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

Author: Melisa Polo Friz, MD, Emanuele Rezoagli, MD, Bijan Safaee Fakhr, MD, Gaetano Florio, MD, Eleonora Carlesso, MS, Riccardo Giudici, MD, Clarissa Forlini, MD, Francesca Tardini, MD, Thomas Langer, MD, Matteo Laratta, MD, Giampaolo Casella, MD, Andrea Forastieri Molinari, MD, Alessandro Protti, MD, Maurizio Cecconi, MD, Luca Cabrini, MD, Emanuela Biagioni, MD, Angela Berselli, MD, Lucia Mirabella, MD, Tommaso Tonetti, MD, Edoardo De Robertis, MD, Domenico Luca Grieco, MD, Massimo Antonelli, MD, Giuseppe Citerio, MD, Roberto Fumagalli, MD, Giuseppe Foti, MD, Alberto Zanella, MD, Giacomo Grasselli, MD, Giacomo Bellani, MD, for the COVID-19 Lombardy ICU Network, Amedeo Guzzardella, Luigi Vivona, Vittorio Scaravilli, Sebastiano Colombo, Alessio Cacioppola, Matteo Brioni, Clarissa Forlini, Francesca Tardini, Thomas Langer, Matteo Laratta, Giampaolo Casella, Maria Marsili, Serena Stropeni, Valentina Cordolcini, Francesco Crimella, Alessandro Santini, Massimiliano Greco, Michele Ferrari, Giacomo Iapichino, Paolo Severgnini, Davide Maraggia, Dario Gasberti, Alessandro Motta, Irene Coloretti, Stefano Busani, Martina Tosi, Ilenia Gatto, Carlo Montalto, Alberto Biondo, Ziad Algamain, Valentina Alaimo, Livio Tullo, Francesco Paolo Padovano, Giacinto Pizzilli, Irene Cavalli, Rachele Simonte, Davide Valeri, Gennaro DePascale, Simone Carelli, Valentina Noseda, Giacomo Cimicchi, Gaia Ottonello, Rossano Ghedin, Francesco Giacalone, Tiziana Bove, Francesco Meroi, Sara Scapol, Laura Pistidda, Angela Muretti, Savino Spadaro, Gaetano Scaramuzzo, Gioconda Ferraro, Giuseppe Gagliardi, Giovanni Sabbatini, Angelo Pezzi, Gabriele Sales, Giorgia Montrucchio, Andrea Carsetti, Federico Longhini, Maria Vargas, Plinio Calligaro, Ilaria Mariani, Vanessa Zambelli, Beatrice Noè, and Filippo Serra
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
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
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2. Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis

Author: Andrea Carsetti, Riccardo Antolini, Erika Casarotta, Elisa Damiani, Francesco Gasparri, Benedetto Marini, Erica Adrario, and Abele Donati
Subjects: Shock index, Massive transfusion, Mortality, Hemorrhagic shock, Trauma, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Management of bleeding trauma patients is still a difficult challenge. Massive transfusion (MT) requires resources to ensure the safety and timely delivery of blood products. Early prediction of MT need may be useful to shorten the time process of blood product preparation. The primary aim of this study was to assess the accuracy of shock index to predict the need for MT in adult patients with trauma. For the same population, we also assessed the accuracy of SI to predict mortality. Methods This systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. We performed a systematic search on MEDLINE, Scopus, and Web of Science from inception to March 2022. Studies were included if they reported MT or mortality with SI recorded at arrival in the field or the emergency department. The risk of bias was assessed using the QUADAS-2. Results Thirty-five studies were included in the systematic review and meta-analysis, for a total of 670,728 patients. For MT the overall sensibility was 0.68 [0.57; 0.76], the overall specificity was 0.84 [0.79; 0.88] and the AUC was 0.85 [0.81; 0.88]. Positive and Negative Likelihood Ratio (LR+; LR−) were 4.24 [3.18–5.65] and 0.39 [0.29–0.52], respectively. For mortality the overall sensibility was 0.358 [0.238; 0.498] the overall specificity 0.742 [0.656; 0.813] and the AUC 0.553 (confidence region for sensitivity given specificity: [0.4014; 0.6759]; confidence region for specificity given sensitivity: [0.4799; 0.6332]). LR+ and LR− were 1.39 [1.36–1.42] and 0.87 [0.85–0.89], respectively. Conclusions Our study demonstrated that SI may have a limited role as the sole tool to predict the need for MT in adult trauma patients. SI is not accurate to predict mortality but may have a role to identify patients with a low risk of mortality.
Published: 2023
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3. Microcirculation-guided resuscitation in sepsis: the next frontier?

Author: Elisa Damiani, Andrea Carsetti, Erika Casarotta, Roberta Domizi, Claudia Scorcella, Abele Donati, and Erica Adrario
Subjects: sepsis, septic shock, microcirculation, sublingual videomicroscopy, tissue perfusion, glycocalyx, Medicine (General), R5-920
Abstract: Microcirculatory dysfunction plays a key role in the pathogenesis of tissue dysoxia and organ failure in sepsis. Sublingual videomicroscopy techniques enable the real-time non-invasive assessment of microvascular blood flow. Alterations in sublingual microvascular perfusion were detected during sepsis and are associated with poor outcome. More importantly, sublingual videomicroscopy allowed to explore the effects of commonly applied resuscitative treatments in septic shock, such as fluids, vasopressors and inotropes, and showed that the optimization of macro-hemodynamic parameters may not be accompanied by an improvement in microvascular perfusion. This loss of “hemodynamic coherence,” i.e., the concordance between the response of the macrocirculation and the microcirculation, advocates for the integration of microvascular monitoring in the management of septic patients. Nonetheless, important barriers remain for a widespread use of sublingual videomicroscopy in the clinical practice. In this review, we discuss the actual limitations of this technique and future developments that may allow an easier and faster evaluation of the microcirculation at the bedside, and propose a role for sublingual microvascular monitoring in guiding and titrating resuscitative therapies in sepsis.
Published: 2023
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4. Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry

Author: Pedro David Wendel-Garcia, André Moser, Marie-Madlen Jeitziner, Hernán Aguirre-Bermeo, Pedro Arias-Sanchez, Janina Apolo, Ferran Roche-Campo, Diego Franch-Llasat, Gian-Reto Kleger, Claudia Schrag, Urs Pietsch, Miodrag Filipovic, Sascha David, Klaus Stahl, Souad Bouaoud, Amel Ouyahia, Patricia Fodor, Pascal Locher, Martin Siegemund, Nuria Zellweger, Sara Cereghetti, Peter Schott, Gianfilippo Gangitano, Maddalena Alessandra Wu, Mario Alfaro-Farias, Gerardo Vizmanos-Lamotte, Hatem Ksouri, Nadine Gehring, Emanuele Rezoagli, Fabrizio Turrini, Herminia Lozano-Gómez, Andrea Carsetti, Raquel Rodríguez-García, Bernd Yuen, Anja Baltussen Weber, Pedro Castro, Jesus Oscar Escos-Orta, Alexander Dullenkopf, Maria C. Martín-Delgado, Theodoros Aslanidis, Marie-Helene Perez, Frank Hillgaertner, Samuele Ceruti, Marilene Franchitti Laurent, Julien Marrel, Riccardo Colombo, Marcus Laube, Alberto Fogagnolo, Michael Studhalter, Tobias Wengenmayer, Emiliano Gamberini, Christian Buerkle, Philipp K. Buehler, Stefanie Keiser, Muhammed Elhadi, Jonathan Montomoli, Philippe Guerci, Thierry Fumeaux, Reto A. Schuepbach, Stephan M. Jakob, Yok-Ai Que, Matthias Peter Hilty, and the RISC-19-ICU Investigators
Subjects: COVID-19, Pandemic, Intensive care unit, ARDS, Disease dynamics, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic. Methods Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic. Results Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60–63] years vs 64 [62–66] years, p
Published: 2022
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5. Anesthetic management of patients with sepsis/septic shock

Author: Andrea Carsetti, Eva Vitali, Lucia Pesaresi, Riccardo Antolini, Erika Casarotta, Elisa Damiani, Erica Adrario, and Abele Donati
Subjects: sepsis, septic shock, anesthesia, surgery, perioperative, infection, Medicine (General), R5-920
Abstract: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, while septic shock is a subset of sepsis with persistent hypotension requiring vasopressors to maintain a mean arterial pressure (MAP) of ≥65 mmHg and having a serum lactate level of >2 mmol/L, despite adequate volume resuscitation. Sepsis and septic shock are medical emergencies and time-dependent diseases with a high mortality rate for which early identification, early antibiotic therapy, and early source control are paramount for patient outcomes. The patient may require surgical intervention or an invasive procedure aiming to control the source of infection, and the anesthesiologist has a pivotal role in all phases of patient management. During the preoperative assessment, patients should be aware of all possible organ dysfunctions, and the severity of the disease combined with the patient's physiological reserve should be carefully assessed. All possible efforts should be made to optimize conditions before surgery, especially from a hemodynamic point of view. Anesthetic agents may worsen the hemodynamics of shock patients, and the anesthesiologist must know the properties of each anesthetic agent. All possible efforts should be made to maintain organ perfusion supporting hemodynamics with fluids, vasoactive agents, and inotropes if required.
Published: 2023
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6. Machine learning using the extreme gradient boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients

Author: Jonathan Montomoli, Luca Romeo, Sara Moccia, Michele Bernardini, Lucia Migliorelli, Daniele Berardini, Abele Donati, Andrea Carsetti, Maria Grazia Bocci, Pedro David Wendel Garcia, Thierry Fumeaux, Philippe Guerci, Reto Andreas Schüpbach, Can Ince, Emanuele Frontoni, Matthias Peter Hilty, Mario Alfaro-Farias, MD, Gerardo Vizmanos-Lamotte, MD, PhD, Thomas Tschoellitsch, MD, Jens Meier, MD, Hernán Aguirre-Bermeo, MD, PhD, Janina Apolo, BSc, Alberto Martínez, MD, Geoffrey Jurkolow, MD, Gauthier Delahaye, MD, Emmanuel Novy, MD, Marie-Reine Losser, MD, PhD, Tobias Wengenmayer, MD, Jonathan Rilinger, MD, Dawid L. Staudacher, MD, Sascha David, MD, Tobias Welte, MD, Klaus Stahl, MD, “Agios Pavlos”, Theodoros Aslanidis, MD, PhD, Anita Korsos, MD, Barna Babik, MD, PhD, Reza Nikandish, MD, Emanuele Rezoagli, MD, PhD, Matteo Giacomini, MD, Alice Nova, MD, Alberto Fogagnolo, MD, Savino Spadaro, MD, PhD, Roberto Ceriani, MD, Martina Murrone, MD, Maddalena A. Wu, MD, Chiara Cogliati, MD, Riccardo Colombo, MD, Emanuele Catena, MD, Fabrizio Turrini, MD, MSc, Maria Sole Simonini, MD, Silvia Fabbri, MD, Antonella Potalivo, MD, Francesca Facondini, MD, Gianfilippo Gangitano, MD, Tiziana Perin, MD, Maria Grazia Bocci, MD, Massimo Antonelli, MD, Diederik Gommers, MD, PhD, Raquel Rodríguez-García, MD, Jorge Gámez-Zapata, MD, Xiana Taboada-Fraga, MD, Pedro Castro, MD, Adrian Tellez, MD, Arantxa Lander-Azcona, MD, Jesús Escós-Orta, MD, Maria C. Martín-Delgado, MD, Angela Algaba-Calderon, MD, Diego Franch-Llasat, MD, Ferran Roche-Campo, MD, PhD, Herminia Lozano-Gómez, MD, Begoña Zalba-Etayo, MD, PhD, Marc P. Michot, MD, Alexander Klarer, Rolf Ensner, MD, Peter Schott, MD, Severin Urech, MD, Nuria Zellweger, Lukas Merki, MD, Adriana Lambert, MD, Marcus Laube, MD, Marie M. Jeitziner, RN, PhD, Beatrice Jenni-Moser, RN, MSc, Jan Wiegand, MD, Bernd Yuen, MD, Barbara Lienhardt-Nobbe, Andrea Westphalen, MD, Petra Salomon, MD, Iris Drvaric, MD, Frank Hillgaertner, MD, Marianne Sieber, Alexander Dullenkopf, MD, Lina Petersen, MD, Ivan Chau, MD, Hatem Ksouri, MD, PhD, Govind Oliver Sridharan, MD, Sara Cereghetti, MD, Filippo Boroli, MD, Jerome Pugin, MD, PhD, Serge Grazioli, MD, Peter C. Rimensberger, MD, Christian Bürkle, MD, Julien Marrel, MD, Mirko Brenni, MD, Isabelle Fleisch, MD, Jerome Lavanchy, MD, Marie-Helene Perez, MD, Anne-Sylvie Ramelet, MD, Anja Baltussen Weber, MD, Peter Gerecke, MD, Andreas Christ, MD, Samuele Ceruti, MD, Andrea Glotta, MD, Katharina Marquardt, MD, Karim Shaikh, MD, Tobias Hübner, MD, Thomas Neff, MD, Hermann Redecker, MD, Mallory Moret-Bochatay, MD, FriederikeMeyer zu Bentrup, MD, MBA, Michael Studhalter, MD, Michael Stephan, MD, Jan Brem, MD, Nadine Gehring, MD, Daniela Selz, MD, Didier Naon, MD, Gian-Reto Kleger, MD, Urs Pietsch, MD, Miodrag Filipovic, MD, Anette Ristic, MD, Michael Sepulcri, MD, Antje Heise, MD, Marilene Franchitti Laurent, MD, Jean-Christophe Laurent, MD, Pedro D. Wendel Garcia, MSc, Reto Schuepbach, MD, Dorothea Heuberger, PhD, Philipp Bühler, MD, Silvio Brugger, MD, PhD, Patricia Fodor, MD, Pascal Locher, MD, Giovanni Camen, MD, Tomislav Gaspert, MD, Marija Jovic, MD, Christoph Haberthuer, MD, Roger F. Lussman, MD, and Elif Colak, MD
Subjects: Machine learning, Extreme gradient boosting (XGBoost), COVID-19, Multiple organ failure, Clinical decision support system (CDSS), Organ dysfunction score, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Background: Accurate risk stratification of critically ill patients with coronavirus disease 2019 (COVID-19) is essential for optimizing resource allocation, delivering targeted interventions, and maximizing patient survival probability. Machine learning (ML) techniques are attracting increased interest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care. Methods: We retrieved data on patients with COVID-19 admitted to an intensive care unit (ICU) between March and October 2020 from the RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry. We applied the Extreme Gradient Boosting (XGBoost) algorithm to the data to predict as a binary outcome the increase or decrease in patients’ Sequential Organ Failure Assessment (SOFA) score on day 5 after ICU admission. The model was iteratively cross-validated in different subsets of the study cohort. Results: The final study population consisted of 675 patients. The XGBoost model correctly predicted a decrease in SOFA score in 320/385 (83%) critically ill COVID-19 patients, and an increase in the score in 210/290 (72%) patients. The area under the mean receiver operating characteristic curve for XGBoost was significantly higher than that for the logistic regression model (0.86 vs. 0.69, P
Published: 2021
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7. Too much tolerance for hyperoxemia in mechanically ventilated patients with SARS-CoV-2 pneumonia? Report from an Italian intensive care unit

