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1. 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

Wendel-Garcia, P, Moser, A, Jeitziner, M, Aguirre-Bermeo, H, Arias-Sanchez, P, Apolo, J, Roche-Campo, F, Franch-Llasat, D, Kleger, G, Schrag, C, Pietsch, U, Filipovic, M, David, S, Stahl, K, Bouaoud, S, Ouyahia, A, Fodor, P, Locher, P, Siegemund, M, Zellweger, N, Cereghetti, S, Schott, P, Gangitano, G, Wu, M, Alfaro-Farias, M, Vizmanos-Lamotte, G, Ksouri, H, Gehring, N, Rezoagli, E, Turrini, F, Lozano-Gomez, H, Carsetti, A, Rodriguez-Garcia, R, Yuen, B, Weber, A, Castro, P, Escos-Orta, J, Dullenkopf, A, Martin-Delgado, M, Aslanidis, T, Perez, M, Hillgaertner, F, Ceruti, S, Franchitti Laurent, M, Marrel, J, Colombo, R, Laube, M, Fogagnolo, A, Studhalter, M, Wengenmayer, T, Gamberini, E, Buerkle, C, Buehler, P, Keiser, S, Elhadi, M, Montomoli, J, Guerci, P, Fumeaux, T, Schuepbach, R, Jakob, S, Que, Y, Hilty, M, Wendel-Garcia P. D., Moser A., Jeitziner M. -M., Aguirre-Bermeo H., Arias-Sanchez P., Apolo J., Roche-Campo F., Franch-Llasat D., Kleger G. -R., Schrag C., Pietsch U., Filipovic M., David S., Stahl K., Bouaoud S., Ouyahia A., Fodor P., Locher P., Siegemund M., Zellweger N., Cereghetti S., Schott P., Gangitano G., Wu M. A., Alfaro-Farias M., Vizmanos-Lamotte G., Ksouri H., Gehring N., Rezoagli E., Turrini F., Lozano-Gomez H., Carsetti A., Rodriguez-Garcia R., Yuen B., Weber A. B., Castro P., Escos-Orta J. O., Dullenkopf A., Martin-Delgado M. C., Aslanidis T., Perez M. -H., Hillgaertner F., Ceruti S., Franchitti Laurent M., Marrel J., Colombo R., Laube M., Fogagnolo A., Studhalter M., Wengenmayer T., Gamberini E., Buerkle C., Buehler P. K., Keiser S., Elhadi M., Montomoli J., Guerci P., Fumeaux T., Schuepbach R. A., Jakob S. M., Que Y. -A., Hilty M. P., Wendel-Garcia, P, Moser, A, Jeitziner, M, Aguirre-Bermeo, H, Arias-Sanchez, P, Apolo, J, Roche-Campo, F, Franch-Llasat, D, Kleger, G, Schrag, C, Pietsch, U, Filipovic, M, David, S, Stahl, K, Bouaoud, S, Ouyahia, A, Fodor, P, Locher, P, Siegemund, M, Zellweger, N, Cereghetti, S, Schott, P, Gangitano, G, Wu, M, Alfaro-Farias, M, Vizmanos-Lamotte, G, Ksouri, H, Gehring, N, Rezoagli, E, Turrini, F, Lozano-Gomez, H, Carsetti, A, Rodriguez-Garcia, R, Yuen, B, Weber, A, Castro, P, Escos-Orta, J, Dullenkopf, A, Martin-Delgado, M, Aslanidis, T, Perez, M, Hillgaertner, F, Ceruti, S, Franchitti Laurent, M, Marrel, J, Colombo, R, Laube, M, Fogagnolo, A, Studhalter, M, Wengenmayer, T, Gamberini, E, Buerkle, C, Buehler, P, Keiser, S, Elhadi, M, Montomoli, J, Guerci, P, Fumeaux, T, Schuepbach, R, Jakob, S, Que, Y, Hilty, M, Wendel-Garcia P. D., Moser A., Jeitziner M. -M., Aguirre-Bermeo H., Arias-Sanchez P., Apolo J., Roche-Campo F., Franch-Llasat D., Kleger G. -R., Schrag C., Pietsch U., Filipovic M., David S., Stahl K., Bouaoud S., Ouyahia A., Fodor P., Locher P., Siegemund M., Zellweger N., Cereghetti S., Schott P., Gangitano G., Wu M. A., Alfaro-Farias M., Vizmanos-Lamotte G., Ksouri H., Gehring N., Rezoagli E., Turrini F., Lozano-Gomez H., Carsetti A., Rodriguez-Garcia R., Yuen B., Weber A. B., Castro P., Escos-Orta J. O., Dullenkopf A., Martin-Delgado M. C., Aslanidis T., Perez M. -H., Hillgaertner F., Ceruti S., Franchitti Laurent M., Marrel J., Colombo R., Laube M., Fogagnolo A., Studhalter M., Wengenmayer T., Gamberini E., Buerkle C., Buehler P. K., Keiser S., Elhadi M., Montomoli J., Guerci P., Fumeaux T., Schuepbach R. A., Jakob S. M., Que Y. -A., and Hilty M. P.

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 < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [

