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1. Algor-ethics: charting the ethical path for AI in critical care

Author

Montomoli, J, Bitondo, M, Cascella, M, Rezoagli, E, Romeo, L, Bellini, V, Semeraro, F, Gamberini, E, Frontoni, E, Agnoletti, V, Altini, M, Benanti, P, Bignami, E, Montomoli J., Bitondo M. M., Cascella M., Rezoagli E., Romeo L., Bellini V., Semeraro F., Gamberini E., Frontoni E., Agnoletti V., Altini M., Benanti P., Bignami E. G., Montomoli, J, Bitondo, M, Cascella, M, Rezoagli, E, Romeo, L, Bellini, V, Semeraro, F, Gamberini, E, Frontoni, E, Agnoletti, V, Altini, M, Benanti, P, Bignami, E, Montomoli J., Bitondo M. M., Cascella M., Rezoagli E., Romeo L., Bellini V., Semeraro F., Gamberini E., Frontoni E., Agnoletti V., Altini M., Benanti P., and Bignami E. G.

Abstract

The integration of Clinical Decision Support Systems (CDSS) based on artificial intelligence (AI) in healthcare is groundbreaking evolution with enormous potential, but its development and ethical implementation, presents unique challenges, particularly in critical care, where physicians often deal with life-threating conditions requiring rapid actions and patients unable to participate in the decisional process. Moreover, development of AI-based CDSS is complex and should address different sources of bias, including data acquisition, health disparities, domain shifts during clinical use, and cognitive biases in decision-making. In this scenario algor-ethics is mandatory and emphasizes the integration of ‘Human-in-the-Loop’ and ‘Algorithmic Stewardship’ principles, and the benefits of advanced data engineering. The establishment of Clinical AI Departments (CAID) is necessary to lead AI innovation in healthcare, ensuring ethical integrity and human-centered development in this rapidly evolving field.

