Search

Your search keyword '"Abbruzzese, C."' showing total 274 results
Start Over Author "Abbruzzese, C."
274 results on '"Abbruzzese, C."'

1. Comparison of multiple definitions for ventilator-associated pneumonia in patients requiring mechanical ventilation for non-pulmonary conditions: preliminary data from PULMIVAP, an Italian multi-centre cohort study

Author

Alagna, L., Palomba, E., Chatenoud, L., Massafra, R., Magni, F., Mancabelli, L., Donnini, S., Elli, F., Forastieri, A., Gaipa, G., Abbruzzese, C., Fumagalli, R., Munari, M., Panacea, A., Picetti, E., Terranova, L., Turroni, F., Vaschetto, R., Zoerle, T., Citerio, G., Gori, A., and Bandera, A.

Published
2023
Full Text
View/download PDF

2. Comparison of multiple definitions for Ventilator-Associated Pneumonia in patients requiring mechanical ventilation for non-pulmonary conditions: preliminary data from PULMIVAP, an Italian multicentre cohort study

Author

Alagna, L, Palomba, E, Chatenoud, L, Massafra, R, Magni, F, Mancabelli, L, Donnini, S, Elli, F, Forastieri, A, Gaipa, G, Abbruzzese, C, Fumagalli, R, Munari, M, Panacea, A, Picetti, E, Terranova, L, Turroni, F, Vaschetto, R, Zoerle, T, Citerio, G, Gori, A, Bandera, A, Alagna, Laura, Palomba, Emanuele, Chatenoud, Liliane, Massafra, Roberta, Magni, Federico, Mancabelli, Leonardo, Donnini, Sara, Elli, Francesca, Forastieri, Andrea, Gaipa, Giuseppe, Abbruzzese, Chiara, Fumagalli, Roberto, Munari, Marina, Panacea, Antonino, Picetti, Edoardo, Terranova, Leonardo, Turroni, Francesca, Vaschetto, Rosanna, Zoerle, Tommaso, Citerio, Giuseppe, Gori, Andrea, Bandera, Alessandra, Alagna, L, Palomba, E, Chatenoud, L, Massafra, R, Magni, F, Mancabelli, L, Donnini, S, Elli, F, Forastieri, A, Gaipa, G, Abbruzzese, C, Fumagalli, R, Munari, M, Panacea, A, Picetti, E, Terranova, L, Turroni, F, Vaschetto, R, Zoerle, T, Citerio, G, Gori, A, Bandera, A, Alagna, Laura, Palomba, Emanuele, Chatenoud, Liliane, Massafra, Roberta, Magni, Federico, Mancabelli, Leonardo, Donnini, Sara, Elli, Francesca, Forastieri, Andrea, Gaipa, Giuseppe, Abbruzzese, Chiara, Fumagalli, Roberto, Munari, Marina, Panacea, Antonino, Picetti, Edoardo, Terranova, Leonardo, Turroni, Francesca, Vaschetto, Rosanna, Zoerle, Tommaso, Citerio, Giuseppe, Gori, Andrea, and Bandera, Alessandra

Abstract

Objectives: To compare intensivist-diagnosed ventilator-associated pneumonia (iVAP) with four established definitions, assessing their agreement in detecting new episodes. Methods: A multi-centric prospective study on pulmonary microbiota was carried out in patients requiring mechanical ventilation (MV). Data collected were used to compare hypothetical VAP onset according to iVAP with the study consensus criteria, the European Centre for Disease Control and Prevention definition, and two versions of the latter adjusted for leukocyte count and fever. Results: In our cohort of 186 adult patients, iVAPs were 36.6% (68/186, 95% confidence interval 30.0–44.0%), with an incidence rate of 4.64/100 patient-MV-days, and median MV-day at diagnosis of 6. Forty-seven percent of patients (87/186) were identified as VAP by at least one criterion, with a median MV-day at diagnosis of 5. Agreement between intensivist judgement (iVAP/no-iVAP) and the criteria was highest for the study consensus criteria (50/87, 57.4%), but still one-third of iVAP were not identified and 9% of patients were identified as VAP contrary to intensivist diagnosis. VAP proportion differed between criteria (25.2–30.1%). Conclusions: Caution is needed when evaluating studies describing VAP incidence. Pre-agreed criteria and definitions that capture VAP's evolving nature provide greater consistency, but new clinically driven definitions are needed to align surveillance and diagnostic criteria with clinical practice.

Published
2023

3. Sigh in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: the PROTECTION pilot randomized clinical trial

Author

Mauri, T, Foti, G, Fornari, C, Grasselli, G, Pinciroli, R, Lovisari, F, Tubiolo, D, Volta, C, Spadaro, S, Rona, R, Rondelli, E, Navalesi, P, Garofalo, E, Knafelj, R, Gorjup, V, Colombo, R, Cortegiani, A, Zhou, J, D'Andrea, R, Calamai, I, Gonzalez, A, Roca, O, Grieco, D, Jovaisa, T, Bampalis, D, Becher, T, Battaglini, D, Ge, H, Luz, M, Constantin, J, Ranieri, M, Guerin, C, Mancebo, J, Pelosi, P, Fumagalli, R, Brochard, L, Pesenti, A, Papoff, A, Di Fenza, R, Gianni, S, Spinelli, E, Lissoni, A, Abbruzzese, C, Bronco, A, Villa, S, Russotto, V, Iachi, A, Ball, L, Patroniti, N, Spina, R, Giuntini, R, Peruzzi, S, Menga, L, Fossali, T, Castelli, A, Ottolina, D, Garcia-De-Acilu, M, Santafe, M, Schadler, D, Weiler, N, Carvajal, E, Calvo, C, Neou, E, Wang, Y, Zhou, Y, Longhini, F, Bruni, A, Leonardi, M, Gregoretti, C, Ippolito, M, Milazzo, Z, Querci, L, Ranieri, S, Insom, G, Berden, J, Noc, M, Mikuz, U, Arzenton, M, Lazzeri, M, Villa, A, Barreto, B, Rios, M, Gusmao-Flores, D, Phull, M, Barnes, T, Musarat, H, Conti, S, Mauri T., Foti G., Fornari C., Grasselli G., Pinciroli R., Lovisari F., Tubiolo D., Volta C. A., Spadaro S., Rona R., Rondelli E., Navalesi P., Garofalo E., Knafelj R., Gorjup V., Colombo R., Cortegiani A., Zhou J. -X., D'Andrea R., Calamai I., Gonzalez A. V., Roca O., Grieco D. L., Jovaisa T., Bampalis D., Becher T., Battaglini D., Ge H., Luz M., Constantin J. -M., Ranieri M., Guerin C., Mancebo J., Pelosi P., Fumagalli R., Brochard L., Pesenti A., Papoff A., Di Fenza R., Gianni S., Spinelli E., Lissoni A., Abbruzzese C., Bronco A., Villa S., Russotto V., Iachi A., Ball L., Patroniti N., Spina R., Giuntini R., Peruzzi S., Menga L. S., Fossali T., Castelli A., Ottolina D., Garcia-De-Acilu M., Santafe M., Schadler D., Weiler N., Carvajal E. R., Calvo C. P., Neou E., Wang Y. -M., Zhou Y. -M., Longhini F., Bruni A., Leonardi M., Gregoretti C., Ippolito M., Milazzo Z., Querci L., Ranieri S., Insom G., Berden J., Noc M., Mikuz U., Arzenton M., Lazzeri M., Villa A., Barreto B. B., Rios M. N. O., Gusmao-Flores D., Phull M., Barnes T., Musarat H., Conti S., Mauri, T, Foti, G, Fornari, C, Grasselli, G, Pinciroli, R, Lovisari, F, Tubiolo, D, Volta, C, Spadaro, S, Rona, R, Rondelli, E, Navalesi, P, Garofalo, E, Knafelj, R, Gorjup, V, Colombo, R, Cortegiani, A, Zhou, J, D'Andrea, R, Calamai, I, Gonzalez, A, Roca, O, Grieco, D, Jovaisa, T, Bampalis, D, Becher, T, Battaglini, D, Ge, H, Luz, M, Constantin, J, Ranieri, M, Guerin, C, Mancebo, J, Pelosi, P, Fumagalli, R, Brochard, L, Pesenti, A, Papoff, A, Di Fenza, R, Gianni, S, Spinelli, E, Lissoni, A, Abbruzzese, C, Bronco, A, Villa, S, Russotto, V, Iachi, A, Ball, L, Patroniti, N, Spina, R, Giuntini, R, Peruzzi, S, Menga, L, Fossali, T, Castelli, A, Ottolina, D, Garcia-De-Acilu, M, Santafe, M, Schadler, D, Weiler, N, Carvajal, E, Calvo, C, Neou, E, Wang, Y, Zhou, Y, Longhini, F, Bruni, A, Leonardi, M, Gregoretti, C, Ippolito, M, Milazzo, Z, Querci, L, Ranieri, S, Insom, G, Berden, J, Noc, M, Mikuz, U, Arzenton, M, Lazzeri, M, Villa, A, Barreto, B, Rios, M, Gusmao-Flores, D, Phull, M, Barnes, T, Musarat, H, Conti, S, Mauri T., Foti G., Fornari C., Grasselli G., Pinciroli R., Lovisari F., Tubiolo D., Volta C. A., Spadaro S., Rona R., Rondelli E., Navalesi P., Garofalo E., Knafelj R., Gorjup V., Colombo R., Cortegiani A., Zhou J. -X., D'Andrea R., Calamai I., Gonzalez A. V., Roca O., Grieco D. L., Jovaisa T., Bampalis D., Becher T., Battaglini D., Ge H., Luz M., Constantin J. -M., Ranieri M., Guerin C., Mancebo J., Pelosi P., Fumagalli R., Brochard L., Pesenti A., Papoff A., Di Fenza R., Gianni S., Spinelli E., Lissoni A., Abbruzzese C., Bronco A., Villa S., Russotto V., Iachi A., Ball L., Patroniti N., Spina R., Giuntini R., Peruzzi S., Menga L. S., Fossali T., Castelli A., Ottolina D., Garcia-De-Acilu M., Santafe M., Schadler D., Weiler N., Carvajal E. R., Calvo C. P., Neou E., Wang Y. -M., Zhou Y. -M., Longhini F., Bruni A., Leonardi M., Gregoretti C., Ippolito M., Milazzo Z., Querci L., Ranieri S., Insom G., Berden J., Noc M., Mikuz U., Arzenton M., Lazzeri M., Villa A., Barreto B. B., Rios M. N. O., Gusmao-Flores D., Phull M., Barnes T., Musarat H., and Conti S.

Abstract

Background: Sigh is a cyclic brief recruitment maneuver: previous physiologic studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity, and increase release of surfactant. Research Question: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? Study Design and Methods: We conducted a multicenter noninferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or ARDS undergoing PSV. Patients were randomized to the no-sigh group and treated by PSV alone, or to the sigh group, treated by PSV plus sigh (increase in airway pressure to 30 cm H2O for 3 s once per minute) until day 28 or death or successful spontaneous breathing trial. The primary end point of the study was feasibility, assessed as noninferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiologic parameters in the first week from randomization, 28-day mortality, and ventilator-free days. Results: Two-hundred and fifty-eight patients (31% women; median age, 65 [54-75] years) were enrolled. In the sigh group, 23% of patients failed to remain on assisted ventilation vs 30% in the no-sigh group (absolute difference, –7%; 95% CI, –18% to 4%; P =. 015 for noninferiority). Adverse events occurred in 12% vs 13% in the sigh vs no-sigh group (P =. 852). Oxygenation was improved whereas tidal volume, respiratory rate, and corrected minute ventilation were lower over the first 7 days from randomization in the sigh vs no-sigh group. There was no significant difference in terms of mortality (16% vs 21%; P =. 337) and ventilator-free days (22 [7-26] vs 22 [3-25] days; P =. 300) for the sigh vs no-sigh group. Interpretation: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk.

Published
2021

5. Dynamic bedside assessment of the physiologic effects of prone position in acute respiratory distress syndrome patients by electrical impedance tomography

Author

Dalla Corte, F, Mauri, T, Spinelli, E, Lazzeri, M, Turrini, C, Albanese, M, Abbruzzese, C, Lissoni, A, Galazzi, A, Eronia, N, Bronco, A, Maffezzini, E, Pesenti, A, Foti, G, Bellani, G, Grasselli, G, Dalla Corte F., Mauri T., Spinelli E., Lazzeri M., Turrini C., Albanese M., Abbruzzese C., Lissoni A., Galazzi A., Eronia N., Bronco A., Maffezzini E., Pesenti A., Foti G., Bellani G., Grasselli G., Dalla Corte, F, Mauri, T, Spinelli, E, Lazzeri, M, Turrini, C, Albanese, M, Abbruzzese, C, Lissoni, A, Galazzi, A, Eronia, N, Bronco, A, Maffezzini, E, Pesenti, A, Foti, G, Bellani, G, Grasselli, G, Dalla Corte F., Mauri T., Spinelli E., Lazzeri M., Turrini C., Albanese M., Abbruzzese C., Lissoni A., Galazzi A., Eronia N., Bronco A., Maffezzini E., Pesenti A., Foti G., Bellani G., and Grasselli G.

Abstract

BACKGROUND: Prone position (PP) improves acute respiratory distress syndrome (ARDS) survival by reducing the risk of ventilation-induced lung injury. However, inter-individual variability is a hallmark of ARDS and lung protection by PP might not be optimal in all patients. In the present study, we dynamically assessed physiologic effects of PP by electrical impedance tomography (EIT) and identified predictors of improved lung protection by PP in ARDS patients. METHODS: Prospective physiologic study on 16 intubated, sedated and paralyzed patients with ARDS undergoing PP as per clinical decision. EIT data were recorded during two consecutive steps: 1) baseline supine position before and after a recruitment maneuver (RM); 2) prone position before and after a RM. “Improved lung protection” by PP was defined in the presence of simultaneous improvement of ventilation homogeneity (Hom), alveolar overdistension and collapse (ODCL) and amount of recruitable lung volume by RM in comparison to supine. RESULTS: PP versus supine increased the tidal volume distending the dependent regions (Vtdep), resulting in improved Hom (1.1±0.9 vs. 1.7±0.9, P=0.021). PP also reduced ODCL (19±9% vs. 28±8%, P=0.005) and increased the recruitable lung volume (80 [71-157] vs. 59 [1-110] mL, P=0.025). “Improved lung protection” by PP was predicted by lower Vtdep, higher Vtndep and poorer Hom measured during baseline supine position (P<0.05). CONCLUSIONS: EIT enables dynamic bedside assessment of the physiologic effects of PP and might support early recognition of ARDS patients more likely to benefit from PP.

