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5 results on '"Cutuli, S.L."'

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. Hospital-Acquired Infections in Critically Ill Patients With COVID-19

Author

Antonio Muscatello, Giacomo Bellani, Paolo Bonfanti, Gabriele Fior, Sara Linguadoca, Antonio Pesenti, Alessandra Bandera, Massimiliano Greco, Michele Bartoletti, Massimo Girardis, Irene Coloretti, Paola Morelli, N Bottino, Mario Carlo Raviglione, Gennaro De Pascale, Marianna Meschiari, Marco Ranieri, Giacomo Grasselli, Roberto Fumagalli, Luigia Scudeller, Giuseppe Foti, Daniela Ferlicca, Andrea Forastieri, Antonio Messina, Emanuela Biagioni, Flavia Stefanini, Pierluigi Viale, Marco Franzetti, Maurizio Cecconi, Tommaso Tonetti, Andrea Gori, Massimo Antonelli, Laura Alagna, Vittorio Scaravilli, Amedeo Guzzardella, SL Cutuli, Simone Redaelli, Davide Mangioni, Gianpaola Monti, Grasselli G., Scaravilli V., Mangioni D., Scudeller L., Alagna L., Bartoletti M., Bellani G., Biagioni E., Bonfanti P., Bottino N., Coloretti I., Cutuli S.L., De Pascale G., Ferlicca D., Fior G., Forastieri A., Franzetti M., Greco M., Guzzardella A., Linguadoca S., Meschiari M., Messina A., Monti G., Morelli P., Muscatello A., Redaelli S., Stefanini F., Tonetti T., Antonelli M., Cecconi M., Foti G., Fumagalli R., Girardis M., Ranieri M., Viale P., Raviglione M., Pesenti A., Gori A., Bandera A., Grasselli, G, Scaravilli, V, Mangioni, D, Scudeller, L, Alagna, L, Bartoletti, M, Bellani, G, Biagioni, E, Bonfanti, P, Bottino, N, Coloretti, I, Cutuli, S, De Pascale, G, Ferlicca, D, Fior, G, Forastieri, A, Franzetti, M, Greco, M, Guzzardella, A, Linguadoca, S, Meschiari, M, Messina, A, Monti, G, Morelli, P, Muscatello, A, Redaelli, S, Stefanini, F, Tonetti, T, Antonelli, M, Cecconi, M, Foti, G, Fumagalli, R, Girardis, M, Ranieri, M, Viale, P, Raviglione, M, Pesenti, A, Gori, A, and Bandera, A

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, COVID-19, SARS-CoV-2, critical care, hospital-acquired infections, medicine.medical_treatment, Critical Illness, Critical Care and Intensive Care Medicine, Aged, Cross Infection, Female, Humans, Middle Aged, Pneumonia, Ventilator-Associated, Retrospective Studies, Sepsis, Interquartile range, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, Hospital-acquired infection, Correspondence, medicine, Mechanical ventilation, hospital-acquired infection, Septic shock, business.industry, Incidence (epidemiology), Mortality rate, Ventilator-associated pneumonia, Pneumonia, medicine.disease, Ventilator-Associated, Cardiology and Cardiovascular Medicine, business
Abstract

