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1. Acute Kidney Injury and Extracorporeal Membrane Oxygenation: Review on Multiple Organ Support Options

Author

Foti L, Villa G, Romagnoli S, and Ricci Z

Subjects
extracorporeal membrane oxygenation, acute kidney injury, continuous renal replacement therapy, multiple organ support therapy, anticoagulation, mortality, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Lorenzo Foti,1,2 Gianluca Villa,1,2 Stefano Romagnoli,1,2 Zaccaria Ricci1,3 1Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy; 2Department of Anesthesia and Intensive Care, AOU Careggi, Florence, Italy; 3Pediatric Intensive Care Unit, Meyer Children’s University Hospital, Florence, ItalyCorrespondence: Zaccaria Ricci Tel +39 3393799848Email zaccaria.ricci@gmail.comAbstract: Extracorporeal membrane oxygenation (ECMO) is a temporary life support system used to assist patients with life-threatening severe cardiac and/or respiratory insufficiency. Patients requiring ECMO can be considered the sickest patients admitted to the intensive care unit (ICU). Acute kidney injury (AKI) represents a frequent complication during ECMO, affecting up to 70% of patients, with multifactorial pathophysiology and an independent risk factor for mortality. Severe AKI requiring Continuous Renal Replacement Therapy (CRRT) occurs in 20% of ECMO patients, but multiple indications and different timing may imply a significantly higher application rate in different centers. CRRT can be run in parallel to ECMO through different vascular access, or it can be conducted in series by connecting the circuits. Anticoagulation of ECMO is typically managed with systemic heparin, but several approaches can be applied for the CRRT circuit, from no anticoagulation to the addition of intra-filter heparin or regional citrate anticoagulation. The combination of CRRT and ECMO can be considered a form of multiple organ support therapy, but this approach still requires optimization in timing, set-up, anticoagulation, prescription and delivery. The aim of this report is to review the pathophysiology of AKI, the CRRT delivery, anticoagulation strategies and outcomes of patients with AKI treated with ECMO.Keywords: extracorporeal membrane oxygenation, acute kidney injury, continuous renal replacement therapy, multiple organ support therapy, anticoagulation, mortality

Published
2021

4. Factors associated with successful liberation from continuous renal replacement therapy in children and young adults: analysis of the worldwide exploration of renal replacement outcomes collaborative in Kidney Disease Registry

Author

Stenson, EK, Alhamoud, I, Alobaidi, R, Bottari, G, Fernandez, S, Fuhrman, DY, Guzzi, F, Haga, T, Kaddourah, A, Marinari, E, Mohamed, T, Morgan, C, Mottes, T, Neumayr, T, Ollberding, NJ, Raggi, V, Ricci, Z, See, E, Stanski, NL, Zang, H, Zangla, E, Gist, KM, Stenson, EK, Alhamoud, I, Alobaidi, R, Bottari, G, Fernandez, S, Fuhrman, DY, Guzzi, F, Haga, T, Kaddourah, A, Marinari, E, Mohamed, T, Morgan, C, Mottes, T, Neumayr, T, Ollberding, NJ, Raggi, V, Ricci, Z, See, E, Stanski, NL, Zang, H, Zangla, E, and Gist, KM

Abstract

PURPOSE: Continuous renal replacement therapy (CRRT) is used for supportive management of acute kidney injury (AKI) and disorders of fluid balance (FB). Little is known about the predictors of successful liberation in children and young adults. We aimed to identify the factors associated with successful CRRT liberation. METHODS: The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease study is an international multicenter retrospective study (32 centers, 7 nations) conducted from 2015 to 2021 in children and young adults (aged 0-25 years) treated with CRRT for AKI or FB disorders. Patients with previous dialysis dependence, tandem extracorporeal membrane oxygenation use, died within the first 72 h of CRRT initiation, and those who never had liberation attempted were excluded. Patients were categorized based on first liberation attempt: reinstituted (resumption of any dialysis within 72 h) vs. success (no receipt of dialysis for ≥ 72 h). Multivariable logistic regression was used to identify factors associated with successful CRRT liberation. RESULTS: A total of 622 patients were included: 287 (46%) had CRRT reinstituted and 335 (54%) were successfully liberated. After adjusting for sepsis at admission and illness severity parameters, several factors were associated with successful liberation, including higher VIS (vasoactive-inotropic score) at CRRT initiation (odds ratio [OR] 1.35 [1.12-1.63]), higher PELOD-2 (pediatric logistic organ dysfunction-2) score at CRRT initiation (OR 1.71 [1.24-2.35]), higher urine output prior to CRRT initiation (OR 1.15 [1.001-1.32]), and shorter CRRT duration (OR 0.19 [0.12-0.28]). CONCLUSIONS: Inability to liberate from CRRT was common in this multinational retrospective study. Modifiable and non-modifiable factors were associated with successful liberation. These results may inform the design of future clinical trials to optimize likelihood of CRRT liberation success.

