Defining the bellwether procedures and processes for global trauma care: an international Delphi study
Anno: 2026
Rivista: BMJ GLOBAL HEALTH
Autori/autrici: Bath, M. F.; Amoako, J.; Edmiston, T.; Ratnayake, A. S.; Kabatoro, D.; Bagaria, D.; Menon, R.; Wohlgemut, J. M.; Hobbs, L.; Smith, B. G.; Nuño-Guzmán, C. M.; Vélez, S. E.; Brennan, R.; Conway Morris, A.; Hardcastle, T. C.; Weiser, T.; Bashford, T.; Feldheiser, A.; Noureldin, A.; Gupta, A.; Meidert, A. S.; Landaluce-Olavarria, A.; Cucino, A.; Strumia, A.; Guner, A.; Lopes, A. S.; Naidoo, A.; Zakaria, A. D.; Carsetti, A.; Gutiérrez, A.; Sanna, A.; Hartjes, A.; Rubiano, A. M.; Robertson, A. G.; Hasnaoui, A.; Gupta, A.; Sharma, A.; Piccolo, A.; Cherian, A.; Sharma, A.; Mahajan, A.; James, A.; Sousa, A. S. D.; Bartakke, A. A.; Roshdy, A.; Panda, A. K.; Zuki, A. M.; Gargavanis, A.; Adamu, A.; Yigit, B.; Hallmann, B.; Nomayo-Oriabure, B. O.; Blondeau, B.; Singh, B.; Madsen, B. E.; Tablov, B. V.; Chu, B. F.; Citgez, B.; Soto, C. L.; Whiffin, C.; Alexopoulou, C.; Terblanche, C.; O'Flynn, C. S.; Slagt, C.; Deana, C.; Akli-Nartey, C. A. O.; Tomescu, D. R.; Leon, D. A.; Puebla, D. B.; Wall, D.; Wineberg, D. L.; Wijayatilake, D.; Adrião, D.; Marcos, D. P.; Visconti, D.; Papadopoulos, D. C.; Toumpanakis, D.; Turitwenka, D.; Kunutsor, D.; Nevins, E. J.; Theophilidou, E.; Rostami, E.; Burrows, E. J.; Rodriguez-Ruiz, E.; Loko, E. M.; Andzie-Mensah, E.; Ikwutah, E.; Noè, E.; Haspels-Hogervorst, E. K.; Borja, E. A. L.; Theodorou, E.; Kaimakamis, E.; Guarracino, F.; Sangalli, F.; Mulazzani, F.; Dépret, F.; Bass, G. A.; Shrestha, G.; Mukoro, G. D.; Tsaousi, G.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/365613
Citazioni:
Defining the bellwether procedures and processes for global trauma care: an international Delphi study / Bath, M.F., Amoako, J., Edmiston, T., Ratnayake, A.S., Kabatoro, D., Bagaria, D., Menon, R., Wohlgemut, J.M., Hobbs, L., Smith, B.G., Nuño-Guzmán, C.M., Vélez, S.E., Brennan, R., Conway Morris, A., Hardcastle, T.C., Weiser, T., Bashford, T., Feldheiser, A., Noureldin, A., Gupta, A., et al.. - In: BMJ GLOBAL HEALTH. - ISSN 2059-7908. - 11:2(2026). [10.1136/bmjgh-2025-020909]
Abstract:
Background: The complexity of delivering trauma care makes the assessment of its provision challenging. The identification of bellwether procedures has previously been successful in the evaluation of global surgical care; however, any equivalent in assessing trauma care is currently lacking. Through... a Delphi process, we aimed to produce the bellwether procedures and processes for global trauma care. Methods: A global Delphi process was undertaken with healthcare professionals and academics involved in trauma care from across the world. A list of potential procedures and processes was identified through literature review and expert opinion, along with subsequent additional options suggested by respondents. Three successive rounds were completed, with respondents rating the importance of each procedure or process to be undertaken at any hospital that cares for trauma patients using a five-point Likert scale. Results: A total of 411 respondents from 78 countries completed the initial round of the Delphi process, with minimal attrition observed across rounds. Following three successive rounds of the Delphi and functional aggregation, nine bellwethers of global trauma care were determined, subdivided into three functional categories: 'Resuscitation & Stabilisation'-(1) Advanced Airway Management, (2) Short-term C-spine Immobilisation, (3) Long Bone Immobilisation; 'Diagnosis & Monitoring'-(4) Blood Gas Analysis, (5) Focused Assessment with Sonography in Trauma (FAST) Scanning, (6) Continuous Access to CT Imaging; 'Optimisation & Intervention'-(7) Blood Transfusion, (8) Tube Thoracostomy, (9) Laparotomy and Splenectomy. Conclusion: The Global Trauma Care Delphi study has produced nine metrics that provide pragmatic indicators for the overall assessment of trauma care capabilities at any healthcare setting worldwide. These bellwethers of global trauma care can enable hospitals, local managers and health ministries to identify institutions or regions that may require more in-depth assessment, allowing standards in the management of traumatic injuries to improve.
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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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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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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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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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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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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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Strategies to prevent ventilator-associated pneumonia in critically ill mechanically ventilated patients: a SIAARTI consensus statement
Anno: 2026
Rivista: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE
Autori/autrici: De Pascale, Gennaro; Cortegiani, Andrea; Busani, Stefano; Corona, Alberto; Carsetti, Andrea; Catalisano, Giulia; Cutuli, Salvatore Lucio; Forfori, Francesco; Girardis, Massimo; Maugeri, Jessica Giuseppina; Pasero, Daniela; Tescione, Marco; Viaggi, Bruno; Vaschetto, Rosanna; Volta, Carlo Alberto; Antonelli, Massimo
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/361292
Citazioni:
Strategies to prevent ventilator-associated pneumonia in critically ill mechanically ventilated patients: a SIAARTI consensus statement / De Pascale, G., Cortegiani, A., Busani, S., Corona, A., Carsetti, A., Catalisano, G., Cutuli, S.L., Forfori, F., Girardis, M., Maugeri, J.G., Pasero, D., Tescione, M., Viaggi, B., Vaschetto, R., Volta, C.A., Antonelli, M.. - In: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE. - ISSN 2731-3786. - (2026). [Epub ahead of print] [10.1186/s44158-026-00432-5]
Abstract:
Background: Ventilator-associated pneumonia (VAP) remains a major complication in mechanically ventilated critically ill patients. Although several preventive strategies have been proposed and incorporated into international guidelines, emerging evidence and evolving epidemiology warrant updated sta...tements. The Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) developed an expert consensus statement to provide pragmatic guidance for VAP prevention. Methods: This consensus statement was developed in accordance with SIAARTI methodology for consensus-based documents. A multidisciplinary panel of 10 experts was appointed and identified key items through a modified Delphi process. Consensus was defined as ≥ 75% agreement within the same Likert scale range. A structured literature search was conducted. Statements and supporting rationales were drafted by multidisciplinary subgroups and subjected to blinded voting. External peer review was performed prior to final approval. Results: Of ten proposed items, four achieved consensus in agreement and were included in the final document. Individual statements address: (1) subglottic secretion drainage, (2) endotracheal cuff pressure control, (3) chlorhexidine for oral hygiene, and (4) selective digestive decontamination (SDD). Subglottic secretions drainage and appropriate cuff pressure control are supported as preventive measures, while routine chlorhexidine use is not recommended outside selected cardiac surgery populations, and SDD was demonstrated effective to reduce VAP and mortality in low multidrug-resistant (MDR) settings. Conclusions: This consensus statement provides updated, pragmatic guidance for VAP prevention. Implementation should consider local epidemiology, particularly MDR prevalence, and patient-specific risk profiles.
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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]

