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5. Level set based eXtended finite element modelling of the response of fibrous networks under hygroscopic swelling

Author

Samantray, P., Peerlings, R. H. J., Bosco, E., Geers, M. G. D., Massart, T. J., and Rokoš, O.

Subjects
Computer Science - Computational Engineering, Finance, and Science
Abstract

Materials like paper, consisting of a network of natural fibres, exposed to variations in moisture, undergo changes in geometrical and mechanical properties. This behaviour is particularly important for understanding the hygro-mechanical response of sheets of paper in applications like digital printing. A two-dimensional microstructural model of a fibrous network is therefore developed to upscale the hygro-expansion of individual fibres, through their interaction, to the resulting overall expansion of the network. The fibres are modelled with rectangular shapes and are assumed to be perfectly bonded where they overlap. For realistic networks the number of bonds is large and the network is geometrically so complex that discretizing it by conventional, geometry-conforming, finite elements is cumbersome. The combination of a level-set and XFEM formalism enables the use of regular, structured grids in order to model the complex microstructural geometry. In this approach, the fibres are described implicitly by a level-set function. In order to represent the fibre boundaries in the fibrous network, an XFEM discretization is used together with a Heaviside enrichment function. Numerical results demonstrate that the proposed approach successfully captures the hygro-expansive properties of the network with fewer degrees of freedom compared to classical FEM, preserving desired accuracy., Comment: 27 pages, 22 figures, 4 tables, J. Appl. Mech. June 19, 2020

Published
2020
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13. Formulation and numerical implementation of micro-scale boundary conditions for particle aggregates

Author

Liu, J., Bosco, E., and Suiker, A. S. J.

Subjects
Condensed Matter - Soft Condensed Matter
Abstract

The aim of this paper is to propose a novel methodology to deal with micro-structural boundary conditions for the analysis of granular materials. The response of the granular assembly is modelled through the discrete element method (DEM), consistent with a micro-macro homogenization scheme formulated in the transition from a continuous to a discrete setting. The three classical types of boundary conditions (displacement, periodic and displacement) are implemented with a servo-control method. Two types of algorithms are developed, which consider or not an initial prediction for the displacement field of the particles. Additionally, to simulate in a more realistic manner the effect of macroscopic deformation on the micro-structure, a mixed type of boundary conditions is introduced, i.e. a combination of classical boundary conditions. The effectiveness of the algorithms is tested on a series of DEM simulations. The influence of the micro-structural morphology and of the size of the micro-structure on the overall response is finally investigated.

Published
2016

14. On the role of moisture in triggering out-of-plane displacement in paper: from the network level to the macroscopic scale

Author

Bosco, E., Peerlings, R. H. J., Lomans, B., van der Sman, C. G., and Geers, M. G. D.

Subjects
Condensed Matter - Materials Science
Abstract

The response of paper to humidity variations is a complex multi-scale problem. The hygroscopic swelling of individual fibres and their interactions within the fibrous network govern the macroscopic response. At this scale, moisture induced instabilities and out-of-plane deformations may occur. This work focuses on several aspects of this issue. A macroscopic phenomenological hygro-mechanical model is first proposed, which aims at predicting moisture induced out-of-plane deformations in paper sheets. The constitutive model is based on the relation between these deformations and typical irreversible phenomena associated to the history of paper manufacturing, i.e. the release of dried-in strains. The model is used to describe bending induced by moisture gradients through the thickness of the sheet as well as buckling due to moisture variation in the presence of mechanical constraints. The results of the model show that the anisotropic sheet-level hygro-expansion has a strong influence on the instability phenomena. Moreover, a comparison with experiments provides adequate semi-quantitative estimates. An additional step is made towards the multi-scale understanding of paper hygro-mechanics. The fundamental mechanisms governing the macroscopic moisture induced response are investigated on the basis of the underlying fibrous network. To this aim, a meso-structural model is developed which consists of a network of fibres randomly positioned in a planar region according to an orientation probability density function. A series of network simulations reveals that upon moisture content variations the expansion of the inter-fibre bonding regions drives the overall deformation. Particularly in the case of anisotropic fibre orientation, this explains the origin of the macro-scale anisotropic hygro-expansion, which is essential for the observed sheet-level instability phenomena.

Published
2016
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17. Hygro-mechanical properties of paper fibrous networks through asymptotic homogenization and comparison with idealized models

Author

Bosco, E., Peerlings, R. H. J., and Geers, M. G. D.