Author: Elisa Damiani, Erika Casarotta, Andrea Carsetti, Giulia Mariotti, Sara Vannicola, Rachele Giorgetti, Roberta Domizi, Claudia Scorcella, Erica Adrario, and Abele Donati
Subjects: COVID-19, SARS-CoV-2, ARDS, hyperoxia, oxygen, ventilator-associated pneumonia, Medicine (General), R5-920
Abstract: BackgroundIn COVID-19 patients requiring mechanical ventilation, the administration of high oxygen (O2) doses for prolonged time periods may be necessary. Although life-saving in most cases, O2 may exert deleterious effects if administered in excessive concentrations. We aimed to describe the prevalence of hyperoxemia and excessive O2 administration in mechanically ventilated patients with SARS-CoV-2 pneumonia and determine whether hyperoxemia is associated with mortality in the Intensive Care Unit (ICU) or the onset of ventilator-associated pneumonia (VAP).Materials and methodsRetrospective single-center study on adult patients with SARS-CoV-2 pneumonia requiring invasive mechanical ventilation for ≥48 h. Patients undergoing extracorporeal respiratory support were excluded. We calculated the excess O2 administered based on the ideal arterial O2 tension (PaO2) target of 55–80 mmHg. We defined hyperoxemia as PaO2 > 100 mmHg and hyperoxia + hyperoxemia as an inspired O2 fraction (FiO2) > 60% + PaO2 > 100 mmHg. Risk factors for ICU-mortality and VAP were assessed through multivariate analyses.ResultsOne hundred thirty-four patients were included. For each day of mechanical ventilation, each patient received a median excess O2 of 1,121 [829–1,449] L. Hyperoxemia was found in 38 [27–55]% of arterial blood gases, hyperoxia + hyperoxemia in 11 [5–18]% of cases. The FiO2 was not reduced in 69 [62–76]% of cases of hyperoxemia. Adjustments were made more frequently with higher PaO2 or initial FiO2 levels. ICU-mortality was 32%. VAP was diagnosed in 48.5% of patients. Hyperoxemia (OR 1.300 95% CI [1.097–1.542]), time of exposure to hyperoxemia (OR 2.758 [1.406–5.411]), hyperoxia + hyperoxemia (OR 1.144 [1.008–1.298]), and daily excess O2 (OR 1.003 [1.001–1.005]) were associated with higher risk for ICU-mortality, independently of age, Sequential Organ failure Assessment score at ICU-admission and mean PaO2/FiO2. Hyperoxemia (OR 1.033 [1.006–1.061]), time of exposure to hyperoxemia (OR 1.108 [1.018–1.206]), hyperoxia + hyperoxemia (OR 1.038 [1.003–1.075]), and daily excess O2 (OR 1.001 [1.000–1.001]) were identified as risk factors for VAP, independently of body mass index, blood transfusions, days of neuromuscular blocking agents (before VAP), prolonged prone positioning and mean PaO2/FiO2 before VAP.ConclusionExcess O2 administration and hyperoxemia were common in mechanically ventilated patients with SARS-CoV-2 pneumonia. The exposure to hyperoxemia may be associated with ICU-mortality and greater risk for VAP.
Published: 2022
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8. Antibiotic Treatment of Acinetobacter baumannii Superinfection in Patients With SARS-CoV-2 Infection Admitted to Intensive Care Unit: An Observational Retrospective Study

Author: Erika Casarotta, Elisa Bottari, Sara Vannicola, Rachele Giorgetti, Roberta Domizi, Andrea Carsetti, Elisa Damiani, Claudia Scorcella, Vincenzo Gabbanelli, Simona Pantanetti, Benedetto Marini, Abele Donati, and Erica Adrario
Subjects: Acinetobacter baumannii, superinfection, SARS-CoV-2, acute respiratory failure, antibiotics, Medicine (General), R5-920
Abstract: IntroductionIn COVID-19 patients on mechanical ventilation, VAP from Acinetobacter baumannii remains a crucial risk factor for death. Antibiotic resistance represents an important problem in treating this infection. This study aims to describe the evolution of the superinfection from PDR Acinetobacter baumannii in patients with acute respiratory failure from SARS-CoV-2 infection admitted to ICU and compare the impact of two different antibiotic strategies on microbiological negativization.MethodsSingle-center observational retrospective study, including patients admitted to our ICU from March 2020 to May 2021 for acute respiratory failure from SARS-CoV-2 infection who developed PDR Acinetobacter baumannii superinfection. Clinical data at ICU admission were collected, as well as the timing of isolation of Acinetobacter baumannii, its resistance profile, the site of infection, and the antibiotic therapy.ResultsOf the 32 patients enrolled, 10 patients (31.2%) were treated with the combination of high-dose ampicillin/sulbactam, high-dose tigecycline, intravenous and inhaled colistin (Protocol), the other 22 (68.8%) were treated with the combination of two antibiotics (Control). Of the 10 patients in the Protocol group, 8 patients (80%) received also fosfomycin. All patients (100%) in the Protocol group had microbiological negativization, while in the Control group microbiological negativization was observed in 8 (36.4%) patients, p < 0.01.ConclusionOur report shows microbiological negativization in all patients treated with the combination therapy of nebulized and intravenous colistin, high-dose tigecycline, and high-dose ampicillin/sulbactam. This combination of antibiotics seems to be a useful alternative when other treatments are not available or fail.
Published: 2022
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9. Procedural sedation for direct current cardioversion: a feasibility study between two management strategies in the emergency department

Author: Giulia Stronati, Alessandro Capucci, Antonio Dello Russo, Erica Adrario, Andrea Carsetti, Michela Casella, Abele Donati, and Federico Guerra
Subjects: Atrial fibrillation, Cardioversion, Emergency procedures, Midazolam, Propofol, Sedation, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Background A cardiologist-only approach to procedural sedation with midazolam in the setting of elective cardioversion (DCC) for AF has already been proven as safe as sedation with propofol and anaesthesiologist assistance. No data exist regarding the safety of such a strategy during emergency procedures. The aim of this study is to compare the feasibility of sedation with midazolam, administered by a cardiologist, to an anaesthesiologist-assisted protocol with propofol in emergency DCC. Methods Single centre, prospective, open blinded, randomized study including all consecutive patients admitted to the Emergency Department requiring urgent or emergency DCC. Patients were randomized in a 1:1 fashion to either propofol or midazolam treatment arm. Patients in the midazolam group were managed by the cardiologist only, while patients treated with propofol group underwent DCC with anaesthesiologist assistance. Results Sixty-nine patients were enrolled and split into two groups. Eighteen patients (26.1%) experienced peri-procedural adverse events (bradycardia, severe hypotension and severe hypoxia), which were similar between the two groups and all successfully managed by the cardiologist. No deaths, stroke or need for invasive ventilation were registered. Patients treated with propofol experienced a greater decrease in systolic and diastolic blood pressure when compared with those treated with midazolam. As the procedure was shorter when midazolam was used, the median cost of urgent/emergency DCC with midazolam was estimated to be 129.0 € (1st-3rd quartiles 114.6–151.6) and 195.6 € (1st-3rd quartiles 147.3–726.7) with propofol (p
Published: 2020
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10. Estimated oxygen extraction versus dynamic parameters of fluid-responsiveness for perioperative hemodynamic optimization of patients undergoing non-cardiac surgery: a non-inferiority randomized controlled trial

Author: Andrea Carsetti, Mirco Amici, Tonino Bernacconi, Paolo Brancaleoni, Elisabetta Cerutti, Marco Chiarello, Diego Cingolani, Luisanna Cola, Daniela Corsi, Giorgio Forlini, Marina Giampieri, Salvatore Iuorio, Tiziana Principi, Giuseppe Tappatà, Michele Tempesta, Erica Adrario, and Abele Donati
Subjects: Perioperative goal directed therapy, Fluid-responsiveness, Oxygen extraction rate, Complications, Anesthesiology, RD78.3-87.3
Abstract: Abstract Background Goal directed therapy (GDT) is able to improve mortality and reduce complications in selected high-risk patients undergoing major surgery. The aim of this study is to compare two different strategies of perioperative hemodynamic optimization: one based on optimization of preload using dynamic parameters of fluid-responsiveness and the other one based on estimated oxygen extraction rate (O2ER) as target of hemodynamic manipulation. Methods This is a multicenter randomized controlled trial. Adult patients undergoing elective major open abdominal surgery will be allocated to receive a protocol based on dynamic parameters of fluid-responsiveness or a protocol based on estimated O2ER. The hemodynamic optimization will be continued for 6 h postoperatively. The primary outcome is difference in overall postoperative complications rate between the two protocol groups. Fluids administered, fluid balance, utilization of vasoactive drugs, hospital length of stay and mortality at 28 day will also be assessed. Discussion As a predefined target of cardiac output (CO) or oxygen delivery (DO2) seems to be not adequate for every patient, a personalized therapy is likely more appropriate. Following this concept, dynamic parameters of fluid-responsiveness allow to titrate fluid administration aiming CO increase but avoiding fluid overload. This approach has the advantage of personalized fluid therapy, but it does not consider if CO is adequate or not. A protocol based on O2ER considers this second important aspect. Although positive effects of perioperative GDT have been clearly demonstrated, currently studies comparing different strategies of hemodynamic optimization are lacking. Trial registration ClinicalTrials.gov, NCT04053595 . Registered on 12/08/2019.
Published: 2020
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11. Implementation Strategies for Preventing Healthcare-Associated Infections across the Surgical Pathway: An Italian Multisociety Document

Author: Massimo Sartelli, Stefano Bartoli, Felice Borghi, Stefano Busani, Andrea Carsetti, Fausto Catena, Nicola Cillara, Federico Coccolini, Andrea Cortegiani, Francesco Cortese, Elisa Fabbri, Domitilla Foghetti, Francesco Forfori, Antonino Giarratano, Francesco Maria Labricciosa, Pierluigi Marini, Claudio Mastroianni, Angelo Pan, Daniela Pasero, Marco Scatizzi, Bruno Viaggi, and Maria Luisa Moro
Subjects: healthcare-associated infections, antimicrobial resistance, infection prevention and control, surgical infections, Therapeutics. Pharmacology, RM1-950
Abstract: Healthcare-associated infections (HAIs) result in significant patient morbidity and can prolong the duration of the hospital stay, causing high supplementary costs in addition to those already sustained due to the patient’s underlying disease. Moreover, bacteria are becoming increasingly resistant to antibiotics, making HAI prevention even more important nowadays. The public health consequences of antimicrobial resistance should be constrained by prevention and control actions, which must be a priority for all health systems of the world at all levels of care. As many HAIs are preventable, they may be considered an important indicator of the quality of patient care and represent an important patient safety issue in healthcare. To share implementation strategies for preventing HAIs in the surgical setting and in all healthcare facilities, an Italian multi-society document was published online in November 2022. This article represents an evidence-based summary of the document.
Published: 2023
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12. Mid-Regional Proadrenomedullin (MR-proADM) and Microcirculation in Monitoring Organ Dysfunction of Critical Care Patients With Infection: A Prospective Observational Pilot Study

Author: Roberta Domizi, Elisa Damiani, Claudia Scorcella, Andrea Carsetti, Paolo Giaccaglia, Erika Casarotta, Jonathan Montomoli, Vincenzo Gabbanelli, Marina Brugia, Marco Moretti, Erica Adrario, and Abele Donati
Subjects: mid-regional proadrenomedullin, microcirculation, sepsis, septic shock, infection, organ failure, Medicine (General), R5-920
Abstract: Introduction: Microvascular alterations are involved in the development of organ injury in critical care patients. Mid-regional proadrenomedullin (MR-proADM) may predict organ damage and its evolution. The main objective of this study was to assess the correlation between MR-proADM and microvascular flow index (MFI) in a small cohort of 20 adult critical care patients diagnosed with infection, sepsis, or septic shock. Further objectives were to evaluate the correlation between the clearance of MR-proADM and the variables of microcirculation and between MR-proADM and the Sequential Organ Failure Assessment (SOFA) score.Materials and Methods: This is a prospective observational pilot study. Inclusion criteria: consecutive adult patients admitted to intensive care unit (ICU) for or with infection-related illness. Daily measurement of MR-proADM and calculation of the SOFA score from admission in ICU to day 5. Repeated evaluations of sublingual microcirculation, collection of clinical data, and laboratory tests.Results: Primary outcome: MR-proADM was not significantly correlated to the MFI at admission in ICU. A clearance of MR-proADM of 20% or more in the first 24 h was related to the improvement of the MFIs and MFIt [percentual variation of the MFIs + 12.35 (6.01–14.59)% vs. +2.23 (−4.45–6.01)%, p = 0.005; MFIt +9.09 (4.53–16.26)% vs. −1.43 (−4.36–3.12)%, p = 0.002].Conclusion: This study did not support a direct correlation of MR-proADM with the MFI at admission in ICU; however, it showed a good correlation between the clearance of MR-proADM, MFI, and other microvascular variables. This study also supported the prognostic value of the marker. Adequately powered studies should be performed to confirm the findings.
Published: 2021
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13. Microvascular alterations in patients with SARS-COV-2 severe pneumonia

Author: Elisa Damiani, Andrea Carsetti, Erika Casarotta, Claudia Scorcella, Roberta Domizi, Erica Adrario, and Abele Donati
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2020
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14. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective

Author: Andrea Carsetti, Agnese Damia Paciarini, Benedetto Marini, Simona Pantanetti, Erica Adrario, and Abele Donati
Subjects: SARS-CoV-2, Prone position ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2020
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15. IgM-enriched immunoglobulins (Pentaglobin) may improve the microcirculation in sepsis: a pilot randomized trial

Author: Roberta Domizi, Erica Adrario, Elisa Damiani, Claudia Scorcella, Andrea Carsetti, Paolo Giaccaglia, Erika Casarotta, Vincenzo Gabbanelli, Simona Pantanetti, Elena Lamura, Silvia Ciucani, and Abele Donati
Subjects: Immunoglobulins, Pentaglobin, Sepsis, Microcirculation, Immunomodulation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Polyclonal or IgM-enriched immunoglobulins may be beneficial during sepsis as an adjuvant immunomodulatory therapy. We aimed to test whether the infusion of IgM-enriched immunoglobulins improves microvascular perfusion during sepsis. Methods Single-centre, randomized, double-blind, placebo-controlled phase II trial including adult patients with a diagnosis of sepsis or septic shock for less than 24 h. Patients received an intravenous infusion of 250 mg/kg (5 mL/kg) per day of IgM-enriched immunoglobulins (Pentaglobin, n = 10) for 72 h or placebo (NaCl 0.9%, n = 9). At baseline and after 24 and 72 h of infusion, the sublingual microcirculation was assessed with Incident Dark Field videomicroscopy. Thenar near-infrared spectroscopy (NIRS) was applied with a vascular occlusion test to assess tissue oxygenation and microvascular reactivity. Levels of interleukin (IL) 1-beta, IL-6, IL-8, IL-10 and tumour necrosis factor alpha were measured in the serum. Results The perfused vessel density (PVD) for small vessels (diameter
Published: 2019
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16. Airway pressure release ventilation during acute hypoxemic respiratory failure: a systematic review and meta-analysis of randomized controlled trials

Author: Andrea Carsetti, Elisa Damiani, Roberta Domizi, Claudia Scorcella, Simona Pantanetti, Stefano Falcetta, Abele Donati, and Erica Adrario
Subjects: Airway pressure release ventilation, Acute respiratory failure, Acute respiratory distress syndrome, Meta-analysis, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Airway pressure release ventilation (APRV) has been considered a tempting mode of ventilation during acute respiratory failure within the concept of open lung ventilation. We performed a systematic review and meta-analysis to verify whether adult patients with hypoxemic respiratory failure have a higher number of ventilator-free days at day 28 when ventilated in APRV compared to conventional ventilation strategy. Secondary outcomes were difference in PaO2/FiO2 at day 3, ICU length of stay (LOS), ICU and hospital mortality, mean arterial pressure (MAP), risk of barotrauma and level of sedation. We searched MEDLINE, Scopus and Cochrane Central Register of Controlled Trials database until December 2018. Results We considered five RCTs for the analysis enrolling a total of 330 patients. For ventilatory-free day at day 28, the overall mean difference (MD) between APRV and conventional ventilation was 6.04 days (95%CI 2.12, 9.96, p = 0.003; I 2 = 65%, p = 0.02). Patients treated with APRV had a lower ICU LOS than patients treated with conventional ventilation (MD 3.94 days [95%CI 1.44, 6.45, p = 0.002; I 2 = 37%, p = 0.19]) and a lower hospital mortality (RD 0.16 [95%CI 0.02, 0.29, p = 0.03; I 2 = 0, p = 0.5]). PaO2/FiO2 at day 3 was not different between the two groups (MD 40.48 mmHg [95%CI − 25.78, 106.73, p = 0.23; I 2 = 92%, p
Published: 2019
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17. Changes in the sublingual microcirculation following aortic surgery under balanced or total intravenous anaesthesia: a prospective observational study

Author: Silvia Loggi, Nicoletta Mininno, Elisa Damiani, Benedetto Marini, Erica Adrario, Claudia Scorcella, Roberta Domizi, Andrea Carsetti, Simona Pantanetti, Gabriele Pagliariccio, Luciano Carbonari, and Abele Donati
Subjects: Aortic surgery, Ischemia/reperfusion injury, Anaesthesia, Haemodynamics, Microcirculation, Anesthesiology, RD78.3-87.3
Abstract: Abstract Background In vascular surgery with aortic cross-clamping, ischemia/reperfusion injury induces systemic haemodynamic and microcirculatory disturbances. Different anaesthetic regimens may have a varying impact on tissue perfusion. The aim of this study was to explore changes in microvascular perfusion in patients undergoing elective open abdominal aortic aneurysm repair under balanced or total intravenous anaesthesia. Methods Prospective observational study. Patients undergoing elective open infrarenal abdominal aortic aneurysm repair received balanced (desflurane + remifentanil, n = 20) or total intravenous anaesthesia (TIVA, propofol + remifentanil using target-controlled infusion, n = 20) according to the clinician’s decision. A goal-directed haemodynamic management was applied in all patients. Measurements were obtained before anaesthesia induction (baseline) and at end-surgery and included haemodynamics, arterial/venous blood gases, sublingual microvascular flow and density (incident dark field illumination imaging), peripheral muscle tissue oxygenation and microcirculatory reactivity (thenar near infrared spectroscopy with a vascular occlusion test). Results The two groups did not differ for baseline characteristics, mean aortic-clamping time and requirement of vasoactive agents during surgery. Changes in mean arterial pressure, systemic vascular resistance index, haemoglobin and blood lactate levels were similar between the two groups, while the cardiac index increased at end-surgery in patients undergoing balanced anaesthesia. The sublingual microcirculation was globally unaltered in the TIVA group at end-surgery, while patients undergoing balanced anaesthesia showed an increase in the total and perfused small vessel densities (from 16.6 ± 4.2 to 19.1 ± 5.4 mm/mm2, p
Published: 2019
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18. Effects of Normoxia, Hyperoxia, and Mild Hypoxia on Macro-Hemodynamics and the Skeletal Muscle Microcirculation in Anesthetised Rats

Author: Elisa Damiani, Erika Casarotta, Fiorenza Orlando, Andrea Carsetti, Claudia Scorcella, Roberta Domizi, Erica Adrario, Silvia Ciucani, Mauro Provinciali, and Abele Donati
Subjects: hyperoxia, hypoxia, microcirculation, oxygen, hemodymamics, Medicine (General), R5-920
Abstract: Objectives: Excessive oxygen (O2) administration may have a negative impact on tissue perfusion by inducing vasoconstriction and oxidative stress. We aimed to evaluate the effects of different inhaled oxygen fractions (FiO2) on macro-hemodynamics and microvascular perfusion in a rat model.Methods: Isoflurane-anesthetised spontaneously breathing male Wistar rats were equipped with arterial (carotid artery) and venous (jugular vein) catheters and tracheotomy, and randomized into three groups: normoxia (FiO2 21%, n = 6), hyperoxia (FiO2 100%, n = 6) and mild hypoxia (FiO2 15%, n = 6). Euvolemia was maintained by infusing Lactate Ringer solution at 10 ml/kg/h. At hourly intervals for 4 h we collected measurements of: mean arterial pressure (MAP); stroke volume index (SVI), heart rate (HR), respiratory rate (by means of echocardiography); arterial and venous blood gases; microvascular density, and flow quality (by means of sidestream dark field videomicroscopy on the hindlimb skeletal muscle).Results: MAP and systemic vascular resistance index increased with hyperoxia and decreased with mild hypoxia (p < 0.001 in both cases, two-way analysis of variance). Hyperoxia induced a reduction in SVI, while this was increased in mild hypoxia (p = 0.002). The HR increased under hyperoxia (p < 0.05 vs. normoxia at 3 h). Cardiax index, as well as systemic O2 delivery, did not significantly vary in the three groups (p = 0.546 and p = 0.691, respectively). At 4 h, microvascular vessel surface (i.e., the percentage of tissue surface occupied by vessels) decreased by 29 ± 4% in the hyperoxia group and increased by 19 ± 7 % in mild hypoxia group (p < 0.001). Total vessel density and perfused vessel density showed similar tendencies (p = 0.003 and p = 0.005, respectively). Parameters of flow quality (microvascular flow index, percentage of perfused vessels, and flow heterogeneity index) remained stable and similar in the three groups.Conclusions: Hyperoxia induces vasoconstriction and reduction in skeletal muscle microvascular density, while mild hypoxia has an opposite effect.
Published: 2021
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19. Variation in the Outcome of Norepinephrine-Dependent Septic Patients After the Institution of a Patient-Tailored Therapy Protocol in an Italian Intensive Care Unit: Retrospective Observational Study

Author: Erika Casarotta, Elisa Damiani, Roberta Domizi, Andrea Carsetti, Claudia Scorcella, Erica Adrario, Sandra Bolognini, Domenico Di Falco, Simona Pantanetti, Sara Vannicola, Agnese Damia Paciarini, and Abele Donati
Subjects: sepsis, septic shock, patient-tailored therapy, outcome, mortality, Medicine (General), R5-920
Abstract: Objective: To evaluate the outcome of patients with septic shock after the institution of a patient tailored therapy protocol in our Intensive Care Unit (ICU).Methods: Single-center retrospective observational study including 100 consecutive septic patients (≥ 16 years) requiring norepinephrine infusion, admitted to our ICU between 2018 and 2019 after the institution of a patient-tailored therapy protocol, compared with a historical control group of 100 patients admitted between 2010 and 2013 (historical controls). The patient-tailored therapy protocol included the use of IgM-enriched immunoglobulins for patients with low plasma IgM levels, blood purification strategies for patients with high plasma levels of cytokines or endotoxin, albumin correction and modulation of vasoactive agents. Clinical and therapeutic parameters were noted at the time of initiation of norepinephrine infusion and for the 1st 24 h. The primary outcome was ICU mortality.Results: ICU-mortality was lower in the patient-tailored therapy cohort as compared to historical controls (32 vs. 57%, p < 0.001). Patient-tailored therapy was associated with a lower risk of ICU-mortality even after adjusting for the main clinical severity indices (adjusted odds ratio 0.331 [95% confidence interval 0.166–0.658], p = 0.002). After propensity score matching, 48 patients in historical control group and 48 patients in the patient-tailored therapy cohort with similar general characteristics were selected. ICU-mortality was lower in the patient-tailored therapy matched subgroup as compared to historical controls (40 vs. 60%, p = 0.037).Conclusions: An individualized therapeutic approach in septic patients may be associated with a survival benefit. However, the use of an historical control group of patients admitted between 2010 and 2013 may introduce substantial bias. Further adequately designed studies are needed to demonstrate the impact of patient-tailored therapy on outcome.
Published: 2020
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20. MicroDAIMON study: Microcirculatory DAIly MONitoring in critically ill patients: a prospective observational study

Author: Claudia Scorcella, Elisa Damiani, Roberta Domizi, Silvia Pierantozzi, Stefania Tondi, Andrea Carsetti, Silvia Ciucani, Valentina Monaldi, Mara Rogani, Benedetto Marini, Erica Adrario, Rocco Romano, Can Ince, E. Christiaan Boerma, and Abele Donati
Subjects: Microcirculation, Physiologic monitoring, Critical illness, Tachycardia, Video microscopy, Capillaries, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Until now, the prognostic value of microcirculatory alterations in critically ill patients has been mainly evaluated in highly selected subgroups. Aim of this study is to monitor the microcirculation daily in mixed group of Intensive Care Unit (ICU)-patients and to establish the association between (the evolution of) microcirculatory alterations and outcome. Methods This is a prospective longitudinal observational single-centre study in adult patients admitted to a 12-bed ICU in an Italian teaching hospital. Sublingual microcirculation was evaluated daily, from admission to discharge/death, using Sidestream Dark Field imaging. Videos were analysed offline to assess flow and density variables. Laboratory and clinical data were recorded simultaneously. A priori, a Microvascular Flow Index (MFI) 2 mmol/L and MFI
Published: 2018
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21. Comment on 'Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study'

Author: Elisa Damiani, Andrea Carsetti, Erika Casarotta, Roberta Domizi, Claudia Scorcella, Erica Adrario, and Abele Donati
Subjects: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2020
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22. Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study.

Author: Roberta Domizi, Elisa Damiani, Claudia Scorcella, Andrea Carsetti, Roberta Castagnani, Sara Vannicola, Sandra Bolognini, Vincenzo Gabbanelli, Simona Pantanetti, and Abele Donati
Subjects: Medicine, Science
Abstract: INTRODUCTION:Previous studies described impaired microvascular perfusion and tissue oxygenation as reliable predictors of Multiple Organ Failure in major trauma. However, this relationship has been incompletely investigated. The objective of this analysis is to further evaluate the association between organ dysfunction and microcirculation after trauma. MATERIALS AND METHODS:This is a retrospective subgroup analysis on 28 trauma patients enrolled for the Microcirculation DAIly MONitoring in critically ill patients study (NCT 02649088). Patients were divided in two groups according with their Sequential Organ Failure Assessment (SOFA) score at day 4. At admission and every 24 hours, the sublingual microcirculation was evaluated with Sidestream Darkfield Imaging (SDF) and peripheral tissue perfusion was assessed with Near Infrared Spectroscopy (NIRS) and Vascular Occlusion Test (VOT). Simultaneously, hemodynamic, clinical/laboratory parameters and main organ supports were collected. RESULTS:Median SOFA score at Day 4 was 6.5. Accordingly, patients were divided in two groups: D4-SOFA ≤6.5 and D4-SOFA >6.5. The Length of Stay in Intensive Care was significantly higher in patients with D4-SOFA>6.5 compared to D4-SOFA≤6.5 (p = 0.013). Total Vessel Density of small vessels was significantly lower in patients with high D4-SOFA score at Day 1 (p = 0.002) and Day 2 (p = 0.006) after admission; the Perfused Vessel Density was lower in patients with high D4-SOFA score at Day 1 (p = 0.007) and Day 2 (p = 0.033). At Day 1, NIRS monitoring with VOT showed significantly faster tissue oxygen saturation downslope (p = 0.018) and slower upslope (p = 0.04) in patients with high D4-SOFA. DISCUSSION:In our cohort of major traumas, sublingual microcirculation and peripheral microvascular reactivity were significantly more impaired early after trauma in those patients who developed more severe organ dysfunctions. Our data would support the hypothesis that restoration of macrocirculation can be dissociated from restoration of peripheral and tissue perfusion, and that microvascular alterations can be associated with organ failure.
Published: 2019
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23. Plasma free hemoglobin and microcirculatory response to fresh or old blood transfusions in sepsis.

