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2. A patient-specific approach for quantitative and automatic analysis of computed tomography images in lung disease: application to COVID-19 patients

Author

Berta, L., De Mattia, C., Rizzetto, F., Carrazza, S., Colombo, P. E., Fumagalli, R., Langer, T., Lizio, D., Vanzulli, A., and Torresin, A.

Subjects
Physics - Medical Physics, Statistics - Machine Learning
Abstract

Quantitative metrics in lung computed tomography (CT) images have been widely used, often without a clear connection with physiology. This work proposes a patient-independent model for the estimation of well-aerated volume of lungs in CT images (WAVE). A Gaussian fit, with mean (Mu.f) and width (Sigma.f) values, was applied to the lower CT histogram data points of the lung to provide the estimation of the well-aerated lung volume (WAVE.f). Independence from CT reconstruction parameters and respiratory cycle was analysed using healthy lung CT images and 4DCT acquisitions. The Gaussian metrics and first order radiomic features calculated for a third cohort of COVID-19 patients were compared with those relative to healthy lungs. Each lung was further segmented in 24 subregions and a new biomarker derived from Gaussian fit parameter Mu.f was proposed to represent the local density changes. WAVE.f resulted independent from the respiratory motion in 80% of the cases. Differences of 1%, 2% and up to 14% resulted comparing a moderate iterative strength and FBP algorithm, 1 and 3 mm of slice thickness and different reconstruction kernel. Healthy subjects were significantly different from COVID-19 patients for all the metrics calculated. Graphical representation of the local biomarker provides spatial and quantitative information in a single 2D picture. Unlike other metrics based on fixed histogram thresholds, this model is able to consider the inter-and intra-subject variability. In addition, it defines a local biomarker to quantify the severity of the disease, independently of the observer., Comment: 31 pages, 7 figures, accepted in EJMP

Published
2021

4. Restored strange metal phase through suppression of charge density waves in underdoped YBa$_2$Cu$_3$O$_{7-\delta}$

Author

Wahlberg, E., Arpaia, R., Seibold, G., Rossi, M., Fumagalli, R., Trabaldo, E., Brookes, N. B., Braicovich, L., Caprara, S., Gran, U., Ghiringhelli, G., Bauch, T., and Lombardi, F.

Subjects
Condensed Matter - Superconductivity, Condensed Matter - Strongly Correlated Electrons
Abstract

The normal state of optimally doped cuprates is dominated by the "strange metal" phase that shows a linear temperature ($T$) dependence of the resistivity persisting down to the lowest $T$. For underdoped cuprates this behavior is lost below the pseudogap temperature $T^*$, where Charge Density Waves (CDW) together with other intertwined local orders characterize the ground state. Here we show that the $T$-linear resistivity of highly strained, ultrathin and underdoped YBa$_2$Cu$_3$O$_{7-\delta}$ films is restored when the CDW amplitude, detected by Resonant Inelastic X-ray scattering, is suppressed. This observation points towards an intimate connection between the onset of CDW and the departure from $T$-linear resistivity in underdoped cuprates. Our results illustrate the potential of using strain control to manipulate the ground state of quantum materials.

Published
2020
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5. Charge density waves in YBa$_2$Cu$_3$O$_{6.67}$ probed by resonant x-ray scattering under uniaxial compression

Author

Kim, H. -H., Lefrançois, E., Kummer, K., Fumagalli, R., Brookes, N. B., Betto, D., Nakata, S., Tortora, M., Porras, J., Loew, T., Barber, M., Braicovich, L., Mackenzie, A. P., Hicks, C. W., Keimer, B., Minola, M., and Tacon, M. Le

Subjects
Condensed Matter - Superconductivity, Condensed Matter - Strongly Correlated Electrons
Abstract

We report a comprehensive Cu L$_3$-edge resonant x-ray scattering study of two- and three-dimensional (2D and 3D) incommensurate charge correlations in single crystals of the underdoped high-temperature superconductor YBa$_2$Cu$_3$O$_{6.67}$ under uniaxial compression up to 1% along the two inequivalent Cu-O-Cu bond directions (a and b) in the CuO$_2$ planes. The pressure response of the 2D charge correlations is symmetric: pressure along a enhances correlations along b, and vice versa. Our results imply that the underlying order parameter is uniaxial. In contrast, 3D long-range charge order is only observed along b in response to compression along a. Spectroscopic resonant x-ray scattering measurements show that the 3D charge order resides exclusively in the CuO$_2$ planes and may thus be generic to the cuprates. We discuss implications of these results for models of electronic nematicity and for the interplay between charge order and superconductivity., Comment: Revised version - Accepted for publication in Phys. Rev. Lett

Published
2020
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6. Outcomes of Radiation Segmentectomy for Hepatocellular Carcinoma in Patients with Non-Alcoholic Fatty Liver Disease versus Chronic Viral Hepatitis

Author

De la Garza-Ramos C, Montazeri SA, Musto KR, Kapp MD, Lewis AR, Frey G, Paz-Fumagalli R, Ilyas S, Harnois DM, Majeed U, Patel T, and Toskich B

Subjects
hepatocellular carcinoma, radiation segmentectomy, nafld, viral hepatitis, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Cynthia De la Garza-Ramos,1 S Ali Montazeri,1 Kaitlyn R Musto,1 Melissa D Kapp,1 Andrew R Lewis,1 Gregory Frey,1 Ricardo Paz-Fumagalli,1 Sumera Ilyas,2 Denise M Harnois,3 Umair Majeed,4 Tushar Patel,3 Beau Toskich1 1Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, FL, USA; 2Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN, USA; 3Department of Transplant, Mayo Clinic, Florida, FL, USA; 4Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville, FL, USACorrespondence: Beau Toskich, Division of Interventional Radiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA, Tel +1 904-953-1496, Email Toskich.Beau@mayo.eduPurpose: To compare the outcomes of radiation segmentectomy for early-stage hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD) versus hepatitis C virus (HCV).Materials and Methods: A retrospective analysis of consecutive patients with NAFLD- or HCV-related HCC treated with radiation segmentectomy from 01/2017-06/2022 was performed. Eligibility criteria included solitary tumor ≤ 8 cm or up to 3 HCC ≤ 3 cm, ECOG 0– 1, and absence of vascular invasion or extrahepatic spread. Imaging best response was assessed per modified Response Evaluation Criteria in Solid Tumors. Target tumor and overall progression, time-to-progression (TTP), and overall survival (OS) were calculated. All outcomes were censored for liver transplantation (LT). Complete pathologic response (CPN) was assessed in patients who underwent LT.Results: Of 142 patients included (NAFLD: 61; HCV: 81), most had cirrhosis (NAFLD: 87%; HCV: 86%) and small tumors (median size NAFLD: 2.3 cm; HCV: 2.5 cm). Patients with NAFLD had higher BMI (p< 0.001) and worse ALBI scores (p=0.003). Patients with HCV were younger (p< 0.001) and had higher AFP levels (p=0.034). Median radiation dose (NAFLD: 508 Gy; HCV: 452 Gy) and specific activity (NAFLD: 700 Bq; HCV: 698 Bq) were similar between cohorts. Objective response was 100% and 97% in the NAFLD and HCV cohorts, respectively. Target tumor progression occurred in 1 (2%) NAFLD and 8 (10%) HCV patients. Target tumor TTP was not met for either cohort. Overall progression occurred in 23 (38%) NAFLD and 39 (48%) HCV patients. Overall TTP was 17.4 months (95% CI 13.5– 22.2) in NAFLD and 13.5 months (95% CI 0.4– 26.6) in HCV patients (p=0.86). LT was performed in 27 (44%) NAFLD and 33 (41%) HCV patients, with a CPN rate of 63% and 54%, respectively. OS was not met in the NAFLD cohort and was 53.9 months (95% CI 32.1– 75.7) in the HCV cohort (p=0.15).Conclusion: Although NAFLD and HCV are associated with different mechanisms of liver injury, patients with early-stage HCC treated with radiation segmentectomy achieve comparable outcomes.Keywords: hepatocellular carcinoma, radiation segmentectomy, NAFLD, viral hepatitis

Published
2023

7. Comparison of multiple definitions for ventilator-associated pneumonia in patients requiring mechanical ventilation for non-pulmonary conditions: preliminary data from PULMIVAP, an Italian multi-centre cohort study

Author

Alagna, L., Palomba, E., Chatenoud, L., Massafra, R., Magni, F., Mancabelli, L., Donnini, S., Elli, F., Forastieri, A., Gaipa, G., Abbruzzese, C., Fumagalli, R., Munari, M., Panacea, A., Picetti, E., Terranova, L., Turroni, F., Vaschetto, R., Zoerle, T., Citerio, G., Gori, A., and Bandera, A.

Published
2023
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8. Formation of Incommensurate Charge Density Waves in Cuprates

Author

Miao, H., Fumagalli, R., Rossi, M., Lorenzana, J., Seibold, G., Kummer, F. Yakhou-Harris K., Brookes, N. B., Gu, G. D., Braicovich, L., Ghiringhelli, G., and Dean, M. P. M.

Subjects
Condensed Matter - Superconductivity, Condensed Matter - Materials Science, Condensed Matter - Strongly Correlated Electrons
Abstract

Although charge density waves (CDWs) are omnipresent in cuprate high-temperature superconductors, they occur at significantly different wavevectors, confounding efforts to understand their formation mechanism. Here, we use resonant inelastic x-ray scattering to investigate the doping- and temperature-dependent CDW evolution in La2-xBaxCuO4 (x=0.115-0.155). We discovered that the CDW develops in two stages with decreasing temperature. A precursor CDW with quasi-commensurate wavevector emerges first at high-temperature. This doping-independent precursor CDW correlation originates from the CDW phase mode coupled with a phonon and "seeds" the low-temperature CDW with strongly doping dependent wavevector. Our observation reveals the precursor CDW and its phase mode as the building blocks of the highly intertwined electronic ground state in the cuprates., Comment: In press at Physical Review X; 11 pages, 6 figures

Published
2019
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9. Strange metal behaviour from charge density fluctuations in cuprates

Author

Seibold, G., Arpaia, R., Peng, Y. Y., Fumagalli, R., Braicovich, L., Di Castro, C., Grilli, M., Ghiringhelli, G., and Caprara, S.

Subjects
Condensed Matter - Superconductivity
Abstract

Besides the mechanism responsible for high critical temperature superconductivity, the grand unresolved issue of the cuprates is the occurrence of a strange metallic state above the so-called pseudogap temperature $T^*$. Even though such state has been successfully described within a phenomenological scheme, the so-called Marginal Fermi-Liquid theory, a microscopic explanation is still missing. However, recent resonant X-ray scattering experiments identified a new class of charge density fluctuations characterized by low characteristic energies and short correlation lengths, which are related to the well-known charge density waves. These fluctuations are present over a wide region of the temperature-vs-doping phase diagram and extend well above $T^*$. Here we investigate the consequences of charge density fluctuations on the electron and transport properties and find that they can explain the strange metal phenomenology. Therefore, charge density fluctuations are likely the long-sought microscopic mechanism underlying the peculiarities of the metallic state of cuprates., Comment: 18 pages including Supplementary Informations, 10 figures

Published
2019
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10. Polarization resolved Cu $L_3$-edge resonant inelastic x-ray scattering of orbital and spin excitations in NdBa$_{2}$Cu$_{3}$O$_{7-\delta}$

Author

Fumagalli, R., Braicovich, L., Minola, M., Peng, Y. Y., Kummer, K., Betto, D., Rossi, M., Lefrançois, E., Morawe, C., Salluzzo, M., Suzuki, H., Yakhou, F., Tacon, M. Le, Keimer, B., Brookes, N. B., Sala, M. Moretti, and Ghiringhelli, G.