Published
2022

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

Author

Wendel Garcia, P, Aguirre-Bermeo, H, Buehler, P, Alfaro-Farias, M, Yuen, B, David, S, Tschoellitsch, T, Wengenmayer, T, Korsos, A, Fogagnolo, A, Kleger, G, Wu, M, Colombo, R, Turrini, F, Potalivo, A, Rezoagli, E, Rodriguez-Garcia, R, Castro, P, Lander-Azcona, A, Martin-Delgado, M, Lozano-Gomez, H, Ensner, R, Michot, M, Gehring, N, Schott, P, Siegemund, M, Merki, L, Wiegand, J, Jeitziner, M, Laube, M, Salomon, P, Hillgaertner, F, Dullenkopf, A, Ksouri, H, Cereghetti, S, Grazioli, S, Burkle, C, Marrel, J, Fleisch, I, Perez, M, Baltussen Weber, A, Ceruti, S, Marquardt, K, Hubner, T, Redecker, H, Studhalter, M, Stephan, M, Selz, D, Pietsch, U, Ristic, A, Heise, A, Meyer zu Bentrup, F, Franchitti Laurent, M, Fodor, P, Gaspert, T, Haberthuer, C, Colak, E, Heuberger, D, Fumeaux, T, Montomoli, J, Guerci, P, Schuepbach, R, Hilty, M, Roche-Campo, F, Algaba-Calderon, A, Apolo, J, Aslanidis, T, Babik, B, Boroli, F, Brem, J, Brenni, M, Brugger, S, Camen, G, Catena, E, Ceriani, R, Chau, I, Christ, A, Cogliati, C, Concha, P, Delahaye, G, Drvaric, I, Escos-Orta, J, Fabbri, S, Facondini, F, Filipovic, M, Gamez-Zapata, J, Gerecke, P, Gommers, D, Hillermann, T, Ince, C, Jenni-Moser, B, Jovic, M, Jurkolow, G, Klarer, A, Lambert, A, Laurent, J, Lavanchy, J, Lienhardt-Nobbe, B, Locher, P, Losser, M, Lussman, R, Magliocca, A, Margarit, A, Martinez, A, Mauri, R, Mayor-Vazquez, E, Meier, J, Moret-Bochatay, M, Murrone, M, Naon, D, Neff, T, Novy, E, Petersen, L, Pugin, J, Ramelet, A, Rilinger, J, Rimensberger, P, Sepulcri, M, Shaikh, K, Sieber, M, Simonini, M, Spadaro, S, Sridharan, G, Stahl, K, Staudacher, D, Taboada-Fraga, X, Tellez, A, Urech, S, Vitale, G, Vizmanos-Lamotte, G, Welte, T, Zalba-Etayo, B, Zellweger, N, Wendel Garcia P. D., Aguirre-Bermeo H., Buehler P. K., Alfaro-Farias M., Yuen B., David S., Tschoellitsch T., Wengenmayer T., Korsos A., Fogagnolo A., Kleger G. -R., Wu M. A., Colombo R., Turrini F., Potalivo A., Rezoagli E., Rodriguez-Garcia R., Castro P., Lander-Azcona A., Martin-Delgado M. C., Lozano-Gomez H., Ensner R., Michot M. P., Gehring N., Schott P., Siegemund M., Merki L., Wiegand J., Jeitziner M. M., Laube M., Salomon P., Hillgaertner F., Dullenkopf A., Ksouri H., Cereghetti S., Grazioli S., Burkle C., Marrel J., Fleisch I., Perez M. -H., Baltussen Weber A., Ceruti S., Marquardt K., Hubner T., Redecker H., Studhalter M., Stephan M., Selz D., Pietsch U., Ristic A., Heise A., Meyer zu Bentrup F., Franchitti Laurent M., Fodor P., Gaspert T., Haberthuer C., Colak E., Heuberger D. M., Fumeaux T., Montomoli J., Guerci P., Schuepbach R. A., Hilty M. P., Roche-Campo F., Algaba-Calderon A., Apolo J., Aslanidis T., Babik B., Boroli F., Brem J., Brenni M., Brugger S. D., Camen G., Catena E., Ceriani R., Chau I., Christ A., Cogliati C., Concha P., Delahaye G., Drvaric I., Escos-Orta J., Fabbri S., Facondini F., Filipovic M., Gamez-Zapata J., Gerecke P., Gommers D., Hillermann T., Ince C., Jenni-Moser B., Jovic M., Jurkolow G., Klarer A., Lambert A., Laurent J. -C., Lavanchy J., Lienhardt-Nobbe B., Locher P., Losser M. -R., Lussman R. F., Magliocca A., Margarit A., Martinez A., Mauri R., Mayor-Vazquez E., Meier J., Moret-Bochatay M., Murrone M., Naon D., Neff T., Novy E., Petersen L., Pugin J., Ramelet A. -S., Rilinger J., Rimensberger P. C., Sepulcri M., Shaikh K., Sieber M., Simonini M. S., Spadaro S., Sridharan G. O., Stahl K., Staudacher D. L., Taboada-Fraga X., Tellez A., Urech S., Vitale G., Vizmanos-Lamotte G., Welte T., Zalba-Etayo B., Zellweger N., Wendel Garcia, P, Aguirre-Bermeo, H, Buehler, P, Alfaro-Farias, M, Yuen, B, David, S, Tschoellitsch, T, Wengenmayer, T, Korsos, A, Fogagnolo, A, Kleger, G, Wu, M, Colombo, R, Turrini, F, Potalivo, A, Rezoagli, E, Rodriguez-Garcia, R, Castro, P, Lander-Azcona, A, Martin-Delgado, M, Lozano-Gomez, H, Ensner, R, Michot, M, Gehring, N, Schott, P, Siegemund, M, Merki, L, Wiegand, J, Jeitziner, M, Laube, M, Salomon, P, Hillgaertner, F, Dullenkopf, A, Ksouri, H, Cereghetti, S, Grazioli, S, Burkle, C, Marrel, J, Fleisch, I, Perez, M, Baltussen Weber, A, Ceruti, S, Marquardt, K, Hubner, T, Redecker, H, Studhalter, M, Stephan, M, Selz, D, Pietsch, U, Ristic, A, Heise, A, Meyer zu Bentrup, F, Franchitti Laurent, M, Fodor, P, Gaspert, T, Haberthuer, C, Colak, E, Heuberger, D, Fumeaux, T, Montomoli, J, Guerci, P, Schuepbach, R, Hilty, M, Roche-Campo, F, Algaba-Calderon, A, Apolo, J, Aslanidis, T, Babik, B, Boroli, F, Brem, J, Brenni, M, Brugger, S, Camen, G, Catena, E, Ceriani, R, Chau, I, Christ, A, Cogliati, C, Concha, P, Delahaye, G, Drvaric, I, Escos-Orta, J, Fabbri, S, Facondini, F, Filipovic, M, Gamez-Zapata, J, Gerecke, P, Gommers, D, Hillermann, T, Ince, C, Jenni-Moser, B, Jovic, M, Jurkolow, G, Klarer, A, Lambert, A, Laurent, J, Lavanchy, J, Lienhardt-Nobbe, B, Locher, P, Losser, M, Lussman, R, Magliocca, A, Margarit, A, Martinez, A, Mauri, R, Mayor-Vazquez, E, Meier, J, Moret-Bochatay, M, Murrone, M, Naon, D, Neff, T, Novy, E, Petersen, L, Pugin, J, Ramelet, A, Rilinger, J, Rimensberger, P, Sepulcri, M, Shaikh, K, Sieber, M, Simonini, M, Spadaro, S, Sridharan, G, Stahl, K, Staudacher, D, Taboada-Fraga, X, Tellez, A, Urech, S, Vitale, G, Vizmanos-Lamotte, G, Welte, T, Zalba-Etayo, B, Zellweger, N, Wendel Garcia P. D., Aguirre-Bermeo H., Buehler P. K., Alfaro-Farias M., Yuen B., David S., Tschoellitsch T., Wengenmayer T., Korsos A., Fogagnolo A., Kleger G. -R., Wu M. A., Colombo R., Turrini F., Potalivo A., Rezoagli E., Rodriguez-Garcia R., Castro P., Lander-Azcona A., Martin-Delgado M. C., Lozano-Gomez H., Ensner R., Michot M. P., Gehring N., Schott P., Siegemund M., Merki L., Wiegand J., Jeitziner M. M., Laube M., Salomon P., Hillgaertner F., Dullenkopf A., Ksouri H., Cereghetti S., Grazioli S., Burkle C., Marrel J., Fleisch I., Perez M. -H., Baltussen Weber A., Ceruti S., Marquardt K., Hubner T., Redecker H., Studhalter M., Stephan M., Selz D., Pietsch U., Ristic A., Heise A., Meyer zu Bentrup F., Franchitti Laurent M., Fodor P., Gaspert T., Haberthuer C., Colak E., Heuberger D. M., Fumeaux T., Montomoli J., Guerci P., Schuepbach R. A., Hilty M. P., Roche-Campo F., Algaba-Calderon A., Apolo J., Aslanidis T., Babik B., Boroli F., Brem J., Brenni M., Brugger S. D., Camen G., Catena E., Ceriani R., Chau I., Christ A., Cogliati C., Concha P., Delahaye G., Drvaric I., Escos-Orta J., Fabbri S., Facondini F., Filipovic M., Gamez-Zapata J., Gerecke P., Gommers D., Hillermann T., Ince C., Jenni-Moser B., Jovic M., Jurkolow G., Klarer A., Lambert A., Laurent J. -C., Lavanchy J., Lienhardt-Nobbe B., Locher P., Losser M. -R., Lussman R. F., Magliocca A., Margarit A., Martinez A., Mauri R., Mayor-Vazquez E., Meier J., Moret-Bochatay M., Murrone M., Naon D., Neff T., Novy E., Petersen L., Pugin J., Ramelet A. -S., Rilinger J., Rimensberger P. C., Sepulcri M., Shaikh K., Sieber M., Simonini M. S., Spadaro S., Sridharan G. O., Stahl K., Staudacher D. L., Taboada-Fraga X., Tellez A., Urech S., Vitale G., Vizmanos-Lamotte G., Welte T., Zalba-Etayo B., and Zellweger N.