Published
2020

6. Assisted mechanical ventilation promotes recovery of diaphragmatic thickness in critically ill patients: A prospective observational study

Author

Grassi, A, Ferlicca, D, Lupieri, E, Calcinati, S, Francesconi, S, Sala, V, Ormas, V, Chiodaroli, E, Abbruzzese, C, Curto, F, Sanna, A, Zambon, M, Fumagalli, R, Foti, G, Bellani, G, Grassi A., Ferlicca D., Lupieri E., Calcinati S., Francesconi S., Sala V., Ormas V., Chiodaroli E., Abbruzzese C., Curto F., Sanna A., Zambon M., Fumagalli R., Foti G., Bellani G., Grassi, A, Ferlicca, D, Lupieri, E, Calcinati, S, Francesconi, S, Sala, V, Ormas, V, Chiodaroli, E, Abbruzzese, C, Curto, F, Sanna, A, Zambon, M, Fumagalli, R, Foti, G, Bellani, G, Grassi A., Ferlicca D., Lupieri E., Calcinati S., Francesconi S., Sala V., Ormas V., Chiodaroli E., Abbruzzese C., Curto F., Sanna A., Zambon M., Fumagalli R., Foti G., and Bellani G.

Abstract

Background: Diaphragm atrophy and dysfunction are consequences of mechanical ventilation and are determinants of clinical outcomes. We hypothesize that partial preservation of diaphragm function, such as during assisted modes of ventilation, will restore diaphragm thickness. We also aim to correlate the changes in diaphragm thickness and function to outcomes and clinical factors. Methods: This is a prospective, multicentre, observational study. Patients mechanically ventilated for more than 48 h in controlled mode and eventually switched to assisted ventilation were enrolled. Diaphragm ultrasound and clinical data collection were performed every 48 h until discharge or death. A threshold of 10% was used to define thinning during controlled and recovery of thickness during assisted ventilation. Patients were also classified based on the level of diaphragm activity during assisted ventilation. We evaluated the association between changes in diaphragm thickness and activity and clinical outcomes and data, such as ventilation parameters. Results: Sixty-two patients ventilated in controlled mode and then switched to the assisted mode of ventilation were enrolled. Diaphragm thickness significantly decreased during controlled ventilation (1.84 ± 0.44 to 1.49 ± 0.37 mm, p < 0.001) and was partially restored during assisted ventilation (1.49 ± 0.37 to 1.75 ± 0.43 mm, p < 0.001). A diaphragm thinning of more than 10% was associated with longer duration of controlled ventilation (10 [5, 15] versus 5 [4, 8.5] days, p = 0.004) and higher PEEP levels (12.6 ± 4 versus 10.4 ± 4 cmH2O, p = 0.034). An increase in diaphragm thickness of more than 10% during assisted ventilation was not associated with any clinical outcome but with lower respiratory rate (16.7 ± 3.2 versus 19.2 ± 4 bpm, p = 0.019) and Rapid Shallow Breathing Index (37 ± 11 versus 44 ± 13, p = 0.029) and with higher Pressure Muscle Index (2 [0.5, 3] versus 0.4 [0, 1.9], p = 0.024). Change in diaphragm thickness wa

Published
2020

7. Ultrasound Versus Computed Tomography for Diaphragmatic Thickness and Skeletal Muscle Index during Mechanical Ventilation

Author

Gatti, S, Abbruzzese, C, Ippolito, D, Lombardi, S, De Vito, A, Gandola, D, Meroni, V, Sala, V, Sironi, S, Pesenti, A, Foti, G, Rezoagli, E, Bellani, G, Gatti, Stefano, Abbruzzese, Chiara, Ippolito, Davide, Lombardi, Sophie, De Vito, Andrea, Gandola, Davide, Meroni, Veronica, Sala, Vittoria Ludovica, Sironi, Sandro, Pesenti, Antonio, Foti, Giuseppe, Rezoagli, Emanuele, Bellani, Giacomo, Gatti, S, Abbruzzese, C, Ippolito, D, Lombardi, S, De Vito, A, Gandola, D, Meroni, V, Sala, V, Sironi, S, Pesenti, A, Foti, G, Rezoagli, E, Bellani, G, Gatti, Stefano, Abbruzzese, Chiara, Ippolito, Davide, Lombardi, Sophie, De Vito, Andrea, Gandola, Davide, Meroni, Veronica, Sala, Vittoria Ludovica, Sironi, Sandro, Pesenti, Antonio, Foti, Giuseppe, Rezoagli, Emanuele, and Bellani, Giacomo

Abstract

Background: Diaphragmatic alterations occurring during mechanical ventilation (MV) can be monitored using ultrasound (US). The performance of computed tomography (CT) to evaluate diaphragmatic thickness is limited. Further, the association between muscle mass and outcome is increasingly recognized. However, no data are available on its correlation with diaphragmatic thickness. We aimed to determine correlation and agreement of diaphragmatic thickness between CT and US; and its association with muscle mass and MV parameters. Methods: Prospective observational study. US measurements of the diaphragmatic thickness were collected in patients undergoing MV within 12 h before or after performing a CT scan of the thorax and/or upper abdomen. Data on skeletal muscle index (SMI), baseline, and ventilatory data were recorded and correlated with US and CT measures of diaphragmatic thickness. Agreement was explored between US and CT data. Results: Twenty-nine patients were enrolled and the diaphragm measured by CT resulted overall thicker than US-based measurement of the right hemidiaphragm. The US thickness showed the strongest correlation with the left posterior pillar at CT (r = 0.49, p = 0.008). The duration of the controlled MV was negatively correlated with US thickness (r = -0.45, p = 0.017), the thickness of the right anterior pillar (r = -0.41, p = 0.029), and splenic dome by CT (r = -0.43, p = 0.023). SMI was positively correlated with US diaphragmatic thickness (r = 0.50, p = 0.007) and inversely correlated with the duration of MV before enrollment (r = -0.426, p = 0.027). Conclusions: CT scan of the left posterior pillar can estimate diaphragmatic thickness and is moderately correlated with US measurements. Both techniques show that diaphragm thickness decreases with MV duration. The diaphragmatic thickness by US showed a good correlation with SMI.

Published
2022

8. Sigh in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: the PROTECTION pilot randomized clinical trial

Author

Mauri T., Foti G., Fornari C., Grasselli G., Pinciroli R., Lovisari F., Tubiolo D., Volta C. A., Spadaro S., Rona R., Rondelli E., Navalesi P., Garofalo E., Knafelj R., Gorjup V., Colombo R., Cortegiani A., Zhou J. -X., D'Andrea R., Calamai I., Gonzalez A. V., Roca O., Grieco D. L., Jovaisa T., Bampalis D., Becher T., Battaglini D., Ge H., Luz M., Constantin J. -M., Ranieri M., Guerin C., Mancebo J., Pelosi P., Fumagalli R., Brochard L., Pesenti A., Papoff A., Di Fenza R., Gianni S., Spinelli E., Lissoni A., Abbruzzese C., Bronco A., Villa S., Russotto V., Iachi A., Ball L., Patroniti N., Spina R., Giuntini R., Peruzzi S., Menga L. S., Fossali T., Castelli A., Ottolina D., Garcia-De-Acilu M., Santafe M., Schadler D., Weiler N., Carvajal E. R., Calvo C. P., Neou E., Wang Y. -M., Zhou Y. -M., Longhini F., Bruni A., Leonardi M., Gregoretti C., Ippolito M., Milazzo Z., Querci L., Ranieri S., Insom G., Berden J., Noc M., Mikuz U., Arzenton M., Lazzeri M., Villa A., Barreto B. B., Rios M. N. O., Gusmao-Flores D., Phull M., Barnes T., Musarat H., Conti S., Mauri, Tommaso, Foti, Giuseppe, Fornari, Carla, Grasselli, Giacomo, Pinciroli, Riccardo, Lovisari, Federica, Tubiolo, Daniela, Volta, Carlo Alberto, Spadaro, Savino, Rona, Roberto, Rondelli, Egle, Navalesi, Paolo, Garofalo, Eugenio, Knafelj, Rihard, Gorjup, Vojka, Colombo, Riccardo, Cortegiani, Andrea, Zhou, Jian-Xin, D'Andrea, Rocco, Calamai, Italo, González, Ánxela Vidal, Roca, Oriol, Grieco, Domenico Luca, Jovaisa, Toma, Bampalis, Dimitrio, Becher, Tobia, Battaglini, Denise, Ge, Huiqing, Luz, Mariana, Constantin, Jean-Michel, Ranieri, Marco, Guerin, Claude, Mancebo, Jordi, Pelosi, Paolo, Fumagalli, Roberto, Brochard, Laurent, Pesenti, Antonio, PROTECTION collaborators: Alessandra Papoff, Raffaele Di Fenza, Stefano Gianni, Elena Spinelli, Alfredo Lissoni, Chiara Abbruzzese, Alfio Bronco, Silvia Villa, Vincenzo Russotto, Arianna Iachi, Lorenzo Ball, Nicolò Patroniti, Rosario Spina, Romano Giuntini, Simone Peruzzi, Luca Salvatore Menga, Tommaso Fossali, Antonio Castelli, Davide Ottolina, Marina García-de-Acilu, Manel Santafè, Dirk Schädler, Norbert Weiler, Emilia Rosas Carvajal, César Pérez Calvo, Evangelia Neou, Yu-Mei Wang, Yi-Min Zhou, Federico Longhini, Andrea Bruni, Mariacristina Leonardi, Cesare Gregoretti, Mariachiara Ippolito, Zelia Milazzo, Lorenzo Querci, Serena Ranieri, Giulia Insom, Jernej Berden, Marko Noc, Ursa Mikuz, Matteo Arzenton, Marta Lazzeri, Arianna Villa, Bruna Brandão Barreto, Marcos Nogueira Oliveira Rios, Dimitri Gusmao-Flores, Mandeep Phull, Tom Barnes, Hussain Musarat, Sara Conti, Mauri, T, Foti, G, Fornari, C, Grasselli, G, Pinciroli, R, Lovisari, F, Tubiolo, D, Volta, C, Spadaro, S, Rona, R, Rondelli, E, Navalesi, P, Garofalo, E, Knafelj, R, Gorjup, V, Colombo, R, Cortegiani, A, Zhou, J, D'Andrea, R, Calamai, I, Gonzalez, A, Roca, O, Grieco, D, Jovaisa, T, Bampalis, D, Becher, T, Battaglini, D, Ge, H, Luz, M, Constantin, J, Ranieri, M, Guerin, C, Mancebo, J, Pelosi, P, Fumagalli, R, Brochard, L, Pesenti, A, Papoff, A, Di Fenza, R, Gianni, S, Spinelli, E, Lissoni, A, Abbruzzese, C, Bronco, A, Villa, S, Russotto, V, Iachi, A, Ball, L, Patroniti, N, Spina, R, Giuntini, R, Peruzzi, S, Menga, L, Fossali, T, Castelli, A, Ottolina, D, Garcia-De-Acilu, M, Santafe, M, Schadler, D, Weiler, N, Carvajal, E, Calvo, C, Neou, E, Wang, Y, Zhou, Y, Longhini, F, Bruni, A, Leonardi, M, Gregoretti, C, Ippolito, M, Milazzo, Z, Querci, L, Ranieri, S, Insom, G, Berden, J, Noc, M, Mikuz, U, Arzenton, M, Lazzeri, M, Villa, A, Barreto, B, Rios, M, Gusmao-Flores, D, Phull, M, Barnes, T, Musarat, H, and Conti, S

Subjects
pressure support, ventilation, sigh, ARDS, mechanical ventilation, feasibility
Abstract

Background: Sigh is a cyclic brief recruitment manoeuvre: previous physiological studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity and increase release of surfactant. Research question: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? Study design and methods: We conducted a multi-center non-inferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or acute respiratory distress syndrome undergoing PSV. Patients were randomized to the No Sigh group and treated by PSV alone, or to the Sigh group, treated by PSV plus sigh (increase of airway pressure to 30 cmH2Ofor 3 seconds once per minute) until day 28 or death or successful spontaneous breathing trial. The primary endpoint of the study was feasibility, assessed as non-inferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiological parameters in the first week from randomization, 28-day mortality and ventilator-free days. Results: Two-hundred fifty-eight patients (31% women; median age 65 [54-75] years) were enrolled. In the Sigh group, 23% of patients failed to remain on assisted ventilation vs. 30% in the No Sigh group (absolute difference -7%, 95%CI -18% to 4%; p=0.015 for non-inferiority). Adverse events occurred in 12% vs. 13% in Sigh vs. No Sigh (p=0.852). Oxygenation was improved while tidal volume, respiratory rate and corrected minute ventilation were lower over the first 7 days from randomization in Sigh vs. No Sigh. There was no significant difference in terms of mortality (16% vs. 21%, p=0.342) and ventilator-free days (22 [7-26] vs. 22 [3-25] days, p=0.300) for Sigh vs. No Sigh. Interpretation: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk.

Published
2020

10. Endothelial damage in septic shock patients as evidenced by circulating syndecan-1, sphingosine-1-phosphate and soluble VE-cadherin: a substudy of ALBIOS

Author

Piotti, A., Novelli, D., Meessen, J. M. T. A., Ferlicca, D., Coppolecchia, S., Marino, A., Salati, G., Savioli, M., Grasselli, G., Bellani, G., Pesenti, A., Masson, S., Caironi, P., Gattinoni, L., Gobbi, M., Fracasso, C., Latini, R., Bruzzone, P., Pagan, F., Russo, R., Confalonieri, A., Abbruzzese, C., Vergnano, B., Faenza, S., Siniscalchi, A., Pierucci, E., Noto, A., Pezzi, A., Spanu, P., Parrini, V., Oggioni, R., Pasetti, G. S., Casadio, M. C., Buontempo, R., Carrer, S., Piccoli, F., Rizzi, T., Caricato, A., La Sala, M., Antonaci, A., Fassini, P., Paganini, S., Porta, V., Moise, G., Marell, S., Furia, M., Urbano, M. C., Carobbi, R., Poleni, S., Kandil, H., Ballotta, A., Bettini, F., Sanseverino, M., Gatta, A., Cecchini, F., Guatteri, L., Ciceri, G., Raimondi, F., Colombo, R., Ferraris, S., Borelli, M., Bellato, V., Cancellieri, F., Senni, S., Bertocchi, E., Ferri, P., Moioli, G., Fedele, A., Molin, A., Salsi, P., Brunori, E., Elisei, D., Maggio, G., Nicola, F. G., Cavana, M., Morelli, G., Guarino, A., Isetta, M., Tulli, G., Mangani, V., Rossi, N., Ferrari, M., Bona, F., Vay, M., Bartoli, T., Gallo, M., Vettoretto, K., Morte, M. D., Boselli, E., Puscio, D., Bovo, M., Galzerano, A., Carli, M., Zagara, G., Piotti, A, Novelli, D, Meessen, J, Ferlicca, D, Coppolecchia, S, Marino, A, Salati, G, Savioli, M, Grasselli, G, Bellani, G, Pesenti, A, Masson, S, Caironi, P, Gattinoni, L, Gobbi, M, Fracasso, C, and Latini, R

Subjects
Male, Letter, medicine.medical_treatment, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Gastroenterology, 0302 clinical medicine, VE-cadherin, Sphingosine, Septic shock, 80 and over, Medicine, Endothelial dysfunction, Phosphorylation, Aged, 80 and over, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Shock, Biomarker, Glycocalyx, Sphingosine-1-phosphate, Syndecan-1, Aged, Antigens, CD, Biomarkers, Cadherins, Endothelium, Female, Humans, Italy, Lysophospholipids, Middle Aged, Retrospective Studies, Shock, Septic, Extravasation, 3. Good health, CD, Endothelial stem cell, medicine.medical_specialty, Sepsis, 03 medical and health sciences, Internal medicine, Albumins, Settore MED/41 - ANESTESIOLOGIA, Renal replacement therapy, Antigens, business.industry, Septic, Research, Albumin, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, business
Abstract

Background Septic shock is characterized by breakdown of the endothelial glycocalyx and endothelial damage, contributing to fluid extravasation, organ failure and death. Albumin has shown benefit in septic shock patients. Our aims were: (1) to identify the relations between circulating levels of syndecan-1 (SYN-1), sphingosine-1-phosphate (S1P) (endothelial glycocalyx), and VE-cadherin (endothelial cell junctions), severity of the disease, and survival; (2) to evaluate the effects of albumin supplementation on endothelial dysfunction in patients with septic shock. Methods This was a retrospective analysis of a multicenter randomized clinical trial on albumin replacement in severe sepsis or septic shock (the Albumin Italian Outcome Sepsis Trial, ALBIOS). Concentrations of SYN-1, S1P, soluble VE-cadherin and other biomarkers were measured on days 1, 2 and 7 in 375 patients with septic shock surviving up to 7 days after randomization. Results Plasma concentrations of SYN-1 and VE-cadherin rose significantly over 7 days. SYN-1 and VE-cadherin were elevated in patients with organ failure, and S1P levels were lower. SYN-1 and VE-cadherin were independently associated with renal replacement therapy requirement during ICU stay, but only SYN-1 predicted its new occurrence. Both SYN-1 and S1P, but not VE-cadherin, predicted incident coagulation failure. Only SYN-1 independently predicted 90-day mortality. Albumin significantly reduced VE-cadherin, by 9.5% (p = 0.003) at all three time points. Conclusion Circulating components of the endothelial glycocalyx and of the endothelial cell junctions provide insights into severity and progression of septic shock, with special focus on incident coagulation and renal failure. Albumin supplementation lowered circulating VE-cadherin consistently over time. Clinical Trial Registration: ALBIOS ClinicalTrials.gov number NCT00707122.

