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1. On the problem of modeling the boat wake climate; the Florida intracoastal waterway

Author

Forlini, C., Qayyum, R., Malej, M., Lam, M. -A. Y. -H., Shi, F., Angelini, C., and Sheremet, A.

Subjects
Physics - Fluid Dynamics, Physics - Data Analysis, Statistics and Probability, Physics - Geophysics
Abstract

The impact of boat traffic on the health of coastal ecosystems is a multi-scale process: from minutes (individual wakes) to days (tidal modulation of sediment transport), to seasons and years (traffic is seasonal). A considerable numerical effort, notwithstanding the value of a boat-by-boat numerical modeling approach, is questionable, because of the practical impossibility of specifying the exact type and navigation characteristics for every boat comprising the traffic at any given time. Here, we propose a statistical-mechanics description of the traffic using a joint probability density of the wake population in some characteristic parameter space. We attempt to answer two basic questions: (1) what is the relevant parameter space and (2) how should a numerical model be tested for a wake population? We describe the linear and nonlinear characteristics of wakes observed in the Florida Intracoastal Waters. Adopting provisionally a two-dimensional parameter space (depth- and length-based Froude numbers) we conduct numerical simulations using the open-source FUNWAVE-TVD Boussinesq model. The model performance is excellent for weakly-dispersive, completely specified wakes (e.g., the analytical linear wakes), and also for the range of Froude numbers observed in the field, or for large container ships generating relatively long waves. The model is challenged by the short waves generated by small, slow boats. However, simulations suggest that the problem is confined to the deeper water domain and linear evolution. Nonlinear wake shoaling, essential for modeling wake-induced sediment transport and wake impact on the environment, is described well.

Published
2020
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2. Ventilation distribution during changes in trunk inclination in ARDS patients

Author

Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, Marrazzo F., Spina S., Zadek F., Forlini C., Bassi G., Giudici R., Bellani G., Fumagalli R., Langer T., Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, Marrazzo F., Spina S., Zadek F., Forlini C., Bassi G., Giudici R., Bellani G., Fumagalli R., and Langer T.

Published
2024

4. Successful Versus Failed Transition From Controlled Ventilation to Pressure Support Ventilation in COVID-19 Patients: A Retrospective Cohort Study

Author

Polo Friz, M, Rezoagli, E, Safaee Fakhr, B, Florio, G, Carlesso, E, Giudici, R, Forlini, C, Tardini, F, Langer, T, Laratta, M, Casella, G, Forastieri Molinari, A, Protti, A, Cecconi, M, Cabrini, L, Biagioni, E, Berselli, A, Mirabella, L, Tonetti, T, De Robertis, E, Grieco, D, Antonelli, M, Citerio, G, Fumagalli, R, Foti, G, Zanella, A, Grasselli, G, Bellani, G, Polo Friz, Melisa, Rezoagli, Emanuele, Safaee Fakhr, Bijan, Florio, Gaetano, Carlesso, Eleonora, Giudici, Riccardo, Forlini, Clarissa, Tardini, Francesca, Langer, Thomas, Laratta, Matteo, Casella, Giampaolo, Forastieri Molinari, Andrea, Protti, Alessandro, Cecconi, Maurizio, Cabrini, Luca, Biagioni, Emanuela, Berselli, Angela, Mirabella, Lucia, Tonetti, Tommaso, De Robertis, Edoardo, Grieco, Domenico Luca, Antonelli, Massimo, Citerio, Giuseppe, Fumagalli, Roberto, Foti, Giuseppe, Zanella, Alberto, Grasselli, Giacomo, Bellani, Giacomo, Polo Friz, M, Rezoagli, E, Safaee Fakhr, B, Florio, G, Carlesso, E, Giudici, R, Forlini, C, Tardini, F, Langer, T, Laratta, M, Casella, G, Forastieri Molinari, A, Protti, A, Cecconi, M, Cabrini, L, Biagioni, E, Berselli, A, Mirabella, L, Tonetti, T, De Robertis, E, Grieco, D, Antonelli, M, Citerio, G, Fumagalli, R, Foti, G, Zanella, A, Grasselli, G, Bellani, G, Polo Friz, Melisa, Rezoagli, Emanuele, Safaee Fakhr, Bijan, Florio, Gaetano, Carlesso, Eleonora, Giudici, Riccardo, Forlini, Clarissa, Tardini, Francesca, Langer, Thomas, Laratta, Matteo, Casella, Giampaolo, Forastieri Molinari, Andrea, Protti, Alessandro, Cecconi, Maurizio, Cabrini, Luca, Biagioni, Emanuela, Berselli, Angela, Mirabella, Lucia, Tonetti, Tommaso, De Robertis, Edoardo, Grieco, Domenico Luca, Antonelli, Massimo, Citerio, Giuseppe, Fumagalli, Roberto, Foti, Giuseppe, Zanella, Alberto, Grasselli, Giacomo, and Bellani, Giacomo

Abstract

OBJECTIVES: In patients with COVID-19 respiratory failure, controlled mechanical ventilation (CMV) is often necessary during the acute phases of the disease. Weaning from CMV to pressure support ventilation (PSV) is a key objective when the patient’s respiratory functions improve. Limited evidence exists regarding the factors predicting a successful transition to PSV and its impact on patient outcomes. DESIGN: Retrospective observational cohort study. SETTING: Twenty-four Italian ICUs from February 2020 to May 2020. PATIENTS: Mechanically ventilated ICU patients with COVID-19-induced respiratory failure. INTERVENTION: The transition period from CMV to PSV was evaluated. We defined it as “failure of assisted breathing” if the patient returned to CMV within the first 72 hours. MEASUREMENTS AND MAIN RESULTS: Of 1260 ICU patients screened, 514 were included. Three hundred fifty-seven patients successfully made the transition to PSV, while 157 failed. Pao2/Fio2 ratio before the transition emerged as an independent predictor of a successful shift (odds ratio 1.00; 95% CI, 0.99–1.00; p = 0.003). Patients in the success group displayed a better trend in Pao2/Fio2, Paco2, plateau and peak pressure, and pH level. Subjects in the failure group exhibited higher ICU mortality (hazard ratio 2.08; 95% CI, 1.42–3.06; p < 0.001), an extended ICU length of stay (successful vs. failure 21 ± 14 vs. 27 ± 17 d; p < 0.001) and a longer duration of mechanical ventilation (19 ± 18 vs. 24 ± 17 d, p = 0.04). CONCLUSIONS: Our study emphasizes that the Pao2/Fio2 ratio was the sole independent factor associated with a failed transition from CMV to PSV. The unsuccessful transition was associated with worse outcomes.

Published
2024

5. Transfusion of blood products during extracorporeal membrane oxygenation: a narrative review of rationale, indications, impact on immune function and outcome

Author

Siragusa A., Siragusa, A, Forlini, C, Fumagalli, B, Redaelli, S, Winterton, D, Foti, G, Giani, M, Siragusa A., Forlini C., Fumagalli B., Redaelli S., Winterton D., Foti G., Giani M., Siragusa A., Siragusa, A, Forlini, C, Fumagalli, B, Redaelli, S, Winterton, D, Foti, G, Giani, M, Siragusa A., Forlini C., Fumagalli B., Redaelli S., Winterton D., Foti G., and Giani M.

Abstract

The use of extracorporeal membrane oxygenation (ECMO) support poses several risks, particularly thrombosis and bleeding. As a result, transfusion of blood components is frequent during extracorporeal support. In this review we aim to describe the rationale and indications of blood products transfusions, and their impact on the immune function and outcome. The red blood cells (RBC) transfusion threshold is very debated, because of awareness of transfusion-associated adverse events due to liberal strategies. To date, no specific recommendations exist but a comprehensive physiologic approach appears feasible to evaluate the need for RBC transfusion. For patients without bleeding, the guidelines of the Extracorporeal Life Support Organization (ELSO) suggest fresh frozen plasma (FFP) administration if the prothrombin time (PT) ratio is higher than 1.5–2.0 and/or there is significant bleeding. Conversely, for bleeding patient indications often refer to trauma guidelines, where it is recommended to use a 1:1 ratio of RBC and FFP in massive transfusion situations. The indications for antithrombin supplementation are unknown and large inhomogeneity exists between different ECMO centers and between pediatric and adult patients. Supplementation of fibrinogen is considered only for bleeding patients and/or with fibrinogen level below 100 or 150 mg/dL. ELSO guidelines suggest 25–50 IU/kg of prothrombin complex concentrate as an alternative to FFP for patients with active bleeding and a prolonged PT. Recombinant activated factor VII might be a potential therapeutic option for intractable bleeding despite conventional treatment but may cause life-threatening thrombotic complications. Platelet transfusions might be limited to cases of severe thrombocytopenia accompanied by bleeding. ELSO guidelines recommend a target of at least 80×109/L platelets. Liberal platelets transfusion thresholds may be reasonable in case of intracranial hemorrhage. Albeit rare, multiple adverse events of

Published
2022

6. PEEP titration is markedly affected by trunk inclination in mechanically ventilated patients with ARDS: a physiologic, cross‐over study

Author

Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, F. Marrazzo, S. Spina, F. Zadek, C. Forlini, G. Bassi, R. Giudici, G. Bellani, R. Fumagalli, T. Langer, Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, F. Marrazzo, S. Spina, F. Zadek, C. Forlini, G. Bassi, R. Giudici, G. Bellani, R. Fumagalli, and T. Langer

Published
2023

7. PEEP Titration Is Markedly Affected by Trunk Inclination in Mechanically Ventilated Patients with COVID-19 ARDS: A Physiologic, Cross-Over Study

Author

Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, Marrazzo, Francesco, Spina, Stefano, Zadek, Francesco, Forlini, Clarissa, Bassi, Gabriele, Giudici, Riccardo, Bellani, Giacomo, Fumagalli, Roberto, Langer, Thomas, Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, Marrazzo, Francesco, Spina, Stefano, Zadek, Francesco, Forlini, Clarissa, Bassi, Gabriele, Giudici, Riccardo, Bellani, Giacomo, Fumagalli, Roberto, and Langer, Thomas

Abstract

Background: Changing trunk inclination affects lung function in patients with ARDS. However, its impacts on PEEP titration remain unknown. The primary aim of this study was to assess, in mechanically ventilated patients with COVID-19 ARDS, the effects of trunk inclination on PEEP titration. The secondary aim was to compare respiratory mechanics and gas exchange in the semi-recumbent (40° head-of-the-bed) and supine-flat (0°) positions following PEEP titration. Methods: Twelve patients were positioned both at 40° and 0° trunk inclination (randomized order). The PEEP associated with the best compromise between overdistension and collapse guided by Electrical Impedance Tomography (PEEPEIT) was set. After 30 min of controlled mechanical ventilation, data regarding respiratory mechanics, gas exchange, and EIT parameters were collected. The same procedure was repeated for the other trunk inclination. Results: PEEPEIT was lower in the semi-recumbent than in the supine-flat position (8 ± 2 vs. 13 ± 2 cmH2O, p < 0.001). A semi-recumbent position with optimized PEEP resulted in higher PaO2:FiO2 (141 ± 46 vs. 196 ± 99, p = 0.02) and a lower global inhomogeneity index (46 ± 10 vs. 53 ± 11, p = 0.008). After 30 min of observation, a loss of aeration (measured by EIT) was observed only in the supine-flat position (−153 ± 162 vs. 27 ± 203 mL, p = 0.007). Conclusions: A semi-recumbent position is associated with lower PEEPEIT and results in better oxygenation, less derecruitment, and more homogenous ventilation compared to the supine-flat position.