Background: Few small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19. Research Question: What characteristics in critically ill patients with COVID-19 are associated with HAIs and how are HAIs associated with outcomes in these patients? Study Design and Methods: Multicenter retrospective analysis of prospectively collected data including adult patients with severe COVID-19 admitted to eight Italian hub hospitals from February 20, 2020, through May 20, 2020. Descriptive statistics and univariate and multivariate Weibull regression models were used to assess incidence, microbial cause, resistance patterns, risk factors (ie, demographics, comorbidities, exposure to medication), and impact on outcomes (ie, ICU discharge, length of ICU and hospital stays, and duration of mechanical ventilation) of microbiologically confirmed HAIs. Results: Of the 774 included patients, 359 patients (46%) demonstrated 759 HAIs (44.7 infections/1,000 ICU patient-days; 35% multidrug-resistant [MDR] bacteria). Ventilator-associated pneumonia (VAP; n = 389 [50%]), bloodstream infections (BSIs; n = 183 [34%]), and catheter-related BSIs (n = 74 [10%]) were the most frequent HAIs, with 26.0 (95% CI, 23.6-28.8) VAPs per 1,000 intubation-days, 11.7 (95% CI, 10.1-13.5) BSIs per 1,000 ICU patient-days, and 4.7 (95% CI, 3.8-5.9) catheter-related BSIs per 1,000 ICU patient-days. Gram-negative bacteria (especially Enterobacterales) and Staphylococcus aureus caused 64% and 28% of cases of VAP, respectively. Variables independently associated with infection were age, positive end expiratory pressure, and treatment with broad-spectrum antibiotics at admission. Two hundred thirty-four patients (30%) died in the ICU (15.3 deaths/1,000 ICU patient-days). Patients with HAIs complicated by septic shock showed an almost doubled mortality rate (52% vs 29%), whereas noncomplicated infections did not affect mortality. HAIs prolonged mechanical ventilation (median, 24 days [interquartile range (IQR), 14-39 days] vs 9 days [IQR, 5-13 days]; P < .001), ICU stay (24 days [IQR, 16-41 days] vs 9 days [IQR, 6-14 days]; P = .003), and hospital stay (42 days [IQR, 25-59 days] vs 23 days [IQR, 13-34 days]; P < .001). Interpretation: Critically ill patients with COVID-19 are at high risk for HAIs, especially VAPs and BSIs resulting from MDR organisms. HAIs prolong mechanical ventilation and hospitalization, and HAIs complicated by septic shock almost double mortality. Trial Registry: ClinicalTrials.gov; No.: NCT04388670; URL: www.clinicaltrials.gov

Published
2020

5. Polymyxin-B hemoperfusion in septic patients: analysis of a multicenter registry

Author

Cutuli, Salvatore Lucio, Artigas, Antonio, Fumagalli, Roberto, Monti, Gianpaola, Ranieri, Vito Marco, Ronco, Claudio, Antonelli, Massimo, The EUPHAS 2 Collaborative Group, Null, Maviglia, Riccardo, Cicconi, Sandra, Silvestri, Davide, Bello, Giuseppe, Brendolan, Alessandra, Nalesso, Federico, Villa, Gianluca, Piccinni, Pasquale, Martin, Erica, Cantaluppi, Vincenzo, Vesconi, Sergio, Casella, Giampaolo, Fasanella, Egidio, Debitonto, Michele, Monza, Gianmario, Blasetti, Angelo, Coletta, Rosaria, D’Ambrosio, Michele, Cinnella, Gilda, Murino, Patrizia, Piscitelli, Eugenio, Centonze, Gaetano, Cucurachi, Marco, Altieri, Giuseppe, Leonardo, Vincenzo, Idra, Anna Sara, Del Rosso, Goffredo, Polidoro, Maria, Stigliano, Nicola, Pittella, Giuseppe, Paternoster, Gianluca, Pulito, Giuseppe, Puscio, Daniela, Cingolani, Diego, Falzetti, Gabriele, Vecchiarelli, Pietro, Giunta, Francesco, Forfori, Francesco, Castiglione, Giacomo, Greco, Stefano, Capra, Carlo, Crema, Luciano, Tamayo, Leonor, Urbano, Cristina, Pezza, Brunello, Zarrillo, Nadia, Di Monaco, Pasquale, Climaco, Giuseppe, De Negri, Pasquale, Modano, Pasqualina, Pagliarulo, Riccardo, Petrillo, Claudio, Stripoli, Tania, Oggioni, Roberto, Campiglia, Laura, Valletta, Anna Rita, Lugano, Manuela, Milella, Domenico, Micucci, Laura, Reist, Ursula, Ensner, Rolf, Gianbarba, Christian, Brander, Lukas, Paul, Rajib, Crawla, Rajesh, Jasujia, Sanjeev, Pande, Rajesh, Dileep, Pratibha, Sundar, Sankaran, Ganesan, Raju, Dewan, Sandeep, Nangia, Vivek, Mani, Raj Kumar, Singh, Omender, Sathe, Pracee, Sachin, Gupta, D’Costa, Pradeep M., Srivanas, Samavedam, Singh, Yogendra Pal, Doi, Kent, Taki, Fumika, Roca, Ricard Ferrer, Medina, Eduardo Romay, Gernacho, Josè, Martí, Francisco, Martinez Ruiz, Alberto, Martinez Sagasti, Fernando, Crespo, Rafael Zaragoza, Torti, Paola, Terzi, Valeria, Cutuli, S.L., Artigas, A., Fumagalli, R., Monti, G., Ranieri, V.M., Ronco, C., Antonelli, M., The EUPHAS 2 Collaborative Group and Maviglia, R., Cicconi, S., Silvestri, D., Bello, G., Brendolan, A., Nalesso, F., Villa, G., Piccinni, P., Martin, E., Cantaluppi, V., Vesconi, S., Casella, G., Fasanella, E., Debitonto, M., Monza, G., Blasetti, A., Coletta, R., D’Ambrosio, M., Cinnella, G., Murino, P., Piscitelli, E., Centonze, G., Cucurachi, M., Altieri, G., Leonardo, V., Idra, A.S., Del Rosso, G., Polidoro, M., Stigliano, N., Pittella, G., Paternoster, G., Pulito, G., Puscio, D., Cingolani, D., Falzetti, G., Vecchiarelli, P., Giunta, F., Forfori, F., Castiglione, G., Greco, S., Capra, C., Crema, L., Tamayo, L., Urbano, C., Pezza, B., Zarrillo, N., Di Monaco, P., Climaco, G., De Negri, P., Modano, P., Pagliarulo, R., Petrillo, C., Stripoli, T., Oggioni, R., Campiglia, L., Valletta, A.R., Lugano, M., Milella, D., Micucci, L., Reist, U., Ensner, R., Gianbarba, C., Brander, L., Paul, R., Crawla, R., Jasujia, S., Pande, R., Dileep, P., Sundar, S., Ganesan, R., Dewan, S., Nangia, V., Mani, R.K., Singh, O., Sathe, P., Sachin, G., D’Costa, P.M., Srivanas, S., Singh, Y.P., Doi, K., Taki, F., Roca, R.F., Medina, E.R., Gernacho, J., Martí, F., Martinez-Ruiz, A., Martinez-Sagasti, F., Crespo, R.Z., Torti, P., Terzi, V., Cutuli, S, Artigas, A, Fumagalli, R, Monti, G, Ranieri, V, Ronco, C, and Antonelli, M

