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1. Regional Cerebral Oxygen Saturation to Predict Favorable Outcome in Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis

Author

Pietro Bertini, Alberto Marabotti, Gianluca Paternoster, Giovanni Landoni, Fabio Sangalli, Adriano Peris, Manuela Bonizzoli, Sabino Scolletta, Federico Franchi, Antonio Rubino, Matteo Nocci, Niccolò Castellani Nicolini, and Fabio Guarracino

Subjects
Anesthesiology and Pain Medicine, Cardiology and Cardiovascular Medicine
Published
2023
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3. Extracorporeal <scp>CPR</scp> after the <scp>INCEPTION</scp> trial: No one steps twice into the same river

Author

Tommaso Scquizzato, Demetris Yannopoulos, Jan Bělohlávek, Fabio S. Taccone, Roberto Lorusso, Anna Mara Scandroglio, Giovanni Landoni, and Justyna Swol

Subjects
extracorporeal cardiopulmonary resuscitation, RESUSCITATION, Biomedical Engineering, HOSPITAL CARDIAC-ARREST, Medicine (miscellaneous), Bioengineering, General Medicine, extracorporeal membrane oxygenation, extracorporeal life support, Biomaterials, OHCA, ECMO, ECPR, out-of-hospital cardiac arrest, ECLS
Abstract

The use of veno-arterial extracorporeal membrane oxygenation as extracorporeal cardiopulmonary resuscitation in patients suffering out-of-hospital cardiac arrest, largely increased in the last decade despite evidence supporting this practice being limited to non-randomized studies. However, between 2020 and 2023, four randomized studies were published comparing extracorporeal cardiopulmonary resuscitation to conventional cardiopulmonary resuscitation with controversial findings that triggered great debates. In this controversy, we discuss merits and pitfalls, and provide a critical interpretation of the available evidence from randomized trials on the use of extracorporeal cardiopulmonary resuscitation, with a particular focus on the recent multi-center INCEPTION trial.

Published
2023
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5. Rationale and design of the colchicine for the prevention of perioperative atrial fibrillation in patients undergoing major noncardiac thoracic surgery (COP-AF) trial

Author

David Conen, Ekaterine Popova, Michael Ke Wang, Matthew T.V. Chan, Giovanni Landoni, Cara Reimer, Sadeesh K. Srinathan, Juan P. Cata, Sean R. McLean, Juan Carlos Trujillo Reyes, Ascensión Martín Grande, Anna Gonzalez Tallada, Daniel I. Sessler, Edith Fleischmann, Donna E. Maziak, Barbara Kabon, Luca Voltolini, Laura Gutiérrez-Soriano, Vikas Tandon, Deborah DuMerton, Biniam Kidane, Ravi Rajaram, Yaron Shargall, John D. Neary, Jennifer R. Wells, William F. McIntyre, Steffen Blum, Sandra N. Ofori, Jessica Vincent, Lizhen Xu, Zhuoru Li, Jeff S. Healey, Amit X. Garg, PJ Devereaux, null Devereaux, Mohammed Amir, Shrikant I. Bangdiwala, Matthias Bossard, John W. Eikelboom, Sanjit S. Jolly, Felix Ramón Montes, Denis Schmartz, Chew Yin Wang, Jesus Alvarez-Garcia, Giuliana Lo Bianco, Danielle de Sa Boasquevisque, Flavia K. Borges, Helene Chiarella-Redfern, Aranzazu Gonzalez-Osuna, Jose M. Guerra-Ramos, Maura Marcucci, Pascal B. Meyre, Christopher Oleynick, Anna Ramos-Pachón, Hugh Traquair, L. Brent Mitchell, George Wyse, Davy Cheng, Finlay A. McAlister, George A. Wells, Geethan Baskaran, Julia Gennaccaro, Rosemary Howe, Louise Mastrangelo, Shirley Pettit, Subana Shahbaz, Makayla Tosh, Simona J. Zucchetto, Laura Heenan, Shun Fu Lee, Christian Reiterer, Alexander Taschner, Katharina Horvath, Nikolas Adamowitsch, Oliver Zotti, Nicole Hantáková, Beatrix Hochreiter, Isabelle Huybrechts, Serge Cappeliez, Christian Finley, John Agzarian, Waël Hanna, Muammar Abdulrahman, Kelly Lawrence, Krysten Gregus, Faraaz Quraishi, Spencer Wikkerink, Christine Wallace, Merissa Prine, Emily Gregus, Jacqueline Hare, Kristen Lombardo, Behashta Fezia, Teresa Columbus, Ken Reid, Joel Parlow, Wiley Chung, Maria Karizhenskaia, Aftab Malik, Richard Liu, Lawrence Tan, Stephen Gowing, Gordon Buduhan, Stephanie Enns, Emma Poole, Kristin Graham, Anna McGuire, Jens Lohser, Shirley Lim, Rebecca Grey, Kyle Grant, Alex L. Lee, James J. Choi, Leith R. Dewar, John Yee, Andrew J.E. Seely, Sebastien Gilbert, P. James Villeneuve, Sudhir Sundaresan, Susan D. Moffatt-Bruce, Molly Gingrich, Anna Fazekas, Kirby Bucciero, Richard A. Malthaner, Deb Lewis, Dalilah Fortin, Mehdi Qiabi, Rahul Nayak, Madelaine Marie Plourde, Daniel Sellers, Laura Donahoe, Marco Lefebvre, Luc Lanthier, Colin Schieman, Amal Bessissow, Gavin M. Joynt, Randolph H.L. Wong, Rainbow W.H. Lau, Wai Tat Wong, Gordon Y.S. Choi, Eva Lee, Ka Yan Hui, Beaker Fung, Chee Sam Chan, Laura Carmenza Castañeda, Luis Jaime Téllez, Lina Marcela Ortiz-Ramirez, Simona De Santis, Giovanni Favaro, Piergiorgio Muriana, Cristina Nakhnoukh, Pierluigi Novellis, Stefano Turi, Giulia Veronesi, Matteo Angelini, Stefano Bongiolatti, Alberto Salvicchi, Lavinia Gatteschi, Rossella Indino, Simone Tombelli, Alice Ravasin, Ottavia Salimbene, Giulio Luca Rosboch, Eleonora Balzani, Domenico Massullo, Silvia Fiorelli, Francesco Londero, William Grossi, Tyng Yan Ng, Woan Shiang See, Mohammed Asghar Nawaz, Elisabeth Martinez Tellez, Josep Belda Sanchis, Georgina Planas Cánovas, Ana Parera Ruiz, Esther Cladellas Gutierrez, Mauro Guarino, Gerard Urrutia Cuchi, Marta Argilaga Nogues, Anna Rovira Juan, Melixa Medina-Aedo, Diego Parise Roux, Luis Gajate Martín, Angélica De Pablo Pajares, Angel Manuel Candela Toha, Nicolás Moreno Mata, Gema Muñoz Molina, Usue Caballero Silva, Alberto Cabañero, Sara Fra Fernandez, Anna Gonzàlez Tallada, Susana González Suarez, Montserrat Ribas Ball, Miriam De Nadal Clanchet, Laura Ruiz-Villa, M.M. Martí-Ejarque, Mireia Gili-Bueno, Jorge Hernández Ferrández, Neus Pons Llobet, Patricia Cruz, Guillermo Sánchez-Pedrosa, Patricia Duque, Leire Azcárate, Lorena Martín-Albo, Alberto Rodríguez-Fuster, Silvia Bermejo-Martínez, Albert Carramiñana, Fabrizio Minervini, German Corrales, Juan Jose Guerra-Londono, Reza Mehran, Boris Sepesi, Garrett Walsh, Daniel S. Cukierman, Bryan E. Marchant, Lynne C. Harris, Bruce D. Cusson, Scott A. Miller, Steven C. Minear, Camila Teixeira, Mario Pimentel, Andrew M. Popoff, Wing Lee Cheung, Kelly Marsack, Sabry Ayad, Jorge Araujo, Tzonghuei H. Chen, Michael Essandoh, Jeremy S. Poppers, and Medicine

Subjects
prevention, inflammation, atrial fibrillation, myocardial injury, Colchicine, Cardiology and Cardiovascular Medicine, thoracic surgery
Abstract

Background: Perioperative atrial fibrillation (AF) and myocardial injury after noncardiac surgery (MINS) are common complications after noncardiac surgery. Inflammation has been implicated in the pathogenesis of both disorders. The COP-AF trial tests the hypothesis that colchicine reduces the incidence of perioperative AF and MINS in patients undergoing major noncardiac thoracic surgery. Design: The 'COlchicine for the Prevention of Perioperative Atrial Fibrillation' (COP-AF) trial is an international, blinded, randomized trial that compares colchicine to placebo in patients aged at least 55 years and undergoing major noncardiac thoracic surgery with general anesthesia. Exclusion criteria include a history of AF and a contraindication to colchicine (e.g., severe renal dysfunction). Oral colchicine at a dose of 0.5 mg or matching placebo is given within 4 hours before surgery. Thereafter, patients receive colchicine 0.5 mg or placebo twice daily for a total of 10 days. The two independent co-primary outcomes are clinically important perioperative AF (including atrial flutter) and MINS during 14 days of follow-up. The main safety outcomes are sepsis or infection and non-infectious diarrhea. We aim to enroll 3,200 patients from approximately 40 sites across 11 countries to have at least 80% power for the independent evaluation of the two co-primary outcomes. Summary: COP-AF is a large randomized and blinded trial designed to determine whether colchicine reduces the risk of perioperative AF or MINS in patients who have major noncardiac thoracic surgery. Population Health Research Institute

Published
2023
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7. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study