Published
2024

2. The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Author

De Rosa, S, Sella, N, Rezoagli, E, Lorenzoni, G, Gregori, D, Bellani, G, Foti, G, Pettenuzzo, T, Baratto, F, Fullin, G, Papaccio, F, Peta, M, Poole, D, Toffoletto, F, Maggiore, S, Navales, P, Navalesi, P, Tiberio, I, Pasin, L, Godi, I, Serra, E, Zarantonello, F, Andreatta, G, Boscolo, A, Persona, P, Cattin, L, Forin, E, Boni, E, Golino, G, Danzi, V, Vetrugno, L, Cornacchia, N, Donadello, K, Gottin, L, Polati, E, Campagnolo, M, Linassi, F, Panciera, G, Garofalo, E, Bruni, A, Carlon, R, Pipitone, M, Candosin, A, Badii, F, Role, S, Girardis, M, Busani, S, Gamberini, E, Tartivita, C, Gamberini, L, Cortegiani, A, Frisella, S, Ippolito, M, Salvo, F, Greco, M, Cecconi, M, Aceto, R, Langer, T, Repishti, M, Zeduri, A, Ottolina, D, Fossali, T, Colombo, R, Predonzani, N, Ferluga, M, Blasi, S, Zardin, M, Vergine, S, Luccarelli, G, Tritapepe, L, Francesconi, A, Pagani, M, Mojoli, F, Orlando, A, Mongodi, S, Bitondo, M, Johnathan, M, Maugeri, J, Bellissima, A, Guzzardella, A, Vallecoccia, M, Spadaro, S, Cricca, V, Andriolo, E, Bianchin, A, Alampi, D, Rocco, M, Anchisi, S, Tenaglia, T, Nicoletti, R, Antonini, B, Zanaty, M, Mogahed, M, Ali, A, Emara, M, Abdullah, E, Awad, A, Abdel-Maboud, M, Hussein, A, Mosleh, A, Ahmed, M, Aziz, M, Elsayed, A, Aldhalia, A, Elkhatid, A, Abodina, A, Khalleefah, A, Shalabi, L, Shamed, H, Bakeer, H, Hawad, A, Abuzaid, T, Alqandouz, R, Saliga, A, Haddud, A, Kredan, A, Shaban, M, Salama, A, Altabit, A, Alflite, A, Hashim, H, Kadhim, Q, Abd-Alreda, A, Al-Juifari, M, Al-Gburi, S, Akram, A, Laila, A, Bakri, A, Abdelmageed, A, Binnawara, M, Mohamed, M, Esaadi, H, Othman, E, Said, A, Alarabi, R, Alameen, H, Albouishi, N, Babaa, K, Salih, R, Elbakheet, D, Abuelyamen, A, Perez-Torres, D, Mattson, J, Al-Sadawi, M, Elseidy, S, De Rosa S., Sella N., Rezoagli E., Lorenzoni G., Gregori D., Bellani G., Foti G., Pettenuzzo T., Baratto F., Fullin G., Papaccio F., Peta M., Poole D., Toffoletto F., Maggiore S. M., Navales P., Navalesi P., Tiberio I., Pasin L., Godi I., Serra E., Zarantonello F., Andreatta G., Boscolo A., Persona P., Cattin L., Forin E., Boni E., Golino G., Danzi V., Vetrugno L., Cornacchia N., Donadello K., Gottin L., Polati E., Campagnolo M., Linassi F., Panciera G., Garofalo E., Bruni A., Carlon R., Pipitone M., Candosin A., Badii F., Role S. D., Girardis M., Busani S., Gamberini E., Tartivita C. N., Gamberini L., Cortegiani A., Frisella S., Ippolito M., Salvo F., Greco M., Cecconi M., Aceto R., Langer T., Repishti M., Zeduri A., Ottolina D., Fossali T., Colombo R., Predonzani N., Ferluga M., Blasi S. D., Zardin M., Vergine S., Luccarelli G., Tritapepe L., Francesconi A. G., Pagani M., Mojoli F., Orlando A., Mongodi S., Bitondo M., Johnathan M., Maugeri J., Bellissima A., Guzzardella A., Vallecoccia M. S., Spadaro S., Cricca V., Andriolo E., Bianchin A., Alampi D., Rocco M., Anchisi S., Tenaglia T., Nicoletti R., Antonini B., Zanaty M., Mogahed M., Ali A., Emara M., Abdullah E., Awad A. K., Abdel-Maboud M., Hussein A. M., Hussein A. A. R. M., Mosleh A. A., Ahmed M. G., Aziz M. G., Elsayed A., Aldhalia A., Elkhatid A., Abodina A. M., Khalleefah A., Shalabi L. E., Shamed H., Bakeer H. B., Hawad A., Abuzaid T., Alqandouz R. A. S., Saliga A. A., Haddud A., Kredan A. A., Shaban M. S., Salama A. A., Altabit A. E. R. M., Alflite A. O. S., Hashim H. T., Kadhim Q. M., Abd-Alreda A. H., Al-Juifari M. A., Al-Gburi S. M., Akram A., Laila A., Bakri A., Abdelmageed A., Binnawara M., Mohamed M., Esaadi H., Othman E., Said A., Alarabi R., Alameen H., Albouishi N., Babaa K. A., Salih R., Elbakheet D. E., Abuelyamen A., Perez-Torres