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

Published
2021

3. Machine learning using the extreme gradient boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients

Author

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, Montomoli J., Romeo L., Moccia S., Bernardini M., Migliorelli L., Berardini D., Donati A., Carsetti A., Bocci M. G., Wendel Garcia P. D., Fumeaux T., Guerci P., Schupbach R. A., Ince C., Frontoni E., Hilty M. P., 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. -R., Wengenmayer T., Rilinger J., Staudacher D. L., 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. A., Cogliati C., Colombo R., Catena E., Turrini F., Simonini M. S., 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. C., Algaba-Calderon A., Franch-Llasat D., Roche-Campo F., Lozano-Gomez H., Zalba-Etayo B., Michot M. P., Klarer A., Ensner R., Schott P., Urech S., Zellweger N., Merki L., Lambert A., Laube M., Jeitziner M. 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. O., Cereghetti S., Boroli F., Pugin J., Grazioli S., Rimensberger P. C., Burkle C., Marrel J., Brenni M., Fleisch I., Lavanchy J., Perez M. -H., Ramelet A. -S., Weber A. B., Gerecke P., Christ A., Ceruti S., Glotta A., Marquardt K., Shaikh K., Hubner T., Neff T., Redecker H., Moret-Bochatay M., Bentrup F. Z., Studhalter M., Stephan M., Brem J., Gehring N., Selz D., Naon D., Kleger G. -R., Pietsch U., Filipovic M., Ristic A., Sepulcri M., Heise A., Franchitti Laurent M., Laurent J. -C., Schuepbach R., Heuberger D., Buhler P., Brugger S., Fodor P., Locher P., Camen G., Gaspert T., Jovic M., Haberthuer C., Lussman R. F., Colak E., 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, Montomoli J., Romeo L., Moccia S., Bernardini M., Migliorelli L., Berardini D., Donati A., Carsetti A., Bocci M. G., Wendel Garcia P. D., Fumeaux T., Guerci P., Schupbach R. A., Ince C., Frontoni E., Hilty M. P., 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. -R., Wengenmayer T., Rilinger J., Staudacher D. L., 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. A., Cogliati C., Colombo R., Catena E., Turrini F., Simonini M. S., 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. C., Algaba-Calderon A., Franch-Llasat D., Roche-Campo F., Lozano-Gomez H., Zalba-Etayo B., Michot M. P., Klarer A., Ensner R., Schott P., Urech S., Zellweger N., Merki L., Lambert A., Laube M., Jeitziner M. 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. O., Cereghetti S., Boroli F., Pugin J., Grazioli S., Rimensberger P. C., Burkle C., Marrel J., Brenni M., Fleisch I., Lavanchy J., Perez M. -H., Ramelet A. -S., Weber A. B., Gerecke P., Christ A., Ceruti S., Glotta A., Marquardt K., Shaikh K., Hubner T., Neff T., Redecker H., Moret-Bochatay M., Bentrup F. Z., Studhalter M., Stephan M., Brem J., Gehring N., Selz D., Naon D., Kleger G. -R., Pietsch U., Filipovic M., Ristic A., Sepulcri M., Heise A., Franchitti Laurent M., Laurent J. -C., Schuepbach R., Heuberger D., Buhler P., Brugger S., Fodor P., Locher P., Camen G., Gaspert T., Jovic M., Haberthuer C., Lussman R. F., and Colak E.