Author

Roberto Lorusso, Maria Elena De Piero, Silvia Mariani, Michele Di Mauro, Thierry Folliguet, Fabio Silvio Taccone, Luigi Camporota, Justyna Swol, Dominik Wiedemann, Mirko Belliato, Lars Mikael Broman, Alain Vuylsteke, Yigal Kassif, Anna Mara Scandroglio, Vito Fanelli, Philippe Gaudard, Stephane Ledot, Julian Barker, Udo Boeken, Sven Maier, Alexander Kersten, Bart Meyns, Matteo Pozzi, Finn M Pedersen, Peter Schellongowski, Kaan Kirali, Nicholas Barrett, Jordi Riera, Thomas Mueller, Jan Belohlavek, Valeria Lo Coco, Iwan C C Van der Horst, Bas C T Van Bussel, Ronny M Schnabel, Thijs Delnoij, Gil Bolotin, Luca Lorini, Martin O Schmiady, David Schibilsky, Mariusz Kowalewski, Luis F Pinto, Pedro E Silva, Igor Kornilov, Aaron Blandino Ortiz, Leen Vercaemst, Simon Finney, Peter P Roeleveld, Matteo Di Nardo, Felix Hennig, Marta Velia Antonini, Mark Davidson, Tim J Jones, Thomas Staudinger, Peter Mair, Juliane Kilo, Christoph Krapf, Kathrin Erbert, Andreas Peer, Nikolaos Bonaros, Florian Kotheletner, Niklas Krenner Mag, Liana Shestakova, Greet Hermans, Dieter Dauwe, Philippe Meersseman, Bernard Stockman, Leda Nobile, Olivier Lhereux, Alexandre Nrasseurs, Jacques Creuter, Daniel De Backer, Simone Giglioli, Gregoire Michiels, Pierre Foulon, Matthias Raes, Inez Rodrigus, Matthias Allegaert, Philippe Jorens, Gerd Debeucklare, Michael Piagnerelli, Patrick Biston, Harlinde Peperstraete, Komeel Vandewiele, Olivier Germay, Dimitri Vandeweghe, Sven Havrin, Marc Bourgeois, Marc-Gilbert Lagny, Genette Alois, Nathalie Lavios, Benoit Misset, Romain Courcelle, Philippe J Timmermans, Alaaddin Yilmaz, Michiel Vantomout, Jerone Lehaen, Ame Jassen, Herbert Guterman, Maarten Strauven, Piet Lormans, Bruno Verhamme, catherine Vandewaeter, Frederik Bonte, Dominique Vionne, Martin Balik, Jan Blàha, Michal Lips, Michal Othal, Filip Bursa, Radim Spacek, Steffen Christensen, Vibeke Jorgensen, Marc Sorensen, Soren A Madsen, Severin Puss, Aleksandr Beljantsev, gabriel Saiydoun, Antonio Fiore, Pascal Colson, Florian Bazalgette, Xavier Capdevila, Sebastien Kollen, Laurent Muller, Jean-Francois Obadia, Pierre-Yves Dubien, Lucrezia Ajrhourh, Pierre G Guinot, Jonathan Zarka, Patricia Besserve, Maximilian V Malfertheiner, Esther Dreier, Birgit Heinze, Payam Akhyari, Artur Lichtenberg, Hug Aubin, Alexander Assman, Diyar Saeed, Holger Thiele, Matthias Baumgaertel, Jan D Schmitto, Natanov Ruslan, Axel Haverich, Matthias Thielmann, Thorsten Brenner, Arjang Ruhpawar, Christoph Benk, Martin Czerny, Dawid L Staudacher, Fridhelm Beyersdorf, Johannes Kalbhenn, Philipp Henn, Aron-Frederik Popov, Torje Iuliu, Ralf Muellenbach, Christian Reyher, Caroline Rolfes, Gosta Lotz, Michael Sonntagbauer, Helen Winkels, Julia Fichte, Robert Stohr, Sebastian Kalverkamp, Christian Karagiannidis, Simone Schafer, Alexei Svetlitchny, Hans-Bernd Hopf, Dominik Jarczak, Heinirich Groesdonk, Magdalena Rommer, Jan Hirsch, Christian Kaehny, Dimitros Soufleris, Georgios Gavriilidis, Kostantinos Pontikis, Magdalini Kyriakopoulou, Anna Kyriakoudi, Serena O'Brien, Ian Conrick-Martin, Edmund Carton, Maged Makhoul, Josef Ben-Ari, Amir Hadash, Alexander Kogan, Reut Kassif Lerner, Anas Abu-Shakra, Moshe Matan, Ahmad Balawona, Erez Kachel, Roman Altshuler, Ori Galante, Lior Fuchs, Yaniv Almog, Yaron S Ishay, Yael Lichter, Amir Gal-oz, Uri Carmi, Asaph Nini, Arie Soroksky, Hagi Dekel, Ziv Rozman, Emad Tayem, Eduard Ilgiyaev, Yuval Hochman, daniel Miltau, Avigal Rapoport, Arieh Eden, Dmitry Kompanietz, Michael Yousif, Miri Golos, Lorenzo Grazioli, Davide Ghitti, Antonio Loforte, Daniela Di Luca, Massimo Baiocchi, Davide Pacini, Antioco Cappai, Paolo Meani, Michele Mondino, Claudio F Russo, Marco Ranucci, Dario Fina, Marco Cotza, Andrea Ballotta, Giovanni Landoni, Pasquale Nardelli, Eygeny V Fominski, Luca Brazzi, Giorgia Montrucchio, Gabriele Sales, Umberto Simonetti, Sergio Livigni, Daniela Silengo, Giulia Arena, Stefania S Sovatzis, Antonella Degani, Mariachiara Riccardi, Elisa Milanesi, Giuseppe Raffa, Gennaro Martucci, Antonio Arcadipane, Giovanna Panarello, Giovanni Chiarini, Sergio Cattaneo, Carmine Puglia, Stefano Benussi, Giuseppe Foti, Marco Giani, Michela Bombino, Maria Cristina Costa, Roberto Rona, Leonello Avalli, Abele Donati, Roberto Carozza, Francesco Gasparri, Andrea Carsetti, Marco Picichè, Anna Marinello, Vinicio Danzi, Anita Zanin, Ignazio Condello, Flavio Fiore, Marco Moscarelli, Giuseppe Nasso, Giuseppe Speziale, Luca Sandrelli, Andrea Montalto, Francesco Musumeci, Alessandro Circelli, Emanuele Russo, Vanni Agnoletti, Ruggero Rociola, Aldo D Milano, Emanuele Pilato, Giuseppe Comentale, Andrea Montisci, Francesco Alessandri, Antonella Tosi, Francesco Pugliese, Giovanni Giordano, Simone Carelli, Domenico L Grieco, Antonio M Dell'Anna, Massimo Antonelli, Enrico Ramoni, Josè Zulueta, Mauro Del Giglio, Sebastiano Petracca, Pietro Bertini, Fabio Guarracino, Luigi De Simone, Paolo M Angeletti, Francesco Forfori, Francesco Taraschi, Veronica N Quintiliani, Robertas Samalavicius, Agne Jankuviene, Nadezda Scupakova, Karolis Urbonas, Juozas Kapturauskas, Gro Soerensen, Piotr Suwalski, Luis Linhares Santos, Ana Marques, Marisa Miranda, Sonia Teixeira, Andrea Salgueiro, Filipe Pereira, Michail Ketskalo, Sergey Tsarenko, Alexandra Shilova, Ivan Afukov, Konstantin Popugaev, Sergei Minin, Daniil Shelukhin, Olga Malceva, Moroz Gleb, Alexander Skopets, Roman Kornelyuk, Alexandr Kulikov, Vadim Okhrimchuk, Alexandr Turchaninov, Maxim Petrushin, Anastasia Sheck, Akhmed Mekulov, Svetlana Ciryateva, Dmitry Urusov, Vojka Gorjup, Alenka Golicnik, Tomaz Goslar, Ricard Ferrer, Maria Martinez-Martinez, Eduard Argudo, Neiser Palmer, Raul De Pablo Sanchez, Lucas Juan Higuera, Lucas Arnau Blasco, Josè A Marquez, Fabrizio Sbraga, Mari Paz Fuset, Pablo Ruiz De Gopegui, Luis M Claraco, Josè A De Ayala, Maranta Peiro, Pilar Ricart, Sergio Martinez, Fernando Chavez, Marc Fabra, elena Sandoval, David Toapanta, Albert Carraminana, Adrian Tellez, Jeysson Ososio, Pablo Milan, Jorge Rodriguez, Garcia Andoni, Carola Gutierrez, Enrique Perez de la Sota, Andrea Eixeres-Esteve, Maria Teresa Garcia-Maellas, Judit Gutierrez-Gutierrez, Rafael Arboleda-Salazar, Patricia Santa Teresa, Alexis Jaspe, Alberto Garrido, Galo Castaneda, Sara Alcantara, Nuria Martinez, Marina Perez, Hector Villanueva, Anxela Vidal Gonzalez, Juan Paez, Arnoldo Santon, Cesar Perez, Marta Lopez, Maria Isabel Rubio Lopez, Antonio Gordillo, Jose Naranjo-Izurieta, Javier Munoz, Immaculada Alcalde, Fernando Onieva, Ricardo Gimeno Costa, Francisco Perez, Isabel Madrid, Monica Gordon, Carlos L Albacete Moreno, Daniel Perez, Nayara Lopez, Domingo Martinenz, Pablo Blanco-Schweizer, Cristina Diez, David Perez, Ana Prieto, Gloria Renedo, Elena Bustamante, Ramon Cicuendez, Rafael Citores, Victoria Boado, Katherine Garcia, Roberto Voces, Monica Domezain, Jose Maria Nunez Martinez, Raimundo Vicente, David Martin, Antonio Andreu, Vanesa Gomez Casal, Ignacio Chico, Eva Maria Menor, Sabela Vara, Jose Gamacho, Helen Perez-Chomon, Francisco Javier Gonzales, Irene Barrero, Luis Martin-Villen, Esperanza Fernandez, Maria Mendoza, Joaquin Navarro, Joaquin Colomina Climent, Alfredo Gonzales-Perez, Guillermo Muniz-Albaceita, Laura Amado, Raquel Rodriguez, Emilio Ruiz, Maria Eiras, Edgars Grins, Rosen Magnus, Mikael Kanetoft, Marcus Eidevald, Pia Watson, Paul R Vogt, Peter Steiger, Tobias Aigner, Alberto Weber, Jurg Grunefelder, Martin Kunz, Martin Grapow, Thierry Aymard, Diana Reser, Gianluca Agus, Jolanda Consiglio, Matthias Haenggi, Jenni Hansjoerg, Manuela Iten, Thomas Doeble, Urs Zenklusen, Xavier Bechtold, Giovanni Faedda, Manuel Iafrate, Amanda Rohjer, Layla Bergamaschi, Jos Maessen, Dinis Reis Miranda, H Endeman, D Gommers, C Meuwese, Jacinta Maas, MJ Van Gijlswijk, RN Van Berg, Dario Candura, Marcel Van der Linden, Merijin Kant, JJ Van der Heijden, Eric Scholten, Nicole Van Belle-van Haren, WK Lagrand, Alexander P Vlaar, Syste De Jong, Basar Cander, Murat Sargin, Murat Ugur, Mehmet A Kaygin, Kathleen Daly, Nicola Agnew, Laura Head, Laura Kelly, Gunawardena Anoma, Clare Russell, Verna Aquino, Ian Scott, Lucy Flemming, Stuart Gillon, Olivia Moore, Elton Gelandt, George Auzinger, Sameer Patel, Robert Loveridge, MUMC+: MA Cardiothoracale Chirurgie (3), CTC, RS: Carim - V04 Surgical intervention, University of Zurich, and Lorusso, Roberto

Subjects
Pulmonary and Respiratory Medicine, 2740 Pulmonary and Respiratory Medicine, 610 Medicine & health, 10023 Institute of Intensive Care Medicine
Abstract

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation.METHODS: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing.FINDINGS: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms.INTERPRETATION: Patient's age, timing of cannulation (FUNDING: None.