Published
2024

5. Research considerations for prospective studies of patients with coma and disorders of consciousness

Author

Tinti, L, Lawson, T, Molteni, E, Kondziella, D, Rass, V, Sharshar, T, Bodien, Y, Giacino, J, Mayer, S, Amiri, M, Muehlschlegel, S, Venkatasubba Rao, C, Vespa, P, Menon, D, Citerio, G, Helbok, R, Mcnett, M, Agarwal, S, Aiyagari, V, Akbari, Y, Albertson, A, Alexander, S, Alexandrov, A, Alkhachroum, A, Al-Mufti, F, Appavu, B, Gebrewold, M, Ayounb, M, Badenes, R, Bader, M, Badjiata, N, Balu, R, Barlow, B, Barra, M, Beekman, R, Beghi, E, Beqiri, E, Berlin, T, Bilotta, F, Bleck, T, Boerwinkle, V, Boly, M, Bonnel, A, Brazzi, L, Brown, E, Bulic, S, Caceres, E, Caceres, A, Cafiero, T, Carroll, E, Cediel, E, Chou, S, Claassen, J, Condie, C, Conti, A, Cosmas, K, Costa, P, Creutzfeldt, C, Dangayach, N, Dauri, M, Debicki, D, Degeorgia, M, Der-Nigoghossian, C, Desai, M, Dhar, R, Diringer, M, Durr, E, Edlow, B, Ercole, A, Estraneo, A, Falcone, G, Farrokh, S, Ferguson, A, Fernandez-Espejo, D, Fink, E, Fins, J, Foreman, B, Franchi, F, Frontera, J, Ganesan, R, Gaspard, N, Ghavam, A, Gibbons, C, Gilmore, E, Glustein, C, Gosseries, O, Green, T, Greer, D, Guanci, M, Gupta, D, Hahn, C, Hakimi, R, Hammond, F, Hanley, D, Hartings, J, Hassan, A, Hemphill, C, Da Cunha, A, Hinson, H, Hirsch, K, Hocker, S, Hu, P, Hu, X, Human, T, Hwang, D, Illes, J, Jaffa, M, James, M, Janas, A, Johnson, S, Jones, M, Jox, R, Kalanuria, A, Keller, E, Kennedy, L, Kennelly, M, Keogh, M, Kim, J, Kim, K, Kirsch, H, Kirschen, M, Ko, N, Kreitzer, N, Kromm, J, Kumar, A, Kurtz, P, Laureys, S, Lejeune, N, Lewis, A, Liang, J, Ling, G, Livesay, S, Luppi, A, Macdonald, J, Maddux, C, Mahanes, D, Mainali, S, Maldonado, N, Ribeiro, R, Mascia, L, Massimini, M, Mathur, R, Mccredie, V, Mejia-Mantilla, J, Mendoza, M, Meyfroidt, G, Mijangos, J, Moberg, D, Moheet, A, Montalenti, E, Monti, M, Morrison, C, Munar, M, Murtaugh, B, Naccache, L, Nagayama, M, Nairon, E, Nakagawa, T, Naldi, A, Narenthiran, G, Natarajan, G, Nemetsky, E, Newcombe, V, Nielsen, N, Niznick, N, Noronha-Falcão, F, Nyquist, P, Olson, D, Othman, M, Owen, A, Padayachy, L, Pajoumand, M, Park, S, Pergakis, M, Perry, H, Polizzotto, L, Pouratian, N, Spivack, M, Prisco, L, Provencio, J, Puglises, F, Puybasset, L, Rao, C, Rasmussen, L, Rasulo, F, Ray, B, Ricci, Z, Richardson, R, Shinotsuka, C, Robba, C, Robertson, C, Rohaut, B, Rolston, J, Romagnoli, S, Rosanova, M, Rosenthal, E, Rowe, S, Rubin, M, Russell, M, Silva, G, Sanz, L, Sarasso, S, Sarwal, A, Schiff, N, Schnakers, C, Seder, D, Shah, V, Shapiro-Rosenbaubm, A, Shapshak, A, Sharma, K, Shutter, L, Sitt, J, Slomine, B, Smetana, K, Smielewski, P, Smith, W, Stamatakis, E, Steinberg, A, Stevens, R, Suarez, J, Sung, G, Sussman, B, Taran, S, Mazzeo, A, Thibaut, A, Thompson, D, Threlkeld, Z, Toker, D, Torbey, M, Tosto, J, Trevick, S, Tsaousi, G, Turgeon, A, Udy, A, Varelas, P, Videtta, W, Voss, H, Vox, F, Wagner, A, Wahlster, S, Wainwright, M, Whyte, J, Witherspoon, B, Yakhkind, A, Yeager, S, Young, M, Zafar, S, Zafonte, R, Zahuranec, D, Zammit, C, Zhang, B, Ziai, W, Zimmerman, L, Zink, E, Tinti, Lorenzo, Lawson, Thomas, Molteni, Erika, Kondziella, Daniel, Rass, Verena, Sharshar, Tarek, Bodien, Yelena G, Giacino, Joseph T, Mayer, Stephan A, Amiri, Moshgan, Muehlschlegel, Susanne, Venkatasubba Rao, Chethan P, Vespa, Paul M, Menon, David K, Citerio, Giuseppe, Helbok, Raimund, McNett, Molly, Agarwal, Sachin, Aiyagari, Venkatesh, Akbari, Yama, Albertson, Asher, Alexander, Sheila, Alexandrov, Anne, Alkhachroum, Ayham, Al-Mufti, Fawaz, Amiri, Moshagan, Appavu, Brian, Gebrewold, Meron Awraris, Ayounb, Marc, Badenes, Rafael, Bader, Mary Kay, Badjiata, Neeraj, Balu, Ram, Barlow, Brooke, Barra, Megan, Beekman, Rachel, Beghi, Ettore, Beqiri, Erta, Berlin, Tracey, Bilotta, Federico, Bleck, Thomas, Bodien, Yelena, Boerwinkle, Varina, Boly, Melanie, Bonnel, Alexandra, Brazzi, Luca, Brown, Emery, Bulic, Sebina, Caceres, Eder, Caceres, Adrian, Cafiero, Tullio, Carroll, Elizabeth, Cediel, Emilio G, Chou, Sherry, Claassen, Jan, Condie, Chad, Conti, Alfredo, Cosmas, Katie, Costa, Paolo, Creutzfeldt, Claire, Dangayach, Neha, Dauri, Mario, Debicki, Derek, DeGeorgia, Michael, Der-Nigoghossian, Caroline, Desai, Masoom, Dhar, Rajat, Diringer, Michael, Durr, Emily, Edlow, Brian, Ercole, Ari, Estraneo, Anna, Falcone, Guido, Farrokh, Salia, Ferguson, Adam, Fernandez-Espejo, Davinia, Fink, Ericka, Fins, Joseph, Foreman, Brandon, Franchi, Federico, Frontera, Jennifer, Ganesan, Rishi, Gaspard, Nicolas, Ghavam, Ahmeneh, Giacino, Joseph, Gibbons, Christie, Gilmore, Emily, Glustein, Chavie, Gosseries, Olivia, Green, Theresa, Greer, David, Guanci, Mary, Gupta, Deepak, Hahn, Cecil, Hakimi, Ryan, Hammond, Flora, Hanley, Daniel F, Hartings, Jed, Hassan, Ahmed, Hemphill, Claude, Da Cunha, Arthur Henrique Galvão Bruno, Hinson, Holly, Hirsch, Karen, Hocker, Sarah, Hu, Peter, Hu, Xiao, Human, Theresa, Hwang, David, Illes, Judy, Jaffa, Matthew, James, Michael L, Janas, Anna, Johnson, Susan, Jones, Morgan, Jox, Ralf J, Kalanuria, Atul, Keller, Emanuela, Kennedy, Lori, Kennelly, Megan, Keogh, Maggie, Kim, Jenn, Kim, Keri, Kirsch, Hannah, Kirschen, Matthew, Ko, Nerissa, Kreitzer, Natalie, Kromm, Julie, Kumar, Abhay, Kurtz, Pedro, Laureys, Steven, Lejeune, Nicolas, Lewis, Ariane, Liang, John, Ling, Geoffrey, Livesay, Sarah, Luppi, Andrea, MacDonald, Jennifer, Maddux, Craig, Mahanes, Dea, Mainali, Shraddha, Maldonado, Nelson, Ribeiro, Rennan Martins, Mascia, Luciana, Massimini, Marcello, Mathur, Rohan, Mayer, Stephan, McCredie, Victoria, Mejia-Mantilla, Jorge, Mendoza, Michael, Menon, David, Meyfroidt, Geert, Mijangos, Julio, Moberg, Dick, Moheet, Asma, Montalenti, Elisa, Monti, Martin, Morrison, Chris, Munar, Marina, Murtaugh, Brooke, Naccache, Lionel, Nagayama, Masao, Nairon, Emerson, Nakagawa, Thomas, Naldi, Andrea, Narenthiran, Ganesalingam, Natarajan, Girija, Nemetsky, Esther, Newcombe, Virginia, Nielsen, Niklas, Niznick, Naomi, Noronha-Falcão, Filipa, Nyquist, Paul, Olson, DaiWai, Othman, Marwan, Owen, Adrian, Padayachy, Llewellyn, Pajoumand, Mehrnaz, Park, Soojin, Pergakis, Melissa, Perry, Heidi, Polizzotto, Len, Pouratian, Nader, Spivack, Marilyn Price, Prisco, Lara, Provencio, Javier, Puglises, Francesco, Puybasset, Louis, Rao, Chethan, Rasmussen, Lindsay, Rasulo, Frank, Ray, Bappaditya, Ricci, Zaccaria, Richardson, Risa, Shinotsuka, Cassia Righy, Robba, Chiara, Robertson, Courtney, Rohaut, Benjamin, Rolston, John, Romagnoli, Stefano, Rosanova, Mario, Rosenthal, Eric, Rowe, Shaun, Rubin, Michael, Russell, Mary Beth, Silva, Gisele Sampaio, Sanz, Leandro, Sarasso, Simone, Sarwal, Aarti, Schiff, Nicolas, Schnakers, Caroline, Seder, David, Shah, Vishank Arun, Shapiro-Rosenbaubm, Amy, Shapshak, Angela, Sharma, Kartavya, Sharma, Kumar Ajay, Shutter, Lori, Sitt, Jacobo, Slomine, Beth, Smetana, Keaton, Smielewski, Peter, Smith, Wade, Stamatakis, Emmanuel, Steinberg, Alexis, Stevens, Robert, Suarez, Jose, Sung, Gene, Sussman, Bethany, Taran, Shaurya, Mazzeo, Anna Teresa, Thibaut, Aurore, Thompson, David, Threlkeld, Zachary, Toker, Daniel, Torbey, Michel, Tosto, Jenna, Trevick, Stephen, Tsaousi, Georgia, Turgeon, Alexis, Udy, Andrew, Varelas, Panos, Vespa, Paul, Videtta, Walter, Voss, Henning, Vox, Ford, Wagner, Amy, Wahlster, Sarah, Wainwright, Mark, Whyte, John, Witherspoon, Briana, Yakhkind, Aleksandra (Sasha), Yeager, Susan, Young, Michael, Zafar, Sahar, Zafonte, Ross, Zahuranec, Darin, Zammit, Chris, Zhang, Bei, Ziai, Wendy, Zimmerman, Lara, Zink, Elizabeth, Tinti, L, Lawson, T, Molteni, E, Kondziella, D, Rass, V, Sharshar, T, Bodien, Y, Giacino, J, Mayer, S, Amiri, M, Muehlschlegel, S, Venkatasubba Rao, C, Vespa, P, Menon, D, Citerio, G, Helbok, R, Mcnett, M, Agarwal, S, Aiyagari, V, Akbari, Y, Albertson, A, Alexander, S, Alexandrov, A, Alkhachroum, A, Al-Mufti, F, Appavu, B, Gebrewold, M, Ayounb, M, Badenes, R, Bader, M, Badjiata, N, Balu, R, Barlow, B, Barra, M, Beekman, R, Beghi, E, Beqiri, E, Berlin, T, Bilotta, F, Bleck, T, Boerwinkle, V, Boly, M, Bonnel, A, Brazzi, L, Brown, E, Bulic, S, Caceres, E, Caceres, A, Cafiero, T, Carroll, E, Cediel, E, Chou, S, Claassen, J, Condie, C, Conti, A, Cosmas, K, Costa, P, Creutzfeldt, C, Dangayach, N, Dauri, M, Debicki, D, Degeorgia, M, Der-Nigoghossian, C, Desai, M, Dhar, R, Diringer, M, Durr, E, Edlow, B, Ercole, A, Estraneo, A, Falcone, G, Farrokh, S, Ferguson, A, Fernandez-Espejo, D, Fink, E, Fins, J, Foreman, B, Franchi, F, Frontera, J, Ganesan, R, Gaspard, N, Ghavam, A, Gibbons, C, Gilmore, E, Glustein, C, Gosseries, O, Green, T, Greer, D, Guanci, M, Gupta, D, Hahn, C, Hakimi, R, Hammond, F, Hanley, D, Hartings, J, Hassan, A, Hemphill, C, Da Cunha, A, Hinson, H, Hirsch, K, Hocker, S, Hu, P, Hu, X, Human, T, Hwang, D, Illes, J, Jaffa, M, James, M, Janas, A, Johnson, S, Jones, M, Jox, R, Kalanuria, A, Keller, E, Kennedy, L, Kennelly, M, Keogh, M, Kim, J, Kim, K, Kirsch, H, Kirschen, M, Ko, N, Kreitzer, N, Kromm, J, Kumar, A, Kurtz, P, Laureys, S, Lejeune, N, Lewis, A, Liang, J, Ling, G, Livesay, S, Luppi, A, Macdonald, J, Maddux, C, Mahanes, D, Mainali, S, Maldonado, N, Ribeiro, R, Mascia, L, Massimini, M, Mathur, R, Mccredie, V, Mejia-Mantilla, J, Mendoza, M, Meyfroidt, G, Mijangos, J, Moberg, D, Moheet, A, Montalenti, E, Monti, M, Morrison, C, Munar, M, Murtaugh, B, Naccache, L, Nagayama, M, Nairon, E, Nakagawa, T, Naldi, A, Narenthiran, G, Natarajan, G, Nemetsky, E, Newcombe, V, Nielsen, N, Niznick, N, Noronha-Falcão, F, Nyquist, P, Olson, D, Othman, M, Owen, A, Padayachy, L, Pajoumand, M, Park, S, Pergakis, M, Perry, H, Polizzotto, L, Pouratian, N, Spivack, M, Prisco, L, Provencio, J, Puglises, F, Puybasset, L, Rao, C, Rasmussen, L, Rasulo, F, Ray, B, Ricci, Z, Richardson, R, Shinotsuka, C, Robba, C, Robertson, C, Rohaut, B, Rolston, J, Romagnoli, S, Rosanova, M, Rosenthal, E, Rowe, S, Rubin, M, Russell, M, Silva, G, Sanz, L, Sarasso, S, Sarwal, A, Schiff, N, Schnakers, C, Seder, D, Shah, V, Shapiro-Rosenbaubm, A, Shapshak, A, Sharma, K, Shutter, L, Sitt, J, Slomine, B, Smetana, K, Smielewski, P, Smith, W, Stamatakis, E, Steinberg, A, Stevens, R, Suarez, J, Sung, G, Sussman, B, Taran, S, Mazzeo, A, Thibaut, A, Thompson, D, Threlkeld, Z, Toker, D, Torbey, M, Tosto, J, Trevick, S, Tsaousi, G, Turgeon, A, Udy, A, Varelas, P, Videtta, W, Voss, H, Vox, F, Wagner, A, Wahlster, S, Wainwright, M, Whyte, J, Witherspoon, B, Yakhkind, A, Yeager, S, Young, M, Zafar, S, Zafonte, R, Zahuranec, D, Zammit, C, Zhang, B, Ziai, W, Zimmerman, L, Zink, E, Tinti, Lorenzo, Lawson, Thomas, Molteni, Erika, Kondziella, Daniel, Rass, Verena, Sharshar, Tarek, Bodien, Yelena G, Giacino, Joseph T, Mayer, Stephan A, Amiri, Moshgan, Muehlschlegel, Susanne, Venkatasubba Rao, Chethan P, Vespa, Paul M, Menon, David K, Citerio, Giuseppe, Helbok, Raimund, McNett, Molly, Agarwal, Sachin, Aiyagari, Venkatesh, Akbari, Yama, Albertson, Asher, Alexander, Sheila, Alexandrov, Anne, Alkhachroum, Ayham, Al-Mufti, Fawaz, Amiri, Moshagan, Appavu, Brian, Gebrewold, Meron Awraris, Ayounb, Marc, Badenes, Rafael, Bader, Mary Kay, Badjiata, Neeraj, Balu, Ram, Barlow, Brooke, Barra, Megan, Beekman, Rachel, Beghi, Ettore, Beqiri, Erta, Berlin, Tracey, Bilotta, Federico, Bleck, Thomas, Bodien, Yelena, Boerwinkle, Varina, Boly, Melanie, Bonnel, Alexandra, Brazzi, Luca, Brown, Emery, Bulic, Sebina, Caceres, Eder, Caceres, Adrian, Cafiero, Tullio, Carroll, Elizabeth, Cediel, Emilio G, Chou, Sherry, Claassen, Jan, Condie, Chad, Conti, Alfredo, Cosmas, Katie, Costa, Paolo, Creutzfeldt, Claire, Dangayach, Neha, Dauri, Mario, Debicki, Derek, DeGeorgia, Michael, Der-Nigoghossian, Caroline, Desai, Masoom, Dhar, Rajat, Diringer, Michael, Durr, Emily, Edlow, Brian, Ercole, Ari, Estraneo, Anna, Falcone, Guido, Farrokh, Salia, Ferguson, Adam, Fernandez-Espejo, Davinia, Fink, Ericka, Fins, Joseph, Foreman, Brandon, Franchi, Federico, Frontera, Jennifer, Ganesan, Rishi, Gaspard, Nicolas, Ghavam, Ahmeneh, Giacino, Joseph, Gibbons, Christie, Gilmore, Emily, Glustein, Chavie, Gosseries, Olivia, Green, Theresa, Greer, David, Guanci, Mary, Gupta, Deepak, Hahn, Cecil, Hakimi, Ryan, Hammond, Flora, Hanley, Daniel F, Hartings, Jed, Hassan, Ahmed, Hemphill, Claude, Da Cunha, Arthur Henrique Galvão Bruno, Hinson, Holly, Hirsch, Karen, Hocker, Sarah, Hu, Peter, Hu, Xiao, Human, Theresa, Hwang, David, Illes, Judy, Jaffa, Matthew, James, Michael L, Janas, Anna, Johnson, Susan, Jones, Morgan, Jox, Ralf J, Kalanuria, Atul, Keller, Emanuela, Kennedy, Lori, Kennelly, Megan, Keogh, Maggie, Kim, Jenn, Kim, Keri, Kirsch, Hannah, Kirschen, Matthew, Ko, Nerissa, Kreitzer, Natalie, Kromm, Julie, Kumar, Abhay, Kurtz, Pedro, Laureys, Steven, Lejeune, Nicolas, Lewis, Ariane, Liang, John, Ling, Geoffrey, Livesay, Sarah, Luppi, Andrea, MacDonald, Jennifer, Maddux, Craig, Mahanes, Dea, Mainali, Shraddha, Maldonado, Nelson, Ribeiro, Rennan Martins, Mascia, Luciana, Massimini, Marcello, Mathur, Rohan, Mayer, Stephan, McCredie, Victoria, Mejia-Mantilla, Jorge, Mendoza, Michael, Menon, David, Meyfroidt, Geert, Mijangos, Julio, Moberg, Dick, Moheet, Asma, Montalenti, Elisa, Monti, Martin, Morrison, Chris, Munar, Marina, Murtaugh, Brooke, Naccache, Lionel, Nagayama, Masao, Nairon, Emerson, Nakagawa, Thomas, Naldi, Andrea, Narenthiran, Ganesalingam, Natarajan, Girija, Nemetsky, Esther, Newcombe, Virginia, Nielsen, Niklas, Niznick, Naomi, Noronha-Falcão, Filipa, Nyquist, Paul, Olson, DaiWai, Othman, Marwan, Owen, Adrian, Padayachy, Llewellyn, Pajoumand, Mehrnaz, Park, Soojin, Pergakis, Melissa, Perry, Heidi, Polizzotto, Len, Pouratian, Nader, Spivack, Marilyn Price, Prisco, Lara, Provencio, Javier, Puglises, Francesco, Puybasset, Louis, Rao, Chethan, Rasmussen, Lindsay, Rasulo, Frank, Ray, Bappaditya, Ricci, Zaccaria, Richardson, Risa, Shinotsuka, Cassia Righy, Robba, Chiara, Robertson, Courtney, Rohaut, Benjamin, Rolston, John, Romagnoli, Stefano, Rosanova, Mario, Rosenthal, Eric, Rowe, Shaun, Rubin, Michael, Russell, Mary Beth, Silva, Gisele Sampaio, Sanz, Leandro, Sarasso, Simone, Sarwal, Aarti, Schiff, Nicolas, Schnakers, Caroline, Seder, David, Shah, Vishank Arun, Shapiro-Rosenbaubm, Amy, Shapshak, Angela, Sharma, Kartavya, Sharma, Kumar Ajay, Shutter, Lori, Sitt, Jacobo, Slomine, Beth, Smetana, Keaton, Smielewski, Peter, Smith, Wade, Stamatakis, Emmanuel, Steinberg, Alexis, Stevens, Robert, Suarez, Jose, Sung, Gene, Sussman, Bethany, Taran, Shaurya, Mazzeo, Anna Teresa, Thibaut, Aurore, Thompson, David, Threlkeld, Zachary, Toker, Daniel, Torbey, Michel, Tosto, Jenna, Trevick, Stephen, Tsaousi, Georgia, Turgeon, Alexis, Udy, Andrew, Varelas, Panos, Vespa, Paul, Videtta, Walter, Voss, Henning, Vox, Ford, Wagner, Amy, Wahlster, Sarah, Wainwright, Mark, Whyte, John, Witherspoon, Briana, Yakhkind, Aleksandra (Sasha), Yeager, Susan, Young, Michael, Zafar, Sahar, Zafonte, Ross, Zahuranec, Darin, Zammit, Chris, Zhang, Bei, Ziai, Wendy, Zimmerman, Lara, and Zink, Elizabeth