D., Mattson J., Al-Sadawi M., Elseidy S., De Rosa, S, Sella, N, Rezoagli, E, Lorenzoni, G, Gregori, D, Bellani, G, Foti, G, Pettenuzzo, T, Baratto, F, Fullin, G, Papaccio, F, Peta, M, Poole, D, Toffoletto, F, Maggiore, S, Navales, P, Navalesi, P, Tiberio, I, Pasin, L, Godi, I, Serra, E, Zarantonello, F, Andreatta, G, Boscolo, A, Persona, P, Cattin, L, Forin, E, Boni, E, Golino, G, Danzi, V, Vetrugno, L, Cornacchia, N, Donadello, K, Gottin, L, Polati, E, Campagnolo, M, Linassi, F, Panciera, G, Garofalo, E, Bruni, A, Carlon, R, Pipitone, M, Candosin, A, Badii, F, Role, S, Girardis, M, Busani, S, Gamberini, E, Tartivita, C, Gamberini, L, Cortegiani, A, Frisella, S, Ippolito, M, Salvo, F, Greco, M, Cecconi, M, Aceto, R, Langer, T, Repishti, M, Zeduri, A, Ottolina, D, Fossali, T, Colombo, R, Predonzani, N, Ferluga, M, Blasi, S, Zardin, M, Vergine, S, Luccarelli, G, Tritapepe, L, Francesconi, A, Pagani, M, Mojoli, F, Orlando, A, Mongodi, S, Bitondo, M, Johnathan, M, Maugeri, J, Bellissima, A, Guzzardella, A, Vallecoccia, M, Spadaro, S, Cricca, V, Andriolo, E, Bianchin, A, Alampi, D, Rocco, M, Anchisi, S, Tenaglia, T, Nicoletti, R, Antonini, B, Zanaty, M, Mogahed, M, Ali, A, Emara, M, Abdullah, E, Awad, A, Abdel-Maboud, M, Hussein, A, Mosleh, A, Ahmed, M, Aziz, M, Elsayed, A, Aldhalia, A, Elkhatid, A, Abodina, A, Khalleefah, A, Shalabi, L, Shamed, H, Bakeer, H, Hawad, A, Abuzaid, T, Alqandouz, R, Saliga, A, Haddud, A, Kredan, A, Shaban, M, Salama, A, Altabit, A, Alflite, A, Hashim, H, Kadhim, Q, Abd-Alreda, A, Al-Juifari, M, Al-Gburi, S, Akram, A, Laila, A, Bakri, A, Abdelmageed, A, Binnawara, M, Mohamed, M, Esaadi, H, Othman, E, Said, A, Alarabi, R, Alameen, H, Albouishi, N, Babaa, K, Salih, R, Elbakheet, D, Abuelyamen, A, Perez-Torres, D, Mattson, J, Al-Sadawi, M, Elseidy, S, De Rosa S., Sella N., Rezoagli E., Lorenzoni G., Gregori D., Bellani G., Foti G., Pettenuzzo T., Baratto F., Fullin G., Papaccio F., Peta M., Poole D., Toffoletto F., Maggiore S. M., Navales P., Navalesi P., Tiberio I., Pasin L., Godi I., Serra E., Zarantonello F., Andreatta G., Boscolo A., Persona P., Cattin L., Forin E., Boni E., Golino G., Danzi V., Vetrugno L., Cornacchia N., Donadello K., Gottin L., Polati E., Campagnolo M., Linassi F., Panciera G., Garofalo E., Bruni A., Carlon R., Pipitone M., Candosin A., Badii F., Role S. D., Girardis M., Busani S., Gamberini E., Tartivita C. N., Gamberini L., Cortegiani A., Frisella S., Ippolito M., Salvo F., Greco M., Cecconi M., Aceto R., Langer T., Repishti M., Zeduri A., Ottolina D., Fossali T., Colombo R., Predonzani N., Ferluga M., Blasi S. D., Zardin M., Vergine S., Luccarelli G., Tritapepe L., Francesconi A. G., Pagani M., Mojoli F., Orlando A., Mongodi S., Bitondo M., Johnathan M., Maugeri J., Bellissima A., Guzzardella A., Vallecoccia M. S., Spadaro S., Cricca V., Andriolo E., Bianchin A., Alampi D., Rocco M., Anchisi S., Tenaglia T., Nicoletti R., Antonini B., Zanaty M., Mogahed M., Ali A., Emara M., Abdullah E., Awad A. K., Abdel-Maboud M., Hussein A. M., Hussein A. A. R. M., Mosleh A. A., Ahmed M. G., Aziz M. G., Elsayed A., Aldhalia A., Elkhatid A., Abodina A. M., Khalleefah A., Shalabi L. E., Shamed H., Bakeer H. B., Hawad A., Abuzaid T., Alqandouz R. A. S., Saliga A. A., Haddud A., Kredan A. A., Shaban M. S., Salama A. A., Altabit A. E. R. M., Alflite A. O. S., Hashim H. T., Kadhim Q. M., Abd-Alreda A. H., Al-Juifari M. A., Al-Gburi S. M., Akram A., Laila A., Bakri A., Abdelmageed A., Binnawara M., Mohamed M., Esaadi H., Othman E., Said A., Alarabi R., Alameen H., Albouishi N., Babaa K. A., Salih R., Elbakheet D. E., Abuelyamen A., Perez-Torres D., Mattson J., Al-Sadawi M., and Elseidy S.