Published
2021

11. PCSK9 is associated with mortality in patients with septic shock: data from the ALBIOS study

Author

Vecchie, A., Bonaventura, A., Meessen, J., Novelli, D., Minetti, S., Elia, E., Ferrara, D., Ansaldo, A. M., Scaravilli, V., Villa, S., Ferla, L., Caironi, P., Latini, R., Carbone, F., Montecucco, F., Bruzzone, P., Pagan, F., Russo, R., Confalonieri, A., Abbruzzese, C., Vergnano, B., Faenza, S., Siniscalchi, A., Pierucci, E., Noto, A., Pezzi, A., Spanu, P., Parrini, V., Oggioni, R., Pasetti, G. S., Casadio, M. C., Buontempo, R., Carrer, S., Piccoli, F., Rizzi, T., Caricato, A., La Sala, M., Antonaci, A., Fassini, P., Paganini, S., Porta, V., Moise, G., Marell, S., Furia, M., Urbano, M. C., Carobbi, R., Poleni, S., Kandil, H., Ballotta, A., Bettini, F., Sanseverino, M., Gatta, A., Cecchini, F., Guatteri, L., Ciceri, G., Raimondi, F., Colombo, R., Ferraris, S., Borelli, M., Bellato, V., Cancellieri, F., Senni, S., Sacchi, N., Ferri, P., Moioli, G., Fedele, A., Molin, A., Salati, G., Salsi, P., Brunori, E., Elisei, D., Maggio, G., Nicola, F. G., Cavana, M., Morelli, G., Guarino, A., Isetta, M., Tulli, G., Mangani, V., Rossi, N., Ferrari, M., Bona, F., Vay, M., Bartoli, T., Gallo, M., Morte, M. D., Boselli, E., Puscio, D., Galzerano, A., Carli, M., and Zagara, G.

Subjects
0301 basic medicine, Male, medicine.medical_specialty, Inflammation, 030204 cardiovascular system & hematology, Gastroenterology, Sepsis, PCSK9, sepsis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, Internal Medicine, Medicine, Humans, pentraxin 3, Aged, business.industry, Proportional hazards model, Septic shock, Septic, Mortality rate, mortality, septic shock, Biomarkers, C-Reactive Protein, Female, Italy, Middle Aged, Proprotein Convertase 9, Serum Amyloid P-Component, Shock, Septic, Shock, PTX3, medicine.disease, 030104 developmental biology, Quartile, Biomarker (medicine), medicine.symptom, business
Abstract

Background Pro-protein convertase subtilisin/kexin 9 (PCSK9) is a proenzyme primarily known to regulate low-density lipoprotein receptor re-uptake on hepatocytes. Whether PCSK9 can concurrently trigger inflammation or not remains unclear. Here, we investigated the potential association between circulating levels of PCSK9 and mortality in patients with severe sepsis or septic shock. Methods Plasma PCSK9 levels at days 1, 2 and 7 were measured in 958 patients with severe sepsis or septic shock previously enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial. Correlations between levels of PCSK9 and pentraxin 3 (PTX3), a biomarker of disease severity, were evaluated with ranked Spearman's coefficients. Cox proportional hazards models were used to assess the association of PCSK9 levels at day 1 with 28- and 90-day mortality. Results Median plasma PCSK9 levels were 278 [182-452] ng mL-1 on day 1. PCSK9 correlated positively with PTX3 at the three time-points, and patients with septic shock within the first quartile of PCSK9 showed higher levels of PTX3. Similar mortality rates were observed in patients with severe sepsis across PCSK9 quartiles. Patients with septic shock with lower PCSK9 levels on day 1 (within the first quartile) showed the highest 28- and 90-day mortality rate as compared to other quartiles. Conclusion In our sub-analysis of the ALBIOS trial, we found that patients with septic shock presenting with lower plasma PCSK9 levels experienced higher mortality rate. Further studies are warranted to better evaluate the pathophysiological role of PCSK9 in sepsis.

Published
2021

12. Sigh in Patients With Acute Hypoxemic Respiratory Failure and ARDS: The PROTECTION Pilot Randomized Clinical Trial

Author

Mauri, T., Foti, G., Fornari, C., Grasselli, G., Pinciroli, R., Lovisari, F., Tubiolo, D., Volta, C. A., Spadaro, S., Rona, R., Rondelli, E., Navalesi, P., Garofalo, E., Knafelj, R., Gorjup, V., Colombo, R., Cortegiani, A., Zhou, J. -X., D'Andrea, R., Calamai, I., Gonzalez, A. V., Roca, O., Grieco, D. L., Jovaisa, T., Bampalis, D., Becher, T., Battaglini, D., Ge, H., Luz, M., Constantin, J. -M., Ranieri, M., Guerin, C., Mancebo, J., Pelosi, P., Fumagalli, R., Brochard, L., Pesenti, A., Papoff, A., Di Fenza, R., Gianni, S., Spinelli, E., Lissoni, A., Abbruzzese, C., Bronco, A., Villa, S., Russotto, V., Iachi, A., Ball, L., Patroniti, N., Spina, R., Giuntini, R., Peruzzi, S., Menga, L. S., Fossali, T., Castelli, A., Ottolina, D., Garcia-De-Acilu, M., Santafe, M., Schadler, D., Weiler, N., Carvajal, E. R., Calvo, C. P., Neou, E., Wang, Y. -M., Zhou, Y. -M., Longhini, F., Bruni, A., Leonardi, M., Gregoretti, C., Ippolito, M., Milazzo, Z., Querci, L., Ranieri, S., Insom, G., Berden, J., Noc, M., Mikuz, U., Arzenton, M., Lazzeri, M., Villa, A., Barreto, B. B., Rios, M. N. O., Gusmao-Flores, D., Phull, M., Barnes, T., Musarat, H., and Conti, S.

Subjects
Male, RCT, Randomized Control Trial, VFDs, Ventilator- free days, sigh, PaO2/FiO2 ratio, Arterial Partial Pressure of O2/ Fraction of Inspired Oxygen, SpO2/FiO2 ratio, Peripheral Oxygen Saturation/ Fraction of Inspired Oxygen, Pilot Projects, ESICM, European Society of Intensive Care Medicine, NO, Positive-Pressure Respiration, ICU, Intensive Care Unit, Vt, Tidal Volume, SBT, Spontaneous Breathing Trial, Intubation, Intratracheal, Humans, PEEP, Positive End Expiratory Pressure, RR, Respiratory Rate, FiO2, Fraction of Inspired Oxygen, ARDS, feasibility, pressure support, ventilation, Aged, Female, Middle Aged, Respiratory Distress Syndrome, Respiratory Insufficiency, Respiratory Mechanics, Original Research, GEE, Generalize Estimate Equation, RASS, Richmond Agitation- Sedation Scale, ARDS, Acute Respiratory Distress Syndrome, P-SILI, Patient - Self Inflicted Lung Injury, AHRF, Acute Hypoxemic Respiratory Failure, PBW, Predicted Body Weight, PSV, Pressure Support Ventilation, SOFA, Sequence Organ Failure Assessment, Intratracheal, SAPS II, Simplified Acute Physiology Score II, SpO2, Peripheral Oxygen Saturation, PaCO2, Arterial Partial Pressure of CO2, TRALI, Transfusion-Related Acute Lung Injury, BMI, Body Mass Index, Intubation, MV, Mechanical Ventilation
Abstract

BACKGROUND: Sigh is a cyclic brief recruitment maneuver: previous physiologic studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity, and increase release of surfactant. RESEARCH QUESTION: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? STUDY DESIGN AND METHODS: We conducted a multicenter noninferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or ARDS undergoing PSV. Patients were randomized to the no-sigh group and treated by PSV alone, or to the sigh group, treated by PSV plus sigh (increase in airway pressure to 30 cm H2O for 3 s once per minute) until day 28 or death or successful spontaneous breathing trial. The primary end point of the study was feasibility, assessed as noninferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiologic parameters in the first week from randomization, 28-day mortality, and ventilator-free days. RESULTS: Two-hundred and fifty-eight patients (31% women; median age, 65 [54-75] years) were enrolled. In the sigh group, 23% of patients failed to remain on assisted ventilation vs 30% in the no-sigh group (absolute difference, -7%; 95% CI, -18% to 4%; P = .015 for noninferiority). Adverse events occurred in 12% vs 13% in the sigh vs no-sigh group (P = .852). Oxygenation was improved whereas tidal volume, respiratory rate, and corrected minute ventilation were lower over the first 7 days from randomization in the sigh vs no-sigh group. There was no significant difference in terms of mortality (16% vs 21%; P = .337) and ventilator-free days (22 [7-26] vs 22 [3-25] days; P = .300) for the sigh vs no-sigh group. INTERPRETATION: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk.

Published
2020

13. PCSK9 is associated with mortality in patients with septic shock: data from the ALBIOS study

Author

Vecchie, A., Bonaventura, A., Meessen, J., Novelli, D., Minetti, S., Elia, E., Ferrara, D., Ansaldo, A. M., Scaravilli, V., Villa, S., Ferla, L., Caironi, P., Latini, R., Carbone, F., Montecucco, F., Bruzzone, P., Pagan, F., Russo, R., Confalonieri, A., Abbruzzese, C., Vergnano, B., Faenza, S., Siniscalchi, A., Pierucci, E., Noto, A., Pezzi, A., Spanu, P., Parrini, V., Oggioni, R., Pasetti, G. S., Casadio, M. C., Buontempo, R., Carrer, S., Piccoli, F., Rizzi, T., Caricato, Anselmo, La Sala, M., Antonaci, A., Fassini, P., Paganini, S., Porta, V., Moise, G., Marell, S., Furia, M., Urbano, M. C., Carobbi, R., Poleni, S., Kandil, H., Ballotta, A., Bettini, F., Sanseverino, M., Gatta, A., Cecchini, F., Guatteri, L., Ciceri, G., Raimondi, F., Colombo, R., Ferraris, S., Borelli, M., Bellato, V., Cancellieri, F., Senni, S., Sacchi, N., Ferri, P., Moioli, G., Fedele, A., Molin, A., Salati, G., Salsi, P., Brunori, E., Elisei, D., Maggio, G., Nicola, F. G., Cavana, M., Morelli, G., Guarino, A., Isetta, M., Tulli, G., Mangani, V., Rossi, N., Ferrari, M., Bona, F., Vay, M., Bartoli, T., Gallo, M., Morte, M. D., Boselli, E., Puscio, D., Galzerano, A., Carli, M., Zagara, G., Caricato A. (ORCID:0000-0001-5929-120X), Vecchie, A., Bonaventura, A., Meessen, J., Novelli, D., Minetti, S., Elia, E., Ferrara, D., Ansaldo, A. M., Scaravilli, V., Villa, S., Ferla, L., Caironi, P., Latini, R., Carbone, F., Montecucco, F., Bruzzone, P., Pagan, F., Russo, R., Confalonieri, A., Abbruzzese, C., Vergnano, B., Faenza, S., Siniscalchi, A., Pierucci, E., Noto, A., Pezzi, A., Spanu, P., Parrini, V., Oggioni, R., Pasetti, G. S., Casadio, M. C., Buontempo, R., Carrer, S., Piccoli, F., Rizzi, T., Caricato, Anselmo, La Sala, M., Antonaci, A., Fassini, P., Paganini, S., Porta, V., Moise, G., Marell, S., Furia, M., Urbano, M. C., Carobbi, R., Poleni, S., Kandil, H., Ballotta, A., Bettini, F., Sanseverino, M., Gatta, A., Cecchini, F., Guatteri, L., Ciceri, G., Raimondi, F., Colombo, R., Ferraris, S., Borelli, M., Bellato, V., Cancellieri, F., Senni, S., Sacchi, N., Ferri, P., Moioli, G., Fedele, A., Molin, A., Salati, G., Salsi, P., Brunori, E., Elisei, D., Maggio, G., Nicola, F. G., Cavana, M., Morelli, G., Guarino, A., Isetta, M., Tulli, G., Mangani, V., Rossi, N., Ferrari, M., Bona, F., Vay, M., Bartoli, T., Gallo, M., Morte, M. D., Boselli, E., Puscio, D., Galzerano, A., Carli, M., Zagara, G., and Caricato A. (ORCID:0000-0001-5929-120X)

Abstract

Background: Pro-protein convertase subtilisin/kexin 9 (PCSK9) is a proenzyme primarily known to regulate low-density lipoprotein receptor re-uptake on hepatocytes. Whether PCSK9 can concurrently trigger inflammation or not remains unclear. Here, we investigated the potential association between circulating levels of PCSK9 and mortality in patients with severe sepsis or septic shock. Methods: Plasma PCSK9 levels at days 1, 2 and 7 were measured in 958 patients with severe sepsis or septic shock previously enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial. Correlations between levels of PCSK9 and pentraxin 3 (PTX3), a biomarker of disease severity, were evaluated with ranked Spearman’s coefficients. Cox proportional hazards models were used to assess the association of PCSK9 levels at day 1 with 28- and 90-day mortality. Results: Median plasma PCSK9 levels were 278 [182–452] ng mL−1 on day 1. PCSK9 correlated positively with PTX3 at the three time-points, and patients with septic shock within the first quartile of PCSK9 showed higher levels of PTX3. Similar mortality rates were observed in patients with severe sepsis across PCSK9 quartiles. Patients with septic shock with lower PCSK9 levels on day 1 (within the first quartile) showed the highest 28- and 90-day mortality rate as compared to other quartiles. Conclusion: In our sub-analysis of the ALBIOS trial, we found that patients with septic shock presenting with lower plasma PCSK9 levels experienced higher mortality rate. Further studies are warranted to better evaluate the pathophysiological role of PCSK9 in sepsis.