Abstract

Disorders of consciousness are neurological conditions characterized by impaired arousal and awareness of self and environment. Behavioural responses are absent or are present but fluctuate. Disorders of consciousness are commonly encountered as a consequence of both acute and chronic brain injuries, yet reliable epidemiological estimates would require inclusive, operational definitions of the concept, as well as wider knowledge dissemination among involved professionals. Whereas several manifestations have been described, including coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state, a comprehensive neurobiological definition for disorders of consciousness is still lacking. The scientific literature is primarily observational, and studies-specific aetiologies lead to disorders of consciousness. Despite advances in these disease-related forms, there remains uncertainty about whether disorders of consciousness are a disease-agnostic unitary entity with a common mechanism, prognosis or treatment response paradigm. Our knowledge of disorders of consciousness has also been hampered by heterogeneity of study designs, variables, and outcomes, leading to results that are not comparable for evidence synthesis. The different backgrounds of professionals caring for patients with disorders of consciousness and the different goals at different stages of care could partly explain this variability. The Prospective Studies working group of the Neurocritical Care Society Curing Coma Campaign was established to create a platform for observational studies and future clinical trials on disorders of consciousness and coma across the continuum of care. In this narrative review, the author panel presents limitations of prior observational clinical research and outlines practical considerations for future investigations. A narrative review format was selected to ensure that the full breadth of study design considerations could be addressed and to facilit

Published
2024

8. PB0287 Thromboembolic and Hemorrhagic Events in Pediatric Patients Assisted with Mechanical Circulatory Support and Bivalirudin Anticoagulation: A Retrospective Observational Study

Author

Giorni, C., primary, lodice, F., additional, Benegni, S., additional, Garisto, C., additional, Raggi, V., additional, Insom, G., additional, Marinari, E., additional, Testa, G., additional, Iacoella, C., additional, Amodeo, A., additional, Ricci, Z., additional, and Di Chiara, L., additional

Published
2023
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11. Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup.

Author

Zarbock, A., Nadim, M.K., Pickkers, P., Gomez, H., Bell, S., Joannidis, M., Kashani, K., Koyner, J.L., Pannu, N., Meersch, M., Reis, T., Rimmelé, T., Bagshaw, S.M., Bellomo, R., Cantaluppi, V., Deep, A., Rosa, S. De, Perez-Fernandez, X., Husain-Syed, F., Kane-Gill, S.L., Kelly, Y., Mehta, R.L., Murray, P.T., Ostermann, M., Prowle, J., Ricci, Z., See, E.J., Schneider, A., Soranno, D.E., Tolwani, A., Villa, G., Ronco, C., Forni, L.G., Zarbock, A., Nadim, M.K., Pickkers, P., Gomez, H., Bell, S., Joannidis, M., Kashani, K., Koyner, J.L., Pannu, N., Meersch, M., Reis, T., Rimmelé, T., Bagshaw, S.M., Bellomo, R., Cantaluppi, V., Deep, A., Rosa, S. De, Perez-Fernandez, X., Husain-Syed, F., Kane-Gill, S.L., Kelly, Y., Mehta, R.L., Murray, P.T., Ostermann, M., Prowle, J., Ricci, Z., See, E.J., Schneider, A., Soranno, D.E., Tolwani, A., Villa, G., Ronco, C., and Forni, L.G.

Abstract

01 juni 2023, Item does not contain fulltext, Sepsis-associated acute kidney injury (SA-AKI) is common in critically ill patients and is strongly associated with adverse outcomes, including an increased risk of chronic kidney disease, cardiovascular events and death. The pathophysiology of SA-AKI remains elusive, although microcirculatory dysfunction, cellular metabolic reprogramming and dysregulated inflammatory responses have been implicated in preclinical studies. SA-AKI is best defined as the occurrence of AKI within 7 days of sepsis onset (diagnosed according to Kidney Disease Improving Global Outcome criteria and Sepsis 3 criteria, respectively). Improving outcomes in SA-AKI is challenging, as patients can present with either clinical or subclinical AKI. Early identification of patients at risk of AKI, or at risk of progressing to severe and/or persistent AKI, is crucial to the timely initiation of adequate supportive measures, including limiting further insults to the kidney. Accordingly, the discovery of biomarkers associated with AKI that can aid in early diagnosis is an area of intensive investigation. Additionally, high-quality evidence on best-practice care of patients with AKI, sepsis and SA-AKI has continued to accrue. Although specific therapeutic options are limited, several clinical trials have evaluated the use of care bundles and extracorporeal techniques as potential therapeutic approaches. Here we provide graded recommendations for managing SA-AKI and highlight priorities for future research.

Published
2023

15. Hemoperfusion in the intensive care unit.

Author

Ricci, Z, Romagnoli, S, Reis, T, Bellomo, R, Ronco, C, Ricci, Z, Romagnoli, S, Reis, T, Bellomo, R, and Ronco, C

Abstract

Multiple organ failure following a septic event derives from immune dysregulation. Many of the mediators of this process are humoral factors (cytokines), which could theoretically be cleared by direct adsorption through a process called hemoperfusion. Hemoperfusion through devices, which bind specific molecules like endotoxin or theoretically provide non-specific adsorption of pro-inflammatory mediators has been attempted and studied for several decades with variable results. More recently, technological evolution has led to the increasing application of adsorption due to more biocompatible and possibly more efficient biomaterials. As a result, new indications are developing in this field, and novel tools are available for clinical use. This narrative review will describe current knowledge regarding technical concepts, safety, and clinical results of hemoperfusion. Finally, it will focus on the most recent literature regarding adsorption applied in critically ill patients and their indications, including recent randomized controlled trials and future areas of investigation. Clinical trials for the assessment of efficacy of hemoperfusion in septic patients should apply the explanatory approach. This includes a highly selected homogenous patient population. Enrichment criteria such as applying genetic signature and molecular biomarkers allows the identification of subphenotypes of patients. The intervention must be delivered by a multidisciplinary team of trained personnel. The aim is to maximize the signals for efficacy and safety. In a homogenous cohort, confounding uncontrolled variables are less likely to exist. Trials with highly selected populations have a high internal validity but poor generalizability. The parallel design described in the figure is robust and usually is required by regulatory agencies for the approval of a new treatment. Allocation concealment and randomization are key to minimize bias such as confirmation bias, observer bias. The interventio

Published
2022

16. Population Pharmacokinetics of Cefoxitin Administered for Pediatric Cardiac Surgery Prophylaxis

Author

Ricci, Z., Benegni, S., Cies, J. J., Marinari, E., Haiberger, R., Garisto, C., Rizza, A., Giorni, C., Di Chiara, L., Arpicco, S., Muntoni, E., Ferrari, F., and Milla, P.

