby, Laura, Maizel, Julien, Titeca-Beauport, Dimitri, Combes, Alain, Nieszkowska, Ania, Masi, Paul, Demoule, Alexandre, Mayaux, Julien, Dres, Martin, Morawiec, Elise, Decalvele, Maxens, Demiri, Suela, Faure, Morgane, Marios, Clémence, Mallet, Maxime, Ordon, Marie Amélie, Morizot, Laura, Cantien, Marie, Pousset, François, Poirson, Florent, Cohen, Yves, Argaud, Laurent, Cour, Martin, Bitker, Laurent, Simon, Marie, Hernu, Romain, Baudry, Thomas, De La Salle, Sylvie, Robine, Adrien, Sedillot, Nicholas, Tchenio, Xavier, Bouisse, Camille, Roux, Sylvie, Barbar, Saber Davide, Trusson, Rémi, Tamion, Fabienne, Grangé, Steven, Carpentier, Dorothée, Chevrel, Guillaume, Ensenyat-Martin, Luis, Marque, Sophie, Quenot, Jean-Pierre, Andreu, Pascal, Dargent, Auguste, Large, Audrey, Chudeau, Nicolas, Landais, Mickael, Derrien, Benoit, Callahan, Jean Christophe, Guitton, Christophe, Le Moal, Charlène, Robert, Alain, Asehnoune, Karim, Cinotti, Raphaël, Grillot, Nicolas, Demeure, Dominique, Vinsonneau, Christophe, Rahmani, Imen, Marzouk, Mehdi, Dekeyser, Thibault, Sejourne, Caroline, Verlay, Mélanie, Thevenin, Fabienne, Delecolle, Lucie, Thevenin, Didier, Souweine, Bertrand, Coupez, Elisabeth, Adda, Mireille, Eraldi, Jean-Pierre, Marchalot, Antoine, De Prost, Nicolas, Dessap, Armand Mekontso, Razazi, Keyvan, Meziani, Ferhat, Boisrame-Helms, Julie, Clere-Jehl, Raphael, Delabranche, Xavier, Kummerlen, Christine, Merdji, Hamid, Monnier, Alexandra, Rabouel, Yannick, Rahmani, Hassene, Allam, Hayat, Chenaf, Samir, Franja, Vincenta, Pons, Bertrand, Carles, Michel, Martino, Frédéric, Richard, Régine, Zuber, Benjamin, Lacave, Guillaume, Lakhal, Karim, Rozec, Bertrand, Van, Hoa Dang, Boulet, Éric, Fadel, Fouad, Cleophax, Cedric, Dufour, Nicolas, Grant, Caroline, Thuong, Marie, Reignier, Jean, Canet, Emmanuel, Nicolet, Laurent, Boulain, Thierry, Nay, Mai-Anh, Benzekri, Dalila, Barbier, François, Bretagnol, Anne, Kamel, Toufik, Mathonnet, Armelle, Muller, Grégoire, Skarzynski, Marie, Rossi, Julie, Pradet, Amandine, Dos Santos, Sandra, Guery, Aurore, Muller, Lucie, Felix, Luis, Bohé, Julien, Thiéry, Guillaume, Aissaoui, Nadia, Vimpere, Damien, Commeureuc, Morgane, Diehl, Jean-Luc, Guerot, Emmanuel, Liangos, Orfeas, Wittig, Monika, Zarbock, Alexander, Küllmar, Mira, van Waegeningh, Thomas, Rosenow, Nadine, Brickell, Kathy, Doran, Peter, Murray, Patrick T., Landoni, Giovanni, Lembo, Rosalba, Zangrillo, Alberto, Monti, Giacomo, Tozzi, Margherita, Marzaroli, Matteo, Lombardi, Gaetano, Paternoster, Gianluca, Vitiello, Michelangelo, Parke, Rachael, Butler, Magdalena, Gilder, Eileen, Cowdrey, Keri-Anne, Wallace, Samantha, Hallion, Jane, Woolett, Melissa, Neal, Philippa, Duffy, Karina, Long, Stephanie, McArthur, Colin, Simmonds, Catherine, Chen, Yan, McConnochie, Rachael, Newby, Lynette, Knight, David, Henderson, Seton, Mehrtens, Jan, Morgan, Stacey, Morris, Anna, Vander Hayden, Kymbalee, Burke, Tara, Bailey, Matthew, Freebairn, Ross, Chadwick, Lesley, Park, Penelope, Rolls, Christine, Thomas, Liz, Buehner, Ulrike, Williams, Erin, Albrett, Jonathan, Kirkham, Simon, Jackson, Carolyn, Browne, Troy, Goodson, Jennifer, Jackson, David, Houghton, James, Callender, Owen, Higson, Vicki, Keet, Owen, Dominy, Clive, Young, Paul, Hunt, Anna, Judd, Harriet, Lawrence, Cassie, Olatunji, Shaanti, Robertson, Yvonne, Latimer-Bell, Charlotte, Hendry, Deborah, Mckay-Vucago, Agnes, Beehre, Nina, Lesona, Eden, Navarra, Leanlove, Robinson, Chelsea, Jang, Ryan, Junge, Andrea, Lambert, Bridget, Thibault, Michel, Eckert, Philippe, Kissling, Sébastien, Polychronopoulos, Erietta, Poli, Elettra, Altarelli, Marco, Schnorf, Madeleine, Mallaird, Samia Abed, Heidegger, Claudia, Perret, Aurelie, Montillier, Philippe, Sangla, Frederic, Neils, Seigenthaller, De Watteville, Aude, Phull, Mandeep-Kaur, George, Aparna, Hussain, Nauman, Pogreban, Tatiana, Lobaz, Steve, Daniels, Alison, Cunningham, Mishell, Kerr, Deborah, Nicholson, Alice, Shanmugasundaram, Pradeep, Abrams, Judith, Manso, Katarina, Hambrook, Geraldine, McKerrow, Elizabeth, Salva, Juvy, Foulkes, Stephen, Wise, Matthew, Morgan, Matt, Brooks, Jenny, Cole, Jade, Davies, Tracy Michelle, Hill, Helen, Thomas, Emma, Vizcaychipi, Marcela, Baharlo, Behrad, Carungcong, Jaime, Costa, Patricia, Martins, Laura, Kapoor, Ritoo, Hazelton, Tracy, Moon, Angela, Musselwhite, Janine, Shelley, Ben, McCall, Philip, Arbane, Gill, Bociek, Aneta, Marotti, Martina, Lim, Rosario, Campos, Sara, Novellas, Neus Grau, Cennamo, Armando, Slack, Andrew, Wyncoll, Duncan, Camporota, Luigi, Sparkes, Simon, Tilley, Rosalinde, Rattray, Austin, Moreland, Gayle, Duffy, Jane, McGonigal, Elizabeth, Hopkins, Philip, Finney, Clare, Smith, John, Noble, Harriet, Watson, Hayley, Harris, Claire-Louise, Clarey, Emma, Corcoran, Eleanor, Beck, James, Howcroft, Clare, Youngs, Nora, Wilby, Elizabeth, Ogg, Bethan, Wolverson, Adam, Lee, Sandra, Butler, Susie, Okubanjo, Maryanne, Hindle, Julia, Welters, Ingeborg, Williams, Karen, Johnson, Emily, Patrick-Heselton, Julie, Shaw, David, Waugh, Victoria, Stewart, Richard, Mwaura, Esther, Wren, Lynn, Mew, Louise, Sutherland, Sara-Beth, Adderley, Jane, Ruddy, Jim, Harkins, Margaret, Kaye, Callum, Scott, Teresa, Mitchell, Wendy, Anderson, Felicity, Willox, Fiona, Jagannathan, Vijay, Clark, Michele, Purv, Sarah, Sharman, Andrew, Meredith, Megan, Ryan, Lucy, Conner, Louise, Peters, Cecilia, Harvey, Dan, Roshdy, Ashraf, Collins, Amy, Sim, Malcolm, Henderson, Steven, Chee, Nigel, Pitts, Sally, Bowman, Katie, Dilawershah, Maria, Vamplew, Luke, Howe, Elizabeth, Rogers, Paula, Hernandez, Clara, Prendergast, Clara, Benton, Jane, Rosenberg, Alex, Forni, Lui G., Grant, Alice, Carvelli, Paula, Raithatha, Ajay, Bird, Sarah, Richardson, Max, Needham, Matthew, Hirst, Claire, Ball, Jonathan, Leaver, Susannah, Howlett, Luisa, Delgado, Carlos Castro, Farnell-Ward, Sarah, Farrah, Helen, Gray, Geraldine, Joseph, Gipsy, Robinson, Francesca, Tridente, Ascanio, Harrop, Clare, Shuker, Karen, McLaughlan, Derek, Ramsey, Judith, Meehan, Sharon, Rose, Bernd Oliver, Reece-Anthony, Rosie, Gurung, Babita, Whitehouse, Tony, Snelson, Catherine, Veenith, Tonny, Johnston, Andy, Cooper, Lauren, Carrera, Ron, Ellis, Karen, Fellows, Emma, Harkett, Samanth, Bergin, Colin, Spruce, Elaine, Despy, Liesl, Goundry, Stephanie, Dooley, Natalie, Mason, Tracy, Clark, Amy, Dignam, Gemma, Ward, Geraldine, Attwood, Ben, Parsons, Penny, Mason, Sophie, Margarson, Michael, Lord, Jenny, McGlone, Philip, Hodgson, Luke E., Chadbourn, Indra, Gomez, Raquel, Margalef, Jordi, Pretorius, Rinus, Hamshere, Alexandra, Carter, Joseph, Cahill, Hazel, Grainger, Lia, Howard, Kate, Forshaw, Greg, Guy, Zoe, Kashani, Kianoush B., Albright, Robert C., Amsbaugh, Amy, Stoltenberg, Anita, Niven, Alexander S., Lynch, Matthew, O’Mara, AnnMarie, Naeem, Syed, Sharif, Sairah, Goulart, Joyce McKenney, Tolwani, Ashita, Lyas, Claretha, Latta, Laura, Bihorac, Azra, Hashemighouchani, Haleh, Efron, Philip, Ruppert, Matthew, Cupka, Julie, Kiley, Sean, Carson, Joshua, White, Peggy, Omalay, George, Brown, Sherry, Velez, Laura, Marceron, Alina, Neyra, Javier A., Aycinena, Juan Carlos, Elias, Madona, Ortiz-Soriano, Victor M., Hauschild, Caroline, Dorfman, Robert, Investigators, STARRT-AKI, Investigators, STARRT-AKI, Zampieri Fernando, G, da Costa Bruno, R, Vaara Suvi, T, Lamontagne, Françoi, Rochwerg, Bram, Nichol Alistair, D, Mcguinness, Shay, McAuley Danny, F, Ostermann, Marlie, Wald, Ron, Bagshaw Sean, M, STARRT-AKI, Investigator, Landoni, G, and Zangrillo, A
Subjects: Kidney-replacement therapy, Critical Illness, Acute Kidney Injury/therapy, Randomized, Bayes Theorem, Acute Kidney Injury, Critical Care and Intensive Care Medicine, Bayesian, Trial, Acute kidney injury, Renal Replacement Therapy, Renal Replacement Therapy/methods, Critical Illness/therapy, Medicine and Health Sciences, Humans, Mortality, Dialysis, Probability
Abstract: Background Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. Methods We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero–one inflated beta regression. Results The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] − 3.30%; 3.40%], − 0.39% [95% CrI − 3.46%; 3.00%], and 0.64% [95% CrI − 2.53%; 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of − 3.55 days [95% CrI − 6.38; − 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI − 1.87; 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. Conclusions In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation.
Published: 2022
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4. Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial

Author: Zangrillo, Alberto, Lomivorotov, Vladimir, Pasyuga, Vadim, Belletti, Alessandro, Gazivoda, Gordana, Monaco, Fabrizio, Nigro Neto, Caetano, Likhvantsev, Valery, Bradic, Nikola, Lozovskiy, Andrey, Lei, Chong, Bukamal, Nazar, Santos Silva, Fernanda, Bautin, Andrey, Ma, Jun, Yen Yong, Chow, Carollo, Cristiana, Kunstyr, Jan, Wang, Chew Yin, Grigoryev, Evgeny, Riha, Hynek, Wang, Chengbin, El-Tahan, Mohamed, Scandroglio, Anna Mara, Mansor, Marzida, Lembo, Rosalba, Ponomarev, Dmitry, Lucena Bezerra, Francisco José, Ruggeri, Laura, Chernyavskiy, Alexander, Xu, Junmei, Tarasov, Dmitry, Navalesi, Paolo, Yavorovskiy, Andrey, Bove, Tiziana, Kuzovlev, Artem, Hajjar, Ludhmila, Landoni, Giovanni, MYRIAD Study Group, Zangrillo, A., Lomivorotov, V. V., Pasyuga, V. V., Belletti, A., Gazivoda, G., Monaco, F., Nigro Neto, C., Likhvantsev, V. V., Bradic, N., Lozovskiy, A., Lei, C., Bukamal, N. A. R., Silva, F. S., Bautin, A. E., Ma, J., Yong, C. Y., Carollo, C., Kunstyr, J., Wang, C. Y., Grigoryev, E. V., Riha, H., Wang, C., El-Tahan, M. R., Scandroglio, A. M., Mansor, M., Lembo, R., Ponomarev, D. N., Bezerra, F. J. L., Ruggeri, L., Chernyavskiy, A. M., Xu, J., Tarasov, D. G., Navalesi, P., Yavorovskiy, A., Bove, T., Kuzovlev, A., Hajjar, L. A., and Landoni, G.
Subjects: cancer, cardiac surgery, cardioprotection, mortality, myocardial infarction, volatile anesthetics, Myocardial Infarction, Middle Aged, Sevoflurane, Anesthesiology and Pain Medicine, Postoperative Complications, Anesthetics, Inhalation, Humans, volatile anesthetic, Coronary Artery Bypass, Cardiology and Cardiovascular Medicine, Propofol, Anesthetics, Intravenous, Aged
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.
Published: 2022

5. Air pollutants and SARS-CoV-2 in 33 European countries

Author: Landoni, Giovanni, Lembo, Rosalba, Cianfanelli, Lorenzo, Frontera, Antonio, Landoni, Giovanni, Lembo, Rosalba, Cianfanelli, Lorenzo, and Frontera, Antonio
Abstract: A potential correlation between severe acute respiratory syndrome coronavirus 2 and air pollution has been suggested in some nationwide studies. It is not clear whether air pollution contributes to the spread of SARS-CoV-2 and to increase mortality.
Published: 2021

6. Propensity-matched comparison for carotid artery stenting in primary stenosis versus post-CEA restenosis

Author: Kahlberg, Andrea, Ardita, Vincenzo, Spertino, Andrea, Mascia, Daniele, Bertoglio, Luca, Baccellieri, Domenico, Lembo, Rosalba, Melissano, Germano, Chiesa, Roberto, Kahlberg, Andrea, Ardita, Vincenzo, Spertino, Andrea, Mascia, Daniele, Bertoglio, Luca, Baccellieri, Domenico, Lembo, Rosalba, Melissano, Germano, and Chiesa, Roberto
Abstract: Objectives Carotid artery stenting (CAS) has been proposed as the treatment of choice in case of post-carotid endarterectomy (CEA) restenosis. The aim of the study is to analyze periprocedural results of CAS for the treatment of post-CEA restenosis (RES) compared with those of CAS performed for primary carotid stenosis (PRS). Methods Data from consecutive patients submitted to CAS at our Institution from 2008 to 2016 were retrospectively reviewed. Patients with in-stent restenosis were excluded. Initially, preoperative risk factors, demographics, intraoperative variables and perioperative outcome were analyzed according to indication group (PRS and RES). Then, propensity score matching was performed obtaining two homogeneous groups of patients. Covariates included were: age, gender, hypertension, hyperlipidemia, cardiac disease, chronic renal disease, symptomatic carotid plaque and positive ipsilateral brain CT-scan. Intraoperative data and perioperative outcomes were then compared between the two matched groups. Results Of 480 included patients, 300 (62.5%) underwent CAS for PRS, and 180 (37.5%) for RES. After propensity score analysis (158 patients per group), no significant difference were observed in terms of technical success, number and type of stent used, except for need of intraoperative atropine administration that was higher in PRS group (38.6% vs 13.3%, respectively; p
Published: 2020

7. sj-pdf-1-jao-10.1177_0391398820975408 – Supplemental material for Venovenous ECMO treatment, outcomes, and complications in adults according to large case series: A systematic review

Author: Kim, Jun Hyun, Pieri, Marina, Landoni, Giovanni, Scandroglio, Anna Mara, Calabrò, Maria Grazia, Fominskiy, Evgeny, Lembo, Rosalba, Heo, Min Hee, and Zangrillo, Alberto
Subjects: FOS: Biological sciences, 69999 Biological Sciences not elsewhere classified
Abstract: Supplemental material, sj-pdf-1-jao-10.1177_0391398820975408 for Venovenous ECMO treatment, outcomes, and complications in adults according to large case series: A systematic review by Jun Hyun Kim, Marina Pieri, Giovanni Landoni, Anna Mara Scandroglio, Maria Grazia Calabrò, Evgeny Fominskiy, Rosalba Lembo, Min Hee Heo and Alberto Zangrillo in The International Journal of Artificial Organs
Published: 2020
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8. sj-pdf-1-jao-10.1177_0391398820975408 – Supplemental material for Venovenous ECMO treatment, outcomes, and complications in adults according to large case series: A systematic review

Author: Kim, Jun Hyun, Pieri, Marina, Landoni, Giovanni, Scandroglio, Anna Mara, Calabrò, Maria Grazia, Fominskiy, Evgeny, Lembo, Rosalba, Heo, Min Hee, and Zangrillo, Alberto
Subjects: FOS: Biological sciences, 69999 Biological Sciences not elsewhere classified
Abstract: Supplemental material, sj-pdf-1-jao-10.1177_0391398820975408 for Venovenous ECMO treatment, outcomes, and complications in adults according to large case series: A systematic review by Jun Hyun Kim, Marina Pieri, Giovanni Landoni, Anna Mara Scandroglio, Maria Grazia Calabrò, Evgeny Fominskiy, Rosalba Lembo, Min Hee Heo and Alberto Zangrillo in The International Journal of Artificial Organs
Published: 2020
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9. Platelet activation is a preoperative risk factor for the development of thromboembolic complications in patients with continuous-flow left ventricular assist device

Author: Consolo, Filippo, Sferrazza, Giulia, Motolone, Giulia, Contri, Rachele, Valerio, Lorenzo, Lembo, Rosalba, Pozzi, Loris, Della Valle, Patrizia, De Bonis, Michele, Zangrillo, Alberto, Fiore, Gianfranco B., Redaelli, Alberto, Slepian, Marvin J., Pappalardo, Federico, Consolo, Filippo, Sferrazza, Giulia, Motolone, Giulia, Contri, Rachele, Valerio, Lorenzo, Lembo, Rosalba, Pozzi, Lori, Della Valle, Patrizia, De Bonis, Michele, Zangrillo, Alberto, Fiore, Gianfranco B., Redaelli, Alberto, Slepian, Marvin J., and Pappalardo, Federico
Subjects: Antithrombotic therapy, Platelet activity state assay, Thrombotic risk, Left ventricular assist device, Platelet activation, Cardiology and Cardiovascular Medicine
Abstract: Aims: To correlate the dynamics of platelet activation with the development of thromboembolic events in patients with continuous-flow left ventricular assist device (cf-LVAD). Methods and results: The platelet activity state (PAS) assay was utilized to evaluate platelet activation in 68 cf-LVAD patients implanted with the HeartMate II (n = 15, 22%), HeartMate 3 (n = 15, 22%), or HeartWare HVAD (n = 38, 56%). PAS was measured preoperatively, early post-implant, and at long-term follow-up (1, 3, 6, 12, 18, and 24 months post-implant). PAS was also measured at the occurrence of adverse events in patients who developed thrombotic complications. Data on patient demographics, medical history, antithrombotic therapy, and coagulation parameters were also analysed. Over a median follow-up of 602 (234-942) days, PAS values did not increase over time in the overall population (P = 0.15). However, PAS measured at event was 15-fold higher in the six patients (9%) who suffered pump thrombosis (n = 2) or ischaemic stroke (n = 4) vs. the rest of the population [6.67% (5.59%-11.98%) vs. 0.45% (0.33%-0.75%); P = 0.012], despite comparable coagulation profile. Pre-implant PAS values were 4.5-fold higher in these patients [1.90% (1.24%-3.17%) vs. 0.42% (0.32%-0.72%); P = 0.006]. Neither preoperative variables nor the type of the pump or the antiplatelet strategy were associated with a higher risk of complications. Conclusions: Thrombotic events are associated with altered PAS values. Moreover, baseline elevated PAS values in patients who developed thrombotic events suggest patient-specific tendency to post-implant thromboembolic complications. Prospectively, systematic monitoring of PAS might guide the development of refined patient-tailored antithrombotic strategies and the technological improvement of LVAD design.
Published: 2018

