21 results on '"Denise Battaglini"'
Search Results
2. Management of Neuromuscular Blocking Agents in Critically Ill Patients with Lung Diseases
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Ida Giorgia Iavarone, Lou’i Al-Husinat, Jorge Luis Vélez-Páez, Chiara Robba, Pedro Leme Silva, Patricia R. M. Rocco, and Denise Battaglini
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neuromuscular blocking agents ,intensive care unit ,acute respiratory distress syndrome ,status asthmaticus ,chronic obstructive pulmonary disease ,Medicine - Abstract
The use of neuromuscular blocking agents (NMBAs) is common in the intensive care unit (ICU). NMBAs have been used in critically ill patients with lung diseases to optimize mechanical ventilation, prevent spontaneous respiratory efforts, reduce the work of breathing and oxygen consumption, and avoid patient–ventilator asynchrony. In patients with acute respiratory distress syndrome (ARDS), NMBAs reduce the risk of barotrauma and improve oxygenation. Nevertheless, current guidelines and evidence are contrasting regarding the routine use of NMBAs. In status asthmaticus and acute exacerbation of chronic obstructive pulmonary disease, NMBAs are used in specific conditions to ameliorate patient–ventilator synchronism and oxygenation, although their routine use is controversial. Indeed, the use of NMBAs has decreased over the last decade due to potential adverse effects, such as immobilization, venous thrombosis, patient awareness during paralysis, development of critical illness myopathy, autonomic interactions, ICU-acquired weakness, and residual paralysis after cessation of NMBAs use. The aim of this review is to highlight current knowledge and synthesize the evidence for the effects of NMBAs for critically ill patients with lung diseases, focusing on patient–ventilator asynchrony, ARDS, status asthmaticus, and chronic obstructive pulmonary disease.
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- 2024
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3. Clinical Characteristics of Spinal versus General Anaesthesia in Older Patients Undergoing Hip Fracture Repair Surgery in Jordan: A Multicentre Study
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Lou’i Al-Husinat, Sarah Al Sharie, Mohammad Araydah, Zaid Al Modanat, Mohammed I. A. Ismail, Hadeel B. Heilat, Mohd Said Dawod, Khaled Ahmad Sawaftah, Silvia De Rosa, and Denise Battaglini
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hip fracture ,spinal anaesthesia ,general anaesthesia ,femur neck fracture ,geriatric ,Medicine - Abstract
Background: The primary aim of this study was to examine the clinical characteristics and outcomes of older patients who underwent hip fracture repair surgery. The secondary aims were to assess the predictors of the choice of spinal or general anaesthesia and to explore the risk factors for all-cause mortality. Methods: This three-tertiary centres study was conducted at a tertiary care centre in Jordan. Clinical data include previous fracture history; medication details; comorbidities; surgical approach; and postoperative pain management. Results: Overall, 1084 patients who underwent hip fracture repair were included in this study. The mean age of patients was 78 years, and 55.2% were women. Twenty-four were treated with bisphosphonates before the fracture, whereas 30 were in steroid therapy. Overall, 61.8% of patients underwent spinal anaesthesia, whereas 38.2% underwent general anaesthesia. Spinal anaesthesia group had a lower prevalence of cardiovascular accidents (16.3% vs. 22.3%, p = 0.014) and Alzheimer’s (3.4% vs. 1.4%, p = 0.049) than the general anaesthesia group. In the spinal anaesthesia group, postoperative opioid administration (p = 0.025) and postoperative blood transfusion (p = 0.011) occurred more frequently than general anaesthesia group. In hospital, 30-day and all-cause mortality were comparable between both groups. Diabetes mellitus (HR = 2.6; 95%CI = 1.5–4.4; p = 0.001); cemented hip hemiarthroplasty (HR = 2.4; 95%CI = 1.1–5.1; p = 0.025); deep venous thrombosis/pulmonary embolism (HR = 5.0; 95%CI = 1.2–12.9; p = 0.001); and readmission within 1 month from surgery (HR = 3.6; 95%CI = 2.0–6.3; p < 0.001) were all significant predictors of mortality. Conclusions: This study provides insights into the outcomes and factors associated with different anaesthesia types in hip fracture repair surgery. The anaesthesia type does not affect all-cause mortality in patients undergoing hip fracture repair.
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- 2023
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4. High-Flow Oxygen Therapy in the Perioperative Setting and Procedural Sedation: A Review of Current Evidence
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Lou’i Al-Husinat, Basil Jouryyeh, Ahlam Rawashdeh, Abdelrahman Alenaizat, Mohammad Abushehab, Mohammad Wasfi Amir, Zaid Al Modanat, Denise Battaglini, and Gilda Cinnella
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high-flow nasal cannula ,high-flow nasal oxygen ,perioperative setting ,non-invasive mechanical ventilation ,acute hypoxemic respiratory failure ,procedural sedation ,Medicine - Abstract
High-flow oxygen therapy (HFOT) is a respiratory support system, through which high flows of humidified and heated gas are delivered to hypoxemic patients. Several mechanisms explain how HFOT improves arterial blood gases and enhances patients’ comfort. Some mechanisms are well understood, but others are still unclear and under investigation. HFOT is an interesting oxygen-delivery modality in perioperative medicine that has many clinical applications in the intensive care unit (ICU) and the operating room (OR). The purpose of this article was to review the literature for a comprehensive understanding of HFOT in the perioperative period, as well as its uses in procedural sedation. This review will focus on the HFOT definition, its physiological benefits, and their mechanisms, its clinical uses in anesthesia, and when it is contraindicated.