Subjects
Condensed Matter - Superconductivity, Condensed Matter - Strongly Correlated Electrons
Abstract

High resolution resonant inelastic x-ray scattering (RIXS) has proven particularly effective in the determination of crystal field and spin excitations in cuprates. Its strength lies in the large Cu $L_{3}$ resonance and in the fact that the scattering cross section follows quite closely the single-ion model predictions, both in the insulating parent compounds and in the superconducting doped materials. However, the spectra become increasingly broader with (hole) doping, hence resolving and assigning spectral features has proven challenging even with the highest energy resolution experimentally achievable. Here we have overcome this limitation by measuring the complete polarization dependence of the RIXS spectra as function of momentum transfer and doping in thin films of NdBa$_{2}$Cu$_{3}$O$_{7-\delta}$. Besides confirming the previous assignment of $dd$ and spin excitations (magnon, bimagnon) in the antiferromagnetic insulating parent compound, we unequivocally single out the actual spin-flip contribution at all dopings. We also demonstrate that the softening of $dd$ excitations is mainly attributed to the shift of the $xy$ peak to lower energy loss. These results provide a definitive assessment of the RIXS spectra of cuprates and demonstrate that RIXS measurements with full polarization control are practically feasible and highly informative., Comment: 14 pages, 10 figures

Published
2019
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11. Dynamic inflation prevents and standardized lung recruitment reverts volume loss associated with percutaneous tracheostomy during volume control ventilation: results from a Neuro-ICU population

Author

Bastia, L, Garberi, R, Querci, L, Cipolla, C, Curto, F, Rezoagli, E, Fumagalli, R, Chieregato, A, Bastia L., Garberi R., Querci L., Cipolla C., Curto F., Rezoagli E., Fumagalli R., Chieregato A., Bastia, L, Garberi, R, Querci, L, Cipolla, C, Curto, F, Rezoagli, E, Fumagalli, R, Chieregato, A, Bastia L., Garberi R., Querci L., Cipolla C., Curto F., Rezoagli E., Fumagalli R., and Chieregato A.

Abstract

To determine how percutaneous tracheostomy (PT) impacts on respiratory system compliance (Crs) and end-expiratory lung volume (EELV) during volume control ventilation and to test whether a recruitment maneuver (RM) at the end of PT may reverse lung derecruitment. This is a single center, prospective, applied physiology study. 25 patients with acute brain injury who underwent PT were studied. Patients were ventilated in volume control ventilation. Electrical impedance tomography (EIT) monitoring and respiratory mechanics measurements were performed in three steps: (a) baseline, (b) after PT, and (c) after a standardized RM (10 sighs of 30 cmH2O lasting 3 s each within 1 min). End-expiratory lung impedance (EELI) was used as a surrogate of EELV. PT determined a significant EELI loss (mean reduction of 432 arbitrary units p = 0.049) leading to a reduction in Crs (55 ± 13 vs. 62 ± 13 mL/cmH2O; p < 0.001) as compared to baseline. RM was able to revert EELI loss and restore Crs (68 ± 15 vs. 55 ± 13 mL/cmH2O; p < 0.001). In a subgroup of patients (N = 8, 31%), we observed a gradual but progressive increase in EELI. In this subgroup, patients did not experience a decrease of Crs after PT as compared to patients without dynamic inflation. Dynamic inflation did not cause hemodynamic impairment nor raising of intracranial pressure. We propose a novel and explorative hyperinflation risk index (HRI) formula. Volume control ventilation did not prevent the PT-induced lung derecruitment. RM could restore the baseline lung volume and mechanics. Dynamic inflation is common during PT, it can be monitored real-time by EIT and anticipated by HRI. The presence of dynamic inflation during PT may prevent lung derecruitment.

Published
2024

12. Ventilation distribution during changes in trunk inclination in ARDS patients

Author

Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, Marrazzo F., Spina S., Zadek F., Forlini C., Bassi G., Giudici R., Bellani G., Fumagalli R., Langer T., Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, Marrazzo F., Spina S., Zadek F., Forlini C., Bassi G., Giudici R., Bellani G., Fumagalli R., and Langer T.

Published
2024

13. Role of hemolysis on pulmonary arterial compliance and right ventricular systolic function after cardiopulmonary bypass

Author

Rezoagli, E, Redaelli, S, Bittner, E, Fumagalli, R, Ichinose, F, Berra, L, Rezoagli E., Redaelli S., Bittner E. A., Fumagalli R., Ichinose F., Berra L., Rezoagli, E, Redaelli, S, Bittner, E, Fumagalli, R, Ichinose, F, Berra, L, Rezoagli E., Redaelli S., Bittner E. A., Fumagalli R., Ichinose F., and Berra L.

Abstract

Background: Cardiopulmonary bypass (CPB) is associated with intravascular hemolysis which depletes endogenous nitric oxide (NO). The impact of hemolysis on pulmonary arterial compliance (PAC) and right ventricular systolic function has not been explored yet. We hypothesized that decreased NO availability is associated with worse PAC and right ventricular systolic function after CPB. Methods: This is a secondary analysis of an observational cohort study in patients undergoing cardiac surgery with CPB at Massachusetts General Hospital, USA (2014–2015). We assessed PAC (stroke volume/pulmonary artery pulse pressure ratio), and right ventricular function index (RVFI) (systolic pulmonary arterial pressure/cardiac output), as well as NO consumption at 15 min, 4 h and 12 h after CPB. Patients were stratified by CPB duration. Further, we assessed the association between changes in NO consumption with PAC and RVFI between 15min and 4 h after CPB. Results: PAC was lowest at 15min after CPB and improved over time (n = 50). RVFI was highest -worse right ventricular function- at CPB end and gradually decreased. Changes in hemolysis, PAC and RVFI differed over time by CPB duration. PAC inversely correlated with total pulmonary resistance (TPR). TPR and PAC positively and negatively correlated with RVFI, respectively. NO consumption between 15min and 4 h after CPB correlated with changes in PAC (−0.28 ml/mmHg, 95%CI −0.49 to −0.01, p = 0.012) and RVFI (0.14 mmHg*L−1*min, 95%CI 0.10 to 0.18, p < 0.001) after multivariable adjustments. Conclusion: PAC and RVFI are worse at CPB end and improve over time. Depletion of endogenous NO may contribute to explain changes in PAC and RVFI after CPB.

Published
2024

16. Three dimensional collective charge excitations in electron-doped cuprate superconductors

Author

Hepting, M., Chaix, L., Huang, E. W., Fumagalli, R., Peng, Y. Y., Moritz, B., Kummer, K., Brookes, N. B., Lee, W. C., Hashimoto, M., Sarkar, T., He, J. F., Rotundu, C. R., Lee, Y. S., Greene, R. L., Braicovich, L., Ghiringhelli, G., Shen, Z. X., Devereaux, T. P., and Lee, W. S.

Subjects
Condensed Matter - Superconductivity, Condensed Matter - Strongly Correlated Electrons
Abstract

High temperature cuprate superconductors consist of stacked CuO2 planes, with primarily two dimensional electronic band structures and magnetic excitations, while superconducting coherence is three dimensional. This dichotomy highlights the importance of out-of-plane charge dynamics, believed to be incoherent in the normal state, yet lacking a comprehensive characterization in energy-momentum space. Here, we use resonant inelastic x-ray scattering (RIXS) with polarization analysis to uncover the pure charge character of a recently discovered collective mode in electron-doped cuprates. This mode disperses along both the in- and, importantly, out-of-plane directions, revealing its three dimensional nature. The periodicity of the out-of-plane dispersion corresponds to the CuO2 plane distance rather than the crystallographic c-axis lattice constant, suggesting that the interplane Coulomb interaction drives the coherent out-of-plane charge dynamics. The observed properties are hallmarks of the long-sought acoustic plasmon, predicted for layered systems and argued to play a substantial role in mediating high temperature superconductivity., Comment: This is the version of first submission. The revised manuscript according to peer reviews is now accepted by Nature and will be published online on 31st Oct., 2018

Published
2018
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17. Dynamical charge density fluctuations pervading the phase diagram of a Cu-based high-Tc superconductor

Author

Arpaia, R., Caprara, S., Fumagalli, R., De Vecchi, G., Peng, Y. Y., Andersson, E., Betto, D., De Luca, G. M., Brookes, N. B., Lombardi, F., Salluzzo, M., Braicovich, L., Di Castro, C., Grilli, M., and Ghiringhelli, G.

Subjects
Condensed Matter - Superconductivity
Abstract

Charge density waves are a common occurrence in all families of high critical temperature superconducting cuprates. Although consistently observed in the underdoped region of the phase diagram and at relatively low temperatures, it is still unclear to what extent they influence the unusual properties of these systems. Using resonant x-ray scattering we carefully determined the temperature dependence of charge density modulations in (Y,Nd)Ba$_2$Cu$_3$O$_{7-{\delta}}$ for three doping levels. We discovered short-range dynamical charge density fluctuations besides the previously known quasi-critical charge density waves. They persist up to well above the pseudogap temperature T*, are characterized by energies of few meV and pervade a large area of the phase diagram, so that they can play a key role in shaping the peculiar normal-state properties of cuprates., Comment: 34 pages, 4 figures, 11 supplementary figures

Published
2018
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18. Dispersion, damping, and intensity of spin excitations in the single-layer (Bi,Pb)$_{2}$(Sr,La)$_{2}$CuO$_{6+\delta}$ cuprate superconductor family

Author

Peng, Y. Y., Huang, E. W., Fumagalli, R., Minola, M., Wang, Y., Sun, X., Ding, Y., Kummer, K., Zhou, X. J., Brookes, N. B., Moritz, B., Braicovich, L., Devereaux, T. P., and Ghiringhelli, G.

Subjects
Condensed Matter - Superconductivity
Abstract

Using Cu-$L_3$ edge resonant inelastic x-ray scattering (RIXS) we measured the dispersion and damping of spin excitations (magnons and paramagnons) in the high-$T_\mathrm{c}$ superconductor (Bi,Pb)$_{2}$(Sr,La)$_{2}$CuO$_{6+\delta}$ (Bi2201), for a large doping range across the phase diagram ($0.03\lesssim p\lesssim0.21$). Selected measurements with full polarization analysis unambiguously demonstrate the spin-flip character of these excitations, even in the overdoped sample. We find that the undamped frequencies increase slightly with doping for all accessible momenta, while the damping grows rapidly, faster in the (0,0)$\rightarrow$(0.5,0.5) nodal direction than in the (0,0)$\rightarrow$(0.5,0) antinodal direction. We compare the experimental results to numerically exact determinant quantum Monte Carlo (DQMC) calculations that provide the spin dynamical structure factor $S(\textbf{Q},\omega)$ of the three-band Hubbard model. The theory reproduces well the momentum and doping dependence of the dispersions and spectral weights of magnetic excitations. These results provide compelling evidence that paramagnons, although increasingly damped, persist across the superconducting dome of the cuprate phase diagram; this implies that long range antiferromagnetic correlations are quickly washed away, while short range magnetic interactions are little affected by doping., Comment: 11 pages, 9 figures

Published
2018
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19. Possibility to realize spin-orbit-induced correlated physics in iridium fluorides

Author

Rossi, M., Retegan, M., Giacobbe, C., Fumagalli, R., Efimenko, A., Kulka, T., Wohlfeld, K., Gubanov, A. I., and Sala, M. Moretti

Subjects
Condensed Matter - Strongly Correlated Electrons
Abstract

Recent theoretical predictions of "unprecedented proximity" of the electronic ground state of iridium fluorides to the SU(2) symmetric $j_{\mathrm{eff}}=1/2$ limit, relevant for superconductivity in iridates, motivated us to investigate their crystal and electronic structure. To this aim, we performed high-resolution x-ray powder diffraction, Ir L$_3$-edge resonant inelastic x-ray scattering, and quantum chemical calculations on Rb$_2$[IrF$_6$] and other iridium fluorides. Our results are consistent with the Mott insulating scenario predicted by Birol and Haule [Phys. Rev. Lett. 114, 096403 (2015)], but we observe a sizable deviation of the $j_{\mathrm{eff}}=1/2$ state from the SU(2) symmetric limit. Interactions beyond the first coordination shell of iridium are negligible, hence the iridium fluorides do not show any magnetic ordering down to at least 20 K. A larger spin-orbit coupling in iridium fluorides compared to oxides is ascribed to a reduction of the degree of covalency, with consequences on the possibility to realize spin-orbit-induced strongly correlated physics in iridium fluorides.

Published
2017
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20. Re-entrant charge order in overdoped (Bi,Pb)$_{2.12}$Sr$_{1.88}$CuO$_{6+\delta}$ outside the pseudogap regime

Author

Peng, Y. Y., Fumagalli, R., Ding, Y., Minola, M., Caprara, S., Betto, D., De Luca, G. M., Kummer, K., Lefrançois, E., Salluzzo, M., Suzuki, H., Tacon, M. Le, Zhou, X. J., Brookes, N. B., Keimer, B., Braicovich, L., Grilli, M., and Ghiringhelli, G.

