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3. Cultural Adaptation and Testing of the Italian Version of the Edmonton Functional Assessment Tool-2 (EFAT2-I)

Author

Magrelli, Andrea, Scannavini, Paolo, D’Angelo, Daniela, Latini, Chiara Maria, Felli, Silvia, Di Nitto, Marco, Russo, Giuseppina, Mastroianni, Chiara, Navalesi, Giovanni, and Casale, Giuseppe

Abstract

Background Physiotherapy in Palliative Care (PC) is effective in the management of a series of respiratory, circulatory and motor symptoms, and often has a positive impact on the patient's mood. The Edmonton Functional Assessment Tool (EFAT) is the only existing validated tool specifically designed for functional assessment in PC, and its use has been recommended in clinical practice. To date, no Italian version of the tool has been validated. The aim of this study was to translate, cross-culturally adapt, and evaluate the psychometric properties of the Italian version of the EFAT2.Method After receiving formal permission from the author, Beaton guidelines for cross-cultural adaptation were followed, namely: (1) forward translation; (2) a multidisciplinary focus group (including 4 physiotherapists, 1 physician, 3 nurses, 1 occupational therapist, 1 psychologist) to assess semantic, idiomatic, experiential, and conceptual equivalence; (3) backward translation. The Content Validity Index (CVI) was used to assess content validity of the tool. Construct and concurrent validity were also evaluated. To evaluate the reliability of the EFAT2-I, reliability was measured using Cronbach alfa, item-total correlation, and Cohen's Kappa.Results 119 patients admitted to a Palliative Care Unit (Italy) agreed to participate in the study. The EFAT2-I mean score was 11.3, ranging from 0 to 30. Very good CVI scores were achieved, both in terms of single item validity (I-CVI) and of whole scale validity (S-CVI). Positive results were obtained from construct, concurrent validity assessment and measures of reliability.Discussion The EFAT2-I showed good psychometric properties and can be used as a rehabilitation assessment tool in palliative care settings. The validation of the Italian version will allow comparison of different centres and palliative care facilities on national and international levels.

Published
2024
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4. General anesthesia or conscious sedation for thrombectomy in stroke patients: an updated systematic review and meta-analysis

Author

Geraldini, Federico, Diana, Paolo, Fregolent, Davide, De Cassai, Alessandro, Boscolo, Annalisa, Pettenuzzo, Tommaso, Sella, Nicolò, Lupelli, Irene, Navalesi, Paolo, and Munari, Marina

Abstract

Purpose: Endovascular treatment for stroke patients usually requires anesthesia care, with no current consensus on the best anesthetic management strategy. Several randomized controlled trials and meta-analyses have attempted to address this. In 2022, additional evidence from three new trials was published: the GASS trial, the CANVAS II trial, and preliminary results from the AMETIS trial, prompting the execution of this updated systematic review and meta-analysis. The primary objective of this study was to evaluate the effects of general anesthesia and conscious sedation on functional outcomes measured with the modified Rankin scale (mRS) at three months. Methods: We performed a systematic review and meta-analysis of randomized controlled trials investigating conscious sedation and general anesthesia in endovascular treatment. The following databases were examined: PubMed, Scopus, Embase, and the Cochrane Database of Randomized Controlled Trials and Systematic Reviews. The Risk of Bias 2 tool was used to assess bias. In addition, trial sequence analysis was performed on the primary outcome to estimate if the cumulative effect is significant enough to be unaffected by further studies. Results: Nine randomized controlled trials were identified, including 1,342 patients undergoing endovascular treatment for stroke. No significant differences were detected between general anesthesia and conscious sedation with regards to mRS, functional independence (mRS, 0–2), procedure duration, onset to reperfusion, mortality, hospital length of stay, and intensive care unit length of stay. Patients treated under general anesthesia may have more frequent successful reperfusion, though the time from groin to reperfusion was slightly longer. Trial sequential analysis showed that additional trials are unlikely to show marked differences in mean mRS at three months. Conclusions: In this updated systematic review and meta-analysis, the choice of anesthetic strategy for endovascular treatment of stroke patients did not significantly impact functional outcome as measured with the mRS at three months. Patients managed with general anesthesia may have more frequent successful reperfusion. Trial registration: PROSPERO (CRD42022319368); registered 19 April 2022.

Published
2023
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6. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Author

