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1. Point-of-care ultrasound for vascular access in neonates and children

Author: Pittiruti, Mauro, Annetta, Maria Giuseppina, D'Andrea, Vito, Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), D’andrea, Vito (ORCID:0000-0002-0980-799X), Pittiruti, Mauro, Annetta, Maria Giuseppina, D'Andrea, Vito, Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), and D’andrea, Vito (ORCID:0000-0002-0980-799X)
Abstract: Ultrasound plays a major role in neonatal/pediatric vascular access, both for venous access and for arterial access, not only just for the insertion of intravascular catheters, but also for many other issues related to this type of maneuver. This "global use of ultrasound" includes a systematic and consistent adoption of this technology for several steps of vascular access: (a) the pre-procedural assessment/evaluation of the vessels, (b) the ultrasound-guided puncture and cannulation of arteries and veins, (c) the real-time diagnosis of immediate, puncture-related complications, (d) the so-called "tip navigation" (i.e., real-time intra-procedural assessment of the direction and trajectory of the guidewire and/or of the catheter inside the vasculature), (e) the so-called "tip location" (i.e., intra-procedural or post-procedural assessment of the proper position of the tip of the catheter), and (f) the early diagnosis and/or management of most non-infective late complications.Conclusion: Therefore, any vascular access expert (nurse or physicians) should have documented competency in the use of ultrasound. This knowledge should include the use of ultrasound for assessment of vessels, for catheter insertion, for proper placement of the tip, and for real-time detection of complications.
Published: 2023

2. Ten years of clinical experience with cyanoacrylate glue for venous access in a 1300-bed university hospital

Author: Pittiruti, Mauro, Annetta, Maria Giuseppina, Marche, Bruno, D'Andrea, Vito, Scoppettuolo, Giancarlo, Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), D'Andrea, Vito (ORCID:0000-0002-0980-799X), Pittiruti, Mauro, Annetta, Maria Giuseppina, Marche, Bruno, D'Andrea, Vito, Scoppettuolo, Giancarlo, Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), and D'Andrea, Vito (ORCID:0000-0002-0980-799X)
Abstract: In the past decade, cyanoacrylate glue has been progressively introduced into the clinical practice of venous access devices used for different purposes. Glue has been used to increase device stabilisation (to reduce the risk of catheter dislodgement), to seal the exit site (to both reduce local bleeding and decrease the risk of bacterial contamination) and to close skin incisions required for the insertion of tunnelled catheters or totally implanted venous ports. For many of these purposes, the efficacy and cost-effectiveness of cyanoacrylate glue has been demonstrated, while some indications are still controversial. This article reports on 10 years of clinical experience with cyanoacrylate glue in a large university hospital, and provides a narrative review of the scientific evidence on the benefits of glue in venous access that has been accumulating over the past decade.
Published: 2022

3. A multicenter retrospective study on 4480 implanted PICC-ports: A GAVeCeLT project

Author: Bertoglio, Sergio, Annetta, Maria Giuseppina, Brescia, F., Emoli, Alessandro, Fabiani, F., Fino, M., Merlicco, D., Musaro, A., Orlandi, Mauro, Parisella, L., Pinelli, F., Reina, Sara, Selmi, V., Solari, N., Tricarico, F., Pittiruti, Mauro, Bertoglio S., Annetta M. G. (ORCID:0000-0001-7574-1311), Emoli A., Orlandi M. (ORCID:0000-0001-5894-3659), Reina S., Pittiruti M. (ORCID:0000-0003-4541-7566), Bertoglio, Sergio, Annetta, Maria Giuseppina, Brescia, F., Emoli, Alessandro, Fabiani, F., Fino, M., Merlicco, D., Musaro, A., Orlandi, Mauro, Parisella, L., Pinelli, F., Reina, Sara, Selmi, V., Solari, N., Tricarico, F., Pittiruti, Mauro, Bertoglio S., Annetta M. G. (ORCID:0000-0001-7574-1311), Emoli A., Orlandi M. (ORCID:0000-0001-5894-3659), Reina S., and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: Background: PICC-ports may be defined as totally implantable central venous devices inserted in the upper limb using the current state-of-the-art techniques of PICC insertion (ultrasound-guided venipuncture of deep veins of the arm, micro-puncture kits, proper location of the tip preferably by intracavitary ECG), with placement of the reservoir at the middle third of the arm. A previous report on breast cancer patients demonstrated the safety and efficacy of these devices, with a very low failure rate. Methods: This retrospective multicenter cohort study—developed by GAVeCeLT (the Italian Group of Long-Term Venous Access Devices)—investigated the outcomes of PICC-ports in a large cohort of unselected patients. The study included 4480 adult patients who underwent PICC-port insertion in five Italian centers, during a period of 60 months. The primary outcome was device failure, defined as any serious adverse event (SAE) requiring removal. The secondary outcome was the incidence of temporary adverse events (TAE) not requiring removal. Results: The median follow-up was 15.5 months. Device failure occurred in 52 cases (1.2%), the main causes being local infection (n = 7; 0.16%) and CRBSI (n = 19; 0.42%). Symptomatic catheter-related thrombosis occurred in 93 cases (2.1%), but removal was required only in one case (0.02%). Early/immediate and late TAE occurred in 904 cases (20.2%) and in 176 cases (3.9%), respectively. Conclusions: PICC-ports are safe venous access devices that should be considered as an alternative option to traditional arm-ports and chest-ports when planning chemotherapy or other long-term intermittent intravenous treatments.
Published: 2023

4. A GAVeCeLT bundle for PICC-port insertion: The SIP-Port protocol

Author: Brescia, F., Annetta, Maria Giuseppina, Pinelli, F., Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Pittiruti M. (ORCID:0000-0003-4541-7566), Brescia, F., Annetta, Maria Giuseppina, Pinelli, F., Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: In the last decade, a new type of brachial port has been introduced in clinical practice, the so-called “PICC-port.” This is a brachial port, but inserted according to the methodologies and technologies currently adopted for the insertion of peripherally inserted central catheters (PICCs). Several studies have shown that PICC-port insertion is safe, not associated with any relevant immediate or early complication, and that the expected incidence of late complications is significantly lower if compared to “traditional” brachial ports (i.e. inserted without ultrasound guidance). Furthermore, PICC-ports yield excellent esthetic results and are associated with optimal patient compliance. This paper describes an insertion bundle—developed by GAVeCeLT, the Italian Group of Long Term Venous Access Devices, and nicknamed “SIP-Port” (Safe Insertion of PICC-Ports)—which consists of few evidence-based strategies aiming to further minimize all immediate, early, or late complications potentially associated with PICC-port insertion. Also, this insertion bundle has been developed for the purpose of defining more closely the differences between a traditional brachial port and a PICC-port. The SIP-Port bundle is currently adopted by all training courses on PICC-port insertion held by GAVeCeLT. It includes eight steps: (1) preprocedural ultrasound assessment utilizing the RaPeVA (Rapid Peripheral Venous Assessment) protocol; (2) appropriate skin antiseptic technique and maximal barrier precautions; (3) choice of appropriate vein, in terms of caliber and site; (4) clear identification of the median nerve and of the brachial artery during the venipuncture; (5) ultrasound-guided puncture and cannulation of the vein; (6) ultrasound-guided tip navigation; (7) intra-procedural assessment of tip location by intracavitary ECG or by trans-thoracic echocardiography; (8) appropriate creation and closure of the subcutaneous pocket.
Published: 2023

5. Catheter-related thrombosis in critically ill patients: a clinical problem or just a matter of definition?

Author: Cutuli, Salvatore Lucio, Dell'Anna, Antonio Maria, Carelli, Simone, Annetta, Maria Giuseppina, Antonelli, Massimo, Cutuli S. L., Dell'Anna A. M., Carelli S., Annetta M. G. (ORCID:0000-0001-7574-1311), Antonelli M. (ORCID:0000-0003-3007-1670), Cutuli, Salvatore Lucio, Dell'Anna, Antonio Maria, Carelli, Simone, Annetta, Maria Giuseppina, Antonelli, Massimo, Cutuli S. L., Dell'Anna A. M., Carelli S., Annetta M. G. (ORCID:0000-0001-7574-1311), and Antonelli M. (ORCID:0000-0003-3007-1670)
Abstract: We read with great interest the study recently published by Wu et al., investigating the incidence of catheter- related thrombosis (CRT) in the largest cohort of criti- cally ill patients thus far [1]. The authors screened by ultrasound (US) the venous district immediately before and daily after the placement of a central venous cath- eter (CVC), and reported a CRT incidence of 16.9% (213/1262), mostly affecting the left side and the internal jugular vein, which accounted for the 54% of CVCs.
Published: 2023

6. Femoral venous access: State of the art and future perspectives

Author: Annetta, Maria Giuseppina, Elli, Sara, Marche, Bruno, Pinelli, F., Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Elli S., Marche B., Pittiruti M. (ORCID:0000-0003-4541-7566), Annetta, Maria Giuseppina, Elli, Sara, Marche, Bruno, Pinelli, F., Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Elli S., Marche B., and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: In the past 5 years, non-dialysis femoral venous access has changed in terms of indications, techniques of insertion, and expected incidence of complications. To the traditional non-emergency indication for femoral catheters—obstruction of the superior vena cava—many other indications have been added, both in intensive and non-intensive care. The insertion technique has evolved, thanks to ultrasound guided venipuncture, tunneling, and ultrasound based intraprocedural tip location. Insertion of femorally inserted central catheters may be today regarded as a procedure with an extremely low intraprocedural and post-procedural risk. The risk of infection is reduced by the possibility of the exit site at mid-thigh, by the use of cyanoacrylate glue for sealing the exit site, and by appropriate intraprocedural strategies of infection prevention. The risk of catheter-related thrombosis is low, due to several concomitant strategies: a proper match between vein diameter and catheter caliber; an accurate intraprocedural assessment of tip location by ultrasound and/or intracavitary ECG; the consistent use of ultrasound guided venipuncture and micro-introducer kits; an adequate stabilization of the catheter at the exit site. The risk of mechanical complications and the risk of lumen occlusion are minimized when using polyurethane, power injectable catheters. All these novelties have brought a revolution in the field of femoral venous access, so that this route may be considered as safe and effective as other approaches to central venous catheterization.
Published: 2023

7. Caliber of the deep veins of the arm in infants and neonates: The VEEIN study (Vascular Echography Evaluation in Infants and Neonates)

Author: Zanaboni, Clelia, Bevilacqua, Michela, Bernasconi, Filippo, Appierto, Linda, Annetta, Maria Giuseppina, Pittiruti, Mauro, Maria Giuseppina Annetta (ORCID:0000-0001-7574-1311), Mauro Pittiruti (ORCID:0000-0003-4541-7566), Zanaboni, Clelia, Bevilacqua, Michela, Bernasconi, Filippo, Appierto, Linda, Annetta, Maria Giuseppina, Pittiruti, Mauro, Maria Giuseppina Annetta (ORCID:0000-0001-7574-1311), and Mauro Pittiruti (ORCID:0000-0003-4541-7566)
Abstract: Purpose: Ultrasound-guided peripherally inserted central catheters (PICCs) are increasingly used in children, though their insertion may be limited by the small caliber of the deep veins of the arm. Previous studies have suggested to use age or weight as a guide to the feasibility of PICC insertion. We have planned an observational study with the purpose of identifying the actual feasibility of PICC insertion based on the ultrasound evaluation of the deep veins of the arm in groups of children of different weight range. Methods: We have studied 252 children weighing between 2.5 and 20 kg, divided in five different groups (group 1: 2.5-4 kg; group 2: 4.1-7 kg; group 3: 7.1-10 kg; group 4: 10.1-15 kg; group 5: 15.1-20 kg): the caliber of brachial vein, basilic vein, and cephalic vein at mid-upper arm + the caliber of the axillary vein at the axilla were measured by ultrasound scan. Results: Veins of caliber >3 mm (appropriate for insertion of a 3 Fr non-tunneled PICC) were found at mid-upper arm in no child of group 1 or 2, in 13% of group 3, in 28% of group 4, and in 54% of group 5. An axillary vein >3 mm (appropriate for insertion of a 3 Fr tunneled PICC) were found in 5.8% of group 1, 30.6% of group 2, 67% of group 3, 82% of group 4, and 94% of group 5. Conclusions: The age and the weight of the child have a small role in predicting the caliber of the veins of the arm. Veins should be measured case by case through a proper and systematic ultrasound evaluation; however, the clinician can expect that insertion of a 3 Fr PICC may be feasible in one third of children weighing between 4 and 7 kg, and in most children weighing more than 7 kg, especially if adopting the tunneling technique.
Published: 2023

8. Secondary malposition of a PICC-port due to heavy physical exercise: A case report

Author: D'Arrigo, Sonia, Annetta, Maria Giuseppina, Musaro, A., Distefano, M., Pittiruti, Mauro, D'Arrigo S. (ORCID:0000-0001-6740-3195), Annetta M. G. (ORCID:0000-0001-7574-1311), Pittiruti M. (ORCID:0000-0003-4541-7566), D'Arrigo, Sonia, Annetta, Maria Giuseppina, Musaro, A., Distefano, M., Pittiruti, Mauro, D'Arrigo S. (ORCID:0000-0001-6740-3195), Annetta M. G. (ORCID:0000-0001-7574-1311), and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: Physical exercise is often encouraged in cancer patients, mainly for the purpose of rehabilitation and for its psychological benefit. Some authors also suggest that exercise—specially in patient with peripherally inserted central venous access devices—may contribute to reduce the risk of catheter-related thrombosis. Still, the impact of physical exercise on the risk of device-related complications is not yet defined. We report a case of secondary migration of the tip of an arm port, caused by high-intensity exercise in a woman undergoing chemotherapy because of ovarian cancer. Tip migration was suspected because of malfunction (persistent withdrawal occlusion) and diagnosis established after ultrasound examination and chest x-ray. Even if exercise may yield benefit in the cancer patient on chemotherapy, the risk of mechanical complication of the venous access device—such as tip migration—should be considered in the case of high-intensity exercise.
Published: 2023

9. The Good, the Bad, and the Serum Creatinine: Exploring the Effect of Muscle Mass and Nutrition

Author: De Rosa, Miriam Stefania, Greco, M., Rauseo, M., Annetta, Maria Giuseppina, De Rosa S. (ORCID:0000-0002-8869-155X), Annetta M. G. (ORCID:0000-0001-7574-1311), De Rosa, Miriam Stefania, Greco, M., Rauseo, M., Annetta, Maria Giuseppina, De Rosa S. (ORCID:0000-0002-8869-155X), and Annetta M. G. (ORCID:0000-0001-7574-1311)
Abstract: Muscle wasting (sarcopenia) is one of the hallmarks of critical illness. Patients admitted to intensive care unit develop sarcopenia through increased protein catabolism, a decrease in protein syntheses, or both. Among the factors known to promote wasting are chronic inflammation and cytokine imbalance, insulin resistance, hypermetabolism, and malnutrition. Moreover, muscle wasting, known to develop in chronic kidney disease patients, is a harmful consequence of numerous complications associated with deteriorated renal function. Plenty of published data suggest that serum creatinine (SCr) reflects increased kidney damage and is also related to body weight. Based on the concept that urea and creatinine are nitrogenous end products of metabolism, the urea:creatinine ratio (UCR) could be applied but with limited clinical usability in case of kidney damage, hypovolemia, excessive, or protein intake, where UCR can be high and independent of catabolism. Recent data suggest that the sarcopenia index should be considered an alternative to serum creatinine. It is more reliable in estimating muscle mass than SCr. However, the optimal biomarker of catabolism is still an unresolved issue. The SCr is not a promising biomarker for renal function and muscle mass based on the influence of several factors. The present review highlights recent findings on the limits of SCr as a surrogate marker of renal function and the assessment modalities of nutritional status and muscle mass measurements.
Published: 2023

10. Should we consider preoperative PICC insertion for adult patients undergoing major surgery?

Author: D'Arrigo, Sonia, Annetta, Maria Giuseppina, Iacobucci, Tiziana, Dottarelli, Alessandra, Pittiruti, Mauro, D'Arrigo S. (ORCID:0000-0001-6740-3195), Annetta M. G. (ORCID:0000-0001-7574-1311), Iacobucci T., Dottarelli A., Pittiruti M. (ORCID:0000-0003-4541-7566), D'Arrigo, Sonia, Annetta, Maria Giuseppina, Iacobucci, Tiziana, Dottarelli, Alessandra, Pittiruti, Mauro, D'Arrigo S. (ORCID:0000-0001-6740-3195), Annetta M. G. (ORCID:0000-0001-7574-1311), Iacobucci T., Dottarelli A., and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: n/a
Published: 2023

11. Chest-to-arm tunneling: A novel technique for medium/long term venous access devices

Author: Annetta, Maria Giuseppina, Ostroff, M., Marche, Bruno, Emoli, Alessandro, Musaro, A., Celentano, Davide, Taraschi, Catia, Dolcetti, Laura, Greca, A. L., Scoppettuolo, Giancarlo, Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Marche B., Emoli A., Celentano D., Taraschi C., Dolcetti L., Scoppettuolo G., Pittiruti M. (ORCID:0000-0003-4541-7566), Annetta, Maria Giuseppina, Ostroff, M., Marche, Bruno, Emoli, Alessandro, Musaro, A., Celentano, Davide, Taraschi, Catia, Dolcetti, Laura, Greca, A. L., Scoppettuolo, Giancarlo, Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Marche B., Emoli A., Celentano D., Taraschi C., Dolcetti L., Scoppettuolo G., and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: Background: Chest-to-arm (CTA) tunneling has been described recently as a technique that allows an optimal exit site at mid-arm even in chronically ill patients with complex clinical issues and challenging problems of vascular access. Method: We adopted CTA tunneling in oncologic and in non-oncologic patients, in totally implanted and in external devices, for both medium and long-term intravenous treatments. We report our experience with 60 cases of CTA tunneling: 19 patients requiring a totally implantable device, who had bilateral contraindication to venous access at the arm and bilateral contraindication to placement of the pocket in the infra-clavicular area; 41 patients requiring an external central venous catheter, who had bilateral contraindication to insertion of peripherally inserted central catheters or femoral catheters, as well as contraindication to an exit site in the infraclavicular area. All venous access devices were inserted with ultrasound guidance and tip location by intracavitary electrocardiography, under local anesthesia. Results: There were no immediate or early complications. Patients with CTA-ports had no late complications. In patients with CTA-tunneled external catheters, there were two dislodgments, four episodes of central line associated blood stream infections, and one local infection. There were no episodes of venous thrombosis or catheter malfunction. Conclusion: Our experience suggests that CTA tunneling is a safe maneuver, with very low risk of complications, and should be considered as an option in patients with complex venous access.
Published: 2023

12. Ultrasound-guided access to the axillary vein for implantation of cardiac implantable electronic devices: A systematic review and meta-analysis

Author: D'Arrigo, Sonia, Perna, Francesco, Annetta, Maria Giuseppina, Pittiruti, Mauro, D'Arrigo S. (ORCID:0000-0001-6740-3195), Perna F., Annetta M. G. (ORCID:0000-0001-7574-1311), Pittiruti M. (ORCID:0000-0003-4541-7566), D'Arrigo, Sonia, Perna, Francesco, Annetta, Maria Giuseppina, Pittiruti, Mauro, D'Arrigo S. (ORCID:0000-0001-6740-3195), Perna F., Annetta M. G. (ORCID:0000-0001-7574-1311), and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: The aims of our systematic review were to quantify the expected rate of procedural success, early and late complications during CIED implantation using US-guided puncture of the axillary vein and to perform a meta-analysis of those studies that compared the US technique (intervention) versus conventional techniques (control) in terms of complication rates. MEDLINE, ISI Web of Science, and EMBASE were searched for eligible studies. Pooled Odds Ratio (OR) and Pooled Mean Difference (PMD) for each predictor were calculated. The quality of evidence (QOE) was evaluated according to the GRADE guidelines. Thirteen studies were included a total of 2073 patients. The overall success of US-guided venipuncture for CIED implantation was 96.8%. As regards early complications, pneumothorax occurred in 0.19%, arterial puncture in 0.63%, and severe hematoma/bleeding requiring intervention in 1.1%. No cases of hemothorax, brachial plexus, or phrenic nerve injury were reported. As regards late complications, the incidence of pocket infection, venous thromboembolism, and leads dislodgement was respectively 0.4%, 0.8%, and 1.2%. In the meta-analysis (five studies), the intervention group (US-guided venipuncture) had a trend versus a lower likelihood of having a pneumothorax (0.19% vs 0.75%, p = 0.21), pocket hematoma (0.8% vs 1.7%, p = 0.32), infection (0.28% vs 1.05%, p = 0.29) than the control group, but this did not reach statistical significance. The overall QOE was low or very low. In conclusions we found that the US-guided axillary venipuncture for CIEDs implantation was associated with a low incidence of early and late complications and a steep learning curve.
Published: 2023

13. An ultrasound-based technique in the management of totally implantable venous access devices with persistent withdrawal occlusion