Author: Elisa Damiani, Erica Adrario, Michele Maria Luchetti, Claudia Scorcella, Andrea Carsetti, Nicoletta Mininno, Silvia Pierantozzi, Tiziana Principi, Daniele Strovegli, Rosella Bencivenga, Armando Gabrielli, Rocco Romano, Paolo Pelaia, Can Ince, and Abele Donati
Subjects: Medicine, Science
Abstract: Free hemoglobin (fHb) may induce vasoconstriction by scavenging nitric oxide. It may increase in older blood units due to storage lesions. This study evaluated whether old red blood cell transfusion increases plasma fHb in sepsis and how the microvascular response may be affected.This is a secondary analysis of a randomized study. Twenty adult septic patients received either fresh or old (15 days storage, respectively) RBC transfusions. fHb was measured in RBC units and in the plasma before and 1 hour after transfusion. Simultaneously, the sublingual microcirculation was assessed with sidestream-dark field imaging. The perfused boundary region was calculated as an index of glycocalyx damage. Tissue oxygen saturation (StO2) and Hb index (THI) were measured with near-infrared spectroscopy and a vascular occlusion test was performed.Similar fHb levels were found in the supernatant of fresh and old RBC units. Despite this, plasma fHb increased in the old RBC group after transfusion (from 0.125 [0.098-0.219] mg/mL to 0.238 [0.163-0.369] mg/mL, p = 0.006). The sublingual microcirculation was unaltered in both groups, while THI increased. The change in plasma fHb was inversely correlated with the changes in total vessel density (r = -0.57 [95% confidence interval -0.82, -0.16], p = 0.008), De Backer score (r = -0.63 [95% confidence interval -0.84, -0.25], p = 0.003) and THI (r = -0.72 [95% confidence interval -0.88, -0.39], p = 0.0003).Old RBC transfusion was associated with an increase in plasma fHb in septic patients. Increasing plasma fHb levels were associated with decreased microvascular density.ClinicalTrials.gov NCT01584999.
Published: 2015
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24. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study

Author: Roberto Lorusso, Maria Elena De Piero, Silvia Mariani, Michele Di Mauro, Thierry Folliguet, Fabio Silvio Taccone, Luigi Camporota, Justyna Swol, Dominik Wiedemann, Mirko Belliato, Lars Mikael Broman, Alain Vuylsteke, Yigal Kassif, Anna Mara Scandroglio, Vito Fanelli, Philippe Gaudard, Stephane Ledot, Julian Barker, Udo Boeken, Sven Maier, Alexander Kersten, Bart Meyns, Matteo Pozzi, Finn M Pedersen, Peter Schellongowski, Kaan Kirali, Nicholas Barrett, Jordi Riera, Thomas Mueller, Jan Belohlavek, Valeria Lo Coco, Iwan C C Van der Horst, Bas C T Van Bussel, Ronny M Schnabel, Thijs Delnoij, Gil Bolotin, Luca Lorini, Martin O Schmiady, David Schibilsky, Mariusz Kowalewski, Luis F Pinto, Pedro E Silva, Igor Kornilov, Aaron Blandino Ortiz, Leen Vercaemst, Simon Finney, Peter P Roeleveld, Matteo Di Nardo, Felix Hennig, Marta Velia Antonini, Mark Davidson, Tim J Jones, Thomas Staudinger, Peter Mair, Juliane Kilo, Christoph Krapf, Kathrin Erbert, Andreas Peer, Nikolaos Bonaros, Florian Kotheletner, Niklas Krenner Mag, Liana Shestakova, Greet Hermans, Dieter Dauwe, Philippe Meersseman, Bernard Stockman, Leda Nobile, Olivier Lhereux, Alexandre Nrasseurs, Jacques Creuter, Daniel De Backer, Simone Giglioli, Gregoire Michiels, Pierre Foulon, Matthias Raes, Inez Rodrigus, Matthias Allegaert, Philippe Jorens, Gerd Debeucklare, Michael Piagnerelli, Patrick Biston, Harlinde Peperstraete, Komeel Vandewiele, Olivier Germay, Dimitri Vandeweghe, Sven Havrin, Marc Bourgeois, Marc-Gilbert Lagny, Genette Alois, Nathalie Lavios, Benoit Misset, Romain Courcelle, Philippe J Timmermans, Alaaddin Yilmaz, Michiel Vantomout, Jerone Lehaen, Ame Jassen, Herbert Guterman, Maarten Strauven, Piet Lormans, Bruno Verhamme, catherine Vandewaeter, Frederik Bonte, Dominique Vionne, Martin Balik, Jan Blàha, Michal Lips, Michal Othal, Filip Bursa, Radim Spacek, Steffen Christensen, Vibeke Jorgensen, Marc Sorensen, Soren A Madsen, Severin Puss, Aleksandr Beljantsev, gabriel Saiydoun, Antonio Fiore, Pascal Colson, Florian Bazalgette, Xavier Capdevila, Sebastien Kollen, Laurent Muller, Jean-Francois Obadia, Pierre-Yves Dubien, Lucrezia Ajrhourh, Pierre G Guinot, Jonathan Zarka, Patricia Besserve, Maximilian V Malfertheiner, Esther Dreier, Birgit Heinze, Payam Akhyari, Artur Lichtenberg, Hug Aubin, Alexander Assman, Diyar Saeed, Holger Thiele, Matthias Baumgaertel, Jan D Schmitto, Natanov Ruslan, Axel Haverich, Matthias Thielmann, Thorsten Brenner, Arjang Ruhpawar, Christoph Benk, Martin Czerny, Dawid L Staudacher, Fridhelm Beyersdorf, Johannes Kalbhenn, Philipp Henn, Aron-Frederik Popov, Torje Iuliu, Ralf Muellenbach, Christian Reyher, Caroline Rolfes, Gosta Lotz, Michael Sonntagbauer, Helen Winkels, Julia Fichte, Robert Stohr, Sebastian Kalverkamp, Christian Karagiannidis, Simone Schafer, Alexei Svetlitchny, Hans-Bernd Hopf, Dominik Jarczak, Heinirich Groesdonk, Magdalena Rommer, Jan Hirsch, Christian Kaehny, Dimitros Soufleris, Georgios Gavriilidis, Kostantinos Pontikis, Magdalini Kyriakopoulou, Anna Kyriakoudi, Serena O'Brien, Ian Conrick-Martin, Edmund Carton, Maged Makhoul, Josef Ben-Ari, Amir Hadash, Alexander Kogan, Reut Kassif Lerner, Anas Abu-Shakra, Moshe Matan, Ahmad Balawona, Erez Kachel, Roman Altshuler, Ori Galante, Lior Fuchs, Yaniv Almog, Yaron S Ishay, Yael Lichter, Amir Gal-oz, Uri Carmi, Asaph Nini, Arie Soroksky, Hagi Dekel, Ziv Rozman, Emad Tayem, Eduard Ilgiyaev, Yuval Hochman, daniel Miltau, Avigal Rapoport, Arieh Eden, Dmitry Kompanietz, Michael Yousif, Miri Golos, Lorenzo Grazioli, Davide Ghitti, Antonio Loforte, Daniela Di Luca, Massimo Baiocchi, Davide Pacini, Antioco Cappai, Paolo Meani, Michele Mondino, Claudio F Russo, Marco Ranucci, Dario Fina, Marco Cotza, Andrea Ballotta, Giovanni Landoni, Pasquale Nardelli, Eygeny V Fominski, Luca Brazzi, Giorgia Montrucchio, Gabriele Sales, Umberto Simonetti, Sergio Livigni, Daniela Silengo, Giulia Arena, Stefania S Sovatzis, Antonella Degani, Mariachiara Riccardi, Elisa Milanesi, Giuseppe Raffa, Gennaro Martucci, Antonio Arcadipane, Giovanna Panarello, Giovanni Chiarini, Sergio Cattaneo, Carmine Puglia, Stefano Benussi, Giuseppe Foti, Marco Giani, Michela Bombino, Maria Cristina Costa, Roberto Rona, Leonello Avalli, Abele Donati, Roberto Carozza, Francesco Gasparri, Andrea Carsetti, Marco Picichè, Anna Marinello, Vinicio Danzi, Anita Zanin, Ignazio Condello, Flavio Fiore, Marco Moscarelli, Giuseppe Nasso, Giuseppe Speziale, Luca Sandrelli, Andrea Montalto, Francesco Musumeci, Alessandro Circelli, Emanuele Russo, Vanni Agnoletti, Ruggero Rociola, Aldo D Milano, Emanuele Pilato, Giuseppe Comentale, Andrea Montisci, Francesco Alessandri, Antonella Tosi, Francesco Pugliese, Giovanni Giordano, Simone Carelli, Domenico L Grieco, Antonio M Dell'Anna, Massimo Antonelli, Enrico Ramoni, Josè Zulueta, Mauro Del Giglio, Sebastiano Petracca, Pietro Bertini, Fabio Guarracino, Luigi De Simone, Paolo M Angeletti, Francesco Forfori, Francesco Taraschi, Veronica N Quintiliani, Robertas Samalavicius, Agne Jankuviene, Nadezda Scupakova, Karolis Urbonas, Juozas Kapturauskas, Gro Soerensen, Piotr Suwalski, Luis Linhares Santos, Ana Marques, Marisa Miranda, Sonia Teixeira, Andrea Salgueiro, Filipe Pereira, Michail Ketskalo, Sergey Tsarenko, Alexandra Shilova, Ivan Afukov, Konstantin Popugaev, Sergei Minin, Daniil Shelukhin, Olga Malceva, Moroz Gleb, Alexander Skopets, Roman Kornelyuk, Alexandr Kulikov, Vadim Okhrimchuk, Alexandr Turchaninov, Maxim Petrushin, Anastasia Sheck, Akhmed Mekulov, Svetlana Ciryateva, Dmitry Urusov, Vojka Gorjup, Alenka Golicnik, Tomaz Goslar, Ricard Ferrer, Maria Martinez-Martinez, Eduard Argudo, Neiser Palmer, Raul De Pablo Sanchez, Lucas Juan Higuera, Lucas Arnau Blasco, Josè A Marquez, Fabrizio Sbraga, Mari Paz Fuset, Pablo Ruiz De Gopegui, Luis M Claraco, Josè A De Ayala, Maranta Peiro, Pilar Ricart, Sergio Martinez, Fernando Chavez, Marc Fabra, elena Sandoval, David Toapanta, Albert Carraminana, Adrian Tellez, Jeysson Ososio, Pablo Milan, Jorge Rodriguez, Garcia Andoni, Carola Gutierrez, Enrique Perez de la Sota, Andrea Eixeres-Esteve, Maria Teresa Garcia-Maellas, Judit Gutierrez-Gutierrez, Rafael Arboleda-Salazar, Patricia Santa Teresa, Alexis Jaspe, Alberto Garrido, Galo Castaneda, Sara Alcantara, Nuria Martinez, Marina Perez, Hector Villanueva, Anxela Vidal Gonzalez, Juan Paez, Arnoldo Santon, Cesar Perez, Marta Lopez, Maria Isabel Rubio Lopez, Antonio Gordillo, Jose Naranjo-Izurieta, Javier Munoz, Immaculada Alcalde, Fernando Onieva, Ricardo Gimeno Costa, Francisco Perez, Isabel Madrid, Monica Gordon, Carlos L Albacete Moreno, Daniel Perez, Nayara Lopez, Domingo Martinenz, Pablo Blanco-Schweizer, Cristina Diez, David Perez, Ana Prieto, Gloria Renedo, Elena Bustamante, Ramon Cicuendez, Rafael Citores, Victoria Boado, Katherine Garcia, Roberto Voces, Monica Domezain, Jose Maria Nunez Martinez, Raimundo Vicente, David Martin, Antonio Andreu, Vanesa Gomez Casal, Ignacio Chico, Eva Maria Menor, Sabela Vara, Jose Gamacho, Helen Perez-Chomon, Francisco Javier Gonzales, Irene Barrero, Luis Martin-Villen, Esperanza Fernandez, Maria Mendoza, Joaquin Navarro, Joaquin Colomina Climent, Alfredo Gonzales-Perez, Guillermo Muniz-Albaceita, Laura Amado, Raquel Rodriguez, Emilio Ruiz, Maria Eiras, Edgars Grins, Rosen Magnus, Mikael Kanetoft, Marcus Eidevald, Pia Watson, Paul R Vogt, Peter Steiger, Tobias Aigner, Alberto Weber, Jurg Grunefelder, Martin Kunz, Martin Grapow, Thierry Aymard, Diana Reser, Gianluca Agus, Jolanda Consiglio, Matthias Haenggi, Jenni Hansjoerg, Manuela Iten, Thomas Doeble, Urs Zenklusen, Xavier Bechtold, Giovanni Faedda, Manuel Iafrate, Amanda Rohjer, Layla Bergamaschi, Jos Maessen, Dinis Reis Miranda, H Endeman, D Gommers, C Meuwese, Jacinta Maas, MJ Van Gijlswijk, RN Van Berg, Dario Candura, Marcel Van der Linden, Merijin Kant, JJ Van der Heijden, Eric Scholten, Nicole Van Belle-van Haren, WK Lagrand, Alexander P Vlaar, Syste De Jong, Basar Cander, Murat Sargin, Murat Ugur, Mehmet A Kaygin, Kathleen Daly, Nicola Agnew, Laura Head, Laura Kelly, Gunawardena Anoma, Clare Russell, Verna Aquino, Ian Scott, Lucy Flemming, Stuart Gillon, Olivia Moore, Elton Gelandt, George Auzinger, Sameer Patel, Robert Loveridge, MUMC+: MA Cardiothoracale Chirurgie (3), CTC, RS: Carim - V04 Surgical intervention, University of Zurich, and Lorusso, Roberto
Subjects: Pulmonary and Respiratory Medicine, 2740 Pulmonary and Respiratory Medicine, 610 Medicine & health, 10023 Institute of Intensive Care Medicine
Abstract: BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation.METHODS: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing.FINDINGS: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms.INTERPRETATION: Patient's age, timing of cannulation (FUNDING: None.
Published: 2023
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25. Efficacy of Bonfils fiberoptic stylet for difficult tracheal intubation with double lumen tube: A prospective observational study