Published
2023
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8. Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients

Author

Valentina Da Prat, Francesco De Cobelli, Giuseppe A. Ramirez, Giovanni Borghi, Agnese Gobbi, Giulia Cristel, Maria Grazia Calabrò, Ettore Di Gaeta, Giovanni Landoni, Clarissa Centurioni, Sarah Damanti, Alberto Zangrillo, Moreno Tresoldi, Andrea Del Prete, Enrica Bozzolo, Maria Rosa Calvi, Damanti, S., Cristel, G., Ramirez, G. A., Bozzolo, E. P., Da Prat, V., Gobbi, A., Centurioni, C., Di Gaeta, E., Del Prete, A., Calabro, M. G., Calvi, M. R., Borghi, G., Zangrillo, A., De Cobelli, F., Landoni, G., and Tresoldi, M.

Subjects
Adult, Critical Care and Intensive Care Medicine, law.invention, Ventilator weaning, law, medicine, Humans, Weaning, Intensive care unit, Respiratory system, Pandemics, Muscle quality, Nutrition and Dietetics, SARS-CoV-2, business.industry, Muscles, Medical record, COVID-19, Muscle mass, Length of Stay, medicine.disease, Respiration, Artificial, Intensive Care Units, Observational Studies as Topic, Pneumonia, Anesthesia, Sarcopenia, Breathing, Observational study, business
Abstract

Summary Background & aims Sarcopenia, a loss of muscle mass, quality and function, which is particularly evident in respiratory muscles, has been associated with many clinical adverse outcomes. In this study, we aimed at evaluating the role of reduced muscle mass and quality in predicting ventilation weaning, complications, length of intensive care unit (ICU) and of hospital stay and mortality in patients admitted to ICU for SARS-CoV-2-related pneumonia. Methods This was an observational study based on a review of medical records of all adult patients admitted to the ICU of a tertiary hospital in Milan and intubated for SARS-CoV-2-related pneumonia during the first wave of the COVID-19 pandemic. Muscle mass and quality measurement were retrieved from routine thoracic CT scans, when sections passing through the first, second or third lumbar vertebra were available. Results A total of 81 patients were enrolled. Muscle mass was associated with successful extubation (OR 1.02, 95% C.I. 1.00–1.03, p = 0.017), shorter ICU stay (OR 0.97, 95% C.I. 0.95–0.99, p = 0.03) and decreased hospital mortality (HR 0.98, 95% C.I. 0.96–0.99, p = 0.02). Muscle density was associated with successful extubation (OR 1.07, 95% C.I. 1.01–1.14; p = 0.02) and had an inverse association with the number of complications in ICU (Β −0.07, 95% C.I. −0.13 - −0.002, p = 0.03), length of hospitalization (Β −1.36, 95% C.I. −2.21 - −0.51, p = 0.002) and in-hospital mortality (HR 0.88, 95% C.I. 0.78–0.99, p = 0.046). Conclusions Leveraging routine CT imaging to measure muscle mass and quality might constitute a simple, inexpensive and powerful tool to predict survival and disease course in patients with COVID-19. Preserving muscle mass during hospitalisation might have an adjuvant role in facilitating remission from COVID-19.

Published
2022
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11. Testosterone in males with COVID‐19: a 12‐month cohort study

Author

Andrea Salonia, Marina Pontillo, Paolo Capogrosso, Edoardo Pozzi, Anna Maria Ferrara, Alice Cotelessa, Federico Belladelli, Christian Corsini, Silvia Gregori, Isaline Rowe, Cristina Carenzi, Giuseppe A. Ramirez, Cristina Tresoldi, Massimo Locatelli, Giulio Cavalli, Lorenzo Dagna, Antonella Castagna, Alberto Zangrillo, Moreno Tresoldi, Giovanni Landoni, Patrizia Rovere‐Querini, Fabio Ciceri, and Francesco Montorsi

Subjects
Endocrinology, Reproductive Medicine, Urology, Endocrinology, Diabetes and Metabolism
Abstract

Male patients with COVID-19 have been found with reduced serum total testosterone (tT) levels and with more severe clinical outcomes.To assess total testosterone (tT) levels and the probability of recovering eugonadal tT levels during a minimum 12-month timespan in a cohort of men who have been followed over time after the recovery from laboratory-confirmed COVID-19.Demographic, clinical and hormonal values were collected for the overall cohort. Hypogonadism was defined as tT ≤9.2 nmol/l. The Charlson Comorbidity Index was used to score health-significant comorbidities. Descriptive statistics was used to compare hormonal levels at baseline versus 7-month (FU1) versus 12-month (FU2) follow-up, respectively. Multivariate cox proportional hazards regression model was used to identify the potential predictors of eugonadism recovery over time among patients with hypogonadism at the time of infection.Of the original cohort of 286 patients, follow-up data were available for 121 (42.3%) at FU1 and 63 (22%) patients at FU2, respectively. Higher median interquartile range (IQR) tT levels were detected at FU2 (13.8 (12.3-15.3) nmol/L) versus FU1 (10.2 [9.3-10.9] nmol/L) and versus baseline (3.6 [3.02-4.02] nmol/L) (all p 0.0001), whilst both LH and ECirculating tT levels keep increasing over time in men after COVID-19. Still, almost 30% of men who recovered from COVID-19 had low circulating T levels suggestive for a condition of hypogonadism at a minimum 12-month follow-up.

Published
2022
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12. The Effect of an Accelerated Renal Replacement Therapy Initiation Is Not Modified by Baseline Risk

Author

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

Subjects
Renal Replacement Therapy, Pulmonary and Respiratory Medicine, Critical Illness, Medicine and Health Sciences, Humans, Acute Kidney Injury
Published
2022
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13. The Effect of Intensive Care Unit Diaries on Posttraumatic Stress Disorder, Anxiety, and Depression

Author

Arianna Gazzato, Tommaso Scquizzato, Guglielmo Imbriaco, Alessandra Negro, Maria Cristina Caballo Garrido, Giovanni Landoni, Alberto Zangrillo, Giovanni Borghi, Gazzato, Arianna, Scquizzato, Tommaso, Imbriaco, Guglielmo, Negro, Alessandra, Caballo Garrido, Maria Cristina, Landoni, Giovanni, Zangrillo, Alberto, and Borghi, Giovanni

Subjects
ICU diary, Stress Disorders, Post-Traumatic, Intensive Care Units, Depression, Depressive symptoms, Posttraumatic stress disorder, Humans, Intensive care unit, Anxiety, Emergency Nursing, Critical Care Nursing, Randomized Controlled Trials as Topic
Abstract

Introduction: Patients discharged from the intensive care unit (ICU) suffer from long-term symptoms affecting the physical, psychological, and cognitive well-being and cannot understand memories and dreams. Intensive care unit diaries describe daily events about the patient and may allow them to reconstruct their experience.Objective: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the effects of ICU diaries on posttraumatic stress disorder (PTSD), depression, and anxiety.Methods: Five electronic databases were searched up to May 6, 2022. We included RCTs comparing patients admitted to the ICU who received a diary to those who did not receive a diary. The primary outcome was the rate of PTSD. Secondary outcomes were rates of depression and anxiety.Results: We included 7 RCTs. Patients who received a diary during the ICU admission had reduced rate of PTSD (78/432 [18%] vs 106/422 [25%]; risk ratio [RR], 0.73; 95% confidence interval [CI], 0.57-0.94; P = .02; I-2 = 0%; trial sequential analysis-adjusted CI, 0.55-0.97) when compared with patients who did not receive a diary. We found a non-statistically significant difference toward a reduction in the rate of depression (38/232 [16%] vs 54/224 [24%]; RR, 0.70; 95% CI, 0.49-1.01; P = .06; I-2 = 0%) and anxiety (63/232 [27%] vs 70/224 [31%]; RR, 0.64; 95% CI, 0.29-1.40; P = .26; I-2 = 67%).Conclusions: Providing an ICU diary to patients admitted to the ICU reduced the rate of PTSD symptoms compared with usual care.