Pham, Tài, Heunks, Leo, Bellani, Giacomo, Madotto, Fabiana, Aragao, Irene, Beduneau, Gaëtan, Goligher, Ewan C, Grasselli, Giacomo, Laake, Jon Henrik, Mancebo, Jordi, Peñuelas, Oscar, Piquilloud, Lise, Pesenti, Antonio, Wunsch, Hannah, van Haren, Frank, Brochard, Laurent, Laffey, John G, Abrough, Fekri, Acharya, Subhash P, Amin, Pravin, Arabi, Yaseen, Aragao, Irene, Bauer, Philippe, Beduneau, Gaëtan, Beitler, Jeremy, Berkius, Johan, Bugedo, Guillermo, Camporota, Luigi, Cerny, Vladimir, Cho, Young-Jae, Clarkson, Kevin, Estenssoro, Elisa, Goligher, Ewan, Grasselli, Giacomo, Gritsan, Alexey, Hashemian, Seyed Mohammadreza, Hermans, Greet, Heunks, Leo M, Jovanovic, Bojan, Kurahashi, Kiyoyasu, Laake, Jon Henrik, Matamis, Dimitrios, Moerer, Onnen, Molnar, Zsolt, Ozyilmaz, Ezgi, Panka, Bernardo, Papali, Alfred, Peñuelas, Óscar, Perbet, Sébastien, Piquilloud, Lise, Qiu, Haibo, Razek, Assem Abdel, Rittayamai, Nuttapol, Roldan, Rollin, Serpa Neto, Ary, Szuldrzynski, Konstanty, Talmor, Daniel, Tomescu, Dana, Van Haren, Frank, Villagomez, Asisclo, Zeggwagh, Amine Ali, Abe, Toshikazu, Aboshady, Abdelrhman, Acampo-de Jong, Melanie, Acharya, Subhash, Adderley, Jane, Adiguzel, Nalan, Agrawal, Vijay Kumar, Aguilar, Gerardo, Aguirre, Gaston, Aguirre-Bermeo, Hernan, Ahlström, Björn, Akbas, Türkay, Akker, Mustafa, Al Sadeh, Ghamdan, Alamri, Sultan, Algaba, Angela, Ali, Muneeb, Aliberti, Anna, Allegue, Jose Manuel, Alvarez, Diana, Amador, Joaquin, Andersen, Finn H, Ansari, Sharique, Apichatbutr, Yutthana, Apostolopoulou, Olympia, Arabi, Yaseen, Arellano, Daniel, Arica, Mestanza, Arikan, Huseyin, Arinaga, Koichi, Arnal, Jean-Michel, Asano, Kengo, Asín-Corrochano, Marta, Avalos Cabrera, Jesus Milagrito, Avila Fuentes, Silvia, Aydemir, Semih, Aygencel, Gulbin, Azevedo, Luciano, Bacakoglu, Feza, Badie, Julio, Baedorf Kassis, Elias, Bai, Gabriela, Balaraj, Govindan, Ballico, Bruno, Banner-Goodspeed, Valerie, Banwarie, Preveen, Barbieri, Rosella, Baronia, Arvind, Barrett, Jonathan, Barrot, Loïc, Barrueco-Francioni, Jesus Emilio, Barry, Jeffrey, Bauer, Philippe, Bawangade, Harshal, Beavis, Sarah, Beck, Eduardo, Beehre, Nina, Belenguer Muncharaz, Alberto, Bellani, Giacomo, Belliato, Mirko, Bellissima, Agrippino, Beltramelli, Rodrigo, Ben Souissi, Asma, Benitez-Cano, Adela, Benlamin, Mohamed, Benslama, Abdellatif, Bento, Luis, Benvenuti, Daniela, Berkius, Johan, Bernabe, Laura, Bersten, Andrew, Berta, Giacomo, Bertini, Pietro, Bertram-Ralph, Elliot, Besbes, Mohamed, Bettini, Lisandro Roberto, Beuret, Pascal, Bewley, Jeremy, Bezzi, Marco, Bhakhtiani, Lakshay, Bhandary, Rakesh, Bhowmick, Kaushik, Bihari, Shailesh, Bissett, Bernie, Blythe, David, Bocher, Simon, Boedjawan, Narain, Bojanowski, Christine M, Boni, Elisa, Boraso, Sabrina, Borelli, Massimo, Borello, Silvina, Borislavova, Margarita, Bosma, Karen J, Bottiroli, Maurizio, Boyd, Owen, Bozbay, Suha, Briva, Arturo, Brochard, Laurent, Bruel, Cédric, Bruni, Andrea, Buehner, Ulrike, Bugedo, Guillermo, Bulpa, Pierre, Burt, Karen, Buscot, Mathieu, Buttera, Stefania, Cabrera, Jorge, Caccese, Roberta, Caironi, Pietro, Canchos Gutierrez, Ivan, Canedo, Nancy, Cani, Alma, Cappellini, Iacopo, Carazo, Jesus, Cardonnet, Luis Pablo, Carpio, David, Carriedo, Demetrio, Carrillo, Ramón, Carvalho, João, Caser, Eliana, Castelli, Antonio, Castillo Quintero, Manuel, Castro, Heloisa, Catorze, Nuno, Cengiz, Melike, Cereijo, Enrique, Ceunen, Helga, Chaintoutis, Christos, Chang, Youjin, Chaparro, Gustavogcha, Chapman, Carmel, Chau, Simon, Chavez, Cecilia Eugenia, Chelazzi, Cosimo, Chelly, Jonathan, Chemouni, Frank, Chen, Kai, Chena, Ariel, Chiarandini, Paolo, Chilton, Phil, Chiumello, Davide, Cho, Young-Jae, Chou-Lie, Yvette, Chudeau, Nicolas, Cinel, Ismail, Cinnella, Gilda, Clark, Michele, Clark, Thomas, Clarkson, Kevin, Clementi, Stefano, Coaguila, Luis, Codecido, Alexis Jaspe, Collins, Amy, Colombo, Riccardo, Conde, Juan, Consales, Guglielmo, Cook, Tim, Coppadoro, Andrea, Cornejo, Rodrigo, Cortegiani, Andrea, Coxo, Cristina, Cracchiolo, Andrea Neville, Crespo Ramirez, Mónica, Crova, Philippe, Cruz, José, Cubattoli, Lucia, Çukurova, Zafer, Curto, Francesco, Czempik, Piotr, D'Andrea, Rocco, da Silva Ramos, Fernando, Dangers, Laurence, Danguy des Déserts, Marc, Danin, Pierre-Eric, Dantas, Fabianne, Daubin, Cédric, Dawei, Wu, de Haro, Candelaria, de Jesus Montelongo, Felipe, De Mendoza, Diego, de Pablo, Raúl, De Pascale, Gennaro, De Rosa, Silvia, Decavèle, Maxens, Declercq, Pierre-Louis, Deicas, Alberto, del Carmen Campos Moreno, María, Dellamonica, Jean, Delmas, Benjamin, Demirkiran, Oktay, Demirkiran, Hilmi, Dendane, Tarek, di Mussi, Rossella, Diakaki, Chrysi, Diaz, Anatilde, Diaz, Willy, Dikmen, Yalim, Dimoula, Aikaterini, Doble, Patricia, Doha, Nagwa, Domingos, Guilherme, Dres, Martin, Dries, David, Duggal, Abhijit, Duke, Graeme, Dunts, Pavel, Dybwik, Knut, Dykyy, Maksym, Eckert, Philippe, Efe, Serdar, Elatrous, Souheil, Elay, Gülseren, Elmaryul, Abubaker S, Elsaadany, Mohamed, Elsayed, Hany, Elsayed, Samar, Emery, Malo, Ena, Sébastien, Eng, Kevin, Englert, Joshua A, Erdogan, Elif, Ergin Ozcan, Perihan, Eroglu, Ege, Escobar, Miguel, Esen, Figen, Esen Tekeli, Arzu, Esquivel, Alejandro, Esquivel Gallegos, Helbert, Ezzouine, Hanane, Facchini, Alberto, Faheem, Mohammad, Fanelli, Vito, Farina, Maria Fernanda, Fartoukh, Muriel, Fehrle, Lutz, Feng, Feng, Feng, Yufeng, Fernandez, Irene, Fernandez, Borja, Fernandez-Rodriguez, Maria Lorena, Ferrando, Carlos, Ferreira da Silva, Maria João, Ferreruela, Mireia, Ferrier, Janet, Flamm Zamorano, Matias Jesús, Flood, Laura, Floris, Leda, Fluckiger, Martin, Forteza, Catalina, Fortunato, Antonella, Frans, Eric, Frattari, Antonella, Fredes, Sebastian, Frenzel, Tim, Fumagalli, Roberto, Furche, Mariano Andres, Fusari, Maurizio, Fysh, Edward, Galeas-Lopez, Juan Luis, Galerneau, Louis-Marie, Garcia, Analía, Garcia, María Fernanda, Garcia, Elisabet, Garcia Olivares, Pablo, Garlicki, Jaroslaw, Garnero, Aude, Garofalo, Eugenio, Gautam, Prabha, Gazenkampf, Andrey, Gelinotte, Stéphanie, Gelormini, Domenico, Ghrenassia, Etienne, Giacomucci, Angelo, Giannoni, Robert, Gigante, Andrea, Glober, Nancy, Gnesin, Paolo, Gollo, Yari, Gomaa, Dina, Gomero Paredes, Rosita, Gomes, Rui, Gomez, Raúl Alejandro, Gomez, Oscar, Gomez, Aroa, Gondim, Louise, Gonzalez, Manuel, Gonzalez, Isabel, Gonzalez-Castro, Alejandro, Gordillo Romero, Orlando, Gordo, Federico, Gouin, Philippe, Graf Santos, Jerónimo, Grainne, Rooney, Grando, Matilde, Granov Grabovica, Sanja, Grasselli, Giacomo, Grasso, Salvatore, Grasso, Rinaldo, Grimmer, Lisa, Grissom, Colin, Gritsan, Alexey, Gu, Qing, Guan, Xiang-Dong, Guarracino, Fabio, Guasch, Neus, Guatteri, Luca, Gueret, Renaud, Guérin, Claude, Guerot, Emmanuel, Guitard, Pierre-Gildas, Gül, Fethi, Gumus, Ayca, Gurjar, Mohan, Gutierrez, Patricia, Hachimi, Abdelhamid, Hadzibegovic, Adi, Hagan, Samantha, Hammel, Clare, Han Song, Joo, Hanlon, Gabrielle, Hashemian, Seyed Mohammadreza, Heines, Serge, Henriksson, Johanna, Herbrecht, Jean-Etienne, Heredia Orbegoso, Gabriel Omar, Hermans, Greet, Hermon, Andrew, Hernandez, Rosana, Hernandez, Carmen, Herrera, Luis, Herrera-Gutierrez, Manuel, Heunks, Leo, Hidalgo, Juan, Hill, Dianne, Holmquist, Dagmar, Homez, Marcela, Hongtao, Xia, Hormis, Anil, Horner, Daniel, Hornos, M Carmen, Hou, Meihong, House, Stacy, Housni, Brahim, Hugill, Keith, Humphreys, Sally, Humbert, Louis, Hunter, Stephanie, Hwa Young, Lee, Iezzi, Nicolas, Ilutovich, Santiago, Inal, Volkan, Innes, Richard, Ioannides, Panagiotis, Iotti, Giorgio Antonio, Ippolito, Mariachiara, Irie, Hiromasa, Iriyama, Hiroki, Itagaki, Taiga, Izura, Javier, Izza, Santiago, Jabeen, Rakhshanda, Jamaati, Hamidreza, Jamadarkhana, Sunil, Jamoussi, Amira, Jankowski, Milosz, Jaramillo, Luis Alberto, Jeon, Kyeongman, Jeong Lee, Seok, Jeswani, Deepak, Jha, Simant, Jiang, Liangyan, Jing, Chen, Jochmans, Sébastien, Johnstad, Bror Anders, Jongmin, Lee, Joret, Aurélie, Jovanovic, Bojan, Junhasavasdikul, Detajin, Jurado, Maria Teresa, Kam, Elisa, Kamohara, Hidenobu, Kane, Caroline, Kara, Iskender, Karakurt, Sait, Karnjanarachata, Cherdkiat, Kataoka, Jun, Katayama, Shinshu, Kaushik, Shuchi, Kelebek Girgin, Nermin, Kerr, Kathryn, Kerslake, Ian, Khairnar, Prakash, Khalid, Abidi, Khan, Akram, Khanna, Ashish K, Khorasanee, Reza, Kienhorst, Dieneke, Kirakli, Cenk, Knafelj, Rihard, Kol, Mark Kol, Kongpolprom, Napplika, Kopitko, Csaba, Korkmaz Ekren, Pervin, Kubisz-Pudelko, Agnieszka, Kulcsar, Zoltan, Kumasawa, Junji, Kurahashi, Kiyoyasu, Kuriyama, Akira, Kutchak, Fernanda, Laake, Jon Henrik, Labarca, Eduardo, Labat, Françoise, Laborda, César, Laca Barrera, Manuel Alberto, Lagache, Laurie, Landaverde Lopez, Antonio, Lanspa, Michael, Lascari, Valeria, Le Meur, Matthieu, Lee, Su Hwan, Lee, Young Ju, Lee, Jinwoo, Lee, Won-Yeon, Lee, Jarone, Legernaes, Terje, Leiner, Tamaas, Lemiale, Virginie, Leonor, Tiago, Lepper, Philipp M, Li, Dahuan, Li, Hongbin, Li, Oleg, Lima, Ana Raquel, Lind, Dan, Litton, Edward, Liu, Ning, Liu, Ling, Liu, Jialin, Llitjos, Jean-François, Llorente, Beatriz, Lopez, Rodolfo, Lopez, Claudia Elizabeth, Lopez Nava, Claudia, Lovazzano, Pablo, Lu, Min, Lucchese, Francesca, Lugano, Manuela, Lugo Goytia, Gustavo, Luo, Hua, Lynch, Ceri, Macheda, Sebastiano, Madrigal Robles, Victor Hugo, Maggiore, Salvatore Maurizio, Magret Iglesias, Mònica, Malaga, Peter, Mallapura Maheswarappa, Harish, Malpartida, Guillermo, Malyarchikov, Andrey, Mansson, Helena, Manzano, Anaid, Marey, Ismael, Marin, Nathalie, Marin, Maria del Carmen, Markman, Eliana, Martin, Felix, Martin, Alex, Martin Dal Gesso, Cristina, Martinez, Felipe, Martínez-Fidalgo, Conchita, Martin-Loeches, Ignacio, Mas, Arantxa, Masaaki, Sakuraya, Maseda, Emilio, Massa, Eleni, Mattsson, Anna, Maugeri, Jessica, McCredie, Victoria, McCullough, James, McGuinness, Shay, McKown, Andrew, Medve, László, Mei, Chengqing, Mellado Artigas, Ricard, Mendes, Vitor, Mervat, Mohamed Khalaf Ebraheim, Michaux, Isabelle, Mikhaeil, Michael, Milagros, Olga, Milet, Igor, Millan, Maria Teresa, Minwei, Zhang, Mirabella, Lucia, Mishra, Sanghamitra, Mistraletti, Giovanni, Mochizuki, Katsunori, Moerer, Onnen, Moghal, Arif, Mojoli, Francesco, Molin, Alexandre, Molnar, Zsolt, Montiel, Raquel, Montini, Luca, Monza, Gianmario, Mora Aznar, Maria, Morakul, Sunthiti, Morales, Maria, Moreno Torres, Daniel, Morocho Tutillo, Diego Rolando, Motherway, Catherine, Mouhssine, Doumiri, Mouloudi, Eleni, Muñoz, Tapia, Munoz de Cabo, Carlos, Mustafa, Mohamed, Muthuchellappan, Radhakrishnan, Muthukrishnan, Muraleekrishnan, Muttini, Stefano, Nagata, Isao, Nahar, Dick, Nakanishi, Misuzu, Nakayama, Izumi, Namendys-Silva, Silvio Antonio, Nanchal, Rahul, Nandakumar, Sivakumar, Nasi, Alessandra, Nasir, Kamal, Navalesi, Paolo, Naz Aslam, Tayyba, Nga Phan, Thuy, Nichol, Alistair, Niiyama, Shuhei, Nikolakopoulou, Sofia, Nikolic, Elena, Nitta, Kenichi, Noc, Marko, Nonas, Stephanie, Nseir, Saad, Nur Soyturk, Ayse, Obata, Yukako, Oeckler, Richard, Oguchi, Moe, Ohshimo, Shinichiro, Oikonomou, Marina, Ojados, Agueda, Oliveira, Maria Teresa, Oliveira Filho, Wilson, Oliveri, Carlo, Olmos, Aitor, Omura, Kazuya, Orlandi, Maria Cristina, Orsenigo, Francesca, Ortiz-Ruiz De Gordoa, Laura, Ota, Kei, Ovalle Olmos, Rainier, Öveges, Nándo, Oziemski, Peter, Ozkan Kuscu, Ozlem, Pachas Alvarado, Fernando, Pagella, Gonzalo, Palaniswamy, Vijayanand, Palazon Sanchez, Eugenio Luis, Palmese, Salvatore, Pan, Guojun, Pan, Wensen, Panka, Bernardo, Papanikolaou, Metaxia, Papavasilopoulou, Theonymfi, Parekh, Ameet, Parke, Rachael, Parrilla, Francisco J, Parrilla, Dácil, Pasha, Taha, Pasin, Laura, Patão, Luis, Patel, Mayur, Patel, Grisma, Pati, Basanta Kumar, Patil, Jayaprakash, Pattnaik, Saroj, Paul, Daniel, Pavesi, Maurizio, Pavlotsky, Vanesa Alejandra, Paz, Graciela, Paz, Enrique, Pecci, Elisabetta, Pellegrini, Carlos, Peña Padilla, Andrea Gabriela, Perchiazzi, Gaetano, Pereira, Tiago, Pereira, Vera, Perez, Manuel, Perez Calvo, Cesar, Perez Cheng, Meisy, Perez Maita, Ronald, Pérez-Araos, Rodrigo, Perez-Teran, Purificación, Perez-Torres, David, Perkins, Gavin, Persona, Paolo, Petnak, Tananchai, Petrova, Marina, Pham, Tai, Philippart, François, Picetti, Edoardo, Pierucci, Elisabetta, Piervincenzi, Edoardo, Pinciroli, Riccardo, Pintado, Maria-Consuelo, Piquilloud, Lise, Piraino, Thomas, Piras, Stephanie, Piras, Claudio, Pirompanich, Pattarin, Pisani, Luigi, Platas, Enrique, Plotnikow, Gustavo, Porras, Willy, Porta, Virginia, Portilla, Mariana, Portugal, José, Povoa, Pedro, Prat, Gwenael, Pratto, Romina, Preda, Gabriel, Prieto, Isidro, Prol-Silva, Estefania, Pugh, Richard, Qi, Yupeng, Qian, Chuanyun, Qin, Tiehe, Qiu, Haibo, Qu, Hongping, Quintana, Teobaldo, Quispe Sierra, Rosari, Quispe Soto, Rocio, Rabbani, Raihan, Rabee, Mohamed, Rabie, Ahmed, Rahe Pereira, Maria Augusta, Rai, Ashish, Raj Ashok, Sundar, Rajab, Mostafa, Ramdhani, Navin, Ramey, Elizabeth, Ranieri, Marco, Rathod, Darshana, Ray, Banambar, Redwanul Huq, Shihan Mahmud, Regli, Adrian, Reina, Rosa, Resano Sarmiento, Natalia, Reynaud, Faustine, Rialp, Gemma, Ricart, Pilar, Rice, Todd, Richardson, Angus, Rieder, Marcelo, Rinket, Martin, Rios, Fernando, Rios, Fernando, Risso Vazquez, Alejandro, Rittayamai, Nuttapol, Riva, Ivano, Rivette, Monaly, Roca, Oriol, Roche-Campo, Ferran, Rodriguez, Covadonga, Rodriguez, Gabriel, Rodriguez Gonzalez, Daniel, Rodriguez Tucto, Xandra Yanina, Rogers, Angela, Romano, María Elena, Rørtveit, Linda, Rose, Alastair, Roux, Damien, Rouze, Anahita, Rubatto Birri, Paolo Nahuel, Ruilan, Wang, Ruiz Robledo, Aldana, Ruiz-Aguilar, Antonio Luis, Sadahiro, Tomohito, Saez, Ignacio, Sagardia, Judith, Saha, Rajnish, Saha, Rohit, Saiphoklang, Narongkorn, Saito, Shigeki, Salem, Maie, Sales, Gabriele, Salgado, Patricia, Samavedam, Srinivas, Sami Mebazaa, Mhamed, Samuelsson, Line, San Juan Roman, Nandyelly, Sanchez, Patricia, Sanchez-Ballesteros, Jesus, Sandoval, Yazcitk, Sani, Emanuele, Santos, Martin, Santos, Carla, Sanui, Masamitsu, Saravanabavan, Lakshmikanthcharan, Sari, Sema, Sarkany, Agnes, Sauneuf, Bertrand, Savioli, Monica, Sazak, Hilal, Scano, Riccardo, Schneider, Francis, Schortgen, Frédérique, Schultz, Marcus J, Schwarz, Gabriele Leonie, Seçkin Yücesoy, Faruk, Seely, Andrew, Seiler, Frederik, Seker Tekdos, Yasemin, Seok Chan, Kim, Serano, Luca, Serednicki, Wojciech, Serpa Neto, Ary, Setten, Mariano, Shah, Asim, Shah, Bhagyesh, Shang, You, Shanmugasundaram, Pradeep, Shapovalov, Konstantin, Shebl, Eman, Shiga, Takuya, Shime, Nobuaki, Shin, Phil, Short, Jack, Shuhua, Chen, Siddiqui, Sughrat, Silesky Jimenez, Juan Ignacio, Silva, Daniel, Silva Sales, Betania, Simons, Koen, Sjøbø, Brit Ågot, Slessor, David, Smiechowicz, Jakub, Smischney, Nathan, Smith, Paul, Smith, Tim, Smith, Mark, Snape, Sarah, Snyman, Lindi, Soetens, Filiep, Sook Hong, Kyung, Sosa Medellin, Miguel Ángel, Soto, Giovanna, Souloy, Xavier, Sousa, Elsa, Sovatzis, Stefania, Sozutek, Didem, Spadaro, Savino, Spagnoli, Marco, Spångfors, Martin, Spittle, Nick, Spivey, Mike, Stapleton, Andrew, Stefanovic, Branislava, Stephenson, Lorraine, Stevenson, Elizabeth, Strand, Kristian, Strano, Maria Teresa, Straus, Slavenka, Sun, Chenliang, Sun, Rongqing, Sundaram, Venkat, SunPark, Tai, Surlemont, Elisabeth, Sutherasan, Yuda, Szabo, Zsuzsanna, Szuldrzynski, Konstanty, Tainter, Christopher, Takaba, Akihiro, Tallott, Mandy, Tamasato, Tamasato, Tang, Zhanhong, Tangsujaritvijit, Viratch, Taniguchi, Leandro, Taniguchi, Daisuke, Tarantino, Fabio, Teerapuncharoen, Krittika, Temprano, Susana, Terragni, Pierpaolo, Terzi, Nicolas, Thakur, Anand, Theerawit, Pongdhep, Thille, Arnaud W, Thomas, Matt, Thungtitigul, Poungrat, Thyrault, Martial, Tilouch, Nejla, Timenetsky, Karina, Tirapu, Juna, Todeschini, Manuel, Tomas, Roser, Tomaszewski, Christian, Tonetti, Tommaso, Tonnelier, Alexandre, Trinder, John, Trongtrakul, Konlawij, Truwit, Jonathon, Tsuei, Betty, Tulaimat, Aiman, Turan, Sema, Turkoglu, Melda, Tyagi, Sanjeev, Ubeda, Alejandro, Vagginelli, Federica, Valenti, María Florencia, Vallverdu, Imma, Van Axel, Alisha, van den Hul, Ingrid, van der Hoeven, Hans, Van Der Meer, Nardo, Van Haren, Frank, Vanhoof, Marc, Vargas-Ordoñez, Mónica, Vaschetto, Rosanna, Vascotto, Ettore, Vatsik, Maria, Vaz, Ana, Vazquez-Sanchez, Antonia, Ventura, Sara, Vermeijden, Jan Wytze, Vidal, Anxela, Vieira, Jocyelle, Vilela Costa Pinto, Bruno, Villagomez, Asisclo, Villagra, Ana, Villegas Succar, Cristina, Vinorum, Ole Georg, Vitale, Giovanni, Vj, Ramesh, Vochin, Ana, Voiriot, Guillaume, Volta, Carlo Alberto, von Seth, Magnus, Wajdi, Maazouzi, Walsh, Don, Wang, Shouhong, Wardi, Gabriel, Ween-Velken, Nils Christian, Wei, Bi-Lin, Weller, Dolf, Welsh, Deborah, Welters, Ingeborg, Wert, Michael, Whiteley, Simon, Wilby, Elizabeth, Williams, Erin, Williams, Karen, Wilson, Antoinette, Wojtas, Jadwiga, Won Huh, Jin, Wrathall, David, Wright, Christopher, Wu, Jian-Feng, Xi, Guo, Xing, Zheng-Jiang, Xu, Hongyang, Yamamoto, Kotaro, Yan, Jie, Yáñez, Julio, Yang, Xiaobo, Yates, Elliot, Yazicioglu Mocin, Ozlem, Ye, Zhenglong, Yildirim, Fatma, Yoshida, Norifumi, Yoshido, Hector Higo Leon, Young Lee, Bo, Yu, Rongguo, Yu, Gong, Yu, Tao, Yuan, Boyun, Yuangtrakul, Nadwipa, Yumoto, Tetsuya, Yun, Xie, Zakalik, Graciela, Zaki, Ahmad, Zalba-Etayo, Begoña, Zambon, Massimo, Zang, Bin, Zani, Gianluca, Zarka, Jonathan, Zerbi, Simone Maria, Zerman, Avsar, Zetterquist, Harald, Zhang, Jiuzhi, Zhang, Hongwen, Zhang, Wei, Zhang, Guoxiu, Zhang, Weixin, Zhao, Hongsheng, Zheng, Jia, Zhu, Bin, and Zumaran, Ronald