Published
2023

8. Modulation of pulmonary blood flow in patients with acute respiratory failure

Author

Spina, S, Marrazzo, F, Morais, C, Victor, M, Forlini, C, Guarnieri, M, Bastia, L, Giudici, R, Bassi, G, Xin, Y, Cereda, M, Amato, M, Langer, T, Berra, L, Fumagalli, R, Spina, Stefano, Marrazzo, Francesco, Morais, CaioC A, Victor, Marcus, Forlini, Clarissa, Guarnieri, Marcello, Bastia, Luca, Giudici, Riccardo, Bassi, Gabriele, Xin, Yi, Cereda, Maurizio, Amato, Marcelo, Langer, Thomas, Berra, Lorenzo, Fumagalli, Roberto, Spina, S, Marrazzo, F, Morais, C, Victor, M, Forlini, C, Guarnieri, M, Bastia, L, Giudici, R, Bassi, G, Xin, Y, Cereda, M, Amato, M, Langer, T, Berra, L, Fumagalli, R, Spina, Stefano, Marrazzo, Francesco, Morais, CaioC A, Victor, Marcus, Forlini, Clarissa, Guarnieri, Marcello, Bastia, Luca, Giudici, Riccardo, Bassi, Gabriele, Xin, Yi, Cereda, Maurizio, Amato, Marcelo, Langer, Thomas, Berra, Lorenzo, and Fumagalli, Roberto

Abstract

Background: Impairment of ventilation and perfusion (V/Q) matching is a common mechanism leading to hypoxemia in patients with acute respiratory failure requiring intensive care unit (ICU) admission. While ventilation has been thoroughly investigated, little progress has been made to monitor pulmonary perfusion at the bedside and treat impaired blood distribution. The study aimed to assess real-time changes in regional pulmonary perfusion in response to a therapeutic intervention. Methods: Single-center prospective study that enrolled adult patients with ARDS caused by SARS-Cov-2 who were sedated, paralyzed, and mechanically ventilated. The distribution of pulmonary perfusion was assessed through electrical impedance tomography (EIT) after the injection of a 10-ml bolus of hypertonic saline. The therapeutic intervention consisted in the administration of inhaled nitric oxide (iNO), as rescue therapy for refractory hypoxemia. Each patient underwent two 15-min steps at 0 and 20 ppm iNO, respectively. At each step, respiratory, gas exchange, and hemodynamic parameters were recorded, and V/Q distribution was measured, with unchanged ventilatory settings. Results: Ten 65 [56–75] years old patients with moderate (40%) and severe (60%) ARDS were studied 10 [4-20] days after intubation. Gas exchange improved at 20 ppm iNO (PaO2/FiO2 from 86 ± 16 to 110 ± 30 mmHg, p = 0.001; venous admixture from 51 ± 8 to 45 ± 7%, p = 0.0045; dead space from 29 ± 8 to 25 ± 6%, p = 0.008). The respiratory system's elastic properties and ventilation distribution were unaltered by iNO. Hemodynamics did not change after gas initiation (cardiac output 7.6 ± 1.9 vs. 7.7 ± 1.9 L/min, p = 0.66). The EIT pixel perfusion maps showed a variety of patterns of changes in pulmonary blood flow, whose increase positively correlated with PaO2/FiO2 increase (R2 = 0.50, p = 0.049). Conclusions: The assessment of lung perfusion is feasible at the bedside and blood distribution can be modulated with effects tha

Published
2023

10. Carboxyhemglobin and Drainage Pressure During Venovenous Extracorporeal Membrane Oxygenation

Author

Giani, M, Forlini, C, Fumagalli, B, Cristina Costa, M, Lucchini, A, Rona, R, Foti, G, Giani M., Forlini C., Fumagalli B., Cristina Costa M., Lucchini A., Rona R., Foti G., Giani, M, Forlini, C, Fumagalli, B, Cristina Costa, M, Lucchini, A, Rona, R, Foti, G, Giani M., Forlini C., Fumagalli B., Cristina Costa M., Lucchini A., Rona R., and Foti G.

Published
2021

11. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients

Author

Langer, T., Brioni, M., Guzzardella, A., Carlesso, E., Cabrini, L., Castelli, G., Dalla Corte, F., De Robertis, E., Favarato, M., Forastieri, A., Forlini, C., Girardis, M., Grieco, D. L., Mirabella, L., Noseda, V., Previtali, P., Protti, A., Rona, R., Tardini, F., Tonetti, T., Zannoni, F., Antonelli, M., Foti, G., Ranieri, M., Pesenti, A., Fumagalli, R., Grasselli, G., Berselli, A., Bove, T., Calligari, P., Coloretti, I., Coluccello, A., Costantini, E., Fanelli, V., Gagliardi, G., Longhini, F., Mariani, F., Mascarello, A., Menga, L., Ottaviani, I., Pasero, D., Pedeferri, M., Pezzi, A., Servillo, G., Severgnini, P., Spadaro, S., Zambelli, V., Langer, T., Brioni, M., Guzzardella, A., Carlesso, E., Cabrini, L., Castelli, G., Dalla Corte, F., De Robertis, E., Favarato, M., Forastieri, A., Forlini, C., Girardis, M., Grieco, D. L., Mirabella, L., Noseda, V., Previtali, P., Protti, A., Rona, R., Tardini, F., Tonetti, T., Zannoni, F., Antonelli, M., Foti, G., Ranieri, M., Pesenti, A., Fumagalli, R., Grasselli, G., Berselli, A., Bove, T., Calligari, P., Coloretti, I., Coluccello, A., Costantini, E., Fanelli, V., Gagliardi, G., Longhini, F., Mariani, F., Mascarello, A., Menga, L., Ottaviani, I., Pasero, D., Pedeferri, M., Pezzi, A., Servillo, G., Severgnini, P., Spadaro, S., Zambelli, V., Langer T., Brioni M., Guzzardella A., Carlesso E., Cabrini L., Castelli G., Dalla Corte F., De Robertis E., Favarato M., Forastieri A., Forlini C., Girardis M., Grieco D.L., Mirabella L., Noseda V., Previtali P., Protti A., Rona R., Tardini F., Tonetti T., Zannoni F., Antonelli M., Foti G., Ranieri M., Pesenti A., Fumagalli R., Grasselli G., Berselli A., Bove T., Calligari P., Coloretti I., Coluccello A., Costantini E., Fanelli V., Gagliardi G., Longhini F., Mariani F., Mascarello A., Menga L., Ottaviani I., Pasero D., Pedeferri M., Pezzi A., Servillo G., Severgnini P., Spadaro S., Zambelli V., Langer, T, Brioni, M, Guzzardella, A, Carlesso, E, Cabrini, L, Castelli, G, Dalla Corte, F, De Robertis, E, Favarato, M, Forastieri, A, Forlini, C, Girardis, M, Grieco, D, Mirabella, L, Noseda, V, Previtali, P, Protti, A, Rona, R, Tardini, F, Tonetti, T, Zannoni, F, Antonelli, M, Foti, G, Ranieri, M, Pesenti, A, Fumagalli, R, and Grasselli, G

Subjects
Male, ARDS, Supine position, medicine.medical_treatment, COVID-19, Mechanical ventilation, Prone positioning, Refractory hypoxemia, Critical Care and Intensive Care Medicine, Cohort Studies, 0302 clinical medicine, Supine Position, 030212 general & internal medicine, education.field_of_study, Respiration, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, Prone position, Italy, Anesthesia, Practice Guidelines as Topic, Artificial, Female, Critical Care, Population, Ventilation/perfusion ratio, Patient Positioning, NO, 03 medical and health sciences, Intensive care, Settore MED/41 - ANESTESIOLOGIA, medicine, Prone Position, Humans, education, Aged, Retrospective Studies, Intubation, Respiration, Artificial, business.industry, Research, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, Respiratory failure, business
Abstract

Background Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. Methods Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position. Results Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p 2/FiO2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively). Conclusions During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching. Trial registration: clinicaltrials.gov number: NCT04388670