Published
2022
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14. Anticoagulation Strategies in Critically Ill Patients With SARS-CoV-2 Infection: The Role of Direct Thrombin Inhibitors

Author

Marina Pieri, Luisa Quaggiotti, Evgeny Fominskiy, Giovanni Landoni, Maria Grazia Calabrò, Silvia Ajello, Matteo Aldo Bonizzoni, Alessandro Belletti, Anna Mara Scandroglio, Pieri, Marina, Quaggiotti, Luisa, Fominskiy, Evgeny, Landoni, Giovanni, Calabrò, Maria Grazia, Ajello, Silvia, Bonizzoni, Matteo Aldo, Belletti, Alessandro, and Scandroglio, Anna Mara

Subjects
bivalirudin, Heparin, SARS-CoV-2, SARS-CoV-2 infection, Critical Illness, Anticoagulants, COVID-19, Hemorrhage, extracorporeal membrane oxygenation, Hirudins, Thrombocytopenia, Antithrombins, Recombinant Proteins, critical care, Extracorporeal Membrane Oxygenation, Anesthesiology and Pain Medicine, Fibrinolytic Agents, Humans, anticoagulation, Cardiology and Cardiovascular Medicine, Retrospective Studies
Abstract

Objectives: To compare heparin-based anticoagulation and bivalirudin-based anticoagulation within the context of critically ill patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design: An observational study. Setting: At the intensive care unit of a university hospital. Participants and interventions: Critically ill patients with a SARS-CoV-2 infection receiving full anticoagulation with heparin or bivalirudin. Measurements and main results: Twenty-three patients received full anticoagulation with bivalirudin and 60 with heparin. Despite patients in the bivalirudin group having higher mortality risk scores (SAPS II 60 ± 16 v 39 ±7, p < 0.001) and a higher need for extracorporeal support compared to the heparin group, hospital mortality was comparable (57% v 45, p=0.3). No difference in thromboembolic complications was observed, and bleeding events were more frequent in patients treated with bivalirudin (65% v 40%, p=0.01). Similar results were confirmed in the subgroup analysis of patients undergoing intravenous anticoagulation; in addition to comparable thrombotic complications occurrence and thrombocytopenia rate, however, no difference in the bleeding rate was observed (65% v 35%, p=0.08). Conclusions: Although heparin is the most used anticoagulant in the intensive care setting, bivalirudin-based anticoagulation was safe and effective in a cohort of critically ill patients with SARS-CoV-2. Bivalirudin may be given full consideration as an anticoagulation strategy for critically ill patients with SARS-CoV-2, especially in those with thrombocytopenia and on extracorporeal support.

Published
2022
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15. Venovenous Extracorporeal Membrane Oxygenation in Awake Non-Intubated Patients With COVID-19 ARDS at High Risk for Barotrauma

Author

Gianluca Paternoster, Pietro Bertini, Alessandro Belletti, Giovanni Landoni, Serena Gallotta, Diego Palumbo, Alessandro Isirdi, Fabio Guarracino, Paternoster, Gianluca, Bertini, Pietro, Belletti, Alessandro, Landoni, Giovanni, Gallotta, Serena, Palumbo, Diego, Isirdi, Alessandro, and Guarracino, Fabio

Subjects
Respiratory Distress Syndrome, Extracorporeal Membrane Oxygenation, Anesthesiology and Pain Medicine, Barotrauma, Macklin effect, COVID-19, Humans, acute respiratory distress syndrome, extracorporeal membrane oxygenation, mechanical ventilation, Wakefulness, barotrauma, Cardiology and Cardiovascular Medicine
Abstract

Objectives: To assess the efficacy of an awake venovenous extracorporeal membrane oxygenation (VV-ECMO) management strategy in preventing clinically relevant barotrauma in patients with coronavirus disease 2019 (COVID-19) with severe acute respiratory distress syndrome (ARDS) at high risk for pneumothorax (PNX)/pneumomediastinum (PMD), defined as the detection of the Macklin-like effect on chest computed tomography (CT) scan. Design: A case series. Setting: At the intensive care unit of a tertiary-care institution. Participants: Seven patients with COVID-19-associated severe ARDS and Macklin-like radiologic sign on baseline chest CT. Interventions: Primary VV-ECMO under spontaneous breathing instead of invasive mechanical ventilation (IMV). All patients received noninvasive ventilation or oxygen through a high-flow nasal cannula before and during ECMO support. The study authors collected data on cannulation strategy, clinical management, and outcome. Failure of awake VV-ECMO strategy was defined as the need for IMV due to worsening respiratory failure or delirium/agitation. The primary outcome was the development of PNX/PMD. Measurements and main results: No patient developed PNX/PMD. The awake VV-ECMO strategy failed in 1 patient (14.3%). Severe complications were observed in 4 (57.1%) patients and were noted as the following: intracranial bleeding in 1 patient (14.3%), septic shock in 2 patients (28.6%), and secondary pulmonary infections in 3 patients (42.8%). Two patients died (28.6%), whereas 5 were successfully weaned off VV-ECMO and were discharged home. Conclusions: VV-ECMO in awake and spontaneously breathing patients with severe COVID-19 ARDS may be a feasible and safe strategy to prevent the development of PNX/PMD in patients at high risk for this complication.

Published
2022
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16. Anticoagulation as secondary prevention of massive lung thromboses in hospitalized patients with COVID-19

Author

Rosaria Sofia, Mattias Carbone, Giovanni Landoni, Alberto Zangrillo, Lorenzo Dagna, Sofia, Rosaria, Carbone, Mattia, Landoni, Giovanni, Zangrillo, Alberto, and Dagna, Lorenzo

Subjects
Antithrombotic therapy, Venous Thrombosis, SARS-CoV-2, MicroCLOTS, Secondary Prevention, Internal Medicine, Anticoagulants, COVID-19, Humans, Thromboinflammatory syndrome, Lung
Published
2022
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17. Clinical characteristics and outcomes of patients with ventricular arrhythmias after continuous‐flow left ventricular assist device implant

Author

Simone Gulletta, Anna Mara Scandroglio, Luigi Pannone, Giulio Falasconi, Giulio Melisurgo, Silvia Ajello, Giuseppe D'Angelo, Lorenzo Gigli, Felicia Lipartiti, Eustachio Agricola, Elisabetta Lapenna, Alessandro Castiglioni, Michele De Bonis, Giovanni Landoni, Paolo Della Bella, Alberto Zangrillo, Pasquale Vergara, Gulletta, Simone, Scandroglio, Mara, Pannone, Luigi, Falasconi, Giulio, Melisurgo, Giulio, Ajello, Silvia, D'Angelo, Giuseppe, Gigli, Lorenzo, Lipartiti, Felicia, Agricola, Eustachio, Lapenna, Elisabetta, Castiglioni, Alessandro, De Bonis, Michele, Landoni, Giovanni, Della Bella, Paolo, Zangrillo, Alberto, and Vergara, Pasquale

Subjects
Cardiac Resynchronization Therapy, Heart Failure, Biomaterials, Treatment Outcome, Biomedical Engineering, Humans, Medicine (miscellaneous), Arrhythmias, Cardiac, Bioengineering, Heart-Assist Devices, General Medicine, Retrospective Studies
Abstract

Background: Ventricular arrhythmias (VAs) are observed in 25-50% of continuous-flow left ventricular assist devices (CF-LVAD) recipients, but their role on mortality is debated. Methods: Sixty-nine consecutive patients with a CF-LVAD were retrospectively analyzed. Study endpoints were death and occurrence of first episode of VAs post-CF-LVAD implantation. Early VAs were defined as VAs in the first month after CF-LVAD implantation. Results: During a median follow-up of 29.0 months, 19 patients (27.5 %) died and 18 patients (26.1%) experienced VAs. Three patients experienced early VAs, and one of them died. Patients with cardiac resynchronization therapy (CRT-D) showed a trend towards more VAs (p=0.076), compared to patients without CRT-D; no significant difference in mortality was found between patients with and without CRT-D (p=0.63). Patients with biventricular (BiV) pacing ≥98% experienced more frequently a VAs (p=0.046), with no difference in mortality (p=0.56), compared with patients experiencing BiV pacing

Published
2022
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18. Perioperative Noninvasive Ventilation After Adult or Pediatric Surgery: A Comprehensive Review

Author

Artem Kuzovlev, Giovanni Landoni, Luca Cabrini, Valery Likhvantsev, Landoni, G., Likhvantsev, V., Kuzovlev, A., and Cabrini, L.

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, 030204 cardiovascular system & hematology, surgery, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Pediatric surgery, medicine, postoperative, Humans, Intubation, Respiratory function, perioperative, Child, Hypoxia, acute respiratory failure, noninvasive ventilation, postoperative pulmonary complication, Noninvasive Ventilation, business.industry, Perioperative, Respiration, Artificial, Obesity, Morbid, Cardiac surgery, Anesthesiology and Pain Medicine, Cardiothoracic surgery, Anesthesia, Noninvasive ventilation, Respiratory Insufficiency, Cardiology and Cardiovascular Medicine, business, Abdominal surgery
Abstract

Postoperative pulmonary complications and acute respiratory failure are among the leading causes of adverse postoperative outcomes. Noninvasive ventilation may safely and effectively prevent acute respiratory failure in high-risk patients after cardiothoracic surgery and after abdominal surgery. Moreover, noninvasive ventilation can be used to treat postoperative hypoxemia, particularly after abdominal surgery. Noninvasive ventilation also can be helpful to prevent or manage intraoperative acute respiratory failure during non-general anesthesia, primarily in patients with poor respiratory function. Finally, noninvasive ventilation is superior to standard preoxygenation in delaying desaturation during intubation in morbidly obese and in critically ill hypoxemic patients. The few available studies in children suggest that noninvasive ventilation could be safe and valuable in treating hypoxemic or hypercapnic acute respiratory failure after cardiac surgery; on the other hand, it could be dangerous after tracheoesophageal correction.