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- 2023
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5. Update on Lean Body Mass Diagnostic Assessment in Critical Illness
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Silvia De Rosa, Michele Umbrello, Paolo Pelosi, and Denise Battaglini
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critical care ,lean body mass ,muscle mass ,assessment ,CT scan ,bioelectrical impedance analysis ,Medicine (General) ,R5-920 - Abstract
Acute critical illnesses can alter vital functions with profound biological, biochemical, metabolic, and functional modifications. Despite etiology, patient’s nutritional status is pivotal to guide metabolic support. The assessment of nutritional status remains complex and not completely elucidated. Loss of lean body mass is a clear marker of malnutrition; however, the question of how to investigate it still remains unanswered. Several tools have been implemented to measure lean body mass, including a computed tomography scan, ultrasound, and bioelectrical impedance analysis, although such methods unfortunately require validation. A lack of uniform bedside measurement tools could impact the nutrition outcome. Metabolic assessment, nutritional status, and nutritional risk have a pivotal role in critical care. Therefore, knowledge about the methods used to assess lean body mass in critical illnesses is increasingly required. The aim of the present review is to update the scientific evidence regarding lean body mass diagnostic assessment in critical illness to provide the diagnostic key points for metabolic and nutritional support.
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- 2023
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6. Challenges in ARDS Definition, Management, and Identification of Effective Personalized Therapies
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Denise Battaglini, Brigitta Fazzini, Pedro Leme Silva, Fernanda Ferreira Cruz, Lorenzo Ball, Chiara Robba, Patricia R. M. Rocco, and Paolo Pelosi
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ARDS ,acute respiratory distress syndrome ,mechanical ventilation ,phenotypes ,pharmacologic therapies ,Medicine - Abstract
Over the last decade, the management of acute respiratory distress syndrome (ARDS) has made considerable progress both regarding supportive and pharmacologic therapies. Lung protective mechanical ventilation is the cornerstone of ARDS management. Current recommendations on mechanical ventilation in ARDS include the use of low tidal volume (VT) 4–6 mL/kg of predicted body weight, plateau pressure (PPLAT) < 30 cmH2O, and driving pressure (∆P) < 14 cmH2O. Moreover, positive end-expiratory pressure should be individualized. Recently, variables such as mechanical power and transpulmonary pressure seem promising for limiting ventilator-induced lung injury and optimizing ventilator settings. Rescue therapies such as recruitment maneuvers, vasodilators, prone positioning, extracorporeal membrane oxygenation, and extracorporeal carbon dioxide removal have been considered for patients with severe ARDS. Regarding pharmacotherapies, despite more than 50 years of research, no effective treatment has yet been found. However, the identification of ARDS sub-phenotypes has revealed that some pharmacologic therapies that have failed to provide benefits when considering all patients with ARDS can show beneficial effects when these patients were stratified into specific sub-populations; for example, those with hyperinflammation/hypoinflammation. The aim of this narrative review is to provide an overview on current advances in the management of ARDS from mechanical ventilation to pharmacological treatments, including personalized therapy.
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- 2023
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7. Biological Markers to Predict Outcome in Mechanically Ventilated Patients with Severe COVID-19 Living at High Altitude
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Jorge Luis Vélez-Páez, Paolo Pelosi, Denise Battaglini, and Ivan Best
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SARS-CoV-2 ,coronavirus infection ,mortality ,biomarkers ,COVID-19 ,Medicine - Abstract
Background: There is not much evidence on the prognostic utility of different biological markers in patients with severe COVID-19 living at high altitude. The objective of this study was to determine the predictive value of inflammatory and hematological markers for the risk of mortality at 28 days in patients with severe COVID-19 under invasive mechanical ventilation, living at high altitude and in a low-resource setting. Methods: We performed a retrospective observational study including patients with severe COVID-19, under mechanical ventilation and admitted to the intensive care unit (ICU) located at 2850 m above sea level, between 1 April 2020 and 1 August 2021. Inflammatory (interleukin-6 (IL-6), ferritin, D-dimer, lactate dehydrogenase (LDH)) and hematologic (mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), MPV/platelet ratio) markers were evaluated at 24 h and in subsequent controls, and when available at 48 h and 72 h after admission to the ICU. The primary outcome was the association of inflammatory and hematological markers with the risk of mortality at 28 days. Results: We analyzed 223 patients (median age (1st quartile [Q1]–3rd quartile [Q3]) 51 (26–75) years and 70.4% male). Patients with severe COVID-19 and with IL-6 values at 24 h ≥ 11, NLR values at 24 h ≥ 22, and NLR values at 72 h ≥ 14 were 8.3, 3.8, and 3.8 times more likely to die at 28 days, respectively. The SOFA and APACHE-II scores were not able to independently predict mortality. Conclusions: In mechanically ventilated patients with severe COVID-19 and living at high altitude, low-cost and immediately available blood markers such as IL-6 and NLR may predict the severity of the disease in low-resource settings.