Author: D'Arrigo, Sonia, Annetta, Maria Giuseppina, Pittiruti, Mauro, D'Arrigo S. (ORCID:0000-0001-6740-3195), Annetta M. G. (ORCID:0000-0001-7574-1311), Pittiruti M. (ORCID:0000-0003-4541-7566), D'Arrigo, Sonia, Annetta, Maria Giuseppina, Pittiruti, Mauro, D'Arrigo S. (ORCID:0000-0001-6740-3195), Annetta M. G. (ORCID:0000-0001-7574-1311), and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: Persistent withdrawal occlusion is a specific catheter malfunction characterized by inability to withdraw blood through the device while infusion is maintained. The main causes are fibroblastic sleeve and tip malposition (associated or not to venous thrombosis around the tip). All current guidelines recommend infusing vesicant/antiblastic drugs through a central venous port only after assessment of blood return. In PWO, blood return is impossible. We have recently started to assess the intravascular position of the tip and the delivery of the infusion in the proximity of the cavo-atrial junction utilizing transthoracic/subxiphoid ultrasound with the ‘bubble test’. We found that this is an easy, real-time, accurate and safe method for verifying the possibility of using a port for chemotherapy even in the absence of blood return, as it occurs with persistent withdrawal occlusion.
Published: 2023

14. Ultrasound based tip location of femorally inserted central catheters into the inferior vena cava: A comparison between the transhepatic and the subcostal view

Author: Annetta, Maria Giuseppina, Marche, Bruno, Mercurio, Giovanna, Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Marche B., Mercurio G., Pittiruti M. (ORCID:0000-0003-4541-7566), Annetta, Maria Giuseppina, Marche, Bruno, Mercurio, Giovanna, Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Marche B., Mercurio G., and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: Background: Intraprocedural catheter tip location is currently recommended. Intracavitary EGC and ultrasound are the preferred methods of tip location for catheters with their tip in the superior vena cava or in the right atrium. Though, the best method of intraprocedural tip location for catheters with their tip in the inferior vena cava is still uncertain. One possibility is to visualize the subdiaphragmatic inferior vena cava by ultrasound, using either the transhepatic or the subxiphoid view. Methods: In this prospective study, we compared two different ultrasound windows for the visualization of the inferior vena cava (transhepatic vs subxiphoid) for the purpose of localizing the catheter tip during the insertion of femorally inserted central catheters. Results: We studied 249 consecutive insertions of central catheters via the superficial femoral vein. Intraprocedural location of the catheter tip was performed by ultrasound, using both transhepatic and subxiphoid view. Visualization of the inferior vena cava was possible only in 81 cases (32.5%) with the subxiphoid view, but it was always possible in all 249 cases with the transhepatic view. The catheter tip was localized in 15 patients out of 81 with the subxiphoid view (18.5%); the transhepatic view allowed the visualization of the tip in all 249 patients. Conclusions: The applicability of the subxiphoid window has several limitations, both in terms of visualization of the inferior vena cava and localization of the catheter tip. The transhepatic view should be the preferred method for intraprocedural ultrasound localization of the catheter tip in the inferior vena cava.
Published: 2023

15. Applicability and feasibility of intraprocedural tip location of femorally inserted central catheters by transhepatic ultrasound visualization of the inferior vena cava in adult patients

Author: Annetta, Maria Giuseppina, Marche, Bruno, Giarretta, Igor, Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Marche B., Giarretta I. (ORCID:0000-0001-5380-0843), Pittiruti M. (ORCID:0000-0003-4541-7566), Annetta, Maria Giuseppina, Marche, Bruno, Giarretta, Igor, Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Marche B., Giarretta I. (ORCID:0000-0001-5380-0843), and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: Background: The ideal intraprocedural method for tip location during insertion of femorally inserted central catheters (FICCs) is still a matter of debate. When the catheter tip is meant to be in the right atrium or in the supradiaphragmatic inferior vena cava (IVC), tip location by either intracavitary electrocardiography or transthoracic echocardiography may be accurate and easy to perform. When the catheter tip is planned to be placed in the subdiaphragmatic IVC, fluoroscopy—though inaccurate and unsafe—has been regarded as the only option for intraprocedural tip location. Methods: We have investigated prospectively the applicability and feasibility of transhepatic ultrasound as intraprocedural method for assessing the location of the catheter tip in the subdiaphragmatic tract of IVC, during FICC insertion. Results: We enrolled 169 consecutive patients undergoing FICC insertion by ultrasound guided puncture of the superficial femoral vein. In 165 out of 169 patients, the subdiaphragmatic IVC was visualized by the transhepatic ultrasound view. In all cases of IVC visualization, the catheter tip could be identified by ultrasound, either directly (direct evidence of the tip inside the vein) or indirectly (enhanced visualization of the tip after “bubble test”). There was no immediate or early complication, and very few late complications. Conclusion: The intraprocedural method of tip location of FICCs by transhepatic ultrasound was applicable in 97.6% of cases and feasible in 100%. When the position of the catheter tip is planned to be in the subdiaphragmatic IVC, this method of tip location is accurate, safe, and inexpensive, and should be considered as an alternative to fluoroscopy.
Published: 2023

16. Catheter-related complications in onco-hematologic children: A retrospective clinical study on 227 central venous access devices

Author: Annetta, Maria Giuseppina, Celentano, Davide, Zumstein, L., Attina, G., Ruggiero, Antonio, Conti, Giorgio, Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Celentano D., Ruggiero A. (ORCID:0000-0002-6052-3511), Conti G. (ORCID:0000-0002-8566-9365), Pittiruti M. (ORCID:0000-0003-4541-7566), Annetta, Maria Giuseppina, Celentano, Davide, Zumstein, L., Attina, G., Ruggiero, Antonio, Conti, Giorgio, Pittiruti, Mauro, Annetta M. G. (ORCID:0000-0001-7574-1311), Celentano D., Ruggiero A. (ORCID:0000-0002-6052-3511), Conti G. (ORCID:0000-0002-8566-9365), and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: Background: The use of central venous access devices (CVADs) is of paramount importance to safely deliver antiblastic and support therapies in children with cancer. Though, in pediatric patients, as much as in adults, CVADs are potentially associated with severe complications which may result in unscheduled interruption of therapy, hospitalization, increased morbidity/mortality, and increased cost of care. Methods: We have reviewed retrospectively our experience with CVADs in children with solid tumors and hematologic diseases, with the purpose of verifying if the adoption of well-defined insertion and maintenance bundles might be effective in reducing catheter-related complications, and in particular catheter-related thrombosis. Results: A total of 227 CVADs were analyzed: 175 peripherally inserted central catheters (PICCs), 50 centrally inserted central catheters (CICCs), and 2 femorally inserted central catheters. All CVADs were non-valved, non-cuffed power injectable polyurethane catheters; 81% were tunneled. Median dwelling time of CVADs was 172 days, for a total number of 39,044 catheter days. A very low incidence of both symptomatic catheter-related thrombosis (0.9%) and catheter-related blood stream infection (0.56 episodes per 1000 catheter days) was found. Unscheduled removal or guidewire replacement because of mechanic complications occurred in 15.7% of CVADs. There was no difference in terms of complications between PICCs and CICCs or between tunneled and non-tunneled catheters. Conclusions: Our experience with CVADs in oncologic and hematologic children suggests that catheter-related complications may be minimized by the adoption of appropriate insertion and maintenance bundles.
Published: 2022

17. Ultrasound versus intracavitary electrocardiography for intraprocedural tip location during central venous catheterization in infants and children: A prospective clinical study

Author: Pittiruti, Mauro, Salerno, Gilda, Mancino, Aldo, Carlini, Debora, Celentano, Davide, Annetta, Maria Giuseppina, Conti, Giorgio, Pittiruti M. (ORCID:0000-0003-4541-7566), Salerno G., Mancino A., Carlini D., Celentano D., Annetta M. G. (ORCID:0000-0001-7574-1311), Conti G. (ORCID:0000-0002-8566-9365), Pittiruti, Mauro, Salerno, Gilda, Mancino, Aldo, Carlini, Debora, Celentano, Davide, Annetta, Maria Giuseppina, Conti, Giorgio, Pittiruti M. (ORCID:0000-0003-4541-7566), Salerno G., Mancino A., Carlini D., Celentano D., Annetta M. G. (ORCID:0000-0001-7574-1311), and Conti G. (ORCID:0000-0002-8566-9365)
Abstract: Background: Both intracavitary electrocardiography (IC-ECG) and ultrasound (US) have been proven to be safe and accurate for intraprocedural tip location during central venous catheterization, and both are known to be easily applicable and feasible in pediatric patients. Though, no prospective clinical study has directly compared the two methods as regards their applicability, feasibility, and procedural time. Methods: This study prospectively enrolled all children requiring a central venous access device in non-emergency situations, during a period of 1 year. All devices were inserted according to a well-defined insertion bundle including both IC-ECG and US-based tip location. The primary endpoint of the study was to compare the two methods in terms of applicability, feasibility and time required. Results: This study included 100 consecutive central venous catheterizations in children of age ranging from 1 month to 18 years. The applicability of IC-ECG based tip location was 98% and its feasibility 100%; the time required for IC-ECG was 1.9 ± 2 min. The applicability of US-based tip location was 96% and its feasibility was 100%; the maneuver required 2.2 ± 3 min. Conclusions: US is an appropriate alternative method for intraprocedural tip location in children. The combined use of US and IC-ECG (both maneuvers being accurate, inexpensive, cost-effective, non-invasive, and equally fast to perform) should be recommended for tip location in pediatric patients, and it will avoid completely the use of fluoroscopy or of post-procedural x-ray.
Published: 2022

18. A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

Author: Pittiruti, Mauro, Celentano, Davide, Barone, Giovanni, D'Andrea, Vito, Annetta, Maria Giuseppina, Conti, Giorgio, Mauro Pittiruti (ORCID:0000-0003-4541-7566), Davide Celentano, Giovanni Barone, Vito D'Andrea (ORCID:0000-0002-0980-799X), Maria Giuseppina Annetta (ORCID:0000-0001-7574-1311), Giorgio Conti (ORCID:0000-0002-8566-9365), Pittiruti, Mauro, Celentano, Davide, Barone, Giovanni, D'Andrea, Vito, Annetta, Maria Giuseppina, Conti, Giorgio, Mauro Pittiruti (ORCID:0000-0003-4541-7566), Davide Celentano, Giovanni Barone, Vito D'Andrea (ORCID:0000-0002-0980-799X), Maria Giuseppina Annetta (ORCID:0000-0001-7574-1311), and Giorgio Conti (ORCID:0000-0002-8566-9365)
Published: 2022

19. Postoperative shivering: prevention or treatment?

Author: Annetta, Maria Giuseppina, Annetta M. G. (ORCID:0000-0001-7574-1311), Annetta, Maria Giuseppina, and Annetta M. G. (ORCID:0000-0001-7574-1311)
Abstract: Postoperative shivering is a well-known and very common side effect after surgery. Its main cause is the disruption of thermoregulatory control provoked by general and neuro-axial anesthesia: anesthetic drugs impair the autonomic response which usually preserves core body heat by vasoconstriction. The threshold temperature associated with the onset of vasoconstriction is variable and depending on gender, exercise, food intake, thyroid function and drugs; it is normally set around 36.5°C, while clinically evident shivering appears at approximately 35.9-36.0°C.
Published: 2022

20. Management of antithrombotic treatment and bleeding disorders in patients requiring venous access devices: A systematic review and a GAVeCeLT consensus statement

Author: Annetta, Maria Giuseppina, Bertoglio, Sergio, Biffi, R., Brescia, F., Giarretta, Igor, Greca, A. L., Panocchia, Nicola, Passaro, G., Perna, Francesco, Pinelli, F., Pittiruti, Mauro, Prisco, D., Sanna, Tommaso, Scoppettuolo, Giancarlo, Annetta M. G. (ORCID:0000-0001-7574-1311), Bertoglio S., Giarretta I. (ORCID:0000-0001-5380-0843), Panocchia N., Perna F., Pittiruti M. (ORCID:0000-0003-4541-7566), Sanna T. (ORCID:0000-0002-5760-6885), Scoppettuolo G., Annetta, Maria Giuseppina, Bertoglio, Sergio, Biffi, R., Brescia, F., Giarretta, Igor, Greca, A. L., Panocchia, Nicola, Passaro, G., Perna, Francesco, Pinelli, F., Pittiruti, Mauro, Prisco, D., Sanna, Tommaso, Scoppettuolo, Giancarlo, Annetta M. G. (ORCID:0000-0001-7574-1311), Bertoglio S., Giarretta I. (ORCID:0000-0001-5380-0843), Panocchia N., Perna F., Pittiruti M. (ORCID:0000-0003-4541-7566), Sanna T. (ORCID:0000-0002-5760-6885), and Scoppettuolo G.
Abstract: Insertion of venous access devices (VAD) is usually considered a procedure with low risk of bleeding. Nonetheless, insertion of some devices is invasive enough to be associated with bleeding, especially in patients with previous coagulopathy or in treatment with antithrombotic drugs for cardiovascular disease. The current practices of platelet/plasma transfusion in coagulopathic patients and of temporary suspension of the antithrombotic treatment before VAD insertion are based on local policies and are often inadequately supported by evidence, since many of the clinical studies on this topic are not recent and are not of high quality. Furthermore, the protocols of antithrombotic treatment have changed during the last decade, after the introduction of new oral anticoagulant drugs. Though some guidelines address some of these issues in relation with specific procedures (port insertion, etc.), no evidence-based document covering all the aspects of this clinical problem is currently available. Thus, the Italian Group of Venous Access Devices (GAVeCeLT) has decided to develop a consensus on the management of antithrombotic treatment and bleeding disorders in patients requiring VADs. After a systematic review of the available evidence, the panel of the consensus (which included vascular access specialists, surgeons, intensivists, anesthetists, cardiologists, vascular medicine experts, nephrologists, infective disease specialists, and thrombotic disease specialists) has structured the final recommendations as detailed answers to three sets of questions: (1) which is an appropriate classification of VAD-related procedures based on the specific bleeding risk? (2) Which is the appropriate management of the patient with bleeding disorders candidate to VAD insertion/removal? (3) Which is the appropriate management of the patient on antithrombotic treatment candidate to VAD insertion/removal? Only statements reaching a complete agreement were included in the final recommendation
Published: 2022

21. Midline catheters for extracorporeal photopheresis in hematological patients

Author: Marche, Bruno, D'Arrigo, Sonia, Annetta, Maria Giuseppina, Musaro, A., Emoli, Alessandro, Sica, Simona, Piccirillo, Nicola, Putzulu, Rossana, De Paolis, M., Bernoldi, M., Pittiruti, Mauro, Marche B., D'Arrigo S. (ORCID:0000-0001-6740-3195), Annetta M. G. (ORCID:0000-0001-7574-1311), Emoli A., Sica S. (ORCID:0000-0003-2426-3465), Piccirillo N. (ORCID:0000-0002-1688-1987), Putzulu R., Pittiruti M. (ORCID:0000-0003-4541-7566), Marche, Bruno, D'Arrigo, Sonia, Annetta, Maria Giuseppina, Musaro, A., Emoli, Alessandro, Sica, Simona, Piccirillo, Nicola, Putzulu, Rossana, De Paolis, M., Bernoldi, M., Pittiruti, Mauro, Marche B., D'Arrigo S. (ORCID:0000-0001-6740-3195), Annetta M. G. (ORCID:0000-0001-7574-1311), Emoli A., Sica S. (ORCID:0000-0003-2426-3465), Piccirillo N. (ORCID:0000-0002-1688-1987), Putzulu R., and Pittiruti M. (ORCID:0000-0003-4541-7566)
Abstract: Introduction: Peripheral venous access for extracorporeal photopheresis (ECP) may be difficult in graft versus host disease (GVHD) patients, because of previous intravenous therapies and multiple peripheral cannulations; in this population of patients, ultrasound guided midline catheters may be an alternative option to central venous access. Methods: In this single-center, prospective preliminary study, we enrolled all consecutive patients with a diagnosis of GVHD and candidate to ECP, over a period of 10 months. We used inserted power injectable, non-valved, polyurethane, 20–25 cm single lumen midline catheters (MC). Results: Sixty-nine ECP procedures were carried out in six patients, using single-lumen MCs for outflow (5Fr in 74% and 4Fr in 26% of cases). For inflow, we used 5Fr or 4Fr MCs, or central venous access devices previously placed for other clinical reasons. There were no catheter-related complications during the entire period of ECP treatment. Mean outflow was significantly higher for 5Fr than for 4Fr MCs (35.8 ± 7.3 vs 29.2 ± 7.8 ml/min; p = 0.0008) and the procedure time was significantly shorter (92.9 ± 9.2 vs 108 ± 13.2 min; p < 0.0001). Conclusion: In GVHD patients, ECP can be performed efficiently and safely using single lumen polyurethane power injectable MCs. The best results are obtained with 5Fr rather than with 4Fr catheters. This strategy of venous access should be implemented in DIVA patients requiring ECP treatments, and probably also in other types of apheresis.
Published: 2021

22. Diaphragm thickening fraction predicts noninvasive ventilation outcome: a preliminary physiological study

Author: Mercurio, Giovanna, D'Arrigo, Sonia, Moroni, R., Grieco, D. L., Menga, Luca Salvatore, Romano, A., Annetta, Maria Giuseppina, Bocci, Maria Grazia, Eleuteri, Davide, Bello, Giuseppe, Montini, Luca, Pennisi, Mariano Alberto, Conti, Giorgio, Antonelli, Massimo, Mercurio G., D'Arrigo S. (ORCID:0000-0001-6740-3195), Menga L. S., Annetta M. G. (ORCID:0000-0001-7574-1311), Bocci M. G., Eleuteri D., Bello G. (ORCID:0000-0003-2648-7235), Montini L. (ORCID:0000-0003-4602-5134), Pennisi M. A. (ORCID:0000-0001-8761-5144), Conti G. (ORCID:0000-0002-8566-9365), Antonelli M. (ORCID:0000-0003-3007-1670), Mercurio, Giovanna, D'Arrigo, Sonia, Moroni, R., Grieco, D. L., Menga, Luca Salvatore, Romano, A., Annetta, Maria Giuseppina, Bocci, Maria Grazia, Eleuteri, Davide, Bello, Giuseppe, Montini, Luca, Pennisi, Mariano Alberto, Conti, Giorgio, Antonelli, Massimo, Mercurio G., D'Arrigo S. (ORCID:0000-0001-6740-3195), Menga L. S., Annetta M. G. (ORCID:0000-0001-7574-1311), Bocci M. G., Eleuteri D., Bello G. (ORCID:0000-0003-2648-7235), Montini L. (ORCID:0000-0003-4602-5134), Pennisi M. A. (ORCID:0000-0001-8761-5144), Conti G. (ORCID:0000-0002-8566-9365), and Antonelli M. (ORCID:0000-0003-3007-1670)
Abstract: Background: A correlation between unsuccessful noninvasive ventilation (NIV) and poor outcome has been suggested in de-novo Acute Respiratory Failure (ARF) patients. Consequently, it is of paramount importance to identify accurate predictors of NIV outcome. The aim of our preliminary study is to evaluate the Diaphragmatic Thickening Fraction (DTF) and the respiratory rate/DTF ratio as predictors of NIV outcome in de-novo ARF patients. Methods: Over 36 months, we studied patients admitted to the emergency department with a diagnosis of de-novo ARF and requiring NIV treatment. DTF and respiratory rate/DTF ratio were measured by 2 trained operators at baseline, at 1, 4, 12, 24, 48, 72 and 96 h of NIV treatment and/or until NIV discontinuation or intubation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of DTF and respiratory rate/DTF ratio to distinguish between patients who were successfully weaned and those who failed. Results: Eighteen patients were included. We found overall good repeatability of DTF assessment, with Intra-class Correlation Coefficient (ICC) of 0.82 (95% confidence interval 0.72–0.88). The cut-off values of DTF for prediction of NIV failure were < 36.3% and < 37.1% for the operator 1 and 2 (p < 0.0001), respectively. The cut-off value of respiratory rate/DTF ratio for prediction of NIV failure was > 0.6 for both operators (p < 0.0001). Conclusion: DTF and respiratory rate/DTF ratio may both represent valid, feasible and noninvasive tools to predict NIV outcome in patients with de-novo ARF. Trial registration ClinicalTrials.gov Identifier: NCT02976233, registered 26 November 2016.
Published: 2021