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 < 0.01 [paired t-test with 95% confidence interval]). Conclusions: The XGBoost model predicted the change in SOFA score in critically ill COVID-19 patients admitted to the ICU and can guide clinical decision support systems (CDSSs) aimed at optimizing available resources.

Published
2021

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

Wendel Garcia P. D., Aguirre-Bermeo H., Buehler P. K., Alfaro-Farias M., Yuen B., David S., Tschoellitsch T., Wengenmayer T., Korsos A., Fogagnolo A., Kleger G. -R., Wu M. A., Colombo R., Turrini F., Potalivo A., Rezoagli E., Rodriguez-Garcia R., Castro P., Lander-Azcona A., Martin-Delgado M. C., Lozano-Gomez H., Ensner R., Michot M. P., Gehring N., Schott P., Siegemund M., Merki L., Wiegand J., Jeitziner M. M., Laube M., Salomon P., Hillgaertner F., Dullenkopf A., Ksouri H., Cereghetti S., Grazioli S., Burkle C., Marrel J., Fleisch I., Perez M. -H., Baltussen Weber A., Ceruti S., Marquardt K., Hubner T., Redecker H., Studhalter M., Stephan M., Selz D., Pietsch U., Ristic A., Heise A., Meyer zu Bentrup F., Franchitti Laurent M., Fodor P., Gaspert T., Haberthuer C., Colak E., Heuberger D. M., Fumeaux T., Montomoli J., Guerci P., Schuepbach R. A., Hilty M. P., Roche-Campo F., Algaba-Calderon A., Apolo J., Aslanidis T., Babik B., Boroli F., Brem J., Brenni M., Brugger S. D., Camen G., Catena E., Ceriani R., Chau I., Christ A., Cogliati C., Concha P., Delahaye G., Drvaric I., Escos-Orta J., Fabbri S., Facondini F., Filipovic M., Gamez-Zapata J., Gerecke P., Gommers D., Hillermann T., Ince C., Jenni-Moser B., Jovic M., Jurkolow G., Klarer A., Lambert A., Laurent J. -C., Lavanchy J., Lienhardt-Nobbe B., Locher P., Losser M. -R., Lussman R. F., Magliocca A., Margarit A., Martinez A., Mauri R., Mayor-Vazquez E., Meier J., Moret-Bochatay M., Murrone M., Naon D., Neff T., Novy E., Petersen L., Pugin J., Ramelet A. -S., Rilinger J., Rimensberger P. C., Sepulcri M., Shaikh K., Sieber M., Simonini M. S., Spadaro S., Sridharan G. O., Stahl K., Staudacher D. L., Taboada-Fraga X., Tellez A., Urech S., Vitale G., Vizmanos-Lamotte G., Welte T., Zalba-Etayo B., Zellweger N., Graduate School, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, AII - Inflammatory diseases, RISC-19-ICU Investigators, Wendel Garcia, P.D., Aguirre-Bermeo, H., Buehler, P.K., Alfaro-Farias, M., Yuen, B., David, S., Tschoellitsch, T., Wengenmayer, T., Korsos, A., Fogagnolo, A., Kleger, G.R., Wu, M.A., Colombo, R., Turrini, F., Potalivo, A., Rezoagli, E., Rodríguez-García, R., Castro, P., Lander-Azcona, A., Martín-Delgado, M.C., Lozano-Gómez, H., Ensner, R., Michot, M.P., Gehring, N., Schott, P., Siegemund, M., Merki, L., Wiegand, J., Jeitziner, M.M., Laube, M., Salomon, P., Hillgaertner, F., Dullenkopf, A., Ksouri, H., Cereghetti, S., Grazioli, S., Bürkle, C., Marrel, J., Fleisch, I., Perez, M.H., Baltussen Weber, A., Ceruti, S., Marquardt, K., Hübner, T., Redecker, H., Studhalter, M., Stephan, M., Selz, D., Pietsch, U., Ristic, A., Heise, A., Meyer Zu Bentrup, F., Franchitti Laurent, M., Fodor, P., Gaspert, T., Haberthuer, C., Colak, E., Heuberger, D.M., Fumeaux, T., Montomoli, J., Guerci, P., Schuepbach, R.A., Hilty, M.P., Roche-Campo, F., Algaba-Calderon, A., Apolo, J., Aslanidis, T., Babik, B., Boroli, F., Brem, J., Brenni, M., Brugger, S.D., Camen, G., Catena, E., Ceriani, R., Chau, I., Christ, A., Cogliati, C., Concha, P., Delahaye, G., Drvaric, I., Escós-Orta, J., Fabbri, S., Facondini, F., Filipovic, M., Gámez-Zapata, J., Gerecke, P., Gommers, D., Hillermann, T., Ince, C., Jenni-Moser, B., Jovic, M., Jurkolow, G., Klarer, A., Lambert, A., Laurent, J.C., Lavanchy, J., Lienhardt-Nobbe, B., Locher, P., Losser, M.R., Lussman, R.F., Magliocca, A., Margarit, A., Martínez, A., Mauri, R., Mayor-Vázquez, E., Meier, J., Moret-Bochatay, M., Murrone, M., Naon, D., Neff, T., Novy, E., Petersen, L., Pugin, J., Ramelet, A.S., Rilinger, J., Rimensberger, P.C., Sepulcri, M., Shaikh, K., Sieber, M., Simonini, M.S., Spadaro, S., Sridharan, G.O., Stahl, K., Staudacher, D.L., Taboada-Fraga, X., Tellez, A., Urech, S., Vitale, G., Vizmanos-Lamotte, G., Welte, T., Zalba-Etayo, B., Zellweger, N., Wendel Garcia, P, Aguirre-Bermeo, H, Buehler, P, Alfaro-Farias, M, Yuen, B, David, S, Tschoellitsch, T, Wengenmayer, T, Korsos, A, Fogagnolo, A, Kleger, G, Wu, M, Colombo, R, Turrini, F, Potalivo, A, Rezoagli, E, Rodriguez-Garcia, R, Castro, P, Lander-Azcona, A, Martin-Delgado, M, Lozano-Gomez, H, Ensner, R, Michot, M, Gehring, N, Schott, P, Siegemund, M, Merki, L, Wiegand, J, Jeitziner, M, Laube, M, Salomon, P, Hillgaertner, F, Dullenkopf, A, Ksouri, H, Cereghetti, S, Grazioli, S, Burkle, C, Marrel, J, Fleisch, I, Perez, M, Baltussen Weber, A, Ceruti, S, Marquardt, K, Hubner, T, Redecker, H, Studhalter, M, Stephan, M, Selz, D, Pietsch, U, Ristic, A, Heise, A, Meyer zu Bentrup, F, Franchitti Laurent, M, Fodor, P, Gaspert, T, Haberthuer, C, Colak, E, Heuberger, D, Fumeaux, T, Montomoli, J, Guerci, P, Schuepbach, R, Hilty, M, Roche-Campo, F, Algaba-Calderon, A, Apolo, J, Aslanidis, T, Babik, B, Boroli, F, Brem, J, Brenni, M, Brugger, S, Camen, G, Catena, E, Ceriani, R, Chau, I, Christ, A, Cogliati, C, Concha, P, Delahaye, G, Drvaric, I, Escos-Orta, J, Fabbri, S, Facondini, F, Filipovic, M, Gamez-Zapata, J, Gerecke, P, Gommers, D, Hillermann, T, Ince, C, Jenni-Moser, B, Jovic, M, Jurkolow, G, Klarer, A, Lambert, A, Laurent, J, Lavanchy, J, Lienhardt-Nobbe, B, Locher, P, Losser, M, Lussman, R, Magliocca, A, Margarit, A, Martinez, A, Mauri, R, Mayor-Vazquez, E, Meier, J, Moret-Bochatay, M, Murrone, M, Naon, D, Neff, T, Novy, E, Petersen, L, Pugin, J, Ramelet, A, Rilinger, J, Rimensberger, P, Sepulcri, M, Shaikh, K, Sieber, M, Simonini, M, Spadaro, S, Sridharan, G, Stahl, K, Staudacher, D, Taboada-Fraga, X, Tellez, A, Urech, S, Vitale, G, Vizmanos-Lamotte, G, Welte, T, Zalba-Etayo, B, Zellweger, N, and Intensive Care

