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1. Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Author

Coccolini, F, Corradi, F, Sartelli, M, Coimbra, R, Kryvoruchko, I, Leppaniemi, A, Doklestic, K, Bignami, E, Biancofiore, G, Bala, M, Ceresoli, M, Damaskos, D, Biffl, W, Fugazzola, P, Santonastaso, D, Agnoletti, V, Sbarbaro, C, Nacoti, M, Hardcastle, T, Mariani, D, De Simone, B, Tolonen, M, Ball, C, Podda, M, Di Carlo, I, Di Saverio, S, Navsaria, P, Bonavina, L, Abu-Zidan, F, Soreide, K, Fraga, G, Carvalho, V, Batista, S, Hecker, A, Cucchetti, A, Ercolani, G, Tartaglia, D, Galante, J, Wani, I, Kurihara, H, Tan, E, Litvin, A, Melotti, R, Sganga, G, Zoro, T, Isirdi, A, De'Angelis, N, Weber, D, Hodonou, A, Tenbroek, R, Parini, D, Khan, J, Sbrana, G, Coniglio, C, Giarratano, A, Gratarola, A, Zaghi, C, Romeo, O, Kelly, M, Forfori, F, Chiarugi, M, Moore, E, Catena, F, Malbrain, M, Coccolini F., Corradi F., Sartelli M., Coimbra R., Kryvoruchko I. A., Leppaniemi A., Doklestic K., Bignami E., Biancofiore G., Bala M., Ceresoli M., Damaskos D., Biffl W. L., Fugazzola P., Santonastaso D., Agnoletti V., Sbarbaro C., Nacoti M., Hardcastle T. C., Mariani D., De Simone B., Tolonen M., Ball C., Podda M., Di Carlo I., Di Saverio S., Navsaria P., Bonavina L., Abu-Zidan F., Soreide K., Fraga G. P., Carvalho V. H., Batista S. F., Hecker A., Cucchetti A., Ercolani G., Tartaglia D., Galante J. M., Wani I., Kurihara H., Tan E., Litvin A., Melotti R. M., Sganga G., Zoro T., Isirdi A., De'Angelis N., Weber D. G., Hodonou A. M., tenBroek R., Parini D., Khan J., Sbrana G., Coniglio C., Giarratano A., Gratarola A., Zaghi C., Romeo O., Kelly M., Forfori F., Chiarugi M., Moore E. E., Catena F., Malbrain M. L. N. G., Coccolini, F, Corradi, F, Sartelli, M, Coimbra, R, Kryvoruchko, I, Leppaniemi, A, Doklestic, K, Bignami, E, Biancofiore, G, Bala, M, Ceresoli, M, Damaskos, D, Biffl, W, Fugazzola, P, Santonastaso, D, Agnoletti, V, Sbarbaro, C, Nacoti, M, Hardcastle, T, Mariani, D, De Simone, B, Tolonen, M, Ball, C, Podda, M, Di Carlo, I, Di Saverio, S, Navsaria, P, Bonavina, L, Abu-Zidan, F, Soreide, K, Fraga, G, Carvalho, V, Batista, S, Hecker, A, Cucchetti, A, Ercolani, G, Tartaglia, D, Galante, J, Wani, I, Kurihara, H, Tan, E, Litvin, A, Melotti, R, Sganga, G, Zoro, T, Isirdi, A, De'Angelis, N, Weber, D, Hodonou, A, Tenbroek, R, Parini, D, Khan, J, Sbrana, G, Coniglio, C, Giarratano, A, Gratarola, A, Zaghi, C, Romeo, O, Kelly, M, Forfori, F, Chiarugi, M, Moore, E, Catena, F, Malbrain, M, Coccolini F., Corradi F., Sartelli M., Coimbra R., Kryvoruchko I. A., Leppaniemi A., Doklestic K., Bignami E., Biancofiore G., Bala M., Ceresoli M., Damaskos D., Biffl W. L., Fugazzola P., Santonastaso D., Agnoletti V., Sbarbaro C., Nacoti M., Hardcastle T. C., Mariani D., De Simone B., Tolonen M., Ball C., Podda M., Di Carlo I., Di Saverio S., Navsaria P., Bonavina L., Abu-Zidan F., Soreide K., Fraga G. P., Carvalho V. H., Batista S. F., Hecker A., Cucchetti A., Ercolani G., Tartaglia D., Galante J. M., Wani I., Kurihara H., Tan E., Litvin A., Melotti R. M., Sganga G., Zoro T., Isirdi A., De'Angelis N., Weber D. G., Hodonou A. M., tenBroek R., Parini D., Khan J., Sbrana G., Coniglio C., Giarratano A., Gratarola A., Zaghi C., Romeo O., Kelly M., Forfori F., Chiarugi M., Moore E. E., Catena F., and Malbrain M. L. N. G.

Abstract

Background: Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods: An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion: Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.

Published
2022

3. Open Abdomen and Fluid Instillation in the Septic Abdomen: Results from the IROA Study

Author

Coccolini F., Gubbiotti F., Ceresoli M., Tartaglia D., Fugazzola P., Ansaloni L., Sartelli M., Kluger Y., Kirkpatrick A., Amico F., Catena F., Chiarugi M., Montori G., Salvetti F., Negoi I., Zese M., Occhionorelli S., Shlyapnikov S., Sugrue M., Demetrashvili Z., Dondossola D., Ioannidis O., Novelli G., Nacoti M., Khor D., Inaba K., Demetriades D., Kaussen T., Jusoh A. C., Ghannam W., Sakakushev B., Guetta O., Dogjani A., Costa S., Singh S., Damaskos D., Isik A., Yuan K. -C., Trotta F., Rausei S., Martinez-Perez A., Bellanova G., Fonseca V. C., Hernandez F., Marinis A., Fernandes W., Quiodettis M., Bala M., Vereczkei A., Curado R., Fraga G. P., Pereira B. M., Gachabayov M., Chagerben G. P., Arellano M. L., Ozyazici S., Costa G., Tezcaner T., Porta M., Li Y., Karateke F., Manatakis D., Mariani F., Lora F., Sahderov I., Atanasov B., Zegarra S., Fattori L., Ivatury R., Xiao J., Ben-Ishay O., Lippi A., Improta M., Zharikov A., Dubuisson V., Coccolini, F, Gubbiotti, F, Ceresoli, M, Tartaglia, D, Fugazzola, P, Ansaloni, L, Sartelli, M, Kluger, Y, Kirkpatrick, A, Amico, F, Catena, F, Chiarugi, M, Montori, G, Salvetti, F, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Sugrue, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Ivatury, R, Xiao, J, Ben-Ishay, O, Lippi, A, Improta, M, Zharikov, A, and Dubuisson, V

Subjects
Adult, Male, medicine.medical_specialty, Original Scientific Report, Fistula, medicine.medical_treatment, open abdomen, Peritonitis, 030230 surgery, NO, 03 medical and health sciences, 0302 clinical medicine, Sepsis, peritoneal resuscitation, Negative-pressure wound therapy, Abdomen, medicine, Humans, Surgical Wound Infection, Prospective Studies, fascial closure, peritoneal resuscitation, management, therapy, fascial closure, Digestive System Surgical Procedures, Aged, therapy, business.industry, Peritoneal fluid, Abdominal Cavity, Abdominal Wound Closure Techniques, Middle Aged, medicine.disease, Surgery, Cardiac surgery, Treatment Outcome, medicine.anatomical_structure, Cardiothoracic surgery, 030220 oncology & carcinogenesis, fluid instillation, Fluid Therapy, Female, business, Negative-Pressure Wound Therapy, management, Abdominal surgery
Abstract

Background Open abdomen (OA) is a surgical option that can be used in patients with severe peritonitis. Few evidences exist to recommend the use of intraperitoneal fluid instillation associated with OA in managing septic abdomen. Materials and methods A prospective analysis of adult patients enrolled in the International Register of Open Abdomen (trial registration: NCT02382770) was performed. Results A total of 387 patients were enrolled in two groups: 84 with peritoneal fluid instillation (FI) and 303 without (NFI). The groups were homogeneous for baseline characteristics. Overall complications were 92.9% in FI and 86.3% in NFI (p = 0.106). Complications during OA were 72.6% in FI and 59.9% in NFI (p = 0.034). Complications after definitive closure were 70.8% in FI and 61.1% in NFI (p = 0.133). Entero-atmospheric fistula was 13.1% in FI and 12% in NFI (p = 0.828). Fascial closure was 78.6% in FI and 63.7% in NFI (p = 0.02). Analysis of FI in negative pressure wound therapy (NPWT) showed: Overall morbidity in NPWT was 94% and in non-NPWT 91.2% (p = 0.622) and morbidity during OA was 68% and 79.4% (p = 0.25), respectively. Definitive fascial closure in NPWT was 87.8% and 96.8% in non-NPWT (p = 0.173). Overall mortality was 40% in NPWT and 29.4% in non-NPWT (p = 0.32) and morality during OA period was 18% and 8.8% (p = 0.238), respectively. Conclusion We found intraperitoneal fluid instillation during open abdomen in peritonitic patients to increase the complication rate during the open abdomen period, with no impact on mortality, entero-atmospheric fistula rate and opening time. Fascial closure rate is increased by instillation. Fluid instillation is feasible even when associated with nonnegative pressure temporary abdominal closure techniques.

Published
2020
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4. Post-operative heparin reduces early venous thrombotic complications after orthotopic paediatric liver transplantation

Author

Colombo, G, Giaccherini, C, Benzi, A, Ferrari, F, Bonacina, D, Corno, M, Colledan, M, Alessio, M, Bonanomi, E, Nacoti, M, Falanga, A, Colombo G., Giaccherini C., Benzi A., Ferrari F., Bonacina D., Corno M., Colledan M., Alessio M. G., Bonanomi E., Nacoti M., Falanga A., Colombo, G, Giaccherini, C, Benzi, A, Ferrari, F, Bonacina, D, Corno, M, Colledan, M, Alessio, M, Bonanomi, E, Nacoti, M, Falanga, A, Colombo G., Giaccherini C., Benzi A., Ferrari F., Bonacina D., Corno M., Colledan M., Alessio M. G., Bonanomi E., Nacoti M., and Falanga A.

Abstract

BACKGROUND: Despite significant improvements in surgical techniques and medical care, thrombotic complications still represent the primary cause of early graft failure and re-transplantation following paediatric liver transplantation. There is still no standardized approach for thrombosis prevention. MATERIALS AND METHODS: The study aimed to evaluate the effectiveness of early intravenous unfractionated heparin started 12 hours postoperatively at 10 UI/kg per hour and used a retrospective "before and after" design to compare the incidence of early thrombotic complications prior to (2002-2010) and after (2011-2016) the introduction of heparin in our institute. RESULTS: From 2002 to 2016, 479 paediatric patients received liver transplantation in our institution with an overall survival rate over one year of 0.91 (95% CI: 0.87-0.94). Of 365 eligible patients, 244 did not receive heparin while 121 did receive heparin. We reported a lower incidence of venous thrombosis (VT) in the group treated with heparin: 2.5% (3/121) vs 7.9% (19/244) (p=0.038). All clinical and laboratory variables considered potential risk factors for VT were studied. By multivariate stepwise Cox proportional hazards models, heparin prophylaxis resulted significantly associated to a reduction in VT (HR=0.29 [95% CI: 0.08-0.97], p=0.045), while age <1 year was found to be an independent risk factor for VT (HR=2.62 [95% CI: 1.11-6.21]; p=0.028). DISCUSSION: Early postoperative heparin could be considered a valid and safe strategy to prevent early VT after paediatric liver transplantation without a concomitant increase in bleeding. A future randomised control trial is mandatory in order to strengthen this conclusion.

