Sepsis-induced coagulopathy is associated with impaired tissue oxygen extraction and microvascular reactivity: a prospective observational study
Anno: 2026
Rivista: MICROVASCULAR RESEARCH
Autori/autrici: Domizi, Roberta; Carsetti, Andrea; Antolini, Riccardo; Casarotta, Erika; Scorcella, Claudia; Zuccari, Samuele; Vitali, Eva; Adrario, Erica; Donati, Abele; Damiani, Elisa
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/353852
Citazioni:
Sepsis-induced coagulopathy is associated with impaired tissue oxygen extraction and microvascular reactivity: a prospective observational study / Domizi, R., Carsetti, A., Antolini, R., Casarotta, E., Scorcella, C., Zuccari, S., Vitali, E., Adrario, E., Donati, A., Damiani, E.. - In: MICROVASCULAR RESEARCH. - ISSN 0026-2862. - ELETTRONICO. - 165:(2026). [10.1016/j.mvr.2026.104924]
Abstract:
Background: Coagulopathy is a key driver of organ dysfunction during sepsis/septic shock, yet its relationship with microcirculatory autoregulation is not fully characterized. This study aimed to evaluate the association between sepsis-induced coagulopathy (SIC) and alterations in tissue oxygenation..., oxygen extraction capacity and microvascular reactivity. Methods: Prospective observational study on 23 adult septic patients. Coagulation status was evaluated with standard laboratory parameters and thromboelastography (TEG). A SIC score ≥ 4 was used to identify the presence of coagulopathy. The peripheral (skeletal muscle) tissue oxygen saturation (StO2) was assessed using thenar near infrared spectroscopy (NIRS). By combining a vascular occlusion test, the desaturation rate during ischemia was assessed as an index of oxygen extraction capacity: this was measured separately for the first (StO2 downslope-1) and last part (StO2 downslope-2) of the desaturation curve, and the difference between the two was calculated (delta-downslope). The reoxygenation rate (StO2 upslope) and the area of the hyperemic phase were calculated to evaluate microvascular reactivity. Results: In patients with SIC, the delta-downslope was higher (1.7 ± 2.5 versus −0.8 ± 3.2, p = 0.049) and the StO2 upslope was reduced (96 ± 74 versus 185 ± 91, p = 0.017), suggesting altered tissue oxygen extraction capacity and microvascular reactivity. Both parameters were able to discriminate the presence of SIC in the receiver operating characteristics curve analysis. Negative correlations were found between StO2 downslope-1 and TEG maximum amplitude (r = −0.470, p = 0.023), and Delta-Downslope and platelet count (r = −0.527, p = 0.01). Conclusions: SIC is associated with alterations in peripheral tissue oxygen extraction capacity and microvascular reactivity.
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Prognostic value and organ-specific correlations of admission MR-proADM in critically ill patients: a retrospective exploratory study
Anno: 2026
Rivista: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE
Autori/autrici: Domizi, Roberta; Damiani, Elisa; Carsetti, Andrea; Casarotta, Erika; Antolini, Riccardo; Calcinari, Alessandra; Moretti, Marco; Gabbanelli, Vincenzo; Compagnucci, Elisa; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/361312
Citazioni:
Prognostic value and organ-specific correlations of admission MR-proADM in critically ill patients: a retrospective exploratory study / Domizi, R., Damiani, E., Carsetti, A., Casarotta, E., Antolini, R., Calcinari, A., Moretti, M., Gabbanelli, V., Compagnucci, E., Adrario, E., Donati, A.. - In: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE. - ISSN 2731-3786. - (2026). [Epub ahead of print] [10.1186/s44158-026-00428-1]
Abstract:
Background: Acute organ dysfunction is a primary driver of ICU mortality. As clinical scores often act as lagging indicators, early recognition of subclinical endothelial stress may be essential for timely intervention. This exploratory study investigated the association of mid-regional pro-adrenome...dullin (MR-proADM)-a stable surrogate of the hormone adrenomedullin-as a potential early indicator of early organ failure. Methods: This retrospective, single-center study analyzed a heterogeneous cohort of 26 critically ill patients. Plasma MR-proADM levels were assessed at admission (t0) and daily for 5 days. The primary outcome was the correlation between admission MR-proADM and the 24-h SOFA score. Secondary outcomes included comparisons between septic and non-septic patients and between survivors and non-survivors. Results: Admission MR-proADM showed a moderate correlation with the 24-h SOFA score (rho = 0.488; p = 0.021), with the most prominent associations observed within the cardiovascular and renal SOFA domains. In the septic subgroup, MR-proADM levels were higher than in non-septic patients (10.90 [IQR 5.91-19.00] vs. 1.30 [IQR 0.74-2.53] nmol/L, p < 0.001); ROC analysis yielded an AUC of 0.88 (95% CI 0.73-1.00; p < 0.001), although this estimate should be interpreted descriptively given the small number of septic cases. Despite the low number of mortality events (n = 4), higher admission MR-proADM values were observed in non-survivors than in survivors, although this finding remains preliminary. Furthermore, admission MR-proADM levels showed positive correlations with procalcitonin at each individual timepoint during the first five ICU days (p < 0.001 at each timepoint). Conclusions: Within the limits of this small cohort, MR-proADM might provide a biological window into incipient organ dysfunction. Its possible role in supporting clinical assessment of sepsis and risk stratification-particularly regarding hemodynamic and renal dysfunction-remains strictly hypothesis-generating and requires validation in larger, prospective multicenter studies.
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Personalized automatic management of tracheal cuff pressure and subglottic secretions drainage to prevent pneumonia in critically ill intubated patients. The MICROINHALO multicenter randomized controlled trial
Anno: 2026
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: De Pascale, Gennaro; Cutuli, Salvatore Lucio; Vargas, Maria; Cortegiani, Andrea; Dalfino, Lidia; Greco, Massimiliano; Baroni, Silvia; Esposito, Clelia; Grieco, Domenico Luca; Grinberg, Reudor; Lombardi, Gianmarco; Pota, Vincenzo; Presti, Gabriele; Stufano, Monica; Tanzarella, Eloisa Sofia; Corcione, Antonio; Pace, Caterina; Sanguinetti, Maurizio; Bove, Tiziana; Urbani, Andrea; Girardis, Massimo; Cecconi, Maurizio; Servillo, Giuseppe; Conti, Giorgio; Antonelli, Massimo; The Microinhalo Study, Group; Franchini, Emanuele Oscar; Di Gravio, Valentina; Livanu, Daniel; Montini, Luca; Dell'Anna, Antonio Maria; Pintaudi, Gabriele; Carelli, Simone; Sarlo, Francesca; Marra, Annachiara; Iacovazzo, Carmine; Merola, Raffaele; Curci, Luigi; Fiore, Marco; Coppolino, Francesco; Nespoli, Moana Rossella; Rispoli, Marco; Fusilli, Nadia; Mainetti, Manuela; Magistrelli, Alessandra; Vanoni, Massimo; Ippolito, Mariachiara; Lapi, Maria; Cannizzaro, Giovanna; Giarratano, Antonino; Iannuzziello, Rachele; Miccolis, Angela; Tucci, Barbara; De Letteriis, Sestilio; Shney-Dor, Noa; Igbaria, Alaa; Serio, Lucia; Carsetti, Andrea; Donati, Abele; Montrucchio, Giorgia; Brazzi, Luca
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/358652
Citazioni:
Personalized automatic management of tracheal cuff pressure and subglottic secretions drainage to prevent pneumonia in critically ill intubated patients. The MICROINHALO multicenter randomized controlled trial / De Pascale, G., Cutuli, S.L., Vargas, M., Cortegiani, A., Dalfino, L., Greco, M., Baroni, S., Esposito, C., Grieco, D.L., Grinberg, R., Lombardi, G., Pota, V., Presti, G., Stufano, M., Tanzarella, E.S., Corcione, A., Pace, C., Sanguinetti, M., Bove, T., Urbani, A., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - (2026). [Epub ahead of print] [10.1007/s00134-026-08459-6]
Abstract:
Purpose: The MICROINHALO trial investigated whether personalized management of endotracheal tube cuff pressure (Pcuff) based on exhaled CO2 measurement combined with automatic subglottic space drainage (SSD) may prevent tracheal colonization in critically ill intubated patients. Methods: This cluste...r-randomized, international, open-label trial (NCT05403320) enrolled adult patients at 10 ICUs. They were randomly assigned to receive either an endotracheal tube equipped with automatic Pcuff management and SSD, or a conventional one with manual Pcuff management and manual SSD. The primary endpoint of the study was the rate of bacterial tracheal colonization (> 103 CFU/mL) on day 3 after intubation. Results: Among 270 randomized patients, 250 were included in the analysis: 127 allocated to the automatic management group and 123 to the manual management group. Bacterial tracheal colonization on day 3 occurred in 47 (37%) patients in the automatic management group and in 51 (41.5%) patients among controls (absolute difference - 4% [95% CI - 16 to 8], P = 0.52). The rate of clinically diagnosed (12.6% vs. 24.4%, P = 0.016) and microbiologically confirmed ventilator-associated pneumonia (VAP) (10.2% vs. 19.5%, P = 0.039) was significantly lower in the automatic management group, along with a lower percentage of Pcuff values outside the safety range (10.2% vs. 24.4%, P < 0.001) and a higher daily SSD volume (25 [8-41] mL vs. 10.5 [6-17] mL, P < 0.001). Conclusions: Among critically ill intubated patients, personalized automatic management of tracheal cuff pressure and subglottic secretion drainage was not superior to manual management to prevent tracheal colonization. Further research is warranted to confirm the observed effect on VAP rate reduction.
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Beyond shear stress: septic microvascular failure remains a multifactorial phenomenon
Anno: 2026
Rivista: CRITICAL CARE
Autori/autrici: Damiani, Elisa; Domizi, Roberta; Carsetti, Andrea; Antolini, Riccardo; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/360052
Citazioni:
Beyond shear stress: septic microvascular failure remains a multifactorial phenomenon / Damiani, E., Domizi, R., Carsetti, A., Antolini, R., Adrario, E., Donati, A.. - In: CRITICAL CARE. - ISSN 1364-8535. - ELETTRONICO. - 30:(2026). [10.1186/s13054-026-06187-3]

Relationship between high VExUS score and echocardiographic parameters: a systematic review and meta-analysis
Anno: 2026
Rivista: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE
Autori/autrici: Carsetti, Andrea; Antolini, Riccardo; Domizi, Roberta; Damiani, Elisa; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/353853
Citazioni:
Relationship between high VExUS score and echocardiographic parameters: a systematic review and meta-analysis / Carsetti, A., Antolini, R., Domizi, R., Damiani, E., Adrario, E., Donati, A.. - In: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE. - ISSN 2731-3786. - 6:(2026). [10.1186/s44158-026-00347-1]
Abstract:
Background: The Venous Excess Ultrasound (VExUS) score integrates inferior vena cava diameter and venous Doppler findings to quantify congestion. Findings are conflicting regarding whether higher VExUS grades reflect worse cardiac function. We conducted a systematic review and meta-analysis to evalu...ate echocardiographic changes across different VExUS grades and their clinical significance. Methods: The systematic review and meta-analysis were performed in accordance with the PRISMA guidelines, including hospitalized patients assessed with the VExUS score and echocardiography. The primary outcome was the association between high VExUS (grades 2–3) and TAPSE. Secondary outcomes explored the association between VExUS and other echocardiographic parameters in different subpopulations. Eligible studies were randomized or observational. The risk of bias was assessed using the ROBINS-I tool. Results: Eight studies were included in the primary outcome analysis. Patients with high VExUS scores had significantly lower TAPSE values compared to those with low scores, with a pooled mean difference of −2.35 mm (95% CI −3.27 to −1.42; p < 0.00001). Moderate heterogeneity was observed (I2 = 61%), but the overall effect remained robust. Secondary outcomes showed consistent associations between high VExUS scores and reduced cardiac output, stroke volume, RV S′, and LVOT VTI. However, in a sensitivity analysis excluding studies enrolling patients with heart failure, no significant association was observed between higher VExUS scores and right ventricular dysfunction. Moreover, the pooled mean values of right heart parameters (TAPSE, S′, and RV FAC) in patients with VExUS 2–3 remained within normal physiological ranges, suggesting preserved right ventricular function despite venous congestion. Conclusion: This systematic review and meta-analysis demonstrate that patients with venous congestion, as assessed by the VExUS score, may exhibit lower values of echocardiographic parameters of right ventricular function. This association is observed particularly in the subgroup of patients with known cardiac dysfunction and is not present in patients without heart failure. These findings suggest that the VExUS score should be primarily interpreted as a marker of established systemic venous congestion, rather than as an indicator of intrinsic right ventricular systolic impairment.
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Impact of appropriate antimicrobial therapy on patient outcomes and antimicrobial use: a sub analysis of the DIANA Study Dataset
Anno: 2026
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Cidade, José Pedro; Póvoa, Pedro; Depuydt, Pieter; Dhaese, Sofie; De Smet, Ken; Tabah, Alexis; Akova, Murat; Cotta, Menino Osbert; De Pascale, Gennaro; Dimopoulos, George; Fujitani, Shigeki; Garnacho-Montero, Jose; Leone, Marc; Lipman, Jeffrey; Ostermann, Marlies; Paiva, José-Artur; Schouten, Jeroen; Sjövall, Fredrik; Timsit, Jean-François; Roberts, Jason A.; Zahar, Jean Ralph; Zand, Farid; Zirpe, Kapil; De Waele, Jan J.; De Bus, Liesbet; Diana Study, Group; Rios, Fernando; Risso Vazquez, Alejandro; Vidal, Maria Gabriela; Zakalik, Graciela; Attokaran, Antony George; Banakh, Iouri; Dey-Chatterjee, Smita; Ewan, Julie; Ferrier, Janet; Forbes, Loretta; Fourie, Cheryl; Leditschke, Anne; Murray, Lauren; Eller, Philipp; Biston, Patrick; Bracke, Stephanie; De Crop, Luc; De Schryver, Nicolas; Frans, Eric; Spapen, Herbert; Van Malderen, Claire; Vansteelandt, Stijn; Vermeiren, Daisy; Arévalo, Elias Pablo; Crespo, Mónica; Zelaya Flores, Roberto; Píza, Petr; Morocho Tutillo, Diego; Elme, Andreas; Kallaste, Anne; Starkopf, Joel; Bourenne, Jeremy; Calypso, Mathieu; Cohen, Yves; Dahyot-Fizelier, Claire; Depret, François; Guillot, Max; Imzi, Nadia; Jochmans, Sebastien; Kouatchet, Achille; Lepape, Alain; Martin, Olivier; Heim, Markus; Schaller, Stefan J.; Arvaniti, Kostoula; Bekridelis, Anestis; Ioannidis, Panagiotis; Mitrakos, Cornelia; Papanikolaou, Metaxia N.; Pouriki, Sofia; Vemvetsou, Anna; Abraham, Babu; Bhattacharya, Pradip Kumar; Budugu, Anusha; Dixit, Subhal; Gurav, Sushma; Kandanuri, Padmaja; Prabhu, Dattatray Arun; Rathod, Darshana; Savaru, Kavitha; Neelavar Udupa, Ashwin; Varghese, Sunitha Binu; Haddad Bakhodaei, Hossein; Dabiri, Gholamreza; Fallahi, Mohammad Javad; Feiz, Farnia; Firoozifar, Mohammad; Khaloo, Vahid; Maghsudi, Behzad; Masjedi, Mansoor; Nikandish, Reza; Sabetian, Golnar; Marsh, Brian; Martin-Loeches, Ignacio; Steiner, Jan; Barbagallo, Maria; Caricato, Anselmo; Cortegiani, Andrea; D'Andrea, Rocco; Deana, Cristian; Donati, Abele; Girardis, Massimo; Mandalà, Giuliana; Panarello, Giovanna; Pasero, Daniela; Pelagalli, Lorella; Soave, Paolo Maurizio; Spadaro, Savino; Fujita, Yoshihito; Fujiwara, Shinsuke; Hara, Yuya; Hashi, Hideki; Hashimoto, Satoru; Hashimoto, Hideki; Hayakawa, Katsura; Inoue, Masashi; Isokawa, Shutaro; Kameda, Shinya; Kamohara, Hidenobu; Kanamoto, Masafumi; Katayama, Shinshu; Kawagishi, Toshiomi; Kawano, Yasumasa; Kida, Yoshiko; Kita, Mami; Kobayashi, Atsuko; Kuriyama, Akira; Naito, Takaki; Nashiki, Hiroshi; Nishiyama, Kei; Shindo, Shunsuke; Suzuki, Taketo; Takaba, Akihiro; Tanaka, Chie; Tetsuya, Komuro; Tomioka, Yoshihiro; Yanagawa, Youichi; Yoshida, Hideki; Adnan, Syamhanin; Hasan, Mohd Shahnaz; Sulaiman, Helmi; Gasca Lopez, Gilberto A.; Hernández-Cárdenas, Carmen M.; Ñamendys-Silva, Silvio A.; Bethlehem, Carina; De Lange, Dylan; Hunfeld, Nicole; Numan, Sandra; Van Leeuwen, Henk; Owens, Daniel; Almeida, Mónica; Fragoso, Elsa; Leonor, Tiago; Pereira, José-Manuel; Filipescu, Daniela; Grigoras, Ioana; Popescu, Mihai; Tomescu, Dana; Alshahrani, Mohammed S.; Alvarez-Gonzalez, Manuel; Barrero-García, Irene; Blasco-Navalpotro, Miguel Angel; Claverias, Laura; Estella, Ángel; Forcelledo Espina, Lorena; Garcia Garmendia, Jose Luis; García Prieto, Emilio; Gómez-Prieto, Gracia; Jiménez Conde, Carlos; Martinez Sagasti, Fernando; Muñoz Cantero, Alicia; Orejas-Gallego, Alberto; Papiol, Elisabeth; Pérez-Civantos, Demetrio; Pozo Laderas, Juan Carlos; Trenado Álvarez, Josep; Vera-Artázcoz, Paula; Vidal Cortés, Pablo; Oldner, Anders; Spångfors, Martin; Alp, Emine; Köksal, Iftihar; Korten, Volkan; Özveren, Arife; Hall, Anna; Hatton, Kevin W.; Laudanski, Krzysztof; Desai, Devashish
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/359794
Citazioni:
Impact of appropriate antimicrobial therapy on patient outcomes and antimicrobial use: a sub analysis of the DIANA Study Dataset / Cidade, J.P., Póvoa, P., Depuydt, P., Dhaese, S., De Smet, K., Tabah, A., Akova, M., Cotta, M.O., De Pascale, G., Dimopoulos, G., Fujitani, S., Garnacho-Montero, J., Leone, M., Lipman, J., Ostermann, M., Paiva, J., Schouten, J., Sjövall, F., Timsit, J., Roberts, J.A., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 52:(2026), pp. 1196-1209. [10.1007/s00134-026-08448-9]
Abstract:
Objective: Although inappropriate therapy has been consistently associated with adverse outcomes, the magnitude and consistency of the benefit associated with appropriate empiric therapy in critically ill patients remain uncertain. We aimed to quantify the prevalence of appropriate empiric antimicro...bial therapy and evaluate its association with outcomes and antimicrobial exposure in a large international ICU cohort. Methods: This predefined sub-analysis of the DIANA study included adult ICU patients receiving empirical antimicrobials for suspected or confirmed bacterial infection. Only patients with microbiologically confirmed infections were analyzed, and therapy was classified as appropriate if at least one agent demonstrated in vitro activity against the identified pathogen. Associations with 28-day mortality and antimicrobial-free days were assessed using multivariable logistic and Cox regression models. Pre-specified interaction analyses explored effect modification by disease severity and diagnostic certainty. Results: Of 845 patients with microbiologically confirmed infections, 87.7% received appropriate empirical antimicrobial therapy. Compared with inappropriate therapy, appropriate therapy was associated with significantly lower ICU mortality and longer 28-day antimicrobial-free days and mechanical ventilation-free days. After multivariable adjustment, appropriate therapy remained independently associated with reduced 28-day mortality [adjusted odds ratio (OR) 1.83, 95% confidence interval 1.11–3.06, p = 0.02; hazard ratio (HR) 1.51, 95% CI 1.03–2.21, p = 0.035]. Effect-modification analyses demonstrated that the survival benefit of appropriate therapy was consistent across levels of diagnostic certainty and was most pronounced in patients with moderate illness severity (SOFA 3–9). Conclusion: In critically ill ICU patients, appropriate empirical antimicrobial therapy is independently associated with reduced 28-day mortality rates. Visual abstract: (Figure presented.)
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Association of intraoperative hypotension and acute kidney injury in noncardiac surgery patients: a post hoc secondary analysis of the EU HYPROTECT registry
Anno: 2026
Rivista: JOURNAL OF CLINICAL MONITORING AND COMPUTING
Autori/autrici: Runge, Julian; Grundmann, Carla D; Mucha, Carolina; Denz, Robin; Kouz, Karim; García, Manuel Ignacio Monge; Cerutti, Elisabetta; Frassanito, Luciano; Sander, Michael; Davies, Simon J; Donati, Abele; Ripolles-Melchor, Javier; García-Lopez, Daniel; Vojnar, Benjamin; Gayat, Etienne; Nol, Eric; Van Den Boom, Tim; Bramlage, Peter; Saugel, Bernd; Scheeren, Thomas W L; Frey, Ulrich H
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/350613
Citazioni:
Association of intraoperative hypotension and acute kidney injury in noncardiac surgery patients: a post hoc secondary analysis of the EU HYPROTECT registry / Runge, J., Grundmann, C.D., Mucha, C., Denz, R., Kouz, K., García, M.I.M., Cerutti, E., Frassanito, L., Sander, M., Davies, S.J., Donati, A., Ripolles-Melchor, J., García-Lopez, D., Vojnar, B., Gayat, E., Nol, E., Van Den Boom, T., Bramlage, P., Saugel, B., Scheeren, T.W.L., et al.. - In: JOURNAL OF CLINICAL MONITORING AND COMPUTING. - ISSN 1573-2614. - STAMPA. - 40:1(2026), pp. 59-67. [10.1007/s10877-025-01329-4]
Abstract:
Purpose: Previous cohort studies suggest that intraoperative hypotension is associated with acute kidney injury (AKI) in noncardiac surgical patients. We sought to ascertain that intraoperative hypotension is independently associated with AKI within the first 3 days after surgery in a contemporary c...ohort of noncardiac surgery patients in whom clinicians strove to avoid profound intraoperative hypotension. Methods: This was a post hoc secondary analysis of the multicentre EU HYPROTECT registry, which includes patients undergoing major noncardiac surgery who underwent predictive blood pressure monitoring. The primary outcome of this secondary analysis was AKI within the first 3 days after surgery. To quantify the duration and severity of intraoperative hypotension we calculated the area under a mean arterial pressure (MAP) of 65 mmHg. We used logistic regression analysis to identify factors independently associated with AKI. Results: We analysed 697 patients. 62 of these 697 patients (9%) developed AKI within the first 3 days after surgery. In multivariable binary logistic regression analysis adjusted for confounding variables, the area under a MAP of 65 mmHg was independently associated with AKI within the first 3 days after surgery (OR 1.03 [95% CI 1.01–1.05] per 10 mmHg*min; P < 0.001). Conclusion: Our secondary analysis of the EU HYPROTECT registry shows that, in a contemporary population of noncardiac surgery patients in whom clinicians strove to avoid profound intraoperative hypotension, intraoperative hypotension is independently associated with AKI within the first 3 days after surgery.
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Dynamic driving pressure and clinical outcomes in mechanically ventilated patients with acute brain injury: a secondary analysis of the VENTIBRAIN study*
Anno: 2026
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Taran, S.; Citerio, G.; Taccone, F. S.; Rezoagli, E.; Liu, K.; Mccredie, V. A.; Laffey, J. G.; Calabro, L.; Patroniti, N. A.; Graziano, F.; Rebora, P.; Robba, C.; Adhikari, N. K. J.; Godoy, D.; Cai, S.; Alrayes, B. M. H.; Felipez, T. H.; Khamees, A.; Henzler, D.; Al-juaifari, M. A.; Liu, J.; Suarez, J. I.; Bower, M.; Cho, S. -M.; Rivera-Chavez, M. J.; Goma, G.; Moller Petrun, A.; Alsharif, M.; Al-Touny, A.; Elsahli, S.; Mohammed, Y. M. I.; Wu, W.; Elsaadany, R.; Nita, C.; Hanley, C.; Babu, I.; Balasubramanian, M.; Manohara, N.; Tang, R.; Zhou, M.; Shama, M.; Nasreddin, M.; Elbahnasawy, M.; Recasens, A.; De Peray, C.; Zattera, L.; Ferrando, C.; Ren, R.; Li, Y.; Feng, G.; Chen, M.; Chen, H.; Brandejs, O.; Spatenkova, V.; Francony, G.; Schilte, C.; Gritti, P.; Micheli, F.; Altaweel, N. M.; Wang, J.; Tahsili-Fahadan, P.; Gelormini, C.; Pisapia, L.; Caricato, A.; Vinan-Garces, E.; Olivella-Gomez, J.; Siddiqui, Z.; Rao, S.; Hunain, R.; Alaa, A.; Shemeis, M.; Elwany, A.; Abdussalam, A. L.; Solanki, F.; Iqbal, P.; Elmelliti, H.; Romero-Garcia, N.; Monleon, B.; Badenes, R.; Gottin, L.; Casartelli Liviero, M.; Gelormini, D.; Harajdova, E.; Beomonte Zobel, M.; Lochner, P.; Alday, U. A. K. A.; Bannaga, H. A.; Eltayeb, E. E. A. B. H.; Hobart, P.; Felli, A.; Krenn, K.; Cinotti, R.; Roquilly, A.; Hourmant, Y.; Batista, D.; Ferreira, J.; Elhadi, M.; Gamberini, L.; Cavagna, S.; Chiarini, V.; Takahji, M. E.; Tahawi, M. N.; Sannoufa, S.; Jiao, A.; Wei, F.; Ippolito, M.; Raineri, S. M.; Ingoglia, G.; Cortegiani, A.; Bono, D.; Villa, F.; Cecconi, M.; Messina, A.; Putnina, L.; Kindl, P.; Rass, V.; Lindner, A.; Siempos, I.; Grigoropoulos, V.; Gkirgkiris, K.; Gavrielatou, E.; Mariotti, G.; Pesaresi, L.; Gabbanelli, V.; Donati, A.; Ferrara, G.; Napolitano, L.; Correnti, D.; Di Pierro, F.; Zimotti, T.; Cotoia, A.; Bosa, L.; Bortolaso, A.; Cipolla, C.; Pozzi, F.; Chieregato, A.; Fossi, F.; Chauchard, C.; Menage-Innocenti, L.; Seube-Remy, P. -A.; Leclercq-Rouget, M.; Floch, T.; Legros, V.; Londono, D. M.; Vivas, J.; Bolanos, L. J.; Figueroa, L.; Aldana, J. L.; Marulanda, A.; Gaviria Villarreal, L.; Mejia-Mantilla, J. H.; Addis, A.; Ogliari, G.; Valla, M.; Del Bianco, S.; Polo Friz, M. J.; Piazza, V.; Mangili, P.; Amigoni, M.; Cosenza, L.; Torrini, E.; De Luca, A.; Picciafuochi, F.; Bucciardini, L.; Orzalesi, V.; Rusagara, P.; Ciabatti, G.; Mandelli, M.; Bandoni, C.; Paolessi, C.; Patroniti, N.; Ciparelli, G.; Chao, Y.; Wang, Z.; Li, Y.; Wang, J.; Bi, L.; Zhang, H.; Wu, L.; Jiang, L.; Chen, W.; Wu, L.; Song, L.; Sang, B.; She, R.; Yang, K.; Xu, M.; Sun, S.; Zhang, Z.; Huang, Q.; Peukert, K.; Bode, C.; Sauer, A.; Klevenhaus, Y.; Poth, J.; Muders, T.; Kreyer, S.; Lehmann, F.; Ehrentraut, S.; Putensen, C.; Wahlster, S.; Town, J. A.; Lele, A. V.; James, A.; Matin, N. S.; Smith, N. L.; Cao, Y.; Xu, D.; Dong, Q.; Zhang, B.; Xia, H.; Lv, Y.; Yang, Y.; Yang, W.; Dong, M.; Liu, T.; Hu, C.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/365515
Citazioni:
Dynamic driving pressure and clinical outcomes in mechanically ventilated patients with acute brain injury: a secondary analysis of the VENTIBRAIN study* / Taran, S., Citerio, G., Taccone, F.S., Rezoagli, E., Liu, K., Mccredie, V.A., Laffey, J.G., Calabro, L., Patroniti, N.A., Graziano, F., Rebora, P., Robba, C., Adhikari, N.K.J., Godoy, D., Cai, S., Alrayes, B.M.H., Felipez, T.H., Khamees, A., Henzler, D., Al-juaifari, M.A., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 52:1(2026), pp. 31-41. [10.1007/s00134-025-08241-0]
Abstract:
Purpose: To investigate the association between dynamic driving pressure (ΔPdyn) and mortality in mechanically ventilated patients with acute brain injury (ABI), and to evaluate whether neurological and pulmonary injury severity modify this relationship. Methods: This prespecified secondary an...alysis of the VENTIBRAIN prospective study (NCT04459884) included mechanically ventilated adult patients with ABI (traumatic brain injury, subarachnoid hemorrhage, intracranial hemorrhage, or ischemic stroke). ΔPdyn was calculated daily over the first 14 days as peak inspiratory pressure minus positive end-expiratory pressure (PEEP). Bayesian joint models evaluated the time-varying association between ΔPdyn and mortality at ICU discharge, hospital discharge, and 6 months. Secondary analyses evaluated effect modification by baseline Glasgow Coma Scale (GCS), PaO₂/FiO₂, and ABI subtype. Results: Among 1,555 patients (median age 59 years, 34.5% female), higher time-varying ΔPdyn was associated with increased ICU mortality (hazard ratio [HR], 1.057 per daily 1cmH2O; 95% credible interval, 1.037–1.078; posterior probability of HR > 1, 99.9%). Findings were consistent across all ABI subtypes and were similar for static ΔP (plateau pressure minus PEEP). The association was strongest in patients with severe ABI (GCS ≤ 8) and severe hypoxemia (PaO₂/FiO₂ ≤ 100). Results were robust across all outcome timepoints and multiple sensitivity analyses. Conclusion: Higher time-varying ΔPdyn was associated with increased mortality in this cohort of patients with ABI. Neurological injury severity independently modified the harm from ΔPdyn with a magnitude comparable to severe hypoxemia. Measurement of ΔPdyn may aid risk stratification and ventilation strategies in ABI; future trials should evaluate the effect of reducing ΔPdyn in this population.
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Role of hypertrophic adipocytes, collagen VI, and CD38 in adipose tissue fibrosis in obesity
Anno: 2026
Rivista: SCIENTIFIC REPORTS
Autori/autrici: Di Vincenzo, Angelica; Luca, Tonia; Perugini, Jessica; Lezoche, Giovanni; Barresi, Vincenza; De Geronimo, Vincenzo; Donati, Abele; Casarotta, Erika; Tomasello, Mario; Pezzino, Salvatore; Scuderi, Chiara; Di Cristoforo, Adriano; Pieroni, Alessio; Petrelli, Massimiliano; Napoli, Maria Vittoria; Figueiredo, Nayra; Corgosinho, Flavia Campos; Sbarbati, Andrea; Merlini, Luciano; Sabatelli, Patrizia; Graciotti, Laura; Spadoni, Tatiana; Dani, Christian; Mattioli-Belmonte, Monica; Condorelli, Daniele Filippo; Gabrielli, Armando; Malavasi, Fabio; Giordano, Antonio; Castorina, Sergio; Cinti, Saverio
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/359795
Citazioni:
Role of hypertrophic adipocytes, collagen VI, and CD38 in adipose tissue fibrosis in obesity / Di Vincenzo, A., Luca, T., Perugini, J., Lezoche, G., Barresi, V., De Geronimo, V., Donati, A., Casarotta, E., Tomasello, M., Pezzino, S., Scuderi, C., Di Cristoforo, A., Pieroni, A., Petrelli, M., Napoli, M.V., Figueiredo, N., Corgosinho, F.C., Sbarbati, A., Merlini, L., Sabatelli, P., et al.. - In: SCIENTIFIC REPORTS. - ISSN 2045-2322. - 16:(2026). [10.1038/s41598-026-49848-7]
Abstract:
Adipose tissue fibrosis is associated with metabolic alterations in patients with obesity and involves three major collagen types: fibrillar collagens I and III and non-fibrillar collagen VI. In this study, fibrosis was found to be significantly increased only in visceral adipose tissue in patients ...with obesity (4.7% vs. 2.5% in controls, p < 0.001), whereas no significant difference was observed in subcutaneous adipose tissue. Transmission electron microscopy and high-resolution scanning electron microscopy suggested that hypertrophic adipocytes may contribute to the production of fibrillar collagens I and III. In vitro data were consistent with this interpretation. Expression of the COL6 gene, which encodes the non-fibrillar collagen VI, was reduced in adipose tissue from obese patients. Notably, patients carrying mutations in COL6 genes displayed increased fibrosis even in subcutaneous fat, approximately 6.5-fold higher than controls in the patient with the severe form (Ullrich) and 2.8-fold higher in two patients with the milder form (Bethlem). Approximately 15% of adipocytes in obese tissue appeared stressed or dead (perilipin-1 negative), and the associated infiltrating macrophages exhibited increased expression of CD38, an ectoenzyme implicated in systemic fibrosis. Correlations with gene expression also indicated the importance of myofibroblasts and the extracellular-matrix peptidase D. Taken together, our data suggest that obese adipocytes may contribute to fibrillar collagen production and identify collagen VI and CD38 as potential molecular contributors, consistent with the concept that adipose tissue fibrosis in humans has a multifactorial origin.
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Correction to: Beyond shear stress: septic microvascular failure remains a multifactorial phenomenon
Anno: 2026
Rivista: CRITICAL CARE
Autori/autrici: Damiani, E.; Domizi, R.; Carsetti, A.; Antolini, R.; Adrario, E.; Donati, A.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/365513
Citazioni:
Correction to: Beyond shear stress: septic microvascular failure remains a multifactorial phenomenon / Damiani, E., Domizi, R., Carsetti, A., Antolini, R., Adrario, E., Donati, A.. - In: CRITICAL CARE. - ISSN 1364-8535. - 30:1(2026). [10.1186/s13054-026-06297-y]
Abstract:
Following publication of the original article [1], the authors identified an error in the author names of all authors. The given name and family name were erroneously transposed. The incorrect author names are: Damiani Elisa, Domizi Roberta, Carsetti Andrea, Antolini Riccardo, Adrario Erica and Dona...ti Abele. The correct author names are: Elisa Damiani, Roberta Domizi, Andrea Carsetti, Riccardo Antolini, Erica Adrario and Abele Donati. The author group has been updated above and the original article [1] has been corrected.
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Phenotype-based appropriateness of IGM-enriched polyclonal immunoglobulin use in critical illness: report of an expert consensus
Anno: 2026
Rivista: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE
Autori/autrici: Coloretti, I.; Bignami, E. G.; Busani, S.; Clerici, D.; Corcione, A.; Corona, A.; Donati, A.; De Pascale, G.; De Rosa, F. G.; Forfori, F.; Grasso, S.; Imperatore, F.; Montrucchio, G.; Mornese, P. S.; Pognuz, E. R.; Rubulotta, M. F.; Paternoster, G.; Pellis, T.; Siniscalchi, A.; Tascini, C.; Tritapepe, L.; Girardis, M.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/365517
Citazioni:
Phenotype-based appropriateness of IGM-enriched polyclonal immunoglobulin use in critical illness: report of an expert consensus / Coloretti, I., Bignami, E.G., Busani, S., Clerici, D., Corcione, A., Corona, A., Donati, A., De Pascale, G., De Rosa, F.G., Forfori, F., Grasso, S., Imperatore, F., Montrucchio, G., Mornese, P.S., Pognuz, E.R., Rubulotta, M.F., Paternoster, G., Pellis, T., Siniscalchi, A., Tascini, C., et al.. - In: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE. - ISSN 2731-3786. - 6:1(2026). [10.1186/s44158-026-00459-8]
Abstract:
: Sepsis and septic shock result from a dysregulated host response to infection, encompassing both hyperinflammatory and immunosuppressed phenotypes. Although immunomodulatory adjunctive therapies have been extensively investigated over the past decades, none have demonstrated consistent clinical ef...ficacy. In contrast, low circulating immunoglobulin levels are common in septic patients and are associated with greater disease severity and poorer outcomes, providing a biological rationale for the use of polyclonal intravenous immunoglobulins (IVIg) as phenotype-targeted adjunctive therapies. This expert consensus sought to systematically evaluate the appropriateness of IVIg therapy across predefined and clinically relevant scenarios in critically ill patients and deliver pragmatic, phenotype-oriented guidance. A multidisciplinary Italian panel comprising experts in intensive care, infectious diseases, transplant medicine, and oncology applied a modified RAND/UCLA Appropriateness Method. The process integrated a structured literature review (PubMed, EMBASE, and the Cochrane Library) with anonymous 9-point Likert scale ratings. Indications were classified according to the median score as appropriate (7-9), uncertain (4-6), or inappropriate (1-3), and interpanel disagreement was assessed using the Interpercentile Range Adjusted for Symmetry. The expert panel evaluated seven phenotypes that were identified as the most clinically relevant and extensively addressed in the available literature. IVIg use was judged appropriate without formal disagreement in severe community-acquired pneumonia with hyperinflammation plus shock (median 8), low IgM < 60 mg/dL (median 8), or prior immunosuppression (median 8), whereas hyperinflammation without shock was uncertain (median 6). Appropriateness was also supported for abdominal infection with endotoxaemic shock, immune suppression/paralysis, or low IgM (all median 8); sepsis in solid-organ transplant recipients (median 7), particularly with low IgM (median 8), while prophylaxis in high-risk transplant recipients was uncertain (median 5). IVIg was rated appropriate for overwhelming septic shock with severe hyperinflammation (median 8), especially with low IgM (median 8) and toxin-mediated syndromes (median 9); for post-cardiac surgery sepsis with immune suppression (median 7) but not clearly for hyperinflammation (uncertain, median 6); for multidrug-resistant pathogen sepsis with immune suppression (median 7-8); and in haematologic malignancies, as prophylaxis or treatment primarily when immunoglobulins are low (medians 7-8), with prophylaxis otherwise uncertain. Across all phenotypes, IgM-enriched preparations were consistently preferred (median 8-9). Available evidence suggests no major safety signals, although adverse events are likely to be underreported. Overall, the consensus supports personalised, phenotype-oriented consideration of IgM-enriched IVIg as an adjunctive strategy to optimise standard care, while underscoring persistent evidence gaps and the need for adequately powered trials to define timing, dosing, and responsive subgroups.
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Intraoperative Volume Decay Measured Through Mechanical Ventilation as a Predictor of Prolonged Postoperative Air Leak After Uniportal Video-Assisted Thoracic Surgery Lung Resection
Anno: 2026
Rivista: JOURNAL OF PERSONALIZED MEDICINE
Autori/autrici: Salati, Michele; Roncon, Alberto; Marco Guiducci, Gian; Tiberi, Michela; Romito, Mara; Chiara Nanto, Anna; Xiumè, Francesco; Coltrinari, Rosanna; Falcetta, Stefano; Gentili, Paolo; Donati, Abele; Refai, Majed
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/365519
Citazioni:
Intraoperative Volume Decay Measured Through Mechanical Ventilation as a Predictor of Prolonged Postoperative Air Leak After Uniportal Video-Assisted Thoracic Surgery Lung Resection / Salati, M., Roncon, A., Marco Guiducci, G., Tiberi, M., Romito, M., Chiara Nanto, A., Xiumè, F., Coltrinari, R., Falcetta, S., Gentili, P., Donati, A., Refai, M.. - In: JOURNAL OF PERSONALIZED MEDICINE. - ISSN 2075-4426. - 16:8(2026). [10.3390/jpm16080434]
Abstract:
: Background/Objectives: Prolonged postoperative air leak (PAL) remains one of the most common complications after lung resection, significantly affecting postoperative recovery and healthcare utilization. While several preoperative risk factors have been identified, reliable intraoperative predicto...rs are still lacking. This study aimed to evaluate whether intraoperative ventilator-derived parameters-volume decay (Vol-Decay) and pressure decay (Pres-Decay)-are associated with the development of PAL following uniportal video-assisted thoracic surgery (VATS) lung resection. Methods: We conducted a single-center study including 277 consecutive patients undergoing uniportal VATS lung resection for neoplastic disease between May 2023 and April 2024. At the end of the surgical procedure, intraoperative Vol-Decay and Pres-Decay were measured using the mechanical ventilator under standardized conditions. PAL was defined as an air leak persisting for more than 5 days within 30 days after surgery. Univariate and multivariate analyses were performed to identify independent predictors of PAL, and the optimal Vol-Decay cut-off was determined using Youden's index. Results: PAL occurred in 18 patients (6.5%). At univariate analysis, higher smoking exposure, lower FEV1, lower FEV1/FVC ratio, and higher Vol-Decay were significantly associated with PAL. At multivariable analysis, only FEV1 (p = 0.013) and Vol-Decay (p = 0.038) remained independent predictors. The optimal Vol-Decay cut-off was 22 mL (AUC 0.64), with high specificity (0.94) but low sensitivity (0.34). Patients with Vol-Decay > 22 mL showed a significantly higher incidence of PAL compared to those with lower values (27.3% vs. 4.7%). Conclusions: Intraoperative Vol-Decay represents a simple, objective, and reproducible parameter associated with the development of prolonged air leak after uniportal VATS lung resection. Its measurement may enable real-time risk stratification and support personalized intraoperative decision-making, potentially guiding targeted corrective strategies. Further prospective multicenter studies are warranted to validate these findings and confirm their clinical applicability.
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The interplay between microcirculatory dysfunction and coagulopathy in patients with sepsis: An exploratory single-center observational study
Anno: 2026
Rivista: JOURNAL OF CRITICAL CARE
Autori/autrici: Damiani, Elisa; Domizi, Roberta; Carsetti, Andrea; Antolini, Riccardo; Scorcella, Claudia; Casarotta, Erika; Gabbanelli, Vincenzo; Spadoni, Tatiana; Graciotti, Laura; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/359792
Citazioni:
The interplay between microcirculatory dysfunction and coagulopathy in patients with sepsis: An exploratory single-center observational study / Damiani, E., Domizi, R., Carsetti, A., Antolini, R., Scorcella, C., Casarotta, E., Gabbanelli, V., Spadoni, T., Graciotti, L., Adrario, E., Donati, A.. - In: JOURNAL OF CRITICAL CARE. - ISSN 0883-9441. - ELETTRONICO. - 95:(2026). [Epub ahead of print] [10.1016/j.jcrc.2026.155663]
Abstract:
Background Sepsis-induced coagulopathy (SIC) and microvascular dysfunction are hallmark features of sepsis, yet their relationship remains poorly understood. The primary aim of this study was to investigate whether early microvascular impairment can predict the presence/development of SIC. The secon...dary objective was to explore the relationship between SIC and the evolution of microvascular perfusion over the first 4 days. Methods Prospective observational study on 30 septic patients. Sublingual microcirculation (incident dark-field video-microscopy) was evaluated at day 0 and 4. Standard coagulation tests and thromboelastography were assessed daily. SIC was identified by a SIC score ≥ 4. Plasma syndecan-1 and thrombomodulin levels were measured on day 0. Results SIC was identified in 20 patients (66.7%) by day 4. On day 0, the microcirculation did not differ between SIC+ and SIC- patients. However those with lower baseline microvascular flow index (MFI <2.92) were more likely to develop SIC (82% vs 46%, p = 0.037). From Day 0 to Day 4, microvascular density (TVD, PVD) decreased in the SIC+ group but increased in the SIC- group (p for interaction <0.05). Baseline Syndecan-1 levels correlated negatively with the variation (Δ) in microvascular density. Correlations were found between Δ-microcirculatory parameters and Δ-coagulation markers, such as Δ-MFI and Δ-INR ( r = −0.516, p < 0.05) or Δ-TVD and Δ-platelets ( r = 0.442, p < 0.05). Conclusions The sublingual microcirculation on day 0 failed to predict the development of SIC. In longitudinal exploratory analysis, SIC was associated with a reduction in microvascular density from day 0 to day 4, although a causal relationship remains to be established.
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Early Antibiotic Prophylaxis in Comatose Patients to Prevent Early-Onset Ventilator-Associated Pneumonia: A Systematic Review and Bayesian Meta-Analysis
Anno: 2026
Rivista: ANTIBIOTICS
Autori/autrici: Antolini, Riccardo; Violini, Filippo; Domizi, Roberta; Damiani, Elisa; Adrario, Erica; Donati, Abele; Carsetti, Andrea
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/359793
Citazioni:
Early Antibiotic Prophylaxis in Comatose Patients to Prevent Early-Onset Ventilator-Associated Pneumonia: A Systematic Review and Bayesian Meta-Analysis / Antolini, R., Violini, F., Domizi, R., Damiani, E., Adrario, E., Donati, A., Carsetti, A.. - In: ANTIBIOTICS. - ISSN 2079-6382. - ELETTRONICO. - 15:6(2026). [10.3390/antibiotics15060622]
Abstract:
Background: Early-onset ventilator-associated pneumonia (EO-VAP) is a frequent complication in comatose patients requiring endotracheal intubation. This systematic review and Bayesian meta-analysis assesses the effectiveness of antibiotic prophylaxis in preventing EO-VAP in this population. Methods:... Randomized controlled trials (RCTs) and observational studies enrolling adult comatose patients (GCS ≤ 8) requiring endotracheal intubation and reporting EO-VAP incidence, late-onset VAP, ICU mortality, 28-day mortality, or ICU length of stay were included. Studies without a control group or not focused on comatose patients were excluded. Following PRISMA 2020 guidelines, a comprehensive search was conducted across three databases from inception to 31 March 2026. Risk of bias was assessed using the RoB2 tool for RCTs and the ROBINS-I tool for observational studies. Results: In accordance with Cochrane Handbook recommendations, only RCTs were included in the quantitative analysis. Five RCTs (735 patients) demonstrated a significant reduction in EO-VAP incidence with antibiotic prophylaxis (RR 0.46 [95% CI: 0.35-0.59], p = 0.001, I2 = 0%), with the strongest effect in neurological patients (RR 0.41 [95% CI: 0.32-0.53], NNT = 5.4). No significant effect on mortality was demonstrated. Bayesian analysis confirmed these findings (posterior median RR 0.44 [95% CrI: 0.33-0.59], P(benefit) = 100%). Limitations: The analysis was limited by the small number of RCTs and the absence of data on antimicrobial resistance. Conclusions: Antibiotic prophylaxis reduces EO-VAP incidence in comatose patients, particularly neurological patients. A general recommendation cannot currently be made pending further evidence on mortality and antimicrobial resistance. Registration: This systematic review was prospectively registered on PROSPERO (CRD42024580280).
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Role of Hypertrophic Adipocytes, Collagen VI and CD38 in Fat Fibrosis of Patients with Obesity
Anno: 2025
Rivista: SCIENTIFIC REPORTS
Autori/autrici: Di Vincenzo, Angelica; Luca, Tonia; Perugini, Jessica; Lezoche, Giovanni; Barresi, Vincenza; De Geronimo, Vincenzo; Donati, Abele; Casarotta, Erika; Tomasello, Mario; Pezzino, Salvatore; Scuderi, Chiara; Di Cristoforo, Adriano; Pieroni, Alessio; Petrelli, Massimiliano; Napoli, Maria Vittoria; Figueiredo, Nayra; Campos Corgosinho, Flavia; Sbarbati, Andrea; Merlini, Luciano; Sabatelli, Patrizia; Graciotti, Laura; Spadoni, Tatiana; Dani, Christian; Mattioli-Belmonte, Monica; Condorelli, Daniele; Gabrielli, Armando; Malavasi, Fabio; Giordano, Antonio; Castorina, Sergio; Cinti, Saverio
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/365532
Citazioni:
Role of Hypertrophic Adipocytes, Collagen VI and CD38 in Fat Fibrosis of Patients with Obesity / Di Vincenzo, A., Luca, T., Perugini, J., Lezoche, G., Barresi, V., De Geronimo, V., Donati, A., Casarotta, E., Tomasello, M., Pezzino, S., Scuderi, C., Di Cristoforo, A., Pieroni, A., Petrelli, M., Napoli, M.V., Figueiredo, N., Campos Corgosinho, F., Sbarbati, A., Merlini, L., Sabatelli, P., et al.. - In: SCIENTIFIC REPORTS. - ISSN 2045-2322. - (2025). [10.1101/2025.10.08.681115]

