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1. Effect of Intraoperative High Positive End-Expiratory Pressure (PEEP) with Recruitment Maneuvers vs Low PEEP on Postoperative Pulmonary Complications in Obese Patients: A Randomized Clinical Trial

Author

Bluth, T, Neto, As, Schultz, Mj, Pelosi, P, de Abreu MG, Bobek, I, Canet, Jc, de Baerdemaeker, L, Gregoretti, C, Hedenstierna, G, Hemmes, Snt, Hiesmayr, M, Hollmann, M, Jaber, S, Laffey, J, Licker, Mj, Markstaller, K, Matot, I, Mills, G, Mulier, Jp, Putensen, C, Rossaint, R, Schmitt, J, Senturk, M, Severgnini, P, Sprung, J, Melo, Mfv, Wrigge, H, Abelha, F, Abitagaoglu, S, Achilles, M, Adebesin, A, Adriaensens, I, Ahene, C, Akbar, F, Al Harbi, M, al Kallab RA, Albanel, X, Aldenkortt, F, Alfouzan, Ras, Alruqaie, R, Altermatt, F, Araujo, Bld, Arbesu, G, Artsi, H, Aurilio, C, Ayanoglu, Oh, Bacuzzi, A, Baig, H, Baird, Y, Balonov, K, Balust, J, Banks, S, Bao, Xd, Baumgartner, M, Tortosa, Ib, Bergamaschi, A, Bergmann, L, Bigatello, L, Perez, Eb, Birr, K, Bojaxhi, E, Bonenti, C, Bonney, I, Bos, Ee, Bowman, S, Braz, Lg, Brugnoni, E, Brunetti, I, Bruni, A, Buenvenida, Sl, Camerini, Cj, Canet, J, Capatti, B, Carmona, J, Carungcong, J, Carvalho, M, Cattan, A, Cavaleiro, C, Chiumello, D, Ciardo, S, Coburn, M, Colella, U, Contreras, V, Dincer, Pc, Cotter, E, Crovetto, M, Crovetto, W, Darrah, W, Davies, S, De Hert, S, Peces, Ed, Delphin, E, Diaper, J, do Nascimento, P, Donatiello, V, Dong, J, Dourado, Md, Dullenkopf, A, Ebner, F, Elgendy, H, Ellenberger, C, Ari, De, Ermert, T, Farah, F, Fernandez-Bustamante, A, Ferreira, C, Fiore, M, Fonte, A, Palahi, Cf, Galimberti, A, Garofano, N, Giaccari, Lg, Gilsanz, F, Girrbach, F, Gobbi, L, Godfried, Mb, Goettel, N, Goldstein, Pa, Goren, O, Gorlin, A, Gil, Mg, Gratarola, A, Graterol, J, Guyon, P, Haire, K, Harou, P, Helf, A, Hempel, G, Cadiz, Mjh, Heyse, B, Hollmann, Mw, Huercio, I, Ilievska, J, Jakus, L, Jeganath, V, Jelting, Y, Jung, M, Kabon, B, Kacha, A, Ilic, Mk, Karuppiah, A, Kavas, Ad, Barcelos, Gk, Kellogg, Ta, Kemper, J, Kerbrat, R, Khodr, S, Kienbaum, P, Kir, B, Kiss, T, Kivrak, S, Klaric, V, Koch, T, Koksal, C, Kowark, A, Kranke, P, Kuvaki, B, Kuzmanovska, B, Lange, M, de Lemos MF, Lopez-Baamonde, M, Lopez-Hernandez, A, Lopez-Martinez, M, Luise, S, Macgregor, M, Magalhaes, D, Maillard, J, Malerbi, P, Manimekalai, N, Margarson, M, Martin, Dp, Martin, Yn, Martinez-Ocon, J, Martin-Loeches, I, Maseda, E, Mcauliffe, N, Mckenzie, Tj, Medina, P, Meersch, M, Menzen, A, Mertens, E, Meurer, B, Meyer-Treschan, T, Miao, Ch, Micalizzi, C, Milic, M, Modolo, Nsp, Moine, P, Molders, P, Montero-Feijoo, A, Moret, E, Muller, Mk, Murphy, Z, Nalwaya, P, Naumovski, F, Navalesi, P, Lima, Lhne, Adam, Vn, Neumann, C, Newell, C, Nisnevitch, Z, Nizamuddin, J, Novazzi, C, O'Connor, M, Oprea, G, Sungur, Mo, Ozbilgin, S, Pace, Mc, Pacheco, M, Packianathaswamy, B, Gonzalez, Ep, Papaspyros, F, Paredes, S, Passavanti, Mb, Pedemonte, Jc, Peremin, S, Philipsenburg, C, Pinho, D, Pinho, S, Posthuma, Lm, Pota, V, Preckel, B, Priani, P, Rached, Ma, Radoeshki, A, Ragazzi, R, Rajamanickam, T, Rajamohan, A, Ramakrishna, H, Rangarajan, D, Reiterer, C, Renew, Jr, Reynaud, T, Rhys, R, Rivas, E, Robitzky, L, Rubulotta, F, Machado, Hs, Nunes, Cs, Sabbatini, G, Sanahuja, Jm, Sansone, P, Santos, A, Sayedalahl, M, Schaefer, Ms, Scharffenberg, E, Scharffenberg, M, Schiffer, E, Schliewe, N, Schorer, R, Schumann, R, Selmo, G, Sendra, M, Shaw, K, Shosholcheva, M, Sibai, A, Simon, P, Simonassi, F, Sinno, C, Sivrikoz, N, Skandalou, V, Smith, N, Soares, M, Artiles, Ts, Castro, Ds, Sousa, M, Spadaro, S, Stamatakis, E, Steiner, La, Stevenazzi, A, Suarez-de-la-Rica, A, Suppan, M, Teichmann, R, Guerrero, Jmt, Thiel, B, Tolos, R, Altun, Gt, Tucci, M, Turnbull, Za, Turudic, Z, Unterberg, M, Van Limmen, J, Van Nieuwenhove, Y, Van Waesberghe, J, Francisco, M, Melo, V, Vitkovic, B, Vivona, L, Vizcaychipi, M, Volta, Ca, Weber, A, Weingarten, Tn, Wittenstein, J, Wyffels, P, Yague, J, Yates, D, Yavru, A, Zac, L, Zhong, J, Intensive Care Medicine, ACS - Heart failure & arrhythmias, Anesthesiology, ACS - Diabetes & metabolism, APH - Quality of Care, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, Bluth T., Serpa Neto A., Schultz M.J., Pelosi P., Gama de Abreu M., Bobek I., Canet J.C., Cinella G., de Baerdemaeker L., Gregoretti C., Hedenstierna G., Hemmes S.N.T., Hiesmayr M., Hollmann M.W., Jaber S., Laffey J., Licker M.-J., Markstaller K., Matot I., Mills G.H., Mulier J.P., Putensen C., Rossaint R., Schmitt J., Senturk M., Severgnini P., Sprung J., Vidal Melo M.F., Wrigge H., Abelha F., Abitagaoglu S., Achilles M., Adebesin A., Adriaensens I., Ahene C., Akbar F., Harbi M.A., Al Kallab R.A.K., Albanel X., Aldenkortt F., Alfouzan R.A.S., Alruqaie R., Altermatt F., de Castro Araujo B.L., Arbesu G., Artsi H., Aurilio C., Ayanoglu O.H., Bacuzzi A., Baig H., Baird Y., Balonov K., Balust J., Banks S., Bao X., Baumgartner M., Tortosa I.B., Bergamaschi A., Bergmann L., Bigatello L., Perez E.B., Birr K., Bojaxhi E., Bonenti C., Bonney I., Bos E.M.E., Bowman S., Braz L.G., Brugnoni E., Brull S.J., Brunetti I., Bruni A., Buenvenida S.L., Busch C.J., Camerini G., Capatti B., Carmona J., Carungcong J., Carvalho M., Cattan A., Cavaleiro C., Chiumello D., Ciardo S., Coburn M., Colella U., Contreras V., Dincer P.C., Cotter E., Crovetto M., Darrah W., Davies S., De Hert S., Peces E.D.C., Delphin E., Diaper J., Do Nascimento Junior P., Donatiello V., Dong J., Dourado M.D.S., Dullenkopf A., Ebner F., Elgendy H., Ellenberger C., Erdogan Ari D., Ermert T., Farah F., Fernandez-Bustamante A., Ferreira C., Fiore M., Fonte A., Palahi C.F., Galimberti A., Garofano N., Giaccari L.G., Gilsanz F., Girrbach F., Gobbi L., Godfried M.B., Goettel N., Goldstein P.A., Goren O., Gorlin A., Gil M.G., Gratarola A., Graterol J., Guyon P., Haire K., Harou P., Helf A., Hempel G., Cadiz M.J.H., Heyse B., Huercio I., Ilievska J., Jakus L., Jeganath V., Jelting Y., Jung M., Kabon B., Kacha A., Ilic M.K., Karuppiah A., Kavas A.D., Barcelos G.K., Kellogg T.A., Kemper J., Kerbrat R., Khodr S., Kienbaum P., Kir B., Kiss T., Kivrak S., Klaric V., Koch T., Koksal C., Kowark A., Kranke P., Kuvaki B., Kuzmanovska B., Lange M., de Lemos M.F., Lopez-Baamonde M., Lopez-Hernandez A., Lopez-Martinez M., Luise S., Macgregor M., Magalhaes D., Maillard J., Malerbi P., Manimekalai N., Margarson M., Martin A.K., Martin D.P., Martin Y.N., Martinez-Ocon J., Martin-Loeches I., Maseda E., McAuliffe N., McKenzie T.J., Medina P., Meersch M., Menzen A., Mertens E., Meurer B., Meyer-Treschan T., Miao C., Micalizzi C., Milic M., Modolo N.S.P., Moine P., Molders P., Montero-Feijoo A., Moret E., Muller M.K., Murphy Z., Nalwaya P., Naumovski F., Navalesi P., Navarro E Lima L.H., Adam V.N., Neumann C., Newell C., Nisnevitch Z., Nizamuddin J., Novazzi C., O'connor M., Oprea G., Sungur M.O., Ozbilgin S., Pace M.C., Pacheco M., Packianathaswamy B., Gonzalez E.P., Papaspyros F., Paredes S., Passavanti M.B., Pedemonte J.C., Peremin S., Philipsenburg C., Pinho D., Pinho S., Posthuma L.M., Pota V., Preckel B., Priani P., Rached M.A., Radoeshki A., Ragazzi R., Rajamanickam T., Rajamohan A., Ramakrishna H., Rangarajan D., Reiterer C., Ross Renew J., Reynaud T., Rhys R., Rivas E., Robitzky L., Rubulotta F., Machado H.S., Nunes C.S., Sabbatini G., Samuels J.D., Sanahuja J.M., Sansone P., Santos A., Sayedalahl M., Schaefer M.S., Scharffenberg M., Schiffer E., Schliewe N., Schorer R., Schumann R., Selmo G., Sendra M., Shaw K., Shosholcheva M., Sibai A., Simon P., Simonassi F., Sinno C., Sivrikoz N., Skandalou V., Smith N., Soares M., Artiles T.S., Castro D.S., Sousa M., Spadaro S., Stamatakis E., Steiner L.A., Stevenazzi A., Suarez-De-la-rica A., Suppan M., Teichmann R., Guerrero J.M.T., Thiel B., Tolos R., Altun G.T., Tucci M., Turnbull Z.A., Turudic Z., Unterberg M., Van Limmen J., Van Nieuwenhove Y., Van Waesberghe J., Vitkovic B., Vivona L., Vizcaychipi M., Volta C.A., Weber A., Weingarten T.N., Wittenstein J., Wyffels P., Yague J., Yates D., Yavru A., Zac L., Zhong J., Bluth, T., Serpa Neto, A., Schultz, M. J., Pelosi, P., Gama De Abreu, M., Aurilio, C., Pace, M. C., Passavanti, M. B., Pota, V., and Sansone, P.