Published
2021

5. A pandemic recap: lessons we have learned

Author

Coccolini, F, Cicuttin, E, Cremonini, C, Tartaglia, D, Viaggi, B, Kuriyama, A, Picetti, E, Ball, C, Abu-Zidan, F, Ceresoli, M, Turri, B, Jain, S, Palombo, C, Guirao, X, Rodrigues, G, Gachabayov, M, Machado, F, Eftychios, L, Kanj, S, Di Carlo, I, Di Saverio, S, Khokha, V, Kirkpatrick, A, Massalou, D, Forfori, F, Corradi, F, Delibegovic, S, Machain Vega, G, Fantoni, M, Demetriades, D, Kapoor, G, Kluger, Y, Ansari, S, Maier, R, Leppaniemi, A, Hardcastle, T, Vereczkei, A, Karamagioli, E, Pikoulis, E, Pistello, M, Sakakushev, B, Navsaria, P, Galeiras, R, Yahya, A, Osipov, A, Dimitrov, E, Doklestic, K, Pisano, M, Malacarne, P, Carcoforo, P, Sibilla, M, Kryvoruchko, I, Bonavina, L, Kim, J, Shelat, V, Czepiel, J, Maseda, E, Marwah, S, Chirica, M, Biancofiore, G, Podda, M, Cobianchi, L, Ansaloni, L, Fugazzola, P, Seretis, C, Gomez, C, Tumietto, F, Malbrain, M, Reichert, M, Augustin, G, Amato, B, Puzziello, A, Hecker, A, Gemignani, A, Isik, A, Cucchetti, A, Nacoti, M, Kopelman, D, Mesina, C, Ghannam, W, Ben-Ishay, O, Dhingra, S, Coimbra, R, Moore, E, Cui, Y, Quiodettis, M, Bala, M, Testini, M, Diaz, J, Girardis, M, Biffl, W, Hecker, M, Sall, I, Boggi, U, Materazzi, G, Ghiadoni, L, Matsumoto, J, Zuidema, W, Ivatury, R, Enani, M, Litvin, A, Al-Hasan, M, Demetrashvili, Z, Baraket, O, Ordonez, C, Negoi, I, Kiguba, R, Memish, Z, Elmangory, M, Tolonen, M, Das, K, Ribeiro, J, O'Connor, D, Tan, B, Van Goor, H, Baral, S, De Simone, B, Corbella, D, Brambillasca, P, Scaglione, M, Basolo, F, De'Angelis, N, Bendinelli, C, Weber, D, Pagani, L, Monti, C, Baiocchi, G, Chiarugi, M, Catena, F, Sartelli, M, Coccolini F., Cicuttin E., Cremonini C., Tartaglia D., Viaggi B., Kuriyama A., Picetti E., Ball C., Abu-Zidan F., Ceresoli M., Turri B., Jain S., Palombo C., Guirao X., Rodrigues G., Gachabayov M., Machado F., Eftychios L., Kanj S. S., Di Carlo I., Di Saverio S., Khokha V., Kirkpatrick A., Massalou D., Forfori F., Corradi F., Delibegovic S., Machain Vega G. M., Fantoni M., Demetriades D., Kapoor G., Kluger Y., Ansari S., Maier R., Leppaniemi A., Hardcastle T., Vereczkei A., Karamagioli E., Pikoulis E., Pistello M., Sakakushev B. E., Navsaria P. H., Galeiras R., Yahya A. I., Osipov A. V., Dimitrov E., Doklestic K., Pisano M., Malacarne P., Carcoforo P., Sibilla M. G., Kryvoruchko I. A., Bonavina L., Kim J. I., Shelat V. G., Czepiel J., Maseda E., Marwah S., Chirica M., Biancofiore G., Podda M., Cobianchi L., Ansaloni L., Fugazzola P., Seretis C., Gomez C. A., Tumietto F., Malbrain M., Reichert M., Augustin G., Amato B., Puzziello A., Hecker A., Gemignani A., Isik A., Cucchetti A., Nacoti M., Kopelman D., Mesina C., Ghannam W., Ben-Ishay O., Dhingra S., Coimbra R., Moore E. E., Cui Y., Quiodettis M. A., Bala M., Testini M., Diaz J., Girardis M., Biffl W. L., Hecker M., Sall I., Boggi U., Materazzi G., Ghiadoni L., Matsumoto J., Zuidema W. P., Ivatury R., Enani M. A., Litvin A., Al-Hasan M. N., Demetrashvili Z., Baraket O., Ordonez C. A., Negoi I., Kiguba R., Memish Z. A., Elmangory M. M., Tolonen M., Das K., Ribeiro J., O'Connor D. B., Tan B. K., Van Goor H., Baral S., De Simone B., Corbella D., Brambillasca P., Scaglione M., Basolo F., De'Angelis N., Bendinelli C., Weber D., Pagani L., Monti C., Baiocchi G., Chiarugi M., Catena F., Sartelli M., Coccolini, F, Cicuttin, E, Cremonini, C, Tartaglia, D, Viaggi, B, Kuriyama, A, Picetti, E, Ball, C, Abu-Zidan, F, Ceresoli, M, Turri, B, Jain, S, Palombo, C, Guirao, X, Rodrigues, G, Gachabayov, M, Machado, F, Eftychios, L, Kanj, S, Di Carlo, I, Di Saverio, S, Khokha, V, Kirkpatrick, A, Massalou, D, Forfori, F, Corradi, F, Delibegovic, S, Machain Vega, G, Fantoni, M, Demetriades, D, Kapoor, G, Kluger, Y, Ansari, S, Maier, R, Leppaniemi, A, Hardcastle, T, Vereczkei, A, Karamagioli, E, Pikoulis, E, Pistello, M, Sakakushev, B, Navsaria, P, Galeiras, R, Yahya, A, Osipov, A, Dimitrov, E, Doklestic, K, Pisano, M, Malacarne, P, Carcoforo, P, Sibilla, M, Kryvoruchko, I, Bonavina, L, Kim, J, Shelat, V, Czepiel, J, Maseda, E, Marwah, S, Chirica, M, Biancofiore, G, Podda, M, Cobianchi, L, Ansaloni, L, Fugazzola, P, Seretis, C, Gomez, C, Tumietto, F, Malbrain, M, Reichert, M, Augustin, G, Amato, B, Puzziello, A, Hecker, A, Gemignani, A, Isik, A, Cucchetti, A, Nacoti, M, Kopelman, D, Mesina, C, Ghannam, W, Ben-Ishay, O, Dhingra, S, Coimbra, R, Moore, E, Cui, Y, Quiodettis, M, Bala, M, Testini, M, Diaz, J, Girardis, M, Biffl, W, Hecker, M, Sall, I, Boggi, U, Materazzi, G, Ghiadoni, L, Matsumoto, J, Zuidema, W, Ivatury, R, Enani, M, Litvin, A, Al-Hasan, M, Demetrashvili, Z, Baraket, O, Ordonez, C, Negoi, I, Kiguba, R, Memish, Z, Elmangory, M, Tolonen, M, Das, K, Ribeiro, J, O'Connor, D, Tan, B, Van Goor, H, Baral, S, De Simone, B, Corbella, D, Brambillasca, P, Scaglione, M, Basolo, F, De'Angelis, N, Bendinelli, C, Weber, D, Pagani, L, Monti, C, Baiocchi, G, Chiarugi, M, Catena, F, Sartelli, M, Coccolini F., Cicuttin E., Cremonini C., Tartaglia D., Viaggi B., Kuriyama A., Picetti E., Ball C., Abu-Zidan F., Ceresoli M., Turri B., Jain S., Palombo C., Guirao X., Rodrigues G., Gachabayov M., Machado F., Eftychios L., Kanj S. S., Di Carlo I., Di Saverio S., Khokha V., Kirkpatrick A., Massalou D., Forfori F., Corradi F., Delibegovic S., Machain Vega G. M., Fantoni M., Demetriades D., Kapoor G., Kluger Y., Ansari S., Maier R., Leppaniemi A., Hardcastle T., Vereczkei A., Karamagioli E., Pikoulis E., Pistello M., Sakakushev B. E., Navsaria P. H., Galeiras R., Yahya A. I., Osipov A. V., Dimitrov E., Doklestic K., Pisano M., Malacarne P., Carcoforo P., Sibilla M. G., Kryvoruchko I. A., Bonavina L., Kim J. I., Shelat V. G., Czepiel J., Maseda E., Marwah S., Chirica M., Biancofiore G., Podda M., Cobianchi L., Ansaloni L., Fugazzola P., Seretis C., Gomez C. A., Tumietto F., Malbrain M., Reichert M., Augustin G., Amato B., Puzziello A., Hecker A., Gemignani A., Isik A., Cucchetti A., Nacoti M., Kopelman D., Mesina C., Ghannam W., Ben-Ishay O., Dhingra S., Coimbra R., Moore E. E., Cui Y., Quiodettis M. A., Bala M., Testini M., Diaz J., Girardis M., Biffl W. L., Hecker M., Sall I., Boggi U., Materazzi G., Ghiadoni L., Matsumoto J., Zuidema W. P., Ivatury R., Enani M. A., Litvin A., Al-Hasan M. N., Demetrashvili Z., Baraket O., Ordonez C. A., Negoi I., Kiguba R., Memish Z. A., Elmangory M. M., Tolonen M., Das K., Ribeiro J., O'Connor D. B., Tan B. K., Van Goor H., Baral S., De Simone B., Corbella D., Brambillasca P., Scaglione M., Basolo F., De'Angelis N., Bendinelli C., Weber D., Pagani L., Monti C., Baiocchi G., Chiarugi M., Catena F., and Sartelli M.

Abstract

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.

Published
2021

6. Open Abdomen and Fluid Instillation in the Septic Abdomen: Results from the IROA Study

Author

Coccolini, F, Gubbiotti, F, Ceresoli, M, Tartaglia, D, Fugazzola, P, Ansaloni, L, Sartelli, M, Kluger, Y, Kirkpatrick, A, Amico, F, Catena, F, Chiarugi, M, Montori, G, Salvetti, F, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Sugrue, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Ivatury, R, Xiao, J, Ben-Ishay, O, Lippi, A, Improta, M, Zharikov, A, Dubuisson, V, Coccolini F., Gubbiotti F., Ceresoli M., Tartaglia D., Fugazzola P., Ansaloni L., Sartelli M., Kluger Y., Kirkpatrick A., Amico F., Catena F., Chiarugi M., Montori G., Salvetti F., Negoi I., Zese M., Occhionorelli S., Shlyapnikov S., Sugrue M., Demetrashvili Z., Dondossola D., Ioannidis O., Novelli G., Nacoti M., Khor D., Inaba K., Demetriades D., Kaussen T., Jusoh A. C., Ghannam W., Sakakushev B., Guetta O., Dogjani A., Costa S., Singh S., Damaskos D., Isik A., Yuan K. -C., Trotta F., Rausei S., Martinez-Perez A., Bellanova G., Fonseca V. C., Hernandez F., Marinis A., Fernandes W., Quiodettis M., Bala M., Vereczkei A., Curado R., Fraga G. P., Pereira B. M., Gachabayov M., Chagerben G. P., Arellano M. L., Ozyazici S., Costa G., Tezcaner T., Porta M., Li Y., Karateke F., Manatakis D., Mariani F., Lora F., Sahderov I., Atanasov B., Zegarra S., Fattori L., Ivatury R., Xiao J., Ben-Ishay O., Lippi A., Improta M., Zharikov A., Dubuisson V., Coccolini, F, Gubbiotti, F, Ceresoli, M, Tartaglia, D, Fugazzola, P, Ansaloni, L, Sartelli, M, Kluger, Y, Kirkpatrick, A, Amico, F, Catena, F, Chiarugi, M, Montori, G, Salvetti, F, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Sugrue, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Ivatury, R, Xiao, J, Ben-Ishay, O, Lippi, A, Improta, M, Zharikov, A, Dubuisson, V, Coccolini F., Gubbiotti F., Ceresoli M., Tartaglia D., Fugazzola P., Ansaloni L., Sartelli M., Kluger Y., Kirkpatrick A., Amico F., Catena F., Chiarugi M., Montori G., Salvetti F., Negoi I., Zese M., Occhionorelli S., Shlyapnikov S., Sugrue M., Demetrashvili Z., Dondossola D., Ioannidis O., Novelli G., Nacoti M., Khor D., Inaba K., Demetriades D., Kaussen T., Jusoh A. C., Ghannam W., Sakakushev B., Guetta O., Dogjani A., Costa S., Singh S., Damaskos D., Isik A., Yuan K. -C., Trotta F., Rausei S., Martinez-Perez A., Bellanova G., Fonseca V. C., Hernandez F., Marinis A., Fernandes W., Quiodettis M., Bala M., Vereczkei A., Curado R., Fraga G. P., Pereira B. M., Gachabayov M., Chagerben G. P., Arellano M. L., Ozyazici S., Costa G., Tezcaner T., Porta M., Li Y., Karateke F., Manatakis D., Mariani F., Lora F., Sahderov I., Atanasov B., Zegarra S., Fattori L., Ivatury R., Xiao J., Ben-Ishay O., Lippi A., Improta M., Zharikov A., and Dubuisson V.

Abstract

Background: Open abdomen (OA) is a surgical option that can be used in patients with severe peritonitis. Few evidences exist to recommend the use of intraperitoneal fluid instillation associated with OA in managing septic abdomen. Materials and methods: A prospective analysis of adult patients enrolled in the International Register of Open Abdomen (trial registration: NCT02382770) was performed. Results: A total of 387 patients were enrolled in two groups: 84 with peritoneal fluid instillation (FI) and 303 without (NFI). The groups were homogeneous for baseline characteristics. Overall complications were 92.9% in FI and 86.3% in NFI (p = 0.106). Complications during OA were 72.6% in FI and 59.9% in NFI (p = 0.034). Complications after definitive closure were 70.8% in FI and 61.1% in NFI (p = 0.133). Entero-atmospheric fistula was 13.1% in FI and 12% in NFI (p = 0.828). Fascial closure was 78.6% in FI and 63.7% in NFI (p = 0.02). Analysis of FI in negative pressure wound therapy (NPWT) showed: Overall morbidity in NPWT was 94% and in non-NPWT 91.2% (p = 0.622) and morbidity during OA was 68% and 79.4% (p = 0.25), respectively. Definitive fascial closure in NPWT was 87.8% and 96.8% in non-NPWT (p = 0.173). Overall mortality was 40% in NPWT and 29.4% in non-NPWT (p = 0.32) and morality during OA period was 18% and 8.8% (p = 0.238), respectively. Conclusion: We found intraperitoneal fluid instillation during open abdomen in peritonitic patients to increase the complication rate during the open abdomen period, with no impact on mortality, entero-atmospheric fistula rate and opening time. Fascial closure rate is increased by instillation. Fluid instillation is feasible even when associated with nonnegative pressure temporary abdominal closure techniques.

Published
2020

7. Open abdomen management for severe peritonitis in elderly. Results from the prospective International Register of Open Abdomen (IROA): Cohort study

Author

Rausei, S, Pappalardo, V, Ceresoli, M, Catena, F, Sartelli, M, Chiarugi, M, Kluger, Y, Kirkpatrick, A, Ansaloni, L, Coccolini, F, Montori, G, Salvetti, F, Fugazzola, P, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Ivatury, R, Xiao, J, Lippi, A, Improta, M, Gubbiotti, F, Zharikov, A, Dubuisson, V, Sugrue, M, Rausei S., Pappalardo V., Ceresoli M., Catena F., Sartelli M., Chiarugi M., Kluger Y., Kirkpatrick A., Ansaloni L., Coccolini F., Montori G., Salvetti F., Fugazzola P., Negoi I., Zese M., Occhionorelli S., Shlyapnikov S., Demetrashvili Z., Dondossola D., Ioannidis O., Novelli G., Nacoti M., Khor D., Inaba K., Demetriades D., Kaussen T., Jusoh A. C., Ghannam W., Sakakushev B., Guetta O., Dogjani A., Costa S., Singh S., Damaskos D., Isik A., Yuan K. -C., Trotta F., Martinez-Perez A., Bellanova G., Fonseca V. C., Hernandez F., Marinis A., Fernandes W., Quiodettis M., Bala M., Vereczkei A., Curado R., Fraga G. P., Pereira B. M., Gachabayov M., Chagerben G. P., Arellano M. L., Ozyazici S., Costa G., Tezcaner T., Porta M., Li Y., Karateke F., Manatakis D., Mariani F., Lora F., Sahderov I., Atanasov B., Zegarra S., Fattori L., Ivatury R., Xiao J., Lippi A., Improta M., Gubbiotti F., Zharikov A., Dubuisson V., Sugrue M., Rausei, S, Pappalardo, V, Ceresoli, M, Catena, F, Sartelli, M, Chiarugi, M, Kluger, Y, Kirkpatrick, A, Ansaloni, L, Coccolini, F, Montori, G, Salvetti, F, Fugazzola, P, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Ivatury, R, Xiao, J, Lippi, A, Improta, M, Gubbiotti, F, Zharikov, A, Dubuisson, V, Sugrue, M, Rausei S., Pappalardo V., Ceresoli M., Catena F., Sartelli M., Chiarugi M., Kluger Y., Kirkpatrick A., Ansaloni L., Coccolini F., Montori G., Salvetti F., Fugazzola P., Negoi I., Zese M., Occhionorelli S., Shlyapnikov S., Demetrashvili Z., Dondossola D., Ioannidis O., Novelli G., Nacoti M., Khor D., Inaba K., Demetriades D., Kaussen T., Jusoh A. C., Ghannam W., Sakakushev B., Guetta O., Dogjani A., Costa S., Singh S., Damaskos D., Isik A., Yuan K. -C., Trotta F., Martinez-Perez A., Bellanova G., Fonseca V. C., Hernandez F., Marinis A., Fernandes W., Quiodettis M., Bala M., Vereczkei A., Curado R., Fraga G. P., Pereira B. M., Gachabayov M., Chagerben G. P., Arellano M. L., Ozyazici S., Costa G., Tezcaner T., Porta M., Li Y., Karateke F., Manatakis D., Mariani F., Lora F., Sahderov I., Atanasov B., Zegarra S., Fattori L., Ivatury R., Xiao J., Lippi A., Improta M., Gubbiotti F., Zharikov A., Dubuisson V., and Sugrue M.