Subjects
Condensed Matter - Superconductivity
Abstract

Charge modulations are considered as a leading competitor of high-temperature superconductivity in the underdoped cuprates, and their relationship to Fermi surface reconstructions and to the pseudogap state is an important subject of current research. Overdoped cuprates, on the other hand, are widely regarded as conventional Fermi liquids without collective electronic order. For the overdoped (Bi,Pb)2.12Sr1.88CuO6+{\delta} (Bi2201) high-temperature superconductor, here we report resonant x-ray scattering measurements revealing incommensurate charge order reflections, with correlation lengths of 40-60 lattice units, that persist up to at least 250K. Charge order is markedly more robust in the overdoped than underdoped regime but the incommensurate wave vectors follow a common trend; moreover it coexists with a single, unreconstructed Fermi surface, without pseudogap or nesting features, as determined from angle-resolved photoemission spectroscopy. This re-entrant charge order is reproduced by model calculations that consider a strong van Hove singularity within a Fermi liquid framework., Comment: 11 pages, 5 figures

Published
2017
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21. Oxygen-Sparing Anesthesia with Electrically Controlled Ventilators: A Bench Study with Implications for Clinical Practice and Resource Management

Author

Torrano, V, Zadek, F, Abbiati, G, Deli, C, Fumagalli, R, Langer, T, Torrano, Vito, Zadek, Francesco, Giacomo, Abbiati, Deli, Chiara, Fumagalli, Roberto, Langer, Thomas, Torrano, V, Zadek, F, Abbiati, G, Deli, C, Fumagalli, R, Langer, T, Torrano, Vito, Zadek, Francesco, Giacomo, Abbiati, Deli, Chiara, Fumagalli, Roberto, and Langer, Thomas

Published
2024

22. Successful Versus Failed Transition From Controlled Ventilation to Pressure Support Ventilation in COVID-19 Patients: A Retrospective Cohort Study

Author

Polo Friz, M, Rezoagli, E, Safaee Fakhr, B, Florio, G, Carlesso, E, Giudici, R, Forlini, C, Tardini, F, Langer, T, Laratta, M, Casella, G, Forastieri Molinari, A, Protti, A, Cecconi, M, Cabrini, L, Biagioni, E, Berselli, A, Mirabella, L, Tonetti, T, De Robertis, E, Grieco, D, Antonelli, M, Citerio, G, Fumagalli, R, Foti, G, Zanella, A, Grasselli, G, Bellani, G, Polo Friz, Melisa, Rezoagli, Emanuele, Safaee Fakhr, Bijan, Florio, Gaetano, Carlesso, Eleonora, Giudici, Riccardo, Forlini, Clarissa, Tardini, Francesca, Langer, Thomas, Laratta, Matteo, Casella, Giampaolo, Forastieri Molinari, Andrea, Protti, Alessandro, Cecconi, Maurizio, Cabrini, Luca, Biagioni, Emanuela, Berselli, Angela, Mirabella, Lucia, Tonetti, Tommaso, De Robertis, Edoardo, Grieco, Domenico Luca, Antonelli, Massimo, Citerio, Giuseppe, Fumagalli, Roberto, Foti, Giuseppe, Zanella, Alberto, Grasselli, Giacomo, Bellani, Giacomo, Polo Friz, M, Rezoagli, E, Safaee Fakhr, B, Florio, G, Carlesso, E, Giudici, R, Forlini, C, Tardini, F, Langer, T, Laratta, M, Casella, G, Forastieri Molinari, A, Protti, A, Cecconi, M, Cabrini, L, Biagioni, E, Berselli, A, Mirabella, L, Tonetti, T, De Robertis, E, Grieco, D, Antonelli, M, Citerio, G, Fumagalli, R, Foti, G, Zanella, A, Grasselli, G, Bellani, G, Polo Friz, Melisa, Rezoagli, Emanuele, Safaee Fakhr, Bijan, Florio, Gaetano, Carlesso, Eleonora, Giudici, Riccardo, Forlini, Clarissa, Tardini, Francesca, Langer, Thomas, Laratta, Matteo, Casella, Giampaolo, Forastieri Molinari, Andrea, Protti, Alessandro, Cecconi, Maurizio, Cabrini, Luca, Biagioni, Emanuela, Berselli, Angela, Mirabella, Lucia, Tonetti, Tommaso, De Robertis, Edoardo, Grieco, Domenico Luca, Antonelli, Massimo, Citerio, Giuseppe, Fumagalli, Roberto, Foti, Giuseppe, Zanella, Alberto, Grasselli, Giacomo, and Bellani, Giacomo

Abstract

OBJECTIVES: In patients with COVID-19 respiratory failure, controlled mechanical ventilation (CMV) is often necessary during the acute phases of the disease. Weaning from CMV to pressure support ventilation (PSV) is a key objective when the patient’s respiratory functions improve. Limited evidence exists regarding the factors predicting a successful transition to PSV and its impact on patient outcomes. DESIGN: Retrospective observational cohort study. SETTING: Twenty-four Italian ICUs from February 2020 to May 2020. PATIENTS: Mechanically ventilated ICU patients with COVID-19-induced respiratory failure. INTERVENTION: The transition period from CMV to PSV was evaluated. We defined it as “failure of assisted breathing” if the patient returned to CMV within the first 72 hours. MEASUREMENTS AND MAIN RESULTS: Of 1260 ICU patients screened, 514 were included. Three hundred fifty-seven patients successfully made the transition to PSV, while 157 failed. Pao2/Fio2 ratio before the transition emerged as an independent predictor of a successful shift (odds ratio 1.00; 95% CI, 0.99–1.00; p = 0.003). Patients in the success group displayed a better trend in Pao2/Fio2, Paco2, plateau and peak pressure, and pH level. Subjects in the failure group exhibited higher ICU mortality (hazard ratio 2.08; 95% CI, 1.42–3.06; p < 0.001), an extended ICU length of stay (successful vs. failure 21 ± 14 vs. 27 ± 17 d; p < 0.001) and a longer duration of mechanical ventilation (19 ± 18 vs. 24 ± 17 d, p = 0.04). CONCLUSIONS: Our study emphasizes that the Pao2/Fio2 ratio was the sole independent factor associated with a failed transition from CMV to PSV. The unsuccessful transition was associated with worse outcomes.

Published
2024

23. Gas Humidification During Helmet Continuous Positive Airway Pressure: A Crossover Randomized Physiologic Study in Healthy Subjects

Author

Ambrosetti, L, Giani, M, Rezoagli, E, Fiorillo, C, Vitale, D, Giacchè, D, Ravasio, G, Fumagalli, R, Foti, G, Lucchini, A, Ambrosetti, Lorenzo, Giani, Marco, Rezoagli, Emanuele, Fiorillo, Chiara, Vitale, Daniela, Giacchè, Damiano, Ravasio, Giambattista, Fumagalli, Roberto, Foti, Giuseppe, Lucchini, Alberto, Ambrosetti, L, Giani, M, Rezoagli, E, Fiorillo, C, Vitale, D, Giacchè, D, Ravasio, G, Fumagalli, R, Foti, G, Lucchini, A, Ambrosetti, Lorenzo, Giani, Marco, Rezoagli, Emanuele, Fiorillo, Chiara, Vitale, Daniela, Giacchè, Damiano, Ravasio, Giambattista, Fumagalli, Roberto, Foti, Giuseppe, and Lucchini, Alberto

Abstract

Background In the last decades, the use of the helmet interface to deliver noninvasive respiratory support has steadily increased. When delivering oxygen therapy, conditioning of inspired gas is mandatory, as the water content of medical gas is neglectable. To minimize the risk of airway damage, it is recommended to achieve an absolute humidity greater than 10 mg H2O/L. The primary aim of the study was to assess the performance of 3 different heated humidifiers to condition gas during helmet continuous positive airway pressure and to compare them with a setting without active humidification. Methods We performed a crossover randomized physiological study in healthy volunteers. Absolute humidity, relative humidity, and temperature were measured during 4 steps (no humidification and the 3 heated humidifiers, performed in a randomized order) and at 3 time points (after 1, 5, and 10 minutes). Results Eight subjects participated to the study. Without active humidification, absolute humidity was constantly below the recommended level. All humidifiers conditioned the inspired gases to an average absolute humidity greater than 10 mg H2O/L. Overall, the best performance, in terms of absolute humidity, was obtained with H900 (19.74 ± 0.50 mg H2O/L), followed by TurbH2O (-6.82 mg H2O/L vs H900; 95% confidence interval, -8.49 to -5.14; P <.05) and F&P 810 (-9.03 mg H2O/L vs H900; 95% confidence interval, -10.70 to -7.35; P <.05). Conclusions Active humidification is required to achieve adequate conditioning of inspired gas during helmet continuous positive airway pressure. The choice between different humidifiers available on the market should be made according to the local needs and expertise.

Published
2024

24. Uncomplicated calcium-citrate anticoagulation during continuous renal replacement therapy in two other patients with metformin accumulation

Author

Brunoni, B, Zadek, F, Protti, A, Cecconi, M, Fumagalli, R, Langer, T, Brunoni, Beatrice, Zadek, Francesco, Protti, Alessandro, Cecconi, Maurizio, Fumagalli, Roberto, Langer, Thomas, Brunoni, B, Zadek, F, Protti, A, Cecconi, M, Fumagalli, R, Langer, T, Brunoni, Beatrice, Zadek, Francesco, Protti, Alessandro, Cecconi, Maurizio, Fumagalli, Roberto, and Langer, Thomas

Published
2024

25. Evidenze scientifiche: confronto tra gli antipertensivi di uso comune e la Clevidipina. Trials Escape, Eclipse, Pronto, Accelerate, Velocity

Author

Ferdinando L. Lorini, Luigi Tritapepe, Aurora Smeriglia, Dojna Stavri, Claudio Ajmone Cat, Miriam Manera, Giada Bettini, Francesco Daverio, Simone Manocchio, Eleonora Pariani, Marta Ravasi, Alessandro Locatelli, Francesco Zadek, Roberto Fumagalli, Elena Onelli, Federica Di Summa, Manuela Arcoria, Andrea Viscone, Marialuigia Dello Russo, Pietro Valastro, Mario Mezzapesa, Lorini, FL, Zadek, F, Fumagalli, R, Ferdinando L. Lorini, Luigi Tritapepe, Aurora Smeriglia, Dojna Stavri, Claudio Ajmone Cat, Miriam Manera, Giada Bettini, Francesco Daverio, Simone Manocchio, Eleonora Pariani, Marta Ravasi, Alessandro Locatelli, Francesco Zadek, Roberto Fumagalli, Elena Onelli, Federica Di Summa, Manuela Arcoria, Andrea Viscone, Marialuigia Dello Russo, Pietro Valastro, Mario Mezzapesa, Lorini, FL, Zadek, F, and Fumagalli, R

Published
2024

26. Management dello scompenso cardiaco: evidenze dalla letteratura

Author

Ferdinando L. LORINI, Luigi Tritapepe, Aurora Smeriglia, Dojna Stavri, Claudio Ajmone Cat, Miriam Manera, Giada Bettini, Francesco Daverio, Simone Manocchio, Eleonora Pariani, Marta Ravasi, Alessandro Locatelli, Francesco Zadek, Roberto Fumagalli, Elena Onelli, Federica Di Summa, Manuela Arcoria, Andrea Viscone, Marialuigia Dello Russo, Pietro Valastro, Mario Mezzapesa, Lorini, FL, Zadek, F, Fumagalli, R, Ferdinando L. LORINI, Luigi Tritapepe, Aurora Smeriglia, Dojna Stavri, Claudio Ajmone Cat, Miriam Manera, Giada Bettini, Francesco Daverio, Simone Manocchio, Eleonora Pariani, Marta Ravasi, Alessandro Locatelli, Francesco Zadek, Roberto Fumagalli, Elena Onelli, Federica Di Summa, Manuela Arcoria, Andrea Viscone, Marialuigia Dello Russo, Pietro Valastro, Mario Mezzapesa, Lorini, FL, Zadek, F, and Fumagalli, R

Published
2024

27. Quantitative CT scan and response to pronation in COVID-19 ARDS

Author

Zadek, F, Berta, L, Zorzi, G, Ubiali, S, Bonaiuti, A, Tundo, G, Brunoni, B, Marrazzo, F, Giudici, R, Rossi, A, Rizzetto, F, Bernasconi, D, Vanzulli, A, Colombo, P, Fumagalli, R, Torresin, A, Langer, T, Zadek, Francesco, Berta, Luca, Zorzi, Giulia, Ubiali, Stefania, Bonaiuti, Amos, Tundo, Giulia, Brunoni, Beatrice, Marrazzo, Francesco, Giudici, Riccardo, Rossi, Anna, Rizzetto, Francesco, Bernasconi, Davide Paolo, Vanzulli, Angelo, Colombo, Paola Enrica, Fumagalli, Roberto, Torresin, Alberto, Langer, Thomas, Zadek, F, Berta, L, Zorzi, G, Ubiali, S, Bonaiuti, A, Tundo, G, Brunoni, B, Marrazzo, F, Giudici, R, Rossi, A, Rizzetto, F, Bernasconi, D, Vanzulli, A, Colombo, P, Fumagalli, R, Torresin, A, Langer, T, Zadek, Francesco, Berta, Luca, Zorzi, Giulia, Ubiali, Stefania, Bonaiuti, Amos, Tundo, Giulia, Brunoni, Beatrice, Marrazzo, Francesco, Giudici, Riccardo, Rossi, Anna, Rizzetto, Francesco, Bernasconi, Davide Paolo, Vanzulli, Angelo, Colombo, Paola Enrica, Fumagalli, Roberto, Torresin, Alberto, and Langer, Thomas