Subjects
Microbiology (medical), Cardiopulmonary bypass, Cefoxitin, Pediatric cardiac surgery, Pharmacodynamics, Pharmacokinetics, Adolescent, Population, Microbial Sensitivity Tests, law.invention, 03 medical and health sciences, Surgical prophylaxis, 0302 clinical medicine, Bolus (medicine), law, 030225 pediatrics, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Cardiac Surgical Procedures, Child, education, Volume of distribution, education.field_of_study, Models, Statistical, business.industry, Infant, Newborn, Infant, Antibiotic Prophylaxis, Anti-Bacterial Agents, surgical procedures, operative, Infectious Diseases, Child, Preschool, Anesthesia, Pediatrics, Perinatology and Child Health, business, Monte Carlo Method, medicine.drug
Abstract

BACKGROUND Available data about pharmacokinetics (PK) of antimicrobials administered as surgical prophylaxis to children undergoing cardiac surgery with cardiopulmonary bypass (CPB) showed that drug concentrations during CPB may be supra or subtherapeutic. The aim of this study was to determine the population PK and pharmacodynamic target attainment (PTA) of cefoxitin during pediatric CPB surgery. METHODS A prospective interventional study was conducted. Cefoxitin (40 mg/kg, up to max 1000 mg) was administered before skin incision. Blood samples were obtained in the operatory room throughout surgery. Population PK, PTA, and safety of cefoxitin were evaluated in neonates, infants, children 10 years old. RESULTS Forty patients were enrolled. Cefoxitin levels correlated with time from bolus administration (r = -0.6, P = 0.0001) and, after 240 minutes from bolus, drug values below the target (8 mg/L) were shown. Cefoxitin concentrations were best described by a one-compartment model with first order elimination. A significant relationship was identified between body weight, age, body mass index, and serum creatinine on drug clearance and age, body weight, and body mass index on cefoxitin volume of distribution. The PTA for free drug concentration being above the minimum inhibitory concentration of 8 mg/L for at least 240 minutes was >90% in all age groups except in patients >10 years of age (PTA = 62%). CONCLUSIONS Cefoxitin PK appears to be significantly influenced by CPB with generally reduced drug clearance. The PTA was adequately achieved in the majority of patients except in patients >10 years old or longer surgeries.

Published
2020

18. Caring for Critically Ill Children With Suspected or Proven Coronavirus Disease 2019 Infection: Recommendations by the Scientific Sections' Collaborative of the European Society of Pediatric and Neonatal Intensive Care

Author

Rimensberger PC, Kneyber MCJ, Deep A, Bansal M, Hoskote A, Javouhey E, Jourdain G, Latten L, MacLaren G, Morin L, Pons-Odena M, Ricci Z, Singh Y, Schlapbach LJ, Scholefield BR, Terheggen U, Tissières P, Tume LN, Verbruggen S, Brierley J, and European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Scientific S

Abstract

OBJECTIVES: In children, coronavirus disease 2019 is usually mild but can develop severe hypoxemic failure or a severe multisystem inflammatory syndrome, the latter considered to be a postinfectious syndrome, with cardiac involvement alone or together with a toxic shock like-presentation. Given the novelty of severe acute respiratory syndrome coronavirus 2, the causative agent of the recent coronavirus disease 2019 pandemic, little is known about the pathophysiology and phenotypic expressions of this new infectious disease nor the optimal treatment approach. STUDY SELECTION: From inception to July 10, 2020, repeated PubMed and open Web searches have been done by the scientific section collaborative group members of the European Society of Pediatric and Neonatal Intensive Care. DATA EXTRACTION: There is little in the way of clinical research in children affected by coronavirus disease 2019, apart from descriptive data and epidemiology. DATA SYNTHESIS: Even though basic treatment and organ support considerations seem not to differ much from other critical illness, such as pediatric septic shock and multiple organ failure, seen in PICUs, some specific issues must be considered when caring for children with severe coronavirus disease 2019 disease. CONCLUSIONS: In this clinical guidance article, we review the current clinical knowledge of coronavirus disease 2019 disease in critically ill children and discuss some specific treatment concepts based mainly on expert opinion based on limited experience and the lack of any completed controlled trials in children at this time.

Published
2021

19. Caring for critically ill children with suspected or proven COVID-19 infection : recommendations by the scientific sections' collaborative of the European Society of Paediatric and Neonatal Intensive Care

Author

Rimmensberger, P, Knebjer, M, Deep, A, Bansal, M, Hoskote, A, Javouhey, E, Jourdain, G, Latten, L, McClaren, G, Morin, L, Pons-Odena, M, Ricci, Z, Singh, Y, Schlapbach, L, Scholifield, B, Terheggen, U, Tissiere, P, Tume, LN, Verbruggen, S, and Brierley, J

Abstract

Objective: In children Coronavirus Disease 2019 is usually mild but can develop to severe hypoxemic failure or a severe multisystem inflammatory syndrome (MIS), the latter considered to be a post-infectious syndrome, with cardiac involvement alone or together with a toxic shock like-presentation. Given the novelty of SARS-CoV-2, the causative agent of the recent COVID-19 pandemic, little is known about the pathophysiology and phenotypic expressions of this new infectious disease, nor the optimal treatment approach.\ud \ud Study selection: From inception to July 10, 2020, repeated PubMed and open Web searches have been done by the scientific section collaborative group members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). \ud \ud Data Extraction: There is little in the way of clinical research in children affected by COVID-19, apart from descriptive data and epidemiology.\ud \ud Data Synthesis: Even though basic treatment and organ support considerations seem not to differ much from other critical illness, such as paediatric septic shock and multiorgan failure, seen in PICUs, some specific issues must be considered when caring for children with severe COVID-19 disease. \ud \ud Conclusions: In this clinical guidance paper, we review the current clinical knowledge of COVID-19 disease in critically ill children and discuss some specific treatment concepts based mainly on expert opinion based on limited experience and the lack of any completed controlled trials in children at this time.

Published
2021

20. Caring for Critically Ill Children With Suspected or Proven Coronavirus Disease 2019 Infection: Recommendations by the Scientific Sections' Collaborative of the European Society of Pediatric and Neonatal Intensive Care

Author

Rimensberger, P.C. (Peter C.), Kneyber, M.C.J. (Martin), Deep, A. (Akash), Bansal, M. (Mehak), Hoskote, A. (Aparna), Javouhey, E. (Etienne), Jourdain, G. (Gilles), Latten, L. (Lynne), MacLaren, G. (Graeme), Morin, L. (Luc), Pons-Odena, M. (Marti), Ricci, Z. (Zaccaria), Singh, Y. (Yogen), Schlapbach, L.J. (Luregn), Scholefield, B.R. (Barnaby R.), Terheggen, U. (Ulrich), Tissières, P. (Pierre), Tume, L.N. (Lyvonne), Verbruggen, S.C.A.T. (Sascha), Brierley, J. (Joe), Rimensberger, P.C. (Peter C.), Kneyber, M.C.J. (Martin), Deep, A. (Akash), Bansal, M. (Mehak), Hoskote, A. (Aparna), Javouhey, E. (Etienne), Jourdain, G. (Gilles), Latten, L. (Lynne), MacLaren, G. (Graeme), Morin, L. (Luc), Pons-Odena, M. (Marti), Ricci, Z. (Zaccaria), Singh, Y. (Yogen), Schlapbach, L.J. (Luregn), Scholefield, B.R. (Barnaby R.), Terheggen, U. (Ulrich), Tissières, P. (Pierre), Tume, L.N. (Lyvonne), Verbruggen, S.C.A.T. (Sascha), and Brierley, J. (Joe)

Abstract

OBJECTIVES: In children, coronavirus disease 2019 is usually mild but can develop severe hypoxemic failure or a severe multisystem inflammatory syndrome, the latter considered to be a postinfectious syndrome, with cardiac involvement alone or together with a toxic shock like-presentation. Given the novelty of severe acute respiratory syndrome coronavirus 2, the causative agent of the recent coronavirus disease 2019 pandemic, little is known about the pathophysiology and phenotypic expressions of this new infectious disease nor the optimal treatment approach. STUDY SELECTION: From inception to July 10, 2020, repeated PubMed and open Web searches have been done by the scientific section collaborative group members of the European Society of Pediatric and Neonatal Intensive Care. DATA EXTRACTION: There is little in the way of clinical research in children affected by coronavirus disease 2019, apart from descriptive data and epidemiology. DATA SYNTHESIS: Even though basic treatment and organ support considerations seem not to differ much from other critical illness, such as pediatric septic shock and multiple organ failure, seen in PICUs, some specific issues must be considered when caring for children with severe coronavirus disease 2019 disease. CONCLUSIONS: In this clinical guidance article, we review the current clinical knowledge of coronavirus disease 2019 disease in critically ill children and discuss some specific treatment concepts based mainly on expert opinion based on limited experience and the lack of any completed controlled trials in children at this time.