Blood culture practices and microbiological capacity for sepsis diagnostics in Europe (2021–2022): a cross-sectional analysis of the European Sepsis Care Survey
Anno: 2026
Rivista: THE LANCET REGIONAL HEALTH. EUROPE
Autori/autrici: Scheer, Christian S.; Giamarellos-Bourboulis, Evangelos J.; Annane, Djillali; Artigas, Antonio; Tarik Aslan, Abdullah; Bottari, Gabriella; Bouma, Hjalmar R.; Černý, Vladimir; Curić Radivojević, Renata; Dewitte, Ken; Filipescu, Daniela; Gründling, Matthias; Hästbacka, Johanna; Laribi, Said; Lassen, Annmarie; Lebedinskii, Konstantin; Linder, Adam; Máca, Jan; Malbrain, Manu L. N. G.; Monti, Gianpaola; Ostermann, Marlies; Osthoff, Michael; Paiva, José Artur; Sabbatucci, Michela; Śmiechowicz, Jakub; Ştefan, Mihai Gabriel; Vollmer, Marcus; Vuković, Natalija; Zaragkoulias, Kyriakos; Reinhart, Konrad; Ferrer, Ricard; Idelevich, Evgeny A.; Scharf, Alexander; Leoniuk, Adam; Linder, Adam; Guimet, Adrià Albis; Da Silva, Adriana América; Cataldo, Adriana; Dąbkowska, Agata; Głusek, Agneverszka; Ioakeimidou, Aikaterini; Blanco, Alberto Del Castillo; Beishuizen, Albertus; Szczepańska, Aldona; Martin-Quiros, Alejandro; Rodriguez, Alejandro; Oliva, Alessandra; Manfredi, Alessandro; Franceschi, Alessia; Bertini, Alessio; Maroccia, Alessio; Koch, Alexander; Nicko, Alexander; Bleibtreu, Alexandre; Demay, Alfonso Arizmendi; Rezaei, Ali; Kazachonak, Aliaksei; Bartkowska-Śniatkowska, Alicja; Ojembarrena, Almudena Alonso; Tosoni, Alvise; Daverio, Marco; Correia, Ana Margarida; Munteanu, Ana Maria; Bártolo, Anabela; Harabor, Anamaria; Akpabie, Anani; Carsetti, Andrea; Magaard, Andrea; Ekman, Andreas; Hecker, Andreas; Nowak, Andreas; Ostermeier, Andreas; Prengel, Andreas; Sielenkämper, Andreas; Thierbach, Andreas; Krystopchuk, Andriy; Pihowicz, Andrzej; Crombach, Aneverk; Liebke, Angela; Lukic, Anita; Heymann, Anja; Baßeler, Sebastian; Lange, Anja-Tamara; Antes-żupa, Anna; Efthymiou, Anna; Eklund, Anna; Lukaszewska, Anna; Meuronen, Anna; Poli, Anna Patrizia; Radlińska, Anna; Rekas-Dudziak, Anna; Heitz, Anne Floor; Tacx, Annelies; Pulkkinen, Anni; Lassen, Annmarie; Frattari, Antonella; Viola, Antonella; Šutalo, Antonija Vrbanić; Carneiro, Antonio; Pereira De Figueiredo, António Manuel; Mäkelä, Antti; Paulus, Arion-Björn; Sablotzki, Armin; Seibel, Armin; Röhrs, Arne; Chalkias, Athanasios; Neverrhaus, Axel; Anuszkiewicz, B.; Kadar, Balazs; Michelangelo, Bartolo; Van Den Poel, Bea; De Simone, Belinda; Sasko, Benjamin; Müllejans, Bernd; Birmes, Bernhard; Cesar, Bernuy Galvez; Cisteró, Berta; Gottschlich, Birgit; Mustac-Hlebec, Biserka; Jäschke, Björn; Sakakushev, Boris E.; Duplancic, Bozidar; Van Herendael, Bruno; Bushra, Ibrahim; Mansson, Anna; Rayner, Caitriona; Cosmin, Calancia; Hopper, Carla; Triginer, Carles; Pallotto, Carlo; Lauterbach, Carmen; Fraga Quintana, Carmen Rosa; Romero, Carolina S.; Riske, Caroline; Gentili, Caterina; Byhahn, Christian; Keuneke, Christian; Prause, Christian; Schlottke, Christian; Lydon, Christina; Weis, Christine; Büttner, Christoph; Dodt, Christoph; Peter, Christoph; Plank, Christoph; Aveline, Christophe; Barletta, Cinzia; Gutsche, Claudia; Holzbauer, Claudia; Bodolea, Constantin; Thörmer, Cordula; Courjon, Johan; Cobilinschi, Cristian; Honorato, Cristina; Viloria, Cristina López; Kopitkó, Csaba; Engemann, Dagmar; Corneci, Dan; Bender, Daniel; Ionescu, Daniela; Orso, Daniele; Annika Van Rijssel, Daphne; Ojeda, David Andaluz; Honan, David; Míra, David; Dörschner, Dietmar; Keller, Dietrich; Schizas, Dimitrios; Bliamplias, Dimitris; Hinz, Dirk; Meininger, Dirk; Strange, Ditte Gry; Annane, Djillali; Schwurack, Astrid; Carine, Dokoula; Einwag, Dominik; Sandesc, Dorel; Van Cotthem, Ilse; Verwulgen, Eefje; Chircov, Elena; Karlafti, Eleni; Riihioja, Elina; Montel, Elisabeth; Matanović, Elora Pavla; Rolén, Els-Marie; Van Den Berg, Else; Sermijn, Erica; Lázaro, Ester Rovira; Javouhey, Etienne; Schaden, Eva; Michailidou, Evangelia Michail; Winklaar, Eveny; Dimitrov, Evgeni; Nikolaev, Evgeni; Voets, Evy; Zabul, Ewa; López Altimiras, F. Xavier; Caramelli, Fabio; Dacapito, Fabrizio; Catena, Fausto; Llopis, Ferran; Abedinov, Filip; Triest, Filip; Nikolaou, Filippia; Luciani, Filippo; Moore, Fiona; Florescu, Simin Aysel; Berteau, Florian; Prätsch, Florian; Schache, Florian; Seidlitz, Florian; Bobirca, Florin Teodor; Greco, Francesca; Lelli, Francesca; Fleres, Francesco; Ezponda, Francisco Jose; Apra, Franco; Fröhlich, Frank; Hendrich, Frank; Schleibach, Frank; Wolffgramm, Frank; Zoerner, Frank; Mewes, Frank-Günter; Klefisch, Frank-R.; Schiöler, Fredrik; Afflerbach, Friedrich; Hahne, Fritz-Ulrich; Nardai, Gabor; Chiriac, Gabriel; Gorexki, Gabriel Petre; Racanelli, Gabriele; Wolz, Gabriele; Bottari, Gabriella; Parisi, Gabriella; Slobodianiuk, Garri; Cadar, Genoveva; Fritz, Georg; Kreuzer, Georg; Notas, George; Sakka, George; Popivanov, Georgi; Klinkmann, Gerd; Giacinto, Ida; Giannini, Michele; Latten, Gideon; Maddalena, Giovanna; Andresen, Gisa; Brisinda, Giuseppe; Lauria, Giuseppe; Angioni, Goffredo; Stenlund, Göran; Płoński, Grzegorz; Oprea, Günther; Kaasjager, H. A. H.; Bouma, H. R.; Mutlak, Haitham; Ekvall, Hakan; Chmelíčková, Hana; Gabriel, Hannes; Hassold, Nolan; Rensing, Hauke; Schlegel-Höfner, Heike; Groth, Heiko; Ruschulte, Heiner; Groesdonk, Heinrich V.; Rüddel, Hendrik; Jansen, Henning; Rueffert, Henrik; Baquerizo Vargas, Herbert Glenny; Cappellini, Iacopo; Toth, Ibolya; Schanz, Ilka; Hajnal-Gabriela, Illes; Grigoras, Ioana; Orfanos, Ioannis; Osojnik, Irena; Rzepnieswski, Ireneusz; Klaus, Iris; Koper, Iris; Bagiu, Iulia; Morlova, Iulia-Roxana; Herold, Ivan; Pavlić, Ivana; Schindler, Ivo; Mohd, Izzaddin; Kraßler, J.; Morales, J. Miquel; Prokopowicz, Jacek; Packmohr, Jacob; Hoogerwerf, Jacobien; Saric, Jadranka Pavicic; Bilski, Jakub; Beneš, Jan; Breuls, Jan; Castan, Jan; Frič, Jan; Mersmann, Jan; Roesner, Jan P.; Seemann, Jan; Zatloukal, Jan; Baumert, Jan-Hinrich; Meyer, Jan-Jakob; Fastnacht-Böttcher, Jana; Protzel, Jana; Szederjesi, Janos; Gruszczyk, Janusz; Michalak, Janusz; Houser, Jaroslav; Janc, Jarosław; Luboński, Jarosław; Yañez, Javier Hermida; Pilar, Javier; Vincent, Jean-Louis; Lanoix, Jean-Philippe; Alsma, Jelmer; Kubitz, Jens Christian; Döffert, Jens; Eriksson, Jens; Heidrich, Jens; Soukup, Jens; Neverlsen, Jeppe Sa.; Pasquier, Jeremie; Svefors, Jesper; Barrueco Francioni, Jesús Emilio; Dvorský, Jiří; Klimeš, Jiří; Pařízek, Jiří; Zurek, Jiri; Bartczak, Joanna; Zorska, Joanna; Lopes, João Gamito; Ribeiro, Joao Miguel; Berkius, Johan; Lindström, Johan; Knotzer, Johann; Hästbacka, Johanna; Rhein, Johannes; Wierzchowska, Jolanta; Weißkirchen, Jona; Sunden-Cullberg, Jonas; Tverring, Jonas; Engel, Jörg; Kappert, Jörg; Rehlinghaus, Jörg; Paiva, José Artur; Cidade, José Pedro; Trenado, Josep; Yebenes, Juan Carlos; Gerber, Juan Fernando; Diaz, Juan Jose; Horcajada, Juan Pablo; Kovacs, Judit; Schön, Julika; Maelegheer, Karel; Stefańska-Wronka, Karina; Reiter, Karl; Baścik, Katarzyna; Skawińska, Katarzyna; Donadello, Katia; Masjosthusmann, Katja; Müller-Forte, Kay-Lars; Straka, Kelly; Dewitte, Ken; Achmus-Stenz, Kerstin; Jie, Kim; Slieker, Kitty; Kogelmann, Klaus; Mauermann, Knut; Müller, Knut; Nikolaos, Koronakis; Oremus, Kresimir; Nõmm, Kuido; Ljungström, Lars; Witt, Lars; Popa, Laura; Ryan, Laura; Ionescu, Lavinia; van Lelyveld-Haas, Lenneke; Licari, Leo; Valeanu, Liana; Zahradníček, Libor; Samuelsson, Line; Mellhammar, Lisa; Hasak, Liudmila; Vladoiu, Livia; Espina, Lorena Forcelledo; Kämmerling, Ludger; Bonavina, Luigi; Ensenat, Luis; Barnas, Lukas; Lörinc, Lukas; Olendrzyński, Łukasz; Rak, Łukasz; Coronel, Lupe; Pfeiffer, Lutz; Gryskova, M.; Schüler, M.; Hult, Maarit; Gawor, Maciej; Miulescu, Magdalena; Wujtewicz, Magdalena; Von Seth, Magnus; Ilic, Maja Karaman; Mikaszewska-Sokoleiwcz, Malgorzata; Morisse, Malte; Meyer-Barner, Matthias; Filippo, Manelli; Hoefler, Manfred; Nuscheler, Manfred; Corina-Cecilia, Null; Manole-Palivan, Null; Lupu, Mary Nicoleta; Beckers, Marc; Bota, Marc; Barchetti, Marco; Ingrosso, Marco; Ripa, Marco; Andersson, Maria; De Marco, Maria; Fortofoiu, Maria; Ivars, Maria Galiana; Pérez Pedrero, María José; Hernández Benito, María Juliana; Barrio, Maria Slocker; Zach, Maria; Anghele, Mariana; Guarino, Mario; Maciaszek, Mariola; Tałałaj, Mariola; Capaldi, Marisa Ann; Papurica, Marius; Neufang, Mark; Bressler, Markus; Eller, Markus; Kestler, Markus; Kredel, Markus; Rudnick, Markus; Teipel, Markus; Rodriguez, Marta Valcarcel; Van Tellingen, Martijn; Beiderlinden, Martin; Bier, Martin; Cermak, Martin; Ebert, Martin; Helan, Martin; Kahl, Martin; Metelka, Martin; Reichert, Martin; Schütz, Martin; Spångfors, Martin; Wagner, Martin; Čehulić, Martina; Pavletić, Martina; Gyenge, Marton; Bedding, Mary; Mehdi, Marzouk; Biberič, Maša; Miszczyszyn, Mateusz; Fischer, Mathias; Sprenger, Mathias; Belavić, Matija; Jurjević, Matija; Groznik, Matjaž; Gründling, Matthias; Huck, Matthias; Lutze, Matthias; Menzel, Matthias; Schmauß, Matthias; Weiß, Matthias; Mazzoni, Maurizio; Müller, Max; Souquet, Jochen; Ragaller, Maximilian; Villamayor, Mercedes Ibarz; Booke, Michael; Buerke, Michael; Dalager-Pedersen, Michael; Dolch, Michael; Fries, Michael; Habenicht, Michael; Kremer, Michael; Meisner, Michael; Meyer, Michael; Pogatschnigg, Michael; Schütz, Michael; Stofkoper, Michael; Holub, Michal; Pelíšek, Michal; Sitina, Michal; Śpiewak, Michał; Ziółkowski, Michał; Behan, Michelle; Castelo-Branco Sousa, Miguel; Blaj, Mihaela; Conci, Mihaela; Lupse, Mihaela; Valtonen, Mika; Moriconi, Mikael; Minaříková, Dagmar; Zajicek, Miroslav; Muhammad Baig, Mirza Aun; Remus, Mitre Ioan; Pillado, Modesto Martinez; Hasaballah, Mohamed; Van Der Lugt, Monique; Unglaube, Moritz; Mrozek, Natacha; Guimarães, Nádia; Issa, Nahema; Layios, Nathalie; Pallarés, Naya Bellaubí; Barros, Nelson; Monleón, Nieves Carbonell; Belaube, Nicolas; Mongardon, Nicolas; Serck, Nicolas; Verbeke, Nikolaas; Lambiris, Nikolas; Rovina, Nikoletta; Haake, Nils; Polze, Nina; Sulen, Nina; Muñoz Guillen, Noelia María; Bruns, Nora; Buenen, Noud; Assadian, Ojan; Broch, Ole; Oliwa, Olena; Klementová, Olga; Beck, Oliver; Habler, Oliver; Hensel, Oliver; Kunitz, Oliver; Schmid, Oliver; Blivik, Olof; Zika, Ondrej; Mörer, Onnen; Ioannidis, Orestis; Ljungquist, Oskar; Cortés, Pablo Vidal; Rodari, Paola; Raffaella, Papa; Lindgren, Pär; Stammet, Pascal; Minchella, Pasquale; Patricio, Patricia; Gille-Johnson, Patrik; Petricci, Patrizia; Pestana, Paula; Vera, Paula; Dostal, Pavel; Malina, Pavel; Sedlák, Pavel; Rebollo, Pedro Castro; Sedes, Pedro Rascado; Brand, Peter; Neumann, Peter; Hubacek, Petr; Stepanek, Petr; Uhlig, Petr; Wegermann, Petra; Tsafoulis, Philipp; Fillatre, Pierre; Guinot, Pierre Gregoire; Tattevin, Pierre; Faust, Pio; Czempik, Piotr; Smuszkiewicz, Piotr; Staniewski, Piotr; Calligaro, Plinio; Tassioudis, Polychronis; Dörr, Přemysl; Michalski, Przemysław; Klimaschewski, R.; Schnabel, R.; Cihlář, Radek; Lopez, Rafael Leon; Gałuszka, Rafał; Wójtowicz, Rafał; Haas, Rainer; Walper, Ralf; Budnik, Ralph; Sander, Ralph; Gukasjan, Raphael; Sitzler, Reiner; Cartuyvels, Reinoud; Szmigielska, Renata; Koch, Renate; Verbeek, René; Ferrer, Ricard; Castelbón, Ricardo; Wilting, Rob; Bocek, Robert; Janda, Robert; Moretti, Roberta; Asperen, Roelie Wösten-van; Jouffroy, Romain; Larcher, Romaric; Seidel, Ronald; Puleo, Rosario Cristoforo; Holten, Rouven-Alexander von; Ungurean, Roxana; Albrecht, Rüdiger; Lott, Rüdiger; Terras, Rui; Alves, Rute Fernandes; Müller, Ruth; Tokarczuk, Ryszard; Kumpulainen, Salla; Mäenpää, Sami; Müller, Sandra; Donovan, Sandra O.; Pohjanpaju, Sanna; Cajander, Sara; Ussat, Sascha; Angela, Saviano; Brandt, Sebastian; Casu, Sebastian; Hafner, Sebastian; Hammerich, Sebastian; Rehberg, Sebastian; Tranca, Sebastian; Knoth, Selena; Mashayekhi, Shahram; Fitzgerald, Shona; Pilia, Silvana; Azabal, Silvia Carbajo; De Rosa, Silvia; Koivisto, Simo-Pekka; Oelsner, Simon; Schäfer, Simon; Barnini, Simona; Viola, Simona; Tudor, Simu; Neill, Sinead O.; Iwańczak, Stanisław; Boye, Söhnke; Krofak, Sonja; Savino, Spadaro; Tevell, Staffan; Angermair, Stefan; Bergt, Stefan; Markoff, Stefan; Ostmeier, Stefan; Otto, Stefan; Wirtz, Stefan P.; Rußwurm, Stefan; Schroeder, Stefan; Staar, Stefan; Vandervelden, Stefanie; Trapassi, Stefano; Volkert, Steffen; Bendel, Stepani; Baumann, Stephan; Blache, Stephan; Koster, Stephanie; Mifsud, Stephanie; Brugger, Sulamita Carvalho; Jagoda, Sunil; Ackermann, Sven; Glöckl, Sybille; Dormans, T.; Robina, Tajana Milanovic; Koskue, Talvikki; Ciomartan, Tatiana; Tomasa, Teresa; Aslanidis, Theodoros; Verneverst, Thessa; Eckermann, Thomas; Grau, Thomas; Hahn, Thomas; Kiss, Thomas; Libuda, Thomas; Melzer, Thomas; Rösel, Thomas; Uhlig, Thomas; Volk, Thomas; Weidermann, Thomas; Keil, Thorsten; Bruckmoser, Tim; Piepho, Tim; Mark, Timmermans; Frolo, Tina; Mahečić, Tina Tomić; Gabrhelik, Toamas; Gropp, Tobias; Klöpper, Tobias; Lahmer, Tobias; Leipold, Tobias; Málek, Tomáš; Tajč, Tomáš; Urbina, Tomas; Vymazal, Tomas; Musiuk, Tomasz; Siegel, Tomasz; Skalec, Tomasz; Fricke, Torsten; Gottschaldt, Udo; Linstedt, Ulf; Blumenthal, Ulrich; Katt, Ulrich; Plog, Ulrich; Ronellenfitsch, Ulrich; George, Ursula; Brüggemann, Ute; Treue, Uwe; Adámková, Václava; Caramello, Valeria; Kaldis, Vasileios; Nolas, Vasileios; Papaioannou, Vasilios; Plötz, Verena; Degoricija, Vesna; Švigelj, Viktor; Jalkanen, Ville; Tripodi, Vincenzo Francesco; Zemánek, Vladimír; Ostermoor, Volker; Osthaus, W. Alexander; Wiersinga, W. Joost; Huiszoon, W. B.; Altaf, Wahid; Sobolewski, Waldemar; Stig, Walravens; Stadlmeyer, Walter; Mizak, Wiktoria; Wasiak, Witold; Dabrowski, Wojciech; Heinke, Wolfgang; Zink, Wolfgang; Muschart, Xavier; Bunin, Yuriy; Boué, Yvo; Young, Yvonne; Kos, Zdenek; Povšić-Čevra, Zdenko; Oremus, Zrinka Safaric; Górska, Zuzanna
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/352633
Citazioni:
Blood culture practices and microbiological capacity for sepsis diagnostics in Europe (2021–2022): a cross-sectional analysis of the European Sepsis Care Survey / Scheer, C.S., Giamarellos-Bourboulis, E.J., Annane, D., Artigas, A., Tarik Aslan, A., Bottari, G., Bouma, H.R., Černý, V., Curić Radivojević, R., Dewitte, K., Filipescu, D., Gründling, M., Hästbacka, J., Laribi, S., Lassen, A., Lebedinskii, K., Linder, A., Máca, J., Malbrain, M.L.N.G., Monti, G., et al.. - In: THE LANCET REGIONAL HEALTH. EUROPE. - ISSN 2666-7762. - 62:(2026). [10.1016/j.lanepe.2025.101570]
Abstract:
Background: Blood cultures (BCs) are key diagnostic elements for sepsis patients. Accurate preanalytical procedures are substantial, and results should be available as soon as possible to guide adequate antimicrobial treatment. This study aimed to evaluate BC collection practices and diagnostic capa...city across European hospitals. Methods: This cross-sectional survey investigated BC diagnostics in acute care hospitals across 37 European countries in the years 2021 and 2022. Analyses included BC guidelines, collection sites, number of BC sets in emergency departments (EDs), wards, and intensive care units (ICUs). We also examined transfer after collection, the use of on-site vs. external laboratories, opening hours, rapid testing capacity, and turn-around times of BCs processed in microbiology laboratories with different infrastructures. Findings: Responses were collected from 907 hospitals in Europe. BC guidelines were available in 84·4% (741/878) of the hospitals. BCs were preferably collected by multiple-site sampling in EDs (62·7%, 461/735), in wards (64·0%, 513/802) and ICUs (68·5%, 518/756). One BC set was preferred in EDs in 38·4% (270/704), in wards in 40·5% (314/775), and ICUs in 34·9% (261/748). Two BC sets were preferred in EDs in 31·0% (218/704), in wards in 28·1% (218/775), and ICUs in 39·2% (293/748). 48·0% (402/838) of hospitals used on-site and 52·0% (436/838) external microbiology laboratories. Around-the-clock microbiological services were available in 10⋅0% (91/907), and rapid pathogen identification in 43·7% (396/907) of hospitals. Infrastructure with around-the-clock microbiological service and rapid testing was available in 7·4% (62/840) of hospitals, and probability of a final microbiological result within two days was highest in these hospitals compared to hospitals with limited microbiology service (for BC collected on wards: 19·6% vs. 52·7%, Odds Ratio 4·59 [95% CI 2·50–7·79], p < 0·0001). Interpretation: Despite the availability of BC guidelines in many hospitals, current recommendations for BC collection were often neglected. Rapid testing capacity was limited in most microbiological laboratories, and around-the-clock service for BCs was very rare. As delay in results may have a detrimental impact on patient outcomes, strategies to improve these processes are urgently needed. Funding: The European Sepsis Alliance and a grant by Becton and Dickinson.
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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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Regional sepsis care in Catalonia: comparative insights from a secondary analysis of the European Sepsis Care Survey
Anno: 2025
Rivista: CRITICAL CARE
Autori/autrici: Adrian, Ceccato; Christian S., Scheer; Ricard, Ferrer; Maria Luisa, Martinez; Berta, Cisteró; Juan Carlos, Yébenes; Josep, Trenado; Carol, Lorencio; Adam, Linder; Daniela, Filipescu; Evgeny A., Idelevich; Evangelos J., Giamarellos-Bourboulis; Antonio, Artigas; European Sepsis Care Study, Group; Carsetti, Andrea
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/352634
Citazioni:
Regional sepsis care in Catalonia: comparative insights from a secondary analysis of the European Sepsis Care Survey / Adrian, C., Christian S., S., Ricard, F., Maria Luisa, M., Berta, C., Juan Carlos, Y., Josep, T., Carol, L., Adam, L., Daniela, F., Evgeny A., I., Evangelos J., G., Antonio, A., European Sepsis Care Study, G., Carsetti, A.. - In: CRITICAL CARE. - ISSN 1364-8535. - 29:(2025). [10.1186/s13054-025-05507-3]