Abstract

Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.

Published
2023
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8. One-Year Follow up of Noninvasive Respiratory Support in General Wards.

Author

Moretto, Francesca, Fracazzini, Martina, Verdina, Federico, Ferrante, Daniela, Baino, Sara, Grossi, Francesca, Castello, Luigi, Cammarota, Gianmaria, Balbo, Piero, Sainaghi, Pier Paolo, Campanini, Mauro, Pirisi, Mario, Patti, Giuseppe, Dal Molin, Alberto, Della Corte, Francesco, Navalesi, Paolo, and Vaschetto, Rosanna

Subjects
PATIENT aftercare, PNEUMONIA, LENGTH of stay in hospitals, RESPIRATORY insufficiency, SCIENTIFIC observation, ACADEMIC medical centers, AGE distribution, CONTINUOUS positive airway pressure, LOG-rank test, TREATMENT duration, HEALTH outcome assessment, RETROSPECTIVE studies, DO-not-resuscitate orders, MANN Whitney U Test, FISHER exact test, REGRESSION analysis, ARTIFICIAL respiration, HOSPITAL mortality, PATIENT monitoring, RISK assessment, PULMONARY edema, OBSTRUCTIVE lung diseases, INTERPROFESSIONAL relations, DESCRIPTIVE statistics, KAPLAN-Meier estimator, SURVIVAL analysis (Biometry), STATISTICAL hypothesis testing, MEDICAL appointments, LOGISTIC regression analysis, DATA analysis software, ACUTE diseases, PROPORTIONAL hazards models
Abstract

BACKGROUND: Noninvasive respiratory support (NRS) has been used to treat acute respiratory failure outside the ICU, but existing data have left many knowledge gaps for managing NRS in general wards. The primary objective of this study was to describe indications, duration of treatment, and outcomes of subjects treated with NRS outside the ICU. The secondary objective was to compare outcomes based on age < 80 or ≥ 80 y. METHODS: This retrospective observational study was conducted at Maggiore della Carita University Hospital in Novara, Italy, and included all patients treated with noninvasive ventilation (NIV) or CPAP outside the ICU from November 2017 to October 2018, with 1 year of follow-up. RESULTS: Of the 570 treatments performed, 383 subjects were analyzed, 136 NIV and 247 CPAP. Subjects' median (interquartile range [IQR]) age was 79 (72-85) y, and the main diagnoses of respiratory failure were cardiogenic pulmonary edema in 128 subjects (33%), pneumonia in 99 (26%), and COPD exacerbation in 52 (14%), with a median (IQR) treatment duration of 38 (16-74) h. Rapid response team visits lasted a median (IQR) 3 (2-6) d. Interface-related pressure lesions occurred in 13% of the subjects, in no case leading to definitive treatment discontinuation. Compared with the subjects ≥ 80 y old, the younger subjects had a median (IQR) longer hospitalization (16 [10-24] d vs 13 [9-20] d; P = .003) but slightly decreased in-hospital mortality (21% vs 30%; P = .061) and a decreased post-discharged 1-year mortality in hospital survivors (25% vs 41%; P = .002), differences observed only in the subjects treated with NIV. CONCLUSIONS: In a real-life setting outside the ICU, NIV and CPAP managed by a rapid response team with a daily visit in collaboration with ward staff highly experienced in NRS allowed us to treat the subjects without major complications. Post-discharge 1-year mortality was higher in the subjects ≥ 80 y old treated with NIV for acute hypercapnic respiratory failure. [ABSTRACT FROM AUTHOR]

Published
2022
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9. Renal-Resistive Index and Acute Kidney Injury in Aortic Surgery: An Observational Pilot Study.

Author

Valeri, Ilaria, Persona, Paolo, Pivetta, Emanuele, De Rosa, Silvia, Cescon, Rossella, Petranzan, Enrico, Antonello, Michele, Grego, Franco, and Navalesi, Paolo

Abstract

Acute kidney injury (AKI) is a common perioperative complication in patients undergoing cardiovascular surgery, increasing mortality, morbidities, and costs. Recently, growing interest has risen in the use of the renal-resistive index (RRI) as a predictor of perioperative AKI. The aim of this study was to evaluate the role of RRI variation to identify postoperative AKI. An observational, prospective, pilot study. Department of Vascular Surgery, University Hospital of Padova. The study authors included 53 consecutive patients undergoing aortic surgery from September 2018 to June 2019. Basal and daily postoperative serum creatinine and urine output were assessed. RRI was measured preoperatively and on the first postoperative day. AKI was defined using Kidney Disease Improving Global Outcome criteria. Twelve patients out of 53 developed AKI. The RRI percentage increase (%RRI) was associated with the development of AKI by univariate regression (p = 0.01). The receiver operating characteristic curve showed an overall diagnostic accuracy of 0.75 (95% confidence interval [CI], 58.2-92.6). The cutoff of 7 percentage points in the %RRI resulted in early identification of AKI onset with 90% specificity (95% CI, 76.9-97.3). The net benefit of postoperative RRI-based management was 11%. RRI variation could be a useful tool to investigate kidney function in patients undergoing aortic surgery. The %RRI in the perioperative time seems to detect AKI onset early and potentially could enhance renal-protective management within 24 hours after surgery. [ABSTRACT FROM AUTHOR]

Published
2022
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10. Renal-Resistive Index and Acute Kidney Injury in Aortic Surgery: An Observational Pilot Study.

Author

Valeri, Ilaria, Persona, Paolo, Pivetta, Emanuele, De Rosa, Silvia, Cescon, Rossella, Petranzan, Enrico, Antonello, Michele, Grego, Franco, and Navalesi, Paolo

Abstract

Acute kidney injury (AKI) is a common perioperative complication in patients undergoing cardiovascular surgery, increasing mortality, morbidities, and costs. Recently, growing interest has risen in the use of the renal-resistive index (RRI) as a predictor of perioperative AKI. The aim of this study was to evaluate the role of RRI variation to identify postoperative AKI. An observational, prospective, pilot study. Department of Vascular Surgery, University Hospital of Padova. The study authors included 53 consecutive patients undergoing aortic surgery from September 2018 to June 2019. Basal and daily postoperative serum creatinine and urine output were assessed. RRI was measured preoperatively and on the first postoperative day. AKI was defined using Kidney Disease Improving Global Outcome criteria. Twelve patients out of 53 developed AKI. The RRI percentage increase (%RRI) was associated with the development of AKI by univariate regression (p = 0.01). The receiver operating characteristic curve showed an overall diagnostic accuracy of 0.75 (95% confidence interval [CI], 58.2-92.6). The cutoff of 7 percentage points in the %RRI resulted in early identification of AKI onset with 90% specificity (95% CI, 76.9-97.3). The net benefit of postoperative RRI-based management was 11%. RRI variation could be a useful tool to investigate kidney function in patients undergoing aortic surgery. The %RRI in the perioperative time seems to detect AKI onset early and potentially could enhance renal-protective management within 24 hours after surgery. [ABSTRACT FROM AUTHOR]

Published
2022
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11. Citing retracted literature: a word of caution.

Author

De Cassai, Alessandro, Volpe, Francesco, Geraldini, Federico, Dost, Burhan, Boscolo, Annalisa, and Navalesi, Paolo

Abstract

Introduction Inappropriate citation of retracted literature is a common problem in the general medical literature. In 2020, more than 2300 articles were retracted, a dramatic increase from 38 in 2000. By exploring a contemporary series of retractions by one research group, we aimed to evaluate if citations of retracted articles is occurring in the area of regional anesthesiology. Methods Using the Scopus database, we examined the full text of all the articles citing research articles coauthored by an anesthesiologist who had multiple articles retracted in 2022. After excluding the research articles citing non-retracted articles authored by the above mentioned anesthesiologist, we included in our analysis all the articles containing a retracted citation and published after the retraction notice. Results The search was performed on October 30, 2022, retrieving a total of 121 articles citing the researcher's work. Among the retrieved articles, 53 correctly cited non-retracted research and 37 were published before the retraction notice. Among the 31 remaining articles, 42 retracted research papers were cited. Twenty-five of the retracted articles were cited in the Discussion section of the manuscripts, 15 in the Introduction section, 1 in the Methods section (description of a technique), and one was cited in a review. No manuscript used the flawed data to calculate the sample size. Discussion In this contemporary example from the regional anesthesia literature, we identified that citation of retracted work remains a common phenomenon. [ABSTRACT FROM AUTHOR]

Published
2023
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12. Identifying and analyzing extremely productive authors in intensive care medicine: A scientometric analysis

Author

Zarantonello, Francesco, Sella, Nicolò, De Cassai, Alessandro, Aviani Fulvio, Giulia, Boscolo, Annalisa, Pettenuzzo, Tommaso, Mormando, Giulia, and Navalesi, Paolo

Abstract

Clinical progress relies heavily on research, however, recent years have seen distortions in this process due to the “publish or perish” model. This model is further amplified by team science, leading to inflated author counts and metrics. Recently the rise of hyperprolific (HA) and almost hyperprolific (AHA) authors has been highlighted in the global literature scenario, but data on intensive care medicine (ICM) is lacking. This study aims to investigate HA and AHA authors in ICM and the impact of COVID-19 pandemic on publication rates.