Published
2021

12. Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Author

Langer, T, Depalo, F, Forlini, C, Landini, S, Mezzetti, A, Previtali, P, Monti, G, de Toma, C, Biscardi, D, Giannini, A, Fumagalli, R, Mistraletti, G, Lissoni, B, De Martini, A, Mareto, N, Rossitto, C, Zummo, U, Taverna, M, Machieraldo, P, Navarra, M, Parlanti Garbero, M, Scaletti, C, Perno, S, Amendolia, L, Montrucchio, G, Veliaj, D, Barbarello, G, Alesci, M, Bolgiaghi, L, Vailati, D, Pezzi, A, Boselli, E, Piccoli, F, Greco, M, Gemma, M, Resta, M, Crotti, S, Bottino, N, Abruzzese, C, Savioli, M, Migliorino, G, Muttini, S, Umbrello, M, Borghi, B, Greco, S, Dizeo, M, Bottiroli, M, Mondino, M, Prosepri, M, Casella, G, Curto, F, Zaniboni, M, Giudici, R, Gentile, C, Bombino, M, Rona, R, Cortinovis, B, Benini, A, Avalli, L, Tavola, M, Ferrario, M, Preda, R, Primerano, E, Russo, G, Porta, V, Valdambrini, F, Fassini, P, Orando, S, Beck, E, Pedeferri, M, Cogliati, G, Testini, D, Moroni, B, Codeluppi, V, Ruggeri, P, Milanesi, E, Belliato, M, Besozzi, A, Riccio, M, Zerbi, S, Corbella, D, Ferri, F, Grazioli, L, Bonanomi, E, Giacomini, M, Sacchi, N, Codognola, C, Ambrosini, A, Guatteri, L, Subert, M, Castelli, G, Borelli, M, Venier, E, Dittura, L, Buttera, S, Bigai, R, Magnoni, S, Rauch, S, Colombo, A, Fullin, G, Donolato, C, Cattin, S, State, V, Redeghieri, E, Russo, A, Pastorini, S, Allena, S, Munari, M, Turchet, F, Peta, M, De Santis, V, Scala, C, Facondini, F, Marangoni, E, Tassinati, T, Zanzani, C, Russo, E, Marchio, A, Barbagallo, M, Girardis, M, Taffache, P, Mordacci, M, Vincenzi, M, Pennica, M, Bracciotti, G, Iori, P, Gambi, D, Cappellini, I, Vegnuti, L, De Luca, A, Romagnoli, S, Mosti, G, Carla, R, Roticiani, V, Pelagalli, L, Fuselli, E, D’Avino, E, De Bellis, M, Gianni, G, Leonardis, F, Rossi, M, Lorusso, R, Magnanimi, E, Martelli, S, Baisi, F, Balsamo, D, Cotticelli, V, Mattei, A, Farinelli, I, Riccini, T, Cola, L, Jorio, A, Iacobone, E, Domizi, R, Pizzi, S, Nasso, A, Graziani, R, Monaco, A, Manno, M, Ottelio, C, Del Rio, M, Serra, A, Enna, B, Loddo, F, Galbiati, R, Mellea, S, Kimberly, M, Vissani, M, Romito, F, Baccari, L, Zarrillo, N, Esposito, C, Murino, P, Notaro, S, Ausiello, C, Marra, A, Policastro, C, Cafora, C, De Benedectis, G, Di Falco, V, Sciddurlo, M, Negro, G, Vetuschi, P, Recchia, A, Pasquariello, R, Squillace, R, Ciambrone, A, Bencivenga, C, Camiolo, M, Agozzino, C, Oliveri, F, Notarrigo, T, Castiglione, G, Mo, A, Condorelli, L, Favarato, M, Langer, Thomas, Depalo, Francesca Carmela, Forlini, Clarissa, Landini, Silvia, Mezzetti, Andrea, Previtali, Paola, Monti, Gianpaola, de Toma, Carolina, Biscardi, Davide, Giannini, Alberto, Fumagalli, Roberto, Mistraletti, Giovanni, Lissoni, Barbara, De Martini, Andrea, Mareto, Nadia, Rossitto, Concetta, Zummo, Ugo, Taverna, Martina, Machieraldo, Patrizia, Navarra, Mauro, Parlanti Garbero, Massimiliano, Scaletti, Chiara, Perno, Silvia, Amendolia, Luca, Montrucchio, Giuseppe, Veliaj, Deliana, Barbarello, Giuseppe, Alesci, Maria, Bolgiaghi, Luca, Vailati, Davide, Pezzi, Angelo, Boselli, Enrico, Piccoli, Francesca, Greco, Massimiliano, Gemma, Marco, Resta, Marco, Crotti, Stefania, Bottino, Nicola, Abruzzese, Chiara, Savioli, Monica, Migliorino, Giuseppina, Muttini, Stefano, Umbrello, Michele, Borghi, Beatrice, Greco, Stefano, Dizeo, Micaela, Bottiroli, Maurizio, Mondino, Michele Giovanni, Prosepri, Manlio, Casella, Giampaolo, Curto, Francesco, Zaniboni, Matteo, Giudici, Riccardo, Gentile, Carlo, Bombino, Michela, Rona, Roberto, Cortinovis, Barbara, Benini, Annalisa, Avalli, Leonello, Tavola, Mario, Ferrario, Matteo, Preda, Roberta, Primerano, Enzo, Russo, Gianluca, Porta, Virginia, Valdambrini, Federico, Fassini, Paola, Orando, Serena, Beck, Eduardo, Pedeferri, Matteo, Cogliati, Giacomina, Testini, Denise, Moroni, Benedetta, Codeluppi, Vito, Ruggeri, Patrizia, Milanesi, Elisa, Belliato, Mirko, Besozzi, Alessandra, Riccio, Mario, Zerbi, Silvia, Corbella, Davide, Ferri, Francesco, Grazioli, Lorenzo, Bonanomi, Ezio, Giacomini, Matteo, Sacchi, Noemi, Codognola, Cristian, Ambrosini, Alessandra, Guatteri, Luca, Subert, Matteo, Castelli, Gian Paolo, Borelli, Massimo, Venier, Erica, Dittura, Loredana, Buttera, Stefania, Bigai, Roberto, Magnoni, Sandra, Rauch, Simon, Colombo, Angelo, Fullin, Giorgio, Donolato, Caterina, Cattin, Silvia, State, Veronica, Redeghieri, Enrico, Russo, Alessandro, Pastorini, Simonetta, Allena, Sandra, Munari, Marina, Turchet, Federica, Peta, Mario, De Santis, Vincenzo, Scala, Cristina, Facondini, Francesca, Marangoni, Elisabetta, Tassinati, Tania, Zanzani, Chiara, Russo, Emanuele, Marchio, Annamaria, Barbagallo, Maria, Girardis, Massimo, Taffache, Paolo, Mordacci, Marco, Vincenzi, Matteo, Pennica, Michele, Bracciotti, Giovanna, Iori, Paola, Gambi, Davide, Cappellini, Iacopo, Vegnuti, Lara, De Luca, Alessandra, Romagnoli, Stefano, Mosti, Giamila, Carla, Rossella, Roticiani, Valeria, Pelagalli, Lorella, Fuselli, Ennio, D’Avino, Emilio, De Bellis, Massimo, Gianni, Giulia, Leonardis, Francesca, Rossi, Marzia, Lorusso, Rossana, Magnanimi, Eugenia, Martelli, Sabrina, Baisi, Floriana, Balsamo, Davide, Cotticelli, Virginia, Mattei, Alessia, Farinelli, Ivano, Riccini, Teresa, Cola, Luisanna, Jorio, Antonella, Iacobone, Emanuele, Domizi, Roberta, Pizzi, Simone, Nasso, Armando, Graziani, Romano, Monaco, Anna, Manno, Manuela, Ottelio, Carla Maria, Del Rio, Michela, Serra, Antonio, Enna, Barbara, Loddo, Francesco Marco, Galbiati, Rita, Mellea, Serena, Kimberly, Michelle Brozzi, Vissani, Matteo, Romito, Francesco Massimo, Baccari, Laura, Zarrillo, Nadia, Esposito, Clelia, Murino, Patrizia, Notaro, Salvatore, Ausiello, Carmine, Marra, Annachiara, Policastro, Carmela, Cafora, Chiara, De Benedectis, Giuseppe, Di Falco, Vincenzo, Sciddurlo, Maria, Negro, Giancarlo, Vetuschi, Paolo, Recchia, Andrea, Pasquariello, Rita, Squillace, Rosalba, Ciambrone, Antonio, Bencivenga, Carmela, Camiolo, Melania, Agozzino, Cristina, Oliveri, Francesco, Notarrigo, Tiziana, Castiglione, Giacomo, Mo, Antonella, Condorelli, Laura, Favarato, Martina, Langer, T, Depalo, F, Forlini, C, Landini, S, Mezzetti, A, Previtali, P, Monti, G, de Toma, C, Biscardi, D, Giannini, A, Fumagalli, R, Mistraletti, G, Lissoni, B, De Martini, A, Mareto, N, Rossitto, C, Zummo, U, Taverna, M, Machieraldo, P, Navarra, M, Parlanti Garbero, M, Scaletti, C, Perno, S, Amendolia, L, Montrucchio, G, Veliaj, D, Barbarello, G, Alesci, M, Bolgiaghi, L, Vailati, D, Pezzi, A, Boselli, E, Piccoli, F, Greco, M, Gemma, M, Resta, M, Crotti, S, Bottino, N, Abruzzese, C, Savioli, M, Migliorino, G, Muttini, S, Umbrello, M, Borghi, B, Greco, S, Dizeo, M, Bottiroli, M, Mondino, M, Prosepri, M, Casella, G, Curto, F, Zaniboni, M, Giudici, R, Gentile, C, Bombino, M, Rona, R, Cortinovis, B, Benini, A, Avalli, L, Tavola, M, Ferrario, M, Preda, R, Primerano, E, Russo, G, Porta, V, Valdambrini, F, Fassini, P, Orando, S, Beck, E, Pedeferri, M, Cogliati, G, Testini, D, Moroni, B, Codeluppi, V, Ruggeri, P, Milanesi, E, Belliato, M, Besozzi, A, Riccio, M, Zerbi, S, Corbella, D, Ferri, F, Grazioli, L, Bonanomi, E, Giacomini, M, Sacchi, N, Codognola, C, Ambrosini, A, Guatteri, L, Subert, M, Castelli, G, Borelli, M, Venier, E, Dittura, L, Buttera, S, Bigai, R, Magnoni, S, Rauch, S, Colombo, A, Fullin, G, Donolato, C, Cattin, S, State, V, Redeghieri, E, Russo, A, Pastorini, S, Allena, S, Munari, M, Turchet, F, Peta, M, De Santis, V, Scala, C, Facondini, F, Marangoni, E, Tassinati, T, Zanzani, C, Russo, E, Marchio, A, Barbagallo, M, Girardis, M, Taffache, P, Mordacci, M, Vincenzi, M, Pennica, M, Bracciotti, G, Iori, P, Gambi, D, Cappellini, I, Vegnuti, L, De Luca, A, Romagnoli, S, Mosti, G, Carla, R, Roticiani, V, Pelagalli, L, Fuselli, E, D’Avino, E, De Bellis, M, Gianni, G, Leonardis, F, Rossi, M, Lorusso, R, Magnanimi, E, Martelli, S, Baisi, F, Balsamo, D, Cotticelli, V, Mattei, A, Farinelli, I, Riccini, T, Cola, L, Jorio, A, Iacobone, E, Domizi, R, Pizzi, S, Nasso, A, Graziani, R, Monaco, A, Manno, M, Ottelio, C, Del Rio, M, Serra, A, Enna, B, Loddo, F, Galbiati, R, Mellea, S, Kimberly, M, Vissani, M, Romito, F, Baccari, L, Zarrillo, N, Esposito, C, Murino, P, Notaro, S, Ausiello, C, Marra, A, Policastro, C, Cafora, C, De Benedectis, G, Di Falco, V, Sciddurlo, M, Negro, G, Vetuschi, P, Recchia, A, Pasquariello, R, Squillace, R, Ciambrone, A, Bencivenga, C, Camiolo, M, Agozzino, C, Oliveri, F, Notarrigo, T, Castiglione, G, Mo, A, Condorelli, L, Favarato, M, Langer, Thomas, Depalo, Francesca Carmela, Forlini, Clarissa, Landini, Silvia, Mezzetti, Andrea, Previtali, Paola, Monti, Gianpaola, de Toma, Carolina, Biscardi, Davide, Giannini, Alberto, Fumagalli, Roberto, Mistraletti, Giovanni, Lissoni, Barbara, De Martini, Andrea, Mareto, Nadia, Rossitto, Concetta, Zummo, Ugo, Taverna, Martina, Machieraldo, Patrizia, Navarra, Mauro, Parlanti Garbero, Massimiliano, Scaletti, Chiara, Perno, Silvia, Amendolia, Luca, Montrucchio, Giuseppe, Veliaj, Deliana, Barbarello, Giuseppe, Alesci, Maria, Bolgiaghi, Luca, Vailati, Davide, Pezzi, Angelo, Boselli, Enrico, Piccoli, Francesca, Greco, Massimiliano, Gemma, Marco, Resta, Marco, Crotti, Stefania, Bottino, Nicola, Abruzzese, Chiara, Savioli, Monica, Migliorino, Giuseppina, Muttini, Stefano, Umbrello, Michele, Borghi, Beatrice, Greco, Stefano, Dizeo, Micaela, Bottiroli, Maurizio, Mondino, Michele Giovanni, Prosepri, Manlio, Casella, Giampaolo, Curto, Francesco, Zaniboni, Matteo, Giudici, Riccardo, Gentile, Carlo, Bombino, Michela, Rona, Roberto, Cortinovis, Barbara, Benini, Annalisa, Avalli, Leonello, Tavola, Mario, Ferrario, Matteo, Preda, Roberta, Primerano, Enzo, Russo, Gianluca, Porta, Virginia, Valdambrini, Federico, Fassini, Paola, Orando, Serena, Beck, Eduardo, Pedeferri, Matteo, Cogliati, Giacomina, Testini, Denise, Moroni, Benedetta, Codeluppi, Vito, Ruggeri, Patrizia, Milanesi, Elisa, Belliato, Mirko, Besozzi, Alessandra, Riccio, Mario, Zerbi, Silvia, Corbella, Davide, Ferri, Francesco, Grazioli, Lorenzo, Bonanomi, Ezio, Giacomini, Matteo, Sacchi, Noemi, Codognola, Cristian, Ambrosini, Alessandra, Guatteri, Luca, Subert, Matteo, Castelli, Gian Paolo, Borelli, Massimo, Venier, Erica, Dittura, Loredana, Buttera, Stefania, Bigai, Roberto, Magnoni, Sandra, Rauch, Simon, Colombo, Angelo, Fullin, Giorgio, Donolato, Caterina, Cattin, Silvia, State, Veronica, Redeghieri, Enrico, Russo, Alessandro, Pastorini, Simonetta, Allena, Sandra, Munari, Marina, Turchet, Federica, Peta, Mario, De Santis, Vincenzo, Scala, Cristina, Facondini, Francesca, Marangoni, Elisabetta, Tassinati, Tania, Zanzani, Chiara, Russo, Emanuele, Marchio, Annamaria, Barbagallo, Maria, Girardis, Massimo, Taffache, Paolo, Mordacci, Marco, Vincenzi, Matteo, Pennica, Michele, Bracciotti, Giovanna, Iori, Paola, Gambi, Davide, Cappellini, Iacopo, Vegnuti, Lara, De Luca, Alessandra, Romagnoli, Stefano, Mosti, Giamila, Carla, Rossella, Roticiani, Valeria, Pelagalli, Lorella, Fuselli, Ennio, D’Avino, Emilio, De Bellis, Massimo, Gianni, Giulia, Leonardis, Francesca, Rossi, Marzia, Lorusso, Rossana, Magnanimi, Eugenia, Martelli, Sabrina, Baisi, Floriana, Balsamo, Davide, Cotticelli, Virginia, Mattei, Alessia, Farinelli, Ivano, Riccini, Teresa, Cola, Luisanna, Jorio, Antonella, Iacobone, Emanuele, Domizi, Roberta, Pizzi, Simone, Nasso, Armando, Graziani, Romano, Monaco, Anna, Manno, Manuela, Ottelio, Carla Maria, Del Rio, Michela, Serra, Antonio, Enna, Barbara, Loddo, Francesco Marco, Galbiati, Rita, Mellea, Serena, Kimberly, Michelle Brozzi, Vissani, Matteo, Romito, Francesco Massimo, Baccari, Laura, Zarrillo, Nadia, Esposito, Clelia, Murino, Patrizia, Notaro, Salvatore, Ausiello, Carmine, Marra, Annachiara, Policastro, Carmela, Cafora, Chiara, De Benedectis, Giuseppe, Di Falco, Vincenzo, Sciddurlo, Maria, Negro, Giancarlo, Vetuschi, Paolo, Recchia, Andrea, Pasquariello, Rita, Squillace, Rosalba, Ciambrone, Antonio, Bencivenga, Carmela, Camiolo, Melania, Agozzino, Cristina, Oliveri, Francesco, Notarrigo, Tiziana, Castiglione, Giacomo, Mo, Antonella, Condorelli, Laura, and Favarato, Martina

Abstract

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0-6]%, 0 [0-4]% and 11 [2-25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was wi