Abstract

Background: Analyzing the data of the International Register of Open Abdomen (IROA), the feasibility of open abdomen treatment has been demonstrated at every age. This new analysis on the IROA database investigates the risk factors for mortality in elderly patients treated with open abdomen for intra-abdominal infection. Methods: Data were derived from the IROA, a prospective observational international cohort study that enrolled patients treated with open abdomen worldwide. A univariate analysis of potential risk factors was performed. Inclusion criteria were patients older than 65 years and treated with open abdomen for intra-abdominal infection. End point was overall mortality, calculated within 30 days after open abdomen management, after 1-month and 1-year follow-up. Results: A total of 116 patients was analyzed with mean age of 76 ± 7 years. Definitive closure was achieved in 93 patients (93/116, 80.2%) for a mean open abdomen duration of 5.0 ± 5.0 days. Complicated patients were 101 (101/116, 87.1%) for a total of 201 complications. Overall, 62 out of 116 patients (53.4%) died: 23 patients (23/62, 37.1%) during open abdomen management, 29 patients (46.8%) within 30 days after abdominal closure, 9 patients (14.5%) after 1-month follow-up, and 1 patient (1.6%) after 1-year follow-up. Age did not affect mortality (75 ± 6 years in alive patients versus 77 ± 7 years in dead patients, p = 0.773). Definitive abdominal closure was the most important factor to prevent mortality. Conclusions: This study confirmed that age alone cannot be considered a determinant for death, even in elderly patients managed with open abdomen for severe intra-abdominal infection.

Published
2020

8. Pressure support ventilation, sigh adjunct to pressure support ventilation, and neurally adjusted ventilatory assist in infants after cardiac surgery: A physiologic crossover randomized study

Author

Bonacina, D, Bronco, A, Nacoti, M, Ferrari, F, Fazzi, F, Bonanomi, E, Bellani, G, Bonacina D., Bronco A., Nacoti M., Ferrari F., Fazzi F., Bonanomi E., Bellani G., Bonacina, D, Bronco, A, Nacoti, M, Ferrari, F, Fazzi, F, Bonanomi, E, Bellani, G, Bonacina D., Bronco A., Nacoti M., Ferrari F., Fazzi F., Bonanomi E., and Bellani G.

Abstract

Objectives: We sought to compare gas exchange, respiratory mechanics, and asynchronies during pressure support ventilation (PSV), sigh adjunct to PSV (PSV SIGH), and neurally adjusted ventilatory assist (NAVA) in hypoxemic infants after cardiac surgery. Design: Prospective, single-center, crossover, randomized physiologic study. Setting: Tertiary-care pediatric intensive care unit. Patients: Fourteen hypoxemic infants (median age 11.5 days [8.7-74]). Interventions: The protocol begins with a 1 hour step of PSV, followed by two consecutive steps in PSV SIGH and NAVA in random order, with a washout period of 30 minutes (PSV) between them. Main Results: Three infants presented an irregular Eadi signal because of diaphragmatic paralysis and were excluded from analysis. For the remaining 11 infants, PaO2/FiO 2 and oxygenation index improved in PSV SIGH compared with PSV (P < 0.05) but not in NAVA compared with PSV. PSV SIGH showed increased tidal volumes and lower respiratory rate than PSV (P < 0.05), as well as a significant improvement in compliance with respiratory system indexed to body weight when compared with both PSV and NAVA (P < 0.01). No changes in mean airway pressure was registered among steps. Inspiratory time resulted prolonged for both PSV SIGH and NAVA than PSV (P < 0.05). NAVA showed the higher coefficient of variability in respiratory parameters and a significative decrease in asynchrony index when compared with both PSV and PSV SIGH (P < 0.01). Conclusions: The adjunct of one SIGH per minute to PSV improved oxygenation and lung mechanics while NAVA provided the best patient-ventilator synchrony in infants after cardiac surgery.

Published
2019

9. Trends in open abdomen management in Italy: a subgroup analysis from the IROA project

Author

Cicuttin, E., Ansaloni, L., Ceresoli, M., Fugazzola, P., Tomasoni, M., Sartelli, M., Catena, F., Coccolini, F., Montori, G., Salvetti, F., Zese, M., Occhionorelli, S., Galatioto, C., Chiarugi, M., Dondossola, D., Novelli, G., Nacoti, M., Costa, S., Zoro, T., Trotta, F., Rausei, S., Bellanova, G., Costa, G., Porta, M., Mariani, F., Lora, F., Fattori, L., Jacopo, V., Lorenzo, C., Cicuttin, E, Ansaloni, L, Ceresoli, M, Fugazzola, P, Tomasoni, M, Sartelli, M, Catena, F, and Coccolini, F

Subjects
Male, Fistula, medicine.medical_treatment, Vascular emergency, Postoperative Complications, 0302 clinical medicine, Abdomen, Prospective Studies, Open abdomen, Univariate analysis, Evidence-Based Medicine, Peritoniti, Incidence (epidemiology), Age Factors, Abdominal Wound Closure Techniques, Middle Aged, Register, Management, IROA, medicine.anatomical_structure, Italy, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Complication, Fistula, IROA, Laparostomy, Management, Morbidity, Mortality, Open abdomen, Pancreatitis, Peritonitis, Register, Trauma, Vascular emergency, medicine.medical_specialty, Peritonitis, Subgroup analysis, Complication, Laparostomy, Morbidity, Mortality, Pancreatitis, Trauma, NO, 03 medical and health sciences, Negative-pressure wound therapy, Internal medicine, medicine, Humans, Aged, Open Abdomen Techniques, Pancreatiti, business.industry, medicine.disease, Surgery, business, Negative-Pressure Wound Therapy
Abstract

Use of open abdomen (OA) progressively acquired increasing importance with the diffusion of the damage control management of critical patients. The purpose of the present study is to identify the state of the art about the use of OA in Italy, focusing on techniques, critical issues and clinical outcomes. A prospective analysis of adult patients enrolled in the IROA, limited to the Italian participating centres was performed. 375 patients were enrolled. Mean age was 64 ± 16 years old, 56% of the patients were male, mean BMI was 26.9 ± 5.2. Main indications for using OA were secondary peritonitis (32.5%), post-operative peritonitis (22.9%) and trauma (11.7%). Main OA techniques used were commercial negative pressure wound therapy (49.6%) and Bogotà bag (27.7%). Definitive closure of the abdomen was reached in 82.4% of patients after 6 ± 7 days of OA. The primary fascia closure rate was 84.7%. Overall mortality was 29.1%. The complication rate was 50.8%, with an enteroatmospheric fistula incidence: 7.5%. A univariate analysis performed on complication type found the duration of OA treatment (p = 0.024) to be statistically significant. Univariate analysis on mortality risk identified as significant age, duration of OA (in days) and pancreatitis as indication; multivariate analysis confirmed age (p < 0.001) and pancreatitis (p = 0.002) as statistically significant. A large variety of behaviours towards the patient requiring OA exists. A strong acceptance of common, recognized and evidence-based guidelines is essential, to obtain more uniformity in patient management and coherence of collected data, thus leading to improvement in outcomes and reduction of costs.

Published
2019
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10. A pandemic recap: lessons we have learned

Author

Coccolini, F., Cicuttin, E., Cremonini, C., Tartaglia, D., Viaggi, B., Kuriyama, A., Picetti, E., Ball, C., Abu-Zidan, F., Ceresoli, M., Turri, B., Jain, S., Palombo, C., Guirao, X., Rodrigues, G., Gachabayov, M., Machado, F., Eftychios, L., Kanj, S.S., Carlo, I. Di, Saverio, S. Di, Khokha, V., Kirkpatrick, A., Massalou, D., Forfori, F., Corradi, F., Delibegovic, S., Vega, G.M. Machain, Fantoni, M., Demetriades, D., Kapoor, G., Kluger, Y., Ansari, S., Maier, R., Leppaniemi, A., Hardcastle, T., Vereczkei, A., Karamagioli, E., Pikoulis, E., Pistello, M., Sakakushev, B.E., Navsaria, P.H., Galeiras, R., Yahya, A.I., Osipov, A.V., Dimitrov, E., Doklestić, K., Pisano, M., Malacarne, P., Carcoforo, P., Sibilla, M.G., Kryvoruchko, I.A., Bonavina, L., Kim, J.I., Shelat, V.G., Czepiel, J., Maseda, E., Marwah, S., Chirica, M., Biancofiore, G., Podda, M., Cobianchi, L., Ansaloni, L., Fugazzola, P., Seretis, C., Gomez, C.A., Tumietto, F., Malbrain, M., Reichert, M., Augustin, G., Amato, B., Puzziello, A., Hecker, A., Gemignani, A., Isik, A., Cucchetti, A., Nacoti, M., Kopelman, D., Mesina, C., Ghannam, W., Ben-Ishay, O., Dhingra, S., Coimbra, R., Moore, E.E., Cui, Y., Quiodettis, M.A., Bala, M., Testini, M., Diaz, J., Girardis, M., Biffl, W.L., Hecker, M., Sall, I., Boggi, U., Materazzi, G., Ghiadoni, L., Matsumoto, J., Zuidema, W.P., Ivatury, R., Enani, M.A., Goor, H. van, Catena, Fausto, Sartelli, M., Coccolini, F., Cicuttin, E., Cremonini, C., Tartaglia, D., Viaggi, B., Kuriyama, A., Picetti, E., Ball, C., Abu-Zidan, F., Ceresoli, M., Turri, B., Jain, S., Palombo, C., Guirao, X., Rodrigues, G., Gachabayov, M., Machado, F., Eftychios, L., Kanj, S.S., Carlo, I. Di, Saverio, S. Di, Khokha, V., Kirkpatrick, A., Massalou, D., Forfori, F., Corradi, F., Delibegovic, S., Vega, G.M. Machain, Fantoni, M., Demetriades, D., Kapoor, G., Kluger, Y., Ansari, S., Maier, R., Leppaniemi, A., Hardcastle, T., Vereczkei, A., Karamagioli, E., Pikoulis, E., Pistello, M., Sakakushev, B.E., Navsaria, P.H., Galeiras, R., Yahya, A.I., Osipov, A.V., Dimitrov, E., Doklestić, K., Pisano, M., Malacarne, P., Carcoforo, P., Sibilla, M.G., Kryvoruchko, I.A., Bonavina, L., Kim, J.I., Shelat, V.G., Czepiel, J., Maseda, E., Marwah, S., Chirica, M., Biancofiore, G., Podda, M., Cobianchi, L., Ansaloni, L., Fugazzola, P., Seretis, C., Gomez, C.A., Tumietto, F., Malbrain, M., Reichert, M., Augustin, G., Amato, B., Puzziello, A., Hecker, A., Gemignani, A., Isik, A., Cucchetti, A., Nacoti, M., Kopelman, D., Mesina, C., Ghannam, W., Ben-Ishay, O., Dhingra, S., Coimbra, R., Moore, E.E., Cui, Y., Quiodettis, M.A., Bala, M., Testini, M., Diaz, J., Girardis, M., Biffl, W.L., Hecker, M., Sall, I., Boggi, U., Materazzi, G., Ghiadoni, L., Matsumoto, J., Zuidema, W.P., Ivatury, R., Enani, M.A., Goor, H. van, Catena, Fausto, and Sartelli, M.

Abstract

Contains fulltext : 238976.pdf (Publisher’s version ) (Open Access), On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.

Published
2021

11. Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference

Author

Nacoti, M, Fazzi, F, Biroli, F, Zangari, R, Barbui, T, Kochanek, P, Guido, B, Ezio, B, Silvia, B, Osvaldo, C, Citerio, G, Anthony, F, Ericka L, F, Alberto, G, Nacoti, Mirco, Fazzi, Francesco, Biroli, Francesco, Zangari, Rosalia, Barbui, Tiziano, Kochanek, Patrick M, Guido, Bertolini, Ezio, Bonanomi, Silvia, Bressan, Osvaldo, Chiara, Citerio, Giuseppe, Anthony, Figaji, Ericka L, Fink, Alberto, Gabriel, Nacoti, M, Fazzi, F, Biroli, F, Zangari, R, Barbui, T, Kochanek, P, Guido, B, Ezio, B, Silvia, B, Osvaldo, C, Citerio, G, Anthony, F, Ericka L, F, Alberto, G, Nacoti, Mirco, Fazzi, Francesco, Biroli, Francesco, Zangari, Rosalia, Barbui, Tiziano, Kochanek, Patrick M, Guido, Bertolini, Ezio, Bonanomi, Silvia, Bressan, Osvaldo, Chiara, Citerio, Giuseppe, Anthony, Figaji, Ericka L, Fink, and Alberto, Gabriel

Abstract

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children and adolescents. Survivors of severe TBI are more prone to functional deficits, resulting in poorer school performance, poor health-related quality of life (HRQoL), and increased risk of mental health problems. Critical gaps in knowledge of pathophysiological differences between children and adults concerning TBI outcomes, the paucity of pediatric trials and prognostic models and the uncertain extrapolation of adult data to pediatrics pose significant challenges and demand global efforts. Here, we explore the clinical and research unmet needs focusing on severe pediatric TBI to identify best practices in pathways of care and optimize both inpatient and outpatient management of children following TBI.

Published
2021

12. Modified pediatric Lung Ultrasound Score compared with computed tomography for assessment of lung aeration in children

Author

Fochi, O, Bronco, A, Nacoti, M, Signori, D, Gatti, S, Sala, F, Rozen, T, Bonanomi, E, Bellani, G, Fochi, Oliviero, Bronco, Alfio, Nacoti, Mirco, Signori, Davide, Gatti, Stefano, Sala, Francesco, Rozen, Thomas, Bonanomi, Ezio, Bellani, Giacomo, Fochi, O, Bronco, A, Nacoti, M, Signori, D, Gatti, S, Sala, F, Rozen, T, Bonanomi, E, Bellani, G, Fochi, Oliviero, Bronco, Alfio, Nacoti, Mirco, Signori, Davide, Gatti, Stefano, Sala, Francesco, Rozen, Thomas, Bonanomi, Ezio, and Bellani, Giacomo

Abstract

BACKGROUND: Lung ultrasound can be used to assess lung density and aeration at the bedside. A few authors have investigated scores based on the ultrasonographic interstitial syndrome for this purpose, but none have compared them with the gold standard computed tomography in children.METHODS: Children < 10 kilograms undergoing a chest computed tomography for clinical purposes at a tertiary hospital Pediatric Intensive Care Unit were enrolled in the study. An ultrasound scan was performed shortly after computed tomography. Each hemithorax was divided in 6 zones, and each zone was scored: 1 = no B lines; 2 = < 3 B lines; 3 > 3 well separated B lines; 4 = crowded, coalescent B lines; 5 = white lung; 6 = consolidation. The pediatric Lung Ultrasound Score was obtained by adding all zones. Interobserver variation for two separate operators was calculated.RESULTS: Ten children, median age 95 days (range 23 - 721), were enrolled. Mean pediatric Lung Ultrasound Score had a significant correlation with lung density (rho = 0.68) and percentage of hypoaerated lung (rho = 0.51). Median density and percentage of hypoaerated lung increased along the ultrasound patterns values (p < 0.05) although not all patterns were significantly different from adjacent ones in the pairwise comparison. Interobserver variability in scoring of ultrasonographic patterns was moderate.CONCLUSIONS: The pediatric Lung Ultrasound Score correlates with lung density and percentage of hypoaerated lung measured with computed tomography.