Published
2025
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14. Diaphragmatic Kinetics Assessment by Tissue Doppler Imaging and Extubation Outcome.

Author

Cammarota, Gianmaria, Boniolo, Ester, Santangelo, Erminio, De Vita, Nello, Verdina, Federico, Crudo, Samuele, Sguazzotti, Ilaria, Perucca, Raffaella, Messina, Antonio, Zanoni, Marta, Azzolina, Danila, Navalesi, Paolo, Longhini, Federico, Vetrugno, Luigi, Bignami, Elena, Corte, Francesco della, Tarquini, Riccardo, De Robertis, Edoardo, and Vaschetto, Rosanna

Subjects
DIAPHRAGM physiology, SCIENTIFIC observation, RESPIRATORY insufficiency, CONTINUOUS positive airway pressure, MECHANICAL ventilators, MANN Whitney U Test, FISHER exact test, DYNAMICS, DOPPLER echocardiography, EXTUBATION, TREATMENT effectiveness, ARTIFICIAL respiration, DESCRIPTIVE statistics, CARDIAC arrest, RESPIRATORY organ physiology, RECEIVER operating characteristic curves, RESPIRATION, LONGITUDINAL method, COMORBIDITY, DISEASE risk factors
Abstract

BACKGROUND: The assessment of diaphragmatic kinetics through tissue Doppler imaging (dTDI) was recently proposed as a means to describe diaphragmatic activity in both healthy individuals and intubated patients undergoing weaning from mechanical ventilation. Our primary aim was to investigate whether the diaphragmatic excursion velocity measured with dTDI at the end of a spontaneous breathing trial (SBT) was different in subjects successfully extubated versus those who passed the trial but exhibited extubation failure within 48 h after extubation. METHODS: We enrolled 100 adult subjects, all of whom had successfully passed a 30-min SBT conducted in CPAP of = cm H2O. In cases of extubation failure within 48 h after liberation from invasive mechanical ventilation, subjects were re-intubated or supported through noninvasive ventilation. dTDI was performed at the end of the SBT to assess excursion, velocity, and acceleration. RESULTS: Extubation was successful in 79 subjects, whereas it failed in 21 subjects. The median (interquartile range [IQR]) inspiratory peak excursion velocity (3.1 [IQR 2.0-4.3] vs 1.8 [1.3-2.6] cm/s, P < .001), mean velocity (1.6 [IQR 1.2-2.4] vs 1.1 [IQR 0.8-1.4] cm/s, P < .001), and acceleration (8.8 [IQR 5.0-17.8] vs 4.2 [IQR 2.4-8.0] cm/s², P = .002) were all significantly higher in subjects who failed extubation compared with those who were successfully extubated. Similarly, the median expiratory peak relaxation velocity (2.6 [IQR 1.9-4.5] vs 1.8 [IQR 1.2-2.5] cm/s, P < .001), mean velocity (1.1 [IQR 0.7-1.7] vs 0.9 [IQR 0.6-1.0] cm/s, P = .002), and acceleration (11.2 [IQR 9.1-19.0] vs 7.1 [IQR 4.6-12.0] cm/s², P = .004) were also higher in the subjects who failed extubation. CONCLUSIONS: In our setting, at the end of SBT, subjects who developed extubation failure within 48 h after extubation experienced a greater diaphragmatic activation compared with subjects who were successfully extubated. (ClinicalTrials.gov registration NCT03962322.) [ABSTRACT FROM AUTHOR]

Published
2021
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16. High-flow nasal cannula oxygen therapy for outpatients undergoing flexible bronchoscopy: a randomised controlled trial

Author

Longhini, Federico, Pelaia, Corrado, Garofalo, Eugenio, Bruni, Andrea, Placida, Roberta, Iaquinta, Caterina, Arrighi, Eugenio, Perri, Graziella, Procopio, Giada, Cancelliere, Anna, Rovida, Serena, Marrazzo, Giuseppina, Pelaia, Girolamo, and Navalesi, Paolo

Abstract

IntroductionHigh-flow nasal cannula (HFNC) provides benefits to patients undergoing flexible bronchoscopy (FOB). We compared the effects of HFNC versus standard therapy (ST) on gas exchange, lung volume and diaphragm function in patients undergoing FOB for bronchoalveolar lavage (BAL).Methods36 outpatients were randomised to ST or HFNC. Arterial blood gases, episodes of severe desaturation, changes of end-expiratory lung impedance (ΔEELI), diaphragm ultrasound were recorded. Measurements were done at baseline (T0), after bronchoscope insertion (T1), at the end of the procedure (T2) and 10 min afterwards (T3).ResultsArterial partial oxygen pressure (PaO2) was not different between T0 (10.8 (95% CI 8.7 to 12.0) kPa and T2 (11.1 (95% CI 10.4 to 12.0) kPa) with HFNC, while decreased from 11.1 (95% CI 10.5 to 12.1) to 9.1 (95% CI 8.4 to 9.8) kPa with ST. At T2, PaO2was significantly higher with HFNC than with ST (p<0.001). Also, with HFNC, compared with ST, fewer desaturations occurred (11% vs 56%; p<0.01). ΔEELI was no different at the different time points with HFNC, while with ST there was a significant decrease at T1 (−170 (95% CI −382 to −32) mL, p=0.003), T2 (−211 (95% CI −425 to −148) mL, p<0.001) and T3 (−213 (95% CI −398 to −81) mL, p<0.001), as opposed to T0. EELI was lower with ST than HFNC at T1 (p=0.006), T2 (p=0.001) and T3 (p=0.002). Diaphragm displacement was no different between groups (p=0.748), while the thickening fraction significantly increased at T1 and T2 with ST only (p<0.01).ConclusionsDuring FOB for BAL, HFNC improves gas exchange, avoiding loss of end-expiratory lung volume and preventing increase of diaphragm activation.Trial registration numberNCT04016480.

Published
2022
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17. Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial

Author

Pearse, Rupert, Ranieri, Marco, Abbott, Tom, Pakats, Mari-Liis, Piervincenzi, Edoardo, Patel, Akshaykumar, Kahan, Brennan, Rhodes, Andrew, Dias, Priyanthi, Hewson, Russell, Jammer, Ib, Chew, Michelle, Aldecoa, Cesar, Rodseth, Reitze, Biccard, Bruce, Stephens, Tim, Payne, Sara, Hepworth, David, Pischke, Soeren, Asvall, Joerund, Hausken, John, Jhanji, Shaman, Rooms, Martin, Flint, Neil, Hales, Dawn, Szakmany, Tamas, Leitch, Andrew, Spadaro, Savino, Chiumello, Davide, Johnston, Paul, Yeung, Joyce, Tellan, Guglielmo, Veenith, Tonny, Macmillan, Josep, Terragni, Pierpaolo, Sander, Caroline, Kasipandian, Vidya, Ahmad, Tahania, Lee, Aaron, Tammaro, Marcello, McAuley, Danny, Skene, Simon, Vohra, Ravinder, Wilson, Matt, Edwards, Mark, Griffiths, Ewen, Pritchard, Naomi, Filippini, Claudia, Aasmundstad, Tor, Aksnes, Einar, Alpers, Lise-Merete, Barratt-Due, Andreas, Dahl, Anita, Feldt, Linda, Figari, Elisa, Flåten, Eva, Granheim, Karen, Hagring, Minna, Haugaa, Håkon, Kjoesen, Gisle, Klaevahaugen, Inge, Lenz, Harald, Myhre, Marianne, Orrem, Hilde, Stitt, Emily, Toennessen, Tor Inge, Al-Kadhimi, Samuel, Anker, Robert, Balint, Mihaela, Barraclough, Lauren, Black, Ethel, Clayton, Matt, Conneely, Leonora, Edwards, Zara, Eeles, Alex, Evans, Matthew, Gerstman, Michelle, Greenshields, Nicole, Harvey, Eleanor, Hegarty, Aoife, Hester, Natalie, Hutchinson, Jenna, Kasivisvanathan, Ramanathan, Lawrence, Helen, Marsh, Veronica, Matthews, Laura, Mazzola, Francesca, McCanny, Jamie, Morrison, Ben, O'Mahony, Michelle, Pang, Ching Ling, Parkinson, David, Pirie, Katrina, Rao Baikady, Ravishankar, Shovel, Louisa, Smith, Lorna, Tatham, Kate, Thomas, Peter, Uren, Sophie, Walker, Susanna, Wills, Alasdair, Andreou, Prematie, Howson, Alex, Kaur, Jasmin, Lewszuk, Adam, Molina, Esther, Ramsamy, Nirmalabaye, Roberts, Emma, Amaral, Vanessa, Begum, Salma, Bekele, Soliana, Cashmore, Richard, Correia, Carmen, Dunkley, Steven, Fernandez, Maria, Fowler, Alexander, Garcia, Amaia, Della Giovampaola, Maria, Greaves, Kathryn, Griffiths, Bethan, Haines, Ryan, Haslop, Richard, Hu, Ying, Hui, Sarah, Januszewska, Marta, Manon, Vasi, Martin, Tim, May, Shaun, Minicozzi, Annamaria, Niebrzegowska, Edyta, Oliveira, Monica, Pates, Katherine, Santos, Filipa, Shahid, Tasnin, Simili, Paolo, Somerville, Alastair, Subhedar, Emily, Uddin, Ruzena, Walker, Sophie, Wan, Yize, Whalley, Jan, Zolfaghari, Parjam, Gunter, Una, Hodkinson, Gemma, Howe, Gwenllian, Baratozzi, Valentina, Casotto, Giulia, Darai, Giulia, Ferrari, Erica, Mistraletti, Giovanni, Palmaverdi, Valentina, Furlani, Stefano, Priani, Paolo, Ragazzi, Riccardo, Salmaso, Marco, Verri, Marco, Volta, Carlo, Nutt, Chris, McKay, Emma, O'Neill, Orla, Patel, Jaimin, Atterbury, Katie, Ballinger, Sarah, Carling, Natalie, Ellis, Kaytie, Gresty, Jo, Melody, Teresa, Monk, Jade, Norman, Chloe, Reeves, Eleanor, Sampson, Julia, Sutton, Peter, Thomas, Marie, Bamford, Amy, Bergin, Colin, Carrera, Ronald, Cooper, Lauren, Despy, Liesl, Ellis, Karen, Fellows, Emma, Goundry, Stephanie, Harkett, Samantha, Ip, Peter, Mason, Tracy, McGhee, Christopher, McLaughlin, Aisling, Neal, Aoife, Pope, Martin, Porter, Stephanie, Smith, Hazel, Snelson, Catherine, Spruce, Elaine, Vigo, Ylenia, Whitehouse, Arlo, Whitehouse, Tony, Donatiello, Maria, Gazzanelli, Sergio, Mezzapesa, Mario, Savino, Martina, Settesoldi, Giacomo, Kunst, Gudrun, Birch, Sian, Greig, Louise, Noble, Harriet, Pappa, Evita, Penhaligon, Bethany, Cossu, Andrea, Floris, Leda, Piredda, Davide, Racca, Alberto, Brattstrom, Olof, Heggelund, Bente, Flodberg, Magnus, Månsson, Sandra, Ahmed, Mamoona, Allen, Jonathan, Bell, Paula, Genetu, Roman, Glennon, Julia, Hanley, Janice, Jenner, Katy, Jogi, Summayyah, Mahjoob, Parisa, McGovern, Clare, Murphy, Anthony, Nazari, Roonak, Routledge, Jacki, Uttamlal, Trishna, Ward, Sinead, Iotti, Giorgio, Picchioni, Raffaella, Poma, Silvia, Navalesi, Paolo, Bruni, Andrea, De Leonardis, Brunella, Garofalo, Eugenio, Patel, Panna, McArthur, Carol, Burns, Karen, Peters, Steven, Foti, Giuseppe, Calcinati, Serena, Grassi, Alice, Villa, Silvia, Berridge, John, Kanakaraj, Muthuraj, Cahill, Hazel, Forshaw, Greg, Gibson, Andy, Grainger, Lia, Howard, Kate, James, Katherine, Murphy, Zoe, Sweeting, Helen, Tait, Rebecca, Wilcock, Danielle, Yates, David, Cope, Sean, Allan, Ashley, Betts, Rebecca, Cornell, Sarah, Sheriff, Julie, Woods, Lindsey, Grasselli, Giacomo, Brioni, Matteo, Castagna, Luigi, von Rahden, Richard, Farina, Zane, Green, Samantha, Gumede, Simphiwe, Rajah, Chantal, Ramkillawan, Arisha, Moug, Susan, Alcorn, David, Dalton, Carol, Dickinson, Natalie, Edwards, Jennifer, Henderson, Steven, McIlveen, Erin, Ramsaran, Richard, Bell, Joanne, Fleming, Lorna, Monks, Kathleen, Parker, Jane, Stamper, Sean, Stokes-Denson, Jo, Elías, Elisa, Guerra, Yessica, Rico-Feijoo, Jesus, Kidel, Carlos, Filipe, Helder, Asis, Gretchelle, Gleeson, Yvonne, Harvey, Alice, Jackson, Christine, McNeil, Margaret, Mingo, Sara, Pakou, Glykeria, Pinto, Manuel, Wright, Stephen, Babio-Galan, Maite, Buckley, David, Calder, Verity, Chishti, Ahmad, Cosgrove, Joseph, Cullen, Katherine, Dunn, Leigh, Faulds, Matthew, Fortune, Jonathan, Gardner, Matthew, Harrison, Abigail, Hays, Carole, Jones, Gerry, Macfie, Caroline, Mccullagh, Iain, Nesbitt, Ian, O'Neil, Suzanne, Phoenix, Catherine, Rangaswamy, Girish, Samson, Craig, Scott, Carmen, Shrestha, Tara, Singh, Rita, Soulsby, Graham, Walton, Jon, Zwiggelaar, Kimberley, Lynch, Ceri, Clarke, Heidi, Deacon, Bethan, Ivatt, Helen, Jones, Leanne, Latif, Ahmed, Oram, Shaun, Perman, Chris, Roche, Lisa, Duys, Rowan, Flint, Margot, Bhagwan, Kamal, Coetzee, Ettienne, Joubert, Ivan, Montoya-Pelaez, Felipe, Navsaria, Pradeep, Picken, Guy, Porrill, Owen, Strathie, Grant, Zungu, Thembinkosi, Aluri, Sireesha, Chau, Simon, Cooper, Deborah, Cunningham, Mishell, Daniels, Allison, Hope, Susan, Nicholson, Alice, Walker, Laura, Giarratano, Antonino, Accurso, Giuseppe, Raineri, Santi, Tricoli, Giuseppe, Innes, Richard, Doble, Patricia, Hutter, Joanne, Pawley, Corinne, Tait, Moira, Hamilton, Mark, Andrade, Edward, Barnes, Veronica, Dalton, Claire, Delgado, Carlos, Farnell-Ward, Sarah, Farrah, Helen, Gray, Geraldine, Hegarty, Aoife, Howlett, Luisa, Joseph, Gipsy, Krupa, Monika, Leaver, Susannah, Macedo, Joao, Maher, Karen, Mellinghoff, Johannes, Oguntimehin, Rachel, Pereira, Joel, Robinson, Frances, Ryan, Christine, Shah, Nirav, Shirley, Paula, Torborg, Alexandra, Biyase, Thuli, Drummond, Leanne, Kusel, Belinda, Mbuyisa, Mbalenhle, Solala, Sivuyisiwe, Taylor, Jenna, Ezihe-Ejiofor, Adanma, Aduse-Poku, Maame, Colville, Gary, Davies, Louise, Kang, Soo, Phillips, Alex, Kirk-Bayley, Justin, Kelliher, Leigh, Carvelli, Paula, Daysal, Gokce, Dickinson, Matthew, Doyle, Nancileigh, Hughes, Christina, Montague, Laura, Potter, Elizabeth, Salberg, Armorel, Sibug, Sheena, Sivarajan, Sinduja, Thomson, Milo, Wakeford, Nichola, Rocco, Monica, Alampi, Daniela, Conway, Daniel, Clark, Richard, Maria, Jashmin, Pomeroy, Fiona, Quraishi, Tanviha, Williams, Abigail, Chukkambotla, Srikanth, Aherne, Caroline, Harrison-Briggs, Donna, Fitchett, Jill, Duberley, Stephen, Zanoni, Andrea, Cardinale, Daniela, Righi, Claudia, Blunt, Mark, Fuller, Tracy, Hodgson, Ruth, Rosbergen, Melissa, Brennan, Andrew, Akeroyd, Louise, Boardman, Victoria, Bull, Christopher, Carrick, Mike, Chadderton, Ian, Cooper, Sarah, Goellner, Sarah, Graham, Laura, Ilyas, Carl, King, James, Laklouk, Muhammad, Lawton, Tom, Macrow, Christopher, Munro, Michael, Neep, Adam, Northey, Martin, Peacock, Victoria, Pye, Kate, Radley, Lydia, Sira, James, Smithson, Beth, Syddall, Stuart, Tooth, David, White, Thomas, Hoel, Sindre, Aakre, Elin, Bakke, Monica, Hoivik, Tone, Makowski, Arystarch, Alcock, Harry, Cardoso, Sean, Coetzee, Samantha, Everett, Mary, Ibrahim, Mohamed, Kouridaki, Christina, Ogbeide, Vongayi, Bertellini, Elisabetta, Bertolotti, Valentina, Buono, Antonio, Fanigliulo, Maria, Kumar, Ram, Richards, Nicole, Allana, Alisha, Bacciarelli, Samantha, Barker, Helen, De Bois, Jessica, Bradley, Isabel, Crooks, Jennifer, Daum, Peter, Feben, Alex, Gannon, Lizzie, Kipling, Sarah, Peetamsingh, Andrew, Quamina, Charlotte, Sethi, Sahiba, Sivadhas, Harry, Sollesta, Kathryn, Swain, Andrew, Tan, Evalyn, Willis, Joan, Zou, Maggie, Cranshaw, Julius, Barratt, Nina, Bowman, Katie, Branney, Debbie, Letts, Maria, Pitts, Sally, Day, Christopher, Benyon, Sarah, Eddy, Sara, Green, Adam, Grice, Anna, Kelly, Sinéad, Mackle, Daisy, Mariano, Victor, Park, Linda, Sibley, Pauline, Spencer, William, Bignami, Elena, Bellini, Valentina, Forfori, Francesco, Curci, Maria, Leo, Alessandra, Jackson, Matthew, Awolesi, Jennifer, Hodgkinson, Sheila, Kent, Alissa, Leonard, Dee, Stapleton, Claire, Tibke, Clare, Alexander-Sefre, Farhad, Campey, Lorraine, Hall, Kathryn, Spimpolo, Jennifer, Nilsson, Malin, Didriksson, Helen, Hamilton, Emma, Carnahan, Mandy, Mowatt, Chris, Stickley, Jo, Corcione, Antonio, Rossi, Giuseppe, Fladby, Hege, Andersen, Nina, Bjoernå, Gunhild, Reite, Mads, Roertveit, Linda, Seidel, Philipp, Arnold, Glenn, Benavente, Melissa, Chattersingh, Anjalee, Chironga, Nyasha, Hornzee, Gillian, Kibaru, Joyce, Malik, Ihtisham, McLeavy, Laura, Pathmanathan, Byiravey, Prior, Florence, Strudwick, Rhea, Vezyrgiannis, Marios, Sinha, Aneeta, Babu, Sheeba, Batuwitage, Bisanth, Daly, Zoe, Ellinor, Katharine, Hawes, Elizabeth, Holmes, Ann, Hudson, Karen, Nightingale, Jeremy, Le Poidevin, Alison, Roberts, Lindsey, Kubisz-Pudelko, Agnieszka, Allison, Joanna, Pippard, Lucy, Hamlyn, Vincent, Organ, Angie, Ezihe-Ejiofor, Adanma, Prabhahar, Thaventhran, Bridger, Hayley, Dvorkin, Lee, Manhas, Vitul, Vincent, Rachel, Laha, Shondipon, Cromie, Terri-Louise, Doyle, Donna, Howarth, Rachel, Verlander, Mark, Watt, Ailsa, Williams, Alexandra, Antonelli, Massimo, Cutuli, Salvatore, Montini, Luca, Graterol, Juan, Adams, Benita, Bean, Sarah, Burt, Karen, Hammonds, Fiona, Jigajinni, Suyogi, Fulton, Laura, Kinghorn, Stephen, Mullenheim, Jost, Baillie, Kirsty, Cain, Martyn, Colling, Kerry, Hannaway, Carol, Corso, Ruggero, Calli, Morena, Ferrando, Carlos, Romero, Esther, Jorge-Monjas, Pablo, Soria-García, María, Gómez-Herreras, José, Rodríguez-Jiménez, Rita, and De Prada-Martín, Blanca

Abstract

Respiratory complications are an important cause of postoperative morbidity. We aimed to investigate whether continuous positive airway pressure (CPAP) administered immediately after major abdominal surgery could prevent postoperative morbidity.

Published
2021
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18. Efficacy and tolerability of tapentadol for the treatment of chronic low back pain in elderly patients.

Author

Freo, Ulderico, Furnari, Maurizio, Ambrosio, Francesco, and Navalesi, Paolo

Abstract

Background: Chronic low back pain (CLBP) is a highly prevalent and disabling condition in the elderly, and yet it is undertreated and understudied in this patient population. Tapentadol is a central analgesic with an improved tolerability profile that may be particularly beneficial to the elderly CLBP. Methods: We performed an observational retrospective study to comparatively assess the efficacy and tolerability of tapentadol in young and elderly patients with severe CLBP. Sixtyfive young patients (< 65 years) and 87 elderly patients (≥ 65 years) were titrated on tapentadol extended release to their optimal dose (25–250 mg bid) over 1 month and, then, maintained at that dose for 3 months. The primary endpoint were changes from baseline in 24-h pain intensity on a 0–10 Numerical Rating Scale (NRS) at month-4 of treatment (titration plus maintenance periods). Patients were assessed for several efficacy and tolerability outcomes using a battery of scales and tests for neuropathic pain intensity, quality of life and sleep, and cognitive and gastrointestinal functions. Results: At pretreatment, young and elderly patients had similar pain intensities with younger patients presenting with more intense depressive and neuropathic pain symptoms, and lesser comorbidities and durations of pain (P < 0.05). Thirty-eight patients discontinued treatment because of adverse events occurring mostly during titration. Treatment with tapentadol was associated with comparable and clinically meaningful pain reductions in 24-h NRS from baseline to treatment month-4 both in young and elderly patients (− 5.3 ± 1.4 and – 4.8 ± 2.1; P < 0.01); a 50% pain relief was achieved in 66% and 58% of young and elderly patients. The percentage of patients with a neuropathic component decreased similarly in young and elderly patients (from 38 to 0% and from 19 to 3%; P < 0.01). Quality of life and sleep improved. The performances in global cognition and sustained attention tasks remained stable or improved across all age group. Conclusions: These findings indicate that tapentadol extended release maintains efficacy and good tolerability in CLBP patients with advancing age. [ABSTRACT FROM AUTHOR]

Published
2021
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19. Corticosteroids for Patients With Coronavirus Disease 2019 (COVID-19) With Different Disease Severity: A Meta-Analysis of Randomized Clinical Trials.

Author

Pasin, Laura, Navalesi, Paolo, Zangrillo, Alberto, Kuzovlev, Artem, Likhvantsev, Valery, Hajjar, Ludhmila Abrahão, Fresilli, Stefano, Lacerda, Marcus Vinicius Guimaraes, and Landoni, Giovanni

Abstract

Efficacy and safety of corticosteroids in patients with 2019-nCoV (novel coronavirus 2019) infection still are debated. Because large randomized clinical trials (RCTs) and a well-conducted meta-analysis on the use of corticosteroids, focused on patients with coronavirus disease (COVID-19) in intensive care units, recently were published, a meta-analysis of RCTs on corticosteroids therapy in patients with different disease severity was performed to evaluate the effect on survival. A meta-analyses of RCTs was performed. Patients admitted to hospital. Patients with coronavirus disease. Administration of corticosteroids. A search was performed for RCTs of adult patients with acute hypoxemic failure related to 2019-nCoV infection who received corticosteroids versus any comparator. The primary endpoint was mortality rate. Five RCTs involving 7,692 patients were included. Overall mortality of patients treated with corticosteroids was slightly but significantly lower than mortality of controls (26% v 28%, relative risk {RR} = 0.89 [95% confidence interval {CI} 0.82-0.96], p = 0.003). The same beneficial effect was found in the subgroup of patients requiring mechanical ventilation (RR = 0.85 [95% CI 0.72-1.00], p = 0.05 number needed to treat {NNT} = 19). Remarkably, corticosteroids increased mortality in the subgroup of patients not requiring oxygen (17% v 13%, RR = 1.23 [95% CI 1.00-1.62], p = 0.05 number needed to harm {NNH} = 29). Tests for comparison between mechanically ventilated subgroups and those not requiring oxygen confirmed that treatment with corticosteroids had a statistically significant different effect on survival. Patients treated with corticosteroids had a significantly lower risk of need for mechanical ventilation. Corticosteroids may be considered in severe critically ill patients with COVID-19 but must be discouraged in patients not requiring oxygen therapy. Urgently, further trials are warranted before implementing this treatment worldwide. [ABSTRACT FROM AUTHOR]

Published
2021
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21. Pharmacokinetics of lidocaine after bilateral ESP block.