Published
2022

13. External chest-wall compression in prolonged COVID-19 ARDS with low-compliance: a physiological study

Author

Bastia, L, Rezoagli, E, Guarnieri, M, Engelberts, D, Forlini, C, Marrazzo, F, Spina, S, Bassi, G, Giudici, R, Post, M, Bellani, G, Fumagalli, R, Brochard, L, Langer, T, Bastia, Luca, Rezoagli, Emanuele, Guarnieri, Marcello, Engelberts, Doreen, Forlini, Clarissa, Marrazzo, Francesco, Spina, Stefano, Bassi, Gabriele, Giudici, Riccardo, Post, Martin, Bellani, Giacomo, Fumagalli, Roberto, Brochard, Laurent J, Langer, Thomas, Bastia, L, Rezoagli, E, Guarnieri, M, Engelberts, D, Forlini, C, Marrazzo, F, Spina, S, Bassi, G, Giudici, R, Post, M, Bellani, G, Fumagalli, R, Brochard, L, Langer, T, Bastia, Luca, Rezoagli, Emanuele, Guarnieri, Marcello, Engelberts, Doreen, Forlini, Clarissa, Marrazzo, Francesco, Spina, Stefano, Bassi, Gabriele, Giudici, Riccardo, Post, Martin, Bellani, Giacomo, Fumagalli, Roberto, Brochard, Laurent J, and Langer, Thomas

Abstract

Background: External chest-wall compression (ECC) is sometimes used in ARDS patients despite lack of evidence. It is currently unknown whether this practice has any clinical benefit in patients with COVID-19 ARDS (C-ARDS) characterized by a respiratory system compliance (Crs) < 35 mL/cmH2O. Objectives: To test if an ECC with a 5 L-bag in low-compliance C-ARDS can lead to a reduction in driving pressure (DP) and improve gas exchange, and to understand the underlying mechanisms. Methods: Eleven patients with low-compliance C-ARDS were enrolled and underwent 4 steps: baseline, ECC for 60 min, ECC discontinuation and PEEP reduction. Respiratory mechanics, gas exchange, hemodynamics and electrical impedance tomography were recorded. Four pigs with acute ARDS were studied with ECC to understand the effect of ECC on pleural pressure gradient using pleural pressure transducers in both non-dependent and dependent lung regions. Results: Five minutes of ECC reduced DP from baseline 14.2 ± 1.3 to 12.3 ± 1.3 cmH2O (P < 0.001), explained by an improved lung compliance. Changes in DP by ECC were strongly correlated with changes in DP obtained with PEEP reduction (R2 = 0.82, P < 0.001). The initial benefit of ECC decreased over time (DP = 13.3 ± 1.5 cmH2O at 60 min, P = 0.03 vs. baseline). Gas exchange and hemodynamics were unaffected by ECC. In four pigs with lung injury, ECC led to a decrease in the pleural pressure gradient at end-inspiration [2.2 (1.1–3) vs. 3.0 (2.2–4.1) cmH2O, P = 0.035]. Conclusions: In C-ARDS patients with Crs < 35 mL/cmH2O, ECC acutely reduces DP. ECC does not improve oxygenation but it can be used as a simple tool to detect hyperinflation as it improves Crs and reduces Ppl gradient. ECC benefits seem to partially fade over time. ECC produces similar changes compared to PEEP reduction.

Published
2022

14. Correction: Communication and visiting policies in Italian intensive care units during the frst COVID-19 pandemic wave and lockdown: a nationwide survey

Author

Langer, Thomas, Langer, T, Depalo, F, Forlini, C, Landini, S, Mezzetti, A, Previtali, P, Monti, G, de Toma, C, Biscardi, D, Giannini, A, Fumagalli, R, Mistraletti, G, Langer, Thomas, Depalo, Francesca Carmela, Forlini, Clarissa, Landini, Silvia, Mezzetti, Andrea, Previtali, Paola, Monti, Gianpaola, de Toma, Carolina, Biscardi, Davide, Giannini, Alberto, Fumagalli, Roberto, Mistraletti, Giovanni, Langer, Thomas, Langer, T, Depalo, F, Forlini, C, Landini, S, Mezzetti, A, Previtali, P, Monti, G, de Toma, C, Biscardi, D, Giannini, A, Fumagalli, R, Mistraletti, G, Langer, Thomas, Depalo, Francesca Carmela, Forlini, Clarissa, Landini, Silvia, Mezzetti, Andrea, Previtali, Paola, Monti, Gianpaola, de Toma, Carolina, Biscardi, Davide, Giannini, Alberto, Fumagalli, Roberto, and Mistraletti, Giovanni

Published
2022

15. Effects of Trunk Inclination on Respiratory Mechanics in Patients with COVID-19 Associated ARDS: Let's Always Report the Angle!

Author

Marrazzo, F, Spina, S, Forlini, C, Guarnieri, M, Giudici, R, Bassi, G, Bastia, L, Bottiroli, M, Fumagalli, R, Langer, T, Marrazzo, Francesco, Spina, Stefano, Forlini, Clarissa, Guarnieri, Marcello, Giudici, Riccardo, Bassi, Gabriele, Bastia, Luca, Bottiroli, Maurizio, Fumagalli, Roberto, Langer, Thomas, Marrazzo, F, Spina, S, Forlini, C, Guarnieri, M, Giudici, R, Bassi, G, Bastia, L, Bottiroli, M, Fumagalli, R, Langer, T, Marrazzo, Francesco, Spina, Stefano, Forlini, Clarissa, Guarnieri, Marcello, Giudici, Riccardo, Bassi, Gabriele, Bastia, Luca, Bottiroli, Maurizio, Fumagalli, Roberto, and Langer, Thomas

Published
2022

16. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients

Author

Langer, T, Brioni, M, Guzzardella, A, Carlesso, E, Cabrini, L, Castelli, G, Dalla Corte, F, De Robertis, E, Favarato, M, Forastieri, A, Forlini, C, Girardis, M, Grieco, D, Mirabella, L, Noseda, V, Previtali, P, Protti, A, Rona, R, Tardini, F, Tonetti, T, Zannoni, F, Antonelli, M, Foti, G, Ranieri, M, Pesenti, A, Fumagalli, R, Grasselli, G, Langer, Thomas, Brioni, Matteo, Guzzardella, Amedeo, Carlesso, Eleonora, Cabrini, Luca, Castelli, Gianpaolo, Dalla Corte, Francesca, De Robertis, Edoardo, Favarato, Martina, Forastieri, Andrea, Forlini, Clarissa, Girardis, Massimo, Grieco, Domenico Luca, Mirabella, Lucia, Noseda, Valentina, Previtali, Paola, Protti, Alessandro, Rona, Roberto, Tardini, Francesca, Tonetti, Tommaso, Zannoni, Fabio, Antonelli, Massimo, Foti, Giuseppe, Ranieri, Marco, Pesenti, Antonio, Fumagalli, Roberto, Grasselli, Giacomo, Langer, T, Brioni, M, Guzzardella, A, Carlesso, E, Cabrini, L, Castelli, G, Dalla Corte, F, De Robertis, E, Favarato, M, Forastieri, A, Forlini, C, Girardis, M, Grieco, D, Mirabella, L, Noseda, V, Previtali, P, Protti, A, Rona, R, Tardini, F, Tonetti, T, Zannoni, F, Antonelli, M, Foti, G, Ranieri, M, Pesenti, A, Fumagalli, R, Grasselli, G, Langer, Thomas, Brioni, Matteo, Guzzardella, Amedeo, Carlesso, Eleonora, Cabrini, Luca, Castelli, Gianpaolo, Dalla Corte, Francesca, De Robertis, Edoardo, Favarato, Martina, Forastieri, Andrea, Forlini, Clarissa, Girardis, Massimo, Grieco, Domenico Luca, Mirabella, Lucia, Noseda, Valentina, Previtali, Paola, Protti, Alessandro, Rona, Roberto, Tardini, Francesca, Tonetti, Tommaso, Zannoni, Fabio, Antonelli, Massimo, Foti, Giuseppe, Ranieri, Marco, Pesenti, Antonio, Fumagalli, Roberto, and Grasselli, Giacomo

Abstract

Background: Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. Methods: Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position. Results: Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p < 0.001). Overall, prone position induced a significant increase in PaO2/FiO2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively). Conclusions: During the COVID-19 pandem

Published
2021

17. Prone Positioning during Venovenous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome: A Multicentre Cohort Study and Propensity-matched Analysis

Author

Giani, M, Martucci, G, Madotto, F, Belliato, M, Fanelli, V, Garofalo, E, Forlini, C, Lucchini, A, Panarello, G, Bottino, N, Zanella, A, Fossi, F, Lissoni, A, Peroni, N, Brazzi, L, Bellani, G, Navalesi, P, Arcadipane, A, Pesenti, A, Foti, G, Grasselli, G, Giani, Marco, Martucci, Gennaro, Madotto, Fabiana, Belliato, Mirko, Fanelli, Vito, Garofalo, Eugenio, Forlini, Clarissa, Lucchini, Alberto, Panarello, Giovanna, Bottino, Nicola, Zanella, Alberto, Fossi, Francesca, Lissoni, Alfredo, Peroni, Nicola, Brazzi, Luca, Bellani, Giacomo, Navalesi, Paolo, Arcadipane, Antonio, Pesenti, Antonio, Foti, Giuseppe, Grasselli, Giacomo, Giani, M, Martucci, G, Madotto, F, Belliato, M, Fanelli, V, Garofalo, E, Forlini, C, Lucchini, A, Panarello, G, Bottino, N, Zanella, A, Fossi, F, Lissoni, A, Peroni, N, Brazzi, L, Bellani, G, Navalesi, P, Arcadipane, A, Pesenti, A, Foti, G, Grasselli, G, Giani, Marco, Martucci, Gennaro, Madotto, Fabiana, Belliato, Mirko, Fanelli, Vito, Garofalo, Eugenio, Forlini, Clarissa, Lucchini, Alberto, Panarello, Giovanna, Bottino, Nicola, Zanella, Alberto, Fossi, Francesca, Lissoni, Alfredo, Peroni, Nicola, Brazzi, Luca, Bellani, Giacomo, Navalesi, Paolo, Arcadipane, Antonio, Pesenti, Antonio, Foti, Giuseppe, and Grasselli, Giacomo

Abstract

Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress syndrome (ARDS). To date, no evidence supports the use of prone positioning (PP) during venovenous extracorporeal oxygenation (ECMO). Objectives: The aim of the study was to assess the feasibility, safety, and effect on oxygenation and lung mechanics of PP during ECMO. As a secondary exploratory aim, we assessed the association between PP and hospital mortality. Methods: We performed a multicenter retrospective cohort study in six Italian ECMO centers, including patients managed with PP during ECMO support (prone group; four centers) and patients managed in the supine position (control group; two centers). Physiological variables were analyzed at four time points (supine before PP, start of PP, end of PP, and supine after PP). The association between PP and hospital mortality was assessed by multivariate analysis and propensity score–matching. Results: A total of 240 patients were included, with 107 in the prone group and 133 in the supine group. The median duration of the 326 pronation cycles was 15 (12–18) hours. Minor reversible complications were reported in 6% of PP maneuvers. PP improved oxygenation and reduced intrapulmonary shunt. Unadjusted hospital mortality was lower in the prone group (34 vs. 50%; P = 0.017). After adjusting for covariates, PP remained significantly associated with a reduction of hospital mortality (odds ratio, 0.50; 95% confidence interval, 0.29–0.87). Sixty-six propensity score–matched patients were identified in each group. In this matched sample, patients who underwent pronation had higher ECMO duration (16 vs. 10 d; P = 0.0344) but lower hospital mortality (30% vs. 53%; P = 0.0241). Conclusions: PP during ECMO improved oxygenation and was associated with a reduction of hospital mortality.