10. Stress lavoro correlato come fattore di rischio della Sindrome Metabolica: impatto organizzativo

Author: Rosa, Debora, Terzoni, Stefano, Lembo, Rosalba, and Destrebecq, Anne
Published: 2018
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11. A randomized controlled trial of levosimendan to reduce mortality in high-risk cardiac surgery patients (CHEETAH): Rationale and design

Author: Zangrillo, Alberto, Alvaro, Gabriele, Pisano, Antonio, Guarracino, Fabio, Lobreglio, Rosetta, Bradić, Nikola, Lembo, Rosalba, Gianni, Stefano, Calabrò, Maria Grazia, Likhvantsev, Valery, Grigoryev, Evgeny, Buscaglia, Giuseppe, Pala, Giovanni, Auci, Elisabetta, Amantea, Bruno, Monaco, Fabrizio, De Vuono, Giovanni, Corcione, Antonio, Galdieri, Nicola, Cariello, Claudia, Bove, Tiziana, Fominskiy, Evgeny, Auriemma, Stefano, Baiocchi, Massimo, Bianchi, Alessandro, Frontini, Mario, Paternoster, Gianluca, Sangalli, Fabio, Wang, Chew-Yin, Zucchetti, Maria Chiara, Biondi-Zoccai, Giuseppe, Gemma, Marco, Lipinski, Michael J., Lomivorotov, Vladimir, and Landoni, Giovanni
Subjects: Levosimendan, High-risk Cardiac Surgery, Myocardial Dysfunction
Abstract: OBJECTIVE: Patients undergoing cardiac surgery are at risk of perioperative low cardiac output syndrome due to postoperative myocardial dysfunction. Myocardial dysfunction in patients undergoing cardiac surgery is a potential indication for the use of levosimendan, a calcium sensitizer with 3 beneficial cardiovascular effects (inotropic, vasodilatory, and anti- inflammatory), which appears effective in improving clinically relevant outcomes. DESIGN: Double-blind, placebo-controlled, multicenter randomized trial. SETTING: Tertiary care hospitals. INTERVENTIONS: Cardiac surgery patients (n = 1, 000) with postoperative myocardial dysfunction (defined as patients with intraaortic balloon pump and/or high-dose standard inotropic support) will be randomized to receive a continuous infusion of either levosimendan (0.05- 0.2 μg/[kg min]) or placebo for 24-48 hours. MEASUREMENTS AND MAIN RESULTS: The primary end point will be 30-day mortality. Secondary end points will be mortality at 1 year, time on mechanical ventilation, acute kidney injury, decision to stop the study drug due to adverse events or to start open-label levosimendan, and length of intensive care unit and hospital stay. We will test the hypothesis that levosimendan reduces 30-day mortality in cardiac surgery patients with postoperative myocardial dysfunction. CONCLUSIONS: This trial is planned to determine whether levosimendan could improve survival in patients with postoperative low cardiac output syndrome. The results of this double-blind, placebo-controlled randomized trial may provide important insights into the management of low cardiac output in cardiac surgery.
Published: 2016

12. Long-term outcome of perioperative low cardiac output syndrome in cardiac surgery: 1-year results of a multicenter randomized trial

Author: Luca Brazzi, Fabio Guarracino, Valery Likhvantsev, Rosalba Lembo, Giovanni Landoni, Martina Crivellari, Eugenio Garofalo, Gianluca Paternoster, A Mara Scandroglio, Vadim Pasyuga, Nora Di Tomasso, Alberto Zangrillo, Maria Grazia Calabrò, Antonio Pisano, Fabrizio Monaco, Alessandro Belletti, Vladimir V. Lomivorotov, Alessandro Bianchi, Evgeny Fominskiy, Marat N Abubakirov, Evgeny Grigoryev, Andrey Yavorovskiy, Alessandro Oriani, Zangrillo, Alberto, Lomivorotov, Vladimir V, Pisano, Antonio, Calabrò, Maria Grazia, Belletti, Alessandro, Brazzi, Luca, Grigoryev, Evgeny V, Guarracino, Fabio, Monaco, Fabrizio, Garofalo, Eugenio, Crivellari, Martina, Likhvantsev, Valery V, Fominskiy, Evgeny V, Paternoster, Gianluca, Yavorovskiy, Andrey, Pasyuga, Vadim V, Oriani, Alessandro, Lembo, Rosalba, Bianchi, Alessandro, Scandroglio, A Mara, Abubakirov, Marat N, Di Tomasso, Nora, and Landoni, Giovanni
Subjects: Male, medicine.medical_specialty, Mean arterial pressure, Cardiotonic Agents, Levosimendan, Cardiac Output, Low, Low-cardiac output syndrome, Critical Care and Intensive Care Medicine, Placebo, law.invention, 03 medical and health sciences, Postoperative Complications, Catecholamines, 0302 clinical medicine, Double-Blind Method, law, Internal medicine, medicine, Cardiopulmonary bypass, Humans, Hemodynamic management, Myocardial infarction, Mortality, Risk factor, Simendan, business.industry, Cardiovascular Surgical Procedures, Age Factors, 030208 emergency & critical care medicine, Perioperative, Middle Aged, Cardiac surgery, medicine.disease, Survival Analysis, Treatment Outcome, 030228 respiratory system, Catecholamine, Cardiology, Female, business, medicine.drug
Abstract: Purpose Perioperative myocardial dysfunction occurs frequently in cardiac surgery, and is a risk factor for morbidity and mortality. Levosimendan has been suggested to reduce mortality of patients with perioperative myocardial dysfunction. However, long-term outcome data on its efficacy in cardiac surgery are lacking. Materials and methods Cardiac surgery patients with perioperative myocardial dysfunction were randomized to levosimendan or placebo, in addition to standard inotropic care. One-year mortality data were collected. Results We randomized 506 patients (248 to levosimendan 258 to placebo). At 1-year follow-up, 41 patients (16.5%) died in the levosimendan group, while 47 (18.3%) died in the placebo group (absolute risk difference −1.8; 95% CI −8.4 to 4.9; P = .60). Female sex, history of chronic obstructive pulmonary disease, previous myocardial infarction, serum creatinine, hematocrit, mean arterial pressure, and duration of cardiopulmonary bypass were independently associated with 1-year mortality. Conclusions Levosimendan administration does not improve 1-year survival in cardiac surgery patients with perioperative myocardial dysfunction. One-year mortality in these patients is 17%. Six predictive factors for long-term mortality were identified. Study registration number NCT00994825 ( ClinicalTrials.gov ).
Published: 2020
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13. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial. The PROTECTION trial

Author: Giovanni Landoni, Claudio Brambillasca, Martina Baiardo Redaelli, Nikola Bradić, Lian Kah Ti, Zdenko Povšić-Čevra, Valery A. Nepomniashchikh, Giuseppe Biondi Zoccai, Fabrizio D'Ascenzo, Enrico Romagnoli, Anna Mara Scandroglio, Andrea Ballotta, Nicola Rondello, Annalisa Franco, Cristiano Massaro, Cristina Viscido, Maria Grazia Calabrò, Eugenio Garofalo, Flaminia Canichella, Fabrizio Monaco, Luca Severi, Antonio Pisano, Gaia Barucco, Maria Venditto, Francesco Federici, Margherita Licheri, Gianluca Paternoster, Annachiara Trompeo, Alessandro Belletti, Lorenzo Filippo Mantovani, Romina Perone, Giuseppe Dalessandro, Daniel Kroeller, Dorela Haxhiademi, Carola Galbiati, Vincenzo Francesco Tripodi, Giuseppe Giardina, Rosalba Lembo, Cristina Nakhnoukh, Fabio Guarracino, Federico Longhini, Tiziana Bove, Alberto Zangrillo, Rinaldo Bellomo, Evgeny Fominskiy, Landoni, Giovanni, Brambillasca, Claudio, Redaelli, Martina Baiardo, Bradić, Nikola, Ti, Lian Kah, Povšić-Čevra, Zdenko, Nepomniashchikh, Valery A, Zoccai, Giuseppe Biondi, D'Ascenzo, Fabrizio, Romagnoli, Enrico, Scandroglio, Anna Mara, Ballotta, Andrea, Rondello, Nicola, Franco, Annalisa, Massaro, Cristiano, Viscido, Cristina, Calabrò, Maria Grazia, Garofalo, Eugenio, Canichella, Flaminia, Monaco, Fabrizio, Severi, Luca, Pisano, Antonio, Barucco, Gaia, Venditto, Maria, Federici, Francesco, Licheri, Margherita, Paternoster, Gianluca, Trompeo, Annachiara, Belletti, Alessandro, Mantovani, Lorenzo Filippo, Perone, Romina, Dalessandro, Giuseppe, Kroeller, Daniel, Haxhiademi, Dorela, Galbiati, Carola, Tripodi, Vincenzo Francesco, Giardina, Giuseppe, Lembo, Rosalba, Nakhnoukh, Cristina, Guarracino, Fabio, Longhini, Federico, Bove, Tiziana, Zangrillo, Alberto, Bellomo, Rinaldo, and Fominskiy, Evgeny
Subjects: Adult, Crystalloid Solutions, General Medicine, Cardiac surgery, Kidney, Acute kidney injury, Amino acids, Anesthesia, Intensive care, Randomized controlled trial, Clinical Trials, Phase III as Topic, Quality of Life, Humans, Multicenter Studies as Topic, Pharmacology (medical), Cardiac Surgical Procedures, Randomized Controlled Trials as Topic
Abstract: Postoperative acute kidney injury (AKI) is frequent in cardiac surgery patients. Its pathophysiology is complex and involves decreased renal perfusion. Preliminary clinical evidence in critically ill patients shows that amino acids infusion increases renal blood flow and may decrease the incidence and severity of AKI. We designed a study to evaluate the effectiveness of perioperative continuous infusion of amino acids in decreasing AKI.This is a phase III, multi-center, randomized, double-blind, placebo-controlled trial. Adults undergoing cardiac surgery with cardiopulmonary bypass (CPB) are included. Patients are randomly assigned to receive either continuous infusion of a balanced mixture of amino acids in a dose of 2 g/kg ideal body weight/day or placebo (balanced crystalloid solution) from the operating room up to start of renal replacement therapy (RRT), or ICU discharge, or 72 h after the first dose. The primary outcome is the incidence of AKI during hospital stay defined by KDIGO (Kidney Disease: Improving Global Outcomes). Secondary outcomes include the need for, and duration of, RRT, mechanical ventilation; ICU and hospital length of stay; all-cause mortality at ICU, hospital discharge, 30, 90, and 180 days after randomization; quality of life at 180 days. Data will be analyzed in 3500 patients on an intention-to-treat basis.The trial is ongoing and currently recruiting. It will be one of the first randomized controlled studies to assess the relationship between amino acids use and kidney injury in cardiac surgery. If our hypothesis is confirmed, this practice could reduce morbidity in the studied population.This trial was registered on ClinicalTrials.gov with the trial identification NCT03709264 in October 2018.
Published: 2022

14. Two‐months quality of life of COVID‐19 invasively ventilated survivors; an Italian single‐center study

Author: Francesca Guzzo, Monica Fedrizzi, Rebecca De Lorenzo, Martina Crivellari, Valentina Da Prat, Evgeny Fominskiy, Alberto Zangrillo, Marina Pieri, Carolina Faustini, Lorenzo Dagna, Giovanni Landoni, Margherita Tozzi, Rosalba Lembo, Giacomo Monti, Elena Moizo, Carlo Leggieri, Sergio Colombo, Antonio Esposito, Martina Di Piazza, Anna Mara Scandroglio, Simona Piemontese, Milena Mucci, Francesca Conte, Monti, Giacomo, Leggieri, Carlo, Fominskiy, Evgeny, Scandroglio, Anna Mara, Colombo, Sergio, Tozzi, Margherita, Moizo, Elena, Mucci, Milena, Crivellari, Martina, Pieri, Marina, Guzzo, Francesca, Piemontese, Simona, De Lorenzo, Rebecca, Da Prat, Valentina, Fedrizzi, Monica, Faustini, Carolina, Di Piazza, Martina, Conte, Francesca, Lembo, Rosalba, Esposito, Antonio, Dagna, Lorenzo, Landoni, Giovanni, and Zangrillo, Alberto
Subjects: Male, ARDS, medicine.medical_specialty, Critical Care, critically ill patients, Disease, Single Center, Quality of life, COVID‐19, Intensive care, Surveys and Questionnaires, follow-up, medicine, Humans, Prospective Studies, Survivors, Cognitive decline, quality‐of‐life, intensive care, follow‐up, Acute respiratory distress syndrome, business.industry, Malnutrition, COVID-19, General Medicine, Original Articles, Recovery of Function, Middle Aged, medicine.disease, Respiration, Artificial, Anesthesiology and Pain Medicine, Italy, quality-of-life, Emergency medicine, Breathing, Quality of Life, Original Article, Female, business, Follow-Up Studies
Abstract: BACKGROUND: COVID-19 disease can lead to severe functional impairments after discharge. We assessed the quality of life of invasively ventilated COVID-19 ARDS survivors. METHODS: We carried out a prospective follow-up study of the patients admitted to the Intensive Care Units (ICUs) of a teaching hospital. Patients affected by COVID-19 ARDS who required invasive ventilation and were successfully discharged home were assessed through the telephone administration of validated tests. We explored survival, functional outcomes, return to work, quality of life, cognitive and psychological sequelae. The main variables of interest were the following: demographics, severity scores, laboratory values, comorbidities, schooling, working status, treatments received during ICU stay, complications, and psychological, cognitive, functional outcomes. RESULTS: Out of 116 consecutive invasively ventilated patients, overall survival was 65/116 (56%) with no death occurring after hospital discharge. Forty-two patients were already discharged home with a median follow-up time of 61 (51-71) days after ICU discharge and 39 of them accepted to be interviewed. Only one patient (1/39) experienced cognitive decline. The vast majority of patients reported no difficulty in walking (32/35:82%), self-care (33/39:85%), and usual activities (30/39:78%). All patients were either malnourished (15/39:38%) or at risk for malnutrition (24/39:62%). Exertional dyspnea was present in 20/39 (51%) patients. 19/39 (49%) reported alterations in senses of smell and/or taste either before or after hospitalization. CONCLUSIONS: Invasively ventilated COVID-19 ARDS survivors have an overall good recovery at a 2-months follow-up which is better than what was previously reported in non-COVID-19 ARDS patients.
Published: 2021

15. Continuous infusion versus intermittent administration of meropenem in critically ill patients (MERCY): A multicenter randomized double-blind trial. Rationale and design

Author: Ingrid Marcela Pabon, Barbara Azzali, Mattia Bozzetti, Vincenzo Pota, Antonio De Sio, Andrey Yavorovskiy, Natascia D'Andrea, Rosetta Lobreglio, Andrea Della Selva, Evgeny Fominskiy, Federico Canavosio, Barbara Ferrara, Vittorio Pazzanese, Francesca Gallicchio, Nicola Pasculli, Valery Likhvantsev, Eugenio Garofalo, Sergio Colombo, Anna Mara Scandroglio, Felice Eugenio Agrò, Margherita Tozzi, Gianluca Paternoster, Francesco Corradi, Tiziana Bove, Filippo Palmesino, Elena Momesso, Luigi Vetrugno, Francesco Giuseppe Nisi, Giorgia Montrucchio, Daniela Missio, Mara Bernasconi, Giacomo Monti, Mariano Ballestra, Marco Gemma, Giovanni Marino, Silvia Ajello, Alberto Zangrillo, Rosalba Lembo, Maria Grazia Calabrò, Romina Perone, Andrea Bruni, Pavel Nogtev, Alberto Cappelletti, Gabriele Finco, Daniele Cristadoro, Leonarda Pia Cantatore, Marina Pieri, Sofia Ananiadou, Italo Calamai, Chiara Millin, A. Mattei, Luca Cabrini, Marina Petrova, Valentina Paola Plumari, Nicoletta Boffa, Davide Maraggia, Elena Moizo, Gianna Curci, Giovanni Landoni, Giuseppe Biondi-Zoccai, Giuseppe Giardina, Giacomo Iapichino, Carola Galbiati, Fabio Guarracino, Antonella Cotoia, Matteo Marzaroli, Nikola Bradic, Umberto Benedetto, Giorgio Gallioli, Fabrizio D'Ascenzo, Francesco Forfori, Fabio Toffoletto, Milena Mucci, Manuela Mainetti, Monti, G., Galbiati, C., Toffoletto, F., Calabro, M. G., Colombo, S., Ferrara, B., Giardina, G., Lembo, R., Marzaroli, M., Moizo, E., Mucci, M., Pasculli, N., Plumari, V. P., Scandroglio, A. M., 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., Bradic, N., Corradi, F., Gemma, M., Nogtev, P., Petrova, M., Agro, F. E., Cabrini, L., Forfori, F., Likhvantsev, V., Bove, T., Finco, G., Landoni, G., Zangrillo, A., Ajello, S., Cappelletti, A. M., Fominskiy, E., Nisi, F. G., Pazzanese, V., Pieri, M., Canavosio, F., Palmesino, F., Bernasconi, M., Gallioli, G., Marino, G., Vetrugno, L., Millin, C., Missio, D., Gallicchio, F., Azzali, B., Bozzetti, M., Cristadoro, D., Perone, R., Cantatore, L. P., Curci, G., Pabon, I. M., Garofalo, E., Mainetti, M., Calamai, I., Maraggia, D., Mattei, A., Yavorovskiy, A., Monti, Giacomo, Galbiati, Carola, Toffoletto, Fabio, Calabrò, Maria Grazia, Colombo, Sergio, Ferrara, Barbara, Giardina, Giuseppe, Lembo, Rosalba, Marzaroli, Matteo, Moizo, Elena, Mucci, Milena, Pasculli, Nicola, Plumari, Valentina, Scandroglio, Anna Mara, Tozzi, Margherita, Momesso, Elena, Boffa, Nicoletta, Lobreglio, Rosetta, Montrucchio, Giorgia, Guarracino, Fabio, Benedetto, Umberto, Biondi-Zoccai, Giuseppe, D'Ascenzo, Fabrizio, D'Andrea, Natascia, Paternoster, Gianluca, Ananiadou, Sofia, Ballestra, Mariano, De Sio, Antonio, Pota, Vincenzo, Cotoia, Antonella, Selva, Andrea Della, Bruni, Andrea, Iapichino, Giacomo, Bradić, Nikola, Corradi, Francesco, Gemma, Marco, Nogtev, Pavel, Petrova, Marina, Agrò, Felice Eugenio, Cabrini, Luca, Forfori, Francesco, Likhvantsev, Valery, Bove, Tiziana, Finco, Gabriele, Landoni, Giovanni, and Zangrillo, Alberto
Subjects: medicine.medical_specialty, Randomization, Critical Care, Antibiotic resistance, Critical patients, Critical Illness, Population, meropenem, intermitent or continuous infusion, critically ill, Intensive care unit, Meropenem, Mortality, Multi-drug resistant pathogens, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Sepsis, medicine, Clinical endpoint, polycyclic compounds, Humans, Pharmacology (medical), 030212 general & internal medicine, education, Antibacterial agent, education.field_of_study, 030505 public health, Septic shock, business.industry, Critical patient, General Medicine, medicine.disease, Anti-Bacterial Agents, Emergency medicine, 0305 other medical science, business, medicine.drug
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.
Published: 2021