Subjects
Condensed Matter - Soft Condensed Matter, Condensed Matter - Materials Science
Abstract

This paper presents a multi-scale approach to predict the effective hygro-mechanical behaviour of paper sheets based on the properties of the underlying fibrous network. Despite the vast amount of literature on paper hygro-expansion, the functional dependence of the effective material properties on the micro-structural features remains yet unclear. In this work, a micro-structural model of the paper fibrous network is first developed by random deposition of the fibres within a planar region according to an orientation probability density function. Asymptotic homogenization is used to determine its effective properties numerically. Alternatively, two much more idealized micro-structural models are considered, one based on a periodic lattice structure with a regular network of perpendicular fibres and one based on the Voigt average. Despite their simplicity, they reproduce representative micro-structural features, such as the orientation anisotropy and network level hygro-elastic properties. These alternative models can be solved analytically, providing closed-form expressions that explicitly reveal the influence of the individual micro-scale parameters on the effective hygro-mechanical response. The trend predicted by the random network model is captured reasonably well by the two idealized models. The resulting hygro-mechanical properties are finally compared with experimental data reported in the literature, revealing an adequate quantitative agreement.

Published
2016
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18. Asymptotic homogenization of hygro-thermo-mechanical properties of fibrous networks

Author

Bosco, E., Peerlings, R. H. J., and Geers, M. G. D.

Subjects
Condensed Matter - Soft Condensed Matter, Condensed Matter - Materials Science
Abstract

The hygro-thermo-expansive response of fibrous networks involves deformation phenomena at multiple length scales. The moisture or temperature induced expansion of individual fibres is transmitted in the network through the inter-fibre bonds; particularly in the case of anisotropic fibres, this substantially influences the resulting overall deformation. This paper presents a methodology to predict the effective properties of bonded fibrous networks. The distinctive features of the work are i) the focus on the hygro-thermo-mechanical response, whereas in the literature generally only the mechanical properties are addressed; ii) the adoption of asymptotic homogenization to model fibrous networks. Asymptotic homogenization is an efficient and versatile multi-scale technique that allows to obtain within a rigorous setting the effective material response, even for complex micro-structural geometries. The fibrous networks considered in this investigation are generated by random deposition of the fibres within a planar region according to an orientation probability density function. Most of the available network descriptions model the fibres essentially as uni-axial elements, thereby not explicitly considering the role of the bonds. In this paper, the fibres are treated as two dimensional ribbon-like elements; this allows to naturally include the contribution of the bonding regions to the effective expansion. The efficacy of the proposed study is illustrated by investigating the effective response for several network realizations, incorporating the influence of different micro-scale parameters, such as fibre hygro-thermo-elastic properties, orientation, geometry, areal coverage.

Published
2016
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22. Art dwells: Heidegger’s concept of dwelling and the spatial relations between architecture and contemporary art in two artworks at Instituto Inhotim (Brazil) | A arte habita: o conceito de habitar em Heidegger e as relações espaciais entre arquitetura e arte contemporânea em dois trabalhos no Instituto Inhotim (Brasil)

Author

Liz Fagundes Oliveira Valente and Luciana Bosco e Silva

Subjects
architecture. contemporary art. dwelling., Architectural engineering. Structural engineering of buildings, TH845-895
Abstract

This article explores the spatial relations between art and architecture in two art galleries of Instituto Inhotim, extending the use of Martin Heidegger’s (1889-1976) concept of “dwelling” — presented in his essays “Building Dwelling Thinking” and “...poetically, Man dwells...” to the artworks under study. Doug Aitken’s Sonic Pavilion and Cristina Iglesias’ Vegetation Room are taken as key examples of how art dwells” through subjective and concrete relations in both built and natural environments.

Published
2019
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25. Autophagy correlates with the therapeutic responsiveness of Malignant pleural mesothelioma in 3D models

Author

Broaddus, V Courtney, Barbone, D, Follo, C, Echeverry, N, Gerbaudo, VH, Klabatsa, A, Bueno, R, Felley-Bosco, E, and Broaddus, VC

Abstract

© 2015 Barbone et al.Malignant pleural mesothelioma is a highly chemoresistant solid tumor. We have studied this apoptotic resistance using in vitro and ex vivo three-dimensional models, which acquire a high level of chemoresistance that can be reduced by

Published
2015

30. Impacto da geometria de edificações sobre o desempenho térmico de acordo com o método prescritivo do RTQ‑R | Impact of the building shape on the thermal performance according to the brazilian labelling program

Author

Laila Oliveira Santana, Joyce Correna Carlo, Luciana Bosco e Silva, and Denise Mônaco dos Santos

Subjects
desempenho. geometria arquitetônica. rtq‑r., Architectural engineering. Structural engineering of buildings, TH845-895
Abstract