Subjects
Male, ARDS, Time Factors, medicine.medical_treatment, Old age, Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, law, Oxygen therapy, Noninvasive mechanical ventilation, Intubation, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Registries, Prospective cohort study, 610 Medicine & health, Unitats de cures intensives, Intensive care units, Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, Intensive care unit, Intensive Care Units, Treatment Outcome, Vellesa, High flow oxygen therapy, Disease Progression, Female, Standard oxygen therapy, medicine.medical_specialty, Respiratory Therapy, Critical Illness, NO, 03 medical and health sciences, Intensive care, medicine, Humans, Invasive mechanical ventilation, Critically ill, Patient self-inflicted lung injury, Aged, Retrospective Studies, Mechanical ventilation, COVID-19/mortality, COVID-19/therapy, Critical Illness/mortality, Critical Illness/therapy, Respiratory Therapy/methods, Respiratory Therapy/statistics & numerical data, COVID-19, Respiratory support, business.industry, RC86-88.9, Research, Retrospective cohort study, medicine.disease, Malalts en estat crític, 030228 respiratory system, Emergency medicine, business
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

9. Accidental poisoning with biodiesel preservative biocide

Author

Aslanidis, T, Ourailoglou, V, Boultoukas, E, and Giannakou-Peftoulidou, M

Subjects
Case Report
Abstract

Although biodiesel fuels’ use is getting more and more popular, there are only few reports in the literature of poisoning with such agents, and none referring to their preservatives: biocides. We present the management of a 49-year-old Caucasian male who was admitted, after accidental ingestion of biocide solution, in the intensive care unit of a tertiary hospital. In spite of his devastating condition upon arrival to the hospital, he had a remarkable recovery with no local or systemic sequel due to multidisciplinary and early supportive approach of his care.

Published
2014

10. Management of a patient with Opalski's syndrome in intensive care unit and mini review of the literature

Author

Aslanidis, T., Chytas, I., Kontos, A., and Giannakou-Peftoulidou, M.

Subjects
Case Report
Abstract

Stroke syndromes include a variety of syndromes with often overlapping clinical presentations. When ipsilateral hemiplegia is associated with symptoms of a lateral medullary syndrome, it corresponds to the submedullary syndrome of Opalski. A 72-year-old woman presented with sudden onset of headache, gait disturbance, and recurrent vomiting. Her clinical status gradually deteriorated and she was admitted to the intensive care unit where a variety of problems, related to her diagnosis (Opalski syndrome), were managed.

Published
2012

14. Management and visualization of a kinked epidural catheter.

Author

Aslanidis, T., Fileli, A., and Pyrgos, P.

Subjects
*EPIDURAL catheters, *CATHETERIZATION complications, *EPIDURAL anesthesia, *PAIN tolerance, *MEDICAL imaging systems, *LABOR (Obstetrics), *ANALGESIA
Abstract

A lumbar epidural catheter inserted in a 29-year-old woman for labor analgesia. The catheter failed to provide ad- equate analgesia. Moreover, after labor, it proved difficult to be removed. After computer tomography (CT) and magnetic resonance impedance (MRI) examination the course of the catheter was visible, the entrapped catheter was dislodged intact, revealing a kinking near its distal tip. Kinking of an epidural catheter leading to entrapment is an unusual complication of epidural catheterization. [ABSTRACT FROM AUTHOR]

Published
2010

16. Management and visualization of a kinked epidural catheter

Author

Aslanidis, T, Fileli, A, and Pyrgos, P

Subjects
lipids (amino acids, peptides, and proteins), Case Report
Abstract

A lumbar epidural catheter inserted in a 29-year-old woman for labor analgesia. The catheter failed to provide adequate analgesia. Moreover, after labor, it proved difficult to be removed. After computer tomography (CT) and magnetic resonance impedance (MRI) examination the course of the catheter was visible, the entrapped catheter was dislodged intact, revealing a kinking near its distal tip. Kinking of an epidural catheter leading to entrapment is an unusual complication of epidural catheterization.

17. Accidental poisoning with biodiesel preservative biocide.

Author

Aslanidis, T., Ourailoglou, V., Boultoukas, E., and Giannakou-Peftoulidou, M.