Published
2021

18. Thromboelastometry, Thromboelastography, and Conventional Tests to Assess Anticoagulation During Extracorporeal Support

Author

Giani, M, Russotto, V, Pozzi, M, Forlini, C, Fornasari, C, Villa, S, Avalli, L, Rona, R, Foti, G, Giani, Marco, Russotto, Vincenzo, Pozzi, Matteo, Forlini, Clarissa, Fornasari, Chiara, Villa, Silvia, Avalli, Leonello, Rona, Roberto, Foti, Giuseppe, Giani, M, Russotto, V, Pozzi, M, Forlini, C, Fornasari, C, Villa, S, Avalli, L, Rona, R, Foti, G, Giani, Marco, Russotto, Vincenzo, Pozzi, Matteo, Forlini, Clarissa, Fornasari, Chiara, Villa, Silvia, Avalli, Leonello, Rona, Roberto, and Foti, Giuseppe

Abstract

Optimal anticoagulation monitoring in patients with extracorporeal membrane oxygenation (ECMO) is fundamental to avoid hemorrhagic and thromboembolic complications. Besides conventional coagulation tests, there is growing interest in the use of viscoelastic hemostatic assays (VHA), in particular of tromboelastography (TEG). Evidence on the use of rotational thromboelastometry (ROTEM) is lacking in this setting. The aim of the study was to evaluate ROTEM as a tool for assessing hemostasis during ECMO, by comparing it to TEG and conventional coagulation assays. We conducted a prospective, observational, single-center study on adult patients on ECMO support anticoagulated with unfractioned heparin (UFH). Kaolin reaction time (R, min) for TEG and INTEM clotting time (CT, sec) for ROTEM were analyzed and compared with conventional coagulation tests. In the study period, we included 25 patients on ECMO support (14 V-A and 11 V-V); 84 data points were available for the analysis. Median UFH infusion rate was 15 [11–18] IU/min/kg. Median values for activated partial thromboplastin time (aPTT) ratio, Kaolin TEG R time, and INTEM CT were 1.44 [1.21–1.7], 22 [13–40] min, and 201 [183–225] sec, respectively. INTEM CT (ROTEM) showed a moderate correlation with standard coagulation tests (R2 = 0.34 and 0.3 for aPTT and activated clotting time (ACT), respectively, p < 0.001). No significant correlation was found between INTEM CT and Kaolin R time (R2 = 0.01). Further studies are needed to identify an appropriate anticoagulation target for ROTEM during ECMO.

Published
2021

19. Erratum: A Neuroethics Framework for the Australian Brain Initiative (Neuron (2019) 101(3) (365–369), (S0896627319300054), (10.1016/j.neuron.2019.01.004))

Author

Carter, A, Richards, LJ, Apthorp, D, Azghadi, MR, Badcock, DR, Balleine, B, Bekkers, JM, Berk, M, Bourne, JA, Bradley, AP, Breakspear, M, Brichta, A, Carter, O, Castles, A, Chakli, K, Cohen-Woods, S, Conn, SJ, Cornish, J, Cornish, K, de Zubicaray, G, Egan, GF, Enticott, PG, Fitzgibbon, BM, Forlini, C, Fornito, A, Griffiths, L, Gullifer, J, Hall, W, Halliday, G, Hannan, AJ, Harrer, S, Harvey, A, Hatherly, C, Hickie, IB, Kennett, J, Kiernan, M, Kilpatrick, T, Kiral-Kornek, I, Korgaonkar, MS, Lawrence, AJ, Leventer, R, Levy, N, Licinio, J, Lovell, N, Mackellar, G, Malcolm, L, Mason, A, Mattingley, JB, Medland, SE, Michie, PT, Nithianantharajah, J, Parker, J, Payne, JM, Poole-Warren, L, Sah, P, Sarnyai, Z, Schofield, PR, Shimoni, O, Shum, DHK, Silk, T, Slee, M, Smith, AE, Soulis, T, Sriram, S, Stuart, GJ, Tapson, J, Thompson, MB, van Schaik, A, Vincent, NA, Vissel, B, Waters, A, Carter, A, Richards, LJ, Apthorp, D, Azghadi, MR, Badcock, DR, Balleine, B, Bekkers, JM, Berk, M, Bourne, JA, Bradley, AP, Breakspear, M, Brichta, A, Carter, O, Castles, A, Chakli, K, Cohen-Woods, S, Conn, SJ, Cornish, J, Cornish, K, de Zubicaray, G, Egan, GF, Enticott, PG, Fitzgibbon, BM, Forlini, C, Fornito, A, Griffiths, L, Gullifer, J, Hall, W, Halliday, G, Hannan, AJ, Harrer, S, Harvey, A, Hatherly, C, Hickie, IB, Kennett, J, Kiernan, M, Kilpatrick, T, Kiral-Kornek, I, Korgaonkar, MS, Lawrence, AJ, Leventer, R, Levy, N, Licinio, J, Lovell, N, Mackellar, G, Malcolm, L, Mason, A, Mattingley, JB, Medland, SE, Michie, PT, Nithianantharajah, J, Parker, J, Payne, JM, Poole-Warren, L, Sah, P, Sarnyai, Z, Schofield, PR, Shimoni, O, Shum, DHK, Silk, T, Slee, M, Smith, AE, Soulis, T, Sriram, S, Stuart, GJ, Tapson, J, Thompson, MB, van Schaik, A, Vincent, NA, Vissel, B, and Waters, A

Abstract

(Neuron 101, 365–369; February 6, 2019) In the original publication of this NeuroView, the member list for the Australian Brain Alliance was omitted. This has now been corrected online. Neuron apologizes for the error.

Published
2020

20. Management of patients on direct oral anticoagulants requiring urgent orthopedic surgery: role of plasmatic drug concentration

Author

Giani, M, Forlini, C, Coccini, V, Corsi, M, Turati, M, Vitullo, V, Foti, G, Giani, Marco, Forlini, Clarissa, Coccini, Veronica, Corsi, Maurizio, Turati, Marco, Vitullo, Valeria, Foti, Giuseppe, Giani, M, Forlini, C, Coccini, V, Corsi, M, Turati, M, Vitullo, V, Foti, G, Giani, Marco, Forlini, Clarissa, Coccini, Veronica, Corsi, Maurizio, Turati, Marco, Vitullo, Valeria, and Foti, Giuseppe

Published
2020

21. A Neuroethics Framework for the Australian Brain Initiative

Author

Kennett, J, Carter, A, Bourne, JA, Hall, W, Levy, N, Mattingley, JB, Lawrence, AJ, Forlini, C, Malcolm, L, Vincent, N, Richards, LJ, Egan, GF, Breakspear, M, Cornish, K, Halliday, G, Poole-Warren, L, Sriram, S, Soulis, T, Fitzgibbon, B, Kiral-Kornek, I, Badcock, DR, Balleine, B, Bekkers, JM, Berk, M, Bradley, A, Brichta, A, Carter, O, Castles, A, Clements, J, Cornish, J, de Zubicaray, G, Enticott, PG, Fornito, A, Griffiths, L, Gullifer, J, Hannan, AJ, Harrer, S, Harvey, A, Hickie, IB, Jazwinska, L, Kiernan, M, Kilpatrick, T, Leventer, R, Licinio, J, Lovell, N, Mackellar, G, Medland, SE, Michie, PT, Nithianantharajah, J, Parker, J, Payne, JM, Rossell, S, Sah, P, Sarnyai, Z, Schofield, PR, Shum, DHK, Silk, T, Slee, M, Stuart, GJ, Tapson, J, van Schaik, A, Vissel, B, Waters, A, Apthorp, D, Cohen-Woods, S, Conn, SJ, Korgaonkar, M, Mason, A, Azghadi, MR, Shimoni, O, Smith, A, Thompson, MB, Kennett, J, Carter, A, Bourne, JA, Hall, W, Levy, N, Mattingley, JB, Lawrence, AJ, Forlini, C, Malcolm, L, Vincent, N, Richards, LJ, Egan, GF, Breakspear, M, Cornish, K, Halliday, G, Poole-Warren, L, Sriram, S, Soulis, T, Fitzgibbon, B, Kiral-Kornek, I, Badcock, DR, Balleine, B, Bekkers, JM, Berk, M, Bradley, A, Brichta, A, Carter, O, Castles, A, Clements, J, Cornish, J, de Zubicaray, G, Enticott, PG, Fornito, A, Griffiths, L, Gullifer, J, Hannan, AJ, Harrer, S, Harvey, A, Hickie, IB, Jazwinska, L, Kiernan, M, Kilpatrick, T, Leventer, R, Licinio, J, Lovell, N, Mackellar, G, Medland, SE, Michie, PT, Nithianantharajah, J, Parker, J, Payne, JM, Rossell, S, Sah, P, Sarnyai, Z, Schofield, PR, Shum, DHK, Silk, T, Slee, M, Stuart, GJ, Tapson, J, van Schaik, A, Vissel, B, Waters, A, Apthorp, D, Cohen-Woods, S, Conn, SJ, Korgaonkar, M, Mason, A, Azghadi, MR, Shimoni, O, Smith, A, and Thompson, MB

Abstract

Neuroethics is central to the Australian Brain Initiative's aim to sustain a thriving and responsible neurotechnology industry. Diverse and inclusive community and stakeholder engagement and a trans-disciplinary approach to neuroethics will be key to the success of the Australian Brain Initiative.

Published
2019

26. Researchers' perspectives on scientific and ethical issues with transcranial direct current stimulation: An international survey

Author

Riggall, K, Forlini, C, Carter, A, Hall, W, Weier, M, Partridge, B, Meinzer, M, Riggall, K, Forlini, C, Carter, A, Hall, W, Weier, M, Partridge, B, and Meinzer, M

Abstract

In the last decade, an increasing number of studies have suggested that transcranial direct current stimulation (tDCS) may enhance brain function in healthy individuals, and ameliorate cognitive and other symptoms in patients suffering from various medical conditions. This, along with its presumed safety, simplicity, and affordability, has generated great enthusiasm amongst researchers, clinicians, patient populations, and the public (including a growing "do-it-yourself" community). However, discussion about the effectiveness and ethics of tDCS thus far has been confined to small groups of tDCS researchers and bioethicists. We conducted an international online survey targeting the opinions of researchers using tDCS who were asked to rate the technique' s efficacy in different contexts. We also surveyed opinions about ethical concerns, self-enhancement and public availability. 265 complete responses were received and analyzed statistically and thematically. Our results emphasize the potential uses of tDCS in clinical and research contexts, but also highlight a number of emerging methodological and safety concerns, ethical challenges and the need for improved communication between researchers and bioethicists with regard to regulation of the device. Neither the media reputation of tDCS as a "miracle device" nor concerns expressed in recent neuroethical publications were entirely borne out in expert opinion.

Published
2015

28. PEEP Titration Is Markedly Affected by Trunk Inclination in Mechanically Ventilated Patients with COVID-19 ARDS: A Physiologic, Cross-Over Study

Author

Marrazzo, Francesco, Spina, Stefano, Zadek, Francesco, Forlini, Clarissa, Bassi, Gabriele, Giudici, Riccardo, Bellani, Giacomo, Fumagalli, Roberto, Langer, Thomas, Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, and Langer, T

Subjects
trunk inclination, COVID-19, ventilator-induced lung injury, acute respiratory distress syndrome, mechanical ventilation
Abstract

Background: Changing trunk inclination affects lung function in patients with ARDS. However, its impacts on PEEP titration remain unknown. The primary aim of this study was to assess, in mechanically ventilated patients with COVID-19 ARDS, the effects of trunk inclination on PEEP titration. The secondary aim was to compare respiratory mechanics and gas exchange in the semi-recumbent (40° head-of-the-bed) and supine-flat (0°) positions following PEEP titration. Methods: Twelve patients were positioned both at 40° and 0° trunk inclination (randomized order). The PEEP associated with the best compromise between overdistension and collapse guided by Electrical Impedance Tomography (PEEPEIT) was set. After 30 min of controlled mechanical ventilation, data regarding respiratory mechanics, gas exchange, and EIT parameters were collected. The same procedure was repeated for the other trunk inclination. Results: PEEPEIT was lower in the semi-recumbent than in the supine-flat position (8 ± 2 vs. 13 ± 2 cmH2O, p < 0.001). A semi-recumbent position with optimized PEEP resulted in higher PaO2:FiO2 (141 ± 46 vs. 196 ± 99, p = 0.02) and a lower global inhomogeneity index (46 ± 10 vs. 53 ± 11, p = 0.008). After 30 min of observation, a loss of aeration (measured by EIT) was observed only in the supine-flat position (−153 ± 162 vs. 27 ± 203 mL, p = 0.007). Conclusions: A semi-recumbent position is associated with lower PEEPEIT and results in better oxygenation, less derecruitment, and more homogenous ventilation compared to the supine-flat position.

