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1. Tracheostomy in critically ill patients with SARS 2 COVID-19 infection: a prospective observational multi-center study of shortand long-term outcomes

Author

Alberto Corona, Vincenzo De Santis, Domenico Vitale, Cecilia Nencini, Antonella Potalivo, Anna Prete, Nicoletta Barzaghi, Sara Tardivo, Marina Terzitta, Anna Malfatto, Luigi Tritapepe, Alessandro Locatelli, and Mervyn Singer

Subjects
covid-19, critically ill patients, tracheostomy, karnofsky, mechanical ventilation, Diseases of the respiratory system, RC705-779
Abstract

Background: We report the characteristics, timing, and factors related to the decision to perform a tracheostomy in patients with confirmed COVID-19 infection admitted to eight Italian intensive care units (ICUs). Materials and methods: Prospective observational cohort study of patients with COVID-19 disease on mechanical ventilation. Long-term functional impairment (up to 180 days’ post-hospital discharge) was assessed using the Karnofsky scale. Kaplan–Meier analysis assessed differences in survival and freedom from tracheostomy in relation to ICU stay. Cox regression model was used to assess which variables impacted on tracheostomy as a categorical outcome. Results: A total of 248 patients were recruited in the eight participating ICUs. Patients undergoing tracheostomy (n = 128) had longer ICU (25 (18–36) vs. 10 (7–16), P = 0.001) and hospital (37 (26.5–50) vs. 19 (8.5–34.5) P = 0.02) stays. ICU and hospital mortality of patients tracheostomized was 34% and 37%, respectively. Cumulative survival Kaplan–Meier analysis documented improved survival rates in patients undergoing tracheostomy (Log-Rank, Mantel–Cox = 4.8, P = 0.028). Median Karnofsky scale values improved over time but were similar between survivors receiving or not receiving tracheostomy. No healthcare worker involved in the tracheostomy procedure developed COVID-19 infection during the study period. Conclusions: Patients with COVID-19 infection who underwent tracheostomy had a better cumulative survival but similar long-term functional outcomes at 30, 60, and 180 days after hospital discharge.

Published
2022
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2. 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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3. Noninvasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease: a systematic review and meta-analysis

Author

Gianmaria Cammarota, Teresa Esposito, Danila Azzolina, Roberto Cosentini, Francesco Menzella, Stefano Aliberti, Andrea Coppadoro, Giacomo Bellani, Giuseppe Foti, Giacomo Grasselli, Maurizio Cecconi, Antonio Pesenti, Michele Vitacca, Tom Lawton, V. Marco Ranieri, Sandro Luigi Di Domenico, Onofrio Resta, Antonio Gidaro, Antonella Potalivo, Giuseppe Nardi, Claudia Brusasco, Simonetta Tesoro, Paolo Navalesi, Rosanna Vaschetto, and Edoardo De Robertis

Subjects
Noninvasive ventilation, COVID-19, Intra-hospital mortality, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Noninvasive respiratory support (NIRS) has been diffusely employed outside the intensive care unit (ICU) to face the high request of ventilatory support due to the massive influx of patients with acute respiratory failure (ARF) caused by coronavirus-19 disease (COVID-19). We sought to summarize the evidence on clinically relevant outcomes in COVID-19 patients supported by NIV outside the ICU. Methods We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials register, along with medRxiv and bioRxiv repositories for pre-prints, for observational studies and randomized controlled trials, from inception to the end of February 2021. Two authors independently selected the investigations according to the following criteria: (1) observational study or randomized clinical trials enrolling ≥ 50 hospitalized patients undergoing NIRS outside the ICU, (2) laboratory-confirmed COVID-19, and (3) at least the intra-hospital mortality reported. Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines were followed. Data extraction was independently performed by two authors to assess: investigation features, demographics and clinical characteristics, treatments employed, NIRS regulations, and clinical outcomes. Methodological index for nonrandomized studies tool was applied to determine the quality of the enrolled studies. The primary outcome was to assess the overall intra-hospital mortality of patients under NIRS outside the ICU. The secondary outcomes included the proportions intra-hospital mortalities of patients who underwent invasive mechanical ventilation following NIRS failure and of those with ‘do-not-intubate’ (DNI) orders. Results Seventeen investigations (14 peer-reviewed and 3 pre-prints) were included with a low risk of bias and a high heterogeneity, for a total of 3377 patients. The overall intra-hospital mortality of patients receiving NIRS outside the ICU was 36% [30–41%]. 26% [21–30%] of the patients failed NIRS and required intubation, with an intra-hospital mortality rising to 45% [36–54%]. 23% [15–32%] of the patients received DNI orders with an intra-hospital mortality of 72% [65–78%]. Oxygenation on admission was the main source of between-study heterogeneity. Conclusions During COVID-19 outbreak, delivering NIRS outside the ICU revealed as a feasible strategy to cope with the massive demand of ventilatory assistance. Registration PROSPERO, https://www.crd.york.ac.uk/prospero/ , CRD42020224788, December 11, 2020.

Published
2021
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4. Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort

Author

Pedro D. Wendel Garcia, Hernán Aguirre-Bermeo, Philipp K. Buehler, Mario Alfaro-Farias, Bernd Yuen, Sascha David, Thomas Tschoellitsch, Tobias Wengenmayer, Anita Korsos, Alberto Fogagnolo, Gian-Reto Kleger, Maddalena A. Wu, Riccardo Colombo, Fabrizio Turrini, Antonella Potalivo, Emanuele Rezoagli, Raquel Rodríguez-García, Pedro Castro, Arantxa Lander-Azcona, Maria C. Martín-Delgado, Herminia Lozano-Gómez, Rolf Ensner, Marc P. Michot, Nadine Gehring, Peter Schott, Martin Siegemund, Lukas Merki, Jan Wiegand, Marie M. Jeitziner, Marcus Laube, Petra Salomon, Frank Hillgaertner, Alexander Dullenkopf, Hatem Ksouri, Sara Cereghetti, Serge Grazioli, Christian Bürkle, Julien Marrel, Isabelle Fleisch, Marie-Helene Perez, Anja Baltussen Weber, Samuele Ceruti, Katharina Marquardt, Tobias Hübner, Hermann Redecker, Michael Studhalter, Michael Stephan, Daniela Selz, Urs Pietsch, Anette Ristic, Antje Heise, Friederike Meyer zu Bentrup, Marilene Franchitti Laurent, Patricia Fodor, Tomislav Gaspert, Christoph Haberthuer, Elif Colak, Dorothea M. Heuberger, Thierry Fumeaux, Jonathan Montomoli, Philippe Guerci, Reto A. Schuepbach, Matthias P. Hilty, Ferran Roche-Campo, and RISC-19-ICU Investigators

Subjects
COVID-19, ARDS, Respiratory support, Noninvasive mechanical ventilation, High flow oxygen therapy, Invasive mechanical ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Methods Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. Results Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). Conclusion In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.