Published
2021

13. Open abdomen and entero-atmospheric fistulae: An interim analysis from the International Register of Open Abdomen (IROA)

Author

Coccolini F, Register of Open Abdomen (IROA)., Ceresoli, M, Kluger, Y, Kirkpatrick, A, Montori, G, Salvetti, F, Fugazzola, P, Tomasoni, M, Sartelli, M, Ansaloni, L1, Catena, F, Nego, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, Ac, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Ardaisik, Yuan, Kc, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, Gp, Pereira, Bm, Gachabayov, M, Chagerben, Gp, Arellano, Ml, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Gianotti, L, Fattori, L, Ivatury, R, IROA study group, Coccolini, F, Ceresoli, M, Kluger, Y, Kirkpatrick, A, Montori, G, Salvetti, F, Fugazzola, P, Tomasoni, M, Sartelli, M, Ansaloni, L, Catena, F, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Gianotti, L, Fattori, L, and Ivatury, R

Subjects
Adult, Male, medicine.medical_specialty, Fistula, medicine.medical_treatment, Peritonitis, Entero-atmospheric fistula, NO, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Negative-pressure wound therapy, MED/18 - CHIRURGIA GENERALE, Intestinal Fistula, Humans, Medicine, Orthopedics and Sports Medicine, Prospective Studies, Young adult, Open abdomen, Prospective cohort study, Digestive System Surgical Procedures, General Environmental Science, 030222 orthopedics, business.industry, Mortality rate, Abdominal Cavity, Abdominal Wound Closure Techniques, 030208 emergency & critical care medicine, Middle Aged, Interim analysis, medicine.disease, Surgery, IROA, Treatment Outcome, Parenteral nutrition, Emergency Medicine, General Earth and Planetary Sciences, Female, business, Negative-Pressure Wound Therapy
Abstract

Introduction No definitive data describing associations between cases of Open Abdomen (OA) and Entero-atmospheric fistulae (EAF) exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) thus analyzed the International Register of Open Abdomen (IROA) to assess this question. Material and methods A prospective analysis of adult patients enrolled in the IROA. Results Among 649 adult patients with OA 58 (8.9%) developed EAF. Indications for OA were peritonitis (51.2%) and traumatic-injury (16.8%). The most frequently utilized temporary abdominal closure techniques were Commercial-NPWT (46.8%) and Bogota-bag (21.9%). Mean OA days were 7.9 ± 18.22. Overall mortality rate was 29.7%, with EAF having no impact on mortality. Multivariate analysis associated cancer (p = 0.018), days of OA (p = 0.003) and time to provision-of-nutrition (p = 0.016) with EAF occurrence. Conclusion Entero-atmospheric fistulas are influenced by the duration of open abdomen treatment and by the nutritional status of the patient. Peritonitis, intestinal anastomosis, negative pressure and oral or enteral nutrition were not risk factors for EAF during OA treatment.

Published
2019

14. Bending-over backwards for a severe technical challenge: 4th split liver transplant (SLTx) with reno-portal anastomosis for recurrent PVT in a situs inversus (SI) pediatric patient

Author

Paderno, N, Zambelli, M, Pinelli, D, Maritato, S, Sala, F, Nicastro, E, Nacoti, M, Colledan, M, Paderno N, Zambelli M, Pinelli D, Maritato S, Sala F, Nicastro E, Nacoti M, Colledan M, Paderno, N, Zambelli, M, Pinelli, D, Maritato, S, Sala, F, Nicastro, E, Nacoti, M, Colledan, M, Paderno N, Zambelli M, Pinelli D, Maritato S, Sala F, Nicastro E, Nacoti M, and Colledan M

Published
2018

16. Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen

Author

Ceresoli, M, Salvetti, F, Kluger, Y, Braga, M, Viganò, J, Fugazzola, P, Sartelli, M, Ansaloni, L, Catena, F, Coccolini, F, Negoi, I, Zese, M, Occhionorelli, S, Gubbiotti, F, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Che Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Cordeiro Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Pereira Fraga, G, M Pereira, B, Gachabayov, M, Perez Chagerben, G, Leon Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Nigro, A, Kirkpatrick, A, Parfenov, A, Montori, G, Dionigi, P, Sugrue, M, Dubuisson, V, Noutakdie Tochie, J, Ivatury, R, Marco Ceresoli, Francesco Salvetti, Yoram Kluger, Marco Braga, Jacopo Viganò, Paola Fugazzola, Massimo Sartelli, Luca Ansaloni, Fausto Catena, Federico Coccolini, Ionut Negoi, Monica Zese, Savino Occhionorelli, Francesca Gubbiotti, Sergei Shlyapnikov, Christian Galatioto, Massimo Chiarugi, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Stefano Rausei, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federic Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Alice Nigro, Andrew Kirkpatrick, Anton Parfenov, Giulia Montori, Paolo Dionigi, Michael Sugrue, Vincent Dubuisson, Joel Noutakdie Tochie, Rao Ivatury, Ceresoli, M, Salvetti, F, Kluger, Y, Braga, M, Viganò, J, Fugazzola, P, Sartelli, M, Ansaloni, L, Catena, F, Coccolini, F, Negoi, I, Zese, M, Occhionorelli, S, Gubbiotti, F, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Che Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Cordeiro Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Pereira Fraga, G, M Pereira, B, Gachabayov, M, Perez Chagerben, G, Leon Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Nigro, A, Kirkpatrick, A, Parfenov, A, Montori, G, Dionigi, P, Sugrue, M, Dubuisson, V, Noutakdie Tochie, J, Ivatury, R, Marco Ceresoli, Francesco Salvetti, Yoram Kluger, Marco Braga, Jacopo Viganò, Paola Fugazzola, Massimo Sartelli, Luca Ansaloni, Fausto Catena, Federico Coccolini, Ionut Negoi, Monica Zese, Savino Occhionorelli, Francesca Gubbiotti, Sergei Shlyapnikov, Christian Galatioto, Massimo Chiarugi, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Stefano Rausei, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federic Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Alice Nigro, Andrew Kirkpatrick, Anton Parfenov, Giulia Montori, Paolo Dionigi, Michael Sugrue, Vincent Dubuisson, Joel Noutakdie Tochie, and Rao Ivatury

Abstract

Background: Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. Methods: This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30 kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero-atmospheric fistula rate and length of ICU stay. Results: A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5 days vs. 6.3 ± 7.5 days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p < 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson’s linear correlation coefficient = 0,201; p < 0,001). Conclusions: Open abdomen in obese patients seems to be safe as in non-obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. Trial registration number: ClinicalTrials.gov, Identifier: NCT02382770.

Published
2020

20. Postoperative complications in cirrhotic pediatric deceased donor liver transplantation: Focus on transfusion therapy

Author

Nacoti, M, Cazzaniga, S, Colombo, G, Corbella, D, Fazzi, F, Fochi, O, Gattoni, C, Zambelli, M, Colledan, M, Bonanomi, E, Nacoti M, Cazzaniga S, Colombo G, Corbella D, Fazzi F, Fochi O, Gattoni C, Zambelli M, Colledan M, Bonanomi E, Nacoti, M, Cazzaniga, S, Colombo, G, Corbella, D, Fazzi, F, Fochi, O, Gattoni, C, Zambelli, M, Colledan, M, Bonanomi, E, Nacoti M, Cazzaniga S, Colombo G, Corbella D, Fazzi F, Fochi O, Gattoni C, Zambelli M, Colledan M, and Bonanomi E

Abstract

Intraoperative transfusions seem associated with patient death and graft failure after PLTx. A retrospective analysis of recipients’ and donors’ characteristics and transplantation data in a cohort of patients undergoing PLTx from 2002 to 2013 at the Bergamo General Hospital was performed. A two-stage hierarchical Cox proportional hazard regression with forward stepwise selection was used to identify the main risk factors for major complications. In addition, propensity score analysis was used to adjust risk estimates for possible selection biases in the use of blood products. Over the 12-year period, 232 pediatric cirrhotic patients underwent PLTx. One-year patient and graft survival rates were 92.3% and 83.7%, respectively. The Kaplan-Meier shows that the main decrease in both graft and patient survival occurs during the first months post-transplantation. At the same time, it appears that most of the complications occur during the first month post-transplantation. One-month and 1-year patient complication-free survival rates were 24.8% and 12.1%, respectively. Our study shows that intraoperative red blood cells and platelet transfusions are independent risk factors for developing one or more major complications in the first year after PLTx. Decreasing major complications will improve the health status and overall long-term patient survival after pediatric PLTx.

Published
2017

21. IROA: International Register of Open Abdomen, preliminary results

Author

Coccolini, F, Montori, G, Ceresoli, M, Catena, F, Ivatury, R, Sugrue, M, Sartelli, M, Fugazzola, P, Corbella, D, Salvetti, F, Negoi, I, Zese, M, Occhionorelli, S, Maccatrozzo, S, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Yovtchev, Y, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Ansaloni, L, Coccolini F., Montori G., Ceresoli M., Catena F., Ivatury R., Sugrue M., Sartelli M., Fugazzola P., Corbella D., Salvetti F., Negoi I., Zese M., Occhionorelli S., Maccatrozzo S., Shlyapnikov S., Galatioto C., Chiarugi M., Demetrashvili Z., Dondossola D., Yovtchev Y., Ioannidis O., Novelli G., Nacoti M., Khor D., Inaba K., Demetriades D., Kaussen T., Jusoh A. C., Ghannam W., Sakakushev B., Guetta O., Dogjani A., Costa S., Singh S., Damaskos D., Isik A., Yuan K. -C., Trotta F., Rausei S., Martinez-Perez A., Bellanova G., Fonseca V. C., Hernandez F., Marinis A., Fernandes W., Quiodettis M., Bala M., Vereczkei A., Curado R. L., Fraga G. P., Pereira B. M., Gachabayov M., Chagerben G. P., Arellano M. L., Ozyazici S., Costa G., Tezcaner T., Ansaloni L., Coccolini, F, Montori, G, Ceresoli, M, Catena, F, Ivatury, R, Sugrue, M, Sartelli, M, Fugazzola, P, Corbella, D, Salvetti, F, Negoi, I, Zese, M, Occhionorelli, S, Maccatrozzo, S, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Yovtchev, Y, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Ansaloni, L, Coccolini F., Montori G., Ceresoli M., Catena F., Ivatury R., Sugrue M., Sartelli M., Fugazzola P., Corbella D., Salvetti F., Negoi I., Zese M., Occhionorelli S., Maccatrozzo S., Shlyapnikov S., Galatioto C., Chiarugi M., Demetrashvili Z., Dondossola D., Yovtchev Y., Ioannidis O., Novelli G., Nacoti M., Khor D., Inaba K., Demetriades D., Kaussen T., Jusoh A. C., Ghannam W., Sakakushev B., Guetta O., Dogjani A., Costa S., Singh S., Damaskos D., Isik A., Yuan K. -C., Trotta F., Rausei S., Martinez-Perez A., Bellanova G., Fonseca V. C., Hernandez F., Marinis A., Fernandes W., Quiodettis M., Bala M., Vereczkei A., Curado R. L., Fraga G. P., Pereira B. M., Gachabayov M., Chagerben G. P., Arellano M. L., Ozyazici S., Costa G., Tezcaner T., and Ansaloni L.

Abstract

Background: No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). Methods: A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org. Results: Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male; Mean BMI: 36±5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p<0.0001) and with the fistula development (Pearson = 0.146 p= 0.016). Pediatric patients: 33 patients. Mean age: 5.91±(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(±3.09) days. Conclusion: Temporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogotà-bag seem to improve results. Trial registration: ClinicalTrials.gov NCT02382770

Published
2017

22. Open abdomen and entero-atmospheric fistulae: An interim analysis from the International Register of Open Abdomen (IROA)

Author

Coccolini, F, Ceresoli, M, Kluger, Y, Kirkpatrick, A, Montori, G, Salvetti, F, Fugazzola, P, Tomasoni, M, Sartelli, M, Ansaloni, L, Catena, F, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Gianotti, L, Fattori, L, Ivatury, R, Coccolini, Federico, Ceresoli, Marco, Kluger, Yoram, Kirkpatrick, Andrew, Montori, Giulia, Salvetti, Fracensco, Fugazzola, Paola, Tomasoni, Matteo, Sartelli, Massimo, Ansaloni, Luca, Catena, Fausto, Negoi, Ionut, Zese, Monica, Occhionorelli, Savino, Shlyapnikov, Sergei, Galatioto, Christian, Chiarugi, Massimo, Demetrashvili, Zaza, Dondossola, Daniele, Ioannidis, Orestis, Novelli, Giuseppe, Nacoti, Mirco, Khor, Desmond, Inaba, Kenji, Demetriades, Demetrios, Kaussen, Torsten, Jusoh, Asri Che, Ghannam, Wagih, Sakakushev, Boris, Guetta, Ohad, Dogjani, Agron, Costa, Stefano, Singh, Sandeep, Damaskos, Dimitrios, Isik, Arda, Yuan, Kuo-Ching, Trotta, Francesco, Rausei, Stefano, Martinez-Perez, Aleix, Bellanova, Giovanni, Fonseca, ViniciusCordeiro, Hernández, Fernando, Marinis, Athanasios, Fernandes, Wellington, Quiodettis, Martha, Bala, Miklosh, Vereczkei, Andras, Curado, Rafael, Fraga, Gustavo Pereira, Pereira, Bruno M, Gachabayov, Mahir, Chagerben, Guillermo Perez, Arellano, Miguel Leon, Ozyazici, Sefa, Costa, Gianluca, Tezcaner, Tugan, Porta, Matteo, Li, Yousheng, Karateke, Faruk, Manatakis, Dimitrios, Mariani, Federico, Lora, Federic, Sahderov, Ivan, Atanasov, Boyko, Zegarra, Sergio, Gianotti, Luca, Fattori, Luca, Ivatury, Rao, Coccolini, F, Ceresoli, M, Kluger, Y, Kirkpatrick, A, Montori, G, Salvetti, F, Fugazzola, P, Tomasoni, M, Sartelli, M, Ansaloni, L, Catena, F, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Gianotti, L, Fattori, L, Ivatury, R, Coccolini, Federico, Ceresoli, Marco, Kluger, Yoram, Kirkpatrick, Andrew, Montori, Giulia, Salvetti, Fracensco, Fugazzola, Paola, Tomasoni, Matteo, Sartelli, Massimo, Ansaloni, Luca, Catena, Fausto, Negoi, Ionut, Zese, Monica, Occhionorelli, Savino, Shlyapnikov, Sergei, Galatioto, Christian, Chiarugi, Massimo, Demetrashvili, Zaza, Dondossola, Daniele, Ioannidis, Orestis, Novelli, Giuseppe, Nacoti, Mirco, Khor, Desmond, Inaba, Kenji, Demetriades, Demetrios, Kaussen, Torsten, Jusoh, Asri Che, Ghannam, Wagih, Sakakushev, Boris, Guetta, Ohad, Dogjani, Agron, Costa, Stefano, Singh, Sandeep, Damaskos, Dimitrios, Isik, Arda, Yuan, Kuo-Ching, Trotta, Francesco, Rausei, Stefano, Martinez-Perez, Aleix, Bellanova, Giovanni, Fonseca, ViniciusCordeiro, Hernández, Fernando, Marinis, Athanasios, Fernandes, Wellington, Quiodettis, Martha, Bala, Miklosh, Vereczkei, Andras, Curado, Rafael, Fraga, Gustavo Pereira, Pereira, Bruno M, Gachabayov, Mahir, Chagerben, Guillermo Perez, Arellano, Miguel Leon, Ozyazici, Sefa, Costa, Gianluca, Tezcaner, Tugan, Porta, Matteo, Li, Yousheng, Karateke, Faruk, Manatakis, Dimitrios, Mariani, Federico, Lora, Federic, Sahderov, Ivan, Atanasov, Boyko, Zegarra, Sergio, Gianotti, Luca, Fattori, Luca, and Ivatury, Rao