Prolonged prone positioning in ARDS: No mortality benefit, no increased risk-But what about the reduced ICU staff workload?
Anno: 2025
Rivista: CRITICAL CARE
Autori/autrici: Domizi, Roberta; Damiani, Elisa; Carsetti, Andrea; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/350592
Citazioni:
Prolonged prone positioning in ARDS: No mortality benefit, no increased risk-But what about the reduced ICU staff workload? / Domizi, R., Damiani, E., Carsetti, A., Adrario, E., Donati, A.. - In: CRITICAL CARE. - ISSN 1364-8535. - ELETTRONICO. - 29:(2025). [10.1186/s13054-025-05777-x]

Incidence of hospital-acquired infections due to carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa in critically ill patients in Italy: a multicentre prospective cohort study
Anno: 2025
Rivista: CRITICAL CARE
Autori/autrici: De Pascale, Gennaro; Cortegiani, Andrea; Rinaldi, Matteo; Antonelli, Massimo; Cattaneo, Sergio; Cecconi, Maurizio; Cuffaro, Raffaele; Dalfino, Lidia; Di Biase, Filomena; Donati, Abele; Fasano, Francesca Romana; Fasciana, Teresa; Foti, Giuseppe; Frattari, Antonella; Fumagalli, Roberto; Girardis, Massimo; Gottin, Leonardo; Mattei, Alessia; Milazzo, Marta; Montrucchio, Giorgia; Pasero, Daniela; Picciafuochi, Fabio; Sensi, Emanuela; Servillo, Giuseppe; Vidal Pereira, Maria Alejandra; Spanu, Teresa; Viale, Pierluigi; Null, Null; Cutuli, Salvatore Lucio; Tanzarella, Eloisa Sofia; Carelli, Simone; Montini, Luca; Giarratano, Antonino; Aceto, Romina; Casari, Erminia; Brazzi, Luca; Curtoni, Antonio; Serio, Lucia; Ferrari, Filippo; Savini, Vincenzo; Taiana, Matteo; Mazzariol, Annarita; Ambretti, Simone; Merola, Grazia; Degl'Innocenti, Linda; Ricciardi, Renato; Gherardi, Giovanni; Guerrero, Fernando Arnaiz; Vismara, Chiara; Vittorielli, Elena; Casarotta, Erika; Vargas, Maria; Rona, Roberto; Cavallero, Annalisa; Muroni, Angela; Rubino, Salvatore; Viaggi, Bruno; Giani, Tommaso; Ippolito, Mariachiara; Tiri, Beatrice; Cappanera, Stefano; Mariottini, Alessandro; Stufano, Monica; Mosca, Adriana; Monti, Giacomo; Buffoli, Fabio
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/339332
Citazioni:
Incidence of hospital-acquired infections due to carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa in critically ill patients in Italy: a multicentre prospective cohort study / De Pascale, G., Cortegiani, A., Rinaldi, M., Antonelli, M., Cattaneo, S., Cecconi, M., Cuffaro, R., Dalfino, L., Di Biase, F., Donati, A., Fasano, F.R., Fasciana, T., Foti, G., Frattari, A., Fumagalli, R., Girardis, M., Gottin, L., Mattei, A., Milazzo, M., Montrucchio, G., et al.. - In: CRITICAL CARE. - ISSN 1364-8535. - ELETTRONICO. - 29:1(2025). [10.1186/s13054-025-05266-1]
Abstract:
Background Carbapenem-Resistant Gram-Negative Bacteria, including Carbapenem-Resistant Enterobacterales (CRE) and Carbapenem-Resistant Pseudomonas aeruginosa (CRPA), are common causes of infections in intensive care units (ICUs) in Italy. Objective This prospective observational study evaluated the ...epidemiology, management, microbiological charac- terization, and outcomes of hospital-acquired CRE or CRPA infections treated in selected ICUs in Italy. Methods The study included patients with hospital-acquired infections due to CRE and CRPA treated in 20 ICUs from June 2021 to February 2023. The primary endpoint was the 1-year incidence of CRE/CRPA infections. Second- ary endpoints included the rate of CRE/CRPA infections, mortality in ICU, infection outcome, and microbiological characterization. Results Among 13,088 patients admitted over the 12-month study period across each of the 20 ICUs, 283 had CRE infections, and 138 had CRPA infections. The incidence of CRE and CRPA infections was 3.57 per 1000 patient days and 1.74 per 1000 patient days, respectively. The proportion of CRE and CRPA infections over the total number of infections due to Enterobacterales and Pseudomonas aeruginosa was 19.2% and 26.8%, respectively. Among 158 patients included in the full analysis, 98 (62%) had CRE infections and 60 (38%) had CRPA infections. Ventilator-associ- ated pneumonia and bloodstream infections were the most common infections, occurring in 53.8 and 34.2% of cases. Empirical therapy targeting gram-negative pathogens resulted inappropriate in 59.2% of analysed patients (77/130). The overall crude mortality in ICU rate was 30.4%, with a higher rate in CRE patients (36.7%) than in CRPA patients (20.0%). Clinical success, including microbiological eradication, was achieved in 50.6% of cases. Klebsiella pneumoniae was observed as the predominant CRE species, and all CRE isolates, including metallo-β-lactamases-producing CRE (MBL-CRE), were susceptible to Aztreonam-Avibactam. Conclusions These results highlight the high prevalence of CRE/CRPA infections in Italian ICUs and emphasize the need for enhanced prevention and surveillance strategies.
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Implementation of intraoperative procedures to prevent anastomotic leak in low anterior rectal resections: a pilot study for a novel technique to evaluate anastomotic vascularization
Anno: 2025
Rivista: SURGICAL ENDOSCOPY
Autori/autrici: Ortenzi, Monica; Carsetti, Andrea; Picchetto, Andrea; D'Ambrosio, Giancarlo; Casarotta, Erika; Sartori, Alberto; Balla, Andrea; Podda, Mauro; Donati, Abele; Iuorio, Salvatore; Lezoche, Giovanni; Arezzo, Alberto; Guerrieri, Mario
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/344338
Citazioni:
Implementation of intraoperative procedures to prevent anastomotic leak in low anterior rectal resections: a pilot study for a novel technique to evaluate anastomotic vascularization / Ortenzi, M., Carsetti, A., Picchetto, A., D'Ambrosio, G., Casarotta, E., Sartori, A., Balla, A., Podda, M., Donati, A., Iuorio, S., Lezoche, G., Arezzo, A., Guerrieri, M.. - In: SURGICAL ENDOSCOPY. - ISSN 1432-2218. - ELETTRONICO. - 39:3(2025), pp. e1.1935-e1.1944. [10.1007/s00464-024-11506-2]
Abstract:
Introduction: Altered vascular microcirculation is recognized as a risk factor for anastomotic leakage (AL) in colorectal surgery. However, few studies evaluated its impact on AL using different devices, with heterogeneous results. The present study reported the initial experience measuring gut micr...ocirculatory density and flow with the aid of incidence dark-field (IDF) videomicroscopy (Cytocam, Braedius, Amsterdam, The Netherlands) comparing its operative outcome using a propensity score matching (PSM) model based on age, gender, and Charlson Comorbidity Index (CCI). Materials and methods: Videos from 5 different sites (at least 10 s/site) were recorded from both the mucosal and serosal site of the left colon end after the colonic resection. Total vessel density (TVD), Perfused Vessel Density (PVD), De Backer score, Proportion of Perfused Vessels (PPV), and Microvascular Flow Index (MFI) were analyzed. At each recording, noninvasive measurements of blood pressure, heart rate, temperature, use of vasoactive drugs, and peripheral oxygen saturation were simultaneously recorded. The association between postoperative outcomes and microcirculation evaluation was investigated using PSM analyses. Results: Ninety-nine patients were included in the Cytocam group. The mean TVD small was 8.9 ± 2.8 mm/mm2, the PPV small % was 100 in all patients but 1, while the MFI was 3 in all patients. The mean PVD small was 8.76 ± 2.8 mm/mm2 and the mean De Becker score was 4.4 ± 1.3. In 2 patients (10.5%), the finding of altered vascularization resulted in the change of the operative strategy with an extension of the resection point. AL occurred in 2 patients of the No Cytocam group (p = 0.811). Conclusion: This type of anastomotic evaluation has shown to be feasible, safe, and useful in easily detecting any alteration of the resected colon before anastomotic construction. Moreover, this technology could offer a more cost-effective manner than other devices.
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Ceftazidime–Avibactam in Critically Ill Patients: A Multicenter Observational Study
Anno: 2025
Rivista: ANTIBIOTICS
Autori/autrici: Olivieri, Silvia; Mazzanti, Sara; Gelo Signorino, Gabriele; Pallotta, Francesco; Ficola, Andrea; Canovari, Benedetta; Di Muzio, Vanessa; Di Prinzio, Michele; Cerutti, Elisabetta; Donati, Abele; Giacometti, Andrea; Barchiesi, Francesco; Brescini, Lucia
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/350612
Citazioni:
Ceftazidime–Avibactam in Critically Ill Patients: A Multicenter Observational Study / Olivieri, S., Mazzanti, S., Gelo Signorino, G., Pallotta, F., Ficola, A., Canovari, B., Di Muzio, V., Di Prinzio, M., Cerutti, E., Donati, A., Giacometti, A., Barchiesi, F., Brescini, L.. - In: ANTIBIOTICS. - ISSN 2079-6382. - 14:8(2025). [10.3390/antibiotics14080797]
Abstract:
Ceftazidime–avibactam (CAZ-AVI) is a second-generation intravenous β-lactam/β-lactamase inhibitor combination. In recent years, substantial evidence has emerged regarding the efficacy and safety of CAZ-AVI. However, data on its use in critically ill patients remain limited. Backgroun...d/Objectives: This multicenter, retrospective, observational cohort study was conducted across four Intensive Care Units (ICUs) in three hospitals in the Marche region of Italy. The primary objective was to evaluate the 30-day clinical outcomes and identify risk factors associated with 30-day clinical failure—defined as death, microbiological recurrence, or persistence within 30 days after discontinuation of therapy—in critically ill patients treated with CAZ-AVI. Methods: The study included all adult critically ill patients admitted to the participating ICUs between January 2020 and September 2023 who received CAZ-AVI for at least 72 h for the treatment of a confirmed or suspected Gram-negative bacterial (GNB) infection. Results: Among the 161 patients included in the study, CAZ-AVI treatment resulted in a positive clinical outcome (i.e., clinical improvement and 30-day survival) in 58% of cases (n = 93/161), while the overall mortality rate was 24% (n = 38/161). Relapse or persistent infection occurred in a substantial proportion of patients (25%, n = 41/161). Notably, acquired resistance to CAZ-AVI was observed in 26% of these cases, likely due to suboptimal use of the drug in relation to its pharmacokinetic/pharmacodynamic (PK/PD) properties in critically ill patients. Furthermore, treatment failure was more frequent among immunosuppressed individuals, particularly liver transplant recipients. Conclusions: This study demonstrates that the mortality rate among ICU patients treated with this novel antimicrobial combination is consistent with findings from other studies involving heterogeneous populations. However, the rapid emergence of resistance underscores the need for vigilant surveillance and the implementation of robust antimicrobial stewardship strategies.
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Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study
Anno: 2025
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Robba, C.; Giardiello, D.; Almondo, C.; Asehnoune, K.; Badenes, R.; Cinotti, R.; Elhadi, M.; Graziano, F.; Helbok, R.; Jiang, L.; Chen, W.; Laffey, J. G.; Messina, A.; Putensen, C.; Schultz, M. J.; Wahlster, S.; Rebora, P.; Galimberti, S.; Taccone, F. S.; Citerio, G.; The Ventibrain Study, Group; Godoy, D.; Cai, S.; Alrayes, B. M. H.; Felipez, T. H.; Khamees, A.; Henzler, D.; Al-juaifari, M. A.; Liu, J.; Suarez, J. I.; Bower, M.; Cho, S. -M.; Rivera-Chavez, M. J.; Goma, G.; Petrun, A. M.; Alsharif, M.; Al-Touny, A.; Elsahli, S.; Mohammed, Y. M. I.; Wu, W.; Elsaadany, R.; Nita, C.; Hanley, C.; Babu, I.; Balasubramanian, M.; Manohara, N.; Tang, R.; Zhou, M.; Shama, M.; Nasreddin, M.; Elbahnasawy, M.; Recasens, A.; De Peray, C.; Zattera, L.; Ferrando, C.; Ren, R.; Li, Y.; Feng, G.; Chen, M.; Chen, H.; Brandejs, O.; Spatenkova, V.; Francony, G.; Schilte, C.; Gritti, P.; Micheli, F.; Altaweel, N. M.; Wang, J.; Tahsili-Fahadan, P.; Gelormini, C.; Pisapia, L.; Caricato, A.; Vinan-Garces, E.; Olivella-Gomez, J.; Siddiqui, Z.; Rao, S.; Hunain, R.; Alaa, A.; Shemeis, M.; Elwany, A.; Abdussalam, A. L.; Solanki, F.; Iqbal, P.; Elmelliti, H.; Romero-Garcia, N.; Monleon, B.; Gottin, L.; Liviero, M. C.; Gelormini, D.; Estera, H.; Michele, B. Z.; Piergiorgio, L.; Alday, U. A. K. A.; Bannaga, H. A.; Eltayeb, E. E. A. B. H.; Hobart, P.; Felli, A.; Krenn, K.; Cinotti, R.; Roquilly, A.; Hourmant, Y.; Batista, D.; Ferreira, J.; Lorenzo, G.; Silvia, C.; Valentina, C.; Takahji, M. E.; Tahawi, M. N.; Sannoufa, S.; Jiao, A.; Wei, F.; Ippolito, M.; Raineri, S. M.; Ingoglia, G.; Cortegiani, A.; Bono, D.; Villa, F.; Cecconi, M.; Putnina, L.; Kindl, P.; Rass, V.; Lindner, A.; Siempos, I.; Grigoropoulos, V.; Gkirgkiris, K.; Gavrielatou, E.; Mariotti, G.; Pesaresi, L.; Gabbanelli, V.; Donati, A.; Ferrara, G.; Napolitano, L.; Correnti, D.; Di Pierro, F.; Zimotti, T.; Cotoia, A.; Bosa, L.; Bortolaso, A.; Cipolla, C.; Pozzi, F.; Chieregato, A.; Fossi, F.; Chauchard, C.; Menage-Innocenti, L.; Seube-Remy, P. -A.; Leclercq-Rouget, M.; Floch, T.; Legros, V.; Londono, D. M.; Vivas, J.; Bolanos, L. J.; Figueroa, L.; Aldana, J. L.; Marulanda, A.; Villarreal, L. G.; Mejia-Mantilla, J. H.; Addis, A.; Ogliari, G.; Valla, M.; Del Bianco, S.; Friz, M. J. P.; Piazza, V.; Mangili, P.; Amigoni, M.; Cosenza, L.; Torrini, E.; De Luca, A.; Picciafuochi, F.; Bucciardini, L.; Orzalesi, V.; Rusagara, P.; Ciabatti, G.; Mandelli, M.; Bandoni, C.; Paolessi, C.; Patroniti, N.; Ciparelli, G.; Chao, Y.; Wang, Z.; Li, Y.; Wang, J.; Bi, L.; Zhang, H.; Wu, L.; Wu, L.; Song, L.; Sang, B.; She, R.; Yang, K.; Xu, M.; Sun, S.; Zhang, Z.; Huang, Q.; Peukert, K.; Bode, C.; Sauer, A.; Klevenhaus, Y.; Poth, J.; Muders, T.; Kreyer, S.; Lehmann, F.; Ehrentraut, S.; Town, J. A.; Lele, A. V.; James, A.; Matin, N. S.; Smith, N. L.; Cao, Y.; Xu, D.; Dong, Q.; Zhang, B.; Xia, H.; Lv, Y.; Yang, Y.; Yang, W.; Dong, M.; Liu, T.; Hu, C.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/365514
Citazioni:
Ventilation practices in acute brain injured patients and association with outcomes: the VENTIBRAIN multicenter observational study / Robba, C., Giardiello, D., Almondo, C., Asehnoune, K., Badenes, R., Cinotti, R., Elhadi, M., Graziano, F., Helbok, R., Jiang, L., Chen, W., Laffey, J.G., Messina, A., Putensen, C., Schultz, M.J., Wahlster, S., Rebora, P., Galimberti, S., Taccone, F.S., Citerio, G., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 51:2(2025), pp. e007473.318-e007473.331. [10.1007/s00134-025-07808-1]
Abstract:
Purpose: Current mechanical ventilation practices for patients with acute brain injury (ABI) are poorly defined. This study aimed to describe ventilator settings/parameters used in intensive care units (ICUs) and evaluate their association with clinical outcomes in these patients. Methods: An intern...ational, prospective, multicenter, observational study was conducted across 74 ICUs in 26 countries, including adult patients with ABI (e.g., traumatic brain injury, intracranial hemorrhage, subarachnoid hemorrhage, and acute ischemic stroke), who required ICU admission and invasive mechanical ventilation. Ventilatory settings were recorded daily during the first week and on days 10 and 14. ICU and 6-months mortality and 6-months neurological outcome were evaluated. Results: On admission, 2095 recruited patients (median age 58 [interquartile range 45–70] years, 66.1% male) had a median plateau pressure (Pplat) of 15 (13–18) cmH20, tidal volume/predicted body weight 6.5 (5.7–7.3) mL/Kg, driving pressure 9 (7–12) cmH20, and positive end-expiratory pressure 5 (5–8) cmH20, with no modifications in case of increased intracranial pressure (> 20 mmHg). Significant differences in practices were observed across different countries. The majority of these ventilatory settings were associated with ICU mortality, with the highest hazard ratio (HR) for Pplat (odds ratio 1.50; 95% confidence interval, CI: 1.27–1.78). The results demonstrated consistent association with 6-month mortality; less clear association was observed for neurological outcome. Conclusions: Protective ventilation strategies are commonly used in ABI patients but with high variability across different countries. Ventilator settings during ICU stay were associated with an increased risk of ICU and 6-month mortality, but not an unfavorable neurological outcome.
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Protein C in adult patients with sepsis: from pathophysiology to monitoring and supplementation
Anno: 2025
Rivista: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE
Autori/autrici: Coloretti, Irene; Corcione, Antonio; De Pascale, Gennaro; Donati, Abele; Forfori, Francesco; Marietta, Marco; Panigada, Mauro; Simioni, Paolo; Tascini, Carlo; Viale, Pierluigi; Girardis, Massimo
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/344337
Citazioni:
Protein C in adult patients with sepsis: from pathophysiology to monitoring and supplementation / Coloretti, I., Corcione, A., De Pascale, G., Donati, A., Forfori, F., Marietta, M., Panigada, M., Simioni, P., Tascini, C., Viale, P., Girardis, M.. - In: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE. - ISSN 2731-3786. - ELETTRONICO. - 5:1(2025). [10.1186/s44158-025-00243-0]
Abstract:
Protein C (PC) plays a crucial role in modulating inflammation and coagulation in sepsis. Its anticoagulant and cytoprotective properties are critical in mitigating sepsis-induced coagulopathy, which is associated with high mortality rates. In sepsis, low levels of PC are associated with an elevated... risk of multiple organ dysfunction and increased mortality. Routine monitoring of PC levels is not widely implemented but appears relevant in selected populations, such as patients with purpura fulminans, sepsis-induced coagulopathy (SIC), disseminated intravascular coagulopathy (DIC) or hyperinflammatory septic shock phenotypes. Treatment with PC has been limited to PC concentrate approved for paediatric use in congenital PC deficiencies and purpura fulminans, while the efficacy of PC supplementation in sepsis remains a subject of debate. Considering the physiological significance of PC and its role in sepsis pathophysiology, additional studies are necessary to fully elucidate its therapeutic efficacy in specific clinical settings.
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The use of angiotensin II for the management of distributive shock: expert consensus statements
Anno: 2024
Rivista: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE
Autori/autrici: Landoni, Giovanni; Cortegiani, Andrea; Bignami, Elena; De Pascale, Gennaro; Donadello, Katia; Donati, Abele; Grasselli, Giacomo; Guarracino, Fabio; Monti, Gianpaola; Paternoster, Gianluca; Tritapepe, Luigi; Girardis, Massimo
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/337264
Citazioni:
The use of angiotensin II for the management of distributive shock: expert consensus statements / Landoni, G., Cortegiani, A., Bignami, E., De Pascale, G., Donadello, K., Donati, A., Grasselli, G., Guarracino, F., Monti, G., Paternoster, G., Tritapepe, L., Girardis, M.. - In: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE. - ISSN 2731-3786. - ELETTRONICO. - 4:1(2024). [10.1186/s44158-024-00186-y]
Abstract:
Background: Despite the growing body of evidence supporting the use of angiotensin II (ATII) in distributive shock, its integration into existing treatment algorithms requires careful consideration of factors related to patient comorbidities, hemodynamic parameters, cost-effectiveness, and risk-bene...fit balance. Moreover, several questions regarding its use in clinical practice warrant further investigations. To address these challenges, a group of Italian intensive care specialists (the panel) developed a consensus process using a modified Delphi technique.MethodsThe panel defined five clinical questions during an online scoping workshop and then provided a short list of statements related to each clinical question based on literature review and clinical experience. A total of 20 statements were collected. Two coordinators screened and selected the final list of statements to be included in the online survey, which consisted of 17 statements. The consensus was reached when >= 75% of respondents assigned a score within the 3-point range of 1-3 (disagreement) or 7-9 (agreement).ResultsOverall, a consensus on agreement was reached on 13 statements defining the existing gaps in scientific evidence, the possibility of evaluating the addition of drugs with different mechanisms of action for the treatment of refractory shock, the utility of ATII in reducing the catecholamine requirements in the treatment of vasopressor-resistant septic shock, and the effectiveness of ATII in treating patients in whom angiotensin-converting enzyme activity is reduced or pharmacologically blocked. It was widely shared that renin concentration can be used to identify patients who most likely benefit from ATII to restore vascular tone. Thus, the patients who might benefit most from using ATII were defined. Lastly, some potential barriers to the use of ATII were described.ConclusionsATII was recognized as a useful treatment to reduce catecholamine requirements in treating vasopressor-resistant septic shock. At the same time, the need for additional clinical trials to further elucidate the efficacy and safety of ATII, as well as investigations into potential mechanisms of action and optimization of treatment protocols in patients with refractory distributive shock, emerged.
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Adjunctive immunotherapeutic agents in patients with sepsis and septic shock: a multidisciplinary consensus of 23
Anno: 2024
Rivista: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE
Autori/autrici: Girardis, Massimo; Coloretti, Irene; Antonelli, Massimo; Berlot, Giorgio; Busani, Stefano; Cortegiani, Andrea; De Pascale, Gennaro; De Rosa, Francesco Giuseppe; De Rosa, Silvia; Donadello, Katia; Donati, Abele; Forfori, Francesco; Giannella, Maddalena; Grasselli, Giacomo; Montrucchio, Giorgia; Oliva, Alessandra; Pasero, Daniela; Piazza, Ornella; Romagnoli, Stefano; Tascini, Carlo; Viaggi, Bruno; Tumbarello, Mario; Viale, Pierluigi
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/337265
Citazioni:
Adjunctive immunotherapeutic agents in patients with sepsis and septic shock: a multidisciplinary consensus of 23 / Girardis, M., Coloretti, I., Antonelli, M., Berlot, G., Busani, S., Cortegiani, A., De Pascale, G., De Rosa, F.G., De Rosa, S., Donadello, K., Donati, A., Forfori, F., Giannella, M., Grasselli, G., Montrucchio, G., Oliva, A., Pasero, D., Piazza, O., Romagnoli, S., Tascini, C., et al.. - In: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE. - ISSN 2731-3786. - ELETTRONICO. - 4:1(2024). [10.1186/s44158-024-00165-3]
Abstract:
Background: In the last decades, several adjunctive treatments have been proposed to reduce mortality in septic shock patients. Unfortunately, mortality due to sepsis and septic shock remains elevated and NO trials evaluating adjunctive therapies were able to demonstrate any clear benefit. In light ...of the lack of evidence and conflicting results from previous studies, in this multidisciplinary consensus, the authors considered the rational, recent investigations and potential clinical benefits of targeted adjunctive therapies.MethodsA panel of multidisciplinary experts defined clinical phenotypes, treatments and outcomes of greater interest in the field of adjunctive therapies for sepsis and septic shock. After an extensive systematic literature review, the appropriateness of each treatment for each clinical phenotype was determined using the modified RAND/UCLA appropriateness method.ResultsThe consensus identified two distinct clinical phenotypes: patients with overwhelming shock and patients with immune paralysis. Six different adjunctive treatments were considered the most frequently used and promising: (i) corticosteroids, (ii) blood purification, (iii) immunoglobulins, (iv) granulocyte/monocyte colony-stimulating factor and (v) specific immune therapy (i.e. interferon-gamma, IL7 and AntiPD1). Agreement was achieved in 70% of the 25 clinical questions.ConclusionsAlthough clinical evidence is lacking, adjunctive therapies are often employed in the treatment of sepsis. To address this gap in knowledge, a panel of national experts has provided a structured consensus on the appropriate use of these treatments in clinical practice.
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The association between cerebral blood flow variations during on-pump coronary artery bypass grafting surgery and postoperative delirium
Anno: 2024
Rivista: PERFUSION-UK
Autori/autrici: Sampaolesi, Caterina; Casarotta, Erika; Gresti, Giacomo; Mariotti, Giulia; Pisani, Leonardo; Veccia, Diego; Di Eusanio, Marco; Malvindi, Pietro Giorgio; Donati, Abele; Münch, Christopher Maria
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/328057
Citazioni:
The association between cerebral blood flow variations during on-pump coronary artery bypass grafting surgery and postoperative delirium / Sampaolesi, C., Casarotta, E., Gresti, G., Mariotti, G., Pisani, L., Veccia, D., Di Eusanio, M., Malvindi, P.G., Donati, A., Münch, C.M.. - In: PERFUSION-UK. - ISSN 0267-6591. - ELETTRONICO. - 40:2(2024). [10.1177/02676591241239823]
Abstract:
Introduction: Postoperative delirium (POD) has a major impact on patient recovery after cardiac surgery. Although its pathophysiology remains unclear, there could be a correlation between cerebral blood flow (CBF) variations during cardio-pulmonary bypass (CPB) and POD. Our study aimed to evaluate w...hether variations in on-pump CBF, compared to pre-anesthesia and pre-CPB values, are associated with POD following coronary artery bypass grafting (CABG) surgery. Methods: This prospective observational cohort study included 95 adult patients undergoing elective on-pump CABG surgery. Right middle cerebral artery blood flow velocity (MCAV) was assessed using Transcranial Doppler before anesthesia induction, before CPB and every fifteen minutes during CPB. Pre-anesthesia and pre-CPB values were chosen as baselines. Individual values, measured during CPB, were converted as percentage changes relative to these baselines and named as %MCAV0 and %MCAV1, respectively. POD was assessed using the Confusion Assessment Method for ICU (CAM-ICU) during the first 48 post-operative hours and with the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) on the fifth post-surgical day. Results: Overall POD incidence was 17.9%. At 30 minutes of CPB, %MCAV0 was higher in POD group than in no-POD group (p = .05). %MCAV0 at 45 minutes of CPB was significantly higher in POD group (87 (±17) %) than in no-POD group (68 (±24) %), p = .04. %MCAV1 at 30 and 45 minutes of CPB were higher in POD group than in no-POD group, at the limit of statistical significance. We found %MCAV1 > 100% in POD group, but not in no-POD group. Conclusions: Significant differences in %MCAV0 became evident after 30 minutes of CPB, whereas differences in %MCAV1 at 45 minutes of CPB were at limit of statistical significance. In POD group %MCAV1 was higher than 100% at 30 and 45 minutes of CPB, which is supposed to be a sign of cerebral hyperperfusion. Monitoring CBF during CPB could have prognostic value for POD.
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Potential of acetaminophen on the sublingual microcirculation and peripheral tissue perfusion of febrile septic patients: prospective observational study
Anno: 2024
Rivista: ANNALS OF INTENSIVE CARE
Autori/autrici: Domizi, R; Damiani, E; Carsetti, A; Graciotti, L; Procopio, A D; Scorcella, C; Casarotta, E; Giaccaglia, P; Donati, A; Adrario, E
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/326884
Citazioni:
Potential of acetaminophen on the sublingual microcirculation and peripheral tissue perfusion of febrile septic patients: prospective observational study / Domizi, R., Damiani, E., Carsetti, A., Graciotti, L., Procopio, A.D., Scorcella, C., Casarotta, E., Giaccaglia, P., Donati, A., Adrario, E.. - In: ANNALS OF INTENSIVE CARE. - ISSN 2110-5820. - ELETTRONICO. - 14:1(2024), pp. 23.1-23.11. [10.1186/s13613-024-01251-z]
Abstract:
Background: Acetaminophen (ACT) has been studied in septic patients with detectable plasmatic levels of cell-free hemoglobin (Hb), where it demonstrated to inhibit the hemoprotein-mediated lipid peroxidation and oxidative injury, with a potential of beneficial effect on the endothelium. On the basis... of this background, the aim of this study was to evaluate the sublingual microcirculation and the peripheral tissue perfusion before-and-after administration of ACT on clinical judgment in a cohort of febrile septic and septic shock patients. Methods: Prospective observational study. 50 adult septic and septic shocks treated with ACT for pyrexia, where the sublingual microcirculation and the peripheral tissue perfusion with Near Infrared Spectroscopy (NIRS) and vascular occlusion test (VOT) were evaluated before ACT (t0), after 30 min (t1) and after 2 h (t2). Cell-free Hb and the markers of oxidative stress and endothelial damage were measured at t0 and t2. Results: The study showed a significant increase of the density of the perfused small and total vessels of the sublingual microcirculation 30 min after the infusion of ACT; it also showed an increase of the Microvascular Flow Index (MFI) and a decrease in the heterogeneity of the flow. At a peripheral muscular level, we found an acceleration in the reperfusion curve after VOT at t1, expression of a higher reactivity of the microvasculature. Conclusions: ACT infusion did not show a clear correlation with cell-free Hb; however, it exhibited protective effect toward the microcirculation that was evident in particular in septic patients. This correlation merits further exploration.
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Effects of different ventilatory settings on alveolar and pulmonary microvessel dimensions in pigs
Anno: 2024
Rivista: SCIENTIFIC REPORTS
Autori/autrici: Damiani, Elisa; Casarotta, Erika; Di Bella, Caterina; Galosi, Margherita; Angorini, Alessio; Serino, Federica; Tambella, Adolfo Maria; Laus, Fulvio; Zuccari, Samuele; Salvucci Salice, Alessio; Domizi, Roberta; Carsetti, Andrea; Ince, Can; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/344339
Citazioni:
Effects of different ventilatory settings on alveolar and pulmonary microvessel dimensions in pigs / Damiani, E., Casarotta, E., Di Bella, C., Galosi, M., Angorini, A., Serino, F., Tambella, A.M., Laus, F., Zuccari, S., Salvucci Salice, A., Domizi, R., Carsetti, A., Ince, C., Donati, A.. - In: SCIENTIFIC REPORTS. - ISSN 2045-2322. - ELETTRONICO. - 14:1(2024). [10.1038/s41598-024-82244-7]
Abstract:
Mechanical ventilation with high tidal volume (TV) or positive end-expiratory pressure (PEEP) may induce lung overinflation and increased pulmonary vascular resistance to flow. In 8 healthy mechanically ventilated pigs, we evaluated whether incident dark field (IDF) vital microscopy, applied through... a small thoracotomy, could be used to evaluate changes in alveolar and pulmonary microvessel dimensions under different ventilator settings. High TV (12 ml/kg) increased alveolar diameters (from 99 ± 13 to 114 ± 6 μm, p < 0.05 repeated measures one way analysis of variance) and reduced septal capillary diameters (from 12.1 ± 1.7 to 10.5 ± 1.4 μm, p < 0.001) as compared to 8 ml/kg TV. This effect was more pronounced in non-dependent lung. Alveolar and microvessel diameters did not change with high PEEP (12 cmH2O Vs. 5 cmH2O). High FiO2 (100%) led to pulmonary vasodilation (from 12.1 ± 1.7 to 14.7 ± 1.4 μm, p < 0.001), with no change in alveolar dimensions as compared to 50% FiO2. In conclusion, IDF imaging enabled to obtain high-quality images of subpleural alveoli and microvessels. High TV ventilation may induce alveolar distension with compression of septal capillaries, thus potentially increasing dead space ventilation.
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Pharmacogenetics in critical care: association between CYP3A5 rs776746 A/G genotype and acetaminophen response in sepsis and septic shock
Anno: 2023
Rivista: BMC ANESTHESIOLOGY
Autori/autrici: Scorcella, C.; Domizi, R.; Amoroso, S.; Carsetti, A.; Casarotta, E.; Castaldo, P.; D’Angelo, C.; Damiani, E.; Gasparri, F.; Donati, A.; Adrario, E.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/311507
Citazioni:
Pharmacogenetics in critical care: association between CYP3A5 rs776746 A/G genotype and acetaminophen response in sepsis and septic shock / Scorcella, C., Domizi, R., Amoroso, S., Carsetti, A., Casarotta, E., Castaldo, P., D’Angelo, C., Damiani, E., Gasparri, F., Donati, A., Adrario, E.. - In: BMC ANESTHESIOLOGY. - ISSN 1471-2253. - ELETTRONICO. - 23:(2023). [10.1186/s12871-023-02018-y]
Abstract:
Background: Pharmacogenetics could represent a further resource to understand the interindividual heterogeneity of response of the host to sepsis and to provide a personalized approach to the critical care patient. Methods: Secondary analysis of data from the prospective observational study NCT02750...163, in 50 adult septic and septic shock patients treated with Acetaminophen (ACT) for pyrexia. We investigated the presence of two polymorphisms, located respectively in the genes UGT1A1 and CYP3A5, that encode for proteins related to the hepatic metabolism of ACT. The main dependent variables explored were plasmatic concentration of ACT, body temperature and hepatic parameters. Results: 8% of the patients carried CYP3A5 rs776746 A/G genotypes and showed significantly higher plasma levels of ACT than GG wild type patients, and than patients with UGT1A1 rs8330 C/G genotypes. Conclusions: Identifying specific genotypes of response to ACT may be helpful to guide a more personalized titration of therapy in sepsis and septic shock. CYP3A5 might be a good biomarker for ACT metabolism; however further studies are needed to confirm this result. Trial registration: NCT02750163.
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Microcirculation-guided resuscitation in sepsis: the next frontier?
Anno: 2023
Rivista: FRONTIERS IN MEDICINE
Autori/autrici: Damiani, Elisa; Carsetti, Andrea; Casarotta, Erika; Domizi, Roberta; Scorcella, Claudia; Donati, Abele; Adrario, Erica
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/325653
Citazioni:
Microcirculation-guided resuscitation in sepsis: the next frontier? / Damiani, E., Carsetti, A., Casarotta, E., Domizi, R., Scorcella, C., Donati, A., Adrario, E.. - In: FRONTIERS IN MEDICINE. - ISSN 2296-858X. - 10:(2023). [10.3389/fmed.2023.1212321]
Abstract:
Microcirculatory dysfunction plays a key role in the pathogenesis of tissue dysoxia and organ failure in sepsis. Sublingual videomicroscopy techniques enable the real-time non-invasive assessment of microvascular blood flow. Alterations in sublingual microvascular perfusion were detected during seps...is and are associated with poor outcome. More importantly, sublingual videomicroscopy allowed to explore the effects of commonly applied resuscitative treatments in septic shock, such as fluids, vasopressors and inotropes, and showed that the optimization of macro-hemodynamic parameters may not be accompanied by an improvement in microvascular perfusion. This loss of "hemodynamic coherence," i.e., the concordance between the response of the macrocirculation and the microcirculation, advocates for the integration of microvascular monitoring in the management of septic patients. Nonetheless, important barriers remain for a widespread use of sublingual videomicroscopy in the clinical practice. In this review, we discuss the actual limitations of this technique and future developments that may allow an easier and faster evaluation of the microcirculation at the bedside, and propose a role for sublingual microvascular monitoring in guiding and titrating resuscitative therapies in sepsis.
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Microcirculation as a guide for therapy: do not condemn an innocent without a fair trial
Anno: 2023
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Damiani, Elisa; Scorcella, Claudia; Carsetti, Andrea; Donati, Abele; Adrario, Erica
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/325655
Citazioni:
Microcirculation as a guide for therapy: do not condemn an innocent without a fair trial / Damiani, E., Scorcella, C., Carsetti, A., Donati, A., Adrario, E.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 49:10(2023), pp. 1270-1271. [10.1007/s00134-023-07192-8]

Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT)
Anno: 2023
Rivista: BJA OPEN
Autori/autrici: Kouz, Karim; Monge García, Manuel Ignacio; Cerutti, Elisabetta; Lisanti, Ivana; Draisci, Gaetano; Frassanito, Luciano; Sander, Michael; Ali Akbari, Amir; Frey, Ulrich H; Grundmann, Carla Davina; Davies, Simon James; Donati, Abele; Ripolles-Melchor, Javier; García-López, Daniel; Vojnar, Benjamin; Gayat, Étienne; Noll, Eric; Bramlage, Peter; Saugel, Bernd
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/326691
Citazioni:
Intraoperative hypotension when using hypotension prediction index software during major noncardiac surgery: a European multicentre prospective observational registry (EU HYPROTECT) / Kouz, K., Monge García, M.I., Cerutti, E., Lisanti, I., Draisci, G., Frassanito, L., Sander, M., Ali Akbari, A., Frey, U.H., Grundmann, C.D., Davies, S.J., Donati, A., Ripolles-Melchor, J., García-López, D., Vojnar, B., Gayat, É., Noll, E., Bramlage, P., Saugel, B.. - In: BJA OPEN. - ISSN 2772-6096. - ELETTRONICO. - 6:(2023), pp. 100140.1-100140.8. [10.1016/j.bjao.2023.100140]
Abstract:
Background: Intraoperative hypotension is associated with organ injury. Current intraoperative arterial pressure management is mainly reactive. Predictive haemodynamic monitoring may help clinicians reduce intraoperative hypotension. The Acumen™ Hypotension Prediction Index software (HPI-softw...are) (Edwards Lifesciences, Irvine, CA, USA) was developed to predict hypotension. We built up the European multicentre, prospective, observational EU HYPROTECT Registry to describe the incidence, duration, and severity of intraoperative hypotension when using HPI-software monitoring in patients having noncardiac surgery. Methods: We enrolled 749 patients having elective major noncardiac surgery in 12 medical centres in five European countries. Patients were monitored using the HPI-software. We quantified hypotension using the time-weighted average MAP <65 mm Hg (primary endpoint), the proportion of patients with at least one ≥1 min episode of a MAP <65 mm Hg, the number of ≥1 min episodes of a MAP <65 mm Hg, and duration patients spent below a MAP of 65 mm Hg. Results: We included 702 patients in the final analysis. The median time-weighted average MAP <65 mm Hg was 0.03 (0.00-0.20) mm Hg. In addition, 285 patients (41%) had no ≥1 min episode of a MAP <65 mm Hg; 417 patients (59%) had at least one. The median number of ≥1 min episodes of a MAP <65 mm Hg was 1 (0-3). Patients spent a median of 2 (0-9) min below a MAP of 65 mm Hg. Conclusions: The median time-weighted average MAP <65 mm Hg was very low in patients in this registry. This suggests that using HPI-software monitoring may help reduce the duration and severity of intraoperative hypotension in patients having noncardiac surgery.
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Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis
Anno: 2023
Rivista: CRITICAL CARE
Autori/autrici: Carsetti, Andrea; Antolini, Riccardo; Casarotta, Erika; Damiani, Elisa; Gasparri, Francesco; Marini, Benedetto; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/312127
Citazioni:
Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis / Carsetti, A., Antolini, R., Casarotta, E., Damiani, E., Gasparri, F., Marini, B., Adrario, E., Donati, A.. - In: CRITICAL CARE. - ISSN 1364-8535. - ELETTRONICO. - 27:1(2023), pp. 85.1-85.10. [10.1186/s13054-023-04386-w]
Abstract:
Background: Management of bleeding trauma patients is still a difficult challenge. Massive transfusion (MT) requires resources to ensure the safety and timely delivery of blood products. Early prediction of MT need may be useful to shorten the time process of blood product preparation. The primary a...im of this study was to assess the accuracy of shock index to predict the need for MT in adult patients with trauma. For the same population, we also assessed the accuracy of SI to predict mortality. Methods: This systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. We performed a systematic search on MEDLINE, Scopus, and Web of Science from inception to March 2022. Studies were included if they reported MT or mortality with SI recorded at arrival in the field or the emergency department. The risk of bias was assessed using the QUADAS-2. Results: Thirty-five studies were included in the systematic review and meta-analysis, for a total of 670,728 patients. For MT the overall sensibility was 0.68 [0.57; 0.76], the overall specificity was 0.84 [0.79; 0.88] and the AUC was 0.85 [0.81; 0.88]. Positive and Negative Likelihood Ratio (LR+; LR-) were 4.24 [3.18-5.65] and 0.39 [0.29-0.52], respectively. For mortality the overall sensibility was 0.358 [0.238; 0.498] the overall specificity 0.742 [0.656; 0.813] and the AUC 0.553 (confidence region for sensitivity given specificity: [0.4014; 0.6759]; confidence region for specificity given sensitivity: [0.4799; 0.6332]). LR+ and LR- were 1.39 [1.36-1.42] and 0.87 [0.85-0.89], respectively. Conclusions: Our study demonstrated that SI may have a limited role as the sole tool to predict the need for MT in adult trauma patients. SI is not accurate to predict mortality but may have a role to identify patients with a low risk of mortality.
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Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock
Anno: 2023
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Kjær, Maj-Brit Nørregaard; Meyhoff, Tine Sylvest; Sivapalan, Praleene; Granholm, Anders; Hjortrup, Peter Buhl; Madsen, Martin Bruun; Møller, Morten Hylander; Egerod, Ingrid; Wetterslev, Jørn; Lange, Theis; Cronhjort, Maria; Laake, Jon Henrik; Jakob, Stephan M; Nalos, Marek; Ostermann, Marlies; Gould, Doug; Cecconi, Maurizio; Malbrain, Manu L N G; Ahlstedt, Christian; Kiel, Louise Bendix; Bestle, Morten H; Nebrich, Lars; Hildebrandt, Thomas; Russell, Lene; Vang, Marianne; Rasmussen, Michael Lindhart; Sølling, Christoffer; Brøchner, Anne Craveiro; Krag, Mette; Pfortmueller, Carmen; Kriz, Miroslav; Siegemund, Martin; Albano, Giovanni; Aagaard, Søren Rosborg; Bundgaard, Helle; Crone, Vera; Wichmann, Sine; Johnstad, Bror; Martin, Yvonne Karin; Seidel, Philipp; Mårtensson, Johan; Hollenberg, Jacob; Wistrand, Mats; Donati, Abele; Barbara, Enrico; Karvunidis, Thomas; Hollinger, Alexa; Carsetti, Andrea; Lumlertgul, Nuttha; Joelsson-Alm, Eva; Lambiris, Nikolas; Aslam, Tayyba Naz; Friberg, Fredrik Femtehjell; Vesterlund, Gitte Kingo; Mortensen, Camilla Bekker; Vestergaard, Stine Rom; Caspersen, Sidsel Fjordbak; Jensen, Diana Bertelsen; Borup, Morten; Rasmussen, Bodil Steen; Perner, Anders
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/318331
Citazioni:
Long-term effects of restriction of intravenous fluid in adult ICU patients with septic shock / Kjær, M.N., Meyhoff, T.S., Sivapalan, P., Granholm, A., Hjortrup, P.B., Madsen, M.B., Møller, M.H., Egerod, I., Wetterslev, J., Lange, T., Cronhjort, M., Laake, J.H., Jakob, S.M., Nalos, M., Ostermann, M., Gould, D., Cecconi, M., Malbrain, M.L.N.G., Ahlstedt, C., Kiel, L.B., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 49:7(2023), pp. 820-830. [10.1007/s00134-023-07114-8]
Abstract:
Purpose: To assess long-term outcomes of restrictive versus standard intravenous (IV) fluid therapy in adult intensive care unit (ICU) patients with septic shock included in the European Conservative versus Liberal Approach to Fluid Therapy in Septic Shock in Intensive Care (CLASSIC) trial. Methods:... We conducted the pre-planned analyses of mortality, health-related quality of life (HRQoL) using EuroQol (EQ)-5D-5L index values and EQ visual analogue scale (VAS), and cognitive function using Mini Montreal Cognitive Assessment (Mini MoCA) test at 1&nbsp;year. Deceased patients were assigned numerical zero for HRQoL as a state equal to death and zero for cognitive function outcomes as worst possible score, and we used multiple imputation for missing data on HRQoL and cognitive function. Results: Among 1554 randomized patients, we obtained 1-year data on mortality in 97.9% of patients, HRQoL in 91.3%, and cognitive function in 86.3%. One-year mortality was 385/746 (51.3%) in the restrictive-fluid group versus 383/767 (49.9%) in the standard-fluid group, absolute risk difference 1.5%-points [99% confidence interval (CI) -&nbsp;4.8 to 7.8]. Mean differences were 0.00 (99% CI -&nbsp;0.06 to 0.05) for EQ-5D-5L index values, -&nbsp;0.65 for EQ VAS (-&nbsp;5.40 to 4.08), and -&nbsp;0.14 for Mini MoCA (-&nbsp;1.59 to 1.14) for the restrictive-fluid group versus the standard-fluid group. The results for survivors only were similar in both groups. Conclusions: Among adult ICU patients with septic shock, restrictive versus standard IV fluid therapy resulted in similar survival, HRQoL, and cognitive function at 1&nbsp;year, but clinically important differences could not be ruled out.
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The intertwining of healthcare-associated infections and COVID-19 in Italian intensive care units: an analysis of the SPIN-UTI project from 2006 to 2021
Anno: 2023
Rivista: JOURNAL OF HOSPITAL INFECTION
Autori/autrici: Barchitta, M; Maugeri, A; Favara, G; Magnano San Lio, R; C La Rosa, M; D'Ancona, F; Agodi, A; Network, SPIN-UTI; D'Errico, Mm; Donati, Abele; Domizi, Roberta
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/327812
Citazioni:
The intertwining of healthcare-associated infections and COVID-19 in Italian intensive care units: an analysis of the SPIN-UTI project from 2006 to 2021 / Barchitta, M., Maugeri, A., Favara, G., Magnano San Lio, R., C La Rosa, M., D'Ancona, F., Agodi, A., Network, S., D'Errico, M.m., Donati, A., Domizi, R.. - In: JOURNAL OF HOSPITAL INFECTION. - ISSN 1532-2939. - ELETTRONICO. - 140:(2023), pp. 124-131. [10.1016/j.jhin.2023.07.021]
Abstract:
Background: Although healthcare-associated infections (HAIs) pose an extraordinary burden on public health, the impact of coronavirus disease 2019 (COVID-19) is still a matter of debate. Aim: To describe trends of HAIs in Italian intensive care units (ICUs) from 2006 to 2021, and to compare charact...eristics and outcomes of patients with or without COVID-19. Methods: We evaluated patients participating in the ‘Italian Nosocomial Infections Surveillance in Intensive Care Units’ (SPIN-UTI) project, who were admitted to ICUs for more than 48 h. Data regarding diagnosis, clinical conditions, therapies, treatments and outcomes of COVID-19 patients were also collected. Findings: From a total of 21,523 patients from 2006 to 2021, 3485 (16.2%) presented at least one HAI. We observed an increasing trend for both the incidence of patients with HAI and the incidence density of HAIs (P-trend <0.001). Compared with the pre-pandemic period, the incidence density of HAIs increased by about 15% in 2020e2021, with pneumoniae being the greatest contributors to this increase (P-trend <0.001). Moreover, incidence of HAIs was higher in ICUs dedicated to COVID-19 patients (P<0.001), who showed a greater risk of HAIs and death than patients without COVID-19 (P-values <0.001). Accordingly, the mortality in ICUs increased over the years and doubled during the pandemic (P-trend <0.001). Notably, co-infected patients had higher mortality (75.2%) than those with COVID-19 (66.2%) or HAI (39.9%) alone, and those without any infection (23.2%). Conclusions: Our analysis provides useful insight into whether and how the COVID-19 pandemic influenced HAI incidence and death in Italian ICUs, highlighting the need for evaluation of the long-term effects of the pandemic
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Anesthetic management of patients with sepsis/septic shock
Anno: 2023
Rivista: FRONTIERS IN MEDICINE
Autori/autrici: Carsetti, Andrea; Vitali, Eva; Pesaresi, Lucia; Antolini, Riccardo; Casarotta, Erika; Damiani, Elisa; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/313247
Citazioni:
Anesthetic management of patients with sepsis/septic shock / Carsetti, A., Vitali, E., Pesaresi, L., Antolini, R., Casarotta, E., Damiani, E., Adrario, E., Donati, A.. - In: FRONTIERS IN MEDICINE. - ISSN 2296-858X. - 10:(2023). [10.3389/fmed.2023.1150124]
Abstract:
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, while septic shock is a subset of sepsis with persistent hypotension requiring vasopressors to maintain a mean arterial pressure (MAP) of ≥65 mmHg and having a serum lactate level of &...gt;2 mmol/L, despite adequate volume resuscitation. Sepsis and septic shock are medical emergencies and time-dependent diseases with a high mortality rate for which early identification, early antibiotic therapy, and early source control are paramount for patient outcomes. The patient may require surgical intervention or an invasive procedure aiming to control the source of infection, and the anesthesiologist has a pivotal role in all phases of patient management. During the preoperative assessment, patients should be aware of all possible organ dysfunctions, and the severity of the disease combined with the patient's physiological reserve should be carefully assessed. All possible efforts should be made to optimize conditions before surgery, especially from a hemodynamic point of view. Anesthetic agents may worsen the hemodynamics of shock patients, and the anesthesiologist must know the properties of each anesthetic agent. All possible efforts should be made to maintain organ perfusion supporting hemodynamics with fluids, vasoactive agents, and inotropes if required.
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In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study
Anno: 2023
Rivista: THE LANCET RESPIRATORY MEDICINE
Autori/autrici: Lorusso, R.; De Piero, M. E.; Mariani, S.; Di Mauro, M.; Folliguet, T.; Taccone, F. S.; Camporota, L.; Swol, J.; Wiedemann, D.; Belliato, M.; Broman, L. M.; Vuylsteke, A.; Kassif, Y.; Scandroglio, A. M.; Fanelli, V.; Gaudard, P.; Ledot, S.; Barker, J.; Boeken, U.; Maier, S.; Kersten, A.; Meyns, B.; Pozzi, M.; Pedersen, F. M.; Schellongowski, P.; Kirali, K.; Barrett, N.; Riera, J.; Mueller, T.; Belohlavek, J.; Lo Coco, V.; Van der Horst, I. C. C.; Van Bussel, B. C. T.; Schnabel, R. M.; Delnoij, T.; Bolotin, G.; Lorini, L.; Schmiady, M. O.; Schibilsky, D.; Kowalewski, M.; Pinto, L. F.; Silva, P. E.; Kornilov, I.; Blandino Ortiz, A.; Vercaemst, L.; Finney, S.; Roeleveld, P. P.; Di Nardo, M.; Hennig, F.; Antonini, M. V.; Davidson, M.; Jones, T. J.; Staudinger, T.; Mair, P.; Kilo, J.; Krapf, C.; Erbert, K.; Peer, A.; Bonaros, N.; Kotheletner, F.; Krenner Mag, N.; Shestakova, L.; Hermans, G.; Dauwe, D.; Meersseman, P.; Stockman, B.; Nobile, L.; Lhereux, O.; Nrasseurs, A.; Creuter, J.; De Backer, D.; Giglioli, S.; Michiels, G.; Foulon, P.; Raes, M.; Rodrigus, I.; Allegaert, M.; Jorens, P.; Debeucklare, G.; Piagnerelli, M.; Biston, P.; Peperstraete, H.; Vandewiele, K.; Germay, O.; Vandeweghe, D.; Havrin, S.; Bourgeois, M.; Lagny, M. -G.; Alois, G.; Lavios, N.; Misset, B.; Courcelle, R.; Timmermans, P. J.; Yilmaz, A.; Vantomout, M.; Lehaen, J.; Jassen, A.; Guterman, H.; Strauven, M.; Lormans, P.; Verhamme, B.; Vandewaeter, C.; Bonte, F.; Vionne, D.; Balik, M.; Blaha, J.; Lips, M.; Othal, M.; Bursa, F.; Spacek, R.; Christensen, S.; Jorgensen, V.; Sorensen, M.; Madsen, S. A.; Puss, S.; Beljantsev, A.; Saiydoun, G.; Fiore, A.; Colson, P.; Bazalgette, F.; Capdevila, X.; Kollen, S.; Muller, L.; Obadia, J. -F.; Dubien, P. -Y.; Ajrhourh, L.; Guinot, P. G.; Zarka, J.; Besserve, P.; Malfertheiner, M. V.; Dreier, E.; Heinze, B.; Akhyari, P.; Lichtenberg, A.; Aubin, H.; Assman, A.; Saeed, D.; Thiele, H.; Baumgaertel, M.; Schmitto, J. D.; Ruslan, N.; Haverich, A.; Thielmann, M.; Brenner, T.; Ruhpawar, A.; Benk, C.; Czerny, M.; Staudacher, D. L.; Beyersdorf, F.; Kalbhenn, J.; Henn, P.; Popov, A. -F.; Iuliu, T.; Muellenbach, R.; Reyher, C.; Rolfes, C.; Lotz, G.; Sonntagbauer, M.; Winkels, H.; Fichte, J.; Stohr, R.; Kalverkamp, S.; Karagiannidis, C.; Schafer, S.; Svetlitchny, A.; Hopf, H. -B.; Jarczak, D.; Groesdonk, H.; Rommer, M.; Hirsch, J.; Kaehny, C.; Soufleris, D.; Gavriilidis, G.; Pontikis, K.; Kyriakopoulou, M.; Kyriakoudi, A.; O'Brien, S.; Conrick-Martin, I.; Carton, E.; Makhoul, M.; Ben-Ari, J.; Hadash, A.; Kogan, A.; Kassif Lerner, R.; Abu-Shakra, A.; Matan, M.; Balawona, A.; Kachel, E.; Altshuler, R.; Galante, O.; Fuchs, L.; Almog, Y.; Ishay, Y. S.; Lichter, Y.; Gal-oz, A.; Carmi, U.; Nini, A.; Soroksky, A.; Dekel, H.; Rozman, Z.; Tayem, E.; Ilgiyaev, E.; Hochman, Y.; Miltau, D.; Rapoport, A.; Eden, A.; Kompanietz, D.; Yousif, M.; Golos, M.; Grazioli, L.; Ghitti, D.; Loforte, A.; Di Luca, D.; Baiocchi, M.; Pacini, D.; Cappai, A.; Meani, P.; Mondino, M.; Russo, C. F.; Ranucci, M.; Fina, D.; Cotza, M.; Ballotta, A.; Landoni, G.; Nardelli, P.; Fominski, E. V.; Brazzi, L.; Montrucchio, G.; Sales, G.; Simonetti, U.; Livigni, S.; Silengo, D.; Arena, G.; Sovatzis, S. S.; Degani, A.; Riccardi, M.; Milanesi, E.; Raffa, G.; Martucci, G.; Arcadipane, A.; Panarello, G.; Chiarini, G.; Cattaneo, S.; Puglia, C.; Benussi, S.; Foti, G.; Giani, M.; Bombino, M.; Costa, M. C.; Rona, R.; Avalli, L.; Donati, A.; Carozza, R.; Gasparri, F.; Carsetti, A.; Piciche, M.; Marinello, A.; Danzi, V.; Zanin, A.; Condello, I.; Fiore, F.; Moscarelli, M.; Nasso, G.; Speziale, G.; Sandrelli, L.; Montalto, A.; Musumeci, F.; Circelli, A.; Russo, E.; Agnoletti, V.; Rociola, R.; Milano, A. D.; Pilato, E.; Comentale, G.; Montisci, A.; Alessandri, F.; Tosi, A.; Pugliese, F.; Giordano, G.; Carelli, S.; Grieco, D. L.; Dell'Anna, A. M.; Antonelli, M.; Ramoni, E.; Zulueta, J.; Del Giglio, M.; Petracca, S.; Bertini, P.; Guarracino, F.; De Simone, L.; Angeletti, P. M.; Forfori, F.; Taraschi, F.; Quintiliani, V. N.; Samalavicius, R.; Jankuviene, A.; Scupakova, N.; Urbonas, K.; Kapturauskas, J.; Soerensen, G.; Suwalski, P.; Linhares Santos, L.; Marques, A.; Miranda, M.; Teixeira, S.; Salgueiro, A.; Pereira, F.; Ketskalo, M.; Tsarenko, S.; Shilova, A.; Afukov, I.; Popugaev, K.; Minin, S.; Shelukhin, D.; Malceva, O.; Gleb, M.; Skopets, A.; Kornelyuk, R.; Kulikov, A.; Okhrimchuk, V.; Turchaninov, A.; Petrushin, M.; Sheck, A.; Mekulov, A.; Ciryateva, S.; Urusov, D.; Gorjup, V.; Golicnik, A.; Goslar, T.; Ferrer, R.; Martinez-Martinez, M.; Argudo, E.; Palmer, N.; De Pablo Sanchez, R.; Juan Higuera, L.; Arnau Blasco, L.; Marquez, J. A.; Sbraga, F.; Fuset, M. P.; De Gopegui, P. R.; Claraco, L. M.; De Ayala, J. A.; Peiro, M.; Ricart, P.; Martinez, S.; Chavez, F.; Fabra, M.; Sandoval, E.; Toapanta, D.; Carraminana, A.; Tellez, A.; Ososio, J.; Milan, P.; Rodriguez, J.; Andoni, G.; Gutierrez, C.; Perez de la Sota, E.; Eixeres-Esteve, A.; Garcia-Maellas, M. T.; Gutierrez-Gutierrez, J.; Arboleda-Salazar, R.; Santa Teresa, P.; Jaspe, A.; Garrido, A.; Castaneda, G.; Alcantara, S.; Martinez, N.; Perez, M.; Villanueva, H.; Vidal Gonzalez, A.; Paez, J.; Santon, A.; Perez, C.; Lopez, M.; Rubio Lopez, M. I.; Gordillo, A.; Naranjo-Izurieta, J.; Munoz, J.; Alcalde, I.; Onieva, F.; Gimeno Costa, R.; Perez, F.; Madrid, I.; Gordon, M.; Albacete Moreno, C. L.; Perez, D.; Lopez, N.; Martinenz, D.; Blanco-Schweizer, P.; Diez, C.; Perez, D.; Prieto, A.; Renedo, G.; Bustamante, E.; Cicuendez, R.; Citores, R.; Boado, V.; Garcia, K.; Voces, R.; Domezain, M.; Nunez Martinez, J. M.; Vicente, R.; Martin, D.; Andreu, A.; Gomez Casal, V.; Chico, I.; Menor, E. M.; Vara, S.; Gamacho, J.; Perez-Chomon, H.; Javier Gonzales, F.; Barrero, I.; Martin-Villen, L.; Fernandez, E.; Mendoza, M.; Navarro, J.; Colomina Climent, J.; Gonzales-Perez, A.; Muniz-Albaceita, G.; Amado, L.; Rodriguez, R.; Ruiz, E.; Eiras, M.; Grins, E.; Magnus, R.; Kanetoft, M.; Eidevald, M.; Watson, P.; Vogt, P. R.; Steiger, P.; Aigner, T.; Weber, A.; Grunefelder, J.; Kunz, M.; Grapow, M.; Aymard, T.; Reser, D.; Agus, G.; Consiglio, J.; Haenggi, M.; Hansjoerg, J.; Iten, M.; Doeble, T.; Zenklusen, U.; Bechtold, X.; Faedda, G.; Iafrate, M.; Rohjer, A.; Bergamaschi, L.; Maessen, J.; Reis Miranda, D.; Endeman, H.; Gommers, D.; Meuwese, C.; Maas, J.; Van Gijlswijk, M. J.; Van Berg, R. N.; Candura, D.; Van der Linden, M.; Kant, M.; Van der Heijden, J. J.; Scholten, E.; Van Belle-van Haren, N.; Lagrand, W. K.; Vlaar, A. P.; De Jong, S.; Cander, B.; Sargin, M.; Ugur, M.; Kaygin, M. A.; Daly, K.; Agnew, N.; Head, L.; Kelly, L.; Anoma, G.; Russell, C.; Aquino, V.; Scott, I.; Flemming, L.; Gillon, S.; Moore, O.; Gelandt, E.; Auzinger, G.; Patel, S.; Loveridge, R.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/316395
Citazioni:
In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study / Lorusso, R., De Piero, M.E., Mariani, S., Di Mauro, M., Folliguet, T., Taccone, F.S., Camporota, L., Swol, J., Wiedemann, D., Belliato, M., Broman, L.M., Vuylsteke, A., Kassif, Y., Scandroglio, A.M., Fanelli, V., Gaudard, P., Ledot, S., Barker, J., Boeken, U., Maier, S., et al.. - In: THE LANCET RESPIRATORY MEDICINE. - ISSN 2213-2600. - 11:2(2023), pp. 151-162. [10.1016/S2213-2600(22)00403-9]
Abstract:
Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-h...ospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation. Methods: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic—from March 1 to Sept 13, 2020—at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing. Findings: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46–60]) were included in the study. Median ECMO duration was 15 days (IQR 8–27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms. Interpretation: Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required. Funding: None.
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Bougie-assisted C-MAC video laryngoscope versus C-MAC video stylet for awake endoscopic intubation in anticipated difficult airways: A randomized controlled trial
Anno: 2023
Rivista: TRENDS IN ANAESTHESIA AND CRITICAL CARE
Autori/autrici: Falcetta, S.; Pecora, L.; Borioni, M.; Montozzi, A.; Carsetti, A.; Sorbello, M.; Cataldo, R.; Di Giacinto, I.; Cerutti, E.; Donati, A.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/315012
Citazioni:
Bougie-assisted C-MAC video laryngoscope versus C-MAC video stylet for awake endoscopic intubation in anticipated difficult airways: A randomized controlled trial / Falcetta, S., Pecora, L., Borioni, M., Montozzi, A., Carsetti, A., Sorbello, M., Cataldo, R., Di Giacinto, I., Cerutti, E., Donati, A.. - In: TRENDS IN ANAESTHESIA AND CRITICAL CARE. - ISSN 2210-8440. - 50:(2023). [10.1016/j.tacc.2023.101258]