16. Treatment of Thoracic Endometriosis Syndrome: A Meta-Analysis and Review

Author: Rosalba Lembo, Paola Ciriaco, Angelo Carretta, Piergiorgio Muriana, Giampiero Negri, Ciriaco, Paola, Muriana, Piegiorgio, Lembo, Rosalba, Carretta, Angelo, and Negri, Giampiero
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Endometriosis, Catamenial pneumothorax, Diaphragmatic breathing, 030204 cardiovascular system & hematology, Videothoracoscopy, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Laparoscopy, Pelvis, medicine.diagnostic_test, business.industry, food and beverages, Syndrome, Thorax, medicine.disease, Surgery, Newcastle–Ottawa scale, medicine.anatomical_structure, 030228 respiratory system, Concomitant, Female, Hormone therapy, Cardiology and Cardiovascular Medicine, business, Algorithms
Abstract: Background Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of functional endometrial tissue within the chest cavity. Up to 80% of women with TES present with concomitant pelvic endometriosis. The diagnostic-curative path is defined by both thoracic surgeons and gynecologists, consistent with the manifestation of the disease. The aim of the study was to analyze the different approaches to generate an ideal diagnosis-treatment algorithm that can be shared by both specialties. Methods We searched PubMed and Scopus for studies that were completed by March 2019 and that included at least 8 patients with TES. Information on preoperative exams, surgical technique, postoperative management, and recurrence of disease was collected for meta-analysis. Results Twenty-five studies including a total of 732 patients were eligible. Almost all of the patients underwent radiologic pelvis investigation (96%; confidence interval [CI], 87%-100%). Videothoracoscopy was the preferred surgical technique (84%; 95% CI, 66%-96%). Intraoperative evaluation revealed the presence of diaphragmatic anomalies in 84% of cases (95% CI, 73%-93%). The overall pooled prevalence of concomitant or staged laparoscopy was 52% (95% CI, 18%-85%). Postoperative hormone therapy was heterogeneous with a pooled prevalence of 61% (95% CI, 33%-86%; I2 = 95.6%; P Conclusions TES should be managed jointly by thoracic surgeons and gynecologists. Chest-abdomen magnetic resonance imaging seems to offer the most details for TES. Combined or staged videothoracoscopy and laparoscopy can provide adequate information to fine-tune proper surgical treatment and postoperative medical therapy.
Published: 2020

17. Effect of Continuous Epinephrine Infusion on Survival in Critically Ill Patients. A Meta-Analysis of Randomized Trials

Author: Rosalba Lembo, Chiara Sartini, Alessandro Belletti, Giovanni Landoni, Marta Mucchetti, Alessandro Putzu, Marianna Sartorelli, Federica Morselli, Ádám Nagy, Alberto Zangrillo, Pierfrancesco De Domenico, University of Zurich, Belletti, Alessandro, Nagy, Adam, Sartorelli, Marianna, Mucchetti, Marta, Putzu, Alessandro, Sartini, Chiara, Morselli, Federica, De Domenico, Pierfrancesco, Zangrillo, Alberto, Landoni, Giovanni, and Lembo, Rosalba
Subjects: Inotrope, Epinephrine, Critical Illness, Adrenergic, Hemodynamics, 610 Medicine & health, Critical Care and Intensive Care Medicine, 11171 Cardiocentro Ticino, law.invention, Norepinephrine, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Dobutamine, Humans, Vasoconstrictor Agents, Medicine, Infusions, Intravenous, Randomized Controlled Trials as Topic, business.industry, 030208 emergency & critical care medicine, Length of Stay, Shock, Septic, Intensive care unit, Renal Replacement Therapy, Intensive Care Units, 030228 respiratory system, Cardiovascular Diseases, Meta-analysis, Anesthesia, Drug Therapy, Combination, Observational study, business, 2706 Critical Care and Intensive Care Medicine, medicine.drug
Abstract: Epinephrine is frequently used as an inotropic and vasopressor agent in critically ill patients requiring hemodynamic support. Data from observational trials suggested that epinephrine use is associated with a worse outcome as compared with other adrenergic and nonadrenergic vasoactive drugs. We performed a systematic review and meta-analysis of randomized controlled trials to investigate the effect of epinephrine administration on outcome of critically ill patients.PubMed, EMBASE, and Cochrane central register were searched by two independent investigators up to March 2019.Inclusion criteria were: administration of epinephrine as IV continuous infusion, patients admitted to an ICU or undergoing major surgery, and randomized controlled trials. Studies on epinephrine administration as bolus (e.g., during cardiopulmonary resuscitation), were excluded. The primary outcome was mortality at the longest follow-up available.Two independent investigators examined and extracted data from eligible trials.A total of 5,249 studies were assessed, with a total of 12 studies (1,227 patients) finally included in the meta-analysis. The majority of the trials were performed in the setting of septic shock, and the most frequent comparator was a combination of norepinephrine plus dobutamine. We found no difference in all-cause mortality at the longest follow-up available (197/579 [34.0%] in the epinephrine group vs 219/648 [33.8%] in the control group; risk ratio = 0.95; 95% CI, 0.82-1.10; p = 0.49; I = 0%). No differences in the need for renal replacement therapy, occurrence rate of myocardial ischemia, occurrence rate of arrhythmias, and length of ICU stay were observed.Current randomized evidence showed that continuous IV administration of epinephrine as inotropic/vasopressor agent is not associated with a worse outcome in critically ill patients.
Published: 2020
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18. The Brachiocephalic Vein as a Safe and Viable Alternative to Internal Jugular Vein for Central Venous Cannulation

Author: D. Mamo, Massimo Zambon, Giacomo Monti, Simona Silvetti, Rosalba Lembo, Paolo Beccaria, Alberto Zangrillo, Giovanni Landoni, Beccaria, Paolo Federico, Silvetti, Simona, Lembo, Rosalba, Landoni, Giovanni, Monti, Giacomo, Zambon, Massimo, Mamo, Daniela, and Zangrillo, Alberto
Subjects: Univariate analysis, medicine.medical_specialty, business.industry, Retrospective cohort study, Odds ratio, Confidence interval, Surgery, 03 medical and health sciences, Catheter, 0302 clinical medicine, Anesthesiology and Pain Medicine, 030202 anesthesiology, medicine, 030212 general & internal medicine, Complication, business, Internal jugular vein, Brachiocephalic vein
Abstract: Background Although many studies have compared success and complication rates for central line insertion sites with and without ultrasound, few have examined the use of the brachiocephalic vein for central venous access. The aim of this study was to describe the brachiocephalic vein as an alternative site for elective ultrasound vascular cannulation in adults, and to compare it with the more commonly used internal jugular vein site in terms of procedural difficulties, first pass failure rate, overall failure rate, and safety. Methods In this single-center, retrospective cohort study, clinical data from consecutive adult patients undergoing elective ultrasound-guided central venous catheterization of upper body were retrieved from the department database. All of these central venous catheters were requested by department team, none was positioned for surgery. Seven hundred nine patients underwent central venous catheterization via the internal jugular approach and 285 patients via the brachiocephalic route. Patients catheterized via the brachiocephalic vein approach were then compared with those catheterized via the internal jugular vein in terms of ease of catheterization, success rate, and complications. Differences between approaches were assessed by univariate analyses and multivariable analysis. Results Overall, 994 patients underwent central venous catheterization. A total of 87% had a successful catheter implantation at the first attempt, 6.7% of insertions were difficult, 5.7% were complicated, and 3.4% failed. Procedural difficulty was more frequent with the internal jugular than with the brachiocephalic approach (odds ratio, 0.38; 95% confidence interval, 0.19-0.76; P = .007) after correction for potential confounders. Differences between groups in complication rate (6.3% vs 4.1%) or failure rate (3.4% vs 3.5%) were not significant. Conclusions Brachiocephalic cannulation is a reasonable alternative to ultrasound-guided internal jugular vein catheterization.
Published: 2018
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19. Levosimendan for Hemodynamic Support after Cardiac Surgery

Author: Federico Pappalardo, Tatiana S. Zabelina, Vladimir A. Boboshko, Antonio Pisano, Fabio Guarracino, Vladimir V. Lomivorotov, Alessandro Belletti, Pietro Bertini, Vadim Pasyuga, Marcello Fonseca Salgado-Filho, Rosetta Lobreglio, Rosalba Lembo, Maria G Michienzi, Tiziana Bove, Anna Mara Scandroglio, Gabriele Alvaro, Massimo Baiocchi, Marat N Abubakirov, Bruno Amantea, Giovanni Landoni, Maria Grazia Calabrò, Luca Brazzi, Rinaldo Bellomo, Dmitriy L Shukevich, Evgeny Grigoryev, Alberto Zangrillo, Luigi Verniero, Valery Likhvantsev, Alessandro Bianchi, Fabrizio Monaco, Landoni, Giovanni, Lomivorotov, Vladimir V., Alvaro, Gabriele, Lobreglio, Rosetta, Pisano, Antonio, Guarracino, Fabio, Calabrò, Maria G., Grigoryev, Evgeny V., Likhvantsev, Valery V., Salgado Filho, Marcello F., Bianchi, Alessandro, Pasyuga, Vadim V., Baiocchi, Massimo, Pappalardo, Federico, Monaco, Fabrizio, Boboshko, Vladimir A., Abubakirov, Marat N., Amantea, Bruno, Lembo, Rosalba, Brazzi, Luca, Verniero, Luigi, Bertini, Pietro, Scandroglio, Anna M., Bove, Tiziana, Belletti, Alessandro, Michienzi, Maria G., Shukevich, Dmitriy L., Zabelina, Tatiana S., Bellomo, Rinaldo, and Zangrillo, Alberto
Subjects: Male, Cardiac output, Cardiac Output, Low, Hemodynamics, 030204 cardiovascular system & hematology, law.invention, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, law, Cardiac Surgical Procedure, Infusions, Intravenou, Treatment Failure, Cardiac Output, Respiration, Medicine (all), General Medicine, Middle Aged, Hydrazone, Intensive care unit, Aged, Cardiotonic Agents, Double-Blind Method, Female, Humans, Hydrazones, Infusions, Intravenous, Length of Stay, Perioperative Period, Pyridazines, Respiration, Artificial, Stroke Volume, Cardiac Surgical Procedures, Mortality, Low, Cardiac surgery, Artificial, Cardiology, Intravenous, Pyridazine, Human, medicine.drug, Infusions, medicine.medical_specialty, Placebo, 03 medical and health sciences, Internal medicine, medicine, Cardiotonic Agent, Hemodynamic, business.industry, 030208 emergency & critical care medicine, Perioperative, Levosimendan, Postoperative Complication, business
Abstract: BACKGROUND Acute left ventricular dysfunction is a major complication of cardiac surgery and is associated with increased mortality. Meta-analyses of small trials suggest that levosimendan may result in a higher rate of survival among patients undergoing cardiac surgery. METHODS We conducted a multicenter, randomized, double-blind, placebo-controlled trial involving patients in whom perioperative hemodynamic support was indicated after cardiac surgery, according to prespecified criteria. Patients were randomly assigned to receive levosimendan (in a continuous infusion at a dose of 0.025 to 0.2 μg per kilogram of body weight per minute) or placebo, for up to 48 hours or until discharge from the intensive care unit (ICU), in addition to standard care. The primary outcome was 30-day mortality. RESULTS The trial was stopped for futility after 506 patients were enrolled. A total of 248 patients were assigned to receive levosimendan and 258 to receive placebo. There was no significant difference in 30-day mortality between the levosimendan group and the placebo group (32 patients [12.9%] and 33 patients [12.8%], respectively; absolute risk difference, 0.1 percentage points; 95% confidence interval [CI], -5.7 to 5.9; P = 0.97). There were no significant differences between the levosimendan group and the placebo group in the durations of mechanical ventilation (median, 19 hours and 21 hours, respectively; median difference, -2 hours; 95% CI, -5 to 1; P = 0.48), ICU stay (median, 72 hours and 84 hours, respectively; median difference, -12 hours; 95% CI, -21 to 2; P = 0.09), and hospital stay (median, 14 days and 14 days, respectively; median difference, 0 days; 95% CI, -1 to 2; P = 0.39). There was no significant difference between the levosimendan group and the placebo group in rates of hypotension or cardiac arrhythmias. CONCLUSIONS In patients who required perioperative hemodynamic support after cardiac surgery, low-dose levosimendan in addition to standard care did not result in lower 30-day mortality than placebo. (Funded by the Italian Ministry of Health; CHEETAH ClinicalTrials.gov number, NCT00994825.).
Published: 2017
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20. Decreased in-hospital mortality in patients with COVID-19 pneumonia

Author: Riccardo Puglisi, Rosalba Lembo, Giovanni Landoni, Annalisa Ruggeri, Alberto Zangrillo, Fabio Ciceri, Ciceri, Fabio, Ruggeri, Annalisa, Lembo, Rosalba, Puglisi, Riccardo, Landoni, Giovanni, and Zangrillo, Alberto
Subjects: 0301 basic medicine, ARDS, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Pneumonia, Viral, 030106 microbiology, 030231 tropical medicine, Acute respiratory distress, Microbiology, Asymptomatic, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, Air Pollution, Internal medicine, medicine, Humans, In patient, Hospital Mortality, Pandemics, In hospital mortality, SARS-CoV-2, business.industry, Mortality rate, Public Health, Environmental and Occupational Health, COVID-19, General Medicine, medicine.disease, mortality, Pneumonia, Infectious Diseases, age, Parasitology, medicine.symptom, Coronavirus Infections, business
Abstract: Clinical manifestations of COVID-19 may range from asymptomatic to severe interstitial pneumonia with acute respiratory distress syndrome (ARDS) and death. COVID-19 mortality rates vary greatly [1]...
Published: 2020

21. A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Increasing Mortality

Author: Francesco Corradi, Massimiliano Conte, L A Hajjar, Mario Musu, Simona Silvetti, Alberto Zangrillo, Daniela Pasero, Salvatore Sardo, Gordana Gazivoda, Luca Severi, Rosetta Lobreglio, Paolo Mura, Chiara Sartini, G Mancino, Marina Pieri, Nikola Bradic, Andrey Yavorovskiy, Chew Yin Wang, Claudia Brusasco, Alessandro Belletti, CY Yong, Juan Carlos Lopez-Delgado, Agostino Roasio, Claudio Riefolo, Maxim Novikov, Emanuela Saporito, Simona Tamà, M Baiardo Redaelli, Gabriele Alvaro, Laura Ruggeri, Savino Spadaro, Rosalba Lembo, D Di Fraja, Chengbin Wang, Luca Cabrini, Fabrizio Monaco, Hynek Riha, Carmine D. Votta, Giovanni Landoni, Vladimir N. Lomivorotov, Laura Pasin, Evgeniy V. Fominskiy, Valery Likhvantsev, Rinaldo Bellomo, Alessandro Ortalda, D Avancini, Gianluca Paternoster, Antonio Pisano, A D'Amico, Sartini, Chiara, Lomivorotov, Vladimir, Pisano, Antonio, Riha, Hynek, Baiardo Redaelli, Martina, Lopez-Delgado, Juan Carlo, Pieri, Marina, Hajjar, Ludhmila, Fominskiy, Evgeny, Likhvantsev, Valery, Cabrini, Luca, Bradic, Nikola, Avancini, Daniele, Wang, Chew Yin, Lembo, Rosalba, Novikov, Maxim, Paternoster, Gianluca, Gazivoda, Gordana, Alvaro, Gabriele, Roasio, Agostino, Wang, Chengbin, Severi, Luca, Pasin, Laura, Mura, Paolo, Musu, Mario, Silvetti, Simona, Votta, Carmine Domenico, Belletti, Alessandro, Corradi, Francesco, Brusasco, Claudia, Tamà, Simona, Ruggeri, Laura, Yong, Chow-Yen, Pasero, Daniela, Mancino, Giuseppe, Spadaro, Savino, Conte, Massimiliano, Lobreglio, Rosetta, Di Fraja, Diana, Saporito, Emanuela, D'Amico, Alessandro, Sardo, Salvatore, Ortalda, Alessandro, Yavorovskiy, Andrey, Riefolo, Claudio, Monaco, Fabrizio, Bellomo, Rinaldo, Zangrillo, Alberto, and Landoni, Giovanni
Subjects: medicine.medical_specialty, Critical Care, consensus conference, critically ill, Critical Illness, Psychological intervention, anesthesia, Perioperative Care, law.invention, NO, Care setting, Randomized controlled trial, law, Physicians, Surveys and Questionnaires, medicine, Humans, perioperative, Cardiac Surgical Procedures, Mortality, Intensive care medicine, Web based survey, democracy-based medicine, Randomized Controlled Trials as Topic, mortality, Internet, anesthesia, consensus conference, critically ill, democracy-based medicine, mortality, perioperative, business.industry, Perioperative, Anesthesiology and Pain Medicine, Cardiology and Cardiovascular Medicine, business
Abstract: Objective: Reducing mortality is a key target in critical care and perioperative medicine. The authors aimed to identify all nonsurgical interventions (drugs, techniques, strategies) shown by randomized trials to increase mortality in these clinical settings. Design: A systematic review of the literature followed by a consensus-based voting process. Setting: A web-based international consensus conference. Participants: Two hundred fifty-one physicians from 46 countries. Interventions: The authors performed a systematic literature search and identified all randomized controlled trials (RCTs) showing a significant increase in unadjusted landmark mortality among surgical or critically ill patients. The authors reviewed such studies during a meeting by a core group of experts. Studies selected after such review advanced to web-based voting by clinicians in relation to agreement, clinical practice, and willingness to include each intervention in international guidelines. Measurements and main results: The authors selected 12 RCTs dealing with 12 interventions increasing mortality: diaspirin-crosslinked hemoglobin (92% of agreement among web voters), overfeeding, nitric oxide synthase inhibitor in septic shock, human growth hormone, thyroxin in acute kidney injury, intravenous salbutamol in acute respiratory distress syndrome, plasma- derived protein C concentrate, aprotinin in high-risk cardiac surgery, cysteine prodrug, hypothermia in meningitis, methylprednisolone in traumatic brain injury, and albumin in traumatic brain injury (72% of agreement). Overall, a high consistency (ranging from 80% to 90%) between agreement and clinical practice was observed. Conclusion: The authors identified 12 clinical interventions showing increased mortality supported by randomized controlled trials with nonconflicting evidence, and wide agreement upon clinicians on a global scale.
Published: 2019

22. A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality

Author: Francesco Corradi, Valery Likhvantsev, Maxim Novikov, Alessandro Belletti, Agostino Roasio, Giovanni Landoni, Massimiliano Conte, Nikola Bradic, Vladimir V. Lomivorotov, Alessandro D'Amico, Juan Carlos Lopez-Delgado, Luca Severi, Mario Musu, Claudio Riefolo, Antonio Pisano, Diana Di Fraja, Gabriele Alvaro, Simona Tamà, Savino Spadaro, Salvatore Sardo, Ludhmila Abrahão Hajjar, Daniele Avancini, Simona Silvetti, Martina Baiardo Redaelli, Gianluca Paternoster, Chengbin Wang, Luca Cabrini, Andrey Yavorovskiy, Chew Yin Wang, Claudia Brusasco, Evgeny Fominskiy, Chow-Yen Yong, Daniela Pasero, Rinaldo Bellomo, Gordana Gazivoda, Hynek Riha, Rosetta Lobreglio, Alessandro Ortalda, Fabrizio Monaco, Carmine D. Votta, Laura Ruggeri, Rosalba Lembo, Laura Pasin, Chiara Sartini, Alberto Zangrillo, Paolo Mura, Emanuela Saporito, Giuseppe Mancino, Marina Pieri, Sartini, Chiara, Lomivorotov, Vladimir, Pieri, Marina, Delgado, Juan Carlos Lopez, Baiardo Redaelli, Martina, Hajjar, Ludhmila, Pisano, Antonio, Likhvantsev, Valery, Fominskiy, Evgeny, Bradic, Nikola, Cabrini, Luca, Novikov, Maxim, Avancini, Daniele, Riha, Hynek, Lembo, Rosalba, Gazivoda, Gordana, Paternoster, Gianluca, Wang, Chengbin, Tamà, Simona, Alvaro, Gabriele, Wang, Chew Yin, Roasio, Agostino, Ruggeri, Laura, Yong, Chow-Yen, Pasero, Daniela, Severi, Luca, Pasin, Laura, Mancino, Giuseppe, Mura, Paolo, Musu, Mario, Spadaro, Savino, Conte, Massimiliano, Lobreglio, Rosetta, Silvetti, Simona, Votta, Carmine Domenico, Belletti, Alessandro, Di Fraja, Diana, Corradi, Francesco, Brusasco, Claudia, Saporito, Emanuela, D'Amico, Alessandro, Sardo, Salvatore, Ortalda, Alessandro, Riefolo, Claudio, Fabrizio, Monaco, Zangrillo, Alberto, Bellomo, Rinaldo, and Landoni, Giovanni
Subjects: medicine.medical_specialty, Critical Care, consensus conference, Critical Illness, critically ill, Psychological intervention, Specialty, 030204 cardiovascular system & hematology, anesthesia, survival, law.invention, NO, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, law, Physicians, Surveys and Questionnaires, Intensive care, Anesthesiology, Humans, Medicine, perioperative, Intensive care medicine, Randomized Controlled Trials as Topic, democracy-based medicine, intensive care, Internet, anesthesia, consensus conference, critically ill, democracy-based medicine, intensive care, mortality, perioperative, survival, business.industry, mortality, Perioperative, Intensive care unit, Clinical trial, Intensive Care Units, Anesthesiology and Pain Medicine, Cardiology and Cardiovascular Medicine, business
Abstract: The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians' opinions and routine practices to understand the clinicians' response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement ≥67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to "do you agree" and "do you use") showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location.
Published: 2019

23. Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery

Author: Alberto Zangrillo, Caetano Nigro Neto, Evgeny Grigoryev, Chew Yin Wang, Nikolay S Uvaliev, Maria Grazia Calabrò, Valery Likhvantsev, Andrey Lozovskiy, Mohammed A Hegazy, Marina Pieri, Dmitry Tarasov, Nikola Bradic, Miomir Jovic, Renato Tambellini Arnoni, A Mara Scandroglio, Massimo Baiocchi, Fabrizio Monaco, Ludhmila Abrahão Hajjar, Giovanni Landoni, Mohamed R. El-Tahan, Vladimir N. Lomivorotov, Abeer M Elnakera, Vadim Pasyuga, Andrey E Bautin, Nora Di Tomasso, Dmitry Ponomarev, Alessandro Belletti, Felice Eugenio Agrò, Paolo Navalesi, Hynek Riha, Ma Jun, Luca Severi, Rosalba Lembo, Vladimir Shmyrev, Gordana Gazivoda, Martina Crivellari, Tiziana Bove, Giuseppe Crescenzi, Cristiana Carollo, Chong Lei, Jan Kunstýř, Fernanda Santos Silva, Luca Brazzi, Rinaldo Bellomo, Nazar Bukamal, Ahmed A. Farag, Landoni, Giovanni, Lomivorotov, Vladimir V, Nigro Neto, Caetano, Monaco, Fabrizio, Pasyuga, Vadim V, Bradic, Nikola, Lembo, Rosalba, Gazivoda, Gordana, Likhvantsev, Valery V, Lei, Chong, Lozovskiy, Andrey, Di Tomasso, Nora, Bukamal, Nazar A R, Silva, Fernanda S, Bautin, Andrey E, Ma, Jun, Crivellari, Martina, Farag, Ahmed M G A, Uvaliev, Nikolay S, Carollo, Cristiana, Pieri, Marina, Kunstýř, Jan, Wang, Chew Yin, Belletti, Alessandro, Hajjar, Ludhmila A, Grigoryev, Evgeny V, Agrò, Felice E, Riha, Hynek, El-Tahan, Mohamed R, Scandroglio, A Mara, Elnakera, Abeer M, Baiocchi, Massimo, Navalesi, Paolo, Shmyrev, Vladimir A, Severi, Luca, Hegazy, Mohammed A, Crescenzi, Giuseppe, Ponomarev, Dmitry N, Brazzi, Luca, Arnoni, Renato, Tarasov, Dmitry G, Jovic, Miomir, Calabrò, Maria G, Bove, Tiziana, Bellomo, Rinaldo, and Zangrillo, Alberto
Subjects: medicine.medical_specialty, Inhalation, business.industry, Medicine (all), medicine.medical_treatment, Percutaneous coronary intervention, General Medicine, Stroke volume, 030204 cardiovascular system & hematology, Revascularization, medicine.disease, Volatile, intravenous, cardiac surgery, Sevoflurane, Cardiac surgery, Coronary artery disease, 03 medical and health sciences, surgical procedures, operative, 0302 clinical medicine, Anesthesia, Anesthetic, medicine, 030212 general & internal medicine, business, medicine.drug
Abstract: Background: Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG). Methods: We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year. Results: A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group ; relative risk, 0.94 ; 95% confidence interval [CI], 0.69 to 1.29 ; P = 0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively ; relative risk, 1.11 ; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction. Conclusions: Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia.
Published: 2019

24. Coagulation Derangements in Patients With Refractory Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

Author: Laura Ruggeri, Rosalba Lembo, Anna Mara Scandroglio, Alberto Zangrillo, Federico Pappalardo, Annalisa Franco, Ada Carla Alba, Samuele Frassoni, Maria Grazia Calabrò, Ruggeri, L, Franco, A, Alba, A, Lembo, R, Frassoni, S, Scandroglio, A, Calabro, M, Zangrillo, A, Pappalardo, F, Ruggeri, Laura, Franco, Annalisa, Alba, Ada Carla, Lembo, Rosalba, Frassoni, Samuele, Scandroglio, Anna Mara, Calabrò, Maria Grazia, Zangrillo, Alberto, and Pappalardo, Federico
Subjects: extracorporeal cardiopulmonary resuscitation, Adult, refractory cardiac arrest, medicine.medical_treatment, Population, cardiac arrest, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, Extracorporeal membrane oxygenation, Medicine, Humans, Extracorporeal cardiopulmonary resuscitation, coagulation, education, Blood Coagulation, disseminated intravascular coagulation, Aged, Retrospective Studies, Disseminated intravascular coagulation, Prothrombin time, education.field_of_study, medicine.diagnostic_test, business.industry, 030208 emergency & critical care medicine, extracorporeal membrane oxygenation, Disseminated Intravascular Coagulation, Middle Aged, medicine.disease, Thrombosis, Cardiopulmonary Resuscitation, Heart Arrest, Anesthesiology and Pain Medicine, Logistic Models, Hemostasis, Anesthesia, Cardiology and Cardiovascular Medicine, business, Partial thromboplastin time
Abstract: Objective Extracorporeal cardiopulmonary resuscitation (eCPR) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is gaining importance as a rescue therapy for refractory cardiac arrest. VA-ECMO, especially in the setting of eCPR, is plagued by hemorrhagic and thromboembolic complications. The authors’ aims were to describe the coagulation profile in refractory cardiac arrest and assess its prognostic role. Design Single-center retrospective study. Setting Cardiac surgical intensive care unit of a university hospital. Participants One hundred eighty-eight patients treated with eCPR for intra-hospital and out-of-hospital refractory cardiac arrest, between 2008 and 2017. Interventions The authors retrospectively analyzed data from the first blood sample drawn during cannulation for VA-ECMO to understand the association of coagulation parameters with survival to hospital discharge, number of blood components transfused, anticoagulation therapy, serum lactate levels, no-flow time, and low-flow time. Measurements and Main Results Platelet count was 126 ± 79 × 109/L and in 17% of the population it was lower than 50 × 109/L, prothrombin time was 3.22 ± 4.01, activated partial thromboplastin time was 117 ± 78 seconds, fibrinogen was 186 ± 148 mg/dL, antithrombin was 47 ± 16%, and D-dimer was ≥2-fold the normal upper limit in 95% of patients. Fifty percent of patients had a disseminated intravascular coagulation (DIC) score ≥6 (52% among out-of-hospital cardiac arrest, 33% among in-hospital cardiac arrest), according to the criteria of the Japanese Society on Thrombosis and Hemostasis (2016). The median DIC score was 5.5 points (interquartile range 4-8), significantly different between survivors and nonsurvivors (4 [3-6] v 6 [4-8], p = 0.007). Every DIC score point contributed to the mortality risk (OR 1.34, 95% CI 1.09-1.67, p = 0.006). Patients with overt DIC less frequently received anticoagulants (28.6% v 55.9%, p = 0.002), started anticoagulant therapy later (12 [10-23] v 8.5 [5-12] hours, p = 0.045), and received a larger quantity of blood products (11 [4-23] v 3 [0-8.5] units, p Conclusion Coagulation derangements are frequent in patients with refractory cardiac arrest and have important consequences for eCPR management for anticoagulant therapy and blood product transfusion. The presence of DIC diagnostic criteria should be considered among the prognostic factors in this population of patients.
Published: 2018

25. The role of different mechanical circulatory support devices and their timing of implantation on myocardial damage and mid-term recovery in acute myocardial infarction related cardiogenic shock

Author: Tania Sorrentino, Giulio Melisurgo, Federico Pappalardo, Rosalba Lembo, Michele Oppizzi, Antonio Colombo, Marina Pieri, Alberto Zangrillo, Pieri, Marina, Sorrentino, Tania, Oppizzi, Michele, Melisurgo, Giulio, Lembo, Rosalba, Colombo, Antonio, Zangrillo, Alberto, and Pappalardo, Federico
Subjects: Male, Radiology, Nuclear Medicine and Imaging, medicine.medical_specialty, Cardiotonic Agents, Myocardial Infarction, Shock, Cardiogenic, heart failure, 030204 cardiovascular system & hematology, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Postoperative Complications, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Myocardial infarction, Hospital Mortality, IABP, Impella, Aged, Retrospective Studies, mechanical circulatory support, Ejection fraction, Intra-Aortic Balloon Pumping, acute myocardial infarction/STEMI, biology, business.industry, impella, Cardiogenic shock, Middle Aged, medicine.disease, Troponin, Survival Rate, Treatment Outcome, Heart failure, Conventional PCI, biology.protein, Cardiology, Female, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business
Abstract: Objectives: Aim of the study was to assess in-hospital survival rate and the degree of myocardial recovery after MCS treatment (IABP or IMPELLA) at discharge and at 6 months in patients with AMI-CS and planned early percutaneous revascularization. Background: All studies on MCS for acute myocardial infarction related cardiogenic shock (AMI-CS) focused on its impact on in-hospital mortality; however, few data about its role on myocardial recovery are available. Methods: Retrospective study on 64 patients: 36 patients (56%) received IABP and 28 (44%) Impella 2.5/CP. Results: Patients treated with Impella were sicker compared to those treated with IABP as shown by a higher need of catecholamines (93% Impella vs 57% IABP, P = 0.002) and higher inotropic score before procedure: 8 (5-15) versus 4.5 (0-9), P = 0.02. In-hospital survival and MCS-related complications were comparable; hemolysis was more frequent in the Impella group (32% vs 0%, P < 0.0001). Myocardial damage was lower in those patients who were implanted with IMPELLA before PCI: lower troponin peak [3831 ng/dL (1441-8436) vs 16 581 (7802-23 675), P = 0.004] and lower CPK peak [893 UI/L (584-4082) vs 5797 (2483-9292) P = 0.04]. Impella patients had higher LVEF at 6 months [45 (38-52) vs 40 (33-45)%, P = 0.04]. LVEF increase at 6 months was statistically significant in both groups (P < 0.0001), with higher myocardial recovery in patients supported with Impella (absolute delta-LVEF increase 20% vs 10% P = 0.005). Conclusions: Cardiac unloading with IMPELLA in ACS-CS, especially if implanted before PCI, might provide lower myocardial damage and improved myocardial recovery which translates into significantly higher LVEF at 6 months.
Published: 2018

26. Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac Surgery: An Updated Consensus Process

Author: Miriam Labonia, Rosalba Lembo, Cristiano Amarelli, Giuseppe Bono, Remo Daniel Covello, Nora Di Tomasso, Daniela Pasero, Hynek Riha, Anna Mara Scandroglio, Claudio Riefolo, Nesrin Ahu Aslan, Carlo Leggieri, Rosetta Lobreglio, Giovanni Landoni, Valery V. Likhvantsev, Vladimir V. Lomivorotov, Gabriele Alvaro, Ludmilla Abrahao Hajjar, Alberto Zangrillo, Chiara Sartini, Martina Baiardo Redaelli, Massimo Baiocchi, Fabrizio Monaco, Giacomo Monti, Carmine D. Votta, Valentina Camarda, Paolo Mura, Evgeny Fominskiy, Alessandro Putzu, Emanuela Saporito, Antonio Pisano, Gianluca Paternoster, Rinaldo Bellomo, Simona Silvetti, Luca Brazzi, Giovanni Affronti, Stefano Turi, Agostino Roasio, Andrea Székely, Jun Ma, Caetano Nigro Neto, Landoni, Giovanni, Lomivorotov, Vladimir, Silvietti, Simona, Nigro Neto, Caetano, Pisano, Antonio, Alvaro, Gabriele, Hajjar, Ludmilla Abrahao, Paternoster, Gianluca, Riha, Hynek, Monaco, Fabrizio, Szekely, Andrea, Lembo, Rosalba, Aslan, Nesrin A., Affronti, Giovanni, Likhvantsev, Valery, Amarelli, Cristiano, Fominskiy, Evgeny, Baiardo Redaelli, Martina, Putzu, Alessandro, Baiocchi, Massimo, Ma, Jun, Bono, Giuseppe, Camarda, Valentina, Covello, Remo Daniel, Di Tomasso, Nora, Labonia, Miriam, Leggieri, Carlo, Lobreglio, Rosetta, Monti, Giacomo, Mura, Paolo, Scandroglio, Anna Mara, Pasero, Daniela, Turi, Stefano, Roasio, Agostino, Votta, Carmine D., Saporito, Emanuela, Riefolo, Claudio, Sartini, Chiara, Brazzi, Luca, Bellomo, Rinaldo, and Zangrillo, Alberto
Subjects: medicine.medical_specialty, Consensus, Cardiac Surgery, Consensus Development Conferences as Topic, Psychological intervention, MEDLINE, Consensu, Review, 030204 cardiovascular system & hematology, Perioperative Care, law.invention, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Anesthesiology, Intensive care, medicine, Humans, 030212 general & internal medicine, Perioperative, Cardiac Surgical Procedures, Mortality, Intensive care medicine, cardiac surgery, consensus, mortality, mortality reduction, perioperative, review, Cardiology and Cardiovascular Medicine, Anesthesiology and Pain Medicine, Randomized Controlled Trials as Topic, Internet, business.industry, Congresses as Topic, Cardiac surgery, Mortality reduction, Bypass surgery, TERAPÊUTICA MÉDICA, business, Mortality Reduction
Abstract: Objective: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. Design: A systematic review of the literature followed by a consensus-based voting process. Setting: A web-based international consensus conference. Participants: More than 400 physicians from 52 countries participated in this web-based consensus conference. Interventions: The authors identified all studies published in peer-reviewed journals that reported on interventions with a statistically significant effect on mortality in the setting of cardiac surgery through a systematic Medline/PubMed search and contacts with experts. These studies were discussed during a consensus meeting and those considered eligible for inclusion in this study were voted on by clinicians worldwide. Measurements and Main Results: Eleven interventions finally were selected: 10 were shown to reduce mortality (aspirin, glycemic control, high-volume surgeons, prophylactic intra-aortic balloon pump, levosimendan, leuko-depleted red blood cells transfusion, noninvasive ventilation, tranexamic acid, vacuum-assisted closure, and volatile agents), whereas 1 (aprotinin) increased mortality. A significant difference in the percentages of agreement among different countries and a variable gap between agreement and clinical practice were found for most of the interventions. Conclusions: This updated consensus process identified 11 nonsurgical interventions with possible survival implications for patients undergoing cardiac surgery. This list of interventions may help cardiac anesthesiologists and intensivists worldwide in their daily clinical practice and can contribute to direct future research in the field. Orion Pharma ; Abbott Laboratories ; Pall ; Tenax
Published: 2018

27. Effect of Levosimendan on Renal Outcome in Cardiac Surgery Patients With Chronic Kidney Disease and Perioperative Cardiovascular Dysfunction: A Substudy of a Multicenter Randomized Trial

Author: Rosalba Lembo, Evgeny Grigoryev, Anna Mara Scandroglio, Vladimir A. Boboshko, Gabriele Alvaro, Marco Comis, Fabrizio Monaco, Antonio Pisano, Fabio Guarracino, Alessandro Belletti, Alberto Zangrillo, Gianluca Paternoster, Valery V. Likhvantsev, Vladimir V. Lomivorotov, Maria Grazia Calabrò, Vadim Pasyuga, Paolo Navalesi, Luca Brazzi, Samuele Frassoni, Tiziana Bove, Zangrillo, A, Alvaro, G, Belletti, A, Pisano, A, Brazzi, L, Calabro, M, Guarracino, F, Bove, T, Grigoryev, E, Monaco, F, Boboshko, V, Likhvantsev, V, Scandroglio, A, Paternoster, G, Lembo, R, Frassoni, S, Comis, M, Pasyuga, V, Navalesi, P, Lomivorotov, V, Zangrillo, Alberto, Alvaro, Gabriele, Belletti, Alessandro, Pisano, Antonio, Brazzi, Luca, Calabrò, Maria G., Guarracino, Fabio, Bove, Tiziana, Grigoryev, Evgeny V., Monaco, Fabrizio, Boboshko, Vladimir A., Likhvantsev, Valery V., Scandroglio, Anna M., Paternoster, Gianluca, Lembo, Rosalba, Frassoni, Samuele, Comis, Marco, Pasyuga, Vadim V., Navalesi, Paolo, and Lomivorotov, Vladimir V.
Subjects: Male, Heart Valve Diseases, inotropes, 030204 cardiovascular system & hematology, Russia, Postoperative Complications, 0302 clinical medicine, Cardiac Surgical Procedure, low cardiac output syndrome, education.field_of_study, Incidence, Acute kidney injury, Middle Aged, hemodynamic support, Cardiac surgery, Heart Valve Disease, Treatment Outcome, Italy, acute kidney injury, Anesthesia, Mitral Valve, inotrope, Female, Cardiology and Cardiovascular Medicine, Brazil, cardiac surgery, Glomerular Filtration Rate, Human, medicine.drug, medicine.medical_specialty, Cardiotonic Agents, Population, Placebo, 03 medical and health sciences, levosimendan, Double-Blind Method, Intensive care, medicine, Humans, Cardiotonic Agent, Cardiac Surgical Procedures, Renal Insufficiency, Chronic, Perioperative Period, education, Simendan, Aged, Dose-Response Relationship, Drug, business.industry, 030208 emergency & critical care medicine, Levosimendan, Perioperative, medicine.disease, chronic kidney disease, mitral valve surgery, Anesthesiology and Pain Medicine, Postoperative Complication, business, Kidney disease
Abstract: Objective: Acute kidney injury (AKI) occurs frequently after cardiac surgery. Levosimendan might reduce the incidence of AKI in patients undergoing cardiac surgery. The authors investigated whether levosimendan administration could reduce AKI incidence in a high-risk cardiac surgical population. Design: Post hoc analysis of a multicenter randomized trial. Setting: Cardiac surgery operating rooms and intensive care units of 14 centers in 3 countries. Participants: The study comprised 90 patients who underwent mitral valve surgery with an estimated glomerular filtration rate
Published: 2018

28. Steroids and Survival in Critically Ill Adult Patients: A Meta-analysis of 135 Randomized Trials

Author: L A Hajjar, Vito Giordano, Martina Baiardo Redaelli, Alberto Zangrillo, Dario Winterton, Laura Ruggeri, Rosalba Lembo, Giovanni Landoni, Enrico Antonio Martino, Salvatore Sardo, Martino, Enrico A., Baiardo Redaelli, Martina, Sardo, Salvatore, Lembo, Rosalba, Giordano, Vito F., Winterton, Dario, Ruggeri, Laura, Hajjar, Ludhmilla A., Zangrillo, Alberto, and Landoni, Giovanni
Subjects: Adult, medicine.medical_specialty, corticosteroid, medicine.drug_class, critically ill, Critical Illness, Population, Psychological intervention, 030204 cardiovascular system & hematology, Placebo, meta-analysi, law.invention, surgery, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, 030212 general & internal medicine, education, Glucocorticoids, Randomized Controlled Trials as Topic, education.field_of_study, business.industry, Critically ill, steroid, Perioperative, mortality, Anesthesiology and Pain Medicine, Meta-analysis, Corticosteroid, business, Cardiology and Cardiovascular Medicine, SOBREVIDA
Abstract: Objective: Corticosteroids have important effects on intermediate outcomes in critically ill patients, but their effect on survival is unknown. The objective of this meta-analysis was to analyze the effect on mortality of corticosteroids in critical and perioperative settings. Design: A meta-analysis of randomized trials. Setting: PubMed, Embase, BioMed Central, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched to February 1, 2018, for randomized trials comparing corticosteroids with placebo or standard care. Participants: Critically ill or surgical adult patients. Interventions: Corticosteroids compared with placebo or standard care. Measurements and Main Results: A total of 44,553 patients from 135 studies were included. Overall, mortality in the corticosteroid group and in the control group were similar (16% v 16%; p = 0.9). Subanalyses identified a beneficial effect of corticosteroids on survival in patients with respiratory system diseases (9% v 13%; p < 0.001) and bacterial meningitis (28% v 32%; p= 0.04), and a detrimental effect on survival in patients with traumatic brain injury (22% v 19%; p < 0.001). No differences in mortality were found in patients with cardiac diseases (7% v 6%; p = 0.7), in patients undergoing cardiac surgery (2.8% v 3.2% p = 0.14), and when treatment duration or patient age were considered. Conclusions: This meta-analysis documents the safety of corticosteroids in the overall critically ill population with the notable exception of brain injury patients, a setting where the authors confirmed their detrimental effect on survival. A possible beneficial effect of corticosteroids on survival was found among patients with respiratory diseases and in patients with bacterial meningitis.
Published: 2017