Subjects
Lung Diseases, Male, medicine.medical_treatment, Atelectasis, Lung Disease, 01 natural sciences, Body Mass Index, Hypoxemia, Positive-Pressure Respiration, Postoperative Complications, 0302 clinical medicine, PEEP, postoperative complications, obese patients, Anesthesia, Respiratory function, 030212 general & internal medicine, Tidal volume, General Medicine, Middle Aged, Pleural Diseases, respiratory system, Adult, Anesthesia, General, Female, Humans, Obesity, Pulmonary Atelectasis, Respiratory Insufficiency, Surgical Procedures, Operative, Tidal Volume, Treatment Outcome, Intraoperative Care, Operative, 3. Good health, Pneumothorax, medicine.symptom, psychological phenomena and processes, Human, circulatory and respiratory physiology, NO, 03 medical and health sciences, mental disorders, medicine, Pleural Disease, 0101 mathematics, General, Positive end-expiratory pressure, Mechanical ventilation, Surgical Procedures, Pulmonary Atelectasi, business.industry, 010102 general mathematics, medicine.disease, respiratory tract diseases, Respiratory failure, Postoperative Complication, business
Abstract

Importance: An intraoperative higher level of positive end-expiratory positive pressure (PEEP) with alveolar recruitment maneuvers improves respiratory function in obese patients undergoing surgery, but the effect on clinical outcomes is uncertain. Objective: To determine whether a higher level of PEEP with alveolar recruitment maneuvers decreases postoperative pulmonary complications in obese patients undergoing surgery compared with a lower level of PEEP. Design, Setting, and Participants: Randomized clinical trial of 2013 adults with body mass indices of 35 or greater and substantial risk for postoperative pulmonary complications who were undergoing noncardiac, nonneurological surgery under general anesthesia. The trial was conducted at 77 sites in 23 countries from July 2014-February 2018; final follow-up: May 2018. Interventions: Patients were randomized to the high level of PEEP group (n = 989), consisting of a PEEP level of 12 cm H2O with alveolar recruitment maneuvers (a stepwise increase of tidal volume and eventually PEEP) or to the low level of PEEP group (n = 987), consisting of a PEEP level of 4 cm H2O. All patients received volume-controlled ventilation with a tidal volume of 7 mL/kg of predicted body weight. Main Outcomes and Measures: The primary outcome was a composite of pulmonary complications within the first 5 postoperative days, including respiratory failure, acute respiratory distress syndrome, bronchospasm, new pulmonary infiltrates, pulmonary infection, aspiration pneumonitis, pleural effusion, atelectasis, cardiopulmonary edema, and pneumothorax. Among the 9 prespecified secondary outcomes, 3 were intraoperative complications, including hypoxemia (oxygen desaturation with Spo2 ≤92% for >1 minute). Results: Among 2013 adults who were randomized, 1976 (98.2%) completed the trial (mean age, 48.8 years; 1381 [69.9%] women; 1778 [90.1%] underwent abdominal operations). In the intention-to-treat analysis, the primary outcome occurred in 211 of 989 patients (21.3%) in the high level of PEEP group compared with 233 of 987 patients (23.6%) in the low level of PEEP group (difference, -2.3% [95% CI, -5.9% to 1.4%]; risk ratio, 0.93 [95% CI, 0.83 to 1.04]; P =.23). Among the 9 prespecified secondary outcomes, 6 were not significantly different between the high and low level of PEEP groups, and 3 were significantly different, including fewer patients with hypoxemia (5.0% in the high level of PEEP group vs 13.6% in the low level of PEEP group; difference, -8.6% [95% CI, -11.1% to 6.1%]; P