Author

De Cassai, Alessandro, Bonanno, Claudio, Padrini, Roberto, Geraldini, Federico, Boscolo, Annalisa, Navalesi, Paolo, and Munari, Marina

Abstract

Introduction: Erector spinae plane (ESP) block is an emerging interfascial block with a wide range of indications for perioperative analgesia and chronic pain treatment. Recent studies have focused their attention on mechanisms of action of ESP block. However, the pharmacokinetics of drugs injected in ESP is, as of now, uninvestigated. The aim of this brief report is to investigate the pharmacokinetics of lidocaine in a series of 10 patients.Methods: We are reporting a case series of 10 patients undergoing bilateral ESP block for multilevel lumbar spine surgery.ESP was performed with 3.5 mg/kg of lidocaine based on ideal body weight. Lidocaine concentration was dosed at 5, 15, 30 min and at 1, 2 and 3 hours.Results: Tmax was 5 min for all the patients. Cmax ranged from 1.2 to 3.8 mg/L (mean: 2.59 mg/L). AUC0-3 was high (76%, on average) suggesting an almost complete bioavailability. Age had a negative correlation with T½ of lidocaine.Conclusions: Lidocaine pharmacokinetic after ESP block is well-described by a two-compartment model with a rapid and extensive rate of absorption. Nevertheless, its peak concentrations never exceeded the accepted toxicity limit. Elimination half-life was slightly prolonged, probably due to the advanced age of some patients. [ABSTRACT FROM AUTHOR]

Published
2021
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22. Diaphragmatic Dysfunction After Elective Cardiac Surgery: A Prospective Observational Study.

Author

Bruni, Andrea, Garofalo, Eugenio, Pasin, Laura, Serraino, Giuseppe Filiberto, Cammarota, Gianmaria, Longhini, Federico, Landoni, Giovanni, Lembo, Rosalba, Mastroroberto, Pasquale, and Navalesi, Paolo

Abstract

To determine the incidence of postoperative diaphragm dysfunction as diagnosed by ultrasonography. Explorative prospective observational study. University intensive care unit. One hundred consecutive patients undergoing elective cardiac surgery. Diaphragm ultrasound was performed the day before surgery during unassisted breath (D-1), at the first spontaneous breathing trial attempt (D SBT), 24 hours after surgery (D+1), and at intensive care unit (ICU) discharge (D ICU). Diaphragm displacement, inspiratory and expiratory thickness, and the thickening fraction were measured at all timepoints. Primary outcome was assessing the rate of postoperative diaphragm dysfunction, defined as a thickening fraction <20% at D SBT. Secondary outcomes were the number of difficult-to-wean patients, the need for rescue noninvasive ventilation, the reintubation rate, and the ICU length of stay. Thirty-eight patients showed diaphragm dysfunction at D SBT , which resolved over time. No differences in preoperative characteristics and comorbidities were found between patients who developed postoperative diaphragm dysfunction and patients without postoperative disorders. The duration of cardiopulmonary bypass (103 ± 34 v 55 ± 34 min; P < 0.001) was significantly associated with the development of postoperative diaphragm dysfunction. When compared with patients without postoperative diaphragm disorders, patients with diaphragm dysfunction were characterized by a higher rate of difficult weaning (32% v 5%; P < 0.001), lower extubation rate at 24 hours after surgery (50% v 92%; P < 0.001), and longer ICU length of stay (19 [16; 88] v 16 [15; 18] hours; P < 0.001). The incidence of postoperative diaphragm dysfunction after elective cardiac surgery is high and might contribute to prolonging ICU length of stay. [ABSTRACT FROM AUTHOR]

Published
2020
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24. Esophageal Pressure Versus Gas Exchange to Set PEEP During Intraoperative Ventilation.

Author

Cammarota, Gianmaria, Lauro, Gianluigi, Sguazzotti, Ilaria, Mariano, Iolanda, Perucca, Raffaella, Messina, Antonio, Zanoni, Marta, Garofalo, Eugenio, Bruni, Andrea, Della Corte, Francesco, Navalesi, Paolo, Bignami, Elena, Vaschetto, Rosanna, and Mojoli, Francesco

Subjects
ESOPHAGEAL physiology, PELVIC surgery, REACTIVE oxygen species, ANESTHESIA, CENTRAL venous pressure, COMPARATIVE studies, FISHER exact test, HEMODYNAMICS, LENGTH of stay in hospitals, HOSPITALS, INTRAOPERATIVE monitoring, LONGITUDINAL method, LUNGS, INTRAOPERATIVE care, EVALUATION of medical care, MIDAZOLAM, OXYGEN in the body, PATIENT monitoring, PULMONARY gas exchange, RESPIRATORY measurements, STATISTICAL sampling, ELECTIVE surgery, SURGICAL therapeutics, PILOT projects, RANDOMIZED controlled trials, SURGICAL robots, DATA analysis software, PNEUMOPERITONEUM, RESPIRATORY mechanics, DESCRIPTIVE statistics, POSITIVE end-expiratory pressure, HEAD-down tilt position, TERTIARY care, MANN Whitney U Test, FRIEDMAN test (Statistics), EVALUATION
Abstract

BACKGROUND: Pneumoperitoneum and Trendelenburg position affect respiratory system mechanics and oxygenation during elective pelvic robotic surgery. The primary aim of this randomized pilot study was to compare the effects of a conventional low tidal volume ventilation with PEEP guided by gas exchange (VGas-guided) versus low tidal volume ventilation tailoring PEEP according to esophageal pressure (VPes-guided) on oxygenation and respiratory mechanics during elective pelvic robotic surgery. METHODS: This study was conducted in a single-center tertiary hospital between September 2017 and January 2019. Forty-nine adult patients scheduled for elective pelvic robotic surgery were screened; 28 subjects completed the full analysis. Exclusion criteria were American Society of Anesthesiologists physical status ≥ 3, contraindications to nasogastric catheter placement, and pregnancy. After dedicated naso/orogastric catheter insertion, subjects were randomly assigned to VGas-guided (and PEEP set to achieve SpO2> 94%) or VPes-guided (PEEP tailored to equalize end-expiratory transpulmonary pressure). Oxygenation (PaO2/F1O2) was evaluated (1) at randomization, after pneumoperitoneum and Trendelenburg application; (2) at 60 min; (3) at 120 min following randomization; and (4) at end of surgery. Respiratory mechanics were assessed during the duration of the study. RESULTS: Compared to VGas-guided, oxygenation was higher with VPes-guided at 60 min (388 ± 90 vs 308 ± 95 mm Hg, P = .02), at 120 min after randomization (400 ± 90 vs 308 ± 81 mm Hg, P = .008), and at the end of surgery (402 ± 95 vs 312 ± 95 mm Hg, P = .009). Respiratory system elastance was lower with VPes-guided compared to VGas-guided at 20 min (24.2 ± 7.3 vs 33.4 ± 10.7 cm H2O/L, P = .001) and 60 min (24.1 ± 5.4 vs 31.9 ± 8.5 cm H2O/L, P = .006) from randomization. CONCLUSIONS: Oxygenation and respiratory system mechanics were improved when applying a ventilatory strategy tailoring PEEP to equalize expiratory transpulmonary pressure in subjects undergoing pelvic robotic surgery compared to a VGas-guided approach. (ClinicalTrials.gov registration NCT03153592). [ABSTRACT FROM AUTHOR]

Published
2020
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25. Sigh in Patients With Acute Hypoxemic Respiratory Failure and ARDS

Author

Mauri, Tommaso, Foti, Giuseppe, Fornari, Carla, Grasselli, Giacomo, Pinciroli, Riccardo, Lovisari, Federica, Tubiolo, Daniela, Volta, Carlo Alberto, Spadaro, Savino, Rona, Roberto, Rondelli, Egle, Navalesi, Paolo, Garofalo, Eugenio, Knafelj, Rihard, Gorjup, Vojka, Colombo, Riccardo, Cortegiani, Andrea, Zhou, Jian-Xin, D’Andrea, Rocco, Calamai, Italo, Vidal González, Ánxela, Roca, Oriol, Grieco, Domenico Luca, Jovaisa, Tomas, Bampalis, Dimitrios, Becher, Tobias, Battaglini, Denise, Ge, Huiqing, Luz, Mariana, Constantin, Jean-Michel, Ranieri, Marco, Guerin, Claude, Mancebo, Jordi, Pelosi, Paolo, Fumagalli, Roberto, Brochard, Laurent, Pesenti, Antonio, ESICM, Plug working group of, Papoff, Alessandra, Di Fenza, Raffaele, Gianni, Stefano, Spinelli, Elena, Lissoni, Alfredo, Abbruzzese, Chiara, Bronco, Alfio, Villa, Silvia, Russotto, Vincenzo, Iachi, Arianna, Ball, Lorenzo, Patroniti, Nicolò, Spina, Rosario, Giuntini, Romano, Peruzzi, Simone, Menga, Luca Salvatore, Fossali, Tommaso, Castelli, Antonio, Ottolina, Davide, García-de-Acilu, Marina, Santafè, Manel, Schädler, Dirk, Weiler, Norbert, Carvajal, Emilia Rosas, Calvo, César Pérez, Neou, Evangelia, Wang, Yu-Mei, Zhou, Yi-Min, Longhini, Federico, Bruni, Andrea, Leonardi, Mariacristina, Gregoretti, Cesare, Ippolito, Mariachiara, Milazzo, Zelia, Querci, Lorenzo, Ranieri, Serena, Insom, Giulia, Berden, Jernej, Noc, Marko, Mikuz, Ursa, Arzenton, Matteo, Lazzeri, Marta, Villa, Arianna, Barreto, Bruna Brandão, Oliveira Rios, Marcos Nogueira, Gusmao-Flores, Dimitri, Phull, Mandeep, Barnes, Tom, Musarat, Hussain, and Conti, Sara

Abstract

Sigh is a cyclic brief recruitment maneuver: previous physiologic studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity, and increase release of surfactant.

Published
2021
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26. Efficacy and tolerability of tapentadol for the treatment of chronic low back pain in elderly patients

Author

Freo, Ulderico, Furnari, Maurizio, Ambrosio, Francesco, and Navalesi, Paolo

Abstract

Background: Chronic low back pain (CLBP) is a highly prevalent and disabling condition in the elderly, and yet it is undertreated and understudied in this patient population. Tapentadol is a central analgesic with an improved tolerability profile that may be particularly beneficial to the elderly CLBP. Methods: We performed an observational retrospective study to comparatively assess the efficacy and tolerability of tapentadol in young and elderly patients with severe CLBP. Sixtyfive young patients (&lt; 65 years) and 87 elderly patients (≥ 65 years) were titrated on tapentadol extended release to their optimal dose (25–250 mg bid) over 1 month and, then, maintained at that dose for 3 months. The primary endpoint were changes from baseline in 24-h pain intensity on a 0–10 Numerical Rating Scale (NRS) at month-4 of treatment (titration plus maintenance periods). Patients were assessed for several efficacy and tolerability outcomes using a battery of scales and tests for neuropathic pain intensity, quality of life and sleep, and cognitive and gastrointestinal functions. Results: At pretreatment, young and elderly patients had similar pain intensities with younger patients presenting with more intense depressive and neuropathic pain symptoms, and lesser comorbidities and durations of pain (P&lt; 0.05). Thirty-eight patients discontinued treatment because of adverse events occurring mostly during titration. Treatment with tapentadol was associated with comparable and clinically meaningful pain reductions in 24-h NRS from baseline to treatment month-4 both in young and elderly patients (− 5.3 ± 1.4 and – 4.8 ± 2.1; P&lt; 0.01); a 50% pain relief was achieved in 66% and 58% of young and elderly patients. The percentage of patients with a neuropathic component decreased similarly in young and elderly patients (from 38 to 0% and from 19 to 3%; P&lt; 0.01). Quality of life and sleep improved. The performances in global cognition and sustained attention tasks remained stable or improved across all age group. Conclusions: These findings indicate that tapentadol extended release maintains efficacy and good tolerability in CLBP patients with advancing age.