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- 2023
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8. T2Bacteria and T2Resistance Assays in Critically Ill Patients with Sepsis or Septic Shock: A Descriptive Experience
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Daniele Roberto Giacobbe, Francesca Crea, Paola Morici, Laura Magnasco, Vincenzo Di Pilato, Federica Briano, Edward Willison, Rachele Pincino, Silvia Dettori, Stefania Tutino, Simone Esposito, Erika Coppo, Chiara Dentone, Federica Portunato, Malgorzata Mikulska, Chiara Robba, Antonio Vena, Denise Battaglini, Iole Brunetti, Lorenzo Ball, Paolo Pelosi, Anna Marchese, and Matteo Bassetti
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T2 ,rapid tests ,diagnosis ,sepsis ,septic shock ,BSI ,Therapeutics. Pharmacology ,RM1-950 - Abstract
The use of rapid molecular tests may anticipate the identification of causative agents and resistance determinants in the blood of critically ill patients with sepsis. From April to December 2021, all intensive care unit patients with sepsis or septic shock who were tested with the T2Bacteria and T2Resistance assays were included in a retrospective, single center study. The primary descriptive endpoints were results of rapid molecular tests and concomitant blood cultures. Overall, 38 combinations of T2Bacteria and T2Resistance tests were performed. One or more causative agent(s) were identified by the T2Bacteria assay in 26% of episodes (10/38), whereas negative and invalid results were obtained in 66% (25/38) and 8% (3/38) of episodes, respectively. The same pathogen detected by the T2Bacteria test grew from blood cultures in 30% of cases (3/10). One or more determinant(s) of resistance were identified by the T2Resistance assay in 11% of episodes (4/38). Changes in therapy based on T2Bacteria and/or T2Resistance results occurred in 21% of episodes (8/38). In conclusion, T2Bacteria/T2Resistance results can influence early treatment decisions in critically ill patients with sepsis or septic shock in real-life practice. Large, controlled studies remain necessary to confirm a favorable impact on patients’ outcomes and antimicrobial stewardship interventions.
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- 2022
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9. The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia
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Rihards P. Rocans, Agnese Ozolina, Denise Battaglini, Evita Bine, Janis V. Birnbaums, Anastasija Tsarevskaya, Sintija Udre, Marija Aleksejeva, Biruta Mamaja, and Paolo Pelosi
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percutaneous tracheostomy ,tracheostomy ,COVID-19 ,intensive care ,Medicine - Abstract
Introduction: The aim was to investigate the impact of different ventilator strategies (non-invasive ventilation (NIV); invasive MV with tracheal tube (TT) and with tracheostomy (TS) on outcomes (mortality and intensive care unit (ICU) length of stay) in patients with COVID-19. We also assessed the impact of timing of percutaneous tracheostomy and other risk factors on mortality. Methods: The retrospective cohort included 868 patients with severe COVID-19. Demographics, MV parameters and duration, and ICU mortality were collected. Results: MV was provided in 530 (61.1%) patients, divided into three groups: NIV (n = 139), TT (n = 313), and TS (n = 78). Prevalence of tracheostomy was 14.7%, and ICU mortality was 90.4%, 60.2%, and 30.2% in TT, TS, and NIV groups, respectively (p < 0.001). Tracheostomy increased the chances of survival and being discharged from ICU (OR 6.3, p < 0.001) despite prolonging ICU stay compared to the TT group (22.2 days vs. 10.7 days, p < 0.001) without differences in survival rates between early and late tracheostomy. Patients who only received invasive MV had higher odds of survival compared to those receiving NIV in ICU prior to invasive MV (OR 2.7, p = 0.001). The odds of death increased with age (OR 1.032, p < 0.001), obesity (1.58, p = 0.041), chronic renal disease (1.57, p = 0.019), sepsis (2.8, p < 0.001), acute kidney injury (1.7, p = 0.049), multiple organ dysfunction (3.2, p < 0.001), and ARDS (3.3, p < 0.001). Conclusions: Percutaneous tracheostomy compared to MV via TT significantly increased survival and the rate of discharge from ICU, without differences between early or late tracheostomy.
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- 2022
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10. Different Methods to Improve the Monitoring of Noninvasive Respiratory Support of Patients with Severe Pneumonia/ARDS Due to COVID-19: An Update
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Paolo Pelosi, Roberto Tonelli, Chiara Torregiani, Elisa Baratella, Marco Confalonieri, Denise Battaglini, Alessandro Marchioni, Paola Confalonieri, Enrico Clini, Francesco Salton, and Barbara Ruaro
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COVID-19 ,respiratory failure ,noninvasive respiratory support (NIRS) ,ARDS ,coronavirus disease ,Medicine - Abstract
The latest guidelines for the hospital care of patients affected by coronavirus disease 2019 (COVID-19)-related acute respiratory failure have moved towards the widely accepted use of noninvasive respiratory support (NIRS) as opposed to early intubation at the pandemic onset. The establishment of severe COVID-19 pneumonia goes through different pathophysiological phases that partially resemble typical acute respiratory distress syndrome (ARDS) and have been categorized into different clinical–radiological phenotypes. These can variably benefit on the application of external positive end-expiratory pressure (PEEP) during noninvasive mechanical ventilation, mainly due to variable levels of lung recruitment ability and lung compliance during different phases of the disease. A growing body of evidence suggests that intense respiratory effort producing excessive negative pleural pressure swings (Ppl) plays a critical role in the onset and progression of lung and diaphragm damage in patients treated with noninvasive respiratory support. Routine respiratory monitoring is mandatory to avoid the nasty continuation of NIRS in patients who are at higher risk for respiratory deterioration and could benefit from early initiation of invasive mechanical ventilation instead. Here we propose different monitoring methods both in the clinical and experimental settings adapted for this purpose, although further research is required to allow their extensive application in clinical practice. We reviewed the needs and available tools for clinical–physiological monitoring that aims at optimizing the ventilatory management of patients affected by acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.