Published
2019

2. Outcomes assessment of hepatitis C virus-positive psoriatic patients treated using pegylated interferon in combination with ribavirin compared to new direct-acting antiviral agents

Author

Paolo D. Pigatto, Sebastiano Leone, Stephen Petrou, Marco Fiore, Alessia Pacifico, Andrea Altomare, Maria Caterina Pace, Giovanni Damiani, C. Franchi, Damiani, G, Franchi, C, Pigatto, P, Altomare, A, Pacifico, A, Petrou, S, Leone, S, Pace, Mc, and Fiore, M

Subjects
Biological disease modifying drugs, viruses, Hepatitis C virus, Observational Study, New Direct-Acting Antiviral agents, medicine.disease_cause, 030207 dermatology & venereal diseases, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Pegylated interferon, Psoriasis, medicine, Hepatology, business.industry, Ribavirin, Hepatitis C, medicine.disease, Virology, humanities, chemistry, Hepatitis C Virus Positive, 030211 gastroenterology & hepatology, business, Direct acting, medicine.drug
Abstract

AIM To evaluate the outcomes in biological treatment and quality of life of psoriatic patients with chronic hepatitis C (CHC) treated with new Direct-Acting Antiviral agents (DAAs) compared to pegylated interferon-2α plus ribavirin (P/R) therapy. METHODS This is a retrospective study involving psoriatic patients in biological therapy who underwent anti-hepatitis C virus (HCV) treatment at the Department of Dermatology Galeazzi Orthopaedic Institute Milan, Italy from January 2010 to November 2017. The patients were divided into two groups: patients that underwent therapy with DAAs and patients that underwent HCV treatment with P/R. Patients were assessed by a dermatologist for psoriasis symptoms, collecting Psoriasis Area Severity Index (PASI) scores and the Dermatology Quality of Life Index (DLQI). PASI and DLQI scores were evaluated 24 wk after the end of HCV treatment and were assumed as an outcome of the progression of psoriasis. Switching to a different bDMARD was considered as an inadequate response to biological therapy. The dropout of HCV therapy and sustained virological response (SVR) were considered as outcomes of HCV therapy. RESULTS Fifty-nine psoriatic patients in biological therapy underwent antiviral therapy for CHC. Of this, 27 patients were treated with DAAs and 32 with P/R. After 24 wk post treatment, the DLQI and the PASI scores were significantly lower (P < 0.001 and P < 0.005, respectively) in the DAAs group compared with P/R group. None of the patients in the DAAs group (0/27) compared to 8 patients of the P/R group (8/32) needed a shift in biological treatment. CONCLUSION DAAs seem to be more effective and safe than P/R in HCV-positive psoriatic patients on biological treatment. Fewer dermatological adverse events may be due to interferon-free therapy.

Published
2018

3. Spontaneous peritonitis in critically ill cirrhotic patients: a diagnostic algorithm for clinicians and future perspectives

Author

Sabrina Bimonte, Marco Cascella, Arturo Cuomo, Alberto Enrico Maraolo, Ivan Gentile, Marco Fiore, Sebastiano Leone, Maria Caterina Pace, Vincenzo Schiavone, Fiore, M, Maraolo, ALBERTO ENRICO, Leone, S, Gentile, Ivan, Cuomo, A, Schiavone, V, Bimonte, S, Pace, Mc, Cascella, M., Fiore, Marco, Maraolo, Alberto Enrico, Leone, Sebastiano, Cuomo, Arturo, Schiavone, Vincenzo, Bimonte, Sabrina, Pace, Maria Caterina, and Cascella, Marco

Subjects
medicine.medical_specialty, Cirrhosis, Therapeutics and Clinical Risk Management, fungal ascites, Peritonitis, RM1-950, Gastroenterology, 03 medical and health sciences, Liver disease, Fungal peritonitis, 0302 clinical medicine, Spontaneous bacterial peritonitis, Internal medicine, medicine, Pharmacology (medical), General Pharmacology, Toxicology and Pharmaceutics, Intensive care medicine, fungal ascite, bacteriascite, Chemical Health and Safety, spontaneous bacterial peritoniti, Critically ill, business.industry, Abdominal Infection, Mortality rate, cirrhosis, Methodology, General Medicine, medicine.disease, Spontaneous fungal peritoniti, spontaneous bacterial peritonitis, spontaneous fungal peritonitis, 030220 oncology & carcinogenesis, Pharmacology, Toxicology and Pharmaceutics (all), bacteriascites, 030211 gastroenterology & hepatology, Therapeutics. Pharmacology, business, Safety Research, cirrhosi
Abstract