Subjects
*BIODIESEL fuels, *BIOCIDES, *INGESTION, *INTENSIVE care units, *TERTIARY care
Abstract

Although biodiesel fuels' use is getting more and more popular, there are only few reports in the literature of poisoning with such agents, and none referring to their preservatives: biocides. We present the management of a 49-year-old Caucasian male who was admitted, after accidental ingestion of biocide solution, in the intensive care unit of a tertiary hospital. In spite of his devastating condition upon arrival to the hospital, he had a remarkable recovery with no local or systemic sequel due to multidisciplinary and early supportive approach of his care. [ABSTRACT FROM AUTHOR]

Published
2014

19. 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, Saba, Al-Ameri, Wendel-Garcia, P, Moser, A, Jeitziner, M, Aguirre-Bermeo, H, Arias-Sanchez, P, Apolo, J, Roche-Campo, F, Franch-Llasat, D, Kleger, G, Schrag, C, Pietsch, U, Filipovic, M, David, S, Stahl, K, Bouaoud, S, Ouyahia, A, Fodor, P, Locher, P, Siegemund, M, Zellweger, N, Cereghetti, S, Schott, P, Gangitano, G, Wu, M, Alfaro-Farias, M, Vizmanos-Lamotte, G, Ksouri, H, Gehring, N, Rezoagli, E, Turrini, F, Lozano-Gomez, H, Carsetti, A, Rodriguez-Garcia, R, Yuen, B, Weber, A, Castro, P, Escos-Orta, J, Dullenkopf, A, Martin-Delgado, M, Aslanidis, T, Perez, M, Hillgaertner, F, Ceruti, S, Franchitti Laurent, M, Marrel, J, Colombo, R, Laube, M, Fogagnolo, A, Studhalter, M, Wengenmayer, T, Gamberini, E, Buerkle, C, Buehler, P, Keiser, S, Elhadi, M, Montomoli, J, Guerci, P, Fumeaux, T, Schuepbach, R, Jakob, S, Que, Y, Hilty, M, Graduate School, Translational Physiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, and AII - Inflammatory diseases

Subjects
Disease dynamic, Disease dynamics, Pandemic, Critical Illness, COVID-19, 610 Medicine & health, Middle Aged, Critical Care and Intensive Care Medicine, Intensive Care Units, Humans, Female, ARDS, Intensive care unit, Prospective Studies, Registries, Pandemics
Abstract

BackgroundIt 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.MethodsProspective, 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.ResultsFour 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 p p p 2/FiO2at admission was lower (132 [123–141] mmHg vs 101 [91–113] mmHg,p p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4–7]% vs 20 [14–29],p p p p p ConclusionCharacteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic.

Published
2022

20. 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

21. Fibroblast Growth Factor 23 in COVID-19: An Observational Study.

Author

Myrou A, Aslanidis T, Makedou K, Mitsianis A, Thisiadou A, Karalazou P, Chatzopoulos G, Papadopoulos A, Kalis A, Giagkoulis D, Lezgidis F, and Savopoulos C

Abstract

Introduction: Fibroblast growth factor 23 (FGF23) belongs structurally to the endocrine FGF protein family, which also includes FGF19 and FGF21. In the past decade, FGF23 has emerged as a possible diagnostic, prognostic biomarker, and therapeutic target in several conditions. Data about COVID-19 and FGF23 is still limited, yet they suggest interesting interactions., Objective: In the present study, the levels of FGF23 were investigated in COVID-19 patients. These levels were also correlated with other inflammatory markers., Materials and Methods: In our prospective observational study, blood samples were collected from 81 patients admitted with COVID-19 (31 males and 50 females). We analyzed the relation of serum FGF23 levels with biochemistry, total blood count, coagulation parameters, and demographic data., Results: The distribution of FGF23 serum levels according to sex and age (n 28-40 =8, n 41-60 =28, n 65-75= 25, n 75+ =20) was similar. No significant correlation between FGF23 and any other biochemistry, total blood count, and coagulation parameter was revealed in the whole sample. Nevertheless, there was a variation in the results among different age groups., Conclusion: FGF23 levels seem to vary in symptomatic COVID-19 infection, but well-organized studies with larger numbers of patients in each group are needed to determine any reliable correlation between FGF23 and other laboratory parameters., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Myrou et al.)

Published
2023
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22. 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

Wendel-Garcia PD, Moser A, Jeitziner MM, Aguirre-Bermeo H, Arias-Sanchez P, Apolo J, Roche-Campo F, Franch-Llasat D, Kleger GR, Schrag C, Pietsch U, Filipovic M, David S, Stahl K, Bouaoud S, Ouyahia A, Fodor P, Locher P, Siegemund M, Zellweger N, Cereghetti S, Schott P, Gangitano G, Wu MA, Alfaro-Farias M, Vizmanos-Lamotte G, Ksouri H, Gehring N, Rezoagli E, Turrini F, Lozano-Gómez H, Carsetti A, Rodríguez-García R, Yuen B, Weber AB, Castro P, Escos-Orta JO, Dullenkopf A, Martín-Delgado MC, Aslanidis T, Perez MH, Hillgaertner F, Ceruti S, Franchitti Laurent M, Marrel J, Colombo R, Laube M, Fogagnolo A, Studhalter M, Wengenmayer T, Gamberini E, Buerkle C, Buehler PK, Keiser S, Elhadi M, Montomoli J, Guerci P, Fumeaux T, Schuepbach RA, Jakob SM, Que YA, and Hilty MP

Subjects
Critical Illness epidemiology, Critical Illness therapy, Female, Humans, Intensive Care Units, Middle Aged, Prospective Studies, Registries, COVID-19 therapy, Pandemics
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 < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO 2 /FiO 2 at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76-86]% vs 74 [64-82]%, p < 0.001). The ICU mortality (23 [19-26]% vs 17 [12-25]%, p < 0.001) and length of stay (14 [13-16] days vs 11 [10-13] days, p < 0.001) decreased over 19 months of the pandemic., Conclusion: Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic., (© 2022. The Author(s).)