Abstract

Introduction: No definitive data describing associations between cases of Open Abdomen (OA) and Entero-atmospheric fistulae (EAF) exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) thus analyzed the International Register of Open Abdomen (IROA) to assess this question. Material and methods: A prospective analysis of adult patients enrolled in the IROA. Results: Among 649 adult patients with OA 58 (8.9%) developed EAF. Indications for OA were peritonitis (51.2%) and traumatic-injury (16.8%). The most frequently utilized temporary abdominal closure techniques were Commercial-NPWT (46.8%) and Bogotà-bag (21.9%). Mean OA days were 7.9 ± 18.22. Overall mortality rate was 29.7%, with EAF having no impact on mortality. Multivariate analysis associated cancer (p = 0.018), days of OA (p = 0.003) and time to provision-of-nutrition (p = 0.016) with EAF occurrence. Conclusion: Entero-atmospheric fistulas are influenced by the duration of open abdomen treatment and by the nutritional status of the patient. Peritonitis, intestinal anastomosis, negative pressure and oral or enteral nutrition were not risk factors for EAF during OA treatment

Published
2019

23. Sevoflurane improves respiratory mechanics and gas exchange in a case series of infants with severe bronchiolitis-induced acute respiratory distress syndrome

Author

Nacoti, M, Colombo, J, Fochi, O, Bonacina, D, Fazzi, F, Bellani, G, Bonanomi, E, Nacoti, Mirco, Colombo, Jacopo, Fochi, Oliviero, Bonacina, Daniele, Fazzi, Francesco, Bellani, Giacomo, Bonanomi, Ezio, Nacoti, M, Colombo, J, Fochi, O, Bonacina, D, Fazzi, F, Bellani, G, Bonanomi, E, Nacoti, Mirco, Colombo, Jacopo, Fochi, Oliviero, Bonacina, Daniele, Fazzi, Francesco, Bellani, Giacomo, and Bonanomi, Ezio

Abstract

This report describes the successful use of a new intervention to improve respiratory mechanics and gas exchange in a relatively homogeneous group of infants with severe bronchiolitis-induced PARDS after failure of conventional treatment. These results may open a new interesting area of research and management for PARDS patients.

Published
2018

24. 37th International Symposium on Intensive Care and Emergency Medicine (part 1 of 3)

Author

Karavana, V., Smith, I., Kanellis, G., Sigala, I., Kinsella, T., Zakynthinos, S., Liu, L., Chen, J., Zhang, X., Liu, A., Guo, F., Liu, S., Yang, Y., Qiu, H., Grimaldi, D. G., Kaya, E., Acicbe, O., Kayaalp, I., Asar, S., Dogan, M., Eren, G., Hergunsel, O., Pavelescu, D., Grintescu, I., Mirea, L., Guanziroli, M., Gotti, M., Marino, A., Cressoni, M., Vergani, G., Chiurazzi, C., Chiumello, D., Gattinoni, L., Spano, S., Massaro, F., Moustakas, A., Johansson, S., Larsson, A., Perchiazzi, G., Zhang, X. W., Guo, F. M., Chen, J. X., Xue, M., Qiu, H. B., Yang, L., Fister, M., Knafelj, R., Suzer, M. A., Kavlak, M. E., Atalan, H. K., Gucyetmez, B., Cakar, N., Weller, D., Grootendorst, A. F., Dijkstra, A., Kuijper, T. M., Cleffken, B. I., Regli, A., De Keulenaer, B., Van Heerden, P., Hadfield, D., Hopkins, P. A., Penhaligon, B., Reid, F., Hart, N., Rafferty, G. F., Grasselli, G., Mauri, T., Lazzeri, M., Carlesso, E., Cambiaghi, B., Eronia, N., Maffezzini, E., Bronco, A., Abbruzzese, C., Rossi, N., Foti, G., Bellani, G., Pesenti, A., Bassi, G. Li, Panigada, M., Ranzani, O., Kolobow, T., Zanella, A., Berra, L., Parrini, V., Kandil, H., Salati, G., Livigni, S., Amatu, A., Girardis, M., Barbagallo, M., Moise, G., Mercurio, G., Costa, A., Vezzani, A., Lindau, S., Babel, J., Cavana, M., Torres, A., Ranzani, O. T., Umbrello, M., Taverna, M., Formenti, P., Mistraletti, G., Vetrone, F., Baisi, A., Garnero, A. G., Novotni, D. N., Arnal, J. A., Urner, M., Fan, E., Dres, M., Vorona, S., Brochard, L., Ferguson, N. D., Goligher, E. C., Leung, C., Joynt, G., Wong, W., Lee, A., Gomersall, C., Poels, S., Casaer, M., Schetz, M., Van den Berghe, G., Meyfroidt, G., Holzgraefe, B., Von Kobyletzki, L. B., Cianchi, G., Becherucci, F., Batacchi, S., Cozzolino, M., Franchi, F., Di Valvasone, S., Ferraro, M. C., Peris, A., Phiphitthanaban, H., Wacharasint, P., Wongsrichanalai, V., Lertamornpong, A., Pengpinij, O., Wattanathum, A., Oer-areemitr, N., Boddi, M., Cappellini, E., Ciapetti, M., Di Lascio, G., Bonizzoli, M., Lazzeri, C., Katsin, M. L., Hurava, M. Y., Dzyadzko, A. M., Hermann, A., Schellongowski, P., Bojic, A., Riss, K., Robak, O., Lamm, W., Sperr, W., Staudinger, T., Buoninsegni, L. Tadini, Parodo, J., Ottaviano, A., Cecci, L., Corsi, E., Ricca, V., de Garibay, A. Perez Ruiz, Ende-Schneider, B., Schreiber, C., Kreymann, B., Turani, F., Resta, M., Niro, D., Castaldi, P., Boscolo, G., Gonsales, G., Martini, S., Belli, A., Zamidei, L., Falco, M., Lamas, T., Mendes, J., Galazzi, A., Benco, B., Binda, F., Masciopinto, L., Lissoni, A., Adamini, I., Thamjamrassri, T., Watcharotayangul, J., Numthavaj, P., Kongsareepong, S., Higuera, J., Cabestrero, D., Rey, L., Narváez, G., Blandino, A., Aroca, M., Saéz, S., De Pablo, R., Mohamed, A., Sklar, M., Munshi, L., Alban, L., Turrini, C., Taccone, P., Marenghi, C., Spadaro, S., Volta, C., Alonso, D. Cabestrero, González, L. Rey, Franci, A., Stocchi, G., Cappuccini, G., Socci, F., Guetti, C., Rastrelli, P., Nestorowicz, A., Glapinski, J., Fijalkowska-Nestorowicz, A., Wosko, J., Duprez, F., Bonus, T., Cuvelier, G., Mashayekhi, S., Ollieuz, S., Reychler, G., Kuchyn, I., Bielka, K., Sergienko, A., Jones, H., Day, C., Park, S. C., Yeom, S. R., Myatra, S. N., Gupta, S., Rajnala, V., Divatia, J., Silva, J. Villalobos, Olvera, O. Aguilera, Schulte, R. Cavazos, Bermudez, M. Castañeda, Zorrilla, L. Pariente, Ferretis, H. Lopez, García, K. Trejo, Balciuniene, N., Ramsaite, J., Kriukelyte, O., Krikscionaitiene, A., Tamosuitis, T., Terragni, P., Brazzi, L., Falco, D., Pistidda, L., Magni, G., Bartoletti, L., Mascia, L., Filippini, C., Ranieri, V., Kyriakoudi, A., Rovina, N., Koltsida, O., Konstantellou, E., Kardara, M., Kostakou, E., Gavriilidis, G., Vasileiadis, I., Koulouris, N., Koutsoukou, A., Van Snippenburg, W., Kröner, A., Flim, M., Buise, M., Hemler, R., Spronk, P., Noffsinger, B., Singh, B., Hockings, L., Spina, C., Magni, F., Di Giambattista, C., Vargiolu, A., Citerio, G., Scaramuzzo, G., Waldmann, A. D., Böhm, S. H., Ragazzi, R., Volta, C. A., Heines, S. J., Strauch, U., Van de Poll, M. C., Roekaerts, P. M., Bergmans, D. C., Sosio, S., Gatti, S., Punzi, V., Asta, A., Mroczka, J., Yaroshetskiy, A. I, Rezepov, N. A., Mandel, I. A., Gelfand, B. R., Ozen, E., Karakoc, E., Ayyildiz, A., Kara, S., Ekemen, S., Yelken, B. Buyukkidan, Saasouh, W., Freeman, J., Turan, A., Hajjej, Z., Sellami, W., Bousselmi, M., Samoud, W., Gharsallah, H., Labbene, I., Ferjani, M., Vetrugno, L., Barbariol, F., Forfori, F., Regeni, I., Della Rocca, G., Jansen, D., Jonkman, A., Doorduin, J., Roesthuis, L., Van der Hoeven, J., Heunks, L., Marocco, S. Arrigoni, Bottiroli, M., Pinciroli, R., Galanti, V., Calini, A., Gagliardone, M., Fumagalli, R., Ippolito, D., Sala, V. L., Meroni, V., Elbanna, M., Nassar, Y., Abdelmohsen, A., Yahia, M., Mongodi, S., Mojoli, F., Via, G., Tavazzi, G., Fava, F., Pozzi, M., Iotti, G. A., Bouhemad, B., Ruiz-Ferron, F., Simón, J. Serrano, Gordillo-Resina, M., Chica-Saez, V., Garcia, M. Ruiz, Vela-Colmenero, R., Redondo-Orts, M., Gontijo-Coutinho, C., Ozahata, T., Nocera, P., Franci, D., Santos, T., Carvalho-Filho, M., Fochi, O., Nacoti, M., Signori, D., Bonacina, D., Bonanomi, E., Bonvecchio, E., Stella, A., Roldi, E., Orlando, A., Luperto, M., Trunfio, D., Licitra, G., Martinelli, R., Vannini, D., Giuliano, G., Näslund, E., Lindberg, L. G., Lund, I., Frithiof, R., Nichols, A., Pentakota, S., Kodali, B., Pranskunas, A., Kiudulaite, I., Simkiene, J., Damanskyte, D., Pranskuniene, Z., Arstikyte, J., Vaitkaitis, D., Pilvinis, V., Brazaitis, M., Pool, R., Haugaa, H., Botero, A., Escobar, D., Maberry, D., Tønnessen, T., Zuckerbraun, B., Pinsky, M., Gomez, H., Lyons, H., Trimmings, A., Domizi, R., Scorcella, C., Damiani, E., Pierantozzi, S., Tondi, S., Monaldi, V., Carletti, A., Zuccari, S., Adrario, E., Pelaia, P., Donati, A., Kazune, S., Grabovskis, A., Volceka, K., Rubins, U., Bol, M., Suverein, M., Delnoij, T., Driessen, R., Heines, S., Delhaas, T., Vd Poll, M., Sels, J., Jozwiak, M., Chambaz, M., Sentenac, P., Richard, C., Monnet, X., Teboul, J. L., Bitar, Z., Maadarani, O., Al Hamdan, R., Huber, W., Malbrain, M., Chew, M., Mallat, J., Tagami, T., Hundeshagen, S., Wolf, S., Mair, S., Schmid, R., Aron, J., Adlam, M., Dua, G., Mu, L., Chen, L., Yoon, J., Clermont, G., Dubrawski, A., Duhailib, Z., Al Assas, K., Shafquat, A., Salahuddin, N., Donaghy, J., Morgan, P., Valeanu, L., Stefan, M., Provenchere, S., Longrois, D., Shaw, A., Mythen, M. G., Shook, D., Hayashida, D., Munson, S. H., Sawyer, A., Mariyaselvam, M., Blunt, M., Young, P., Nakwan, N., Khwannimit, B., Checharoen, P., Berger, D., Moller, P., Bloechlinger, S., Bloch, A., Jakob, S., Takala, J., Van den Brule, J. M., Stolk, R., Vinke, E., Van Loon, L. M., Pickkers, P., Van der Hoeven, J. G., Kox, M., Hoedemaekers, C. W., Werner-Moller, P., Bertini, P., Guarracino, F., Colosimo, D., Gonnella, S., Brizzi, G., Mancino, G., Baldassarri, R., Pinsky, M. R., Amitrano, D., Goslar, T., Stajer, D., Radsel, P., De Vos, R., Dijk, N. Bussink-van, Stringari, G., Cogo, G., Devigili, A., Graziadei, M. Ceola, Bresadola, E., Lubli, P., Amella, S., Marani, F., Polati, E., Gottin, L., Colinas, L., Hernández, G., Vicho, R., Serna, M., Canabal, A., Cuena, R., Gimenez, J., Mercado, P., Depret, F., Sassi, K., Herner, A., Abded, N., Elghonemi, M., Monir, A., Nikhilesh, J., Apurv, T., Uber, A. U., Grossestreuer, A., Moskowitz, A., Patel, P., Holmberg, M. J., Donnino, M. W., Graham, C. A., Hung, K., Lo, R., Leung, L. Y., Lee, K. H., Yeung, C. Y., Chan, S. Y., Trembach, N., Zabolotskikh, I., Caldas, J., Panerai, R., Camara, L., Ferreira, G., Almeida, J., de Oliveira, G. Queiroz, Jardim, J., Bor-Seng-Shu, E., Lima, M., Nogueira, R., Jatene, F., Zeferino, S., Galas, F., Robinson, T., Hajjar, L. A., Oliveira, M., Norgueira, R., Groehs, R., Ferreira-Santos, L., Oliveira, G., Hajjar, L., Ribeiro, J., Gaiotto, F., Lisboa, L., Fukushima, J., Rizk, S., Osawa, E., Franco, R., Kalil, R., Chlabicz, M., Sobkowicz, B., Kaminski, K., Kazimierczyk, R., Musial, W., Tycińska, A., Siranovic, M., Gopcevic, A., Gavranovic, Z. G., Horvat, A. H., Krolo, H., Rode, B., Videc, L., Trifi, A., Abdellatif, S., Ismail, K. Ben, Bouattour, A., Daly, F., Nasri, R., Lakhal, S. Ben, Beurton, A., Girotto, V., Galarza, L., Guedj, T., Iliæ, M. Karaman, Sakic, L., NN, V., Stojcic, L., Alphonsine, J., Lai, C., Tapanwong, N., Chuntupama, P., Hoellthaler, J., Lahmer, T., Latham, H., Bengtson, C. D., Satterwhite, L., Stites, M., Simpson, S. Q., Skladzien, T., Cicio, M., Garlicki, J., Serednicki, W., Wordliczek, J., Vargas, P., Salazar, A., Espinoza, M., Graf, J., Kongpolprom, N., Sanguanwong, N., Jonnada, S., Gerrard, C., Jones, N., Morley, T., Thorburn, P. T., Musaeva, T., Horst, S., Lipcsey, M., Kawati, R., Pikwer, A., Rasmusson, J., Castegren, M., Shilova, A., Yafarova, A., Gilyarov, M., Stojiljkovic, D. L. Loncar, Ulici, A., Reidt, S., Lam, T., Jancik, J., Ragab, D., Taema, K., Farouk, W., Saad, M., Liu, X., Uber, A., Montissol, S., Donnino, M., Andersen, L. W., Perlikos, F., Lagiou, M., Papalois, A., Kroupis, C., Toumpoulis, I., Carter, D., Sardo, S., Landoni, G., Kongsayreepong, S., Sungsiri, R., Wongsripunetit, P., Marchio, P., Guerra-Ojeda, S., Gimeno-Raga, M., Mauricio, M. D., Valles, S. L., Aldasoro, C., Jorda, A., Aldasoro, M., Vila, J. M., Borg, U. B., Neitenbach, A. M., García, M., González, P. Guijo, Romero, M. Gracia, Orduña, P. Saludes, Cano, A. Gil, Rhodes, A., Grounds, R. M., Cecconi, M., Lee, C., Hatib, F., Jian, Z., Rinehart, J., De Los Santos, J., Canales, C., Cannesson, M., García, M. I. Monge, Scheeren, T., Chantziara, V., Vassi, A., Michaloudis, G., Sanidas, E., Golemati, S., Bateman, R. M., Mokhtar, A., Omar, W., Aziz, K. Abdel, El Azizy, H., Nielsen, D. L. Lykke, Holler, J. G., Lassen, A., Eriksson, M., Strandberg, G., Capoletto, C., Nakamura, R., Risk, S., Park, C., Dias, F., D’Arrigo, N., Fortuna, F., Redaelli, S., Zerman, L., Becker, L., Serrano, T., Cotes, L., Ramos, F., Fadel, L., Coelho, F., Mendes, C., Real, J., Pedron, B., Kuroki, M., Costa, E., and Azevedo, L.