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- 2022
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11. Reactivation of Herpes Simplex Virus Type 1 (HSV-1) Detected on Bronchoalveolar Lavage Fluid (BALF) Samples in Critically Ill COVID-19 Patients Undergoing Invasive Mechanical Ventilation: Preliminary Results from Two Italian Centers
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Daniele Roberto Giacobbe, Stefano Di Bella, Silvia Dettori, Giorgia Brucci, Verena Zerbato, Riccardo Pol, Ludovica Segat, Pierlanfranco D’Agaro, Erik Roman-Pognuz, Federica Friso, Luigi Principe, Umberto Lucangelo, Lorenzo Ball, Chiara Robba, Denise Battaglini, Andrea De Maria, Iole Brunetti, Nicolò Patroniti, Federica Briano, Bianca Bruzzone, Giulia Guarona, Laura Magnasco, Chiara Dentone, Giancarlo Icardi, Paolo Pelosi, Roberto Luzzati, and Matteo Bassetti
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HSV-1 ,herpes simplex virus ,reactivation ,intensive care ,COVID-19 ,SARS-CoV-2 ,Biology (General) ,QH301-705.5 - Abstract
Reactivation of herpes simplex virus type 1 (HSV-1) has been described in critically ill patients with coronavirus disease 2019 (COVID-19) pneumonia. In the present two-center retrospective experience, we primarily aimed to assess the cumulative risk of HSV-1 reactivation detected on bronchoalveolar fluid (BALF) samples in invasively ventilated COVID-19 patients with worsening respiratory function. The secondary objectives were the identification of predictors for HSV-1 reactivation and the assessment of its possible prognostic impact. Overall, 41 patients met the study inclusion criteria, and 12/41 patients developed HSV-1 reactivation (29%). No independent predictors of HSV-1 reactivation were identified in the present study. No association was found between HSV-1 reactivation and mortality. Eleven out of 12 patients with HSV-1 reactivation received antiviral therapy with intravenous acyclovir. In conclusion, HSV-1 reactivation is frequently detected in intubated patients with COVID-19. An antiviral treatment in COVID-19 patients with HSV-1 reactivation and worsening respiratory function might be considered.
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- 2022
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12. Early Administration of Bamlanivimab in Combination with Etesevimab Increases the Benefits of COVID-19 Treatment: Real-World Experience from the Liguria Region
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Antonio Vena, Giovanni Cenderello, Elisa Balletto, Laura Mezzogori, Alessandro Santagostino Barbone, Marco Berruti, Lorenzo Ball, Denise Battaglini, Alessandro Bonsignore, Chiara Dentone, Daniele Roberto Giacobbe, Tarek Kamal Eldin, Malgorzata Mikulska, Barbara Rebesco, Chiara Robba, Ambra Scintu, Andrea Stimamiglio, Lucia Taramasso, Paolo Pelosi, Stefania Artioli, and Matteo Bassetti
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COVID-19 ,bamlanivimab ,etesevimab ,hospital admission ,Medicine - Abstract
Monoclonal antibodies, such as bamlanivimab and etesevimab combination (BEC), have been proposed for patients with mild or moderate coronavirus disease 2019 (COVID-19). However, few studies have assessed the factors associated with the early administration of BEC or the impact of early BEC treatment on the clinical evolution of the patients. We conducted a retrospective cohort study of all adults with COVID-19 who received BEC at three institutions in the Liguria region. The primary endpoint was to investigate the clinical variables associated with early BEC infusion. Secondary endpoints were 30-day overall mortality and the composite endpoint of requirement of hospital admission or need for supplemental oxygen during the 30-day follow-up period. A total of 127 patients (median age 70 years; 56.7% males) received BEC. Of those, 93 (73.2%) received BEC within 5 days from symptoms onset (early BEC). Patients with a higher Charlson comorbidity index were more likely to receive early treatment (odds ratio (OR) 1.60, 95% confidence interval (CI) 1.04–2.45; p = 0.03) in contrast to those reporting fever at presentation (OR 0.26, 0.08–0.82; p = 0.02). Early BEC was associated with lower likelihood of hospital admission or need for supplemental oxygen (OR 0.19, 0.06–0.65; p = 0.008). Five patients who received early BEC died during the follow-up period, but only one of them due to COVID-19-related causes. Early bamlanivimab and etesevimab combination was more frequently administered to patients with a high Charlson comorbidity index. Despite this, early BEC was associated with a lower rate of hospital admission or need for any supplementary oxygen compared to late administration. These results suggest that efforts should focus on encouraging early BEC use in patients with mild–moderate COVID-19 at risk for complications.