Published
2021
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5. Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study

Author

Gaetano Scaramuzzo, Lorenzo Gamberini, Tommaso Tonetti, Gianluca Zani, Irene Ottaviani, Carlo Alberto Mazzoli, Chiara Capozzi, Emanuela Giampalma, Maria Letizia Bacchi Reggiani, Elisabetta Bertellini, Andrea Castelli, Irene Cavalli, Davide Colombo, Federico Crimaldi, Federica Damiani, Maurizio Fusari, Emiliano Gamberini, Giovanni Gordini, Cristiana Laici, Maria Concetta Lanza, Mirco Leo, Andrea Marudi, Giuseppe Nardi, Raffaella Papa, Antonella Potalivo, Emanuele Russo, Stefania Taddei, Guglielmo Consales, Iacopo Cappellini, Vito Marco Ranieri, Carlo Alberto Volta, Claude Guerin, Savino Spadaro, and The ICU-RER COVID-19 Collaboration

Subjects
COVID19, Prone positioning, Ventilatory free days, ICU, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (≥ median PaO2/FiO2 variation) or non-responders (

Published
2021
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6. Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs

Author

Lorenzo Gamberini, Tommaso Tonetti, Savino Spadaro, Gianluca Zani, Carlo Alberto Mazzoli, Chiara Capozzi, Emanuela Giampalma, Maria Letizia Bacchi Reggiani, Elisabetta Bertellini, Andrea Castelli, Irene Cavalli, Davide Colombo, Federico Crimaldi, Federica Damiani, Alberto Fogagnolo, Maurizio Fusari, Emiliano Gamberini, Giovanni Gordini, Cristiana Laici, Maria Concetta Lanza, Mirco Leo, Andrea Marudi, Giuseppe Nardi, Irene Ottaviani, Raffaella Papa, Antonella Potalivo, Emanuele Russo, Stefania Taddei, Carlo Alberto Volta, V. Marco Ranieri, and the ICU-RER COVID-19 Collaboration

Subjects
Coronavirus disease 2019, Intensive care, Mechanical ventilation, Outcomes, mortality, Respiration, artificial, ARDS, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation. The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. Methods This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. Results Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO2/FiO2 ratio during the first 5 days of MV, respiratory system compliance (CRS) lower than 40 mL/cmH2O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications. ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable. Conclusions Age, SOFA score at ICU admission, CRS, PaO2/FiO2, renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19. Trial registration NCT04411459

Published
2020
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7. Lactate Arterial-Central Venous Gradient among COVID-19 Patients in ICU: A Potential Tool in the Clinical Practice

Author

Giuseppe Nardi, Gianfranco Sanson, Lucia Tassinari, Giovanna Guiotto, Antonella Potalivo, Jonathan Montomoli, and Fernando Schiraldi

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Objective. In physiological conditions, arterial blood lactate concentration is equal to or lower than central venous blood lactate concentration. A reversal in this rate (i.e., higher lactate concentration in central venous blood), which could reflect a derangement in the mitochondrial metabolism of lung cells induced by inflammation, has been previously reported in patients with ARDS but has been never explored in COVID-19 patients. The aim of this study was to explore if the COVID-19-induced lung cell damage was mirrored by an arterial lactatemia higher than the central venous one; then if the administration of anti-inflammatory therapy (i.e., canakinumab 300 mg subcutaneous) could normalize such abnormal lactate a-cv difference. Methods. A prospective cohort study was conducted, started on March 25, 2020, for a duration of 10 days, enrolling 21 patients affected by severe COVID-19 pneumonia undergoing mechanical ventilation consecutively admitted to the ICU of the Rimini Hospital, Italy. Arterial and central venous blood samples were contemporarily collected to calculate the difference between arterial and central venous lactate (Delta a-cv lactate) concentrations within 24 h from tracheal intubation (T0) and 24 hours after canakinumab administration (T1). Results. At T0, 19 of 21 (90.5%) patients showed a pathologic Delta a-cv lactate (median 0.15 mmol/L; IQR 0.07–0.25). In the 13 patients undergoing canakinumab administration, at T1, Delta a-cv lactate decreased in 92.3% of cases, the decrease being statistically significant (T0: median 0.24, IQR 0.09–0.31 mmol/L; T1: median −0.01, IQR −0.08–0.04 mmol/L; p=0.002). Conclusion. A reversed Delta a-cv lactate might be interpreted as one of the effects of COVID-19-related cytokine storm, which could reflect a derangement in the mitochondrial metabolism of lung cells induced by severe inflammation or other uncoupling mediators. In addition, Delta a-cv lactate decrease might also reflect the anti-inflammatory activity of canakinumab. Our preliminary findings need to be confirmed by larger outcome studies.

Published
2020
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8. Correction to: Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs

Author

Lorenzo Gamberini, Tommaso Tonetti, Savino Spadaro, Gianluca Zani, Carlo Alberto Mazzoli, Chiara Capozzi, Emanuela Giampalma, Maria Letizia Bacchi Reggiani, Elisabetta Bertellini, Andrea Castelli, Irene Cavalli, Davide Colombo, Federico Crimaldi, Federica Damiani, Alberto Fogagnolo, Maurizio Fusari, Emiliano Gamberini, Giovanni Gordini, Cristiana Laici, Maria Concetta Lanza, Mirco Leo, Andrea Marudi, Giuseppe Nardi, Irene Ottaviani, Raffaella Papa, Antonella Potalivo, Emanuele Russo, Stefania Taddei, Carlo Alberto Volta, V. Marco Ranieri, and the ICU-RER COVID-19 Collaboration

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

An amendment to this paper has been published and can be accessed via the original article.

Published
2020
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9. Phenotypes of Patients with COVID-19 Who Have a Positive Clinical Response to Helmet Noninvasive Ventilation

Author

Domenico Luca Grieco, Luca S. Menga, Melania Cesarano, Savino Spadaro, Maria Maddalena Bitondo, Cecilia Berardi, Tommaso Rosà, Filippo Bongiovanni, Salvatore Maurizio Maggiore, Massimo Antonelli, Jonathan Montomoli, Giulia Falò, Tommaso Tonetti, Salvatore L. Cutuli, Gabriele Pintaudi, Eloisa S. Tanzarella, Edoardo Piervincenzi, Antonio M. Dell’Anna, Luca Delle Cese, Simone Carelli, Maria Grazia Bocci, Luca Montini, Giuseppe Bello, Daniele Natalini, Gennaro De Pascale, Matteo Velardo, Carlo Alberto Volta, V. Marco Ranieri, Giorgio Conti, Riccardo Maviglia, Giovanna Mercurio, Paolo De Santis, Mariano Alberto Pennisi, Gian Marco Anzellotti, Flavia Torrini, Carlotta Rubino, Tony C. Morena, Veronica Gennenzi, Stefania Postorino, Joel Vargas, Nicoletta Filetici, Donatella Settanni, Miriana Durante, Laura Cascarano, Mariangela Di Muro, Roberta Scarascia, Martina Murdolo, Alessandro Mele, Serena Silva, Carmelina Zaccone, Francesca Pozzana, Alessio Maccaglia, Martina Savino, Antonella Potalivo, Francesca Ceccaroni, Angela Scavone, Gianmarco Lombardi, and Teresa Michi