Marco Fiore,1 Alberto Enrico Maraolo,2 Sebastiano Leone,3 Ivan Gentile,2 Arturo Cuomo,4 Vincenzo Schiavone,5 Sabrina Bimonte,4 Maria Caterina Pace,1 Marco Cascella4 1Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy; 2Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy; 3Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino, Italy; 4Division of Anesthesia, Department of Anesthesia and Pain Medicine, Istituto Nazionale Tumori – IRCCS – Fondazione G.Pascale, Naples, Italy; 5Division of Anesthesia and Intensive Care, Hospital “Pineta Grande”, Castel Volturno, Italy Abstract: Spontaneous peritonitis (SP) is the most common infection among decompensated end-stage liver disease patients. SP is the infection of ascitic fluid (neutrophil ascitic count ≥250/mL) without an alternative focus of abdominal infection. According to the causative agent, clinicians can make the diagnosis of spontaneous bacterial peritonitis or spontaneous fungal peritonitis. The mortality rate is very high, ranging from one-fifth of the patients with spontaneous bacterial peritonitis to four-fifths of the patients with spontaneous fungal peritonitis. An immediate and accurate diagnosis can improve the outcome in end-stage liver disease patients. The aim of this work is to provide physicians with a practical diagnostic guidance for SP diagnosis according to current evidence, in order to improve the management of cirrhotic patients with infected ascitic fluid. Keywords: cirrhosis, spontaneous bacterial peritonitis, spontaneous fungal peritonitis, bacteriascites, fungal ascites