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- 2021
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13. Extension of Collagen Deposition in COVID-19 Post Mortem Lung Samples and Computed Tomography Analysis Findings
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Lorenzo Ball, Emanuela Barisione, Luca Mastracci, Michela Campora, Delfina Costa, Chiara Robba, Denise Battaglini, Marco Micali, Federico Costantino, Giuseppe Cittadini, Nicolò Patroniti, Paolo Pelosi, Roberto Fiocca, and Federica Grillo
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COVID-19 ,fibrosis ,collagen ,computed tomography ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Lung fibrosis has specific computed tomography (CT) findings and represents a common finding in advanced COVID-19 pneumonia whose reversibility has been poorly investigated. The aim of this study was to quantify the extension of collagen deposition and aeration in postmortem cryobiopsies of critically ill COVID-19 patients and to describe the correlations with qualitative and quantitative analyses of lung CT. Postmortem transbronchial cryobiopsy samples were obtained, formalin fixed, paraffin embedded and stained with Sirius red to quantify collagen deposition, defining fibrotic samples as those with collagen deposition above 10%. Lung CT images were analyzed qualitatively with a radiographic score and quantitatively with computer-based analysis at the lobe level. Thirty samples from 10 patients with COVID-19 pneumonia deceased during invasive mechanical ventilation were included in this study. The median [interquartile range] percent collagen extension was 6.8% (4.6–16.2%). In fibrotic compared to nonfibrotic samples, the qualitative score was higher (260 (250–290) vs. 190 (120–270), p = 0.036) while the gas fraction was lower (0.46 (0.32–0.47) vs. 0.59 (0.37–0.68), p = 0.047). A radiographic score above 230 had 100% sensitivity (95% confidence interval, CI: 66.4% to 100%) and 66.7% specificity (95% CI: 41.0% to 92.3%) to detect fibrotic samples, while a gas fraction below 0.57 had 100% sensitivity (95% CI: 66.4% to 100%) and 57.1% specificity (95% CI: 26.3% to 88.0%). In COVID-19 pneumonia, qualitative and quantitative analyses of lung CT images have high sensitivity but moderate to low specificity to detect histopathological fibrosis. Pseudofibrotic CT findings do not always correspond to increased collagen deposition.
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- 2021
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14. Tracheostomy Timing and Outcome in Severe COVID-19: The WeanTrach Multicenter Study
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Denise Battaglini, Francesco Missale, Irene Schiavetti, Marta Filauro, Francesca Iannuzzi, Alessandro Ascoli, Alberto Bertazzoli, Federico Pascucci, Salvatore Grasso, Francesco Murgolo, Simone Binda, Davide Maraggia, Giorgia Montrucchio, Gabriele Sales, Giuseppe Pascarella, Felice Eugenio Agrò, Gaia Faccio, Sandra Ferraris, Savino Spadaro, Giulia Falò, Nadia Mereto, Alessandro Uva, Jessica Giuseppina Maugeri, Bellissima Agrippino, Maria Vargas, Giuseppe Servillo, Chiara Robba, Lorenzo Ball, Francesco Mora, Alessio Signori, Antoni Torres, Daniele Roberto Giacobbe, Antonio Vena, Matteo Bassetti, Giorgio Peretti, Patricia R. M. Rocco, and Paolo Pelosi
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tracheostomy ,COVID-19 ,SARS-CoV-2 ,intensive care ,coronavirus ,surgical technique ,Medicine - Abstract
Background: Tracheostomy can be performed safely in patients with coronavirus disease 2019 (COVID-19). However, little is known about the optimal timing, effects on outcome, and complications. Methods: A multicenter, retrospective, observational study. This study included 153 tracheostomized COVID-19 patients from 11 intensive care units (ICUs). The primary endpoint was the median time to tracheostomy in critically ill COVID-19 patients. Secondary endpoints were survival rate, length of ICU stay, and post-tracheostomy complications, stratified by tracheostomy timing (early versus late) and technique (surgical versus percutaneous). Results: The median time to tracheostomy was 15 (1–64) days. There was no significant difference in survival between critically ill COVID-19 patients who received tracheostomy before versus after day 15, nor between surgical and percutaneous techniques. ICU length of stay was shorter with early compared to late tracheostomy (p < 0.001) and percutaneous compared to surgical tracheostomy (p = 0.050). The rate of lower respiratory tract infections was higher with surgical versus percutaneous technique (p = 0.007). Conclusions: Among critically ill patients with COVID-19, neither early nor percutaneous tracheostomy improved outcomes, but did shorten ICU stay. Infectious complications were less frequent with percutaneous than surgical tracheostomy.