Published
2020

14. The kinase inhibitor SI113 induces autophagy and synergizes with quinacrine in hindering the growth of human glioblastoma multiforme cells

Author

Matteoni, S., Abbruzzese, C., Matarrese, P., De Luca, G., Mileo, A. M., Miccadei, S., Schenone, S., Musumeci, F., Haas, Tobias Longin, Sette, Giovanni, Carapella, C. M., Amato, R., Perrotti, N., Signore, M., Paggi, M. G., Haas T. L. (ORCID:0000-0003-2336-0263), Sette G., Matteoni, S., Abbruzzese, C., Matarrese, P., De Luca, G., Mileo, A. M., Miccadei, S., Schenone, S., Musumeci, F., Haas, Tobias Longin, Sette, Giovanni, Carapella, C. M., Amato, R., Perrotti, N., Signore, M., Paggi, M. G., Haas T. L. (ORCID:0000-0003-2336-0263), and Sette G.

Abstract

Background: Glioblastoma multiforme (GBM), due to its location, aggressiveness, heterogeneity and infiltrative growth, is characterized by an exceptionally dismal clinical outcome. The small molecule SI113, recently identified as a SGK1 inhibitor, has proven to be effective in restraining GBM growth in vitro and in vivo, showing also encouraging results when employed in combination with other antineoplastic drugs or radiotherapy. Our aim was to explore the pharmacological features of SI113 in GBM cells in order to elucidate the pivotal molecular pathways affected by the drug. Such knowledge would be of invaluable help in conceiving a rational offensive toward GBM. Methods: We employed GBM cell lines, either established or primary (neurospheres), and used a Reverse-Phase Protein Arrays (RPPA) platform to assess the effect of SI113 upon 114 protein factors whose post-translational modifications are associated with activation or repression of specific signal transduction cascades. Results: SI113 strongly affected the PI3K/mTOR pathway, evoking a pro-survival autophagic response in neurospheres. These results suggested the use of SI113 coupled, for maximum efficiency, with autophagy inhibitors. Indeed, the association of SI113 with an autophagy inhibitor, the antimalarial drug quinacrine, induced a strong synergistic effect in inhibiting GBM growth properties in all the cells tested, including neurospheres. Conclusions: RPPA clearly identified the molecular pathways influenced by SI113 in GBM cells, highlighting their vulnerability when the drug was administered in association with autophagy inhibitors, providing a strong molecular rationale for testing SI113 in clinical trials in associative GBM therapy.

Published
2019

18. Pressure support ventilation + sigh in acute hypoxemic respiratory failure patients: study protocol for a pilot randomized controlled trial, the PROTECTION trial

Author

Mauri, T, Foti, G, Fornari, C, Constantin, J, Guerin, C, Pelosi, P, Ranieri, M, Conti, S, Tubiolo, D, Rondelli, E, Lovisari, F, Fossali, T, Spadaro, S, Grieco, D, Navalesi, P, Calamai, I, Becher, T, Roca, O, Wang, Y, Knafelj, R, Cortegiani, A, Mancebo, J, Brochard, L, Pesenti, A, Grasselli, G, Spinelli, E, Abbruzzese, C, Rona, R, Bronco, A, Villa, S, Gianni, S, Papoff, A, Pinciroli, R, Colombo, R, Sproccati, C, Mandelli, P, Villa, F, Patroniti, N, Brunetti, I, Ball, L, Volta, C, Lazzeri, M, Maragoni, E, Eleuteri, D, Bello, G, Dell'Anna, A, Garofalo, E, Bruni, A, Biamonte, E, D'Andrea, R, Querci, L, Pierucci, E, Spina, R, Mori, I, Tomeo, F, Mercat, A, Beloncle, F, Jochmans, S, Mazerand, S, Baboi, L, Yonis, H, Jabaudon, M, Godet, T, Jovaisa, T, Barnes, T, Tariq, U, Weiler, N, Schädler, D, Frerichs, I, García-de-Acilu, M, Vidal, A, Rosas, E, Calvo, C, Zhou, J, Karagiannis, S, Zisopoulou, V, Staikos, I, Noc, M, Fister, M, Radsel, P, Gregoretti, C, Sabella, I, Raineri, S, Mauri, Tommaso, Foti, Giuseppe, Fornari, Carla, Constantin, Jean-Michel, Guerin, Claude, Pelosi, Paolo, Ranieri, Marco, Conti, Sara, Tubiolo, Daniela, RONDELLI, EGLE ROSALIA, Lovisari, Federica, Fossali, Tommaso, Spadaro, Savino, Grieco, Domenico Luca, Navalesi, Paolo, Calamai, Italo, Becher, Tobias, Roca, Oriol, Wang, Yu-Mei, Knafelj, Rihard, Cortegiani, Andrea, Mancebo, Jordi, Brochard, Laurent, Pesenti, Antonio, Volta, CA, dell'Anna, A, Calvo, CP, Zhou, JX, Raineri, SM, Mauri, T, Foti, G, Fornari, C, Constantin, J, Guerin, C, Pelosi, P, Ranieri, M, Conti, S, Tubiolo, D, Rondelli, E, Lovisari, F, Fossali, T, Spadaro, S, Grieco, D, Navalesi, P, Calamai, I, Becher, T, Roca, O, Wang, Y, Knafelj, R, Cortegiani, A, Mancebo, J, Brochard, L, Pesenti, A, Grasselli, G, Spinelli, E, Abbruzzese, C, Rona, R, Bronco, A, Villa, S, Gianni, S, Papoff, A, Pinciroli, R, Colombo, R, Sproccati, C, Mandelli, P, Villa, F, Patroniti, N, Brunetti, I, Ball, L, Volta, C, Lazzeri, M, Maragoni, E, Eleuteri, D, Bello, G, Dell'Anna, A, Garofalo, E, Bruni, A, Biamonte, E, D'Andrea, R, Querci, L, Pierucci, E, Spina, R, Mori, I, Tomeo, F, Mercat, A, Beloncle, F, Jochmans, S, Mazerand, S, Baboi, L, Yonis, H, Jabaudon, M, Godet, T, Jovaisa, T, Barnes, T, Tariq, U, Weiler, N, Schädler, D, Frerichs, I, García-de-Acilu, M, Vidal, A, Rosas, E, Calvo, C, Zhou, J, Karagiannis, S, Zisopoulou, V, Staikos, I, Noc, M, Fister, M, Radsel, P, Gregoretti, C, Sabella, I, Raineri, S, Mauri, Tommaso, Foti, Giuseppe, Fornari, Carla, Constantin, Jean-Michel, Guerin, Claude, Pelosi, Paolo, Ranieri, Marco, Conti, Sara, Tubiolo, Daniela, RONDELLI, EGLE ROSALIA, Lovisari, Federica, Fossali, Tommaso, Spadaro, Savino, Grieco, Domenico Luca, Navalesi, Paolo, Calamai, Italo, Becher, Tobias, Roca, Oriol, Wang, Yu-Mei, Knafelj, Rihard, Cortegiani, Andrea, Mancebo, Jordi, Brochard, Laurent, Pesenti, Antonio, Volta, CA, dell'Anna, A, Calvo, CP, Zhou, JX, and Raineri, SM

Abstract

BACKGROUND: Adding cyclic short sustained inflations (sigh) to assisted ventilation yields optimizes lung recruitment, decreases heterogeneity and reduces inspiratory effort in patients with acute hypoxemic respiratory failure (AHRF). These findings suggest that adding sigh to pressure support ventilation (PSV) might decrease the risk of lung injury, shorten weaning and improve clinical outcomes. Thus, we conceived a pilot trial to test the feasibility of adding sigh to PSV (the PROTECTION study). METHODS: PROTECTION is an international randomized controlled trial that will be conducted in 23 intensive care units (ICUs). Patients with AHRF who have been intubated from 24 h to 7 days and undergoing PSV from 4 to 24 h will be enrolled. All patients will first undergo a 30-min sigh test by adding sigh to clinical PSV for 30 min to identify early oxygenation responders. Then, patients will be randomized to PSV or PSV + sigh until extubation, ICU discharge, death or day 28. Sigh will be delivered as a 3-s pressure control breath delivered once per minute at 30 cmH2O. Standardized protocols will guide ventilation settings, switch back to controlled ventilation, use of rescue treatments, performance of spontaneous breathing trial, extubation and reintubation. The primary endpoint of the study will be to verify the feasibility of PSV + sigh evaluated through reduction of failure to remain on assisted ventilation during the first 28 days in the PSV + sigh group versus standard PSV (15 vs. 22%). Failure will be defined by switch back to controlled ventilation for more than 24 h or use of rescue treatments or reintubation within 48 h from elective extubation. Setting the power to 80% and first-risk order to 5%, the computed size of the trial is 129 patients per arm. DISCUSSION: PROTECTION is a pilot randomized controlled trial testing the feasibility of adding sigh to PSV. If positive, it will provide physicians with an effective addition to standard PSV for lung protection, a

Published
2018

20. 37th International Symposium on Intensive Care and Emergency Medicine (part 1 of 3)