Abstract

Background: The use of the prone position (PP) has been widespread during the COVID-19 pandemic. While it has demonstrated benefits, including improved oxygenation and lung aeration, the factors influencing the response in terms of gas exchange to PP remain unclear. In particular, the association between baseline quantitative Computed Tomography (qCT) scan results and gas exchange response to PP in intubated, mechanically ventilated subjects with COVID-19 ARDS is unknown. The present study aimed to compare baseline qCT results between subjects responding to PP in terms of oxygenation or carbon dioxide (CO2) clearance and those who did not.Methods: This was a single-center, retrospective observational study, including critically ill, intubated, mechanically ventilated subjects with COVID-19 related acute respiratory distress syndrome admitted to the ICUs of Niguarda Hospital between March 2020 and November 2021. Blood-gas samples were collected before and after PP. Subjects in whom the PaO2/FiO2 increase was ≥ 20 mmHg after PP were defined as Oxygen responders (Oxy-R). CO2-responders (CO2R) were defined when the ventilatory ratio (VR) decreased during PP. Automated qCT analyses were performed to obtain tissue mass and density of the lungs.Results: One hundred twenty-five subjects were enrolled, of which 116 (93%) were Oxy-R and 51 (41%) CO2R. No difference in qCT characteristics and oxygen were observed between Oxy-R and Oxygen Non Responders (Tissue mass 1532 ±396 vs. 1654 ±304 g, p= .28; density -544±109 vs. -562±58 HU, p= .42). Similar findings were observed when dividing the population according to CO2 response (Tissue mass 1551±412 vs. 1534±377 g, p= .89; density -545±123 vs. -546±94 HU, p= .99).Conclusions: Most COVID-19 related ARDS subjects improve their oxygenation at the first pronation cycle. The study suggests that baseline qCT scan data are not associated with the response to PP in oxygenation or CO2 in mechanically ventilated COVID-19 related ARDS subje

Published
2024

32. Treatment with levosimendan in an experimental model of early ventilator-induced diaphragmatic dysfunction

Author

Zambelli, V, Murphy, E, Delvecchio, P, Rizzi, L, Fumagalli, R, Rezoagli, E, Bellani, G, Zambelli V., Murphy E. J., Delvecchio P., Rizzi L., Fumagalli R., Rezoagli E., Bellani G., Zambelli, V, Murphy, E, Delvecchio, P, Rizzi, L, Fumagalli, R, Rezoagli, E, Bellani, G, Zambelli V., Murphy E. J., Delvecchio P., Rizzi L., Fumagalli R., Rezoagli E., and Bellani G.

Abstract

Introduction: Mechanical ventilation (MV) is a life-saving approach in critically ill patients. However, it may affect the diaphragmatic structure and function, beyond the lungs. Levosimendan is a calcium sensitizer widely used in clinics to improve cardiac contractility in acute heart failure patients. In vitro studies have demonstrated that levosimendan increased force-generating capacity of the diaphragm in chronic obstructive pulmonary disease patients. Thus the aim of this study was to evaluate the effects of levosimendan administration in an animal model of ventilator-induced diaphragmatic dysfunction (VIDD) on muscle contraction and diaphragm muscle cell viability. Methods: Sprague-Dawley rats underwent prolonged MV (5 hours). VIDD+Levo group received a starting bolus of levosimendan immediately after intratracheal intubation and then an intravenous infusion of levosimendan throughout the study. Diaphragms were collected for ex vivo contractility measurement (with electric stimulation), histological analysis and Western blot analysis. Healthy rats were used as the control. Results: Levosimendan treatment maintained an adequate mean arterial pressure during the entire experimental protocol, preserved levels of autophagy-related proteins (LC3BI and LC3BII) and the muscular cell diameter demonstrated by histological analysis. Levosimendan did not affect the diaphragmatic contraction or the levels of proteins involved in the protein degradation (atrogin). Conclusions: Our data suggest that levosimendan preserves muscular cell structure (cross-sectional area) and muscle autophagy after 5 hours of MV in a rat model of VIDD. However, levosimendan did not improve diaphragm contractile efficiency.

Published
2023

33. Alactic base excess in trauma patients: a simple clinical tool to identify the presence of unmeasured anions

Author

Brunoni, B, Altomare, A, Zadek, F, Bulian, M, Baccoli, F, Bernareggi, A, Cioffi, S, Cimbanassi, S, Chiara, O, Langer, T, Fumagalli, R, Brunoni, B., Altomare, A., Zadek, F., Bulian, M., Baccoli, F., Bernareggi, A., Cioffi, SPB., Cimbanassi, S., Langer, T., Fumagalli, R., Brunoni, B, Altomare, A, Zadek, F, Bulian, M, Baccoli, F, Bernareggi, A, Cioffi, S, Cimbanassi, S, Chiara, O, Langer, T, Fumagalli, R, Brunoni, B., Altomare, A., Zadek, F., Bulian, M., Baccoli, F., Bernareggi, A., Cioffi, SPB., Cimbanassi, S., Langer, T., and Fumagalli, R.

Published
2023

34. Clinical risk factors for increased respiratory drive in intubated hypoxemic patients

Author

Spinelli, E, Pesenti, A, Slobod, D, Fornari, C, Fumagalli, R, Grasselli, G, Volta, C, Foti, G, Navalesi, P, Knafelj, R, Pelosi, P, Mancebo, J, Brochard, L, Mauri, T, Spinelli E., Pesenti A., Slobod D., Fornari C., Fumagalli R., Grasselli G., Volta C. A., Foti G., Navalesi P., Knafelj R., Pelosi P., Mancebo J., Brochard L., Mauri T., Spinelli, E, Pesenti, A, Slobod, D, Fornari, C, Fumagalli, R, Grasselli, G, Volta, C, Foti, G, Navalesi, P, Knafelj, R, Pelosi, P, Mancebo, J, Brochard, L, Mauri, T, Spinelli E., Pesenti A., Slobod D., Fornari C., Fumagalli R., Grasselli G., Volta C. A., Foti G., Navalesi P., Knafelj R., Pelosi P., Mancebo J., Brochard L., and Mauri T.

Abstract

BackgroundThere is very limited evidence identifying factors that increase respiratory drive in hypoxemic intubated patients. Most physiological determinants of respiratory drive cannot be directly assessed at the bedside (e.g., neural inputs from chemo- or mechano-receptors), but clinical risk factors commonly measured in intubated patients could be correlated with increased drive. We aimed to identify clinical risk factors independently associated with increased respiratory drive in intubated hypoxemic patients.MethodsWe analyzed the physiological dataset from a multicenter trial on intubated hypoxemic patients on pressure support (PS). Patients with simultaneous assessment of the inspiratory drop in airway pressure at 0.1-s during an occlusion (P-0.1) and risk factors for increased respiratory drive on day 1 were included. We evaluated the independent correlation of the following clinical risk factors for increased drive with P-0.1: severity of lung injury (unilateral vs. bilateral pulmonary infiltrates, PaO2/FiO(2), ventilatory ratio); arterial blood gases (PaO2, PaCO2 and pHa); sedation (RASS score and drug type); SOFA score; arterial lactate; ventilation settings (PEEP, level of PS, addition of sigh breaths).ResultsTwo-hundred seventeen patients were included. Clinical risk factors independently correlated with higher P-0.1 were bilateral infiltrates (increase ratio [IR] 1.233, 95%CI 1.047-1.451, p = 0.012); lower PaO2/FiO(2) (IR 0.998, 95%CI 0.997-0.999, p = 0.004); higher ventilatory ratio (IR 1.538, 95%CI 1.267-1.867, p < 0.001); lower pHa (IR 0.104, 95%CI 0.024-0.464, p = 0.003). Higher PEEP was correlated with lower P-0.1 (IR 0.951, 95%CI 0.921-0.982, p = 0.002), while sedation depth and drugs were not associated with P-0.1.ConclusionsIndependent clinical risk factors for higher respiratory drive in intubated hypoxemic patients include the extent of lung edema and of ventilation-perfusion mismatch, lower pHa, and lower PEEP, while sedation strategy doe

Published
2023

35. Helmet continuous positive airway pressure for patients’ transport using a single oxygen cylinder: A bench study

Author

Capsoni, N, Zadek, F, Privitera, D, Parravicini, G, Zoccali, G, Galbiati, F, Bombelli, M, Fumagalli, R, Langer, T, Capsoni, N., Zadek, F., Privitera, D., Parravicini, G., Zoccali, G. V., Galbiati, F., Bombelli, M., Fumagalli, R., Langer, T., Capsoni, N, Zadek, F, Privitera, D, Parravicini, G, Zoccali, G, Galbiati, F, Bombelli, M, Fumagalli, R, Langer, T, Capsoni, N., Zadek, F., Privitera, D., Parravicini, G., Zoccali, G. V., Galbiati, F., Bombelli, M., Fumagalli, R., and Langer, T.

Abstract

Background: Continuous positive airway pressure (CPAP) is frequently used to treat patients with acute respiratory failure in out-of-hospital settings. Compared to a facemask, the helmet has many advantages for the patient but requires a minimum gas flow of 60 L/min to avoid CO2 rebreathing. The aim of the present bench study was to evaluate the performance of four Venturi devices, connected to a single oxygen cylinder, in delivering helmet-CPAP with clinically relevant gas flow, fraction of inspired oxygen (FiO2), and positive end-expiratory pressure (PEEP) values. Methods: Three double-inlet Venturi systems (EasyVent, Ventuplus, Compact-HAR) were connected to full 5-L oxygen cylinders using a double flowmeter, and their oxygen requirements to reach different setups (flow 60-80 L/min; FiO2 0.4-0.5-0.6, PEEP 7.5-10-12.5 cmH2O) were tested. The fourth Venturi system (O2-MAX) was directly attached to the tank, and the flow and FiO2 delivered at preset FiO2 0.3 and 0.6 were recorded. The runtime of the cylinder was assessed. Results: EasyVent, Ventuplus, and O2-MAX were able to deliver helmet-CPAP with clinically useful setups when connected to a single oxygen cylinder, while Compact-HAR did not. The runtime of the cylinders ranged between 28 and 60 minutes according to the preset flow and FiO2. The delivered gas flow decreased slowly and linearly with the drop in cylinder pressure until its exhaustion. Conclusions: Helmet-CPAP might be provided using portable Venturi systems connected to an oxygen cylinder, but not all of them are able to deliver it. The use of a double flowmeter allows delivery of both high flow and high FiO2 when double-inlet Venturi systems are used. Due to the flow drop observed during the cylinder consumption, a flow >60 L/min should be set when helmet-CPAP is started. Considering the flow drop phenomenon, the estimated duration of the tank runtime can be used with a margin of safety when planning patient transport.

Published
2023

36. Efficacy and adverse events profile of videolaryngoscopy in critically ill patients: subanalysis of the INTUBE study

Author

Russotto, V, Lascarrou, J, Tassistro, E, Parotto, M, Antolini, L, Bauer, P, Szułdrzyński, K, Camporota, L, Putensen, C, Pelosi, P, Sorbello, M, Higgs, A, Greif, R, Grasselli, G, Valsecchi, M, Fumagalli, R, Foti, G, Caironi, P, Bellani, G, Laffey, J, Myatra, S, Russotto V., Lascarrou J. B., Tassistro E., Parotto M., Antolini L., Bauer P., Szułdrzyński K., Camporota L., Putensen C., Pelosi P., Sorbello M., Higgs A., Greif R., Grasselli G., Valsecchi M. G., Fumagalli R., Foti G., Caironi P., Bellani G., Laffey J. G., Myatra S. N., Russotto, V, Lascarrou, J, Tassistro, E, Parotto, M, Antolini, L, Bauer, P, Szułdrzyński, K, Camporota, L, Putensen, C, Pelosi, P, Sorbello, M, Higgs, A, Greif, R, Grasselli, G, Valsecchi, M, Fumagalli, R, Foti, G, Caironi, P, Bellani, G, Laffey, J, Myatra, S, Russotto V., Lascarrou J. B., Tassistro E., Parotto M., Antolini L., Bauer P., Szułdrzyński K., Camporota L., Putensen C., Pelosi P., Sorbello M., Higgs A., Greif R., Grasselli G., Valsecchi M. G., Fumagalli R., Foti G., Caironi P., Bellani G., Laffey J. G., and Myatra S. N.