In-hospital outcomes and 6-month follow-up results of patients supported with extracorporeal membrane oxygenation for COVID-19 from the second wave to the end of the pandemic (EuroECMO-COVID): a prospective, international, multicentre, observational study
Anno: 2025
Rivista: THE LANCET RESPIRATORY MEDICINE
Autori/autrici: De Piero, Maria Elena; Mariani, Silvia; Van Bussel, Bas C T; Jarczak, Dominik; Krenner, Niklas; De La Sota, Enrique Perez; Silva, Pedro E; Roemmer, Magdalena; Kowalewski, Mariusz; Carelli, Simone; Broman, Lars Mikael; Vuylsteke, Alain; Fortuna, Philip; Alessandri, Francesco; Martucci, Gennaro; Patel, Brijesh V; Lotz, Gosta; Boeken, Udo; Maier, Sven; Filip, Bursa; Meyns, Bart; Haenggi, Matthias; Puss, Severin; Schellongowski, Peter; Kirali, Kaan; Bolotin, Gil; Barrett, Nicholas; Riera, Jordi; Mueller, Thomas; Belohlavek, Jan; Lorusso, Roberto; Di Mauro, Michele; Van Der Horst, Iwan C. C.; Van Kruijk, Sander M. J.; Delnoij, Thijs; Schibilsky, David; Wiedemann, Dominik; Vercaemst, Leen; Scandroglio, Anna Mara; Belliato, Mirko; Bertini, Pietro; Agrò, Felice Eugenio; Bombino, Michela; Halbe, Maximilian; Camporota, Luigi; Swol, Justyna; Circelli, Alessandro; Goriup, Vojka; Ugur, Murat; Raes, Matthias; Muellenbach, Ralf M.; Peperstraete, Harlinde; Kyriakoudi, Anna; Timmermans, Philippe; Guinot, Pierre-Grégoire; Moeller Pedersen, Finn; Samalavicius, Robertas; Strauven, Maarten; Havrin, Sven; Parasido, Alessandro; Debeuckelaere, Gerdy; Lagrand, Wim K; Pacini, Davide; Picichè, Marco; Vionne, Dominique; Kothleutner, Florian; Lagny, Marc-Gilbert; Besserve, Patricia; O'Brien, Serena; Mass, Jacinta J.; Taccone, Fabio S.; Gaudard, Philippe; Staudinger, Thomas; Nagler, Bernhard; Buchtele, Nina; Mair, Peter; Kilo, Juliane; Krapf, Christoph; Erbert, Kathrin; Peer, Andreas; Bonaros, Nikolaos; Dier, Helga; Karner, Marina; Reining, Georg; Umgeher, Martin; Lipusch, Jurgen; Shestakova, Liana; Hermans, Greet; Dauwe, Dieter; Meersseman, Philippe; Stockman, Bernard; Nobile, Leda; Annoni, Filippo; Halenanova, Katarina; De Backer, Daniel; Giglioli, Simone; Michiels, Gregoire; Foulon, Pierre; Rodrigus, Inez; Jorens, Philippe; Jacobs, Sharon; Piagnerelli, Michael; Biston, Patrick; Vandewiele, Komeel; Germay, Olivier; Vandeweghe, Dimitri; Bourgeois, Marc; Dewulf, Bram; Vandeweghe, Dimitri; Bourgeois, Marc; Alois, Genette; Lavios, Nathalie; Courcelle, Romain; Lavios, Nathalie; Misset, Benoit; Courcelle, Romain; Yilmaz, Alaaddin; Van Tomout, Michiel; Lehaen, Jerone; Gutermann, Herbert; Thiessen, Steven; De Keyzer, Dieter; Lormans, Piet; Verhamme, Bruno; Vandewaeter, Catherine; Bonte, Frederik; Blàha, Jan; Lips, Michal; Othal, Michal; Spacek, Radim; Christensen, Steffen; Jorgensen, Vibeke; Sorensen, Marc; Madsen, Soren A.; Beljantsev, Aleksandr; Saiydoun, Gabriel; Fiore, Antonio; Colson, Pascal; Bazalgette, Florian; Capdevila, Xavier; Kollen, Sebastien; Muller, Laurent; Obadia, Jean-Francois; Dubien, Pierre-Yves; Richard, Jean Christophe; Verhove, Jean-Philippe; Flecher, Erwan; Airhourh, Lucrezia; Nguyen, Maxime; Bouhemad, Belaid; Zarka, Jonathan; Mahjoub, Yazine; Malfertheiner, Maximilian V; Dreier, Esther; Wiest, Clement; Lichtenberg, Artur; Aubin, Hug; Hettlich, Vincent; Saeed, Diyar; Thiele, Holger; Baumgaertel, Matthias; Schmitto, Jan D; Ruslan, Natanov; Haverich, Axel; Thielmann, Matthias; Brenner, Thorsten; Ruhpawar, Arjang; Benk, Christoph; Czerny, Martin; Staudacher, Dawid L; Beyersdorf, Fridhelm; Kalbhenn, Johannes; Henn, Philipp; Popov, Aron-Frederik; Iuliu, Torje; Rolfes, Caroline; Ajouri, Jonas; Sonntagbauer, Michael; Winkels, Helen; Fichte, Julia; Friedrichson, Benjamin; Stohr, Robert; Kalverkamp, Sebastian; Karagiannidis, Christian; Schafer, Simone; Svetlitchny, Alexei; Fichte, Julia; Hopf, Hans-Bernd; Kluge, Stefan; Keinn, Melanie; Conrad, Andrea; Krebs, Lisa; Groesdonk, Heinirich; Hirsch, Jan; Kaehny, Christian; Soufleris, Dimitros; Gavriilidis, Georgios; Pontikis, Kostantinos; Oikonomou, Evangelos; Tsagkari, Vasiliki; Conrick-Martin, Ian; Carton, Edmund; Cruz, Leonora; Macnamara, Vanessa; Makhoul, Maged; Ben-Ari, Josef; Hadash, Amir; Kogan, Alexander; Kassif Lerner, Reut; Abu-Shakra, Anas; Matan, Moshe; Balawona, Ahmad; Kachel, Erez; Altshuler, Roman; Galante, Ori; Fuchs, Lior; Almog, Yaniv; Ishay, Yaron S; Lichter, Yael; Gal-oz, Amir; Carmi, Uri; Nini, Asaph; Soroksky, Arie; Dekel, Hagi; Rozman, Ziv; Tayem, Emad; Ilgiyaev, Eduard; Hochman, Yuval; Miltau, Daniel; Rapoport, Avigal; Eden, Arieh; Kompanietz, Dmitry; Yousif, Michael; Golos, Miri; Grazioli, Lorenzo; Ghitti, Davide; Loforte, Antonio; Di Luca, Daniela; Baiocchi, Massimo; Pacini, Davide; Cappai, Antioco; Meani, Paolo; Mondino, Michele; Russo, Claudio F; Ranucci, Marco; Fina, Dario; Cotza, Marco; Ballotta, Andrea; Landoni, Giovanni; Nardelli, Pasquale; Fominski, Eygeny V; Brazzi, Luca; Montrucchio, Giorgia; Sales, Gabriele; Simonetti, Umberto; Livigni, Sergio; Silengo, Daniela; Arena, Giulia; Sovatzis, Stefania S; Degani, Antonella; Riccardi, Mariachiara; Milanesi, Elisa; Raffa, Giuseppe; Arcadipane, Antonio; Panarello, Giovanna; Chiarini, Giovanni; Cattaneo, Sergio; Puglia, Carmine; Benussi, Stefano; Foti, Giuseppe; Giani, Marco; Costa, Maria Cristina; Rona, Roberto; Avalli, Leonello; Donati, Abele; Carozza, Roberto; Gasparri, Francesco; Carsetti, Andrea; Marinello, Anna; Danzi, Vinicio; Zanin, Anita; Marinello, Anna; Condello, Ignazio; Fiore, Flavio; Moscarelli, Marco; Nasso, Giuseppe; Speziale, Giuseppe; Sandrelli, Luca; Montalto, Andrea; Musumeci, Francesco; Russo, Emanuele; Agnoletti, Vanni; Antonini, Marta V; Rociola, Ruggero; Milano, Aldo D; Pilato, Emanuele; Comentale, Giuseppe; Montisci, Andrea; Tosi, Antonella; Pugliese, Francesco; Giordano, Giovanni; Grieco, Domenico L; Dell'Anna, Antonio M; Antonelli, Massimo; Ramoni, Enrico; Zulueta, Josè; Del Giglio, Mauro; Petracca, Sebastiano; Guarracino, Fabio; De Simone, Luigi; Forfori, Francesco; Angeletti, Paolo M; Taraschi, Francesco; Quintiliani, Veronica N; Mattei, Alessia; Schiavoni, Lorenzo; Lavorante, Fedra; Sgarlato, Giuseppe; Jankuviene, Agne; Sabliauskas, Jurij; Vasilkeviciute, Ugne; Soerensen, Gro; Suwalski, Piotr; Szuldrynski, Konstanty; Pinto, Luis F.; Linhares Santos, Luis; Marques, Ana; Miranda, Marisa; Teixeira, Sonia; Trigo, Emilia; Pereira, Filipe; Barrigoto, Cleide; Rodeia, Simao; Ketskalo, Michail; Tsarenko, Sergey; Shilova, Alexandra; Afukov, Ivan; Popugaev, Konstantin; Minin, Sergei; Shelukhin, Daniil; Malceva, Olga; Gleb, Moroz; Skopets, Alexander; Kornelyuk, Roman; Kulikov, Alexandr; Okhrimchuk, Vadim; Turchaninov, Alexandr; Shelukhin, Daniil; Petrushin, Maxim; Sheck, Anastasia; Mekulov, Akhmed; Ciryateva, Svetlana; Urusov, Dmitry; Golicnik, Alenka; Goslar, Tomaz; Ferrer, Ricard; Martinez-Martinez, Maria; Argudo, Eduard; Martinez-Pla, Maria; De Pablo Sanchez, Raul; Juan Higuera, Lucas; Marquez, Josè A; Arnau Blasco, Lucas; Sbraga, Fabrizio; Fuset, Mari Paz; De Gopegui, Pablo Ruiz; Claraco, Luis M; De Ayala, Josè A; Peiro, Maranta; Ricart, Pilar; Martinez, Sergio; Chavez, Fernando; Fabra, Marc; Sandoval, Elena; Toapanta, David; Carraminana, Albert; Tellez, Adrian; Ososio, Jeysson; Milan, Pablo; Rodriguez, Jorge; Andoni, Garcia; Gutierrez, Carola; Eixeres-Esteve, Andrea; Garcia-Maellas, Maria Teresa; Arboleda-Salazar, Rafael; Pérez-Vela, José; Santa Teresa, Patricia; Jaspe, Alexis; Garrido, Alberto; Castaneda, Galo; Alcantara, Sara; Martinez, Nuria; Perez, Marina; Villanueva, Hector; Vidal Gonzalez, Anxela; Paez, Juan; Santon, Arnoldo; Perez, Cesar; Lopez, Marta; Rubio Lopez, Maria Isabel; Gordillo, Antonio; Naranjo-Izurieta, Jose; Munoz, Javier; Alcalde, Immaculada; Onieva, Fernando; Gimeno Costa, Ricardo; Perez, Francisco; Madrid, Isabel; Gordon, Monica; Albacete Moreno, Carlos L; Perez, Daniel; Lopez, Nayara; Martinenz, Domingo; Blanco-Schweizer, Pablo; Diez, Cristina; Perez, David; Prieto, Ana; Renedo, Gloria; Bustamante, Elena; Cicuendez, Ramon; Citores, Rafael; Boado, Victoria; Garcia, Katherine; Voces, Roberto; Domezain, Monica; Nunez Martinez, Jose Maria; Vicente, Raimundo; Martin, David; Andreu, Antonio; Gomez Casal, Vanesa; Chico, Ignacio; Menor, Eva Maria; Vara, Sabela; Gamacho, Jose; Perez-Chomon, Helen; Javier Gonzales, Francisco; Barrero, Irene; Martin-Villen, Luis; Fernandez, Esperanza; Mendoza, Maria; Navarro, Joaquin; Colomina Climent, Joaquin; Gonzales-Perez, Alfredo; Muniz-Albaceita, Guillermo; Amado, Laura; Rodriguez, Raquel; Ruiz, Emilio; Eiras, Maria; Grins, Edgars; Magnus, Rosen; Kanetoft, Mikael; Eidevald, Marcus; Watson, Pia; Vogt, Paul R; Steiger, Peter; Aigner, Tobias; Weber, Alberto; Grunefelder, Jurg; Kunz, Martin; Grapow, Martin; Aymard, Thierry; Reser, Diana; Agus, Gianluca; Consiglio, Jolanda; Hansjoerg, Jenni; Iten, Manuela; Doeble, Thomas; Zenklusen, Urs; Bechtold, Xavier; Faedda, Giovanni; Iafrate, Manuel; Rohjer, Amanda; Bergamaschi, Layla; Reis Miranda, Dinis; Endeman, H; Gommers, D; Meuwese, C; Elzo Kraemer, Carlos V; Lopez Matta, Jorge E; Janson, Jeroen A; Candura, Dario; Van Der Linden, Marcel; Kant, Merijin; Van Der Heijden, Jj; Scholten, Eric; Van Belle-van Haren, Nicole; Vlaar, Alexander P; De Jong, Syste; Cander, Basar; Adiyeke, Esra; Kaygin, Mehmet A; Tomarchio, Emilia; Momigliano, Francesca; Williams, Kate; Musa, Khairil; Barker, Julian; Head, Laura; Kelly, Laura; Anoma, Gunawardena; Russell, Clare; Aquino, Verna; Scott, Ian; Flemming, Lucy; Gillon, Stuart; Moore, Olivia; Fowles, Jo-anne; Gelandt, Elton; Auzinger, George; Patel, Sameer; Loveridge, Robert
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/345373
Citazioni:
In-hospital outcomes and 6-month follow-up results of patients supported with extracorporeal membrane oxygenation for COVID-19 from the second wave to the end of the pandemic (EuroECMO-COVID): a prospective, international, multicentre, observational study / De Piero, M.E., Mariani, S., Van Bussel, B.C.T., Jarczak, D., Krenner, N., De La Sota, E.P., Silva, P.E., Roemmer, M., Kowalewski, M., Carelli, S., Broman, L.M., Vuylsteke, A., Fortuna, P., Alessandri, F., Martucci, G., Patel, B.V., Lotz, G., Boeken, U., Maier, S., Filip, B., et al.. - In: THE LANCET RESPIRATORY MEDICINE. - ISSN 2213-2600. - 13:4(2025), pp. 307-317. [10.1016/s2213-2600(24)00369-2]
Abstract:
Background: Extracorporeal membrane oxygenation (ECMO) for COVID-19 was thoroughly assessed during the first pandemic wave, but data on subsequent waves are limited. We aimed to investigate in-hospital and 6-month survival of patients with COVID-19 supported with ECMO from the second pandemic wave (...Sept 15, 2020) until the end of the pandemic (March 21, 2023, announced by WHO). Methods: EuroECMO-COVID is a prospective, observational study including adults (aged ≥16 years) requiring ECMO respiratory support for COVID-19 from 98 centres in 21 countries. We compared patient characteristics and outcomes between in-hospital survivors and non-survivors. Mixed-effects multivariable logistic regressions were used to investigate factors linked to in-hospital mortality. 6-month survival and overall patient status were determined via patient contact or chart review. This study is registered with ClinicalTrials.gov, NCT04366921, and is complete. Findings: We included 3860 patients (2687 [69·7%] were male and 1169 [30·3%] were female; median age 51 years [SD 11]) from 98 centres in 21 countries. In-hospital mortality was 55·9% (n=2158), with 81·2% (n=1752) deaths occurring during ECMO support. More non-survivors had diabetes, hypertension, cardiovascular disease, and renal failure, and required more pre-ECMO inotropes and vasopressors compared with survivors. Median support duration was 18 days (IQR 10–31) for both groups. Factors linked to in-hospital mortality included older age, pre-ECMO renal failure, pre-ECMO vasopressors use, longer time from intubation to ECMO initiation, and complications, including neurological events, sepsis, bowel ischaemia, renal failure, and bleeding. Of the 1702 (44·1%) in-hospital survivors, 99·7% (n=1697) were alive at 6 months follow-up. Many patients at 6 months follow-up had dyspnoea (501 [32·0%] of 1568 patients), cardiac (122 [7·8%] of 1568 patients), or neurocognitive (168 [10·7%] of 1567 patients) symptoms. Interpretation: Our data for patients undergoing ECMO support for respiratory distress from the second COVID-19 wave onwards confirmed most findings from the first wave regarding patient characteristics and factors correlated to in-hospital mortality. Nevertheless, in-hospital mortality was higher than during the initial pandemic wave while 6-month post-discharge survival remained favourable (99·7%). Persisting post-discharge symptoms confirmed the need for post-ECMO patient follow-up programmes. Funding: None.
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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]