Subjects
Critical Care and Intensive Care Medicine, Meeting Abstracts
Published
2017

25. IROA: International Register of Open Abdomen, preliminary results (vol 12, pg 13, 2017)

Author

Coccolini F, Montori G, Ceresoli M, Catena F, Ivatury R, Sugrue M, Sartelli M, Fugazzola P, Corbella D, Salvetti F, Negoi I, Zese M, Occhionorelli S, Maccatrozzo S, Shlyapnikov S, Galatioto C, Chiarugi M, Demetrashvili Z, Dondossola D, Yovtchev Y, Ioannidis O, Novelli G, Nacoti M, Khor D, Inaba K, Demetriades D, Kaussen T, Jusoh AC, Ghannam W, Sakakushev B, Guetta O, Dogjani A, Costa S, Singh S, Damaskos D, Isik A, Yuan KC, Trotta F, Rausei S, Martinez-Perez A, Bellanova G, Fonseca VC, Hernández F, Marinis A, Fernandes W, Quiodettis M, Bala M, Vereczkei A, Curado RL, Fraga GP, Pereira BM, Gachabayov M, Chagerben GP, Arellano ML, Ozyazici S, Costa G, Tezcaner T, and Ansaloni L

Abstract

[This corrects the article DOI: 10.1186/s13017-017-0123-8.].

Published
2017

26. Erratum to: IROA: International Register of Open Abdomen, preliminary results. [World J Emerg Surg. 12, (2017), (10)] DOI: 10.1186/s13017-017-0123-8

Author

Coccolini, F., Montori, G., Ceresoli, M., Catena, F., Ivatury, R., Sugrue, M., Sartelli, M., Fugazzola, P., Corbella, D., Salvetti, F., Negoi, I., Zese, M., Occhionorelli, S., Maccatrozzo, S., Shlyapnikov, S., Galatioto, C., Chiarugi, M., Demetrashvili, Z., Dondossola, D., Yovtchev, Y., Ioannidis, O., Novelli, G., Nacoti, M., Khor, D., Inaba, K., Demetriades, D., Kaussen, T., Jusoh, A. C., Ghannam, W., Sakakushev, B., Guetta, O., Dogjani, A., Costa, S., Singh, S., Damaskos, D., Isik, A., Yuan, K. -C., Trotta, F., Rausei, S., Martinez-Perez, A., Bellanova, G., Fonseca, V. C., Hernandez, F., Marinis, A., Fernandes, W., Quiodettis, M., Bala, M., Vereczkei, A., Curado, R. L., Fraga, G. P., Pereira, B. M., Gachabayov, M., Chagerben, G. P., Arellano, M. L., Ozyazici, S., Costa, G., Tezcaner, T., and Ansaloni, L.

Subjects
Surgery, Emergency Medicine, NO
Published
2017

27. THE IMPACT OF INTRAOPERATIVE TRANSFUSION OF BLOOD PRODUCT ON SURVIVAL AFTER PAEDIATRIC LIVER TRANSPLANTATION

Author

Nacoti, M, Lorusso, F, Buoro, S, Vedovati, S, Brambillasca, P, Naldi, L, Corno, V, Colledan, M, Benigni, A, Carrara, B, Pirola, C, Sonzogni, V, Nacoti M, Lorusso F, Buoro S, Vedovati S, Brambillasca P, Naldi L, Corno V, Colledan M, Benigni A, Carrara B, Pirola C, Sonzogni V, Nacoti, M, Lorusso, F, Buoro, S, Vedovati, S, Brambillasca, P, Naldi, L, Corno, V, Colledan, M, Benigni, A, Carrara, B, Pirola, C, Sonzogni, V, Nacoti M, Lorusso F, Buoro S, Vedovati S, Brambillasca P, Naldi L, Corno V, Colledan M, Benigni A, Carrara B, Pirola C, and Sonzogni V

Published
2011

29. Pediatric liver re-transplantation: A single center experience

Author

Corno, V, Manfredi, R, Dezza, M, Luciarietti, A, Pinelli, D, Maldini, G, Zambelli, M, Guizzetti, M, Giovanelli, M, Stroppa, P, Nacoti, M, Codazzi, D, Torre, G, Colledan, M, Corno V, Manfredi R, Dezza MC, Luciarietti A, Pinelli D, Maldini G, Zambelli M, Guizzetti M, Giovanelli M, Stroppa P, Nacoti M, Codazzi D, Torre G, Colledan M, Corno, V, Manfredi, R, Dezza, M, Luciarietti, A, Pinelli, D, Maldini, G, Zambelli, M, Guizzetti, M, Giovanelli, M, Stroppa, P, Nacoti, M, Codazzi, D, Torre, G, Colledan, M, Corno V, Manfredi R, Dezza MC, Luciarietti A, Pinelli D, Maldini G, Zambelli M, Guizzetti M, Giovanelli M, Stroppa P, Nacoti M, Codazzi D, Torre G, and Colledan M

Published
2007

30. Prognostic significance of ammonia, lactate and creatinine trend in the early phase post-pediatric liver transplantation

Author

Sperti, L, Codazzi, D, Nacoti, M, Vedovati, S, Bonanomi, E, Barbanti, C, Torre, G, Colledan, M, Fumagalli, R, Sperti LR, Codazzi D, Nacoti M, Vedovati S, Bonanomi E, Barbanti C, Torre G, Colledan M, Fumagalli R, Sperti, L, Codazzi, D, Nacoti, M, Vedovati, S, Bonanomi, E, Barbanti, C, Torre, G, Colledan, M, Fumagalli, R, Sperti LR, Codazzi D, Nacoti M, Vedovati S, Bonanomi E, Barbanti C, Torre G, Colledan M, and Fumagalli R

Published
2006

31. Liver transplants in children: The 8 years experience in Bergamo

Author

Torre, G, Melzi, M, Stroppa, P, Candusso, M, Bravi, M, Bosisio, M, Andreoli, M, Sonzogni, A, Colledan, M, Lucinetti, A, Corno, V, Alberti, D, Spotti, A, Nacoti, M, Maldini, G, Torre G, Melzi ML, Stroppa P, Candusso M, Bravi M, Bosisio M, Andreoli M, Sonzogni A, Colledan M, Lucinetti A, Corno V, Alberti D, Spotti A, Nacoti M, Maldini G, Torre, G, Melzi, M, Stroppa, P, Candusso, M, Bravi, M, Bosisio, M, Andreoli, M, Sonzogni, A, Colledan, M, Lucinetti, A, Corno, V, Alberti, D, Spotti, A, Nacoti, M, Maldini, G, Torre G, Melzi ML, Stroppa P, Candusso M, Bravi M, Bosisio M, Andreoli M, Sonzogni A, Colledan M, Lucinetti A, Corno V, Alberti D, Spotti A, Nacoti M, and Maldini G

Published
2006

32. Liver transplantation in children with metabolic and genetic disorders: Experience of one center

Author

Torre, G, Manila, C, Luisa, M, Paola, S, Bravi, M, Bosisio, M, Parini, R, Codazzi, D, Sonzogni, A, Sonzogni, V, Colledan, M, Pinelli, D, Guizzetti, M, Alberti, D, Nacoti, M, Torre G, Manila C, Luisa MM, Paola S, Bravi M, Bosisio M, Parini R, Codazzi D, Sonzogni A, Sonzogni V, Colledan M, Pinelli D, Guizzetti M, Alberti D, Nacoti M, Torre, G, Manila, C, Luisa, M, Paola, S, Bravi, M, Bosisio, M, Parini, R, Codazzi, D, Sonzogni, A, Sonzogni, V, Colledan, M, Pinelli, D, Guizzetti, M, Alberti, D, Nacoti, M, Torre G, Manila C, Luisa MM, Paola S, Bravi M, Bosisio M, Parini R, Codazzi D, Sonzogni A, Sonzogni V, Colledan M, Pinelli D, Guizzetti M, Alberti D, and Nacoti M

Published
2006

33. Pediatric liver re-transplantation: A single center experience

Author

Corno V, Manfredi R, Dezza MC, Luciarietti A, Pinelli D, Maldini G, Zambelli M, Guizzetti M, Giovanelli M, Stroppa P, Nacoti M, Codazzi D, Torre G, Colledan M, Corno, V, Manfredi, R, Dezza, M, Luciarietti, A, Pinelli, D, Maldini, G, Zambelli, M, Guizzetti, M, Giovanelli, M, Stroppa, P, Nacoti, M, Codazzi, D, Torre, G, and Colledan, M

Subjects
Pediatric, Transplantation
Published
2007

34. Liver transplants in children: The 8 years experience in Bergamo

Author

Torre, G., Melzi, Ml, Stroppa, P., Candusso, M., Bravi, M., Bosisio, M., Andreoli, M., aurelio sonzogni, Colledan, M., Lucinetti, A., Corno, V., Alberti, D., Spotti, A., Nacoti, M., Maldini, G., Torre, G, Melzi, M, Stroppa, P, Candusso, M, Bravi, M, Bosisio, M, Andreoli, M, Sonzogni, A, Colledan, M, Lucinetti, A, Corno, V, Alberti, D, Spotti, A, Nacoti, M, and Maldini, G

Subjects
Transplantation, Hepatology, Gastroenterology, Surgery
Published
2006

36. Liver transplantation in children with metabolic and genetic disorders: Experience of one center

Author

Torre, G., Manila, C., Luisa, Mm, Paola, S., Bravi, M., Bosisio, M., Parini, R., Codazzi, D., Sonzogni, A., Sonzogni, V., Colledan, M., Pinelli, D., Guizzetti, M., Alberti, D., Nacoti, M., Torre, G, Manila, C, Luisa, M, Paola, S, Bravi, M, Bosisio, M, Parini, R, Codazzi, D, Sonzogni, A, Sonzogni, V, Colledan, M, Pinelli, D, Guizzetti, M, Alberti, D, and Nacoti, M

Subjects
Transplantation, Hepatology, Gastroenterology, Surgery
Published
2006

37. Sigh Improves Gas Exchange and Respiratory Mechanics in children Undergoing Pressure Support after major surgery

Author

Nacoti, M, Spagnolli, E, Bonanomi, E, Barbanti, C, Cereda, M, Fumagalli, R, SPAGNOLLI, ESTER, FUMAGALLI, ROBERTO, Nacoti, M, Spagnolli, E, Bonanomi, E, Barbanti, C, Cereda, M, Fumagalli, R, SPAGNOLLI, ESTER, and FUMAGALLI, ROBERTO

Abstract

Background Children undergoing major surgery can develop lung de-recruitment and gas exchange impairment in the postoperative period.The aim of this study was to assess the effect of periodic sigh breaths (Sighs) during pressure support ventilation (PSV) on gas exchange and respiratory pattern in children after major surgery. Methods Twenty children were enrolled and received PSV alone and with Sighs in a randomized order. Sighs were administered once per minute by adding to baseline pressure support a pressure controlled breath set at 30 cm H2O of peak airway pressure. At the end of each study period air flow, pressure traces, and compliance of respiratory system, together with hemodynamic parameters and venous and arterial blood gas tensions, were recorded. Results PaO2/FiO2 improved from baseline to Sigh group (312.6±137.4 vs. 394.2±127.0; P<0.01) and PaCO2 decreased from baseline to Sigh group (39.3±3.3 vs. 34.3±4.6 mmHg; P<0.001), without any change in minute expiratory volume. Indexed to body weight compliance of respiratory system improved from baseline to Sigh group (0.85± 0.35 vs. 1.01±0.30 mL/kg/cm H2O; P<0.01). There were no significant differences between the two groups for the hemodynamic parameters. Conclusion Te addition of one Sigh per minute during PSV in the post-operative period of children that underwent major surgery improved gas exchange and decreased respiratory drive without producing major short-term complications. Further long-term studies are necessary to evaluate the efficacy and safety of Sigh in pediatric patients.

Published
2012

38. Early detection of the graft failure after pediatric liver transplantation: a Bergamo experience

Author

Nacoti, M, Barlera, S, Codazzi, D, Bonanomi, E, Passoni, M, Vedovati, S, ROTA SPERTI, L, Colledan, M, Fumagalli, R, CODAZZI, DANIELA, ROTA SPERTI, LIDIA, FUMAGALLI, ROBERTO, Nacoti, M, Barlera, S, Codazzi, D, Bonanomi, E, Passoni, M, Vedovati, S, ROTA SPERTI, L, Colledan, M, Fumagalli, R, CODAZZI, DANIELA, ROTA SPERTI, LIDIA, and FUMAGALLI, ROBERTO

Abstract

Effective indicators of the early graft failure after pediatric liver transplantation are currently a crucial question. The aim of this study was to analyze retrospectively laboratory parameters that may help anticipate an early graft loss (GL)., Background: Effective indicators of the early graft failure after pediatric liver transplantation are currently a crucial question. The aim of this study was to analyze retrospectively laboratory parameters that may help anticipate an early graft loss (GL). Methods: The 131 pediatric liver transplantations, performed in our hospital from January 2002 to December 2005, were reviewed. Post-operative laboratory parameters, collected in the first 36 h of the Paediatric Intensive Care Unit (PICU) stay, were analyzed for children with both graft survival and GL. Receiver operating characteristics analysis was used to identify the optimal cut-off for the laboratory parameters. Multivariate logistic regression analysis was used to calculate the adjusted risk of GL for the prognostic parameters identified. Results: The mean age at transplant was 1.1 years. The two groups were comparable for all recipient and donor variables considered. Children with GL showed significantly higher levels of ammonia and transaminase at the admission to the PICU and higher levels of prothrombin time, creatinine, lactate and a lower level of platelets at the 36 h of PICU. The laboratory parameters over the cut-off value by the multivariate logistic regression identified all early thromboses earlier than Doppler ultrasound. Conclusions: This study suggests that routine blood tests may help to anticipate an early loss of liver grafts in children after transplantation and may improve our diagnostic investigation in the case of thrombosis suspicion. Further validation by a prospective study is needed to carefully assess the sensitivity and specificity of the identified criteria. © 2011 The Authors. Acta Anaesthesiologica Scandinavica.