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), MEDLINE, Critical Care and Intensive Care Medicine, Respiratory Rate, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, Intubation, Intratracheal, Humans, Medicine, Aged, Noninvasive Ventilation, business.industry, Oxygen Inhalation Therapy, COVID-19, Middle Aged, Phenotype, Respiratory Function Tests, Treatment Outcome, Italy, Female, Noninvasive ventilation, business, Phenotypes of Patients with COVID-19
Published
2022

10. Sixty-Day Mortality Among 520 Italian Hospitalized COVID-19 Patients According to the Adopted Ventilatory Strategy in the Context of an Integrated Multidisciplinary Clinical Organization: A Population-Based Cohort Study

Author

Raffaella De Giovanni, Luca Giampaolo, Elisa Marchionni, Enrico Cavagna, Elena Mosconi, Francesco Muratore, Tiziana Perin, Gianfilippo Gangitano, Luigi Arcangelo Lazzari Agli, Maria Maddalena Bitondo, Giovanni Giuliani, Ilaria Valentini, Francesca Facondini, Sonia Guarino, Cinzia Ravaioli, Antonella Potalivo, Daniela Guerra, Francesco Cristini, Ilaria Panzini, Giuseppe Nardi, Jonathan Montomoli, Gianfranco Sanson, Carlo Biagetti, Potalivo, Antonella, Montomoli, Jonathan, Facondini, Francesca, Sanson, Gianfranco, Lazzari Agli, Luigi Arcangelo, Perin, Tiziana, Cristini, Francesco, Cavagna, Enrico, De Giovanni, Raffaella, Biagetti, Carlo, Panzini, Ilaria, Ravaioli, Cinzia, Bitondo, Maria Maddalena, Guerra, Daniela, Giuliani, Giovanni, Mosconi, Elena, Guarino, Sonia, Marchionni, Elisa, Gangitano, Gianfilippo, Valentini, Ilaria, Giampaolo, Luca, Muratore, Francesco, and Nardi, Giuseppe

Subjects
medicine.medical_specialty, ARDS, multidisciplinary team approach, Coronavirus disease 2019 (COVID-19), Epidemiology, medicine.medical_treatment, Population, Context (language use), 030204 cardiovascular system & hematology, mechanical ventilation, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Tocilizumab, COVID-19, mortality, noninvasive ventilation, Informed consent, Internal medicine, medicine, Clinical Epidemiology, lcsh:RC109-216, 030212 general & internal medicine, Respiratory system, education, Original Research, Mechanical ventilation, education.field_of_study, business.industry, medicine.disease, Institutional review board, Canakinumab, chemistry, covid-19, ards, Breathing, Observational study, business, Cohort study, medicine.drug
Abstract

Antonella Potalivo,1,* Jonathan Montomoli,1,* Francesca Facondini,1 Gianfranco Sanson,2 Luigi Arcangelo Lazzari Agli,3,4 Tiziana Perin,5 Francesco Cristini,6 Enrico Cavagna,7 Raffaella De Giovanni,8 Carlo Biagetti,6 Ilaria Panzini,9 Cinzia Ravaioli,10 Maria Maddalena Bitondo,1 Daniela Guerra,1 Giovanni Giuliani,1 Elena Mosconi,1 Sonia Guarino,1 Elisa Marchionni,6 Gianfilippo Gangitano,5 Ilaria Valentini,3,4 Luca Giampaolo,8 Francesco Muratore,7 Giuseppe Nardi1 1Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy; 2Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; 3Department of Pneumology, Infermi Hospital, Rimini, Italy; 4Ceccarini Hospital, AUSL della Romagna, Riccione, Italy; 5Department of Emergency Medicine, Infermi Hospital, AUSL Della Romagna, Rimini, Italy; 6Department of Infectious Diseases, Infermi Hospital, AUSL della Romagna, Rimini,Italy; 7Department of Radiology, Infermi Hospital, AUSL della Romagna, Rimini, Italy; 8Department of Internal Medicine, Cervesi Hospital, AUSL della Romagna, Cattolica, Italy; 9Department of Clinical Research, AUSL della Romagna, Ravenna, Italy; 10Ausl della Romagna Health Care Service Direction, Ravenna, Italy*These authors contributed equally to this workCorrespondence: Giuseppe NardiDepartment of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Viale Settembrini 2, Rimini 47921, ItalyTel +39 0541-705254Fax +39 0541 705886Email 4doctornardi@gmail.comPurpose: Although the decision of which ventilation strategy to adopt in COVID-19 patients is crucial, yet the most appropriate means of carrying out this undertaking is not supported by strong evidence. We therefore described the organization of a province-level healthcare system during the occurrence of the COVID-19 epidemic and the 60-day outcomes of the hospitalized COVID-19 patients according to the respiratory strategy adopted given the limited available resources.Patients and Methods: All COVID-19 patients (26/02/2020– 18/04/2020) in the Rimini Province of Italy were included in this population-based cohort study. The hospitalized patients were classified according to the maximum level of respiratory support: oxygen supplementation (Oxygen group), non-invasive ventilation (NIV-only group), invasive mechanical ventilation (IMV-only group), and IMV after an NIV trial (IMV-after-NIV group). Sixty-day mortality risk was estimated with a Cox proportional hazard analysis adjusted by age, sex, and administration of steroids, canakinumab, and tocilizumab.Results: We identified a total of 1,424 symptomatic patients: 520 (36.5%) were hospitalized, while 904 (63.5%) were treated at home with no 60-day deaths. Based on the respiratory support, 408 (78.5%) were assigned to the Oxygen group, 46 (8.8%) to the NIV-only group, 25 (4.8%) to the IMV-after-NIV group, and 41 (7.9%) to the IMV-only group. There was no significant difference in the PaO2/FiO2 at IMV inception in the IMV-after-NIV and IMV-only groups (p=0.9). Overall 60-day mortality was 24.2% (Oxygen: 23.0%; NIV-only: 19.6%; IMV-after-NIV: 32.0%; IMV-only: 36.6%; p=0.165). Compared with the Oxygen group, the adjusted 60-day mortality risk significantly increased in the IMV-after-NIV (HR 2.776; p=0.024) and IMV-only groups (HR 2.966; p=0.001).Conclusion: This study provided a population-based estimate of the impact of the COVID-19 outbreak in a severely affected Italian province. A similar 60-day mortality risk was found for patients undergoing immediate IMV and those intubated after an NIV trial with favorable outcomes after prolonged IMV.Keywords: COVID-19, mechanical ventilation, mortality, noninvasive ventilation, multidisciplinary team approach, ARDS

Published
2020

11. Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation

Author

Giorgia Dalpiaz, Lorenzo Gamberini, Aldo Carnevale, Savino Spadaro, Carlo Alberto Mazzoli, Sara Piciucchi, Davide Allegri, Chiara Capozzi, Ersenad Neziri, Maurizio Bartolucci, Francesco Muratore, Francesca Coppola, Antonio Poerio, Emanuela Giampalma, Luca Baldini, Tommaso Tonetti, Iacopo Cappellini, Davide Colombo, Gianluca Zani, Lorenzo Mellini, Vanni Agnoletti, Federica Damiani, Giovanni Gordini, Cristiana Laici, Giuliano Gola, Antonella Potalivo, Jonathan Montomoli, Vito Marco Ranieri, Emanuele Russo, Stefania Taddei, Carlo Alberto Volta, Gaetano Scaramuzzo, Dalpiaz G., Gamberini L., Carnevale A., Spadaro S., Mazzoli C.A., Piciucchi S., Allegri D., Capozzi C., Neziri E., Bartolucci M., Muratore F., Coppola F., Poerio A., Giampalma E., Baldini L., Tonetti T., Cappellini I., Colombo D., Zani G., Mellini L., Agnoletti V., Damiani F., Gordini G., Laici C., Gola G., Potalivo A., Montomoli J., Ranieri V.M., Russo E., Taddei S., Volta C.A., and Scaramuzzo G.