Status of Sepsis Care in European Hospitals: Results from an International Cross-Sectional Survey
Anno: 2025
Rivista: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
Autori/autrici: Scheer, Christian S.; Giamarellos-Bourboulis, Evangelos J.; Ferrer, Ricard; Idelevich, Evgeny A.; Annane, Djillali; Artigas, Antonio; Aslan, Abdullah Tarik; Bottari, Gabriella; Bouma, Hjalmar R.; Černý, Vladimir; Curić Radivojević, Renata; Dakou, Konstantina; Dewitte, Ken; Elbahnasawy, Mohamed; Gründling, Matthias; Gurjar, Mohan; Hästbacka, Johanna; Kyprianou, Miltiadis; Laribi, Said; Lassen, Annmarie; Lebedinskii, Konstantin; Máca, Jan; Malbrain, Manu L. N. G.; Monti, Gianpaola; Ostermann, Marlies; Osthoff, Michael; Paiva, José-Artur; Sabbatucci, Michela; Śmiechowicz, Jakub; Ştefan, Mihai Gabriel; Vollmer, Marcus; Vuković, Natalija; Zaragkoulias, Kyriakos; Reinhart, Konrad; Linder, Adam; Filipescu, Daniela; Abdel-Elsalam, Wafaa; Abed, Alaa; Abedinov, Fillip; Abramyan, Marina; Adams, Katie; Egil Afset, Jan; Agibalova, Mariia; Aipeissov, Murat; Akalın, Halis; Aksoy, Firdevs; Al Duhailib, Zainab; Al-Fares, Abdulrahman; Al-Touny, Aiman; Al-Touny, Shimaa; Albis, Adrià; Aleksic, Tatjana; Alkan, Aslı; Alkan, Sevil; Almekhlafi, Ghalib; Alonso-Ojembarrena, Almudena; Alrabayah, Mustafa; Subhy Alsheikhly, Ahmed; Alsma, Jelmer; Althobaiti, Hisham; Engin Altıntop, Sabri; Altuntaş, Simge; Alvarez, Particia; Alves, Rute; Amanati, Ali; Amir, Lisa; Ammari, Fatma; Andaluz Ojeda, David; Andersson, Maria; Andrijević, Ana; Angermair, Stefan; Anghele, Mariana; Angioni, Goffredo; Annakin, Sian; Annane, Djillali; Anuszkiewicz, Bartosz; Arłukowicz, Elżbieta; Arméstar, Fernando; Arroyo, Abel; Arunachala, Sumalatha; Tarik Aslan, Abdullah; Aslanidis, Theodoros; Assadian, Ojan; Assen, Dorette; Korkut Atalan, Hakan; Nur Ayar, Sefika; Aygencel, Gulbin; Azim, Afzal; Azma Haryaty, Ahmad; Baeten, Wannes; Bagin, Vladimir; Bagiu, Iulia-Cristina; Aun Muhammad Baig, Mirza; Balan-Ilevskaia, Uliana; Baltaga, Ruslan; Baquerizo Vargas, Herbert; Barchetti, Marco; Barcz, Anna; Bardakhchyan, Vladislav; Barnas, Lukas; Baroni, Monica; Barros, Nelson; Barrueco-Francioni, Jesus Emilio; Bartczak, Joanna; Bartolo, Michelangelo; Bas, Onur; Basar, Hulya; Batir, Nicolae; Baumert, Jan-Hinrich; Beck, Oliver; Beckers, Marc; Bedding, Mary; Horea Bedreag, Ovidiu; Beiderlinden, Martin; Beishuizen, Albertus; Belavić, Matija; Bellaubí-Pallarés, Naya; Belskii, Vladislav; Bendel, Stepani; Beneš, Jan; Benjaminsson Nyberg, Patrik; Berkius, Johan; Berkova, Jana; Berteau, Florian; Berttini, Alessio; Betout, Samia; Bier, Martin; Blaj, Mihaela; Blaschke-Steinbrecher, Sabine; Abellán, Ana Blázquez; Bleasdale, John; Bleibtreu, Alexandre; Blessing, Auta; Bliamplias, Dimitris; Bloch-Infanger, Constantine; Bobirca, Florin; Bobyshkin, Aleksandr; Bodolea, Constantin; Boenhof, Felix; Boldyrev, Pavel; Bonavina, Luigi; Booke, Michael; Bottari, Gabriella; Boué, Yvonnick; Bouma, Hjalmar; Brandt, Sebastian; Bregman, Gennady; Briciu, Violeta; BriciuGiuseppe Brisinda, Violeta Tincuta; Bruns, Nora; Brzanov, Nikola; Bubenek, Serban-Ion; Marina Bubonja, Sonje; Budankova, Ekaterina; Buenen, Arnoldus; Buerke, Michael; Buowari, Dabota; Cajander, Sara; Calligaro, Plinio; Campbell, Andrew; Aktaş, Can; Cankayalı, Ilkin; Cansu, Zhanna; Cantón Bulnes, María Luisa; Cappellini, Iacopo; Caramello, Valeria; Carbajo Azabal, Silva; Carbonell, Nieves; Carneiro, Antonio; Carsetti, Andrea; Cartuyvels, Reinoud; Carvalho-Brugger, Sulamita; Castan, Jan; Castelo-Branco Sousa, Miguel; Castro, Pedro; Cataldo, Adriana; Catena, Fausto; Cattin, Lucia; Čehulić Širac, Martina; Čermák, Martin; Chaintoutis, Christos; Chakraborty, Nilanchal; Chalasiewicz, Agata; Chalkias, Athanasios; Chircov, Elena; Cicek, Candan; Pedro Cidade, José; Ciomartan, Tatiana; Cirit, Osman Sezer; Cisteró Roig, Berta; Cobilinschi, Cristian; Colak, Elif; Collins, Cathal; Conen, Anna; Consales, Guglielmo; Contreras Jaquez, Jorge Alejandro; Copacianu, Brandusa; Chumbi, Lupe del Rocio Coronel; Correia, Ana; Cortez, Miguel; Costa Ferreira, Augusto Cesar; Courjon, Johan; Creagh-Brown, Ben; L. Cremer, Olaf; Crombach, Aniek; Cuevas-Asturias, Sofia; Čurdová, Martina; Radivojević, Renata Curić; Cvetković, Marko; Czempik, Piotr; D'Acapito, Fabrizio; D'Incau, Stephanie; Daavittila, Iita; Dalager-Pedersen, Michael; Marietti, Dario; Das, Swarup; Dash, Abhilash; Davda, Mitesh; De Cal, Massimo; De Groot, Bas; De Marco, Maria; De Rosa, Silvia; De Schryver, Nicolas; De Simone, Belinda; Degoricija, Vesna; Degtyar, Mikhail; Dehria, Wissem; Dekker, Douwe; Delaney, Christopher; Demirtakan, Türker; Deniz, Secil; Descamps, Dominique; Dewit, Kevin; Dewitte, Ken; Dhama, Vipin; Di Giacinto, Ida; Diaz, Emilio; Jose Diaz Diaz, Juan; Dimitrov, Evgeni; Kübra Dindar, Emine; Sebastian Dîrzu, Dan; Dolch, Michael; Dominic Savio, Raymond; Domisse, Laure; Donadello, Katia; Dono, Laura; Dormans, Tom; Dostal, Pavel; Dutta, Sambhu; Dvorsky, Jiri; Dzierzanowska-Fangrat, Katarzyna; Efthymiou, Anna; Egorova, Anastasiya; Ehrnström, Brigitta; Einwag, Dominik; Eklund, Anna; Ekman, Andreas; Ekvall, Hakan; El Azab, Samia; Elbahnasawy, Mohamed; Elqurashi, Hussam; Elshekhali, Hossam; Maher Emara, Moataz; Enseñat, Luis; Erbolat, Kanat; Erdem, Gul; Eryilmaz-Eren, Esma; Oviedo del Aguila, Esther; Eyüpoğlu, Selin; Ezponda Inchauspe, Francisco Jose; Ezugbaia, Beka; Fahoum, Sami; Faust, Pio; Fedorov, Sergay; Ferreira, Betânia; Ferrer, Ricard; Fico, Valeria; Fiersen, Jan; Fillatre, Pierre; Fischer, Mathias; Fleres, Francesco; Flonta, Mirela; Aysel Florescu, Simin; Fontana, Francois; Forcelledo, Lorena; Fortofoiu, Maria; Fraga Quintana, Carmen Rosa; Fraire Felix, Irving Santiago; Franceschi, Alessia; Frattari, Antonella; Frey, Christian; Frolo, Tina; Füller, Christina; Galuszka, Rafal; Gamberini, Lorenzo; Gamito Lopes, Joao; Garcia Casallas, Julio César; García-Olivares, Pablo; Garcia-Salcido, Roxana; Garg, Piyush; Gavrilovska-Brzanov, Aleksandra; Campello, Gc.; Gentili, Caterina; Gergova, Ivanka; Giannini, Michele; Gille-Johnson, Patrik; Gillet, Yves; Glover, Guy; Golubic, Sanja; Gomes, Paulo; Petre Gorecki, Gabriel; Gorokhovskiy, Vadim; Gottschaldt, Udo; Govoruha, Egor; Grande, Dominic; Grazioli, Serge; Grigoras, Ioana; Grigoryev, Evgeny; Grillet, Guillaume; Marina Grintescu, Ioana; Gritsan, Alexey; Volker Groesdonk, Heinrich; Grovan, Fredrik; Groznik, Matjaž; Gründling, Matthias; Grupp, Caroline; Guarino, Mario; Guenther, Joern-Tryggve; Guidet, Bertrand; Guimaraes, Teresa; Guimarães, Nádia; Gukasjan, Raphael; Gupta, Amit; Gupta, Bikram; Gupta, Manish; Ajay Kumar, Gupta; Gurjar, Mohan; Guzeldag, Seda; Gyenge, Marton; Habenicht, Michael; Habler, Oliver; Hadi, Najah; Hafner, Sebastian; Hahn, Thomas; Hanif, Raheela; Harabor, Anamaria; Hasaballah, Mohamed; Hasak, Liudmila; Hasemaki, Natasa; Hassan, Mohamed; Hassan Abdalrady Hassan, Nasser; Hästbacka, Johanna; Hecker, Andreas; Helán, Martin; Hendrich, Frank; Herbel, Lucia; Carlos Heredia Cedeño, Juan; Hernández-Benito, María Juliana; Herold, Ivan; Hidalgo Ramos, Juan Antonio; Hoefler, Manfred; Hokenek, Nihat Müjdat; Rygh Holten, Aleksander; Holub, Michal; Holzbauer, Claudia; Honan, David; Honorato-Cia, Cristina; Hoogerwerf, Jacobien; Hopper, Carla; Horcajada, Juan; Hubacek, Petr; Huiszoon-Brummelhuis, Willemijn Barbara; Mahmud Huq, Shihan; Ulaş, Pınar Hüseyin; Ibarra-Estrada, Miguel; Ibarz Villamayor, Mercedes; Ibrahim-Baker, Bushra; Idzik, Miroslawa; Ileri, Fatih; İlhan, Bugra; Ilic, Rosanda; Iliyasu, Garba; Ioakeimidou, Aikaterini; Ioannidis, Orestis; Simutis, Ionas; Ionescu, Daniela; Iqbal, Ahtesham; Irga-Staniukiewicz, Anna; Isik, Arda; Issa, Nahema; Ivičić, Toni; Ivkin, Artem; Jain, Anshul; Jalkanen, Ville; Janc, Jarosław; Janković, Slobodan; Jansen, Henry; Jansens, Hilde; Järhult, Susann J.; Jäschke, Björn; Jasvant, Singh; Javeri, Yash; Javouhey, Etienne; Jena, Pragnya; Jie, Kim; Joad, Shabbar; Jones, Anna; Jørgensen, Silje Bakken; Jouffroy, Romain; Jovanovski-Srceva, Marija; Juricic, Kazimir; Jurjević, Matija; Kaasjager, Karin; Kabir, Maheen; Kacmaz, Ebru; Kaldis, Vasileios; Kallias, Dominik; Kalluraya, Madhusudan; Kamal, Mrinal; Karbek Akarca, Funda; Karimov, Ildar; Karlafti, Eleni; Keryakos, Hesham; Keuneke, Christian; Saif Khan, Mohd; Khasanov, Almir; Khinovker, Ekaterina; Khomiakov, Sergey; Kim, Kihoon; Hyun Kim, Sung; Kirov, Mikhail; Kiss, Thomas; Kılıç, Behçet; Kjossev, Kirien; Klaus, Iris; Klementova, Olga; Klingler, Heinrich; Klinkmann, Gerd; Knotzer, Hans; Kochergin, Vladimir; Koci, Jaromir; Kočí, Karolína; Kogelmann, Klaus; Kolbusz, Julia; Kolho, Elina; Konkayev, Aidos; Koper, Iris; Kopitkó, Csaba; Koronakis, Nikolaos; Korshunkova, Oksana; Kos, Zdenek; Kovacs, Judit; Kozar, Sergeja; Krämer, Sebastian; Kredel, Markus; Kremer, Michael; Krystopchuk, Andriy; Kucher, Maxim; Küçükdemirci-Kaya, Pınar; Kulabukhov, Vladimir; Kumar, Anil; Kumar, Neeraj; Kumar, Ramesh; Kumar, Rajesh; Kupka, Pavel; Kurnaz, Eray; Kurucin, Tatjana; Kuzmanovska, Biljana; J. Lago, Marcos; Lahmer, Tobias; Lakhssassi, Jaafar; Lambiris, Nikolas; Lanoix, Jean-Philippe; Larcher, Romaric; Lassen, Annmarie; Layios, Nathalie; Lazic, Igor; Lebedinskii, Konstantin; Lekmanov, Andrei; Lenkin, Andrey; Leon Gonzalez, Jose; León Lopez, Rafael; Leoniuk, Adam; Lepshin, Sergey; Lerouge, David; Licari, Leo; Licker, Monica; Lillebo, Børge; Linder, Adam; Lindgren, Par; Lindstrom, Johan; Lipp, Kirill; Ljungquist, Oskar; Ljungström, Lars; Llopis, Ferran; López Viloria, Cristina; López-Altimiras, F. Xavier; Lott, Rüdiger; Lowsby, Richard; Luboński, Jarosław; Luciani, Filippo; de Guadiana-Romualdo Luis, García; Lukic, Anita; Lupse, Mihaela; Luthra, Niti; Lydia, Lydia; Maciaszek, Mariola; Maelegheer, Karel; Mäenpää, Sami; Magdy, Mohamed; Mahmoodpoor, Ata; Maia, Marcelo; Mäkelä, Antti; Malina, Pavel; Mamidanna, Ravikrishna; Mangal, Kishore; Mancini, Simone; Manole-Pălivan, Corina-Cecilia; Månsson, Anna; Marchese, Salvatore; Marchioni, Luisa; Marchionni, Elisa; Marghli, Soudani; Marisov, Roman; Siemiński, Mariusz; Markopoulou, Demetra; Maroccia, Alessio; Martin-Quiros, Alejandro; Martinez Pillado, Modesto; Martins, Alfredo; Marzouk, Mehdi; Matanović, Elora; Matuvo, Elijah; Matveev, Afanasy; Matveeva, Ekaterina; Mauch, Martin; Mazanowska, Oktawia; Teresa Mazzeo, Anna; Mazzeo, Carmelo; Mazzoni, Maurizio; Mechergui, Karim; Melani, Dario; Mellhammar, Lisa; Meraj, Ahmad; Meuronen, Anna; Michailidou, Evangelia; Mifsud, Stephanie; Mihaila, Mariana; Mijangos-Mendez, Julio; Mikaszewska-Sokolewicz, Malgorzata; Milheiro, Ruth; Minkov, Georgi; MishraIoan Remus Mitre, Shakti Bedanta; Miulescu, Magdalena; Mo, Skule; Moerer, Onnen; Monedero, Pablo; Mongardon, Nicolas; Montel, Elisabeth; Moraitou, Eleni; Morales, J. Miquel; Morisse, Malte; Morocho Tutillo, Diego; Mota, Paula; Butt, Ashraf; Mukherjee, Sudipta; Mulyanti, Apollo; Maria Munteanu, Ana; Musaeva, Tatiana; Muschart, Xavier; Musiuk, Tomasz; Mustac-Hlebec, Biserka; Mutafchiyski, Ventsislav; Mutuka, Olena; Nadel, Simon; Nasa, Prashant; Nastasovic, Tijana; Naumiuk, Lukasz; Neporada, Elena; Nickel, Christian; Nicko, Alexander; Nicolai, Batir; Angaard Nielsen, Jeppe Sylvest; Nierhaus, Axel; Nijman, Ruud; Nikolaou, Filippia; Nisii, Carla; Nolas, Vasileios; Nomm, Kuido; Nosenko, Maxim; Notas, Georgios; Nowak, Andreas; O'Neill, Sinead; Obradović, Dušanka; Oelsner, Simon; Olaleye, Esther; Oliva, Alessandra; Oltra, Rosa; Önal, Uğur; Oremus, Kresimir; Orhan, Çiğdem; Orso, Daniele; Ortler, Ulrich; Osthoff, Michael; Ostmeier, Stefan; Ovezov, Alexey; Özcan, Nida; Can Öztürk, Osman; Özüdoğru, Osman; Pacheco, Catarina; Packmohr, Jacob; Paiva, José-Artur; Pallotto, Carlo; Antonella Paolucci, Ivana; Papa, Raffaella; Papurica, Marius; Kumar Parmar, Nitish; Pasquier, Jeremie; Passos Pinheiro, Débora O.; Paterova, Pavla; Patricio, Patricia; Paul, Mical; Pavičić Šarić, Jadranka; Pavletic, Martina; Pederson, Robert; Pelgrims, Kurt; Peñalver Sanchez, Juan Pedro; de Figueiredo, António Manuel Pereira; Pereviznyk, Bohdana; Pérez-Fernández, Jose Luis; Persson, Stefan; Pestana, Paula; Peter, Christoph; Petrica, Alina; Petros, Sirak; Pfersdorff, Matthias; Philips, Barbara; Pichler, Dominik; Pidhirnyi, Yaroslav; Piedra Rubio, Juan Francisco; Pihowicz, Andrzej; Pilar-Orive, F Javier; Pilia, Silvana; Pinck, Eric; Pinheiro, Paulo; Plachtzik, Claudia; Plank, Christoph; Plog, Ulrich; Polze, Nina; Ponce, Franz; Popescu, Mihai; Popivanov, Georgi; Poplavskaya, Olga; Popov, Dmitriy; Póvoa, Pedro; Prätsch, Florian; Preda, Gabriel; Prengel, Andreas; Protsenko, Denis; Pujol Jover, Montserrat; Cristoforo Puleo, Rosario; Pulkkinen, Anni; Pyregov, Alexey; Rabbani, Raihan; Racanelli, Gabriele; Radnev, Petar; Rajani, Monika; Rak, Lukasz; Rakonjac, Marija; Ramos, Marta; Ramshorn-Zimmer, Alexandra; Rára, Aleš; Sedes, Pedro Rascado; Rashid, Haroon; Ratnicki, Krzysztof; Rehberg, Sebastian; Reichert, Martin; Reiter, Karl; Renuka, M K; Resta, Marco; Miguel Ribeiro, Joao; Ribeiro de Castro, Eduardo A.; Riccardi, Niccolo; Riihioja, Elina; Ripa, Marco; Riske, Caroline; Ristescu, Irina; Rivera, Alba; Rödel, Jürgen; Fernández-Reverte, Fernando Rodríguez; Rodríguez Mulero, María Dolores; Roesner, Jan; S Romero, Carolina; Ronellenfitsch, Ulrich; Rose, Katy; Rossi, Serena; Rovina, Nikoletta; Lázaro, Ester Rovira; Rsovac, Snezana; Rüddel, Hendrik; Ruiz-Rodriguez, Juan Carlos; Ruschulte, Heiner; Ruslyakova, Irina; Russwurm, Stefan; Ryan, Laura; Sablotzki, Armin; Sachan, Shikha; Sadangi, Ajit; Saeed, Amir; Oremus, Zrinka Safaric; Sahu, Chinmoy; Said-Criado, Ismael; Sakakushev, Boris; Sakka, Samir; Salamone, Giuseppe; Salter, Nigel; Salygina, Darya; Samal, Samir; Samorodov, Aleksandr; Samuelsson, Line; Sandesc, Dorel; Sanskriti, Dutta; Saran, Sai; Sarı, Ali; Sasko, Benjamin; Saviano, Angela; Schaden, Eva; Schiöler, Fredrik; Schizas, Dimitrios; Schlottke, Christian; Schmauß, Matthias; Schmitz, Tom; Schütz, Philipp; Schwandt, Martin; Schwendinger, Markus; Seak, Chen-June; Sehgal, Saloni; Seibel, Armin; Seidel, Ronald; Seidlitz, Florian; Selada, Joana; Selim, Gjulshen; Sengu, Bilal; Şentürk, Evren; Serck, Nicolas; Sermijn, Erica; Serrander, Lena; Shabanov, Aslan; Shah, Bhagyesh; Shah, Vitrag; Ghosh, Pralay Shankar; Shapovalov, Konstantin; Sharma, Sanjay; Shukla, Aditya Nath; Shvetsov, Valery; Siddiqi, Khalid; Siegel, Tomasz; Siegemund, Martin; Sierra, Rafael; Sigurdsson, Martin; Sik, Ali H; Silva, Adriana; Silva Bártolo, Anabela Leonor; Silva, Nuno; Simons, Koen; Dan Simu, Tudor; Sinai, Martina; Singh, Ritu; Sinkov, Sergey; Sitina, Michal; Skalec, Tomasz; Skawińska, Katarzyna; Skotsimara, Antonia; Slieker, Kitty; Slöcker-Barrio, Maria; Smiechowicz, Jakub; Smyrniotis, Dimitris; Sokolowski, Janusz; Solvaer Rosvoll, Torill; Solymos, Orsolya; Dev Soni, Kapil; Lal