29. MortalitY in caRdIAc surgery (MYRIAD):A randomizeD controlled trial of volatile anesthetics. Rationale and design

Author: Fernanda Santos Silva, Vladimir V. Lomivorotov, Samuele Frassoni, Abeer M Elnakera, Bukamal Nazar, Massimo Baiocchi, Dario Winterton, Felice Eugenio Agrò, Chong Lei, Jan Kunstyr, Luca Severi, Mohamed R. El-Tahan, Colin Royse, Evgeny Fominskiy, Rinaldo Bellomo, Vadim Pasyuga, Weiqing Huang, Jingui Yu, Antonio Pisano, Andrey Lozovskiy, Fabio Guarracino, Cristiana Carollo, Giuseppe Crescenzi, Marco Gemma, Jun Ma, Sidik Hanafi, Laura Ruggeri, Hynek Riha, Caetano Nigro Neto, Rosalba Lembo, Zhi jian Li, Gordana Gazivoda, Andrei Bautin, Filomena Regina Barbosa Gomes Galas, Chow Yen Yong, Ahmed G. Farag, Stefano Gianni, Nikola Bradic, Umberto Benedetto, Alberto Zangrillo, Paolo Navalesi, Cheng Bin Wang, Giovanni Landoni, Nikolay S Uvaliev, Gudrun Kunst, Vladimir Shmyrev, Valery Likhvantsev, Giuseppe Biondi Zoccai, Chew Yin Wang, Evgeny Grigoryev, Fabrizio Monaco, Elena Porteri, Landoni, Giovanni, Lomivorotov, Vladimir, Pisano, Antonio, Nigro Neto, Caetano, Benedetto, Umberto, Biondi Zoccai, Giuseppe, Gemma, Marco, Frassoni, Samuele, Agrò, Felice Eugenio, Baiocchi, Massimo, Barbosa Gomes Galas, Filomena R., Bautin, Andrei, Bradic, Nikola, Carollo, Cristiana, Crescenzi, Giuseppe, Elnakera, Abeer M., El Tahan, Mohamed R., Fominskiy, Evgeny, Farag, Ahmed G., Gazivoda, Gordana, Gianni, Stefano, Grigoryev, Evgeny, Guarracino, Fabio, Hanafi, Sidik, Huang, Weiqing, Kunst, Gudrun, Kunstyr, Jan, Lei, Chong, Lembo, Rosalba, Li, Zhi jian, Likhvantsev, Valery, Lozovskiy, Andrey, Ma, Jun, Monaco, Fabrizio, Navalesi, Paolo, Nazar, Bukamal, Pasyuga, Vadim, Porteri, Elena, Royse, Colin, Ruggeri, Laura, Riha, Hynek, Santos Silva, Fernanda, Severi, Luca, Shmyrev, Vladimir, Uvaliev, Nikolay, Wang, Cheng Bin, Wang, Chew Yin, Winterton, Dario, Yong, Chow Yen, Yu, Jingui, Bellomo, Rinaldo, Zangrillo, Alberto, Landoni, G, Lomivorotov, V, Pisano, A, Nigro Neto, C, Benedetto, U, Biondi Zoccai, G, Gemma, M, Frassoni, S, Agro, F, Baiocchi, M, Barbosa Gomes Galas, F, Bautin, A, Bradic, N, Carollo, C, Crescenzi, G, Elnakera, A, El-Tahan, M, Fominskiy, E, Farag, A, Gazivoda, G, Gianni, S, Grigoryev, E, Guarracino, F, Hanafi, S, Huang, W, Kunst, G, Kunstyr, J, Lei, C, Lembo, R, Li, Z, Likhvantsev, V, Lozovskiy, A, Ma, J, Monaco, F, Navalesi, P, Nazar, B, Pasyuga, V, Porteri, E, Royse, C, Ruggeri, L, Riha, H, Santos Silva, F, Severi, L, Shmyrev, V, Uvaliev, N, Wang, C, Winterton, D, Yong, C, Yu, J, Bellomo, R, and Zangrillo, A
Subjects: Adult, Male, Total intravenous anesthesia, Coronary Artery Disease, 030204 cardiovascular system & hematology, law.invention, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Intensive care, medicine, Clinical endpoint, Anesthesia, Cardiac Procedures, Humans, Pharmacology (medical), 030212 general & internal medicine, Myocardial infarction, Coronary Artery Bypass, Cardiac anesthesia, Cardiac surgery, Randomized trial, Volatile anesthetics, business.industry, Coronary Artery Bypa, Medicine (all), General Medicine, medicine.disease, Intensive care unit, Survival Analysis, Volatile anesthetic, Outcome and Process Assessment, Health Care, Intravenous anesthesia, Anesthesia, Anesthetic, Anesthetics, Inhalation, Female, Survival Analysi, Volatilization, business, Anesthesia, Cardiac Procedure, Human, medicine.drug
Abstract: Objective There is initial evidence that the use of volatile anesthetics can reduce the postoperative release of cardiac troponin I, the need for inotropic support, and the number of patients requiring prolonged hospitalization following coronary artery bypass graft (CABG) surgery. Nevertheless, small randomized controlled trials have failed to demonstrate a survival advantage. Thus, whether volatile anesthetics improve the postoperative outcome of cardiac surgical patients remains uncertain. An adequately powered randomized controlled trial appears desirable. Design Single blinded, international, multicenter randomized controlled trial with 1:1 allocation ratio. Setting Tertiary and University hospitals. Interventions Patients (n = 10,600) undergoing coronary artery bypass graft will be randomized to receive either volatile anesthetic as part of the anesthetic plan, or total intravenous anesthesia. Measurements and main results The primary end point of the study will be one-year mortality (any cause). Secondary endpoints will be 30-day mortality; 30-day death or non-fatal myocardial infarction (composite endpoint); cardiac mortality at 30 day and at one year; incidence of hospital re-admission during the one year follow-up period and duration of intensive care unit, and hospital stay. The sample size is based on the hypothesis that volatile anesthetics will reduce 1-year unadjusted mortality from 3% to 2%, using a two-sided alpha error of 0.05, and a power of 0.9. Conclusions The trial will determine whether the simple intervention of adding a volatile anesthetic, an intervention that can be implemented by all anesthesiologists, can improve one-year survival in patients undergoing coronary artery bypass graft surgery.
Published: 2017
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30. Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Author: Giovanni Landoni, Rosalba Lembo, Elena Bignami, Marina Pieri, Francesco De Simone, Marcello Guarnieri, Luigi Cassarà, Alberto Zangrillo, Alcira Rodriguez, Bignami, Elena, Guarnieri, Marcello, Pieri, Marina, De Simone, Francesco, Rodriguez, Alcira, Cassarà, Luigi, Lembo, Rosalba, Landoni, Giovanni, and Zangrillo, Alberto
Subjects: Male, medicine.medical_specialty, Cardiac troponin, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, law, Internal medicine, Cardiopulmonary bypass, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Retrospective Studies, Advanced and Specialized Nursing, Cardiopulmonary Bypass, biology, troponin, business.industry, Troponin I, anaesthesia, General Medicine, Surgical procedures, Middle Aged, cardiopulmonary bypa, Troponin, Cardiac surgery, Anesthesia, volatile anaesthetics, Anesthetics, Inhalation, Cardiology, biology.protein, Female, Myocardial necrosis, Cardiology and Cardiovascular Medicine, business, Safety Research, cardiac surgery, Anesthetics, Intravenous
Abstract: Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.
Published: 2017

31. The authors reply

Author: Luca Cabrini, Rosalba Lembo, Giacomo Monti, Alberto Zangrillo, Cabrini, Luca, Lembo, Rosalba, Monti, Giacomo, and Zangrillo, Alberto
Subjects: Survival Rate, Respiratory Distress Syndrome, Noninvasive Ventilation, Humans, Respiratory Insufficiency, Critical Care and Intensive Care Medicine
Published: 2017

32. Do patients undergoing MitraClip implantation require routine ICU admission?

Author: Francesco Maisano, Cosmo Godino, Daniel Remo Covello, Chiara Gerli, Annalisa Franco, Ambra Licia Di Prima, Maurizio Taramasso, Rosalba Lembo, Paolo Denti, Federico Pappalardo, Di Prima, Ambra L., Covello, Daniel R., Franco, Annalisa, Gerli, Chiara, Lembo, Rosalba, Denti, Paolo, Godino, Cosmo, Taramasso, Maurizio, Maisano, Francesco, Pappalardo, Federico, and University of Zurich
Subjects: Male, medicine.medical_specialty, Critical Care, medicine.medical_treatment, Population, Intensive Care Unit, Shock, Cardiogenic, 610 Medicine & health, Ventricular tachycardia, 2705 Cardiology and Cardiovascular Medicine, law.invention, Postoperative Complications, law, Retrospective Studie, Intensive care, medicine, MitraClip, Humans, postoperative complication, education, Aged, Retrospective Studies, Mechanical ventilation, Heart Valve Prosthesis Implantation, education.field_of_study, business.industry, Cardiogenic shock, Medicine (all), Mitral Valve Insufficiency, Retrospective cohort study, medicine.disease, Intensive care unit, Surgery, 10020 Clinic for Cardiac Surgery, Intensive Care Units, ICU management, Anesthesiology and Pain Medicine, Treatment Outcome, Italy, Female, 2703 Anesthesiology and Pain Medicine, mitral regurgitation, business, Cardiology and Cardiovascular Medicine, Human
Abstract: Objectives Because of its reduced invasiveness, MitraClip (Abbott Vascular, Menlo Park, CA) therapy usually is reserved for patients with extreme left ventricular dysfunction or severe comorbidity contraindicating surgery. The appropriate post-procedural care in this high-risk population is yet to be defined. In this study, the postoperative course of such patients is reported, focusing on early complications and need for intensive care unit (ICU) management. Design, Setting, and Participants A retrospective analysis of patients with severe mitral regurgitation undergoing transcatheter mitral valve repair with the MitraClip system in the authors institution was performed. Interventions One hundred thirty patients underwent MitraClip implantation between 2008 and 2012. At the end of the procedure, all patients were admitted to the ICU. Measurements and Main Results Median ICU stay was 0.98 (0.82-1.87) days. Median mechanical ventilation time was 9.5 (6.8-14.1) hours. One hundred one patients (78%) required inotropic support and 13 patients (10%) suffered cardiogenic shock and required intra-aortic balloon pump support. No patient died during the procedure, but 3 patients died in the ICU. Three postoperative course profiles were identified: Fast-track, overnight stay, and critical illness. Twenty-four patients (18.5%) had an uneventful postoperative course, 89 patients (68.5%) suffered minor complications, and 17 patients (13.1%) required intensive care management and organ support. Preoperative serum creatinine (odds ratio [OR] 1.8; p = 0.014), cardiogenic shock (OR 34,8; p = 0.002), ventricular tachycardia (OR 2.8; p = 0.03), and intra procedural inotropes (OR 4; p = 0.001) were correlated with a complicated postoperative course. Conclusions A large number of patients undergoing MitraClip could be managed with a fast-track ICU course; however, it still is difficult to predict the postoperative course based on preoperative characteristics.
Published: 2014

33. Noninvasive ventilation practice in cardiac surgery patients: insights from a European survey

Author: Luca Cabrini, Rosalba Lembo, Giovanni Landoni, Marta Mucchetti, Speranza Bocchino, Badassare Ferro, Fabio Guarracino, Nicolino Ambrosino, Alberto Zangrillo, Guarracino, Fabio, Cabrini, Luca, Ferro, Badassare, Landoni, Giovanni, Lembo, Rosalba, Mucchetti, Marta, Bocchino, Speranza, Zangrillo, Alberto, and Ambrosino, Nicolino
Subjects: medicine.medical_specialty, Noninvasive Ventilation, business.industry, Data Collection, MEDLINE, Cardiac surgery, Europe, Anesthesiology and Pain Medicine, Physicians, Medicine, Humans, Noninvasive ventilation, Blood Gas Analysis, Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine, business, Intensive care medicine
Published: 2013