Author

Karavana, V., Smith, I., Kanellis, G., Sigala, I., Kinsella, T., Zakynthinos, S., Liu, L., Chen, J., Zhang, X., Liu, A., Guo, F., Liu, S., Yang, Y., Qiu, H., Grimaldi, D. G., Kaya, E., Acicbe, O., Kayaalp, I., Asar, S., Dogan, M., Eren, G., Hergunsel, O., Pavelescu, D., Grintescu, I., Mirea, L., Guanziroli, M., Gotti, M., Marino, A., Cressoni, M., Vergani, G., Chiurazzi, C., Chiumello, D., Gattinoni, L., Spano, S., Massaro, F., Moustakas, A., Johansson, S., Larsson, A., Perchiazzi, G., Zhang, X. W., Guo, F. M., Chen, J. X., Xue, M., Qiu, H. B., Yang, L., Fister, M., Knafelj, R., Suzer, M. A., Kavlak, M. E., Atalan, H. K., Gucyetmez, B., Cakar, N., Weller, D., Grootendorst, A. F., Dijkstra, A., Kuijper, T. M., Cleffken, B. I., Regli, A., De Keulenaer, B., Van Heerden, P., Hadfield, D., Hopkins, P. A., Penhaligon, B., Reid, F., Hart, N., Rafferty, G. F., Grasselli, G., Mauri, T., Lazzeri, M., Carlesso, E., Cambiaghi, B., Eronia, N., Maffezzini, E., Bronco, A., Abbruzzese, C., Rossi, N., Foti, G., Bellani, G., Pesenti, A., Bassi, G. Li, Panigada, M., Ranzani, O., Kolobow, T., Zanella, A., Berra, L., Parrini, V., Kandil, H., Salati, G., Livigni, S., Amatu, A., Girardis, M., Barbagallo, M., Moise, G., Mercurio, G., Costa, A., Vezzani, A., Lindau, S., Babel, J., Cavana, M., Torres, A., Ranzani, O. T., Umbrello, M., Taverna, M., Formenti, P., Mistraletti, G., Vetrone, F., Baisi, A., Garnero, A. G., Novotni, D. N., Arnal, J. A., Urner, M., Fan, E., Dres, M., Vorona, S., Brochard, L., Ferguson, N. D., Goligher, E. C., Leung, C., Joynt, G., Wong, W., Lee, A., Gomersall, C., Poels, S., Casaer, M., Schetz, M., Van den Berghe, G., Meyfroidt, G., Holzgraefe, B., Von Kobyletzki, L. B., Cianchi, G., Becherucci, F., Batacchi, S., Cozzolino, M., Franchi, F., Di Valvasone, S., Ferraro, M. C., Peris, A., Phiphitthanaban, H., Wacharasint, P., Wongsrichanalai, V., Lertamornpong, A., Pengpinij, O., Wattanathum, A., Oer-areemitr, N., Boddi, M., Cappellini, E., Ciapetti, M., Di Lascio, G., Bonizzoli, M., Lazzeri, C., Katsin, M. L., Hurava, M. Y., Dzyadzko, A. M., Hermann, A., Schellongowski, P., Bojic, A., Riss, K., Robak, O., Lamm, W., Sperr, W., Staudinger, T., Buoninsegni, L. Tadini, Parodo, J., Ottaviano, A., Cecci, L., Corsi, E., Ricca, V., de Garibay, A. Perez Ruiz, Ende-Schneider, B., Schreiber, C., Kreymann, B., Turani, F., Resta, M., Niro, D., Castaldi, P., Boscolo, G., Gonsales, G., Martini, S., Belli, A., Zamidei, L., Falco, M., Lamas, T., Mendes, J., Galazzi, A., Benco, B., Binda, F., Masciopinto, L., Lissoni, A., Adamini, I., Thamjamrassri, T., Watcharotayangul, J., Numthavaj, P., Kongsareepong, S., Higuera, J., Cabestrero, D., Rey, L., Narváez, G., Blandino, A., Aroca, M., Saéz, S., De Pablo, R., Mohamed, A., Sklar, M., Munshi, L., Alban, L., Turrini, C., Taccone, P., Marenghi, C., Spadaro, S., Volta, C., Alonso, D. Cabestrero, González, L. Rey, Franci, A., Stocchi, G., Cappuccini, G., Socci, F., Guetti, C., Rastrelli, P., Nestorowicz, A., Glapinski, J., Fijalkowska-Nestorowicz, A., Wosko, J., Duprez, F., Bonus, T., Cuvelier, G., Mashayekhi, S., Ollieuz, S., Reychler, G., Kuchyn, I., Bielka, K., Sergienko, A., Jones, H., Day, C., Park, S. C., Yeom, S. R., Myatra, S. N., Gupta, S., Rajnala, V., Divatia, J., Silva, J. Villalobos, Olvera, O. Aguilera, Schulte, R. Cavazos, Bermudez, M. Castañeda, Zorrilla, L. Pariente, Ferretis, H. Lopez, García, K. Trejo, Balciuniene, N., Ramsaite, J., Kriukelyte, O., Krikscionaitiene, A., Tamosuitis, T., Terragni, P., Brazzi, L., Falco, D., Pistidda, L., Magni, G., Bartoletti, L., Mascia, L., Filippini, C., Ranieri, V., Kyriakoudi, A., Rovina, N., Koltsida, O., Konstantellou, E., Kardara, M., Kostakou, E., Gavriilidis, G., Vasileiadis, I., Koulouris, N., Koutsoukou, A., Van Snippenburg, W., Kröner, A., Flim, M., Buise, M., Hemler, R., Spronk, P., Noffsinger, B., Singh, B., Hockings, L., Spina, C., Magni, F., Di Giambattista, C., Vargiolu, A., Citerio, G., Scaramuzzo, G., Waldmann, A. D., Böhm, S. H., Ragazzi, R., Volta, C. A., Heines, S. J., Strauch, U., Van de Poll, M. C., Roekaerts, P. M., Bergmans, D. C., Sosio, S., Gatti, S., Punzi, V., Asta, A., Mroczka, J., Yaroshetskiy, A. I, Rezepov, N. A., Mandel, I. A., Gelfand, B. R., Ozen, E., Karakoc, E., Ayyildiz, A., Kara, S., Ekemen, S., Yelken, B. Buyukkidan, Saasouh, W., Freeman, J., Turan, A., Hajjej, Z., Sellami, W., Bousselmi, M., Samoud, W., Gharsallah, H., Labbene, I., Ferjani, M., Vetrugno, L., Barbariol, F., Forfori, F., Regeni, I., Della Rocca, G., Jansen, D., Jonkman, A., Doorduin, J., Roesthuis, L., Van der Hoeven, J., Heunks, L., Marocco, S. Arrigoni, Bottiroli, M., Pinciroli, R., Galanti, V., Calini, A., Gagliardone, M., Fumagalli, R., Ippolito, D., Sala, V. L., Meroni, V., Elbanna, M., Nassar, Y., Abdelmohsen, A., Yahia, M., Mongodi, S., Mojoli, F., Via, G., Tavazzi, G., Fava, F., Pozzi, M., Iotti, G. A., Bouhemad, B., Ruiz-Ferron, F., Simón, J. Serrano, Gordillo-Resina, M., Chica-Saez, V., Garcia, M. Ruiz, Vela-Colmenero, R., Redondo-Orts, M., Gontijo-Coutinho, C., Ozahata, T., Nocera, P., Franci, D., Santos, T., Carvalho-Filho, M., Fochi, O., Nacoti, M., Signori, D., Bonacina, D., Bonanomi, E., Bonvecchio, E., Stella, A., Roldi, E., Orlando, A., Luperto, M., Trunfio, D., Licitra, G., Martinelli, R., Vannini, D., Giuliano, G., Näslund, E., Lindberg, L. G., Lund, I., Frithiof, R., Nichols, A., Pentakota, S., Kodali, B., Pranskunas, A., Kiudulaite, I., Simkiene, J., Damanskyte, D., Pranskuniene, Z., Arstikyte, J., Vaitkaitis, D., Pilvinis, V., Brazaitis, M., Pool, R., Haugaa, H., Botero, A., Escobar, D., Maberry, D., Tønnessen, T., Zuckerbraun, B., Pinsky, M., Gomez, H., Lyons, H., Trimmings, A., Domizi, R., Scorcella, C., Damiani, E., Pierantozzi, S., Tondi, S., Monaldi, V., Carletti, A., Zuccari, S., Adrario, E., Pelaia, P., Donati, A., Kazune, S., Grabovskis, A., Volceka, K., Rubins, U., Bol, M., Suverein, M., Delnoij, T., Driessen, R., Heines, S., Delhaas, T., Vd Poll, M., Sels, J., Jozwiak, M., Chambaz, M., Sentenac, P., Richard, C., Monnet, X., Teboul, J. L., Bitar, Z., Maadarani, O., Al Hamdan, R., Huber, W., Malbrain, M., Chew, M., Mallat, J., Tagami, T., Hundeshagen, S., Wolf, S., Mair, S., Schmid, R., Aron, J., Adlam, M., Dua, G., Mu, L., Chen, L., Yoon, J., Clermont, G., Dubrawski, A., Duhailib, Z., Al Assas, K., Shafquat, A., Salahuddin, N., Donaghy, J., Morgan, P., Valeanu, L., Stefan, M., Provenchere, S., Longrois, D., Shaw, A., Mythen, M. G., Shook, D., Hayashida, D., Munson, S. H., Sawyer, A., Mariyaselvam, M., Blunt, M., Young, P., Nakwan, N., Khwannimit, B., Checharoen, P., Berger, D., Moller, P., Bloechlinger, S., Bloch, A., Jakob, S., Takala, J., Van den Brule, J. M., Stolk, R., Vinke, E., Van Loon, L. M., Pickkers, P., Van der Hoeven, J. G., Kox, M., Hoedemaekers, C. W., Werner-Moller, P., Bertini, P., Guarracino, F., Colosimo, D., Gonnella, S., Brizzi, G., Mancino, G., Baldassarri, R., Pinsky, M. R., Amitrano, D., Goslar, T., Stajer, D., Radsel, P., De Vos, R., Dijk, N. Bussink-van, Stringari, G., Cogo, G., Devigili, A., Graziadei, M. Ceola, Bresadola, E., Lubli, P., Amella, S., Marani, F., Polati, E., Gottin, L., Colinas, L., Hernández, G., Vicho, R., Serna, M., Canabal, A., Cuena, R., Gimenez, J., Mercado, P., Depret, F., Sassi, K., Herner, A., Abded, N., Elghonemi, M., Monir, A., Nikhilesh, J., Apurv, T., Uber, A. U., Grossestreuer, A., Moskowitz, A., Patel, P., Holmberg, M. J., Donnino, M. W., Graham, C. A., Hung, K., Lo, R., Leung, L. Y., Lee, K. H., Yeung, C. Y., Chan, S. Y., Trembach, N., Zabolotskikh, I., Caldas, J., Panerai, R., Camara, L., Ferreira, G., Almeida, J., de Oliveira, G. Queiroz, Jardim, J., Bor-Seng-Shu, E., Lima, M., Nogueira, R., Jatene, F., Zeferino, S., Galas, F., Robinson, T., Hajjar, L. A., Oliveira, M., Norgueira, R., Groehs, R., Ferreira-Santos, L., Oliveira, G., Hajjar, L., Ribeiro, J., Gaiotto, F., Lisboa, L., Fukushima, J., Rizk, S., Osawa, E., Franco, R., Kalil, R., Chlabicz, M., Sobkowicz, B., Kaminski, K., Kazimierczyk, R., Musial, W., Tycińska, A., Siranovic, M., Gopcevic, A., Gavranovic, Z. G., Horvat, A. H., Krolo, H., Rode, B., Videc, L., Trifi, A., Abdellatif, S., Ismail, K. Ben, Bouattour, A., Daly, F., Nasri, R., Lakhal, S. Ben, Beurton, A., Girotto, V., Galarza, L., Guedj, T., Iliæ, M. Karaman, Sakic, L., NN, V., Stojcic, L., Alphonsine, J., Lai, C., Tapanwong, N., Chuntupama, P., Hoellthaler, J., Lahmer, T., Latham, H., Bengtson, C. D., Satterwhite, L., Stites, M., Simpson, S. Q., Skladzien, T., Cicio, M., Garlicki, J., Serednicki, W., Wordliczek, J., Vargas, P., Salazar, A., Espinoza, M., Graf, J., Kongpolprom, N., Sanguanwong, N., Jonnada, S., Gerrard, C., Jones, N., Morley, T., Thorburn, P. T., Musaeva, T., Horst, S., Lipcsey, M., Kawati, R., Pikwer, A., Rasmusson, J., Castegren, M., Shilova, A., Yafarova, A., Gilyarov, M., Stojiljkovic, D. L. Loncar, Ulici, A., Reidt, S., Lam, T., Jancik, J., Ragab, D., Taema, K., Farouk, W., Saad, M., Liu, X., Uber, A., Montissol, S., Donnino, M., Andersen, L. W., Perlikos, F., Lagiou, M., Papalois, A., Kroupis, C., Toumpoulis, I., Carter, D., Sardo, S., Landoni, G., Kongsayreepong, S., Sungsiri, R., Wongsripunetit, P., Marchio, P., Guerra-Ojeda, S., Gimeno-Raga, M., Mauricio, M. D., Valles, S. L., Aldasoro, C., Jorda, A., Aldasoro, M., Vila, J. M., Borg, U. B., Neitenbach, A. M., García, M., González, P. Guijo, Romero, M. Gracia, Orduña, P. Saludes, Cano, A. Gil, Rhodes, A., Grounds, R. M., Cecconi, M., Lee, C., Hatib, F., Jian, Z., Rinehart, J., De Los Santos, J., Canales, C., Cannesson, M., García, M. I. Monge, Scheeren, T., Chantziara, V., Vassi, A., Michaloudis, G., Sanidas, E., Golemati, S., Bateman, R. M., Mokhtar, A., Omar, W., Aziz, K. Abdel, El Azizy, H., Nielsen, D. L. Lykke, Holler, J. G., Lassen, A., Eriksson, M., Strandberg, G., Capoletto, C., Nakamura, R., Risk, S., Park, C., Dias, F., D’Arrigo, N., Fortuna, F., Redaelli, S., Zerman, L., Becker, L., Serrano, T., Cotes, L., Ramos, F., Fadel, L., Coelho, F., Mendes, C., Real, J., Pedron, B., Kuroki, M., Costa, E., and Azevedo, L.

Subjects
Critical Care and Intensive Care Medicine, Meeting Abstracts
Published
2017

25. “Extended subcutaneous route” technique: a quick subcutaneous tunnelling technique for PICC insertion

Author

Elli, S, Abbruzzese, C, Cannizzo, L, Vimercati, S, Vanini, S, Lucchini, A, Elli, Stefano, Abbruzzese, Chiara, Cannizzo, Luigi, Vimercati, Simona, Vanini, Stefania, Lucchini, Alberto, Elli, S, Abbruzzese, C, Cannizzo, L, Vimercati, S, Vanini, S, Lucchini, A, Elli, Stefano, Abbruzzese, Chiara, Cannizzo, Luigi, Vimercati, Simona, Vanini, Stefania, and Lucchini, Alberto

Abstract

Purpose: To describe a quick tunnelling technique for peripherally inserted central catheter (PICC) insertion called the “extended subcutaneous route” technique. Methods: The “extended subcutaneous route” technique is described step by step. Results: In 18 consecutive PICCs, inserted with extended route technique in ASST Monza, no complications during insertion were registered. In 969 catheter days observed, we identified only one accidental dislodgement. No other mid-term complications were observed. Conclusions: Extended subcutaneous route technique allows the creation of a subcutaneous tunnel <5 cm, without skin incision and additional manipulation. Extended subcutaneous route technique may be feasible and useful, particularly for patients with high risk of bleeding or infection.