Effect of Whey Proteins on Malnutrition and Extubating Time of Critically Ill COVID-19 Patients
Anno: 2022
Rivista: NUTRIENTS
Autori/autrici: Scarcella, Marialaura; Scarpellini, Emidio; Ascani, Alessandra; Commissari, Rita; Scorcella, Claudia; Zanetti, Michela; Parisi, Amilcare; Monti, Riccardo; Milic, Natasa; Donati, Abele; Luzza, Francesco; De Robertis, Edoardo; Abenavoli, Ludovico
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/294813
Citazioni:
Effect of Whey Proteins on Malnutrition and Extubating Time of Critically Ill COVID-19 Patients / Scarcella, M., Scarpellini, E., Ascani, A., Commissari, R., Scorcella, C., Zanetti, M., Parisi, A., Monti, R., Milic, N., Donati, A., Luzza, F., De Robertis, E., Abenavoli, L.. - In: NUTRIENTS. - ISSN 2072-6643. - ELETTRONICO. - 14:3(2022), p. 437. [10.3390/nu14030437]
Abstract:
Abstract: The novel SARS-CoV-2 virus has led to a severe pandemic, starting from early 2020. Intensive care (ICU) management of the COVID-19 disease is difficult with high morbidity and mortality. Early nutritional support, especially with whey protein, seems to be crucial in this medical case. Thus..., we aimed to assess the effects of an adequate nutritional protocol rich in whey protein on nutritional and inflammatory status, extubating time, and mortality of critically ill COVID-19 patients (CICP). Methods: A prospective single-center exploratory observational study was undertaken on 32 consecutive CICP admitted to the ICU of Santa Maria Hospital, Terni, Italy, and treated with whey protein-enriched formula. Patients’ demographics, nutritional status, indexes of inflammation, daily pre-albumin serum levels, duration of mechanical ventilation, and mortality were recorded. Results: Thirty-two patients were enrolled. Ninety-five percent of them showed a gradual reduction in C-reactive protein (CRP) values and increase in pre-albumin levels after the whey protein-enriched formula. Prealbumin levels were not correlated with a better nutritional status but with a shorter extubating time and better survival. Conclusions: An adequate administration of whey protein during COVID-19 patients’ ICU stays can provide fast achievement of protein targets, reducing the duration of mechanical ventilation, and improving inflammatory status and ICU survival. Further prospective and large-scale, controlled studies are needed to confirm these results.
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Efficacy of Bonfils fiberoptic stylet for difficult tracheal intubation with double lumen tube: A prospective observational study
Anno: 2022
Rivista: TRENDS IN ANAESTHESIA AND CRITICAL CARE
Autori/autrici: Falcetta, S; Bartolini, F; Carsetti, A; Sorbello, M; Gentili, P; Coltrinari, R; Cortese, G; Godoroja, D; Refai, M; Donati, A
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/312167
Citazioni:
Efficacy of Bonfils fiberoptic stylet for difficult tracheal intubation with double lumen tube: A prospective observational study / Falcetta, S., Bartolini, F., Carsetti, A., Sorbello, M., Gentili, P., Coltrinari, R., Cortese, G., Godoroja, D., Refai, M., Donati, A.. - In: TRENDS IN ANAESTHESIA AND CRITICAL CARE. - ISSN 2210-8440. - 47:(2022), pp. 1-6. [10.1016/j.tacc.2022.09.006]

Too much tolerance for hyperoxemia in mechanically ventilated patients with SARS-CoV-2 pneumonia? Report from an Italian intensive care unit
Anno: 2022
Rivista: FRONTIERS IN MEDICINE
Autori/autrici: Damiani, Elisa; Casarotta, Erika; Carsetti, Andrea; Mariotti, Giulia; Vannicola, Sara; Giorgetti, Rachele; Domizi, Roberta; Scorcella, Claudia; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/304839
Citazioni:
Too much tolerance for hyperoxemia in mechanically ventilated patients with SARS-CoV-2 pneumonia? Report from an Italian intensive care unit / Damiani, E., Casarotta, E., Carsetti, A., Mariotti, G., Vannicola, S., Giorgetti, R., Domizi, R., Scorcella, C., Adrario, E., Donati, A.. - In: FRONTIERS IN MEDICINE. - ISSN 2296-858X. - ELETTRONICO. - 9:(2022), pp. 1-12. [10.3389/fmed.2022.957773]
Abstract:
Background: In COVID-19 patients requiring mechanical ventilation, the administration of high oxygen (O2) doses for prolonged time periods may be necessary. Although life-saving in most cases, O2 may exert deleterious effects if administered in excessive concentrations. We aimed to describe the prev...alence of hyperoxemia and excessive O2 administration in mechanically ventilated patients with SARS-CoV-2 pneumonia and determine whether hyperoxemia is associated with mortality in the Intensive Care Unit (ICU) or the onset of ventilator-associated pneumonia (VAP). Materials and methods: Retrospective single-center study on adult patients with SARS-CoV-2 pneumonia requiring invasive mechanical ventilation for ≥48 h. Patients undergoing extracorporeal respiratory support were excluded. We calculated the excess O2 administered based on the ideal arterial O2 tension (PaO2) target of 55–80 mmHg. We defined hyperoxemia as PaO2 > 100 mmHg and hyperoxia + hyperoxemia as an inspired O2 fraction (FiO2) > 60% + PaO2 > 100 mmHg. Risk factors for ICU-mortality and VAP were assessed through multivariate analyses. Results: One hundred thirty-four patients were included. For each day of mechanical ventilation, each patient received a median excess O2 of 1,121 [829–1,449] L. Hyperoxemia was found in 38 [27–55]% of arterial blood gases, hyperoxia + hyperoxemia in 11 [5–18]% of cases. The FiO2 was not reduced in 69 [62–76]% of cases of hyperoxemia. Adjustments were made more frequently with higher PaO2 or initial FiO2 levels. ICU-mortality was 32%. VAP was diagnosed in 48.5% of patients. Hyperoxemia (OR 1.300 95% CI [1.097–1.542]), time of exposure to hyperoxemia (OR 2.758 [1.406–5.411]), hyperoxia + hyperoxemia (OR 1.144 [1.008–1.298]), and daily excess O2 (OR 1.003 [1.001–1.005]) were associated with higher risk for ICU-mortality, independently of age, Sequential Organ failure Assessment score at ICU-admission and mean PaO2/FiO2. Hyperoxemia (OR 1.033 [1.006–1.061]), time of exposure to hyperoxemia (OR 1.108 [1.018–1.206]), hyperoxia + hyperoxemia (OR 1.038 [1.003–1.075]), and daily excess O2 (OR 1.001 [1.000–1.001]) were identified as risk factors for VAP, independently of body mass index, blood transfusions, days of neuromuscular blocking agents (before VAP), prolonged prone positioning and mean PaO2/FiO2 before VAP. Conclusion: Excess O2 administration and hyperoxemia were common in mechanically ventilated patients with SARS-CoV-2 pneumonia. The exposure to hyperoxemia may be associated with ICU-mortality and greater risk for VAP.
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Hypotension Prediction Index Software to Prevent Intraoperative Hypotension during Major Non-Cardiac Surgery: Protocol for a European Multicenter Prospective Observational Registry (EU-HYPROTECT)
Anno: 2022
Rivista: JOURNAL OF CLINICAL MEDICINE
Autori/autrici: Monge García, Manuel Ignacio; García-López, Daniel; Gayat, Étienne; Sander, Michael; Bramlage, Peter; Cerutti, Elisabetta; Davies, Simon James; Donati, Abele; Draisci, Gaetano; Frey, Ulrich H; Noll, Eric; Ripollés-Melchor, Javier; Wulf, Hinnerk; Saugel, Bernd
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/307661
Citazioni:
Hypotension Prediction Index Software to Prevent Intraoperative Hypotension during Major Non-Cardiac Surgery: Protocol for a European Multicenter Prospective Observational Registry (EU-HYPROTECT) / Monge García, M.I., García-López, D., Gayat, É., Sander, M., Bramlage, P., Cerutti, E., Davies, S.J., Donati, A., Draisci, G., Frey, U.H., Noll, E., Ripollés-Melchor, J., Wulf, H., Saugel, B.. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 11:19(2022), p. 5585. [10.3390/jcm11195585]
Abstract:
Intraoperative hypotension is common in patients having non-cardiac surgery and associated with postoperative acute myocardial injury, acute kidney injury, and mortality. Avoiding intraoperative hypotension is a complex task for anesthesiologists. Using artificial intelligence to predict hypotension... from clinical and hemodynamic data is an innovative and intriguing approach. The AcumenTM Hypotension Prediction Index (HPI) software (Edwards Lifesciences; Irvine, CA, USA) was developed using artificial intelligence-specifically machine learning-and predicts hypotension from blood pressure waveform features. We aimed to describe the incidence, duration, severity, and causes of intraoperative hypotension when using HPI monitoring in patients having elective major non-cardiac surgery.
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Microvascular dysfunction in pediatric patients with SARS-COV-2 pneumonia: report of three severe cases
Anno: 2022
Rivista: MICROVASCULAR RESEARCH
Autori/autrici: Bottari, G; Damiani, E; Confalone, V; Scorcella, C; Casarotta, E; Gandolfo, C; Stoppa, F; Cecchetti, C; Donati, A
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/304471
Citazioni:
Microvascular dysfunction in pediatric patients with SARS-COV-2 pneumonia: report of three severe cases / Bottari, G., Damiani, E., Confalone, V., Scorcella, C., Casarotta, E., Gandolfo, C., Stoppa, F., Cecchetti, C., Donati, A.. - In: MICROVASCULAR RESEARCH. - ISSN 0026-2862. - STAMPA. - 141:(2022), p. 104312. [10.1016/j.mvr.2022.104312]
Abstract:
The coronavirus 19 (COVID-19) pandemic has affected hundreds of millions of people worldwide: in most of cases children and young people developed asymptomatic or pauci-symptomatic clinical pictures. However authors have showed that there are some categories of childhood more vulnerable to COVID-19 ...infection such as newborns or children with comorbidities. We report for the first time to the best of our knowledge about microvascular dysfunction in three pediatric clinical cases who developed COVID-19 infections with need of pediatric critical care. We found that sublingual microcirculation is altered in children with severe COVID-19 infection. Our findings confirmed most of data already observed by other authors in adult population affected by severe COVID-19 infection, but with distinct characteristics than microcirculation alterations previous observed in a clinical case of MIS-C. However we cannot establish direct correlation between microcirculation analysis and clinical or laboratory parameters in our series, by our experience we have found that sublingual microcirculation analysis allow clinicians to report directly about microcirculation dysfunction in COVID-19 patients and it could be a valuable bedside technique to monitor thrombosis complication in this population.
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Antibiotic Treatment of Acinetobacter baumannii Superinfection in Patients With SARS-CoV-2 Infection Admitted to Intensive Care Unit: An Observational Retrospective Study
Anno: 2022
Rivista: FRONTIERS IN MEDICINE
Autori/autrici: Casarotta, Erika; Bottari, Elisa; Vannicola, Sara; Giorgetti, Rachele; Domizi, Roberta; Carsetti, Andrea; Damiani, Elisa; Scorcella, Claudia; Gabbanelli, Vincenzo; Pantanetti, Simona; Marini, Benedetto; Donati, Abele; Adrario, Erica
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/304470
Citazioni:
Antibiotic Treatment of Acinetobacter baumannii Superinfection in Patients With SARS-CoV-2 Infection Admitted to Intensive Care Unit: An Observational Retrospective Study / Casarotta, E., Bottari, E., Vannicola, S., Giorgetti, R., Domizi, R., Carsetti, A., Damiani, E., Scorcella, C., Gabbanelli, V., Pantanetti, S., Marini, B., Donati, A., Adrario, E.. - In: FRONTIERS IN MEDICINE. - ISSN 2296-858X. - 9:(2022), p. 910031.910031. [10.3389/fmed.2022.910031]
Abstract:
Introduction: In COVID-19 patients on mechanical ventilation, VAP from Acinetobacter baumannii remains a crucial risk factor for death. Antibiotic resistance represents an important problem in treating this infection. This study aims to describe the evolution of the superinfection from PDR Acinetoba...cter baumannii in patients with acute respiratory failure from SARS-CoV-2 infection admitted to ICU and compare the impact of two different antibiotic strategies on microbiological negativization. Methods: Single-center observational retrospective study, including patients admitted to our ICU from March 2020 to May 2021 for acute respiratory failure from SARS-CoV-2 infection who developed PDR Acinetobacter baumannii superinfection. Clinical data at ICU admission were collected, as well as the timing of isolation of Acinetobacter baumannii, its resistance profile, the site of infection, and the antibiotic therapy. Results: Of the 32 patients enrolled, 10 patients (31.2%) were treated with the combination of high-dose ampicillin/sulbactam, high-dose tigecycline, intravenous and inhaled colistin (Protocol), the other 22 (68.8%) were treated with the combination of two antibiotics (Control). Of the 10 patients in the Protocol group, 8 patients (80%) received also fosfomycin. All patients (100%) in the Protocol group had microbiological negativization, while in the Control group microbiological negativization was observed in 8 (36.4%) patients, p &lt; 0.01. Conclusion: Our report shows microbiological negativization in all patients treated with the combination therapy of nebulized and intravenous colistin, high-dose tigecycline, and high-dose ampicillin/sulbactam. This combination of antibiotics seems to be a useful alternative when other treatments are not available or fail.
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Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis
Anno: 2022
Rivista: ANESTHESIA AND ANALGESIA
Autori/autrici: Carsetti, Andrea; Sorbello, Massimiliano; Adrario, Erica; Donati, Abele; Falcetta, Stefano
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/293982
Citazioni:
Airway Ultrasound as Predictor of Difficult Direct Laryngoscopy: A Systematic Review and Meta-analysis / Carsetti, A., Sorbello, M., Adrario, E., Donati, A., Falcetta, S.. - In: ANESTHESIA AND ANALGESIA. - ISSN 0003-2999. - STAMPA. - 134:4(2022), pp. 740-750. [10.1213/ANE.0000000000005839]
Abstract:
Background: Despite several clinical index tests that are currently applied for airway assessment, unpredicted difficult laryngoscopy may still represent a serious problem in anesthesia practice. The aim of this systematic review and meta-analysis was to evaluate whether preoperative airway ultrasou...nd can predict difficult direct laryngoscopy in adult patients undergoing elective surgery under general anesthesia. Methods: We searched the Medline, Scopus, and Web of Science databases from their inception to December 2020. The population of interest included adults who required tracheal intubation for elective surgery under general anesthesia without clear anatomical abnormalities suggesting difficult laryngoscopy. A bivariate model has been used to assess the accuracy of each ultrasound index test to predict difficult direct laryngoscopy. Results: Fifteen studies have been considered for quantitative analysis of summary receiver operating characteristic (SROC). The sensitivity for distance from skin to epiglottis (DSE), distance from skin to hyoid bone (DSHB), and distance from skin to vocal cords (DSVC) was 0.82 (0.74-0.87), 0.71 (0.58-0.82), and 0.75 (0.62-0.84), respectively. The specificity for DSE, DSHB, and DSVC was 0.79 (0.70-0.87), 0.71 (0.57-0.82), and 0.72 (0.45-0.89), respectively. The area under the curve (AUC) for DSE, DSHB, DSVC, and ratio between the depth of the pre-epiglottic space and the distance from the epiglottis to the vocal cords (Pre-E/E-VC) was 0.87 (0.84-0.90), 0.77 (0.73-0.81), 0.78 (0.74-0.81), and 0.71 (0.67-0.75), respectively. Patients with difficult direct laryngoscopy have higher DSE, DSVC, and DSHB values than patients with easy laryngoscopy, with a mean difference of 0.38 cm (95% confidence interval [CI], 0.17-0.58 cm; P = .0004), 0.18 cm (95% CI, 0.01-0.35 cm; P = .04), and 0.23 cm (95% CI, 0.08-0.39 cm; P = .004), respectively. Conclusions: Our study demonstrates that airway ultrasound index tests are significantly different between patients with easy versus difficult direct laryngoscopy, and the DSE is the most studied index test in literature to predict difficult direct laryngoscopy. However, it is not currently possible to reach a definitive conclusion. Further studies are needed with better standardization of ultrasound assessment to limit all possible sources of heterogeneity.
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Editorial: Putting the Spotlight on the Role of Oxygen in Critically-Ill Patients: From Basic Mechanisms to Clinical Effects
Anno: 2022
Rivista: FRONTIERS IN MEDICINE
Autori/autrici: Busani, S.; Munari, E.; Taccone, F. S.; Donati, A.; Girardis, M.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/365512
Citazioni:
Editorial: Putting the Spotlight on the Role of Oxygen in Critically-Ill Patients: From Basic Mechanisms to Clinical Effects / Busani, S., Munari, E., Taccone, F.S., Donati, A., Girardis, M.. - In: FRONTIERS IN MEDICINE. - ISSN 2296-858X. - 9:(2022). [10.3389/fmed.2022.859632]

Cluster analysis identifies patients at risk of catheter- associated urinary tract infections in intensive care units: findings from the SPIN-UTI Network
Anno: 2021
Rivista: THE JOURNAL OF HOSPITAL INFECTION
Autori/autrici: Barchitta, M.; Maugeri, A.; Favara, G.; Riela, P. M.; La Mastra, C.; La Rosa, M. C.; Magnano San Lio, R.; Gallo, G.; Mura, I; Agodi, A.; behalf of the SPIN-UTI Network, On; D'Errico, Marcello Mario; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/286202
Citazioni:
Cluster analysis identifies patients at risk of catheter- associated urinary tract infections in intensive care units: findings from the SPIN-UTI Network / Barchitta, M., Maugeri, A., Favara, G., Riela, P.M., La Mastra, C., La Rosa, M.C., Magnano San Lio, R., Gallo, G., Mura, I., Agodi, A., behalf of the SPIN-UTI Network, O.n., D'Errico, M.M., Donati, A.. - In: THE JOURNAL OF HOSPITAL INFECTION. - ISSN 0195-6701. - ELETTRONICO. - 107:(2021), pp. 57-63. [10.1016/j.jhin.2020.09.030]
Abstract:
Background: Although preventive strategies have been proposed against catheter- associated urinary tract infections (CAUTIs) in intensive care units (ICUs), more efforts are needed to control the incidence rate. Aim: To distinguish patients according to their characteristics at ICU admission, and t...o identify clusters of patients at higher risk for CAUTIs. Methods: A two-step cluster analysis was conducted on 9656 patients from the Italian Nosocomial Infections Surveillance in Intensive Care Units project. Findings: Three clusters of patients were identified. Type of admission, patient origin and administration of antibiotics had the greatest weight on the clustering model. Cluster 1 comprised more patients with a medical type of ICU admission who came from the com- munity. Cluster 2 comprised patients who were more likely to come from other wards/ hospitals, and to report administration of antibiotics 48 h before or after ICU admission. Cluster 3 was similar to Cluster 2 but was characterized by a lower percentage of patients with administration of antibiotics 48 h before or after ICU admission. Patients in Clusters 1 and 2 had a longer duration of urinary catheterization [median 7 days, interquartile range (IQR) 12 days for Cluster 1; median 7 days, IQR 11 days for Cluster 2] than patients in Cluster 3 (median 6 days, IQR 8 days; P<0.001). Interestingly, patients in Cluster 1 had a higher incidence of CAUTIs (3.5 per 100 patients) compared with patients in the other two clusters (2.5 per 100 patients in both clusters; P1⁄40.033). Conclusion: To the authors’ knowledge, this is the first study to use cluster analysis to identify patients at higher risk of CAUTIs who could gain greater benefit from preventive strategies.
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Rationale for Polyclonal Intravenous Immunoglobulin Adjunctive Therapy in COVID-19 Patients: Report of a Structured Multidisciplinary Consensus
Anno: 2021
Rivista: JOURNAL OF CLINICAL MEDICINE
Autori/autrici: Coloretti, Irene; Berlot, Giorgio; Busani, Stefano; De Rosa, Francesco Giuseppe; Donati, Abele; Forfori, Francesco; Grasselli, Giacomo; Mirabella, Lucia; Tascini, Carlo; Viale, Pierluigi; Girardis, Massimo
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/291529
Citazioni:
Rationale for Polyclonal Intravenous Immunoglobulin Adjunctive Therapy in COVID-19 Patients: Report of a Structured Multidisciplinary Consensus / Coloretti, I., Berlot, G., Busani, S., De Rosa, F.G., Donati, A., Forfori, F., Grasselli, G., Mirabella, L., Tascini, C., Viale, P., Girardis, M.. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - ELETTRONICO. - 10:16(2021), p. 3500. [10.3390/jcm10163500]

Tocilizumab in COVID-19 interstitial pneumonia
Anno: 2021
Rivista: JOURNAL OF INTERNAL MEDICINE
Autori/autrici: Pomponio, G; Ferrarini, A; Bonifazi, M; Moretti, M; Salvi, A; Giacometti, A; Tavio, M; Titolo, G; Morbidoni, L; Frausini, G; Onesta, M; Amico, D; B Rocchi, M L; Menzo, S; Zuccatosta, L; Mei, F; Menditto, V; Svegliati, S; Donati, A; M D'Errico, M; Pavani, M; Gabrielli, A
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/290128
Citazioni:
Tocilizumab in COVID-19 interstitial pneumonia / Pomponio, G., Ferrarini, A., Bonifazi, M., Moretti, M., Salvi, A., Giacometti, A., Tavio, M., Titolo, G., Morbidoni, L., Frausini, G., Onesta, M., Amico, D., B Rocchi, M.L., Menzo, S., Zuccatosta, L., Mei, F., Menditto, V., Svegliati, S., Donati, A., M D'Errico, M., et al.. - In: JOURNAL OF INTERNAL MEDICINE. - ISSN 0954-6820. - ELETTRONICO. - 289:5(2021), pp. 738-746. [10.1111/joim.13231]
Abstract:
Background: Published reports on tocilizumab in COVID-19 pneumonitis show conflicting results due to weak designs or heterogeneity in critical methodological issues. Methods: This open-label trial, structured according to Simon's optimal design, aims to identify factors predicting which patient...s could benefit from anti-IL6 strategies and to enhance the design of unequivocal and reliable future randomized trials. A total of 46 patients with COVID-19 pneumonia needing of oxygen therapy to maintain SO2 &gt; 93% and with recent worsening of lung function received a single infusion of tocilizumab. Clinical and biological markers were measured to test their predictive values. Primary end point was early and sustained clinical response. Results: Twenty-one patients fulfilled pre-defined response criteria. Lower levels of IL-6 at 24 h after tocilizumab infusion (P = 0.049) and higher baseline values of PaO2/FiO2 (P = 0.008) predicted a favourable response. Conclusions: Objective clinical response rate overcame the pre-defined threshold of 30%. Efficacy of tocilizumab to improve respiratory function in patients selected according to our inclusion criteria warrants investigations in randomized trials.
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Effects of Normoxia, Hyperoxia, and Mild Hypoxia on Macro-Hemodynamics and the Skeletal Muscle Microcirculation in Anesthetised Rats
Anno: 2021
Rivista: FRONTIERS IN MEDICINE
Autori/autrici: Damiani, E.; Casarotta, E.; Orlando, F.; Carsetti, A.; Scorcella, C.; Domizi, R.; Adrario, E.; Ciucani, S.; Provinciali, M.; Donati, A.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/291390
Citazioni:
Effects of Normoxia, Hyperoxia, and Mild Hypoxia on Macro-Hemodynamics and the Skeletal Muscle Microcirculation in Anesthetised Rats / Damiani, E., Casarotta, E., Orlando, F., Carsetti, A., Scorcella, C., Domizi, R., Adrario, E., Ciucani, S., Provinciali, M., Donati, A.. - In: FRONTIERS IN MEDICINE. - ISSN 2296-858X. - ELETTRONICO. - 8:(2021). [10.3389/fmed.2021.672257]
Abstract:
Objectives: Excessive oxygen (O2) administration may have a negative impact on tissue perfusion by inducing vasoconstriction and oxidative stress. We aimed to evaluate the effects of different inhaled oxygen fractions (FiO2) on macro-hemodynamics and microvascular perfusion in a rat model. Methods: ...Isoflurane-anesthetised spontaneously breathing male Wistar rats were equipped with arterial (carotid artery) and venous (jugular vein) catheters and tracheotomy, and randomized into three groups: normoxia (FiO2 21%, n = 6), hyperoxia (FiO2 100%, n = 6) and mild hypoxia (FiO2 15%, n = 6). Euvolemia was maintained by infusing Lactate Ringer solution at 10 ml/kg/h. At hourly intervals for 4 h we collected measurements of: mean arterial pressure (MAP); stroke volume index (SVI), heart rate (HR), respiratory rate (by means of echocardiography); arterial and venous blood gases; microvascular density, and flow quality (by means of sidestream dark field videomicroscopy on the hindlimb skeletal muscle). Results: MAP and systemic vascular resistance index increased with hyperoxia and decreased with mild hypoxia (p < 0.001 in both cases, two-way analysis of variance). Hyperoxia induced a reduction in SVI, while this was increased in mild hypoxia (p = 0.002). The HR increased under hyperoxia (p < 0.05 vs. normoxia at 3 h). Cardiax index, as well as systemic O2 delivery, did not significantly vary in the three groups (p = 0.546 and p = 0.691, respectively). At 4 h, microvascular vessel surface (i.e., the percentage of tissue surface occupied by vessels) decreased by 29 ± 4% in the hyperoxia group and increased by 19 ± 7 % in mild hypoxia group (p < 0.001). Total vessel density and perfused vessel density showed similar tendencies (p = 0.003 and p = 0.005, respectively). Parameters of flow quality (microvascular flow index, percentage of perfused vessels, and flow heterogeneity index) remained stable and similar in the three groups. Conclusions: Hyperoxia induces vasoconstriction and reduction in skeletal muscle microvascular density, while mild hypoxia has an opposite effect.
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ECMO for COVID-19 patients in Europe and Israel
Anno: 2021
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Lorusso, R.; Combes, A.; Coco, V. L.; De Piero, M. E.; Belohlavek, J.; Delnoij, T.; van der Horst, I.; Miranda, D. R.; van der Linden, M.; van der Heijden, J. J.; Scholten, E.; van Belle-van Haren, N.; Lagrand, W.; de Jong, S.; Candura, D.; Maas, J.; van den Berg, M. J. G.; Malfertheiner, M.; Dreier, E.; Mueller, T.; Boeken, U.; Akhyari, P.; Lichtenberg, A.; Saeed, D.; Thiele, H.; Baumgaertel, M.; Schmitto, J. D.; Mariani, S.; Thielmann, M.; Brenner, T.; Benk, C.; Czerny, M.; Kalbhenn, J.; Maier, S.; Schibilsky, D.; Staudacher, D. L.; Henn, P.; Iuliu, T.; Muellenbach, R.; Reyher, C.; Rolfes, C.; Zacharowski, K.; Lotz, G.; Sonntagbauer, M.; Kersten, A.; Karagiannidis, C.; Schafer, S.; Fichte, J.; Hopf, H. -B.; Samalavicius, R.; Lorini, L.; Ghitti, D.; Grazioli, L.; Loforte, A.; Baiocchi, M.; Checco, E. D.; Pacini, D.; Meani, P.; Cappai, A.; Russo, C. F.; Bottiroli, M.; Mondino, M.; Ranucci, M.; Fina, D.; Ballotta, A.; Scandroglio, A. M.; Zangrillo, A.; Pieri, M.; Nardelli, P.; Fominskiy, E.; Landoni, G.; Fanelli, V.; Brazzi, L.; Montrucchio, G.; Sales, G.; Simonetti, U.; Urbino, R.; Livigni, S.; Degani, A.; Raffa, G.; Pilato, M.; Martucci, G.; Arcadipane, A.; Chiarini, G.; Latronico, N.; Cattaneo, S.; Puglia, C.; Reina, G.; Sponga, S.; Livi, U.; Foti, G.; Giani, M.; Rona, R.; Avalli, L.; Bombino, M.; Costa, M. C.; Carozza, R.; Donati, A.; Piciche, M.; Favaro, A.; Salvador, L.; Danzi, V.; Zanin, A.; Condello, I.; Fiore, F.; Moscarelli, M.; Nasso, G.; Speziale, G.; Sandrelli, L.; Montalto, A.; Musumeci, F.; Circelli, A.; Gamberini, E.; Russo, E.; Benni, M.; Agnoletti, V.; Rociola, R.; Milano, A. D.; Grasso, S.; Civita, A.; Murgolo, F.; Pilato, E.; Comentale, G.; Montisci, A.; Alessandri, F.; Tosi, A.; Pugliese, F.; Carelli, S.; Grieco, D. L.; Antonelli, M.; Ramoni, E.; Di Nardo, M.; Maisano, F.; Bettex, D.; Weber, A.; Grunenfelder, J.; Consiglio, J.; Hansjoerg, J.; Haenggi, M.; Agus, G.; Doeble, T.; Zenklusen, U.; Bechtold, X.; Stockman, B.; De Backer, D.; Giglioli, S.; Meyns, B.; Vercaemst, L.; Herman, G.; Meersseman, P.; Vandenbriele, C.; Dauwe, D.; Vlasselaers, D.; Raes, M.; Debeuckelaere, G.; Rodrigus, I.; Biston, P.; Piagnerelli, M.; Peperstraete, H.; Germay, O.; Vandewiele, K.; Vandeweghe, D.; Witters, I.; Havrin, S.; Bourgeois, M.; Taccone, F. S.; Nobile, L.; Lheureux, O.; Brasseur, A.; Creteur, J.; Defraigne, J. -O.; Misset, B.; Courcelle, R.; Timmermans, P. J.; Lehaen, J.; Frederik, B.; Riera, J.; Castro, M. A.; Gallart, E.; Martinez-Martinez, M.; Argudo, E.; Garcia-de-Acilu, M.; de Pablo Sanchez, R.; Ortiz, A. B.; Cabanes, M. -P. F.; Higa, K. O.; Cassina, A. M.; Berbel, D. O.; Sanchez-Salado, J. C.; Arnau, B. -L.; de Gopegui, P. R.; Ricart, P.; Sandoval, E.; Veganzones, J.; Millan, P.; de la Sota, P.; Santa Teresa, P.; Alcantara, S.; Alvarez, J. D.; Gonzalez, A. V.; Lopez, M.; Gordillo, A.; Naranjo-Izurieta, J.; Costa, R. G.; Albacete Moreno, C. L.; de Ayala, J. A.; Blanco-Schweizer, P.; Andres, N. H.; Boado, V.; Martinez, J. M. N.; Casal, V. G.; Garcia, E. F.; Martin-Villen, L.; Climent, J. C.; Pinto, L. F.; Leprince, P.; Lebreton, G.; Juvin, C.; Schmidt, M.; Pineton, M.; Folliguet, T.; Saiydoun, G.; Gaudard, P.; Colson, P.; Obadia, J. -F.; Pozzi, M.; Fellahi, J. L.; Yonis, H.; Richard, J. C.; Parasido, A.; Verhoye, J. -P.; Flecher, E.; Ajrhourh, L.; Nesseler, N.; Mansour, A.; Guinot, P. -G.; Zarka, J.; Besserve, P.; Makhoul, M.; Bolotin, G.; Kassif, Y.; Soufleris, D.; Schellongowski, P.; Bonaros, N.; Krapf, C.; Ebert, K.; Mair, P.; Kothleutner, F.; Kowalewsky, M.; Christensen, S.; Pedersen, F. M.; Balik, M.; Blaha, J.; Lips, M.; Otahal, M.; Camporota, L.; Daly, K.; Agnew, N.; Barker, J.; Head, L.; Garcia, M.; Ledot, S.; Aquino, V.; Lewis, R.; Worthy, J.; Noor, H.; Scott, I.; O'Brien, S.; Conrick-Martin, I.; Carton, E.; Gillon, S.; Scott, I.; Flemming, L.; Broman, L. M.; Grins, E.; Ketskalo, M.; Tsarenko, S.; Popugaev, K.; Minin, S.; Kornilov, I.; Skopets, A.; Kornelyuk, R.; Turchaninov, A.; Gorjup, V.; Shelukhin, D.; Dsouki, Y. E.; Sargin, M.; Kaygin, M. A.; Liana, S.; Puss, S.; Soerensen, G.; Magnus, R.; Kanetoft, M.; Watson, P.; Redfors, B.; Krenner, N.; Velia Antonini, M.; Barrett, N. A.; Belliato, M.; Davidson, M.; Di Nardo, M.; Finney, S.; Fowles, J. -A.; Halbe, M.; Hennig, F.; Jones, T.; Mueller, T.; Pinto, L.; Smith, J.; Riera, J.; Roeleveld, P.; Swol, J.; Vercaemst, L.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/290692
Citazioni:
ECMO for COVID-19 patients in Europe and Israel / Lorusso, R., Combes, A., Coco, V.L., De Piero, M.E., Belohlavek, J., Delnoij, T., van der Horst, I., Miranda, D.R., van der Linden, M., van der Heijden, J.J., Scholten, E., van Belle-van Haren, N., Lagrand, W., de Jong, S., Candura, D., Maas, J., van den Berg, M.J.G., Malfertheiner, M., Dreier, E., Mueller, T., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - STAMPA. - 47:3(2021), pp. 344-348. [10.1007/s00134-020-06272-3]