Subjects
Male, Acute respiratory distress syndrome, SARS-CoV-2, Chest Radiology, Novel coronavirus disease 2019, COVID-19, General Medicine, Length of Stay, Middle Aged, Respiration, Artificial, NO, Intensive Care Units, Pulmonary perfusion, Mechanical ventilation, Italy, Microvessels, Thoracic imaging, Humans, Radiology, Nuclear Medicine and imaging, Female, Prospective Studies, Tomography, X-Ray Computed, Lung, Aged
Abstract

Purpose COVID-19-related acute respiratory distress syndrome (ARDS) is characterized by the presence of signs of microvascular involvement at the CT scan, such as the vascular tree in bud (TIB) and the vascular enlargement pattern (VEP). Recent evidence suggests that TIB could be associated with an increased duration of invasive mechanical ventilation (IMV) and intensive care unit (ICU) stay. The primary objective of this study was to evaluate whether microvascular involvement signs could have a prognostic significance concerning liberation from IMV. Material and methods All the COVID-19 patients requiring IMV admitted to 16 Italian ICUs and having a lung CT scan recorded within 3 days from intubation were enrolled in this secondary analysis. Radiologic, clinical and biochemical data were collected. Results A total of 139 patients affected by COVID-19 related ARDS were enrolled. After grouping based on TIB or VEP detection, we found no differences in terms of duration of IMV and mortality. Extension of VEP and TIB was significantly correlated with ground-glass opacities (GGOs) and crazy paving pattern extension. A parenchymal extent over 50% of GGO and crazy paving pattern was more frequently observed among non-survivors, while a VEP and TIB extent involving 3 or more lobes was significantly more frequent in non-responders to prone positioning. Conclusions The presence of early CT scan signs of microvascular involvement in COVID-19 patients does not appear to be associated with differences in duration of IMV and mortality. However, patients with a high extension of VEP and TIB may have a reduced oxygenation response to prone positioning. Trial Registration: NCT04411459 Supplementary Information The online version contains supplementary material available at 10.1007/s11547-021-01444-7.

Published
2022

12. 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

13. Bacterial infections in critically ill patients with SARS-2-COVID-19 infection: results of a prospective observational multicenter study

Author

Antonella Potalivo, Luigi Tritapepe, Cecilia Nencini, Vittorio Sambri, Maurizio Fusari, Gianluca Zani, Anna Malfatto, Alessandro Locatelli, Domenico Vitale, Vincenzo De Santis, Stefania Taddei, Alberto Corona, Anna Prete, Mervyn Singer, De Santis V., Corona A., Vitale D., Nencini C., Potalivo A., Prete A., Zani G., Malfatto A., Tritapepe L., Taddei S., Locatelli A., Sambri V., Fusari M., and Singer M.

Subjects
Microbiology (medical), medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Secondary infection, Critical Illness, Intensive Care Unit, Bacterial Infection, Critically ill patients, Internal medicine, medicine, Infection control, Humans, Prospective Studies, Original Paper, business.industry, SARS-CoV-2, Incidence (epidemiology), COVID-19, General Medicine, Odds ratio, Bacterial Infections, medicine.disease, Secondary bacterial infection, Co-infection, Prospective Studie, Pneumonia, Intensive Care Units, Infectious Diseases, Bacteremia, Critical Illne, Observational study, Critically ill patient, business, Human
Abstract

Purpose To investigate the prevalence, incidence and characteristics of bacterial infections and their impact on outcome in critically ill patients infected with COVID-19. Methods We conducted a prospective observational study in eight Italian ICUs from February to May 2020; data were collected through an interactive electronic database. Kaplan–Meier analysis (limit product method) was used to identify the occurrence of infections and risk of acquisition. Results During the study period 248 patients were recruited in the eight participating ICUs. Ninety (36.3%) patients developed at least one episode of secondary infection. An ICU length of stay between 7 and 14 days was characterized by a higher occurrence of infectious complications, with ventilator-associated pneumonia being the most frequent. At least one course of antibiotic therapy was given to 161 (64.9%) patients. Overall ICU and hospital mortality were 33.9% and 42.9%, respectively. Patients developing bacteremia had a higher risk of ICU mortality [45.9% vs. 31.6%, odds ratio 1.8 (95% CI 0.9–3.7), p = 0.069] and hospital mortality [56.8% vs. 40.3%, odds ratio 1.9 (95% CI 1.1–3.9), p = 0.04]. Conclusion In critically ill patients infected with COVID-19 the incidence of bacterial infections is high and associated with worse outcomes. Regular microbiological surveillance and strict infection control measures are mandated. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01661-2.