Published
2011

39. Continuous positive airway pressure with modified helmet for treatment of hypoxemic acute respiratory failure in infants and a preschool population: A feasibility study

Author

Codazzi, D, Nacoti, M, Passoni, M, Bonanomi, E, Sperti, L, Fumagalli, R, Sperti, LR, FUMAGALLI, ROBERTO, Codazzi, D, Nacoti, M, Passoni, M, Bonanomi, E, Sperti, L, Fumagalli, R, Sperti, LR, and FUMAGALLI, ROBERTO

Abstract

Objective: To analyze the feasibility of using continuous positive airway pressure (CPAP) delivered via a modified helmet to treat children with hypoxemic acute respiratory failure. Design: A single-center, prospective, clinical study. Setting. Pediatric intensive care unit in a university hospital. Patients: Fifteen consecutive children (from 1 month to 5 yrs of age) with hypoxemic acute respiratory failure (defined as Pao(2)/ FIO2 < 300). Interventions. CPAP was delivered via a modified helmet (CaStar, Starmed, Italy) of reduced size, fastened by a device we call a "baby-body." The feasibility of CPAP with the helmet was the primary end point. The improvement of gas exchange was the secondary one. Measurements and Main Results. Ten of 15 children had multiple organ failure. Nine of 15 children were <= 1 yr old. The helmet was well tolerated by all the children. Additional sedation was provided to four patients. No children developed significant complications (skin lesion, gastric distension, conjunctivitis, epistaxis, or loss of invasive devices) or lethal, helmet-related events. Oxygenation improved above baseline after 2 hrs of CPAP with the helmet; no significant variation of hemodynamic variables was detected. Conclusions. The helmet is a suitable device for delivery of CPAP to infants and preschool children with hypoxemic acute respiratory failure. It was well tolerated and improved oxygenation.

Published
2006

40. Internal pancreatic fistula in a child with pancreas divisum: An unusual manifestation of an uncommon anomaly

Author

Nacoti, M, Riva, L, Vedovati, S, Bolis, A, Agazzi, R, Fumagalli, R, FUMAGALLI, ROBERTO, Nacoti, M, Riva, L, Vedovati, S, Bolis, A, Agazzi, R, Fumagalli, R, and FUMAGALLI, ROBERTO

Abstract

Objectives: Report of an unusual case of pancreatic fistula in a child. Background: Pancreatic diseases are relatively uncommon in the pediatric age group, with a rather heterogeneous clinical picture from generic abdominal distension to massive pleural effusion. Clinical Relevance: The amylase analysis of pleural liquid is crucial for the etiologic diagnosis of pancreatitis with internal pancreatic fistula. Magnetic resonance cholangiopancreatography may support the etiologic diagnosis of pancreatic pleural fistula in children. Management of internal pancreatic fistula is analyzed. Conclusion: Maintaining a high index of suspicion is essential for the etiologic diagnosis of pancreatic pleural fistula in children.

Published
2006

42. Closed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation.

Author

Cereda, Maurizio, Villa, Federico, Colombo, Enrico, Greco, Gianluca, Nacoti, Mirco, Pesenti, Antonio, Cereda, M, Villa, F, Colombo, E, Greco, G, Nacoti, M, and Pesenti, A

Subjects
HOSPITAL wards, PATIENTS, BLOOD circulation, CRITICAL care medicine, HEMODYNAMICS, INTENSIVE care units, AIRWAY (Anatomy), ADULT respiratory distress syndrome treatment, ARTIFICIAL respiration, BLOOD gases analysis, CLINICAL trials, COMPARATIVE studies, LONGITUDINAL method, LUNGS, RESEARCH methodology, MEDICAL cooperation, PLETHYSMOGRAPHY, RESEARCH, RESPIRATORY measurements, ADULT respiratory distress syndrome, TRACHEA intubation, EVALUATION research, RANDOMIZED controlled trials, MEDICAL suction, LUNG volume measurements, PHYSIOLOGY
Abstract

Objective: A closed suction system (CS) maintains connection with the mechanical ventilator during tracheal suctioning and is claimed to limit loss in lung volume and oxygenation. We compared changes in lung volume, oxygenation, airway pressure and hemodynamics during endotracheal suctioning performed with CS and with an open suction system (OS).Design: Prospective, randomized study.Setting: Intensive care unit in a university hospital.Patients: We enrolled ten patients, volume-controlled (VC) ventilated with a Siemens Servo 900 ventilator (PaO2/FIO2 192 +/- 70, PEEP 10.7 +/- 3.9 cmH2O).Interventions: We performed four consecutive tracheal suction maneuvers, two with CS and two with OS, at 20-min intervals. During the suction maneuvers continuous suction was applied for 20 s.Measurements and Main Results: We measured end-expiratory lung volume changes (delta VL), tidal volume (VTrt), respiratory rate (RR) and minute volume (VErt) by respiratory inductive plethysmography; arterial oxygen saturation (SpO2), airway pressure and arterial pressure (PA). Loss in lung volume during OS (delta VL 1.2 +/- 0.7 l) was significantly higher than during CS (delta VL 0.14 +/- 0.1 l). During OS we observed a marked drop in SpO2, while during CS the change was only minor. During CS ventilation was not interrupted and we observed an immediate increase in RR (due to the activation of the ventilator's trigger), while VTrt decreased, VErt was maintained.Conclusions: Avoiding suction-related lung volume loss can be helpful in patients with an increased tendency to alveolar collapse; CS allows suctioning while avoiding dramatic drops in lung volumes and seems to be safe during the VC ventilation setting that we used. [ABSTRACT FROM AUTHOR]

Published
2001
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44. A pandemic recap: lessons we have learned

Author

Ugo Boggi, Julival Ribeiro, Luigi Bonavina, Mauro Pistello, Fikri M. Abu-Zidan, Massimo Sartelli, Dieter G. Weber, Vladimir Khokha, Pietro Brambillasca, Dario Tartaglia, Yoram Kluger, Lorenzo Cobianchi, Damien Massalou, Cristian Mesina, Arda Isik, Alessandro Cucchetti, Mutasim M. Elmangory, Xavier Guirao, Salomone Di Saverio, Ibrahima Sall, Emmanouil Pikoulis, Aleksei V. Osipov, Krstina Doklestic, Mahir Gachabayov, Maria Grazia Sibilla, Charalampos Seretis, Fabio Tumietto, M Chirica, Paola Fugazzola, Isidoro Di Carlo, Gian Luca Baiocchi, Chad G. Ball, Yunfeng Cui, Lorenzo Ghiadoni, Timothy Craig Hardcastle, Massimo Fantoni, Boun Kim Tan, Bruno Turri, Edoardo Picetti, Federico Coccolini, Jacek Czepiel, Jae Il Kim, Evgeni Dimitrov, R. V. Maier, Camilla Cremonini, Ali I. Yahya, I. A. Kryvoruchko, Akira Kuriyama, Wagih Ghannam, Shamshul Ansari, Fernando Machado, Enrico Cicuttin, Sumita A Jain, Ronald Kiguba, Doron Kopelman, Martha Quiodettis, Michele Pisano, Marco Ceresoli, Harry van Goor, Garima Kapoor, Andrew W. Kirkpatrick, Mauro Podda, Angelo Gemignani, Boris Sakakushev, Souha S. Kanj, Ernest E. Moore, Samir Delibegovic, Cinzia Monti, Massimo Girardis, Matti Tolonen, Mushira Enani, Massimo Chiarugi, Carlos A. Ordoñez, Zaza Demetrashvili, Leonardo Pagani, Ziad A. Memish, Pradeep H. Navsaria, Paolo Malacarne, Nicola de’Angelis, Giandomenico Luigi Biancofiore, Fulvio Basolo, Goran Augustin, Junichi Matsumoto, Fausto Catena, Ari Leppäniemi, Gabriel Rodrigues, W.P. Zuidema, Raul Coimbra, Manu Malbrain, Emilio Maseda, Suman Baral, Demetrios Demetriades, M. Hecker, Davide Corbella, András Vereczkei, Sanjay Marwah, Francesco Forfori, Donal B. O’Connor, Carlo Palombo, Vishal G Shelat, Michelangelo Scaglione, Walter L. Biffl, Andrey Litvin, Majdi N. Al-Hasan, Sameer Dhingra, Miklosh Bala, Oussama Baraket, Carlos Augusto Gomez, Offir Ben-Ishay, Gabriele Materazzi, Paolo Carcoforo, Rita Galeiras, Belinda De Simone, Ionut Negoi, Mirco Nacoti, Luca Ansaloni, Bruno Viaggi, Jose J. Diaz, Alessandro Puzziello, Bruno Amato, Lostoridis Eftychios, Cino Bendinelli, Mario Testini, Andreas Hecker, Martin Reichert, Francesco Corradi, Korey Das, Gustavo M. Machain Vega, Evika Karamagioli, Rao R. Ivatury, HUS Abdominal Center, II kirurgian klinikka, Coccolini, F, Cicuttin, E, Cremonini, C, Tartaglia, D, Viaggi, B, Kuriyama, A, Picetti, E, Ball, C, Abu-Zidan, F, Ceresoli, M, Turri, B, Jain, S, Palombo, C, Guirao, X, Rodrigues, G, Gachabayov, M, Machado, F, Eftychios, L, Kanj, S, Di Carlo, I, Di Saverio, S, Khokha, V, Kirkpatrick, A, Massalou, D, Forfori, F, Corradi, F, Delibegovic, S, Machain Vega, G, Fantoni, M, Demetriades, D, Kapoor, G, Kluger, Y, Ansari, S, Maier, R, Leppaniemi, A, Hardcastle, T, Vereczkei, A, Karamagioli, E, Pikoulis, E, Pistello, M, Sakakushev, B, Navsaria, P, Galeiras, R, Yahya, A, Osipov, A, Dimitrov, E, Doklestic, K, Pisano, M, Malacarne, P, Carcoforo, P, Sibilla, M, Kryvoruchko, I, Bonavina, L, Kim, J, Shelat, V, Czepiel, J, Maseda, E, Marwah, S, Chirica, M, Biancofiore, G, Podda, M, Cobianchi, L, Ansaloni, L, Fugazzola, P, Seretis, C, Gomez, C, Tumietto, F, Malbrain, M, Reichert, M, Augustin, G, Amato, B, Puzziello, A, Hecker, A, Gemignani, A, Isik, A, Cucchetti, A, Nacoti, M, Kopelman, D, Mesina, C, Ghannam, W, Ben-Ishay, O, Dhingra, S, Coimbra, R, Moore, E, Cui, Y, Quiodettis, M, Bala, M, Testini, M, Diaz, J, Girardis, M, Biffl, W, Hecker, M, Sall, I, Boggi, U, Materazzi, G, Ghiadoni, L, Matsumoto, J, Zuidema, W, Ivatury, R, Enani, M, Litvin, A, Al-Hasan, M, Demetrashvili, Z, Baraket, O, Ordonez, C, Negoi, I, Kiguba, R, Memish, Z, Elmangory, M, Tolonen, M, Das, K, Ribeiro, J, O'Connor, D, Tan, B, Van Goor, H, Baral, S, De Simone, B, Corbella, D, Brambillasca, P, Scaglione, M, Basolo, F, De'Angelis, N, Bendinelli, C, Weber, D, Pagani, L, Monti, C, Baiocchi, G, Chiarugi, M, Catena, F, Sartelli, M, Surgery, Other Research, APH - Quality of Care, Department of Surgery, and Faculty of Health Sciences

Subjects
Biomedical Research, Pandemics / prevention & control, Delivery of Health Care / organization & administration, International Cooperation, Reflection, 030230 surgery, Global Health, Health Services Accessibility, COVID-19 / epidemiology, 0302 clinical medicine, White paper, Telemedicine / organization & administration, Multidisciplinary approach, Pandemic, Health care, Global health, 030212 general & internal medicine, Letter to the Editor, Health Policy, Politics, Medical emergencies. Critical care. Intensive care. First aid, COVID-19 / therapy, Public relations, Telemedicine, Primary Health Care / organization & administration, 3. Good health, Policy, International, Emergency Medicine, Thought, medicine.medical_specialty, COVID-19 Vaccines, RD1-811, Thoughts, Mass Vaccination, Mass Vaccination / organization & administration, NO, 03 medical and health sciences, medicine, Politic, Humans, Ethic, Healthcare Disparities, Biology, Pandemics, Health policy, LS7_4, Ethics, Pandemia, Primary Health Care, RC86-88.9, business.industry, Public health, COVID-19, Health Status Disparities, 3126 Surgery, anesthesiology, intensive care, radiology, Delivery of Health Care, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Surgery, business, COVID-19 / diagnosis
Abstract

Contains fulltext : 238976.pdf (Publisher’s version ) (Open Access) On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.

Published
2021
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45. Modified pediatric Lung Ultrasound Score compared with computed tomography for assessment of lung aeration in children

Author

Oliviero Fochi, Giacomo Bellani, Mirco Nacoti, Stefano Gatti, Thomas H Rozen, Davide Signori, Alfio Bronco, Ezio Bonanomi, Francesco Sala, Fochi, O, Bronco, A, Nacoti, M, Signori, D, Gatti, S, Sala, F, Rozen, T, Bonanomi, E, and Bellani, G

Subjects
ARDS, Computed tomography, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, medicine, Humans, Intensive care unit, Child, Lung, Ultrasonography, Aged, 80 and over, Pediatric, medicine.diagnostic_test, business.industry, Ultrasound, 030208 emergency & critical care medicine, Gold standard (test), respiratory system, medicine.disease, respiratory tract diseases, Lung ultrasound, Lung density, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Interobserver Variation, Lung disease, Diagnostic imaging, Tomography, X-Ray Computed, business, Nuclear medicine
Abstract

BACKGROUND: Lung ultrasound can be used to assess lung density and aeration at the bedside. A few authors have investigated scores based on the ultrasonographic interstitial syndrome for this purpose, but none have compared them with the gold standard computed tomography in children.METHODS: Children < 10 kilograms undergoing a chest computed tomography for clinical purposes at a tertiary hospital Pediatric Intensive Care Unit were enrolled in the study. An ultrasound scan was performed shortly after computed tomography. Each hemithorax was divided in 6 zones, and each zone was scored: 1 = no B lines; 2 = < 3 B lines; 3 > 3 well separated B lines; 4 = crowded, coalescent B lines; 5 = white lung; 6 = consolidation. The pediatric Lung Ultrasound Score was obtained by adding all zones. Interobserver variation for two separate operators was calculated.RESULTS: Ten children, median age 95 days (range 23 - 721), were enrolled. Mean pediatric Lung Ultrasound Score had a significant correlation with lung density (rho = 0.68) and percentage of hypoaerated lung (rho = 0.51). Median density and percentage of hypoaerated lung increased along the ultrasound patterns values (p < 0.05) although not all patterns were significantly different from adjacent ones in the pairwise comparison. Interobserver variability in scoring of ultrasonographic patterns was moderate.CONCLUSIONS: The pediatric Lung Ultrasound Score correlates with lung density and percentage of hypoaerated lung measured with computed tomography.