Mid-Regional Proadrenomedullin (MR-proADM) and Microcirculation in Monitoring Organ Dysfunction of Critical Care Patients With Infection: A Prospective Observational Pilot Study
Anno: 2021
Rivista: FRONTIERS IN MEDICINE
Autori/autrici: Domizi, Roberta; Damiani, Elisa; Scorcella, Claudia; Carsetti, Andrea; Giaccaglia, Paolo; Casarotta, Erika; Montomoli, Jonathan; Gabbanelli, Vincenzo; Brugia, Marina; Moretti, Marco; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/293981
Citazioni:
Mid-Regional Proadrenomedullin (MR-proADM) and Microcirculation in Monitoring Organ Dysfunction of Critical Care Patients With Infection: A Prospective Observational Pilot Study / Domizi, R., Damiani, E., Scorcella, C., Carsetti, A., Giaccaglia, P., Casarotta, E., Montomoli, J., Gabbanelli, V., Brugia, M., Moretti, M., Adrario, E., Donati, A.. - In: FRONTIERS IN MEDICINE. - ISSN 2296-858X. - ELETTRONICO. - 8:(2021). [10.3389/fmed.2021.680244]
Abstract:
Introduction: Microvascular alterations are involved in the development of organ injury in critical care patients. Mid-regional proadrenomedullin (MR-proADM) may predict organ damage and its evolution. The main objective of this study was to assess the correlation between MR-proADM and microvascular... flow index (MFI) in a small cohort of 20 adult critical care patients diagnosed with infection, sepsis, or septic shock. Further objectives were to evaluate the correlation between the clearance of MR-proADM and the variables of microcirculation and between MR-proADM and the Sequential Organ Failure Assessment (SOFA) score. Materials and Methods: This is a prospective observational pilot study. Inclusion criteria: consecutive adult patients admitted to intensive care unit (ICU) for or with infection-related illness. Daily measurement of MR-proADM and calculation of the SOFA score from admission in ICU to day 5. Repeated evaluations of sublingual microcirculation, collection of clinical data, and laboratory tests. Results: Primary outcome: MR-proADM was not significantly correlated to the MFI at admission in ICU. A clearance of MR-proADM of 20% or more in the first 24 h was related to the improvement of the MFIs and MFIt [percentual variation of the MFIs + 12.35 (6.01-14.59)% vs. +2.23 (-4.45-6.01)%, p = 0.005; MFIt +9.09 (4.53-16.26)% vs. -1.43 (-4.36-3.12)%, p = 0.002]. Conclusion: This study did not support a direct correlation of MR-proADM with the MFI at admission in ICU; however, it showed a good correlation between the clearance of MR-proADM, MFI, and other microvascular variables. This study also supported the prognostic value of the marker. Adequately powered studies should be performed to confirm the findings.
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Early Prediction of Seven-Day Mortality in Intensive Care Unit Using a Machine Learning Model: Results from the SPIN-UTI Project
Anno: 2021
Rivista: JOURNAL OF CLINICAL MEDICINE
Autori/autrici: Barchitta, Martina; Maugeri, Andrea; Favara, Giuliana; Marco Riela, Paolo; Gallo, Giovanni; Mura, Ida; Agodi, Antonella; behalf of the SPIN-UTI network, On; D'Errico, Marcello M.; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/288970
Citazioni:
Early Prediction of Seven-Day Mortality in Intensive Care Unit Using a Machine Learning Model: Results from the SPIN-UTI Project / Barchitta, M., Maugeri, A., Favara, G., Marco Riela, P., Gallo, G., Mura, I., Agodi, A., behalf of the SPIN-UTI network, O.n., D'Errico, M.M., Donati, A.. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - ELETTRONICO. - 10:5(2021). [10.3390/jcm10050992]
Abstract:
Patients in intensive care units (ICUs) were at higher risk of worsen prognosis and mortality. Here, we aimed to evaluate the ability of the Simplified Acute Physiology Score (SAPS II) to predict the risk of 7-day mortality, and to test a machine learning algorithm which combines the SAPS II with ad...ditional patients’ characteristics at ICU admission. We used data from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” network. Support Vector Machines (SVM) algorithm was used to classify 3782 patients according to sex, patient’s origin, type of ICU admission, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II, presence of invasive devices, trauma, impaired immunity, antibiotic therapy and onset of HAI. The accuracy of SAPS II for predicting patients who died from those who did not was 69.3%, with an Area Under the Curve (AUC) of 0.678. Using the SVM algorithm, instead, we achieved an accuracy of 83.5% and AUC of 0.896. Notably, SAPS II was the variable that weighted more on the model and its removal resulted in an AUC of 0.653 and an accuracy of 68.4%. Overall, these findings suggest the present SVM model as a useful tool to early predict patients at higher risk of death at ICU admission
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Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts
Anno: 2021
Rivista: CRITICAL CARE
Autori/autrici: Sakr, Y.; Francois, B.; Sole-Violan, J.; Kotfis, K.; Jaschinski, U.; Estella, A.; Leone, M.; Jakob, S. M.; Wittebole, X.; Fontes, L. E.; De Melo Gurgel, M.; Midega, T.; Vincent, J. -L.; Ranieri, V. M.; Karth, G. D.; Draxler, V.; Filzwieser, G.; Heindl, W.; Kellner, G.; Bauer, T.; Lenz, K.; Rossmann, E.; Wiedermann, C.; Biston, P.; Chochrad, D.; Collin, V.; Damas, P.; Decruyenaere, J.; Hoste, E.; Devriendt, J.; Espeel, B.; Fraipont, V.; Installe, E.; Malbrain, M.; Nollet, G.; Preiser, J. -C.; Raemaekers, J.; Roman, A.; Simon, M.; Spapen, H.; Swinnen, W.; Vallot, F.; Vincent, J. -L.; Chytra, I.; Dadak, L.; Herold, I.; Polak, F.; Sterba, M.; Bestle, M.; Espersen, K.; Guldager, H.; Welling, K. -L.; Nyman, D.; Ruokonen, E.; Saarinen, K.; Annane, D.; Catogni, P.; Colas, G.; Coulomb, F.; Dorne, R.; Garrouste, M.; Isetta, C.; Larche, J.; Le Gall, J. -R.; Lessire, H.; Malledant, Y.; Mateu, P.; Ossart, M.; Payen, D.; Schlossmacher, P.; Timsit, J. -F.; Winnock, S.; Sollet, J. -P.; Mallet, L.; Maurer, P.; Sab, J. -M.; Aykut, G.; Brunkhorst, F.; Nierhaus, A.; Lauterbach, M.; Ragaller, M.; Gatz, R.; Gerlach, H.; Henzler, D.; Hopf, H. -B.; Hueneburg, H.; Karzai, W.; Keller, A.; Kuhlmann, U.; Langgartner, J.; Manhold, C.; Reith, B.; Schuerholz, T.; Spies, C.; Stogbauer, R.; Unterburger, J.; Clouva-Molyvdas, P. -M.; Giokas, G.; Ioannidou, E.; Lahana, A.; Liolios, A.; Marathias, K.; Nakos, G.; Tasiou, A.; Tsangaris, H.; Tamasi, P.; Marsh, B.; Power, M.; Sprung, C.; Biagioli, B.; Pallavicini, F. B.; Pesenti, A.; Capra, C.; Corte, F. D.; Donadio, P.; Donati, A.; Giarratano, A.; Giorgio, T.; Giudici, D.; Greco, S.; Guadagnucci, A.; Lapichino, G.; Livigni, S.; Moise, G.; Nardi, G.; Panascia, E.; Pizzamiglio, M.; Rosi, R.; Sicignano, A.; Solca, M.; Vignali, G.; Rinonapoli, I. V.; Barnas, M.; De Bel, E. E.; De Pont, A. -C.; Groeneveld, J.; Nijsten, M.; Sie, L. -H.; Zandstra, D. F.; Harboe, S.; Linden, S.; Lovstad, R. Z.; Moen, H.; Smith-Erichsen, N.; Piotrowski, A.; Karpel, E.; Almeida, E.; Moreno, R.; Pais-De-Lacerda, A.; Paiva, J. A.; Serra, I.; Pimentel, J. M.; Filipescu, D.; Jovanovic, K.; Malik, P.; Lucka, K.; Voga, G.; Alvarez-Santullano, C. A.; Artigas, A.; Zavala, E.; Escorsell, A.; Nicolas, J.; Cea, J. J. I.; Marina, L.; Montejo, J.; Palencia, E.; Santos, F.; Sierra-Camerino, R.; Sipmann, F.; Brodersen, K.; Haggqvist, J.; Hermansson, D.; Hjelmqvist, H.; Heer, K.; Loderer, G.; Maggiorini, M.; Zender, H.; Andrews, P.; Appadu, B.; Groba, C. B.; Bewley, J.; Burchett, K.; Chambers, P.; Coakley, J.; Doberenz, D.; Eastwood, N.; Ferguson, A.; Fielden, J.; Gedney, J.; Gunning, K.; Harling, D.; Jankowski, S.; Jayson, D.; Kilner, A.; Krishna-Kumar, V.; Lei, K.; Mackenzie, S.; Macnaughton, P.; Marx, G.; Mcculloch, C.; Morgan, P.; Rhodes, A.; Roberts, C.; Russell, M.; Tupper-Carey, D.; Wright, M.; Twohey, L.; Watts, J.; Webster, R.; Williams, D.; Urbanek, P.; Schlieber, J.; Reisinger, J.; Auer, J.; Hartjes, A.; Lerche, A.; Janous, T.; Kink, E.; Krahulec, W.; Smolle, K. -H.; Van Der Schueren, M.; Thibo, P.; Vanhoof, M.; Ahmet, I.; Gadisseux, P.; Dufaye, P.; Jacobs, O.; Dive, A.; Bouckaert, Y.; Gilbert, E.; Gressens, B.; Pinck, E.; De Waele, J. J.; Rimachi, R.; Gusu, D.; De Decker, K.; Mandianga, K.; Heytens, L.; Van Collie, O.; Vandenheede, W.; Rogiers, P.; Pavlik, P.; Manak, J.; Kieslichova, E.; Turek, R.; Fischer, M.; Valkova, R.; Dostal, P.; Malaska, J.; Hajek, R.; Zidkova, A.; Lavicka, P.; Kolodzeike, P.; Kruse, M.; Andersen, T.; Harjola, V. -P.; Durocher, A.; Moulront, S.; Lepape, A.; Losser, M. -R.; Cabaret, P.; Kalaitzis, E.; Zogheib, E.; Charve, P.; Lefrant, J. -Y.; Beilouny, B.; Forceville, X.; Misset, B.; Jacobs, F.; Floccard, B.; Wynckel, A.; Castelain, V.; Faure, A.; Lavagne, P.; Lepoivre, T.; Moussa, M. D.; Vieillard-Baron, A.; Durand, M.; Gainnier, M.; Ichai, C.; Arens, S.; Hoffmann, C.; Kaffarnik, M.; Scharnofske, C. -J.; Voigt, I.; Peckelsen, C.; Weber, M.; Gille, J.; Lange, A.; Schoser, G.; Sablotzki, A.; Bluethgen, A.; Vogel, F.; Tscheu, A.; Fuchs, T.; Wattenberg, M.; Helmes, T.; Scieszka, S.; Heintz, M.; Sakka, S.; Kohler, J.; Fiedler, F.; Danz, M.; Riessen, R.; Kerz, T.; Kersten, A.; Tacke, F.; Marx, G.; Volkert, T.; Schmutz, A.; Kluge, S.; Abel, P.; Janosi, R. A.; Utzolino, S.; Bracht, H.; Toussaint, S.; Peftoulidou, M. G.; Myrianthefs, P.; Armaganidis, A.; Routsi, C.; Xini, A.; Mouloudi, E.; Kokoris, I.; Kyriazopoulos, G.; Vlachos, S.; Lavrentieva, A.; Partala, P.; Medve, L.; Sarkany, A.; Kremer, I.; Marjanek, Z.; Barry, J.; O'Leary, R. A.; Motherway, C.; Faheem, M.; Dunne, E.; Donnelly, M.; Konrad, T.; Cohen, J.; Sold, O.; Bonora, E.; Achilli, C.; Rossi, S.; Castiglione, G.; Peris, A.; Albanese, D.; Stocchetti, N.; Citerio, G.; Mozzoni, L.; Sisillo, E.; De Negri, P.; Savioli, M.; Vecchiarelli, P.; Puflea, F.; Stankovic, V.; Minoja, G.; Montibeller, S.; Calligaro, P.; Sorrentino, R.; Feri, M.; Zambon, M.; Colombaroli, E.; Pellis, T.; Antonelli, M.; Gullo, A.; Chelazzi, C.; De Capraris, A.; Patroniti, N.; Girardis, M.; Franchi, F.; Berlot, G.; Ponssen, H.; Cate, J. T.; Bormans, L.; Husada, S.; Buise, M.; Van Der Hoven, B.; Reidinga, A.; Kuiper, M.; Pickkers, P.; Kluge, G.; Boer, S. D.; Kesecioglu, J.; Van Leeuwen, H.; Flaatten, H.; Mo, S.; Kolbusz, J.; Kubler, A.; Mielczarek, B.; Mikaszewska-Sokolewicz, M.; Tamowicz, B.; Sulkowski, W.; Smuszkiewicz, P.; Pihowicz, A.; Trejnowska, E.; Branco, V.; Rua, F.; Lafuente, E.; Sousa, M.; Catorze, N.; Barros, M.; Pereira, L.; De Oliveira, A. V.; Gomes, J.; Gaspar, I.; Pereira, M. F.; Cymbron, M.; Dias, A.; Beirao, S.; Ribeiro, R.; Povoa, P.; Faria, F.; Costa-E-Silva, Z.; Nobrega, J. J.; Fernandes, F.; Hagau, N.; Droc, G.; Lupu, M. N.; Nica, A.; Stoica, R.; Tomescu, D. R.; Constantinescu, D. L.; Zbaganu, G. M. V.; Slavcovici, A.; Soskic, L.; Palibrk, I.; Jankovic, R.; Jovanovic, B.; Pandurovic, M.; Bumbasirevic, V.; Uljarevic, B.; Surbatovic, M.; Ladjevic, N.; Slobodianiuk, G.; Sobona, V.; Cikova, A.; Gebhardtova, A.; Rupnik, E.; Kosec, L.; Povsic, M. K.; Osojnik, I.; Tomic, V.; Gonzalez, J.; Valenzuela, J. P.; Vidal-Cortes, P.; Posada, P.; Martin-Loeches, I.; Guillen, N. M.; Palomar, M.; Sole-Violan, J.; Torres, A.; Gallego, M. A. G.; Aguilar, G.; Allue, R. M.; Argueso, M.; Parejo, M.; Navarro, M. P.; Jose, A.; Nin, N.; Lerma, F. A.; Martinez, O.; Lozano, E. T.; Lopez, S. A.; Granda, M. J. P.; Moreno, S.; Llubia, C.; De La Fuente Martos, C.; Gonzalez-Arenas, P.; Fernandez, N. L.; Rueda, B. G.; Pons, I. E.; Cruza, N.; Maroto, F.; Ferrer, A.; Fraile, L. I.; Quindos, B.; Quintano, A.; Tebar, M. T.; Cardinal, P.; Reyes, A.; Rodriguez, A.; Abella, A.; Del Valle, S. G.; Yus, S.; Maseda, E.; Berezo, J. A.; Pedregosa, A. T.; Laplaza, C.; Ferrer, R.; Rico-Feijoo, J.; Rodriguez, M.; Monedero, P.; Eriksson, K.; Chabanel, D.; Frankenberger, B.; Jakob, S.; Matthew, S.; Downes, R.; Johnston, A.; Meacher, R.; Keays, R.; Haji-Michael, P.; Tyler, C.; Jones, S.; Tyl, D.; Ball, A.; Vogel, J.; Booth, M.; Downie, P.; Watters, M.; Brett, S.; Garfield, M.; Everett, L.; Heenen, S.; Dhir, S.; Beardow, Z.; Mostert, M.; Brosnan, S.; Pinto, N.; Harris, S.; Summors, A.; Norton, A.; Rose, A.; Appelboam, R.; Davies, O.; Vickers, E.; Agarwal, B.; Szakmany, T.; Wimbush, S.; Welters, I.; Pearse, R.; Hollands, R.; Kirk-Bayley, J.; Fletcher, N.; Bray, B.; Brealey, D.; Alexander, P.; Henderson, S.; Hargreaves, C.; Black, H.; Gowda, K.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/365516
Citazioni:
Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts / Sakr, Y., Francois, B., Sole-Violan, J., Kotfis, K., Jaschinski, U., Estella, A., Leone, M., Jakob, S.M., Wittebole, X., Fontes, L.E., De Melo Gurgel, M., Midega, T., Vincent, J.-L., Ranieri, V.M., Karth, G.D., Draxler, V., Filzwieser, G., Heindl, W., Kellner, G., Bauer, T., et al.. - In: CRITICAL CARE. - ISSN 1364-8535. - 25:1(2021). [10.1186/s13054-020-03455-8]
Abstract:
Background: Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients.... Methods: This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24&nbsp;h. In both studies, patients were followed for outcome until death, hospital discharge or for 60&nbsp;days. Results: The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24&nbsp;h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (&gt; 29 cmH2O) and driving pressure (&gt; 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (&gt; 8&nbsp;ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion: The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure &gt; 29 cmH2O and driving pressure &gt; 14 cmH2O on the first day of mechanical ventilation but not tidal volume &gt; 8&nbsp;ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies.
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Machine learning using the extreme gradient boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients
Anno: 2021
Rivista: JOURNAL OF INTENSIVE MEDICINE
Autori/autrici: Montomoli, Jonathan; Romeo, Luca; Moccia, Sara; Bernardini, Michele; Migliorelli, Lucia; Berardini, Daniele; Donati, Abele; Carsetti, Andrea; Bocci, Maria Grazia; Wendel Garcia, Pedro David; Fumeaux, Thierry; Guerci, Philippe; Schüpbach, Reto Andreas; Ince, Can; Frontoni, Emanuele; Hilty, Matthias Peter; Alfaro-Farias, Mario; Vizmanos-Lamotte, Gerardo; Tschoellitsch, Thomas; Meier, Jens; Aguirre-Bermeo, Hernán; Apolo, Janina; Martínez, Alberto; Jurkolow, Geoffrey; Delahaye, Gauthier; Novy, Emmanuel; Losser, Marie-Reine; Wengenmayer, Tobias; Rilinger, Jonathan; Staudacher, Dawid L.; David, Sascha; Welte, Tobias; Stahl, Klaus; Pavlos”, “Agios; Aslanidis, Theodoros; Korsos, Anita; Babik, Barna; Nikandish, Reza; Rezoagli, Emanuele; Giacomini, Matteo; Nova, Alice; Fogagnolo, Alberto; Spadaro, Savino; Ceriani, Roberto; Murrone, Martina; Wu, Maddalena A.; Cogliati, Chiara; Colombo, Riccardo; Catena, Emanuele; Turrini, Fabrizio; Simonini, Maria Sole; Fabbri, Silvia; Potalivo, Antonella; Facondini, Francesca; Gangitano, Gianfilippo; Perin, Tiziana; Grazia Bocci, Maria; Antonelli, Massimo; Gommers, Diederik; Rodríguez-García, Raquel; Gámez-Zapata, Jorge; Taboada-Fraga, Xiana; Castro, Pedro; Tellez, Adrian; Lander-Azcona, Arantxa; Escós-Orta, Jesús; Martín-Delgado, Maria C.; Algaba-Calderon, Angela; Franch-Llasat, Diego; Roche-Campo, Ferran; Lozano-Gómez, Herminia; Zalba-Etayo, Begoña; Michot, Marc P.; Klarer, Alexander; Ensner, Rolf; Schott, Peter; Urech, Severin; Zellweger, Nuria; Merki, Lukas; Lambert, Adriana; Laube, Marcus; Jeitziner, Marie M.; Jenni-Moser, Beatrice; Wiegand, Jan; Yuen, Bernd; Lienhardt-Nobbe, Barbara; Westphalen, Andrea; Salomon, Petra; Drvaric, Iris; Hillgaertner, Frank; Sieber, Marianne; Dullenkopf, Alexander; Petersen, Lina; Chau, Ivan; Ksouri, Hatem; Sridharan, Govind Oliver; Cereghetti, Sara; Boroli, Filippo; Pugin, Jerome; Grazioli, Serge; Rimensberger, Peter C.; Bürkle, Christian; Marrel, Julien; Brenni, Mirko; Fleisch, Isabelle; Lavanchy, Jerome; Perez, Marie-Helene; Ramelet, Anne-Sylvie; Weber, Anja Baltussen; Gerecke, Peter; Christ, Andreas; Ceruti, Samuele; Glotta, Andrea; Marquardt, Katharina; Shaikh, Karim; Hübner, Tobias; Neff, Thomas; Redecker, Hermann; Moret-Bochatay, Mallory; Bentrup, FriederikeMeyer zu; Studhalter, Michael; Stephan, Michael; Brem, Jan; Gehring, Nadine; Selz, Daniela; Naon, Didier; Kleger, Gian-Reto; Pietsch, Urs; Filipovic, Miodrag; Ristic, Anette; Sepulcri, Michael; Heise, Antje; Franchitti Laurent, Marilene; Laurent, Jean-Christophe; Wendel Garcia, Pedro D.; Schuepbach, Reto; Heuberger, Dorothea; Bühler, Philipp; Brugger, Silvio; Fodor, Patricia; Locher, Pascal; Camen, Giovanni; Gaspert, Tomislav; Jovic, Marija; Haberthuer, Christoph; Lussman, Roger F.; Colak, Elif
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/293984
Citazioni:
Machine learning using the extreme gradient boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients / Montomoli, J., Romeo, L., Moccia, S., Bernardini, M., Migliorelli, L., Berardini, D., Donati, A., Carsetti, A., Bocci, M.G., Wendel Garcia, P.D., Fumeaux, T., Guerci, P., Schüpbach, R.A., Ince, C., Frontoni, E., Hilty, M.P., Alfaro-Farias, M., Vizmanos-Lamotte, G., Tschoellitsch, T., Meier, J., et al.. - In: JOURNAL OF INTENSIVE MEDICINE. - ISSN 2667-100X. - ELETTRONICO. - 1:2(2021), pp. 110-116. [10.1016/j.jointm.2021.09.002]
Abstract:
Background: Accurate risk stratification of critically ill patients with coronavirus disease 2019 (COVID-19) is essential for optimizing resource allocation, delivering targeted interventions, and maximizing patient survival probability. Machine learning (ML) techniques are attracting increased inte...rest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care. Methods: We retrieved data on patients with COVID-19 admitted to an intensive care unit (ICU) between March and October 2020 from the RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry. We applied the Extreme Gradient Boosting (XGBoost) algorithm to the data to predict as a binary out- come the increase or decrease in patients’ Sequential Organ Failure Assessment (SOFA) score on day 5 after ICU admission. The model was iteratively cross-validated in different subsets of the study cohort. Results: The final study population consisted of 675 patients. The XGBoost model correctly predicted a decrease in SOFA score in 320/385 (83%) critically ill COVID-19 patients, and an increase in the score in 210/290 (72%) patients. The area under the mean receiver operating characteristic curve for XGBoost was significantly higher than that for the logistic regression model (0.86 vs . 0.69, P < 0.01 [paired t -test with 95% confidence interval]). Conclusions: The XGBoost model predicted the change in SOFA score in critically ill COVID-19 patients admitted to the ICU and can guide clinical decision support systems (CDSSs) aimed at optimizing available resources.
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Adjunctive IgM-enriched immunoglobulin therapy with a personalised dose based on serum igm-titres versus standard dose in the treatment of septic shock: A randomised controlled trial (igm-fat trial)
Anno: 2021
Rivista: BMJ OPEN
Autori/autrici: Biagioni, E.; Tosi, M.; Berlot, G.; Castiglione, G.; Corona, A.; De Cristofaro, M. G.; Donati, A.; Feltracco, P.; Forfori, F.; Fragranza, F.; Murino, P.; Piazza, O.; Tullo, L.; Grasselli, G.; D'Amico, R.; Girardis, M.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/288203
Citazioni:
Adjunctive IgM-enriched immunoglobulin therapy with a personalised dose based on serum igm-titres versus standard dose in the treatment of septic shock: A randomised controlled trial (igm-fat trial) / Biagioni, E., Tosi, M., Berlot, G., Castiglione, G., Corona, A., De Cristofaro, M.G., Donati, A., Feltracco, P., Forfori, F., Fragranza, F., Murino, P., Piazza, O., Tullo, L., Grasselli, G., D'Amico, R., Girardis, M.. - In: BMJ OPEN. - ISSN 2044-6055. - ELETTRONICO. - 11:2(2021), p. e036616. [10.1136/bmjopen-2019-036616]
Abstract:
Introduction In patients with septic shock, low levels of circulating immunoglobulins are common and their kinetics appear to be related to clinical outcome. The pivotal role of immunoglobulins in the host immune response to infection suggests that additional therapy with polyclonal intravenous immu...noglobulins may be a promising option in patients with septic shock. Immunoglobulin preparations enriched with the IgM component have largely been used in sepsis, mostly at standard dosages (250 mg/kg per day), regardless of clinical severity and without any dose adjustment based on immunoglobulin serum titres or other biomarkers. We hypothesised that a personalised dose of IgM enriched preparation based on patient IgM titres and aimed to achieve a specific threshold of IgM titre is more effective in decreasing mortality than a standard dose. Methods and analysis The study is designed as a multicentre, interventional, randomised, single-blinded, prospective, investigator sponsored, two-armed study. Patients with septic shock and IgM titres <60 mg/dL will be randomly assigned to an IgM titre-based treatment or a standard treatment group in a ratio of 1:1. The study will involve 12 Italian intensive care units and 356 patients will be enrolled. Patients assigned to the IgM titre-based treatment will receive a personalised daily dose based on an IgM serum titre aimed at achieving serum titres above 100 mg/dL up to discontinuation of vasoactive drugs or day 7 after enrolment. Patients assigned to the IgM standard treatment group will receive IgM enriched preparation daily for three consecutive days at the standard dose of 250 mg/kg. The primary endpoint will be all-cause mortality at 28 days. Ethics and dissemination The study protocol was approved by the ethics committees of the coordinating centre (Comitato Etico dell'Area Vasta Emilia Nord) and collaborating centres. The results of the trial will be published within 12 months from the end of the study and the steering committee has the right to present them at public symposia and conferences. Trial registration details The trial protocol and information documents have received a favourable opinion from the Area Vasta Emilia Nord Ethical Committee on 12 September 2019. The trial protocol has been registered on EudraCT (2018-001613-33) on 18 April 2018 and on ClinicalTrials.gov (NCT04182737) on 2 December 2019.
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A machine learning approach to predict healthcare-associated infections at intensive care unit admission:findings from the SPIN-UTI project
Anno: 2021
Rivista: THE JOURNAL OF HOSPITAL INFECTION
Autori/autrici: Barchitta, M; Maugeri, A; Favara, G; M Riela, P; Gallo, G; Mura, I; Agodi, A; Network, SPIN-UTI; D'Errico, Mm; Donati, A
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/289949
Citazioni:
A machine learning approach to predict healthcare-associated infections at intensive care unit admission:findings from the SPIN-UTI project / Barchitta, M., Maugeri, A., Favara, G., M Riela, P., Gallo, G., Mura, I., Agodi, A., Network, S., D'Errico, M.m., Donati, A.. - In: THE JOURNAL OF HOSPITAL INFECTION. - ISSN 0195-6701. - ELETTRONICO. - 112:(2021), pp. 77-86. [10.1016/j.jhin.2021.02.025]
Abstract:
Background: Identifying patients at higher risk of healthcare-associated infections (HAIs) in intensive care units (ICUs) represents a major challenge for public health. Machine learning could improve patient risk stratification and lead to targeted infection prevention and control interventions. ... Aim: To evaluate the performance of the Simplified Acute Physiology Score (SAPS) II for HAI risk prediction in ICUs, using both traditional statistical and machine learning approaches. Methods: Data for 7827 patients from the 'Italian Nosocomial Infections Surveillance in Intensive Care Units' project were used in this study. The Support Vector Machines (SVM) algorithm was applied to classify patients according to sex, patient origin, non-surgical treatment for acute coronary disease, surgical intervention, SAPS II at admission, presence of invasive devices, trauma, impaired immunity, and antibiotic therapy in 48 h preceding ICU admission. Findings: The performance of SAPS II for predicting HAI risk provides a receiver operating characteristic curve with an area under the curve of 0.612 (P<0.001) and accuracy of 56%. Considering SAPS II along with other characteristics at ICU admission, the SVM classifier was found to have accuracy of 88% and an AUC of 0.90 (P<0.001) for the test set. The predictive ability was lower when considering the same SVM model but with the SAPS II variable removed (accuracy 78%, AUC 0.66). Conclusions: This study suggested that the SVM model is a useful tool for early prediction of patients at higher risk of HAIs at ICU admission.
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Candidemia in intensive care units over nine years at a large Italian university hospital: Comparison with other wards
Anno: 2021
Rivista: PLOS ONE
Autori/autrici: Mazzanti, S.; Brescini, L.; Morroni, G.; Orsetti, E.; Pocognoli, A.; Donati, A.; Cerutti, E.; Munch, C.; Montalti, R.; Barchiesi, F.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/291391
Citazioni:
Candidemia in intensive care units over nine years at a large Italian university hospital: Comparison with other wards / Mazzanti, S., Brescini, L., Morroni, G., Orsetti, E., Pocognoli, A., Donati, A., Cerutti, E., Munch, C., Montalti, R., Barchiesi, F.. - In: PLOS ONE. - ISSN 1932-6203. - ELETTRONICO. - 16:5(2021), p. e0252165. [10.1371/journal.pone.0252165]
Abstract:
Purpose Candidemia is an alarming problem in critically ill patients including those admitted in intensive care units (ICUs). We aimed to describe the clinical and microbiological characteristics of bloodstream infections (BSIs) due to Candida spp. in patients admitted to ICUs of an italian tertiary... referral university hospital over nine years. Methods A retrospective observational study of all cases of candidemia in adult patients was carried out from January 1, 2010 to December 31, 2018 at a 980-bedded University Hospital in Ancona, Italy, counting five ICUs. The incidence, demographics, clinical and microbiologic characteristics, therapeutic approaches and outcomes of ICU-patients with candidemia were collected. Non-ICU patients with candidemia hospitalized during the same time period were considered for comparison purposes. Early (7 days from the occurrence of the episode of Candida BSI) and late (30 days) mortality rates were calculated. Results During the study period, 188/505 (36%) episodes of candidemia occurred in ICU patients. Cumulative incidence was 9.9/1000 ICU admission and it showed to be stable over time. Candida albicans accounted for 52% of the cases, followed by C. parapsilosis (24%), and C. glabrata (14%). There was not a significant difference in species distribution between ICU and non-ICU patients. With the exception of isolates of C. tropicalis which showed to be fluconazole resistant in 25% of the cases, resistance to antifungals was not of concern in our patients. Early and late mortality rates, were 19% and 41% respectively, the latter being significantly higher than that observed in non-ICU patients. At multivariate analysis, factors associated with increased risk of death were septic shock, acute kidney failure, pulmonary embolism and lack of antifungal therapy. The type of antifungal therapy did not influence the outcome. Mortality did not increased significantly over time. Conclusion Neither cumulative incidence nor crude mortality of candidemia in ICU patients increased over time at our institution. However, mortality rate remained high and significantly associated with specific host-related factors in the majority of cases Copyright:
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Automated algorithm analysis of sublingual microcirculation in an international multicentral database identifies alterations associated with disease and mechanism of resuscitation
Anno: 2020
Rivista: CRITICAL CARE MEDICINE
Autori/autrici: Hilty, M. P.; Akin, S.; Boerma, C.; Donati, A.; Erdem, O.; Giaccaglia, P.; Guerci, P.; Milstein, D. M. J.; Montomoli, J.; Toraman, F.; Uz, Z.; Veenstra, G.; Ince, C.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/284031
Citazioni:
Automated algorithm analysis of sublingual microcirculation in an international multicentral database identifies alterations associated with disease and mechanism of resuscitation / Hilty, M.P., Akin, S., Boerma, C., Donati, A., Erdem, O., Giaccaglia, P., Guerci, P., Milstein, D.M.J., Montomoli, J., Toraman, F., Uz, Z., Veenstra, G., Ince, C.. - In: CRITICAL CARE MEDICINE. - ISSN 0090-3493. - STAMPA. - 48:10(2020), pp. E864-E875. [10.1097/CCM.0000000000004491]
Abstract:
Objectives: Reliable automated handheld vital microscopy image sequence analysis and the identification of disease states and effects of therapy are prerequisites for the routine use of quantitative sublingual microcirculation measurements at the point-of-care. The present study aimed to clinically ...validate the recently introduced MicroTools software in a large multicentral database of perioperative and critically ill patients and to use this automatic algorithm to data-mine and identify the sublingual microcirculatory variable changes in response to disease and therapy. Design: Retrospective algorithm-based image analysis and data-mining within a large international database of sublingual capillary microscopy. Algorithm-based analysis was compared with manual analysis for validation. Thereafter, MicroTools was used to identify the functional microcirculatory alterations associated with disease conditions and identify therapeutic options for recruiting functional microcirculatory variables. Setting: Ten perioperative/ICU/volunteer studies in six international teaching hospitals. Patients: The database encompass 267 adult and pediatric patients undergoing surgery, treatment for sepsis, and heart failure in the ICU and healthy volunteers. Interventions: Perioperative and ICU standard of care. Measurements and Main Results: One thousand five hundred twenty-five handheld vital microscopy image sequences containing 149,257 microscopy images were analyzed. 3.89 × 1012RBC positions were tracked by the algorithm in real time, and offline manual analysis was performed. Good correlation and trending ability were found between manual and automatic total and functional capillary density (r = 0.6-0.8; p < 0.0001). RBC tracking within the database demonstrated changes in functional capillary density and/or RBC velocity in septic shock, heart failure, hypovolemia, obstructive shock, and hemodilution and thus detected the presence of a disease condition. Therapies recruiting the microcirculatory diffusion and convection capacity associated with systemic vasodilation and an increase in cardiac output were separately identified. Conclusions: Algorithm-based analysis of the sublingual microcirculation closely matched manual analysis across a broad spectrum of populations. It successfully identified a methodology to quantify microcirculatory alterations associated with disease and the success of capillary recruitment, improving point-of-care application of microcirculatory-targeted resuscitation procedures.
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Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort
Anno: 2020
Rivista: ECLINICALMEDICINE
Autori/autrici: Wendel Garcia, Pedro David; Fumeaux, Thierry; Guerci, Philippe; Heuberger, Dorothea Monika; Montomoli, Jonathan; Roche-Campo, Ferran; Schuepbach, Reto Andreas; Hilty, Matthias Peter; RISC-19-ICU, Investigators; Alfaro Farias, Mario; Margarit, Antoni; Vizmanos-Lamotte, Gerardo; Tschoellitsch, Thomas; Meier, Jens; Cardona, Francesco S.; Skola, Josef; Horakova, Lenka; Aguirre-Bermeo, Hernan; Apolo, Janina; Novy, Emmanuel; Losser, Marie-Reine; Jurkolow, Geoffrey; Delahaye, Gauthier; David, Sascha; Welte, Tobias; Wengenmayer, Tobias; Staudacher, Dawid L.; Aslanidis, Theodoros; Babik, Barna; Korsos, Anita; Gal, Janos; Csaba, Hermann; Donati, Abele; Carsetti, Andrea; Turrini, Fabrizio; Simonini, Maria Sole; Ceriani, Roberto; Murrone, Martina; Rezoagli, Emanuele; Vitale, Giovanni; Fogagnolo, Alberto; Spadaro, Savino; Wu, Maddalena Alessandra; Cogliati, Chiara; Colombo, Riccardo; Catena, Emanuele; Facondini, Francesca; Potalivo, Antonella; Gangitano, Gianfilippo; Perin, Tiziana; Bocci, Maria Grazia; Antonelli, Massimo; Gommers, Diederik; Ince, Can; Mayor-Vázquez, Eric; Cruz, Maria; Delgado, Martin; Garcia, Raquel Rodriguez; Gamez Zapata, Jorge; Zalba-Etayo, Begoña; Lozano-Gomez, Herminia; Castro, Pedro; Tellez, Adrian; Jacas, Adriana; Muñoz, Guido; Andrea, Rut; Ortiz, Jose; Quintana, Eduard; Rovira, Irene; Reverter, Enric; Fernandez, Javier; Ferrer, Miquel; Badia, Joan R.; Lander Azcona, Arantxa; Orta, Jesus Escos; Bühler, Philipp; Brugger, Silvio; Hofmaenner, Daniel; Unseld, Simone; Ruschitzka, Frank; Moret-Bochatay, Mallory; Yuen, Bernd; Hillermann, Thomas; Ksouri, Hatem; Sridharan, Govind Oliver; Ristic, Anette; Sepulcri, Michael; Filipovic, Miodrag; Pietsch, Urs; Salomon, Petra; Drvaric, Iris; Schott, Peter; Urech, Severin; Lambert, Adriana; Merki, Lukas; Laube, Marcus; Hillgaertner, Frank; Sieber, Marianne; Dullenkopf, Alexander; Petersen, Lina; Grazioli, Serge; Rimensberger, Peter C.; Fleisch, Isabelle; Lavanchy, Jerome; Marquardt, Katharina; Shaikh, Karim; Redecker, Hermann; Stephan, Michael; Brem, Jan; Rogdo, Bjarte; Birkenmaier, Andre; Meyer Zu Bentrup, Friederike; Fodor, Patricia; Locher, Pascal; Camen, Giovanni; Siegemund, Martin; Zellweger, Nuria; Jeitziner, Marie-Madlen; Jenni-Moser, Beatrice; Bürkle, Christian; Kleger, Gian-Reto; Franchitti Laurent, Marilene; Laurent, Jean-Christophe; Gaspert, Tomislav; Jovic, Marija; Studhalter, Michael; Haberthuer, Christoph; Lussman, Roger F.; Selz, Daniela; Naon, Didier; Mauri, Romano; Ceruti, Samuele; Marrel, Julien; Brenni, Mirko; Ensner, Rolf; Gehring, Nadine; Heise, Antje; Huebner, Tobias; Neff, Thomas A.; Cereghetti, Sara; Boroli, Filippo; Pugin, Jerome; Marczin, Nandor; Wong, Joyce
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/358653
Citazioni:
Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort / Wendel Garcia, P.D., Fumeaux, T., Guerci, P., Heuberger, D.M., Montomoli, J., Roche-Campo, F., Schuepbach, R.A., Hilty, M.P., RISC-19-ICU, I., Alfaro Farias, M., Margarit, A., Vizmanos-Lamotte, G., Tschoellitsch, T., Meier, J., Cardona, F.S., Skola, J., Horakova, L., Aguirre-Bermeo, H., Apolo, J., Novy, E., et al.. - In: ECLINICALMEDICINE. - ISSN 2589-5370. - 25:(2020). [10.1016/j.eclinm.2020.100449]
Abstract:
Background: Coronavirus disease 2019 (COVID-19) is associated with a high disease burden with 10% of confirmed cases progressing towards critical illness. Nevertheless, the disease course and predictors of mortality in critically ill patients are poorly understood. Methods: Following the critical de...velopments in ICUs in regions experiencing early inception of the pandemic, the European-based, international RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry was created to provide near real-time assessment of patients developing critical illness due to COVID-19. Findings: As of April 22, 2020, 639 critically ill patients with confirmed SARS-CoV-2 infection were included in the RISC-19-ICU registry. Of these, 398 had deceased or been discharged from the ICU. ICU-mortality was 24%, median length of stay 12 (IQR, 5–21) days. ARDS was diagnosed in 74%, with a minimum P/F-ratio of 110 (IQR, 80–148). Prone positioning, ECCO2R, or ECMO were applied in 57%. Off-label therapies were prescribed in 265 (67%) patients, and 89% of all bloodstream infections were observed in this subgroup (n = 66; RR=3·2, 95% CI [1·7–6·0]). While PCT and IL-6 levels remained similar in ICU survivors and non-survivors throughout the ICU stay (p = 0·35, 0·34), CRP, creatinine, troponin, D-dimer, lactate, neutrophil count, P/F-ratio diverged within the first seven days (p&lt;0·01). On a multivariable Cox proportional-hazard regression model at admission, creatinine, D-dimer, lactate, potassium, P/F-ratio, alveolar-arterial gradient, and ischemic heart disease were independently associated with ICU-mortality. Interpretation: The European RISC-19-ICU cohort demonstrates a moderate mortality of 24% in critically ill patients with COVID-19. Despite high ARDS severity, mechanical ventilation incidence was low and associated with more rescue therapies. In contrast to risk factors in hospitalized patients reported in other studies, the main mortality predictors in these critically ill patients were markers of oxygenation deficit, renal and microvascular dysfunction, and coagulatory activation. Elevated risk of bloodstream infections underscores the need to exercise caution with off-label therapies.
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Multi-centre, three arm, randomized controlled trial on the use of methylprednisolone and unfractionated heparin in critically ill ventilated patients with pneumonia from SARS-CoV-2 infection: A structured summary of a study protocol for a randomised controlled trial
Anno: 2020
Rivista: TRIALS
Autori/autrici: Busani, Stefano; Tosi, Martina; Mighali, Pasquale; Vandelli, Paola; D’Amico, Roberto; Marietta, Marco; Forfori, Francesco; Donati, Abele; Cinnella, Gilda; De Monte, Amato; Pasero, Daniela; Bellani, Giacomo; Tascini, Carlo; Foti, Giuseppe; Ranieri, Marco; Girardis, Massimo
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/283595
Citazioni:
Multi-centre, three arm, randomized controlled trial on the use of methylprednisolone and unfractionated heparin in critically ill ventilated patients with pneumonia from SARS-CoV-2 infection: A structured summary of a study protocol for a randomised controlled trial / Busani, S., Tosi, M., Mighali, P., Vandelli, P., D’Amico, R., Marietta, M., Forfori, F., Donati, A., Cinnella, G., De Monte, A., Pasero, D., Bellani, G., Tascini, C., Foti, G., Ranieri, M., Girardis, M.. - In: TRIALS. - ISSN 1745-6215. - ELETTRONICO. - 21:1(2020), pp. 1-4. [10.1186/s13063-020-04645-z]