Published
2023

29. Prone Positioning during Venovenous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome. A Multicenter Cohort Study and Propensity-matched Analysis

Author

Fabiana Madotto, Antonio Arcadipane, Marco Giani, Alfredo Lissoni, Mirko Belliato, Antonio Pesenti, Alberto Lucchini, Giacomo Bellani, Luca Brazzi, Giuseppe Foti, Nicola Bottino, Giacomo Grasselli, Clarissa Forlini, Francesca Fossi, Eugenio Garofalo, Paolo Navalesi, Nicola Peroni, Gennaro Martucci, Giovanna Panarello, Vito Fanelli, Alberto Zanella, Giani, M, Martucci, G, Madotto, F, Belliato, M, Fanelli, V, Garofalo, E, Forlini, C, Lucchini, A, Panarello, G, Bottino, N, Zanella, A, Fossi, F, Lissoni, A, Peroni, N, Brazzi, L, Bellani, G, Navalesi, P, Arcadipane, A, Pesenti, A, Foti, G, and Grasselli, G

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, ARDS, medicine.medical_treatment, Prone positioning, Acute respiratory distress, Extracorporeal, 03 medical and health sciences, 0302 clinical medicine, mental disorders, Extracorporeal membrane oxygenation, medicine, 030212 general & internal medicine, Acute respiratory distress syndrome, business.industry, Oxygenation, medicine.disease, Prone position, surgical procedures, operative, 030228 respiratory system, Emergency medicine, Propensity score matching, ECMO, business, psychological phenomena and processes, Cohort study
Abstract

Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress syndrome (ARDS). To date, no evidence supports the use of prone positioning (PP) during venovenous extracorporeal oxygenation (ECMO). Objectives: The aim of the study was to assess the feasibility, safety, and effect on oxygenation and lung mechanics of PP during ECMO. As a secondary exploratory aim, we assessed the association between PP and hospital mortality. Methods: We performed a multicenter retrospective cohort study in six Italian ECMO centers, including patients managed with PP during ECMO support (prone group; four centers) and patients managed in the supine position (control group; two centers). Physiological variables were analyzed at four time points (supine before PP, start of PP, end of PP, and supine after PP). The association between PP and hospital mortality was assessed by multivariate analysis and propensity score–matching. Results: A total of 240 patients were included, with 107 in the prone group and 133 in the supine group. The median duration of the 326 pronation cycles was 15 (12–18) hours. Minor reversible complications were reported in 6% of PP maneuvers. PP improved oxygenation and reduced intrapulmonary shunt. Unadjusted hospital mortality was lower in the prone group (34 vs. 50%; P = 0.017). After adjusting for covariates, PP remained significantly associated with a reduction of hospital mortality (odds ratio, 0.50; 95% confidence interval, 0.29–0.87). Sixty-six propensity score–matched patients were identified in each group. In this matched sample, patients who underwent pronation had higher ECMO duration (16 vs. 10 d; P = 0.0344) but lower hospital mortality (30% vs. 53%; P = 0.0241). Conclusions: PP during ECMO improved oxygenation and was associated with a reduction of hospital mortality.

Published
2021
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30. Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Author

Langer, Thomas, Depalo, Francesca Carmela, Forlini, Clarissa, Landini, Silvia, Mezzetti, Andrea, Previtali, Paola, Monti, Gianpaola, de Toma, Carolina, Biscardi, Davide, Giannini, Alberto, Fumagalli, Roberto, Mistraletti, Giovanni, Lissoni, Barbara, De Martini, Andrea, Mareto, Nadia, Rossitto, Concetta, Zummo, Ugo, Taverna, Martina, Machieraldo, Patrizia, Navarra, Mauro, Parlanti Garbero, Massimiliano, Scaletti, Chiara, Perno, Silvia, Amendolia, Luca, Montrucchio, Giuseppe, Veliaj, Deliana, Barbarello, Giuseppe, Alesci, Maria, Bolgiaghi, Luca, Vailati, Davide, Pezzi, Angelo, Boselli, Enrico, Piccoli, Francesca, Greco, Massimiliano, Gemma, Marco, Resta, Marco, Crotti, Stefania, Bottino, Nicola, Abruzzese, Chiara, Savioli, Monica, Migliorino, Giuseppina, Muttini, Stefano, Umbrello, Michele, Borghi, Beatrice, Greco, Stefano, Dizeo, Micaela, Bottiroli, Maurizio, Mondino, Michele Giovanni, Prosepri, Manlio, Casella, Giampaolo, Curto, Francesco, Zaniboni, Matteo, Giudici, Riccardo, Gentile, Carlo, Bombino, Michela, Rona, Roberto, Cortinovis, Barbara, Benini, Annalisa, Avalli, Leonello, Tavola, Mario, Ferrario, Matteo, Preda, Roberta, Primerano, Enzo, Russo, Gianluca, Porta, Virginia, Valdambrini, Federico, Fassini, Paola, Orando, Serena, Beck, Eduardo, Pedeferri, Matteo, Cogliati, Giacomina, Testini, Denise, Moroni, Benedetta, Codeluppi, Vito, Ruggeri, Patrizia, Milanesi, Elisa, Belliato, Mirko, Besozzi, Alessandra, Riccio, Mario, Zerbi, Silvia, Corbella, Davide, Ferri, Francesco, Grazioli, Lorenzo, Bonanomi, Ezio, Giacomini, Matteo, Sacchi, Noemi, Codognola, Cristian, Ambrosini, Alessandra, Guatteri, Luca, Subert, Matteo, Castelli, Gian Paolo, Borelli, Massimo, Venier, Erica, Dittura, Loredana, Buttera, Stefania, Bigai, Roberto, Magnoni, Sandra, Rauch, Simon, Colombo, Angelo, Fullin, Giorgio, Donolato, Caterina, Cattin, Silvia, State, Veronica, Redeghieri, Enrico, Russo, Alessandro, Pastorini, Simonetta, Allena, Sandra, Munari, Marina, Turchet, Federica, Peta, Mario, De Santis, Vincenzo, Scala, Cristina, Facondini, Francesca, Marangoni, Elisabetta, Tassinati, Tania, Zanzani, Chiara, Russo, Emanuele, Marchio, Annamaria, Barbagallo, Maria, Girardis, Massimo, Taffache, Paolo, Mordacci, Marco, Vincenzi, Matteo, Pennica, Michele, Bracciotti, Giovanna, Iori, Paola, Gambi, Davide, Cappellini, Iacopo, Vegnuti, Lara, De Luca, Alessandra, Romagnoli, Stefano, Mosti, Giamila, Carla, Rossella, Roticiani, Valeria, Pelagalli, Lorella, Fuselli, Ennio, D’Avino, Emilio, De Bellis, Massimo, Gianni, Giulia, Leonardis, Francesca, Rossi, Marzia, Lorusso, Rossana, Magnanimi, Eugenia, Martelli, Sabrina, Baisi, Floriana, Balsamo, Davide, Cotticelli, Virginia, Mattei, Alessia, Farinelli, Ivano, Riccini, Teresa, Cola, Luisanna, Jorio, Antonella, Iacobone, Emanuele, Domizi, Roberta, Pizzi, Simone, Nasso, Armando, Graziani, Romano, Monaco, Anna, Manno, Manuela, Ottelio, Carla Maria, Del Rio, Michela, Serra, Antonio, Enna, Barbara, Loddo, Francesco Marco, Galbiati, Rita, Mellea, Serena, Kimberly, Michelle Brozzi, Vissani, Matteo, Romito, Francesco Massimo, Baccari, Laura, Zarrillo, Nadia, Esposito, Clelia, Murino, Patrizia, Notaro, Salvatore, Ausiello, Carmine, Marra, Annachiara, Policastro, Carmela, Cafora, Chiara, De Benedectis, Giuseppe, Di Falco, Vincenzo, Sciddurlo, Maria, Negro, Giancarlo, Vetuschi, Paolo, Recchia, Andrea, Pasquariello, Rita, Squillace, Rosalba, Ciambrone, Antonio, Bencivenga, Carmela, Camiolo, Melania, Agozzino, Cristina, Oliveri, Francesco, Notarrigo, Tiziana, Castiglione, Giacomo, Mo, Antonella, Condorelli, Laura, Favarato, Martina, Langer, T, Depalo, F, Forlini, C, Landini, S, Mezzetti, A, Previtali, P, Monti, G, de Toma, C, Biscardi, D, Giannini, A, Fumagalli, R, Mistraletti, G, Lissoni, B, De Martini, A, Mareto, N, Rossitto, C, Zummo, U, Taverna, M, Machieraldo, P, Navarra, M, Parlanti Garbero, M, Scaletti, C, Perno, S, Amendolia, L, Montrucchio, G, Veliaj, D, Barbarello, G, Alesci, M, Bolgiaghi, L, Vailati, D, Pezzi, A, Boselli, E, Piccoli, F, Greco, M, Gemma, M, Resta, M, Crotti, S, Bottino, N, Abruzzese, C, Savioli, M, Migliorino, G, Muttini, S, Umbrello, M, Borghi, B, Greco, S, Dizeo, M, Bottiroli, M, Mondino, M, Prosepri, M, Casella, G, Curto, F, Zaniboni, M, Giudici, R, Gentile, C, Bombino, M, Rona, R, Cortinovis, B, Benini, A, Avalli, L, Tavola, M, Ferrario, M, Preda, R, Primerano, E, Russo, G, Porta, V, Valdambrini, F, Fassini, P, Orando, S, Beck, E, Pedeferri, M, Cogliati, G, Testini, D, Moroni, B, Codeluppi, V, Ruggeri, P, Milanesi, E, Belliato, M, Besozzi, A, Riccio, M, Zerbi, S, Corbella, D, Ferri, F, Grazioli, L, Bonanomi, E, Giacomini, M, Sacchi, N, Codognola, C, Ambrosini, A, Guatteri, L, Subert, M, Castelli, G, Borelli, M, Venier, E, Dittura, L, Buttera, S, Bigai, R, Magnoni, S, Rauch, S, Colombo, A, Fullin, G, Donolato, C, Cattin, S, State, V, Redeghieri, E, Russo, A, Pastorini, S, Allena, S, Munari, M, Turchet, F, Peta, M, De Santis, V, Scala, C, Facondini, F, Marangoni, E, Tassinati, T, Zanzani, C, Russo, E, Marchio, A, Barbagallo, M, Girardis, M, Taffache, P, Mordacci, M, Vincenzi, M, Pennica, M, Bracciotti, G, Iori, P, Gambi, D, Cappellini, I, Vegnuti, L, De Luca, A, Romagnoli, S, Mosti, G, Carla, R, Roticiani, V, Pelagalli, L, Fuselli, E, D’Avino, E, De Bellis, M, Gianni, G, Leonardis, F, Rossi, M, Lorusso, R, Magnanimi, E, Martelli, S, Baisi, F, Balsamo, D, Cotticelli, V, Mattei, A, Farinelli, I, Riccini, T, Cola, L, Jorio, A, Iacobone, E, Domizi, R, Pizzi, S, Nasso, A, Graziani, R, Monaco, A, Manno, M, Ottelio, C, Del Rio, M, Serra, A, Enna, B, Loddo, F, Galbiati, R, Mellea, S, Kimberly, M, Vissani, M, Romito, F, Baccari, L, Zarrillo, N, Esposito, C, Murino, P, Notaro, S, Ausiello, C, Marra, A, Policastro, C, Cafora, C, De Benedectis, G, Di Falco, V, Sciddurlo, M, Negro, G, Vetuschi, P, Recchia, A, Pasquariello, R, Squillace, R, Ciambrone, A, Bencivenga, C, Camiolo, M, Agozzino, C, Oliveri, F, Notarrigo, T, Castiglione, G, Mo, A, Condorelli, L, and Favarato, M

Subjects
Adult, Pandemic, Patient-centered care, Communication, COVID-19, Professional-family relations, Intensive Care Units, Policy, Anesthesiology and Pain Medicine, Health communication, Professional-family relation, Surveys and Questionnaires, Communicable Disease Control, Intensive care units, Pandemics, Humans, Intensive care unit, Child
Abstract

Background During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p Conclusions Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted.

Published
2022
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31. Effects of Trunk Inclination on Respiratory Mechanics in Patients with COVID-19 Associated ARDS: Let's Always Report the Angle!