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- 2021
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15. An Experimental Pre-Post Study on the Efficacy of Respiratory Physiotherapy in Severe Critically III COVID-19 Patients
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Denise Battaglini, Salvatore Caiffa, Giovanni Gasti, Elena Ciaravolo, Chiara Robba, Jacob Herrmann, Sarah E. Gerard, Matteo Bassetti, Paolo Pelosi, Lorenzo Ball, and on behalf of the GECOVID Group
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COVID-19 ,chest physiotherapy ,lung ultrasound ,intensive care unit ,SARS-CoV-2 ,respiratory physiotherapy ,Medicine - Abstract
Background: Respiratory physiotherapy (RPT) is considered essential in patients’ management during intensive care unit (ICU) stay. The role of RPT in critically ill COVID-19 patients is poorly described. We aimed to investigate the effects of RPT on oxygenation and lung aeration in critically ill COVID-19 patients admitted to the ICU. Methods: Observational pre-post study. Patients with severe COVID-19 admitted to the ICU, who received a protocolized CPT session and for which a pre-and post-RPT lung ultrasound (LUS) was performed, were included. A subgroup of patients had an available quantitative computed tomography (CT) scan performed within 4 days from RPT. The primary aim was to evaluate whether RPT improved oxygenation; secondary aims included correlations between LUS, CT and response to RPT. Results: Twenty patients were included. The median (1st–3rd quartile) PaO2/FiO2 was 181 (105–456), 244 (137–497) and 246 (137–482) at baseline (T0), after RPT (T1), and after 6 h (T2), respectively. PaO2/FiO2 improved throughout the study (p = 0.042); particularly, PaO2/FiO2 improved at T1 in respect to T0 (p = 0.011), remaining higher at T2 (p = 0.007) compared to T0. Correlations between LUS, volume of gas (rho = 0.58, 95%CI 0.05–0.85, p = 0.033) and hyper-aerated mass at CT scan (rho = 0.54, 95% CI 0.00–0.84, p = 0.045) were detected. No significant changes in LUS score were observed before and after RPT. Conclusions: RPT improved oxygenation and the improvement persisted after 6 h. Oxygenation improvement was not reflected by aeration changes assessed with LUS. Further studies are warranted to assess the efficacy of RPT in COVID-19 ICU patients.
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- 2021
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16. Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study
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Daniele Roberto Giacobbe, Denise Battaglini, Elisa Martina Enrile, Chiara Dentone, Antonio Vena, Chiara Robba, Lorenzo Ball, Michele Bartoletti, Irene Coloretti, Stefano Di Bella, Antonio Di Biagio, Iole Brunetti, Malgorzata Mikulska, Novella Carannante, Andrea De Maria, Laura Magnasco, Alberto Enrico Maraolo, Michele Mirabella, Giorgia Montrucchio, Nicolò Patroniti, Lucia Taramasso, Giusy Tiseo, Giacomo Fornaro, Fiorentino Fraganza, Luca Monastra, Erik Roman-Pognuz, Giacomo Paluzzano, Giuseppe Fiorentino, Antonio Corcione, Linda Bussini, Renato Pascale, Silvia Corcione, Tommaso Tonetti, Matteo Rinaldi, Marco Falcone, Emanuela Biagioni, Vito Marco Ranieri, Maddalena Giannella, Francesco Giuseppe De Rosa, Massimo Girardis, Francesco Menichetti, Pierluigi Viale, Paolo Pelosi, and Matteo Bassetti
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VAP ,COVID-19 ,SARS-CoV-2 ,coronavirus ,ventilation ,Medicine - Abstract
The primary objective of this multicenter, observational, retrospective study was to assess the incidence rate of ventilator-associated pneumonia (VAP) in coronavirus disease 2019 (COVID-19) patients in intensive care units (ICU). The secondary objective was to assess predictors of 30-day case-fatality of VAP. From 15 February to 15 May 2020, 586 COVID-19 patients were admitted to the participating ICU. Of them, 171 developed VAP (29%) and were included in the study. The incidence rate of VAP was of 18 events per 1000 ventilator days (95% confidence intervals [CI] 16–21). Deep respiratory cultures were available and positive in 77/171 patients (45%). The most frequent organisms were Pseudomonas aeruginosa (27/77, 35%) and Staphylococcus aureus (18/77, 23%). The 30-day case-fatality of VAP was 46% (78/171). In multivariable analysis, septic shock at VAP onset (odds ratio [OR] 3.30, 95% CI 1.43–7.61, p = 0.005) and acute respiratory distress syndrome at VAP onset (OR 13.21, 95% CI 3.05–57.26, p < 0.001) were associated with fatality. In conclusion, VAP is frequent in critically ill COVID-19 patients. The related high fatality is likely the sum of the unfavorable prognostic impacts of the underlying viral and the superimposed bacterial diseases.