Published
2022
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19. Percutaneous tracheostomy in COVID-19 patients: a new apneic approach

Author

Alessia La Bruna, Carlo Leggieri, Roberto Dossi, Nicola Pasculli, Giovanni Borghi, Elena Moizo, Giovanni Landoni, Anna Tornaghi, Antonio Dell'Acqua, Gaetano Lombardi, Giacomo Monti, Francesca Guzzo, Alberto Zangrillo, Martina Baiardo Redaelli, Valentina Paola Plumari, Milena Mucci, Paolo Beccaria, Sergio Colombo, Moizo, Elena, Zangrillo, Alberto, Colombo, Sergio, Leggieri, Carlo, Mucci, Milena, Beccaria, Paolo, Pasculli, Nicola, Borghi, Giovanni, Plumari, Valentina Paola, La Bruna, Alessia, Dossi, Roberto, Baiardo Redaelli, Martina, Tornaghi, Anna, Lombardi, Gaetano, Landoni, Giovanni, Dell'Acqua, Antonio, Guzzo, Francesca, and Monti, Giacomo

Subjects
medicine.medical_specialty, Percutaneous, Apnea, Percutaneous dilation tracheostomy, medicine.medical_treatment, law.invention, Tracheostomy, Tracheotomy, Bronchoscopy, Clinical Research, law, Intensive care, medicine, Fiberscope, Humans, Pandemics, Mechanical ventilation, medicine.diagnostic_test, business.industry, COVID-19, General Medicine, Respiration, Artificial, Cannula, Surgery, Critical care, Respiratory virus, business
Abstract

Background Percutaneous dilation tracheostomy is an aerosol-generating procedure carrying a documented infectious risk during respiratory virus pandemics. For this reason, during the COVID-19 outbreak, surgical tracheostomy was preferred to the percutaneous one, despite the technique related complications increased risk. Methods We describe a new sequence for percutaneous dilation tracheostomy procedure that could be considered safe both for patients and healthcare personnel. A fiberscope was connected to a video unit to allow bronchoscopy. Guidewire positioning was performed as usual. While the established standard procedure continues with the creation of the stoma without any change in mechanical ventilation, we retracted the bronchoscope until immediately after the access valve in the mount tube, allowing normal ventilation. After 3 minutes of ventilation with 100% oxygen, mechanical ventilation was stopped without disconnecting the circuit. During apnea, the stoma was created by dilating the trachea and the tracheostomy cannula was inserted. Ventilation was then resumed. We evaluated the safeness of the procedure by recording any severe desaturation and by performing serological tests to all personnel. Results Thirty-six patients (38%) of 96 underwent tracheostomy; 22 (23%) percutaneous dilation tracheostomies with the new approach were performed without any desaturation. All personnel (150 operators) were evaluated for serological testing: 9 (6%) had positive serology but none of them had participated in tracheostomy procedures. Conclusion This newly described percutaneous dilation tracheostomy technique was not related to severe desaturation events and we did not observe any positive serological test in health workers who performed the tracheostomies.

Published
2022
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24. Protocol and statistical analysis plan for the mega randomised registry trial comparing conservative vs. liberal oxygenation targets in adults with sepsis in the intensive care unit (Mega-ROX Sepsis)

Author

Paul J. Young, Abdulrahman Al-Fares, Diptesh Aryal, Yaseen M. Arabi, Muhammad Sheharyar Ashraf, Sean M. Bagshaw, Abigail Beane, Airton L. de Oliveira Manoel, Layoni Dullawe, Fathima Fazla, Tomoko Fujii, Rashan Haniffa, Carol L. Hodgson, Anna Hunt, Bharath Kumar Tirupakuzhi Vijayaraghavan, Giovanni Landoni, Cassie Lawrence, Israel Silva Maia, Diane Mackle, Mohd Zulfakar Mazlan, Alistair D. Nichol, Shaanti Olatunji, Aasiyah Rashan, Sumayyah Rashan, and Jessica Kasza

Subjects
Anesthesiology and Pain Medicine, Emergency Medicine, Critical Care and Intensive Care Medicine
Published
2023
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27. Propofol and survival: an updated meta-analysis of randomized clinical trials

Author

Yuki Kotani, Alessandro Pruna, Stefano Turi, Giovanni Borghi, Todd C. Lee, Alberto Zangrillo, Giovanni Landoni, and Laura Pasin

Subjects
Critical Care and Intensive Care Medicine
Abstract

Background Propofol is one of the most widely used hypnotic agents in the world. Nonetheless, propofol might have detrimental effects on clinically relevant outcomes, possibly due to inhibition of other interventions' organ protective properties. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate if propofol reduced survival compared to any other hypnotic agent in any clinical setting. Methods We searched eligible studies in PubMed, Google Scholar, and the Cochrane Register of Clinical Trials. The following inclusion criteria were used: random treatment allocation and comparison between propofol and any comparator in any clinical setting. The primary outcome was mortality at the longest follow-up available. We conducted a fixed-effects meta-analysis for the risk ratio (RR). Using this RR and 95% confidence interval, we estimated the probability of any harm (RR > 1) through Bayesian statistics. We registered this systematic review and meta-analysis in PROSPERO International Prospective Register of Systematic Reviews (CRD42022323143). Results We identified 252 randomized trials comprising 30,757 patients. Mortality was higher in the propofol group than in the comparator group (760/14,754 [5.2%] vs. 682/16,003 [4.3%]; RR = 1.10; 95% confidence interval, 1.01–1.20; p = 0.03; I2 = 0%; number needed to harm = 235), corresponding to a 98.4% probability of any increase in mortality. A statistically significant mortality increase in the propofol group was confirmed in subgroups of cardiac surgery, adult patients, volatile agent as comparator, large studies, and studies with low mortality in the comparator arm. Conclusions Propofol may reduce survival in perioperative and critically ill patients. This needs careful assessment of the risk versus benefit of propofol compared to other agents while planning for large, pragmatic multicentric randomized controlled trials to provide a definitive answer. Graphical Abstract

Published
2023
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30. Extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest: A systematic review and meta‐analysis of randomized and propensity score‐matched studies

Author

Tommaso Scquizzato, Alessandra Bonaccorso, Michela Consonni, Anna Mara Scandroglio, Justyna Swol, Giovanni Landoni, Alberto Zangrillo, Scquizzato, T., Bonaccorso, A., Consonni, M., Scandroglio, A. M., Swol, J., Landoni, G., and Zangrillo, A.

Subjects
extracorporeal cardiopulmonary resuscitation, Adult, Biomedical Engineering, Medicine (miscellaneous), Bioengineering, General Medicine, extracorporeal membrane oxygenation, Cardiopulmonary Resuscitation, Biomaterials, Extracorporeal Membrane Oxygenation, Treatment Outcome, Humans, out-of-hospital cardiac arrest, Propensity Score, neurological outcome, Out-of-Hospital Cardiac Arrest
Abstract

Background: In selected patients with refractory out-of-hospital cardiac arrest, extracorporeal cardiopulmonary resuscitation represents a promising approach when conventional cardiopulmonary resuscitation fails to achieve return of spontaneous circulation. This systematic review and meta-analysis aimed to compare extracorporeal cardiopulmonary resuscitation to conventional cardiopulmonary resuscitation. Methods: We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials up to November 28, 2021, for randomized trials and observational studies reporting propensity score-matched data and comparing adults with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation with those treated with conventional cardiopulmonary resuscitation. The primary outcome was survival with favorable neurological outcome at the longest follow-up available. Secondary outcomes were survival at the longest follow-up available and survival at hospital discharge/30days. Results: We included six studies, two randomized and four propensity score-matched studies. Patients treated with extracorporeal cardiopulmonary resuscitation had higher rates of survival with favorable neurological outcome (81/584 [14%] vs. 46/593 [7.8%]; OR=2.11; 95% CI, 1.41–3.15; p&nbsp

Published
2022
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31. A radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients

Author

Diego Palumbo, Alberto Zangrillo, Alessandro Belletti, Giorgia Guazzarotti, Maria Rosa Calvi, Francesca Guzzo, Renato Pennella, Giacomo Monti, Chiara Gritti, Marilena Marmiere, Margherita Rocchi, Sergio Colombo, Davide Valsecchi, Anna Mara Scandroglio, Lorenzo Dagna, Patrizia Rovere-Querini, Moreno Tresoldi, Giovanni Landoni, Francesco De Cobelli, Carolina Faustini, Nicolò Maimeri, Rosalba Lembo, Giuseppe Di Lucca, Raffaella Scotti, Maria Vittoria Lavorato, Alessandro Tomellieri, Corrado Campochiaro, Fatemeh Darvizeh, Francesca Calabrese, Roberto Mapelli, Nicola Pasculli, Giovanni Borghi, Antonella Cipriani, Maria Grazia Calabrò, Martina Crivellari, Annalisa Franco, Marina Pieri, Evgeny V. Fominskiy, Stefano Franchini, Antonio Dell'Acqua, Alessandro Marinosci, Giordano Vitali, Nicola Compagnone, Palumbo, D., Zangrillo, A., Belletti, A., Guazzarotti, G., Calvi, M. R., Guzzo, F., Pennella, R., Monti, G., Gritti, C., Marmiere, M., Rocchi, M., Colombo, S., Valsecchi, D., Scandroglio, A. M., Dagna, L., Rovere-Querini, P., Tresoldi, M., Landoni, G., De Cobelli, F., Faustini, C., Maimeri, N., Lembo, R., Di Lucca, G., Scotti, R., Lavorato, M. V., Tomellieri, A., Campochiaro, C., Darvizeh, F., Calabrese, F., Mapelli, R., Pasculli, N., Borghi, G., Cipriani, A., Calabro, M. G., Crivellari, M., Franco, A., Pieri, M., Fominskiy, E. V., Franchini, S., Dell'Acqua, A., Marinosci, A., Vitali, G., and Compagnone, N.

Subjects
ARDS, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, LR, likelihood ratio, Pneumomediastinum, Acute respiratory distress, Critical Care and Intensive Care Medicine, Article, Mechanical ventilation, Humans, Medicine, ARDS, acute respiratory distress syndrome, Mediastinal Emphysema, COVID-19, coronavirus disease 2019, PMD, pneumomediastinum, Respiratory Distress Syndrome, Chest imaging, Acute respiratory distress syndrome, SARS-CoV-2, business.industry, Tomography, X-ray computed, Pneumothorax, COVID-19, medicine.disease, PPV, positive predictive value, PNX, pneumothorax, NPV, negative predictive value, Case-Control Studies, Radiological weapon, Radiology, business
Abstract

Purpose: To determine whether Macklin effect (a linear collection of air contiguous to the bronchovascular sheath) on baseline CT imaging is an accurate predictor for subsequent pneumomediastinum (PMD)/pneumothorax (PNX) development in invasively ventilated patients with COVID-19-related acute respiratory distress syndrome (ARDS). Materials and methods: This is an observational, case-control study. From a prospectively acquired database, all consecutive invasively ventilated COVID-19 ARDS patients who underwent at least one baseline chest CT scan during the study time period (February 25th, 2020–December 31st, 2020) were identified; those who had tracheal lesion or already had PMD/PNX at the time of the first available chest imaging were excluded. Results: 37/173 (21.4%) patients enrolled had PMD/PNX; specifically, 20 (11.5%) had PMD, 10 (5.8%) PNX, 7 (4%) both. 33/37 patients with subsequent PMD/PNX had Macklin effect on baseline CT (89.2%, true positives) 8.5 days [range, 1–18] before the first actual radiological evidence of PMD/PNX. Conversely, 6/136 patients without PMD/PNX (4.4%, false positives) demonstrated Macklin effect (p < 0.001). Macklin effect yielded a sensitivity of 89.2% (95% confidence interval [CI]: 74.6–96.9), a specificity of 95.6% (95% CI: 90.6–98.4), a positive predictive value (PV) of 84.5% (95% CI: 71.3–92.3), a negative PV of 97.1% (95% CI: 74.6–96.9) and an accuracy of 94.2% (95% CI: 89.6–97.2) in predicting PMD/PNX (AUC:0.924). Conclusions: Macklin effect accurately predicts, 8.5 days in advance, PMD/PNX development in COVID-19 ARDS patients.