Soni, Shiv; Soric, Masa; Soukup, Jens; Southern, David; Spadaro, Savino; Spångfors, Martin; SpinelliMathias Sprenger, Alessandra Maria; Srivastava, Namita; Staar, Stefan; Stammet, Pascal; Stassen, Patricia; Stenlund, Göran; Stepanek, Petr; Stevic, Marija; Steyaert, Sanne; Straka, Kelly; Gry Strange, Ditte; Straub, Birgitt; Strezh, Yulia; Sulen, Nina; Sunarmiasih, Sri; Fjesme Sundby, Christina; Sundén-Cullberg, Jonas; Sundqvist, Martin; Svefors, Jesper; Švigelj, Viktor; Sweeney, Eileen; Naz Syed Shamsuddin, Syed Shahrul; Szakmany, Tamas; Szederjesi, Janos; Taban, Hakan; Tacx, Annelies; Tafaj, Silva; Taikın, Ömer; Tajč, Tomáš; Talalaj, Mariola; Tanriverdi, Lokman Hekim; Tasić, Darko; Tasioudis, Polychronis; Tattevin, Pierre; Tekin, Fatih; Tekin, Recep; Tevell, Staffan; Thierbach, Andreas R.; Thoelen, Inge; Timmermans, Mark; Tkachenko, Ekaterina; Tkaczyk, Łukasz; Tolonen, Matti; Tomasi, Ivan; Tomescu, Dana; Mahečić, Tina Tomić; Toth, Ibolya; Tranca, Sebastian; Trapassi, Stefano; Trembach, Nikita; Álvarez, Josep Trenado; Tribulev, Maksim; Triest, Filip; Shanker Tripathi, Shiv; Francesco Tripodi, Vincenzo; Tsentsiper, Liubov; Ture, Zeynep; Tuyls, Sebastian; Tverring, Jonas; Tyagi, Niraj; Uddin, Ryhan; Uğuz, Mustafa; Uhlig, Thomas; Oana Ungurean, Roxana; Ussat, Sascha; Usuga Perilla, Sandra; Valeanu, Liana; Valença, Alda; Valentini, Silvia; Valli, Juha; Valtonen, Mika; Van Cotthem, Ilse; Van den Poel, Bea; Van der Lugt, Monique; Van Herendael, Bruno; Van Lelyveld-Haas, Lenneke; Van Severen, Tom; Van Tellingen, Martijn; Vandervelden, Stefanie; Vanhove, Philippe; Varela-Duran, Marina; Veiga, Viviane; Vera-Artazcoz, Paula; Verbeke, Nikolaas; Verma, Anil; Verniest, Thessa; Verstreken, Isabelle; Vesely, Jiri; Vidal, Pablo; Vincent, Jean-Louis; Viola, Antonella; Viola, Simona; Viscosi, Francesca; Voennov, Oleg; Volk, Thomas; Alberto Volta, Carlo; von Holten, Rouven-Alexander; von Seth, Magnus; Vrbanić Šutalo, Antonija; Vrijsen, Bram; Vryonis, Evangelos; Vukovic, Natalija; Wagner, Martin; Walravens, Stig; Wegermann, Petra; Weis, Christine; Welters, Ingeborg; Wiggli, Benedikt; Winklaar, Eveny; Wirtz, Stefan P.; Wójtowicz, Rafał; Wongsurakiat, Phunsup; Worner Tomasa, Nuria; Wösten-van Asperen, Roelie M.; Wujtewicz, Magdalena; Xing, Zhaoyang; Yaroustovsky, Michael; Yildizdas, Dincer; Young, Yvonne; Zabolotskikh, Igor; Zabul, Ewa; Zach, Maria; Załustowicz, Aleksandra; Zaragkoulias, Kyriakos; Zawiślak, Barbara; Ribeiro Gomes, Marisa Zenaide; Zerbib, Yoann; Zilbert, Elena; Zink, Wolfgang; Zoerner, Frank; Zolotukhin, Konstantin; Zorska, Joanna; Zubareva, Nadezhda; Zuleika, Mehrun
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/343556
Citazioni:
Status of Sepsis Care in European Hospitals: Results from an International Cross-Sectional Survey / Scheer, C.S., Giamarellos-Bourboulis, E.J., Ferrer, R., Idelevich, E.A., Annane, D., Artigas, A., Aslan, A.T., Bottari, G., Bouma, H.R., Černý, V., Curić Radivojević, R., Dakou, K., Dewitte, K., Elbahnasawy, M., Gründling, M., Gurjar, M., Hästbacka, J., Kyprianou, M., Laribi, S., Lassen, A., et al.. - In: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. - ISSN 1073-449X. - 211:4(2025), pp. 587-599. [10.1164/rccm.202406-1167oc]
Abstract:
Rationale: Early detection, standardized therapy, adequate infrastructure, and strategies for quality improvement should constitute essential components of every hospital’s sepsis plan. Objectives: To investigate the extent to which recommendations from the sepsis guidelines are implemented an...d the availability of infrastructure for the care of patients with sepsis in acute-care hospitals. Methods: A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives (QIIs) in hospitals. Measurements and Main Results: A total of 1,023 hospitals in 69 countries were included. Most of them, 835 (81.6%), were in Europe. Sepsis screening was used in 54.2% of emergency departments (EDs), 47.9% of wards, and 61.7% of ICUs. Sepsis management was standardized in 57.3% of EDs, 45.2% of wards, and 70.7% of ICUs. The implementation of comprehensive QIIs was associated with increased screening (EDs, 133.3%; wards, 144.4%; ICUs, 123.8% absolute difference) and increased standardized sepsis management (EDs, 133.6%; wards, 140.0%; ICUs, 117.7% absolute difference) compared with hospitals without QIIs. A total of 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs. Conclusions: The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regard to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.
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European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2—the volume of resuscitation fluids
Anno: 2025
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Mekontso Dessap, Armand; Alshamsi, Fayez; Belletti, Alessandro; De Backer, Daniel; Delaney, Anthony; Møller, Morten Hylander; Gendreau, Segolène; Hernandez, Glenn; Machado, Flavia R.; Mer, Mervyn; Monge Garcia, Manuel Ignacio; Myatra, Sheila Nainan; Peng, Zhiyong; Perner, Anders; Pinsky, Michael R.; Sharif, Sameer; Teboul, Jean-Louis; Vieillard-Baron, Antoine; Alhazzani, Waleed; De Backer, Daniel; Møller, Morten Hylander; Arabi, Yaseen M.; Alshamsi, Fayez; Belley-Cote, Emilie; Carsetti, Andrea; Protti, Alessandro; Donadello, Katia; Juffermans, Nicole; Hammond, Naomi; Laake, Jon Henrik; Liu, Dawei; Maitland, Kathryn; Messina, Antonio; Mac Sweeney, Rob; Vincent, Jean-Louis; Zampieri, Fernando; Poole, Daniele; Mekontso-Dessap, Armand; Alhazzani, Waleed; Alshamsi, Fayez; Belletti, Alessandro; Delaney, Anthony; Hernandez, Glen; Machado, Flavia R.; García, Manuel Ignacio Monge; Mer, Mervin; Myatra, Sheila Nainan; Pinsky, Michael R.; Perner, Anders; Peng, Zhiyong; Sharif, Sameer; Teboul, Jean-Louis; Vieillard-Baron, Antoine; Gendreau, Ségolène; Osterman, Marlies; Raventós, Antonio Artigas; Carole, Ichai; Cecconi, Maurizio; Jones, Christina; Monnet, Xavier; Malbrain, Manu; Nalos, Marek; Peng, Zhiyong; Pfortmueller, Carmen; Prowle, John; Ranzani, Otavio; Wong, Manu Shankar-Hari Adrian; Anthon, Carl Thomas; Granholm, Anders
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/343555
Citazioni:
European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2—the volume of resuscitation fluids / Mekontso Dessap, A., Alshamsi, F., Belletti, A., De Backer, D., Delaney, A., Møller, M.H., Gendreau, S., Hernandez, G., Machado, F.R., Mer, M., Monge Garcia, M.I., Myatra, S.N., Peng, Z., Perner, A., Pinsky, M.R., Sharif, S., Teboul, J., Vieillard-Baron, A., Alhazzani, W., De Backer, D., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 51:3(2025), pp. 461-477. [10.1007/s00134-025-07840-1]
Abstract:
OBJECTIVE: This European Society of Intensive Care Medicine (ESICM) guideline provides evidence-based recommendations on the volume of early resuscitation fluid for adult critically ill patients. METHODS: An international panel of experts developed the guideline, focusing on fluid resuscitation volu...me in adult critically ill patients with circulatory failure. Using the PICO format, questions were formulated, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess evidence and formulate recommendations. RESULTS: In adults with sepsis or septic shock, the guideline suggests administering up to 30 ml/kg of intravenous crystalloids in the initial phase, with adjustments based on clinical context and frequent reassessments (very low certainty of evidence). We suggest using an individualized approach in the optimization phase (very low certainty of evidence). No recommendation could be made for or against restrictive or liberal fluid strategies in the optimization phase (moderate certainty of no effect). For hemorrhagic shock, a restrictive fluid strategy is suggested after blunt trauma (moderate certainty) and penetrating trauma (low certainty), with fluid administration for non-traumatic hemorrhagic shock guided by hemodynamic and biochemical parameters (ungraded best practice). For circulatory failure due to left-sided cardiogenic shock, fluid resuscitation as the primary treatment is not recommended. Fluids should be administered cautiously for cardiac tamponade until definitive treatment and guided by surrogate markers of right heart congestion in acute pulmonary embolism (ungraded best practice). No recommendation could be made for circulatory failure associated with acute respiratory distress syndrome. CONCLUSIONS: The panel made four conditional recommendations and four ungraded best practice statements. No recommendations were made for two questions. Knowledge gaps were identified, and suggestions for future research were provided.
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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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European Society of Intensive Care Medicine clinical practice guideline on fluid therapy in adult critically ill patients. Part 1: the choice of resuscitation fluids
Anno: 2024
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Arabi, Yaseen M.; Belley-Cote, Emilie; Carsetti, Andrea; De Backer, Daniel; Donadello, Katia; Juffermans, Nicole P.; Hammond, Naomi; Laake, Jon Henrik; Liu, Dawei; Maitland, Kathryn; Messina, Antonio; Møller, Morten Hylander; Poole, Daniele; Mac Sweeney, Rob; Vincent, Jean-Louis; Zampieri, Fernando G.; Alshamsi, Fayez
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/330672
Citazioni:
European Society of Intensive Care Medicine clinical practice guideline on fluid therapy in adult critically ill patients. Part 1: the choice of resuscitation fluids / Arabi, Y.M., Belley-Cote, E., Carsetti, A., De Backer, D., Donadello, K., Juffermans, N.P., Hammond, N., Laake, J.H., Liu, D., Maitland, K., Messina, A., Møller, M.H., Poole, D., Mac Sweeney, R., Vincent, J., Zampieri, F.G., Alshamsi, F.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 50:6(2024), pp. 813-831. [10.1007/s00134-024-07369-9]
Abstract:
Purpose: This is the first of three parts of the clinical practice guideline from the European Society of Intensive Care Medicine (ESICM) on resuscitation fluids in adult critically ill patients. This part addresses fluid choice and the other two will separately address fluid amount and fluid remova...l. Methods: This guideline was formulated by an international panel of clinical experts and methodologists. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was applied to evaluate the certainty of evidence and to move from evidence to decision. Results: For volume expansion, the guideline provides conditional recommendations for using crystalloids rather than albumin in critically ill patients in general (moderate certainty of evidence), in patients with sepsis (moderate certainty of evidence), in patients with acute respiratory failure (very low certainty of evidence) and in patients in the perioperative period and patients at risk for bleeding (very low certainty of evidence). There is a conditional recommendation for using isotonic saline rather than albumin in patients with traumatic brain injury (very low certainty of evidence). There is a conditional recommendation for using albumin rather than crystalloids in patients with cirrhosis (very low certainty of evidence). The guideline provides conditional recommendations for using balanced crystalloids rather than isotonic saline in critically ill patients in general (low certainty of evidence), in patients with sepsis (low certainty of evidence) and in patients with kidney injury (very low certainty of evidence). There is a conditional recommendation for using isotonic saline rather than balanced crystalloids in patients with traumatic brain injury (very low certainty of evidence). There is a conditional recommendation for using isotonic crystalloids rather than small-volume hypertonic crystalloids in critically ill patients in general (very low certainty of evidence). Conclusions: This guideline provides eleven recommendations to inform clinicians on resuscitation fluid choice in critically ill patients.
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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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Implementation Strategies for Preventing Healthcare-Associated Infections across the Surgical Pathway: An Italian Multisociety Document
Anno: 2023
Rivista: ANTIBIOTICS
Autori/autrici: Sartelli, Massimo; Bartoli, Stefano; Borghi, Felice; Busani, Stefano; Carsetti, Andrea; Catena, Fausto; Cillara, Nicola; Coccolini, Federico; Cortegiani, Andrea; Cortese, Francesco; Fabbri, Elisa; Foghetti, Domitilla; Forfori, Francesco; Giarratano, Antonino; Labricciosa, Francesco Maria; Marini, Pierluigi; Mastroianni, Claudio; Pan, Angelo; Pasero, Daniela; Scatizzi, Marco; Viaggi, Bruno; Moro, Maria Luisa
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/312847
Citazioni:
Implementation Strategies for Preventing Healthcare-Associated Infections across the Surgical Pathway: An Italian Multisociety Document / Sartelli, M., Bartoli, S., Borghi, F., Busani, S., Carsetti, A., Catena, F., Cillara, N., Coccolini, F., Cortegiani, A., Cortese, F., Fabbri, E., Foghetti, D., Forfori, F., Giarratano, A., Labricciosa, F.M., Marini, P., Mastroianni, C., Pan, A., Pasero, D., Scatizzi, M., et al.. - In: ANTIBIOTICS. - ISSN 2079-6382. - 12:3(2023), p. 521. [10.3390/antibiotics12030521]
Abstract:
: Healthcare-associated infections (HAIs) result in significant patient morbidity and can prolong the duration of the hospital stay, causing high supplementary costs in addition to those already sustained due to the patient's underlying disease. Moreover, bacteria are becoming increasingly resi...stant to antibiotics, making HAI prevention even more important nowadays. The public health consequences of antimicrobial resistance should be constrained by prevention and control actions, which must be a priority for all health systems of the world at all levels of care. As many HAIs are preventable, they may be considered an important indicator of the quality of patient care and represent an important patient safety issue in healthcare. To share implementation strategies for preventing HAIs in the surgical setting and in all healthcare facilities, an Italian multi-society document was published online in November 2022. This article represents an evidence-based summary of the document.
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Aspiration and drowning
Anno: 2023
Autori/autrici: Bazurro, Simone; Carsetti, Andrea; Mcanulty, Greg
Classificazione IRIS: 2.1 Contributo in volume (Capitolo o Saggio)
Scheda completa IRIS: https://iris.univpm.it/handle/11566/325657
Citazioni:
Aspiration and drowning / Bazurro, S., Carsetti, A., Mcanulty, G.. - (2023). [10.1093/med/9780198766438.001.0001]