Nas ultimas décadas, com a evolução da tecnologia computacional, surgiram ferramentas de simulação do desempenho ambiental, trazendo novos paradigmas ao ato de projetar. Elas externalizam aspectos perceptivos não‑visuais ao projetista, e assim, auxiliam o cumprimento das premissas arquitetônicas, como, por exemplo, o conforto dos usuários. Muitas vezes, esses preceitos não são incorporados a etapa de concepção, tanto devido as abordagens prevalecentes de projeto, que pouco se modificaram nos últimos quatro séculos, como a incipiência de aplicações dos princípios de eficiência energética ao parque edificado. Neste sentido, foram instituídos regulamentos e requisitos técnicos por meio de políticas energéticas internacionais e nacionais. Um dos vigentes no Brasil e o Regulamento Técnico da Qualidade para o Nível de Eficiência Energética de Edificações Residenciais, aplicado ao presente estudo. O intuito foi estudar, por meio do método prescritivo do Regulamento Técnico da Qualidade para o Nível de Eficiência Energética de Edificações Residenciais, o impacto da geometria arquitetônica sobre o desempenho energético de edifícios — por meio de um modelo de unidade habitacional autônoma. Verificou‑se relações entre o pé‑direito e o fator de forma atreladas ao conforto térmico. Realizou‑se comparação entre as geometrias dos modelos, com exposição dos resultados de desempenho. Por fim, ressalta‑se que descontinuidades e incertezas verificadas no método prescritivo exigem análise posterior dos dados obtidos, por meio de simulações em regime dinâmico.

Published
2019
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35. Comunicação e política urbana: a comunicação como meio e ferramenta em gestão e políticas públicas urbanas em algumas experiências no Brasil. / Communication and urban policy: communication as medium and tools for urban management and public policies in some experiences in Brazil

Author

Lucas Berdague Corrêa and Luciana Bosco e Silva

Subjects
General Medicine, General Chemistry
Abstract

Resumo O presente trabalho buscou compreender a comunicação enquanto meio interacional e ferramenta para o desenvolvimento de estratégias e políticas públicas de gestão da cidade. Este estudo qualitativo foi desenvolvido por meio de revisão bibliográfica para a primeira seção, de cunho teórico, em que se trouxe uma perspectiva sistêmica-compreensiva-interacional para enxergar as cidades e as condições de comunicação entre Poder Público, Sociedade Civil e o meio em que se encontram. Na segunda parte, foram apresentados estudos de caso em três experiências nas regiões sul e sudeste do Brasil, cujo levantamento de dados se deu por meio de consultas públicas às prefeituras municipais estudadas, acesso às redes sociais e sites institucionais delas, além da revisão de trabalhos acadêmicos, matérias de jornal e artigos de opinião que versam sobre tais experiências e/ou à temática da pandemia da COVID-19. Foi possível perceber, ao final da análise, que a perspectiva sistêmica proposta pode ser aplicada para compreender e propor boas práticas nos processos de comunicação e gestão desta nas cidades do contexto estudado e, talvez, replicada em outros, seguindo diretrizes sistêmicas- interacionais-autopoiéticas, de caráter dialógico, que reconheçam a diversidade, a possibilidade dos conflitos e as condições de cooperação pela força dos argumentos, não pelo argumento da força.Palavras-chave: Comunicação urbana; Sistemas complexos; Redes sociais; Gestão de cidades; Administração Pública. Abstract This paper sought to understand communication as an interactional medium and as tools for the development of strategies and public policies for city management. This qualitative study was developed through a bibliographic review for the first section, using a systemic-comprehensive- interactional perspective as theoretical lenses to see the cities and the conditions of communication between the Public Power, Civil Society and the environment in which they are. In the second part, case studies were developed in three experiences in the south and southeast regions of Brazil. The data were collected through public consultations answered by the studied city halls, the access to their social networks and institutional websites, and by reviewing academic works, newspaper and opinion articles dealing with such experiences and/or about the COVID-19 pandemic. It was possible to realize, at the end of the analysis, that the proposed systemic perspective can be applied to understand and propose good practices for communication and its management processes in the studied cities context and, perhaps, can be replicated in others, following systemic-interactive-autopoietic guidelines, from a dialogical outlook, that recognize diversity, the possibility of conflicts and the conditions for cooperation by virtue of the arguments, not by the argument of force.Keywords: Urban Communication; Complex Systems; Social Networks; Cities Management; Public Administration.

