10 results on '"Zacchetti, Lucia"'
Search Results
2. The Effect of Positive Pressure Ventilation on Acute Kidney Injury in COVID-19 Patients with Acute Respiratory Distress Syndrome: An Observational Study.
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Zacchetti, Lucia, Brivio, Matteo, Mezzapesa, Mario, Martinelli, Alessandra, Punzi, Veronica, Monti, Martina, Marchesi, Federica, Scarpa, Laura, Zangari, Rosalia, Longhi, Luca, Raimondi, Federico, Novelli, Luca, Gritti, Paolo, Grazioli, Lorenzo, Villa, Gianluca, and Lorini, Luca Ferdinando more...
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ADULT respiratory distress syndrome , *POSITIVE pressure ventilation , *ACUTE kidney failure , *COVID-19 , *WATER-electrolyte balance (Physiology) - Abstract
Introduction: Acute kidney injury (AKI) is frequent in critically ill COVID-19 patients and is associated with a higher mortality risk. By increasing intrathoracic pressure, positive pressure ventilation (PPV) may reduce renal perfusion pressure by reducing venous return to the heart or by increasing renal venous congestion. This study's aim was to evaluate the association between AKI and haemodynamic and ventilatory parameters in COVID-19 patients with ARDS. Methods: This is a single-centre retrospective observational study. Consecutive patients diagnosed with COVID-19 who met ARDS criteria and required invasive mechanical ventilation were enrolled. The relationship between respiratory and haemodynamic parameters influenced by PPV and AKI development was evaluated. AKI was defined according to KDIGO criteria. AKI recovery was evaluated a month after ICU admission and patients were classified as "recovered," if serum creatinine (sCr) value returned to baseline, or as having "acute kidney disease" (AKD), if criteria for AKI stage 1 or greater persisted. The 6-month all-cause mortality was collected. Results: A total of 144 patients were included in the analysis. AKI occurred in 69 (48%) patients and 26 (18%) required renal replacement therapy. In a multivariate logistic regression analysis, sex, hypertension, cumulative dose of furosemide, fluid balance, and plateau pressure were independently associated with AKI. Mortality at 6 months was 50% in the AKI group and 32% in the non-AKI group (p = 0.03). Among 36 patients who developed AKI and were discharged alive from the hospital, 56% had a full renal recovery after a month, while 14%, 6%, and 14% were classified as having an AKD of stage 0, 2, and 3, respectively. Conclusions: In our cohort, AKI was independently associated with multiple variables, including high plateau pressure, suggesting a possible role of PPV on AKI development. Further studies are needed to clarify the role of mechanical ventilation on renal function. [ABSTRACT FROM AUTHOR] more...
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- 2024
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Catalog
3. Exploring alternative routes for oxygen administration
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Damiani, Elisa, Dyson, Alex, Zacchetti, Lucia, Donati, Abele, and Singer, Mervyn
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- 2016
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4. Accuracy of intracranial pressure monitoring: systematic review and meta-analysis
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Zacchetti, Lucia, Magnoni, Sandra, Di Corte, Federica, Zanier, Elisa R., and Stocchetti, Nino
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- 2015
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5. Impaired dynamics of clot formation and hypofibrinolysis in severe sepsis are coexisting and strictly related
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Panigada, Mauro, Sampietro, Francesca, L’Acqua, Camilla, Zacchetti, Lucia, Anzoletti, Massimo Boscolo, Bader, Rossella, Gattinoni, Luciano, and D’Angelo, Armando
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- 2016
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6. Combined Effect of Awake Prone Position and Noninvasive Ventilation on Respiratory Effort and Gas Exchange in Severe COVID-19--Related Pneumonia.
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Bianchi, Isabella M., Zacchetti, Lucia, Punzi, Veronica, Raimondi, Federico, Novelli, Luca, Brivio, Matteo, Grazioli, Lorenzo S., Mojoli, Francesco, Di Marco, Fabiano, and Lorini, Luca F.