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- 2021
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17. Coagulative Disorders in Critically Ill COVID-19 Patients with Acute Distress Respiratory Syndrome: A Critical Review
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Chiara Robba, Denise Battaglini, Lorenzo Ball, Alberto Valbusa, Italo Porto, Roberta Della Bona, Giovanni La Malfa, Nicolò Patroniti, Iole Brunetti, Maurizio Loconte, Matteo Bassetti, Daniele R. Giacobbe, Antonio Vena, Claudia Lucia M. Silva, Patricia R. M. Rocco, and Paolo Pelosi
- Subjects
COVID-19 ,thrombosis ,coagulopathy ,platelets ,bleeding ,heparin ,Medicine - Abstract
In critically ill patients with acute respiratory distress syndrome (ARDS) coronavirus disease 2019 (COVID-19), a high incidence of thromboembolic and hemorrhagic events is reported. COVID-19 may lead to impairment of the coagulation cascade, with an imbalance in platelet function and the regulatory mechanisms of coagulation and fibrinolysis. Clinical manifestations vary from a rise in laboratory markers and subclinical microthrombi to thromboembolic events, bleeding, and disseminated intravascular coagulation. After an inflammatory trigger, the mechanism for activation of the coagulation cascade in COVID-19 is the tissue factor pathway, which causes endotoxin and tumor necrosis factor-mediated production of interleukins and platelet activation. The consequent massive infiltration of activated platelets may be responsible for inflammatory infiltrates in the endothelial space, as well as thrombocytopenia. The variety of clinical presentations of the coagulopathy confronts the clinician with the difficult questions of whether and how to provide optimal supportive care. In addition to coagulation tests, advanced laboratory tests such as protein C, protein S, antithrombin, tissue factor pathway inhibitors, D-dimers, activated factor Xa, and quantification of specific coagulation factors can be useful, as can thromboelastography or thromboelastometry. Treatment should be tailored, focusing on the estimated risk of bleeding and thrombosis. The aim of this review is to explore the pathophysiology and clinical evidence of coagulation disorders in severe ARDS-related COVID-19 patients.
- Published
- 2021
- Full Text
- View/download PDF
18. Prevalence of Antibodies to SARS-CoV-2 in Italian Adults and Associated Risk Factors
- Author
-
Antonio Vena, Marco Berruti, Andrea Adessi, Pietro Blumetti, Michele Brignole, Renato Colognato, Germano Gaggioli, Daniele Roberto Giacobbe, Luisa Bracci-Laudiero, Laura Magnasco, Alessio Signori, Lucia Taramasso, Marco Varelli, Nicoletta Vendola, Lorenzo Ball, Chiara Robba, Denise Battaglini, Iole Brunetti, Paolo Pelosi, and Matteo Bassetti
- Subjects
SARS-CoV-2 ,COVID-19 ,antibodies ,serological test ,Medicine - Abstract
We aimed to assess the prevalence of and factors associated with anti- severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positivity in a large population of adult volunteers from five administrative departments of the Liguria and Lombardia regions. A total of 3609 individuals were included in this analysis. Participants were tested for anti-SARS-CoV-2 antibodies [Immunoglobulin G (IgG) and M (IgM) class antibodies] at three private laboratories (Istituto Diganostico Varelli, Medical Center, and Casa della Salute di Genova). Demographic data, occupational or private exposure to SARS-CoV-2-infected patients, and prior medical history consistent with SARS-CoV-2 infection were collected according to a preplanned analysis. The overall seroprevalence of anti-SARS-CoV-2 antibodies (IgG and/or IgM) was 11.0% [398/3609; confidence interval (CI) 10.0%–12.1%]. Seroprevalence was higher in female inmates than in male inmates (12.5% vs. 9.2%, respectively, p = 0.002), with the highest rate observed among adults aged >55 years (13.2%). A generalized estimating equations model showed that the main risk factors associated with SARS-CoV-2 seroprevalence were the following: an occupational exposure to the virus [Odd ratio (OR) = 2.36; 95% CI 1.59–3.50, p = 0.001], being a long-term care facility resident (OR = 4.53; 95% CI 3.19–6.45, p = 0.001), and reporting previous symptoms of influenza-like illness (OR = 4.86; 95% CI 3.75–6.30, p = 0.001) or loss of sense of smell or taste (OR = 41.00; 95% CI 18.94–88.71, p = 0.001). In conclusion, we found a high prevalence (11.0%) of SARS-CoV-2 infection that is significantly associated with residing in long-term care facilities or occupational exposure to the virus. These findings warrant further investigation into SARS-CoV-2 antibody prevalence among the Italian population.
- Published
- 2020
- Full Text
- View/download PDF
19. Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia
- Author
-
Catia Cillóniz, Cristina Dominedò, Antonella Ielpo, Miquel Ferrer, Albert Gabarrús, Denise Battaglini, Jesús Bermejo-Martin, Andrea Meli, Carolina García-Vidal, Adamanthia Liapikou, Mervyn Singer, and Antoni Torres
- Subjects
sepsis ,community-acquired pneumonia ,very old ,pneumonia ,Medicine - Abstract
Background: Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). Methods: We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison. Sepsis was diagnosed based on the Sepsis-3 criteria. The main clinical outcome was 30-day mortality. Results: Among the 4219 patients hospitalized with CAP during the study period, 1238 (29%) were very old. The prevalence of sepsis in this age group was 71%. Male sex, chronic renal disease, and diabetes mellitus were independent risk factors for sepsis, while antibiotic therapy before admission was independently associated with a lower risk of sepsis. Thirty-day and intensive care unit (ICU) mortality did not differ between patients with and without sepsis. In CAP-sepsis group, chronic renal disease and neurological disease were independent risk factors for 30-day mortality. Conclusion: In very old patients hospitalized with CAP, in-hospital and 1-year mortality rates were increased if they developed sepsis. Antibiotic therapy before hospital admission was associated with a lower risk of sepsis.