23. Asthma in patients admitted to emergency department for COVID-19: prevalence and risk of hospitalization

Author: Gabrielli, Maurizio, Pignataro, Giulia, Candelli, Marcello, Sacco Fernandez, Marta, Bizzarri, Martina, Esperide, Alessandra, Franceschi, Francesco, Abbate, Valeria, Nicola, Acampora, Addolorato, Giovanni, Agostini, Fabiana, Ainora, Maria Elena, Akacha, Karim, Amato, Elena, Andreani, Francesca, Andriollo, Gloria, Annetta, Maria Giuseppina, Annicchiarico, Brigida Eleonora, Mariangela, Antonelli, Antonucci, Gabriele, Marco, Anzellotti Gian, Armuzzi, Alessandro, Baldi, Fabiana, Barattucci, Ilaria, Barillaro, Christian, Fabiana, Barone, Bellantone, Rocco Domenico Alfonso, Andrea, Bellieni, Bello, Giuseppe, Benicchi, Andrea, Benvenuto, Francesca, Berardini, Ludovica, Berloco, Filippo, Bernabei, Roberto, Bianchi, Antonio, Biasucci, Daniele Guerino, Biasucci, Luigi Marzio, Stefano, Bibbò, Bini, Alessandra, Alessandra, Bisanti, Biscetti, Federico, Bocci, Maria Grazia, Nicola, Bonadia, Bongiovanni, Filippo, Borghetti, Alberto, Bosco, Giulia, Bosello, Silvia Laura, Bove, Vincenzo, Bramato, Giulia, Brandi, Vincenzo, Teresa, Bruni, Bruno, Carmine, Bruno, Dario, Bungaro, Maria Chiara, Buonomo, Alessandro, Livia, Burzo, Angelo, Calabrese, Rosaria, Calvello Maria, Andrea, Cambieri, Cambise, Chiara, Camma, Giulia, Gennaro, Canistro, Antonello, Cantanale, Capalbo, Gennaro, Capaldi, Lorenzo, Capone, Emanuele, Capristo, Esmeralda, Carbone, Luigi, Silvia, Cardone, Carelli, Simone, Carfi', Angelo, Annamaria, Carnicelli, Caruso, Cristiano, Antonio, Casciaro Francesco, Catalano, Lucio, Cauda, Roberto, Cecchini, Andrea Leonardo, Cerrito, Lucia, Melania, Cesarano, Chiarito, Annalisa, Cianci, Rossella, Cicetti, Marta, Cicchinelli, Sara, Arturo, Ciccullo, Ciciarello, Francesca, Cingolani, Antonella, Cipriani, Maria Camilla, Consalvo, Ludovica Maria, Coppola, Gaetano, Corbo, Giuseppe Maria, Corsello, Andrea, Costante, Federico, Matteo, Costanzi, Covino, Marcello, Davide, Crupi, Lucio, Cutuli Salvatore, D'Addio, Stefano, D'Alessandro, Alessia, D'Alfonso, Maria Elena, D'Angelo, Emanuela, Francesca, D’Aversa, Damiano, Fernando, De Maria, Berardinis Gian, De Cunzo, Tommaso, De Gaetano Donati, Katleen, De Luca, Giulio, De Matteis, Giuseppe, De Pascale, Gennaro, De Paolo, Santi, De Martina, Siena, De Francesco, Vito, Del Valeria, Gatto, Del Paola, Giacomo, Del Fabio, Zompo, Maria, Dell’Anna Antonio, Della Davide, Polla, Di Luca, Gialleonardo, Di Simona, Giambenedetto, Di Roberta, Luca, Di Luca, Maurizio, Di Mariangela, Muro, Alex, Dusina, Davide, Eleuteri, Alessandra, Esperide, Daniele, Facheci, Domenico, Faliero, Cinzia, Falsiroli, Massimo, Fantoni, Annalaura, Fedele, Daniela, Feliciani, Cristina, Ferrante, Giuliano, Ferrone, Rossano, Festa, Chiara, Fiore Maria, Andrea, Flex, Evelina, Forte, Francesco, Franceschi, Alessandra, Francesconi, Laura, Franza, Barbara, Funaro, Mariella, Fuorlo, Domenico, Fusco, Maurizio, Gabrielli, Eleonora, Gaetani, Claudia, Galletta, Antonella, Gallo, Giovanni, Gambassi, Matteo, Garcovich, Antonio, Gasbarrini, Irene, Gasparrini, Silvia, Gelli, Antonella, Giampietro, Laura, Gigante, Gabriele, Giuliano, Giorgia, Giuliano, Bianca, Giupponi, Elisa, Gremese, Grieco, Domenico Luca, Manuel, Guerrera, Valeria, Guglielmi, Caterina, Guidone, Antonio, Gullì, Amerigo, Iaconelli, Aurora, Iafrati, Ianiro, Gianluca, Angela, Iaquinta, Michele, Impagnatiello, Riccardo, Inchingolo, Enrica, Intini, Raffaele, Iorio, Maria, Izzi Immacolata, Tamara, Jovanovic, Cristina, Kadhim, Rosa, La Macchia, Ignazio, La Milia Daniele, Francesco, Landi, Giovanni, Landi, Rosario, Landi, Raffaele, Landolfi, Massimo, Leo, Maria, Leone Paolo, Laura, Levantesi, Antonio, Liguori, Rosa, Liperoti, Maria, Lizzio Marco, Rita, Lo Monaco Maria, Pietro, Locantore, Francesco, Lombardi, Gianmarco, Lombardi, Loris, Lopetuso, Valentina, Loria, Raffaella, Losito Angela, Patricia, Lucia Mothanje Barbara, Francesco, Macagno, Noemi, Macerola, Giampaolo, Maggi, Giuseppe, Maiuro, Francesco, Mancarella, Francesca, Mangiola, Alberto, Manno, Debora, Marchesini, Marco, Maresca Gian, Giuseppe, Marrone, Ilaria, Marti, Maria, Martone Anna, Marzetti, Emanuele, Chiara, Mattana, Valeria, Matteo Maria, Riccardo, Maviglia, Ada, Mazzarella, Carmen, Memoli, Miele, Luca, Alessio, Migneco, Irene, Mignini, Alessandro, Milani, Domenico, Milardi, Massimo, Montalto, Giuliano, Montemurro, Flavia, Monti, Montini, Luca, Christian, Morena Tony, Vincenzina, Morra, Davide, Moschese, Ambra, Murace Celeste, Martina, Murdolo, Rita, Murri, Marco, Napoli, Elisabetta, Nardella, Gerlando, Natalello, Daniele, Natalini, Maria, Navarra Simone, Antonio, Nesci, Alberto, Nicoletti, Rocco, Nicoletti, Filippo, Nicoletti Tommaso, Rebecca, Nicolò, Nicola, Nicolotti, Celestino, Nista Enrico, Eugenia, Nuzzo, Marco, Oggiano, Veronica, Ojetti, Cosimo, Pagano Francesco, Gianfranco, Paiano, Cristina, Pai, Federico, Paolillo, Federico, Pallavicini, Andrea, Palombo, Alfredo, Papa, Domenico, Papanice, Giovanni, Papparella Luigi, Mattia, Paratore, Giuseppe, Parrinello, Giuliana, Pasciuto, Pierpaolo, Pasculli, Giovanni, Pecorini, Simone, Perniola, Erika, Pero, Luca, Petricca, Martina, Petrucci, Chiara, Picarelli, Andrea, Piccioni, Annalisa, Piccolo, Edoardo, Piervincenzi, Giulia, Pignataro, Raffaele, Pignataro, Gabriele, Pintaudi, Luca, Pisapia, Marco, Pizzoferrato, Fabrizio, Pizzolante, Roberto, Pola, Caterina, Policola, Maurizio, Pompili, Flavia, Pontecorvi, Valerio, Pontecorvi, Francesca, Ponziani, Valentina, Popolla, Enrica, Porceddu, Angelo, Porfidia, Maria, Porro Lucia, Annalisa, Potenza, Francesca, Pozzana, Giuseppe, Privitera, Daniela, Pugliese, Gabriele, Pulcini, Simona, Racco, Francesca, Raffaelli, Vittoria, Ramunno, Ludovico, Rapaccini Gian, Richeldi, Luca, Rinninella, Emanuele, Sara, Rocchi, Bruno, Romanò, Stefano, Romano, Federico, Rosa, Laura, Rossi, Raimondo, Rossi, Enrica, Rossini, Elisabetta, Rota, Fabiana, Rovedi, Carlotta, Rubino, Gabriele, Rumi, Andrea, Russo, Luca, Sabia, Andrea, Salerno, Sara, Salini, Lucia, Salvatore, Dehara, Samori, Sandroni, Claudio, Maurizio, Sanguinetti, Luca, Santarelli, Paolo, Santini, Danilo, Santolamazza, Angelo, Santoliquido, Francesco, Santopaolo, Cosimo, Santoro Michele, Francesco, Sardeo, Caterina, Sarnari, Angela, Saviano, Luisa, Saviano, Scaldaferri, Franco, Roberta, Scarascia, Tommaso, Schepi, Francesca, Schiavello, Giancarlo, Scoppettuolo, Davide, Sedda, Flaminio, Sessa, Luisa, Sestito, Carlo, Settanni, Matteo, Siciliano, Valentina, Siciliano, Rossella, Sicuranza, Benedetta, Simeoni, Jacopo, Simonetti, Andrea, Smargiassi, Maurizio, Soave Paolo, Chiara, Sonnino, Domenico, Staiti, Claudia, Stella, Leonardo, Stella, Eleonora, Stival, Eleonora, Taddei, Rossella, Talerico, Elio, Tamburello, Enrica, Tamburrini, Sofia, Tanzarella Eloisa, Elena, Tarascio, Claudia, Tarli, Alessandra, Tersali, Pietro, Tilli, Jacopo, Timpano, Enrico, Torelli, Flavia, Torrini, Matteo, Tosato, Alberto, Tosoni, Luca, Tricoli, Marcello, Tritto, Mario, Tumbarello, Maria, Tummolo Anita, Sole, Vallecoccia Maria, Federico, Valletta, Francesco, Varone, Francesco, Vassalli, Giulio, Ventura, Lucrezia, Verardi, Lorenzo, Vetrone, Giuseppe, Vetrugno, Elena, Visconti, Felicia, Visconti, Andrea, Viviani, Raffaella, Zaccaria, Carmelina, Zaccone, Lorenzo, Zelano, Lorenzo, Zileri Dal Verme, Giuseppe, Zuccalà, Candelli, Marcello (ORCID:0000-0001-8443-7880), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Valeria, Abbate, Giovanni, Addolorato (ORCID:0000-0002-1522-9946), Fabiana, Agostini, Elena, Ainora Maria, Karim, Akacha, Elena, Amato, Francesca, Andreani, Gloria, Andriollo, Giuseppina, Annetta Maria (ORCID:0000-0001-7574-1311), Eleonora, Annicchiarico Brigida, Gabriele, Antonucci, Alessandro, Armuzzi (ORCID:0000-0003-1572-0118), Fabiana, Baldi, Ilaria, Barattucci, Christian, Barillaro, Alfonso, Bellantone Rocco Domenico (ORCID:0000-0002-0844-3469), Giuseppe, Bello (ORCID:0000-0003-2648-7235), Andrea, Benicchi, Francesca, Benvenuto, Ludovica, Berardini, Filippo, Berloco, Roberto, Bernabei (ORCID:0000-0002-9197-004X), Antonio, Bianchi, Guerino, Biasucci Daniele, Marzio, Biasucci Luigi (ORCID:0000-0002-6921-6497), Alessandra, Bini, Federico, Biscetti (ORCID:0000-0001-7449-657X), Grazia, Bocci Maria, Filippo, Bongiovanni, Alberto, Borghetti, Giulia, Bosco, Silvia, Bosello (ORCID:0000-0002-4837-447X), Vincenzo, Bove, Giulia, Bramato, Vincenzo, Brandi, Carmine, Bruno, Dario, Bruno, Chiara, Bungaro Maria, Alessandro, Buonomo, Chiara, Cambise, Giulia, Cammà, Marcello, Candelli (ORCID:0000-0001-8443-7880), Gennaro, Capalbo, Lorenzo, Capaldi, Emanuele, Capone, Esmeralda, Capristo (ORCID:0000-0002-5753-3495), Luigi, Carbone, Simone, Carelli, Angelo, Carfì, Cristiano, Caruso, Lucio, Catalano, Roberto, Cauda (ORCID:0000-0002-1498-4229), Leonardo, Cecchini Andrea, Lucia, Cerrito, Annalisa, Chiarito, Rossella, Cianci (ORCID:0000-0001-5378-8442), Marta, Cicetti, Sara, Cicchinelli, Francesca, Ciciarello, Antonella, Cingolani (ORCID:0000-0002-3793-2755), Camilla, Cipriani Maria, Ludovica, Consalvo Maria, Gaetano, Coppola, Maria, Corbo Giuseppe (ORCID:0000-0002-8104-4659), Andrea, Corsello, Federico, Costante, Marcello, Covino (ORCID:0000-0002-6709-2531), Stefano, D’Addio, Alessia, D’Alessandro, Elena, D’alfonso Maria, Emanuela, D’Angelo, Fernando, Damiano (ORCID:0000-0003-0960-0232), De Tommaso, Cunzo, de Katleen, Gaetano Donati, De Giulio, Luca, De Giuseppe, Matteis, De Gennaro, Pascale (ORCID:0000-0002-8255-0676), Luca, Grieco Domenico (ORCID:0000-0002-4557-6308), Gianluca, Ianiro (ORCID:0000-0002-8318-0515), Emanuele, Marzetti (ORCID:0000-0001-9567-6983), Luca, Miele (ORCID:0000-0003-3464-0068), Luca, Montini (ORCID:0000-0003-4602-5134), Luca, Richeldi (ORCID:0000-0001-8594-1448), Emanuele, Rinninella (ORCID:0000-0002-9165-2367), Claudio, Sandroni (ORCID:0000-0002-8878-2611), Franco, Scaldaferri (ORCID:0000-0001-8334-7541), Gabrielli, Maurizio, Pignataro, Giulia, Candelli, Marcello, Sacco Fernandez, Marta, Bizzarri, Martina, Esperide, Alessandra, Franceschi, Francesco, Abbate, Valeria, Nicola, Acampora, Addolorato, Giovanni, Agostini, Fabiana, Ainora, Maria Elena, Akacha, Karim, Amato, Elena, Andreani, Francesca, Andriollo, Gloria, Annetta, Maria Giuseppina, Annicchiarico, Brigida Eleonora, Mariangela, Antonelli, Antonucci, Gabriele, Marco, Anzellotti Gian, Armuzzi, Alessandro, Baldi, Fabiana, Barattucci, Ilaria, Barillaro, Christian, Fabiana, Barone, Bellantone, Rocco Domenico Alfonso, Andrea, Bellieni, Bello, Giuseppe, Benicchi, Andrea, Benvenuto, Francesca, Berardini, Ludovica, Berloco, Filippo, Bernabei, Roberto, Bianchi, Antonio, Biasucci, Daniele Guerino, Biasucci, Luigi Marzio, Stefano, Bibbò, Bini, Alessandra, Alessandra, Bisanti, Biscetti, Federico, Bocci, Maria Grazia, Nicola, Bonadia, Bongiovanni, Filippo, Borghetti, Alberto, Bosco, Giulia, Bosello, Silvia Laura, Bove, Vincenzo, Bramato, Giulia, Brandi, Vincenzo, Teresa, Bruni, Bruno, Carmine, Bruno, Dario, Bungaro, Maria Chiara, Buonomo, Alessandro, Livia, Burzo, Angelo, Calabrese, Rosaria, Calvello Maria, Andrea, Cambieri, Cambise, Chiara, Camma, Giulia, Gennaro, Canistro, Antonello, Cantanale, Capalbo, Gennaro, Capaldi, Lorenzo, Capone, Emanuele, Capristo, Esmeralda, Carbone, Luigi, Silvia, Cardone, Carelli, Simone, Carfi', Angelo, Annamaria, Carnicelli, Caruso, Cristiano, Antonio, Casciaro Francesco, Catalano, Lucio, Cauda, Roberto, Cecchini, Andrea Leonardo, Cerrito, Lucia, Melania, Cesarano, Chiarito, Annalisa, Cianci, Rossella, Cicetti, Marta, Cicchinelli, Sara, Arturo, Ciccullo, Ciciarello, Francesca, Cingolani, Antonella, Cipriani, Maria Camilla, Consalvo, Ludovica Maria, Coppola, Gaetano, Corbo, Giuseppe Maria, Corsello, Andrea, Costante, Federico, Matteo, Costanzi, Covino, Marcello, Davide, Crupi, Lucio, Cutuli Salvatore, D'Addio, Stefano, D'Alessandro, Alessia, D'Alfonso, Maria Elena, D'Angelo, Emanuela, Francesca, D’Aversa, Damiano, Fernando, De Maria, Berardinis Gian, De Cunzo, Tommaso, De Gaetano Donati, Katleen, De Luca, Giulio, De Matteis, Giuseppe, De Pascale, Gennaro, De Paolo, Santi, De Martina, Siena, De Francesco, Vito, Del Valeria, Gatto, Del Paola, Giacomo, Del Fabio, Zompo, Maria, Dell’Anna Antonio, Della Davide, Polla, Di Luca, Gialleonardo, Di Simona, Giambenedetto, Di Roberta, Luca, Di Luca, Maurizio, Di Mariangela, Muro, Alex, Dusina, Davide, Eleuteri, Alessandra, Esperide, Daniele, Facheci, Domenico, Faliero, Cinzia, Falsiroli, Massimo, Fantoni, Annalaura, Fedele, Daniela, Feliciani, Cristina, Ferrante, Giuliano, Ferrone, Rossano, Festa, Chiara, Fiore Maria, Andrea, Flex, Evelina, Forte, Francesco, Franceschi, Alessandra, Francesconi, Laura, Franza, Barbara, Funaro, Mariella, Fuorlo, Domenico, Fusco, Maurizio, Gabrielli, Eleonora, Gaetani, Claudia, Galletta, Antonella, Gallo, Giovanni, Gambassi, Matteo, Garcovich, Antonio, Gasbarrini, Irene, Gasparrini, Silvia, Gelli, Antonella, Giampietro, Laura, Gigante, Gabriele, Giuliano, Giorgia, Giuliano, Bianca, Giupponi, Elisa, Gremese, Grieco, Domenico Luca, Manuel, Guerrera, Valeria, Guglielmi, Caterina, Guidone, Antonio, Gullì, Amerigo, Iaconelli, Aurora, Iafrati, Ianiro, Gianluca, Angela, Iaquinta, Michele, Impagnatiello, Riccardo, Inchingolo, Enrica, Intini, Raffaele, Iorio, Maria, Izzi Immacolata, Tamara, Jovanovic, Cristina, Kadhim, Rosa, La Macchia, Ignazio, La Milia Daniele, Francesco, Landi, Giovanni, Landi, Rosario, Landi, Raffaele, Landolfi, Massimo, Leo, Maria, Leone Paolo, Laura, Levantesi, Antonio, Liguori, Rosa, Liperoti, Maria, Lizzio Marco, Rita, Lo Monaco Maria, Pietro, Locantore, Francesco, Lombardi, Gianmarco, Lombardi, Loris, Lopetuso, Valentina, Loria, Raffaella, Losito Angela, Patricia, Lucia Mothanje Barbara, Francesco, Macagno, Noemi, Macerola, Giampaolo, Maggi, Giuseppe, Maiuro, Francesco, Mancarella, Francesca, Mangiola, Alberto, Manno, Debora, Marchesini, Marco, Maresca Gian, Giuseppe, Marrone, Ilaria, Marti, Maria, Martone Anna, Marzetti, Emanuele, Chiara, Mattana, Valeria, Matteo Maria, Riccardo, Maviglia, Ada, Mazzarella, Carmen, Memoli, Miele, Luca, Alessio, Migneco, Irene, Mignini, Alessandro, Milani, Domenico, Milardi, Massimo, Montalto, Giuliano, Montemurro, Flavia, Monti, Montini, Luca, Christian, Morena Tony, Vincenzina, Morra, Davide, Moschese, Ambra, Murace Celeste, Martina, Murdolo, Rita, Murri, Marco, Napoli, Elisabetta, Nardella, Gerlando, Natalello, Daniele, Natalini, Maria, Navarra Simone, Antonio, Nesci, Alberto, Nicoletti, Rocco, Nicoletti, Filippo, Nicoletti Tommaso, Rebecca, Nicolò, Nicola, Nicolotti, Celestino, Nista Enrico, Eugenia, Nuzzo, Marco, Oggiano, Veronica, Ojetti, Cosimo, Pagano Francesco, Gianfranco, Paiano, Cristina, Pai, Federico, Paolillo, Federico, Pallavicini, Andrea, Palombo, Alfredo, Papa, Domenico, Papanice, Giovanni, Papparella Luigi, Mattia, Paratore, Giuseppe, Parrinello, Giuliana, Pasciuto, Pierpaolo, Pasculli, Giovanni, Pecorini, Simone, Perniola, Erika, Pero, Luca, Petricca, Martina, Petrucci, Chiara, Picarelli, Andrea, Piccioni, Annalisa, Piccolo, Edoardo, Piervincenzi, Giulia, Pignataro, Raffaele, Pignataro, Gabriele, Pintaudi, Luca, Pisapia, Marco, Pizzoferrato, Fabrizio, Pizzolante, Roberto, Pola, Caterina, Policola, Maurizio, Pompili, Flavia, Pontecorvi, Valerio, Pontecorvi, Francesca, Ponziani, Valentina, Popolla, Enrica, Porceddu, Angelo, Porfidia, Maria, Porro Lucia, Annalisa, Potenza, Francesca, Pozzana, Giuseppe, Privitera, Daniela, Pugliese, Gabriele, Pulcini, Simona, Racco, Francesca, Raffaelli, Vittoria, Ramunno, Ludovico, Rapaccini Gian, Richeldi, Luca, Rinninella, Emanuele, Sara, Rocchi, Bruno, Romanò, Stefano, Romano, Federico, Rosa, Laura, Rossi, Raimondo, Rossi, Enrica, Rossini, Elisabetta, Rota, Fabiana, Rovedi, Carlotta, Rubino, Gabriele, Rumi, Andrea, Russo, Luca, Sabia, Andrea, Salerno, Sara, Salini, Lucia, Salvatore, Dehara, Samori, Sandroni, Claudio, Maurizio, Sanguinetti, Luca, Santarelli, Paolo, Santini, Danilo, Santolamazza, Angelo, Santoliquido, Francesco, Santopaolo, Cosimo, Santoro Michele, Francesco, Sardeo, Caterina, Sarnari, Angela, Saviano, Luisa, Saviano, Scaldaferri, Franco, Roberta, Scarascia, Tommaso, Schepi, Francesca, Schiavello, Giancarlo, Scoppettuolo, Davide, Sedda, Flaminio, Sessa, Luisa, Sestito, Carlo, Settanni, Matteo, Siciliano, Valentina, Siciliano, Rossella, Sicuranza, Benedetta, Simeoni, Jacopo, Simonetti, Andrea, Smargiassi, Maurizio, Soave Paolo, Chiara, Sonnino, Domenico, Staiti, Claudia, Stella, Leonardo, Stella, Eleonora, Stival, Eleonora, Taddei, Rossella, Talerico, Elio, Tamburello, Enrica, Tamburrini, Sofia, Tanzarella Eloisa, Elena, Tarascio, Claudia, Tarli, Alessandra, Tersali, Pietro, Tilli, Jacopo, Timpano, Enrico, Torelli, Flavia, Torrini, Matteo, Tosato, Alberto, Tosoni, Luca, Tricoli, Marcello, Tritto, Mario, Tumbarello, Maria, Tummolo Anita, Sole, Vallecoccia Maria, Federico, Valletta, Francesco, Varone, Francesco, Vassalli, Giulio, Ventura, Lucrezia, Verardi, Lorenzo, Vetrone, Giuseppe, Vetrugno, Elena, Visconti, Felicia, Visconti, Andrea, Viviani, Raffaella, Zaccaria, Carmelina, Zaccone, Lorenzo, Zelano, Lorenzo, Zileri Dal Verme, Giuseppe, Zuccalà, Candelli, Marcello (ORCID:0000-0001-8443-7880), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Valeria, Abbate, Giovanni, Addolorato (ORCID:0000-0002-1522-9946), Fabiana, Agostini, Elena, Ainora Maria, Karim, Akacha, Elena, Amato, Francesca, Andreani, Gloria, Andriollo, Giuseppina, Annetta Maria (ORCID:0000-0001-7574-1311), Eleonora, Annicchiarico Brigida, Gabriele, Antonucci, Alessandro, Armuzzi (ORCID:0000-0003-1572-0118), Fabiana, Baldi, Ilaria, Barattucci, Christian, Barillaro, Alfonso, Bellantone Rocco Domenico (ORCID:0000-0002-0844-3469), Giuseppe, Bello (ORCID:0000-0003-2648-7235), Andrea, Benicchi, Francesca, Benvenuto, Ludovica, Berardini, Filippo, Berloco, Roberto, Bernabei (ORCID:0000-0002-9197-004X), Antonio, Bianchi, Guerino, Biasucci Daniele, Marzio, Biasucci Luigi (ORCID:0000-0002-6921-6497), Alessandra, Bini, Federico, Biscetti (ORCID:0000-0001-7449-657X), Grazia, Bocci Maria, Filippo, Bongiovanni, Alberto, Borghetti, Giulia, Bosco, Silvia, Bosello (ORCID:0000-0002-4837-447X), Vincenzo, Bove, Giulia, Bramato, Vincenzo, Brandi, Carmine, Bruno, Dario, Bruno, Chiara, Bungaro Maria, Alessandro, Buonomo, Chiara, Cambise, Giulia, Cammà, Marcello, Candelli (ORCID:0000-0001-8443-7880), Gennaro, Capalbo, Lorenzo, Capaldi, Emanuele, Capone, Esmeralda, Capristo (ORCID:0000-0002-5753-3495), Luigi, Carbone, Simone, Carelli, Angelo, Carfì, Cristiano, Caruso, Lucio, Catalano, Roberto, Cauda (ORCID:0000-0002-1498-4229), Leonardo, Cecchini Andrea, Lucia, Cerrito, Annalisa, Chiarito, Rossella, Cianci (ORCID:0000-0001-5378-8442), Marta, Cicetti, Sara, Cicchinelli, Francesca, Ciciarello, Antonella, Cingolani (ORCID:0000-0002-3793-2755), Camilla, Cipriani Maria, Ludovica, Consalvo Maria, Gaetano, Coppola, Maria, Corbo Giuseppe (ORCID:0000-0002-8104-4659), Andrea, Corsello, Federico, Costante, Marcello, Covino (ORCID:0000-0002-6709-2531), Stefano, D’Addio, Alessia, D’Alessandro, Elena, D’alfonso Maria, Emanuela, D’Angelo, Fernando, Damiano (ORCID:0000-0003-0960-0232), De Tommaso, Cunzo, de Katleen, Gaetano Donati, De Giulio, Luca, De Giuseppe, Matteis, De Gennaro, Pascale (ORCID:0000-0002-8255-0676), Luca, Grieco Domenico (ORCID:0000-0002-4557-6308), Gianluca, Ianiro (ORCID:0000-0002-8318-0515), Emanuele, Marzetti (ORCID:0000-0001-9567-6983), Luca, Miele (ORCID:0000-0003-3464-0068), Luca, Montini (ORCID:0000-0003-4602-5134), Luca, Richeldi (ORCID:0000-0001-8594-1448), Emanuele, Rinninella (ORCID:0000-0002-9165-2367), Claudio, Sandroni (ORCID:0000-0002-8878-2611), and Franco, Scaldaferri (ORCID:0000-0001-8334-7541)
Published: 2021