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RESPIRATORY muscle physiology ,STATISTICS ,COVID-19 ,RESPIRATORY insufficiency ,SCIENTIFIC observation ,ARTIFICIAL respiration ,TREATMENT effectiveness ,PEARSON correlation (Statistics) ,DESCRIPTIVE statistics ,REACTIVE oxygen species ,FRIEDMAN test (Statistics) ,DATA analysis ,LYING down position ,OXYGEN in the body ,ACUTE diseases ,HYPOXEMIA ,LONGITUDINAL method - Abstract
The article discusses a study which examines the combined effect of awake prone positioning (PP) and noninvasive ventilation (NIV) on respiratory effort and oxygenation in COVID-19 subjects affected by acute hypoxemic respiratory failure (AHRF). Topics covered include the characteristics of the study subjects, the association of combined PP and NIV with reduced inspiratory effort and improved oxygenation, and the strengths and limitations of the study. more...
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- 2023
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7. Assessment of Fibrinolysis in Sepsis Patients with Urokinase Modified Thromboelastography.
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Panigada, Mauro, Zacchetti, Lucia, L’Acqua, Camilla, Cressoni, Massimo, Anzoletti, Massimo Boscolo, Bader, Rossella, Protti, Alessandro, Consonni, Dario, D’Angelo, Armando, and Gattinoni, Luciano
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FIBRINOLYSIS , *SEPSIS , *UROKINASE , *ELASTOGRAPHY , *HEMOSTASIS , *HEALTH outcome assessment - Abstract
Introduction: Impairment of fibrinolysis during sepsis is associated with worse outcome. Early identification of this condition could be of interest. The aim of this study was to evaluate whether a modified point-of-care viscoelastic hemostatic assay can detect sepsis-induced impairment of fibrinolysis and to correlate impaired fibrinolysis with morbidity and mortality. Methods: This single center observational prospective pilot study was performed in an adult Intensive Care Unit (ICU) of a tertiary academic hospital. Forty consecutive patients admitted to the ICU with severe sepsis or septic shock were included. Forty healthy individuals served as controls. We modified conventional kaolin activated thromboelastography (TEG) adding urokinase to improve assessment of fibrinolysis in real time (UK-TEG). TEG, UK-TEG, plasminogen activator inhibitor (PAI)-1, thrombin-activatable fibrinolysis inhibitor (TAFI), d-dimer, DIC scores and morbidity (rated with the SOFA score) were measured upon ICU admission. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) of mortality at ICU discharge. Results: UK-TEG revealed a greater impairment of fibrinolysis in sepsis patients compared to healthy individuals confirmed by PAI-1. TAFI was not different between sepsis patients and healthy individuals. 18/40 sepsis patients had fibrinolysis impaired according to UK-TEG and showed higher SOFA score (8 (6–13) vs 5 (4–7), p = 0.03), higher mortality (39% vs 5%, p = 0.01) and greater markers of cellular damage (lactate levels, LDH and bilirubin). Mortality at ICU discharge was predicted by the degree of fibrinolysis impairment measured by UK-TEG Ly30 (%) parameter (OR 0.95, 95% CI 0.93–0.98, p = 0.003). Conclusions: Sepsis-induced impairment of fibrinolysis detected at UK-TEG was associated with increased markers of cellular damage, morbidity and mortality. [ABSTRACT FROM AUTHOR] more...
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- 2015
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8. Comparing survival and outcomes in isolated versus polytrauma-associated TBI: a retrospective cohort study.
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Corbella D, Zangari R, Biroli F, Magnone S, Cavalleri G, Passoni M, Martchenko S, Marchesi S, Zacchetti L, Ferri F, Urbaz L, Aliprandi M, Lorini LF, and Gritti P
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Background: One in four patients with moderate to severe traumatic brain injury (TBI) also has other body district injuries (OBD). The impact of OBD on mortality and disability is debated. This study compared outcomes of TBI patients with polytrauma (p-TBI) versus isolated TBI (alone-TBI) and identified outcome determinants, focusing on survival time and prognosis., Methods: This single-center, retrospective cohort study analyzed 193 patients with moderate to severe TBI admitted to an ICU from 2011 to 2012. Patients were divided into p-TBI and alone-TBI groups. Clinical, demographic, and outcome data were extracted from medical records. Key outcomes included survival time and Glasgow Outcome Scale-Extended (GOSE) scores at 1-year., Results: The alone-TBI group (N.=126) was older with more comorbidities and higher use of antiplatelet/anticoagulant medications. The p-TBI group (N.=67) had greater physiological dysfunction (hypotension, acidosis, anemia, coagulopathy). Trauma severity (Glasgow Coma Scale), in-hospital mortality, and GOSE were similar between groups, but p-TBI patients had a shorter median survival time (3.5 vs. 18 days, P=0.016). Key determinants of poor outcomes were age, coagulopathy, neurological impairment at admission, and intracranial hypertension., Conclusions: Polytrauma does not appear to be independently associated with the prognosis of moderate to severe TBI patients but is associated with earlier mortality. Coagulopathy and physiological instability are more critical factors in determining mortality and poor outcomes. Future research should explore whether polytrauma is a bystander in TBI or if it has a causal role in adverse outcomes. more...