- Published
- 2019
- Full Text
- View/download PDF
20. Coagulative Disorders in Critically Ill COVID-19 Patients with Acute Distress Respiratory Syndrome: A Critical Review
- Author
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Nicolò Patroniti, Claudia Lucia Martins Silva, Daniele Roberto Giacobbe, Paolo Pelosi, Patricia R. M. Rocco, Italo Porto, Denise Battaglini, Antonio Vena, Lorenzo Ball, Roberta Della Bona, Chiara Robba, Maurizio Loconte, Iole Brunetti, Giovanni La Malfa, Alberto Valbusa, and Matteo Bassetti
- Subjects
medicine.medical_specialty ,ARDS ,acute distress respiratory syndrome ,lcsh:Medicine ,Review ,030204 cardiovascular system & hematology ,heparin ,Gastroenterology ,coagulopathy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Coagulopathy ,Coagulation testing ,030212 general & internal medicine ,Platelet activation ,Coagulation Disorder ,thrombosis ,Disseminated intravascular coagulation ,medicine.diagnostic_test ,business.industry ,lcsh:R ,COVID-19 ,General Medicine ,medicine.disease ,bleeding ,Thromboelastography ,Thromboelastometry ,platelets ,business - Abstract
In critically ill patients with acute respiratory distress syndrome (ARDS) coronavirus disease 2019 (COVID-19), a high incidence of thromboembolic and hemorrhagic events is reported. COVID-19 may lead to impairment of the coagulation cascade, with an imbalance in platelet function and the regulatory mechanisms of coagulation and fibrinolysis. Clinical manifestations vary from a rise in laboratory markers and subclinical microthrombi to thromboembolic events, bleeding, and disseminated intravascular coagulation. After an inflammatory trigger, the mechanism for activation of the coagulation cascade in COVID-19 is the tissue factor pathway, which causes endotoxin and tumor necrosis factor-mediated production of interleukins and platelet activation. The consequent massive infiltration of activated platelets may be responsible for inflammatory infiltrates in the endothelial space, as well as thrombocytopenia. The variety of clinical presentations of the coagulopathy confronts the clinician with the difficult questions of whether and how to provide optimal supportive care. In addition to coagulation tests, advanced laboratory tests such as protein C, protein S, antithrombin, tissue factor pathway inhibitors, D-dimers, activated factor Xa, and quantification of specific coagulation factors can be useful, as can thromboelastography or thromboelastometry. Treatment should be tailored, focusing on the estimated risk of bleeding and thrombosis. The aim of this review is to explore the pathophysiology and clinical evidence of coagulation disorders in severe ARDS-related COVID-19 patients.
- Published
- 2021
21. Prevalence of Antibodies to SARS-CoV-2 in Italian Adults and Associated Risk Factors
- Author
-
Laura Magnasco, Paolo Pelosi, Andrea Adessi, Renato Colognato, Marco Varelli, Chiara Robba, Michele Brignole, Matteo Bassetti, Denise Battaglini, Nicoletta Vendola, Alessio Signori, Marco Berruti, Luisa Bracci-Laudiero, Daniele Roberto Giacobbe, Lorenzo Ball, Lucia Taramasso, Antonio Vena, Pietro Blumetti, Iole Brunetti, and Germano Gaggioli
- Subjects
medicine.medical_specialty ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,viruses ,lcsh:Medicine ,SARS-CoV-2 ,COVID-19 ,antibodies ,serological test ,030204 cardiovascular system & hematology ,Immunoglobulin G ,Article ,Serology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Seroprevalence ,Medical history ,030212 general & internal medicine ,skin and connective tissue diseases ,Generalized estimating equation ,biology ,business.industry ,fungi ,lcsh:R ,virus diseases ,General Medicine ,Confidence interval ,body regions ,biology.protein ,Antibody ,business - Abstract
We aimed to assess the prevalence of and factors associated with anti- severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positivity in a large population of adult volunteers from five administrative departments of the Liguria and Lombardia regions. A total of 3609 individuals were included in this analysis. Participants were tested for anti-SARS-CoV-2 antibodies [Immunoglobulin G (IgG) and M (IgM) class antibodies] at three private laboratories (Istituto Diganostico Varelli, Medical Center, and Casa della Salute di Genova). Demographic data, occupational or private exposure to SARS-CoV-2-infected patients, and prior medical history consistent with SARS-CoV-2 infection were collected according to a preplanned analysis. The overall seroprevalence of anti-SARS-CoV-2 antibodies (IgG and/or IgM) was 11.0% [398/3609; confidence interval (CI) 10.0%–12.1%]. Seroprevalence was higher in female inmates than in male inmates (12.5% vs. 9.2%, respectively, p = 0.002), with the highest rate observed among adults aged >55 years (13.2%). A generalized estimating equations model showed that the main risk factors associated with SARS-CoV-2 seroprevalence were the following: an occupational exposure to the virus [Odd ratio (OR) = 2.36; 95% CI 1.59–3.50, p = 0.001], being a long-term care facility resident (OR = 4.53; 95% CI 3.19–6.45, p = 0.001), and reporting previous symptoms of influenza-like illness (OR = 4.86; 95% CI 3.75–6.30, p = 0.001) or loss of sense of smell or taste (OR = 41.00; 95% CI 18.94–88.71, p = 0.001). In conclusion, we found a high prevalence (11.0%) of SARS-CoV-2 infection that is significantly associated with residing in long-term care facilities or occupational exposure to the virus. These findings warrant further investigation into SARS-CoV-2 antibody prevalence among the Italian population.
- Published
- 2020
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