Published
2022

45. El paradigma de la sostenibilidad urbana: una discusión sobre la Ciudad de 15 minutos y el Desarrollo Orientado al Transporte Sostenible (DOTS)

Author

Yanka Flor Pinheiro Eleutério, Denise Mônaco dos Santos, and Luciana Bosco e Silva

Subjects
General Computer Science
Abstract

La búsqueda de nuevas formas de urbanización basadas en la compacidad urbana y el desarrollo sostenible favoreció el surgimiento de varios conceptos y modelos que han sido discutidos y propuestos a escala global. Dos modelos que se destacan hoy en día son el Desarrollo Orientado al Transporte Sostenible (DOTS), que se basa en el vínculo intrínseco entre el sistema de transporte y el uso y ocupación del suelo; y la Ciudad de 15 minutos, que ofrece acceso a los servicios urbanos básicos en 15 minutos a pie o en bicicleta. El objetivo del artículo es analizar estos dos modelos, con el fin de comprender el enfoque y el objetivo principal, las similitudes y diferencias en el contexto de las ciudades brasileñas, así como sus potencialidades y limitaciones. Para eso, utilizamos un levantamiento bibliográfico que analizó informes, artículos científicos y libros relacionados con los temas Ciudad de 15 minutos, DOTS y sus transversalidades. En términos de planificación física, la mayoría de los elementos presentados son atributos comunes a ambos conceptos y comunican con los preceptos de compacidad urbana y sustentabilidad urbana. La principal diferencia entre ellas en términos de planificación es la importancia que se le da a la proximidad de funciones y recursos que presenta la Ciudad de 15 minutos frente a la importancia de la accesibilidad de los recursos DOTS en el contexto de la sostenibilidad y compacidad urbana. y proponer cambios significativos en el tejido urbano que impliquen la combinación de los más variados agentes urbanos en su eficiente estructuración e implementación.

Published
2022

46. Expression of phosphorylated ribosomal protein S6 in mesothelioma patients-correlation with clinico-pathological characteristics and outcome: results from the European Thoracic Oncology Platform (ETOP) Mesoscape project (Oct, 10.1038/s41379-022-01170-z, 2022)

Author

Ruschoff, J.H., Haberecker, M., Tsourti, Z., Nackaerts, K., Perrot, M. de, Brcic, L., Nadal, E., Tsimpoukis, S., Gray, S.G., Ampollini, L., Aerts, J.G., Felley-Bosco, E., Kirschner, M.B., Monkhorst, K., Weynand, B., Bavaghar-Zaeimi, F., Samarzija, M., Llatjos, R., Finn, S.P., Silini, E., Thusen, J. von der, Marti, N., Vervita, K., Kammler, R., Peters, S., Stahel, R.A., Baas, P., Opitz, I., and Consortium, E.M.