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- 2024
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9. Clinical frailty scale as a predictor of outcome in elderly patients affected by moderate or severe traumatic brain injury.
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Zacchetti L, Longhi L, Zangari R, Aresi S, Marchesi F, Gritti P, Biroli F, and Lorini LF
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Background: Older age is a well-known risk factor for unfavorable outcome in traumatic brain injury (TBI). However, many older people with TBI respond well to aggressive treatments, suggesting that chronological age and TBI severity alone may be inadequate prognostic markers. Frailty is an age-related homeostatic imbalance of loss of physiologic and cognitive reserve resulting in both limitation in autonomy of activities of daily living and vulnerability to adverse events. We hypothesized that frailty would be associated with 6-month adverse functional outcome in older people affected by moderate or severe TBI., Methods: This was a single-center prospective observational study. We enrolled consecutive patients aged ≥65 years after TBI with Glasgow Coma Scale ≤13 and admitted to our Neurosurgical Intensive Care Unit. Frailty was evaluated by Clinical Frailty Scale (CFS). Relationships between TBI severity, frailty and extended Glasgow Outcome Scale (GOSE) at 6-month were evaluated., Results: Sixty patients were studied, 65% were males, their age was 76 years (IQR 70-80) and their admission GCS was 8 (IQR 6-11) with a GCS motor score of 5 (IQR 4-5). Twenty eight were vulnerable-frail (defined as CFS ≥ 4). Vulnerable-frail patients showed greater 6-month mortality and unfavorable outcome compared to non-frail [87% vs. 30% OR and 95% CI: 15.7 (3.9-55.2), p < 0.0001 and 92% vs. 51% OR and 95% CI: 9.9 (2.1-46.3), p = 0.002]. In univariate analysis patients with unfavorable outcome were more frequently male and vulnerable-frail, had a higher prevalence of pre-existing neurodegenerative disease, abnormal pupil, lower GCS and had worst CT scan characteristics. At multivariate analysis, only CFS ≥ 4 and traumatic subarachnoid hemorrhage remained associated to 6-month outcome., Conclusion: Frailty was associated with 6 month-outcome, suggesting that the pre-injury functional status could represent an additional indicator to stratify patient's severity and to predict outcome., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zacchetti, Longhi, Zangari, Aresi, Marchesi, Gritti, Biroli and Lorini.) more...
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- 2023
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10. Coagulopathy and COVID-19.
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Lorini FL, Di Matteo M, Gritti P, Grazioli L, Benigni A, Zacchetti L, Bianchi I, Fabretti F, and Longhi L
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SARS-CoV-2 infection is associated with frequent thrombotic events, at the micro and macro-vascular level, due to the perpetuation of a state of hypercoagulability. The so-called 'COVID-19 associated coagulopathy' (CAC) represents a key aspect in the genesis of organ damage from SARS-CoV-2. The main coagulative alterations described in the literature are represented by high levels of D-dimer and fibrinogen. Although CAC has some common features with disseminated intravascular coagulation and sepsis-induced coagulopathy, there are important differences between these clinical pictures and the phenotype of CAC is unique. The pathogenesis of CAC is complex and is affected by the strong interconnection between the inflammatory system and coagulation, in the phenomenon of immunothrombosis and thrombo-inflammation. Several mechanisms come into play, such as inflammatory cytokines, neutrophils, the complement system as well as an alteration of the fibrinolytic system. Finally, an altered platelet function and especially endothelial dysfunction also play a central role in the pathophysiology of CAC. Heparin has several potential effects in CAC, in fact in addition to the anticoagulant effect, it could have a direct antiviral effect and anti-inflammatory properties. The high incidence of thrombo-embolic phenomena despite the use of antithrombotic prophylaxis have led some experts to recommend the use of anticoagulant doses of heparin, but at present the optimal anticoagulant regimen remains to be determined., (Published on behalf of the European Society of Cardiology. © The Author(s) 2021.) more...
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- 2021
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