Published
2021

14. Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study

Author

Antonio Poerio, Andrea Castelli, Sara Piciucchi, Giulia Falò, Davide Allegri, Marco Verri, Andrea Marudi, Massimiliano Mazzolini, Michele Imbriani, Loredana Franchini, Carlo Coniglio, Mirco Leo, Antonella Potalivo, Luigi Lazzari Agli, Roberta Nicali, Marco Cavagnino, Guglielmo Consales, Marina Terzitta, Harri Sintonen, Raffaella Papa, Maria Teresa Minguzzi, Cristiana Laici, Paolo Orlandi, Federica Damiani, Carlo Alberto Mazzoli, Silvia Orlando, Vito Marco Ranieri, Iacopo Cappellini, Valentina Chiarini, Elisa Marinangeli, Stefano Oldani, Virginia Buldini, Marco Tartaglione, Gianluca Zani, Lorenzo Mellini, Carlo Alberto Volta, Irene Ottaviani, Silvia Candini, Filippo Becherucci, Emanuela Giampalma, Maria Concetta Lanza, Federica Ciccarese, Irene Cavalli, Annalisa Marchio, Bruno Balbi, Fabrizio Racca, Matteo Monari, Luca Morini, Anna Malfatto, Elisabetta Bertellini, Francesco Boni, Emanuele Russo, Lorenzo Viola, Michele Valli, Savino Spadaro, Martina Ferioli, Emanuele Matteo, Giovanni Gordini, Marco Contoli, Ilaria Valentini, Chiara Tartivita, Alessia Guzzo, Lorenzo Giuntoli, Gaetano Scaramuzzo, Davide Colombo, Jessica Maccieri, Luca Bissoni, Stefano Nava, Angela Bellocchio, Patrizio Goti, Laura Bernabé, Jonathan Montomoli, Stefano Maitan, Tommaso Meconi, Angelo Senzi, Lorenzo Gamberini, Silvia Pareschi, Stefania Taddei, Angelica Venni, Fabio Ferrari, Marco Miceli, Chiara Capozzi, Elisabetta Marangoni, Lorenzo Tutino, Giulia Felloni, Antonio Siniscalchi, Giacinto Pizzilli, Francesco Muratore, Giorgia Dalpiaz, Federico Moro, Daniele Fecarotti, Vanni Agnoletti, Gabriele Melegari, Rita Golfieri, Federico Domenico Baccarini, Francesca Facondini, Patrizia Pompa Cleta, Marianna Padovani, Eva Bernardi, Tommaso Tonetti, Angelina Adduci, Federico Daniele, Anna Filomena Ferravante, Maurizio Fusari, Igor Bacchilega, Claudia Ravaglia, Nicola Cilloni, Martina Mughetti, Vittorio Pavoni, Ersenad Neziri, Irene Prediletto, Aline Pagni, Gamberini L., Mazzoli C.A., Prediletto I., Sintonen H., Scaramuzzo G., Allegri D., Colombo D., Tonetti T., Zani G., Capozzi C., Dalpiaz G., Agnoletti V., Cappellini I., Melegari G., Damiani F., Fusari M., Gordini G., Laici C., Lanza M.C., Leo M., Marudi A., Papa R., Potalivo A., Montomoli J., Taddei S., Mazzolini M., Ferravante A.F., Nicali R., Ranieri V.M., Russo E., Volta C.A., Spadaro S., Tartaglione M., Chiarini V., Buldini V., Coniglio C., Moro F., Orlando S., Fecarotti D., Cilloni N., Giuntoli L., Bellocchio A., Matteo E., Pizzilli G., Siniscalchi A., Tartivita C., Cavalli I., Castelli A., Marchio A., Bacchilega I., Bernabe L., Facondini F., Morini L., Bissoni L., Viola L., Meconi T., Pavoni V., Venni A., Pagni A., Cleta P.P., Cavagnino M., Guzzo A., Malfatto A., Adduci A., Pareschi S., Bertellini E., Maccieri J., Marinangeli E., Racca F., Verri M., Falo G., Marangoni E., Ottaviani I., Boni F., Felloni G., Baccarini F.D., Terzitta M., Maitan S., Tutino L., Senzi A., Consales G., Becherucci F., Imbriani M., Orlandi P., Candini S., Golfieri R., Ciccarese F., Poerio A., Muratore F., Ferrari F., Mughetti M., Giampalma E., Franchini L., Neziri E., Miceli M., Minguzzi M.T., Mellini L., Piciucchi S., Monari M., Valli M., Daniele F., Ferioli M., Nava S., Lazzari Agli L.A., Valentini I., Bernardi E., Balbi B., Contoli M., Padovani M., Oldani S., Ravaglia C., and Goti P.

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Health-related quality of life, Population, Article, NO, Pulmonary function testing, 03 medical and health sciences, 0302 clinical medicine, Quality of life, DLCO, Acute respiratory distress syndrome, COVID-19, Dyspnea, Respiratory function tests, Internal medicine, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Survivors, education, Aged, Mechanical ventilation, Health related quality of life, education.field_of_study, Respiratory Distress Syndrome, business.industry, Middle Aged, Respiration, Artificial, Patient Discharge, humanities, 3. Good health, Intensive Care Units, 030228 respiratory system, Italy, Quality of Life, Female, business, Icu discharge, Follow-Up Studies
Abstract

Background Health-related quality of life (HRQoL) impairment is often reported among COVID-19 ICU survivors, and little is known about their long-term outcomes. We evaluated the HRQoL trajectories between 3 months and 1 year after ICU discharge, the factors influencing these trajectories and the presence of clusters of HRQoL profiles in a population of COVID-19 patients who underwent invasive mechanical ventilation (IMV). Moreover, pathophysiological correlations of residual dyspnea were tested. Methods We followed up 178 survivors from 16 Italian ICUs up to one year after ICU discharge. HRQoL was investigated through the 15D instrument. Available pulmonary function tests (PFTs) and chest CT scans at 1 year were also collected. A linear mixed-effects model was adopted to identify factors associated with different HRQoL trajectories and a two-step cluster analysis was performed to identify HRQoL clusters. Results We found that HRQoL increased during the study period, especially for the significant increase of the physical dimensions, while the mental dimensions and dyspnea remained substantially unchanged. Four main 15D profiles were identified: full recovery (47.2%), bad recovery (5.1%) and two partial recovery clusters with mostly physical (9.6%) or mental (38.2%) dimensions affected. Gender, duration of IMV and number of comorbidities significantly influenced HRQoL trajectories. Persistent dyspnea was reported in 58.4% of patients, and weakly, but significantly, correlated with both DLCO and length of IMV. Conclusions HRQoL impairment is frequent 1 year after ICU discharge, and the lowest recovery is found in the mental dimensions. Persistent dyspnea is often reported and weakly correlated with PFTs alterations. Trial registration NCT04411459.

Published
2021

15. Efficacy of corticosteroid treatment for hospitalized patients with severe COVID-19: a multicentre study

Author

Marco Merli, Annalisa Saracino, Maddalena Giannella, Michele Bartoletti, Ilaria Valentini, Pierluigi Viale, Giacomo Fornaro, Vito Marco Ranieri, Francesco Barchiesi, Tommaso Tonetti, Francesca Volpato, Matteo Rinaldi, Linda Bussini, Anna Filomena Ferravante, Antonella Potalivo, Renato Pascale, Zeno Pasquini, Luigia Scudeller, Paolo Gaibani, Francesco Cristini, Massimo Puoti, Arianna Rubin, E. Marchionni, Sara K. Tedeschi, Lorenzo Marconi, Livia Pancaldi, Bartoletti M., Marconi L., Scudeller L., Pancaldi L., Tedeschi S., Giannella M., Rinaldi M., Bussini L., Valentini I., Ferravante A.F., Potalivo A., Marchionni E., Fornaro G., Pascale R., Pasquini Z., Puoti M., Merli M., Barchiesi F., Volpato F., Rubin A., Saracino A., Tonetti T., Gaibani P., Ranieri V.M., Viale P., and Cristini F.