Published
2022

47. Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

Author

Tonetti T., Grasselli G., Zanella A., Pizzilli G., Fumagalli R., Piva S., Lorini L., Iotti G., Foti G., Colombo S., Vivona L., Rossi S., Girardis M., Agnoletti V., Campagna A., Gordini G., Navalesi P., Boscolo A., Graziano A., Valeri I., Vianello A., Cereda D., Filippini C., Cecconi M., Locatelli F., Bartoletti M., Giannella M., Viale P., Antonelli M., Nava S., Pesenti A., Ranieri V. M., Albano G., Alborghetti A., Aldegheri G., Antonini B., Belgiorno N., Bellani G., Beretta E., Bonazzi S., Borelli M., Cabrini L., Carnevale L., Carnevale S., Castelli G., Catena E., Chiumello D., Coluccello A., Coppini D., Covello D., DeFilippi G., DeiPoli M., Dughi P., Gallioli G., Gnesin P., Greco S., Guatteri L., Guzzon D., Keim R., Landoni G., Langer T., Lombardo A., Marino G., Merli G., Merlo D., Mojoli F., Muttini S., Natalini G., Petrucci N., Pezzi A., Radrizzani D., Raimondi M., Riccio M., Storti E., Tavola M., Vitale G., Bosco E., Calo M. A., Danzi V., DeRosa S., Farnia A., Lazzari F., Meggiolaro M., Munari M., Saia M., Sella N., Serra E., Tiberio I., Baiocchi M., Benedetto M., Bordini M., Caramelli F., Cilloni N., DellaGiovampaola M., Fanelli A., Frascaroli G., Fusari M., Maitan S., Martino C., Melotti R. M., Merola R., Minardi F., Moro F., Nardi G., Nolli M., Pierucci E., Potalivo A., Repetti F., Salsi P., Terzitta M., Tosi M., Venturi S., Volta C. A., Zani G., Zanoni A (COVID-19 Northern Italian ICU Network), Landoni G, Tonetti, Tommaso, Grasselli, Giacomo, Zanella, Alberto, Pizzilli, Giacinto, Fumagalli, Roberto, Piva, Simone, Lorini, Luca, Iotti, Giorgio, Foti, Giuseppe, Colombo, Sergio, Vivona, Luigi, Rossi, Sandra, Girardis, Massimo, Agnoletti, Vanni, Campagna, Anselmo, Gordini, Giovanni, Navalesi, Paolo, Boscolo, Annalisa, Graziano, Alessandro, Valeri, Ilaria, Vianello, Andrea, Cereda, Danilo, Filippini, Claudia, Cecconi, Maurizio, Locatelli, Franco, Bartoletti, Michele, Giannella, Maddalena, Viale, Pierluigi, Antonelli, Massimo, Nava, Stefano, Pesenti, Antonio, Ranieri, V Marco, Tonetti, T, Grasselli, G, Zanella, A, Pizzilli, G, Fumagalli, R, Piva, S, Lorini, L, Iotti, G, Foti, G, Colombo, S, Vivona, L, Rossi, S, Girardis, M, Agnoletti, V, Campagna, A, Gordini, G, Navalesi, P, Boscolo, A, Graziano, A, Valeri, I, Vianello, A, Cereda, D, Filippini, C, Cecconi, M, Locatelli, F, Bartoletti, M, Giannella, M, Viale, P, Antonelli, M, Nava, S, Pesenti, A, Ranieri, V, Langer, T, Tonetti, T., Grasselli, G., Zanella, A., Pizzilli, G., Fumagalli, R., Piva, S., Lorini, L., Iotti, G., Foti, G., Colombo, S., Vivona, L., Rossi, S., Girardis, M., Agnoletti, V., Campagna, A., Gordini, G., Navalesi, P., Boscolo, A., Graziano, A., Valeri, I., Vianello, A., Cereda, D., Filippini, C., Cecconi, M., Locatelli, F., Bartoletti, M., Giannella, M., Viale, P., Antonelli, M., Nava, S., Pesenti, A., Ranieri, V. M., Albano, G., Alborghetti, A., Aldegheri, G., Antonini, B., Belgiorno, N., Bellani, G., Beretta, E., Bonazzi, S., Borelli, M., Cabrini, L., Carnevale, L., Carnevale, S., Castelli, G., Catena, E., Chiumello, D., Coluccello, A., Coppini, D., Covello, D., Defilippi, G., Deipoli, M., Dughi, P., Gallioli, G., Gnesin, P., Greco, S., Guatteri, L., Guzzon, D., Keim, R., Landoni, G., Langer, T., Lombardo, A., Marino, G., Merli, G., Merlo, D., Mojoli, F., Muttini, S., Natalini, G., Petrucci, N., Pezzi, A., Radrizzani, D., Raimondi, M., Riccio, M., Storti, E., Tavola, M., Vitale, G., Bosco, E., Calo, M. A., Danzi, V., Derosa, S., Farnia, A., Lazzari, F., Meggiolaro, M., Munari, M., Saia, M., Sella, N., Serra, E., Tiberio, I., Baiocchi, M., Benedetto, M., Bordini, M., Caramelli, F., Cilloni, N., Dellagiovampaola, M., Fanelli, A., Frascaroli, G., Fusari, M., Maitan, S., Martino, C., Melotti, R. M., Merola, R., Minardi, F., Moro, F., Nardi, G., Nolli, M., Pierucci, E., Potalivo, A., Repetti, F., Salsi, P., Terzitta, M., Tosi, M., Venturi, S., Volta, C. A., Zani, G., Zanoni, A (COVID-19 Northern Italian ICU Network), and Landoni, G

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Respiratory rate, Socio-culturale, Critical Care and Intensive Care Medicine, Acute respiratory failure, acute respiratory failure, COVID-19, ICU, non-invasive ventilation, rationing, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, Intensive care, Retrospective analysis, Medicine, 030212 general & internal medicine, Non-invasive ventilation, Rationing, Case report form, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Outbreak, lcsh:RC86-88.9, Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, 030228 respiratory system, Emergency medicine, Base excess, business
Abstract

Background A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.