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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Chronic Obstructive Pulmonary Disease
Anno: 2023
Autori/autrici: Carsetti, Andrea; Bazurro, Simone
Classificazione IRIS: 2.1 Contributo in volume (Capitolo o Saggio)
Scheda completa IRIS: https://iris.univpm.it/handle/11566/325656
Citazioni:
Chronic Obstructive Pulmonary Disease / Carsetti, A., Bazurro, S.. - (2023). [10.1093/med/9780198766438.001.0001]

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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Expert consensus on difficult airway assessment
Anno: 2023
Rivista: HEPATOBILIARY SURGERY AND NUTRITION
Autori/autrici: Xia, Ming; Ma, Wuhua; Zuo, Mingzhang; Deng, Xiaoming; Xue, Fushan; Battaglini, Denise; Aggarwal, Vivek; Varrassi, Giustino; Cerny, Vladimir; Di Giacinto, Ida; Cataldo, Rita; Ma, Daqing; Yamamoto, Toru; Rekatsina, Martina; De Cassai, Alessandro; Carsetti, Andrea; Chang, Marvin G; Seet, Edwin; Davis, Daniel P; Irwin, Michael G; Huang, Yuguang; Jiang, Hong
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/325654
Citazioni:
Expert consensus on difficult airway assessment / Xia, M., Ma, W., Zuo, M., Deng, X., Xue, F., Battaglini, D., Aggarwal, V., Varrassi, G., Cerny, V., Di Giacinto, I., Cataldo, R., Ma, D., Yamamoto, T., Rekatsina, M., De Cassai, A., Carsetti, A., Chang, M.G., Seet, E., Davis, D.P., Irwin, M.G., et al.. - In: HEPATOBILIARY SURGERY AND NUTRITION. - ISSN 2304-3881. - 12:4(2023), pp. 545-566. [10.21037/hbsn-23-46]
Abstract:
Background: Identifying a potentially difficult airway is crucial both in anaesthesia in the operating room (OR) and non-operation room sites. There are no guidelines or expert consensus focused on the assessment of the difficult airway before, so this expert consensus is developed to provide guidan...ce for airway assessment, making this process more standardized and accurate to reduce airway-related complications and improve safety.Methods: Seven members from the Airway Management Group of the Chinese Society of Anaesthesiology (CSA) met to discuss the first draft and then this was sent to 15 international experts for review, comment, and approval. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) is used to determine the level of evidence and grade the strength of recommendations. The recommendations were revised through a three-round Delphi survey from experts.Results: This expert consensus provides a comprehensive approach to airway assessment based on the medical history, physical examination, comprehensive scores, imaging, and new developments including transnasal endoscopy, virtual laryngoscopy, and 3D printing. In addition, this consensus also reviews some new technologies currently under development such as prediction from facial images and voice information with the aim of proposing new research directions for the assessment of difficult airway.Conclusions: This consensus applies to anesthesiologists, critical care, and emergency physicians refining the preoperative airway assessment and preparing an appropriate intubation strategy for patients with a potentially difficult airway.
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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]

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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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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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]

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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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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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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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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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]

Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry
Anno: 2022
Rivista: CRITICAL CARE
Autori/autrici: Wendel-Garcia, Pd; Moser, A; Jeitziner, Mm; Aguirre-Bermeo, H; Arias-Sanchez, P; Apolo, J; Roche-Campo, F; Franch-Llasat, D; Kleger, Gr; Schrag, C; Pietsch, U; Filipovic, M; David, S; Stahl, K; Bouaoud, S; Ouyahia, A; Fodor, P; Locher, P; Siegemund, M; Zellweger, N; Cereghetti, S; Schott, P; Gangitano, G; Wu, Ma; Alfaro-Farias, M; Vizmanos-Lamotte, G; Ksouri, H; Gehring, N; Rezoagli, E; Turrini, F; Lozano-Gómez, H; Carsetti, A; Rodríguez-García, R; Yuen, B; Weber, Ab; Castro, P; Escos-Orta, Jo; Dullenkopf, A; Martín-Delgado, Mc; Aslanidis, T; Perez, Mh; Hillgaertner, F; Ceruti, S; Franchitti Laurent, M; Marrel, J; Colombo, R; Laube, M; Fogagnolo, A; Studhalter, M; Wengenmayer, T; Gamberini, E; Buerkle, C; Buehler, Pk; Keiser, S; Elhadi, M; Montomoli, J; Guerci, P; Fumeaux, T; Schuepbach, Ra; Jakob, Sm; Que, Ya; Hilty, Mp; RISC-19-ICU, Investigators.
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/304759
Citazioni:
Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry / Wendel-Garcia, P.d., Moser, A., Jeitziner, M.m., Aguirre-Bermeo, H., Arias-Sanchez, P., Apolo, J., Roche-Campo, F., Franch-Llasat, D., Kleger, G.r., Schrag, C., Pietsch, U., Filipovic, M., David, S., Stahl, K., Bouaoud, S., Ouyahia, A., Fodor, P., Locher, P., Siegemund, M., Zellweger, N., et al.. - In: CRITICAL CARE. - ISSN 1466-609X. - 26:1(2022). [10.1186/s13054-022-04065-2]
Abstract:
Background: It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic. Methods: Prospective, observational registry con...stituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic. Results: Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60-63] years vs 64 [62-66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76-86]% vs 74 [64-82]%, p < 0.001). The ICU mortality (23 [19-26]% vs 17 [12-25]%, p < 0.001) and length of stay (14 [13-16] days vs 11 [10-13] days, p < 0.001) decreased over 19 months of the pandemic. Conclusion: Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic.
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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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Time course of risk factors associated with mortality of 1260 critically ill patients with COVID-19 admitted to 24 Italian intensive care units
Anno: 2021
Rivista: INTENSIVE CARE MEDICINE
Autori/autrici: Zanella, A.; Florio, G.; Antonelli, M.; Bellani, G.; Berselli, A.; Bove, T.; Cabrini, L.; Carlesso, E.; Castelli, G. P.; Cecconi, M.; Citerio, G.; Coloretti, I.; Corti, D.; Dalla Corte, F.; De Robertis, E.; Foti, G.; Fumagalli, R.; Girardis, M.; Giudici, R.; Guiotto, L.; Langer, T.; Mirabella, L.; Pasero, D.; Protti, A.; Ranieri, M. V.; Rona, R.; Scudeller, L.; Severgnini, P.; Spadaro, S.; Stocchetti, N.; Vigano, M.; Pesenti, A.; Grasselli, G.; Aspesi, M.; Baccanelli, F.; Bassi, F.; Bet, A.; Biagioni, E.; Biondo, A.; Bonenti, C.; Bottino, N.; Brazzi, L.; Buquicchio, I.; Busani, S.; Calini, A.; Calligaro, P.; Cantatore, L. P.; Carelli, S.; Carsetti, A.; Cavallini, S.; Cimicchi, G.; Coppadoro, A.; Dall'Ara, L.; Di Gravio, V.; Erba, M.; Evasi, G.; Facchini, A.; Fanelli, V.; Feliciotti, G.; Fusarini, C. F.; Ferraro, G.; Gagliardi, G.; Garberi, R.; Gay, H.; Giacche, L.; Grieco, D.; Guzzardella, A.; Longhini, F.; Manzan, A.; Maraggia, D.; Milani, A.; Mischi, A.; Montalto, C.; Mormina, S.; Noseda, V.; Paleari, C.; Pedeferri, M.; Pezzi, A.; Pizzilli, G.; Pozzi, M.; Properzi, P.; Rauseo, M.; Russotto, V.; Saccarelli, L.; Servillo, G.; Spano, S.; Tagliabue, P.; Tonetti, T.; Tullo, L.; Vetrugno, L.; Vivona, L.; Volta, C. A.; Zambelli, V.; Zanoni, A.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/293983
Citazioni:
Time course of risk factors associated with mortality of 1260 critically ill patients with COVID-19 admitted to 24 Italian intensive care units / Zanella, A., Florio, G., Antonelli, M., Bellani, G., Berselli, A., Bove, T., Cabrini, L., Carlesso, E., Castelli, G.P., Cecconi, M., Citerio, G., Coloretti, I., Corti, D., Dalla Corte, F., De Robertis, E., Foti, G., Fumagalli, R., Girardis, M., Giudici, R., Guiotto, L., et al.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 47:9(2021), pp. 995-1008. [10.1007/s00134-021-06495-y]
Abstract:
Purpose: To evaluate the daily values and trends over time of relevant clinical, ventilatory and laboratory parameters during the intensive care unit (ICU) stay and their association with outcome in critically ill patients with coronavirus disease 19 (COVID-19). Methods: In this retrospective–...prospective multicentric study, we enrolled COVID-19 patients admitted to Italian ICUs from February 22 to May 31, 2020. Clinical data were daily recorded. The time course of 18 clinical parameters was evaluated by a polynomial maximum likelihood multilevel linear regression model, while a full joint modeling was fit to study the association with ICU outcome. Results: 1260 consecutive critically ill patients with COVID-19 admitted in 24 ICUs were enrolled. 78% were male with a median age of 63 [55–69] years. At ICU admission, the median ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) was 122 [89–175] mmHg. 79% of patients underwent invasive mechanical ventilation. The overall mortality was 34%. Both the daily values and trends of respiratory system compliance, PaO2/FiO2, driving pressure, arterial carbon dioxide partial pressure, creatinine, C-reactive protein, ferritin, neutrophil, neutrophil–lymphocyte ratio, and platelets were associated with survival, while for lactate, pH, bilirubin, lymphocyte, and urea only the daily values were associated with survival. The trends of PaO2/FiO2, respiratory system compliance, driving pressure, creatinine, ferritin, and C-reactive protein showed a higher association with survival compared to the daily values. Conclusion: Daily values or trends over time of parameters associated with acute organ dysfunction, acid–base derangement, coagulation impairment, or systemic inflammation were associated with patient survival.
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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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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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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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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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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 "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]

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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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]

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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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]

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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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]

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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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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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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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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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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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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Does ICU Admission Improve Outcome?
Anno: 2016
Autori/autrici: Carsetti, Andrea; Aya, Hollmann D.; Cecconi, Maurizio; Rhodes, Andrew
Lingua: ENG
Classificazione IRIS: 2.1 Contributo in volume (Capitolo o Saggio)
Scheda completa IRIS: https://iris.univpm.it/handle/11566/276373
Citazioni:
Does ICU Admission Improve Outcome? / Carsetti, A., Aya, H.D., Cecconi, M., Rhodes, A.. - (2016), pp. 616-621.

How to treat post-operative complications: An evidence-based approach
Anno: 2016
Rivista: BAILLIERE'S BEST PRACTICE IN CLINICAL ANAESTHESIOLOGY
Autori/autrici: Carsetti, A.; Rhodes, A.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/276368
Citazioni:
How to treat post-operative complications: An evidence-based approach / Carsetti, A., Rhodes, A.. - In: BAILLIERE'S BEST PRACTICE IN CLINICAL ANAESTHESIOLOGY. - ISSN 1521-6896. - 30:2(2016), pp. 229-236. [10.1016/j.bpa.2016.04.001]
Abstract:
Post-operative complication can be defined as any deviation from the normal post-operative course. The majority of post-operative complications affects the subgroup of high-risk patients, and they are clearly associated with increased hospital length of stay and mortality. This review deals with the... principal complications occurring during the post-operative period. In particular, we describe the preventive and management strategies to face pulmonary, cardiac, renal and neurological complications.
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Haemodynamic coherence in perioperative setting
Anno: 2016
Rivista: BAILLIERE'S BEST PRACTICE IN CLINICAL ANAESTHESIOLOGY
Autori/autrici: Carsetti, A.; Watson, X.; Cecconi, M.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/276367
Citazioni:
Haemodynamic coherence in perioperative setting / Carsetti, A., Watson, X., Cecconi, M.. - In: BAILLIERE'S BEST PRACTICE IN CLINICAL ANAESTHESIOLOGY. - ISSN 1521-6896. - 30:4(2016), pp. 445-452. [10.1016/j.bpa.2016.10.007]
Abstract:
Over the last decade, there has been an increased interest in the use of goal-directed therapy (GDT) in patients undergoing high-risk surgery, and various haemodynamic monitoring tools have been developed to guide perioperative care. Both the complexity of the patient and surgical procedure need to ...be considered when deciding whether GDT will be beneficial. Ensuring optimum tissue perfusion is paramount in the perioperative period and relies on the coherence between both macrovascular and microvascular circulations. Although global haemodynamic parameters may be optimised with the use of GDT, microvascular impairment can still persist. This review will provide an overview of both haemodynamic optimisation and microvascular assessment in the perioperative period.
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Near-infrared spectroscopy for assessing tissue oxygenation and microvascular reactivity in critically ill patients: a prospective observational study
Anno: 2016
Rivista: CRITICAL CARE
Autori/autrici: Donati, Abele; Damiani, Elisa; Domizi, Roberta; Scorcella, Claudia; Carsetti, Andrea; Tondi, Stefania; Monaldi, Valentina; Adrario, Erica; Romano, Rocco; Pelaia, Paolo; Singer, Mervyn
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/238687
Citazioni:
Near-infrared spectroscopy for assessing tissue oxygenation and microvascular reactivity in critically ill patients: a prospective observational study / Donati, A., Damiani, E., Domizi, R., Scorcella, C., Carsetti, A., Tondi, S., Monaldi, V., Adrario, E., Romano, R., Pelaia, P., Singer, M.. - In: CRITICAL CARE. - ISSN 1466-609X. - ELETTRONICO. - 20:1(2016), p. 311. [10.1186/s13054-016-1500-5]
Abstract:
Impaired microcirculatory perfusion and tissue oxygenation during critical illness are associated with adverse outcome. The aim of this study was to detect alterations in tissue oxygenation or microvascular reactivity and their ability to predict outcome in critically ill patients using thenar near-...infrared spectroscopy (NIRS) with a vascular occlusion test (VOT).
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The role of cardiac dysfunction in multiorgan dysfunction
Anno: 2016
Rivista: CURRENT OPINION IN ANAESTHESIOLOGY
Autori/autrici: Donati, Abele; Carsetti, Andrea; Damiani, Elisa
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/232982
Citazioni:
The role of cardiac dysfunction in multiorgan dysfunction / Donati, A., Carsetti, A., Damiani, E.. - In: CURRENT OPINION IN ANAESTHESIOLOGY. - ISSN 1473-6500. - STAMPA. - 29:2(2016), pp. 172-177. [10.1097/ACO.0000000000000296]
Abstract:
The aim of this review was to examine the main determinants of cardiac dysfunction in critically ill patients, as well as how a reduction in cardiac performance influences other organ function.

Accuracy of an automatic analysis software to detect microvascular density parameters
Anno: 2015
Rivista: INTENSIVE CARE MEDICINE EXPERIMENTAL
Autori/autrici: Carsetti, A.; Pierantozzi, S.; Aya, H. D.; Bazurro, S.; Donati, A.; Rhodes, A.; Cecconi, M.
Lingua: ENG
Classificazione IRIS: 1.5 Abstract in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/316393
Citazioni:
Accuracy of an automatic analysis software to detect microvascular density parameters / Carsetti, A., Pierantozzi, S., Aya, H.D., Bazurro, S., Donati, A., Rhodes, A., Cecconi, M.. - In: INTENSIVE CARE MEDICINE EXPERIMENTAL. - ISSN 2197-425X. - 3:(2015). [10.1186/2197-425X-3-S1-A415]

Changes on mean systemic filling pressure and microcirculation after a fluid challenge
Anno: 2015
Rivista: INTENSIVE CARE MEDICINE EXPERIMENTAL
Autori/autrici: Aya, H. D.; Carsetti, A.; Pierantozzi, S.; Mellinghof, J.; Fletcher, N.; Rhodes, A.; Cecconi, M.
Lingua: ENG
Classificazione IRIS: 1.5 Abstract in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/316394
Citazioni:
Changes on mean systemic filling pressure and microcirculation after a fluid challenge / Aya, H.D., Carsetti, A., Pierantozzi, S., Mellinghof, J., Fletcher, N., Rhodes, A., Cecconi, M.. - In: INTENSIVE CARE MEDICINE EXPERIMENTAL. - ISSN 2197-425X. - 3:(2015). [10.1186/2197-425X-3-S1-A20]

Plasma free hemoglobin and microcirculatory response to fresh or old blood transfusions in sepsis
Anno: 2015
Rivista: PLOS ONE
Autori/autrici: Damiani, Elisa; Adrario, Erica; Luchetti, MICHELE MARIA; Scorcella, Claudia; Carsetti, Andrea; Mininno, Nicoletta; Pierantozzi, Silvia; Principi, Tiziana; Strovegli, Daniele; Bencivenga, Rosella; Gabrielli, Armando; Romano, Rocco; Pelaia, Paolo; Ince, Can; Donati, Abele
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/225971
Citazioni:
Plasma free hemoglobin and microcirculatory response to fresh or old blood transfusions in sepsis / Damiani, E., Adrario, E., Luchetti, M.M., Scorcella, C., Carsetti, A., Mininno, N., Pierantozzi, S., Principi, T., Strovegli, D., Bencivenga, R., Gabrielli, A., Romano, R., Pelaia, P., Ince, C., Donati, A.. - In: PLOS ONE. - ISSN 1932-6203. - ELETTRONICO. - 10:5(2015), p. e0122655. [10.1371/journal.pone.0122655]
Abstract:
Free hemoglobin (fHb) may induce vasoconstriction by scavenging nitric oxide. It may increase in older blood units due to storage lesions. This study evaluated whether old red blood cell transfusion increases plasma fHb in sepsis and how the microvascular response may be affected.