34. Mortality after surgery in Europe: a 7 day cohort study

Author: Pearse, R, Moreno, R, Bauer, P, Pelosi, P, Metnitz, P, Spies, C, Vallet, B, Vincent, J, Hoeft, A, Rhodes, A, Fagnoul, D, van Obbergh, L, Al Subaie, N, Arif, F, Cashman, J, Cecconi, M, Edsell, M, Fossati, N, Hammond, S, Hamilton, M, Lonsdale, D, Moran, C, Siegmueller, C, Velzeboer, F, Wong, P, Awlakpui, E, Scheidemann, M, Wittmann, M, Damster, S, Golder, K, Hewson, R, Januszewska, M, Leva, B, Ramos, V, Hoste, E, Huyghens, L, Jacobs, R, Van Mossevelde, V, Opdenacker, G, Poelaert, J, Spapen, H, Leleu, K, Rijckaert, D, De Decker, K, Foubert, L, De Neve, N, Biston, P, Piagnerelli, M, Collin, V, den Blauwen, N, Clauwaert, C, De Crop, L, Verbeke, A, Derumeaux, P, Gardin, C, Kindt, S, Louage, S, Verhamme, B, Druwé, P, Lahaye, I, Rosseel, F, Rutsaert, R, Vanlinthout, L, De Kock, M, Forget, P, Georges, P, Grosu, I, Kahn, D, Lois, F, Momeni, M, Pospiech, A, Yemnga, B, Jadoul, J, Malbrain, M, Bosinceanu, D, Collard, E, Jorens, P, Reyntiens, D, Smitz, C, Vercauteren, M, Goranović, T, Mazul Sunko, B, Toplice, K, Oremuš, K, Bešlić, G, Duzel, V, Hauptman, A, Peremin, S, Šribar, A, Župčić, M, Brod, S, Mirković, I, Šarić Bauer, Z, Belavić, M, Blažanin, B, Katušin, M, Brozović Krijan, A, Mišković, P, Šimić Korać, N, Topić, J, Žilić, A, Žuni, J, Acan, I, Adanić, M, Ivanov, N, Pavičić Šarić, J, Tomulić, K, Visković, N, Bošnjak, S, Haršanji Drenjančevic, I, Kristek, G, Kvolik, S, Markić, S, Stojanovic Rakipovic, A, Katarina Tot, O, Venzera Azenic, D, Kalagac Fabris, L, Bačak Kocman, I, Balenović, I, Bandić, D, Judith Deutsch, P, Divjak, L, Filipović, I, Gužvinec, Z, Krznarić, Z, Lončarić, Y, Magaš, J, Mitrović, M, Okić, M, Pavlek, M, Ramov, E, Rezek, K, Sekulić, A, Tomasevic, B, Mirić, M, Tomašević, A, Tomić Mahečić, T, Vrbanović, V, Bobinac, M, Božić, A, Debelic, D, Frkovic, V, Batinica, I, Baranović, S, Gavranović, Ž, Kikec, M, Maldini, B, Marić, S, Agnić, I, Delić, N, Dropulić, N, Kljaković Gašpić, T, Ilić, D, Ivančev, B, Karanović, N, Kuščević, D, Marović, Z, Milić, M, Nevešćanin, A, Petković, T, Smoje, M, Brozović, G, Jelisavac, M, Matolić, M, Oberhofer, D, Marija Pavičić, A, Šakić, K, Delija Bozovic, M, Kotorac Krecek, Z, Krobot, R, Andabaka, T, Bratanić, M, Dzepina, O, Kraljev, M, Šeric, J, Šimurina, T, Grujić, R, Nacevski Bulaja, B, Barižon, M, Danira, V, Dražen, B, Dušanka, K, Bašić Halužan, M, Joško, Ž, Katica, R, Labor, M, Grgurević Marinković, T, Mihovilčević, D, Marija, B, Srečko, M, Vranković, S, Kyprianou, T, Neophytou, K, Cerny, V, Cvachovec, K, Belikova, B, Drab, M, Hudacek, K, Krikava, I, Stourac, P, Zadrazilova, K, Bicek, V, Brabcová, M, Klozová, R, Vajter, J, Vymazal, T, Toft, P, Blichfeldt, L, Dilling Hansen, B, Moller, K, Sylvest Nielsen, J, Frederiksen, J, Dohn Andersen, J, Peter Kühne, J, Leivdal, S, Stendell, L, Simonsen, M, Konrad Zoltowski, M, Salman Ali, Z, Freundlich, M, Pilypaite, J, Groes Clausen, N, Thorup, L, Hansen, F, Bestle, M, Steen Hansen, C, Afshari, A, Bastholm Bille, A, Lefort, M, Secher, E, Liboriussen, L, Herodes, V, Härma, E, Marvet, K, Pool, K, Kallas, P, Mägi, T, Sütt, J, Vijar, K, Visk, E, Vinnal, M, Ellermaa, J, Liibusk, L, Tikkerberi, A, Falk, I, Mällo, E, Talving, J, Pettilä, V, Hovilehto, S, Kirsi, A, Mustola, S, Tiainen, P, Toivonen, J, Dabnell, S, Kaminski, T, Sysimetsa, A, Kaukonen, M, Silvasti, P, Vainio, K, Lund, V, Sjövall, S, Saarinen, K, Viitanen, M, Ahonen, T, Alaspää, A, Zittling, R, Saarinen, A, Moisander, A, Wagner, B, Laru Sompa, R, Elomaa, E, Lavonen, L, Nevantaus, J, Geier, K, Kavasmaa, T, Koorits, U, Kubjas, M, Lauritsalo, S, Ottelin, L, Palve, M, Pynnönen, J, Rääbis, I, Saarelainen, M, Heikkilä, T, Kontula, T, Lehtimäki, M, Liimatainen, J, Moilanen Oikarinen, M, Pakarinen, M, Palanne, R, Seppänen, H, Pulkkinen, A, Vääräniemi, H, Koskenkari, J, Sälkiö, S, Vakkala, M, Koskue, T, Loisa, P, Laitio, R, Hautamäki, R, Koivisto, S, Futier, E, Lefrant, J, Leon, A, Bonnet, F, Marret, E, Spielvogel, C, Papageorgiou, C, Szymkiewicz, O, Tounou Akue, F, Aubrun, F, Bonnet, A, Gazon, M, Guiraud, M, Laurent, V, Tachon, G, Demars, N, Dumenil, A, Mercier, F, Landais, A, Mentec, H, Bazin, M, Gonnu, S, Petit, A, Albaladejo, P, Almeras, L, Bataillard, A, Rossi Blancher, M, Yves Lefrant, J, Barthel, F, Hallel, D, Sbai, H, Khalifeh, P, Lidzborski, L, Jully, M, Platon, E, Pottecher, J, Baumgarten, R, Schultz, C, Elmiloudi, F, Lefebvre, J, Waton, K, Sprunck, A, Steib, A, Thibaud, A, Thuet, V, Kieffer, V, Dubois Vallaud, D, Jacob, L, Becanne, X, Cherfaoui, S, Gauzit, R, Godier, A, Lakhdari, M, Samma, C, Bigeon, J, Burtin, P, Halchini, C, Lacroix, M, Pinna, F, Barbes, A, Just, B, Mateu, P, Benayoun, L, Berger, P, Granier, N, Francois Perrigault, P, Libert, N, De Rudnicki, S, Merat, S, Bourdet, B, Ferré, F, Minville, V, Piriou, V, Rague, P, Wallet, F, Lebuffe, G, Desbordes, J, Robin, E, Ichai, C, Orban, J, Marx, G, Sander, M, Gottschalk, A, Piontek, A, Unterberg, M, Hilpert, J, Kees, M, Triltsch, A, Wiegand Löhnert, C, Glöckner, C, Hohn, A, Rose, E, Schröder, S, Wiese, O, Ramminger, A, Dresden, C, de Abreu, M, Heller, A, Marx, C, Neidel, J, Goldmann, A, von Heymann, C, Laetsch, B, Maahs, E, Scholz, L, Frenzel, D, Massarat, K, Lenhart, F, Reichle, F, Rudlof, K, Borchers, F, Buettner, C, Schmutzler, M, Burgard, G, Lucht, A, Wagner, J, Pilge, S, Schneider, G, Untergehrer, G, Bis, B, Krassler, J, Dittmann, J, Haberkorn, J, Eberitsch, J, Eberitsch, K, Nippraschk, T, Wepler, U, Engelen, W, Nau, C, Scholler, A, Schüttler, J, Wintzheimer, S, Bloos, F, Braune, A, Fergen, D, Ludewig, K, Paxian, M, Reinhart, K, Graf, N, Schwarzkopf, K, Berger, K, Habicher, M, Kasperiunaite, R, Savelsberg, S, Krep, H, Reindl, M, Weber, M, Bauer, W, Bingold, F, Christ, S, Friederich, P, Kaviani, R, Auer, P, Bonnländer, G, Drescher, J, Braun, R, Eichenauer, T, Kerner, J, Bierbaum, K, Brünner, H, Grond, S, Perez Platz, U, Andresen, B, Linstedt, U, Stegmann, N, Erkens, U, Kopcke, J, Meyer, A, Brestrich, H, Ernst, S, Merkel, S, Krieger, L, Luers, F, Weyland, A, Noeldge Schomburg, G, Menckie, T, Wasmund, C, Bredtmann, R, Erler, I, Raufhake, C, Haumann, C, Möllemann, A, Oehmichen, U, Sergejewa, O, Lehning, B, Czeslick, E, Geyer, M, Malcharek, M, Sablotzki, A, Stier, M, Feld, F, Rossaint, R, Simon, V, Armaganidis, A, Koulenti, D, Kotanidou, A, Nanas, S, Papastylianou, A, Psevdi, A, Stathopoulos, A, Voulas, A, Kanna, E, Koutsikou, A, Moustaka, A, Chovas, A, Komnos, A, Zafiridis, T, Franses, J, Lavrentieva, A, Koraki, E, Katsenos, C, Flora Kasianidou, M, Nasopoulou, P, Spyropoulou, E, Gousia, C, Katsanoulas, C, Lathyris, D, Kyriazopoulos, G, Sfyras, D, Tsirogianni, A, Kostopanagiotou, G, Lignos, M, Matsota, P, Christopoulos, C, Mouratidou, A, Vrettou, E, Boufidis, S, Moka, E, Arnaoutoglou, E, Koulouras, V, Nakos, G, Papathanakos, G, Anthopoulos, G, Choutas, G, Karapanos, D, Tzani, V, Gkiokas, G, Nastos, K, Nikolakopoulos, F, Dragoumanis, C, Nikitidis, N, Pneumatikos, I, Theodorou, V, Zacharouli, D, Kandi, S, Tasopoulos, K, Arvaniti, K, Matamis, D, Mplougoura, E, 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Crooks, N, Gao Smith, F, Melody, T, Snaith, C, Patel, J, Parekh, D, Yeung, J, Loughnan, B, Moosajee, V, Rope, T, Edger, L, Dawson, J, Hadfield, D, Hopkins, P, Mcdonald, L, Willars, C, Campbell, G, Craig, J, Ladipo, K, Lockwood, G, Moreno, J, Ballington, R, Hamandishe, S, Rogerson, D, Cowman, S, Hayden, P, Pinto, N, Sandhar, T, Arawwawala, D, Brotherston, L, Mitchell Inwang, C, Walsh, H, Alagarsamy, F, Goon, S, Karcheva, S, Krepska, A, Mckinney, B, Patil, V, Batchelor, N, Day, C, Finch, L, Gibson, C, Grayling, M, Hubble, S, Key, W, Knight, T, Loosley, A, Margetts, P, Stewart, H, Bewley, J, Hurley, K, Murphy, R, Philpott, C, Pollock, K, Sweet, K, Thomas, M, Tucker, K, Windsor, D, Conway, D, Gold, S, Quraishi, T, Cupitt, J, Baddeley, S, Brown, J, Foo, I, Mantle, D, Carvalho, P, Huddart, S, Kirk Bayley, J, Smith, R, Milligan, L, Poulose, S, Sarkar, S, Nolan, J, Pedley, E, Padkin, A, Pesian, S, Rajamanickam, S, Ramkumar, K, Crayford, A, Turner, A, Bottrill, F, Webb, S, Jhanji, S, Maccallum, N, Wessels, K, Wigmore, T, Meikle, A, Wilson, S, White, S, Bonnett, A, Rushton, A, Williams, C, Zuzan, O, Hall, A, Montgomery, J, Piggot, A, Read, R, Stocker, M, Tamm, T, Agarwal, B, Ward, S, Brown, L, Joy, M, Venkatesh, S, Hughes, T, Zsisku, L, Roy, A, Hooper, V, Mouland, J, Nightingale, J, Rose, S, Chiam, P, Chohan, H, Dickson, C, Gibb, S, Higham, C, Harvey, C, Janarthanan, C, Jones, L, Kapoor, A, Moll, M, Roberts, L, Saunders, D, Arnold, G, Gibbs, C, Jhurgursing, M, Pierro, D, Pritchard, F, Doyle, P, Templeton, M, Wilson, R, Zantua, K, Collyer, T, Featherstone, J, Worton, R, Bruce, J, Mcguigan, K, Price, G, Moreton, S, Pulletz, M, Anderson, H, Baxter, I, Beckingsale, A, Callaghan, M, Datta, A, Gollogly, J, Izod, C, Lobaz, S, Macfie, C, Patel, M, Payne, H, Singh, R, Timms, G, Mcleod, S, O'Brian, P, Horner, E, Joshi, V, Stuart Smith, K, Seale, T, Bolger, C, Collins, H, Ekins, E, Hawkins, L, Jonas, M, Linford, K, Wadams, B, Beach, M, Vizcaychipi, M, Jewsbury, W, Davies, S, Balaji, P, Kangaraj, M, Pissay, N, Smith, N, Gopalakrishnan, S, Mackinnon, J, Strandvik, G, Francis, R, Jennings, A, Keating, M, Kumar, S, Leese, S, Magee, C, Pilsbury, J, Ralph, J, Riddington, D, Sachdeva, R, Snelson, C, Vasanth, S, Wilde, J, Lavender, B, Lyons, R, Watters, M, Adams, T, Dyer, S, Tindall, L, Claxton, A, Netke, M, Akouds, E, Bates, D, Gallagher, H, Hatton, J, Holroyd, W, Mitra, A, Nurse, T, Reed, D, Desikan, S, Barber, R, Childs, S, O'Carroll Kuehn, B, Wyldbore, M, Al Abdaly, A, Amatya, S, Bhaskaran, S, Chandan, G, Chaudhry, S, Chikungwa, M, Earnshaw, G, Grewal, M, Haque, S, Hawkins, J, Javaid, A, Jackson, C, Kamel, M, Marla, R, Mculloch, D, Parker, T, Salib, Y, Saravanmuthu, R, Secker, C, Sockalingam, S, Taylor, A, Austine, P, Kanade, V, Paal, D, Sam Mok, M, Burtenshaw, A, Davis, L, Ellahee, P, Freeman, D, Pierson, R, Wollaston, J, Karmarkar, A, Ball, C, Calton, E, Maxwell, L, Walker, R, Bland, M, Bullock, L, Harrison Briggs, D, Hodge, P, Krige, A, Dempsey, G, Hammell, C, Loveridge, R, Parker, R, Snell, J, Wright, C, Baker, A, Barr, K, Belcher, A, Bonnington, S, Bougeard, A, Fitzgerald, E, Ford, R, Gillard, C, Griffiths, L, Greenberg, L, Huber, J, Mathieu, S, Richardson, N, Tompsett, L, White, N, Patel, S, Corner, V, Thomas, R, Trodd, D, Wilson, J, Copley, E, Flutter, L, Hulme, J, Susarla, J, Thwaites, A, Jayasundera, S, Mcafee, S, Chantler, J, Mckechnie, S, Neely, J, Mouton, R, Scarth, E, Soar, J, Buss, J, Currie, V, Sange, M, Kuttler, A, Power, F, Alexander, D, Dunne, K, Shinner, G, Black, E, Haldane, G, Kerr, J, Saran, T, Ward, G, Jefferies, F, Alexander, P, Royle, A, Nahla, F, Bowles, T, Gregory, M, Ahern, R, Cartlidge, D, Craker, L, Thompson, C, Bidd, H, Giles, J, Manser, A, Parry, G, Chan, P, Das, D, Fahmy, N, Higgins, D, Khader, A, Stone, A, Leonardi, S, Rose, O, Bright, E, Ercole, A, Amir Rafi, M, Ramasamy, R, Sheshgiri, B, Merrill, C, Page, V, Walker, E, Harris, S, Hughes, S, Morrison, A, Razouk, K, Ayman, M, Jakeman, A, Mowatt, C, Paananen, S, Translational Physiology, Other departments, ACS - Amsterdam Cardiovascular Sciences, AII - Amsterdam institute for Infection and Immunity, Anesthesiology, APH - Amsterdam Public Health, Pearse Rupert, Moreno Rui P., Bauer Peter, Pelosi Paolo, Metnitz Philipp, Spies Claudia, Vallet Benoit, Vincent Jean-Loui, Hoeft Andrea, Rhodes Andrew, Fagnoul David, van Obbergh Luc, Al-Subaie Nawaf, Arif Fuhazia, Cashman Jeremy, Cecconi Maurizio, Edsell Mark, Fossati Nicoletta, Hammond Sarah Jane, Hamilton Mark, Lonsdale Dagan, Moran Carl, Siegmueller Claa, Velzeboer Freya, Wong Patrick, Awlakpui Eli, Scheidemann Mona, Wittmann Maria, Damster Sandrine, Golder Kim, Hewson Russell, Januszewska Marta, Leva Brigitte, Ramos Vasco, Hoste Eric, Huyghens Luc, Jacobs Rita, Van Mossevelde Veerle, Opdenacker Godelieve, Poelaert Jan, Spapen Herbert, Leleu Kri, Rijckaert Dirk, De Decker Koen, Foubert Luc, De Neve Nikolaa, Biston Patrick, Piagnerelli Michael, Collin Vincent, den Blauwen Nadia, Clauwaert Charlotte, De Crop Luc, Verbeke An, Derumeaux Pieter, Gardin Christophe, Kindt Sebastiaan, Louage Sofie, Verhamme Bruno, Druwé Patrick, Lahaye Ingrid, Rosseel Franci, Rutsaert Robert, Vanlinthout Luc, De Kock Marc, Forget Patrice, Georges Pascal, Grosu Irina, Kahn David, Lois Fernande, Momeni Mona, Pospiech Audrey, Yemnga Bernadette, Jadoul Jean-Luc, Malbrain Manu, Bosinceanu Dana, Collard Edith, Jorens Philippe, Reyntiens Dirk, Smitz Carine, Vercauteren Marcel, Goranović Tatjana, Mazul-Sunko Branka, Toplice Krapinske, Oremuš Krešimir, Bešlić Gabrijela, Duzel Viktor, Hauptman Ada, Peremin Sanja, Šribar Andrej, Župčić Miroslav, Brod Slavonski, Mirković Ivan, Šarić Bauer Zlata, Belavić Matija, Blažanin Božidar, Katušin Mirjana Lončarić, Brozović Krijan Antonija, Mišković Petar, Šimić-Korać Nataša, Topić Jasna, Žilić Antonio, Žuni Josip, Acan Ivana, Adanić Mirta, Ivanov Nikola, Pavičić Šarić Jadranka, Tomulić Katarina, Visković Nataša, Bošnjak Silvana, Haršanji Drenjančevic Ivana, Kristek Gordana, Kvolik Slavica, Markić Stela, Stojanovic Rakipovic Andreja, Katarina Tot Ozana, Venzera-Azenic Darija, Kalagac Fabris Lada, Bačak-Kocman Iva, Balenović Igor, Bandić Daniela, Judith Deutsch Patricia Adrianne, Divjak Loredana, Filipović Ina Grčić, Gužvinec Zvonka, Krznarić Zrinka, Lončarić Yvonne, Magaš Jelena Vadlja, Mitrović Marek, Okić Marija, Pavlek Mario, Ramov Elza, Rezek Karolina, Sekulić Ante, Tomasevic Bori, Mirić Mirjana, Tomašević Anita, Tomić Mahečić Tina, Vrbanović Vilena, Bobinac Mirna, Božić Alfred, Debelic Danijela, Frkovic Vedran, Batinica Inga Mladić, Baranović Senka, Gavranović Željka, Kikec Mirna, Maldini Branka, Marić Stela, Agnić Ivan, Delić Nikola, Dropulić Nataša, Kljaković Gašpić Toni, Ilić Darko, Ivančev Božena, Karanović Nenad, Kuščević Dorjan, Marović Zlatko, Milić Matija, Nevešćanin Ana, Petković Tatjana, Smoje Mario, Brozović Gordana, Jelisavac Milana, Matolić Martina, Oberhofer Dagmar, Marija Pavičić Ana, Šakić Kata, Delija Bozovic Margarita, Kotorac Krecek Zvjezdana, Krobot Renata, Andabaka Tatjana, Bratanić Mislav, Dzepina Orjana, Kraljev Martina, Šeric Julija, Šimurina Tatjana, Grujić Rosa, Nacevski-Bulaja Biljana, Barižon Mirna, Danira Vrančić, Dražen Bulaja, Dušanka Kimer, Bašić Halužan Marijana, Joško Žaja, Katica Roca, Labor Magda, Grgurević Marinković Tea, Mihovilčević Danči, Marija Bego, Srečko Marinković, Vranković Srdan, Kyprianou Theodoro, Neophytou Kyriako, Cerny Vladimir, Cvachovec Karel, Belikova Barbora, Drab Michal, Hudacek Kamil, Krikava Ivo, Stourac Petr, Zadrazilova Katarina, Bicek Vladimír, Brabcová Milena, Klozová Radka, Vajter Jaromír, Vymazal Tomáš, Toft Palle, Blichfeldt Louise, Dilling Hansen Bo, Moller Kirsten, Sylvest Nielsen Jeppe, Frederiksen Joachim, Dohn Andersen Johnny, Peter Kühne Jan, Leivdal Siv, Stendell Line, Simonsen Martin, Konrad Zoltowski Marcin, Salman Ali Zahida, Freundlich Morten, Pilypaite Jurgita, Groes Clausen Nicola, Thorup Line, Hansen Frank, Bestle Morten, Steen Hansen Christian, Afshari Arash, Bastholm Bille Ander, Lefort Michele, Secher Erik L., Liboriussen Lisbeth, Herodes Veiko, Härma Eve, Marvet Kadri, Pool Kristiina, Kallas Pille, Mägi Triinu-Kreete, Sütt Jaan, Vijar Kerli, Visk Evelin, Vinnal Mare, Ellermaa Jaanu, Liibusk Liia, Tikkerberi Artur, Falk Ilme, Mällo Esta, Talving Jaak, Pettilä Ville, Hovilehto Seppo, Kirsi Anne, Mustola Seppo, Tiainen Pekka, Toivonen Juhani, Dabnell Sandra, Kaminski Tadeusz, Sysimetsa Anu, Kaukonen Maija, Silvasti Päivi, Vainio Kaisa, Lund Vesa, Sjövall Sari, Saarinen Kari, Viitanen Matti, Ahonen Tommi, Alaspää Ari, Zittling Ritva, Saarinen Aarne, Moisander Annette, Wagner Bodo, Laru-Sompa Raili, Elomaa Esa, Lavonen Leena, Nevantaus Juha, Geier Klau, Kavasmaa Tomi, Koorits Ursula, Kubjas Mare, Lauritsalo Seppo, Ottelin Lauri, Palve Markki, Pynnönen Jari, Rääbis Inga, Saarelainen Minna, Heikkilä Tapani, Kontula Timo, Lehtimäki Markku, Liimatainen Jari, Moilanen-Oikarinen Mari, Pakarinen Marika, Palanne Riku, Seppänen Hanna, Pulkkinen Anni, Vääräniemi Heikki, Koskenkari Juha, Sälkiö Sinikka, Vakkala Merja, Koskue Talvikki, Loisa Pekka, Laitio Ruut, Hautamäki Raku, Koivisto Simo-Pekka, Futier Emmanuel, Lefrant Jean-Yve, Leon Alain, Bonnet Franci, Marret Emmanuel, Spielvogel Catherine, Papageorgiou Chryssa, Szymkiewicz Olga, Tounou-Akue Felix, Aubrun Frederic, Bonnet Aurélie, Gazon Mathieu, Guiraud Michel, Laurent Virginie, Tachon Guillaume, Demars Nadège, Dumenil Anne-Sylvie, Mercier Frederic, Landais Alain, Mentec Herve, Bazin Marie, Gonnu Sophie, Petit Antoine, Albaladejo Pierre, Almeras Luc, Bataillard Amélie, Rossi-Blancher Marine, Yves Lefrant Jean, Barthel Florian, Hallel Dan, Sbai Hicham, Khalifeh Pamela, Lidzborski Lionel, Jully Marion, Platon Ecaterina, Pottecher Julien, Baumgarten Romain, Schultz Christel, Elmiloudi Fayçal, Lefebvre Julie, Waton Karen, Sprunck Adrien, Steib Annick, Thibaud Adrien, Thuet Vincent, Kieffer Vianney, Dubois-Vallaud Delphine, Jacob Laurent, Becanne Xavier, Cherfaoui Salim, Gauzit Remy, Godier Anne, Lakhdari Mourad, Samma Charle, Bigeon Jean-Yve, Burtin Philippe, Halchini Constantin, Lacroix Magali, Pinna Frederic, Barbes Aurélie, Just Bernard, Mateu Philippe, Benayoun Laurent, Berger Philippe, Granier Nathalie, Francois Perrigault Pierre, Libert Nicola, De Rudnicki Stephan, Merat Stéphane, Bourdet Benoit, Ferré Fabrice, Minville Vincent, Piriou Vincent, Rague Philippe, Wallet Florent, Lebuffe Gille, Desbordes Jacque, Robin Emmanuel, Ichai Carole, Orban Jean-Christophe, Marx Gernot, Sander Michael, Gottschalk André, Piontek André, Unterberg Matthia, Hilpert Justu, Kees Martin, Triltsch Andrea, Wiegand-Löhnert Carola, Glöckner Christiane, Hohn Andrea, Rose Elmar, Schröder Stefan, Wiese Oliver, Ramminger Axel, Dresden Caru, de Abreu Marcelo Gama, Heller Axel, Marx Christine, Neidel Julia, Goldmann Anton, von Heymann Christian, Laetsch Beatrix, Maahs Esther, Scholz Lar, Frenzel Dirk, Massarat Kyro, Lenhart Franz-Peter, Reichle Florian, Rudlof Kristina, Borchers Friedrich, Buettner Christoph, Schmutzler Martin, Burgard Gerald, Lucht Alexander, Wagner Jan, Pilge Stefanie, Schneider Gerhard, Untergehrer Gisela, Bis Beata, Krassler Jen, Dittmann Jan, Haberkorn Jörg, Eberitsch Jürgen, Eberitsch Karola, Nippraschk Thoma, Wepler Ulrich, Engelen Wolf-Christian, Nau Carla, Scholler Axel, Schüttler Jürgen, Wintzheimer Simone, Bloos Frank, Braune Anke, Fergen Daniela, Ludewig Katrin, Paxian Marku, Reinhart Konrad, Graf Nikolau, Schwarzkopf Konrad, Berger Katharina, Habicher Marit, Kasperiunaite Ruta, Savelsberg Sabine, Krep Henning, Reindl Michael, Weber Matthia, Bauer Wolfgang, Bingold Florian, Christ Saskia, Friederich Patrick, Kaviani Reza, Auer Patrick, Bonnländer Georg, Drescher Jürgen, Braun Roland, Eichenauer Tim, Kerner John, Bierbaum Kathrin, Brünner Horst, Grond Stefan, Perez-Platz Ursula, Andresen Bent, Linstedt Ulf, Stegmann Nil, Erkens Uwe, Kopcke Jen, Meyer Andrea, Brestrich Hartmut, Ernst Sandra, Merkel Stella, Krieger Lena, Luers Frank, Weyland Andrea, Noeldge-Schomburg Gabriele, Menckie Thoma, Wasmund Christina, Bredtmann Ralph-Dieter, Erler Ine, Raufhake Carsten, Haumann Christine, Möllemann Angela, Oehmichen Uwe, Sergejewa Olga, Lehning Brigitte, Czeslick Elke, Geyer Michaela, Malcharek Michael, Sablotzki Armin, Stier Marina, Feld Florian, Rossaint Rolf, Simon Verena, Armaganidis Apostolo, Koulenti Despoina, Kotanidou Anastasia, Nanas Serafim, Papastylianou Androula, Psevdi Aikaterini, Stathopoulos Anastasio, Voulas Asklepieion, Kanna Efthymia, Koutsikou Anastasia, Moustaka Alexandra, Chovas Achillea, Komnos Apostolo, Zafiridis Tilemacho, Franses Josef, Lavrentieva Athena, Koraki Eleni, Katsenos Chrysostomo, Flora Kasianidou Maria, Nasopoulou Pantelia, Spyropoulou Eleni, Gousia Chrysoula, Katsanoulas Constantine, Lathyris Dimitrio, Kyriazopoulos George, Sfyras Dimitrio, Tsirogianni Athanasia, Kostopanagiotou Georgia, Lignos Mihail, Matsota Paraskevi, Christopoulos Christo, Mouratidou Alexandra, Vrettou Efstratia, Boufidis Spyro, Moka Eleni, Arnaoutoglou Eleni, Koulouras Vasileio, Nakos George, Papathanakos Georgio, Anthopoulos Georgio, Choutas Georgio, Karapanos Dimitrio, Tzani Vaso, Gkiokas Georgio, Nastos Konstantino, Nikolakopoulos Fotio, Dragoumanis Christo, Nikitidis Niko, Pneumatikos Ioanni, Theodorou Vassiliki, Zacharouli Danai, Kandi Stella, Tasopoulos Konstantino, Arvaniti Kostoula, Matamis Dimitrio, Mplougoura Eva, Petropoulou Polixeni, Soumpasis Ioanni, Amaniti Ekaterini, Giannakou-Peftoulidou Maria, Gkeka Eleni, Soultati Ioanna, Kokinou Maria, Papatheodorou Lambrini, Stafylaraki Maria, Giasnetsova Tatiana, Gritsi-Gerogianni Nikoleta, Kydona Christina, Kiskira Olga, Koulentis Ioanni, Apsokardos Alexandro, Dimitropoulos Konstantino, Soldatou Ourania, Nathanail Christodoulo, Papazotos Alexio, Tsakas Pirro, Clouva-Molyvdas Phyllis-Maria, Kolotoura Athina, Sartzi Monika, Papanikolaou Spiro, Polakis Pavlo, Karatzas Styliano, Kyparissi Aikaterini, Papavasilopoulou Theonymfi, Koukoubani Triantafillia, Mastora Evangelia, Spyropoulou-Pagdatoglou Kyriaki, Nyktari Vasileia, Malliotakis Polychroni, Papaioannou Alexandra, Bekos Vasileio, Maragkou Elisavet, Spring Anna, Evagelatos Stavro, Ioakeimidou Aikaterini, Noulas Niko, Molnár Zsolt, Csüllög Emese, Elekes Eniko, Molnár Tamá, Katona Zsuzsana, Kremer Ildiko, Miko Angela, Csomos Ako, Galambos Zsuzsanna, Szucs Ako, Nyikos Gyorgy, Szekeres Gabor, Szabo Ervin, Kranitz Katalin, Simon Melinda, Szigeti Jano, Gaál Emánuel, Havas Attila, Ille Alexandru, Bráz Krisztina, Nagy Geza, Sigurdsson Gisli, Sigurbjörnsson Fridrik T., Sigurdsson Gisli H., Kárason Sigurbergur, Edda Sigurdardottir Elin, Blöndal Ásbjörn, Gunnarsson Björn, Westbrook Andrew, Broderick Alan, Hafeez Parvaiz, Hanumanthaiah Deepak, Brohan Janette, O'Chroinin Donal, Bailey Kevin, Ramamoorthy Karthik, Doyle Yvonne, Freir Noelle, O'Rourke Jame, Jonson Philip, Saeed Sabir, Hayes Ivan, Loughrey John, Frohlich Stephen, Mccauley Nuala, Ryan Donal, Fitzpatrick Gerry, Kevin Leo, Thomas Jubil, Warde Barry, Woolhead Alan, Duggan Michelle, Egan Cara, Crowley Seamu, Lebese Soloman, Bergin Anne, Page Rory, Collins Daniel, Mckenny Michael, Della Rocca Giorgio, Grasso Salvatore, Bresciani Anna, Carmino Livio, Ghelfi Silvia, Lorenzelli Laura, Teresa Novelli Maria, Pescarmona Chiara, Roasio Agostino, Gatta Alessandro, Nastasi Mauro, Sanseverino Manlio, Tinti Carla, Bianchin Andrea, Tormena Maria, Franco Antonio, Marini Federica, Di Mauro Piero, Rapido Francesca, Tommasino Concezione, Bellotti Ferdinando, Boninsegna Daniele, Castellani Gianluca, Sances Daniele, Spano Gianluca, Tredici Stefano, Vezzoli Dario, Fucecchio Igneo, Bacci Alessandro, Coppini Roberta, Dell'Unto Sandro, Mori Emanuele, Rosa Stanzani Maria, Tosi Monica, Collareta Michele, Forfori Francesco, Franchi Matteo, Mancino Giuseppe, Battistella Massimo, Baricocchi Elisa, Bona Francesco, Debernardi Felicino, Giacoletto Gianmarco, Iacobellis Antonio, Massucco Paolo, Moselli Nora, Muratore Andrea, Palomba Graziella, Sardo Elena, De Simone Michele, Suita Luisa, Zocca Edoardo, Bucci Barbara, Della Corte Francesco, Piciucco Tiziana, Viarengo