Published
2022
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23. Efficacy and Safety of Ketamine in the Treatment of Neuropathic Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Author

Guimarães Pereira JE, Ferreira Gomes Pereira L, Mercante Linhares R, Darcy Alves Bersot C, Aslanidis T, and Ashmawi HA

Abstract

Purpose: Ketamine is a N-methyl-D-aspartate (NMDA) antagonist with strong analgesic properties. Its addition to the treatment of neuropathic pain may reduce pain intensity and improve overall quality of life. A systematic review and meta-analysis of randomized controlled trials was performed to investigate the addition of ketamine to the treatment of patients with neuropathic pain., Patients and Methods: GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to rate the overall certainty of the evidence for each outcome. Eighteen (18) randomized controlled trials including 706 participants were included for further analysis., Results: Ketamine addition to standard treatment of neuropathic pain (NP) resulted in a statistically significant reduction of pain intensity at one week after the end of treatment with ketamine (MD -2.14, 95% CI -2.65 to -1.63; p<0.00001) and after 30 days after the end of treatment with ketamine (MD -1.68, 95% CI -2.25 to -1.12; p<0.00001) and a statistically significant increase in discomfort (RR 4.06; 95% CI 1.18 to 13.95; p=0.03), and psychedelic effects (RR 4.94; 95% CI 2.76 to 8.84; p<0.00001)., Conclusion: There is a statistically significant pain reduction by adding ketamine to the treatment of chronic NP when compared to the standard treatment. However, such pain reduction comes at the expense of adverse outcomes, especially psychedelic effects related to the administration of ketamine. However, the overall quality of certainty of evidence is low due to the clinical heterogeneity among the intervention characteristics of the trials analyzed (different administration routes, dosing regimen, therapy durations, different clinical characteristics of the population investigated). Future large multi-centered trials are necessary to confirm or not the results of the present review., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Guimarães Pereira et al.)

Published
2022
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24. Primary gastric melanoma of unknown origin: a case report and short literature review.

Author

Myrou A, Aslanidis T, Protopapas A, Psoma E, Kontosis A, and Koletsa T

Subjects
Aged, Humans, Male, Melanoma diagnosis, Stomach Neoplasms
Abstract

Though being usually a cutaneous tumor, melanomas can occur in several extracutaneous sites. Primary mucosal melanomas are rare, and primary gastric mucosal melanomas are considered extremely rare. Compared with cutaneous and ocular melanoma, mucosal melanomas have the lowest five-year survival. High level of suspicion of such rare condition may be the only way for early detection, diagnosis and chance for successful management of similar cases. In the present report, a case of a primary gastric melanoma in a 73-year-old man is described, along with a short review of the literature., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Published
2021
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25. Traumatic tricuspid valve papillary muscle case with concomitant acquired patent foramen ovale and covert right atrial rupture.

Author

Pertsas E, Aslanidis T, Andricopoulos G, and Gulielmos V

Subjects
Accidents, Traffic, Cardiac Valve Annuloplasty methods, Female, Foramen Ovale, Patent diagnosis, Foramen Ovale, Patent surgery, Heart Atria injuries, Heart Injuries diagnosis, Heart Injuries etiology, Heart Injuries surgery, Humans, Middle Aged, Papillary Muscles surgery, Tricuspid Valve surgery, Foramen Ovale, Patent etiology, Heart Atria surgery, Papillary Muscles injuries, Tricuspid Valve injuries
Abstract

Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.

Published
2019
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26. Electrodermal Activity during Blood Pooling for Arterial Blood Gases Analysis in Sedated Adult Intensive Care Unit Patients.

Author

Aslanidis T, Grosomanidis V, Karakoulas K, and Chatzisotiriou A

Abstract

Electrodermal activity (EDA) is considered a measure of autonomous nervous system activity. This study performed an exploratory analysis of the EDA changes during blood pooling for arterial blood gas analysis in sedated adult critical care patients and correlated the variations to other monitored parameters. EDA, along with other parameters, were monitored during 4 h routine daytime intensive care nursing and treatment in an adult ICU. 4 h measurements were divided into two groups based upon the sedation level. Selected recordings before and after blood pooling for arterial blood gases analysis (stress event) was performed. Nine stress events from Group A and 17 from Group B were included for further analysis. Patients' demographics, laboratory exams, and severity scores were recorded. For both sedation levels, EDA changes are much greater than any other monitoring parameters used. The changes are noticed in both measurement (15 s and 60 s), even though in the 60 s measurement only selected EDA parameters are significantly changed after the start of the procedure. EDA measurements are more sensitive to a given stress event than cardiovascular or respiratory parameters. However, the present results could only be considered as a pilot study. More studies are needed in order to identify the real stress-load and clinical significance of such stimuli, which are considered otherwise painless in those patients., Competing Interests: The authors declare no conflict of interest.

Published
2018
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27. Electrodermal Activity Monitoring during Endotracheal Suction in Sedated Adult Intensive Care Unit Patients.

Author

Aslanidis T, Grosomanidis V, Karakoulas K, and Chatzisotiriou A

Subjects
Aged, Female, Humans, Intensive Care Units, Male, Middle Aged, Pain Measurement, Prospective Studies, Conscious Sedation statistics & numerical data, Deep Sedation statistics & numerical data, Galvanic Skin Response physiology, Intubation, Intratracheal adverse effects, Suction adverse effects, Suction methods, Suction statistics & numerical data
Abstract

Background: Endotracheal suctioning of respiratory secretions is one of the most common causes of pain and discomfort in Intensive Care Unit environment. The electrical properties of the skin, also known as electrodermal activity (EDA), are considered as an indirect measure of autonomous nervous system., Aim: This study explores EDA changes during endotracheal suction in sedated adult critical care patients; and compares these changes to other monitoring parameters., Materials and Methods: Skin conductance variability, selected hemodynamic and respiratory parameters, bispectral index (BIS) and ambient noise level, were monitored during 4 hour routine daytime intensive care nursing and treatment in an adult Intensive Care Unit. 4h-measurements were divided into 2 groups, based upon the sedation level (group A: Ramsay sedation scale 2-4 and group B: 5-6 respectively) of the patients. Selected recordings before and after endotracheal suction (stress events) were performed. Seven stress events from Group A and 17 from Group B were included for further analysis. Patients' demographics, laboratory exams and severity scores were recorded. Pain status evaluation before every event was also performed via 2 independent observers., Results: In both groups the rate of EDA changes was greater than in other monitoring parameters. Yet, in group A only selected parameters were significantly changed after the start of the procedure, while in group B, every parameter showed significant change (p<0.05). Groups were similar for other co-founding factors., Conclusion: EDA measurements are more sensitive to stress stimuli, than cardiovascular, respiratory or even BIS monitoring. Deeper sedation seems to affect more the intensity of EDA changes during suction.