Published
2021
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27. Vancomycin Adsorption During in vitro Model of Hemoperfusion with HA380 Cartridge

Author

Godi, Ilaria, Lorenzin, Anna, De Rosa, Silvia, Golino, Gianlorenzo, Knust, Maira, Gaspar, Ana, Sandini, Alessandra, Fiorin, Francesco, de Cal, Massimo, Navalesi, Paolo, and Ronco, Claudio

Abstract

Introduction:A critical point for using blood purification during sepsis may be the potential interaction with antimicrobial therapy, the mainstay of sepsis treatment. The aim of our study was to investigate the vancomycin removal during hemoperfusion (HP) using HA380 cartridge. Methods:This is an experimental study, in which 500 mL of solution was circulated in a closed-circuit (blood flow of 250 mL/min) simulating HP ran using HA380. Vancomycin was added to reach a through concentration or a very high concentration to evaluate the removal ratio (RR) during 120 min of HP. Comparison between blood-crystalloid solution and balanced solution was performed by using Kruskal-Wallis test. The kinetics of vancomycin removal and the adsorption isotherm were evaluated. Results:We found a complete removal of vancomycin at baseline through concentration of 23.0 ± 7.4 mg/L. Using extremely high concentration (baseline 777.0 ± 62.2 mg/L), RR was 90.1 ± 0.6% at 5 min and 99.2 ± 0.6% at 120 min. No difference in terms of RR was found between blood-crystalloid mixture and balanced solution. The kinetics of the vancomycin reduction followed an exponential decay. Repeated boluses (total amount of 2,000 mg) resulted in cumulative adsorption of 1,919.4 mg with RR of 96.6 ± 1.4%, regardless of the amount injected (100 vs. 500 mg). Vancomycin adsorption onto HA380 followed the Langmuir isotherm model. Conclusions:A considerable amount of vancomycin was rapidly removed during in vitro HP with HA380. Clinical studies are needed to determine whether this may lead to underdosing. Drug therapeutic monitoring is highly recommended when using HA380 for blood purification in patients receiving vancomycin.

Published
2021
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28. Are thromboelastometric and thromboelastographic parameters associated with mortality in septic patients? A systematic review and meta-analysis

Author

Boscolo, Annalisa, Spiezia, Luca, De Cassai, Alessandro, Pasin, Laura, Pesenti, Elisa, Zatta, Matteo, Zampirollo, Stefano, Andreatta, Giulio, Sella, Nicolò, Pettenuzzo, Tommaso, Rose, Kirstin, Simioni, Paolo, and Navalesi, Paolo

Abstract

Thromboelastometry/elastography (ROTEM/TEG) showed promising results for diagnosis of sepsis-induced coagulopathy, but their association with the outcome is unclear. Our aim was to assess any difference in ROTEM/TEG measurements between septic survivors and non-survivors.

Published
2021
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30. Esophageal balloon calibration during Sigh: A physiologic, randomized, cross-over study

Author

Cammarota, Gianmaria, Santangelo, Erminio, Lauro, Gianluigi, Verdina, Federico, Boniolo, Ester, De Vita, Nello, Tarquini, Riccardo, Spinelli, Elena, Garofalo, Eugenio, Bruni, Andrea, Zanoni, Marta, Messina, Antonio, Pesenti, Antonio, Corte, Francesco Della, Navalesi, Paolo, Vaschetto, Rosanna, and Mauri, Tommaso

Abstract

Optimal esophageal balloon filling volume (Vbest) depends on the intrathoracic pressure. During Sigh breath delivered by the ventilator machine, esophageal balloon is surrounded by elevated intrathoracic pressure that might require higher filling volume for accurate measure of tidal changes in esophageal pressure (Pes). The primary aim of our investigation was to evaluate and compare Vbestduring volume controlled and pressure support breaths vs. Sigh breath.

Published
2021
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33. COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City

Author

Borczuk, Alain C., Salvatore, Steven P., Seshan, Surya V., Patel, Sanjay S., Bussel, James B., Mostyka, Maria, Elsoukkary, Sarah, He, Bing, Del Vecchio, Claudia, Fortarezza, Francesco, Pezzuto, Federica, Navalesi, Paolo, Crisanti, Andrea, Fowkes, Mary E., Bryce, Clare H., Calabrese, Fiorella, and Beasley, Mary Beth

Abstract

SARS-CoV-2, the etiologic agent of COVID-19, is a global pandemic with substantial mortality dominated by acute respiratory distress syndrome. We systematically evaluated lungs of 68 autopsies from 3 institutions in heavily hit areas (2 USA, 1 Italy). Detailed evaluation of several compartments (airways, alveolar walls, airspaces, and vasculature) was performed to determine the range of histologic features. The cohort consisted of 47 males and 21 females with a median age of 73 years (range 30–96). Co-morbidities were present in most patients with 60% reporting at least three conditions. Tracheobronchitis was frequently present, independent from intubation or superimposed pneumonia. Diffuse alveolar damage (DAD) was seen in 87% of cases. Later phases of DAD were less frequent and correlated with longer duration of disease. Large vessel thrombi were seen in 42% of cases but platelet (CD61 positive) and/or fibrin microthrombi were present at least focally in 84%. Ultrastructurally, small vessels showed basal membrane reduplication and significant endothelial swelling with cytoplasmic vacuolization. In a subset of cases, virus was detected using different tools (immunohistochemistry for SARS-CoV-2 viral spike protein, RNA in situ hybridization, lung viral culture, and electron microscopy). Virus was seen in airway epithelium and type 2 pneumocytes. IHC or in situ detection, as well as viable form (lung culture positive) was associated with the presence of hyaline membranes, usually within 2 weeks but up to 4 weeks after initial diagnosis. COVID-19 pneumonia is a heterogeneous disease (tracheobronchitis, DAD, and vascular injury), but with consistent features in three centers. The pulmonary vasculature, with capillary microthrombi and inflammation, as well as macrothrombi, is commonly involved. Viral infection in areas of ongoing active injury contributes to persistent and temporally heterogeneous lung damage.

Published
2020
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34. COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City

Author

Borczuk, Alain C., Salvatore, Steven P., Seshan, Surya V., Patel, Sanjay S., Bussel, James B., Mostyka, Maria, Elsoukkary, Sarah, He, Bing, Del Vecchio, Claudia, Fortarezza, Francesco, Pezzuto, Federica, Navalesi, Paolo, Crisanti, Andrea, Fowkes, Mary E., Bryce, Clare H., Calabrese, Fiorella, and Beasley, Mary Beth

Abstract

SARS-CoV-2, the etiologic agent of COVID-19, is a global pandemic with substantial mortality dominated by acute respiratory distress syndrome. We systematically evaluated lungs of 68 autopsies from 3 institutions in heavily hit areas (2 USA, 1 Italy). Detailed evaluation of several compartments (airways, alveolar walls, airspaces, and vasculature) was performed to determine the range of histologic features. The cohort consisted of 47 males and 21 females with a median age of 73 years (range 30–96). Co-morbidities were present in most patients with 60% reporting at least three conditions. Tracheobronchitis was frequently present, independent from intubation or superimposed pneumonia. Diffuse alveolar damage (DAD) was seen in 87% of cases. Later phases of DAD were less frequent and correlated with longer duration of disease. Large vessel thrombi were seen in 42% of cases but platelet (CD61 positive) and/or fibrin microthrombi were present at least focally in 84%. Ultrastructurally, small vessels showed basal membrane reduplication and significant endothelial swelling with cytoplasmic vacuolization. In a subset of cases, virus was detected using different tools (immunohistochemistry for SARS-CoV-2 viral spike protein, RNA in situ hybridization, lung viral culture, and electron microscopy). Virus was seen in airway epithelium and type 2 pneumocytes. IHC or in situ detection, as well as viable form (lung culture positive) was associated with the presence of hyaline membranes, usually within 2 weeks but up to 4 weeks after initial diagnosis. COVID-19 pneumonia is a heterogeneous disease (tracheobronchitis, DAD, and vascular injury), but with consistent features in three centers. The pulmonary vasculature, with capillary microthrombi and inflammation, as well as macrothrombi, is commonly involved. Viral infection in areas of ongoing active injury contributes to persistent and temporally heterogeneous lung damage.

Published
2020
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36. COVID-19 challenge: proactive management of a Tertiary University Hospital in Veneto Region, Italy

Author

Carretta, Giovanni, Contessa, Cristina, Boemo, Deris Gianni, Bordignon, Greta, Bennici, Silvia Eugenia, Merigliano, Stefano, Boschetto, Margherita, Capizzi, Alfio, Cattelan, Annamaria, Causin, Francesco, Cianci, Vito, Flor, Luciano, Friziero, Alberto, Navalesi, Paolo, Nesoti, Maria Vittoria, Saieva, Anna Maria, Scapellato, Maria, Tiberio, Ivo, Vettor, Roberto, Vianello, Andrea, Salvador, Renato, and Donato, Daniele

Abstract

ABSTRACTBackgroundThe aim of this study is to describe the successful emergency plan implemented by Padova University Hospital (AOUP) during the COVID-19 pandemic.MethodsThe emergency plan included early implementation of procedures aimed at meeting the increasing demand for testing and care while ensuring safe and timely care of all patients and guaranteeing the safety of healthcare workers.ResultsFrom 21 February to 1 May 2020, there were 3,862 confirmed cases of SARS-CoV-2 infection in the Province of Padua.A total of 485 patients were hospitalized in AOUP, of which 91 were admitted to the ICU; 12 .6% of admitted patients died. The average bed occupancy rate in the ICU was 61.1% (IQR 43.6%:77.4%). Inpatient surgery and inpatient admissions were kept for 76% and 74%, respectively, compared to March 2019.A total of 123,077 swabs were performed, 19.3% of which (23,725 swabs) to screen AOUP workers. The screening of all staff showed that 137 of 7,649 (1.8%) hospital workers were positive. No healthcare worker died.DiscussionAOUP strategy demonstrated effective management of the epidemic thanks to the timely implementation of emergency procedures, a well-coordinated effort shared by all hospital Departments, and their continuous adjustment to the ongoing epidemic. Timely screening of all hospital workers proved to be particularly important to defend the hospital, avoiding epidemic clusters due to unknown positive cases.

Published
2020
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38. Diaphragmatic Ultrasound Assessment in Subjects With Acute Hypercapnic Respiratory Failure Admitted to the Emergency Department.

Author

Cammarota, Gianmaria, Sguazzotti, Ilaria, Zanoni, Marta, Messina, Antonio, Colombo, Davide, Vignazia, Gian Luca, Vetrugno, Luigi, Garofalo, Eugenio, Bruni, Andrea, Navalesi, Paolo, Avanzi, Gian Carlo, Della Corte, Francesco, Volpicelli, Giovanni, and Vaschetto, Rosanna

Subjects
DIAPHRAGM physiology, OBSTRUCTIVE lung disease treatment, APACHE (Disease classification system), ARTIFICIAL respiration, BLOOD gases analysis, DYSPNEA, FISHER exact test, HOSPITAL emergency services, HYPERCAPNIA, INFORMED consent (Medical law), LONGITUDINAL method, SCIENTIFIC observation, QUESTIONNAIRES, RESPIRATORY insufficiency, TIME, TRACHEA intubation, ULTRASONIC imaging, MATHEMATICAL variables, SAMPLE size (Statistics), PILOT projects, VISUAL analog scale, CONTINUING education units, HUMAN research subjects, RECEIVER operating characteristic curves, DATA analysis software, DESCRIPTIVE statistics, GLASGOW Coma Scale, MANN Whitney U Test, FRIEDMAN test (Statistics), INTRACLASS correlation, ADULTS
Abstract

BACKGROUND: Early identification of noninvasive ventilation (NIV) outcome predictors in patients with COPD who are experiencing acute hypercapnic respiratory failure consequent to exacerbation or pneumon'a is a critical issue. The primary aim of this study was to investigate the feasibility of performing diaphragmatic ultrasound for excursion, thickness, and thickening fraction in highly dyspneic subjects with COPD admitted to the emergency department for exacerbation or pneumonia, before starting NIV (T0) and after the first (T1) and second hour (T2) of treatment. Secondarily, we determined whether these variables predicted early NIV failure. METHODS: Adult subjects with COPD admitted to the emergency department for exacerbation or pneumonia requiring NIV were eligible. Right-sided diaphragmatic excursion, bilateral thickness, thickening fraction, and arterial blood gas analyses were performed at T0, T1, and T2. Feasibility was estimated by considering the number of subjects whose diaphragmatic function could be evaluated at each time point. At T2, subjects were classified in 2 sub-groups according to early NIV failure, which was defined as the inability to achieve a pH ≥ 7.35; the ability to achieve pH ≥ 7.35 indicated NIV success. RESULTS: Of the 22 subjects enrolled, 21 under- went complete diaphragm ultrasound evaluation (ie, right excursion and bilateral thickness at T0, T1, and T2) for a total of 63 excursion and 126 thickness assessments. At T2, 12 NIV successes and 9 NIV failures were recorded. Diaphragmatic excursion was greater in NIV successes than in NIV failures at T0 (1.92 [1.22-2.54] cm versus 1.00 [0.60-1.41] cm, P = .02), at T1 (2.14 [1.76-2.77] cm versus 0.93 [0.82-1.27] cm, P = .007), and at T2 (1.99 [1.63-2.54] cm versus 1.20 [0.79-1.41] cm, P = .008), respectively. Diaphragmatic thickness and thickening fraction were similar in both groups. CONCLUSIONS: In our emergency department setting, diaphragm ultrasound was a feasible and reliable tool to monitor highly dyspneic acute hypercapnic respiratory failure subjects with COPD undergoing NIV. (ClinicalTrials.gov registration NCT03314883.) [ABSTRACT FROM AUTHOR]

Published
2019
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39. Evaluation of a New Interface Combining High-Flow Nasal Cannula and CPAP.