Published
2017

26. Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels

Author

Michalopoulos, A., Groeneveld, J., Lev, A., Sprung, C., Vakalos, A., Kotanidou, A., Zakynthinos, E., Filos, K., Pneumatikos, I., Moraiti, A., Clouva-molyvdas, P., Mandragos, K., Kyriazopoulos, G., Karampela, I., Koulenti, D., Myrianthefs, P., Ioannidou, E., Mouloudi, E., Chalkiadaki, A., Bitzani, M., Routsi, C., Armaganidis, A., Sofianos, E., Harjola, V., Berezowicz, P., Jacobsen, K., Espersen, K., Fogh, B., Betsch, H., Vincent, Jean-Louis, Vanhems, Philippe, Walther, Sten M., Sakr, Yasser, Rello, Jordi, Leone, Marc, Pickkers, P., Lipman, Jeffrey, Holmbom, Martin, Antonelli, Massimo, Hanberger, Håkan, Kocak, S., Ulger, F., Guven, H., Turkmen, A., Dogruer, K., Adanir, T., Demirkiran, O., Tugrul, S., Cakar, N., Akinci, I., Uzel, N., Togal, T., Topeli, A., Turkoglu, M., Guven, M., Akan, M., Bodur, H., Bosnak, M., Kizilkaya, M., Ozgencil, E., Kaya, A., Fistikci, H., Ates, C., Atalan, K., Jacobson, S., Owall, A., Kokinsky, E., Rudenstam, J., Häggqvist, J., Hulting, J., Sellgren, J., Arvidsson, S., Schindele, M., Hammarskjöld, F., Friberg, H., Petersson, J., Paulsson, A., Lindström, I., Stiernstrom, H., Peterzén, B., Blomqvist, H., Petersen, P., Soto Ibáñez, J., González, J., Izura, J., Corcobado Márquez, C., Rico-Feijoo, J., Sierra, R., Rello, J., Posada, P., Briones Lopez, M., Jara, R., Luis, V., Maria Jesus, H., de la Torre-Prados, M., Felices, F., Sanchez Garcia, M., Macias Pingarrón, J., Garcia-Fuentes, C., Cerdá, E., Serrano, N., Barcenilla-Gaite, F., Sirvent, J., Montejo González, J., Guerrero Gomez, F., Amador Amerigo, J., Borges, M., Sánchez-Olmedo, J., López Ciudad, V., Moreno, M., Esteban, E., Vallés, J., De Rojas Román, J., Yuste, I., Ugarte Peña, P., Sole-violán, J., Bustinza, A., Albaya, A., Latour-Perez, J., Navarro, J., Garcia, F., Martin Delgado, M., Rovira, A., Ramos-gómez, L., Garro, P., Silva, J., Iglesias, L., María Jesús, L., Pueyo, L., Lorente, C., Martinon-Torres, F., Aguilar, G., Martinez-Sagasti, F., Blesa Malpica, A., Valencia, M., Zavala, E., Bustamante Munguira, E., Arribas, M., Insausti, J., Vegas Pinto, R., Bocero, L., Estella, A., Esteban-Reboll, F., Lopez Camps, V., Antón Caraballo, E., Muñoz, E., Olaechea, P., Escriba, A., Santos, I., Campiñez, Burgueño., Moreira, P., Pizzamiglio, M., Conti, V., Kahveci, A., Nydahl, A., Lind, D., Caballero Zirena, A., Guerrero, F., Palomar, M., Einar, V., Agvald-Ohman, C., Wyon, N., Johansson, L., Gil, B., Mariscal, F., Galvan, B., Espinosa, E., Lesmes Serrano, A., Mesalles Sanjuan, E., Manzano Ramirez, A., Quintana Tort-Martorell, E., Monton Dito, J., Ibañez, A., Garcia del Valle, S., Alemparte-Pardavila, E., Monedero, P., Naveira-Abeigón, E., Jorda, R., Alvarez, M., Rubio, O., Bouw, M., Afonso, Susana, Matos, Ricardo, Carneiro, A., Amaro, P., Ribeiro, R., Paiva, J., Galdos-Anuncibay, P., Nieto, M., Ruiz, J., Perez Calvo, C., Mañez, R., França, C., Moreno, R., Dias, C., Sousa, A., Rezende, A., Mourão, L., Ponce, P., Oliveira, T., Esteves, F., Den Boer, S., Bakker, J., Van Berkel, G., Borg, M., Gullo, A., Gianesello, L., Martinelli, L., Antonelli, M., Bassetti, M., Telo, L., Alves, M., Almeida, E., Leite, A., Pádua, F., Costa, H., Póvoa, P., Lopes, V., Carmo, E., Febra, C., Martins, A., Castelo-Branco Sousa, M., Bártolo, A., Junker, A., Erno, P., Klepstad, P., Loevstad, R., Bergmans, D., Rodgers, M., Pham, C., Speelberg, B., Wesselink, R., Ammann, J., Vet, J., Gille, A., Kuiper, M., Kieft, H., Blom, H., Vogelaar, J., Corsten, S., Ten Cate, J., Rosseel, P., De Pont, A., Della Rocca, G., Biancofiore, G., Morelli, A., Ranieri, MV., Cotogni, P., Alessandro, D., Clementi, S., Ferraro, F., Giuseppe, N., Sforza, D., Castiglione, G., Marino, G., Fumagalli, R., Santagostino, G., De Negri, P., De Gasperi, A., Oggioni, R., Conte, V., Sicignano, A., Marri, I., Locicero, M., Guadagnucci, A., Chieregato, A., Fiore, G., Sorbara, C., Munch, C., Ruatti, H., Lorella, P., Borrelli, F., Panella, L., De Blasi, R., Ceriani, R., Colonna, S., Abbruzzese, C., Rosano, A., Caspani, M., Emmi, V., Stelian, E., Scolz, S., Guberti, A., Margarit, O., Giarratano, A., Rosi, R., Marzorati, S., De blasio, E., Minerva, M., Petrucci, N., Mangani, V., Lazzero, A., Sapuppo, M., Cecilia, P., Borelli, M., Greco, S., Vesconi, S., Sofer, S., Cohen, J., Kishinevsky, E., Selçuk Üniversitesi, Hanberger, H, Antonelli, M, Holmbom, M, Lipman, J, Pickkers, P, Leone, M, Rello, J, Sakr, Y, Walther, S, Vanhems, P, Vincent, J, Betsch, H, Fogh, B, Espersen, K, Jacobsen, K, Berezowicz, P, Harjola, V, Sofianos, E, Armaganidis, A, Routsi, C, Bitzani, M, Chalkiadaki, A, Michalopoulos, A, Mouloudi, E, Ioannidou, E, Myrianthefs, P, Koulenti, D, Karampela, I, Kyriazopoulos, G, Mandragos, K, Clouva molyvdas, P, Moraiti, A, Pneumatikos, I, Filos, K, Zakynthinos, E, Kotanidou, A, Vakalos, A, Sprung, C, Lev, A, Kishinevsky, E, Cohen, J, Sofer, S, Vesconi, S, Greco, S, Borelli, M, Cecilia, P, Sapuppo, M, Lazzero, A, Mangani, V, Petrucci, N, Minerva, M, De blasio, E, Marzorati, S, Rosi, R, Giarratano, A, Margarit, O, Guberti, A, Scolz, S, Stelian, E, Emmi, V, Caspani, M, Rosano, A, Abbruzzese, C, Colonna, S, Ceriani, R, De Blasi, R, Panella, L, Borrelli, F, Lorella, P, Ruatti, H, Munch, C, Sorbara, C, Fiore, G, Chieregato, A, Conti, V, Guadagnucci, A, Pizzamiglio, M, Locicero, M, Marri, I, Sicignano, A, Conte, V, Oggioni, R, De Gasperi, A, De Negri, P, Santagostino, G, Fumagalli, R, Marino, G, Castiglione, G, Sforza, D, Giuseppe, N, Bassetti, M, Ferraro, F, Clementi, S, Alessandro, D, Cotogni, P, Ranieri, M, Martinelli, L, Gianesello, L, Gullo, A, Morelli, A, Biancofiore, G, Della Rocca, G, Borg, M, De Pont, A, Rosseel, P, Ten Cate, J, Van Berkel, G, Corsten, S, Bakker, J, Vogelaar, J, Blom, H, Kieft, H, Kuiper, M, Gille, A, Vet, J, Ammann, J, Den Boer, S, Wesselink, R, Speelberg, B, Pham, C, Rodgers, M, Bergmans, D, Groeneveld, J, Loevstad, R, Klepstad, P, Erno, P, Junker, A, Bártolo, A, Castelo Branco Sousa, M, Esteves, F, Martins, A, Oliveira, T, Ponce, P, Mourão, L, Febra, C, Carmo, E, Lopes, V, Póvoa, P, Rezende, A, Costa, H, Moreira, P, Pádua, F, Leite, A, Almeida, E, Alves, M, Sousa, A, Telo, L, Dias, C, Paiva, J, Ribeiro, R, Amaro, P, Carneiro, A, Moreno, R, Matos, R, Afonso, S, Bouw, M, França, C, Rubio, O, Mañez, R, Campiñez, B, Alvarez, M, Jorda, R, Naveira Abeigón, E, Monedero, P, Alemparte Pardavila, E, Garcia del Valle, S, Perez Calvo, C, Palomar, M, Guerrero, F, Caballero Zirena, A, Arribas, M, Bustamante Munguira, E, Ruiz, J, Iglesias, L, Zavala, E, Valencia, M, Blesa Malpica, A, Martinez Sagasti, F, Nieto, M, Aguilar, G, Martinon Torres, F, Lorente, C, Insausti, J, Vegas Pinto, R, Santos, I, Escriba, A, Olaechea, P, Muñoz, E, Antón Caraballo, E, Galdos Anuncibay, P, Lopez Camps, V, Esteban Reboll, F, Estella, A, Bocero, L, Ibañez, A, Pueyo, L, María Jesús, L, Silva, J, Garro, P, Ramos gómez, L, Rovira, A, Martin Delgado, M, Monton Dito, J, Garcia, F, Navarro, J, Latour Perez, J, Albaya, A, Bustinza, A, Sole violán, J, Ugarte Peña, P, Yuste, I, De Rojas Román, J, Vallés, J, Esteban, E, Quintana Tort Martorell, E, Moreno, M, López Ciudad, V, Manzano Ramirez, A, Sánchez Olmedo, J, Borges, M, Amador Amerigo, J, Guerrero Gomez, F, Montejo González, J, Sirvent, J, Mesalles Sanjuan, E, Barcenilla Gaite, F, Serrano, N, Cerdá, E, Lesmes Serrano, A, Garcia Fuentes, C, Macias Pingarrón, J, Espinosa, E, Sanchez Garcia, M, Felices, F, de la Torre Prados, M, Maria Jesus, H, Luis, V, Jara, R, Briones Lopez, M, Posada, P, Galvan, B, Mariscal, F, Gil, B, Sierra, R, Rico Feijoo, J, Corcobado Márquez, C, Izura, J, González, J, Soto Ibáñez, J, Petersen, P, Johansson, L, Blomqvist, H, Peterzén, B, Wyon, N, Stiernstrom, H, Lindström, I, Paulsson, A, Agvald Ohman, C, Petersson, J, Friberg, H, Einar, V, Hammarskjöld, F, Schindele, M, Arvidsson, S, Sellgren, J, Hulting, J, Häggqvist, J, Rudenstam, J, Lind, D, Kokinsky, E, Owall, A, Jacobson, S, Nydahl, A, Atalan, K, Ates, C, Kahveci, A, Fistikci, H, Kaya, A, Ozgencil, E, Kizilkaya, M, Bosnak, M, Bodur, H, Akan, M, Guven, M, Turkoglu, M, Topeli, A, Togal, T, Uzel, N, Akinci, I, Cakar, N, Tugrul, S, Demirkiran, O, Adanir, T, Dogruer, K, Turkmen, A, Guven, H, Ulger, F, Kocak, S, İç Hastalıkları, and OMÜ

Subjects
Male, Pediatrics, Cross-sectional study, health care facilities, manpower, and services, Antibiotics, Resistance, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Prevalence, Drug Resistance, law.invention, Medical microbiology, law, Pathologie maladies infectieuses, Antibiotic, Critically ill, Infection, Aged, Anti-Bacterial Agents, Bacteria, Bacterial Infections, Cross-Sectional Studies, Europe, Female, Hospitalization, Humans, Middle Aged, Treatment Outcome, Drug Resistance, Bacterial, Intensive Care Units, Infectious Diseases, Critically ill -- Care, Mortality rate, Bacterial, Intensive care unit, SAPS II, Beta lactam antibiotics, Research Article, Human, medicine.medical_specialty, medicine.drug_class, Intensive Care Unit, Bacterial Infection, Antibiotic resistance, Internal medicine, Settore MED/41 - ANESTESIOLOGIA, Anti-Bacterial Agent, medicine, Cross-Sectional Studie, business.industry, Aminopeptidases -- Analysis, Klinisk medicin, Polypeptides, Bacterial diseases -- Diagnosis, Antibiotics -- Therapeutic use, Clinical Medicine, business
Abstract

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome., 0, SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2014

27. Albumin replacement in patients with severe sepsis or septic shock

Author

Gattinoni L, Caironi P, Pesenti A, Fumagalli R, Tognoni G, Romero M, Latini R, Masson S, Vincent JL, Suter PM, Valsecchi MG, Santosuosso A, Cavana M, Ortu A, Gabini R, Perno S, Anelli A, Amoruso R, Ferraris S, Borelli M, Massei R, Riva I, Poli G, Papagni G, Bortone F, Mamprin F, Keim R, Brivio M, Colageo U, Mimii EP, Sangiorgi G, Siniscalchi A, Pierucci E, Giovannitti A, Gentile C, Pascucci F, Antonini B, Zummo U, Valsecchi R, Cerisara M, Trezzi T, Dossena A, Ribola A, Tamayo L, Zoppellari R, Volta CA, Mangani V, Fanfani E, Chelazzi C, Bartoli T, Parrini V, Oggioni R, Fedele A, Molin A, Berri C, Guarino A, Isetta M, Bonfiglio M, Tissino F, Silvestri L, Milanesi M, Sbrana G, Motta E, Iannaco I, Casadio MC, Pasetti GS, Palandini A, Cascione C, Puscio D, Cellai F, Boccalatte D, Silvestri S, Fausto CI, Lupo V, Zompanti V, Iacobone E, Gattari D, Ronzoni G, Beck E, Francesconi S, Colombo R, Raimondi F, Castelli A, De Gasperi A, Radrizzani D, Ferla LE, Giudici R, Bellato V, Bordone G, Gavazzeni V, Lesmo A, Ripamonti D, Vesconi S, Papoff A, Rossi A, Noto A, Pezzi A, Zanforlin G, Kandil H, Ballotta A, Bettini F, Vaghi GM, Rossi S, Pessina C, Casagrande D, Trivellato A, Costagli V, Moise G, Furla M, Marelli S, Caspani L, Panigada M, Bruzzone P, Isgrò S, Abbruzzese C, Tagliabue P, Solca M, Bonazzi M, Cattaneo A, Rossi N, Andreoni P, Pasetto A, Girardis M, Barbieri E, Piazza O, Zagara G, Bono M, Galzerano A, Garzilli T, Dentini N, Bindi M, Biancofiore G, Mercante WP, Disconzi MM, Todesco N, Lunardi S, Sani E, Carli M, Bracciotti G, Gori V, Braccini P, Maggio G, Braschi A, Bottazzi A, Iotti G, Nicora B, Salati G, Salsi P, Antonelli M, Pennisi MA, Bello G, Caccese R, D'Ambrosio M, Rocco M, Sanseverino M, Gatta A, Nastasi M, Corsi A, Facondini F, Franchi F, Mongelli P, Ferrario M, Carulli F, Del Curto S, Schiappacasse G, Dalpiaz C, Armani S, Verderosa I, Marzullo A, Tonetti F, De Piero ME, Livigni S, Fiore G, Cerutti A, Erbetta S, Napolitano R, Pastorelli M, Bona F, Debernardi F, Gallo M, Segala V, Parigi L, Perzolla D, Marson F, Chiarandini P, Cammarano C, Sermann G, De Lucia S, Frigerio A, Distaso F, Franco R, Bossi E, Laudi C, De Nardin M, Violo T, Lazzari F, Vestali A, Della Mora E, Polati E, Martini A, Cristallini S, Totaro C, Milan B, Dan M, Ruberti S, Danzi V., GIARRATANO, Antonino, RAINERI, Santi Maurizio, CORTEGIANI, Andrea, Caironi, P, Tognoni, G, Masson, S, Fumagalli, R, Pesenti, A, Romero, M, Fanizza, C, Caspani, L, Faenza, S, Grasselli, G, Iapichino, G, Antonelli, M, Parrini, V, Fiore, G, Latini, R, Gattinoni, L, Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L, Vincent JL, Suter PM, Valsecchi MG, Santosuosso A, Cavana M, Ortu A, Gabini R, Perno S, Anelli A, Amoruso R, Ferraris S, Borelli M, Massei R, Riva I, Poli G, Papagni G, Bortone F, Mamprin F, Keim R, Brivio M, Colageo U, Mimii EP, Sangiorgi G, Siniscalchi A, Pierucci E, Giovannitti A, Gentile C, Pascucci F, Antonini B, Zummo U, Valsecchi R, Cerisara M, Trezzi T, Dossena A, Ribola A, Tamayo L, Zoppellari R, Volta CA, Mangani V, Fanfani E, Chelazzi C, Bartoli T, Oggioni R, Fedele A, Molin A, Berri C, Guarino A, Isetta M, Bonfiglio M, Tissino F, Silvestri L, Milanesi M, Sbrana G, Motta E, Iannaco I, Casadio MC, Pasetti GS, Palandini A, Cascione C, Puscio D, Cellai F, Boccalatte D, Silvestri S, Fausto CI, Lupo V, Zompanti V, Iacobone E, Gattari D, Ronzoni G, Beck E, Francesconi S, Colombo R, Raimondi F, Castelli A, De Gasperi A, Radrizzani D, Ferla LE, Giudici R, Bellato V, Bordone G, Gavazzeni V, Lesmo A, Ripamonti D, Vesconi S, Papoff A, Rossi A, Noto A, Pezzi A, Zanforlin G, Kandil H, Ballotta A, Bettini F, Vaghi GM, Rossi S, Pessina C, Casagrande D, Trivellato A, Costagli V, Moise G, Furla M, Marelli S, Panigada M, Bruzzone P, Isgrò S, Abbruzzese C, Tagliabue P, Solca M, Bonazzi M, Cattaneo A, Rossi N, Andreoni P, Pasetto A, Girardis M, Barbieri E, Piazza O, Giarratano A, Raineri SM, Cortegiani A, Zagara G, Bono M, Galzerano A, Garzilli T, Dentini N, Bindi M, Biancofiore G, Mercante WP, Disconzi MM, Todesco N, Lunardi S, Sani E, Carli M, Bracciotti G, Gori V, Braccini P, Maggio G, Braschi A, Bottazzi A, Iotti G, Nicora B, Salati G, Salsi P, Pennisi MA, Bello G, Caccese R, D'Ambrosio M, Rocco M, Sanseverino M, Gatta A, Nastasi M, Corsi A, Facondini F, Franchi F, Mongelli P, Ferrario M, Carulli F, Del Curto S, Schiappacasse G, Dalpiaz C, Armani S, Verderosa I, Marzullo A, Tonetti F, De Piero ME, Livigni S, Cerutti A, Erbetta S, Napolitano R, Pastorelli M, Bona F, Debernardi F, Gallo M, Segala V, Parigi L, Perzolla D, Marson F, Chiarandini P, Cammarano C, Sermann G, De Lucia S, Frigerio A, Distaso F, Franco R, Bossi E, Laudi C, De Nardin M, Violo T, Lazzari F, Vestali A, Della Mora E, Polati E, Martini A, Cristallini S, Totaro C, Milan B, Dan M, Ruberti S, and Danzi V