Changes in Cytokines, Haemodynamics and Microcirculation in Patients with Sepsis/Septic Shock Undergoing Continuous Renal Replacement Therapy and Blood Purification with CytoSorb
Anno: 2020
Rivista: BLOOD PURIFICATION
Autori/autrici: Zuccari, Samuele; Damiani, Elisa; Domizi, Roberta; Scorcella, Claudia; D'Arezzo, Mario; Carsetti, Andrea; Pantanetti, Simona; Vannicola, Sara; Casarotta, Erika; Ranghino, Andrea; Donati, Abele; Adrario, Erica
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/270430
Citazioni:
Changes in Cytokines, Haemodynamics and Microcirculation in Patients with Sepsis/Septic Shock Undergoing Continuous Renal Replacement Therapy and Blood Purification with CytoSorb / Zuccari, S., Damiani, E., Domizi, R., Scorcella, C., D'Arezzo, M., Carsetti, A., Pantanetti, S., Vannicola, S., Casarotta, E., Ranghino, A., Donati, A., Adrario, E.. - In: BLOOD PURIFICATION. - ISSN 0253-5068. - STAMPA. - 49:1-2(2020), pp. 107-113. [10.1159/000502540]
Abstract:
BACKGROUND Extracorporeal blood purification therapies have been proposed as a strategy to remove inflammatory mediators during sepsis, thus improving outcome.OBJECTIVES:We aimed to evaluate changes in cytokines, haemodynamics and microcirculation during blood purification with Cytosorb adsorber in ...septic patients.METHODS:Prospective observational study on critically ill adult patients with sepsis/septic shock underwent renal replacement therapy (RRT) for acute renal failure and haemoadsorption with Cytosorb as adjunctive therapy for 24 h. Measurements were taken at baseline, after 6 and 24 h: haemodynamic parameters, arterial and central venous blood gases, plasma levels of tumour necrosis factor alpha, interleukin (IL) 1-beta, IL-6, IL-8 and IL-10. The sublingual microcirculation was assessed with sidestream dark field videomicroscopy to evaluate the perfused vessel density (PVD) and microvascular flow quality. Tissue oxygenation and microvascular reactivity were assessed with thenar near infrared spectroscopy (NIRS) with a vascular occlusion test.RESULTS:Nine patients; plasma levels of IL-8 decreased at 24 h (p &lt; 0.05 versus 6 h); no significant variation was found for other cytokines. Haemodynamic remained stable throughout the observation. Microvascular perfusion improved over time, with an increase in PVDs at 6 and 24 h (from 13.9 [13.3-16.4] to 15.7 [15-17.3] and 17 [14.8-18.6] mm/mm2 respectively, p = 0.003) and total vessel densities at 24 h (14.9 [13.9-16.9] vs. 17.9 [15.3-20], p = 0.0015). No significant variation was detected in NIRS-derived parameters. The Sequential Organ Failure Assessment score decreased from 12 ± 3 to 10 ± 1 at 24 h (p = 0.039).CONCLUSIONS:In septic patients undergoing RRT, haemoadsorption with Cytosorb seems to determine a decreasing in plasma levels of IL-8, although levels of other cytokines did not vary significantly, and an improvement of microcirculation despite no significant variation in macro-haemodynamics.
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Evaluation of the Microcirculation in Critically Ill Patients
Anno: 2020
Autori/autrici: Damiani, Elisa; Domizi, Roberta; Scorcella, Claudia; Carsetti, Andrea; Donati, Abele
Lingua: ENG
Classificazione IRIS: 2.1 Contributo in volume (Capitolo o Saggio)
Scheda completa IRIS: https://iris.univpm.it/handle/11566/272854
Citazioni:
Evaluation of the Microcirculation in Critically Ill Patients / Damiani, E., Domizi, R., Scorcella, C., Carsetti, A., Donati, A.. - STAMPA. - (2020), pp. 373-388. [10.1007/978-3-030-33832-9_25]
Abstract:
Abstract: The first goal of therapies in critically ill patients is to improve tissue perfusion and oxygenation. Hemodynamic monitoring has long been limited to measure-ments of cardiac output and global oxygen delivery. The clinical introduction of hand-held vital microscopes in the late 1990s enab...led the real-time, non-invasive, bedside ob-servation of blood flow in the microcirculation (vessels with diameter <100 µm), i.e. the real site of oxygen and nutrient exchange between blood and cells. Microcirculatory alter-ations have been described during sepsis and shock states and were associated with mor-tality. These can occur independently of systemic hemodynamic alterations. Sublingual videomicroscopy allowed evaluating the microvascular response to resuscitation proce-dures, including oxygen therapy, fluids, blood transfusions, vasopressors. Future re-search directions should be aimed to integrate microcirculatory monitoring with standard hemodynamic measurements and verify the utility of microcirculation as a therapeutic tar-get. Continuous technological developments are imperative to facilitate the introduction of sublingual videomicroscopy in the clinical practice.
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Sublingual microcirculation in patients with SARS-CoV-2 undergoing veno-venous extracorporeal membrane oxygenation
Anno: 2020
Rivista: MICROVASCULAR RESEARCH
Autori/autrici: Carsetti, Andrea; Damiani, Elisa; Casarotta, Erika; Scorcella, Claudia; Domizi, Roberta; Montomoli, Jonathan; Gasparri, Francesco; Gabbanelli, Vincenzo; Pantanetti, Simona; Carozza, Roberto; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/283662
Citazioni:
Sublingual microcirculation in patients with SARS-CoV-2 undergoing veno-venous extracorporeal membrane oxygenation / Carsetti, A., Damiani, E., Casarotta, E., Scorcella, C., Domizi, R., Montomoli, J., Gasparri, F., Gabbanelli, V., Pantanetti, S., Carozza, R., Adrario, E., Donati, A.. - In: MICROVASCULAR RESEARCH. - ISSN 0026-2862. - STAMPA. - 132:(2020). [10.1016/j.mvr.2020.104064]
Abstract:
Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is a rescue treatment for severe acute respiratory failure refractory to conventional ventilation. We examined the alterations of sublingual microcirculation in patients with SARS-CoV-2 during VV-ECMO treatment and assessed the relationship b...etween microvascular parameters and ventilation, hemodynamics, and laboratory tests. Nine patients were included in the study and the following microcirculatory parameters were estimated: TVD 16.81 (14.46-18.6) mm/mm2; PVD 15.3 (14.09-17.96) mm/mm2; PPV 94.85% (93.82%-97.79%); MFI 2.5 (2.5-2.92); HI 0.4 (0.18-0.4). TVD and PVD were inversely related to D-dimer levels (rho=-0.667, p=0.05 and rho=-0.733, p=0.025 respectively), aspartate aminotransferase (AST) (rho=-0.886, p=0.019 and rho=-0.886, p=0.019 respectively) and alanine aminotransferase (ALT) (rho=-0.829, p=0.042 and rho=-0.829, p=0.042 respectively). Our results showed an altered sublingual microcirculation in patients receiving VV-ECMO for severe SARS-CoV-2 and suggest a potential contribution of endothelia dysfunction to determine microvascular alteration.
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Easy to see does not mean easy to perform: Rigid videostylet vs. videolaryngoscope
Anno: 2020
Rivista: MINERVA ANESTESIOLOGICA
Autori/autrici: Falcetta, S.; Sorbello, M.; Di Giacinto, I.; Cortese, G.; Donati, A.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/291394
Citazioni:
Easy to see does not mean easy to perform: Rigid videostylet vs. videolaryngoscope / Falcetta, S., Sorbello, M., Di Giacinto, I., Cortese, G., Donati, A.. - In: MINERVA ANESTESIOLOGICA. - ISSN 0375-9393. - STAMPA. - 87:4(2020), pp. 495-497. [10.23736/S0375-9393.20.15157-5]

An (Italian) proposal for a comprehensive approach to infections across the surgical pathway
Anno: 2020
Rivista: WORLD JOURNAL OF EMERGENCY SURGERY
Autori/autrici: Sartelli, Massimo; Pagani, Leonardo; Iannazzo, Stefania; Luisa Moro, Maria; Viale, Pierluigi; Pan, Angelo; Ansaloni, Luca; Coccolini, Federico; D'Errico, Marcello M.; Agreiter, Iris; Amadio Nespola, Giorgio; Barchiesi, Francesco; Benigni, Valeria; Binazzi, Raffaella; Cappanera, Stefano; Chiodera, Alessandro; Cola, Valentina; Corsi, Daniela; Cortese, Francesco; Crapis, Massimo; Cristini, Francesco; D’Arpino, Alessandro; De Simone, Belinda; Di Bella, Stefano; Di Marzo, Francesco; Donati, Abele; Elisei, Daniele; Fantoni, Massimo; Ferrari, Anna; Foghetti, Domitilla; Francisci, Daniela; Gattuso, Gianni; Giacometti, Andrea; Cesare Gesuelli, Guido; Marmorale, Cristina; Martini, Enrica; Meledandri, Marcello; Murri, Rita; Padrini, Daniela; Palmieri, Dalia; Pauri, Paola; Rebagliati, Carla; Ricchizzi, Enrico; Sambri, Vittorio; Maria Schimizzi, Anna; Siquini, Walter; Scoccia, Loredana; Scoppettuolo, Giancarlo; Sganga, Gabriele; Storti, Nadia; Tavio, Marcello; Toccafondi, Giulio; Tumietto, Fabio; Viaggi, Bruno; Vivarelli, Marco; Tranà, Cristian; Raso, Melina; Maria Labricciosa, Francesco; Dhingra and Fausto Catena, Sameer
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/274969
Citazioni:
An (Italian) proposal for a comprehensive approach to infections across the surgical pathway / Sartelli, M., Pagani, L., Iannazzo, S., Luisa Moro, M., Viale, P., Pan, A., Ansaloni, L., Coccolini, F., D'Errico, M.M., Agreiter, I., Amadio Nespola, G., Barchiesi, F., Benigni, V., Binazzi, R., Cappanera, S., Chiodera, A., Cola, V., Corsi, D., Cortese, F., Crapis, M., et al.. - In: WORLD JOURNAL OF EMERGENCY SURGERY. - ISSN 1749-7922. - ELETTRONICO. - 15:1(2020), pp. 13.1-13.26. [10.1186/s13017-020-00295-3]
Abstract:
Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should a...lways focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.
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Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: State-of-the-art and expert consensus
Anno: 2020
Rivista: MINERVA ANESTESIOLOGICA
Autori/autrici: Carsetti, A.; Bignami, E.; Cortegiani, A.; Donadello, K.; Donati, A.; Foti, G.; Grasselli, G.; Romagnoli, S.; Antonelli, M.; De Blasio, E.; Forfori, F.; Guarracino, F.; Scolletta, S.; Pepe, L. T.; Scudeller, L.; Cecconi, M.; Girardis, M.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/291393
Citazioni:
Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: State-of-the-art and expert consensus / Carsetti, A., Bignami, E., Cortegiani, A., Donadello, K., Donati, A., Foti, G., Grasselli, G., Romagnoli, S., Antonelli, M., De Blasio, E., Forfori, F., Guarracino, F., Scolletta, S., Pepe, L.T., Scudeller, L., Cecconi, M., Girardis, M.. - In: MINERVA ANESTESIOLOGICA. - ISSN 0375-9393. - ELETTRONICO. - 87:6(2020), pp. 714-732. [10.23736/S0375-9393.20.14866-1]
Abstract:
Vasopressors and inotropic agents are widely used in critical care. However, strong evidence supporting their use in critically ill patients is lacking in many clinical scenarios. Thus, the Italian Society of Anesthesia and Intensive Care (SIAARTI) promoted a project aimed to provide indications for... good clinical practice on the use of vasopressors and inotropes, and on the management of critically ill patients with shock. A panel of 16 experts in the field of intensive care medicine and hemodynamics has been established. Systematic review of the available literature was performed based on PICO questions. Basing on available evidence, the panel prepared a summary of evidence and then wrote the clinical questions. A modified semi-quantitative RAND/UCLA appropriateness method has been used to determine the appropriateness of specific clinical scenarios. The panel identified 29 clinical questions for the use of vasopressors and inotropes in patients with septic shock and cardiogenic shock. High level of agreement exists among the panel members about appropriateness of inotropes/vasopressors' use in patients with septic shock and cardiogenic shock.
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Comment on "Effects of short-term hyperoxia on sytemic hemodynamics, oxygen transport, and microcirculation: An observational study in patients with septic shock and healthy volunteers"
Anno: 2020
Rivista: JOURNAL OF CRITICAL CARE
Autori/autrici: Damiani, Elisa; Adrario, Erica; Carsetti, Andrea; Domizi, Roberta; Scorcella, Claudia; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/272421
Citazioni:
Comment on "Effects of short-term hyperoxia on sytemic hemodynamics, oxygen transport, and microcirculation: An observational study in patients with septic shock and healthy volunteers" / Damiani, E., Adrario, E., Carsetti, A., Domizi, R., Scorcella, C., Donati, A.. - In: JOURNAL OF CRITICAL CARE. - ISSN 0883-9441. - STAMPA. - 56:(2020), pp. 316-317. [10.1016/j.jcrc.2019.11.015]

The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice
Anno: 2020
Rivista: ANAESTHESIA
Autori/autrici: Sorbello, M.; El-Boghdadly, K.; Di Giacinto, I.; Cataldo, R.; Esposito, C.; Falcetta, S.; Merli, G.; Cortese, G.; Corso, R. M.; Bressan, F.; Pintaudi, S.; Greif, R.; Donati, A.; Petrini, F.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/276457
Citazioni:
The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice / Sorbello, M., El-Boghdadly, K., Di Giacinto, I., Cataldo, R., Esposito, C., Falcetta, S., Merli, G., Cortese, G., Corso, R.M., Bressan, F., Pintaudi, S., Greif, R., Donati, A., Petrini, F.. - In: ANAESTHESIA. - ISSN 0003-2409. - STAMPA. - 75:6(2020), pp. 724-732. [10.1111/anae.15049]
Abstract:
Novel coronavirus 2019 is a single-stranded, ribonucleic acid virus that has led to an international pandemic of coronavirus disease 2019. Clinical data from the Chinese outbreak have been reported, but experiences and recommendations from clinical practice during the Italian outbreak have not. We r...eport the impact of the coronavirus disease 2019 outbreak on regional and national healthcare infrastructure. We also report on recommendations based on clinical experiences of managing patients throughout Italy. In particular, we describe key elements of clinical management, including: safe oxygen therapy; airway management; personal protective equipment; and non-technical aspects of caring for patients diagnosed with coronavirus disease 2019. Only through planning, training and team working will clinicians and healthcare systems be best placed to deal with the many complex implications of this new pandemic.
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Relationship between norepinephrine dose, tachycardia and outcome in septic shock: A multicentre evaluation
Anno: 2020
Rivista: JOURNAL OF CRITICAL CARE
Autori/autrici: Domizi, R.; Calcinaro, S.; Harris, S.; Beilstein, C.; Boerma, C.; Chiche, J. -D.; D'Egidio, A.; Damiani, E.; Donati, A.; Koetsier, P. M.; Madden, M. P.; Mcauley, D. F.; Morelli, A.; Pelaia, P.; Royer, P.; Shankar-Hari, M.; Wickboldt, N.; Zolfaghari, P.; Singer, M.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/276454
Citazioni:
Relationship between norepinephrine dose, tachycardia and outcome in septic shock: A multicentre evaluation / Domizi, R., Calcinaro, S., Harris, S., Beilstein, C., Boerma, C., Chiche, J.-D., D'Egidio, A., Damiani, E., Donati, A., Koetsier, P.M., Madden, M.P., Mcauley, D.F., Morelli, A., Pelaia, P., Royer, P., Shankar-Hari, M., Wickboldt, N., Zolfaghari, P., Singer, M.. - In: JOURNAL OF CRITICAL CARE. - ISSN 0883-9441. - STAMPA. - 57:(2020), pp. 185-190. [10.1016/j.jcrc.2020.02.014]
Abstract:
Purpose: Septic shock is associated with massive release of endogenous catecholamines. Adrenergic agents may exacerbate catecholamine toxicity and contribute to poor outcomes. We sought to determine whether an association existed between tachycardia and mortality in septic shock patients requiring n...orepinephrine for more than 6 h despite adequate volume resuscitation. Materials and methods: Multicentre retrospective observational study on 730 adult patients in septic shock consecutively admitted to eight European ICUs between 2011 and 2013. Three timepoints were selected: T1 (first hour of infusion of norepinephrine), Tpeak (time of highest dose during the first 24 h of treatment), and T24 (24-h post-T1). Binary logistic regression models were constructed for the three time-points. Results: Overall ICU mortality was 38.4%. Mortality was higher in those requiring high-dose (≥0.3 mcg/kg/min) versus low-dose (&lt;0.3 mcg/kg/min) norepinephrine at T1 (53.4% vs 30.6%; p &lt; 0.001) and T24 (61.4% vs 20.4%; p &lt; 0.0001). Patients requiring high-dose with concurrent tachycardia had higher mortality at T1; in the low-dose group tachycardia was not associated with mortality. Resolving tachycardia (from T1 to T24) was associated with lower mortality compared to patients where tachycardia persisted (27.8% vs 46.4%; p = 0.001). Conclusions: Use of high-dose norepinephrine and concurrent tachycardia are associated with poor outcomes in septic shock.
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Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study
Anno: 2020
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: De Bus, L.; Depuydt, P.; Steen, J.; Dhaese, S.; De Smet, K.; Tabah, A.; Akova, M.; Cotta, M. O.; De Pascale, G.; Dimopoulos, G.; Fujitani, S.; Garnacho-Montero, J.; Leone, M.; Lipman, J.; Ostermann, M.; Paiva, J. -A.; Schouten, J.; Sjovall, F.; Timsit, J. -F.; Roberts, J. A.; Zahar, J. -R.; Zand, F.; Zirpe, K.; De Waele, J. J.; Rios, F.; Vazquez, A. R.; Vidal, M. G.; Zakalik, G.; Attokaran, A. G.; Banakh, I.; Dey-Chatterjee, S.; Ewan, J.; Ferrier, J.; Forbes, L.; Fourie, C.; Leditschke, A.; Murray, L.; Eller, P.; Biston, P.; Bracke, S.; De Crop, L.; De Schryver, N.; Frans, E.; Spapen, H.; Van Malderen, C.; Vansteelandt, S.; Vermeiren, D.; Arevalo, E. P.; Crespo, M.; Flores, R. Z.; Piza, P.; Tutillo, D. M.; Elme, A.; Kallaste, A.; Starkopf, J.; Bourenne, J.; Calypso, M.; Cohen, Y.; Dahyot-Fizelier, C.; Depret, F.; Guillot, M.; Imzi, N.; Jochmans, S.; Kouatchet, A.; Lepape, A.; Martin, O.; Heim, M.; Schaller, S. J.; Arvaniti, K.; Bekridelis, A.; Ioannidis, P.; Mitrakos, C.; Papanikolaou, M. N.; Pouriki, S.; Vemvetsou, A.; Abraham, B.; Bhattacharya, P. K.; Budugu, A.; Dixit, S.; Gurav, S.; Kandanuri, P.; Prabhu, D. A.; Rathod, D.; Savaru, K.; Udupa, A. N.; Varghese, S. B.; Bakhodaei, H. H.; Dabiri, G.; Fallahi, M. J.; Feiz, F.; Firoozifar, M.; Khaloo, V.; Maghsudi, B.; Masjedi, M.; Nikandish, R.; Sabetian, G.; Marsh, B.; Martin-Loeches, I.; Steiner, J.; Barbagallo, M.; Caricato, A.; Cortegiani, A.; D'Andrea, R.; Deana, C.; Donati, A.; Girardis, M.; Mandala, G.; Panarello, G.; Pasero, D.; Pelagalli, L.; Soave, P. M.; Spadaro, S.; Fujita, Y.; Fujiwara, S.; Hara, Y.; Hashi, H.; Hashimoto, S.; Hashimoto, H.; Hayakawa, K.; Inoue, M.; Isokawa, S.; Kameda, S.; Kamohara, H.; Kanamoto, M.; Katayama, S.; Kawagishi, T.; Kawano, Y.; Kida, Y.; Kita, M.; Kobayashi, A.; Kuriyama, A.; Naito, T.; Nashiki, H.; Nishiyama, K.; Shindo, S.; Suzuki, T.; Takaba, A.; Tanaka, C.; Tetsuya, K.; Tomioka, Y.; Yanagawa, Y.; Yoshida, H.; Adnan, S.; Hasan, M. S.; Sulaiman, H.; Gasca Lopez, G. A.; Hernandez-Cardenas, C. M.; Namendys-Silva, S. A.; Bethlehem, C.; de Lange, D.; Hunfeld, N.; Numan, S.; van Leeuwen, H.; Owens, D.; Almeida, M.; Fragoso, E.; Leonor, T.; Pereira, J. -M.; Filipescu, D.; Grigoras, I.; Popescu, M.; Tomescu, D.; Alshahrani, M. S.; Alvarez-Gonzalez, M.; Barrero-Garcia, I.; Blasco-Navalpotro, M. A.; Claverias, L.; Estella, A.; Espina, L. F.; Garmendia, J. L. G.; Prieto, E. G.; Gomez-Prieto, G.; Conde, C. J.; Sagasti, F. M.; Cantero, A. M.; Orejas-Gallego, A.; Papiol, E.; Perez-Civantos, D.; Laderas, J. C. P.; Alvarez, J. T.; Vera-Artazcoz, P.; Cortes, P. V.; Oldner, A.; Spangfors, M.; Alp, E.; Koksal, I.; Korten, V.; Ozveren, A.; Hall, A.; Hatton, K. W.; Laudanski, K.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/283596
Citazioni:
Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study / De Bus, L., Depuydt, P., Steen, J., Dhaese, S., De Smet, K., Tabah, A., Akova, M., Cotta, M.O., De Pascale, G., Dimopoulos, G., Fujitani, S., Garnacho-Montero, J., Leone, M., Lipman, J., Ostermann, M., Paiva, J.-A., Schouten, J., Sjovall, F., Timsit, J.-F., Roberts, J.A., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - STAMPA. - 46:7(2020), pp. 1404-1417. [10.1007/s00134-020-06111-5]
Abstract:
Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical anti...microbial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60–1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14–1.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.
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SARS-CoV-2 infection in kidney transplant recipients: Experience of the italian marche region
Anno: 2020
Rivista: TRANSPLANT INFECTIOUS DISEASE
Autori/autrici: Maritati, F.; Cerutti, E.; Zuccatosta, L.; Fiorentini, A.; Finale, C.; Ficosecco, M.; Cristiano, F.; Capestro, A.; Balestra, E.; Taruscia, D.; Vivarelli, M.; Donati, A.; Perna, G. P.; Giacometti, A.; Tavio, M.; Onesta, M.; Di Sante, L.; Ranghino, A.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/283561
Citazioni:
SARS-CoV-2 infection in kidney transplant recipients: Experience of the italian marche region / Maritati, F., Cerutti, E., Zuccatosta, L., Fiorentini, A., Finale, C., Ficosecco, M., Cristiano, F., Capestro, A., Balestra, E., Taruscia, D., Vivarelli, M., Donati, A., Perna, G.P., Giacometti, A., Tavio, M., Onesta, M., Di Sante, L., Ranghino, A.. - In: TRANSPLANT INFECTIOUS DISEASE. - ISSN 1398-2273. - ELETTRONICO. - 22:5(2020). [10.1111/tid.13377]
Abstract:
Background: Infection related to Coronavirus-19 (CoV-2) is pandemic affecting more than 4 million people in 187 countries worldwide. By May 10, 2020, it caused more than 280 000 deaths all over the world. Preliminary data reported a high prevalence of CoV-2 infection and mortality due to severe... acute respiratory syndrome related CoV-2 (SARS-CoV-2) in kidney-transplanted patients (KTRs). Nevertheless, the outcomes and the best treatments for SARS-CoV-2-affected KTRs remain unclear. Methods: In this report, we describe the clinical data, the treatments, and the outcomes of 5 KTRs with SARS-CoV-2 admitted to our hospital in Ancona, Marche region, Italy, from March 17 to present. Due to the severity of SARS-CoV-2, immunosuppression with calcineurin inhibitors, antimetabolites, and mTOR-inhibitors were stopped at the admission. All KTRs were treated with low-dose steroids. 4/5 KTRs were treated with hydroxychloroquine. All KTRs received tocilizumab up to one dose. Results: Overall, the incidence of SARS-CoV-2 in KTRs in the Marche region was 0.85%. 3/5 were admitted in ICU and intubated. One developed AKI with the need of CRRT with Cytosorb. At present, two patients died, two patients were discharged, and one is still inpatient in ICU. Conclusions: The critical evaluation of all cases suggests that the timing of the administration of tocilizumab, an interleukin-6 receptor antagonist, could be associated with a better efficacy when administered in concomitance to the drop of the oxygen saturation. Thus, in SARS-CoV-2-affected KTRs, a close biochemical and clinical monitoring should be set up to allow physicians to hit the virus in the right moment such as a sudden reduction of the oxygen saturation and/or a significant increase in the laboratory values such as D-dimer.
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Comment on "Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study"
Anno: 2020
Rivista: ANNALS OF INTENSIVE CARE
Autori/autrici: Damiani, Elisa; Carsetti, Andrea; Casarotta, Erika; Domizi, Roberta; Scorcella, Claudia; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/284759
Citazioni:
Comment on "Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study" / Damiani, E., Carsetti, A., Casarotta, E., Domizi, R., Scorcella, C., Adrario, E., Donati, A.. - In: ANNALS OF INTENSIVE CARE. - ISSN 2110-5820. - ELETTRONICO. - 10:1(2020), p. 147. [10.1186/s13613-020-00765-6]