Author

Garofalo, Eugenio, Bruni, Andrea, Pelaia, Corrado, Cammarota, Gianmaria, Murabito, Paolo, Biamonte, Eugenio, Abdalla, Karim, Longhini, Federico, and Navalesi, Paolo

Subjects
ACADEMIC medical centers, ANALYSIS of variance, ARTIFICIAL respiration, MEDICAL students, PRESSURE, STATISTICS, T-test (Statistics), DATA analysis, BODY mass index, CONTINUOUS positive airway pressure, DESCRIPTIVE statistics, MANN Whitney U Test, NASAL cannula
Abstract

BACKGROUND: This study assessed the effects of a new interface that combined CPAP 10 cm H2O by using a helmet with high-flow nasal cannula (HFNC) at varying flows in healthy volunteers. Outcome measures included pharyngeal pressures, diaphragm kinetics, breathing frequency, the temperature inside the helmet, and comfort. METHODS: After baseline assessment during spontaneous breathing, HFNC was applied at flows of 30, 40, and 50 L/min. Successively, the volunteers underwent helmet CPAP at 10 cm H2O and CPAP + HFNC at flows of 30, 40, and 50 L/min. We measured the variations of pharyngeal pressures at end-expiration and end-inspiration, referenced to spontaneous breathing for HFNC and to CPAP for CPAP + HFNC, diaphragm displacement and thickness at end-expiration and thickness at end-inspiration, breathing frequency, the temperature inside the helmet, the occurrence of the fog effect, and comfort. RESULTS: Variations of pharyngeal pressures at end-inspiration changes were small overall and clinically unimportant. With the mouth closed, at increasing HFNC flow, variations of pharyngeal pressures at endexpiration increased during both HFNC (from 2.8 up to 7.7) and, to a lesser extent, CPAP + HFNC (from 2.7 up to 3.8) (P < .001 for all comparisons). These variations were attenuated during open-mouth breathing. HFNC > 40 L/min and CPAP + HFNC ≥ 40 L/min compared with spontaneous breathing and CPAP, respectively, increased diaphragm displacement (P = .001), thickness at end-inspiration and thickness at end-expiration (P < .003 for both). At all flows, breathing frequency was slightly, although significantly, lower with CPAP + HFNC than with HFNC alone (P < .003). The temperature inside the helmet increased slightly and insignificantly at flows of ≤40 L/min with CPAP + HFNC compared with CPAP alone. The fog effect never occurred, whereas comfort was always rated as optimal, without differences between trials. CONCLUSIONS: CPAP + HFNC was well tolerated, with no adverse effects. Based on our findings, there was no need to vary the CPAP level when adding HFNC. At least in healthy subjects, CPAP + HFNC at 30 L/min seemed to be the best combination. [ABSTRACT FROM AUTHOR]

Published
2019
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40. Neurally-Adjusted Ventilatory Assist for Noninvasive Ventilation via a Helmet in Subjects With COPD Exacerbation: A Physiologic Study.

Author

Longhini, Federico, Ling Liu, Chun Pan, Jianfeng Xie, Cammarota, Gianmaria, Bruni, Andrea, Garofalo, Eugenio, Yi Yang, Navalesi, Paolo, and Haibo Qiu

Subjects
AIRWAY (Anatomy), ARTIFICIAL respiration, BLOOD gases analysis, HUMAN comfort, OBSTRUCTIVE lung diseases, PHYSIOLOGICAL research, PRESSURE breathing, PULMONARY gas exchange, RESPIRATION, RESPIRATORY measurements, SAFETY hats, STATISTICS, DATA analysis, CROSS-sectional method, DISEASE exacerbation, DATA analysis software, RESPIRATORY mechanics, DESCRIPTIVE statistics
Abstract

BACKGROUND: In patients with COPD exacerbation, noninvasive ventilation (NIV) is strongly recommended. NIV is generally delivered by using patient triggered and flow-cycled pressure support through a face mask. A specific method to generate neurally-controlled pressure support has been shown to improve comfort and patient-ventilator interaction. In addition, the helmet interface was better tolerated by patients compared with a face mask. Herein, we compared neurally-controlled pressure support through a helmet with pressure support through a face mask with respect to subject comfort, breathing pattern, gas exchange, pressurization and triggering performance, and patientventilator synchrony. METHODS: Two 30-min trials of NIV were randomly delivered to 10 subjects with COPD exacerbation redundant: (1) pressure support through a face mask with inspiratory pressure support of ≥8 cmH2O to obtain a tidal volume of 6-8 mL/kg of ideal body weight; and (2) NAVA through a helmet, setting the neurally-adjusted ventilatory assist level at 15 cm H2O/µV, with an upper airway pressure limit to obtain the same overall airway pressure applied during pressure support through a face mask. We assessed subject comfort, breathing frequency, respiratory drive, arterial blood gases, pressure-time product (PTP) of the first 300 ms and 500ms after initiation of subject effort, inspiratory trigger delay, and rate of asynchrony determined as the asynchrony index. RESULTS: Median and interquartile range NAVA through a helmet improved comfort (7.0 [6.0-8.0]) compared with pressure support through a face mask (5.0 [4.7-5.2], P = .005). The breathing pattern was not different between the methods. Respiratory drive was slightly, although not significantly, reduced (P = .19) during NAVA through a helmet in comparison with pressure support through a face mask. Gas exchange was also not different between the trials. The PTP of the first 300 ms (P = .92) and PTP of the first 500 ms (P = .08) were not statistically different between trials, whereas triggering performance, patient-ventilator interaction, and synchrony were all improved by NAVA through a helmet compared with pressure support through a face mask. CONCLUSIONS: In the subjects with COPD with exacerbation, NAVA through a helmet improved comfort, triggering performance, and patient-ventilator synchrony compared with pressure support through a face mask. [ABSTRACT FROM AUTHOR]

Published
2019
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42. Avaliação ecocardiográfica transtorácica do débito cardíaco feita por médicos da unidade de terapia intensiva em pacientes críticos sob ventilação mecânica.

Author

Bergamaschi, Valentina, Vignazia, Gian Luca, Messina, Antonio, Colombo, Davide, Cammarota, Gianmaria, Corte, Francesco Della, Traversi, Egidio, and Navalesi, Paolo

Abstract

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Published
2019
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43. 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

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.

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 <60 mL/min/1.73 m2 and perioperative myocardial dysfunction. Interventions Patients were assigned randomly to receive levosimendan (0.025-0.2 μg/kg/min) or placebo in addition to standard inotropic treatment. Measurements and Main Results Forty-six patients were assigned to receive levosimendan and 44 to receive placebo. Postoperative AKI occurred in 14 (30%) patients in the levosimendan group versus 23 (52%) in the placebo group (absolute difference –21.8; 95% confidence interval –41.7 to –1.97; p = 0.035). The incidence of major complications also was lower (18 [39%]) in the levosimendan group versus that in the placebo group (29 [66%]) (absolute difference –26.8 [–46.7 to –6.90]; p = 0.011). A trend toward lower serum creatinine at intensive care unit discharge was observed in the levosimendan group (1.18 [0.99-1.49] mg/dL) versus that in the placebo group (1.39 [1.05-1.76] mg/dL) (95% confidence interval –0.23 [–0.49 to 0.01]; p = 0.07). Conclusions Levosimendan may improve renal outcome in cardiac surgery patients with chronic kidney disease undergoing mitral valve surgery who develop perioperative myocardial dysfunction. Results of this exploratory analysis should be investigated in future properly designed randomized controlled trials. [ABSTRACT FROM AUTHOR]

Published
2018
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44. High Flow Through Nasal Cannula in Stable and Exacerbated Chronic Obstructive Pulmonary Disease Patients

Author

Bruni, Andrea, Garofalo, Eugenio, Cammarota, Gianmaria, Murabito, Paolo, Astuto, Marinella, Navalesi, Paolo, Luzza, Francesco, Abenavoli, Ludovico, and Longhini, Federico

Abstract

Background: High-Flow through Nasal Cannula (HFNC) is a system delivering heated humidified air-oxygen mixture at a flow up to 60 L/min. Despite increasing evidence in hypoxemic acute respiratory failure, a few is currently known in chronic obstructive pulmonary disease (COPD) patients. Objective: To describe the rationale and physiologic advantages of HFNC in COPD patients, and to systematically review the literature on the use of HFNC in stable and exacerbated COPD patients, separately. Methods: A search strategy was launched on MEDLINE. Two authors separately screened all potential references. All (randomized, non-randomized and quasi-randomized) trials dealing with the use of HFNC in both stable and exacerbated COPD patients in MEDLINE have been included in the review. Results: Twenty-six studies have been included. HFNC: 1) provides heated and humidified airoxygen admixture; 2) washes out the anatomical dead space of the upper airway; 3) generates a small positive end-expiratory pressure; 4) guarantees a more stable inspired oxygen fraction, as compared to conventional oxygen therapy (COT); and 5) is more comfortable as compared to both COT and non-invasive ventilation (NIV). In stable COPD patients, HFNC improves gas exchange, the quality of life and dyspnea with a reduced cost of muscle energy expenditure, compared to COT. In exacerbated COPD patients, HFNC may be an alternative to NIV (in case of intolerance) and to COT at extubation or NIV withdrawal. Conclusion: Though evidence of superiority still lacks and further studies are necessary, HFNC might play a role in the treatment of both stable and exacerbated COPD patients.

Published
2019
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45. Utility of pleural effusion drainage in the ICU: An updated systematic review and META-analysis

Author

Vetrugno, Luigi, Bignami, Elena, Orso, Daniele, Vargas, Maria, Guadagnin, Giovanni M., Saglietti, Francesco, Servillo, Giuseppe, Volpicelli, Giovanni, Navalesi, Paolo, and Bove, Tiziana

Abstract

The effects on the respiratory or hemodynamic function of drainage of pleural effusion on critically ill patients are not completely understood. First outcome was to evaluate the PiO2/FiO2(P/F) ratio before and after pleural drainage. Secondary outcomes: evaluation of A-a gradient, End-Expiratory lung volume (EELV), heart rate (HR), mean arterial pressure (mAP), left ventricular end-diastolic volume (LVEDV), stroke volume (SV), cardiac output (CO), ejection fraction (EF), and E/A waves ratio (E/A). A tertiary outcome: evaluation of pneumothorax and hemothorax complications.

Published
2019
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47. Transthoracic echocardiographic assessment of cardiac output in mechanically ventilated critically ill patients by intensive care unit physicians

Author

Bergamaschi, Valentina, Vignazia, Gian Luca, Messina, Antonio, Colombo, Davide, Cammarota, Gianmaria, Corte, Francesco Della, Traversi, Egidio, and Navalesi, Paolo

Abstract

Transthoracic echocardiography may potentially be useful to obtain a prompt, accurate and non-invasive estimation of cardiac output. We evaluated whether non-cardiologist intensivists may obtain accurate and reproducible cardiac output determination in hemodynamically unstable mechanically ventilated patients.

Published
2019
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48. Avaliação ecocardiográfica transtorácica do débito cardíaco feita por médicos da unidade de terapia intensiva em pacientes críticos sob ventilação mecânica

Author

Bergamaschi, Valentina, Vignazia, Gian Luca, Messina, Antonio, Colombo, Davide, Cammarota, Gianmaria, Corte, Francesco Della, Traversi, Egidio, and Navalesi, Paolo

Abstract

A ecocardiografia transtorácica pode ser potencialmente útil para obter uma estimativa rápida, precisa e não invasiva do débito cardíaco. Avaliamos se os intensivistas não cardiologistas podem obter uma determinação precisa e reprodutível do débito cardíaco em pacientes mecanicamente ventilados e hemodinamicamente instáveis.

Published
2019
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50. Biological mechanisms underlying the clinical effects of allergen-specific immunotherapy in asthmatic children

Author

Pelaia, Corrado, Vatrella, Alessandro, Lombardo, Nicola, Terracciano, Rosa, Navalesi, Paolo, Savino, Rocco, and Pelaia, Girolamo

Abstract

ABSTRACTIntroduction: Allergen-specific immunotherapy (AIT) is indicated for patients with allergic asthma and/or allergic rhinitis, and can be implemented by either subcutaneous injection (SCIT) or sublingual administration (SLIT). AIT reduces asthma symptoms, lowers the use of pharmacologic controller therapy, and decreases the need for rescue medications. SLIT appears to be safer than SCIT, but SCIT seems to be more efficacious and acts earlier in allergic asthmatic children.Areas covered: This review looks at the pathobiology of allergic asthma as well as the role of regulatory T and B cells in allergen tolerance. It also reviews the immunological mechanisms underlying the clinical effects induced by AIT in allergic asthmatic children.Expert opinion: AIT is very effective in allergic asthmatic children, who can significantly benefit from this particular type of immunotherapy in order to achieve a better control of their disease. AIT is also capable of modifying the natural history of allergic asthma. Furthermore, AIT can potentially represent a valuable therapeutic tool within the context of precision medicine, as recombinant allergen technology might allow the creation of targeted extracts able to be effective against specific proteins to which individual asthmatic children are allergic, thus helping to implement a personalized approach to treatment.

Published
2018
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