Subjects
Male, medicine.medical_specialty, ALBUMIN, SEPSIS, SEVERE SEPSIS, SEPTIC SHOCK, Sepsi, Serum albumin, Settore MED/41 - Anestesiologia, Aged, Albumins, Female, Humans, Isotonic Solutions, Middle Aged, Rehydration Solutions, Sepsis, Serum Albumin, Shock, Septic, Survival Rate, Treatment Outcome, Intensive care, medicine, albumin replacement, Survival rate, Isotonic Solution, Medicine (all), SEPSIS, biology, business.industry, Septic shock, Rehydration Solution, Septic, Albumin, SEPTIC SHOCK, Organ dysfunction, Shock, General Medicine, medicine.disease, Surgery, Anesthesia, Relative risk, biology.protein, medicine.symptom, business, Human
Abstract

BACKGROUND: Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established. METHODS: In this multicenter, open-label trial, we randomly assigned 1818 patients with severe sepsis, in 100 intensive care units (ICUs), to receive either 20% albumin and crystalloid solution or crystalloid solution alone. In the albumin group, the target serum albumin concentration was 30 g per liter or more until discharge from the ICU or 28 days after randomization. The primary outcome was death from any cause at 28 days. Secondary outcomes were death from any cause at 90 days, the number of patients with organ dysfunction and the degree of dysfunction, and length of stay in the ICU and the hospital. RESULTS: During the first 7 days, patients in the albumin group, as compared with those in the crystalloid group, had a higher mean arterial pressure (P = 0.03) and lower net fluid balance (P

Published
2014

28. In vitro evaluation of fluid reflux after flushing different types of needleless connectors

Author

Elli, S, Abbruzzese, C, Cannizzo, L, Lucchini, A, Elli, Stefano, Abbruzzese, Chiara, Cannizzo, Luigi, Lucchini, Alberto, Elli, S, Abbruzzese, C, Cannizzo, L, Lucchini, A, Elli, Stefano, Abbruzzese, Chiara, Cannizzo, Luigi, and Lucchini, Alberto

Abstract

Purpose: To evaluate fluid reflux, when disconnecting syringe, for different needleless connectors. Materials: Nine connectors were tested; 540 measurements were carried out. Results: The connectors tested showed very different performances, about reflux, on disconnection of the syringe used for flushing. The calculated reflux volumes are: Max Zero® - BD: 6.90 (±2.47) mm3; MicroClave Clear® - ICU Medical: 6.14 (±1.46) mm3; Bionecteur® - Vygon: 1.24(±0.73) mm3; Neutron® - ICU Medical: 0.12 (±0.15) mm3; SmartSite® Carefusion: 33.51 (±11.50) mm3; Safe Plus® - Cremascoli: 23.54 (±3.56) mm3; NeutraClear® - Cair: 9.36 (±1.87) mm3; NeutroX® - Cair: 0.33 (±0.31) mm3; Dasa® BTC: 2.38 (±1.67) mm3. Differences between investigated devices were statistically significant (p<0.001). Discussion: It is difficult to establish the best quality-price ratio for needleless connectors. It is important to consider several variable factors: continuous or discontinuous infusion, catheter type, usage environment and caliber of catheter used. It would therefore be useful to have an indication of the intraluminal space potentially affected by blood reflux in relation to a specific device. Conclusions: Needleless connector is one of the main factors involved in keeping catheter patency. It is important to perform the best choice among the connectors available. An empirical reflux measurement, relative to the needleless connector and the catheter in use, can be obtained using an 18G cannula.

Published
2016

29. Management of acute respiratory complications from influenza A (H1N1) infection: experience of a tertiary-level Intensive Care Unit

Author

Grasselli, G., Bombino, M., Nicolò Patroniti, Foti, G., Benini, A., Abbruzzese, C., Fumagalli, R., Pesenti, A., Grasselli, G, Bombino, M, Patroniti, N, Foti, G, Benini, A, Abbruzzese, C, Fumagalli, R, and Pesenti, A

Subjects
Adult, Male, Adolescent, Critical Care, Respiratory distress syndrome, Young Adult, Extracorporeal Membrane Oxygenation, Influenza A Virus, H1N1 Subtype, Artificial-Influenza a virus, Influenza, Human, Adult-Ventilation, H1N1 subtype-Extracorporeal membrane oxygenation, Anesthesiology and Pain Medicine, Humans, MED/41 - ANESTESIOLOGIA, Child, Aged, Pulmonary Gas Exchange, H1N1, Middle Aged, Respiration, Artificial, Respiratory Function Tests, Italy, Acute Disease, Female, ARDS, Respiratory Insufficiency
Abstract

Background. The novel influenza A (H1N1) pandemic was associated with an epidemic of critical illness. Methods. We describe the clinical profiles of critically ill patients with severe complications due to microbiologically confirmed pandemic influenza A (H1N1) infection admitted to a medical ICU in Monza, Italy, over a 6-month period. Results. From August 2009 to January 2010, 19 patients (13 adults and 6 children) required ICU admission. Nine subjects were referred to our hospital from other ICUs. In all patients, with the exception of a case of severe septic shock, the cause of ICU admission was acute respiratory failure. Other nonpulmonary organ failures were common. A trial of non-invasive ventilation was attempted in 13 cases and was successful in four of them. The majority of the patients required invasive mechanical ventilation. In the 7 most severely hypoxemic patients, we applied veno-venous ECLS, with a very high rate of success. The median ICU stay was 9 days (range 1-78 days). Sixteen out of 19 (84%) patients survived. Conclusion. In the majority of our patients, critical illness caused by pandemic influenza A (H1N1) was associated with severe hypoxemia multiple organ failure, requirement for mechanical ventilation and frequent use of rescue therapies and ECLS support.

Published
2011

30. Intracranial pressure monitoring in pediatric bacterial meningitis: A fancy or useful tool? A case report

Author

Sala, F., Abbruzzese, C., Galli, D., Marco Grimaldi, Abate, M. G., Sganzerla, E. P., Citerio, G., Sala, F, Abbruzzese, C, Galli, D, Grimaldi, M, Abate, M, Sganzerla, E, and Citerio, G

Subjects
Male, Intracranial Pressure, Child, Preschool, Humans, MED/27 - NEUROCHIRURGIA, Monitoring, Physiologic, Meningitis, Bacterial
Abstract

Childhood meningitis is associated with high mortality and morbidity. In selected cases, the prompt institution of invasive intracranial pressure (ICP) monitoring and therapy may improve survival but few studies have evaluated the indications for ICP monitoring in this specific neurological disease. This article examines the case of a five-year-old child who was comatose when admitted to the hospital with unilateral dilated pupil, neck stiffness and fever (T 39 degrees C). The initial brain computed tomography scan was unremarkable. Dexamethasone and empirical antibiotic therapy for suspected meningitis was started and a lumbar puncture (LP) was performed. The LP opening pressure was 45 mmHg. Cerebrospinal fluid microscopy demonstrated Meningococcal meningitis. The likelihood of raised ICP, associated with third nerve palsy, prompted insertion of an intraparenchymal catheter for ICP monitoring. Intracranial hypertension was treated with medical therapy. ICP was controlled within 72 hours. On day nine, the ICP device was removed. On the same day, the child started to obey commands, was rapidly weaned from mechanical ventilation and was extubated. He was discharged from the Department on day 13 and after two weeks went home with residual dysmetria and mild motor impairment. This study indicates that ICP-targeted treatment in children improves the outcome of severe cases of bacterial meningitis. ICP monitoring could particularly be useful to optimize brain perfusion and provide relief from severe neurological impairment, which is associated with the clinical signs of meningitis and increased ICP levels.

Published
2009

31. Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels

Author

Hanberger, H. Antonelli, M. Holmbom, M. Lipman, J. Pickkers, P. Leone, M. Rello, J. Sakr, Y. Walther, S.M. Vanhems, P. Vincent, J.-L. Betsch, H. Fogh, B. Espersen, K. Jacobsen, K. Berezowicz, P. Harjola, V. Sofianos, E. Armaganidis, A. Routsi, C. Bitzani, M. Chalkiadaki, A. Michalopoulos, A. Mouloudi, E. Ioannidou, E. Myrianthefs, P. Koulenti, D. Karampela, I. Kyriazopoulos, G. Mandragos, K. Clouva-molyvdas, P. Moraiti, A. Pneumatikos, I. Filos, K. Zakynthinos, E. Kotanidou, A. Vakalos, A. Sprung, C. Lev, A. Kishinevsky, E. Cohen, J. Sofer, S. Vesconi, S. Greco, S. Borelli, M. Cecilia, P. Sapuppo, M. Lazzero, A. Mangani, V. Petrucci, N. Minerva, M. De blasio, E. Marzorati, S. Rosi, R. Giarratano, A. Margarit, O. Guberti, A. Scolz, S. Stelian, E. Emmi, V. Caspani, M. Rosano, A. Abbruzzese, C. Colonna, S. Ceriani, R. De Blasi, R. Panella, L. Borrelli, F. Lorella, P. Ruatti, H. Munch, C. Sorbara, C. Fiore, G. Chieregato, A. Conti, V. Guadagnucci, A. Pizzamiglio, M. Locicero, M. Marri, I. Sicignano, A. Conte, V. Oggioni, R. De Gasperi, A. De Negri, P. Santagostino, G. Fumagalli, R. Marino, G. Castiglione, G. Sforza, D. Giuseppe, N. Bassetti, M. Ferraro, F. Clementi, S. Alessandro, D. Cotogni, P. Ranieri, MV. Antonelli, M. Martinelli, L. Gianesello, L. Gullo, A. Morelli, A. Biancofiore, G. Della Rocca, G. Borg, M. De Pont, A. Rosseel, P. Ten Cate, J. Van Berkel, G. Corsten, S. Bakker, J. Vogelaar, J. Blom, H. Kieft, H. Kuiper, M. Gille, A. Pickkers, P. Vet, J. Ammann, J. Den Boer, S. Wesselink, R. Speelberg, B. Pham, C. Rodgers, M. Bergmans, D. Groeneveld, J. Loevstad, R. Klepstad, P. Erno, P. Junker, A. Bártolo, A. Castelo-Branco Sousa, M. Esteves, F. Martins, A. Oliveira, T. Ponce, P. Mourão, L. Febra, C. Carmo, E. Lopes, V. Póvoa, P. Rezende, A. Costa, H. Moreira, P. Pádua, F. Leite, A. Almeida, E. Alves, M. Sousa, A. Telo, L. Dias, C. Paiva, J. Ribeiro, R. Amaro, P. Carneiro, A. Moreno, R. Matos, R. Afonso, S. Bouw, M. França, C. Rubio, O. Mañez, R. Campiñez, M. Alvarez, M. Jorda, R. Naveira-Abeigón, E. Monedero, P. Alemparte-Pardavila, E. Garcia del Valle, S. Perez Calvo, C. Palomar, M. Guerrero, F. Caballero Zirena, A. Arribas, M. Bustamante Munguira, E. Ruiz, J. Iglesias, L. Zavala, E. Valencia, M. Blesa Malpica, A. Martinez-Sagasti, F. Nieto, M. Aguilar, G. Martinon-Torres, F. Lorente, C. Insausti, J. Vegas Pinto, R. Santos, I. Escriba, A. Olaechea, P. Muñoz, E. Antón Caraballo, E. Galdos-Anuncibay, P. Lopez Camps, V. Esteban-Reboll, F. Estella, A. Bocero, L. Ibañez, A. Pueyo, L. María Jesús, L. Iglesias, L. Silva, J. Garro, P. Ramos-gómez, L. Rovira, A. Martin Delgado, M. Monton Dito, J. Garcia, F. Navarro, J. Latour-Perez, J. Albaya, A. Bustinza, A. Sole-violán, J. Ugarte Peña, P. Yuste, I. De Rojas Román, J. Vallés, J. Esteban, E. Quintana Tort-Martorell, E. Moreno, M. López Ciudad, V. Manzano Ramirez, A. Sánchez-Olmedo, J. Borges, M. Amador Amerigo, J. Guerrero Gomez, F. Montejo González, J. Sirvent, J. Mesalles Sanjuan, E. Barcenilla-Gaite, F. Serrano, N. Cerdá, E. Lesmes Serrano, A. Garcia-Fuentes, C. Macias Pingarrón, J. Espinosa, E. Sanchez Garcia, M. Felices, F. de la Torre-Prados, M. Maria Jesus, H. Luis, V. Jara, R. Briones Lopez, M. Posada, P. Galvan, B. Mariscal, F. Gil, B. Sierra, R. Rico-Feijoo, J. Corcobado Márquez, C. Izura, J. González, J. Soto Ibáñez, J. Petersen, P. Johansson, L. Blomqvist, H. Peterzén, B. Wyon, N. Stiernstrom, H. Lindström, I. Paulsson, A. Agvald-Ohman, C. Petersson, J. Friberg, H. Einar, V. Hammarskjöld, F. Schindele, M. Arvidsson, S. Sellgren, J. Hulting, J. Häggqvist, J. Rudenstam, J. Lind, D. Kokinsky, E. Owall, A. Jacobson, S. Nydahl, A. Atalan, K. Ates, C. Kahveci, A. Fistikci, H. Kaya, A. Ozgencil, E. Kizilkaya, M. Bosnak, M. Bodur, H. Akan, M. Guven, M. Turkoglu, M. Topeli, A. Togal, T. Uzel, N. Akinci, I. Cakar, N. Tugrul, S. Demirkiran, O. Adanir, T. Dogruer, K. Turkmen, A. Guven, H. Ulger, F. Kocak, S. the EPIC II Group of Investigators

Subjects
health care facilities, manpower, and services
Abstract

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome. © 2014 Hanberger et al.; licensee BioMed Central Ltd.

Published
2014

32. How to improve ischemic stroke treatment in the fibrinolysis era

Author

Giuseppe Citerio, Galli D, Cadore B, Rondelli E, Sala F, Abbruzzese C, Citerio, G, Galli, D, Cadore, B, Rondelli, E, Sala, F, and Abbruzzese, C

Subjects
Hospitalization, Stroke, Emergency Medical Services, Time Factors, Cerebrovascular accident, Emergency Medicine, Reperfusion, Stroke, Humans, Thrombolytic Therapy, Brain Ischemia
Abstract

In the last 15 years new therapeutic approaches have influenced the treatment of ischemic stroke victims. Aim of this review is to point out the elements of a modern approach to the acute stroke patient. The likelihood of saving ischemic cerebral tissue is time-dependent and the treatment goal is to minimise brain damage. The NINDS trial has documented a higher likelihood of better outcome if the fibrinolytic therapy is administered within 3 h of onset of symptoms. To reach this target several interventions are necessary. First of all, education is needed to diffuse public awareness of stroke warning signs. Moreover, out-of-hospital treatment should be optimised with rapid triage and transport to an hospital with a comprehensive stroke approach. The early hospital phase should comprehend a rapid evaluation and an urgent CT scan. After the verification of the inclusion/exclusion criteria, in a authorised SITS-MOST centre, the patient should receive fibrinolytic therapy. The diagnostic and the therapeutic phase should include rapid identification and treatment of secondary insults, as hyperthermia and hyperglycaemia, that have a negative influence on outcome. Despite advances in diagnosis and monitoring, fibrinolytic therapy is the only treatment with a proven efficacy in achieving a higher functional outcome. The narrow time-window is the reason for the need of rapid and well-organised out-of-hospital and in-hospital systems.