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance
Anno: 2020
Rivista: THE LANCET RESPIRATORY MEDICINE
Autori/autrici: Mcgrath, Brendan A; Brenner, Michael J; Warrillow, Stephen J; Pandian, Vinciya; Arora, Asit; Cameron, Tanis S; Añon, José Manuel; Hernández Martínez, Gonzalo; Truog, Robert D; Block, Susan D; Lui, Grace C Y; Mcdonald, Christine; Rassekh, Christopher H; Atkins, Joshua; Qiang, Li; Vergez, Sébastien; Dulguerov, Pavel; Zenk, Johannes; Antonelli, Massimo; Pelosi, Paolo; Walsh, Brian K; Ward, Erin; Shang, You; Gasparini, Stefano; Donati, Abele; Singer, Mervyn; Openshaw, Peter J M; Tolley, Neil; Markel, Howard; Feller-Kopman, David J
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/280389
Citazioni:
Tracheostomy in the COVID-19 era: global and multidisciplinary guidance / Mcgrath, B.A., Brenner, M.J., Warrillow, S.J., Pandian, V., Arora, A., Cameron, T.S., Añon, J.M., Hernández Martínez, G., Truog, R.D., Block, S.D., Lui, G.C.Y., Mcdonald, C., Rassekh, C.H., Atkins, J., Qiang, L.i., Vergez, S., Dulguerov, P., Zenk, J., Antonelli, M., Pelosi, P., et al.. - In: THE LANCET RESPIRATORY MEDICINE. - ISSN 2213-2600. - ELETTRONICO. - 8:7(2020), pp. 717-725. [10.1016/S2213-2600(20)30230-7]
Abstract:
Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free ...patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about case selection, the timing and performance of tracheostomy, and the subsequent management of patients. In response, we convened an international working group of individuals with relevant expertise in tracheostomy. We did a literature and internet search for reports of research pertaining to tracheostomy during the COVID-19 pandemic, supplemented by sources comprising statements and guidance on tracheostomy care. By synthesising early experiences from countries that have managed a surge in patient numbers, emerging virological data, and international, multidisciplinary expert opinion, we aim to provide consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.
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Microvascular alterations in patients with SARS-COV-2 severe pneumonia
Anno: 2020
Rivista: ANNALS OF INTENSIVE CARE
Autori/autrici: Damiani, Elisa; Carsetti, Andrea; Casarotta, Erika; Scorcella, Claudia; Domizi, Roberta; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/280291
Citazioni:
Microvascular alterations in patients with SARS-COV-2 severe pneumonia / Damiani, E., Carsetti, A., Casarotta, E., Scorcella, C., Domizi, R., Adrario, E., Donati, A.. - In: ANNALS OF INTENSIVE CARE. - ISSN 2110-5820. - ELETTRONICO. - 10:(2020). [10.1186/s13613-020-00680-w]

Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective
Anno: 2020
Rivista: CRITICAL CARE
Autori/autrici: Carsetti, Andrea; Damia Paciarini, Agnese; Marini, Benedetto; Pantanetti, Simona; Adrario, Erica; Donati, Abele
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/278826
Citazioni:
Prolonged prone position ventilation for SARS-CoV-2 patients is feasible and effective / Carsetti, A., Damia Paciarini, A., Marini, B., Pantanetti, S., Adrario, E., Donati, A.. - In: CRITICAL CARE. - ISSN 1364-8535. - ELETTRONICO. - 24:(2020). [10.1186/s13054-020-02956-w]

Procedural sedation for direct current cardioversion: a feasibility study between two management strategies in the emergency department
Anno: 2020
Rivista: BMC CARDIOVASCULAR DISORDERS
Autori/autrici: Stronati, Giulia; Capucci, Alessandro; Dello Russo, Antonio; Adrario, Erica; Carsetti, Andrea; Casella, Michela; Donati, Abele; Guerra, Federico
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/283645
Citazioni:
Procedural sedation for direct current cardioversion: a feasibility study between two management strategies in the emergency department / Stronati, G., Capucci, A., Dello Russo, A., Adrario, E., Carsetti, A., Casella, M., Donati, A., Guerra, F.. - In: BMC CARDIOVASCULAR DISORDERS. - ISSN 1471-2261. - ELETTRONICO. - 20:1(2020), pp. 1-8. [10.1186/s12872-020-01664-1]
Abstract:
Background: A cardiologist-only approach to procedural sedation with midazolam in the setting of elective cardioversion (DCC) for AF has already been proven as safe as sedation with propofol and anaesthesiologist assistance. No data exist regarding the safety of such a strategy during emergency proc...edures. The aim of this study is to compare the feasibility of sedation with midazolam, administered by a cardiologist, to an anaesthesiologist-assisted protocol with propofol in emergency DCC. Methods: Single centre, prospective, open blinded, randomized study including all consecutive patients admitted to the Emergency Department requiring urgent or emergency DCC. Patients were randomized in a 1:1 fashion to either propofol or midazolam treatment arm. Patients in the midazolam group were managed by the cardiologist only, while patients treated with propofol group underwent DCC with anaesthesiologist assistance. Results: Sixty-nine patients were enrolled and split into two groups. Eighteen patients (26.1%) experienced peri- procedural adverse events (bradycardia, severe hypotension and severe hypoxia), which were similar between the two groups and all successfully managed by the cardiologist. No deaths, stroke or need for invasive ventilation were registered. Patients treated with propofol experienced a greater decrease in systolic and diastolic blood pressure when compared with those treated with midazolam. As the procedure was shorter when midazolam was used, the median cost of urgent/emergency DCC with midazolam was estimated to be 129.0 € (1st-3rd quartiles 114.6–151.6) and 195.6 € (1st-3rd quartiles 147.3–726.7) with propofol (p < .001). Conclusions: Procedural sedation with midazolam given by the cardiologist alone was feasible, well-tolerated and cost-effective in emergency DCC.
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Estimated oxygen extraction versus dynamic parameters of fluid-responsiveness for perioperative hemodynamic optimization of patients undergoing non-cardiac surgery: a non-inferiority randomized controlled trial
Anno: 2020
Rivista: BMC ANESTHESIOLOGY
Autori/autrici: Carsetti, Andrea; Amici, Mirco; Bernacconi, Tonino; Brancaleoni, Paolo; Cerutti, Elisabetta; Chiarello, Marco; Cingolani, Diego; Cola, Luisanna; Corsi, Daniela; Forlini, Giorgio; Giampieri, Marina; Iuorio, Salvatore; Principi, Tiziana; Tappatà, Giuseppe; Tempesta, Michele; Adrario, Erica; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/276865
Citazioni:
Estimated oxygen extraction versus dynamic parameters of fluid-responsiveness for perioperative hemodynamic optimization of patients undergoing non-cardiac surgery: a non-inferiority randomized controlled trial / Carsetti, A., Amici, M., Bernacconi, T., Brancaleoni, P., Cerutti, E., Chiarello, M., Cingolani, D., Cola, L., Corsi, D., Forlini, G., Giampieri, M., Iuorio, S., Principi, T., Tappatà, G., Tempesta, M., Adrario, E., Donati, A.. - In: BMC ANESTHESIOLOGY. - ISSN 1471-2253. - ELETTRONICO. - 20:1(2020), p. 87. [10.1186/s12871-020-01011-z]
Abstract:
Goal directed therapy (GDT) is able to improve mortality and reduce complications in selected high-risk patients undergoing major surgery. The aim of this study is to compare two different strategies of perioperative hemodynamic optimization: one based on optimization of preload using dynamic parame...ters of fluid-responsiveness and the other one based on estimated oxygen extraction rate (O2ER) as target of hemodynamic manipulation.
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Variation in the Outcome of Norepinephrine-Dependent Septic Patients After the Institution of a Patient-Tailored Therapy Protocol in an Italian Intensive Care Unit: Retrospective Observational Study
Anno: 2020
Rivista: FRONTIERS IN MEDICINE
Autori/autrici: Casarotta, E.; Damiani, E.; Domizi, R.; Carsetti, A.; Scorcella, C.; Adrario, E.; Bolognini, S.; Di Falco, D.; Pantanetti, S.; Vannicola, S.; Damia Paciarini, A.; Donati, A.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/285654
Citazioni:
Variation in the Outcome of Norepinephrine-Dependent Septic Patients After the Institution of a Patient-Tailored Therapy Protocol in an Italian Intensive Care Unit: Retrospective Observational Study / Casarotta, E., Damiani, E., Domizi, R., Carsetti, A., Scorcella, C., Adrario, E., Bolognini, S., Di Falco, D., Pantanetti, S., Vannicola, S., Damia Paciarini, A., Donati, A.. - In: FRONTIERS IN MEDICINE. - ISSN 2296-858X. - ELETTRONICO. - 7:(2020). [10.3389/fmed.2020.592282]
Abstract:
Objective: To evaluate the outcome of patients with septic shock after the institution of a patient tailored therapy protocol in our Intensive Care Unit (ICU). Methods: Single-center retrospective observational study including 100 consecutive septic patients (≥ 16 years) requiring norepinephrine ...infusion, admitted to our ICU between 2018 and 2019 after the institution of a patient-tailored therapy protocol, compared with a historical control group of 100 patients admitted between 2010 and 2013 (historical controls). The patient-tailored therapy protocol included the use of IgM-enriched immunoglobulins for patients with low plasma IgM levels, blood purification strategies for patients with high plasma levels of cytokines or endotoxin, albumin correction and modulation of vasoactive agents. Clinical and therapeutic parameters were noted at the time of initiation of norepinephrine infusion and for the 1st 24 h. The primary outcome was ICU mortality. Results: ICU-mortality was lower in the patient-tailored therapy cohort as compared to historical controls (32 vs. 57%, p < 0.001). Patient-tailored therapy was associated with a lower risk of ICU-mortality even after adjusting for the main clinical severity indices (adjusted odds ratio 0.331 [95% confidence interval 0.166–0.658], p = 0.002). After propensity score matching, 48 patients in historical control group and 48 patients in the patient-tailored therapy cohort with similar general characteristics were selected. ICU-mortality was lower in the patient-tailored therapy matched subgroup as compared to historical controls (40 vs. 60%, p = 0.037). Conclusions: An individualized therapeutic approach in septic patients may be associated with a survival benefit. However, the use of an historical control group of patients admitted between 2010 and 2013 may introduce substantial bias. Further adequately designed studies are needed to demonstrate the impact of patient-tailored therapy on outcome.
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Sorveglianza degli eventi avversi associati alla ventilazione meccanica in un’Unità di Terapia Intensiva
Anno: 2019
Rivista: JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE
Autori/autrici: Mariotti, A; Lombardi, M; Formenti, L; Dolcini, J; Bellini, M; Biardi, Lgb; Ciotti, M; Donati, A; Carletti, P; Mentrasti, Damiano; Gregori, Perseo; Micheletti, R; Barbadoro, P; D'Errico, Mm
Lingua: ITA
Classificazione IRIS: 1.5 Abstract in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/270959
Citazioni:
Sorveglianza degli eventi avversi associati alla ventilazione meccanica in un’Unità di Terapia Intensiva / Mariotti, A., Lombardi, M., Formenti, L., Dolcini, J., Bellini, M., Biardi, L., Ciotti, M., Donati, A., Carletti, P., Mentrasti, D., Gregori, P., Micheletti, R., Barbadoro, P., D'Errico, M.m.. - In: JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE. - ISSN 2421-4248. - ELETTRONICO. - 60:(2019), pp. 158-158.
Abstract:
Introduzione La sorveglianza degli eventi avversi associati alla ventilazione meccanica ha un ruolo chiave per la tutela del paziente. Lo scopo di questo studio è valutare l’impatto che gli eventi associati alla ventilazione meccanica (VAE) hanno su mortalità, durata della degen...za e durata della ventilazione nei pazienti di un’unità di terapia intensiva. Materiali e metodi È stato condotto uno studio di coorte retrospettivo. Sono stati valutati tutti i pazienti degenti per più di 48 ore presso la Clinica di Anestesia e Rianimazione ammessi presso l’Azienda Ospedaliero-Universitaria di Ancona nel periodo dicembre 2017 - gennaio 2019. Sono state individuate le VAE nel rispetto dei criteri del National Healthcare Safety Network (NHSN) che le classifica come complicanze associate alla ventilazione meccanica (VAC), condizioni infettive associate alla ventilazione meccanica (IVAC) e polmoniti associate alla ventilazione meccanica (PVAP). Sono stati valutati gli outcomes clinici nei pazienti che avevano avuto una VAE e nei pazienti senza VAE in termini di decesso, prolungamento della ventilazione e della degenza. L’analisi statistica è stata condotta utilizzando il test del chi-quadro e il test di U-Mann Whitney, quando appropriato. Il livello di significatività è stato fissato a 0,05. Risultati Sono stati raccolti i dati relativi a 279 pazienti, di cui il 15% (n = 42) ha sviluppato una VAE. I tassi d’incidenza su 1000 giornate di ventilazione meccanica sono stati: per le VAE 14,06 (IC 95% 10,14-18,95), per le VAC 14,06 (IC 95% 10,14-18,95), per le IVAC 6,02 (IC 95% 3,57-9,50) e per le PVAP 3,68 (IC 95% 1,84-6,58). L’insorgenza della VAE è risultata associata ad un aumento non statisticamente significativo della mortalità [pazienti con VAE deceduti 23,81%(IC 95% 12,05-39,45) vs pazienti senza VAE deceduti 14,35% (IC 95% 10,14-19,47); p > 0,05], ma ad un aumento statisticamente significativo delle giornate medie di degenza (18 gg di degenza nei pz con VAE vs 12 gg di degenza nei pz senza VAE; p < 0,05) e della durata della ventilazione meccanica (17 gg di ventilazione nei pz con VAE vs 10 gg di ventilazione nei pz senza VAE; p < 0,05). Conclusioni Dall’analisi dei dati risulta che le VAE sono associate ad un aumento significativo delle giornate di degenza e di ventilazione meccanica, ma non hanno impatto sulla mortalità dei pazienti, confermando quindi il loro effetto in termini di morbosità per il paziente sottoposto a ventilazione meccanica. In tale contesto implementare misure preventive, quali sorveglianza, formazione e aggiornamento, risulta un elemento imprescindibile per la buona pratica clinica.
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Unità di Terapia intensiva: consumo, trend di utilizzo degli antibiotici e pattern di resistenza dei microrganismi isolati. Risultati preliminari
Anno: 2019
Rivista: JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE
Autori/autrici: Lombardi, M; Mariotti, A; Bellini, M; Biardi, Lgb; Ciotti, M; Formenti, L; Micheletti, R; Dolcini, J; Rapazzetti, S; Mentrasti, D; Gregori, P; Carletti, P; Donati, A; Barbadoro, P; D'Errico, Mm
Lingua: ITA
Classificazione IRIS: 1.5 Abstract in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/270974
Citazioni:
Unità di Terapia intensiva: consumo, trend di utilizzo degli antibiotici e pattern di resistenza dei microrganismi isolati. Risultati preliminari / Lombardi, M., Mariotti, A., Bellini, M., Biardi, L., Ciotti, M., Formenti, L., Micheletti, R., Dolcini, J., Rapazzetti, S., Mentrasti, D., Gregori, P., Carletti, P., Donati, A., Barbadoro, P., D'Errico, M.m.. - In: JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE. - ISSN 2421-4248. - ELETTRONICO. - 60:(2019), pp. 138-138.
Abstract:
Introduzione Lo scopo di questo studio è stato valutare l’intensità di utilizzo degli antibiotici e l’epidemiologia dell’antibioticoresistenza in un’Unità di Terapia Intensiva (UTI). Materiali e metodi Nell’ambito di un sistema di sorveglianza condo...tto con riferimento alla metodologia del National Healthcare Safety Network, sono stati raccolti i dati relativi all’utilizzo degli antibiotici (molecola, dosaggio e durata) e gli isolamenti microbiologici (microrganismo e relativo antibiogramma) nel periodo dicembre 2017 - gennaio 2019 presso la Clinica di Anestesia e Rianimazione dell’AOU Ospedali Riuniti di Ancona Il consumo totale e per classi d’interesse degli antibiotici sono stati valutati utilizzando la metodologia Defined Daily Dose (DDD) per 100 giornate di degenza (HD). Per l’analisi del trend è stato utilizzato il test di Cochran Armitage valutando i dati su base trimestrale. La densità d’incidenza degli isolamenti per ogni microrganismo è stata espressa come tasso d’isolamento per 100 HD. Risultati Sono stati sorvegliati 279 pazienti, di cui l’87,5% (n = 244) è stato sottoposto a terapia antibiotica, per un consumo totale di antibiotici di 200 DDD/100 HD (IC 95% 195-204). Le classi più utilizzate sono state: penicilline (54,5 DDD/100 HD; IC 95% 52,8-56,1), chinoloni (24,2 DDD/100 HD; IC 95% 22,8-25,6), carbapenemi (21,9 DDD/100 HD; IC 95% 20,5-23,3), cefalosporine di prima, seconda e quarta generazione (13,4 DDD/100 HD; IC 95% 12,3-14,6) e di terza generazione (11,4 DDD/100HD; IC 95% 10,412,5). Nel periodo in studio è stato rilevato un trend di utilizzo in diminuzione (p < 0,05). I batteri isolati più frequentemente sono stati: Staphylococcus aureus, di cui il 9% (IC 95% 3,0-20,0) meticillino-resistente (MRSA); Escherichia coli, di cui il 5% (IC 95% 0,6-17,3) resistente ai carbapenemi e il 18% (IC 95% 7,5-33,5) produttore di Extended Spectrum Beta Lactamase (ESBL); Klebsiella pneumoniae, di cui il 28% (IC 95% 9,753,4) resistente ai carbapenemi e il 17% (IC 95% 3,6-41,4) produttore di ESBL; Pseudomonas aeruginosa, di cui il 15% resistente ai carbapenemi (IC 95% 3,2-37,9) e il 20% resistente ai fluorochinoloni(IC 95% 5,7-43,66 e Acinetobacter baumannii, di cui il 60% (IC 95% 14,7-94,7) resistente ai carbapenemi. Conclusioni Nonostante il rilievo di un utilizzo elevato di farmaci antibiotici, è stato osservato trend in diminuzione rispetto all’inizio della rilevazione. L’incidenza di Klebsiella pneumoniae resistente ai carbapenemi e di MRSA risulta relativamente contenuta, da rilevare l’emergenza della resistenza ai carbapenemi in Escherichia coli. I dati suggeriscono come sia necessaria un’attenta politica di stewardship antibiotica, associata a sistemi di sorveglianza per il controllo dell’antibioticoresistenza in UTI.
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Tissue oxygen saturation changes and postoperative complications in cardiac surgery: a prospective observational study
Anno: 2019
Rivista: BMC ANESTHESIOLOGY
Autori/autrici: Scolletta, Sabino; Franchi, Federico; Damiani, Elisa; Cennamo, Armando; Domizi, Roberta; Meola, Antonio; Scorcella, Claudia; Vanoli, Davide; Münch, Christopher; Adrario, Erica; Marchetti, Luca; Taccone, Fabio Silvio; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/272646
Citazioni:
Tissue oxygen saturation changes and postoperative complications in cardiac surgery: a prospective observational study / Scolletta, S., Franchi, F., Damiani, E., Cennamo, A., Domizi, R., Meola, A., Scorcella, C., Vanoli, D., Münch, C., Adrario, E., Marchetti, L., Taccone, F.S., Donati, A.. - In: BMC ANESTHESIOLOGY. - ISSN 1471-2253. - ELETTRONICO. - 19:299(2019), pp. 1-10. [10.1186/s12871-019-0905-5]
Abstract:
Cardiac surgery with extracorporeal circulation (ECC) can induce microvascular dysfunction and tissue hypoperfusion. We hypothesized that the alterations in near-infrared spectroscopy (NIRS)-derived parameters would be associated with post-operative complications in cardiac surgery patients.

Awake fiberoptic intubation with double lumen tube for severe predicted difficult airways: Could it be feasible with a rigid fiberoptic stylet?
Anno: 2019
Rivista: INDIAN JOURNAL OF ANAESTHESIA
Autori/autrici: Falcetta, Stefano; Sorbello, Massimiliano; Giacinto, Ida; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/266026
Citazioni:
Awake fiberoptic intubation with double lumen tube for severe predicted difficult airways: Could it be feasible with a rigid fiberoptic stylet? / Falcetta, S., Sorbello, M., Giacinto, I., Donati, A.. - In: INDIAN JOURNAL OF ANAESTHESIA. - ISSN 0019-5049. - STAMPA. - 63:4(2019), pp. 323-325. [10.4103/ija.IJA_789_18]

IgM-enriched immunoglobulins (Pentaglobin) may improve the microcirculation in sepsis: a pilot randomized trial
Anno: 2019
Rivista: ANNALS OF INTENSIVE CARE
Autori/autrici: Domizi, Roberta; Adrario, Erica; Damiani, Elisa; Scorcella, Claudia; Carsetti, Andrea; Giaccaglia, Paolo; Casarotta, Erika; Gabbanelli, Vincenzo; Pantanetti, Simona; Lamura, Elena; Ciucani, Silvia; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/272419
Citazioni:
IgM-enriched immunoglobulins (Pentaglobin) may improve the microcirculation in sepsis: a pilot randomized trial / Domizi, R., Adrario, E., Damiani, E., Scorcella, C., Carsetti, A., Giaccaglia, P., Casarotta, E., Gabbanelli, V., Pantanetti, S., Lamura, E., Ciucani, S., Donati, A.. - In: ANNALS OF INTENSIVE CARE. - ISSN 2110-5820. - ELETTRONICO. - 9:1(2019), p. 135. [10.1186/s13613-019-0609-5]
Abstract:
BACKGROUND: Polyclonal or IgM-enriched immunoglobulins may be beneficial during sepsis as an adjuvant immunomodulatory therapy. We aimed to test whether the infusion of IgM-enriched immunoglobulins improves microvascular perfusion during sepsis. METHODS: Single-centre, randomized, double-blind, plac...ebo-controlled phase II trial including adult patients with a diagnosis of sepsis or septic shock for less than 24 h. Patients received an intravenous infusion of 250 mg/kg (5 mL/kg) per day of IgM-enriched immunoglobulins (Pentaglobin, n = 10) for 72 h or placebo (NaCl 0.9%, n = 9). At baseline and after 24 and 72 h of infusion, the sublingual microcirculation was assessed with Incident Dark Field videomicroscopy. Thenar near-infrared spectroscopy (NIRS) was applied with a vascular occlusion test to assess tissue oxygenation and microvascular reactivity. Levels of interleukin (IL) 1-beta, IL-6, IL-8, IL-10 and tumour necrosis factor alpha were measured in the serum. RESULTS: The perfused vessel density (PVD) for small vessels (diameter < 20 micron) increased in the Pentaglobin group (from 21.7 ± 4.7 to 25.5 ± 5.1 mm/mm2) and decreased in the placebo group (from 25 ± 5.8 to 20.7 ± 4.1 mm/mm2, p for interaction < 0.001, two-way analysis of variance). The absolute between-group difference at 72 h was 4.77 (standard error 2.34), p = 0.140. The microvascular flow index for small vessels increased at 24 h in the Pentaglobin group (from 2.68 [2.38-2.78] to 2.93 [2.82-3], p < 0.01) and decreased at 72 h in the placebo group (from 2.83 [2.60-2.97] to 2.67 [2.48-2.73], p < 0.05). Changes in general parameters, cytokines and NIRS-derived parameters were similar between the two groups, except for IL-6 and IL-10 that significantly decreased at 72 h only in the Pentaglobin group. CONCLUSIONS: A 72-h infusion of IgM-enriched immunoglobulins (Pentaglobin) in patients with sepsis or septic shock may be associated with an increase in sublingual microvascular perfusion. Further studies are needed to confirm our findings. Trial registration NCT02655133, www.ClinicalTrials.gov, date of registration 7th January 2016, https://www.clinicaltrials.gov/ct2/show/NCT02655133.
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Acute Kidney Injury and Fluid Resuscitation in Septic Patients: Are We Protecting the Kidney?
Anno: 2019
Rivista: NEPHRON JOURNALS
Autori/autrici: Montomoli, Jonathan; Donati, A.; Ince, C.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/270431
Citazioni:
Acute Kidney Injury and Fluid Resuscitation in Septic Patients: Are We Protecting the Kidney? / Montomoli, J., Donati, A., Ince, C.. - In: NEPHRON JOURNALS. - ISSN 1660-8151. - STAMPA. - 143:3(2019), pp. 170-173. [10.1159/000501748]
Abstract:
Acute kidney injury (AKI) is a common complication in critically ill patients, especially among septic patients. Sepsis and hypovolemia are the 2 most frequent etiologies of AKI in intensive care units and frequently coexist in critically ill patients. Effective fluid resuscitation is crucial for th...e stabilization of sepsis-induced tissue hypoperfusion or septic shock. However, the lack of a goal-directed therapy targeting kidney oxygenation prevents from optimization of the fluid therapy with regard to improvement of renal oxygen delivery and extraction. Similarly, fluid administration as all therapeutic actions carries adverse effects such as the activation of cytokines, disruption of the capillary glycocalyx, and adverse effects on kidney metabolism and oxygenation. Moreover, a positive fluid balance is associated with an increased risk of AKI and is a negative predictor for recovery of renal function. The role of fluid resuscitation on kidney injury stems from the high renal vulnerability to hypoxemic injury. Indeed, fluids have a poor oxygen solubility and hemodilution decreases blood viscosity both promoting intrarenal shunting and heterogeneity with a decreased capillary density and enhanced intrarenal cortex and medullary hypoxia. The development of physiological biomarkers that are able to detect the early development of AKI specifically aimed at the identification of renal microcirculatory dysfunctions should form a valuable contribution to monitoring therapeutic modalities.
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Airway pressure release ventilation during acute hypoxemic respiratory failure: a systematic review and meta-analysis of randomized controlled trials
Anno: 2019
Rivista: ANNALS OF INTENSIVE CARE
Autori/autrici: Carsetti, Andrea; Damiani, Elisa; Domizi, Roberta; Scorcella, Claudia; Pantanetti, Simona; Falcetta, Stefano; Donati, Abele; Adrario, Erica
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/266027
Citazioni:
Airway pressure release ventilation during acute hypoxemic respiratory failure: a systematic review and meta-analysis of randomized controlled trials / Carsetti, A., Damiani, E., Domizi, R., Scorcella, C., Pantanetti, S., Falcetta, S., Donati, A., Adrario, E.. - In: ANNALS OF INTENSIVE CARE. - ISSN 2110-5820. - STAMPA. - 9:1(2019), p. 44. [10.1186/s13613-019-0518-7]
Abstract:
BACKGROUND: Airway pressure release ventilation (APRV) has been considered a tempting mode of ventilation during acute respiratory failure within the concept of open lung ventilation. We performed a systematic review and meta-analysis to verify whether adult patients with hypoxemic respiratory fai...lure have a higher number of ventilator-free days at day 28 when ventilated in APRV compared to conventional ventilation strategy. Secondary outcomes were difference in PaO2/FiO2 at day 3, ICU length of stay (LOS), ICU and hospital mortality, mean arterial pressure (MAP), risk of barotrauma and level of sedation. We searched MEDLINE, Scopus and Cochrane Central Register of Controlled Trials database until December 2018. RESULTS: We considered five RCTs for the analysis enrolling a total of 330 patients. For ventilatory-free day at day 28, the overall mean difference (MD) between APRV and conventional ventilation was 6.04 days (95%CI 2.12, 9.96, p = 0.003; I2 = 65%, p = 0.02). Patients treated with APRV had a lower ICU LOS than patients treated with conventional ventilation (MD 3.94 days [95%CI 1.44, 6.45, p = 0.002; I2 = 37%, p = 0.19]) and a lower hospital mortality (RD 0.16 [95%CI 0.02, 0.29, p = 0.03; I2 = 0, p = 0.5]). PaO2/FiO2 at day 3 was not different between the two groups (MD 40.48 mmHg [95%CI - 25.78, 106.73, p = 0.23; I2 = 92%, p < 0.001]). MAP was significantly higher during APRV (MD 5 mmHg [95%CI 1.43, 8.58, p = 0.006; I2 = 0%, p = 0.92]). Then, there was no difference regarding the onset of pneumothorax under the two ventilation strategies (RR 1.94 [95%CI 0.54, 6.94, p = 0.31; I2 = 0%, p = 0.74]). ICU mortality and sedation level were not included into quantitative analysis. CONCLUSION: This study showed a higher number of ventilator-free days at 28 day and a lower hospital mortality in acute hypoxemic patients treated with APRV than conventional ventilation, without any negative hemodynamic impact or higher risk of barotrauma. However, these results need to be interpreted with caution because of the low-quality evidence supporting them and the moderate heterogeneity found. Other well-designed RCTs need to be conducted to confirm our findings.
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Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study
Anno: 2019
Rivista: PLOS ONE
Autori/autrici: Domizi, Roberta; Damiani, Elisa; Scorcella, Claudia; Carsetti, Andrea; Castagnani, Roberta; Vannicola, Sara; Bolognini, Sandra; Gabbanelli, Vincenzo; Pantanetti, Simona; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/266028
Citazioni:
Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study / Domizi, R., Damiani, E., Scorcella, C., Carsetti, A., Castagnani, R., Vannicola, S., Bolognini, S., Gabbanelli, V., Pantanetti, S., Donati, A.. - In: PLOS ONE. - ISSN 1932-6203. - ELETTRONICO. - 14:3(2019), p. e0213085. [10.1371/journal.pone.0213085]
Abstract:
INTRODUCTION: Previous studies described impaired microvascular perfusion and tissue oxygenation as reliable predictors of Multiple Organ Failure in major trauma. However, this relationship has been incompletely investigated. The objective of this analysis is to further evaluate the association be...tween organ dysfunction and microcirculation after trauma. MATERIALS AND METHODS: This is a retrospective subgroup analysis on 28 trauma patients enrolled for the Microcirculation DAIly MONitoring in critically ill patients study (NCT 02649088). Patients were divided in two groups according with their Sequential Organ Failure Assessment (SOFA) score at day 4. At admission and every 24 hours, the sublingual microcirculation was evaluated with Sidestream Darkfield Imaging (SDF) and peripheral tissue perfusion was assessed with Near Infrared Spectroscopy (NIRS) and Vascular Occlusion Test (VOT). Simultaneously, hemodynamic, clinical/laboratory parameters and main organ supports were collected. RESULTS: Median SOFA score at Day 4 was 6.5. Accordingly, patients were divided in two groups: D4-SOFA ≤6.5 and D4-SOFA >6.5. The Length of Stay in Intensive Care was significantly higher in patients with D4-SOFA>6.5 compared to D4-SOFA≤6.5 (p = 0.013). Total Vessel Density of small vessels was significantly lower in patients with high D4-SOFA score at Day 1 (p = 0.002) and Day 2 (p = 0.006) after admission; the Perfused Vessel Density was lower in patients with high D4-SOFA score at Day 1 (p = 0.007) and Day 2 (p = 0.033). At Day 1, NIRS monitoring with VOT showed significantly faster tissue oxygen saturation downslope (p = 0.018) and slower upslope (p = 0.04) in patients with high D4-SOFA. DISCUSSION: In our cohort of major traumas, sublingual microcirculation and peripheral microvascular reactivity were significantly more impaired early after trauma in those patients who developed more severe organ dysfunctions. Our data would support the hypothesis that restoration of macrocirculation can be dissociated from restoration of peripheral and tissue perfusion, and that microvascular alterations can be associated with organ failure.
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Changes in the sublingual microcirculation following aortic surgery under balanced or total intravenous anaesthesia: a prospective observational study
Anno: 2019
Rivista: BMC ANESTHESIOLOGY
Autori/autrici: Loggi, Silvia; Mininno, Nicoletta; Damiani, Elisa; Marini, Benedetto; Adrario, Erica; Scorcella, Claudia; Domizi, Roberta; Carsetti, Andrea; Pantanetti, Simona; Pagliariccio, Gabriele; Carbonari, Luciano; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/262774
Citazioni:
Changes in the sublingual microcirculation following aortic surgery under balanced or total intravenous anaesthesia: a prospective observational study / Loggi, S., Mininno, N., Damiani, E., Marini, B., Adrario, E., Scorcella, C., Domizi, R., Carsetti, A., Pantanetti, S., Pagliariccio, G., Carbonari, L., Donati, A.. - In: BMC ANESTHESIOLOGY. - ISSN 1471-2253. - ELETTRONICO. - 19:1(2019), pp. 1-11. [10.1186/s12871-018-0673-7]
Abstract:
In vascular surgery with aortic cross-clamping, ischemia/reperfusion injury induces systemic haemodynamic and microcirculatory disturbances. Different anaesthetic regimens may have a varying impact on tissue perfusion. The aim of this study was to explore changes in microvascular perfusion in patien...ts undergoing elective open abdominal aortic aneurysm repair under balanced or total intravenous anaesthesia.
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Sorveglianza degli eventi associati alla ventilazione meccanica: studio pilota in un’Unità di Terapia Intensiva
Anno: 2018
Rivista: GIORNALE ITALIANO MULTIDISCIPLINARE PER LA PREVENZIONE DELLE INFEZIONI NELLE ORGANIZZAZIONI SANITARIE
Autori/autrici: Formenti, L; Rapazzetti, S; Micheletti, R; Luciani, A; Bianchi, E; Arsego, D; Carletti, P; Domizi, R; Donati, A; Barbadoro, P; D’Errico, Mm
Lingua: ITA
Classificazione IRIS: 4.2 Abstract in Atti di convegno
Scheda completa IRIS: https://iris.univpm.it/handle/11566/259185
Citazioni:
Sorveglianza degli eventi associati alla ventilazione meccanica: studio pilota in un’Unità di Terapia Intensiva / Formenti, L., Rapazzetti, S., Micheletti, R., Luciani, A., Bianchi, E., Arsego, D., Carletti, P., Domizi, R., Donati, A., Barbadoro, P., D’Errico, M.m.. - In: GIORNALE ITALIANO MULTIDISCIPLINARE PER LA PREVENZIONE DELLE INFEZIONI NELLE ORGANIZZAZIONI SANITARIE. - ISSN 2280-644X. - STAMPA. - 8 (1):(2018), pp. 8-8. (Attualità e prospettive nella prevenzione e controllo delle infezioni nelle organizzazioni sanitarie Bergamo 21-23 maggio 2018) [10.1716/2942.29566].
Abstract:
Introduzione. Il monitoraggio degli eventi avversi associati alla ventilazione meccanica (VAE) rappresenta un elemento essenziale per la tutela della sicurezza del paziente. Lo scopo di questo studio è valutare l’impatto che le VAE hanno su mortalità, durata della degenza e dur...ata della ventilazione nei pazienti degenti in un’Unità di Terapia Intensiva. Metodi. È stato condotto uno studio di coorte retrospettivo. Sono stati inseriti nello studio tutti i pazienti degenti per più di 48 ore presso la Clinica di Anestesia e Rianimazione dell’Azienda Ospedaliero-Universitaria di Ancona nel periodo dicembre 2017 - febbraio 2018. Nel 2013 il National Healthcare Safety Network (NHSN) ha introdotto un nuovo sistema di sorveglianza che considera tutte le VAE definendole come complicanze associate alla ventilazione meccanica (VAC), condizioni infettive associate alla ventilazione meccanica (IVAC) e polmoniti associate alla ventilazione meccanica (PVAP). Le VAE sono state identificate secondo queste nuove definizioni. Sono stati valutati gli outcomes clinici nei pazienti che avevano avuto una VAE e nei pazienti senza VAE. L’analisi statistica è stata condotta utilizzando il test del chi-quadro e del t di Student, quando appropriato. Il livello di significatività è stato fissato a 0,05. Risultati. Sono stati raccolti i dati relativi a 50 pazienti, di cui il 22% (n=12) ha sviluppato una VAE. I tassi d’incidenza su 1.000 giornate di ventilazione meccanica sono stati: per le VAE 18,46 (IC 95% 9,2-32,8), per le VAC 20,13 (IC 95% 10,4-34,9), per le IVAC 3,36 (IC 95% 0,4-12) e per le PVAP 3,36 (IC 95% 0,4-12). L’insorgenza della VAE non è risultata associata ad aumento della mortalità [25%(IC 95% 5,5-57,1) vs 13% (IC 95% 4,4-28)] (p>0,05), ma all’aumento delle giornate di degenza (19 gg vs 12 gg) (p<0,05) e della durata della ventilazione meccanica (14 gg vs 8 gg) (p<0,05). Conclusioni. Dall’analisi di questi dati risulta che le VAE causano un aumento significativo delle giornate di degenza e di ventilazione meccanica, ma non hanno impatto sulla mortalità dei pazienti, confermando dunque il loro effetto in termini di morbosità per il paziente sottoposto a ventilazione meccanica.
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Consumo di antibiotici e pattern di resistenza di microrganismi in un’Unità di Terapia Intensiva
Anno: 2018
Rivista: GIORNALE ITALIANO MULTIDISCIPLINARE PER LA PREVENZIONE DELLE INFEZIONI NELLE ORGANIZZAZIONI SANITARIE
Autori/autrici: Micheletti, R; Rapazzetti, S; Arsego, D; Formenti, L; Luciani, A; Bianchi, E; Donati, A; Carletti, P; Domizi, R; Barbadoro, P; D’Errico, Mm
Lingua: ITA
Classificazione IRIS: 4.2 Abstract in Atti di convegno
Scheda completa IRIS: https://iris.univpm.it/handle/11566/259184
Citazioni:
Consumo di antibiotici e pattern di resistenza di microrganismi in un’Unità di Terapia Intensiva / Micheletti, R., Rapazzetti, S., Arsego, D., Formenti, L., Luciani, A., Bianchi, E., Donati, A., Carletti, P., Domizi, R., Barbadoro, P., D’Errico, M.m.. - In: GIORNALE ITALIANO MULTIDISCIPLINARE PER LA PREVENZIONE DELLE INFEZIONI NELLE ORGANIZZAZIONI SANITARIE. - ISSN 2280-644X. - STAMPA. - 8 (1):(2018), pp. 37-37. (Attualità e prospettive nella prevenzione e controllo delle infezioni nelle organizzazioni sanitarie Bergamo 21-23 maggio 2018) [10.1716/2942.29569].
Abstract:
Introduzione. Lo scopo di questo studio è di valutare l’utilizzo di antibiotici e l’antibioticoresistenza di microrganismi selezionati circolanti in un’Unità di Terapia Intensiva. ... Metodi. È stato attuato un sistema di sorveglianza basato sulla metodologia del National Healthcare Safety Network (NHSN). A partire da dicembre 2017 fino a febbraio 2018 presso la Clinica di Anestesia e Rianimazione dell’Azienda Ospedaliero-Universitaria di Ancona sono stati raccolti quotidianamente i dati relativi all’utilizzo degli antibiotici (molecola, dosaggio e durata) e gli isolamenti microbiologici (microrganismo e relativo antibiogramma).Il consumo totale di antibiotici e il consumo per classi d’interesse sono stati valutati utilizzando la metodologia Defined Daily Dose (DDD) e il calcolo delle DDD per 1000 Hospital Days (HD). La densità d’incidenza degli isolamenti è stata espressa come tasso d’isolamento per 1000 HD. Risultati. Sono stati raccolti i dati di 50 pazienti, di cui il 94% (n=47) ha effettuato terapia antibiotica. Il consumo totale di antibiotici è risultato di 2549 DDD/1000 HD (IC 95% 2433-2668). Le classi più utilizzate sono state: penicilline (902 DDD/1000 HD), fluorochinoloni (245 DDD/1000 HD), carbapenemi (217 DDD/1000 HD) e cefalosporine di terza generazione (135 DDD/1000 HD). Sono stati analizzati 115 isolamenti microbiologici con un tasso d’isolamento dei microrganismi selezionati del 30,47 per 1000 HD. I batteri isolati più frequentemente sono stati: Staphylococcus aureus, di cui il 14% Methicillin Resistant Staphylococcus aureus; Escherichia coli, di cui il 12% resistente ai carbapenemi e il 12% produttore di Extended Spectrum Beta Lactamase (ESBL); Klebsiella pneumoniae, di cui il 13% resistente ai carbapenemi e il 13% produttore di ESBL; Pseudomonas aeruginosa, di cui il 38% resistente ai carbapenemi e il 25% resistente ai fluorochinoloni e Acinetobacter baumannii, di cui il 100% resistente ai carbapenemi. Conclusioni. Durante lo studio è stato individuato un elevato utilizzo di fluorochinoloni, cefalosporine di terza generazione e carbapenemi nel reparto, ma nonostante ciò l’incidenza di Klebsiella pneumoniae resistente ai carbapenemi risulta contenuta. I dati testimoniano l’importanza dell’utilizzo appropriato di antibiotici nelle Unità di Terapia Intensiva.
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Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine
Anno: 2018
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Ince, Can; Boerma, E Christiaan; Cecconi, Maurizio; De Backer, Daniel; Shapiro, Nathan I; Duranteau, Jacques; Pinsky, Michael R; Artigas, Antonio; Teboul, Jean-Louis; Reiss, Irwin K M; Aldecoa, Cesar; Hutchings, Sam D; Donati, Abele; Maggiorini, Marco; Taccone, Fabio S; Hernandez, Glenn; Payen, Didier; Tibboel, Dick; Martin, Daniel S; Zarbock, Alexander; Monnet, Xavier; Dubin, Arnaldo; Bakker, Jan; Vincent, Jean-Louis; Scheeren, Thomas W L
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/253170
Citazioni:
Second consensus on the assessment of sublingual microcirculation in critically ill patients: results from a task force of the European Society of Intensive Care Medicine / Ince, C., Boerma, E.C., Cecconi, M., De Backer, D., Shapiro, N.I., Duranteau, J., Pinsky, M.R., Artigas, A., Teboul, J., Reiss, I.K.M., Aldecoa, C., Hutchings, S.D., Donati, A., Maggiorini, M., Taccone, F.S., Hernandez, G., Payen, D., Tibboel, D., Martin, D.S., Zarbock, A., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 1432-1238. - STAMPA. - 44:3(2018), pp. 281-299. [10.1007/s00134-018-5070-7]
Abstract:
Hand-held vital microscopes (HVMs) were introduced to observe sublingual microcirculatory alterations at the bedside in different shock states in critically ill patients. This consensus aims to provide clinicians with guidelines for practical use and interpretation of the sublingual microcirculation.... Furthermore, it aims to promote the integration of routine application of HVM microcirculatory monitoring in conventional hemodynamic monitoring of systemic hemodynamic variables.
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Oxygen in the critically ill: friend or foe?
Anno: 2018
Rivista: CURRENT OPINION IN ANAESTHESIOLOGY
Autori/autrici: Damiani, Elisa; Donati, Abele; Girardis, Massimo
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/253171
Citazioni:
Oxygen in the critically ill: friend or foe? / Damiani, E., Donati, A., Girardis, M.. - In: CURRENT OPINION IN ANAESTHESIOLOGY. - ISSN 1473-6500. - STAMPA. - 31:2(2018), pp. 129-135. [10.1097/ACO.0000000000000559]
Abstract:
To examine the potential harmful effects of hyperoxia and summarize the results of most recent clinical studies evaluating oxygen therapy in critically ill patients.