Abstract

Background: Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated. Methods: This is a subanalysis of a large international prospective cohort of critically ill patients (INTUBE Study) performed from 1 October 2018 to 31 July 2019 and involving 197 sites from 29 countries across five continents. Our primary aim was to determine the first-pass intubation success rates of videolaryngoscopy. Secondary aims were characterising (a) videolaryngoscopy use in the critically ill patient population and (b) the incidence of severe adverse effects compared with direct laryngoscopy. Results: Of 2916 patients, videolaryngoscopy was used in 500 patients (17.2%) and direct laryngoscopy in 2416 (82.8%). First-pass intubation success was higher with videolaryngoscopy compared with direct laryngoscopy (84% vs 79%, P=0.02). Patients undergoing videolaryngoscopy had a higher frequency of difficult airway predictors (60% vs 40%, P<0.001). In adjusted analyses, videolaryngoscopy increased the probability of first-pass intubation success, with an OR of 1.40 (95% confidence interval [CI] 1.05-1.87). Videolaryngoscopy was not significantly associated with risk of major adverse events (odds ratio 1.24, 95% CI 0.95-1.62) or cardiovascular events (odds ratio 0.78, 95% CI 0.60-1.02). Conclusions: In critically ill patients, videolaryngoscopy was associated with higher first-pass intubation success rates, despite being used in a population at higher risk of difficult airway management. Videolaryngoscopy was not associated with overall risk of major adverse events. Clinical trial registration: NCT03616054.

Published
2023

37. Correction: Intravenous fluid therapy in patients with severe acute pancreatitis admitted to the intensive care unit: a narrative review (Annals of Intensive Care, (2022), 12, 1, (98), 10.1186/s13613-022-01072-y)

Author

Crosignani A., Crosignani, A, Spina, S, Marrazzo, F, Cimbanassi, S, Malbrain, M, Van Regenmortel, N, Fumagalli, R, Langer, T, Crosignani A., Spina S., Marrazzo F., Cimbanassi S., Malbrain M. L. N. G., Van Regenmortel N., Fumagalli R., Langer T., Crosignani A., Crosignani, A, Spina, S, Marrazzo, F, Cimbanassi, S, Malbrain, M, Van Regenmortel, N, Fumagalli, R, Langer, T, Crosignani A., Spina S., Marrazzo F., Cimbanassi S., Malbrain M. L. N. G., Van Regenmortel N., Fumagalli R., and Langer T.

Published
2023

38. Prone position for acute respiratory distress syndrome and the hazards of meta-analysis

Author

Poole, D, Pisa, A, Fumagalli, R, Poole D., Pisa A., Fumagalli R., Poole, D, Pisa, A, Fumagalli, R, Poole D., Pisa A., and Fumagalli R.

Abstract

Background: Researchers have tried unsuccessfully for many years using randomized controlled trials to show the efficacy of prone ventilation in treating ARDS. These failed attempts were of use in designing the successful PROSEVA trial, published in 2013. However, the evidence provided by meta-analyses in support of prone ventilation for ARDS was too low to be conclusive. The present study shows that meta-analysis is indeed not the best approach for the assessment of evidence as to the efficacy of prone ventilation. Methods: We performed a cumulative meta-analysis to prove that only the PROSEVA trial, due to its strong protective effect, has substantially impacted on the outcome. We also replicated nine published meta-analyses including the PROSEVA trial. We performed leave-one-out analyses, removing one trial at a time from each meta-analysis, measuring p values for effect size, and also the Cochran's Q test for heterogeneity assessment. We represented these analyses in a scatter plot to identify outlier studies influencing heterogeneity or overall effect size. We used interaction tests to formally identify and evaluate differences with the PROSEVA trial. Results: The positive effect of the PROSEVA trial accounted for most of the heterogeneity and for the reduction of overall effect size in the meta-analyses. The interaction tests we conducted on the nine meta-analyses formally confirmed the difference in the effectiveness of prone ventilation between the PROSEVA trial the other studies. Conclusions: The clinical lack of homogeneity between the PROSEVA trial design and the other studies should have discouraged the use of meta-analysis. Statistical considerations support this hypothesis, suggesting that the PROSEVA trial is an independent source of evidence.

Published
2023

39. Reliability of Respiratory System Compliance Calculation during Assisted Mechanical Ventilation: A Retrospective Study

Author

Bastia, L, Amendolagine, L, Pozzi, F, Carenini, S, Cipolla, C, Curto, F, Bellani, G, Fumagalli, R, Chieregato, A, Bastia L., Amendolagine L., Pozzi F., Carenini S., Cipolla C., Curto F., Bellani G., Fumagalli R., Chieregato A., Bastia, L, Amendolagine, L, Pozzi, F, Carenini, S, Cipolla, C, Curto, F, Bellani, G, Fumagalli, R, Chieregato, A, Bastia L., Amendolagine L., Pozzi F., Carenini S., Cipolla C., Curto F., Bellani G., Fumagalli R., and Chieregato A.

Abstract

OBJECTIVES: To compare respiratory system compliance (Crs) calculation during controlled mechanical ventilation (MV) and, subsequently, during assisted MV. DESIGN: This is a single-center, retrospective, observational study. SETTING: This study was conducted on patients admitted to Neuro-ICU of Niguarda Hospital (tertiary referral hospital). PATIENTS: We analyzed every patient greater than or equal to 18 years old having a Crsmeasurement in controlled and in assisted MV within 60 minutes. Plateau pressure (Pplat) was considered reliable if it was deemed visually stable for at least 2 seconds. Interventions: Inspiratory pause was incorporated to detect Pplatin controlled and assisted MV. Calculation of Crsand driving pressure were achieved. MEASUREMENTS AND MAIN RESULTS: A total of 101 patients were studied. An acceptable agreement was found (Bland-Altman plot bias-3.9, level of agreement upper 21.6, lower-29.6). Crsin assisted MV was 64.1 (52.6-79.3) and in controlled MV it was 61.2 (50-71.2) mL/cm H2o (p = 0.006). No statistical difference was found in Crs(assisted vs controlled MV) when peak pressure was lower than Pplatnor when peak pressure was higher than Pplat. CONCLUSIONS: A Pplatvisually stable for at least 2 seconds leads to reliable Crscalculation during assisted MV.

Published
2023

40. Inhaled Nitric Oxide in Acute Respiratory Distress Syndrome Subsets: Rationale and Clinical Applications

Author

Redaelli, S, Pozzi, M, Giani, M, Magliocca, A, Fumagalli, R, Foti, G, Berra, L, Rezoagli, E, Redaelli S., Pozzi M., Giani M., Magliocca A., Fumagalli R., Foti G., Berra L., Rezoagli E., Redaelli, S, Pozzi, M, Giani, M, Magliocca, A, Fumagalli, R, Foti, G, Berra, L, Rezoagli, E, Redaelli S., Pozzi M., Giani M., Magliocca A., Fumagalli R., Foti G., Berra L., and Rezoagli E.

Abstract

Acute respiratory distress syndrome (ARDS) is a life-threatening condition, characterized by diffuse inflammatory lung injury. Since the coronavirus disease 2019 (COVID-19) pandemic spread worldwide, the most common cause of ARDS has been the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Both the COVID-19-associated ARDS and the ARDS related to other causes - also defined as classical ARDS - are burdened by high mortality and morbidity. For these reasons, effective therapeutic interventions are urgently needed. Among them, inhaled nitric oxide (iNO) has been studied in patients with ARDS since 1993 and it is currently under investigation. In this review, we aim at describing the biological and pharmacological rationale of iNO treatment in ARDS by elucidating similarities and differences between classical and COVID-19 ARDS. Thereafter, we present the available evidence on the use of iNO in clinical practice in both types of respiratory failure. Overall, iNO seems a promising agent as it could improve the ventilation/perfusion mismatch, gas exchange impairment, and right ventricular failure, which are reported in ARDS. In addition, iNO may act as a viricidal agent and prevent lung hyperinflammation and thrombosis of the pulmonary vasculature in the specific setting of COVID-19 ARDS. However, the current evidence on the effects of iNO on outcomes is limited and clinical studies are yet to demonstrate any survival benefit by administering iNO in ARDS.

Published
2023

41. SARS-CoV-2 breakthrough infections in vaccinated individuals requiring ventilatory support for severe acute respiratory failure

Author

Finazzi, S, Perego, M, Tricella, G, Poole, D, Ranieri, V, Rizzo, C, Fumagalli, R, Antonella, J, Nicola, P, Andrea, D, Rita, T, Francesco, C, Manuela, B, Francesca, C, Romano, G, Vieri, P, Giampiero, B, Stefano, F, Rita, C, Monica, G, Omar, A, Loredana, F, Riccardo, G, Alessandra, P, Dino, D, Cleto, A, Paolo, M, Manuela, C, Andrea, B, Maria, B, Gianluca, Z, Michela, Z, Alessandro, M, Mario, P, Alic, P, Finazzi S., Perego M., Tricella G., Poole D., Ranieri V. M., Rizzo C., Fumagalli R., Antonella J., Nicola P., Andrea D. S., Rita T., Francesco C., Manuela B., Francesca C. F., Romano G., Vieri P., Giampiero B., Stefano F., Rita C., Monica G., Omar A., Loredana F., Riccardo G., Alessandra P., Dino D. P., Cleto A., Paolo M., Manuela C., Andrea B., Maria B., Gianluca Z., Michela Z., Alessandro M., Mario P., Alic P., Finazzi, S, Perego, M, Tricella, G, Poole, D, Ranieri, V, Rizzo, C, Fumagalli, R, Antonella, J, Nicola, P, Andrea, D, Rita, T, Francesco, C, Manuela, B, Francesca, C, Romano, G, Vieri, P, Giampiero, B, Stefano, F, Rita, C, Monica, G, Omar, A, Loredana, F, Riccardo, G, Alessandra, P, Dino, D, Cleto, A, Paolo, M, Manuela, C, Andrea, B, Maria, B, Gianluca, Z, Michela, Z, Alessandro, M, Mario, P, Alic, P, Finazzi S., Perego M., Tricella G., Poole D., Ranieri V. M., Rizzo C., Fumagalli R., Antonella J., Nicola P., Andrea D. S., Rita T., Francesco C., Manuela B., Francesca C. F., Romano G., Vieri P., Giampiero B., Stefano F., Rita C., Monica G., Omar A., Loredana F., Riccardo G., Alessandra P., Dino D. P., Cleto A., Paolo M., Manuela C., Andrea B., Maria B., Gianluca Z., Michela Z., Alessandro M., Mario P., and Alic P.

Published
2023

42. Severe Acute Respiratory Syndrome Coronavirus 2 and Medical Evacuation in Lombardy: Lessons Learned from an Unprecedented Pandemic

Author

Stucchi, R, Ripoll-Gallardo, A, Sechi, G, Weinstein, E, Villa, G, Frigerio, C, Federighi, F, Grasselli, G, Zoli, A, Bonora, R, Fumagalli, R, Stucchi R., Ripoll-Gallardo A., Sechi G. M., Weinstein E. S., Villa G. F., Frigerio C., Federighi F., Grasselli G., Zoli A., Bonora R., Fumagalli R., Stucchi, R, Ripoll-Gallardo, A, Sechi, G, Weinstein, E, Villa, G, Frigerio, C, Federighi, F, Grasselli, G, Zoli, A, Bonora, R, Fumagalli, R, Stucchi R., Ripoll-Gallardo A., Sechi G. M., Weinstein E. S., Villa G. F., Frigerio C., Federighi F., Grasselli G., Zoli A., Bonora R., and Fumagalli R.

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerging infectious disease pandemic developed in Lombardy (northern Italy) during the last week of February 2020 with a progressive increase of patients presenting with serious clinical findings. Despite the efforts of the Central Italian Government, regional resources were rapidly at capacity. The solution was to plan the medical evacuation (MEDEVAC) of 119 critically ill patients (median age 61 years) to in-patient intensive care units in other Italian regions (77) and Germany (42). Once surviving patients were deemed suitable, the repatriation process concluded the assignment. The aim of this report is to underline the importance of a rapid organization and coordination process between different nodes of an effective national and international network during an emerging infectious disease outbreak and draw lessons learned from similar published reports.