Published
2021
Full Text
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21. Caring for Critically Ill Children With Suspected or Proven Coronavirus Disease 2019 Infection: Recommendations by the Scientific Sections' Collaborative of the European Society of Pediatric and Neonatal Intensive Care.

Author

Rimensberger, PC, Kneyber, MCJ, Deep, A, Bansal, M, Hoskote, A, Javouhey, E, Jourdain, G, Latten, L, MacLaren, G, Morin, L, Pons-Odena, M, Ricci, Z, Singh, Y, Schlapbach, LJ, Scholefield, BR, Terheggen, U, Tissières, P, Tume, LN, Verbruggen, S, Brierley, J, European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Scientific Sections’ Collaborative Group, Rimensberger, PC, Kneyber, MCJ, Deep, A, Bansal, M, Hoskote, A, Javouhey, E, Jourdain, G, Latten, L, MacLaren, G, Morin, L, Pons-Odena, M, Ricci, Z, Singh, Y, Schlapbach, LJ, Scholefield, BR, Terheggen, U, Tissières, P, Tume, LN, Verbruggen, S, Brierley, J, and European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Scientific Sections’ Collaborative Group

Abstract

OBJECTIVES: In children, coronavirus disease 2019 is usually mild but can develop severe hypoxemic failure or a severe multisystem inflammatory syndrome, the latter considered to be a postinfectious syndrome, with cardiac involvement alone or together with a toxic shock like-presentation. Given the novelty of severe acute respiratory syndrome coronavirus 2, the causative agent of the recent coronavirus disease 2019 pandemic, little is known about the pathophysiology and phenotypic expressions of this new infectious disease nor the optimal treatment approach. STUDY SELECTION: From inception to July 10, 2020, repeated PubMed and open Web searches have been done by the scientific section collaborative group members of the European Society of Pediatric and Neonatal Intensive Care. DATA EXTRACTION: There is little in the way of clinical research in children affected by coronavirus disease 2019, apart from descriptive data and epidemiology. DATA SYNTHESIS: Even though basic treatment and organ support considerations seem not to differ much from other critical illness, such as pediatric septic shock and multiple organ failure, seen in PICUs, some specific issues must be considered when caring for children with severe coronavirus disease 2019 disease. CONCLUSIONS: In this clinical guidance article, we review the current clinical knowledge of coronavirus disease 2019 disease in critically ill children and discuss some specific treatment concepts based mainly on expert opinion based on limited experience and the lack of any completed controlled trials in children at this time.

Published
2021

22. Extracorporeal Blood Purification and Organ Support in the Critically Ill Patient during COVID-19 Pandemic: Expert Review and Recommendation

Author

Ronco, C, Bagshaw, SM, Bellomo, R, Clark, WR, Husain-Syed, F, Kellum, JA, Ricci, Z, Rimmel, T, Reis, T, Ostermann, M, Ronco, C, Bagshaw, SM, Bellomo, R, Clark, WR, Husain-Syed, F, Kellum, JA, Ricci, Z, Rimmel, T, Reis, T, and Ostermann, M

Abstract

Critically ill COVID-19 patients are generally admitted to the ICU for respiratory insufficiency which can evolve into a multiple-organ dysfunction syndrome requiring extracorporeal organ support. Ongoing advances in technology and science and progress in information technology support the development of integrated multi-organ support platforms for personalized treatment according to the changing needs of the patient. Based on pathophysiological derangements observed in COVID-19 patients, a rationale emerges for sequential extracorporeal therapies designed to remove inflammatory mediators and support different organ systems. In the absence of vaccines or direct therapy for COVID-19, extracorporeal therapies could represent an option to prevent organ failure and improve survival. The enormous demand in care for COVID-19 patients requires an immediate response from the scientific community. Thus, a detailed review of the available technology is provided by experts followed by a series of recommendation based on current experience and opinions, while waiting for generation of robust evidence from trials.

Published
2021

34. Recent Advances for Stroke Prevention in Patients With Atrial Fibrillation and Advanced Kidney Disease

Author

Ronco, C, Bellomo, R, Kellum, JA, Ricci, Z, Ronco, F, Mazzone, P, Hosseinian, L, Genovesi, S, Ronco F., Mazzone P., Hosseinian L., Genovesi S., Ronco, C, Bellomo, R, Kellum, JA, Ricci, Z, Ronco, F, Mazzone, P, Hosseinian, L, Genovesi, S, Ronco F., Mazzone P., Hosseinian L., and Genovesi S.

Abstract

Chronic kidney disease (CKD) is associated with a high prevalence of atrial fibrillation (AF), but in patients with severe renal impairment, the risk/benefit ratio of anticoagulant therapy with vitamin K antagonists (VKA) for thromboprophylaxis is uncertain. In end-stage renal disease (ESRD) patients undergoing hemodialysis, VKA seem less effective in stroke prevention than in the general population, with an increased risk of major bleeding. Recently, novel oral anticoagulant agents (NOACs) have proven to be effective for stroke prevention in AF and have demonstrated an improved safety profile compared with VKA. Limited data from posthoc analyses of controlled clinical trials suggest the safe and effective use of NOACs in patients with moderate renal impairment (i.e., estimated glomerular filtration rate [eGFR] between 30 and 50 mL/min). The question still remains whether NOACs can be used in patients with an eGFR less than 30 mL/min, because there are no studies addressing this subject. In fact, patients with CKD stage 4 and 5 were excluded from controlled clinical trials on anticoagulation therapy for stroke prevention in AF. Left atrial appendage (LAA) occlusion represents a nonpharmacologic alternative for stroke prevention in patients with AF who are difficult to manage medically. Preliminary data indicate a similar efficacy and safety profile in patients with CKD compared with patients with normal renal function. Stroke prevention in patients with ESRD and AF represents a clinical challenge with poor evidence. LAA occlusion may become the standard of care for stroke prevention in patients with ESRD and AF.

Published
2019

35. Pulse high volume hemofiltration

Author

BRENDOLAN, A., DʼINTINI, V., RICCI, Z., BONELLO, M., RATANARAT, R., SALVATORI, G., BORDONI, V., DE CAL, M., ANDRIKOS, E., and RONCO, C.

Published
2004

39. Guidelines for the prevention, diagnosis and treatment of acute kidney injury syndromes: Italian version of KDIGO, integrated with new evidence and international commentaries [Linee guida alla prevenzione, diagnosi e terapia delle sindromi di danno renale acuto: versione italiana delle KDIGO, integrata con le nuove evidenze e i commentari internazionali]

Author

Ronco, C, Antonelli, M, Capasso, G, De Gaudio, R, Fiaccadori, E, Lorini, L, Mancini, E, Monti, G, Morabito, S, Nalesso, F, Piccinni, P, Ricci, Z, Romagnoli, S, Santoro, A, Aresu, S, De Rosa, S, Samoni, S, Spinelli, A, Villa, G, Armignacco, P, Basile, C, Biancofiore, G, Cantaluppi, V, Cerutti, S, De Pascalis, A, FUMAGALLI, ROBERTO, Garzotto, F, Gaspardone, A, GENOVESI, SIMONETTA CARLA, Guggia, S, Inguaggiato, P, Lorenzin, A, Marenzi, G, Mariano, F, Neri, M, Pani, A, Pertosa, G, Pistolesi, V, Sartori, M., LORINI, FERDINANDO LUCA, Ronco, C, Antonelli, M, Capasso, G, De Gaudio, R, Fiaccadori, E, Lorini, L, Mancini, E, Monti, G, Morabito, S, Nalesso, F, Piccinni, P, Ricci, Z, Romagnoli, S, Santoro, A, Aresu, S, De Rosa, S, Samoni, S, Spinelli, A, Villa, G, Armignacco, P, Basile, C, Biancofiore, G, Cantaluppi, V, Cerutti, S, De Pascalis, A, Fumagalli, R, Garzotto, F, Gaspardone, A, Genovesi, S, Guggia, S, Inguaggiato, P, Lorenzin, A, Marenzi, G, Mariano, F, Neri, M, Pani, A, Pertosa, G, Pistolesi, V, Sartori, M, and Lorini, F

Subjects
linee guida, KDIGO,Italia, Insufficienza renale acuta, Acute Kidney Injury
Published
2015

40. Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications

Author

Villa, Gianluca, Neri, M., Bellomo, R., Cerda, J., De Gaudio, Angelo Raffaele, De Rosa, S., Garzotto, F., Honore, P. M., Kellum, J., Lorenzin, A., Payen, D., Ricci, Z., Samoni, S., Vincent, J. L., Wendon, J., Zaccaria, M., Ronco, C., Bagshaw, S. M., Balducci, A., Baldwin, I., Barbarigo, F., Braganó, P., Braunsky, J., Calletti, F., Chawla, L., Di Somma, S., Doi, K., Dosil Rosende, P., Emmett, M., Fecondini, L., Galavotti, D., Gibney, N., Goldstein, S. L., Guadagni, G., Honorè, P., Hoste, E., Inadome, S., Kashani, K., Katz, N., Kenley, R., Kobayashi, Y., Lannoy, J., Lewington, A., Mariano, F., McCullough, P. A., Mehta, R. L., Menneguerre, J., Mettifogo, M., Ostermann, M., Pani, A., Pirazzoli, P., Pohlmeier, R., Pouchoulin, D., Rosner, M., Seamann, M., Shaw, A., Tolwani, A., Supporting clinical sciences, and Internal Medicine Specializations

Subjects
CRRT machine, HIGH-VOLUME HEMOFILTRATION, INTENSIVE-CARE-UNIT, medicine.medical_treatment, Continuous plasmafiltration coupled with adsorption, continuous veno-venous hemodiafiltration, continuous veno-venous hemodialysis, continuous veno-venous hemofiltration, hemoperfusion, high volume hemofiltration, pressure sensor, pump, terminology, critical care and Intensive care medicine, 030232 urology & nephrology, Review, Continuous veno-venous hemofiltration, Critical Care and Intensive Care Medicine, High volume hemofiltration, 0302 clinical medicine, Continuous veno-venous hemodiafiltration, DIALYSIS, Medicine and Health Sciences, FAILURE, Medicine(all), Acute kidney injury, Acute Kidney Injury, RANDOMIZED CONTROLLED-TRIAL, Terminology, Continuous veno-venous hemodialysis, Renal Replacement Therapy, medicine.symptom, medicine.medical_specialty, Consensus, Critical Care, Pressure sensor, POLYMYXIN-B HEMOPERFUSION, Critical Illness, ACUTE KIDNEY INJURY, Hemodiafiltration, Extracorporeal, EXTRACORPOREAL MEMBRANE-OXYGENATION, Sepsis, 03 medical and health sciences, Hemofiltration, medicine, Extracorporeal membrane oxygenation, Humans, Renal replacement therapy, Intensive care medicine, Septic shock, business.industry, Hemoperfusion, Pump, SEPTIC SHOCK, Organ dysfunction, Généralités, 030208 emergency & critical care medicine, medicine.disease, LIVER SUPPORT, business
Abstract

This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis., 0, SCOPUS: re.j, info:eu-repo/semantics/published

Published
2016

41. Nomenclature for renal replacement therapy in acute kidney injury: Basic principles

Author

Neri, Mauro, Villa, Gianluca, Garzotto, Francesco, Bagshaw, Sean, Bellomo, ELENA MARIA RITA, Cerda, Jorge, Ferrari, Fiorenza, Guggia, Silvia, Joannidis, Michael, Kellum, John, Kim, Jeong Chul, Mehta, Ravindra L., Ricci, Zaccaria, Trevisani, Alberto, Marafon, Silvio, Clark, William R., Vincent, Jean Louis, Ronco, Claudio, Bagshaw, S. M., Balducci, Alessandro, Baldwin, I., Barbarigo, F., Bellomo, R., Braganó, P., Braunsky, J., Calletti, F., Cerda, J., Chawla, L., De Rosa, S., Di Somma, S., Doi, K., Dosil Rosende, P., Emmett, M., Fecondini, L., Galavotti, D., Kellum, J., Garzotto, F., Lorenzin, A., Neri, M., Ronco, C., Goldstein, S. L., Guadagni, G., Honoré, P., Hoste, E., Kashani, K., Katz, N., Kenley, R., Lannoy, J., Lewington, A., Mariano, F., Mccullough, P. A., Mehta, R. L., Menneguerre, J., Mettifogo, M., Ostermann, M., Pani, A., Pirazzoli, P., Pohlmeier, R., Pouchoulin, D., Ricci, Z., Rosner, M., Seamann, M., Shaw, A., Tolwani, A., Villa, G., Vincent, J. L., and Wendon, J.

Subjects
medicine.medical_specialty, CRRT efficiency, medicine.medical_treatment, Critical Illness, 030232 urology & nephrology, Transmembrane pressure, Ultrafiltration, CRRT modalities, Review, 030204 cardiovascular system & hematology, urologic and male genital diseases, Clearance, Convection, CRRT membranes, Diffusion, Dose, Terminology, Critical Care and Intensive Care Medicine, Extracorporeal, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, Terminology as Topic, medicine, Humans, Renal replacement therapy, Intensive care medicine, Acute Kidney Injury, Renal Replacement Therapy, business.industry, Critically ill, Consensus conference, Acute kidney injury, Généralités, medicine.disease, Critical illness, business
Abstract

This article reports the conclusions of a consensus expert conference on the basic principles and nomenclature of renal replacement therapy (RRT) currently utilized to manage acute kidney injury (AKI). This multidisciplinary consensus conference discusses common definitions, components, techniques, and operations of the machines and platforms used to deliver extracorporeal therapies, utilizing a "machine-centric" rather than a "patient-centric" approach. We provide a detailed description of the performance characteristics of membranes, filters, transmembrane transport of solutes and fluid, flows, and methods of measurement of delivered treatment, focusing on continuous renal replacement therapies (CRRT) which are utilized in the management of critically ill patients with AKI. This is a consensus report on nomenclature harmonization for principles of extracorporeal renal replacement therapies. Devices and operations are classified and defined in detail to serve as guidelines for future use of terminology in papers and research., 0, SCOPUS: re.j, info:eu-repo/semantics/published

Published
2016

42. Intensive care

Author

Ricci, Z, Cruz, Dn, and Ronco, C

Subjects
Transplantation, Evidence-Based Medicine, Critical Care, Hemodiafiltration, Acute Kidney Injury, Lipocalins, Renal Replacement Therapy, Extracorporeal Membrane Oxygenation, Lipocalin-2, Nephrology, Proto-Oncogene Proteins, Humans, Biomarkers, Acute-Phase Proteins
Published
2010

43. Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications

Author

Villa, G, Neri, M, Bellomo, R, Cerda, J, De Gaudio, AR, De Rosa, S, Garzotto, F, Honore, PM, Kellum, J, Lorenzin, A, Payen, D, Ricci, Z, Samoni, S, Vincent, J-L, Wendon, J, Zaccaria, M, Ronco, C, Villa, G, Neri, M, Bellomo, R, Cerda, J, De Gaudio, AR, De Rosa, S, Garzotto, F, Honore, PM, Kellum, J, Lorenzin, A, Payen, D, Ricci, Z, Samoni, S, Vincent, J-L, Wendon, J, Zaccaria, M, and Ronco, C

Abstract

This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients. In addition, the article describes recent developments in other extracorporeal therapies, including therapeutic plasma exchange, multiple organ support therapy, liver support, lung support, and blood purification in sepsis. This is a consensus report on nomenclature harmonization in extracorporeal blood purification therapies, such as hemofiltration, plasma exchange, multiple organ support therapies, and blood purification in sepsis.

Published
2016

44. Nomenclature for renal replacement therapy in acute kidney injury: basic principles

Author

Neri, M, Villa, G, Garzotto, F, Bagshaw, S, Bellomo, R, Cerda, J, Ferrari, F, Guggia, S, Joannidis, M, Kellum, J, Kim, JC, Mehta, RL, Ricci, Z, Trevisani, A, Marafon, S, Clark, WR, Vincent, J-L, Ronco, C, Neri, M, Villa, G, Garzotto, F, Bagshaw, S, Bellomo, R, Cerda, J, Ferrari, F, Guggia, S, Joannidis, M, Kellum, J, Kim, JC, Mehta, RL, Ricci, Z, Trevisani, A, Marafon, S, Clark, WR, Vincent, J-L, and Ronco, C

Abstract

This article reports the conclusions of a consensus expert conference on the basic principles and nomenclature of renal replacement therapy (RRT) currently utilized to manage acute kidney injury (AKI). This multidisciplinary consensus conference discusses common definitions, components, techniques, and operations of the machines and platforms used to deliver extracorporeal therapies, utilizing a "machine-centric" rather than a "patient-centric" approach. We provide a detailed description of the performance characteristics of membranes, filters, transmembrane transport of solutes and fluid, flows, and methods of measurement of delivered treatment, focusing on continuous renal replacement therapies (CRRT) which are utilized in the management of critically ill patients with AKI. This is a consensus report on nomenclature harmonization for principles of extracorporeal renal replacement therapies. Devices and operations are classified and defined in detail to serve as guidelines for future use of terminology in papers and research.