Author: Stefano Falcetta, Federica Bartolini, Andrea Carsetti, Massimiliano Sorbello, Paolo Gentili, Rosanna Coltrinari, Gerardo Cortese, Daniela Godoroja, Majed Refai, and Abele Donati
Subjects: History, Anesthesiology and Pain Medicine, Polymers and Plastics, Business and International Management, Critical Care and Intensive Care Medicine, Industrial and Manufacturing Engineering
Published: 2022
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26. Estimated oxygen extraction versus dynamic parameters of fluid-responsiveness for perioperative hemodynamic optimization of patients undergoing non-cardiac surgery: a non-inferiority randomized controlled trial

Author: Erica Adrario, Marco Chiarello, Daniela Corsi, Abele Donati, Giuseppe Tappatà, Paolo Brancaleoni, Andrea Carsetti, Giorgio Forlini, Diego Cingolani, Salvatore Iuorio, Marina Giampieri, T Principi, Luisanna Cola, Tonino Bernacconi, Michele Tempesta, Mirco Amici, and Elisabetta Cerutti
Subjects: Adult, medicine.medical_specialty, Cardiac output, Complications, Perioperative goal directed therapy, Hemodynamics, Perioperative Care, law.invention, lcsh:RD78.3-87.3, Study Protocol, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, law, Anesthesiology, Abdomen, Humans, Medicine, 030212 general & internal medicine, Cardiac Output, business.industry, 030208 emergency & critical care medicine, Perioperative, Oxygen extraction rate, Oxygen, Fluid-responsiveness, Preload, Anesthesiology and Pain Medicine, Elective Surgical Procedures, lcsh:Anesthesiology, Anesthesia, Fluid Therapy, business, Abdominal surgery, Oxygen extraction
Abstract: Background Goal directed therapy (GDT) is able to improve mortality and reduce complications in selected high-risk patients undergoing major surgery. The aim of this study is to compare two different strategies of perioperative hemodynamic optimization: one based on optimization of preload using dynamic parameters of fluid-responsiveness and the other one based on estimated oxygen extraction rate (O2ER) as target of hemodynamic manipulation. Methods This is a multicenter randomized controlled trial. Adult patients undergoing elective major open abdominal surgery will be allocated to receive a protocol based on dynamic parameters of fluid-responsiveness or a protocol based on estimated O2ER. The hemodynamic optimization will be continued for 6 h postoperatively. The primary outcome is difference in overall postoperative complications rate between the two protocol groups. Fluids administered, fluid balance, utilization of vasoactive drugs, hospital length of stay and mortality at 28 day will also be assessed. Discussion As a predefined target of cardiac output (CO) or oxygen delivery (DO2) seems to be not adequate for every patient, a personalized therapy is likely more appropriate. Following this concept, dynamic parameters of fluid-responsiveness allow to titrate fluid administration aiming CO increase but avoiding fluid overload. This approach has the advantage of personalized fluid therapy, but it does not consider if CO is adequate or not. A protocol based on O2ER considers this second important aspect. Although positive effects of perioperative GDT have been clearly demonstrated, currently studies comparing different strategies of hemodynamic optimization are lacking. Trial registration ClinicalTrials.gov, NCT04053595. Registered on 12/08/2019.
Published: 2020
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27. Antibiotic Treatment of

Author: Erika, Casarotta, Elisa, Bottari, Sara, Vannicola, Rachele, Giorgetti, Roberta, Domizi, Andrea, Carsetti, Elisa, Damiani, Claudia, Scorcella, Vincenzo, Gabbanelli, Simona, Pantanetti, Benedetto, Marini, Abele, Donati, and Erica, Adrario
Abstract: In COVID-19 patients on mechanical ventilation, VAP fromOf the 32 patients enrolled, 10 patients (31.2%) were treated with the combination of high-dose ampicillin/sulbactam, high-dose tigecycline, intravenous and inhaled colistinOur report shows microbiological negativization in all patients treated with the combination therapy of nebulized and intravenous colistin, high-dose tigecycline, and high-dose ampicillin/sulbactam. This combination of antibiotics seems to be a useful alternative when other treatments are not available or fail.
Published: 2022

28. Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis

Author: Andrea Carsetti, Massimiliano Sorbello, Erica Adrario, Abele Donati, and Stefano Falcetta
Subjects: Adult, Anesthesiology and Pain Medicine, Laryngoscopy, Respiratory System, Intubation, Intratracheal, Humans, Anesthesia, General, Ultrasonography
Abstract: Despite several clinical index tests that are currently applied for airway assessment, unpredicted difficult laryngoscopy may still represent a serious problem in anesthesia practice. The aim of this systematic review and meta-analysis was to evaluate whether preoperative airway ultrasound can predict difficult direct laryngoscopy in adult patients undergoing elective surgery under general anesthesia.We searched the Medline, Scopus, and Web of Science databases from their inception to December 2020. The population of interest included adults who required tracheal intubation for elective surgery under general anesthesia without clear anatomical abnormalities suggesting difficult laryngoscopy. A bivariate model has been used to assess the accuracy of each ultrasound index test to predict difficult direct laryngoscopy.Fifteen studies have been considered for quantitative analysis of summary receiver operating characteristic (SROC). The sensitivity for distance from skin to epiglottis (DSE), distance from skin to hyoid bone (DSHB), and distance from skin to vocal cords (DSVC) was 0.82 (0.74-0.87), 0.71 (0.58-0.82), and 0.75 (0.62-0.84), respectively. The specificity for DSE, DSHB, and DSVC was 0.79 (0.70-0.87), 0.71 (0.57-0.82), and 0.72 (0.45-0.89), respectively. The area under the curve (AUC) for DSE, DSHB, DSVC, and ratio between the depth of the pre-epiglottic space and the distance from the epiglottis to the vocal cords (Pre-E/E-VC) was 0.87 (0.84-0.90), 0.77 (0.73-0.81), 0.78 (0.74-0.81), and 0.71 (0.67-0.75), respectively. Patients with difficult direct laryngoscopy have higher DSE, DSVC, and DSHB values than patients with easy laryngoscopy, with a mean difference of 0.38 cm (95% confidence interval [CI], 0.17-0.58 cm; P = .0004), 0.18 cm (95% CI, 0.01-0.35 cm; P = .04), and 0.23 cm (95% CI, 0.08-0.39 cm; P = .004), respectively.Our study demonstrates that airway ultrasound index tests are significantly different between patients with easy versus difficult direct laryngoscopy, and the DSE is the most studied index test in literature to predict difficult direct laryngoscopy. However, it is not currently possible to reach a definitive conclusion. Further studies are needed with better standardization of ultrasound assessment to limit all possible sources of heterogeneity.
Published: 2021

29. Machine learning using the Extreme Gradient Boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients

Author: Marie M. Jeitziner, Iris Drvaric, Jan Wiegand, Abele Donati, Janina Apolo, Emanuele Rezoagli, Jesús Escós-Orta, Herminia Lozano-Gómez, Mirko Brenni, Giovanni Camen, Frank Hillgaertner, Sara Moccia, Antje Heise, Alexander Dullenkopf, Michael Stephan, Can Ince, Marcus Laube, Julien Marrel, Michele Bernardini, Barbara Lienhardt-Nobbe, Hernán Aguirre-Bermeo, Alberto Fogagnolo, Dorothea M. Heuberger, Severin Urech, Reto A. Schuepbach, Andrea Glotta, Samuele Ceruti, Isabelle Fleisch, Marc P. Michot, Alice Nova, Matthias P. Hilty, Tomislav Gaspert, Gianfilippo Gangitano, Savino Spadaro, Ivan Chau, Daniele Berardini, Tiziana Perin, Andrea Westphalen, Marie-Reine Losser, Hatem Ksouri, Marie-Hélène Perez, Theodoros Aslanidis, Christoph Haberthuer, Gerardo Vizmanos-Lamotte, Jorge Gámez-Zapata, Filippo Boroli, Adriana Lambert, Serge Grazioli, Petra Salomon, Christian Bürkle, Didier Naon, Philipp Bühler, Dawid L. Staudacher, Miodrag Filipovic, Hermann Redecker, Mario Alfaro-Farias, Massimo Antonelli, Rolf Ensner, Jerome Lavanchy, Lukas Merki, Roberto Ceriani, Anette Ristic, Chiara Cogliati, Reto Andreas Schüpbach, Daniela Selz, Begoña Zalba-Etayo, Anne-Sylvie Ramelet, Thierry Fumeaux, Andrea Carsetti, Peter Gerecke, Riccardo Colombo, Marilene Franchitti Laurent, Fabrizio Turrini, Tobias Wengenmayer, Tobias Welte, Philippe Guerci, Antonella Potalivo, Lucia Migliorelli, Barna Babik, Reza Nikandish, Pedro D. Wendel Garcia, Alberto Martínez, Maria Sole Simonini, Diederik Gommers, Xiana Taboada-Fraga, Jerome Pugin, Peter C. Rimensberger, Angela Algaba-Calderon, FriederikeMeyer zu Bentrup, Agios Pavlos, Thomas Tschoellitsch, Marianne Sieber, Karim Shaikh, Nuria Zellweger, Silvio Brugger, Geoffrey Jurkolow, Anja Baltussen Weber, Maria C. Martín-Delgado, Anita Korsós, Gian-Reto Kleger, Alexander Klarer, Emmanuel Novy, Diego Franch-Llasat, Adrian Tellez, Peter Schott, Jonathan Rilinger, Andreas Christ, Bernd Yuen, Jean-Christophe Laurent, Nadine Gehring, Pedro Castro, Sascha David, Francesca Facondini, Arantxa Lander-Azcona, Maria Grazia Bocci, Maddalena Alessandra Wu, Mallory Moret-Bochatay, Sara Cereghetti, Urs Pietsch, Martina Murrone, Gauthier Delahaye, Luca Romeo, Pascal Locher, Pedro David Wendel Garcia, Michael Sepulcri, Marija Jovic, Katharina Marquardt, Emanuele Frontoni, Patricia Fodor, Emanuele Catena, Tobias Hübner, Thomas Neff, Roger F. Lussman, Matteo Giacomini, Govind Oliver Sridharan, Beatrice Jenni-Moser, Jan Brem, Michael Studhalter, Elif Colak, Raquel Rodríguez-García, Silvia Fabbri, Jens Meier, Lina Petersen, Jonathan Montomoli, Ferran Roche-Campo, Klaus Stahl, Montomoli, J, Romeo, L, Moccia, S, Bernardini, M, Migliorelli, L, Berardini, D, Donati, A, Carsetti, A, Bocci, M, Wendel Garcia, P, Fumeaux, T, Guerci, P, Schupbach, R, Ince, C, Frontoni, E, Hilty, M, Alfaro-Farias, M, Vizmanos-Lamotte, G, Tschoellitsch, T, Meier, J, Aguirre-Bermeo, H, Apolo, J, Martinez, A, Jurkolow, G, Delahaye, G, Novy, E, Losser, M, Wengenmayer, T, Rilinger, J, Staudacher, D, David, S, Welte, T, Stahl, K, Pavlos, A, Aslanidis, T, Korsos, A, Babik, B, Nikandish, R, Rezoagli, E, Giacomini, M, Nova, A, Fogagnolo, A, Spadaro, S, Ceriani, R, Murrone, M, Wu, M, Cogliati, C, Colombo, R, Catena, E, Turrini, F, Simonini, M, Fabbri, S, Potalivo, A, Facondini, F, Gangitano, G, Perin, T, Grazia Bocci, M, Antonelli, M, Gommers, D, Rodriguez-Garcia, R, Gamez-Zapata, J, Taboada-Fraga, X, Castro, P, Tellez, A, Lander-Azcona, A, Escos-Orta, J, Martin-Delgado, M, Algaba-Calderon, A, Franch-Llasat, D, Roche-Campo, F, Lozano-Gomez, H, Zalba-Etayo, B, Michot, M, Klarer, A, Ensner, R, Schott, P, Urech, S, Zellweger, N, Merki, L, Lambert, A, Laube, M, Jeitziner, M, Jenni-Moser, B, Wiegand, J, Yuen, B, Lienhardt-Nobbe, B, Westphalen, A, Salomon, P, Drvaric, I, Hillgaertner, F, Sieber, M, Dullenkopf, A, Petersen, L, Chau, I, Ksouri, H, Sridharan, G, Cereghetti, S, Boroli, F, Pugin, J, Grazioli, S, Rimensberger, P, Burkle, C, Marrel, J, Brenni, M, Fleisch, I, Lavanchy, J, Perez, M, Ramelet, A, Weber, A, Gerecke, P, Christ, A, Ceruti, S, Glotta, A, Marquardt, K, Shaikh, K, Hubner, T, Neff, T, Redecker, H, Moret-Bochatay, M, Bentrup, F, Studhalter, M, Stephan, M, Brem, J, Gehring, N, Selz, D, Naon, D, Kleger, G, Pietsch, U, Filipovic, M, Ristic, A, Sepulcri, M, Heise, A, Franchitti Laurent, M, Laurent, J, Schuepbach, R, Heuberger, D, Buhler, P, Brugger, S, Fodor, P, Locher, P, Camen, G, Gaspert, T, Jovic, M, Haberthuer, C, Lussman, R, Colak, E, Biomedical Engineering and Physics, ACS - Microcirculation, Translational Physiology, ACS - Atherosclerosis & ischemic syndromes, Graduate School, AII - Infectious diseases, and University of Zurich
Subjects: 610 Medicine & health, Organ dysfunction score, Machine learning, computer.software_genre, Logistic regression, Clinical decision support system, law.invention, law, Medicine, Clinical decision support system (CDSS), Receiver operating characteristic, RC86-88.9, business.industry, Clinical decision support systems, COVID-19, Medical emergencies. Critical care. Intensive care. First aid, Extreme Gradient Boosting (XGBoost), Intensive care unit, Multiple organ failure, Cohort, Population study, SOFA score, Original Article, Artificial intelligence, 10023 Institute of Intensive Care Medicine, business, Algorithm, computer, Predictive modelling
Abstract: Background : Accurate risk stratification of critically ill patients with coronavirus disease 2019 (COVID-19) is essential for optimizing resource allocation, delivering targeted interventions, and maximizing patient survival probability. Machine learning (ML) techniques are attracting increased interest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care. Methods : We retrieved data on patients with COVID-19 admitted to an intensive care unit (ICU) between March and October 2020 from the RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry. We applied the Extreme Gradient Boosting (XGBoost) algorithm to the data to predict as a binary outcome the increase or decrease in patients’ Sequential Organ Failure Assessment (SOFA) score on day 5 after ICU admission. The model was iteratively cross-validated in different subsets of the study cohort. Results : The final study population consisted of 675 patients. The XGBoost model correctly predicted a decrease in SOFA score in 320/385 (83%) critically ill COVID-19 patients, and an increase in the score in 210/290 (72%) patients. The area under the mean receiver operating characteristic curve for XGBoost was significantly higher than that for the logistic regression model {0.86 vs. 0.69, P
Published: 2021