24. ORal anticoagulants In fraGile patients with percutAneous endoscopic gastrostoMy and atrIal fibrillation: the (ORIGAMI) study

Author: D'Amario, Domenico, Galli, Mattia, Canonico, Francesco, Restivo, Attilio, Arcudi, Alessandra, Scacciavillani, Roberto, Cappannoli, Luigi, Riccioni, Maria Elena, Annetta, Maria Giuseppina, Di Stefano, G., Piccinni, C., Vergallo, Rocco, Montone, Rocco Antonio, Leone, Antonio Maria, Niccoli, Giampaolo, Sabatelli, Mario, Antonelli, Massimo, Andreotti, Felicita, De Cristofaro, Raimondo, Crea, Filippo, D'Amario D., Galli M., Canonico F. (ORCID:0000-0001-6936-4548), Restivo A., Arcudi A., Scacciavillani R., Cappannoli L., Riccioni M. E. (ORCID:0000-0002-9239-4312), Annetta M. G. (ORCID:0000-0001-7574-1311), Vergallo R., Montone R. A., Leone A. M. (ORCID:0000-0002-1276-9883), Niccoli G. (ORCID:0000-0002-3187-6262), Sabatelli M. (ORCID:0000-0001-6635-4985), Antonelli M. (ORCID:0000-0003-3007-1670), Andreotti F. (ORCID:0000-0002-1456-6430), De Cristofaro R. (ORCID:0000-0002-8066-8849), Crea F. (ORCID:0000-0001-9404-8846), D'Amario, Domenico, Galli, Mattia, Canonico, Francesco, Restivo, Attilio, Arcudi, Alessandra, Scacciavillani, Roberto, Cappannoli, Luigi, Riccioni, Maria Elena, Annetta, Maria Giuseppina, Di Stefano, G., Piccinni, C., Vergallo, Rocco, Montone, Rocco Antonio, Leone, Antonio Maria, Niccoli, Giampaolo, Sabatelli, Mario, Antonelli, Massimo, Andreotti, Felicita, De Cristofaro, Raimondo, Crea, Filippo, D'Amario D., Galli M., Canonico F. (ORCID:0000-0001-6936-4548), Restivo A., Arcudi A., Scacciavillani R., Cappannoli L., Riccioni M. E. (ORCID:0000-0002-9239-4312), Annetta M. G. (ORCID:0000-0001-7574-1311), Vergallo R., Montone R. A., Leone A. M. (ORCID:0000-0002-1276-9883), Niccoli G. (ORCID:0000-0002-3187-6262), Sabatelli M. (ORCID:0000-0001-6635-4985), Antonelli M. (ORCID:0000-0003-3007-1670), Andreotti F. (ORCID:0000-0002-1456-6430), De Cristofaro R. (ORCID:0000-0002-8066-8849), and Crea F. (ORCID:0000-0001-9404-8846)
Abstract: AIMS: The ORal anticoagulants In fraGile patients with percutAneous endoscopic gastrostoMy and atrIal fibrillation (ORIGAMI) study investigates the safety and efficacy of Edoxaban administered via PEG in patients with atrial fibrillation and a clinical indication for a long-term anticoagulation. DESIGN: In this prospective, single-centre observational study, 12 PEG-treated patients with indication to anticoagulation will receive edoxaban via PEG and will be followed up to 6 months. Plasma antifactor Xa activity and edoxaban concentrations will be assessed. Thromboembolic (ischaemic stroke, systemic embolism, venous thromboembolism) and bleeding events (Bleeding Academic Research Consortium and Thrombolysis in Myocardial Infarction) will be recorded at 1 and 6 months. PRELIMINARY RESULTS: A retrospective analysis of five atrial fibrillation cases undergoing PEG implantation at our Institution who received edoxaban via PEG showed plasma anti-FXa levels at a steady state of 146 ± 15 ng/ml, without major adverse event at a mean follow-up of 6 months. CONCLUSION: ORIGAMI prospectively investigates PEG-administration of edoxaban in PEG-treated patients requiring long-term anticoagulation. Our preliminary retrospective data support this route of DOAC administration. CLINICALTRIALSGOV IDENTIFIER: NCT04271293.
Published: 2021

25. Ethical Aspects of Artificially Administered Nutrition and Hydration: An ASPEN Position Paper

Author: Schwartz, D. B., Barrocas, A., Annetta, Maria Giuseppina, Stratton, K., Mcginnis, C., Hardy, G., Wong, T., Arenas, D., Turon-Findley, M. P., Kliger, R. G., Corkins, K. G., Mirtallo, J., Amagai, T., Guenter, P., Annetta M. G. (ORCID:0000-0001-7574-1311), Schwartz, D. B., Barrocas, A., Annetta, Maria Giuseppina, Stratton, K., Mcginnis, C., Hardy, G., Wong, T., Arenas, D., Turon-Findley, M. P., Kliger, R. G., Corkins, K. G., Mirtallo, J., Amagai, T., Guenter, P., and Annetta M. G. (ORCID:0000-0001-7574-1311)
Abstract: The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective.
Published: 2021

26. ORal anticoagulants In fraGile patients with percutAneous endoscopic gastrostoMy and atrIal fibrillation: the (ORIGAMI) study

Author: 1, Domenico D'Amario, Galli, Mattia, Canonico, Francesco, Restivo, Attilio, Arcudi, Alessandra, Scacciavillani, Roberto, Cappannoli, Luigi, Riccioni, Maria Elena, Annetta, Maria Giuseppina, Di Stefano, Gaetano, Piccinni, Carlo, Vergallo, Rocco, Montone, Rocco Antonio, Leone, Antonio Maria, Niccoli, Giampaolo, Sabatelli, Mario, Antonelli, Massimo, Andreotti, Felicita, De Cristofaro, Raimondo, Crea, Filippo, Mattia Galli, Francesco Canonico (ORCID:0000-0001-6936-4548), Alessandra Arcudi, Roberto Scacciavillani, Luigi Cappannoli, Maria Elena Riccioni (ORCID:0000-0002-9239-4312), Maria Giuseppina Annetta (ORCID:0000-0001-7574-1311), Rocco Antonio Montone, Antonio Maria Leone (ORCID:0000-0002-1276-9883), Giampaolo Niccoli (ORCID:0000-0002-3187-6262), Mario Sabatelli (ORCID:0000-0001-6635-4985), Massimo Antonelli (ORCID:0000-0003-3007-1670), Felicita Andreotti (ORCID:0000-0002-1456-6430), Raimondo De Cristofaro (ORCID:0000-0002-8066-8849), Filippo Crea (ORCID:0000-0001-9404-8846), 1, Domenico D'Amario, Galli, Mattia, Canonico, Francesco, Restivo, Attilio, Arcudi, Alessandra, Scacciavillani, Roberto, Cappannoli, Luigi, Riccioni, Maria Elena, Annetta, Maria Giuseppina, Di Stefano, Gaetano, Piccinni, Carlo, Vergallo, Rocco, Montone, Rocco Antonio, Leone, Antonio Maria, Niccoli, Giampaolo, Sabatelli, Mario, Antonelli, Massimo, Andreotti, Felicita, De Cristofaro, Raimondo, Crea, Filippo, Mattia Galli, Francesco Canonico (ORCID:0000-0001-6936-4548), Alessandra Arcudi, Roberto Scacciavillani, Luigi Cappannoli, Maria Elena Riccioni (ORCID:0000-0002-9239-4312), Maria Giuseppina Annetta (ORCID:0000-0001-7574-1311), Rocco Antonio Montone, Antonio Maria Leone (ORCID:0000-0002-1276-9883), Giampaolo Niccoli (ORCID:0000-0002-3187-6262), Mario Sabatelli (ORCID:0000-0001-6635-4985), Massimo Antonelli (ORCID:0000-0003-3007-1670), Felicita Andreotti (ORCID:0000-0002-1456-6430), Raimondo De Cristofaro (ORCID:0000-0002-8066-8849), and Filippo Crea (ORCID:0000-0001-9404-8846)
Abstract: Background: Randomized trials support the safety and efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients with nonvalvular atrial fibrillation, leading to increased use of these compounds. Crushed forms of DOACs have been shown to be reliable, but evidence supporting percutaneous endoscopic gastrostomy (PEG) delivery is lacking. PEG is a long-term option for enteral food and drug delivery in patients unable to maintain oral intake, bypassing the risks and disadvantages of parenteral nutrition. Aims: The ORal anticoagulants In fraGile patients with percutAneous endoscopic gastrostoMy and atrIal fibrillation (ORIGAMI) study investigates the safety and efficacy of Edoxaban administered via PEG in patients with atrial fibrillation and a clinical indication for a long-term anticoagulation. Design: In this prospective, single-centre observational study, 12 PEG-treated patients with indication to anticoagulation will receive edoxaban via PEG and will be followed up to 6 months. Plasma antifactor Xa activity and edoxaban concentrations will be assessed. Thromboembolic (ischaemic stroke, systemic embolism, venous thromboembolism) and bleeding events (Bleeding Academic Research Consortium and Thrombolysis in Myocardial Infarction) will be recorded at 1 and 6 months. Preliminary cases: A retrospective analysis of five atrial fibrillation cases undergoing PEG implantation at our Institution who received edoxaban via PEG showed plasma anti-FXa levels at a steady state of 146 ± 15 ng/ml, without major adverse event at a mean follow-up of 6 months. Conclusion: ORIGAMI prospectively investigates PEG-administration of edoxaban in PEG-treated patients requiring long-term anticoagulation. Our preliminary retrospective data support this route of DOAC administration. CLINICALTRIALS.
Published: 2020