Published
2016

45. Sonographic dynamic assessment of lung injury in a child with hypoplastic left heart syndrome undergoing extracorporeal membrane oxygenation

Author

Biasucci, Dg, Ricci, Z, Conti, G, and Cogo, P

Subjects
Pulmonary and Respiratory Medicine, Male, Acute Lung Injury, Respiratory failure, Pediatrics, Congenital heart diseases, Mechanical ventilation, Extracorporeal Membrane Oxygenation, Postoperative Complications, Hypoplastic Left Heart Syndrome, Humans, Lung, Ultrasonography, Lung ultrasound, ECMO, congenital heart diseases, heart surgery, lung ultrasound, mechanical ventilation, pediatric critical care, respiratory failure, Infant, Newborn, Infant, Perinatology and Child Health, Newborn, Respiration Disorders, Heart surgery, Pediatric critical care, Settore MED/41, Pleura, Pediatrics, Perinatology and Child Health
Abstract

Performed for many years in clinical settings, pleural and lung ultrasound (PLUS) has emerged to be an invaluable tool to diagnose underlying conditions of respiratory failure, to monitor disease progression and to ensure appropriate therapeutic intervention. PLUS basically relies on the analysis of two prevalent ultrasound artefacts: A-lines and B-lines. A-lines are hyperechoic reverberation artefacts of the pleural line. A-lines combined with lung sliding show that lungs are well aerated. B-lines are vertical hyperechoic reverberation artefacts arising from pleural line extending to the bottom of the screen. The prevalence of B-lines indicates a pathologic parenchyma. Since PLUS is readily available, easily affordable, and biologically non-invasive, it is especially suitable for bedside clinical care in critically ill and unstable adult patients. Several authors have recently proposed PLUS for application in critically ill neonates and children. We report a case in which PLUS was used to clinically monitor a complex lung lesion during treatment of a child with congenital heart disease suffering from severe lung injury.A 1-year-old male with hypoplastic left heart syndrome underwent bidirectional Glenn procedure and systemic-to-left pulmonary artery shunt for heart palliation. After surgery, he developed a severe acute respiratory distress syndrome (ARDS) and extra-corporeal membrane oxygenation (ECMO) treatment was started. PLUS was performed daily to monitor the disease's progression and response to treatment during lung rest. As B-lines were decreasing and A-lines were becoming visible, we were able to monitor the improving aeration of the injured lung. The ultrasound showed high consistency with traditional imaging.Due to its non-ionizing nature, low cost, easy availability, easy repeatability and real-time results, PLUS is a feasible and beneficial bedside imaging technique for critically ill and unstable adult and pediatric patients. A reliable monitoring of ongoing treatments is certainly helpful to provide appropriate intervention, correctly schedule chest X-ray and CT-scan, and optimize ECMO weaning. The present case suggests that PLUS may be a successful and useful tool for monitoring lung diseases in children with CHD with severe post-operative complex lung injury.

Published
2014

46. [Guidelines for the prevention, diagnosis and treatment of acute kidney injury syndromes: Italian version of KDIGO, integrated with new evidence and international commentaries]

Author

Ronco, C, ANTONELLI, MASSIMO, Capasso, G, De Gaudio, R, Fiaccadori, E, Lorini, L, Mancini, E, Monti, G, Morabito, S, Nalesso, F, Piccinni, P, Ricci, Z, Romagnoli, S, Santoro, A, Aresu, S, DE ROSA, SILVIA, Samoni, S, Spinelli, A, Villa, G, Armignacco, P, Basile, C, Biancofiore, G, Cantaluppi, V, Cerutti, S, De Pascalis, A, Fumagalli, R, Garzotto, F, Gaspardone, A, Genovesi, S, Guggia, S, Inguaggiato, P, Lorenzin, A, Marenzi, G, Mariano, F, Neri, M, Pani, A, Pertosa, G, Pistolesi, V, Sartori, M, Ronco, C, ANTONELLI, MASSIMO, Capasso, G, De Gaudio, R, Fiaccadori, E, Lorini, L, Mancini, E, Monti, G, Morabito, S, Nalesso, F, Piccinni, P, Ricci, Z, Romagnoli, S, Santoro, A, Aresu, S, DE ROSA, SILVIA, Samoni, S, Spinelli, A, Villa, G, Armignacco, P, Basile, C, Biancofiore, G, Cantaluppi, V, Cerutti, S, De Pascalis, A, Fumagalli, R, Garzotto, F, Gaspardone, A, Genovesi, S, Guggia, S, Inguaggiato, P, Lorenzin, A, Marenzi, G, Mariano, F, Neri, M, Pani, A, Pertosa, G, Pistolesi, V, and Sartori, M

Published
2015

47. Renal replacement therapy in acute kidney injury: controversy and consensus

Author

Ronco, C., Ricci, Z., Backer, D. De, Kellum, J.A., Taccone, F.S., Joannidis, M., Pickkers, P., Cantaluppi, V., Turani, F., Saudan, P., Bellomo, R., Joannes-Boyau, O., Antonelli, M., Payen, D., Prowle, J.R., Vincent, J.L., Ronco, C., Ricci, Z., Backer, D. De, Kellum, J.A., Taccone, F.S., Joannidis, M., Pickkers, P., Cantaluppi, V., Turani, F., Saudan, P., Bellomo, R., Joannes-Boyau, O., Antonelli, M., Payen, D., Prowle, J.R., and Vincent, J.L.

Abstract

Contains fulltext : 153854.pdf (publisher's version ) (Open Access), Renal replacement therapies (RRTs) represent a cornerstone in the management of severe acute kidney injury. This area of intensive care and nephrology has undergone significant improvement and evolution in recent years. Continuous RRTs have been a major focus of new technological and treatment strategies. RRT is being used increasingly in the intensive care unit, not only for renal indications but also for other organ-supportive strategies. Several aspects related to RRT are now well established, but others remain controversial. In this review, we review the available RRT modalities, covering technical and clinical aspects. We discuss several controversial issues, provide some practical recommendations, and where possible suggest a research agenda for the future.

Published
2015

48. Renal replacement therapy in acute kidney injury: controversy and consensus

Author

Ronco, C, Ricci, Z, De Backer, D, Kellum, JA, Taccone, FS, Joannidis, M, Pickkers, P, Cantaluppi, V, Turani, F, Saudan, P, Bellomo, R, Joannes-Boyau, O, Antonelli, M, Payen, D, Prowle, JR, Vincent, J-L, Ronco, C, Ricci, Z, De Backer, D, Kellum, JA, Taccone, FS, Joannidis, M, Pickkers, P, Cantaluppi, V, Turani, F, Saudan, P, Bellomo, R, Joannes-Boyau, O, Antonelli, M, Payen, D, Prowle, JR, and Vincent, J-L

Abstract

Renal replacement therapies (RRTs) represent a cornerstone in the management of severe acute kidney injury. This area of intensive care and nephrology has undergone significant improvement and evolution in recent years. Continuous RRTs have been a major focus of new technological and treatment strategies. RRT is being used increasingly in the intensive care unit, not only for renal indications but also for other organ-supportive strategies. Several aspects related to RRT are now well established, but others remain controversial. In this review, we review the available RRT modalities, covering technical and clinical aspects. We discuss several controversial issues, provide some practical recommendations, and where possible suggest a research agenda for the future.

Published
2015

50. Renal support

Author

Ricci Z, Romagnoli S, and Claudio Ronco

Subjects
Renal Replacement Therapy, Treatment Outcome, Critical Care, Multiple Organ Failure, Sepsis, Biomedical Technology, Humans, Kidney Diseases, Acute Kidney Injury
Abstract

Renal support, intended as a refined and context-sensitive form of severe acute kidney injury management, might be achieved by administering renal replacement therapy with the correct timing and indication, correct prescription and, also, by the expertise and capacity of clinicians to tailor different RRTs to different patients. Furthermore, technical evolution and extended indications for extracorporeal treatments, currently allow the support of multiple organs, other than the isolated kidney failure. Unfortunately, current literature in the field of optimal management of severe acute kidney injury is controversial and lacks a standard of care. This review aims to describe the recent clinical, scientific and technical evolution of renal replacement therapy and the potential suggestive concept of multiple organ support therapy.

Published
2011

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