Abstract

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

Published
2022

3. Long-term outcome of COVID-19 patients treated with helmet noninvasive ventilation vs. high-flow nasal oxygen: a randomized trial

Author

Michi T., Mattana C., Menga L. S., Bocci M. G., Cesarano M., Rosa T., Gualano M. R., Montomoli J., Spadaro S., Tosato M., Rota E., Landi F., Cutuli S. L., Tanzarella E. S., Pintaudi G., Piervincenzi E., Bello G., Tonetti T., Rucci P., De Pascale G., Maggiore S. M., Grieco D. L., Conti G., Antonelli M., Maviglia R., Mercurio G., De Santis P., Pennisi M. A., Anzellotti G. M., Torrini F., Rubino C., Morena T. C., Gennenzi V., Postorino S., Vargas J., Filetici N., Settanni D., Durante M., Cascarano L., Di Muro M., Scarascia R., Bitondo M. M., Murdolo M., Mele A., Silva S., Zaccone C., Pozzana F., Maccaglia A., Savino M., Potalivo A., Ceccaroni F., Scavone A., Lombardi G., Montini L., Dell'Anna A. M., Volta C. A., Ranieri V. M., Falo G., Carelli S., Natalini D., Berardi C., Delle Cese L., Vetrugno L., Balzani E., Michi T., Mattana C., Menga L.S., Bocci M.G., Cesarano M., Rosa T., Gualano M.R., Montomoli J., Spadaro S., Tosato M., Rota E., Landi F., Cutuli S.L., Tanzarella E.S., Pintaudi G., Piervincenzi E., Bello G., Tonetti T., Rucci P., De Pascale G., Maggiore S.M., Grieco D.L., Conti G., Antonelli M., Maviglia R., Mercurio G., De Santis P., Pennisi M.A., Anzellotti G.M., Torrini F., Rubino C., Morena T.C., Gennenzi V., Postorino S., Vargas J., Filetici N., Settanni D., Durante M., Cascarano L., Di Muro M., Scarascia R., Bitondo M.M., Murdolo M., Mele A., Silva S., Zaccone C., Pozzana F., Maccaglia A., Savino M., Potalivo A., Ceccaroni F., Scavone A., Lombardi G., Montini L., Dell'Anna A.M., Volta C.A., Ranieri V.M., Falo G., Carelli S., Natalini D., Berardi C., Delle Cese L., Vetrugno L., and Balzani E.

Subjects
Helmet, COVID-19, Acute respiratory failure, High-flow nasal oxygen, Noninvasive ventilation, Patient self-inflicted lung injury (P-SILI)
Abstract

Background: Long-term outcomes of patients treated with helmet noninvasive ventilation (NIV) are unknown: safety concerns regarding the risk of patient self-inflicted lung injury and delayed intubation exist when NIV is applied in hypoxemic patients. We assessed the 6-month outcome of patients who received helmet NIV or high-flow nasal oxygen for COVID-19 hypoxemic respiratory failure. Methods: In this prespecified analysis of a randomized trial of helmet NIV versus high-flow nasal oxygen (HENIVOT), clinical status, physical performance (6-min-walking-test and 30-s chair stand test), respiratory function and quality of life (EuroQoL five dimensions five levels questionnaire, EuroQoL VAS, SF36 and Post-Traumatic Stress Disorder Checklist for the DSM) were evaluated 6months after the enrollment. Results: Among 80 patients who were alive, 71 (89%) completed the follow-up: 35 had received helmet NIV, 36 high-flow oxygen. There was no inter-group difference in any item concerning vital signs (N = 4), physical performance (N = 18), respiratory function (N = 27), quality of life (N = 21) and laboratory tests (N = 15). Arthralgia was significantly lower in the helmet group (16% vs. 55%, p = 0.002). Fifty-two percent of patients in helmet group vs. 63% of patients in high-flow group had diffusing capacity of the lungs for carbon monoxide < 80% of predicted (p = 0.44); 13% vs. 22% had forced vital capacity < 80% of predicted (p = 0.51). Both groups reported similar degree of pain (p = 0.81) and anxiety (p = 0.81) at the EQ-5D-5L test; the EQ-VAS score was similar in the two groups (p = 0.27). Compared to patients who successfully avoided invasive mechanical ventilation (54/71, 76%), intubated patients (17/71, 24%) had significantly worse pulmonary function (median diffusing capacity of the lungs for carbon monoxide 66% [Interquartile range: 47–77] of predicted vs. 80% [71–88], p = 0.005) and decreased quality of life (EQ-VAS: 70 [53–70] vs. 80 [70–83], p = 0.01). Conclusions: In patients with COVID-19 hypoxemic respiratory failure, treatment with helmet NIV or high-flow oxygen yielded similar quality of life and functional outcome at 6months. The need for invasive mechanical ventilation was associated with worse outcomes. These data indicate that helmet NIV, as applied in the HENIVOT trial, can be safely used in hypoxemic patients. Trial registration Registered on clinicaltrials.gov NCT04502576 on August 6, 2020