Author

Marrazzo, Francesco, Spina, Stefano, Forlini, Clarissa, Guarnieri, Marcello, Giudici, Riccardo, Bassi, Gabriele, Bastia, Luca, Bottiroli, Maurizio, Fumagalli, Roberto, Langer, Thomas, Marrazzo, F, Spina, S, Forlini, C, Guarnieri, M, Giudici, R, Bassi, G, Bastia, L, Bottiroli, M, Fumagalli, R, and Langer, T

Subjects
Mechanical ventilation, Trunk inclination, Respiratory mechanic, COVID-19, ARDS
Published
2022

32. External chest-wall compression in prolonged COVID-19 ARDS with low-compliance: a physiological study

Author

Luca Bastia, Emanuele Rezoagli, Marcello Guarnieri, Doreen Engelberts, Clarissa Forlini, Francesco Marrazzo, Stefano Spina, Gabriele Bassi, Riccardo Giudici, Martin Post, Giacomo Bellani, Roberto Fumagalli, Laurent J. Brochard, Thomas Langer, Bastia, L, Rezoagli, E, Guarnieri, M, Engelberts, D, Forlini, C, Marrazzo, F, Spina, S, Bassi, G, Giudici, R, Post, M, Bellani, G, Fumagalli, R, Brochard, L, and Langer, T

Subjects
Ventilator-induced lung injury, Mechanical ventilation, ARDS, Chest-wall compression, COVID-19, Driving pressure, Gas exchange, Respiratory mechanics, Respiratory mechanic, Critical Care and Intensive Care Medicine
Abstract

Background External chest-wall compression (ECC) is sometimes used in ARDS patients despite lack of evidence. It is currently unknown whether this practice has any clinical benefit in patients with COVID-19 ARDS (C-ARDS) characterized by a respiratory system compliance (Crs) 2O. Objectives To test if an ECC with a 5 L-bag in low-compliance C-ARDS can lead to a reduction in driving pressure (DP) and improve gas exchange, and to understand the underlying mechanisms. Methods Eleven patients with low-compliance C-ARDS were enrolled and underwent 4 steps: baseline, ECC for 60 min, ECC discontinuation and PEEP reduction. Respiratory mechanics, gas exchange, hemodynamics and electrical impedance tomography were recorded. Four pigs with acute ARDS were studied with ECC to understand the effect of ECC on pleural pressure gradient using pleural pressure transducers in both non-dependent and dependent lung regions. Results Five minutes of ECC reduced DP from baseline 14.2 ± 1.3 to 12.3 ± 1.3 cmH2O (P R2 = 0.82, P 2O at 60 min, P = 0.03 vs. baseline). Gas exchange and hemodynamics were unaffected by ECC. In four pigs with lung injury, ECC led to a decrease in the pleural pressure gradient at end-inspiration [2.2 (1.1–3) vs. 3.0 (2.2–4.1) cmH2O, P = 0.035]. Conclusions In C-ARDS patients with Crs 2O, ECC acutely reduces DP. ECC does not improve oxygenation but it can be used as a simple tool to detect hyperinflation as it improves Crs and reduces Ppl gradient. ECC benefits seem to partially fade over time. ECC produces similar changes compared to PEEP reduction.

Published
2021

33. Management of patients on direct oral anticoagulants requiring urgent orthopedic surgery: role of plasmatic drug concentration

Author

Maurizio Corsi, Clarissa Forlini, Giuseppe Foti, Veronica Coccini, Valeria Vitullo, Marco Giani, Marco Turati, Giani, M, Forlini, C, Coccini, V, Corsi, M, Turati, M, Vitullo, V, and Foti, G

Subjects
medicine.medical_specialty, orthopedic surgery, business.industry, MEDLINE, Anticoagulants, direct oral anticoagulant, Anesthesiology and Pain Medicine, Drug concentration, Pharmaceutical Preparations, Anesthesia, Conduction, Anesthesia, Orthopedic surgery, Medicine, Humans, Orthopedic Procedures, business, Aged
Published
2020

34. Carboxyhemglobin and Drainage Pressure During Venovenous Extracorporeal Membrane Oxygenation

Author

Marco Giani, Alberto Lucchini, Roberto Rona, Giuseppe Foti, Benedetta Fumagalli, Maria Cristina Costa, Clarissa Forlini, Giani, M, Forlini, C, Fumagalli, B, Cristina Costa, M, Lucchini, A, Rona, R, and Foti, G

Subjects
Carboxyhemglobin, business.industry, medicine.medical_treatment, Biomedical Engineering, Biophysics, Bioengineering, General Medicine, Cannula, Biomaterials, Anesthesia, Extracorporeal membrane oxygenation, Medicine, ECMO, Drainage, business
Published
2021
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35. Successful Versus Failed Transition From Controlled Ventilation to Pressure Support Ventilation in COVID-19 Patients: A Retrospective Cohort Study.

Author

Polo Friz M, Rezoagli E, Safaee Fakhr B, Florio G, Carlesso E, Giudici R, Forlini C, Tardini F, Langer T, Laratta M, Casella G, Forastieri Molinari A, Protti A, Cecconi M, Cabrini L, Biagioni E, Berselli A, Mirabella L, Tonetti T, De Robertis E, Grieco DL, Antonelli M, Citerio G, Fumagalli R, Foti G, Zanella A, Grasselli G, and Bellani G

Abstract

Objectives: In patients with COVID-19 respiratory failure, controlled mechanical ventilation (CMV) is often necessary during the acute phases of the disease. Weaning from CMV to pressure support ventilation (PSV) is a key objective when the patient's respiratory functions improve. Limited evidence exists regarding the factors predicting a successful transition to PSV and its impact on patient outcomes., Design: Retrospective observational cohort study., Setting: Twenty-four Italian ICUs from February 2020 to May 2020., Patients: Mechanically ventilated ICU patients with COVID-19-induced respiratory failure., Intervention: The transition period from CMV to PSV was evaluated. We defined it as "failure of assisted breathing" if the patient returned to CMV within the first 72 hours., Measurements and Main Results: Of 1260 ICU patients screened, 514 were included. Three hundred fifty-seven patients successfully made the transition to PSV, while 157 failed. Pao 2 /Fio 2 ratio before the transition emerged as an independent predictor of a successful shift (odds ratio 1.00; 95% CI, 0.99-1.00; p = 0.003). Patients in the success group displayed a better trend in Pao 2 /Fio 2 , Paco 2 , plateau and peak pressure, and pH level. Subjects in the failure group exhibited higher ICU mortality (hazard ratio 2.08; 95% CI, 1.42-3.06; p < 0.001), an extended ICU length of stay (successful vs. failure 21 ± 14 vs. 27 ± 17 d; p < 0.001) and a longer duration of mechanical ventilation (19 ± 18 vs. 24 ± 17 d, p = 0.04)., Conclusions: Our study emphasizes that the Pao 2 /Fio 2 ratio was the sole independent factor associated with a failed transition from CMV to PSV. The unsuccessful transition was associated with worse outcomes., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Published
2024
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38. Modulation of pulmonary blood flow in patients with acute respiratory failure.

Author

Spina S, Marrazzo F, Morais CCA, Victor M, Forlini C, Guarnieri M, Bastia L, Giudici R, Bassi G, Xin Y, Cereda M, Amato M, Langer T, Berra L, and Fumagalli R

Subjects
Adult, Humans, Middle Aged, Aged, Pulmonary Circulation, Prospective Studies, Pulmonary Gas Exchange, SARS-CoV-2, Nitric Oxide, Hypoxia, Administration, Inhalation, COVID-19 complications, Respiratory Distress Syndrome drug therapy, Respiratory Distress Syndrome etiology, Respiratory Insufficiency drug therapy
Abstract

Background: Impairment of ventilation and perfusion (V/Q) matching is a common mechanism leading to hypoxemia in patients with acute respiratory failure requiring intensive care unit (ICU) admission. While ventilation has been thoroughly investigated, little progress has been made to monitor pulmonary perfusion at the bedside and treat impaired blood distribution. The study aimed to assess real-time changes in regional pulmonary perfusion in response to a therapeutic intervention., Methods: Single-center prospective study that enrolled adult patients with ARDS caused by SARS-Cov-2 who were sedated, paralyzed, and mechanically ventilated. The distribution of pulmonary perfusion was assessed through electrical impedance tomography (EIT) after the injection of a 10-ml bolus of hypertonic saline. The therapeutic intervention consisted in the administration of inhaled nitric oxide (iNO), as rescue therapy for refractory hypoxemia. Each patient underwent two 15-min steps at 0 and 20 ppm iNO, respectively. At each step, respiratory, gas exchange, and hemodynamic parameters were recorded, and V/Q distribution was measured, with unchanged ventilatory settings., Results: Ten 65 [56-75] years old patients with moderate (40%) and severe (60%) ARDS were studied 10 [4-20] days after intubation. Gas exchange improved at 20 ppm iNO (PaO 2 /FiO 2 from 86 ± 16 to 110 ± 30 mmHg, p = 0.001; venous admixture from 51 ± 8 to 45 ± 7%, p = 0.0045; dead space from 29 ± 8 to 25 ± 6%, p = 0.008). The respiratory system's elastic properties and ventilation distribution were unaltered by iNO. Hemodynamics did not change after gas initiation (cardiac output 7.6 ± 1.9 vs. 7.7 ± 1.9 L/min, p = 0.66). The EIT pixel perfusion maps showed a variety of patterns of changes in pulmonary blood flow, whose increase positively correlated with PaO 2 /FiO 2 increase (R 2  = 0.50, p = 0.049)., Conclusions: The assessment of lung perfusion is feasible at the bedside and blood distribution can be modulated with effects that are visualized in vivo. These findings might lay the foundations for testing new therapies aimed at optimizing the regional perfusion in the lungs., Competing Interests: Declaration of competing interest CCAM and MA disclose receiving research grants by Timpel., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2023
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39. PEEP Titration Is Markedly Affected by Trunk Inclination in Mechanically Ventilated Patients with COVID-19 ARDS: A Physiologic, Cross-Over Study.

Author

Marrazzo F, Spina S, Zadek F, Forlini C, Bassi G, Giudici R, Bellani G, Fumagalli R, and Langer T

Abstract

Background: Changing trunk inclination affects lung function in patients with ARDS. However, its impacts on PEEP titration remain unknown. The primary aim of this study was to assess, in mechanically ventilated patients with COVID-19 ARDS, the effects of trunk inclination on PEEP titration. The secondary aim was to compare respiratory mechanics and gas exchange in the semi-recumbent (40° head-of-the-bed) and supine-flat (0°) positions following PEEP titration., Methods: Twelve patients were positioned both at 40° and 0° trunk inclination (randomized order). The PEEP associated with the best compromise between overdistension and collapse guided by Electrical Impedance Tomography (PEEP EIT ) was set. After 30 min of controlled mechanical ventilation, data regarding respiratory mechanics, gas exchange, and EIT parameters were collected. The same procedure was repeated for the other trunk inclination., Results: PEEP EIT was lower in the semi-recumbent than in the supine-flat position (8 ± 2 vs. 13 ± 2 cmH 2 O, p < 0.001). A semi-recumbent position with optimized PEEP resulted in higher PaO 2 :FiO 2 (141 ± 46 vs. 196 ± 99, p = 0.02) and a lower global inhomogeneity index (46 ± 10 vs. 53 ± 11, p = 0.008). After 30 min of observation, a loss of aeration (measured by EIT) was observed only in the supine-flat position (-153 ± 162 vs. 27 ± 203 mL, p = 0.007)., Conclusions: A semi-recumbent position is associated with lower PEEP EIT and results in better oxygenation, less derecruitment, and more homogenous ventilation compared to the supine-flat position.

Published
2023
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42. Recommendations on dose level selection for repeat dose toxicity studies.

Author

Sewell F, Corvaro M, Andrus A, Burke J, Daston G, Delaney B, Domoradzki J, Forlini C, Green ML, Hofmann T, Jäckel S, Lee MS, Temerowski M, Whalley P, and Lewis R

Subjects
Animals, Risk Assessment, Ecotoxicology, Toxicity Tests
Abstract

Prior to registering and marketing any new pharmaceutical, (agro)chemical or food ingredient product manufacturers must, by law, generate data to ensure human safety. Safety testing requirements vary depending on sector, but generally repeat-dose testing in animals form the basis for human health risk assessments. Dose level selection is an important consideration when designing such studies, to ensure that exposure levels that lead to relevant hazards are identified. Advice on dose level selection is provided in test guidelines and allied guidance documents, but it is not well harmonised, particularly for selection of the highest dose tested. This paper further builds on concepts developed in a technical report by the European Centre for Ecotoxicology and Toxicology of Chemicals (ECETOC) which recommends pragmatic approaches to dose selection considering regulatory requirements, animal welfare and state of the art scientific approaches. Industry sectors have differing degrees of freedom to operate regarding dose level selection, depending on the purpose of the studies and the regulatory requirements/legislation, and this is reflected in the overall recommended approaches. An understanding of systemic exposure should be utilised where possible (e.g., through toxicokinetic approaches) and used together with apical endpoints from existing toxicity studies to guide more appropriate dose level selection. The highest dose should be limited to a reasonable level, causing minimal but evident toxicity to the test animals without significantly compromising their well-being. As the science of predictive human exposure further develops and matures, this will provide exciting and novel opportunities for more human-relevant approaches to dose level selection., (© 2022. The Author(s).)