30. Airway pressure release ventilation during acute hypoxemic respiratory failure: a systematic review and meta-analysis of randomized controlled trials

Author: Stefano Falcetta, Elisa Damiani, Claudia Scorcella, Simona Pantanetti, Erica Adrario, Roberta Domizi, Abele Donati, and Andrea Carsetti
Subjects: Airway pressure release ventilation, Mean arterial pressure, medicine.medical_specialty, Acute respiratory distress syndrome, business.industry, Sedation, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Hemodynamics, lcsh:RC86-88.9, Critical Care and Intensive Care Medicine, medicine.disease, Acute respiratory failure, law.invention, Meta-analysis, Randomized controlled trial, Pneumothorax, law, Anesthesia, Anesthesiology, Breathing, Medicine, medicine.symptom, business
Abstract: Background Airway pressure release ventilation (APRV) has been considered a tempting mode of ventilation during acute respiratory failure within the concept of open lung ventilation. We performed a systematic review and meta-analysis to verify whether adult patients with hypoxemic respiratory failure have a higher number of ventilator-free days at day 28 when ventilated in APRV compared to conventional ventilation strategy. Secondary outcomes were difference in PaO2/FiO2 at day 3, ICU length of stay (LOS), ICU and hospital mortality, mean arterial pressure (MAP), risk of barotrauma and level of sedation. We searched MEDLINE, Scopus and Cochrane Central Register of Controlled Trials database until December 2018. Results We considered five RCTs for the analysis enrolling a total of 330 patients. For ventilatory-free day at day 28, the overall mean difference (MD) between APRV and conventional ventilation was 6.04 days (95%CI 2.12, 9.96, p = 0.003; I 2 = 65%, p = 0.02). Patients treated with APRV had a lower ICU LOS than patients treated with conventional ventilation (MD 3.94 days [95%CI 1.44, 6.45, p = 0.002; I 2 = 37%, p = 0.19]) and a lower hospital mortality (RD 0.16 [95%CI 0.02, 0.29, p = 0.03; I 2 = 0, p = 0.5]). PaO2/FiO2 at day 3 was not different between the two groups (MD 40.48 mmHg [95%CI − 25.78, 106.73, p = 0.23; I 2 = 92%, p
Published: 2019
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31. Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: state-of-the-science and expert consensus

Author: Andrea Cortegiani, Massimo Girardis, Giuseppe Foti, Massimo Antonelli, Luigi Tritapepe, Giacomo Grasselli, Luigia Scudeller, Elvio De Blasio, Elena Bignami, Sabino Scolletta, Francesco Forfori, Maurizio Cecconi, Andrea Carsetti, Stefano Romagnoli, Katia Donadello, Abele Donati, Fabio Guarracino, Carsetti A., Bignami E., Cortegiani A., Donadello K., Donati A., Foti G., Grasselli G., Romagnoli S., Antonelli M., De Blasio E., Forfori F., Guarracino F., Scolletta S., Pepe L.T., Scudeller L., Cecconi M., and Girardis M.
Subjects: Inotrope, medicine.medical_specialty, Consensus, Critical Care, Critical Illness, MEDLINE, shock, Cardiotonic Agents, Cardiotonic agents,Vasoconstrictor agents, Cardiogenic shock, Cardiotonic agents, Septic shock, Vasoconstrictor agents, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Intensive care, medicine, Humans, Vasoconstrictor Agents, Intensive care medicine, business.industry, 030208 emergency & critical care medicine, medicine.disease, Anesthesiology and Pain Medicine, Pharmaceutical Preparations, Shock (circulatory), Good clinical practice, medicine.symptom, business
Abstract: Vasopressors and inotropic agents are widely used in critical care. However, strong evidence supporting their use in critically ill patients is lacking in many clinical scenarios. Thus, the Italian Society of Anesthesia and Intensive Care (SIAARTI) promoted a project aimed to provide indications for good clinical practice on the use of vasopressors and inotropes, and on the management of critically ill patients with shock. A panel of 16 experts in the field of intensive care medicine and hemodynamics has been established. Systematic review of the available literature was performed based on PICO questions. Basing on available evidence, the panel prepared a summary of evidences and then wrote the clinical questions. A modified semi-quantitative RAND/UCLA appropriateness method has been used to determine the appropriateness of specific clinical scenarios. The panel identified 29 clinical questions for the use of vasopressors and inotropes in patients with septic shock and cardiogenic shock. High level of agreement exists among the panel members about appropriateness of inotropes/vasopressors' use in patients with septic shock and cardiogenic shock.
Published: 2021

32. Sublingual microcirculation in patients with SARS-CoV-2 undergoing veno-venous extracorporeal membrane oxygenation

Author: Erika Casarotta, Claudia Scorcella, Simona Pantanetti, Roberto Carozza, Andrea Carsetti, Elisa Damiani, Francesco Gasparri, Vincenzo Gabbanelli, Erica Adrario, Jonathan Montomoli, Abele Donati, and Roberta Domizi
Subjects: 0301 basic medicine, Male, Sublingual microcirculation, medicine.medical_specialty, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, Pneumonia, Viral, Hemodynamics, 030204 cardiovascular system & hematology, Biochemistry, Article, Microcirculation, Veins, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Refractory, Internal medicine, Extracorporeal membrane oxygenation, Medicine, Humans, In patient, Mouth Floor, Pandemics, Retrospective Studies, Microscopy, Video, business.industry, SARS-CoV-2, COVID-19, Cell Biology, Middle Aged, extracorporeal membrane oxygenation, Capillaries, 030104 developmental biology, Breathing, Cardiology, Female, Endothelium, Vascular, business, Coronavirus Infections, Cardiology and Cardiovascular Medicine
Abstract: Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is a rescue treatment for severe acute respiratory failure refractory to conventional ventilation. We examined the alterations of sublingual microcirculation in patients with SARS-CoV-2 during VV-ECMO treatment and assessed the relationship between microvascular parameters and ventilation, hemodynamics, and laboratory tests. Nine patients were included in the study and the following microcirculatory parameters were estimated: TVD 16.81 (14.46-18.6) mm/mm2; PVD 15.3 (14.09-17.96) mm/mm2; PPV 94.85% (93.82%-97.79%); MFI 2.5 (2.5-2.92); HI 0.4 (0.18-0.4). TVD and PVD were inversely related to D-dimer levels (rho = -0.667, p = 0.05 and rho = -0.733, p = 0.025 respectively), aspartate aminotransferase (AST) (rho = -0.886, p = 0.019 and rho = -0.886, p = 0.019 respectively) and alanine aminotransferase (ALT) (rho = -0.829, p = 0.042 and rho = -0.829, p = 0.042 respectively). Our results showed an altered sublingual microcirculation in patients receiving VV-ECMO for severe SARS-CoV-2 and suggest a potential contribution of endothelia dysfunction to determine microvascular alteration.
Published: 2020
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33. Comment on 'Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study'

Author: Roberta Domizi, Erika Casarotta, Elisa Damiani, Claudia Scorcella, Abele Donati, Andrea Carsetti, and Erica Adrario
Subjects: 2019-20 coronavirus outbreak, medicine.medical_specialty, ARDS, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), lcsh:Medical emergencies. Critical care. Intensive care. First aid, MEDLINE, lcsh:RC86-88.9, Respiratory physiology, Critical Care and Intensive Care Medicine, medicine.disease, Anesthesiology, Medicine, business, Intensive care medicine, Letter to the Editor
Published: 2020
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34. Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort

Author: Pedro David Wendel Garcia, Thierry Fumeaux, Philippe Guerci, Dorothea Monika Heuberger, Jonathan Montomoli, Ferran Roche-Campo, Reto Andreas Schuepbach, Matthias Peter Hilty, Mario Alfaro Farias, Antoni Margarit, Gerardo Vizmanos-Lamotte, Thomas Tschoellitsch, Jens Meier, Francesco S. Cardona, Josef Skola, Lenka Horakova, Hernan Aguirre-Bermeo, Janina Apolo, Emmanuel Novy, Marie-Reine Losser, Geoffrey Jurkolow, Gauthier Delahaye, Sascha David, Tobias Welte, Tobias Wengenmayer, Dawid L. Staudacher, Theodoros Aslanidis, Barna Babik, Anita Korsos, Janos Gal, Hermann Csaba, Abele Donati, Andrea Carsetti, Fabrizio Turrini, Maria Sole Simonini, Roberto Ceriani, Martina Murrone, Emanuele Rezoagli, Giovanni Vitale, Alberto Fogagnolo, Savino Spadaro, Maddalena Alessandra Wu, Chiara Cogliati, Riccardo Colombo, Emanuele Catena, Francesca Facondini, Antonella Potalivo, Gianfilippo Gangitano, Tiziana Perin, Maria Grazia Bocci, Massimo Antonelli, Diederik Gommers, Can Ince, Eric Mayor-Vázquez, Maria Cruz, Martin Delgado, Raquel Rodriguez Garcia, Jorge Gamez Zapata, Begoña Zalba-Etayo, Herminia Lozano-Gomez, Pedro Castro, Adrian Tellez, Adriana Jacas, Guido Muñoz, Rut Andrea, Jose Ortiz, Eduard Quintana, Irene Rovira, Enric Reverter, Javier Fernandez, Miquel Ferrer, Joan R. Badia, Arantxa Lander Azcona, Jesus Escos Orta, Philipp Bühler, Silvio Brugger, Daniel Hofmaenner, Simone Unseld, Frank Ruschitzka, Mallory Moret-Bochatay, Bernd Yuen, Thomas Hillermann, Hatem Ksouri, Govind Oliver Sridharan, Anette Ristic, Michael Sepulcri, Miodrag Filipovic, Urs Pietsch, Petra Salomon, Iris Drvaric, Peter Schott, Severin Urech, Adriana Lambert, Lukas Merki, Marcus Laube, Frank Hillgaertner, Marianne Sieber, Alexander Dullenkopf, Lina Petersen, Serge Grazioli, Peter C. Rimensberger, Isabelle Fleisch, Jerome Lavanchy, Katharina Marquardt, Karim Shaikh, Hermann Redecker, Michael Stephan, Jan Brem, Bjarte Rogdo, Andre Birkenmaier, Friederike Meyer zu Bentrup, Patricia Fodor, Pascal Locher, Giovanni Camen, Martin Siegemund, Nuria Zellweger, Marie-Madlen Jeitziner, Beatrice Jenni-Moser, Christian Bürkle, Gian-Reto Kleger, Marilene Franchitti Laurent, Jean-Christophe Laurent, Tomislav Gaspert, Marija Jovic, Michael Studhalter, Christoph Haberthuer, Roger F. Lussman, Daniela Selz, Didier Naon, Romano Mauri, Samuele Ceruti, Julien Marrel, Mirko Brenni, Rolf Ensner, Nadine Gehring, Antje Heise, Tobias Huebner, Thomas A. Neff, Sara Cereghetti, Filippo Boroli, Jerome Pugin, Nandor Marczin, Joyce Wong, University of Zurich, Wendel Garcia, Pedro David, RISC-19 ICU investigators, Graduate School, Translational Physiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Intensive Care, Grazioli, Serge, and Rimensberger, Peter
Subjects: medicine.medical_specialty, ARDS, medicine.medical_treatment, 610 Medicine & health, Disease, 2700 General Medicine, 01 natural sciences, Article, NO, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, Medicine, 030212 general & internal medicine, 0101 mathematics, Disease burden, Mechanical ventilation, lcsh:R5-920, Public health, ddc:618, Acute respiratory distress syndrome, Pandemic, business.industry, Incidence (epidemiology), 010102 general mathematics, COVID-19, General Medicine, medicine.disease, Intensive care unit, Coronavirus, Cohort, Absolute neutrophil count, 10209 Clinic for Cardiology, 10023 Institute of Intensive Care Medicine, lcsh:Medicine (General), business
Abstract: Background Coronavirus disease 2019 (COVID-19) is associated with a high disease burden with 10% of confirmed cases progressing towards critical illness. Nevertheless, the disease course and predictors of mortality in critically ill patients are poorly understood. Methods Following the critical developments in ICUs in regions experiencing early inception of the pandemic, the European-based, international RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry was created to provide near real-time assessment of patients developing critical illness due to COVID-19. Findings As of April 22, 2020, 639 critically ill patients with confirmed SARS-CoV-2 infection were included in the RISC-19-ICU registry. Of these, 398 had deceased or been discharged from the ICU. ICU-mortality was 24%, median length of stay 12 (IQR, 5-21) days. ARDS was diagnosed in 74%, with a minimum P/F-ratio of 110 (IQR, 80-148). Prone positioning, ECCO2R, or ECMO were applied in 57%. Off-label therapies were prescribed in 265 (67%) patients, and 89% of all bloodstream infections were observed in this subgroup (n = 66; RR=3·2, 95% CI [1·7-6·0]). While PCT and IL-6 levels remained similar in ICU survivors and non-survivors throughout the ICU stay (p = 0·35, 0·34), CRP, creatinine, troponin, d-dimer, lactate, neutrophil count, P/F-ratio diverged within the first seven days (p
Published: 2020
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35. Microvascular alterations in patients with SARS-COV-2 severe pneumonia