27. Assessment of neurological manifestations in hospitalized patients with COVID-19

Author: Luigetti, Marco, Iorio, Raffaele, Bentivoglio, Anna Rita, Tricoli, Luca, Riso, Vittorio, Marotta, Jessica, Piano, Carla, Primiano, Guido Alessandro, Zileri Del Verme, L., Lo Monaco, Maria Rita, Calabresi, Paolo, Abbate, V., Acampora, N., Addolorato, G., Agostini, F., Ainora, M. E., Akacha, K., Amato, E., Andreani, F., Andriollo, G., Annetta, Maria Giuseppina, Annicchiarico, B. E., Antonelli, Massimo, Antonucci, G., Anzellotti, G. M., Armuzzi, A., Baldi, F., Barattucci, I., Barillaro, C., Barone, F., Bellantone, R. D. A., Bellieni, A., Bello, G., Benicchi, A., Benvenuto, F., Berardini, L., Berloco, F., Bernabei, R., Bianchi, A., Biasucci, D. G., Biasucci, L. M., Bibbo, S., Bini, A., Bisanti, A., Biscetti, F., Bocci, M. G., Bonadia, N., Bongiovanni, F., Borghetti, A., Bosco, G., Bosello, Silvia Laura, Bove, V., Bramato, G., Brandi, V., Bruni, T., Bruno, C., Bruno, D., Bungaro, M. C., Buonomo, A., Burzo, L., Calabrese, A., Calvello, M. R., Cambieri, A., Cambise, C., Camma, G., Candelli, M., Canistro, G., Cantanale, A., Capalbo, G., Capaldi, L., Capone, E., Capristo, E., Carbone, L., Cardone, S., Carelli, S., Carfi, A., Carnicelli, A., Caruso, C., Casciaro, F. A., Catalano, L., Cauda, R., Cecchini, A. L., Cerrito, L., Cesarano, M., Chiarito, A., Cianci, Rossella, Cicchinelli, S., Ciccullo, A., Cicetti, M., Ciciarello, F., Cingolani, A., Cipriani, M. C., Consalvo, M. L., Coppola, G., Corbo, G. M., Corsello, A., Costante, F., Costanzi, M., Covino, M., Crupi, D., Cutuli, S. L., D'Addio, S., D'Alessandro, A., D'Alfonso, M. E., D'Angelo, E., D'Aversa, F., Damiano, F., De Berardinis, G. M., De Cunzo, T., De Gaetano, D. K., De Luca, G., De Matteis, G., De Pascale, G., De Santis, P., De Siena, M., De Vito, F., Del Gatto, V., Del Giacomo, P., Del Zompo, F., Dell'Anna, A. M., Della, P. D., Di Gialleonardo, L., Di Giambenedetto, S., Di Luca, R., Di Maurizio, L., Di Muro, M., Dusina, A., Eleuteri, D., Esperide, A., Fachechi, D., Faliero, D., Falsiroli, C., Fantoni, M., Fedele, A., Feliciani, D., Ferrante, C., Ferrone, G., Festa, R., Fiore, M. C., Flex, A., Forte, E., Franceschi, Francesco, Francesconi, A., Franza, L., Funaro, B., Fuorlo, M., Fusco, D., Gabrielli, M., Gaetani, E., Galletta, C., Gallo, A., Gambassi, G., Garcovich, M., Gasbarrini, A., Gasparrini, I., Gelli, S., Giampietro, A., Gigante, L., Giuliano, G., Giupponi, B., Gremese, E., Grieco, Domenico Luca, Guerrera, M., Guglielmi, V., Guidone, C., Gulli, A., Iaconelli, A., Iafrati, A., Ianiro, Gianluca, Iaquinta, A., Impagnatiello, M., Inchingolo, R., Intini, E., Iorio, R., Izzi, I. M., Jovanovic, T., Kadhim, C., La Macchia, R., La Milia, D. I., Landi, F., Landi, G., Landi, R., Landolfi, R., Leo, M., Leone, P. M., Levantesi, L., Liguori, A., Liperoti, R., Lizzio, M. M., Lo Monaco Maria, R., Locantore, P., Lombardi, F., Lombardi, G., Lopetuso, L., Loria, V., Losito, A. R., Lucia, M. B. P., Macagno, F., Macerola, N., Maggi, G., Maiuro, G., Mancarella, F., Mangiola, F., Manno, A., Marchesini, D., Maresca, G. M., Marrone, G., Martis, I., Martone, A. M., Marzetti, Emanuele, Mattana, C., Matteo, M. V., Maviglia, R., Mazzarella, A., Memoli, C., Miele, Luca, Migneco, A., Mignini, I., Milani, A., Milardi, D., Montalto, M., Montemurro, G., Monti, F., Montini, Luca, Morena, T. C., Morra, V., Morretta, C., Moschese, D., Murace, C. A., Murdolo, M., Murri, Rita, Napoli, M., Nardella, E., Natalello, G., Natalini, D., Navarra, S. M., Nesci, A., Nicoletti, A., Nicoletti, R., Nicoletti, T. F., Nicolo, R., Nicolotti, N., Nista, E. C., Nuzzo, E., Oggiano, M., Ojetti, V., Pagano, F. C., Paiano, G., Pais, C., Pallavicini, F., Palombo, A., Paolillo, F., Papa, Alfredo, Papanice, D., Papparella, L. G., Paratore, M., Parrinello, G., Pasciuto, G., Pasculli, P., Pecorini, G., Perniola, S., Pero, E., Petricca, L., Petrucci, M., Picarelli, C., Piccioni, A., Piccolo, A., Piervincenzi, E., Pignataro, G., Pignataro, R., Pintaudi, G., Pisapia, L., Pizzoferrato, M., Pizzolante, F., Pola, R., Policola, C., Pompili, M., Pontecorvi, F., Pontecorvi, V., Ponziani, F., Popolla, V., Porceddu, E., Porfidia, A., Porro, L. M., Potenza, A., Pozzana, F., Privitera, G., Pugliese, D., Pulcini, G., Racco, S., Raffaelli, F., Ramunno, V., Rapaccini, G. L., Richeldi, Luca, Rinninella, Emanuele, Rocchi, S., Romano, B., Romano, S., Rosa, F., Rossi, L., Rossi, R., Rossini, E., Rota, E., Rovedi, F., Rubino, C., Rumi, G., Russo, A., Sabia, L., Salerno, A., Salini, S., Salvatore, L., Samori, D., Sandroni, Claudio, Sanguinetti, M., Santarelli, L., Santini, P., Santolamazza, D., Santoliquido, A., Santopaolo, F., Santoro, M. C., Sardeo, F., Sarnari, C., Saviano, A., Saviano, L., Scaldaferri, Franco, Scarascia, R., Schepis, T., Schiavello, F., Scoppettuolo, G., Sedda, D., Sessa, F., Sestito, L., Settanni, C., Siciliano, M., Siciliano, V., Sicuranza, R., Simeoni, B., Simonetti, J., Smargiassi, A., Soave, P. M., Sonnino, C., Staiti, D., Stella, C., Stella, L., Stival, E., Taddei, E., Talerico, R., Tamburello, E., Tamburrini, E., Tanzarella, E. S., Tarascio, E., Tarli, C., Tersali, A., Tilli, P., Timpano, J., Torelli, E., Torrini, F., Tosato, M., Tosoni, A., Tricoli, L., Tritto, M., Tumbarello, M., Tummolo, A. M., Vallecoccia, M. S., Valletta, F., Varone, F., Vassalli, F., Ventura, G., Verardi, L., Vetrone, L., Vetrugno, G., Visconti, E., Visconti, F., Viviani, A., Zaccaria, R., Zaccone, C., Zelano, L., Zileri Dal Verme, L., Zuccala, G., Luigetti M. (ORCID:0000-0001-7539-505X), Iorio R. (ORCID:0000-0002-6270-0956), Bentivoglio A. R. (ORCID:0000-0002-9663-095X), Tricoli L., Riso V., Marotta J., Piano C., Primiano G., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Calabresi P. (ORCID:0000-0003-0326-5509), Annetta M. G. (ORCID:0000-0001-7574-1311), Antonelli M. (ORCID:0000-0003-3007-1670), Bosello S. (ORCID:0000-0002-4837-447X), Cianci R. (ORCID:0000-0001-5378-8442), Franceschi F. (ORCID:0000-0001-6266-445X), Grieco D. L. (ORCID:0000-0002-4557-6308), Ianiro G. (ORCID:0000-0002-8318-0515), Marzetti E. (ORCID:0000-0001-9567-6983), Miele L. (ORCID:0000-0003-3464-0068), Montini L. (ORCID:0000-0003-4602-5134), Murri R. (ORCID:0000-0003-4263-7854), Papa A. (ORCID:0000-0002-4186-7298), Richeldi L. (ORCID:0000-0001-8594-1448), Rinninella E. (ORCID:0000-0002-9165-2367), Sandroni C. (ORCID:0000-0002-8878-2611), Scaldaferri F. (ORCID:0000-0001-8334-7541), Luigetti, Marco, Iorio, Raffaele, Bentivoglio, Anna Rita, Tricoli, Luca, Riso, Vittorio, Marotta, Jessica, Piano, Carla, Primiano, Guido Alessandro, Zileri Del Verme, L., Lo Monaco, Maria Rita, Calabresi, Paolo, Abbate, V., Acampora, N., Addolorato, G., Agostini, F., Ainora, M. E., Akacha, K., Amato, E., Andreani, F., Andriollo, G., Annetta, Maria Giuseppina, Annicchiarico, B. E., Antonelli, Massimo, Antonucci, G., Anzellotti, G. M., Armuzzi, A., Baldi, F., Barattucci, I., Barillaro, C., Barone, F., Bellantone, R. D. A., Bellieni, A., Bello, G., Benicchi, A., Benvenuto, F., Berardini, L., Berloco, F., Bernabei, R., Bianchi, A., Biasucci, D. G., Biasucci, L. M., Bibbo, S., Bini, A., Bisanti, A., Biscetti, F., Bocci, M. G., Bonadia, N., Bongiovanni, F., Borghetti, A., Bosco, G., Bosello, Silvia Laura, Bove, V., Bramato, G., Brandi, V., Bruni, T., Bruno, C., Bruno, D., Bungaro, M. C., Buonomo, A., Burzo, L., Calabrese, A., Calvello, M. R., Cambieri, A., Cambise, C., Camma, G., Candelli, M., Canistro, G., Cantanale, A., Capalbo, G., Capaldi, L., Capone, E., Capristo, E., Carbone, L., Cardone, S., Carelli, S., Carfi, A., Carnicelli, A., Caruso, C., Casciaro, F. A., Catalano, L., Cauda, R., Cecchini, A. L., Cerrito, L., Cesarano, M., Chiarito, A., Cianci, Rossella, Cicchinelli, S., Ciccullo, A., Cicetti, M., Ciciarello, F., Cingolani, A., Cipriani, M. C., Consalvo, M. L., Coppola, G., Corbo, G. M., Corsello, A., Costante, F., Costanzi, M., Covino, M., Crupi, D., Cutuli, S. L., D'Addio, S., D'Alessandro, A., D'Alfonso, M. E., D'Angelo, E., D'Aversa, F., Damiano, F., De Berardinis, G. M., De Cunzo, T., De Gaetano, D. K., De Luca, G., De Matteis, G., De Pascale, G., De Santis, P., De Siena, M., De Vito, F., Del Gatto, V., Del Giacomo, P., Del Zompo, F., Dell'Anna, A. M., Della, P. D., Di Gialleonardo, L., Di Giambenedetto, S., Di Luca, R., Di Maurizio, L., Di Muro, M., Dusina, A., Eleuteri, D., Esperide, A., Fachechi, D., Faliero, D., Falsiroli, C., Fantoni, M., Fedele, A., Feliciani, D., Ferrante, C., Ferrone, G., Festa, R., Fiore, M. C., Flex, A., Forte, E., Franceschi, Francesco, Francesconi, A., Franza, L., Funaro, B., Fuorlo, M., Fusco, D., Gabrielli, M., Gaetani, E., Galletta, C., Gallo, A., Gambassi, G., Garcovich, M., Gasbarrini, A., Gasparrini, I., Gelli, S., Giampietro, A., Gigante, L., Giuliano, G., Giupponi, B., Gremese, E., Grieco, Domenico Luca, Guerrera, M., Guglielmi, V., Guidone, C., Gulli, A., Iaconelli, A., Iafrati, A., Ianiro, Gianluca, Iaquinta, A., Impagnatiello, M., Inchingolo, R., Intini, E., Iorio, R., Izzi, I. M., Jovanovic, T., Kadhim, C., La Macchia, R., La Milia, D. I., Landi, F., Landi, G., Landi, R., Landolfi, R., Leo, M., Leone, P. M., Levantesi, L., Liguori, A., Liperoti, R., Lizzio, M. M., Lo Monaco Maria, R., Locantore, P., Lombardi, F., Lombardi, G., Lopetuso, L., Loria, V., Losito, A. R., Lucia, M. B. P., Macagno, F., Macerola, N., Maggi, G., Maiuro, G., Mancarella, F., Mangiola, F., Manno, A., Marchesini, D., Maresca, G. M., Marrone, G., Martis, I., Martone, A. M., Marzetti, Emanuele, Mattana, C., Matteo, M. V., Maviglia, R., Mazzarella, A., Memoli, C., Miele, Luca, Migneco, A., Mignini, I., Milani, A., Milardi, D., Montalto, M., Montemurro, G., Monti, F., Montini, Luca, Morena, T. C., Morra, V., Morretta, C., Moschese, D., Murace, C. A., Murdolo, M., Murri, Rita, Napoli, M., Nardella, E., Natalello, G., Natalini, D., Navarra, S. M., Nesci, A., Nicoletti, A., Nicoletti, R., Nicoletti, T. F., Nicolo, R., Nicolotti, N., Nista, E. C., Nuzzo, E., Oggiano, M., Ojetti, V., Pagano, F. C., Paiano, G., Pais, C., Pallavicini, F., Palombo, A., Paolillo, F., Papa, Alfredo, Papanice, D., Papparella, L. G., Paratore, M., Parrinello, G., Pasciuto, G., Pasculli, P., Pecorini, G., Perniola, S., Pero, E., Petricca, L., Petrucci, M., Picarelli, C., Piccioni, A., Piccolo, A., Piervincenzi, E., Pignataro, G., Pignataro, R., Pintaudi, G., Pisapia, L., Pizzoferrato, M., Pizzolante, F., Pola, R., Policola, C., Pompili, M., Pontecorvi, F., Pontecorvi, V., Ponziani, F., Popolla, V., Porceddu, E., Porfidia, A., Porro, L. M., Potenza, A., Pozzana, F., Privitera, G., Pugliese, D., Pulcini, G., Racco, S., Raffaelli, F., Ramunno, V., Rapaccini, G. L., Richeldi, Luca, Rinninella, Emanuele, Rocchi, S., Romano, B., Romano, S., Rosa, F., Rossi, L., Rossi, R., Rossini, E., Rota, E., Rovedi, F., Rubino, C., Rumi, G., Russo, A., Sabia, L., Salerno, A., Salini, S., Salvatore, L., Samori, D., Sandroni, Claudio, Sanguinetti, M., Santarelli, L., Santini, P., Santolamazza, D., Santoliquido, A., Santopaolo, F., Santoro, M. C., Sardeo, F., Sarnari, C., Saviano, A., Saviano, L., Scaldaferri, Franco, Scarascia, R., Schepis, T., Schiavello, F., Scoppettuolo, G., Sedda, D., Sessa, F., Sestito, L., Settanni, C., Siciliano, M., Siciliano, V., Sicuranza, R., Simeoni, B., Simonetti, J., Smargiassi, A., Soave, P. M., Sonnino, C., Staiti, D., Stella, C., Stella, L., Stival, E., Taddei, E., Talerico, R., Tamburello, E., Tamburrini, E., Tanzarella, E. S., Tarascio, E., Tarli, C., Tersali, A., Tilli, P., Timpano, J., Torelli, E., Torrini, F., Tosato, M., Tosoni, A., Tricoli, L., Tritto, M., Tumbarello, M., Tummolo, A. M., Vallecoccia, M. S., Valletta, F., Varone, F., Vassalli, F., Ventura, G., Verardi, L., Vetrone, L., Vetrugno, G., Visconti, E., Visconti, F., Viviani, A., Zaccaria, R., Zaccone, C., Zelano, L., Zileri Dal Verme, L., Zuccala, G., Luigetti M. (ORCID:0000-0001-7539-505X), Iorio R. (ORCID:0000-0002-6270-0956), Bentivoglio A. R. (ORCID:0000-0002-9663-095X), Tricoli L., Riso V., Marotta J., Piano C., Primiano G., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Calabresi P. (ORCID:0000-0003-0326-5509), Annetta M. G. (ORCID:0000-0001-7574-1311), Antonelli M. (ORCID:0000-0003-3007-1670), Bosello S. (ORCID:0000-0002-4837-447X), Cianci R. (ORCID:0000-0001-5378-8442), Franceschi F. (ORCID:0000-0001-6266-445X), Grieco D. L. (ORCID:0000-0002-4557-6308), Ianiro G. (ORCID:0000-0002-8318-0515), Marzetti E. (ORCID:0000-0001-9567-6983), Miele L. (ORCID:0000-0003-3464-0068), Montini L. (ORCID:0000-0003-4602-5134), Murri R. (ORCID:0000-0003-4263-7854), Papa A. (ORCID:0000-0002-4186-7298), Richeldi L. (ORCID:0000-0001-8594-1448), Rinninella E. (ORCID:0000-0002-9165-2367), Sandroni C. (ORCID:0000-0002-8878-2611), and Scaldaferri F. (ORCID:0000-0001-8334-7541)
Abstract: Background and purpose: The objective of this study was to assess the neurological manifestations in a series of consecutive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients, comparing their frequency with a population hospitalized in the same period for flu/respiratory symptoms, finally not related to SARS-CoV-2. Methods: Patients with flu/respiratory symptoms admitted to Fondazione Policlinico Gemelli hospital from 14 March 2020 to 20 April 2020 were retrospectively enrolled. The frequency of neurological manifestations of patients with SARS-CoV-2 infection was compared with a control group. Results: In all, 213 patients were found to be positive for SARS-CoV-2, after reverse transcriptase polymerase chain reaction on nasal or throat swabs, whilst 218 patients were found to be negative and were used as a control group. Regarding central nervous system manifestations, in SARS-CoV-2-positive patients a higher frequency of headache, hyposmia and encephalopathy always related to systemic conditions (fever or hypoxia) was observed. Furthermore, muscular involvement was more frequent in SARS-CoV-2 infection. Conclusions: Patients with COVID-19 commonly have neurological manifestations but only hyposmia and muscle involvement seem more frequent compared with other flu diseases.
Published: 2020

28. Nutritional management in hospital setting during SARS-CoV-2 pandemic: a real-life experience.

Author: Cintoni, Marco, Rinninella, Emanuele, Annetta, Maria Giuseppina, Mele, Maria Cristina, Cintoni M (ORCID:0000-0002-9610-0748), Rinninella E (ORCID:0000-0002-9165-2367), Annetta M (ORCID:0000-0001-7574-1311), Mele M. (ORCID:0000-0003-0153-5819), Cintoni, Marco, Rinninella, Emanuele, Annetta, Maria Giuseppina, Mele, Maria Cristina, Cintoni M (ORCID:0000-0002-9610-0748), Rinninella E (ORCID:0000-0002-9165-2367), Annetta M (ORCID:0000-0001-7574-1311), and Mele M. (ORCID:0000-0003-0153-5819)
Abstract: Coronaviruses are a family of pathogens that primarily affect the human respiratory tract. In December 2019 first cases of a new Coronavirus (SARS-CoV-2) were reported in China. On the 24th of March, the worldwide confirmed cases rose to 372.757 and 16.231 deaths, while in Italy, there were 63.927 total confirmed cases and 6.077 deaths. On March 11, 2020, WHO declared the SARS-CoV-2 outbreak a pandemic. While actual evidence is focusing on the general management of coronavirus disease (COVID-19), little is known regarding nutritional support during hospital stay (HS). The lack of nutritional procedures could, in turn, prolong patients’ recovery and increase further infectious complications. To better plan the nutritional management of this hospital emergency, we report the strategy adopted in our institution, the «Fondazione Policlinico A. Gemelli-IRCCS» of Rome, Italy, which recently became one of the COVID-19 reference centers in our region.
Published: 2020

29. Ultrasound assessment of rectus femoris and anterior tibialis muscles in young trauma patients

Author: Annetta, Maria Giuseppina, Pittiruti, Mauro, Silvestri, Davide, Grieco, Domenico Luca, Maccaglia, Alessio, La Torre, Michele Fabio, Magarelli, Nicola, Mercurio, Giovanna, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Magarelli, Nicola (ORCID:0000-0002-2521-086X), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Pittiruti, Mauro, Silvestri, Davide, Grieco, Domenico Luca, Maccaglia, Alessio, La Torre, Michele Fabio, Magarelli, Nicola, Mercurio, Giovanna, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Magarelli, Nicola (ORCID:0000-0002-2521-086X), Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: Purpose: Quantitative and qualitative changes of skeletal muscle are typical and early findings in trauma patients, being possibly associated with functional impairment. Early assessment of muscle changes—as evaluated by muscle ultrasonography—could yield important information about patient’s outcome. Methods: In this prospective observational study, we used ultrasonography to evaluate the morphological changes of rectus femoris (RF) and anterior tibialis (AT) muscles in a group of young, previously healthy trauma patients on enteral feeding. Results: We studied 38 severely injured patients (median Injury Severity Score = 34; median age = 40 y.o.) over the course of the ICU stay up to 3 weeks after trauma. We found a progressive loss of muscle mass from day 0 to day 20, that was more relevant for the RF (45%) than for the AT (22%); this was accompanied by an increase in echogenicity (up to 2.5 by the Heckmatt Scale, where normal echogenicity = 1), which is an indicator of myofibers depletion. Conclusions: Ultrasound evaluation of skeletal muscles is inexpensive, noninvasive, simple and easily repeatable. By this method, we were able to quantify the morphological changes of skeletal muscle in trauma patients. Further studies may rely on this technicque to evaluate the impact of different therapeutic strategies on muscle wasting.
Published: 2017

30. Nutritional support in acute pancreatitis: from physiopathology to practice. An evidence-based approach

Author: Rinninella, Emanuele, Annetta, Maria Giuseppina, Serricchio, Michele Lorenzo, Dal Lago, Antonio Angelo, Miggiano, Giacinto Abele Donato, Mele, Maria Cristina, Rinninella, Emanuele (ORCID:0000-0002-9165-2367), Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Serricchio, Michele Lorenzo (ORCID:0000-0003-1832-9608), Dal Lago, Antonio Angelo (ORCID:0000-0003-2095-5368), Miggiano, Giacinto Abele Donato (ORCID:0000-0002-8627-5528), Mele, Maria Cristina (ORCID:0000-0003-0153-5819), Rinninella, Emanuele, Annetta, Maria Giuseppina, Serricchio, Michele Lorenzo, Dal Lago, Antonio Angelo, Miggiano, Giacinto Abele Donato, Mele, Maria Cristina, Rinninella, Emanuele (ORCID:0000-0002-9165-2367), Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Serricchio, Michele Lorenzo (ORCID:0000-0003-1832-9608), Dal Lago, Antonio Angelo (ORCID:0000-0003-2095-5368), Miggiano, Giacinto Abele Donato (ORCID:0000-0002-8627-5528), and Mele, Maria Cristina (ORCID:0000-0003-0153-5819)
Abstract: Acute Pancreatitis (AP) is a potentially fatal syndrome, associated with a hyper-catabolic state as well as early and late complications that may lead to multi-organ failure and death. Clinical researches produced in recent years suggest that acute pancreatitis may benefit from early oral or enteral nutrition. Nevertheless, many clinicians still believe erroneously that fasting – particularly in the early phase – may reduce AP complications and mortality. The goal of our review is to demonstrate that such false belief may harm the patients and that the whole management paradigm must change, adopting a more rational, evidence-based approach. First, we will describe AP physiopathology and the clinical assessment of its severity. Then we will discuss evidence-based data supporting early oral or enteral nutrition in AP. Finally, we will offer some practice recommendations as regards nutritional support.
Published: 2017

31. Are Peripherally Inserted Central Catheters Suitable for Cardiac Output Assessment With Transpulmonary Thermodilution?.