Subjects
0301 basic medicine, Male, Severity of Illness Index, corticosteroids, 0302 clinical medicine, Prednisone, Adrenal Cortex Hormones, Fraction of inspired oxygen, Clinical endpoint, Odds Ratio, Medicine, Corticosteroid, 030212 general & internal medicine, Hospital Mortality, Respiratory Distress Syndrome, Mortality rate, General Medicine, Middle Aged, Hospitals, Infectious Diseases, Treatment Outcome, Italy, Original Article, Female, medicine.drug, Hydroxychloroquine, Microbiology (medical), Adult, medicine.medical_specialty, Critical Illness, 030106 microbiology, Lower risk, Antiviral Agents, 03 medical and health sciences, Internal medicine, Humans, Mortality, Aged, Retrospective Studies, business.industry, SARS-CoV-2, COVID-19, Odds ratio, Heparin, Low-Molecular-Weight, Length of Stay, Survival Analysis, Confidence interval, COVID-19 Drug Treatment, Propensity score matching, ARDS, business
Abstract

Objective: To assess the efficacy of corticosteroids in patients with coronavirus disease 2019 (COVID-19). Methods: A multicentre observational study was performed from 22 February through 30 June 2020. We included consecutive adult patients with severe COVID-19, defined as respiratory rate ≥30 breath per minute, oxygen saturation ≤93% on ambient air or arterial partial pressure of oxygen to fraction of inspired oxygen ≤300 mm Hg. We excluded patients being treated with other immunomodulant drugs, receiving low-dose corticosteroids and receiving corticosteroids 72 hours after admission. The primary endpoint was 30-day mortality from hospital admission. The main exposure variable was corticosteroid therapy at a dose of ≥0.5 mg/kg of prednisone equivalents. It was introduced as binomial covariate in a logistic regression model for the primary endpoint and inverse probability of treatment weighting using the propensity score. Results: Of 1717 patients with COVID-19 evaluated, 513 were included in the study, and of these, 170 (33%) were treated with corticosteroids. During hospitalization, 166 patients (34%) met the criteria of the primary outcome (60/170, 35% in the corticosteroid group and 106/343, 31% in the noncorticosteroid group). At multivariable analysis corticosteroid treatment was not associated with lower 30-day mortality rate (adjusted odds ratio, 0.59; 95% confidence interval (CI), 0.20–1.74; p 0.33). After inverse probability of treatment weighting, corticosteroids were not associated with lower 30-day mortality (average treatment effect, 0.05; 95% CI, −0.02 to 0.09; p 0.12). However, subgroup analysis revealed that in patients with PO2/FiO2 < 200 mm Hg at admission (135 patients, 52 (38%) treated with corticosteroids), corticosteroid treatment was associated with a lower risk of 30-day mortality (23/52, 44% vs. 45/83, 54%; adjusted odds ratio, 0.20; 95% CI, 0.04–0.90; p 0.036). Conclusions: The effect of corticosteroid treatment on mortality might be limited to critically ill COVID-19 patients.

Published
2021

16. Quality of life of COVID-19 critically ill survivors after ICU discharge: 90 days follow-up

Author

Mirco Leo, Harri Sintonen, Irene Cavalli, Vanni Agnoletti, Emanuela Giampalma, Maurizio Fusari, Cristiana Laici, Andrea Castelli, Chiara Capozzi, Irene Ottaviani, Andrea Marudi, Carlo Alberto Mazzoli, Tommaso Tonetti, Iacopo Cappellini, Stefania Taddei, Federica Damiani, Carlo Alberto Volta, Gianluca Zani, Raffaella Papa, Filippo Becherucci, Lorenzo Gamberini, Savino Spadaro, Davide Colombo, Davide Allegri, Gaetano Scaramuzzo, Antonella Potalivo, Giuseppe Nardi, Maria Concetta Lanza, Elisabetta Bertellini, Giovanni Gordini, Federico Crimaldi, Vito Marco Ranieri, Emanuele Russo, Gamberini L., Mazzoli C.A., Sintonen H., Colombo D., Scaramuzzo G., Allegri D., Tonetti T., Zani G., Capozzi C., Giampalma E., Agnoletti V., Becherucci F., Bertellini E., Castelli A., Cappellini I., Cavalli I., Crimaldi F., Damiani F., Fusari M., Gordini G., Laici C., Lanza M.C., Leo M., Marudi A., Nardi G., Ottaviani I., Papa R., Potalivo A., Ranieri V.M., Russo E., Taddei S., Volta C.A., Spadaro S., Clinicum, Harri Sintonen Research Group, and Department of Public Health

Subjects
Male, medicine.medical_specialty, ARDS, Coronavirus disease 2019 (COVID-19), Critical Illness, medicine.medical_treatment, Health-related quality of life, Coronaviru, Disease, Severity of Illness Index, Article, NO, law.invention, Quality of life, law, medicine, Humans, Survivors, Aged, Mechanical ventilation, Respiratory Distress Syndrome, Acute respiratory distress syndrome, SARS-CoV-2, business.industry, Public Health, Environmental and Occupational Health, COVID-19, 15D instrument, Coronavirus, Middle Aged, medicine.disease, Intensive care unit, Patient Discharge, humanities, Intensive Care Units, 3121 General medicine, internal medicine and other clinical medicine, Emergency medicine, Cohort, Quality of Life, Female, Icu discharge, business, Follow-Up Studies
Abstract

Purpose The onset of the coronavirus disease 19 (COVID-19) pandemic in Italy induced a dramatic increase in the need for intensive care unit (ICU) beds for a large proportion of patients affected by COVID-19-related acute respiratory distress syndrome (ARDS). The aim of the present study was to describe the health-related quality of life (HRQoL) at 90 days after ICU discharge in a cohort of COVID-19 patients undergoing invasive mechanical ventilation and to compare it with an age and sex-matched sample from the general Italian and Finnish populations. Moreover, the possible associations between clinical, demographic, social factors, and HRQoL were investigated. Methods COVID-19 ARDS survivors from 16 participating ICUs were followed up until 90 days after ICU discharge and the HRQoL was evaluated with the 15D instrument. A parallel cohort of age and sex-matched Italian population from the same geographic areas was interviewed and a third group of matched Finnish population was extracted from the Finnish 2011 National Health survey. A linear regression analysis was performed to evaluate potential associations between the evaluated factors and HRQoL. Results 205 patients answered to the questionnaire. HRQoL of the COVID-19 ARDS patients was significantly lower than the matched populations in both physical and mental dimensions. Age, sex, number of comorbidities, ARDS class, duration of invasive mechanical ventilation, and occupational status were found to be significant determinants of the 90 days HRQoL. Clinical severity at ICU admission was poorly correlated to HRQoL. Conclusion COVID-19-related ARDS survivors at 90 days after ICU discharge present a significant reduction both on physical and psychological dimensions of HRQoL measured with the 15D instrument. Trial Registration: NCT04411459. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02865-7.