Fluid bolus therapy: Monitoring and predicting fluid responsiveness
Anno: 2015
Rivista: CURRENT OPINION IN CRITICAL CARE
Autori/autrici: Carsetti, A.; Cecconi, M.; Rhodes, A.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/276370
Citazioni:
Fluid bolus therapy: Monitoring and predicting fluid responsiveness / Carsetti, A., Cecconi, M., Rhodes, A.. - In: CURRENT OPINION IN CRITICAL CARE. - ISSN 1070-5295. - 21:5(2015), pp. 388-394. [10.1097/MCC.0000000000000240]
Abstract:
Purpose of review When a condition of hypoperfusion has been identified, clinicians must decide whether fluids may increase blood flow or whether other therapeutic approaches are needed. For this purpose, several tests and parameters have been introduced in clinical practice to predict fluid respons...iveness and guide therapy. Recent findings Fluid challenge is the gold standard test to assess the preload dependence of the patients. Moreover, several parameters and tests avoiding fluid administration are now available. Pulse pressure variation and stroke volume variation are based on heart-lung interaction and can be used to assess fluid responsiveness. These parameters have several limitations and can really be used in a limited number of critically ill patients. End-expiratory occlusion test and passive leg raising have been proposed to overcome these limitations. The aim of resuscitation is to increase blood flow and perfusion pressure. Dynamic arterial elastance has been recently proposed to predict the pressure response after fluid challenge in preload-dependent patients. Finally, the effects of volume expansion of hemodynamic parameters do not necessarily reach the microcirculation, which should also be assessed. Summary Nowadays, several parameters are available to assess fluid responsiveness. Clinicians need to know all of them, with their limitations, without forgetting that the final aim of all therapies is to improve the microcirculation.
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From cardiac output to blood flow auto-regulation in shock
Anno: 2015
Rivista: ANAESTHESIOLOGY, INTENSIVE THERAPY
Autori/autrici: Aya, H. D.; Carsetti, A.; Bazurro, S.; Bastoni, D.; Malbrain, M. L. N. G.; Cecconi, M.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/276369
Citazioni:
From cardiac output to blood flow auto-regulation in shock / Aya, H.D., Carsetti, A., Bazurro, S., Bastoni, D., Malbrain, M.L.N.G., Cecconi, M.. - In: ANAESTHESIOLOGY, INTENSIVE THERAPY. - ISSN 1642-5758. - 47:1(2015), pp. s56-s62. [10.5603/AIT.a2015.0077]
Abstract:
Shock is defined as a state in which the circulation is unable to deliver sufficient oxygen to meet the demands of the tissues, resulting in cellular dysoxia and organ failure. In this process, the factors that govern the circulation at a haemodynamic level and oxygen delivery at a microcirculatory ...level play a major role. This manuscript aims to review the blood flow regulation from macro- and micro-haemodynamic point of view and to discuss new potential therapeutic approaches for cardiovascular instability in patients in cardiovascular shock. Despite the recent advances in haemodynamics, the mechanisms that control the vascular resistance and the venous return are not fully understood in critically ill patients. The physical properties of the vascular wall, as well as the role of the mean systemic filling pressure are topics that require further research. However, the haemodynamics do not totally explain the physiopathology of cellular dysoxia, and several factors such as inflammatory changes at the microcirculatory level can modify vascular resistance and tissue perfusion. Cellular vasoactive mediators and endothelial and glucocalix damage are also involved in microcirculatory impairment. All the levels of the circulatory system must be taken into account. Evaluation of microcirculation may help one to detect under-diagnosed shock, and together with classic haemodynamics, guide one towards the appropriate therapy. Restoration of classic haemodynamic parameters is essential but not sufficient to detect and treat patients in cardiovascular shock.
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Fluid responsiveness in critically ill patients
Anno: 2015
Rivista: INDIAN JOURNAL OF CRITICAL CARE MEDICINE
Autori/autrici: Donati, Abele; Carsetti, Andrea; Damiani, Elisa; Adrario, Erica; Romano, Rocco; Pelaia, Paolo
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/233369
Citazioni:
Fluid responsiveness in critically ill patients / Donati, A., Carsetti, A., Damiani, E., Adrario, E., Romano, R., Pelaia, P.. - In: INDIAN JOURNAL OF CRITICAL CARE MEDICINE. - ISSN 0972-5229. - STAMPA. - 19:7(2015), p. 375-6. [10.4103/0972-5229.160263]
Abstract:
Not available

Thermodilution vs pressure recording analytical method in hemodynamic stabilized patients.
Anno: 2014
Rivista: JOURNAL OF CRITICAL CARE
Autori/autrici: Donati, Abele; Carsetti, A.; Tondi, S.; Scorcella, C.; Domizi, Roberta; Damiani, Elisa; Gabbanelli, V.; Münch, C.; Adrario, Erica; Pelaia, Paolo; Cecconi, M.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/142477
Citazioni:
Thermodilution vs pressure recording analytical method in hemodynamic stabilized patients / Donati, A., Carsetti, A., Tondi, S., Scorcella, C., Domizi, R., Damiani, E., Gabbanelli, V., Münch, C., Adrario, E., Pelaia, P., Cecconi, M.. - In: JOURNAL OF CRITICAL CARE. - ISSN 0883-9441. - STAMPA. - 29:2(2014), pp. 260-264. [10.1016/j.jcrc.2013.11.003]
Abstract:
Many mini-invasive devices to monitor cardiac output (CO) have been introduced and, among them, the pressure recording analytical method (PRAM). The aim of this study was to assess the agreement of PRAM with the intermittent transpulmonary thermodilution and continuous pulmonary thermodilution in me...asuring CO in hemodynamically stabilized patients.This is a prospective clinical study in a mixed medical-surgical intensive care unit (ICU) and in a postcardiac surgical ICU. Forty-eight patients were enrolled: 32 patients to the medical-surgical ICU monitored with PiCCO (Pulsion Medical System AG, Munich, Germany) and 16 were cardiac patients monitored with Vigilance (Edwards Lifesciences, Irvine, CA).A total of 112 measurements were made. Ninety-six comparisons of paired CO measurements were made in patients hospitalized in medical-surgical ICU; 16, in cardiac surgical patients. The mean Vigilance-CO was 4.49 ± 0.99 L/min (range, 2.80-5.90 L/min), and the mean PRAM-CO was 4.27 ± 0.88 L/min (range, 2.85-6.19 L/min). The correlation coefficient between Vigilance-CO and PRAM-CO was 0.83 (95% confidence interval, 0.57-0.94; P < .001). The bias was 0.22 ± 0.55 L/min with limits of agreement between 0.87 and 1.30 L/min. The percentage error was 25%. Mean TP-CO was 6.78 ± 2.04 L/min (range, 4.12-11.27 L/min), and the mean PRAM-CO was 6.11 ± 2.18 L/min (range, 2.82-10.90 L/min). The correlation coefficient between PiCCO-CO and PRAM-CO was 0.91 (95% confidence interval, 0.83-0.96; P < .0001). The bias was 0.67 ± 0.89 L/min with limits of agreement -1.07 and 2.41 L/min. The coefficient of variation for PiCCO was 4% ± 2%, and the coefficient of variation for PRAM was 10% ± 8%. The percentage error was 28%.The PRAM system showed good agreement with pulmonary artery catheter and PiCCO in hemodynamically stabilized patients.
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Glycaemic variability, infections and mortality in a medical-surgical intensive care unit.
Anno: 2014
Rivista: CRITICAL CARE AND RESUSCITATION
Autori/autrici: Donati, Abele; Damiani, Elisa; Domizi, R.; Botticelli, L.; Castagnani, R.; Gabbanelli, V.; Nataloni, S.; Carsetti, A.; Scorcella, C.; Adrario, Erica; Pelaia, Paolo; Preiser, J.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/149502
Citazioni:
Glycaemic variability, infections and mortality in a medical-surgical intensive care unit / Donati, A., Damiani, E., Domizi, R., Botticelli, L., Castagnani, R., Gabbanelli, V., Nataloni, S., Carsetti, A., Scorcella, C., Adrario, E., Pelaia, P., Preiser, J.. - In: CRITICAL CARE AND RESUSCITATION. - ISSN 1441-2772. - STAMPA. - 16:(2014), pp. 13-23.
Abstract:
In critically ill patients, glycaemic variability (GV) was reported as a better predictor of mortality than mean blood glucose level (BGL). We compared the ability of different GV indices and mean BGLs to predict mortality and intensive care unit-acquired infections in a population of ICU patients.R...etrospective study on adult ICU patients with ≥ three BGL measurements. GV was assessed by SD, coefficient of variation (CV) and mean amplitude of glycaemic excursion (MAGE), and by one timeweighted index, the glycaemic lability index (GLI), and compared with mean BGL. We studied 2782 patients admitted to the 12-bed medical-surgical ICU of a teaching hospital from January 2004 until December 2010.Logistic regression analyses were performed to assess the association between GV and ICU mortality and ICU-acquired infections. The areas under receiver operating characteristic curves were calculated to compare the discriminatory ability of GV and mean BGL for infections and mortality.Mortality was 16.6%, and 30% of patients had at least one infection. Patients with infections or diabetes or who were treated with insulin had a higher mean BGL and GV than other patients. GLI, SD, CV and MAGE were significantly associated with infections and mortality; mean BGL was not. Quartiles of increasing GLI were independently associated with higher mortality and an increased infection rate. Patients in the upper quartile of mean BGL and GLI had the strongest association with infections (odds ratio, 5.044 [95% CI, 1.695-15.007]; P = 0.004).High GV is associated with higher risk of ICUCrit acquired infection and mortality.
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Microcirculatory effects of the transfusion of leukodepleted or non-leukodepleted red blood cells in patients with sepsis: a pilot study.
Anno: 2014
Rivista: CRITICAL CARE
Autori/autrici: Donati, Abele; Damiani, Elisa; Luchetti, MICHELE MARIA; Domizi, Roberta; Scorcella, Claudia; Carsetti, Andrea; V., Gabbanelli; P., Carletti; R., Bencivenga; H., Vink; Adrario, Erica; M., Piagnerelli; Gabrielli, Armando; Pelaia, Paolo; C., Ince
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/206715
Citazioni:
Microcirculatory effects of the transfusion of leukodepleted or non-leukodepleted red blood cells in patients with sepsis: a pilot study / Donati, A., Damiani, E., Luchetti, M.M., Domizi, R., Scorcella, C., Carsetti, A., V., G., P., C., R., B., H., V., Adrario, E., M., P., Gabrielli, A., Pelaia, P., C., I.. - In: CRITICAL CARE. - ISSN 1364-8535. - STAMPA. - 18:1(2014), p. R33. [10.1186/cc13730]
Abstract:
Microvascular alterations impair tissue oxygenation during sepsis. A red blood cell (RBC) transfusion increases oxygen (O2) delivery but rarely improves tissue O2 uptake in patients with sepsis. Possible causes include RBC alterations due to prolonged storage or residual leukocyte-derived inflammato...ry mediators. The aim of this study was to compare the effects of two types of transfused RBCs on microcirculation in patients with sepsis.In a prospective randomized trial, 20 patients with sepsis were divided into two separate groups and received either non-leukodepleted (n = 10) or leukodepleted (n = 10) RBC transfusions. Microvascular density and perfusion were assessed with sidestream dark field (SDF) imaging sublingually, before and 1 hour after transfusions. Thenar tissue O2 saturation (StO2) and tissue hemoglobin index (THI) were determined with near-infrared spectroscopy, and a vascular occlusion test was performed. The microcirculatory perfused boundary region was assessed in SDF images as an index of glycocalyx damage, and glycocalyx compounds (syndecan-1, hyaluronan, and heparan sulfate) were measured in the serum.No differences were observed in microvascular parameters at baseline and after transfusion between the groups, except for the proportion of perfused vessels (PPV) and blood flow velocity, which were higher after transfusion in the leukodepleted group. Microvascular flow index in small vessels (MFI) and blood flow velocity exhibited different responses to transfusion between the two groups (P = 0.03 and P = 0.04, respectively), with a positive effect of leukodepleted RBCs. When within-group changes were examined, microcirculatory improvement was observed only in patients who received leukodepleted RBC transfusion as suggested by the increase in De Backer score (P = 0.02), perfused vessel density (P = 0.04), PPV (P = 0.01), and MFI (P = 0.04). Blood flow velocity decreased in the non-leukodepleted group (P = 0.03). THI and StO2 upslope increased in both groups. StO2 and StO2 downslope increased in patients who received non-leukodepleted RBC transfusions. Syndecan-1 increased after the transfusion of non-leukodepleted RBCs (P = 0.03).This study does not show a clear superiority of leukodepleted over non-leukodepleted RBC transfusions on microvascular perfusion in patients with sepsis, although it suggests a more favorable effect of leukodepleted RBCs on microcirculatory convective flow. Further studies are needed to confirm these findings.ClinicalTrials.gov, NCT01584999.
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A rare case of central venous catheter malpositioning in polytraumatic patient not recognized by chest x-ray.
Anno: 2013
Rivista: JOURNAL OF VASCULAR ACCESS
Autori/autrici: Nataloni, S.; Carsetti, A.; Gabbanelli, V.; Donati, Abele; Adrario, Erica; Pelaia, Paolo
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/79168
Citazioni:
A rare case of central venous catheter malpositioning in polytraumatic patient not recognized by chest x-ray / Nataloni, S., Carsetti, A., Gabbanelli, V., Donati, A., Adrario, E., Pelaia, P.. - In: JOURNAL OF VASCULAR ACCESS. - ISSN 1129-7298. - STAMPA. - 14:(2013), pp. 97-98. [10.5301/jva.5000101]
Abstract:
Central venous catheter (CVC) insertion is one of the most widely practiced procedures in the intensive care unit (ICU) and the most common complications of this procedure are pneumothorax, artery puncture and malposition. The location of malpositioned subclavian vein catheters may include the ...ipsilateral internal jugular vein, the controlateral brachiocephalic vein and loop formation. The cannulation of tributaries of the main intra-thoracic vein is a rare complication (1). A 40-year-old man was admitted to our ICU for polytrauma following an eight meter fall into a manhole left accidentally uncovered. He reported a thoracic trauma and pelvic fractures. The patient was sedated, intubated and mechanically ventilated and a CVC was inserted through the left subclavian vein without complications. No resistance was felt during insertion and venous blood was aspirated through the lumen without signs of obstruction. A chest x-ray was performed to verify the correct position of the central line and no complication was recognized (Fig. 1). A chest CT scan was then performed to control the lung contusion and this revealed that the CVC tip was controlaterally inserted into the right internal thoracic vein (Fig. 2). Thus, the catheter was removed and inserted into the right internal jugular vein. Most of the cases reported in literature associate this complication with left internal jugular vein cannulation with the catether tip into the ipsilateral internal thoracic vein. Other possibilities are azygos vein or pericardiophrenic vein cannulation. Finally, some congenital variant could be present such as the persistence of the left superior vena cava (2). The peculiarity of our case (the first of this kind) is left subclavian vein cannulation with the catheter tip into the controlateral internal thoracic vein. A predisposition of this complication in patients with portal hypertension has been reported because of engorgement of the venous system (3). Patients can be symptomatic or asymptomatic. Symptoms include chest pain, especially during hyperosmolar solution infusion (e.g., total parenteral nutrition) and during high flow infusion rate. Other complications may include venous thrombosis or thrombophlebitis, extravasation of infusate, pleural effusion, pulmonary edema and chest wall abscess (4). Central venous pressure (CVP) waveform analysis could help us suspect this rare complication, by showing flattened waves instead of the typical a, c, v, x, y waves (5). Conclusion: The chest x-ray cannot always demonstrate CVC malpositioning since the catheter can be projected into the vena cava profile (2). We must suspect this complication in case of difficult catheter insertion, typical symptoms or altered CVP waveform. In these cases other diagnostic tests for correct catheter placement should be considered if chest x-ray is negative.
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