Published
2020

48. Management of intracranial hypertension following traumatic brain injury: a best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy. Joint statements by the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch) and the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

Author

Iaccarino C., Lippa L., Munari M., Castioni C. A., Robba C., Caricato A., Pompucci A., Signoretti S., Zona G., Rasulo F. A., Aimar E., Amato S., Angileri F. F., Anile C., Assietti R., Baratto V., Barbanera A., Basile L., Battaglia R., Bellocchi S., Bertuccio A., Blanco S., Bolognini A., Boniferro B., Bordi L., Bortolotti C., Brandini V., Broger M., Brollo M., Caffarella D. D., Caggiano C., Cantisani P. L., Capone C., Cappelletto B., Capuano C., Carangelo B., Caruselli G., Chessa M. A., Chiara M., Chibbaro S., Cioffi V., Ciprianocecchi P., Colistra D., Conti C., Contratti F., Costella G. B., Cuoci A., D'Avella D., D'Ercole M., Deangelis M., Defalco R., de Luca G., de Marinis P., Del Vecchio C., Delfinis C., Denaro L., Deodato F., Desogus N., Disomma A., Domenicucci M., Dones F., Fina M., Fiori L., Fricia M., Gaetani P., Gazzeri R., Gentile M., Germano A., Ghadirpour R., Gianfreda C. D., Gigante N., Gigli R., Giorgetti J., Giusa M., Gravina U. G., Grippi L., Guida F., Guizzardi G., Iannuzzo G., Kropp M., Lattanzi L., Lucantoni D., Maffei L., Magliulo M., Marconi F., Marruzzo D., Martellotta N., Marton E., Maugeri R., Mauro G., Meli F., Menniti A., Merciadri P., Milanese L., Nardacci B., Nasi D., Orvieto P., Pacca P., Pansini G., Panzarasa G., Passanisi M., Pavesi G., Pizzoni C., Pulera F., Rapana A., Ricci A., Rispoli R., Rotondo M., Russo N., Santilli S., Scarano E., Schwarz A., Servadei F., Simonetti G., Stefini R., Talamonti G., Turrisi A., Valente V. M., Villa A., Vindigni M., Visocchi M., Vitali M., Wierzbicki V., Zambon G., Zanotti B., Zenga F., Alampi D., Alessandri F., Aloj F., Amigoni A., Aspide R., Bertuetti R., Betti V., Bilotta F., Bonato V., Bosco E., Brita M., Buscema G., Cafiero T., Cappuccio D., Caradonna M., Caria C. G., Casartelliliviero M., Ciritella P., Cirrincione S., Citerio G., Colelli S., Coletta F., Concordia L., Congedo E., Covotta M., Crimella F., Dall'Acqua G., De Cassai A., Defulviis S., Deperi E., Deana C., Delgaudio A., Denittis N., Dicolandrea S., Divezza F., Ferri F., Flocco R., Fontana C., Forastierimolinari A., Frangiosa A., Fumagalli P., Fuselli E., Garbarino M. M., Gelormini D., Geraci C., Geraldini F., Giacomucci A., Giampaoli V., Giorgetti D., Gritti P., Gualdani S., Iacovazzo C., Iermano C., Latronico N., Lugari S., Lusenti F., Maglione C., Magnoni S., Maiarota F., Malla M., Marchesi M., Martino C., Matteotti I., Mazzeo A. T., Morello G., Nardiello I., Paticchio F., Pegoli M., Perotti V., Piazzolla M., Picciafuochi F., Rachedi N., Radolovich D. K., Recchia A., Riccardi S., Romagnoli S., Sala S., Scafuro M. A., Sgarlata P., Soragni A., Stefani F., Stival E., Stofella G., Terranova F., Tinturini R., Togni T., Toto R., Trapani D., Tringali E., Tullo L., Valente A., Valeo T., Varelli G., Villani R., Zamacavicchi F., Zanello M., Zarrillo N., Zugni N., Iaccarino, C, Lippa, L, Munari, M, Castioni, C, Robba, C, Caricato, A, Pompucci, A, Signoretti, S, Zona, G, Rasulo, F, Aimar, E, Amato, S, Angileri, F, Anile, C, Assietti, R, Baratto, V, Barbanera, A, Basile, L, Battaglia, R, Bellocchi, S, Bertuccio, A, Blanco, S, Bolognini, A, Boniferro, B, Bordi, L, Bortolotti, C, Brandini, V, Broger, M, Brollo, M, Caffarella, D, Caggiano, C, Cantisani, P, Capone, C, Cappelletto, B, Capuano, C, Carangelo, B, Caruselli, G, Chessa, M, Chiara, M, Chibbaro, S, Cioffi, V, Ciprianocecchi, P, Colistra, D, Conti, C, Contratti, F, Costella, G, Cuoci, A, D'Avella, D, D'Ercole, M, Deangelis, M, Defalco, R, de Luca, G, de Marinis, P, Del Vecchio, C, Delfinis, C, Denaro, L, Deodato, F, Desogus, N, Disomma, A, Domenicucci, M, Dones, F, Fina, M, Fiori, L, Fricia, M, Gaetani, P, Gazzeri, R, Gentile, M, Germano, A, Ghadirpour, R, Gianfreda, C, Gigante, N, Gigli, R, Giorgetti, J, Giusa, M, Gravina, U, Grippi, L, Guida, F, Guizzardi, G, Iannuzzo, G, Kropp, M, Lattanzi, L, Lucantoni, D, Maffei, L, Magliulo, M, Marconi, F, Marruzzo, D, Martellotta, N, Marton, E, Maugeri, R, Mauro, G, Meli, F, Menniti, A, Merciadri, P, Milanese, L, Nardacci, B, Nasi, D, Orvieto, P, Pacca, P, Pansini, G, Panzarasa, G, Passanisi, M, Pavesi, G, Pizzoni, C, Pulera, F, Rapana, A, Ricci, A, Rispoli, R, Rotondo, M, Russo, N, Santilli, S, Scarano, E, Schwarz, A, Servadei, F, Simonetti, G, Stefini, R, Talamonti, G, Turrisi, A, Valente, V, Villa, A, Vindigni, M, Visocchi, M, Vitali, M, Wierzbicki, V, Zambon, G, Zanotti, B, Zenga, F, Alampi, D, Alessandri, F, Aloj, F, Amigoni, A, Aspide, R, Bertuetti, R, Betti, V, Bilotta, F, Bonato, V, Bosco, E, Brita, M, Buscema, G, Cafiero, T, Cappuccio, D, Caradonna, M, Caria, C, Casartelliliviero, M, Ciritella, P, Cirrincione, S, Citerio, G, Colelli, S, Coletta, F, Concordia, L, Congedo, E, Covotta, M, Crimella, F, Dall'Acqua, G, De