Published
2018
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28. Electrodermal Activity Monitoring During Painful Stimulation in Sedated Adult Intensive Care Unit Patients: a Pilot Study.

Author

Aslanidis T, Grosomanidis V, Karakoulas K, and Chatzisotiriou A

Subjects
Aged, Female, Humans, Intensive Care Units, Male, Middle Aged, Pilot Projects, Prospective Studies, Conscious Sedation, Galvanic Skin Response, Monitoring, Physiologic, Pain Measurement, Physical Stimulation
Abstract

Introduction-Aim: Newer methods, such as infrared digital pupillometry and electrodermal activity (EDA) measurement have been suggested as good alternatives for analgesia monitoring in critically ill patients. This study analyzed EDA changes due to pain stimulus in sedated adult critical care patients Methods: Skin conductance variability, selected hemodynamic and respiratory parameters, Bispectral index (BIS) and ambient noise level, were monitored during 4 hour routine daytime in an adult ICU. 4h-Measurements were divided into 2 groups, based upon the sedation level of the patients: Group A - Ramsay Sedation Score 2-4 and Group B - Ramsay Sedation Score of 5-6. Selected recordings before and after pain stimulus were performed. The stimulus chosen was the pressure applied to nail bed for 10 sec, which was performed routinely during neurological examination. Patients' demographics, laboratory exams and severity scores were recorded. Pain status evaluation before every event was also performed by 2 independent observers via Critical Care Pain Observation Tool (CPOT) and Adult Non Verbal Pain Score (ANVPS) Results: In both groups the rate of EDA changes was greater than other monitoring parameters: more in Group A than in Group B. Yet, the difference between groups was not statistically significant., Conclusion: EDA measurements are greater to pain stimuli, than cardiovascular, respiratory or even BIS monitoring. These encouraging results suggest that, further studies are needed to better define EDA role in ICU.

Published
2018
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29. Management of a young female patient with Fournier's gangrene and Lemierre's syndrome.

Author

Aslanidis T, Myrou A, and Giannakou-Peftoulidou M

Subjects
Acetamides therapeutic use, Candida albicans isolation & purification, Candidiasis complications, Candidiasis microbiology, Caspofungin, Debridement, Drug Therapy, Combination, Echinocandins therapeutic use, Female, Fournier Gangrene complications, Fournier Gangrene microbiology, Humans, Klebsiella Infections complications, Klebsiella Infections microbiology, Klebsiella pneumoniae isolation & purification, Lemierre Syndrome complications, Lemierre Syndrome microbiology, Linezolid, Lipopeptides, Oxazolidinones therapeutic use, Staphylococcal Infections complications, Staphylococcal Infections microbiology, Staphylococcus epidermidis isolation & purification, Young Adult, Anti-Bacterial Agents therapeutic use, Antifungal Agents therapeutic use, Candidiasis drug therapy, Fournier Gangrene drug therapy, Klebsiella Infections drug therapy, Lemierre Syndrome drug therapy, Staphylococcal Infections drug therapy
Abstract

Fournier's gangrene is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions. Lemierre's syndrome is a condition characterized by thrombophlebitis of the internal jugular vein and bacteremia caused by primarily anaerobic organisms, following a recent oropharyngeal infection. Although the literature about either of them is rich, there is no report about co-appearance of the two syndromes. We present the case of a young healthy female patient who suffered concomitantly from Fournier's gangrene and Lemierre's syndrome after minor surgery.

Published
2014
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30. Management of a patient with Opalski's syndrome in intensive care unit and mini review of the literature.

Author

Aslanidis T, Chytas I, Kontos A, and Giannakou-Peftoulidou M

Abstract

Stroke syndromes include a variety of syndromes with often overlapping clinical presentations. When ipsilateral hemiplegia is associated with symptoms of a lateral medullary syndrome, it corresponds to the submedullary syndrome of Opalski. A 72-year-old woman presented with sudden onset of headache, gait disturbance, and recurrent vomiting. Her clinical status gradually deteriorated and she was admitted to the intensive care unit where a variety of problems, related to her diagnosis (Opalski syndrome), were managed.

Published
2012

31. Appendectomy for an adult with cyanotic congenital heart disease.

Author

Chatzidaki R, Koraki E, Vasiliadis K, Aslanidis T, and Vasilakos D

Subjects
Androstanols, Appendicitis complications, Arrhythmias, Cardiac prevention & control, Contraindications, Cyanosis, Embolism, Paradoxical prevention & control, Emergencies, Endocarditis, Subacute Bacterial prevention & control, Female, Fentanyl, Heart Defects, Congenital diagnostic imaging, Heart Defects, Congenital physiopathology, Humans, Intraoperative Complications prevention & control, Ketamine, Narcotics, Oxygen administration & dosage, Propofol, Risk, Rocuronium, Ultrasonography, Vascular Resistance drug effects, Young Adult, Anesthesia, Intravenous methods, Appendectomy, Appendicitis surgery, Heart Defects, Congenital complications
Abstract

Few patients with cyanotic congenital heart disease reach adulthood without a cardiac operation. The prognosis for ''unrepaired'' pulmonary atresia with ventricular septal defect is approximately 8% in the 1st decade of age. Consequently, the number of adults with this particular heart disease (unrepaired) who are expected to need a non-cardiac surgery is extremely low. General anesthesia may aggravate the preexisting right to left shunt and lead to persistent severe hypoxemia. The goal of anesthetic management should be to maintain intravascular volume. Systemic and pulmonary vascular resistance changes, such as might occur due to acidosis, hypothermia, hypercarbia or excessive airway pressures, should be avoided. Maintenance of preload, contractility and sinus rhythm is of major importance. The complex pathophysiology of such heart disease, in addition to the circumstances of emergency operation, exacerbate the total anesthetic risk. We present here a rare case of an acute appendectomy with successful outcome in an adult with pulmonary atresia and ventricular septal defect.

Published
2009

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