Published
2023

43. Prehospital Mass Casualty Incident Response to a Fire in a Nursing Home in Milan, Italy: Actions Taken and Shortcomings

Author

Ripoll-Gallardo, A, D'Ambrosio, A, Manzoni, P, Grifone, V, Pedrazzi, C, De Luca, G, Arghetti, D, Stellini, A, Zambelan, A, Ruggiero, I, Cusmà-Piccione, R, Bacullo, G, Lorito, F, Perbellini, P, Giacovelli, M, De Donno, M, Pelà, S, Colzani, G, Brioschi, E, Chiodini, G, Sechi, G, Zoli, A, Fumagalli, R, Stucchi, R, Ripoll-Gallardo A., D'Ambrosio A., Manzoni P., Grifone V., Pedrazzi C., De Luca G., Arghetti D., Stellini A., Zambelan A., Ruggiero I., Cusmà-Piccione R., Bacullo G., Lorito F., Perbellini P., Giacovelli M., De Donno M., Pelà S., Colzani G., Brioschi E., Chiodini G., Sechi G., Zoli A., Fumagalli R., Stucchi R., Ripoll-Gallardo, A, D'Ambrosio, A, Manzoni, P, Grifone, V, Pedrazzi, C, De Luca, G, Arghetti, D, Stellini, A, Zambelan, A, Ruggiero, I, Cusmà-Piccione, R, Bacullo, G, Lorito, F, Perbellini, P, Giacovelli, M, De Donno, M, Pelà, S, Colzani, G, Brioschi, E, Chiodini, G, Sechi, G, Zoli, A, Fumagalli, R, Stucchi, R, Ripoll-Gallardo A., D'Ambrosio A., Manzoni P., Grifone V., Pedrazzi C., De Luca G., Arghetti D., Stellini A., Zambelan A., Ruggiero I., Cusmà-Piccione R., Bacullo G., Lorito F., Perbellini P., Giacovelli M., De Donno M., Pelà S., Colzani G., Brioschi E., Chiodini G., Sechi G., Zoli A., Fumagalli R., and Stucchi R.

Abstract

On July 7, 2023, at 1:21 am, a fire was declared in a retirement home in Milan, Italy. The number of casualties (n = 87) according to the Simple Triage and Rapid Treatment (START) triage system was categorized as 65 green, 14 yellow, 2 red, and 6 black; 75% were women, and the mean age was 85.1 years (± 9). Most patients were unable to walk. A total of 30 basic life support (BLS) ambulances, 3 advanced cardiac life support (ACLS) teams on fast cars, 2 buses, and 1 coordination team were deployed. A scoop and run approach was adopted with patients being transported to 15 health care facilities. The event was terminated at 5:43 am. Though the local mass casualty incident (MCI) response plan was correctly applied, the evacuation of the building was difficult due to the age and comorbidities of the patients. START failed to correctly identify patients categorized as minor. Communication problems arose on site that led to the late evacuation of critical patients.

Published
2023

44. Amplitude Spectrum Area of ventricular fibrillation to guide defibrillation: a small open-label, pseudo-randomized controlled multicenter trial

Author

Ruggeri, L, Fumagalli, F, Bernasconi, F, Semeraro, F, Meessen, J, Blanda, A, Migliari, M, Magliocca, A, Gordini, G, Fumagalli, R, Sechi, G, Pesenti, A, Skrifvars, M, Li, Y, Latini, R, Wik, L, Ristagno, G, Ruggeri L., Fumagalli F., Bernasconi F., Semeraro F., Meessen J. M. T. A., Blanda A., Migliari M., Magliocca A., Gordini G., Fumagalli R., Sechi G., Pesenti A., Skrifvars M. B., Li Y., Latini R., Wik L., Ristagno G., Ruggeri, L, Fumagalli, F, Bernasconi, F, Semeraro, F, Meessen, J, Blanda, A, Migliari, M, Magliocca, A, Gordini, G, Fumagalli, R, Sechi, G, Pesenti, A, Skrifvars, M, Li, Y, Latini, R, Wik, L, Ristagno, G, Ruggeri L., Fumagalli F., Bernasconi F., Semeraro F., Meessen J. M. T. A., Blanda A., Migliari M., Magliocca A., Gordini G., Fumagalli R., Sechi G., Pesenti A., Skrifvars M. B., Li Y., Latini R., Wik L., and Ristagno G.

Abstract

Background: Ventricular fibrillation (VF) waveform analysis has been proposed as a potential non-invasive guide to optimize timing of defibrillation. Methods: The AMplitude Spectrum Area (AMSA) trial is an open-label, multicenter randomized controlled study reporting the first in-human use of AMSA analysis in out-of-hospital cardiac arrest (OHCA). The primary efficacy endpoint was the termination of VF for an AMSA ≥ 15.5 mV-Hz. Adult shockable OHCAs randomly received either an AMSA-guided cardiopulmonary resuscitation (CPR) or a standard-CPR. Randomization and allocation to trial group were carried out centrally. In the AMSA-guided CPR, an initial AMSA ≥ 15.5 mV-Hz prompted for immediate defibrillation, while lower values favored chest compression (CC). After completion of the first 2-min CPR cycle, an AMSA < 6.5 mV-Hz deferred defibrillation in favor of an additional 2-min CPR cycle. AMSA was measured and displayed in real-time during CC pauses for ventilation with a modified defibrillator. Findings: The trial was early discontinued for low recruitment due to the COVID-19 pandemics. A total of 31 patients were recruited in 3 Italian cities, 19 in AMSA-CPR and 12 in standard-CPR, and included in the data analysis. No difference in primary outcome was observed between the two groups. Termination of VF occurred in 74% of patients in the AMSA-CPR compared to 75% in the standard CPR (OR 0.93 [95% CI 0.18–4.90]). No adverse events were reported. Interpretation: AMSA was used prospectively in human patients during ongoing CPR. In this small trial, an AMSA-guided defibrillation provided no evidence of an improvement in termination of VF. Trial registration: NCT03237910. Funding: European Commission - Horizon 2020; ZOLL Medical Corp., Chelmsford, USA (unrestricted grant); Italian Ministry of Health - Current research IRCCS.