Author: Abele Donati, Elisa Damiani, Erika Casarotta, Claudia Scorcella, Andrea Carsetti, Erica Adrario, and Roberta Domizi
Subjects: 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), lcsh:Medical emergencies. Critical care. Intensive care. First aid, MEDLINE, lcsh:RC86-88.9, Critical Care and Intensive Care Medicine, medicine.disease, Pneumonia, Internal medicine, Anesthesiology, Medicine, In patient, business, Letter to the Editor
Published: 2020
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36. Procedural sedation for direct current cardioversion: a feasibility study between two management strategies in the emergency department

Author: Erica Adrario, Antonio Dello Russo, Abele Donati, Andrea Carsetti, Giulia Stronati, Alessandro Capucci, Michela Casella, and Federico Guerra
Subjects: Male, Emergency procedures, lcsh:Diseases of the circulatory (Cardiovascular) system, Time Factors, medicine.medical_treatment, Cost-Benefit Analysis, 030204 cardiovascular system & hematology, Cardioversion, law.invention, 0302 clinical medicine, Cardiologists, Randomized controlled trial, law, Atrial Fibrillation, Medicine, Hypnotics and Sedatives, 030212 general & internal medicine, Prospective Studies, Hospital Costs, Stroke, Propofol, Aged, 80 and over, Middle Aged, Treatment Outcome, Italy, Anesthesia, Sedation, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, Emergency Service, Hospital, medicine.drug, Research Article, Midazolam, Electric Countershock, Drug Costs, 03 medical and health sciences, Cost Savings, Humans, Aged, business.industry, Emergency department, medicine.disease, Anesthesiologists, Blood pressure, lcsh:RC666-701, Feasibility Studies, business
Abstract: Background A cardiologist-only approach to procedural sedation with midazolam in the setting of elective cardioversion (DCC) for AF has already been proven as safe as sedation with propofol and anaesthesiologist assistance. No data exist regarding the safety of such a strategy during emergency procedures. The aim of this study is to compare the feasibility of sedation with midazolam, administered by a cardiologist, to an anaesthesiologist-assisted protocol with propofol in emergency DCC. Methods Single centre, prospective, open blinded, randomized study including all consecutive patients admitted to the Emergency Department requiring urgent or emergency DCC. Patients were randomized in a 1:1 fashion to either propofol or midazolam treatment arm. Patients in the midazolam group were managed by the cardiologist only, while patients treated with propofol group underwent DCC with anaesthesiologist assistance. Results Sixty-nine patients were enrolled and split into two groups. Eighteen patients (26.1%) experienced peri-procedural adverse events (bradycardia, severe hypotension and severe hypoxia), which were similar between the two groups and all successfully managed by the cardiologist. No deaths, stroke or need for invasive ventilation were registered. Patients treated with propofol experienced a greater decrease in systolic and diastolic blood pressure when compared with those treated with midazolam. As the procedure was shorter when midazolam was used, the median cost of urgent/emergency DCC with midazolam was estimated to be 129.0 € (1st-3rd quartiles 114.6–151.6) and 195.6 € (1st-3rd quartiles 147.3–726.7) with propofol (p Conclusions Procedural sedation with midazolam given by the cardiologist alone was feasible, well-tolerated and cost-effective in emergency DCC.
Published: 2020

37. Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective

Author: Abele Donati, Benedetto Marini, Simona Pantanetti, Andrea Carsetti, Erica Adrario, and Agnese Damia Paciarini
Subjects: Male, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Prone position ventilation, Pneumonia, Viral, Critical Care and Intensive Care Medicine, law.invention, Betacoronavirus, law, Pandemic, medicine, Research Letter, Prone Position, Humans, Pandemics, Retrospective Studies, biology, business.industry, SARS-CoV-2, lcsh:Medical emergencies. Critical care. Intensive care. First aid, COVID-19, lcsh:RC86-88.9, Middle Aged, biology.organism_classification, Respiration, Artificial, Prone position, Emergency medicine, Ventilation (architecture), business, Coronavirus Infections
Published: 2020

38. Evaluation of the Microcirculation in Critically Ill Patients

Author: Roberta Domizi, Abele Donati, Claudia Scorcella, Andrea Carsetti, and Elisa Damiani
Subjects: medicine.medical_specialty, Resuscitation, business.industry, medicine.medical_treatment, Hemodynamics, Blood flow, medicine.disease, Microcirculation, Sepsis, Internal medicine, Oxygen therapy, Shock (circulatory), medicine, Cardiology, medicine.symptom, business, Perfusion
Abstract: The first goal of therapies in critically ill patients is to improve tissue perfusion and oxygenation. Hemodynamic monitoring has long been limited to measurements of cardiac output and global oxygen delivery. The clinical introduction of hand-held vital microscopes in the late 1990s enabled the real-time, non-invasive, bedside observation of blood flow in the microcirculation (vessels with diameter
Published: 2020
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39. Clinical characteristics of 2019 novel coronavirus pneumonia and risk factors for severe cases: a meta-analysis involving 5,729 patients

Author: Zhang, Zhongheng, primary, Chen, Lin, additional, Ni, Hongying, additional, Yao, Min, additional, Erika, Casarotta, additional, Abele, Donati, additional, Andrea, Carsetti, additional, Guo, Yizhan, additional, and Wang, Qing, additional
Published: 2020
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40. Response to the Letter: Comment on 'Effects of short-term hyperoxia on sytemic hemodynamics, oxygen transport, and microcirculation: An observational study in patients with septic shock and healthy volunteers'

Author: Roberta Domizi, Claudia Scorcella, Erica Adrario, Elisa Damiani, Abele Donati, and Andrea Carsetti
Subjects: Hyperoxia, Septic shock, business.industry, Microcirculation, Hemodynamics, Oxygen transport, Critical Care and Intensive Care Medicine, medicine.disease, Shock, Septic, Healthy Volunteers, Oxygen, Anesthesia, Shock (circulatory), Healthy volunteers, medicine, Humans, Observational study, medicine.symptom, business
Published: 2020
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41. IgM-enriched immunoglobulins (Pentaglobin) may improve the microcirculation in sepsis: a pilot randomized trial

Author: Elisa Damiani, Paolo Giaccaglia, Erica Adrario, Erika Casarotta, Claudia Scorcella, Roberta Domizi, Simona Pantanetti, Elena Lamura, Vincenzo Gabbanelli, Abele Donati, Silvia Ciucani, and Andrea Carsetti
Subjects: medicine.medical_specialty, Immunoglobulins, Critical Care and Intensive Care Medicine, Placebo, Vascular occlusion, Gastroenterology, Microcirculation, law.invention, Immunomodulation, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, 030212 general & internal medicine, Septic shock, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Pentaglobin, Interleukin, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, Analysis of variance, medicine.symptom, business
Abstract: Background Polyclonal or IgM-enriched immunoglobulins may be beneficial during sepsis as an adjuvant immunomodulatory therapy. We aimed to test whether the infusion of IgM-enriched immunoglobulins improves microvascular perfusion during sepsis. Methods Single-centre, randomized, double-blind, placebo-controlled phase II trial including adult patients with a diagnosis of sepsis or septic shock for less than 24 h. Patients received an intravenous infusion of 250 mg/kg (5 mL/kg) per day of IgM-enriched immunoglobulins (Pentaglobin, n = 10) for 72 h or placebo (NaCl 0.9%, n = 9). At baseline and after 24 and 72 h of infusion, the sublingual microcirculation was assessed with Incident Dark Field videomicroscopy. Thenar near-infrared spectroscopy (NIRS) was applied with a vascular occlusion test to assess tissue oxygenation and microvascular reactivity. Levels of interleukin (IL) 1-beta, IL-6, IL-8, IL-10 and tumour necrosis factor alpha were measured in the serum. Results The perfused vessel density (PVD) for small vessels (diameter 2) and decreased in the placebo group (from 25 ± 5.8 to 20.7 ± 4.1 mm/mm2, p for interaction p = 0.140. The microvascular flow index for small vessels increased at 24 h in the Pentaglobin group (from 2.68 [2.38–2.78] to 2.93 [2.82–3], p p Conclusions A 72-h infusion of IgM-enriched immunoglobulins (Pentaglobin) in patients with sepsis or septic shock may be associated with an increase in sublingual microvascular perfusion. Further studies are needed to confirm our findings. Trial registration NCT02655133, www.ClinicalTrials.gov, date of registration 7th January 2016, https://www.clinicaltrials.gov/ct2/show/NCT02655133.
Published: 2019
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42. Changes in Cytokines, Haemodynamics and Microcirculation in Patients with Sepsis/Septic Shock Undergoing Continuous Renal Replacement Therapy and Blood Purification with CytoSorb

Author: Samuele Zuccari, Mario D'Arezzo, Abele Donati, Erica Adrario, Simona Pantanetti, Sara Vannicola, Andrea Ranghino, Elisa Damiani, Roberta Domizi, Erika Casarotta, Claudia Scorcella, and Andrea Carsetti
Subjects: Male, medicine.medical_specialty, Continuous Renal Replacement Therapy, medicine.medical_treatment, Critical Illness, 030232 urology & nephrology, Hemodynamics, 030204 cardiovascular system & hematology, Vascular occlusion, Microcirculation, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, Renal replacement therapy, Prospective Studies, Aged, Aged, 80 and over, business.industry, Septic shock, Interleukin, Hematology, General Medicine, Venous blood, Middle Aged, medicine.disease, Shock, Septic, Nephrology, Cardiology, Cytokines, Female, medicine.symptom, business
Abstract: Background: Extracorporeal blood purification therapies have been proposed as a strategy to remove inflammatory mediators during sepsis, thus improving outcome. Objectives: We aimed to evaluate changes in cytokines, haemodynamics and microcirculation during blood purification with Cytosorb adsorber in septic patients. Methods: Prospective observational study on critically ill adult patients with sepsis/septic shock underwent renal replacement therapy (RRT) for acute renal failure and haemoadsorption with Cytosorb as adjunctive therapy for 24 h. Measurements were taken at baseline, after 6 and 24 h: haemodynamic parameters, arterial and central venous blood gases, plasma levels of tumour necrosis factor alpha, interleukin (IL) 1-beta, IL-6, IL-8 and IL-10. The sublingual microcirculation was assessed with sidestream dark field videomicroscopy to evaluate the perfused vessel density (PVD) and microvascular flow quality. Tissue oxygenation and microvascular reactivity were assessed with thenar near infrared spectroscopy (NIRS) with a vascular occlusion test. Results: Nine patients; plasma levels of IL-8 decreased at 24 h (p < 0.05 versus 6 h); no significant variation was found for other cytokines. Haemodynamic remained stable throughout the observation. Microvascular perfusion improved over time, with an increase in PVDs at 6 and 24 h (from 13.9 [13.3–16.4] to 15.7 [15–17.3] and 17 [14.8–18.6] mm/mm2 respectively, p = 0.003) and total vessel densities at 24 h (14.9 [13.9–16.9] vs. 17.9 [15.3–20], p = 0.0015). No significant variation was detected in NIRS-derived parameters. The Sequential Organ Failure Assessment score decreased from 12 ± 3 to 10 ± 1 at 24 h (p = 0.039). Conclusions: In septic patients undergoing RRT, haemoadsorption with Cytosorb seems to determine a decreasing in plasma levels of IL-8, although levels of other cytokines did not vary significantly, and an improvement of microcirculation despite no significant variation in macro-haemodynamics.
Published: 2019

43. Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study

Author: Claudia Scorcella, Elisa Damiani, Abele Donati, Roberta Domizi, Sara Vannicola, Sandra Bolognini, Andrea Carsetti, Simona Pantanetti, Vincenzo Gabbanelli, and R Castagnani
Subjects: Male, Physiology, Organ Dysfunction Scores, Blood Pressure, 030204 cardiovascular system & hematology, Cardiovascular Physiology, Pathology and Laboratory Medicine, Biochemistry, Vascular Medicine, Norepinephrine, 0302 clinical medicine, Spectrum Analysis Techniques, Catecholamines, Medicine and Health Sciences, Prospective Studies, Amines, Prospective cohort study, Multidisciplinary, Spectroscopy, Near-Infrared, Organic Compounds, near-Infrared Spectroscopy, Neurochemistry, Neurotransmitters, Hematology, Middle Aged, Hospitals, Systemic Inflammatory Response Syndrome, Chemistry, Intensive Care Units, Blood Circulation, Physical Sciences, Cardiology, Medicine, SOFA score, Female, medicine.symptom, Perfusion, Research Article, Chemical Elements, Adult, medicine.medical_specialty, Biogenic Amines, Critical Illness, Multiple Organ Failure, Science, Infrared Spectroscopy, Research and Analysis Methods, Vascular occlusion, Microcirculation, 03 medical and health sciences, Signs and Symptoms, Oxygen Consumption, Diagnostic Medicine, Intensive care, Internal medicine, Sepsis, medicine, Humans, Mouth Floor, Aged, Retrospective Studies, business.industry, Organ dysfunction, Organic Chemistry, Chemical Compounds, Hemodynamics, Biology and Life Sciences, 030208 emergency & critical care medicine, Hormones, Oxygen, Health Care, Health Care Facilities, Wounds and Injuries, business, Neuroscience
Abstract: Introduction Previous studies described impaired microvascular perfusion and tissue oxygenation as reliable predictors of Multiple Organ Failure in major trauma. However, this relationship has been incompletely investigated. The objective of this analysis is to further evaluate the association between organ dysfunction and microcirculation after trauma. Materials and methods This is a retrospective subgroup analysis on 28 trauma patients enrolled for the Microcirculation DAIly MONitoring in critically ill patients study (NCT 02649088). Patients were divided in two groups according with their Sequential Organ Failure Assessment (SOFA) score at day 4. At admission and every 24 hours, the sublingual microcirculation was evaluated with Sidestream Darkfield Imaging (SDF) and peripheral tissue perfusion was assessed with Near Infrared Spectroscopy (NIRS) and Vascular Occlusion Test (VOT). Simultaneously, hemodynamic, clinical/laboratory parameters and main organ supports were collected. Results Median SOFA score at Day 4 was 6.5. Accordingly, patients were divided in two groups: D4-SOFA ≤6.5 and D4-SOFA >6.5. The Length of Stay in Intensive Care was significantly higher in patients with D4-SOFA>6.5 compared to D4-SOFA≤6.5 (p = 0.013). Total Vessel Density of small vessels was significantly lower in patients with high D4-SOFA score at Day 1 (p = 0.002) and Day 2 (p = 0.006) after admission; the Perfused Vessel Density was lower in patients with high D4-SOFA score at Day 1 (p = 0.007) and Day 2 (p = 0.033). At Day 1, NIRS monitoring with VOT showed significantly faster tissue oxygen saturation downslope (p = 0.018) and slower upslope (p = 0.04) in patients with high D4-SOFA. Discussion In our cohort of major traumas, sublingual microcirculation and peripheral microvascular reactivity were significantly more impaired early after trauma in those patients who developed more severe organ dysfunctions. Our data would support the hypothesis that restoration of macrocirculation can be dissociated from restoration of peripheral and tissue perfusion, and that microvascular alterations can be associated with organ failure.
Published: 2019