Published
2021
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32. Microvascular lung vessels obstructive thromboinflammatory syndrome in patients with COVID-19: Insights from lung intravascular optical coherence tomography

Author

Ludhmila Abrahão Hajjar, Marco B. Ancona, Roberto Kalil Filho, Moreno Tresoldi, José Guilherme Caldas, Giacomo Monti, Francisco Cesar Carnevale, Francesco De Cobelli, André Moreira de Assis, Fabio Ciceri, Giovanni Landoni, Jouke Dijkstra, Francesco Moroni, Alexandre Antônio Cunha Abizaid, Fernanda Willemann Ungaretti, Maria José Carvalho Carmona, Daniel De Backer, Carlos Eduardo Pompilio, Fábio S. de Britto, Carlos M. Campos, Alberto Zangrillo, and Matteo Montorfano

Subjects
General Medicine
Abstract

BackgroundMicrovascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome.MethodsThe COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients.ResultsA total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 ± 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 ± 4.6 mm2, with stenosis of 60.9 ± 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 ± 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 ± 2.6, and the mean thrombus-containing lesion length was 14.1 ± 13.9 mm. No peri-procedural complications occurred in any of the 13 patients.ConclusionOCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis.Clinical trial registrationClinicalTrial.gov, identifier NCT04410549.

Published
2023
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34. An updated 'norepinephrine equivalent' score in intensive care as a marker of shock severity

Author

Yuki Kotani, Annamaria Di Gioia, Giovanni Landoni, Alessandro Belletti, and Ashish K. Khanna

Subjects
Critical Care and Intensive Care Medicine
Abstract

Vasopressors and fluids are the cornerstones for the treatment of shock. The current international guidelines on shock recommend norepinephrine as the first-line vasopressor and vasopressin as the second-line vasopressor. In clinical practice, due to drug availability, local practice variations, special settings, and ongoing research, several alternative vasoconstrictors and adjuncts are used in the absence of precise equivalent doses. Norepinephrine equivalence (NEE) is frequently used in clinical trials to overcome this heterogeneity and describe vasopressor support in a standardized manner. NEE quantifies the total amount of vasopressors, considering the potency of each such agent, which typically includes catecholamines, derivatives, and vasopressin. Intensive care studies use NEE as an eligibility criterion and also an outcome measure. On the other hand, NEE has several pitfalls which clinicians should know, important the lack of conversion of novel vasopressors such as angiotensin II and also adjuncts such as methylene blue, including a lack of high-quality data to support the equation and validate its predictive performance in all types of critical care practice. This review describes the history of NEE and suggests an updated formula incorporating novel vasopressors and adjuncts.

Published
2023
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36. List of contributors: volume I

Author

Taylan Adademir, Özge Altaş, Kyriakos Anastasiadis, Polychronis Antonitsis, Helena Argiriadou, Thanos Athanasiou, Dimitrios V. Avgerinos, Paul G. Bannon, Michael J. Bates, Pınar Karaca Baysal, Tolga Baş, Christoph Benk, Annalisa Bernabei, Stephanie Bertolin, Stefaan Bouchez, Walter Doug Boyd, Mehmet Can, Nuray Çankaya, Thierry Carrel, Davut Çekmecelioğlu, W. Randolph Chitwood, Giorgia Cibin, Stephen Clark, John R. Cooper, Joseph S. Coselli, Yongwook Dan, Maria Elena De Piero, Filip M.J.J. De Somer, Apostolos Deliopoulos, Mustafa Duman, Uğur Eke, Magdy M. El-Sayed Ahmed, Ercan Ersoy, Patricia Martinez Évora, Paulo Roberto B. Evora, Assunta Fabozzo, Giuseppe Faggian, Jonathon Paul Fanning, Maria Fergadi, David Fisher, David Fitzgerald, Alessandra Francica, O. Howard Frazier, Nicola Galdieri, Gino Gerosa, Gabriel Giuliani, Katherine L. Gordon, Pınar Atagün Güney, Mustafa Emre Gürcü, Erich Gygax, Hakan Hançer, Amer Harky, Axel Haverich, Ryan M. Holcomb, Kay Hon, Cristina Ibáñez, Cecilio Jacob, Afksendiyos Kalangos, Kathleen Kibler, Leonard Kritharides, Alexander S. Krupnick, Şefika Kılıç, Kaan Kırali, Yeşim Uygun Kızmaz, Giovanni Landoni, Peter Lang, Joshua L. Leibowitz, Daniele Linardi, Vladimir Lomivorotov, Ludmila Lomivorotova, Sarah Henning Longnus, Giovanni Battista Luciani, Dimitrios Magouliotis, Sven Maier, Giulia Maj, Silvia Mariani, Naomi Melamed, Alícia Molina-Andujar, John M. Murkin, Gerard J. Myers, Konstantinos S. Mylonas, Manoj Myneni, L. Wiley Nifong, Francesco Onorati, Vicente Orozco-Sevilla, Tanıl Özer, Mustafa Mert Özgür, Özlem Oğuzhan, Halide Oğuş, Federico Pappalardo, Krishna Patel, Vikrant Pathania, Sri Harsha Patlolla, Juan Perdomo, Antonio Pisano, Esteban Poch, Erdal Polat, Agya B.A. Prempeh, John D. Puskas, Eduard Quintana, Shahzad G. Raja, Keshava Rajagopal, Fabio Ramponi, Justin Resley, Carolina Soledad Romero García, Alessio Rungatscher, Başar Sareyyüpoğlu, Hartzell V. Schaff, Michael Seco, Aakash Shah, Nataliia Shatelen, Hoxha Stiljan, Zhonghua Sun, Justyna Swol, Mine Şimşek, Chiara Tessari, Mathew Thomas, Ilaria Tropea, Steven Tsui, Marko Turina, Akif Ündar, Michael P. Vallely, Korneel Vandewiele, Ismail Vokshi, Claudia Yu Yao Wei, Georg Maximilian Wieselthaler, Kelly Wright, Hülya Yük, and Vipin Zamvar

Published
2023
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39. Noninvasive Ventilation for Acute Respiratory Failure in Pediatric Patients: A Systematic Review and Meta-Analysis

Author

Daniele Boghi, Kyung Woo Kim, Jun Hyun Kim, Sang-Il Lee, Ji Yeon Kim, Kyung-Tae Kim, Andrea Ambrosoli, Giovanni Guarneri, Giovanni Landoni, and Luca Cabrini

Subjects
Pediatrics, Perinatology and Child Health, Critical Care and Intensive Care Medicine
Abstract

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) on the use of noninvasive ventilation (NIV) for acute respiratory failure (ARF) in pediatric patients.We searched PubMed, EMBASE, the Cochrane Central Register of Clinical Trials, and Clinicaltrials.gov with a last update on July 31, 2022.We included RCTs comparing NIV with any comparator (standard oxygen therapy and high-flow nasal cannula [HFNC]) in pediatric patients with ARF. We excluded studies performed on neonates and on chronic respiratory failure patients.Baseline characteristics, intubation rate, mortality, and hospital and ICU length of stays were extracted by trained investigators.We identified 15 RCTs (2,679 patients) for the final analyses. The intubation rate was 109 of 945 (11.5%) in the NIV group, and 158 of 1,086 (14.5%) in the control group (risk ratio, 0.791; 95% CI, 0.629-0.996; p = 0.046; I2 = 0%; number needed to treat = 31). Findings were strengthened after removing studies with intervention duration shorter than an hour and after excluding studies with cross-over as rescue treatment. There was no difference in mortality, and ICU and hospital length of stays.In pediatric patients, NIV applied for ARF might reduce the intubation rate compared with standard oxygen therapy or HFNC. No difference in mortality was observed.

Published
2022

40. Outcomes of noninvasive ventilation as the ceiling of treatment in patients with COVID-19

Author

Giuseppe A, Ramirez, Enrica P, Bozzolo, Agnese, Gobbi, Elena, Castelli, Clarissa, Centurioni, Mattia, DI Meo, Emanuel, Della Torre, Flavia, DI Scala, Anna, Morgillo, Alessandro, Marinosci, Martina, Miglio, Paolo, Scarpellini, Chiara, Tassan Din, Barbara, Castiglioni, Chiara, Oltolini, Marco, Ripa, Gaetano, DI Terlizzi, Valentina, DA Prat, Sarah, Damanti, Raffaella, Scotti, Giuseppe, DI Lucca, Martina, Baiardo Redaelli, Valentina P, Plumari, Elena, Moizo, Francesco, Carcó, Paolo, Silvani, Francesco, DE Cobelli, Giovanni, Landoni, Moreno, Tresoldi, Mona-Rita, Yacoub, Ramirez, Giuseppe A, Bozzolo, Enrica P, Gobbi, Agnese, Castelli, Elena, Centurioni, Clarissa, DI Meo, Mattia, Della Torre, Emanuel, DI Scala, Flavia, Morgillo, Anna, Marinosci, Alessandro, Miglio, Martina, Scarpellini, Paolo, Tassan Din, Chiara, Castiglioni, Barbara, Oltolini, Chiara, Ripa, Marco, DI Terlizzi, Gaetano, DA Prat, Valentina, Damanti, Sarah, Scotti, Raffaella, DI Lucca, Giuseppe, Baiardo Redaelli, Martina, Plumari, Valentina P, Moizo, Elena, Carcó, Francesco, Silvani, Paolo, DE Cobelli, Francesco, Landoni, Giovanni, and Tresoldi, Moreno