Cassai, A, Defulviis, S, Deperi, E, Deana, C, Delgaudio, A, Denittis, N, Dicolandrea, S, Divezza, F, Ferri, F, Flocco, R, Fontana, C, Forastierimolinari, A, Frangiosa, A, Fumagalli, P, Fuselli, E, Garbarino, M, Gelormini, D, Geraci, C, Geraldini, F, Giacomucci, A, Giampaoli, V, Giorgetti, D, Gritti, P, Gualdani, S, Iacovazzo, C, Iermano, C, Latronico, N, Lugari, S, Lusenti, F, Maglione, C, Magnoni, S, Maiarota, F, Malla, M, Marchesi, M, Martino, C, Matteotti, I, Mazzeo, A, Morello, G, Nardiello, I, Paticchio, F, Pegoli, M, Perotti, V, Piazzolla, M, Picciafuochi, F, Rachedi, N, Radolovich, D, Recchia, A, Riccardi, S, Romagnoli, S, Sala, S, Scafuro, M, Sgarlata, P, Soragni, A, Stefani, F, Stival, E, Stofella, G, Terranova, F, Tinturini, R, Togni, T, Toto, R, Trapani, D, Tringali, E, Tullo, L, Valente, A, Valeo, T, Varelli, G, Villani, R, Zamacavicchi, F, Zanello, M, Zarrillo, N, Zugni, N, Iaccarino, C., Lippa, L., Munari, M., Castioni, C. A., Robba, C., Caricato, A., Pompucci, A., Signoretti, S., Zona, G., Rasulo, F. A., Aimar, E., Amato, S., Angileri, F. F., Anile, C., Assietti, R., Baratto, V., Barbanera, A., Basile, L., Battaglia, R., Bellocchi, S., Bertuccio, A., Blanco, S., Bolognini, A., Boniferro, B., Bordi, L., Bortolotti, C., Brandini, V., Broger, M., Brollo, M., Caffarella, D. D., Caggiano, C., Cantisani, P. L., Capone, C., Cappelletto, B., Capuano, C., Carangelo, B., Caruselli, G., Chessa, M. A., Chiara, M., Chibbaro, S., Cioffi, V., Ciprianocecchi, P., Colistra, D., Conti, C., Contratti, F., Costella, G. B., Cuoci, A., D'Avella, D., D'Ercole, M., Deangelis, M., Defalco, R., de Luca, G., de Marinis, P., Del Vecchio, C., Delfinis, C., Denaro, L., Deodato, F., Desogus, N., Disomma, A., Domenicucci, M., Dones, F., Fina, M., Fiori, L., Fricia, M., Gaetani, P., Gazzeri, R., Gentile, M., Germano, A., Ghadirpour, R., Gianfreda, C. D., Gigante, N., Gigli, R., Giorgetti, J., Giusa, M., Gravina, U. G., Grippi, L., Guida, F., Guizzardi, G., Iannuzzo, G., Kropp, M., Lattanzi, L., Lucantoni, D., Maffei, L., Magliulo, M., Marconi, F., Marruzzo, D., Martellotta, N., Marton, E., Maugeri, R., Mauro, G., Meli, F., Menniti, A., Merciadri, P., Milanese, L., Nardacci, B., Nasi, D., Orvieto, P., Pacca, P., Pansini, G., Panzarasa, G., Passanisi, M., Pavesi, G., Pizzoni, C., Pulera, F., Rapana, A., Ricci, A., Rispoli, R., Rotondo, M., Russo, N., Santilli, S., Scarano, E., Schwarz, A., Servadei, F., Simonetti, G., Stefini, R., Talamonti, G., Turrisi, A., Valente, V. M., Villa, A., Vindigni, M., Visocchi, M., Vitali, M., Wierzbicki, V., Zambon, G., Zanotti, B., Zenga, F., Alampi, D., Alessandri, F., Aloj, F., Amigoni, A., Aspide, R., Bertuetti, R., Betti, V., Bilotta, F., Bonato, V., Bosco, E., Brita, M., Buscema, G., Cafiero, T., Cappuccio, D., Caradonna, M., Caria, C. G., Casartelliliviero, M., Ciritella, P., Cirrincione, S., Citerio, G., Colelli, S., Coletta, F., Concordia, L., Congedo, E., Covotta, M., Crimella, F., Dall'Acqua, G., De Cassai, A., Defulviis, S., Deperi, E., Deana, C., Delgaudio, A., Denittis, N., Dicolandrea, S., Divezza, F., Ferri, F., Flocco, R., Fontana, C., Forastierimolinari, A., Frangiosa, A., Fumagalli, P., Fuselli, E., Garbarino, M. M., Gelormini, D., Geraci, C., Geraldini, F., Giacomucci, A., Giampaoli, V., Giorgetti, D., Gritti, P., Gualdani, S., Iacovazzo, C., Iermano, C., Latronico, N., Lugari, S., Lusenti, F., Maglione, C., Magnoni, S., Maiarota, F., Malla, M., Marchesi, M., Martino, C., Matteotti, I., Mazzeo, A. T., Morello, G., Nardiello, I., Paticchio, F., Pegoli, M., Perotti, V., Piazzolla, M., Picciafuochi, F., Rachedi, N., Radolovich, D. K., Recchia, A., Riccardi, S., Romagnoli, S., Sala, S., Scafuro, M. A., Sgarlata, P., Soragni, A., Stefani, F., Stival, E., Stofella, G., Terranova, F., Tinturini, R., Togni, T., Toto, R., Trapani, D., Tringali, E., Tullo, L., Valente, A., Valeo, T., Varelli, G., Villani, R., Zamacavicchi, F., Zanello, M., Zarrillo, N., and Zugni, N.