Valeria, Bettelli Gabriella, Cantarini Eugenia, Giampieri Marina, Tanfani Alessandra, Recchia Eugenio, Bignami Elena, Bruno Giovanna, Costagliola Roberto, Gandolfi Azzurra, Greco Massimiliano, Lembo Rosalba, Monti Giacomo, Nicelli Elisa, Pasculli Nicola, Turi Stefano, Baroselli Antonio, Brazzoni Marcella, Buttazzoni Mattia, Buttera Stefania, Centonze Carlo, Serena Giovanni, Spagnesi Lorenzo, Toretti Ilaria, Vilardi Anna, Zearo Ester, Arpino Ine, Baraldi Sara, Guarnerio Chiara, Molene Vincenzo, Concetta Monea Maria, Vaccarisi Enrico, Vicari Luigi, Albante Alida, Aversano Marco, Loiacono Cinzia, Marandola Maurizio, Fusari Maurizio, Petrucci Nicola, Galla Amerigo, Mascia Antonio, Primieri Paolo, Di Noto Anna, Gratarola Angelo, Molin Alessandro, Spagnolo Luigi, Spena Claudio, Calligaro Plinio, Marchiotto Simonetta, Merlini Alberto, Pedrazzoli Eleonora, Perina Giulia, Visentin Renea, Fumagalli Roberto, Garbagnati Andrea, Manetti Bruna, Snaier Chiara, Somaini Marta, Farnia Antonio, Nani Roberto, Pierantonio Novello, De Michele Michele, Gazzanelli Sergio, Pugliese Francesco, Ruberto Franco, Bergamini Elena, Tassinati Tania, Capuzzo Maurizia, Cirillo Vera, Tufano Rosalba, Oggioni Roberto, Parrini Vieri, Brunori Emanuela, Capone Micaela, Carbone Luigi, Corradetti Francesco, Elisei Daniele, Fiorentino Stefano, Francesconi Maurizio, Gattari Diego, Gorgoglione Maria, Lacobone Emanuele, Minnucci Francesco, Montironi Claudio, Riccioni Gianrenato, Tappata Giuseppe, Zompanti Valeria, Verdenelli Paola, Cerutti Elisabetta, Ranieri Vito Marco, Golubovska Iveta, Grigorjevs Sergej, Rikmane Maija, Rozkalne Daina, Stepanovs Jevgenij, Suba Oleg, Kazune Sigita, Miscuk Aleksej, Nemme Jani, Oss Peteri, Sipylaite Jurate, Macas Andriu, Ragaisis Vytauta, Kontrimaviciute Egle, Tomkute Gabija, Boerma Christiaan, Fleur Kramer Irene, Poeze Martijn, Maria John, Pelzer Gerardu, Winsser Lex, Nijsten Maarten, Schoorl Michiel, Spanjersberg Rob, Buhre Wolfgang, Dieleman Stefan, van Klei Wilton, Bouw Martijn, Pickkers Peter, van der Marieke A., Schreiner Frodo, Zandvliet Ria, van den Berg Roy, De Wit Esther, Keijzer Christaan, Hollmann Marku, Preckel Benedikt, van Acker Gij, Dennesen Paul, Veld Ba, Kuijpers-Visser Agne, Inan T., Koopman-van Gemert A., Ponssen Huibert, Brouwer Tammo, Koopmans Matty, van Bommel Jasper, van Duijn Ditty, van der Hoven Ben, Ormskerk Patricia, Beck Oliver, Schiere Sjouke, Reidinga Auke, Venema Allart, Hoogendoorn Marga, Olthof Kee, Flaatten Han, Jammer Ib, Dokka Vegard, Arne Monsen Svein, Marius Ytrebo Lar, Noursadeghi Mostafa, Shahzad Ahmed, Dagfinn Boksasp Ola, Roiss Christoph, Frank Strietzel Han, Gina Anne, Berntsen Schie, Haugland Helge, Ove Vingsnes Svein, Axelsson Patric, Risom Olsen Thoma, Katre Sanjay, Aakeroey Kristin, Mikstacki Adam, Tamowicz Barbara, Boziłow Dominika, Goch Robert, Grabowski Piotr, Kupisiak Jacek, Małłek Małgorzata, Szyca Robert, Kostyrka Włodzimierz, Choma Robert, Jankowski Grzegorz, Kościelniak Władysław, Pietraszek Paweł, Szarowar Bartosz, Matos Ricardo, França Carlo, Pais Lacerda António, Ormonde Lucindo, Rosa Rosário, Pereira Inê, Vitor Paula, Completo Bento Henrique, Raquel Lopes Maria, Carvalho Marque, Faria Manuela, Cláudia de Sousa Ana, de Freitas Pereira, Almeida Eduardo, Mealha Rui, Vicente Rachel, Monte Raquel, Rua Fernando, Barros Nelson, Esteves Francisco, Gouveia Pinheiro Célia Maria, Real Vila, Miguel Oliveira Vítor, Fátima Oliveira Maria, Martins Isabel, Pedro Saraiva José, Pedro Assunção José, Bártolo Anabela, Carvalho Anabela, Correia Carlo, Martins Salomé, Milheiro Ruth, Diaz Alejandro, Imelda Gonçalves Maria, Ribeiro Rosa, Estilita Joana, Glória Carlo, de Almeida José, Barros Filipa, Ramos Armindo, Camara Margarida, Richard Maul Edward, Nobrega Julio, Langner Anuscka, Faria Maia Dionísio, Afonso Ofélia, Faria Filomena, Serra Sofia, Manuela Botelho Maria, Ferreira Pedro, Mourão Luí, Vintém Oliveira Ana, Resende Margarida, Aleman Miguel, Fonseca Jorge, Isidoro Marta, de Meneses Helena, Pêgas António, Pereira José, Pereira Lui, Ramos Bárbara, Matos Francisco, Gonçalves Castro Maria de Lurde, Martins Ana, Ramos Cristina, de Sousa Manuel, Bento Luí, Botas Conceição, Lopes Vitor, Mendes Rosa, Grigoras Ioana, Blaj Mihaela, Damian Mihaela, Lupusoru Andreea, Ristescu Irina, Codreanu Monica, Diaconescu Ciresica, Nistor Alina, Stanescu Stelian Dorin, Streanga Livia, Berneanu Maria, Bordeianu Cristina, Florenta Calarasu, Iacob Alina, Nicoleta Lupu Mary, Mocanu Iulian, Moraru Coca, Meran Carleta, Nicolae Bacalbasa, Sandu Madalina, Turcanu Roxana, Epure Florina, Grigore Monica, Hotaranu Cristina, Popescu Nicoleta, Baban Oleg, Baciu Manuela, Ciobanu Aurica, Ioan Denciu Catalin, Gurau Vitalie, Maftei Ion, Moldovan Ion, Ungureanu Liviu, Bogdan Prodan, Corneci Dan, Dinu Melania, Madalina Dutu, Rely Manolescu, Silvius Negoita, Tomescu Dana, Gabriela Droc, Adrian Dinescu Stelian, Calin Mitre, Ionescu Daniela, Margarit Simona, Vasian Horatiu, Albu Corina, Balasa Carmen, Cadrigati Alina, Dragulescu Dorian, Gavra Loredana, Hentia Ciprian, Macarie Claudiu, Manescu Mihaela, Nediglea Ioan, Ocica Dana, Ovidiu Bedreag, Papurica Mariu, Plavat Cosmin, Popa Claudia, Ramneantu Mihaela, Sandesc Dorel, Sandici Zoran, Sarandan Mihaela, Belciu Ioana, Tincu Eugen, Ursu Irina, Aignatoaie Mariana, Huzuneanu Mariana, Cocu Simona, Hagau Natalia, Ciubotaru Roxana, Copotoiu Sanda-Maria, Copotoiu Ruxandra, Ioana Ghitescu, Kovacs Judit, Leonard Azamfirei, Szederjesi Iano, Genoveva Vanvu, Mosnegutu Simona, Surbatovic Maja, Djordjevic Dragan, Djordjevic Biljana, Grujic Krasimirka, Jovanovic Dusko, Krstic-Lecic Ivana, Obradovic Jovana, Zeba Snjezana, Jevdjic Jasna, Miletic Milo, Zunic Filip, Bulasevic Aleksandra, Brko Radoslava, Gazibegovic Narcisa, Kendrisic Mirjana, Vojinovic Radisa, Firment Jozef, Zahorec Roman, Capková Judita, Grochova Monika, Trenkler Stefan, Griger Martin, Bakosova Erika, Kvasnica Martin, Saniova Beata, Sulaj Miroslav, Zacharovska Andrea, Simkova Alexandra, Číková Andrea, Gebhardtova Andrea, Hanuljaková Slávka, Koutun Juraj, Martonová Andrea, Žilinčárová Veronika, Galkova Katarína, Krbila Stefan, Sobona Viliam, Ocenasova Marieta, Novak-Jankovic Vesna, Stecher Adela, Stivan Feri, Grynyuk Andriy, Damjanovska Marija, Kostadinov Ivan, Knezevic Mile, Malivojevic Marko, Borovsak Zvonko, Kamenik Mirt, Mekiš Dušan, Osojnik Irena, Kosec Lučka, Ostojič Kapš Silva, Aleksic Dragoslav, Gerjevič Božena, Kalan Katja, Ursic Tomaz, Aldecoa Cesar, Montejo González Juan, Artigas Anna, Garcia Andre, Lisi Alberto, Perez Isabel, Perez Gisela, Poch Nuria, Vaquer Sergi, Balciscueta Goiatz, Barrasa Helena, Cabanes Sara, Maynar Javier, Poveda Yolanda, Quintano Rodero Amaia, Vallejo Ana, Duque Patrícia, Garcia-Bunger Beatriz, Adoracion Elvira Maria, María Lajara Ana, Palencia María, Ramos Rafael, Saez Fernandez Ana, Tirapu León Juan, Iza López Jaione, Yoldi Murillo Francisco, Turumbay Ramirez Eva, Unzué Rico Patricia, Patricia Marta, Vizcaíno Martín, Bernat Álvarez Maria José, Planas Real Kenneth, Mas Serra Arantxa, Aracil Norma, Menendez Bodega Begoña, Fernández García Raquel, Álvarez García Marivi, Gordon Borja de la Quintana, Gutiérrez Jodrá Alicia, De Santos López Angela, Llavador Ros Juan José, Ayala Soto Rocío, Sepúlveda Isabel, Pascual Díez Esperanza, Fernández Fernández Luisa, Soria Gulina Carlo, Pérez Arviza Laura, Fernandez Lorena Mouriz, Río Gómez Antía, Alonso Martínez Concepción, Rodríguez Rodríguez Ana Belén, Lopez Soto Carmen, Garcia Clara, Lorenzo Mario, Pinilla Elena, Rico Jesu, Ruperez Irene, Saiz Alonso Eduardo, Leira Fernando, Emilio Maseda David Pestaña, Royo Concepcion, Villagran Jose, Murillo Candi Giralt, Eduardo Esteva Garcia, Mansilla Folgado Raquel, Joan Fornaguera Nadal, Calonge Montse Pijoan, Sape Prat Anna, Sintes Dolore, Arteta Arteta Donaldo, García Delgado Horacio, Fajardo López-Cuervo Juan, López Mikel Celaya, Ramírez Alejandro, José Saldaña Francisco, Aliste Pilar, Hermira Anchuelo Ana, García Campos Ascensión, Catalán Mercede, García Gómez Mónica, Gonzalez Gonzalaez Olga, López López Eloísa, Real Navacerrada Isabel, de Quevedo Sara Arlanzón, Gonzalez Serrano Matilde, Silvestre Francisco Perez-Cerdá, Martinez Torrente Francisco, Arocas Blanca, Pastor Martinez Ernesto, Soro Marina, Maroto Fernando, Robledo Algarra Ruth, Silla Aleixandre Iné, Argente Gemma Rodriguez, Lleó Ana Broseta, Rubio Antonio Vela, Vicente Sánchez José Lui, Enríquez Valcárcel Irene, Balust Clara, Balust Jaume, Borrat Xavier, Jose Carretero Maria, Gracia Isabel, Matute Purificacion, Mercadal Jordi, Pujol Roger, Tena Beatriz, Ubre Marta, Dorda Albalad Dolore, Muñoz Alcaide Concepción, Caballero Jesu, Camps Cervantes Angel, de Nadal Clanchet Miriam, Montferrer Estruch Nuria, Ballvé Ferrer Mercè, Lacasta Fornells Albert, Terrer Galera Eduard, Garcia Martinez Irene, Manrique Muñoz Susana, Pelavski Andre, Tormos Perez Pilar, Gonzalez Posada Miguel Angel, de Prat Ivette Chocron, Rello Jordi, García Serrano Llum, Naya Sieiro José Manuel, Silva Lorena, Colomina Sole Maria Jose, Biarnes Suñé Alfon, Rochera Villach Isabel, Gómez Herreras José Ignacio, Poves Rodrigo, Martinez Rafael Beatriz, Martinez Almeida Icier, Fernandez Collates Angel, Jose Bartolomé Maria, Cimadevilla Bonifacio, González González Antonio Manuel, Rabanal Llevot Jose Manuel, de Terán Mira Juan Carlos Diaz, González Molina Begoña, Pardo Sara, López Sánchez Carlo, Williams Monica, Zaldibar Estibaliz, Muñoz Corsini Lourde, Rodríguez Fraile José Ramón, de la Lastra Maria, Kabiri Sacramento Monir, López Saña Francisco Javier, Trenado Ålvarez Josep, Cantón Bulnes Maria Luisa, Gándara Carrasco Violeta, Crespo Ma del Rocío Míguez, Narváez Cubillos Diana, Laza Laza Enrique, Pérez Ma del Pino Heredia, Arenzana Seisdedos Ángel, Fernández Torres Bartolomé, Santos Ampuero Marian, Chicot Llano Marta, Mata Esperanza, Munoz Manuel, Orts Mar, Planas Antonio, Ramasco Fernando, Roman Carlo, Varela Durán Marina, Fernandez Sabela del Río, Sanduende Otero Yolanda, Lopez Pineiro Susana, Barreiro Pardal Cristina, Fernández Alcantud Jesú, Ayuso Antolinos Mercede, Barrios Francisco, Collantes Casanova Ana, Ruiz Castro Manuel, Infantes Crespo Beatriz, Lancha Felipe Uzuri, Liceras Fuster Marta, Sanz García Máximo, Herrero Garrote Begoña, Moreno Gonzalez Ricardo, Montes Granero Maria José, de la Guía Carlos Lloreda, Chaves López Raquel, de Frutos López Santiago, Marco Martinez Jose Javier, Garcia Mostaza Angel, Jiménez Moreno Antonio, Riquelme Osado Irene, Bardina Pastor Ana, Peña Rosa, Rustarazo Pérez Mónica, Aliaño Piña María, Aranda Romero Carlo, Rodríguez Elena Rodríguez, Pedroviejo Sáez Vicente, Safatle Fernando, Hernández Salvan Javier, Galán Sampedro Mar, de la Torre Patricia Alfaro, Pérez Toro Jonatan, Lasa Unzúe Crsitina, José Vargas Maria, Garcia Bernal David, Echevarria Mercede, Ubeda Iglesias Alejandro, Loza Ana, Rodriguez Morillo Araceli, Diaz Serrano Pedro, Barrientos Sevilla Fernando Caba, Cacho Elena, Calderón Ricardo, Dufur Mercede, Marginet Carolina, Monedero Pablo, José Yepes Maria, Rellán Alvarez Luzdivina, Fernández Carballal Francisca, Pensado Castiñeiras Alberto, Dieguez García Paula, Ramos López Lorena, Rama Maceiras Pablo, Martínez Puente María Socorro, Rey Rilo Maria Teresa, Trujillo Alonso Ana Esther, Rodríguez Fernández Sonia, Omaña García Rafael, Pérez García Aníbal, Bello Puentes Rafael, Nunez Aguado Domingo, Lopez Carballo Carlo, Fernandez Fernandez Ricardo, Toledo Presedo Amadeo, de Rabago Ricardo Bermejo Diaz, Rodriguez Velasco Ana, Jiménez Capel Yolanda, Fernández Cortés Ana, Martínez García Esther, Martinez Gimeno Laura, Klamburg Jordi, Castillo Omedas Rosa, González Núñez Miriam, Llubià Maristany Clara, Moret Ruiz Enrique, Artigas Xavier, Castrillón Sebastian, Espinosa Nieve, Gomez-Caro Ana M., Illa Susana, India Inmaculada, Martín-Huerta Beatriz, Moral Victoria, Moreno Marisa, Iglesias Fernández Cristina, Fernández García Violeta, Picatto Hernández Pedro, Honrubia Checa Angel Alberto, Salvatierra Diaz David, Linero Noguera Manuel, Pujol Varela Ignacio, González Gallego Miguel, Martínez García Oscar, Ariño Irujo José Javier, González Perrino Carlo, Rey Picazo Julio, López Timoneda Francisco, Manzanero Arroyo María, Albalá Blanco Isabel, Martínez Borja Marco, Martín Burcio Sara, Martinez Castro Nilda, Puente Cerdeiriña Aránzazu, de la Torre Concostrina Marta, Viñas Cristina Medrano, Dorado Díaz Trinidad, Avellanosa Esteruelas Juan, Ingelmo Ingelmo Ildefonso, Duran Insuga Paco, Claros Llamas Elisabeth, Martín Lopez Jose Juan, Beltran Martín María, Elías Martín Elena, Ureta Mesa Eva, Loren Monterde Manuela, Alonso Montoiro Paloma, Gonzalez Móstoles Maria Luisa, Velasco Olarte Eva, Martínez Pérez Adolfo, Domínguez Perez Fernando, Serrano Romero Ana, Parise Rous Diego, Mané Ruiz Nuria, Palomo Ruiz Jose Angel, Ruigomez Saiz Alvaro, Terol Alvaro de la Vega, Candela Toha Angel, Alvarez Utrera Fernando, Alberdi Fermín, Elósegui Itxaso, García Javier, Marco Garde Pilar, Itziar Mintegui Escudero, García Sáez Iker, Salas Estibaliz, Zabarte Mercede, Diaz-Boladeras Rosa-Maria, Mora-Guevara Emilio, Ferreras Zamora Julia, Bonet Alfon, Salo Lidia, Salinas Unai, Zaballos Juan, Abella Alvarez Ana, Jimenez Garrido Carlo, Hita Roa Juan Ramón, Gordo Vidal Federico, Garcia-Egea Jorge, Zamora Elson Monica, Seron-Arbeloa Carlo, Mendiola Asensio Miguel Angel, Gastaldo Simeón Rosa, Muñoz Alameda Luis Enrique, Oeding Angulo Guillermo, Aranzubia Monserrat, Juan Arcas Jose, Arevalo Julian, Quesada Belvert Belén, Pérez Calvo César, Cremades Marta, Crespo Pascual, Cuarental Ana, Del Olmo Mercede, Turrión Fernández Pablo, Garcia Vega José Luis Franqueza García Isabel, Herrera Elena, Alcala Llorente Miguel Angel, Martin Rabes Cecilia, de Maeyer Ana Gamo, Pérez Marquez Manuel, López Mendoza Diego, Milicua Muñoz José María, Arias Martínez Natividad, Santos Oviedo Arnoldo, Benavent Garrigues Pau, Alonso Íñigo José, Tormo Ferrandiz Sergi, Sanchez-Morcillo Silvia, Lafuente Sánchez Matilde, Marqués Parra Asunción, Gomar Vidal Sonia, Montoiro Allué Raquel, Zalba Etayo Begoña, Bustamante Rodriguez Raquel, Martin Villen Lui, Molla Jimenez Cristina, de Zayas Ricardo Sala, Dolera Moreno Cristina, SanJose Pacheco Fernando, Anton Pascual Jose Lui, Tejera Gude Fernando, Manteiga Riestra Eva, Cota Delgado Francisco, de la Torre Prados Maria Victoria, Barrios Javier, Cervera-Montes Manuel, García-Sanz Mercede, García Vicente, Sanmiguel Guillermo, López Álvaro Julian, Bornay Barrachima Beatriz, Romero Bermejo Francisco Jose, Martinez Garcia Alberto Garcia Fernandez Pilar, Navarro Ramírez Carolina, Gómez Ramos Jorge, Angel Samaniego Lui, Belenguer-Muncharaz Alberto, Ferrándiz-Selles Amparo, Mateu-Campos Maria-Lidon, Domínguez David, Espinosa Elena, León Teresa, Ojeda Betancor Nazario, Garcia Cortes Javier, Díaz Díaz Juan José, Manzano Canalechevarria Ana, Fores Novales Beatriz, Garcia Peña Jose Manuel, Rodriguez Delgado Toma, Santamaria Roquerio Beatriz, Gomez Sainz Juan Jose, Tebar Soto Teresa, Chew Michelle, Seeman-Lodding Heléne, Dahm Peter, Odenstedt Hergès Helena, Lundborg Christoffer, Söndergaard Sören, Rylander Christian, Sari Ferenc, Oscarsson Tibblin Anna, Adolfsson Anne, Klarin Bengt, Schrey Susann, Merisson Edyta, Rydén Jörgen, Britt Divander Mona, Hedin Annika, Hedlund Daniel, Axelsson Lindkvist Mikael, Jawad Monir, Layous Lona, Wernerman Jan, Björne Håkan, Brattström Olof, Olheden Staffan, Oldner Ander, Sellden Eva, Walder Bernhard, Wickboldt Nadine, Rossi Ariane, Steiner Luziu, Djurdjevic Mirjana, Lussmann Roger, Geisen Martin, Hofer Christoph, Turina Matthia, Grocott Mike, Goldhill David, Everett Lynn, Harris Katy, Wright Maggie, Adams David, Alderson Lorraine, Baker Julie, Christie Iain, Ferguson Colin, Hill Matthew, Holmes Kate, Hutton Andrew, Minto Gary, Moor Paul, Porter Andrew, Struthers Richard, Akotia Niven, Belhaj Alaa, Chang Serene, Collantes Enrique, Eigener Katrin, Husband Michael, Khan Ahsun, Kong Ming-Li, Jane McAlees Eleanor, Macdonald Neil, Niebrzegowska Edyta, Parnell Wendy, Smith Amanda, Chhatwal Ally, Jhingan Smriti, Muswell Richard, Poon Yoyo, Singh Nidhita, Stephens Robert, Vasan Robin, Waife Nicola, Weda Tahmina, Clarke Adrian, Szakmany Tama, Fletcher Simon, Rosbergen Melissa, Blunt Mark, Prince Liz, Wong Kate, Kumar Ram, Stilwell Sarah, Couper Keith, Crooks Neil, Gao-Smith Fang, Melody Teresa, Snaith Catherine, Patel Jaimin, Parekh Dhruv, Yeung Joyce, Loughnan Bernadette, Moosajee Va, Rope Tamsin, Edger Lliam, Dawson Julie, Hadfield Daniel, Hopkins Phil, Mcdonald Lisa, Willars Chri, Campbell Gillian, Craig Jayne, Smith Andrew, Ladipo Karleen, Lockwood Geoff, Moreno Juan, Ballington Ruth, Hamandishe Sibongilele, Rogerson David, Cowman Sarah, Hayden Paul, Pinto Nuno, Sandhar Taj, Arawwawala Dilshan, Brotherston Lauren, Mitchell-Inwang Christine, Walsh Helena, Alagarsamy Famila, Goon Serena, Karcheva Sylvia, Krepska Amy, Mckinney Brian, Patil Vishal, Batchelor Nichola, Day Christopher, Finch Louise, Gibson Charlie, Grayling Matthew, Hubble Sheena, Key William, Knight Thoma, Loosley Alexander, Margetts Paul, Stewart Hannah, Bewley Jeremy, Hurley Katrina, Murphy Ruth, Philpott Catherine, Pollock Kathryn, Sweet Katie, Thomas Matthew, Tucker Katy, Windsor David, Conway Daniel, Gold Steve, Quraishi Tanviha, Cupitt Jason, Baddeley Sally, Brown John David, Foo Irwin, Mantle Damien, Carvalho Peter, Huddart Sam, Kirk-Bayley Justin, Smith Rebecca, Milligan Lisa, Poulose Sonia, Sarkar Som, Nolan Jerry, Pedley Emma, Padkin Andrew, Pesian Siamak, Rajamanickam Satish, Ramkumar Konnur, Thomas Jerry, Crayford Alison, Turner Angu, Bottrill Fiona, Webb Stephen, Jhanji Shaman, Maccallum Niall, Wessels Kate, Wigmore Tim, Meikle Alistair, Wilson Stephen, White Stuart, Bonnett Andrew, Rushton Andrew, Williams Colin, Zuzan Oliver, Hall Andrew, Montgomery Jane, Piggot Ailie, Read Richard, Stocker Mary, Tamm Tiina, Agarwal Banwari, Ward Stephen, Brown Lucy, Joy Manju, Venkatesh Suresh, Hughes Thoma, Zsisku Lajo, Roy Alistair, Hooper Victoria, Mouland Johanna, Nightingale Jeremy, Rose Steve, Chiam Patrick, Chohan Harnita, Dickson Chri, Gibb Sarah, Higham Charley, Harvey Caroline, Janarthanan Chandra, Jones Laura, Kapoor Avinash, Moll Mark, Roberts Louise, Saunders David, Arnold Glenn, Gibbs Claire, Jhurgursing Mhairi, Pierro Dena, Pritchard France, Doyle Patrick, Templeton Maie, Wilson Robert, Zantua Kim, Collyer Thoma, Featherstone Jame, Worton Rachael, Bruce Jean, Mcguigan Kate, Price Grant, Moreton Sarah, Pulletz Mark, Anderson Helen, Baxter Ian, Beckingsale Alex, Callaghan Mark, Datta Ansu, Dawson Jo, Gollogly Jackit, Izod Chri, Lobaz Steve, Macfie Caroline, Patel Manju, Payne Heather, Singh Raj, Timms Gemma, Mcleod Shaun, O'Brian Peter, Horner Elspeth, Joshi Vivekananda, Stuart-Smith Karen, Seale Tania, Bolger Clare, Collins Hannah, Ekins Emma, Hawkins Lesley, Jonas Max, Linford Karen, Wadams Beverley, Beach Madeleine, Vizcaychipi Marcela, Jewsbury William, Davies Simon, Balaji Packianathaswamy, Kangaraj Muthuraj, Pissay Nagesh, Smith Neil, Gopalakrishnan Senthilkumar, Mackinnon John, Strandvik Gustav, Francis Ruth, Jennings Adrian, Keating Matthew, Kumar Sajith, Leese Sarah, Magee Cliona, Pilsbury Jane, Ralph Jame, Riddington David, Sachdeva Rajneesh, Snelson Catherine, Vasanth Suresh, Wilde Judith, Lavender Beth, Lyons Rachel, Watters Malcolm, Adams Tim, Dyer Simon, Tindall Lucy, Claxton Andrew, Netke Meenu, Akouds Esam, Bates Debrah, Gallagher Heather, Hatton Jonathan, Holroyd William, Mitra Atideb, Nurse Trudy, Reed Deborah, Desikan Somi, Barber Russell, Childs Sophie, O'Carroll-Kuehn Britta, Wyldbore Mark, Al-Abdaly Ayad, Amatya Suman, Bhaskaran Sherly, Chandan Garud, Chaudhry Suman, Chikungwa Mose, Earnshaw Greg, Grewal Moni, Haque Shamimul, Hawkins John, Javaid Ahmed, Jackson Clare, Kamel Miriam, Marla Ruchira, Mculloch Dori-Ann, Parker Tom, Salib Yussof, Saravanmuthu Ramesh, Secker Chri, Sockalingam Siva, Taylor Anne, Austine Pauline, Kanade Vrushali, Paal Dora, Sam Mok May Un, Burtenshaw Andrew, Davis Laura, Ellahee Parvez, Freeman David, Pierson Richard, Wollaston Julie, Karmarkar Amara, Ball Clare, Calton Emily, Maxwell Louise, Walker Rachel, Bland Martin, Bullock Lynne, Harrison-Briggs Donna, Hodge Paul, Krige Anton, Dempsey Ged, Hammell Claire, Loveridge Robert, Parker Robert, Snell Jane, Wright Carl, Baker Andy, Barr Katharine, Belcher Alex, Bonnington Sam, Bougeard Anne-Marie, Fitzgerald Emma, Ford Rachael, Gillard Chantal, Griffiths Liz, Greenberg Lizzie, Huber Jonathan, Mathieu Steve, Richardson Neil, Tompsett Laura, White Nigel, Patel Santosh, Corner Victoria, Thomas Richard, Trodd Dawn, Wilson Jennifer, Copley Ed, Flutter Laura, Hulme Jonathan, Susarla Jay, Thwaites Alison, Jayasundera Suraj, Mcafee Sean, Chantler Jonathan, Mckechnie Stuart, Neely Julia, Mouton Ronelle, Scarth Edward, Soar Jasmeet, Buss Joanne, Currie Vicki, Sange Mansoor, Kuttler Anja, Power Fiona, Alexander David, Dunne Kevin, Shinner Guy, Black Euan, Haldane Grant, Kerr Jennie, Saran Taj, Ward Geraldine, Jefferies Fiona, Alexander Peter, Royle Alison, Nahla Farid, Bowles Tim, Gregory Maggie, Ahern Rebecca, Cartlidge David, Craker Lloyd, Thompson Christopher, Bidd Heena, Giles Julian, Manser Amanda, Parry Gareth, Chan Peter, Das Dinesh, Fahmy Nisreen, Higgins David, Khader Ahmed, Stone Alex, Leonardi Silvia, Rose Oliver, Bright Elizabeth, Ercole Ari, Amir Rafi Muhammed, Ramasamy Radhika, Sheshgiri Bengeri, Merrill Colin, Page Valerie, Walker Elaine, Harris Stephen, Hughes Sarah, Morrison Alan, Razouk Khaled, Ayman Mustafa, Jakeman Alicia, Mowatt Chri, Paananen Sami, Supporting clinical sciences, Intensive Care, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SSS/IREC/MEDA - Pôle de médecine aiguë, UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - (SLuc) Service d'anesthésiologie, Surgery, and RS: NUTRIM - R2 - Gut-liver homeostasis
Subjects: Male, The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients, Hospital admission, Hospital discharge, Intensive care, Length of stay, Surgical mortality, Epidemiology, Iron metabolism Pathogenesis and modulation of inflammation [IGMD 7], surgery, Cohort Studies, Clinical endpoint, Medicine, Hospital Mortality, Hospital discharge, education.field_of_study, Mortality rate, Medicine (all), Confounding, General Medicine, Middle Aged, Surgical mortality, Operative, Europe, Hospitalization, Treatment Outcome, Surgical Procedures, Operative, outcomes, surgery, mortality, Female, mortality, cohort study, Cohort study, Human, Adult, medicine.medical_specialty, Critical Care, Population, MEDLINE, Settore MED/41 - ANESTESIOLOGIA, Humans, ddc:610, Mortality, education, surgery, mortality, Europe, Aged, Postoperative Care, Surgical Procedures, business.industry, Length of Stay, Hospital admission, Surgery, Clinical outcomes, Intensive care, Mann–Whitney U test, Cohort Studie, business
Abstract: Item does not contain fulltext BACKGROUND: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe. METHODS: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used chi(2) and Fisher's exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p
Published: 2012
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34 results on '"Lembo, Rosalba"'

1. Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis: The MERCY Randomized Clinical Trial

2. Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis: The MERCY Randomized Clinical Trial

3. A Bayesian reanalysis of the standard versus accelerated initiation of renal-replacement therapy in acute kidney injury (STARRT-AKI) trial

4. Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial

5. Air pollutants and SARS-CoV-2 in 33 European countries

6. Propensity-matched comparison for carotid artery stenting in primary stenosis versus post-CEA restenosis

7. sj-pdf-1-jao-10.1177_0391398820975408 – Supplemental material for Venovenous ECMO treatment, outcomes, and complications in adults according to large case series: A systematic review

8. sj-pdf-1-jao-10.1177_0391398820975408 – Supplemental material for Venovenous ECMO treatment, outcomes, and complications in adults according to large case series: A systematic review

9. Platelet activation is a preoperative risk factor for the development of thromboembolic complications in patients with continuous-flow left ventricular assist device

10. Stress lavoro correlato come fattore di rischio della Sindrome Metabolica: impatto organizzativo

11. A randomized controlled trial of levosimendan to reduce mortality in high-risk cardiac surgery patients (CHEETAH): Rationale and design

12. Long-term outcome of perioperative low cardiac output syndrome in cardiac surgery: 1-year results of a multicenter randomized trial

13. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial. The PROTECTION trial

14. Two‐months quality of life of COVID‐19 invasively ventilated survivors; an Italian single‐center study

15. Continuous infusion versus intermittent administration of meropenem in critically ill patients (MERCY): A multicenter randomized double-blind trial. Rationale and design

16. Treatment of Thoracic Endometriosis Syndrome: A Meta-Analysis and Review

17. Effect of Continuous Epinephrine Infusion on Survival in Critically Ill Patients. A Meta-Analysis of Randomized Trials

18. The Brachiocephalic Vein as a Safe and Viable Alternative to Internal Jugular Vein for Central Venous Cannulation

19. Levosimendan for Hemodynamic Support after Cardiac Surgery

20. Decreased in-hospital mortality in patients with COVID-19 pneumonia

21. A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Increasing Mortality

22. A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality

23. Volatile Anesthetics versus Total Intravenous Anesthesia for Cardiac Surgery

24. Coagulation Derangements in Patients With Refractory Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

25. The role of different mechanical circulatory support devices and their timing of implantation on myocardial damage and mid-term recovery in acute myocardial infarction related cardiogenic shock

26. Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac Surgery: An Updated Consensus Process

27. Effect of Levosimendan on Renal Outcome in Cardiac Surgery Patients With Chronic Kidney Disease and Perioperative Cardiovascular Dysfunction: A Substudy of a Multicenter Randomized Trial

28. Steroids and Survival in Critically Ill Adult Patients: A Meta-analysis of 135 Randomized Trials

29. MortalitY in caRdIAc surgery (MYRIAD):A randomizeD controlled trial of volatile anesthetics. Rationale and design

30. Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

31. The authors reply

32. Do patients undergoing MitraClip implantation require routine ICU admission?

33. Noninvasive ventilation practice in cardiac surgery patients: insights from a European survey

34. Mortality after surgery in Europe: a 7 day cohort study

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