Published
2023

4. The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Author

De Rosa, S., Sella, N., Rezoagli, E., Lorenzoni, G., Gregori, D., Bellani, G., Foti, G., Pettenuzzo, T., Baratto, F., Fullin, G., Papaccio, F., Peta, M., Poole, D., Toffoletto, F., Maggiore, S. M., Navales, P., Navalesi, P., Tiberio, I., Pasin, L., Godi, I., Serra, E., Zarantonello, F., Andreatta, G., Boscolo, A., Persona, P., Cattin, L., Forin, E., Boni, E., Golino, G., Danzi, V., Vetrugno, L., Cornacchia, N., Donadello, K., Gottin, L., Polati, E., Campagnolo, M., Linassi, F., Panciera, G., Garofalo, E., Bruni, A., Carlon, R., Pipitone, M., Candosin, A., Badii, F., Role, S. D., Girardis, M., Busani, S., Gamberini, E., Tartivita, C. N., Gamberini, L., Cortegiani, A., Frisella, S., Ippolito, M., Salvo, F., Greco, M., Cecconi, M., Aceto, R., Langer, T., Repishti, M., Zeduri, A., Ottolina, D., Fossali, T., Colombo, R., Predonzani, N., Ferluga, M., Blasi, S. D., Zardin, M., Vergine, S., Luccarelli, G., Tritapepe, L., Francesconi, A. G., Pagani, M., Mojoli, F., Orlando, A., Mongodi, S., Bitondo, M., Johnathan, M., Maugeri, J., Bellissima, A., Guzzardella, A., Vallecoccia, M. S., Spadaro, S., Cricca, V., Andriolo, E., Bianchin, A., Alampi, D., Rocco, M., Anchisi, S., Tenaglia, T., Nicoletti, R., Antonini, B., Zanaty, M., Mogahed, M., Ali, A., Emara, M., Abdullah, E., Awad, A. K., Abdel-Maboud, M., Hussein, A. M., Hussein, A. A. R. M., Mosleh, A. A., Ahmed, M. G., Aziz, M. G., Elsayed, A., Aldhalia, A., Elkhatid, A., Abodina, A. M., Khalleefah, A., Shalabi, L. E., Shamed, H., Bakeer, H. B., Hawad, A., Abuzaid, T., Alqandouz, R. A. S., Saliga, A. A., Haddud, A., Kredan, A. A., Shaban, M. S., Salama, A. A., Altabit, A. E. R. M., Alflite, A. O. S., Hashim, H. T., Kadhim, Q. M., Abd-Alreda, A. H., Al-Juifari, M. A., Al-Gburi, S. M., Akram, A., Laila, A., Bakri, A., Abdelmageed, A., Binnawara, M., Mohamed, M., Esaadi, H., Othman, E., Said, A., Alarabi, R., Alameen, H., Albouishi, N., Babaa, K. A., Salih, R., Elbakheet, D. E., Abuelyamen, A., Perez-Torres, D., Mattson, J., Al-Sadawi, M., Elseidy, S., De Rosa, Silvia, Sella, Nicolò, Rezoagli, Emanuele, Lorenzoni, Giulia, Gregori, Dario, Bellani, Giacomo, Foti, Giuseppe, Pettenuzzo, Tommaso, Baratto, Fabio, Fullin, Giorgio, Papaccio, Francesco, Peta, Mario, Poole, Daniele, Toffoletto, Fabio, Maggiore, Salvatore Maurizio, Navalesi, Paolo, SIAARTI Study group, Cortegiani, Andrea, Frisella, Sara, and Ippolito, Mariachiara