Published
2017

4. Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial

Author

Bluth, T., Teichmann, R., Hiesmayr, M., Socorro, Tania, Izquierdo, Ana, Soro, Marina, Granell Gil, Manuel, Hernández Cádiz, María José, Biosca Pérez, Elena, Suarez-de-la-Rica, Alejandro, Lopez-Martinez, Mercedes, Huercio, Iván, Maseda, Emilio, Hollmann, M. W., Yagüe, Julio, Cebrian Moreno, Alba, Rivas, Eva, Lopez-Baamonde, Manuel, Elgendy, Hamed, Sayedalahl, Mohamed, SIibai, Abdul Razak, Yavru, Aysen, Sivrikoz, Nukhet, Karadeniz, Meltem, Jaber, S., Corman Dincer, Pelin, Ayanoglu, Hilmi Omer, Tore Altun, Gulbin, Kavas, Ayse Duygu, Dinc, Bora, Kuvaki, Bahar, Ozbilgin, Sule, Erdogan, Dilek, Koksal, Ceren, Abitagaglu, Suheyla, Laffey, J. G., Aurilio, Caterina, Sansone, Pasquale, Pace, Caterina Maria, Donatiello, Valerio, Mattera, Silvana, Nazareno, Palange, Di Colandrea, Salvatore, Spadaro, Savino, Volta, Carlo Alberto, Ragazzi, Riccardo, Licker, M. J., Ciardo, Stefano, Gobbi, Luca, Severgnini, Paolo, Bacuzzi, Alessandro, Brugnoni, Elisa, Gratarola, Angelo, Micalizzi, Camilla, Simonassi, Francesca, Malerbi, Patrizia, Carboni, Adrea, Markstaller, K., Licker, Marc-Joseph, Dullenkopf, Alexander, Goettel, Nicolai, Nesek Adam, Visnja, Karaman Ilic, Maja, Klaric, Vlasta, Vitkovic, Bibiana, Milic, Morena, Zupcic, Miro, De Baerdemaeker, Luc, Matot, I., De Hert, Stefan, Heyse, Bjorn, Van Limmen, Jurgen, Van Nieuwenhove, Yves, Mertens, Els, Neyrinck, Arne, Mulier, Jan, Kahn, David, Godoroja, Daniela, Martin-Loeches, Martin, Müller, G., Vorotyntsev, Sergiy, Fronchko, Valentyna, Matot, Idit, Goren, Or, Zac, Lilach, Gaszynski, Thomasz, Laffey, Jon, Mills, Gary, Nalwaya, Pramod, Mac Gregor, Mark, Mills, G. H., Paddle, Jonathan, Balaji, Packianathaswamy, Rubulotta, Francesca, Adebesin, Afeez, Margarson, Mike, Davies, Simon, Rangarajan, Desikan, Newell, Christopher, Shosholcheva, Mirjana, Papaspyros, Fotios, Mulier, J. P., Skandalou, Vasiliki, Dzurnakov, Paula, Kiss, T., Putensen, C., Rossaint, Rolf, Schmitt, J., Senturk, M., Serpa Neto, A., Severgnini, P., Sprung, J., Vidal Melo, M. F., Wrigge, H., Schultz, M. J., Bobek, I., Pelosi, P., Gama de Abreu, M., PROBESE investigators, PROtective VEntilation Network (PROVEnet), Clinical Trial Network of the European Society of Anaesthesiology (ESA), Güldner, Andreas, Huhle, Robert, Uhlig, Christopher, Vivona, Luigi, Bergamaschi, Alice, Canet, J., Stevanovic, Ana, Treschan, Tanja, Schaefer, Maximilian, Kienbaum, Peter, Laufenberg-Feldmann, Rita, Bergmann, Lars, Ebner, Felix, Robitzky, Luisa, Mölders, Patrick, Cinnella, G., Unterberg, Matthias, Busch, Cornelius, Achilles, Marc, Menzen, Angelika, Freesemann, Harbert, Putensen, Christian, Machado, Humberto, Cavaleiro, Carla, Ferreira, Cristina, Pinho, Daniela, De Baerdemaeker, L., Carvalho, Marta, Pinho, Sílvia, Soares, Maria, Castro, Diogo Sousa, Abelha, Fernando, Rabico, Rui, Delphin, Ellise, Sprung, Juraj, Weingarten, Toby N., Kellogg, Todd A., Gregoretti, C., Martin, Yvette N., McKenzie, Travis J., Brull, Sorin J., Renew, J. Ross, Ramakrishna, Harish, Fernandez-Bustamante, Ana, Balonov, Konstantin, Baig, Harris R., Kacha, Aalok, Pedemonte, Juan C., Hedenstierna, G., Altermatt, Fernando, Corvetto, Marcia A., Paredes, Sebastian, Carmona, Javiera, Rolle, Augusto, Bos, Elke, Beurskens, Charlotte, Veering, B., Zonneveldt, Harry, Boer, Christa, Hemmes, S. N., Godfried, Marc, Thiel, Bram, Kabon, Barbara, Reiterer, Christian, Canet, Jaume, Tolós, Raquel, Sendra, Mar, González, Miriam, Gómez, Noemí, Ferrando, Carlos, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Bluth T., Teichmann R., Kiss T., Bobek I., Canet J., Cinnella G., De Baerdemaeker L., Gregoretti C., Hedenstierna G., Hemmes S.N., Hiesmayr M., Hollmann M.W., Jaber S., Laffey J.G., Licker M.J., Markstaller K., Matot I., Muller G., Mills G.H., Mulier J.P., Putensen C., Rossaint R., Schmitt J., Senturk M., Serpa Neto A., Severgnini P., Sprung J., Vidal Melo M.F., Wrigge H., Schultz M.J., Pelosi P., Gama de Abreu M., Guldner A., Huhle R., Uhlig C., Vivona L., Bergamaschi A., Stevanovic A., Treschan T., Schaefer M., Kienbaum P., Laufenberg-Feldmann R., Bergmann L., Ebner F., Robitzky L., Molders P., Unterberg M., Busch C., Achilles M., Menzen A., Freesemann H., Machado H., Cavaleiro