Published
2021

17. Implications of early respiratory support strategies on disease progression in critical COVID-19

Author

RISC-19-ICU Investigators, Pedro D. Wendel Garcia, Hernán Aguirre-Bermeo, Philipp K. Buehler, Mario Alfaro-Farias, Bernd Yuen, Sascha David, Thomas Tschoellitsch, Tobias Wengenmayer, Anita Korsos, Alberto Fogagnolo, Gian Reto Kleger, Maddalena A. Wu, Riccardo Colombo, Fabrizio Turrini, Antonella Potalivo, Emanuele Rezoagli, Raquel Rodríguez-García, Pedro Castro, Arantxa Lander-Azcona, Maria C. Martín-Delgado, Herminia Lozano-Gómez, Rolf Ensner, Marc P. Michot, Nadine Gehring, Peter Schott, Martin Siegemund, Lukas Merki, Jan Wiegand, Marie M. Jeitziner, Marcus Laube, Petra Salomon, Frank Hillgaertner, Alexander Dullenkopf, Hatem Ksouri, Sara Cereghetti, Serge Grazioli, Christian Bürkle, Julien Marrel, Isabelle Fleisch, Marie Helene Perez, Anja Baltussen Weber, Samuele Ceruti, Katharina Marquardt, Tobias Hübner, Hermann Redecker, Michael Studhalter, Michael Stephan, D.A.M.P.J. (Diederik) Gommers, C (Can) Ince, G (Giovanni) Vitale, RISC-19-ICU Investigators, Pedro D. Wendel Garcia, Hernán Aguirre-Bermeo, Philipp K. Buehler, Mario Alfaro-Farias, Bernd Yuen, Sascha David, Thomas Tschoellitsch, Tobias Wengenmayer, Anita Korsos, Alberto Fogagnolo, Gian Reto Kleger, Maddalena A. Wu, Riccardo Colombo, Fabrizio Turrini, Antonella Potalivo, Emanuele Rezoagli, Raquel Rodríguez-García, Pedro Castro, Arantxa Lander-Azcona, Maria C. Martín-Delgado, Herminia Lozano-Gómez, Rolf Ensner, Marc P. Michot, Nadine Gehring, Peter Schott, Martin Siegemund, Lukas Merki, Jan Wiegand, Marie M. Jeitziner, Marcus Laube, Petra Salomon, Frank Hillgaertner, Alexander Dullenkopf, Hatem Ksouri, Sara Cereghetti, Serge Grazioli, Christian Bürkle, Julien Marrel, Isabelle Fleisch, Marie Helene Perez, Anja Baltussen Weber, Samuele Ceruti, Katharina Marquardt, Tobias Hübner, Hermann Redecker, Michael Studhalter, Michael Stephan, D.A.M.P.J. (Diederik) Gommers, C (Can) Ince, and G (Giovanni) Vitale

Abstract

Background: Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Methods: Subanalysis of a prospective, multinational registry of critically ill

Published
2021
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18. 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

19. Gestione del trauma grave

Author

Emiliano Cingolani, Maria Grazia Bocci, Antonella Potalivo, Concetta Pellegrini, Silvia Rogante, Alessia Ciarlone, Giuliana Miraglia, Giovanni Giuliani, Laura Bernabè, Caterina Baraldi, Davide Morri, Elvio De Blasio, Gianfranco Sanson, Giuseppe Nardi, Giuseppe Nardi, Elvio De Blasio, Roberta Ciraolo, Cingolani, Emiliano, Grazia Bocci, Maria, Potalivo, Antonella, Pellegrini, Concetta, Rogante, Silvia, Ciarlone, Alessia, Miraglia, Giuliana, Giuliani, Giovanni, Bernabè, Laura, Baraldi, Caterina, Morri, Davide, De Blasio, Elvio, Sanson, Gianfranco, and Nardi, Giuseppe

Subjects
Terapia intensiva, Linee guida
Abstract

Descrizione del libro Il titolo del libro “Linee Guida…” è certamente fuori luogo. Le Linee Guida odierne sono il risultato di processi sistematici di analisi della letteratura e del grado di evidenza di ogni dato. Noi partiamo dal lavoro svolto da altri, gli esperti dei diversi settori, ma siamo alla terza edizione e per almeno due di noi sarà, sicuramente, l’ultima, per cui non ce la siamo sentita di cambiare il titolo in “Consigli e Suggerimenti” come sarebbe stato, forse, più opportuno.

Published
2020

20. Lactate Arterial-Central Venous Gradient among COVID-19 Patients in ICU: A Potential Tool in the Clinical Practice

Author

Fernando Schiraldi, Gianfranco Sanson, Lucia Tassinari, Antonella Potalivo, Giuseppe Nardi, Giovanna Guiotto, Jonathan Montomoli, Nardi, Giuseppe, Sanson, Gianfranco, Tassinari, Lucia, Guiotto, Giovanna, Potalivo, Antonella, Montomoli, Jonathan, and Schiraldi, Fernando

Subjects
ARDS, Article Subject, medicine.medical_treatment, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, medicine, pneumonia, Prospective cohort study, Mechanical ventilation, Lung, RC86-88.9, business.industry, Tracheal intubation, COVID-19, 030208 emergency & critical care medicine, Medical emergencies. Critical care. Intensive care. First aid, Venous blood, medicine.disease, Arterial lactate, central venous lactate, Pneumonia, Canakinumab, medicine.anatomical_structure, Anesthesia, Arterial blood, business, medicine.drug
Abstract

Objective. In physiological conditions, arterial blood lactate concentration is equal to or lower than central venous blood lactate concentration. A reversal in this rate (i.e., higher lactate concentration in central venous blood), which could reflect a derangement in the mitochondrial metabolism of lung cells induced by inflammation, has been previously reported in patients with ARDS but has been never explored in COVID-19 patients. The aim of this study was to explore if the COVID-19-induced lung cell damage was mirrored by an arterial lactatemia higher than the central venous one; then if the administration of anti-inflammatory therapy (i.e., canakinumab 300 mg subcutaneous) could normalize such abnormal lactate a-cv difference. Methods. A prospective cohort study was conducted, started on March 25, 2020, for a duration of 10 days, enrolling 21 patients affected by severe COVID-19 pneumonia undergoing mechanical ventilation consecutively admitted to the ICU of the Rimini Hospital, Italy. Arterial and central venous blood samples were contemporarily collected to calculate the difference between arterial and central venous lactate (Delta a-cv lactate) concentrations within 24 h from tracheal intubation (T0) and 24 hours after canakinumab administration (T1). Results. At T0, 19 of 21 (90.5%) patients showed a pathologic Delta a-cv lactate (median 0.15 mmol/L; IQR 0.07–0.25). In the 13 patients undergoing canakinumab administration, at T1, Delta a-cv lactate decreased in 92.3% of cases, the decrease being statistically significant (T0: median 0.24, IQR 0.09–0.31 mmol/L; T1: median −0.01, IQR −0.08–0.04 mmol/L; p=0.002). Conclusion. A reversed Delta a-cv lactate might be interpreted as one of the effects of COVID-19-related cytokine storm, which could reflect a derangement in the mitochondrial metabolism of lung cells induced by severe inflammation or other uncoupling mediators. In addition, Delta a-cv lactate decrease might also reflect the anti-inflammatory activity of canakinumab. Our preliminary findings need to be confirmed by larger outcome studies.

Published
2020

21. Severe Respiratory Distress in a Child with Pulmonary Idiopathic Hemosiderosis Initially Presenting with Iron-Deficiency Anemia

Author

Giovanni Giuliani, A. Lupo, L. Finessi, C. Andreoni, Antonella Potalivo, Francesca Facondini, and C. Cavicchi

Subjects
lcsh:RC705-779, Pulmonary and Respiratory Medicine, Mechanical ventilation, Pediatrics, medicine.medical_specialty, Respiratory distress, business.industry, Anemia, medicine.medical_treatment, Clinical course, Case Report, lcsh:Diseases of the respiratory system, Hemosiderosis, medicine.disease, Surgery, Pathogenesis, Iron-deficiency anemia, medicine, Intubation, business
Abstract

Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of alveolar hemorrhage in children but should be considered in children with anemia of unknown origin who develop respiratory complications. It is commonly characterized by the triad of recurrent hemoptysis, diffuse parenchymal infiltrates, and iron-deficiency anemia. Pathogenesis is unclear and diagnosis may be difficult along with a variable clinical course. A 6-year-old boy was admitted to the hospital with a severe iron-deficiency anemia, but he later developed severe acute respiratory failure and hemoptysis requiring intubation and mechanical ventilation. The suspicion of IPH led to the use of immunosuppressive therapy with high dose of corticosteroids with rapid improvement in clinical condition and discharge from hospital.