Subjects
Mechanical ventilation, ARDS, medicine.medical_specialty, business.industry, medicine.medical_treatment, Vital signs, General Medicine, Disease, medicine.disease, Heart failure, Cohort, Emergency medicine, medicine, Intubation, Continuous positive airway pressure, business
Abstract

Background: Non-invasive mechanical ventilation (NIV) is effective for symptom relief and respiratory support in patients with respiratory insufficiency, severe comorbidities and no indication to intubation. Experience with NIV as the ceiling of treatment in severely compromised novel coronavirus disease (COVID-19) patients is lacking. Methods: We evaluated 159 patients with COVID-19-related acute respiratory syndrome (ARDS), 38 of whom with NIV as the ceiling of treatment, admitted to an ordinary ward and treated with continuous positive airway pressure (CPAP) and respiratory physiotherapy. Treatment failure and death were correlated with clinical and laboratory parameters in the whole cohort and in patients with NIV as the ceiling of treatment. Results: Patients who had NIV as the ceiling of treatment were elderly, with a low BMI and a high burden of comorbidities, showed clinical and laboratory signs of multi-organ insufficiency on admission and of rapidly deteriorating vital signs during the first week of treatment. NIV failure occurred overall in 77 (48%) patients, and 27/38 patients with NIV as the ceiling of treatment died. Congestive heart failure, chronic benign haematological diseases and inability/refusal to receive respiratory physiotherapy were independently associated to NIV failure and mortality. Need for increased positive end-expiratory pressures and low platelets were associated with NIV failure. Death was associated to cerebrovascular disease, need for CPAP cycles longer than 12h and, in the subgroup of patients with NIV as the ceiling of treatment, was heralded by vital sign deterioration within 48 h. Conclusions: NIV and physiotherapy are a viable treatment option for patients with severe COVID-19 and severe comorbidities.

Published
2022
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42. Outcomes of out-of-hospital cardiac arrest in patients with SARS-CoV-2 infection: a systematic review and meta-analysis

Author

Andrea Paoli, Tommaso Scquizzato, Maria Grazia Calabrò, Alberto Zangrillo, Anna Mara Scandroglio, Giovanni Landoni, Andrey Yavorovskiy, Filippo D'Amico, Annalisa Franco, Scquizzato, Tommaso, Landoni, Giovanni, Scandroglio, Anna Mara, Franco, Annalisa, Calabrò, Maria Grazia, Paoli, Andrea, D'Amico, Filippo, Yavorovskiy, Andrey, and Zangrillo, Alberto

Subjects
Emergency Medical Services, Resuscitation, medicine.medical_specialty, medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Reviews, Return of spontaneous circulation, cardiopulmonary resuscitation, Internal medicine, Emergency medical services, Humans, Medicine, Cardiopulmonary resuscitation, out-of-hospital cardiac arrest, Pandemics, SARS-CoV-2, business.industry, COVID-19, Odds ratio, Cardiopulmonary Resuscitation, Confidence interval, Meta-analysis, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Emergency Medicine, business, Out-of-Hospital Cardiac Arrest
Abstract

Supplemental Digital Content is available in the text., Introduction Out-of-hospital cardiac arrests increased during the COVID-19 pandemic and a direct mechanism of cardiac arrest in infected patients was hypothesized. Therefore, we conducted a systematic review and meta-analysis to assess outcomes of SARS-CoV-2 patients with out-of-hospital cardiac arrest. Methods PubMed and EMBASE were searched up to April 05, 2021. We included studies comparing out-of-hospital cardiac arrests patients with suspected or confirmed SARS-CoV-2 infection versus noninfected patients. The primary outcome was survival at hospital discharge or at 30 days. Secondary outcomes included return of spontaneous circulation, cardiac arrest witnessed and occurring at home, bystander-initiated cardiopulmonary resuscitation, proportion of nonshockable rhythm and resuscitation attempted, and ambulance arrival time. Results In the ten included studies, 18% (1341/7545) of out-of-hospital cardiac arrests occurred in patients with SARS-CoV-2 infection. Patients with out-of-hospital cardiac arrest and SARS-CoV-2 infection had reduced rates of survival (16/856 [1.9%] vs. 153/2344 [6.5%]; odds ratio (OR) = 0.33; 95% confidence interval (CI), 0.17–0.65; P = 0.001; I2 = 28%) and return of spontaneous circulation (188/861 [22%] vs. 640/2403 [27%]; OR = 0.75; 95% CI, 0.65–0.86; P < 0.001; I2 = 0%) when compared to noninfected patients. Ambulance arrived later (15 ± 10 vs. 13 ± 7.5 min; mean difference = 1.64; 95% CI, 0.41–2.88; P = 0.009; I2 = 61%) and nonshockable rhythms (744/803 [93%] vs. 1828/2217 [82%]; OR = 2.79; 95% CI, 2.08–3.73; P < 0.001; I2 = 0%) occurred more frequently. SARS-CoV-2 positive patients suffered a cardiac arrest at home more frequently (1186/1263 [94%] vs. 3598/4055 [89%]; OR = 1.86; 95% CI, 1.45–2.40; P

Published
2021
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43. Venoarterial Extracorporeal Membrane Oxygenation Support in Lung Cancer Resection

Author

Fabrizio Monaco, Pierluigi Novellis, Alberto Zangrillo, Francesca Rossetti, Giovanni Landoni, Vanesa Gregorc, Angelo Carretta, Giulia Veronesi, Novellis, Pierluigi, Monaco, Fabrizio, Landoni, Giovanni, Rossetti, Francesca, Carretta, Angelo, Gregorc, Vanesa, Zangrillo, Alberto, and Veronesi, Giulia

Subjects
Pulmonary and Respiratory Medicine, Lung cancer surgery, medicine.medical_specialty, ARDS, business.industry, Dilated cardiomyopathy, Perioperative, medicine.disease, Surgery, surgical procedures, operative, Cardiothoracic surgery, Heart failure, medicine.artery, Pulmonary artery, medicine, Respiratory function, Cardiology and Cardiovascular Medicine, business
Abstract

Cardiovascular comorbidities often prevent patients with otherwise resectable early-stage lung cancer from undergoing surgery due to prohibitive peri-operative risk. Here we describe the first intraoperative use of venoarterial (VA) ECMO in a stage cIIA lung cancer patient with arterial infiltration and severe post-ischemic dilated cardiomyopathy (EF 23%) undergoing left upper lobectomy with pulmonary artery angioplasty. Providing intra-operative cardiovascular and respiratory function support, VA-ECMO represents a suitable option for patients with heart failure, ensuring adequate hemodynamic profile and reducing the risk of complications. These otherwise inoperable patients can thus be offered a potentially curative surgical resection of the malignancy. Surgery is the standard treatment for patients with early-stage lung cancer 1. However, several patients with advanced heart failure may be excluded from surgery due to prohibitive perioperative risk. Providing circulatory and respiratory support, extracorporeal membrane oxygenator (ECMO) may represent a suitable option for such patients 2. While there is a published experience on intraoperative use of veno-venous (VV) ECMO, primarily in thoracic surgery 3, an extremely limited number of reports considered the use of venoarterial (VA)-ECMO in patients undergoing non-cardiac surgery 45. VA-ECMO is currently indicated in patients with cardiovascular failure and concomitant cardiac pump dysfunction, as in post-operative ARDS associated with septic shock 4; outside the intensive care unit, the use of pre-emptive VA-ECMO has traditionally been limited to patients undergoing elective ventricular tachycardia ablation and structural heart procedures5. Here we report the first case of intraoperative use of VA-ECMO in a patient with resectable lung cancer and ischemic heart disease with prohibitive left ventricular function, and describe the benefits of this new indication.

Published
2022
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44. Combined plasma levels of IL-10 and testosterone, but not soluble HLA-G5, predict the risk of death in COVID-19 patients

Author

Giada Amodio, Paolo Capogrosso, Marina Pontillo, Michela Tassara, Luca Boeri, Cristina Carenzi, Daniele Cignoli, Anna Maria Ferrara, Giuseppe A. Ramirez, Cristina Tresoldi, Massimo Locatelli, Luca Santoleri, Antonella Castagna, Alberto Zangrillo, Francesco De Cobelli, Moreno Tresoldi, Giovanni Landoni, Patrizia Rovere‐Querini, Fabio Ciceri, Francesco Montorsi, Andrea Salonia, and Silvia Gregori

Subjects
Endocrinology, Reproductive Medicine, Urology, Endocrinology, Diabetes and Metabolism
Abstract

The identification of biomarkers correlated with coronavirus disease 2019 (COVID-19) outcomes is a relevant need for clinical management. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is characterized by elevated interleukin (IL)-6, IL-10, HLA-G, and impaired testosterone production.We aimed at defining the combined impact of sex hormones, interleukin-10, and HLA-G on COVID-19 pathophysiology and their relationship in male patients.We measured by chemiluminescence immunoassay, electrochemiluminescent assays, and enzyme-linked immunosorbent assay circulating total testosterone, 17β-estradiol (EWe found significantly higher levels of IL-10, HLA-G, and EOur findings indicate that combined evaluation of IL-10 and testosterone predicts the risk of death in men with COVID-19 and support the hypothesis that IL-10 fails to suppress excessive inflammation by promoting viral spreading.