C., Ferreira C.P., Pinho D., Carvalho M., Pinho S., Soares M., Castro D.S., Abelha F., Rabico R., Delphin E., Weingarten T.N., Kellogg T.A., Martin Y.N., McKenzie T.J., Brull S.J., Renew J.R., Ramakrishna H., Fernandez-Bustamante A., Balonov K., Baig H.R., Kacha A., Pedemonte J.C., Altermatt F., Corvetto M.A., Paredes S., Carmona J., Rolle A., Bos E., Beurskens C., Veering B., Zonneveldt H., Boer C., Godfried M., Thiel B., Kabon B., Reiterer C., Tolos R., Sendra M., Gonzalez M., Gomez N., Ferrando C., Socorro T., Izquierdo A., Soro M., Granell Gil M., Hernandez Cadiz M.J., Biosca Perez E., Suarez-de-la-Rica A., Lopez-Martinez M., Huercio I., Maseda E., Yague J., Cebrian Moreno A., Rivas E., Lopez-Baamonde M., Elgendy H., Sibai A.R., Yavru A., Sivrikoz N., Karadeniz M., Corman Dincer P., Ayanoglu H., Tore Altun G., Kavas A.D., Dinc B., Kuvaki B., Ozbilgin S., Erdogan D., Koksal C., Abitagaglu S., Aurilio C., Sansone P., Pace C.M., Donatiello V., Mattera S., Palange N., Di Colandrea S., Spadaro S., Volta C.A., Ragazzi R., Ciardo S., Gobbi L., Bacuzzi A., Brugnoni E., Gratarola A., Micalizzi C., Simonassi F., Malerbi P., Carboni A., Dullenkopf A., Goettel N., Nesek Adam V., Karaman Ilic M., Klaric V., Vitkovic B., Milic M., Miro Z., De Hert S., Heyse B., Van Limmen J., Van Nieuwenhove Y., Mertens E., Kahn D., Godoroja D., Martin-Loeches M., Vorotyntsev S., Fronchko V., Goren O., Zac L., Gaszynski T., Nalwaya P., Mac Gregor M., Paddle J., Balaji P., Rubulotta F., Adebesin A., Margarson M., Davies S., Rangarajan D., Newell C., Shosholcheva M., Papaspyros F., Skandalou V., Dzurnakova P., Anesthesiology, ACS - Heart failure & arrhythmias, AII - Inflammatory diseases, Intensive Care Medicine, ACS - Diabetes & metabolism, ACS - Pulmonary hypertension & thrombosis, ACS - Microcirculation, UCL - (SLuc) Département de médecine aiguë, UCL - (SLuc) Service d'anesthésiologie, Bluth, T, Teichmann, R, Kiss, T, Bobek, I, Canet, J, Cinnella, G, De Baerdemaeker, L, Gregoretti, C, Hedenstierna, G, Hemmes, S N, Hiesmayr, M, Hollmann, M W, Jaber, S, Laffey, J G, Licker, M J, Markstaller, K, Matot, I, Müller, G, Mills, G H, Mulier, J P, Putensen, C, Rossaint, R, Schmitt, J, Senturk, M, Serpa Neto, A, Severgnini, P, Sprung, J, Vidal Melo, M F, Wrigge, H, Schultz, M J, Pelosi, P, Gama de Abreu, M, Güldner, A, Huhle, R, Uhlig, C, Vivona, L, Bergamaschi, A, Stevanovic, A, Treschan, T, Schaefer, M, Kienbaum, P, Laufenberg-Feldmann, R, Bergmann, L, Ebner, F, Robitzky, L, Mölders, P, Unterberg, M, Busch, C, Achilles, M, Menzen, A, Freesemann, H, Machado, H, Cavaleiro, C, Ferreira, C, Pinho, D, Carvalho, M, Pinho, S, Soares, M, Castro, D, Abelha, F, Rabico, R, Delphin, E, Weingarten, Tn, Kellogg, Ta, Martin, Yn, Mckenzie, Tj, Brull, Sj, Renew, Jr, Ramakrishna, H, Fernandez-Bustamante, A, Balonov, K, Baig, Hr, Kacha, A, Pedemonte, Jc, Altermatt, F, Corvetto, Ma, Paredes, S, Carmona, J, Rolle, A, Bos, E, Beurskens, C, Veering, B, Zonneveldt, H, Boer, C, Godfried, M, Thiel, B, Kabon, B, Reiterer, C, Tolós, R, Sendra, M, González, M, Gómez, N, Ferrando, C, Socorro, T, Izquierdo, A, Soro, M, Granell Gil, M, Hernández Cádiz, Mj, Biosca Pérez, E, Suarez-de-la-Rica, A, Lopez-Martinez, M, Huercio, I, Maseda, E, Yagüe, J, Cebrian Moreno, A, Rivas, E, Lopez-Baamonde, M, Elgendy, H, Sayedalahl, M, Siibai, Ar, Yavru, A, Sivrikoz, N, Karadeniz, M, Corman Dincer, P, Ayanoglu, Ho, Tore Altun, G, Kavas, Ad, Dinc, B, Kuvaki, B, Ozbilgin, S, Erdogan, D, Koksal, C, Abitagaglu, S, Aurilio, C, Sansone, P, Pace, Mc, Donatiello, V, Mattera, S, Nazareno, P, Di Colandrea, S, Spadaro, Antonino, Volta, Ca, Ragazzi, R, Ciardo, S, Gobbi, L, Bacuzzi, A, Brugnoni, E, Gratarola, A, Micalizzi, C, Simonassi, F, Malerbi, P, Carboni, A, Licker, Mj, Dullenkopf, A, Goettel, N, Nesek Adam, V, Karaman Ilić, M, Klaric, V, Vitkovic, B, Milic, M, Zupcic, M, De Hert, S, Heyse, B, Van Limmen, J, Van Nieuwenhove, Y, Mertens, E, Neyrinck, A, Mulier, J, Kahn, D, Godoroja, D, Martin-Loeches, M, Vorotyntsev, S, Fronchko, V, Goren, O, Zac, L, Gaszynski, T, Laffey, J, Mills, G, Nalwaya, P, Mac Gregor, M, Paddle, J, Balaji, P, Rubulotta, F, Adebesin, A, Margarson, M, Davies, S, Rangarajan, D, Newell, C, Shosholcheva, M, Papaspyros, F, Skandalou, V, and Dzurňáková, P.