MicroDAIMON study: Microcirculatory DAIly MONitoring in critically ill patients: a prospective observational study
Anno: 2018
Rivista: ANNALS OF INTENSIVE CARE
Autori/autrici: Scorcella, Claudia; Damiani, Elisa; Domizi, Roberta; Pierantozzi, Silvia; Tondi, Stefania; Carsetti, Andrea; Ciucani, Silvia; Monaldi, Valentina; Rogani, Mara; Marini, Benedetto; Adrario, Erica; Romano, Rocco; Ince, Can; Boerma, E Christiaan; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/259283
Citazioni:
MicroDAIMON study: Microcirculatory DAIly MONitoring in critically ill patients: a prospective observational study / Scorcella, C., Damiani, E., Domizi, R., Pierantozzi, S., Tondi, S., Carsetti, A., Ciucani, S., Monaldi, V., Rogani, M., Marini, B., Adrario, E., Romano, R., Ince, C., Boerma, E.C., Donati, A.. - In: ANNALS OF INTENSIVE CARE. - ISSN 2110-5820. - ELETTRONICO. - 8:64(2018), pp. 1-9. [10.1186/s13613-018-0411-9]
Abstract:
Until now, the prognostic value of microcirculatory alterations in critically ill patients has been mainly evaluated in highly selected subgroups. Aim of this study is to monitor the microcirculation daily in mixed group of Intensive Care Unit (ICU)-patients and to establish the association between ...(the evolution of) microcirculatory alterations and outcome.
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Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP)
Anno: 2018
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Vincent, J. -L.; Lefrant, J. -Y.; Kotfis, K.; Nanchal, R.; Martin-Loeches, I.; Wittebole, X.; Sakka, S. G.; Pickkers, P.; Moreno, R.; Sakr, Y.; Pavlik, P.; Manak, J.; Kieslichova, E.; Turek, R.; Fischer, M.; Valkova, R.; Dadak, L.; Dostal, P.; Malaska, J.; Hajek, R.; Zidkova, A.; Lavicka, P.; Medve, L.; Sarkany, A.; Kremer, I.; Marjanek, Z.; Tamasi, P.; Kolbusz, J.; Kubler, A.; Mielczarek, B.; Mikaszewska-Sokolewicz, M.; Tamowicz, B.; Sulkowski, W.; Smuszkiewicz, P.; Pihowicz, A.; Trejnowska, E.; Hagau, N.; Filipescu, D.; Droc, G.; Lupu, M.; Nica, A.; Stoica, R.; Tomescu, D.; Constantinescu, D.; Valcoreanu Zbaganu, G.; Slavcovici, A.; Soskic, L.; Palibrk, I.; Jankovic, R.; Jovanovic, B.; Pandurovic, M.; Bumbasirevic, V.; Uljarevic, B.; Surbatovic, M.; Ladjevic, N.; Slobodianiuk, G.; Sobona, V.; Cikova, A.; Gebhardtova, A.; Cohen, J.; Sold, O.; Urbanek, P.; Schlieber, J.; Reisinger, J.; Auer, J.; Hartjes, A.; Lerche, A.; Janous, T.; Kink, E.; Krahulec, W.; Smolle, K.; Van Der Schueren, M.; Thibo, P.; Vanhoof, M.; Ahmet, I.; Philippe, G.; Dufaye, P.; Jacobs, O.; Fraipont, V.; Biston, P.; Dive, A.; Bouckaert, Y.; Gilbert, E.; Gressens, B.; Pinck, E.; Collin, V.; De Waele, J.; Rimachi, R.; Gusu, D.; De Decker, K.; Mandianga, K.; Heytens, L.; Herbert, S.; Olivier, V.; Vandenheede, W.; Rogiers, P.; Kolodzeike, P.; Kruse, M.; Andersen, T.; Harjola, V.; Saarinen, K.; Leone, M.; Durocher, A.; Moulront, S.; Lepape, A.; Losser, M.; Cabaret, P.; Kalaitzis, E.; Zogheib, E.; Charve, P.; Francois, B.; Beilouny, B.; Forceville, X.; Misset, B.; Jacobs, F.; Bernard, F.; Payen, D.; Wynckel, A.; Castelain, V.; Faure, A.; Lavagne, P.; Thierry, L.; Moussa, M.; Vieillard-Baron, A.; Durand, M.; Gainnier, M.; Ichai, C.; Arens, S.; Hoffmann, C.; Kaffarnik, M.; Scharnofske, C.; Voigt, I.; Peckelsen, C.; Weber, M.; Gille, J.; Lange, A.; Schoser, G.; Sablotzki, A.; Jaschinski, U.; Bluethgen, A.; Vogel, F.; Tscheu, A.; Fuchs, T.; Wattenberg, M.; Helmes, T.; Scieszka, S.; Heintz, M.; Sakka, S.; Kohler, J.; Fiedler, F.; Danz, M.; Riessen, R.; Kerz, T.; Kersten, A.; Tacke, F.; Marx, G.; Volkert, T.; Schmutz, A.; Nierhaus, A.; Kluge, S.; Abel, P.; Janosi, R.; Utzolino, S.; Bracht, H.; Toussaint, S.; Giannakou Peftoulidou, M.; Myrianthefs, P.; Armaganidis, A.; Routsi, C.; Xini, A.; Mouloudi, E.; Kokoris, I.; Kyriazopoulos, G.; Vlachos, S.; Lavrentieva, A.; Partala, P.; Nakos, G.; Barry, J.; O'Leary, R.; Motherway, C.; Faheem, M.; Dunne, E.; Donnelly, M.; Konrad, T.; Bonora, E.; Achilli, C.; Rossi, S.; Castiglione, G.; Peris, A.; Albanese, D.; Stocchetti, N.; Citerio, G.; Mozzoni, L.; Sisillo, E.; De Negri, P.; Savioli, M.; Vecchiarelli, P.; Puflea, F.; Stankovic, V.; Minoja, G.; Montibeller, S.; Calligaro, P.; Sorrentino, R.; Feri, M.; Zambon, M.; Colombaroli, E.; Giarratano, A.; Pellis, T.; Capra, C.; Antonelli, M.; Gullo, A.; Chelazzi, C.; De Capraris, A.; Patroniti, N.; Girardis, M.; Franchi, F.; Berlot, G.; Ponssen, H.; Ten Cate, J.; Bormans, L.; Husada, S.; Buise, M.; Van Der Hoven, B.; Reidinga, A.; Kuiper, M.; Kluge, G.; Den Boer, S.; Kesecioglu, J.; Van Leeuwen, H.; Flaatten, H.; Mo, S.; Branco, V.; Rua, F.; Lafuente, E.; Sousa, M.; Catorze, N.; Barros, M.; Pereira, L.; Vintem De Oliveira, A.; Gomes, J.; Gaspar, I.; Pereira, M.; Cymbron, M.; Dias, A.; Almeida, E.; Beirao, S.; Serra, I.; Ribeiro, R.; Povoa, P.; Faria, F.; Costa-E-Silva, Z.; Nobrega, J.; Fernandes, F.; Gabriel, J.; Voga, G.; Rupnik, E.; Kosec, L.; Kerin Povsic, M.; Osojnik, I.; Tomic, V.; Sinkovic, A.; Gonzalez, J.; Zavala, E.; Perez Valenzuela, J.; Marina, L.; Vidal-Cortes, P.; Posada, P.; Ignacio Martin-Loeches, A.; Munoz Guillen, N.; Palomar, M.; Sole-Violan, J.; Torres, A.; Gonzalez Gallego, M.; Aguilar, G.; Montoiro Allue, R.; Argueso, M.; Parejo, M.; Palomo Navarro, M.; Jose, A.; Nin, N.; Alvarez Lerma, F.; Martinez, O.; Tenza Lozano, E.; Arenal Lopez, S.; Perez Granda, M.; Moreno, S.; Llubia, C.; De La Fuente Martos, C.; Gonzalez-Arenas, P.; Llamas Fernandez, N.; Gil Rueda, B.; Estruch Pons, I.; Cruza, N.; Maroto, F.; Estella, A.; Ferrer, A.; Iglesias Fraile, L.; Quindos, B.; Quintano, A.; Tebar, M.; Cardinal, P.; Reyes, A.; Rodriguez, A.; Abella, A.; Garcia Del Valle, S.; Yus, S.; Maseda, E.; Berezo, J.; Tejero Pedregosa, A.; Laplaza, C.; Ferrer, R.; Rico-Feijoo, J.; Rodriguez, M.; Monedero, P.; Eriksson, K.; Lind, D.; Chabanel, D.; Zender, H.; Heer, K.; Frankenberger, B.; Jakob, S.; Haller, A.; Mathew, S.; Downes, R.; Barrera Groba, C.; Johnston, A.; Meacher, R.; Keays, R.; Haji-Michael, P.; Tyler, C.; Ferguson, A.; Jones, S.; Tyl, D.; Ball, A.; Vogel, J.; Booth, M.; Downie, P.; Watters, M.; Brett, S.; Garfield, M.; Everett, L.; Heenen, S.; Dhir, S.; Beardow, Z.; Mostert, M.; Brosnan, S.; Pinto, N.; Harris, S.; Summors, A.; Andrew, N.; Rose, A.; Appelboam, R.; Davies, O.; Vickers, E.; Agarwal, B.; Szakmany, T.; Wimbush, S.; Welters, I.; Pearse, R.; Hollands, R.; Kirk-Bayley, J.; Fletcher, N.; Bray, B.; Brealey, D.; Delle Karth, G.; Draxler, V.; Filzwieser, G.; Heindl, W.; Kellner, G.; Lenz, K.; Rossmann, E.; Wiedermann, C.; Chochrad, D.; Damas, P.; Decruyenaere, J.; Hoste, E.; Devriendt, J.; Espeel, B.; Installe, E.; Malbrain, M.; Nollet, G.; Preiser, J. C.; Raemaekers, J.; Roman, A.; Simon, M.; Spapen, H.; Swinnen, W.; Vallot, F.; Chytra, I.; Herold, I.; Polak, F.; Sterba, M.; Bestle, M.; Espersen, K.; Guldager, H.; Welling, K. -L.; Nyman, D.; Ruokonen, E.; Annane, D.; Catogni, P.; Colas, G.; Coulomb, F.; Dorne, R.; Garrouste, M.; Isetta, C.; Larche, J.; Legall, J. -R.; Lessire, H.; Malledant, Y.; Mateu, P.; Ossart, M.; Schlossmacher, P.; Timsit, J. -F.; Winnock, S.; Sollet, J. -P.; Mallet, L.; Maurer, P.; Sab, J. M.; Aykut, G.; Brunkhorst, F.; Lauterbach, M.; Ragaller, M.; Gatz, R.; Gerlach, H.; Henzler, D.; Hopf, H. -B.; Hueneburg, H.; Karzai, W.; Keller, A.; Bauer, T.; Kuhlmann, U.; Langgartner, J.; Manhold, C.; Reith, B.; Schuerholz, T.; Spies, C.; Stogbauer, R.; Unterburger, J.; Clouva-Molyvdas, P. -M.; Giokas, G.; Ioannidou, E.; Lahana, A.; Liolios, A.; Marathias, K.; Tasiou, A.; Tsangaris, H.; Marsh, B.; Power, M.; Sprung, C.; Biagioli, B.; Bobbio Pallavicini, F.; Pesenti, A.; Della Corte, F.; Donadio, P. P.; Donati, A.; Giorgio, T.; Giudici, D.; Greco, S.; Guadagnucci, A.; Lapichino, G.; Livigni, S.; Moise, G.; Nardi, G.; Panascia, E.; Pizzamiglio, M.; Ranieri, V. M.; Rosi, R.; Sicignano, A.; Solca, M.; Vignali, G.; Volpe Rinonapoli, I.; Barnas, M.; De Bel, E. E.; De Pont, A. -C.; Groeneveld, J.; Nijsten, M.; Sie, L.; Zandstra, D. F.; Harboe, S.; Linden, S.; Lovstad, R. Z.; Moen, H.; Smith-Erichsen, N.; Piotrowski, A.; Karpel, E.; Pais-De-Lacerda, A.; Paiva, J. A.; Pimentel, A.; Jovanovic, K.; Malik, P.; Lucka, K.; Aldecoa Alvarez-Santullano, C.; Artigas, A.; Escorsell, A.; Nicolas, J.; Izura Cea, J. J.; Montejo, J.; Palencia, E.; Santos, F.; Sierra-Camerino, R.; Sipmann, F.; Brodersen, K.; Haggqvist, J.; Hermansson, D.; Hjelmqvist, H.; Loderer, G.; Maggiorini, M.; Andrews, P.; Appadu, B.; Bewley, J.; Burchett, K.; Chambers, P.; Coakley, J.; Doberenz, D.; Eastwood, N.; Fielden, J.; Gedney, J.; Gunning, K.; Harling, D.; Jankowski, S.; Jayson, D.; Kilner, A.; Krishna-Kumar, V.; Lei, K.; Mackenzie, S.; Macnaughton, P.; Mcculloch, C.; Morgan, P.; Rhodes, A.; Roberts, C.; Russell, M.; Tupper-Carey, D.; Wright, M.; Twohey, L.; Watts, J.; Webster, R.; Williams, D.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/365572
Citazioni:
Comparison of European ICU patients in 2012 (ICON) versus 2002 (SOAP) / Vincent, J.-L., Lefrant, J.-Y., Kotfis, K., Nanchal, R., Martin-Loeches, I., Wittebole, X., Sakka, S.G., Pickkers, P., Moreno, R., Sakr, Y., Pavlik, P., Manak, J., Kieslichova, E., Turek, R., Fischer, M., Valkova, R., Dadak, L., Dostal, P., Malaska, J., Hajek, R., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 44:3(2018), pp. 337-344. [10.1007/s00134-017-5043-2]
Abstract:
Purpose: To evaluate differences in the characteristics and outcomes of intensive care unit (ICU) patients over time. Methods: We reviewed all epidemiological data, including comorbidities, types and severity of organ failure, interventions, lengths of stay and outcome, for patients from the Sepsis ...Occurrence in Acutely ill Patients (SOAP) study, an observational study conducted in European intensive care units in 2002, and the Intensive Care Over Nations (ICON) audit, a survey of intensive care unit patients conducted in 2012. Results: We compared the 3147 patients from the SOAP study with the 4852 patients from the ICON audit admitted to intensive care units in the same countries as those in the SOAP study. The ICON patients were older (62.5&nbsp;±&nbsp;17.0 vs. 60.6&nbsp;±&nbsp;17.4&nbsp;years) and had higher severity scores than the SOAP patients. The proportion of patients with sepsis at any time during the intensive care unit stay was slightly higher in the ICON study (31.9 vs. 29.6%, p&nbsp;=&nbsp;0.03). In multilevel analysis, the adjusted odds of ICU mortality were significantly lower for ICON patients than for SOAP patients, particularly in patients with sepsis [OR 0.45 (0.35–0.59), p&nbsp;&lt;&nbsp;0.001]. Conclusions: Over the 10-year period between 2002 and 2012, the proportion of patients with sepsis admitted to European ICUs remained relatively stable, but the severity of disease increased. In multilevel analysis, the odds of ICU mortality were lower in our 2012 cohort compared to our 2002 cohort, particularly in patients with sepsis.
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Evaluation of two neck ultrasound measurements as predictors of difficult direct laryngoscopy: A prospective observational study
Anno: 2018
Rivista: EUROPEAN JOURNAL OF ANAESTHESIOLOGY
Autori/autrici: Falcetta, Stefano; Cavallo, Simona; Gabbanelli, Vincenzo; Pelaia, Paolo; Sorbello, Massimiliano; Zdravkovic, Ivana; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/259282
Citazioni:
Evaluation of two neck ultrasound measurements as predictors of difficult direct laryngoscopy: A prospective observational study / Falcetta, S., Cavallo, S., Gabbanelli, V., Pelaia, P., Sorbello, M., Zdravkovic, I., Donati, A.. - In: EUROPEAN JOURNAL OF ANAESTHESIOLOGY. - ISSN 0265-0215. - STAMPA. - 35:8(2018), pp. 605-612. [10.1097/EJA.0000000000000832]
Abstract:
Unpredictable difficult laryngoscopy remains a challenge for anaesthesiologists, especially if difficult ventilation occurs during standard laryngoscopy. Accurate airway assessment should always be performed, but the common clinical screening tests have shown low sensitivity and specificity with a l...imited predictive value. Ultrasound-based airway assessment has been proposed recently as a useful, simple, noninvasive bedside tool as an adjunct to clinical methods, but to date, few studies are available about the potential role of ultrasound in difficult airway evaluation, and these are mostly limited to specific groups of patients.
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Impact of microcirculatory video quality on the evaluation of sublingual microcirculation in critically ill patients
Anno: 2017
Rivista: JOURNAL OF CLINICAL MONITORING AND COMPUTING
Autori/autrici: Damiani, Elisa; Ince, Can; Scorcella, Claudia; Domizi, Roberta; Carsetti, Andrea; Mininno, Nicoletta; Pierantozzi, Silvia; Adrario, Erica; Romano, Rocco; Pelaia, Paolo; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/236656
Citazioni:
Impact of microcirculatory video quality on the evaluation of sublingual microcirculation in critically ill patients / Damiani, E., Ince, C., Scorcella, C., Domizi, R., Carsetti, A., Mininno, N., Pierantozzi, S., Adrario, E., Romano, R., Pelaia, P., Donati, A.. - In: JOURNAL OF CLINICAL MONITORING AND COMPUTING. - ISSN 1573-2614. - STAMPA. - 31:5(2017), pp. 981-988. [10.1007/s10877-016-9924-7]
Abstract:
We aimed to assess the impact of image quality on microcirculatory evaluation with sidestream dark-field (SDF) videomicroscopy in critically ill patients and explore factors associated with low video quality. This was a retrospective analysis of a single-centre prospective observational st...udy. Videos of the sublingual microcirculation were recorded using SDF videomicroscopy in 100 adult patients within 12 h from admittance to the intensive care unit and every 24 h until discharge/death. Parameters of vessel density and perfusion were calculated offline for small vessels. For all videos, a quality score (-12 = unacceptable, 1 = suboptimal, 2 = optimal) was assigned for brightness, focus, content, stability, pressure and duration. Videos with a total score ≤8 were deemed as unacceptable. A total of 2455 videos (853 triplets) was analysed. Quality was acceptable in 56 % of videos. Lower quality was associated with worse microvascular density and perfusion. Unreliable triplets (≥1 unacceptable or missing video, 65 % of total) showed lower vessel density, worse perfusion and higher flow heterogeneity as compared to reliable triplets (p < 0.001). Quality was higher among triplets collected by an extensively-experienced investigator or in patients receiving sedation or mechanical ventilation. Perfused vessel density was higher in patients with Glasgow Coma Scale (GCS) ≤8 (18.9 ± 4.5 vs. 17.0 ± 3.9 mm/mm(2) in those with GCS >8, p < 0.001) or requiring mechanical ventilation (18.0 ± 4.5 vs. 17.2 ± 3.8 mm/mm(2) in not mechanically ventilated patients, p = 0.059). We concluded that SDF video quality depends on both the operator's experience and patient's cooperation. Low-quality videos may produce spurious data, leading to an overestimation of microvascular alterations.
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Ability and efficiency of an automatic analysis software to measure microvascular parameters.
Anno: 2017
Rivista: JOURNAL OF CLINICAL MONITORING AND COMPUTING
Autori/autrici: Carsetti, Andrea; Aya, Hd; Pierantozzi, Silvia; Bazurro, S; Donati, Abele; Rhodes, A; Cecconi, M.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/238343
Citazioni:
Ability and efficiency of an automatic analysis software to measure microvascular parameters / Carsetti, A., Aya, H.d., Pierantozzi, S., Bazurro, S., Donati, A., Rhodes, A., Cecconi, M.. - In: JOURNAL OF CLINICAL MONITORING AND COMPUTING. - ISSN 1387-1307. - STAMPA. - 31:4(2017), pp. 669-676. [10.1007/s10877-016-9928-3]
Abstract:
Analysis of the microcirculation is currently performed offline, is time consuming and operator dependent. The aim of this study was to assess the ability and efficiency of the automatic analysis software CytoCamTools 1.7.12 (CC) to measure microvascular parameters in comparison with Automated Vascu...lar Analysis (AVA) software 3.2. 22 patients admitted to the cardiothoracic intensive care unit following cardiac surgery were prospectively enrolled. Sublingual microcirculatory videos were analysed using AVA and CC software. The total vessel density (TVD) for small vessels, perfused vessel density (PVD) and proportion of perfused vessels (PPV) were calculated. Blood flow was assessed using the microvascular flow index (MFI) for AVA software and the averaged perfused speed indicator (APSI) for the CC software. The duration of the analysis was also recorded. Eighty-four videos from 22 patients were analysed. The bias between TVD-CC and TVD-AVA was 2.20 mm/mm2 (95 % CI 1.37-3.03) with limits of agreement (LOA) of -4.39 (95 % CI -5.66 to -3.16) and 8.79 (95 % CI 7.50-10.01) mm/mm2. The percentage error (PE) for TVD was ±32.2 %. TVD was positively correlated between CC and AVA (r = 0.74, p < 0.001). The bias between PVD-CC and PVD-AVA was 6.54 mm/mm2 (95 % CI 5.60-7.48) with LOA of -4.25 (95 % CI -8.48 to -0.02) and 17.34 (95 % CI 13.11-21.57) mm/mm2. The PE for PVD was ±61.2 %. PVD was positively correlated between CC and AVA (r = 0.66, p < 0.001). The median PPV-AVA was significantly higher than the median PPV-CC [97.39 % (95.25, 100 %) vs. 81.65 % (61.97, 88.99), p < 0.0001]. MFI categories cannot estimate or predict APSI values (p = 0.45). The time required for the analysis was shorter with CC than with AVA system [2'42″ (2'12″, 3'31″) vs. 16'12″ (13'38″, 17'57″), p < 0.001]. TVD is comparable between the two softwares, although faster with CC software. The values for PVD and PPV are not interchangeable given the different approach to assess microcirculatory flow.
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Effects of short-term hyperoxia on erythropoietin levels and microcirculation in critically Ill patients: a prospective observational pilot study
Anno: 2017
Rivista: BMC ANESTHESIOLOGY
Autori/autrici: Donati, Abele; Damiani, Elisa; Zuccari, Samuele; Domizi, Roberta; Scorcella, Claudia; Girardis, Massimo; Giulietti, Alessia; Vignini, Arianna; Adrario, Erica; Romano, Rocco; Mazzanti, Laura; Pelaia, Paolo; Singer, Mervyn
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/246165
Citazioni:
Effects of short-term hyperoxia on erythropoietin levels and microcirculation in critically Ill patients: a prospective observational pilot study / Donati, A., Damiani, E., Zuccari, S., Domizi, R., Scorcella, C., Girardis, M., Giulietti, A., Vignini, A., Adrario, E., Romano, R., Mazzanti, L., Pelaia, P., Singer, M.. - In: BMC ANESTHESIOLOGY. - ISSN 1471-2253. - ELETTRONICO. - 17:49(2017), pp. 1-10. [10.1186/s12871-017-0342-2]
Abstract:
The normobaric oxygen paradox states that a short exposure to normobaric hyperoxia followed by rapid return to normoxia creates a condition of 'relative hypoxia' which stimulates erythropoietin (EPO) production. Alterations in glutathione and reactive oxygen species (ROS) may be involved i...n this process. We tested the effects of short-term hyperoxia on EPO levels and the microcirculation in critically ill patients.
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Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis
Anno: 2017
Rivista: CRITICAL CARE
Autori/autrici: Vellinga, Namkje A R; Boerma, E Christiaan; Koopmans, Matty; Donati, Abele; Dubin, Arnaldo; Shapiro, Nathan I; Pearse, Rupert M; van der Voort, Peter H J; Dondorp, Arjen M; Bafi, Tony; Fries, Michael; Akarsu-Ayazoglu, Tulin; Pranskunas, Andrius; Hollenberg, Steven; Balestra, Gianmarco; van Iterson, Mat; Sadaka, Farid; Minto, Gary; Aypar, Ulku; Hurtado, F Javier; Martinelli, Giampaolo; Payen, Didier; van Haren, Frank; Holley, Anthony; Gomez, Hernando; Mehta, Ravindra L; Rodriguez, Alejandro H; Ruiz, Carolina; Canales, Héctor S; Duranteau, Jacques; Spronk, Peter E; Jhanji, Shaman; Hubble, Sheena; Chierego, Marialuisa; Jung, Christian; Martin, Daniel; Sorbara, Carlo; Bakker, Jan; Ince, Can
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/252918
Citazioni:
Mildly elevated lactate levels are associated with microcirculatory flow abnormalities and increased mortality: a microSOAP post hoc analysis / Vellinga, N.A.R., Boerma, E.C., Koopmans, M., Donati, A., Dubin, A., Shapiro, N.I., Pearse, R.M., van der Voort, P.H.J., Dondorp, A.M., Bafi, T., Fries, M., Akarsu-Ayazoglu, T., Pranskunas, A., Hollenberg, S., Balestra, G., van Iterson, M., Sadaka, F., Minto, G., Aypar, U., Hurtado, F.J., et al.. - In: CRITICAL CARE. - ISSN 1466-609X. - ELETTRONICO. - 21:1(2017), p. 255. [10.1186/s13054-017-1842-7]
Abstract:
Mildly elevated lactate levels (i.e., 1-2 mmol/L) are increasingly recognized as a prognostic finding in critically ill patients. One of several possible underlying mechanisms, microcirculatory dysfunction, can be assessed at the bedside using sublingual direct in vivo microscopy. We aimed to e...valuate the association between relative hyperlactatemia, microcirculatory flow, and outcome.
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Exploring alternative routes for oxygen administration
Anno: 2016
Rivista: INTENSIVE CARE MEDICINE EXPERIMENTAL
Autori/autrici: Damiani, Elisa; Dyson, Alex; Zacchetti, Lucia; Donati, Abele; Singer, Mervyn
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/238750
Citazioni:
Exploring alternative routes for oxygen administration / Damiani, E., Dyson, A., Zacchetti, L., Donati, A., Singer, M.. - In: INTENSIVE CARE MEDICINE EXPERIMENTAL. - ISSN 2197-425X. - STAMPA. - 4:1(2016), p. 34. [10.1186/s40635-016-0108-z]
Abstract:
Hypoxemia may compromise cell metabolism and organ function. Supplemental oxygen (O2) at high concentrations may prove ineffective, and issues relating to hyperoxia, barotrauma, mechanical ventilation, and extracorporeal oxygenation are well documented. Old reports suggest the potential safety and e...fficacy of alternative routes for O2 administration, such as intravenous or intestinal. We re-explored these routes in rat models of hypoxemia.
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Intravenous immunoglobulin in septic shock: review of the mechanisms of action and meta-analysis of the clinical effectiveness
Anno: 2016
Rivista: MINERVA ANESTESIOLOGICA
Autori/autrici: Busani, S; Damiani, Elisa; Cavazzuti, I; Donati, Abele; Girardis, M.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/232986
Citazioni:
Intravenous immunoglobulin in septic shock: review of the mechanisms of action and meta-analysis of the clinical effectiveness / Busani, S., Damiani, E., Cavazzuti, I., Donati, A., Girardis, M.. - In: MINERVA ANESTESIOLOGICA. - ISSN 1827-1596. - STAMPA. - 82:5(2016), pp. 559-572.
Abstract:
Sepsis is characterized by a complex immune response. In this study we aimed to provide a review of the mechanisms of action of immunoglobulin (Ig) related to sepsis and an updated meta-analysis of the clinical effectiveness of the Ig use in septic patients.

Comparison Between Doppler-Echocardiography and Uncalibrated Pulse Contour Method for Cardiac Output Measurement: A Multicenter Observational Study
Anno: 2016
Rivista: CRITICAL CARE MEDICINE
Autori/autrici: Scolletta, Sabino; Franchi, Federico; Romagnoli, Stefano; Carlà, Rossella; Donati, Abele; Fabbri, Lea P; Forfori, Francesco; Alonso Iñigo, José M; Laviola, Silvia; Mangani, Valerio; Maj, Giulia; Martinelli, Giampaolo; Mirabella, Lucia; Morelli, Andrea; Persona, Paolo; Payen, Didier
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/235915
Citazioni:
Comparison Between Doppler-Echocardiography and Uncalibrated Pulse Contour Method for Cardiac Output Measurement: A Multicenter Observational Study / Scolletta, S., Franchi, F., Romagnoli, S., Carlà, R., Donati, A., Fabbri, L.P., Forfori, F., Alonso Iñigo, J.M., Laviola, S., Mangani, V., Maj, G., Martinelli, G., Mirabella, L., Morelli, A., Persona, P., Payen, D.. - In: CRITICAL CARE MEDICINE. - ISSN 1530-0293. - STAMPA. - 44:7(2016), pp. 1370-1379. [10.1097/CCM.0000000000001663]
Abstract:
Echocardiography and pulse contour methods allow, respectively, noninvasive and less invasive cardiac output estimation. The aim of the present study was to compare Doppler echocardiography with the pulse contour method MostCare for cardiac output estimation in a large and nonselected critically ill... population.
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