Author: D'Arrigo, Sonia, Sandroni, Claudio, Cacciola, S, Dell'Anna, Antonio Maria, Pittiruti, Mauro, Annetta, Maria Giuseppina, Colosimo, Cesare, Antonelli, Massimo, D'Arrigo S (ORCID:0000-0001-6740-3195), Sandroni C (ORCID:0000-0002-8878-2611), Dell'Anna AM, Pittiruti M (ORCID:0000-0003-4541-7566), Annetta MG (ORCID:0000-0001-7574-1311), Colosimo C (ORCID:0000-0003-3800-3648), Antonelli M. (ORCID:0000-0003-3007-1670), D'Arrigo, Sonia, Sandroni, Claudio, Cacciola, S, Dell'Anna, Antonio Maria, Pittiruti, Mauro, Annetta, Maria Giuseppina, Colosimo, Cesare, Antonelli, Massimo, D'Arrigo S (ORCID:0000-0001-6740-3195), Sandroni C (ORCID:0000-0002-8878-2611), Dell'Anna AM, Pittiruti M (ORCID:0000-0003-4541-7566), Annetta MG (ORCID:0000-0001-7574-1311), Colosimo C (ORCID:0000-0003-3800-3648), and Antonelli M. (ORCID:0000-0003-3007-1670)
Abstract: OBJECTIVES: Peripherally inserted central catheters are increasingly used in ICU as an alternative to centrally inserted central catheters for IV infusion. However, their reliability for hemodynamic measurements with transpulmonary thermodilution is currently unknown. We investigated the agreement between transpulmonary thermodilution measurements obtained with bolus injection through peripherally inserted central catheter and centrally inserted central catheter (reference standard) using a transpulmonary thermodilution-calibrated Pulse Contour hemodynamic monitoring system (VolumeView/EV1000). DESIGN: Prospective method-comparison study. SETTING: Twenty-bed medical-surgical ICU of a teaching hospital. PATIENTS: Twenty adult ICU patients who required hemodynamic monitoring because of hemodynamic instability and had both peripherally inserted central catheter and centrally inserted central catheter in place. INTERVENTION: The hemodynamic measurements obtained by transpulmonary thermodilution after injection of a cold saline bolus via both centrally inserted central catheter and either a single-lumen 4F or a double-lumen 5F peripherally inserted central catheter using were compared. In order to rule out bias related to manual injection, measurements were repeated using an automated rapid injection system. MEASUREMENTS AND MAIN RESULTS: A total of 320 measurements were made. Cardiac index was significantly higher when measured with double-lumen 5F peripherally inserted central catheter than with centrally inserted central catheter (mean, 4.5 vs 3.3 L/min/m; p < 0.0001; bias, 1.24 L/min/m [0.27, 2.22 L/min/m]; bias percentage, 31%). Global end-diastolic index, extravascular lung water index, and stroke volume index were also overestimated (853 ± 240 vs 688 ± 175 mL/m, 12.2 ± 4.2 vs 9.4 ± 2.9 mL/kg, and 49.6 ± 14.9 vs 39.5 ± 9.6 mL/m, respectively; p < 0.0001). Lower, albeit significant differences were found using single-lumen 4F peripherally inserted central cath
Published: 2019

32. a new a promising tool to evaluate mass and structural changes of skeletal muscle in trauma patients

Author: Annetta, Maria Giuseppina, Silvestri, Davide, Grieco, Domenico Luca, La Torre, Michele Fabio, Magarelli, Nicola, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Grieco, Domenico Luca (ORCID:0000-0002-4557-6308), Magarelli, Nicola (ORCID:0000-0002-2521-086X), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Silvestri, Davide, Grieco, Domenico Luca, La Torre, Michele Fabio, Magarelli, Nicola, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Grieco, Domenico Luca (ORCID:0000-0002-4557-6308), Magarelli, Nicola (ORCID:0000-0002-2521-086X), Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: Loss of mass and function of skeletal muscle during critical illness is associated with poor clinical outcome, reduced ventilator-free days, increased length of ICU stay, increased mortality, high costs of health care, and delay of rehabilitation [1]. The magnitude of muscle impairment correlates with the severity of the illness, the entity of the inflammation, and the appropriateness of nutritional support [2, 3]. Recent papers have advocated the use of ultrasound evaluation of skeletal muscle [2, 4, 5] to get information about its thickness and structural changes, which can be related to the degree of myopathy and to the final functional outcome [5]. We are investigating the morphological changes of skeletal muscle in trauma patients during their stay in our ICU, by ultrasound evaluation of the rectus femuris (RF) and anterior tibialis (AT) muscles (transverse scan 15 cm above the patella and 5 cm below the fibular head, respectively), on day 0 (within 24 h after admission to ICU) and on day 21. We adopted a 5–7 MHz linear transducer and a well-defined setting for all patients (overall gain 67 %; time gain compensation in neutral position; focal zone set in the middle of the muscle). Muscle echogenicity is rated according to Heckmatt’s scale [6], which is a semiquantitative, four-rank score, the higher rank (D) corresponding to reduced visualization of bone surface and thus to a more severe degree of muscle fibrosis. In this preliminary study, we evaluated six severe trauma patients: three women/three men; age range 44–61 years; body mass index ranging from 23.1 to 28.2; injury severity score 29–52; all but one had brain injury, with Glasgow Coma Scale at admission ranging from 3 to 11; ICU stay was 25–52 days and survival was 100 %. In all patients, we found a progressive decrease in the muscle mass and a progressive increase of echogenicity, suggesting not only protein depletion but degenerative changes: during the ICU stay, the anterior–posterior diameters decr
Published: 2015

33. Immunonutrients in critically ill patients: an analysis of the most recent literature

Author: Annetta, Maria Giuseppina, Pittiruti, Mauro, Vecchiarelli, P, Silvestri, Daniela, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Pittiruti, Mauro, Vecchiarelli, P, Silvestri, Daniela, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: Modulation of inflammatory and immune response to critical illness has been the goal of much research in the last decade and a variety of drugs and nutrients (so called 'immunonutrients') have been tested in experimental models with promising results. Though, in the clinical setting of intensive care, their efficacy have been inconsistently proven, most likely because the effects of each drug may vary in relation to the timing, the dose, the route of administration, the interaction with other nutrients, the severity of illness and many other factors. Though the early studies of the beginning of this century (2000-2009) have shown some clinical benefits, recent multicenter trials (2011-2015) have failed to prove a consistent benefit of immunonutrition in terms of mortality or other clinical endpoints. Reviewing the latest evidence-based documents on this subject (multicenter trials, systematic reviews, meta-analyses and international guidelines), there is no convincing evidence that immunonutrients may be beneficial in the critically ill. Considering that these substances invariably increase the costs of health care and may be unsafe or even harmful in some subgroups, particularly in septic patients, we conclude that routine administration of immune-nutrients (glutamine, arginine, omega-3 fatty acids, selenium, etc.) cannot be currently recommended in the critically ill.
Published: 2015

34. Echography in brain imaging in intensive care unit: State of the art

Author: Caricato, Anselmo, Pitoni, Sara, Montini, Luca, Bocci, Maria Grazia, Annetta, Maria Giuseppina, Antonelli, Massimo, Caricato, Anselmo (ORCID:0000-0001-5929-120X), Montini, Luca (ORCID:0000-0003-4602-5134), Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Caricato, Anselmo, Pitoni, Sara, Montini, Luca, Bocci, Maria Grazia, Annetta, Maria Giuseppina, Antonelli, Massimo, Caricato, Anselmo (ORCID:0000-0001-5929-120X), Montini, Luca (ORCID:0000-0003-4602-5134), Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: Transcranial Sonography (TCS) is an ultrasound-based imaging technique, which allows the identification of several structures within the brain parenchyma. In the past it has been applied for bedside assessment of different intracranial pathologies in children. Presently, TCS is also used on adult patients to diagnose intracranial space occupying lesions of various origins, intracranial hemorrhage, hydrocephalus, midline shift and neurodegenerative movement disorders, in both acute and chronic clinical settings. In comparison with conventional neuroimaging methods (such as Computed Tomography or Magnetic Resonance), TCS has the advantages of low costs, short investigation times, repeatability, and bedside availability. These noninvasive characteristics, together with the possibility of offering a continuous patient neuro-monitoring system, determine its applicability in multiple emergency and non-emergency settings. Currently, TCS is a still underestimated imaging modality that requires a wider diffusion and a qualified training process.
Published: 2014

35. Preventing against hospital malnutrition: a survey on nutritional policies in an italian university hospital

Author: Annetta, Maria Giuseppina, Pittiruti, Mauro, De Rosa, Silvia, Franchi, Paola, Pintaudi, Gabriele, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Pittiruti, Mauro, De Rosa, Silvia, Franchi, Paola, Pintaudi, Gabriele, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: A proper strategy for fighting hospital malnutrition should include nutritional screening of all hospitalized patients, adequate utilization of the Hospital facilities - such as Clinical Nutrition Services or Nutrition Teams - and an adequate algorithm for the adoption of proper nutrition support (oral, enteral or parenteral) with proper timing. The main aim of the present study was to investigate the current policies of different non--intensive wards of our institution (a 1,100 beds University Hospital) in terms of prevention of hospital malnutrition.
Published: 2014

36. Treating nonthyroidal illness syndrome in the critically ill patient: still a matter of controversy.

Author: Antonelli, Massimo, Bello, Giuseppe, Paliani, Giuditta, Annetta, Maria Giuseppina, Pontecorvi, Alfredo, Antonelli, Massimo (ORCID:0000-0003-3007-1670), Bello, Giuseppe (ORCID:0000-0003-2648-7235), Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865), Antonelli, Massimo, Bello, Giuseppe, Paliani, Giuditta, Annetta, Maria Giuseppina, Pontecorvi, Alfredo, Antonelli, Massimo (ORCID:0000-0003-3007-1670), Bello, Giuseppe (ORCID:0000-0003-2648-7235), Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), and Pontecorvi, Alfredo (ORCID:0000-0003-0570-6865)
Abstract: The nonthyroidal illness syndrome (NTIS) is a clinical condition of abnormal thyroid function tests observed in patients with acute or chronic systemic illnesses. The laboratory parameters of NTIS usually include low serum levels of triiodothyronine, with normal or low levels of thyroxine and normal or low levels of thyroid-stimulating hormone. It is still a matter of controversy whether the NTIS represents a protective adaptation of the organism to a stressful event or a maladaptive response to illness that needs correction. Multiple studies have investigated the effect of thyroid hormone replacement therapy in certain clinical situations, such as caloric restriction, cardiac disease, acute renal failure, brain-dead potential donors, and burn patients. Treating patients with NTIS seems not to be harmful, but there is no persuasive evidence that it is beneficial. The administration of hypothalamic releasing factors in patients with NTIS appears to be safe and effective in improving metabolism and restoring the anterior pituitary pulsatile secretion in the chronic phase of critical illness. However, also this promising strategy needs to be explored further. Anyhow, an extremely prudent approach is needed if treatment is given. Much of the data appearing in the literature on the treatment of NTIS encourage further randomized controlled trials on large number of patients. At present, however, we believe that there is no indication for treating thyroid hormone abnormalities in critically ill patients until convincing proof of efficacy and safety is provided.
Published: 2009

37. Ultrasound-guided “short” midline catheters for difficult venous access in the emergency department: a retrospective analysis

Author: Scoppettuolo, Giancarlo, Pittiruti, Mauro, Pitoni, S., Dolcetti, Laura, Emoli, Alessandro, Mitidieri, A., Migliorini, I., Annetta, Maria Giuseppina, Scoppettuolo G., Pittiruti M. (ORCID:0000-0003-4541-7566), Dolcetti L., Emoli A., Annetta M. G. (ORCID:0000-0001-7574-1311), Scoppettuolo, Giancarlo, Pittiruti, Mauro, Pitoni, S., Dolcetti, Laura, Emoli, Alessandro, Mitidieri, A., Migliorini, I., Annetta, Maria Giuseppina, Scoppettuolo G., Pittiruti M. (ORCID:0000-0003-4541-7566), Dolcetti L., Emoli A., and Annetta M. G. (ORCID:0000-0001-7574-1311)
Abstract: Background: Acutely ill patients admitted to the emergency department (ED) constantly require at least one fast and reliable peripheral intravenous (PIV) access. In many conditions (morbid obesity, underweight state, chronic diseases, intravenous drug abuse, adverse local conditions, etc.), PIV placement may be challenging. Ultrasound guidance is a useful tool for obtaining a peripheral intravenous access in the emergency department, particularly when superficial veins are difficult to identify by palpation and direct visualization, though standard peripheral intravenous cannulas are not ideal for this technique of insertion and may have limited duration. Long polyurethane catheters inserted with ultrasound guidance and direct Seldinger technique appear to have several advantages over short cannulas in terms of success of insertion and of duration. Methods: A retrospective analysis was conducted on all the ultrasound-guided peripheral venous accesses obtained by insertion of long polyurethane catheters in patients admitted to the emergency department of our university hospital during 1 year. The main indication to the procedure was the urgent need of a peripheral venous access in patients with superficial veins difficult to palpate and/or visualize. All relevant data concerning the insertion and the maintenance of these peripheral lines were collected from the chart. Results: Seventy-six patients were included in this review. The success rate of insertion was 100 %, with an average of 1.57 punctures per each successful cannulation. The mean time needed for the complete procedure was 9.5 min. In 73 % of patients, the catheter was used for more than 1 week; a minority of catheters were removed prematurely for end of use. No major infective or thrombotic complication was reported. Conclusions: In our experience, 8- to 10-cm-long polyurethane catheters may offer a fast and reliable peripheral venous access in the emergency department, if placed
Published: 2016

38. Muscle wasting in icu trauma patients: Quantitative and qualitative changes

Author: Annetta, Maria Giuseppina, Silvestri, D., Grieco, D. L., La Torre, M. F., Magarelli, Nicola, Policola, Caterina, Caricato, Anselmo, Della Casa, Silvia, Antonelli, Massimo, Annetta M. G. (ORCID:0000-0001-7574-1311), Magarelli N. (ORCID:0000-0002-2521-086X), Policola C., Caricato A. (ORCID:0000-0001-5929-120X), Della Casa S. (ORCID:0000-0003-4796-9217), Antonelli M. (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Silvestri, D., Grieco, D. L., La Torre, M. F., Magarelli, Nicola, Policola, Caterina, Caricato, Anselmo, Della Casa, Silvia, Antonelli, Massimo, Annetta M. G. (ORCID:0000-0001-7574-1311), Magarelli N. (ORCID:0000-0002-2521-086X), Policola C., Caricato A. (ORCID:0000-0001-5929-120X), Della Casa S. (ORCID:0000-0003-4796-9217), and Antonelli M. (ORCID:0000-0003-3007-1670)
Published: 2015

39. A new and promising tool to evaluate mass and structural changes of skeletal muscle in trauma patients

Author: Annetta, Maria Giuseppina, Silvestri, D, Grieco, D, La Torre, M, Magarelli, Nicola, Caricato, Anselmo, Antonelli, Massimo, Annetta, Mg (ORCID:0000-0001-7574-1311), Magarelli, N (ORCID:0000-0002-2521-086X), Caricato, A (ORCID:0000-0001-5929-120X), Antonelli, M. (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Silvestri, D, Grieco, D, La Torre, M, Magarelli, Nicola, Caricato, Anselmo, Antonelli, Massimo, Annetta, Mg (ORCID:0000-0001-7574-1311), Magarelli, N (ORCID:0000-0002-2521-086X), Caricato, A (ORCID:0000-0001-5929-120X), and Antonelli, M. (ORCID:0000-0003-3007-1670)
Published: 2015

40. Clinical experience with power-injectable PICCs in intensive care patients

Author: Pittiruti, Mauro, Brutti, Alberto, Celentano, Davide, Pomponi, M., Biasucci, Daniele Guerino, Annetta, Maria Giuseppina, Scoppettuolo, Giancarlo, Pittiruti M. (ORCID:0000-0003-4541-7566), Brutti A., Celentano D., Biasucci D. G., Annetta M. G. (ORCID:0000-0001-7574-1311), Scoppettuolo G., Pittiruti, Mauro, Brutti, Alberto, Celentano, Davide, Pomponi, M., Biasucci, Daniele Guerino, Annetta, Maria Giuseppina, Scoppettuolo, Giancarlo, Pittiruti M. (ORCID:0000-0003-4541-7566), Brutti A., Celentano D., Biasucci D. G., Annetta M. G. (ORCID:0000-0001-7574-1311), and Scoppettuolo G.
Abstract: Introduction: In the ICU, peripherally inserted central catheters (PICCs) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome with the use of power-injectable catheters.Methods: We retrospectively reviewed all of the power-injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance.Results: We collected 89 power-injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related bloodstream infection. Non-infective complications during management were not clinically significant. There was one episode of symptomatic thrombosis during the stay in the ICU and one episode after transfer of a patient to a non-intensive ward.Conclusion: Power-injectable PICCs have many advantages in the ICU: they can be used as multipurpose central lines for any type of infusion including high-flow infusion, for hemodynamic monitoring, and for high-pressure injection of contrast media during radiological procedures. Their insertion is successful in 100% of cases and is not associated with significant risks, even in patients with coagulation disorders. Their maintenance is associated with an extremely low rate of infective and non-infective complications. © 2012 Pittiruti et al.; licensee BioMed Central Ltd.
Published: 2012

41. Massive facial edema and airway obstruction secondary to acute postoperative sialadenitis or 'anesthesia mumps': A case report

Author: Cavaliere, Franco, Conti, Giorgio, Annetta, Maria Giuseppina, Greco, A., Cina, Alessandro, Proietti, Rodolfo, Cavaliere F. (ORCID:0000-0003-3278-1940), Conti G. (ORCID:0000-0002-8566-9365), Annetta M. G. (ORCID:0000-0001-7574-1311), Cina A., Proietti R. (ORCID:0000-0003-1137-9928), Cavaliere, Franco, Conti, Giorgio, Annetta, Maria Giuseppina, Greco, A., Cina, Alessandro, Proietti, Rodolfo, Cavaliere F. (ORCID:0000-0003-3278-1940), Conti G. (ORCID:0000-0002-8566-9365), Annetta M. G. (ORCID:0000-0001-7574-1311), Cina A., and Proietti R. (ORCID:0000-0003-1137-9928)
Abstract: Introduction. A case of massive facial edema and airway obstruction secondary to an acute sialadenitis is described that occurred a few hours after a neurosurgical procedure performed in the prone position. Literature on this topic is reviewed. Case presentation. A 73-year-old Caucasian woman underwent a right parieto-occipital craniotomy to remove a meningioma. The procedure was performed in the prone position and lasted for 7 hours. One hour after the end of surgery, left submandibular gland swelling was clearly visible and in a few hours, she developed massive facial edema. Imaging (computed tomography and magnetic resonance) showed inflammatory swelling of the submandibular and parotid glands and of the periglandular tissues, undilated excretory ducts, and complete obliteration of the pharynx lumen (pharyngeal mucosa adhered to the endotracheal tube). Analgesics, corticosteroids, and antibiotics were administered. Edema regressed from the 4th postoperative day and the endotracheal tube could be removed on the 7th postoperative day. The patient was discharged from the surgical intensive care unit on the 14th postoperative day and from hospital on the 28th postoperative day. Conclusion. This is the first case report in which acute postoperative sialadenitis caused complete upper airway obstruction: only the presence of a tracheal tube avoided the need for an emergency tracheostomy. Since edema evolves insidiously, we recommend caution when removing the endotracheal tube in patients who are acutely developing postoperative sialadenitis. © 2009 Cavaliere et al; licensee Cases Network Ltd.
Published: 2009

42. Use of corticosteroids in critically ill septic patients: A review of mechanisms of adrenal insufficiency in sepsis and treatment

Author: Annetta, Maria Giuseppina, Maviglia, Riccardo, Proietti, Rodolfo, Antonelli, M., Annetta M. G. (ORCID:0000-0001-7574-1311), Maviglia R., Proietti R. (ORCID:0000-0003-1137-9928), Annetta, Maria Giuseppina, Maviglia, Riccardo, Proietti, Rodolfo, Antonelli, M., Annetta M. G. (ORCID:0000-0001-7574-1311), Maviglia R., and Proietti R. (ORCID:0000-0003-1137-9928)
Abstract: Adrenal insufficiency has been reported with increased frequency in critical ill patients with sepsis and other inflammatory states. Its incidence varies widely depending on the criteria used to define it and the patient population studied. Increased glucocorticoid action is essential in the stress response to acute injury and even minor degrees of adrenal insufficiency can be fatal. Recently the so-called relative or functional adrenal insufficiency (CIRCI) has been described: in this syndrome cortisol levels may be low or high but nonetheless inadequate to meet the elevated metabolic demand. Since laboratory diagnosis of adrenal insufficiency is still controversial, the diagnosis of ICU associated adrenal insufficiency is essentially a clinical diagnosis. Whether exogenous corticosteroid support may be beneficial in critical illness is still a matter of debate: most international guidelines recommend that the decision to treat patients with corticosteroids should be based on clinical criteria (low blood pressure poorly responsive to vasopressor despite adequate fluid resuscitation) rather than on tests of the hypothalamic-pituitary-adrenal axis alone. As regards specifically the role of steroids in the treatment of sepsis and septic shock, at present there are no strong evidence-based recommendations. More studies are needed to reach consensus about several issues: which is the best target population, whether a cosyntropin test should be used to guide treatment, whether fludrocortisones should be given along with hydrocortisone, and how long treatment should continue. © 2009 Bentham Science Publishers Ltd.
Published: 2009

43. Predicting outcome after traumatic brain injury: Practical prognostic models based on large cohort of international patients