Subjects
Male, Lung Diseases, Time Factors, [SDV]Life Sciences [q-bio], Respiratory Medicine and Allergy, medicine.medical_treatment, RESPIRATORY-DISTRESS-SYNDROME, Medicine (miscellaneous), Hemodynamics, Mechanical ventilation, Obesity, Positive end-expiratory pressure, Postoperative pulmonary complication, Recruitment maneuver, Pharmacology (medical), LAPAROSCOPIC BARIATRIC SURGERY, Lung Disease, Body Mass Index, law.invention, Positive-Pressure Respiration, Study Protocol, 0302 clinical medicine, Clinical Protocols, Randomized controlled trial, Risk Factors, 030202 anesthesiology, law, Medicine and Health Sciences, Clinical endpoint, Anesthesia, Respiratory function, 030212 general & internal medicine, Lung, Lungmedicin och allergi, 2. Zero hunger, lcsh:R5-920, ddc:617, respiratory system, Operative, 3. Good health, Treatment Outcome, TIDAL VOLUMES, Research Design, Mechanical ventilation, Positive end-expiratory pressure, Recruitment maneuver, Obesity, Postoperative pulmonary complication, Surgical Procedures, Operative, Breathing, Female, Erratum, lcsh:Medicine (General), ALVEOLAR RECRUITMENT MANEUVER, Human, circulatory and respiratory physiology, medicine.medical_specialty, Time Factor, Anesthesia, General, Lung injury, Humans, Intraoperative Care, Protective Factors, NO, GENERAL-ANESTHESIA, DRIVING PRESSURE, 03 medical and health sciences, medicine, ddc:610, Clinical Protocol, General, Protective Factor, POSTOPERATIVE PULMONARY COMPLICATIONS, Surgical Procedures, INTERNATIONAL CONSENSUS, business.industry, Risk Factor, Surgery, respiratory tract diseases, business, LUNG INJURY
Abstract