Subjects
Multidisciplinary, prone position, respiratory failure, COVID-19
Abstract

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the “PROVENT-C19 Registry”, endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care…’(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Trial registration The registry was registered (ClinicalTrial.Gov Trials Register NCT04905875) on May 28,2021.

Published
2022
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5. Post-operative analgesia following total knee arthroplasty: comparison of low-dose intrathecal morphine and single-shot ultrasound-guided femoral nerve block: a randomized, single blinded, controlled study

Author

Luciano Frassanito, Vergari A, Zanghi F, Messina A, Bitondo M, and Antonelli M

Subjects
Male, Analysis of Variance, Pain, Postoperative, Morphine, Analgesia, Patient-Controlled, Nerve Block, Middle Aged, Amides, Bupivacaine, Analgesics, Opioid, Humans, Female, Ropivacaine, Single-Blind Method, Anesthetics, Local, Arthroplasty, Replacement, Knee, Femoral Nerve, Aged, Pain Measurement
Abstract

Total knee arthroplasty often results in marked postoperative pain. A recent meta-analysis supports the use of femoral nerve block or alternatively spinal injection of morphine plus local anaesthetic for post-operative analgesia. On the other hand, the use of intrathecal morphine may be associated with a large number of distressing side effects (itching, urinary retention, nausea and vomiting, delayed respiratory depression). The aim of this study was to compare the effectiveness of femoral nerve block and low dose intrathecal morphine in post-operative analgesia after primary unilateral total knee arthroplasty.Fifty-two consecutive patients scheduled for primary unilateral total knee arthroplasty were allocated to the intrathecal morphine group (ITM group) or to the femoral nerve block group (FNB group). In ITM group a subarachnoid puncture was performed at the L3-L4 inter-vertebral space with hyperbaric bupivacaine 15 mg plus 100 mcg of preservative-free morphine. Patients allocated to the FNB group received a single-injection ultrasound-assisted femoral nerve block with ropivacaine 0.75% 25 ml before the spinal injection of hyperbaric bupivacaine 15 mg. All patients received postoperative patient-controlled-analgesia (PCA) morphine, using a 1-mg bolus and a 5-minute lockout period. Data were analyzed using Student t test or two-way analysis of variance (ANOVA) for repeated measures with time and treatment as the 2 factors. Post hoc comparisons were performed by Bonferroni test. Statistical significance for all test was a p value0.05.Patient characteristics were similar between the 2 groups. We found a statistically significant differences in postoperative pain between the two groups: ITM group had the lower visual analogic pain score (VAS) values. Morphine consumption was lower in the ITM group: average consumption within the first 6 hours was 0.9 mg in IT group compared to 3.1 mg in FNB group; at 12 h 4.2 mg vs 6.3 mg; at 24 h 6.9 mg vs 10.3 mg; at 48 h 9.7 mg vs 13.6 mg. However, the difference in the opiate consumption was not statistically different (p value = 0.06). Thirteen patients in ITM group experienced itching, only 5 in FNB group. We did not find any difference in the two treatment groups in the use of antiemetic and antipruritic medication. No cases of respiratory depression was recorded.Our results show that low dose of intrathecal morphine may be safe and more efficient than single-shot femoral nerve block for post-operative analgesia after total knee arthroplasty.

Published
2010

6. Post-operative analgesia following total knee arthroplasty: comparison of low-dose intrathecal morphine and single-shot ultrasound-guided femoral nerve block: a randomized, single blinded, controlled study.