Author: Perel, P. A., Olldashi, F., Muzha, I., Filipi, N., Lede, R., Copertari, P., Traverso, C., Copertari, A., Vergara, E. A., Montenegro, C., De Huidobro, R. R., Saladino, P., Surt, K., Cialzeta, J., Lazzeri, S., Pinero, G., Ciccioli, F., Videtta, W., Barboza, M. F., Svampa, S., Sciuto, V., Domeniconi, G., Bustamante, M., Waschbusch, M., Gullo, M. P., Drago, D. A., Linares, J. C. A., Camputaro, L., Troccoli, G., Galimberti, H., Tallott, M., Eybner, C., Buchinger, W., Fitzal, S., Mazairac, G., Oleffe, V., Grollinger, T., Delvaux, P., Carlier, L., Braet, V., Jacques, J. -M., De Knoop, D., Nasi, L., Choi, H. K., Schmitt, M., Gentil, A., Nacul, F., Barrios, P. B., Xinkang, C., Hua, L. S., Tian, H. H., Xiaodong, C., Gualteros, W., Otero, A. A., Arango, M., Ciro, J., Jaramillo, H., Gonzalez, I., Gomez, C., Arias, A., Fonseca, M., Mora, C., Cabrera, E. G. L., Betancurth, J. L., Munoz, P., Quinonez, J. A., Castillo, M. E. G., Lopez, O., Yepes, R. P., Cuellar, D. L., Paez, G., Chaves, H. D., Ordonez, P. E., Plata, Riccardo, Pineda, M., Pulido, L. E., Jaramillo, J. S. V., Rebolledo, C., Palma, O., Soler, C., Pastrana, I., Falero, R., Perera, M. D., Garcia, A. A., Oliva, R., Delgado, H. L., Carnero, A. M., Lopez, B. L., Gallardo, A. L., Morales, A. O., Lezcano, H., Ferrer, M. I., Bess, I. Z., Canino, G. R., Ruiz, E. M. P., Cruz, O. G., Svoboda, P., Kantorova, I., Ochmann, J., Scheer, P., Kozumplik, L., Marsova, J., Edelmann, K., Chytra, I., Bosman, R., Andrejsova, H., Pachl, J., Burger, J., Kramar, F., Ulloa, M. I., Gonzalez, L., Daccach, A., Ortega, A., Cevallos, S., Cueva, B. Z., Ochoa, M., Tapia, J. V., Hurtado, J., Wong, M. C. S., Santos, R., Khamis, H., Abaza, A. H., Fekry, A., El Kordy, S., Shawky, T., El-Sayed, H., Khalil, N., Negm, N., Fisal, S., Alamin, M., Shokry, H., Elhusseny, A. Y., Radwan, A., Rashid, M., Gogichaisvili, T., Ingorokva, G., Gongadze, N., Otarashvili, A., Kleist, W., Kalkum, M., Ulrich, P., Andrews, N., Nakos, G., Karavelis, A., Archontakis, G., Myrianthefs, P., Yadav, Y., Yadav, S., Khatri, R., Baghel, A., Husain, M., Jha, D., Chhang, W. H., Dhandhania, M., Fonning, C., Iyengar, S. N., Gupta, S., Ravi, R. R., Bopiah, K. S., Herur, A., Venkataramana, N. K., Satish, A., Bhavadasan, K., Morris, R., Ramesh, S., Dewan, Y., Singh, Y., Bhagchandani, R., Bhagchandani, S., Sethurayar, V. U., Ipe, S., Sreekumar, G., Panigrahi, M., Reddy, A., Khosla, V., Pillay, H., Thomas, N., Sridhar, K., Jose, B., Kurian, N., Praharaj, S., Pillai, S., Ramana, Kiyawat, D., Maheshwari, K., Panikar, D., Chawla, J., Shenoy, S., Raja, A., Rupayana, Y., Reddy, S., Mohan, N., Kelkar, S., Johri, M., Golden, N., Maliawan, S., Fauzi, A., Farouk, U., Fakharian, E., Aramesh, A., Eghtedari, M., Ahmadzadeh, F., Gholami, A., Plunkett, P., Redican, C., Mcmahon, G., Annetta, Maria Giuseppina, Mouchaty, H., Bruzzone, E., Harding, B., Qureshi, M., Idris, Z., Jafri Abdullah, N. C., Ghazali, G., Ghani, A. R. I., Cheah, F., Cabrera, A., Gonzalez, J. L. M., Loria-Castellanos, J., Jackson, S., Hutchinson, R., Komolafe, E., Adeolu, A., Komolafe, M., Adeyemi-Doro, O., Bankole, F., Shehu, B., Danlami, V., Odebode, O., Oluwadiya, K., Sanni, A., Giebel, H., Kumar, S., Jooma, R., Mezquita, J. E., Ovelar, C. O., Portillo, M. G., Rodriguez, D., Balica, L., Oprita, B., Sklerniacof, M., Steflea, L., Bandut, L., Danil, A., Iliescu, R., Ciurea, J., El-Dawlatly, A., Alwatidy, S., Al-Yafi, W., El-Dawlatly, M., Krunic-Protic, R., Janosevic, V., Tan, J., Seah, C., Trenkler, S., Humenansky, M., Stajancova, T., Schwendt, I., Laincz, A., Julius, Z., Maros, S., Firment, J., Cifranicova, M., Saniova, B., Kalig, K., Medekova, S., Wiszt, R., Macuga, I., Hartzenberg, B., Du Plessis, G., Houlie, Z., Nathoo, N., Khumalo, S., Tracey, R., Munoz-Sanchez, A., Francisco Murillo-Cabezas, N. C., Flores-Cordero, J., Rincon- Ferrari, D., Rubi, M., Caler, L., Del Campo, M. M., Laguna, L. B., Nava, J. M., Minguillon, M. A., Lopez, A. M., Ramos-Gomez, L., De La Torre-Prados, V., Pellejero, R., Laloe, V., Mandrella, B., Suganthan, Perera, S., Mahendran, K., Stocker, R., Ludwig, S., Zimmermann, H., Denzler, U., Yutthakasemsunt, S., Kittiwattanagul, W., Piyavechvirat, P., Tapsai, P., Namuang-Jan, A., Chantapimpa, U., Watanachai, C., Subsompon, P., Pussanakawatin, W., Khunjan, P., Tangchitvittaya, S., Nilapong, S., Klangsang, T., Taechakosol, W., Srinat, A., Jerbi, Z., Borsali- Falfoul, N., Rezgui, M., Cakar, N., Ssenyonjo, H., Kobusingye, O., Lomas, G., Yates, D., Lecky, F., Bleetman, A., Baldwin, A., Jenkinson, E., Pantrini, S., Stewart, J., Contractor, N., Roberts, T., Butler, J., Pinto, A., Lee, D., Brayley, N., Robbshaw, K., Dix, C., Graham, S., Pye, S., Green, M., Kellins, A., Moulton, C., Fogg, B., Cottingham, R., Funnell, S., Shanker, U., Summers, C., Malek, L., Ashcroft, C., Powell, J., Moore, S., Buckley, S., Grocutt, M., Chambers, S., Morrice, A., Marshall, H., Harris, J., Matthews, W., Tippet, J., Mardell, S., Macmillan, F., Shaw, A., Luthra, P., Dixon, G., Ahmed, M., Young, M., Mason, S., Loveday, I., Clark, C., Taylor, S., Wilson, P., Ali, K., Greenwood, S., White, M., Perez, R., Eljamel, S., Wasserberg, J., Shale, H., Read, C., Mccarron, J., Pennell, A., Ray, G., Thurston, J., Brown, E., Jaffey, L., Graves, M., Bailey, R., Loveridge, N., Evans, G., Hughes, S., Ahmed, M. K., Richardson, J., Gallagher, C., Odedun, T., Lees, K., Foley, D., Payne, N., Pennycook, A., Griffiths, C., Moore, D., Byrne, D., Dasan, S., Banerjee, Abhishek, Mcguinness, S., Chikhani, C., Zoltie, N., Barlow, I., Stell, I., Hulse, W., Crossley, J., Watkins, L., Dorani, B., Van Viet, T., Plata R., Annetta M. G. (ORCID:0000-0001-7574-1311), Banerjee A., Perel, P. A., Olldashi, F., Muzha, I., Filipi, N., Lede, R., Copertari, P., Traverso, C., Copertari, A., Vergara, E. A., Montenegro, C., De Huidobro, R. R., Saladino, P., Surt, K., Cialzeta, J., Lazzeri, S., Pinero, G., Ciccioli, F., Videtta, W., Barboza, M. F., Svampa, S., Sciuto, V., Domeniconi, G., Bustamante, M., Waschbusch, M., Gullo, M. P., Drago, D. A., Linares, J. C. A., Camputaro, L., Troccoli, G., Galimberti, H., Tallott, M., Eybner, C., Buchinger, W., Fitzal, S., Mazairac, G., Oleffe, V., Grollinger, T., Delvaux, P., Carlier, L., Braet, V., Jacques, J. -M., De Knoop, D., Nasi, L., Choi, H. K., Schmitt, M., Gentil, A., Nacul, F., Barrios, P. B., Xinkang, C., Hua, L. S., Tian, H. H., Xiaodong, C., Gualteros, W., Otero, A. A., Arango, M., Ciro, J., Jaramillo, H., Gonzalez, I., Gomez, C., Arias, A., Fonseca, M., Mora, C., Cabrera, E. G. L., Betancurth, J. L., Munoz, P., Quinonez, J. A., Castillo, M. E. G., Lopez, O., Yepes, R. P., Cuellar, D. L., Paez, G., Chaves, H. D., Ordonez, P. E., Plata, Riccardo, Pineda, M., Pulido, L. E., Jaramillo, J. S. V., Rebolledo, C., Palma, O., Soler, C., Pastrana, I., Falero, R., Perera, M. D., Garcia, A. A., Oliva, R., Delgado, H. L., Carnero, A. M., Lopez, B. L., Gallardo, A. L., Morales, A. O., Lezcano, H., Ferrer, M. I., Bess, I. Z., Canino, G. R., Ruiz, E. M. P., Cruz, O. G., Svoboda, P., Kantorova, I., Ochmann, J., Scheer, P., Kozumplik, L., Marsova, J., Edelmann, K., Chytra, I., Bosman, R., Andrejsova, H., Pachl, J., Burger, J., Kramar, F., Ulloa, M. I., Gonzalez, L., Daccach, A., Ortega, A., Cevallos, S., Cueva, B. Z., Ochoa, M., Tapia, J. V., Hurtado, J., Wong, M. C. S., Santos, R., Khamis, H., Abaza, A. H., Fekry, A., El Kordy, S., Shawky, T., El-Sayed, H., Khalil, N., Negm, N., Fisal, S., Alamin, M., Shokry, H., Elhusseny, A. Y., Radwan, A., Rashid, M., Gogichaisvili, T., Ingorokva, G., Gongadze, N., Otarashvili, A., Kleist, W., Kalkum, M., Ulrich, P., Andrews, N., Nakos, G., Karavelis, A., Archontakis, G., Myrianthefs, P., Yadav, Y., Yadav, S., Khatri, R., Baghel, A., Husain, M., Jha, D., Chhang, W. H., Dhandhania, M., Fonning, C., Iyengar, S. N., Gupta, S., Ravi, R. R., Bopiah, K. S., Herur, A., Venkataramana, N. K., Satish, A., Bhavadasan, K., Morris, R., Ramesh, S., Dewan, Y., Singh, Y., Bhagchandani, R., Bhagchandani, S., Sethurayar, V. U., Ipe, S., Sreekumar, G., Panigrahi, M., Reddy, A., Khosla, V., Pillay, H., Thomas, N., Sridhar, K., Jose, B., Kurian, N., Praharaj, S., Pillai, S., Ramana, Kiyawat, D., Maheshwari, K., Panikar, D., Chawla, J., Shenoy, S., Raja, A., Rupayana, Y., Reddy, S., Mohan, N., Kelkar, S., Johri, M., Golden, N., Maliawan, S., Fauzi, A., Farouk, U., Fakharian, E., Aramesh, A., Eghtedari, M., Ahmadzadeh, F., Gholami, A., Plunkett, P., Redican, C., Mcmahon, G., Annetta, Maria Giuseppina, Mouchaty, H., Bruzzone, E., Harding, B., Qureshi, M., Idris, Z., Jafri Abdullah, N. C., Ghazali, G., Ghani, A. R. I., Cheah, F., Cabrera, A., Gonzalez, J. L. M., Loria-Castellanos, J., Jackson, S., Hutchinson, R., Komolafe, E., Adeolu, A., Komolafe, M., Adeyemi-Doro, O., Bankole, F., Shehu, B., Danlami, V., Odebode, O., Oluwadiya, K., Sanni, A., Giebel, H., Kumar, S., Jooma, R., Mezquita, J. E., Ovelar, C. O., Portillo, M. G., Rodriguez, D., Balica, L., Oprita, B., Sklerniacof, M., Steflea, L., Bandut, L., Danil, A., Iliescu, R., Ciurea, J., El-Dawlatly, A., Alwatidy, S., Al-Yafi, W., El-Dawlatly, M., Krunic-Protic, R., Janosevic, V., Tan, J., Seah, C., Trenkler, S., Humenansky, M., Stajancova, T., Schwendt, I., Laincz, A., Julius, Z., Maros, S., Firment, J., Cifranicova, M., Saniova, B., Kalig, K., Medekova, S., Wiszt, R., Macuga, I., Hartzenberg, B., Du Plessis, G., Houlie, Z., Nathoo, N., Khumalo, S., Tracey, R., Munoz-Sanchez, A., Francisco Murillo-Cabezas, N. C., Flores-Cordero, J., Rincon- Ferrari, D., Rubi, M., Caler, L., Del Campo, M. M., Laguna, L. B., Nava, J. M., Minguillon, M. A., Lopez, A. M., Ramos-Gomez, L., De La Torre-Prados, V., Pellejero, R., Laloe, V., Mandrella, B., Suganthan, Perera, S., Mahendran, K., Stocker, R., Ludwig, S., Zimmermann, H., Denzler, U., Yutthakasemsunt, S., Kittiwattanagul, W., Piyavechvirat, P., Tapsai, P., Namuang-Jan, A., Chantapimpa, U., Watanachai, C., Subsompon, P., Pussanakawatin, W., Khunjan, P., Tangchitvittaya, S., Nilapong, S., Klangsang, T., Taechakosol, W., Srinat, A., Jerbi, Z., Borsali- Falfoul, N., Rezgui, M., Cakar, N., Ssenyonjo, H., Kobusingye, O., Lomas, G., Yates, D., Lecky, F., Bleetman, A., Baldwin, A., Jenkinson, E., Pantrini, S., Stewart, J., Contractor, N., Roberts, T., Butler, J., Pinto, A., Lee, D., Brayley, N., Robbshaw, K., Dix, C., Graham, S., Pye, S., Green, M., Kellins, A., Moulton, C., Fogg, B., Cottingham, R., Funnell, S., Shanker, U., Summers, C., Malek, L., Ashcroft, C., Powell, J., Moore, S., Buckley, S., Grocutt, M., Chambers, S., Morrice, A., Marshall, H., Harris, J., Matthews, W., Tippet, J., Mardell, S., Macmillan, F., Shaw, A., Luthra, P., Dixon, G., Ahmed, M., Young, M., Mason, S., Loveday, I., Clark, C., Taylor, S., Wilson, P., Ali, K., Greenwood, S., White, M., Perez, R., Eljamel, S., Wasserberg, J., Shale, H., Read, C., Mccarron, J., Pennell, A., Ray, G., Thurston, J., Brown, E., Jaffey, L., Graves, M., Bailey, R., Loveridge, N., Evans, G., Hughes, S., Ahmed, M. K., Richardson, J., Gallagher, C., Odedun, T., Lees, K., Foley, D., Payne, N., Pennycook, A., Griffiths, C., Moore, D., Byrne, D., Dasan, S., Banerjee, Abhishek, Mcguinness, S., Chikhani, C., Zoltie, N., Barlow, I., Stell, I., Hulse, W., Crossley, J., Watkins, L., Dorani, B., Van Viet, T., Plata R., Annetta M. G. (ORCID:0000-0001-7574-1311), and Banerjee A.
Abstract: Objective: To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumatic brain injury. Design: Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: "basic" model (demographic and clinical variables only) and "CT" model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately. Setting: Medical Research Council (MRC) CRASH Trial. Subjects: 10 008 patients with traumatic brain injury. Models externally validated in a cohort of 8509. Results: The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial haemorrhages, obliteration of the third ventricle or basal cisterns, subarachnoid bleeding, midline shift, and non-evacuated haematoma. In the derivation sample the models showed excellent discrimination (C statistic above 0.80). The models showed good calibration graphically. The Hosmer-Lemeshow test also indicated good calibration, except for the CT model in low-middle income countries. External validation for unfavourable outcome at six months in high income countries showed that basic and CT models had good discrimination (C statistic 0.77 for both models) but poorer calibration. Conclusion: Simple prognostic models can be used to obtain valid predictions of relevant outcomes in patients with traumatic brain injury.
Published: 2008

44. Unusual presentation of leptospirosis in the late stage of pregnancy

Author: Gaspari, Rita, Annetta, Maria Giuseppina, Cavaliere, Franco, Pallavicini, Federico, Grillo, R., Conti, Giorgio, Antonelli Marco, Valerio, Tafani, C., Proietti, Rodolfo, Gaspari R. (ORCID:0000-0003-0141-3686), Annetta M. G. (ORCID:0000-0001-7574-1311), Cavaliere F. (ORCID:0000-0003-3278-1940), Pallavicini F. (ORCID:0000-0001-6874-0302), Conti G. (ORCID:0000-0002-8566-9365), Proietti R. (ORCID:0000-0003-1137-9928), Gaspari, Rita, Annetta, Maria Giuseppina, Cavaliere, Franco, Pallavicini, Federico, Grillo, R., Conti, Giorgio, Antonelli Marco, Valerio, Tafani, C., Proietti, Rodolfo, Gaspari R. (ORCID:0000-0003-0141-3686), Annetta M. G. (ORCID:0000-0001-7574-1311), Cavaliere F. (ORCID:0000-0003-3278-1940), Pallavicini F. (ORCID:0000-0001-6874-0302), Conti G. (ORCID:0000-0002-8566-9365), and Proietti R. (ORCID:0000-0003-1137-9928)
Abstract: Here we report a case of leptospirosis without fever during the late stage of pregnancy in which the initial clinical presentation was more suggestive of a pregnancy-related liver dysfunction rather than an infectious disease. A 32-year-old primipara at 37 week of gestation was hospitalised with a 10-day history of nausea, vomiting, and abdominal pain without fever. Initial routine blood tests showed hyperbilirubinemia, a moderate increase in transaminase levels, severe coagulopathy and an increased creatinine level. On clinical suspicion of pregnancy-related liver dysfunction such as HELLP syndrome (hemolysis, elevated liver enzyme levels, low platelet count) or acute fatty liver of pregnancy (AFLP), emergency caesarean section was performed and a healthy baby was delivered. Postoperatively, the patient was stable, but 5 days later she developed clouding of consciousness, severe jaundice and respiratory failure. At this time, an infectious disease was considered and leptospirosis was confirmed by serological tests. In conjunction with intensive care management, antibiotic therapy was given; the patient was discharged in good condition and her baby did not develop signs of active leptospirosis. While leptospirosis is rare in pregnancy, this is the first report of acute infection without fever mimicking the clinical pattern of HELLP syndrome or AFLP.
Published: 2007

45. Diabetic and nondiabetic hyperglycemia in the ICU

Author: Annetta, Maria Giuseppina, Ciancia, Mariana, Soave, M., Proietti, Rodolfo, Annetta M. G. (ORCID:0000-0001-7574-1311), Ciancia M., Proietti R. (ORCID:0000-0003-1137-9928), Annetta, Maria Giuseppina, Ciancia, Mariana, Soave, M., Proietti, Rodolfo, Annetta M. G. (ORCID:0000-0001-7574-1311), Ciancia M., and Proietti R. (ORCID:0000-0003-1137-9928)
Abstract: Hyperglycemia is a common feature in critically ill patients, whether they are diabetic or not, and it is associated with unfavorable outcome. The more severe the underlying disease, the more important the hyperglycemia appears to be although, we still cannot define whether hyperglycemia is just a marker of the severity of the acute illness or rather an active contributor to poor outcome. The review of the literature on this subject published from 2001 up today conveys a massive amount of information the interpretation of which is equivocal, due to the heterogeneity of patients (nondiabetic vs. diabetic, medical intensive care unit (ICU) pts vs. surgical ICU pts) and of interventions (dose and modality of insulin infusion). The association between high glucose level and mortality is strong in critically ill patients without a previous history of diabetes. Admission hyperglycemia seems to be an independent risk factor of in-hospital mortality in patients both with and without diabetes in cardiac, cardiothoracic and neurosurgical ICUs. No data are still available on general surgical ICU patients. Tight control of blood glucose levels has been demonstrated to improve outcome in both diabetic and nondiabetic critically ill patients. In surgical ICUs, tight glucose control improves mortality and reduces morbidity only among patients admitted in ICU for more than 5 days, while outcome is not improved in patients who stay in ICU for less than 3 days. However, it is not yet understood if such favorable effect is secondary to glucose control itself or if insulin plays a part, by means of its nonglucose, anabolic effects. More randomized controlled trials are needed, addressing specific issues-such as the optimal target glucose concentration and the most effective insulin regimen-especially in the general surgical patient. © 2007 Elsevier Ltd. All rights reserved.
Published: 2006

46. Pneumothorax and pneumomediastinum after feeding tube placement

Author: Pittiruti, Mauro, Izzi, Immacolata Maria, Annetta, Maria Giuseppina, Sermoneta, D., Pittiruti M. (ORCID:0000-0003-4541-7566), Izzi I. M., Annetta M. G. (ORCID:0000-0001-7574-1311), Pittiruti, Mauro, Izzi, Immacolata Maria, Annetta, Maria Giuseppina, Sermoneta, D., Pittiruti M. (ORCID:0000-0003-4541-7566), Izzi I. M., and Annetta M. G. (ORCID:0000-0001-7574-1311)
Published: 2006