Background Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients. Methods/design The PRotective Ventilation with Higher versus Lower PEEP during General Anesthesia for Surgery in OBESE Patients (PROBESE) study is a multicenter, two-arm, international randomized controlled trial. In total, 2013 obese patients with body mass index ≥35 kg/m2 scheduled for at least 2 h of surgery under general anesthesia and at intermediate to high risk for PPCs will be included. Patients are ventilated intraoperatively with a low tidal volume of 7 ml/kg (predicted body weight) and randomly assigned to PEEP of 12 cmH2O with lung recruitment maneuvers (high PEEP) or PEEP of 4 cmH2O without recruitment maneuvers (low PEEP). The occurrence of PPCs will be recorded as collapsed composite of single adverse pulmonary events and represents the primary endpoint. Discussion To our knowledge, the PROBESE trial is the first multicenter, international randomized controlled trial to compare the effects of two different levels of intraoperative PEEP during protective low tidal volume ventilation on PPCs in obese patients. The results of the PROBESE trial will support anesthesiologists in their decision to choose a certain PEEP level during general anesthesia for surgery in obese patients in an attempt to prevent PPCs. Trial registration ClinicalTrials.gov identifier: NCT02148692. Registered on 23 May 2014; last updated 7 June 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1929-0) contains supplementary material, which is available to authorized users.

Published
2017
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5. Metabolic syndrome is associated with a poor outcome in patients affected by outflow tract premature ventricular contractions treated by catheter ablation

Author

Sardu, Celestino, Carreras, Giovanni, Katsanos, Spyridon, Kamperidis, Vasileios, Pace, Maria Caterina, Passavanti, Maria Beatrice, Fava, Ilaria, Paolisso, Pasquale, Pieretti, Gorizio, Nicoletti, Giovanni Francesco, Paolisso, Giuseppe Marfella, Raffaele, SANTULLI, GAETANO, Sardu, Celestino, Carreras, Giovanni, Katsanos, Spyridon, Kamperidis, Vasileio, Pace, Maria Caterina, Passavanti, Maria Beatrice, Fava, Ilaria, Paolisso, Pasquale, Pieretti, Gorizio, Nicoletti, Giovanni Francesco, Santulli, Gaetano, Paolisso, Giuseppe, Marfella, Raffaele, Sardu, C, Carreras, G, Katsanos, S, Kamperidis, V, Pace, Mc, Passavanti, Mb, Fava, I, Paolisso, P, Pieretti, G, Nicoletti, Gf, Santulli, G, Paolisso, G, and Marfella, R.

Subjects
medicine.medical_specialty, Heart disease, medicine.medical_treatment, Biophysics, Catheter ablation, Recurrence, Internal medicine, medicine, Humans, Ventricular outflow tract, Prospective Studies, cardiovascular diseases, Prospective cohort study, Angiology, Metabolic Syndrome, business.industry, Proportional hazards model, Metabolic Syndrome X, medicine.disease, Ventricular Premature Complexes, Ventricular Premature Complexe, Cardiac surgery, Prospective Studie, Treatment Outcome, Catheter Ablation, cardiovascular system, Cardiology, Medicine, Metabolic syndrome, Cardiology and Cardiovascular Medicine, business, Research Article, Human
Abstract

Background The purpose of this study was to investigate the impact of metabolic syndrome (MS) on outcome of catheter ablation (CA) for treatment of frequent premature ventricular contraction beats (PVCs) originating from right ventricular outflow tract (RVOT), left ventricular outflow tract (LVOT) or coronary cusps (CUSPs), in patients with normal ventricular systolic function and absence of cardiac structural disease. Methods In this multicentre prospective study we evaluated 90 patients with frequent PVCs originating from RVOT (n = 68), LVOT (n = 19) or CUSPs (n = 3), treated with CA. According to baseline diagnosis they were divided in patients with MS (n = 24) or without MS (n = 66). The study endpoint was a composite of recurrence of acute or delayed outflow tract ventricular arrhythmia: acute spontaneous or inducible outflow tract ventricular arrhythmia recurrence or recurrence of outflow tract PVCs in holter monitoring at follow up. Results Patients with MS compared to patients without MS showed a higher acute post-procedural recurrence of outflow tract PVCs (n = 8, 66.6%, vs. n = 6, 9.0%, p = 0.005). At a mean follow up of 35 (17-43) months survival free of recurrence of outflow tract PVCs was lower in patients with baseline MS compared to patients without MS diagnosis (log-rank test, p

Published
2014
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