Subjects
medicine.medical_specialty, Decompressive Craniectomy, Consensus development conference, Decompressive craniectomy, Guideline, Traumatic brain injuries, Critical Care, Intracranial Pressure, medicine.medical_treatment, MEDLINE, Neurosurgery, Traumatic brain injurie, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intensive care, Settore MED/41 - ANESTESIOLOGIA, Brain Injuries, Traumatic, medicine, Humans, Anesthesia, Intensive care medicine, Randomized Controlled Trials as Topic, business.industry, Neurointensive care, Evidence-based medicine, Italy, 030220 oncology & carcinogenesis, Intracranial pressure monitoring, Surgery, Neurology (clinical), Analgesia, Intracranial Hypertension, business, 030217 neurology & neurosurgery, Human
Abstract

No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from "TBI Section" of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the "TBI Section" of the SINch and the 111 members of the Neuroanesthesia and Neurocritical Care Study Group of the SIAARTI. The aim of the survey was to test a preliminary evaluation of the grade of predictable future adherence of the recommendations following this intersociety proposal. The following recommendations are suggested as representing best clinical practice, nevertheless, adoption of local multidisciplinary protocols regarding thresholds of ICP values, drug therapies, hemostasis management and perioperative care of decompressed patients is strongly recommended to improve treatment efficiency, to increase the quality of data collection and to provide more powerful evidence with future studies. Thus, for this future perspective a rapid overview of the role of the multimodal neuromonitoring in the optimal severe TBI management is also provided in this document. It is reasonable to assume that the recommendations reported in this paper will in future be updated by new observations arising from future trials. They are not binding, and this document should be offered as a guidance for clinical practice through an intersociety agreement, taking in consideration the low level of evidence.

Published
2021

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