47. A relational database to store Poison Centers calls

Author: Barelli, Alessandro, Biondi, I., Tafani, C., Pellegrini, A., Soave, Paolo Maurizio, Gaspari, Rita, Annetta, Maria Giuseppina, Barelli A. (ORCID:0000-0001-9789-7421), Soave M., Gaspari R. (ORCID:0000-0003-0141-3686), Annetta M. G. (ORCID:0000-0001-7574-1311), Barelli, Alessandro, Biondi, I., Tafani, C., Pellegrini, A., Soave, Paolo Maurizio, Gaspari, Rita, Annetta, Maria Giuseppina, Barelli A. (ORCID:0000-0001-9789-7421), Soave M., Gaspari R. (ORCID:0000-0003-0141-3686), and Annetta M. G. (ORCID:0000-0001-7574-1311)
Abstract: Italian Poison Centers answer to approximately 100 000 calls per year. Potentially, this activity is a huge source of data for toxicovigilance and for syndromic surveillance. During the last decade, surveillance systems for early detection of outbreaks have drawn the attention of public health institutions due to the threat of terrorism and high-profile disease outbreaks. Poisoning surveillance needs the ongoing, systematic collection, analysis, interpretation, and dissemination of harmonised data about poisonings from all Poison Centers for use in public health action to reduce morbidity and mortality and to improve health. The entity-relationship model for a Poison Center relational database is extremely complex and not studied in detail. For this reason, not harmonised data collection happens among Italian Poison Centers. Entities are recognizable concepts, either concrete or abstract, such as patients and poisons, or events which have relevance to the database, such as calls. Connectivity and cardinality of relationships are complex as well. A one-to-many relationship exist between calls and patients: for one instance of entity calls, there are zero, one, or many instances of entity patients. At the same time, a one-to-many relationship exist between patients and poisons: for one instance of entity patients, there are zero, one, or many instances of entity poisons. This paper shows a relational model for a poison center database which allows the harmonised data collection of poison centers calls.
Published: 2006

48. Ketamine: New indications for an old drug

Author: Annetta, Maria Giuseppina, Iemma, D., Garisto, C., Tafani, C., Proietti, Rodolfo, Annetta M. G. (ORCID:0000-0001-7574-1311), Proietti R. (ORCID:0000-0003-1137-9928), Annetta, Maria Giuseppina, Iemma, D., Garisto, C., Tafani, C., Proietti, Rodolfo, Annetta M. G. (ORCID:0000-0001-7574-1311), and Proietti R. (ORCID:0000-0003-1137-9928)
Abstract: Ketamine is a non-competitive antagonist to the phencyclidine site of N-methyl-d-aspartate (NMDA) receptor for glutamate, though its effects are mediated by interaction with many others receptors. It has been introduced in clinical use since 1960's but today it is not largely employed as a general anaesthetic for its undesired psychic effects (emergence reactions) occurring in approximately 12% of patients. In the last decade, there has been a renewed interest in the use of subanaesthetic doses of ketamine for the treatment of acute and chronic pain. In the late 1990's, multiple prospective, randomised, controlled study has shown the efficacy of low dose of ketamine for postoperative pain relief, for analgesia during regional or local anaesthesia, and for opioid-sparing effect. At present, non-definitive conclusion can be drawn. More data are needed to define the possible long term effects and the clinical goal of ketamine use. © 2005 Bentham Science Publishers Ltd.
Published: 2005

49. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): Randomised placebo-controlled trial

Author: Olldashi, F., Muzha, I., Filipi, N., Lede, R., Copertari, P., Traverso, C., Copertari, A., Vergara, E. A., Montenegro, C., De Huidobro, R. R., Surt, K., Cialzeta, J., Lazzeri, S., Pinero, G., Ciccioli, F., Videtta, W., Barboza, M. F., Svampa, S., Sciuto, V., Domeniconi, G., Bustamante, M., Waschbusch, M., Gullo, M. P., Drago, D. A., Linares, J. C. A., Camputaro, L., Troccoli, G., Galimberti, H., Tallott, M., Eybner, C., Buchinger, W., Fitzal, S., Mazairac, G., Oleffe, V., Grollinger, T., Delvaux, P., Carlier, L., Braet, V., Jacques, J. -M., De Knoop, D., Nasi, L., Choi, H. K., Schmitt, M., Gentil, A., Nacul, F., Barrios, P. B., Xinkang, C., Hua, L. S., Tian, H. H., Xiaodong, C., Gualteros, W., Otero, A. A., Arango, M., Ciro, J., Jaramillo, H., Garcia, G., Gonzalez, I., Gomez, C., Arias, A., Fonseca, M., Mora, C., Cabrera, E. G. L., Betancurth, J. L., Munoz, P., Quinonez, J. A., Castillo, M. E. G., Lopez, O., Yepes, R. P., Cuellar, D. L., Paez, G., Chaves, H. D., Ordonez, P. E., Plata, Riccardo, Pineda, M., Pulido, L. E., Jaramillo, J. S. V., Rebolledo, C., Palma, O., Soler, C., Pastrana, I., Falero, R., Perera, M. D., Garcia, A. A., Oliva, R., Delgado, H. L., Carnero, A. M., Lopez, B. L., Gallardo, A. L., Morales, A. O., Lezcano, H., Ferrer, M. I., Bess, I. Z., Canino, G. R., Ruiz, E. M. P., Cruz, O. G., Svoboda, P., Kantorova, I., Ochmann, J., Scheer, P., Kozumplik, L., Marsova, J., Edelmann, K., Chytra, I., Bosman, R., Andrejsova, H., Pachl, J., Burger, J., Kramar, F., Ulloa, M. I., Gonzalez, L., Daccach, A., Ortega, A., Cevallos, S., Cueva, B. Z., Ochoa, M., Tapia, J. V., Hurtado, J., Wong, M. C. S., Santos, R., Khamis, H., Abaza, A. H., Fekry, A., El Kordy, S., Shawky, T., El-Sayed, H., Khalil, N., Negm, N., Fisal, S., Shokry, H., Alamin, M., Elhusseny, A. Y., Radwan, A., Rashid, M., Gogichaisvili, T., Ingorokva, G., Gongadze, N., Otarashvili, A., Kleist, W., Kalkum, M., Ulrich, P., Andrews, N., Nakos, G., Karavelis, A., Archontakis, G., Myrianthefs, P., Yadav, Y., Yadav, S., Khatri, R., Baghel, A., Husain, M., Jha, D., Hoong Chhang, W., Dhandhania, M., Fonning, C., Iyengar, S. N., Gupta, S., Ravi, R. R., Bopiah, K. S., Herur, A., Venkataramana, N. K., Satish, A., Bhavadasan, K., Morris, R., Ramesh, S., Dewan, Y., Singh, Y., Bhagchandani, R., Bhagchandani, S., Sethurayar, V., Ipe, S., Sreekumar, G., Panigrahi, M., Reddy, A., Khosla, V., Pillay, H., Thomas, N., Sridhar, K., Jose, B., Kurian, N., Praharaj, S., Pillai, S., Ramana, Kiyawat, D., Maheshwari, K., Panikar, D., Chawla, J., Shenoy, S., Raja, A., Rupayana, Y., Reddy, S., Mohan, N., Kelkar, S., Johri, M., Golden, N., Maliawan, S., Fauzi, A., Farouk, U., Fakharian, E., Aramesh, A., Eghtedari, M., Ahmadzadeh, F., Gholami, A., Plunkett, P., Redican, C., Mcmahon, G., Annetta, Maria Giuseppina, Mouchaty, H., Bruzzone, E., Harding, B., Qureshi, M., Idris, Z., Abdullah, J., Ghazali, G., Ghani, A., Cheah, F., Gonzalez, J., Loria-Castellanos, J., Jackson, S., Hutchinson, R., Komolafe, E., Adeolu, A., Komolafe, M., Adeyemi-Doro, O., Bankole, F., Shehu, B., Danlami, V., Odebode, O., Oluwadiya, K., Sanni, A., Giebel, H., Kumar, S., Jooma, R., Mezquita, J., Ortiz Ovelar, C., Gonzales-Portillo, M., Rodriguez, D., Balica, L., Oprita, B., Sklerniacof, M., Steflea, L., Bandut, L., Danil, A., Iliescu, R., Ciurea, J., El-Dawlatly, A., Alwatidy, S., Al-Yafi, W., El-Dawlatly, M., Krunic-Protic, R., Janosevic, V., Tan, J., Seah, C., Trenkler, S., Humenansky, M., Stajancova, T., Schwendt, I., Laincz, A., Julius, Z., Maros, S., Firment, J., Cifranicova, M., Saniova, B., Kalig, K., Medekova, S., Wiszt, R., Macsuga, I., Hartzenberg, B., Du Plessis, G., Houlie, Z., Nathoo, N., Khumalo, S., Tracey, R., Munoz-Sanchez, A., Murillo-Cabezas, F., Flores-Cordero, J., Rincon-Ferrari, D., Rubi, M., Caler, L., Del Campo, M., Laguna, L., Manuel Nava, J., Minguillon, M., Lopez, A., Ramos-Gomez, L., De La Torre-Prados, V., Pellejero, R., Laloe, V., Mandrella, B., Suganthan, Perera, S., Mahendran, K., Stocker, R., Ludwig, S., Zimmermann, H., Denzler, U., Yutthakasemsunt, S., Kittiwattanagul, W., Watanachai, C., Subsompon, P., Pussanakawatin, W., Khunjan, P., Tangchitvittaya, S., Nilapong, S., Klangsang, T., Taechakosol, W., Srinat, A., Jerbi, Z., Borsali-Falfoul, N., Rezgui, M., Cakar, N., Ssenyonjo, H., Kobusingye, O., Lomas, G., Yates, D., Lecky, F., Bleetman, A., Baldwin, A., Jenkinson, E., Pantrini, S., Stewart, J., Contractor, N., Roberts, T., Butler, J., Pinto, A., Lee, D., Brayley, N., Robbshaw, K., Dix, C., Graham, S., Pye, S., Green, M., Kellins, A., Moulton, C., Fogg, B., Cottingham, R., Funnell, S., Shanker, U., Summers, C., Malek, L., Ashcroft, C., Powell, J., Moore, S., Buckley, S., Grocutt, M., Chambers, S., Morrice, A., Marshall, H., Harris, J., Matthews, W., Tippet, J., Mardell, S., Macmillan, F., Shaw, A., Luthra, P., Dixon, G., Ahmed, M., Young, M., Mason, S., Loveday, I., Clark, C., Taylor, S., Wilson, P., Ali, K., Greenwood, S., White, M., Perez, R., Eljamel, S., Wasserberg, J., Shale, H., Read, C., Mccarron, J., Pennell, A., Ray, G., Thurston, J., Brown, E., Jaffey, L., Graves, M., Bailey, R., Loveridge, N., Evans, G., Hughes, S., Richardson, J., Gallagher, C., Odedun, T., Lees, K., Foley, D., Payne, N., Pennycook, A., Griffiths, C., Moore, D., Byrne, D., Dasan, S., Banerjee, Abhishek, Mcguinness, S., Chikhani, C., Zoltie, N., Barlow, I., Stell, I., Hulse, W., Crossley, J., Watkins, L., Dorani, B., Vanviet, T., Saladino, P., Cabrera, A., Baigent, C., Bracken, M., Chadwick, D., Curley, K., Duley, L., Farrell, B., Haegi, M., Nickson, G., Peto, R., Pickard, J., Roberts, I., Sandercock, P., Teasdale, G., Collins, R., Haines, S., Macmahon, S., Warlow, C., Edwards, P., Ritchie, N., Shakur, H., Ramos, M., Barnetson, L., Fernandes, J., Tooth, D., Free, C., Narayanan, L., Collander, J., Abernethy, J., Bardswell, J., Mashru, R., Godward, C., Afolabi, L., Ritchie, A., Hosford, T., Collingwood, A., Massey, S., Plata R., Annetta M. (ORCID:0000-0001-7574-1311), Banerjee A., Olldashi, F., Muzha, I., Filipi, N., Lede, R., Copertari, P., Traverso, C., Copertari, A., Vergara, E. A., Montenegro, C., De Huidobro, R. R., Surt, K., Cialzeta, J., Lazzeri, S., Pinero, G., Ciccioli, F., Videtta, W., Barboza, M. F., Svampa, S., Sciuto, V., Domeniconi, G., Bustamante, M., Waschbusch, M., Gullo, M. P., Drago, D. A., Linares, J. C. A., Camputaro, L., Troccoli, G., Galimberti, H., Tallott, M., Eybner, C., Buchinger, W., Fitzal, S., Mazairac, G., Oleffe, V., Grollinger, T., Delvaux, P., Carlier, L., Braet, V., Jacques, J. -M., De Knoop, D., Nasi, L., Choi, H. K., Schmitt, M., Gentil, A., Nacul, F., Barrios, P. B., Xinkang, C., Hua, L. S., Tian, H. H., Xiaodong, C., Gualteros, W., Otero, A. A., Arango, M., Ciro, J., Jaramillo, H., Garcia, G., Gonzalez, I., Gomez, C., Arias, A., Fonseca, M., Mora, C., Cabrera, E. G. L., Betancurth, J. L., Munoz, P., Quinonez, J. A., Castillo, M. E. G., Lopez, O., Yepes, R. P., Cuellar, D. L., Paez, G., Chaves, H. D., Ordonez, P. E., Plata, Riccardo, Pineda, M., Pulido, L. E., Jaramillo, J. S. V., Rebolledo, C., Palma, O., Soler, C., Pastrana, I., Falero, R., Perera, M. D., Garcia, A. A., Oliva, R., Delgado, H. L., Carnero, A. M., Lopez, B. L., Gallardo, A. L., Morales, A. O., Lezcano, H., Ferrer, M. I., Bess, I. Z., Canino, G. R., Ruiz, E. M. P., Cruz, O. G., Svoboda, P., Kantorova, I., Ochmann, J., Scheer, P., Kozumplik, L., Marsova, J., Edelmann, K., Chytra, I., Bosman, R., Andrejsova, H., Pachl, J., Burger, J., Kramar, F., Ulloa, M. I., Gonzalez, L., Daccach, A., Ortega, A., Cevallos, S., Cueva, B. Z., Ochoa, M., Tapia, J. V., Hurtado, J., Wong, M. C. S., Santos, R., Khamis, H., Abaza, A. H., Fekry, A., El Kordy, S., Shawky, T., El-Sayed, H., Khalil, N., Negm, N., Fisal, S., Shokry, H., Alamin, M., Elhusseny, A. Y., Radwan, A., Rashid, M., Gogichaisvili, T., Ingorokva, G., Gongadze, N., Otarashvili, A., Kleist, W., Kalkum, M., Ulrich, P., Andrews, N., Nakos, G., Karavelis, A., Archontakis, G., Myrianthefs, P., Yadav, Y., Yadav, S., Khatri, R., Baghel, A., Husain, M., Jha, D., Hoong Chhang, W., Dhandhania, M., Fonning, C., Iyengar, S. N., Gupta, S., Ravi, R. R., Bopiah, K. S., Herur, A., Venkataramana, N. K., Satish, A., Bhavadasan, K., Morris, R., Ramesh, S., Dewan, Y., Singh, Y., Bhagchandani, R., Bhagchandani, S., Sethurayar, V., Ipe, S., Sreekumar, G., Panigrahi, M., Reddy, A., Khosla, V., Pillay, H., Thomas, N., Sridhar, K., Jose, B., Kurian, N., Praharaj, S., Pillai, S., Ramana, Kiyawat, D., Maheshwari, K., Panikar, D., Chawla, J., Shenoy, S., Raja, A., Rupayana, Y., Reddy, S., Mohan, N., Kelkar, S., Johri, M., Golden, N., Maliawan, S., Fauzi, A., Farouk, U., Fakharian, E., Aramesh, A., Eghtedari, M., Ahmadzadeh, F., Gholami, A., Plunkett, P., Redican, C., Mcmahon, G., Annetta, Maria Giuseppina, Mouchaty, H., Bruzzone, E., Harding, B., Qureshi, M., Idris, Z., Abdullah, J., Ghazali, G., Ghani, A., Cheah, F., Gonzalez, J., Loria-Castellanos, J., Jackson, S., Hutchinson, R., Komolafe, E., Adeolu, A., Komolafe, M., Adeyemi-Doro, O., Bankole, F., Shehu, B., Danlami, V., Odebode, O., Oluwadiya, K., Sanni, A., Giebel, H., Kumar, S., Jooma, R., Mezquita, J., Ortiz Ovelar, C., Gonzales-Portillo, M., Rodriguez, D., Balica, L., Oprita, B., Sklerniacof, M., Steflea, L., Bandut, L., Danil, A., Iliescu, R., Ciurea, J., El-Dawlatly, A., Alwatidy, S., Al-Yafi, W., El-Dawlatly, M., Krunic-Protic, R., Janosevic, V., Tan, J., Seah, C., Trenkler, S., Humenansky, M., Stajancova, T., Schwendt, I., Laincz, A., Julius, Z., Maros, S., Firment, J., Cifranicova, M., Saniova, B., Kalig, K., Medekova, S., Wiszt, R., Macsuga, I., Hartzenberg, B., Du Plessis, G., Houlie, Z., Nathoo, N., Khumalo, S., Tracey, R., Munoz-Sanchez, A., Murillo-Cabezas, F., Flores-Cordero, J., Rincon-Ferrari, D., Rubi, M., Caler, L., Del Campo, M., Laguna, L., Manuel Nava, J., Minguillon, M., Lopez, A., Ramos-Gomez, L., De La Torre-Prados, V., Pellejero, R., Laloe, V., Mandrella, B., Suganthan, Perera, S., Mahendran, K., Stocker, R., Ludwig, S., Zimmermann, H., Denzler, U., Yutthakasemsunt, S., Kittiwattanagul, W., Watanachai, C., Subsompon, P., Pussanakawatin, W., Khunjan, P., Tangchitvittaya, S., Nilapong, S., Klangsang, T., Taechakosol, W., Srinat, A., Jerbi, Z., Borsali-Falfoul, N., Rezgui, M., Cakar, N., Ssenyonjo, H., Kobusingye, O., Lomas, G., Yates, D., Lecky, F., Bleetman, A., Baldwin, A., Jenkinson, E., Pantrini, S., Stewart, J., Contractor, N., Roberts, T., Butler, J., Pinto, A., Lee, D., Brayley, N., Robbshaw, K., Dix, C., Graham, S., Pye, S., Green, M., Kellins, A., Moulton, C., Fogg, B., Cottingham, R., Funnell, S., Shanker, U., Summers, C., Malek, L., Ashcroft, C., Powell, J., Moore, S., Buckley, S., Grocutt, M., Chambers, S., Morrice, A., Marshall, H., Harris, J., Matthews, W., Tippet, J., Mardell, S., Macmillan, F., Shaw, A., Luthra, P., Dixon, G., Ahmed, M., Young, M., Mason, S., Loveday, I., Clark, C., Taylor, S., Wilson, P., Ali, K., Greenwood, S., White, M., Perez, R., Eljamel, S., Wasserberg, J., Shale, H., Read, C., Mccarron, J., Pennell, A., Ray, G., Thurston, J., Brown, E., Jaffey, L., Graves, M., Bailey, R., Loveridge, N., Evans, G., Hughes, S., Richardson, J., Gallagher, C., Odedun, T., Lees, K., Foley, D., Payne, N., Pennycook, A., Griffiths, C., Moore, D., Byrne, D., Dasan, S., Banerjee, Abhishek, Mcguinness, S., Chikhani, C., Zoltie, N., Barlow, I., Stell, I., Hulse, W., Crossley, J., Watkins, L., Dorani, B., Vanviet, T., Saladino, P., Cabrera, A., Baigent, C., Bracken, M., Chadwick, D., Curley, K., Duley, L., Farrell, B., Haegi, M., Nickson, G., Peto, R., Pickard, J., Roberts, I., Sandercock, P., Teasdale, G., Collins, R., Haines, S., Macmahon, S., Warlow, C., Edwards, P., Ritchie, N., Shakur, H., Ramos, M., Barnetson, L., Fernandes, J., Tooth, D., Free, C., Narayanan, L., Collander, J., Abernethy, J., Bardswell, J., Mashru, R., Godward, C., Afolabi, L., Ritchie, A., Hosford, T., Collingwood, A., Massey, S., Plata R., Annetta M. (ORCID:0000-0001-7574-1311), and Banerjee A.
Abstract: Background Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial—a multicentre international collaboration—aimed to confirm or refute such an effect by recruiting 20 000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. Methods 10 008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Findings Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21·1%] vs 893 [17·9%] deaths; relative risk 1·18 [95% CI 1·09-1·27]; p=0·0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0·22) or time since injury (p=0·05). Interpretation Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear.
Published: 2004

50. Neuroendocrine stress response in laparoscopic surgery for benign ovarian cyst [3]

Author: Marana, Elisabetta, Annetta, Maria Giuseppina, Marana, Riccardo, Maussier, Maria Lodovica, Galeone, M., Mensi, Sonia, D'Angelo, F., Proietti, Rodolfo, Marana E. (ORCID:0000-0002-8685-145X), Annetta M. G. (ORCID:0000-0001-7574-1311), Marana R. (ORCID:0000-0003-1616-7836), Maussier M. L. (ORCID:0000-0001-9252-3973), Mensi S., Proietti R. (ORCID:0000-0003-1137-9928), Marana, Elisabetta, Annetta, Maria Giuseppina, Marana, Riccardo, Maussier, Maria Lodovica, Galeone, M., Mensi, Sonia, D'Angelo, F., Proietti, Rodolfo, Marana E. (ORCID:0000-0002-8685-145X), Annetta M. G. (ORCID:0000-0001-7574-1311), Marana R. (ORCID:0000-0003-1616-7836), Maussier M. L. (ORCID:0000-0001-9252-3973), Mensi S., and Proietti R. (ORCID:0000-0003-1137-9928)
Abstract: n/a
Published: 2004

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