Published
2023

45. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Author

Pham, T, Heunks, L, Bellani, G, Madotto, F, Aragao, I, Beduneau, G, Goligher, E, Grasselli, G, Laake, J, Mancebo, J, Penuelas, O, Piquilloud, L, Pesenti, A, Wunsch, H, van Haren, F, Brochard, L, Laffey, J, Abrough, F, Acharya, S, Amin, P, Arabi, Y, Bauer, P, Beitler, J, Berkius, J, Bugedo, G, Camporota, L, Cerny, V, Cho, Y, Clarkson, K, Estenssoro, E, Gritsan, A, Hashemian, S, Hermans, G, Jovanovic, B, Kurahashi, K, Matamis, D, Moerer, O, Molnar, Z, Ozyilmaz, E, Panka, B, Papali, A, Perbet, S, Qiu, H, Razek, A, Rittayamai, N, Roldan, R, Serpa Neto, A, Szuldrzynski, K, Talmor, D, Tomescu, D, Villagomez, A, Zeggwagh, A, Abe, T, Aboshady, A, Acampo-de Jong, M, Adderley, J, Adiguzel, N, Agrawal, V, Aguilar, G, Aguirre, G, Aguirre-Bermeo, H, Ahlstrom, B, Akbas, T, Akker, M, Al Sadeh, G, Alamri, S, Algaba, A, Ali, M, Aliberti, A, Allegue, J, Alvarez, D, Amador, J, Andersen, F, Ansari, S, Apichatbutr, Y, Apostolopoulou, O, Arellano, D, Arica, M, Arikan, H, Arinaga, K, Arnal, J, Asano, K, Asin-Corrochano, M, Avalos Cabrera, J, Avila Fuentes, S, Aydemir, S, Aygencel, G, Azevedo, L, Bacakoglu, F, Badie, J, Baedorf Kassis, E, Bai, G, Balaraj, G, Ballico, B, Banner-Goodspeed, V, Banwarie, P, Barbieri, R, Baronia, A, Barrett, J, Barrot, L, Barrueco-Francioni, J, Barry, J, Bawangade, H, Beavis, S, Beck, E, Beehre, N, Belenguer Muncharaz, A, Belliato, M, Bellissima, A, Beltramelli, R, Ben Souissi, A, Benitez-Cano, A, Benlamin, M, Benslama, A, Bento, L, Benvenuti, D, Bernabe, L, Bersten, A, Berta, G, Bertini, P, Bertram-Ralph, E, Besbes, M, Bettini, L, Beuret, P, Bewley, J, Bezzi, M, Bhakhtiani, L, Bhandary, R, Bhowmick, K, Bihari, S, Bissett, B, Blythe, D, Bocher, S, Boedjawan, N, Bojanowski, C, Boni, E, Boraso, S, Borelli, M, Borello, S, Borislavova, M, Bosma, K, Bottiroli, M, Boyd, O, Bozbay, S, Briva, A, Bruel, C, Bruni, A, Buehner, U, Bulpa, P, Burt, K, Buscot, M, Buttera, S, Cabrera, J, Caccese, R, Caironi, P, Canchos Gutierrez, I, Canedo, N, Cani, A, Cappellini, I, Carazo, J, Cardonnet, L, Carpio, D, Carriedo, D, Carrillo, R, Carvalho, J, Caser, E, Castelli, A, Castillo Quintero, M, Castro, H, Catorze, N, Cengiz, M, Cereijo, E, Ceunen, H, Chaintoutis, C, Chang, Y, Chaparro, G, Chapman, C, Chau, S, Chavez, C, Chelazzi, C, Chelly, J, Chemouni, F, Chen, K, Chena, A, Chiarandini, P, Chilton, P, Chiumello, D, Chou-Lie, Y, Chudeau, N, Cinel, I, Cinnella, G, Clark, M, Clark, T, Clementi, S, Coaguila, L, Codecido, A, Collins, A, Colombo, R, Conde, J, Consales, G, Cook, T, Coppadoro, A, Cornejo, R, Cortegiani, A, Coxo, C, Cracchiolo, A, Crespo Ramirez, M, Crova, P, Cruz, J, Cubattoli, L, Cukurova, Z, Curto, F, Czempik, P, D'Andrea, R, da Silva Ramos, F, Dangers, L, Danguy des Deserts, M, Danin, P, Dantas, F, Daubin, C, Dawei, W, de Haro, C, de Jesus Montelongo, F, De Mendoza, D, de Pablo, R, De Pascale, G, De Rosa, S, Decavele, M, Declercq, P, Deicas, A, del Carmen Campos Moreno, M, Dellamonica, J, Delmas, B, Demirkiran, O, Demirkiran, H, Dendane, T, di Mussi, R, Diakaki, C, Diaz, A, Diaz, W, Dikmen, Y, Dimoula, A, Doble, P, Doha, N, Domingos, G, Dres, M, Dries, D, Duggal, A, Duke, G, Dunts, P, Dybwik, K, Dykyy, M, Eckert, P, Efe, S, Elatrous, S, Elay, G, Elmaryul, A, Elsaadany, M, Elsayed, H, Elsayed, S, Emery, M, Ena, S, Eng, K, Englert, J, Erdogan, E, Ergin Ozcan, P, Eroglu, E, Escobar, M, Esen, F, Esen Tekeli, A, Esquivel, A, Esquivel Gallegos, H, Ezzouine, H, Facchini, A, Faheem, M, Fanelli, V, Farina, M, Fartoukh, M, Fehrle, L, Feng, F, Feng, Y, Fernandez, I, Fernandez, B, Fernandez-Rodriguez, M, Ferrando, C, Ferreira da Silva, M, Ferreruela, M, Ferrier, J, Flamm Zamorano, M, Flood, L, Floris, L, Fluckiger, M, Forteza, C, Fortunato, A, Frans, E, Frattari, A, Fredes, S, Frenzel, T, Fumagalli, R, Furche, M, Fusari, M, Fysh, E, Galeas-Lopez, J, Galerneau, L, Garcia, A, Garcia, M, Garcia, E, Garcia Olivares, P, Garlicki, J, Garnero, A, Garofalo, E, Gautam, P, Gazenkampf, A, Gelinotte, S, Gelormini, D, Ghrenassia, E, Giacomucci, A, Giannoni, R, Gigante, A, Glober, N, Gnesin, P, Gollo, Y, Gomaa, D, Gomero Paredes, R, Gomes, R, Gomez, R, Gomez, O, Gomez, A, Gondim, L, Gonzalez, M, Gonzalez, I, Gonzalez-Castro, A, Gordillo Romero, O, Gordo, F, Gouin, P, Graf Santos, J, Grainne, R, Grando, M, Granov Grabovica, S, Grasso, S, Grasso, R, Grimmer, L, Grissom, C, Gu, Q, Guan, X, Guarracino, F, Guasch, N, Guatteri, L, Gueret, R, Guerin, C, Guerot, E, Guitard, P, Gul, F, Gumus, A, Gurjar, M, Gutierrez, P, Hachimi, A, Hadzibegovic, A, Hagan, S, Hammel, C, Han Song, J, Hanlon, G, Heines, S, Henriksson, J, Herbrecht, J, Heredia Orbegoso, G, Hermon, A, Hernandez, R, Hernandez, C, Herrera, L, Herrera-Gutierrez, M, Hidalgo, J, Hill, D, Holmquist, D, Homez, M, Hongtao, X, Hormis, A, Horner, D, Hornos, M, Hou, M, House, S, Housni, B, Hugill, K, Humphreys, S, Humbert, L, Hunter, S, Hwa Young, L, Iezzi, N, Ilutovich, S, Inal, V, Innes, R, Ioannides, P, Iotti, G, Ippolito, M, Irie, H, Iriyama, H, Itagaki, T, Izura, J, Izza, S, Jabeen, R, Jamaati, H, Jamadarkhana, S, Jamoussi, A, Jankowski, M, Jaramillo, L, Jeon, K, Jeong Lee, S, Jeswani, D, Jha, S, Jiang, L, Jing, C, Jochmans, S, Johnstad, B, Jongmin, L, Joret, A, Junhasavasdikul, D, Jurado, M, Kam, E, Kamohara, H, Kane, C, Kara, I, Karakurt, S, Karnjanarachata, C, Kataoka, J, Katayama, S, Kaushik, S, Kelebek Girgin, N, Kerr, K, Kerslake, I, Khairnar, P, Khalid, A, Khan, A, Khanna, A, Khorasanee, R, Kienhorst, D, Kirakli, C, Knafelj, R, Kol, M, Kongpolprom, N, Kopitko, C, Korkmaz Ekren, P, Kubisz-Pudelko, A, Kulcsar, Z, Kumasawa, J, Kuriyama, A, Kutchak, F, Labarca, E, Labat, F, Laborda, C, Laca Barrera, M, Lagache, L, Landaverde Lopez, A, Lanspa, M, Lascari, V, Le Meur, M, Lee, S, Lee, Y, Lee, J, Lee, W, Legernaes, T, Leiner, T, Lemiale, V, Leonor, T, Lepper, P, Li, D, Li, H, Li, O, Lima, A, Lind, D, Litton, E, Liu, N, Liu, L, Liu, J, Llitjos, J, Llorente, B, Lopez, R, Lopez, C, Lopez Nava, C, Lovazzano, P, Lu, M, Lucchese, F, Lugano, M, Lugo Goytia, G, Luo, H, Lynch, C, Macheda, S, Madrigal Robles, V, Maggiore, S, Magret Iglesias, M, Malaga, P, Mallapura Maheswarappa, H, Malpartida, G, Malyarchikov, A, Mansson, H, Manzano, A, Marey, I, Marin, N, Marin, M, Markman, E, Martin, F, Martin, A, Martin Dal Gesso, C, Martinez, F, Martinez-Fidalgo, C, Martin-Loeches, I, Mas, A, Masaaki, S, Maseda, E, Massa, E, Mattsson, A, Maugeri, J, Mccredie, V, Mccullough, J, Mcguinness, S, Mckown, A, Medve, L, Mei, C, Mellado Artigas, R, Mendes, V, Mervat, M, Michaux, I, Mikhaeil, M, Milagros, O, Milet, I, Millan, M, Minwei, Z, Mirabella, L, Mishra, S, Mistraletti, G, Mochizuki, K, Moghal, A, Mojoli, F, Molin, A, Montiel, R, Montini, L, Monza, G, Mora Aznar, M, Morakul, S, Morales, M, Moreno Torres, D, Morocho Tutillo, D, Motherway, C, Mouhssine, D, Mouloudi, E, Munoz, T, Munoz de Cabo, C, Mustafa, M, Muthuchellappan, R, Muthukrishnan, M, Muttini, S, Nagata, I, Nahar, D, Nakanishi, M, Nakayama, I, Namendys-Silva, S, Nanchal, R, Nandakumar, S, Nasi, A, Nasir, K, Navalesi, P, Naz Aslam, T, Nga Phan, T, Nichol, A, Niiyama, S, Nikolakopoulou, S, Nikolic, E, Nitta, K, Noc, M, Nonas, S, Nseir, S, Nur Soyturk, A, Obata, Y, Oeckler, R, Oguchi, M, Ohshimo, S, Oikonomou, M, Ojados, A, Oliveira, M, Oliveira Filho, W, Oliveri, C, Olmos, A, Omura, K, Orlandi, M, Orsenigo, F, Ortiz-Ruiz De Gordoa, L, Ota, K, Ovalle Olmos, R, Oveges, N, Oziemski, P, Ozkan Kuscu, O, Pachas Alvarado, F, Pagella, G, Palaniswamy, V, Palazon Sanchez, E, Palmese, S, Pan, G, Pan, W, Papanikolaou, M, Papavasilopoulou, T, Parekh, A, Parke, R, Parrilla, F, Parrilla, D, Pasha, T, Pasin, L, Patao, L, Patel, M, Patel, G, Pati, B, Patil, J, Pattnaik, S, Paul, D, Pavesi, M, Pavlotsky, V, Paz, G, Paz, E, Pecci, E, Pellegrini, C, Pena Padilla, A, Perchiazzi, G, Pereira, T, Pereira, V, Perez, M, Perez Calvo, C, Perez Cheng, M, Perez Maita, R, Perez-Araos, R, Perez-Teran, P, Perez-Torres, D, Perkins, G, Persona, P, Petnak, T, Petrova, M, Philippart, F, Picetti, E, Pierucci, E, Piervincenzi, E, Pinciroli, R, Pintado, M, Piraino, T, Piras, S, Piras, C, Pirompanich, P, Pisani, L, Platas, E, Plotnikow, G, Porras, W, Porta, V, Portilla, M, Portugal, J, Povoa, P, Prat, G, Pratto, R, Preda, G, Prieto, I, Prol-Silva, E, Pugh, R, Qi, Y, Qian, C, Qin, T, Qu, H, Quintana, T, Quispe Sierra, R, Quispe Soto, R, Rabbani, R, Rabee, M, Rabie, A, Rahe Pereira, M, Rai, A, Raj Ashok, S, Rajab, M, Ramdhani, N, Ramey, E, Ranieri, M, Rathod, D, Ray, B, Redwanul Huq, S, Regli, A, Reina, R, Resano Sarmiento, N, Reynaud, F, Rialp, G, Ricart, P, Rice, T, Richardson, A, Rieder, M, Rinket, M, Rios, F, Risso Vazquez, A, Riva, I, Rivette, M, Roca, O, Roche-Campo, F, Rodriguez, C, Rodriguez, G, Rodriguez Gonzalez, D, Rodriguez Tucto, X, Rogers, A, Romano, M, Rortveit, L, Rose, A, Roux, D, Rouze, A, Rubatto Birri, P, Ruilan, W, Ruiz Robledo, A, Ruiz-Aguilar, A, Sadahiro, T, Saez, I, Sagardia, J, Saha, R, Saiphoklang, N, Saito, S, Salem, M, Sales, G, Salgado, P, Samavedam, S, Sami Mebazaa, M, Samuelsson, L, San Juan Roman, N, Sanchez, P, Sanchez-Ballesteros, J, Sandoval, Y, Sani, E, Santos, M, Santos, C, Sanui, M, Saravanabavan, L, Sari, S, Sarkany, A, Sauneuf, B, Savioli, M, Sazak, H, Scano, R, Schneider, F, Schortgen, F, Schultz, M, Schwarz, G, Seckin Yucesoy, F, Seely, A, Seiler, F, Seker Tekdos, Y, Seok Chan, K, Serano, L, Serednicki, W, Setten, M, Shah, A, Shah, B, Shang, Y, Shanmugasundaram, P, Shapovalov, K, Shebl, E, Shiga, T, Shime, N, Shin, P, Short, J, Shuhua, C, Siddiqui, S, Silesky Jimenez, J, Silva, D, Silva Sales, B, Simons, K, Sjobo, B, Slessor, D, Smiechowicz, J, Smischney, N, Smith, P, Smith, T, Smith, M, Snape, S, Snyman, L, Soetens, F, Sook Hong, K, Sosa Medellin, M, Soto, G, Souloy, X, Sousa, E, Sovatzis, S, Sozutek, D, Spadaro, S, Spagnoli, M, Spangfors, M, Spittle, N, Spivey, M, Stapleton, A, Stefanovic, B, Stephenson, L, Stevenson, E, Strand, K, Strano, M, Straus, S, Sun, C, Sun, R, Sundaram, V, Sunpark, T, Surlemont, E, Sutherasan, Y, Szabo, Z, Tainter, C, 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A., Paz G., Paz E., Pecci E., Pellegrini C., Pena Padilla A. G., Perchiazzi G., Pereira T., Pereira V., Perez M., Perez Calvo C., Perez Cheng M., Perez Maita R., Perez-Araos R., Perez-Teran P., Perez-Torres D., Perkins G., Persona P., Petnak T., Petrova M., Philippart F., Picetti E., Pierucci E., Piervincenzi E., Pinciroli R., Pintado M. -C., Piraino T., Piras S., Piras C., Pirompanich P., Pisani L., Platas E., Plotnikow G., Porras W., Porta V., Portilla M., Portugal J., Povoa P., Prat G., Pratto R., Preda G., Prieto I., Prol-Silva E., Pugh R., Qi Y., Qian C., Qin T., Qu H., Quintana T., Quispe Sierra R., Quispe Soto R., Rabbani R., Rabee M., Rabie A., Rahe Pereira M. A., Rai A., Raj Ashok S., Rajab M., Ramdhani N., Ramey E., Ranieri M., Rathod D., Ray B., Redwanul Huq S. M., Regli A., Reina R., Resano Sarmiento N., Reynaud F., Rialp G., Ricart P., Rice T., Richardson A., Rieder M., Rinket M., Rios F., Risso Vazquez A., Riva I., Rivette M., Roca O., Roche-Campo F., Rodriguez C., Rodriguez G., Rodriguez Gonzalez D., Rodriguez Tucto X. Y., Rogers A., Romano M. E., Rortveit L., Rose A., Roux D., Rouze A., Rubatto Birri P. N., Ruilan W., Ruiz Robledo A., Ruiz-Aguilar A. L., Sadahiro T., Saez I., Sagardia J., Saha R., Saiphoklang N., Saito S., Salem M., Sales G., Salgado P., Samavedam S., Sami Mebazaa M., Samuelsson L., San Juan Roman N., Sanchez P., Sanchez-Ballesteros J., Sandoval Y., Sani E., Santos M., Santos C., Sanui M., Saravanabavan L., Sari S., Sarkany A., Sauneuf B., Savioli M., Sazak H., Scano R., Schneider F., Schortgen F., Schultz M. J., Schwarz G. L., Seckin Yucesoy F., Seely A., Seiler F., Seker Tekdos Y., Seok Chan K., Serano L., Serednicki W., Setten M., Shah A., Shah B., Shang Y., Shanmugasundaram P., Shapovalov K., Shebl E., Shiga T., Shime N., Shin P., Short J., Shuhua C., Siddiqui S., Silesky Jimenez J. I., Silva D., Silva Sales B., Simons K., Sjobo B. A., Slessor D., Smiechowicz J., Smischney N., Smith P., Smith T., Smith M., Snape S., Snyman L., Soetens F., Sook Hong K., Sosa Medellin M. A., Soto G., Souloy X., Sousa E., Sovatzis S., Sozutek D., Spadaro S., Spagnoli M., Spangfors M., Spittle N., Spivey M., Stapleton A., Stefanovic B., Stephenson L., Stevenson E., Strand K., Strano M. T., Straus S., Sun C., Sun R., Sundaram V., SunPark T., Surlemont E., Sutherasan Y., Szabo Z., Tainter C., Takaba A., Tallott M., Tamasato T., Tang Z., Tangsujaritvijit V., Taniguchi L., Taniguchi D., Tarantino F., Teerapuncharoen K., Temprano S., Terragni P., Terzi N., Thakur A., Theerawit P., Thille A. W., Thomas M., Thungtitigul P., Thyrault M., Tilouch N., Timenetsky K., Tirapu J., Todeschini M., Tomas R., Tomaszewski C., Tonetti T., Tonnelier A., Trinder J., Trongtrakul K., Truwit J., Tsuei B., Tulaimat A., Turan S., Turkoglu M., Tyagi S., Ubeda A., Vagginelli F., Valenti M. F., Vallverdu I., Van Axel A., van den Hul I., van der Hoeven H., Van Der Meer N., Vanhoof M., Vargas-Ordonez M., Vaschetto R., Vascotto E., Vatsik M., Vaz A., Vazquez-Sanchez A., Ventura S., Vermeijden J. W., Vidal A., Vieira J., Vilela Costa Pinto B., Villagra A., Villegas Succar C., Vinorum O. G., Vitale G., Vj R., Vochin A., Voiriot G., Volta C. A., von Seth M., Wajdi M., Walsh D., Wang S., Wardi G., Ween-Velken N. C., Wei B. -L., Weller D., Welsh D., Welters I., Wert M., Whiteley S., Wilby E., Williams E., Williams K., Wilson A., Wojtas J., Won Huh J., Wrathall D., Wright C., Wu J. -F., Xi G., Xing Z. -J., Xu H., Yamamoto K., Yan J., Yanez J., Yang X., Yates E., Yazicioglu Mocin O., Ye Z., Yildirim F., Yoshida N., Yoshido H. H. L., Young Lee B., Yu R., Yu G., Yu T., Yuan B., Yuangtrakul N., Yumoto T., Yun X., Zakalik G., Zaki A., Zalba-Etayo B., Zambon M., Zang B., Zani G., Zarka J., Zerbi S. M., Zerman A., Zetterquist H., Zhang J., Zhang H., Zhang W., Zhang G., Zhao H., Zheng J., Zhu B., and Zumaran R.