Author

FRASSANITO, L., VERGARI, A., ZANGHI, F., MESSINA, A., BITONDO, M., and ANTONELLI, M.

Abstract

Background and Objectives: Total knee arthroplasty often results in marked postoperative pain. A recent meta-analysis supports the use of femoral nerve block or alternatively spinal injection of morphine plus local anaesthetic for post-operative analgesia. On the other hand, the use of intrathecal morphine may be associated with a large number of distressing side effects (itching, urinary retention, nausea and vomiting, delayed respiratory depression). The aim of this study was to compare the effectiveness of femoral nerve block and low dose intrathecal morphine in post-operative analgesia after primary unilateral total knee arthroplasty. Material and Methods: Fifty-two consecutive patients scheduled for primary unilateral total knee arthroplasty were allocated to the intrathecal morphine group (ITM group) or to the femoral nerve block group (FNB group). In ITM group a subarachnoid puncture was performed at the L3-L4 inter-vertebral space with hyperbaric bupivacaine 15 mg plus 100 mcg of preservative-free morphine. Patients allocated to the FNB group received a single-injection ultrasound-assisted femoral nerve block with ropivacaine 0.75% 25 ml before the spinal injection of hyperbaric bupivacaine 15 mg. All patients received postoperative patient-controlled- analgesia (PCA) morphine, using a 1- mg bolus and a 5-minute lockout period. Data were analyzed using Student t test or two-way analysis of variance (ANOVA) for repeated measures with time and treatment as the 2 factors. Post hoc comparisons were performed by Bonferroni test. Statistical significance for all test was a p value <0.05. Results: Patient characteristics were similar between the 2 groups. We found a statistically significant differences in postoperative pain between the two groups: ITM group had the lower visual analogic pain score (VAS) values. Morphine consumption was lower in the ITM group: average consumption within the first 6 hours was 0.9 mg in IT group compared to 3.1 mg in FNB group; at 12 h 4.2 mg vs 6.3 mg; at 24 h 6.9 mg vs 10.3 mg; at 48 h 9.7 mg vs 13.6 mg. However, the difference in the opiate consumption was not statistically different (p value =0.06). Thirteen patients in ITM group experienced itching, only 5 in FNB group. We did not find any difference in the two treatment groups in the use of antiemetic and antipruritic medication. No cases of respiratory depression was recorded. Conclusions: Our results show that low dose of intrathecal morphine may be safe and more efficient than single-shot femoral nerve block for post-operative analgesia after total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Published
2010

7. Lung volumes and lung volume recruitment in ARDS: a comparison between supine and prone position.

Author

Aguirre-Bermeo H, Turella M, Bitondo M, Grandjean J, Italiano S, Festa O, Morán I, and Mancebo J

Abstract

Background: The use of positive end-expiratory pressure (PEEP) and prone position (PP) is common in the management of severe acute respiratory distress syndrome patients (ARDS). We conducted this study to analyze the variation in lung volumes and PEEP-induced lung volume recruitment with the change from supine position (SP) to PP in ARDS patients., Methods: The investigation was conducted in a multidisciplinary intensive care unit. Patients who met the clinical criteria of the Berlin definition for ARDS were included. The responsible physician set basal PEEP. To avoid hypoxemia, FiO 2 was increased to 0.8 1 h before starting the protocol. End-expiratory lung volume (EELV) and functional residual capacity (FRC) were measured using the nitrogen washout/washin technique. After the procedures in SP, the patients were turned to PP and 1 h later the same procedures were made in PP., Results: Twenty-three patients were included in the study, and twenty were analyzed. The change from SP to PP significantly increased FRC (from 965 ± 397 to 1140 ± 490 ml, p = 0.008) and EELV (from 1566 ± 476 to 1832 ± 719 ml, p = 0.008), but PEEP-induced lung volume recruitment did not significantly change (269 ± 186 ml in SP to 324 ± 188 ml in PP, p = 0.263). Dynamic strain at PEEP decreased with the change from SP to PP (0.38 ± 0.14 to 0.33 ± 0.13, p = 0.040)., Conclusions: As compared to supine, prone position increases resting lung volumes and decreases dynamic lung strain.

Published
2018
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