Published
2021

46. Post-operative heparin reduces early venous thrombotic complications after orthotopic paediatric liver transplantation

Author

Colombo, Giovanna, Giaccherini, Cinzia, Benzi, Alberto, Ferrari, Floriana, Bonacina, Daniele, Corno, Manuela, Colledan, Michele, Alessio, Maria Grazia, Bonanomi, Ezio, Nacoti, Mirco, Falanga, Anna, Colombo, G, Giaccherini, C, Benzi, A, Ferrari, F, Bonacina, D, Corno, M, Colledan, M, Alessio, M, Bonanomi, E, Nacoti, M, and Falanga, A

Subjects
Postoperative Complications, liver transplantation, children, Heparin, Anticoagulants, Humans, thrombosi, Thrombosis, Child, Haemostasis and Thrombosis, Retrospective Studies
Abstract

BACKGROUND: Despite significant improvements in surgical techniques and medical care, thrombotic complications still represent the primary cause of early graft failure and re-transplantation following paediatric liver transplantation. There is still no standardized approach for thrombosis prevention. MATERIALS AND METHODS: The study aimed to evaluate the effectiveness of early intravenous unfractionated heparin started 12 hours postoperatively at 10 UI/kg per hour and used a retrospective "before and after" design to compare the incidence of early thrombotic complications prior to (2002-2010) and after (2011-2016) the introduction of heparin in our institute. RESULTS: From 2002 to 2016, 479 paediatric patients received liver transplantation in our institution with an overall survival rate over one year of 0.91 (95% CI: 0.87-0.94). Of 365 eligible patients, 244 did not receive heparin while 121 did receive heparin. We reported a lower incidence of venous thrombosis (VT) in the group treated with heparin: 2.5% (3/121) vs 7.9% (19/244) (p=0.038). All clinical and laboratory variables considered potential risk factors for VT were studied. By multivariate stepwise Cox proportional hazards models, heparin prophylaxis resulted significantly associated to a reduction in VT (HR=0.29 [95% CI: 0.08-0.97], p=0.045), while age

Published
2021

47. Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference

Author

Mirco Nacoti, Francesco Fazzi, Francesco Biroli, Rosalia Zangari, Tiziano Barbui, Patrick M. Kochanek, The Collaborative Pediatric TBI Working Group, Guido Bertolini, Ezio Bonanomi, Silvia Bressan, Osvaldo Chiara, Giuseppe Citerio, Anthony Figaji, Ericka L Fink, Alberto Gabrieli, Simonetta Gerevini, Maurizio Iacoangeli, Isaac Lazar, Luca Ferdinando Lorini, Christian Matula, Isabella Pellicioli, Gianluca Piatelli, Franco Servadei, Mirco Sicignano, Dennis W Simon, Sandra Strazzer, Giuliana Vitali, Nacoti, M, Fazzi, F, Biroli, F, Zangari, R, Barbui, T, Kochanek, P, Guido, B, Ezio, B, Silvia, B, Osvaldo, C, Citerio, G, Anthony, F, Ericka L, F, and Alberto, G

Subjects
medicine.medical_specialty, Traumatic brain injury, Best practice, intracranial pressure, Review, outcomes, Pediatrics, Quality of life (healthcare), medicine, Clinical care, Intensive care medicine, Prognostic models, business.industry, traumatic brain injury, lcsh:RJ1-570, lcsh:Pediatrics, medicine.disease, Mental health, nervous system diseases, Clinical research, School performance, pediatric, nervous system, Pediatrics, Perinatology and Child Health, outcome, prognosis, business, prognosi
Abstract

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children and adolescents. Survivors of severe TBI are more prone to functional deficits, resulting in poorer school performance, poor health-related quality of life (HRQoL), and increased risk of mental health problems. Critical gaps in knowledge of pathophysiological differences between children and adults concerning TBI outcomes, the paucity of pediatric trials and prognostic models and the uncertain extrapolation of adult data to pediatrics pose significant challenges and demand global efforts. Here, we explore the clinical and research unmet needs focusing on severe pediatric TBI to identify best practices in pathways of care and optimize both inpatient and outpatient management of children following TBI.

Published
2021

48. Open abdomen management for severe peritonitis in elderly. Results from the prospective International Register of Open Abdomen (IROA): Cohort study

Author

Stefano Rausei, Vincenzo Pappalardo, Marco Ceresoli, Fausto Catena, Massimo Sartelli, Massimo Chiarugi, Yoram Kluger, Andrew Kirkpatrick, Luca Ansaloni, Federico Coccolini, Giulia Montori, Fracensco Salvetti, Paola Fugazzola, Ionut Negoi, Monica Zese, Savino Occhionorelli, Sergei Shlyapnikov, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M. Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federico Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Rao Ivatury, Jimmy Xiao, Andrea Lippi, Mario Improta, Francesca Gubbiotti, Andrey Zharikov, Vincent Dubuisson, Michael Sugrue, Rausei, S, Pappalardo, V, Ceresoli, M, Catena, F, Sartelli, M, Chiarugi, M, Kluger, Y, Kirkpatrick, A, Ansaloni, L, Coccolini, F, Montori, G, Salvetti, F, Fugazzola, P, Negoi, I, Zese, M, Occhionorelli, S, Shlyapnikov, S, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Martinez-Perez, A, Bellanova, G, Fonseca, V, Hernandez, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Fraga, G, Pereira, B, Gachabayov, M, Chagerben, G, Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Ivatury, R, Xiao, J, Lippi, A, Improta, M, Gubbiotti, F, Zharikov, A, Dubuisson, V, and Sugrue, M

Subjects
Male, medicine.medical_specialty, Sepsi, Peritonitis, NO, Sepsis, 03 medical and health sciences, Elderly, Intra-abdominal infection, Open abdomen management, Source control, 0302 clinical medicine, Postoperative Complications, Abdomen, Medicine, Humans, Prospective Studies, Registries, Open abdomen, Aged, Aged, 80 and over, Univariate analysis, business.industry, Potential risk, Age Factors, Mean age, General Medicine, medicine.disease, Surgery, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Observational study, Female, business, Cohort study
Abstract

Background Analyzing the data of the International Register of Open Abdomen (IROA), the feasibility of open abdomen treatment has been demonstrated at every age. This new analysis on the IROA database investigates the risk factors for mortality in elderly patients treated with open abdomen for intra-abdominal infection. Methods Data were derived from the IROA, a prospective observational international cohort study that enrolled patients treated with open abdomen worldwide. A univariate analysis of potential risk factors was performed. Inclusion criteria were patients older than 65 years and treated with open abdomen for intra-abdominal infection. End point was overall mortality, calculated within 30 days after open abdomen management, after 1-month and 1-year follow-up. Results A total of 116 patients was analyzed with mean age of 76 ± 7 years. Definitive closure was achieved in 93 patients (93/116, 80.2%) for a mean open abdomen duration of 5.0 ± 5.0 days. Complicated patients were 101 (101/116, 87.1%) for a total of 201 complications. Overall, 62 out of 116 patients (53.4%) died: 23 patients (23/62, 37.1%) during open abdomen management, 29 patients (46.8%) within 30 days after abdominal closure, 9 patients (14.5%) after 1-month follow-up, and 1 patient (1.6%) after 1-year follow-up. Age did not affect mortality (75 ± 6 years in alive patients versus 77 ± 7 years in dead patients, p = 0.773). Definitive abdominal closure was the most important factor to prevent mortality. Conclusions This study confirmed that age alone cannot be considered a determinant for death, even in elderly patients managed with open abdomen for severe intra-abdominal infection.

Published
2020

49. Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen

Author

Marco Ceresoli, Francesco Salvetti, Yoram Kluger, Marco Braga, Jacopo Viganò, Paola Fugazzola, Massimo Sartelli, Luca Ansaloni, Fausto Catena, Federico Coccolini, Ionut Negoi, Monica Zese, Savino Occhionorelli, Francesca Gubbiotti, Sergei Shlyapnikov, Christian Galatioto, Massimo Chiarugi, Zaza Demetrashvili, Daniele Dondossola, Orestis Ioannidis, Giuseppe Novelli, Mirco Nacoti, Desmond Khor, Kenji Inaba, Demetrios Demetriades, Torsten Kaussen, Asri Che Jusoh, Wagih Ghannam, Boris Sakakushev, Ohad Guetta, Agron Dogjani, Stefano Costa, Sandeep Singh, Dimitrios Damaskos, Arda Isik, Kuo-Ching Yuan, Francesco Trotta, Stefano Rausei, Aleix Martinez-Perez, Giovanni Bellanova, Vinicius Cordeiro Fonseca, Fernando Hernández, Athanasios Marinis, Wellington Fernandes, Martha Quiodettis, Miklosh Bala, Andras Vereczkei, Rafael Curado, Gustavo Pereira Fraga, Bruno M Pereira, Mahir Gachabayov, Guillermo Perez Chagerben, Miguel Leon Arellano, Sefa Ozyazici, Gianluca Costa, Tugan Tezcaner, Matteo Porta, Yousheng Li, Faruk Karateke, Dimitrios Manatakis, Federico Mariani, Federic Lora, Ivan Sahderov, Boyko Atanasov, Sergio Zegarra, Luca Fattori, Alice Nigro, Andrew Kirkpatrick, Anton Parfenov, Giulia Montori, Paolo Dionigi, Michael Sugrue, Vincent Dubuisson, Joel Noutakdie Tochie, Rao Ivatury, Ceresoli, M, Salvetti, F, Kluger, Y, Braga, M, Viganò, J, Fugazzola, P, Sartelli, M, Ansaloni, L, Catena, F, Coccolini, F, Negoi, I, Zese, M, Occhionorelli, S, Gubbiotti, F, Shlyapnikov, S, Galatioto, C, Chiarugi, M, Demetrashvili, Z, Dondossola, D, Ioannidis, O, Novelli, G, Nacoti, M, Khor, D, Inaba, K, Demetriades, D, Kaussen, T, Che Jusoh, A, Ghannam, W, Sakakushev, B, Guetta, O, Dogjani, A, Costa, S, Singh, S, Damaskos, D, Isik, A, Yuan, K, Trotta, F, Rausei, S, Martinez-Perez, A, Bellanova, G, Cordeiro Fonseca, V, Hernández, F, Marinis, A, Fernandes, W, Quiodettis, M, Bala, M, Vereczkei, A, Curado, R, Pereira Fraga, G, M Pereira, B, Gachabayov, M, Perez Chagerben, G, Leon Arellano, M, Ozyazici, S, Costa, G, Tezcaner, T, Porta, M, Li, Y, Karateke, F, Manatakis, D, Mariani, F, Lora, F, Sahderov, I, Atanasov, B, Zegarra, S, Fattori, L, Nigro, A, Kirkpatrick, A, Parfenov, A, Montori, G, Dionigi, P, Sugrue, M, Dubuisson, V, Noutakdie Tochie, J, and Ivatury, R

Subjects
Adult, Male, medicine.medical_specialty, Abdominal compartment syndrome, Fistula, open abdomen, NO, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Acute care, Abdomen, Female, Humans, Intensive Care Units, Length of Stay, Middle Aged, Obesity, Registries, medicine, business.industry, Fascia, medicine.disease, Cardiac surgery, Surgery, medicine.anatomical_structure, Cardiothoracic surgery, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business, Trauma surgery, Abdominal surgery
Abstract

Background: Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. Methods: This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30 kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero-atmospheric fistula rate and length of ICU stay. Results: A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5 days vs. 6.3 ± 7.5 days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p < 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson’s linear correlation coefficient = 0,201; p < 0,001). Conclusions: Open abdomen in obese patients seems to be safe as in non-obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. Trial registration number: ClinicalTrials.gov, Identifier: NCT02382770.

Published
2019

50. Pressure support ventilation, sigh adjunct to pressure support ventilation, and neurally adjusted ventilatory assist in infants after cardiac surgery: A physiologic crossover randomized study

Author

Mirco Nacoti, Daniele Bonacina, Ezio Bonanomi, Giacomo Bellani, Floriana Ferrari, Alfio Bronco, Francesco Fazzi, Bonacina, D, Bronco, A, Nacoti, M, Ferrari, F, Fazzi, F, Bonanomi, E, and Bellani, G

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, genetic structures, Respiratory rate, Pressure support ventilation, pediatric cardiac surgery, Respiratory physiology, Mean airway pressure, Intensive Care Units, Pediatric, 03 medical and health sciences, 0302 clinical medicine, Respiratory Rate, 030225 pediatrics, Internal medicine, Tidal Volume, medicine, Neurally adjusted ventilatory assist, Humans, Cardiac Surgical Procedures, Hypoxia, Pediatric intensive care unit, Cross-Over Studies, pressure support ventilation, business.industry, Infant, Newborn, Infant, asynchronie, Oxygenation, Respiration, Artificial, Cardiac surgery, 030228 respiratory system, Pediatrics, Perinatology and Child Health, Respiratory Mechanics, Cardiology, SIGH, Female, Blood Gas Analysis, business, neurally adjusted ventilatory assist, circulatory and respiratory physiology
Abstract

Objectives: We sought to compare gas exchange, respiratory mechanics, and asynchronies during pressure support ventilation (PSV), sigh adjunct to PSV (PSV SIGH), and neurally adjusted ventilatory assist (NAVA) in hypoxemic infants after cardiac surgery. Design: Prospective, single-center, crossover, randomized physiologic study. Setting: Tertiary-care pediatric intensive care unit. Patients: Fourteen hypoxemic infants (median age 11.5 days [8.7-74]). Interventions: The protocol begins with a 1 hour step of PSV, followed by two consecutive steps in PSV SIGH and NAVA in random order, with a washout period of 30 minutes (PSV) between them. Main Results: Three infants presented an irregular Eadi signal because of diaphragmatic paralysis and were excluded from analysis. For the remaining 11 infants, PaO2/FiO 2 and oxygenation index improved in PSV SIGH compared with PSV (P < 0.05) but not in NAVA compared with PSV. PSV SIGH showed increased tidal volumes and lower respiratory rate than PSV (P < 0.05), as well as a significant improvement in compliance with respiratory system indexed to body weight when compared with both PSV and NAVA (P < 0.01). No changes in mean airway pressure was registered among steps. Inspiratory time resulted prolonged for both PSV SIGH and NAVA than PSV (P < 0.05). NAVA showed the higher coefficient of variability in respiratory parameters and a significative decrease in asynchrony index when compared with both PSV and PSV SIGH (P < 0.01). Conclusions: The adjunct of one SIGH per minute to PSV improved oxygenation and lung mechanics while NAVA provided the best patient-ventilator synchrony in infants after cardiac surgery.

Published
2019

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