44. The role of cardiac dysfunction in multiorgan dysfunction

Author: Abele Donati, Elisa Damiani, and Andrea Carsetti
Subjects: Cardiac output, medicine.medical_specialty, Critical Illness, Multiple Organ Failure, Myocardial Ischemia, Ischemia, Hemodynamics, 030204 cardiovascular system & hematology, Kidney, 03 medical and health sciences, Catecholamines, 0302 clinical medicine, Stress, Physiological, medicine, Humans, Cardiac Output, Respiratory system, Intensive care medicine, Lung, business.industry, Heart, 030208 emergency & critical care medicine, medicine.disease, Systemic Inflammatory Response Syndrome, Pathophysiology, Gastrointestinal Tract, Intensive Care Units, Anesthesiology and Pain Medicine, Reperfusion Injury, Splanchnic, Complication, business, Adrenergic alpha-Agonists, Reperfusion injury
Abstract: Purpose of review The aim of this review was to examine the main determinants of cardiac dysfunction in critically ill patients, as well as how a reduction in cardiac performance influences other organ function. Recent findings Cardiac dysfunction is a frequent complication in critically ill patients and contributes to organ hypoperfusion and poor outcome. Pathophysiological determinants may include a primary ischaemia/reperfusion injury of the heart, effects of systemic inflammatory and adrenergic responses of the body to a variety of acute insults, as well as cardiovascular effects of commonly applied intensive respiratory or haemodynamic treatments. A strict connection exists between cardiac and other organ function, mediated by haemodynamic, humoral, and immune mechanisms. Heart, lungs, kidneys, and other splanchnic organs such as gut and liver influence each other function in a bidirectional way: this organ crosstalk must be regarded as a key aspect in multiorgan dysfunction. Summary The heart should never be regarded as an isolated organ. When dealing with cardiac dysfunction, clinicians must consider the underlying pathophysiology, potential myocardial depressant effects of intensive treatments, and the complex interaction with other organ function.
Published: 2016
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45. The importance of hemodynamic monitoring in patients with SARS-CoV-2

Author: Erica Adrario, Abele Donati, Erika Casarotta, Claudia Scorcella, Andrea Carsetti, and Roberta Domizi
Subjects: medicine.medical_specialty, business.industry, Internal medicine, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Emergency Medicine, medicine, Cardiology, Hemodynamics, In patient, Critical Care and Intensive Care Medicine, business
Published: 2020
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46. Changes in the sublingual microcirculation following aortic surgery under balanced or total intravenous anaesthesia: a prospective observational study

Author: Erica Adrario, Benedetto Marini, Abele Donati, Roberta Domizi, Elisa Damiani, Luciano Carbonari, Andrea Carsetti, S Loggi, Nicoletta Mininno, Simona Pantanetti, Gabriele Pagliariccio, and Claudia Scorcella
Subjects: Male, Mean arterial pressure, Cardiac index, Remifentanil, Hemodynamics, Ischemia/reperfusion injury, lcsh:RD78.3-87.3, Anaesthesia, 03 medical and health sciences, Aortic aneurysm, 0302 clinical medicine, 030202 anesthesiology, medicine, Humans, Prospective Studies, Mouth Floor, Propofol, Aged, Aged, 80 and over, Haemodynamics, business.industry, Microcirculation, 030208 emergency & critical care medicine, medicine.disease, Abdominal aortic aneurysm, Anesthesiology and Pain Medicine, medicine.anatomical_structure, lcsh:Anesthesiology, Anesthesia, Anesthetics, Inhalation, Vascular resistance, Female, business, Desflurane, Aortic surgery, Anesthetics, Intravenous, Abdominal surgery, medicine.drug, Aortic Aneurysm, Abdominal, Research Article
Abstract: Background In vascular surgery with aortic cross-clamping, ischemia/reperfusion injury induces systemic haemodynamic and microcirculatory disturbances. Different anaesthetic regimens may have a varying impact on tissue perfusion. The aim of this study was to explore changes in microvascular perfusion in patients undergoing elective open abdominal aortic aneurysm repair under balanced or total intravenous anaesthesia. Methods Prospective observational study. Patients undergoing elective open infrarenal abdominal aortic aneurysm repair received balanced (desflurane + remifentanil, n = 20) or total intravenous anaesthesia (TIVA, propofol + remifentanil using target-controlled infusion, n = 20) according to the clinician’s decision. A goal-directed haemodynamic management was applied in all patients. Measurements were obtained before anaesthesia induction (baseline) and at end-surgery and included haemodynamics, arterial/venous blood gases, sublingual microvascular flow and density (incident dark field illumination imaging), peripheral muscle tissue oxygenation and microcirculatory reactivity (thenar near infrared spectroscopy with a vascular occlusion test). Results The two groups did not differ for baseline characteristics, mean aortic-clamping time and requirement of vasoactive agents during surgery. Changes in mean arterial pressure, systemic vascular resistance index, haemoglobin and blood lactate levels were similar between the two groups, while the cardiac index increased at end-surgery in patients undergoing balanced anaesthesia. The sublingual microcirculation was globally unaltered in the TIVA group at end-surgery, while patients undergoing balanced anaesthesia showed an increase in the total and perfused small vessel densities (from 16.6 ± 4.2 to 19.1 ± 5.4 mm/mm2, p
Published: 2018

47. MicroDAIMON study: Microcirculatory DAIly MONitoring in critically ill patients: a prospective observational study

Author: Silvia Pierantozzi, Elisa Damiani, Abele Donati, Silvia Ciucani, Can Ince, Andrea Carsetti, E. Christiaan Boerma, Stefania Tondi, Rocco Romano, Claudia Scorcella, Valentina Monaldi, Benedetto Marini, Roberta Domizi, Mara Rogani, Erica Adrario, ACS - Microcirculation, and Translational Physiology
Subjects: medicine.medical_specialty, Population, Hemodynamics, Video microscopy, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Microcirculation, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Anesthesiology, Tachycardia, medicine, education, education.field_of_study, business.industry, Critically ill, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Intensive care unit, Capillaries, Emergency medicine, Physiologic monitoring, Observational study, business, Critical illness
Abstract: Background Until now, the prognostic value of microcirculatory alterations in critically ill patients has been mainly evaluated in highly selected subgroups. Aim of this study is to monitor the microcirculation daily in mixed group of Intensive Care Unit (ICU)-patients and to establish the association between (the evolution of) microcirculatory alterations and outcome. Methods This is a prospective longitudinal observational single-centre study in adult patients admitted to a 12-bed ICU in an Italian teaching hospital. Sublingual microcirculation was evaluated daily, from admission to discharge/death, using Sidestream Dark Field imaging. Videos were analysed offline to assess flow and density variables. Laboratory and clinical data were recorded simultaneously. A priori, a Microvascular Flow Index (MFI) 2 mmol/L and MFI
Published: 2018

48. Fluid bolus therapy

Author: Andrew Rhodes, Andrea Carsetti, and Maurizio Cecconi
Subjects: medicine.medical_specialty, business.industry, Critical Illness, Resuscitation, Fluid responsiveness, Treatment outcome, Hemodynamics, Blood Pressure, Stroke Volume, Blood flow, Critical Care and Intensive Care Medicine, Clinical Practice, Treatment Outcome, Cardiovascular Diseases, Critical illness, medicine, Fluid Therapy, Humans, Therapy monitoring, Intensive care medicine, business, Fluid bolus, Blood Flow Velocity
Abstract: When a condition of hypoperfusion has been identified, clinicians must decide whether fluids may increase blood flow or whether other therapeutic approaches are needed. For this purpose, several tests and parameters have been introduced in clinical practice to predict fluid responsiveness and guide therapy.Fluid challenge is the gold standard test to assess the preload dependence of the patients. Moreover, several parameters and tests avoiding fluid administration are now available. Pulse pressure variation and stroke volume variation are based on heart-lung interaction and can be used to assess fluid responsiveness. These parameters have several limitations and can really be used in a limited number of critically ill patients. End-expiratory occlusion test and passive leg raising have been proposed to overcome these limitations. The aim of resuscitation is to increase blood flow and perfusion pressure. Dynamic arterial elastance has been recently proposed to predict the pressure response after fluid challenge in preload-dependent patients. Finally, the effects of volume expansion of hemodynamic parameters do not necessarily reach the microcirculation, which should also be assessed.Nowadays, several parameters are available to assess fluid responsiveness. Clinicians need to know all of them, with their limitations, without forgetting that the final aim of all therapies is to improve the microcirculation.
Published: 2015
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49. Ability and efficiency of an automatic analysis software to measure microvascular parameters

Author: Simone Bazurro, Andrea Carsetti, Hollmann D. Aya, Abele Donati, Maurizio Cecconi, Silvia Pierantozzi, and Andrew Rhodes
Subjects: Automated, Critical Care, Image Processing, Incident dark field imaging, Health Informatics, 030204 cardiovascular system & hematology, Pattern Recognition, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Automation, 0302 clinical medicine, Vessel density, Computer-Assisted, Medicine, Analysis software, Humans, Prospective Studies, Simulation, Observer Variation, Microscopy, business.industry, Microcirculation, Limits of agreement, Reproducibility of Results, 030208 emergency & critical care medicine, Video, Blood flow, Microcirculatory flow, Perfusion, CytoCam, Intensive Care Units, Anesthesiology and Pain Medicine, Analysis, Blood Flow Velocity, Blood Vessels, Microscopy, Video, Image Processing, Computer-Assisted, Pattern Recognition, Automated, Software, business, Nuclear medicine, Microvascular flow
Abstract: Analysis of the microcirculation is currently performed offline, is time consuming and operator dependent. The aim of this study was to assess the ability and efficiency of the automatic analysis software CytoCamTools 1.7.12 (CC) to measure microvascular parameters in comparison with Automated Vascular Analysis (AVA) software 3.2. 22 patients admitted to the cardiothoracic intensive care unit following cardiac surgery were prospectively enrolled. Sublingual microcirculatory videos were analysed using AVA and CC software. The total vessel density (TVD) for small vessels, perfused vessel density (PVD) and proportion of perfused vessels (PPV) were calculated. Blood flow was assessed using the microvascular flow index (MFI) for AVA software and the averaged perfused speed indicator (APSI) for the CC software. The duration of the analysis was also recorded. Eighty-four videos from 22 patients were analysed. The bias between TVD-CC and TVD-AVA was 2.20 mm/mm2 (95 % CI 1.37–3.03) with limits of agreement (LOA) of −4.39 (95 % CI −5.66 to −3.16) and 8.79 (95 % CI 7.50–10.01) mm/mm2. The percentage error (PE) for TVD was ±32.2 %. TVD was positively correlated between CC and AVA (r = 0.74, p
Published: 2017

50. Thermodilution vs pressure recording analytical method in hemodynamic stabilized patients

Author: Erica Adrario, Christopher Munch, Elisa Damiani, Stefania Tondi, Andrea Carsetti, Abele Donati, Maurizio Cecconi, Roberta Domizi, Claudia Scorcella, Vincenzo Gabbanelli, and Paolo Pelaia
Subjects: Adult, Male, Cardiac output, Critical Illness, medicine.medical_treatment, Thermodilution, Hemodynamics, Blood Pressure, Critical Care and Intensive Care Medicine, law.invention, law, Germany, medicine, Humans, In patient, Prospective Studies, Pressure recording, Cardiac Output, Aged, Monitoring, Physiologic, business.industry, Pulmonary artery catheter, Reproducibility of Results, Middle Aged, Intensive care unit, Confidence interval, Intensive Care Units, Catheterization, Swan-Ganz, Anesthesia, Female, business, Surgical patients
Abstract: Many mini-invasive devices to monitor cardiac output (CO) have been introduced and, among them, the pressure recording analytical method (PRAM). The aim of this study was to assess the agreement of PRAM with the intermittent transpulmonary thermodilution and continuous pulmonary thermodilution in measuring CO in hemodynamically stabilized patients.This is a prospective clinical study in a mixed medical-surgical intensive care unit (ICU) and in a postcardiac surgical ICU. Forty-eight patients were enrolled: 32 patients to the medical-surgical ICU monitored with PiCCO (Pulsion Medical System AG, Munich, Germany) and 16 were cardiac patients monitored with Vigilance (Edwards Lifesciences, Irvine, CA).A total of 112 measurements were made. Ninety-six comparisons of paired CO measurements were made in patients hospitalized in medical-surgical ICU; 16, in cardiac surgical patients. The mean Vigilance-CO was 4.49 ± 0.99 L/min (range, 2.80-5.90 L/min), and the mean PRAM-CO was 4.27 ± 0.88 L/min (range, 2.85-6.19 L/min). The correlation coefficient between Vigilance-CO and PRAM-CO was 0.83 (95% confidence interval, 0.57-0.94; P.001). The bias was 0.22 ± 0.55 L/min with limits of agreement between 0.87 and 1.30 L/min. The percentage error was 25%. Mean TP-CO was 6.78 ± 2.04 L/min (range, 4.12-11.27 L/min), and the mean PRAM-CO was 6.11 ± 2.18 L/min (range, 2.82-10.90 L/min). The correlation coefficient between PiCCO-CO and PRAM-CO was 0.91 (95% confidence interval, 0.83-0.96; P.0001). The bias was 0.67 ± 0.89 L/min with limits of agreement -1.07 and 2.41 L/min. The coefficient of variation for PiCCO was 4% ± 2%, and the coefficient of variation for PRAM was 10% ± 8%. The percentage error was 28%.The PRAM system showed good agreement with pulmonary artery catheter and PiCCO in hemodynamically stabilized patients.
Published: 2014
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