Abstract

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 d

Published
2023

46. Extracorporeal Membrane Oxygenation (ECMO) in Trauma Patients

Author

Aseni, P, Grande, AM, Leppäniemi, A, Chiara, O, Mariani, S, Willers, A, Fumagalli, R, Sangalli, F, Mariani S., Willers A., Fumagalli R., Sangalli F., Aseni, P, Grande, AM, Leppäniemi, A, Chiara, O, Mariani, S, Willers, A, Fumagalli, R, Sangalli, F, Mariani S., Willers A., Fumagalli R., and Sangalli F.

Abstract

Although the first successful use of extracorporeal life support (ECLS) in adults was reported in post-traumatic respiratory failure, trauma has been traditionally considered a relative contraindication to ECLS due to the possible complications. In recent years, however, technological improvement and a better pathophysiological understanding led to increased use of ECLS in selected patients. Indeed, most uncertainties were related to hemorrhagic and thrombotic complications and were overcome with newer materials that allow for the initiation of support without anticoagulation when hemorrhagic risk is high. The main indications for ECLS in trauma are represented by acute respiratory distress syndrome (ARDS) and chest trauma, including cardiac trauma and traumatic cardiac arrest, cerebral trauma and bleeding, hemorrhage, hypothermia, and burns in both adults and children. Specific scenarios including combat casualties are emerging indications as well. Extracorporeal support can interrupt the vicious circle represented by the lethal triad of trauma (hypothermia, acidosis, and coagulopathy) by controlling temperature, providing an adequate cardiac output, and unloading the venous system. This can lead, according to registry data, to survival rates of around 60% in thoracic trauma patients supported with ECLS. In this chapter, we will discuss the rationale and indications of ECLS in trauma and present some challenges for the application in this setting.

Published
2023

47. Multidrug-Resistant Bacterial Colonization and Infections in Large Retrospective Cohort of Mechanically Ventilated COVID-19 Patients

Author

Mangioni, D, Chatenoud, L, Colombo, J, Palomba, E, Guerrero, F, Bolis, M, Bottino, N, Breda, G, Chiaruttini, M, Fior, G, Marotta, M, Massobrio, G, Matinato, C, Muscatello, A, Previtali, P, Santambrogio, S, Tardini, F, Zuglian, G, Grasselli, G, Fumagalli, R, Gori, A, Stocchetti, N, Monti, G, Bandera, A, Mangioni D., Chatenoud L., Colombo J., Palomba E., Guerrero F. A., Bolis M., Bottino N., Breda G., Chiaruttini M. V., Fior G., Marotta M., Massobrio G., Matinato C., Muscatello A., Previtali P., Santambrogio S., Tardini F., Zuglian G., Grasselli G., Fumagalli R., Gori A., Stocchetti N., Monti G., Bandera A., Mangioni, D, Chatenoud, L, Colombo, J, Palomba, E, Guerrero, F, Bolis, M, Bottino, N, Breda, G, Chiaruttini, M, Fior, G, Marotta, M, Massobrio, G, Matinato, C, Muscatello, A, Previtali, P, Santambrogio, S, Tardini, F, Zuglian, G, Grasselli, G, Fumagalli, R, Gori, A, Stocchetti, N, Monti, G, Bandera, A, Mangioni D., Chatenoud L., Colombo J., Palomba E., Guerrero F. A., Bolis M., Bottino N., Breda G., Chiaruttini M. V., Fior G., Marotta M., Massobrio G., Matinato C., Muscatello A., Previtali P., Santambrogio S., Tardini F., Zuglian G., Grasselli G., Fumagalli R., Gori A., Stocchetti N., Monti G., and Bandera A.

Abstract

Few data are available on incidence of multidrug-resistant organism (MDRO) colonization and infections in mechanically ventilated patients, particularly during the COVID-19 pandemic. We retrospectively evaluated all patients admitted to the COVID-19 intensive care unit (ICU) of Hub Hospital in Milan, Italy, during October 2020‒May 2021. Microbiologic surveillance was standardized with active screening at admission and weekly during ICU stay. Of 435 patients, 88 (20.2%) had MDROs isolated ≤48 h after admission. Of the remaining patients, MDRO colonization was diagnosed in 173 (51.2%), MDRO infections in 95 (28.1%), and non-MDRO infections in 212 (62.7%). Non-MDRO infections occurred earlier than MDRO infections (6 days vs. 10 days; p<0.001). Previous exposure to antimicrobial drugs within the ICU was higher in MDRO patients than in non-MDRO patients (116/197 [58.9%] vs. 18/140 [12.9%]; p<0.001). Our findings might serve as warnings for future respiratory viral pandemics and call for increased measures of antimicrobial stewardship and infection control.

Published
2023

48. Extracorporeal Life Support (ECLS) for Critically Ill Patients in the Emergency Department

Author

Aseni, P, Grande, AM, Leppäniemi, A, Chiara, O, Sangalli, F, Mariani, S, Fumagalli, R, Sangalli F., Mariani S., Fumagalli R., Aseni, P, Grande, AM, Leppäniemi, A, Chiara, O, Sangalli, F, Mariani, S, Fumagalli, R, Sangalli F., Mariani S., and Fumagalli R.

Abstract

Extracorporeal life support (ECLS) is a set of therapies that focus on oxygenation, carbon dioxide removal, and circulatory support to provide adequate oxygen delivery to the tissues for the time needed to restore damaged cardiac or pulmonary function, identify therapeutic options, or plan a transplantation or long-term mechanical support implantation. ELCS is, at present, a highly specialized therapy, and the possibility to deliver it in the emergency department depends largely on the existence of an ECLS program in the center or from a retrieval team arriving from a hub center. Different configurations allow for different indications. Namely, ECLS with veno-arterial cannulation provides circulatory and respiratory support, while in its veno-venous configuration, it delivers uniquely respiratory assistance. The main indication for the use of ECLS in the emergency department is represented by cardiogenic shock, a life-threatening clinical syndrome characterized by cardiac dysfunction resulting in end-organ hypoperfusion, tissue hypoxia, and increased lactate levels. ECLS can also be applied in patients suffering from cardiac arrest in whom conventional cardiopulmonary resuscitation is unsuccessful in achieving a sustained return of spontaneous circulation. Finally, indications for ECLS in respiratory failure in the emergency department are limited, since most patients are generally managed with mechanical ventilation upon presentation, while the indication for ECLS is commonly a second line. So far, when an ECLS is initiated in an emergency department, a highly specialized multidisciplinary team is required. However, future directions imply the development of portable, automated, and biocompatible devices to be easily used in a larger number of emergency departments.

Published
2023

49. How the Italian Formula 1 Grand Prix 2022 Mass Gathering Event Compares to the Arbon Model: A Descriptive Study

Author

Paleari, A, Spina, S, Marrazzo, F, Ripoll, A, Volontè, F, Greco, G, Zoli, A, Sechi, G, Saggiante, D, Chiodini, G, Stucchi, R, Fumagalli, R, Paleari A., Spina S., Marrazzo F., Ripoll A., Volontè F., Greco G., Zoli A., Sechi G. M., Saggiante D., Chiodini G., Stucchi R., Fumagalli R., Paleari, A, Spina, S, Marrazzo, F, Ripoll, A, Volontè, F, Greco, G, Zoli, A, Sechi, G, Saggiante, D, Chiodini, G, Stucchi, R, Fumagalli, R, Paleari A., Spina S., Marrazzo F., Ripoll A., Volontè F., Greco G., Zoli A., Sechi G. M., Saggiante D., Chiodini G., Stucchi R., and Fumagalli R.

Abstract

Objective: To describe the health-care resources implemented during the Italian Formula 1 Grand Prix (F1GP) and to calculate the patient presentation rate (PPR) based on both real data and a prediction model. Methods: Observational and descriptive study conducted from September 9 to September 11, 2022, during the Italian F1GP hosted in Monza (Italy). Maurer's formula was applied to decide the number and type of health resources to be allocated. Patient presentation rate (PPR) was computed based on real data (PPR_real) and based on the Arbon formula (PPR_est). Results: Of 336,000 attendees, n = 263 requested medical assistance with most of them receiving treatment at the advanced medical post, and n = 16 needing transport to the hospital. The PPR_real was 51 for Friday, 78 for Saturday, 134 for Sunday, and 263 when considering the whole event as a single event. The PPR_est resulted in 85 for Friday, 93 for Saturday, 97 for Sunday, and 221 for the total population. Conclusions: A careful organization of health-care resources could mitigate the impact of the Italian F1GP on local hospital facilities. The Arbon formula is an acceptable model to predict and estimate the number of patients requesting medical assistance, but further investigation needs to be conducted to implement the model and tailor it to broader categories of MGE.

Published
2023

50. Identifying Trauma Patients in Need for Emergency Surgery in the Prehospital Setting: The Prehospital Prediction of In-Hospital Emergency Treatment (PROPHET) Study

Author

Isgro, S, Giani, M, Antolini, L, Giudici, R, Valsecchi, M, Bellani, G, Chiara, O, Bassi, G, Latronico, N, Cabrini, L, Fumagalli, R, Chieregato, A, Sammartano, F, Sechi, G, Zoli, A, Pagliosa, A, Palo, A, Valoti, O, Carlucci, M, Benini, A, Foti, G, Isgro S., Giani M., Antolini L., Giudici R., Valsecchi M. G., Bellani G., Chiara O., Bassi G., Latronico N., Cabrini L., Fumagalli R., Chieregato A., Sammartano F., Sechi G., Zoli A., Pagliosa A., Palo A., Valoti O., Carlucci M., Benini A., Foti G., Isgro, S, Giani, M, Antolini, L, Giudici, R, Valsecchi, M, Bellani, G, Chiara, O, Bassi, G, Latronico, N, Cabrini, L, Fumagalli, R, Chieregato, A, Sammartano, F, Sechi, G, Zoli, A, Pagliosa, A, Palo, A, Valoti, O, Carlucci, M, Benini, A, Foti, G, Isgro S., Giani M., Antolini L., Giudici R., Valsecchi M. G., Bellani G., Chiara O., Bassi G., Latronico N., Cabrini L., Fumagalli R., Chieregato A., Sammartano F., Sechi G., Zoli A., Pagliosa A., Palo A., Valoti O., Carlucci M., Benini A., and Foti G.

Abstract

Prehospital field triage often fails to accurately identify the need for emergent surgical or non-surgical procedures, resulting in inefficient resource utilization and increased costs. This study aimed to analyze prehospital factors associated with the need for emergent procedures (such as surgery or interventional angiography) within 6 h of hospital admission. Additionally, our goal was to develop a prehospital triage tool capable of estimating the likelihood of requiring an emergent procedure following hospital admission. We conducted a retrospective observational study, analyzing both prehospital and in-hospital data obtained from the Lombardy Trauma Registry. We conducted a multivariable logistic regression analysis to identify independent predictors of emergency procedures within the first 6 h from admission. Subsequently, we developed and internally validated a triage score composed of factors associated with the probability of requiring an emergency procedure. The study included a total of 3985 patients, among whom 295 (7.4%) required an emergent procedure within 6 h. Age, penetrating injury, downfall, cardiac arrest, poor neurological status, endotracheal intubation, systolic pressure, diastolic pressure, shock index, respiratory rate and tachycardia were identified as predictors of requiring an emergency procedure. A triage score generated from these predictors showed a good predictive power (AUC of the ROC curve: 0.81) to identify patients requiring an emergent surgical or non-surgical procedure within 6 h from hospital admission. The proposed triage score might contribute to predicting the need for immediate resource availability in trauma patients.

Published
2023

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