Subjects
hypotension, retrospective study, 030232 urology & nephrology, race difference, polymyxin B, abdominal infection, tachycardia, Critical Care and Intensive Care Medicine, 0302 clinical medicine, respiratory function, Septic shock, antibiotic therapy, EAA, Medicine, Respiratory function, randomized controlled trial (topic), Gram negative sepsi, kidney function, Extracorporeal endotoxin removal, intensive care, lung infection, endotoxemia, adult, continuous infusion, clinical practice, aged, female, priority journal, liver function, multicenter study (topic), disease severity, SOFA score, Infection, survival rate, medicine.medical_specialty, Polymyxin-B hemoperfusion, Sepsis, Sepsi, cardiovascular response, European, blood clotting, Article, 03 medical and health sciences, length of stay, male, blood clotting disorder, Intensive care, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, Sequential Organ Failure Assessment Score, human, MED/41 - ANESTESIOLOGIA, survival time, Survival rate, hospital mortality, Asian, business.industry, Research, Abdominal Infection, 030208 emergency & critical care medicine, bleeding, medicine.disease, major clinical study, Surgery, hospital admission, multicenter study, treatment outcome, Liver function, business
Abstract

Background: In 2010, the EUPHAS 2 collaborative group created a registry with the purpose of recording data from critically ill patients suffering from severe sepsis and septic shock treated with polymyxin-B hemoperfusion (PMX-HP) for endotoxin removal. The aim of the registry was to verify the application of PMX-HP in the daily clinical practice. Methods: The EUPHAS 2 registry involved 57 centers between January 2010 and December 2014, collecting retrospective data of 357 patients (297 in Europe and 60 in Asia) suffering from severe sepsis and septic shock caused by proved or suspected infection related to Gram negative bacteria. All patients received atleast one cycle of extracorporeal endotoxin removal by PMX-HP. Results: Septic shock was diagnosed in 305 (85.4%) patients. The most common source of infection was abdominal (44.0%) followed by pulmonary (17.6%). Gram negative bacteria represented 60.6% of the pathogens responsible of infection. After 72h from the first cycle of PMX-HP, some of the SOFA score components significantly improved with respect to baseline: cardiovascular (2.16±1.77 from 3.32±1.29, p&nbsp

Published
2016

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