Published
2015

23. The analgesic efficacy of continuous elastomeric pump ropivacaine wound instillation after appendectomy

Author

Rita Maria Melotti, Stefano Gagliardi, Morena Calli, Vanni Agnoletti, Fausto Catena, Antonella Potalivo, Dario Bettini, Mario Taffurelli, Angelo De Cataldis, Emmanuel Gasperoni, Antonio Leone, Gabriella Simoncini, Antonio Caira, Gianfranco Di Nino, Miria Celotti, Luca Ansaloni, Ansaloni L, Agnoletti V, Bettini D, Caira A, Calli M, Catena F, Celotti M, De Cataldis A, Gagliardi S, Gasperoni E, Leone A, Melotti RM, Potalivo A, Simoncini G, Taffurelli M, and Di Nino G.

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, medicine.drug_class, Visual analogue scale, medicine.medical_treatment, Analgesic, Placebo, law.invention, Randomized controlled trial, Double-Blind Method, law, medicine, Appendectomy, Humans, Ropivacaine, Prospective Studies, Anesthetics, Local, Prospective cohort study, Saline, Infusion Pumps, Pain, Postoperative, Local anesthetic, business.industry, Amides, Surgery, Anesthesiology and Pain Medicine, Anesthesia, Wounds and Injuries, Female, business, medicine.drug
Abstract

Study Objective To evaluate the analgesic efficacy and safety of ropivacaine 0.2% when administered continuously via elastomeric pump after appendectomy. Design Prospective, randomized, double-blinded study. Setting Surgical ward of a university hospital. Patients 96 ASA physical status I and II patients of at least 14 years of age, undergoing appendectomy through a McBurney incision. Interventions Patients were randomly assigned into two groups: 500 mg of ropivacaine in 48 hours (10 mL of 0.2% ropivacaine 20 mg, starter dose plus 5 mL/h continuous wound infusion via elastomeric pump device; n=48) in the experimental group and 250 mL of normal saline, as placebo, in the control group. Measurements Postappendectomy pain, measured either with a simple verbal scale or with a visual analog scale, parenteral analgesic consumption, and global satisfaction were all measured. Main Results A reduction in postoperative pain was observed in the ropivacaine group. Degree of pain, with a simple verbal scale measurement of severe and unbearable, was significantly lower in the ropivacaine group than in the normal saline group from time 0 to 24 hours at rest and from time 0 to 36 hours on coughing. A significant lower pain intensity (visual analog scale) was found in the ropivacaine group both at rest and on coughing, beginning at three hours and continuing to 36 hours postoperatively. The mean number of rescue analgesic doses was significantly lower in the ropivacaine group. There were no statistically significant differences in the frequency of adverse events between the two groups. Conclusions Wound instillation with ropivacaine 0.2% is a useful, practical, and safe method for management of postoperative pain after appendectomy.

Published
2006

24. Postoperative Delirium after elective and emergency surgery: analysis and checking of risk factors. A study protocol

Author

Rabbih Chattat, Claudio Franceschi, Fausto Catena, Stefano Gagliardi, Luca Ansaloni, Vanni Agnoletti, Mario Taffurelli, Gianfranco Di Nino, Angelo De Cataldis, Rita Maria Melotti, Antonella Potalivo, Agnoletti V., Ansaloni L., Catena F., Chattat R., De Cataldis A., Di Nino G., Franceschi C., Gagliardi S., Melotti R.M, Potalivo A., and Taffurelli M.

Subjects
Research design, medicine.medical_specialty, lcsh:Surgery, MEDLINE, ELECTIVE SURGERY, Study Protocol, Cognition, Postoperative Complications, Clinical Protocols, Risk Factors, EMERGENCY SURGERY, mental disorders, medicine, Humans, Postoperative delirium, Elective surgery, POSTOPERATIVE DELIRIUM, Intensive care medicine, Aged, Aged, 80 and over, business.industry, Incidence (epidemiology), Case-control study, Delirium, lcsh:RD1-811, General Medicine, Surgery, Research Design, Case-Control Studies, medicine.symptom, business
Abstract

Background Delirum is common in hospitalized elderly patients and may be associated with increased morbidity, length of stay and patient care costs. Delirium (acute confusional state) is defined as an acute disorder of attention and cognition. In elderly patients, delirium is often an early indicator of patho-physiological disturbances. Despite landmark studies dating back to the 1940s, the pathogenesis of Delirium remains poorly understood. Early investigators noted that Delirium was characterized by global cortical dysfunction that was associated predominantly with specific electroencephalographic changes. It's important to understand the risk factors and incidence of Delirium. Some of the risk factors are already identified in literature and can be summarized in the word "VINDICATE" which stands for: Vascular, Infections, Nutrition, Drugs, Injury, Cardiac, Autoimmune, Tumors, Endocrine. Aims of this study are: to re-evaluate the above mentioned clinical risk factors, adding some others selected from literature, and to test, as risk factors, a pattern of some genes associated to cognitive dysfunction and inflammation possibly related to postoperative Delirium. Design All patients admitted to our Emergency Unit who are meet our inclusion/exclusion criteria will be recruited. The arising of postoperative Delirium will select incidentally two groups (Delirium/non Delirium) and the forward analysis of correlate risk factors will be performed. As in a typical observational case/control study we will consider all the exposure factors to which our population are submitted towards the outcome (presence of Delirium). Our exposures are the following: ASA, Pain (SVS; VAS), Blood gas analysis (pH; Hb; pO2; pCO2), Residence pharmacological therapy (BDZ; hypnotics; narcotic drugs; alcohol; nitrous derivates), Body temperature, Arterial pressure, Heart frequency, Breath frequency, Na, K, Creatinin, Glicemia, Albumin, Hct, White blood cells, Glasgow Coma Scale (GCS), Cognitive state (SPMSQ), Functional state (ADL and IADL), Psychological Distress (HADS), Cumulative Illness Rating Scale (CIRS), Hypotension (classified in: light; moderate and severe and duration), Blood loss (classified in: < 2 lt and > 2 lt), Blood transfusions (< 2 lt and > 2 lt), Quantity of red cells and plasma transfusions, Visual VAS / SVS (timing: I-II-III post-operative day), Red cells and Plasma transfusions, Blood count evaluation and Saturation (O2%), Postoperative analgesia (Emilia-Romagna protocol), Presence of malignant tumoral disease, APACHE Score II. Moreover the presence of some relevant genetic polymorphisms will be studied in different genes such as IL-6, IL-10, TNF-alpha, and IL-1 cluster.

Published
2005

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