Published
2022

45. Reparixin on survival of critically ill or transplant patients: a meta-analysis of randomized trials

Author

giovanni, landoni, Piersanti, Gioia, zangrillo, alberto, and Piemonti, Lorenzo

Subjects
Critical Care, Pulmonology, Endocrinology, Diabetes, and Metabolism, Cardiology, Diseases, SARS-COV-2, Virus Diseases, Nephrology, Reparixin, Medicine and Health Sciences, Medical Specialties, Surgery, Covid-19, intensive and critical care, anti-inflammatory
Abstract

meta-analysis of randomized clinical trial

Published
2022
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46. Angiotensin II infusion and markers of organ function in invasively ventilated COVID-19 patients

Author

Alberto Zangrillo, Chiara Sartini, Marina Pieri, Sergio Colombo, Maria Rosa Calvi, Giacomo Monti, Francesca Guzzo, Antonella Cipriani, Pasquale Nardelli, Rinaldo Bellomo, Giovanni Landoni, Paolo Beccaria, Alessandro Ortalda, Stefano Franchini, Ary Serpa Neto, Lorenzo Dagna, Gaetano Lombardi, Evgeny Fominskiy, Moreno Tresoldi, Marianna Sartorelli, Maria Grazia Calabrò, Andrea Assanelli, Anna Mara Scandroglio, Nicola Pasculli, Zangrillo, A, Colombo, S, Scandroglio, Am, Fominskiy, E, Pieri, M, Calabro, Mg, Beccaria, Pf, Pasculli, N, Guzzo, F, Calvi, Mr, Cipriani, A, Sartini, C, Nardelli, P, Ortalda, A, Lombardi, G, Sartorelli, M, Monti, G, Assanelli, A, Tresoldi, M, Dagna, L, Franchini, S, Neto, A, Bellomo, R, and Landoni, G

Subjects
Mechanical ventilation, medicine.medical_specialty, Mean arterial pressure, Creatinine, business.industry, medicine.medical_treatment, Odds ratio, Angiotensin II, Intensive care unit, law.invention, chemistry.chemical_compound, Blood pressure, chemistry, law, Internal medicine, Cardiology, medicine, Renal replacement therapy, business
Abstract

OBJECTIVE: The use of angiotensin II in invasively ventilated patients with coronavirus disease 2019 (COVID-19) is controversial. Its effect on organ function is unknown. DESIGN: Prospective observational study. SETTING: Intensive care unit (ICU) of a tertiary academic hospital in Milan, Italy. PARTICIPANTS: Adult patients receiving mechanical ventilation due to COVID-19. INTERVENTIONS: Use angiotensin II either as rescue vasopressor agent or as low dose vasopressor support. MAIN OUTCOME MEASURES: Patients treated before angiotensin II was available or treated in an adjacent COVID-19 ICU served as controls. For data analysis, we applied Bayesian modelling as appropriate. We assessed the effects of angiotensin II on organ function. RESULTS: We compared 46 patients receiving angiotensin II therapy with 53 controls. Compared with controls, angiotensin II increased the mean arterial pressure (median difference, 9.05 mmHg; 95% CI, 1.87–16.22; P = 0.013) and the Pao2/Fio2 ratio (median difference, 23.17; 95% CI, 3.46–42.88; P = 0.021), and decreased the odds ratio (OR) of liver dysfunction (OR, 0.32; 95% CI, 0.09–0.94). However, angiotensin II had no effect on lactate, urinary output, serum creatinine, C-reactive protein, platelet count, or thromboembolic complications. In patients with abnormal baseline serum creatinine, Bayesian modelling showed that angiotensin II carried a 95.7% probability of reducing the use of renal replacement therapy (RRT). CONCLUSIONS: In ventilated patients with COVID-19, angiotensin II therapy increased blood pressure and Pao2/Fio2 ratios, decreased the OR of liver dysfunction, and appeared to decrease the risk of RRT use in patients with abnormal baseline serum creatinine. However, all of these findings are hypothesis-generating only. TRIAL REGISTRATION: ClinicalTrials.gov NCT04318366.

Published
2021
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47. Epicardial adipose tissue characteristics, obesity and clinical outcomes in COVID-19: A post-hoc analysis of a prospective cohort study

Author

Riccardo Leone, Alberto Zangrillo, Valeria Nicoletti, Luigi di Filippo, Guglielmo Gallone, Fabio Ciceri, Francesco De Cobelli, Paolo G. Camici, Antonio Secchi, Antonella Castagna, Rebecca De Lorenzo, Annalisa Ruggeri, Emanuele Bosi, Anna Palmisano, Giovanni Landoni, Patrizia Rovere-Querini, Moreno Tresoldi, Antonio Esposito, Caterina Conte, Davide Vignale, Conte, Caterina, Esposito, Antonio, De Lorenzo, Rebecca, Di Filippo, Luigi, Palmisano, Anna, Vignale, Davide, Leone, Riccardo, Nicoletti, Valeria, Ruggeri, Annalisa, Gallone, Guglielmo, Secchi, Antonio, Bosi, Emanuele, Tresoldi, Moreno, Castagna, Antonella, Landoni, Giovanni, Zangrillo, Alberto, De Cobelli, Francesco, Ciceri, Fabio, Camici, Paolo, and Rovere-Querini, Patrizia

Subjects
Male, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), 030204 cardiovascular system & hematology, Overweight, law.invention, 0302 clinical medicine, Risk Factors, law, Medicine, Visceral fat, Hospital Mortality, Prospective Studies, Prospective cohort study, Adiposity, Nutrition and Dietetics, Middle Aged, Prognosis, Intensive care unit, Cardiac injury, Italy, Predictive value of tests, Female, Radiography, Thoracic, medicine.symptom, Cardiology and Cardiovascular Medicine, Pericardium, medicine.medical_specialty, 030209 endocrinology & metabolism, Intra-Abdominal Fat, Risk Assessment, Article, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, Diabetes mellitus, Epicardial adipose tissue, Post-hoc analysis, Humans, Obesity, Aged, Inflammation, SARS-CoV-2, business.industry, Proportional hazards model, COVID-19, medicine.disease, Tomography, X-Ray Computed, business
Abstract

Background and aims Obesity-related cardiometabolic risk factors associate with COVID-19 severity and outcomes. Epicardial adipose tissue (EAT) is associated with cardiometabolic disturbances, is a source of proinflammatory cytokines and a marker of visceral adiposity. We investigated the relation between EAT characteristics and outcomes in COVID-19 patients. Methods and results This post-hoc analysis of a large prospective investigation included all adult patients (≥18 years) admitted to San Raffaele University Hospital in Milan, Italy, from February 25th to April 19th, 2020 with confirmed SARS-CoV-2 infection who underwent a chest computed tomography (CT) scan for COVID-19 pneumonia and had anthropometric data available for analyses. EAT volume and attenuation (EAT-At, a marker of EAT inflammation) were measured on CT scan. Primary outcome was critical illness, defined as admission to intensive care unit (ICU), invasive ventilation or death. Cox regression and regression tree analyses were used to assess the relationship between clinical variables, EAT characteristics and critical illness. One-hundred and ninety-two patients were included (median [25th-75th percentile] age 60 years [53-70], 76% men). Co-morbidities included overweight/obesity (70%), arterial hypertension (40%), and diabetes (16%). At multivariable Cox regression analysis, EAT-At (HR 1.12 [1.04-1.21]) independently predicted critical illness, while increasing PaO2/FiO2 was protective (HR 0.996 [95% CI 0.993; 1.00]). CRP, plasma glucose on admission, EAT-At and PaO2/FiO2 identified five risk groups that significantly differed with respect to time to death or admission to ICU (log-rank p, Graphical abstract Image 1

Published
2021
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48. Gender-gap in randomized clinical trials reporting mortality in the perioperative setting and critical care: 20 years behind the scenes

Author

Carolina S. Romero, Nicolò Maimeri, Alessandra Bonaccorso, Martina Baiardo-Redaelli, Gaetano Lombardi, Otito Frances Iwuchukwu, Alessandro Ortalda, Benedikt Schmid, Magdalena Fleming, and Giovanni Landoni

Subjects
Pharmacology, General Medicine, Article
Abstract

BACKGROUND: Women researchers might experience obstacles in academic environments and might be underrepresented in the authorship of articles published in peer-reviewed journals. MATERIAL AND METHODS: This is a cross-sectional analysis of female-led RCTs describing all interventions reducing mortality in critically ill and perioperative patients from 1981 to December 31, 2020. We searched PubMed/MEDLINE and EMBASE with the keywords RCTs and mortality. The gender of the first author was extracted and descriptive analysis was performed including the year of publication, impact factor, country of the first author, and methodological aspects. RESULTS: We analyzed 340 RCTs, of which 42 (12%) were led by female researchers. The presence of women increased from 8% (14/172) until 2010 up to 17% (28/168) in 2010 and beyond. The United States, the United Kingdom, and Brazil were the main countries of origin of female researchers. Women authors conducted mainly single-center and single-nation studies as compared to male authors. The median impact factor of the target journal was 6 (3-27) in women vs. 7 (3-28) in men, with a p-value of 0.67; Critical Care Medicine, JAMA, and The New England Journal of Medicine were the most frequent target journals for both women and men. CONCLUSION: In the last 40 years, only one out of eight RCTs had a woman as the first author but the presence of women increased up to 17% by 2010 and beyond. The impact factor of publication target journals was high and not different between genders.

Published
2023
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49. The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

Author

Giovanni Landoni, Andrey Yavorovskiy, Michele Torella, Antonio Pisano, Pisano, A., Torella, M., Yavorovskiy, A., and Landoni, G.

Subjects
Adult, medicine.medical_specialty, coronary artery bypass grafting, sevoflurane, anesthesia, 030204 cardiovascular system & hematology, Perioperative Care, cardiac anesthesia, Sevoflurane, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, 030202 anesthesiology, medicine, Humans, Anesthesia, Cardiac Surgical Procedures, Intensive care medicine, business.industry, Acute kidney injury, medicine.disease, Cardiac surgery, Neurologic injury, Regimen, Anesthesiology and Pain Medicine, Anesthetics, Inhalation, Anesthetic, Perioperative care, Narrative review, Cardiology and Cardiovascular Medicine, business, cardiac surgery, medicine.drug
Abstract

Despite improvements in surgical techniques and perioperative care, cardiac surgery still is burdened by relatively high mortality and frequent major postoperative complications, including myocardial dysfunction, pulmonary complications, neurologic injury, and acute kidney injury. Although the surgeon's skills and volume and patient- and procedure-related risk factors play a major role in the success of cardiac surgery, there is growing evidence that also optimizing perioperative care may improve outcomes significantly. The present review focuses on the aspects of perioperative care that are strictly related to the anesthesia regimen, with special reference to volatile anesthetics and neuraxial anesthesia, whose effect on outcome in adult cardiac surgery has been investigated extensively.

Published
2021
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