Published
2022
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43. External chest-wall compression in prolonged COVID-19 ARDS with low-compliance: a physiological study.

Author

Bastia L, Rezoagli E, Guarnieri M, Engelberts D, Forlini C, Marrazzo F, Spina S, Bassi G, Giudici R, Post M, Bellani G, Fumagalli R, Brochard LJ, and Langer T

Abstract

Background: External chest-wall compression (ECC) is sometimes used in ARDS patients despite lack of evidence. It is currently unknown whether this practice has any clinical benefit in patients with COVID-19 ARDS (C-ARDS) characterized by a respiratory system compliance (C rs ) < 35 mL/cmH 2 O., Objectives: To test if an ECC with a 5 L-bag in low-compliance C-ARDS can lead to a reduction in driving pressure (DP) and improve gas exchange, and to understand the underlying mechanisms., Methods: Eleven patients with low-compliance C-ARDS were enrolled and underwent 4 steps: baseline, ECC for 60 min, ECC discontinuation and PEEP reduction. Respiratory mechanics, gas exchange, hemodynamics and electrical impedance tomography were recorded. Four pigs with acute ARDS were studied with ECC to understand the effect of ECC on pleural pressure gradient using pleural pressure transducers in both non-dependent and dependent lung regions., Results: Five minutes of ECC reduced DP from baseline 14.2 ± 1.3 to 12.3 ± 1.3 cmH 2 O (P < 0.001), explained by an improved lung compliance. Changes in DP by ECC were strongly correlated with changes in DP obtained with PEEP reduction (R 2  = 0.82, P < 0.001). The initial benefit of ECC decreased over time (DP = 13.3 ± 1.5 cmH 2 O at 60 min, P = 0.03 vs. baseline). Gas exchange and hemodynamics were unaffected by ECC. In four pigs with lung injury, ECC led to a decrease in the pleural pressure gradient at end-inspiration [2.2 (1.1-3) vs. 3.0 (2.2-4.1) cmH 2 O, P = 0.035]., Conclusions: In C-ARDS patients with C rs  < 35 mL/cmH 2 O, ECC acutely reduces DP. ECC does not improve oxygenation but it can be used as a simple tool to detect hyperinflation as it improves C rs and reduces P pl gradient. ECC benefits seem to partially fade over time. ECC produces similar changes compared to PEEP reduction., (© 2022. The Author(s).)

Published
2022
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44. Effects of Trunk Inclination on Respiratory Mechanics in Patients with COVID-19-associated Acute Respiratory Distress Syndrome: Let's Always Report the Angle!

Author

Marrazzo F, Spina S, Forlini C, Guarnieri M, Giudici R, Bassi G, Bastia L, Bottiroli M, Fumagalli R, and Langer T

Subjects
Aged, COVID-19 complications, Cross-Over Studies, Female, Hemodynamics, Humans, Male, Middle Aged, Pulmonary Gas Exchange, Respiratory Distress Syndrome etiology, SARS-CoV-2, COVID-19 therapy, Patient Positioning methods, Respiration, Artificial methods, Respiratory Distress Syndrome therapy, Respiratory Mechanics
Published
2022
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45. Death determination, organ donation and the importance of the Dead Donor Rule following withdrawal of life-sustaining treatment: a survey of community opinions.

Author

O'Leary MJ, Skowronski G, Critchley C, O'Reilly L, Forlini C, Sheahan L, Stewart C, and Kerridge I

Subjects
Attitude, Australia, Humans, Male, Surveys and Questionnaires, Tissue Donors, Death, Tissue and Organ Procurement
Abstract

Background: Background: Organ donation (OD) following circulatory determination of death (DCDD) is an increasing source of transplant organs but little is known about community opinions on treatment withdrawal, determination of death and acceptance of OD in DCDD., Aims: To determine attitudes on death determination in DCDD, the importance of patient choice in treatment withdrawal and OD agreement, and the importance of the 'Dead Donor Rule'., Methods: Scenario-based online survey of 1017 members of the Australian general public. Mean levels of agreement across respondent's responses to statements were compared by repeated measures ANOVA., Results: 54% (548) of respondents agreed that a DCDD scenario patient could be declared dead 2 minutes after circulatory standstill, however over 80% nonetheless agreed OD would be appropriate, including 77% (136/176) of those disagreeing with a 2-minute death declaration. 48% (484) supported OD even if it caused the patient's death. 75% (766) would accept relatively benign ante-mortem treatments administered to improve transplant outcomes. Over 70% supported a high quadriplegic patient's request to be allowed to die, with 61% (622) agreeing that he should be allowed to donate his organs under anaesthesia, but 60% (610) also agreed that he should first be declared dead., Conclusions: We found high levels of support for treatment withdrawal in severe brain injury and when requested by a quadriplegic patient. While there was variable agreement with the timing of death determination and with OD under anaesthesia, support for OD was high in both scenarios. For many people death determination prior to OD may not be of paramount importance., (© 2021 Royal Australasian College of Physicians.)

Published
2022
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46. A scoping review of the perceptions of death in the context of organ donation and transplantation.

Author

Skowronski G, Ramnani A, Walton-Sonda D, Forlini C, O'Leary MJ, O'Reilly L, Sheahan L, Stewart C, and Kerridge I

Subjects
Brain Death, Humans, Prospective Studies, Tissue Donors, Organ Transplantation, Tissue and Organ Procurement
Abstract

Background: Socio-cultural perceptions surrounding death have profoundly changed since the 1950s with development of modern intensive care and progress in solid organ transplantation. Despite broad support for organ transplantation, many fundamental concepts and practices including brain death, organ donation after circulatory death, and some antemortem interventions to prepare for transplantation continue to be challenged. Attitudes toward the ethical issues surrounding death and organ donation may influence support for and participation in organ donation but differences between and among diverse populations have not been studied., Objectives: In order to clarify attitudes toward brain death, organ donation after circulatory death and antemortem interventions in the context of organ donation, we conducted a scoping review of international English-language quantitative surveys in various populations., Study Appraisal: A search of literature up to October 2020 was performed, using multiple databases. After screening, 45 studies were found to meet pre-specified inclusion criteria., Results: 32 studies examined attitudes to brain death, predominantly in healthcare professionals. In most, around 75% of respondents accepted brain death as equivalent to death of the person. Less common perspectives included equating death with irreversible coma and willingness to undertake organ donation even if it caused death. 14 studies examined attitudes to organ donation following circulatory death. Around half of respondents in most studies accepted that death could be confidently diagnosed after only 5 min of cardiorespiratory arrest. The predominant reason was lack of confidence in doctors or diagnostic procedures. Only 6 studies examined attitudes towards antemortem interventions in prospective organ donors. Most respondents supported minimally invasive procedures and only where specific consent was obtained., Conclusions: Our review suggests a considerable proportion of people, including healthcare professionals, have doubts about the medical and ethical validity of modern determinations of death. The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death., (© 2021. The Author(s).)

Published
2021
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47. The pharmaceuticalisation of 'healthy' ageing: Testosterone enhancement for longevity.

Author

Dunn M, Mulrooney KJ, Forlini C, van de Ven K, and Underwood M

Subjects
Aged, Australia, Canada, Humans, Life Expectancy, Male, United States, Longevity, Testosterone
Abstract

The United Nations estimates that the world's population will reach 8.5 billion by 2030, and the populations of most countries are expected to grow older. This is case for many developed countries, including Australia, the United Kingdom, Canada, the United States of America, and member states of the European Union. Older cohorts will comprise a larger proportion of overall populations, driven in part by our increases in life expectancy. An ageing population poses challenges for governments; notably, older people tend to have multiple, chronic health conditions which can place a burden of health budgets. At the same time, we are witnessing a shift in how we respond to the health needs of our populations, with global drug policy acknowledging that some substances are contributing to increased morbidity and mortality (e.g. opioids) while others may have beneficial therapeutic effects (e.g. psylocibin, cannabis). There is general agreement that as men age their levels of testosterone decrease, and there is some evidence to suggest that there have been population-level declines in testosterone which are not associated with age. Anecdotally, testosterone is accessed by men seeking to self-medicate in the belief that they are experiencing low testosterone levels. There has also been a rise in anti-ageing clinics in the United States, providing access to testosterone replacement therapy (TRT). The non-medical use of testosterone can result in a number of adverse health events, including complications from the use of black market or underground products. Placing testosterone under a new prescribing regime may address some of these concerns, but is society ready for this change, and if so, what would this regime look like? This paper will explore the issue of how society responds to enhancement for longevity, or how we increasingly use pharmaceuticals to address and prevent illness, with a specific focus on testosterone and testosterone deficiency., Competing Interests: Declarations of Interest The authors declare that they have no conflict of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Published
2021
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49. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients.

Author

Langer T, Brioni M, Guzzardella A, Carlesso E, Cabrini L, Castelli G, Dalla Corte F, De Robertis E, Favarato M, Forastieri A, Forlini C, Girardis M, Grieco DL, Mirabella L, Noseda V, Previtali P, Protti A, Rona R, Tardini F, Tonetti T, Zannoni F, Antonelli M, Foti G, Ranieri M, Pesenti A, Fumagalli R, and Grasselli G

Subjects
Aged, Cohort Studies, Female, Humans, Italy, Male, Middle Aged, Practice Guidelines as Topic, Retrospective Studies, COVID-19 therapy, Critical Care standards, Intubation standards, Patient Positioning standards, Prone Position, Respiration, Artificial standards, Supine Position
Abstract

Background: Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave., Methods: Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO 2 /FiO 2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position., Results: Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p < 0.001). Overall, prone position induced a significant increase in PaO 2 /FiO 2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively)., Conclusions: During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching., Trial Registration: clinicaltrials.gov number: NCT04388670.

Published
2021
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50. Prone Positioning during Venovenous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome. A Multicenter Cohort Study and Propensity-matched Analysis.

Author

Giani M, Martucci G, Madotto F, Belliato M, Fanelli V, Garofalo E, Forlini C, Lucchini A, Panarello G, Bottino N, Zanella A, Fossi F, Lissoni A, Peroni N, Brazzi L, Bellani G, Navalesi P, Arcadipane A, Pesenti A, Foti G, and Grasselli G

Subjects
Cohort Studies, Humans, Prone Position, Retrospective Studies, Extracorporeal Membrane Oxygenation, Respiratory Distress Syndrome therapy
Abstract

Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress syndrome (ARDS). To date, no evidence supports the use of prone positioning (PP) during venovenous extracorporeal oxygenation (ECMO). Objectives: The aim of the study was to assess the feasibility, safety, and effect on oxygenation and lung mechanics of PP during ECMO. As a secondary exploratory aim, we assessed the association between PP and hospital mortality. Methods: We performed a multicenter retrospective cohort study in six Italian ECMO centers, including patients managed with PP during ECMO support (prone group; four centers) and patients managed in the supine position (control group; two centers). Physiological variables were analyzed at four time points (supine before PP, start of PP, end of PP, and supine after PP). The association between PP and hospital mortality was assessed by multivariate analysis and propensity score-matching. Results: A total of 240 patients were included, with 107 in the prone group and 133 in the supine group. The median duration of the 326 pronation cycles was 15 (12-18) hours. Minor reversible complications were reported in 6% of PP maneuvers. PP improved oxygenation and reduced intrapulmonary shunt. Unadjusted hospital mortality was lower in the prone group (34 vs. 50%; P  = 0.017). After adjusting for covariates, PP remained significantly associated with a reduction of hospital mortality (odds ratio, 0.50; 95% confidence interval, 0.29-0.87). Sixty-six propensity score-matched patients were identified in each group. In this matched sample, patients who underwent pronation had higher ECMO duration (16 vs. 10 d; P  = 0.0344) but lower hospital mortality (30% vs. 53%; P  = 0.0241). Conclusions: PP during ECMO improved oxygenation and was associated with a reduction of hospital mortality.

Published
2021
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