Published
2006

33. Effects of Sigh on Regional Lung Strain and Ventilation Heterogeneity in Acute Respiratory Failure Patients Undergoing Assisted Mechanical Ventilation

Author

Mauri, T, Eronia, N, Abbruzzese, C, Marcolin, R, Coppadoro, A, Spadaro, S, Patroniti, N, Bellani, G, Pesenti, A, MAURI, TOMMASO, ERONIA, NILDE, ABBRUZZESE, CHIARA, MARCOLIN, ROBERTO, COPPADORO, ANDREA, PATRONITI, NICOLO' ANTONINO, BELLANI, GIACOMO, PESENTI, ANTONIO MARIA, Mauri, T, Eronia, N, Abbruzzese, C, Marcolin, R, Coppadoro, A, Spadaro, S, Patroniti, N, Bellani, G, Pesenti, A, MAURI, TOMMASO, ERONIA, NILDE, ABBRUZZESE, CHIARA, MARCOLIN, ROBERTO, COPPADORO, ANDREA, PATRONITI, NICOLO' ANTONINO, BELLANI, GIACOMO, and PESENTI, ANTONIO MARIA

Abstract

In acute respiratory failure patients undergoing pressure support ventilation, a short cyclic recruitment maneuver (Sigh) might induce reaeration of collapsed lung regions, possibly decreasing regional lung strain and improving the homogeneity of ventilation distribution. We aimed to describe the regional effects of different Sigh rates on reaeration, strain, and ventilation heterogeneity, as measured by thoracic electrical impedance tomography. Design: Prospective, randomized, cross-over study. Setting: General ICU of a single university-affiliated hospital. Patients: We enrolled 20 critically ill patients intubated and mechanically ventilated with Pao2/Fio2 up to 300 mm Hg and positive end-expiratory pressure at least 5 cm H2O (15 with acute respiratory distress syndrome), undergoing pressure support ventilation as per clinical decision. Interventions: Sigh was added to pressure support ventilation as a 35 cm H2O continuous positive airway pressure period lasting 3-4 seconds at different rates (no-Sigh vs 0.5, 1, and 2 Sigh(s)/min). All study phases were randomly performed and lasted 20 minutes. Measurements and Main Results: In the last minutes of each phase, we measured arterial blood gases, changes in end-expiratory lung volume of nondependent and dependent regions, tidal volume reaching nondependent and dependent lung (Vtnondep and Vtdep), dynamic intratidal ventilation heterogeneity, defined as the average ratio of Vt reaching nondependent/Vt reaching dependent lung regions along inspiration (VtHit). With Sigh, oxygenation improved (p < 0.001 vs no-Sigh), end-expiratory lung volume of nondependent and dependent regions increased (p < 0.01 vs no-Sigh), Vtnondep showed a trend to reduction, and Vtdep significantly decreased (p = 0.11 and p < 0.01 vs no-Sigh, respectively). VtHit decreased only when Sigh was delivered at 0.5/min (p < 0.05 vs no-Sigh), while it did not vary during the other two phases. Conclusions: Sigh decreases regional lung strain and intratid

Published
2015

34. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

Author

Keth, Th, Azoulay, E, Echeverria, Pm, Vincent, Jl, Collaboratorsmargarit, A, Valentini, R, Alan Javier, Z, Bevilacqua, C, Curone, M, Rabuffetti, R, Comignani, P, Torres Boden, M, Chertcoff, F, Cardonatti, G, Adén, F, Marcos, L, Dónofrio, M, Fernández, R, Lamberghini, R, Balasini, S, Teves, J, Las Heras, M, Sinner, J, Ceraso, D, Curcio, D, Aguilar, L, Weller, C, Cardonnet, L, Santa Cruz, R, Manrique, E, Bernardez, D, Iolster, T, Chiappero, G, Ramos, P, Vergara, J, Moine, I, Ilutovich, S, Jannello, G, Waschbusch, M, Rios Picaza, G, Raimondi, A, Miriam, M, Lovesio, C, Caridi, M, Leong, T, Orford, N, Reece, G, Ernest, D, Hawker, F, Tan, J, Giannellis, C, Ihle, B, Bersten, A, Mcinnes, J, Tallott, M, Mcfadyen, B, Vibert, J, Parr, M, Tran, K, Sutton, J, Webb, S, Groves, N, Cole, L, Long, D, Bass, F, Erickson, S, Lipman, J, Delzoppo, C, Thomas, J, Dobb, G, Daley, M, Roberts, B, Santamaria, J, Young, J, Festa, M, Holland, R, Mullany, D, Williams, P, Corkeron, M, Gales, M, Banerjee, A, Yung, M, Mutz, N, Hiesmayr, M, Faybik, P, Fitzgerald, R, Firlinger, F, Zasmeta, G, Zink, M, Sieber, W, Hildegard, J, Bakondy, R, Schlieber, J, Filzwieser, G, Beer, R, Joannidis, M, Schuster, R, Scherzer, W, Smolle, K, Fitzal, S, Manzoor, R, Brunain, J, D'Hondt, A, Huylenbroeck, G, Van der Schueren, M, 't Kindt, H, Slock, E, Rijckaert, D, Raemaekers, J, Bourgeois, M, Van Cotthem, I, Nackaerts, G, Gusu, D, Gadisseux, P, Vancollie, O, Lignian, H, Michel, P, Fraipont, V, Vander Stappen, M, Forêt, F, De Bels, D, Devriendt, J, Massaut, J, Biston, P, Roman, A, Lambermont, B, De Meulder, A, Frederic, V, Sottiaux, T, Ruyffelaere, P, Collin, V, Anane, S, Kleiren, P, Simon, M, Machayekhi, S, Frans, E, Leroy, G, Berghmans, T, Joseph, R, Eerens, J, Laterre, P, Lagrou, B, Rutsaert, R, Pisarek, W, Dive, A, De Waele, J, Spapen, H, Damas, P, Malbrain, M, Hidalgo, J, Baptista, M, Salgado, D, Braga, M, Avila, C, Westphal, G, Caser, E, Alves, A, Friedman, G, Luz, M, Assuncao, M, Reis, H, Gomes, A, Silva, U, Nogueira Fh, W, El Dash, S, Valiatti, J, Barbosa, A, Coelho, C, Knibel, M, Minelli, C, Caovilla, J, Teixeira, G, Hovnanian, A, Rea Neto, A, Lobo, S, Lugarinho, M, Souza, P, Ferreira, D, Duarte, P, Oliveira, M, Marques, J, Machado, R, Rehder, P, Mataloun, S, Grilo, M, Quesado, P, Moock, M, Ferreira, F, Teles, J, Silva, E, Morais, A, Bruzzi de Carvalho, F, Wanderley, M, Velasco, M, Brandão da Silva, N, Feijó, J, Souza Dantas, V, Costa Filho, R, Japiassú, A, Villela, D, Santos, C, Passos, R, Alheira Rocha, R, Silva, R, Houly, J, Aldrighi, J, Hatum, R, Suparregui Dias, F, Ferreira, L, Ferro, L, Gomez, J, Fleury, R, David, C, Resener, T, Mendes, C, Germano, A, De Marco, F, Lage, S, Salluh, J, Torelly, A, Sad, R, Oliveira, G, Lima, R, Paranhos, J, Rocha, M, Bitencourt, W, Grion, C, Forte, D, Guimarães, H, Piras, C, Stephanova, L, Lyubenov, L, Tsarianski, G, Dimov, G, Green, R, Levasseur, J, Ward, R, Lesur, O, Poirier, G, Wax, R, Wood, G, Cook, D, Marshall, J, Herridge, M, Ferguson, N, Espinoza, M, Valdés jimenez, S, Bruhn, A, Micolich, J, Fricke, G, Galvez, S, Escamilla Leon, I, Zhan, Q, Xu, Y, Zhao, Y, Zhang, L, Qin, T, Du, B, Li, M, Wang, X, Jing, Y, Zhang, Z, Xianyao, W, Li, F, Congshan, Y, Rebolledo, C, Diaz, D, Murillo Arboleda, R, Arias Antun, A, Montenegro, G, Granados, M, Dueñas, C, Perez, N, Libreros Duque, G, Coral, M, Ortiz, G, Rodriguez, D, Barsic, B, Cubrilo Turek, M, Gornik, I, Grljusic, M, Caballero lopez, A, Iraola Ferrer, M, Pavlik, P, Manak, J, Radej, J, Belohlavek, J, Sevcik, P, Blahut, L, Tyl, D, Steinbach, J, Herold, I, Zykova, I, Prchal, D, Bartosik, T, Kolarova, M, Hájek, R, Kohoutová, J, Marek, O, Hon, P, Chytra, I, Betsch, H, Fogh, B, Espersen, K, Jacobsen, K, Berezowicz, P, Andrade, C, Guerrero, F, Salgado, E, Barahona, D, Del Pozo Sanchez, H, Jibaja, M, Alansary, A, Reintam, A, Starkopf, J, Harjola, V, Tual, L, Leone, M, Serge, M, Leroy, O, Mallet, L, Marc, B, Dormoy, D, Pascal, H, Tronchon, L, Garrigues, B, Santré, C, Dupont, H, Duranteau, J, Leon, A, Henry, L, Canevet, C, Dube, L, Julien, H, Nadia, A, Francois, B, Gérard, J, Freysz, M, Remy, G, Blanloeil, Y, Squara, P, Korach, Jm, Durand, M, Gabriel, C, Eric, P, Jacobs, F, Bronchard, R, Kipnis, E, Moussa, M, Launoy, A, Guérin, C, Vanhems, P, Wynckel, A, Clair, B, Fulgencio, J, Gottwalles, Y, Krummel, T, Lepape, A, Lesieur, O, Payen, D, Hérvé, O, Farkas, J, Cougot, P, Mallédant, Y, Joannes Boyau, O, Standl, T, Sierig, U, Geiseler, J, Hopf, H, Conrad Opel, E, Hermann, C, Ventzke, M, Henneberg, T, Esposito, F, Loeser, H, Spies, C, Zuckermann Becker, H, Voegeler, S, Scherer, R, Pauer, A, Kljucar, S, Delfs, K, Blank, E, Busch, J, Wendt, K, Lessmann, J, Bach, F, Sakr, Y, Berlet, T, Kernchen, A, Quintel, M, Holst, D, Kilger, E, Holubarsch, T, Raufhake, C, Stolt, C, Lubasch, A, Meier Hellmann, A, Woebker, G, Scharnofske, C, Breyer, M, Risch, T, Manhold, C, Goethe, Jw, Meininger, D, Greive, C, Rau, J, Seibel, A, Henn beilharz, A, Wolbert, R, Scherke, T, Martin, J, Rudolph, M, Gleissner, J, Wolf, M, Schleibach, F, Jaschinski, U, Lunkeit, A, Welte, M, Bingold, T, Kogelmann, K, Fischer, F, Fischer, B, Schmid, M, Klein, M, Bechtold, A, Bodmann, K, Klasen, J, Meyrl, H, Goetz, J, Geldner, G, Helmes, T, Jensen, N, Eickmeyer, H, Lengfelder, W, Langenstein, B, Bogdanski, R, Jelen Esselborn, S, Umgelter, A, Dörr, F, Lüttje, K, Heinemeyer, D, Uhl, M, Schirle, P, Benad, H, Glaser, M, Panzer, W, Huettemann, E, Stierwaldt, R, Schappacher, M, Müller, E, Stadlmeyer, W, Fantini, M, Dummer, B, Thörner, M, Jost, V, Loerbroks, T, Glück, T, Zimmermann, R, Clement, R, Hering, R, Klinger, T, Mehl, J, Polozek, H, Rothhammer, A, Seidler, R, Lorenz, P, Mueritz, W, Lutze, M, Euler, M, Heintz, M, Winkler, M, Angstwurm, M, Krohe, K, Treu, T, Steiner, T, Locher, S, Walz, A, Zahn, P, Brandt, W, Marks, M, Henning, F, Janssens, U, Luethgens, M, Theelen, W, Sydow, M, Weber, M, Meiser, A, Deutschmann, C, Buttner, C, Jokiel, M, Bozzetti, C, Jürgen, B, Fiedler, F, Wresch, K, Kremer, A, Bleier, H, Rueckert, M, Ditter, H, Peckelsen, C, Friederich, P, Weber, K, Krueger, W, Lowack, R, Michalsen, A, Ragaller, M, Groeschel, A, Friedrich, T, Hinz, M, Christel, A, Hartwig, T, Kaisers, U, Schmitt, D, Vögeler, S, Weiss, M, Reiter, K, Schwab, T, Trieschmann, U, Kindgen milles, D, Engel, J, Sedemund adib, B, Lauterbach, M, Max, M, Volkert, T, Waydhas, C, Hien, S, Briegel, J, Guralnik, V, Zoremba, N, Riessen, R, Müllges, W, Nierhaus, A, Strauss, R, Utzolino, S, Thul, J, Abel, P, Gründling, M, Kessler, W, Scheuren, K, Vagts, D, Rensing, H, Schoch, B, Kopp, K, Gerlach, H, Corea, M, Uhrig, A, Schroeder, S, Jordan, F, Huber, T, Bittinger, M, Sofianos, E, Armaganidis, A, Routsi, C, Bitzani, M, Chalkiadaki, A, Michalopoulos, A, Mouloudi, E, Ioannidou, E, Myrianthefs, P, Koulenti, D, Karampela, I, Kyriazopoulos, G, Mandragos, K, Clouva molyvdas, P, Moraiti, A, Pneumatikos, I, Filos, K, Zakynthinos, E, Kotanidou, A, Vakalos, A, Cheng, A, Buckley, T, Gomersall, C, Kiss, K, Tamási, P, Sarkany, A, Csomos, A, Zöllei, É, Todi, S, Udwadia, F, Shah, R, Amin, P, Samavedam, S, Mathai, A, Patil, M, Jog, S, Gurjar, M, Vats, M, Varma, A, Gopal, P, Kapadia, F, Chawla, R, Iyer, S, Sahu, S, Bakshi, C, Ambike, D, Govil, D, Karipparambath, V, Chacko, J, Sathe, P, Rungta, N, Jani, C, Bhome, A, Prayag, S, Ray, S, Rajagopalan, R, Divatia, J, Da costa, R, Shyam Sunder, T, Wibowo, P, Maskoen, T, Sugiman, T, Nowruzinia, S, Lotfi, A, Mahmoodpoor, A, Donnelly, M, Breen, D, Ng, S, Bates, J, Sprung, C, Lev, A, Kishinevsky, E, Cohen, J, Sofer, S, Vesconi, S, Greco, S, Borelli, M, Cecilia, P, Sapuppo, M, Lazzero, A, Mangani, V, Petrucci, N, Minerva, M, Rummo, G, De blasio, E, Marzorati, S, Rosi, R, Giarratano, A, Margarit, O, Guberti, A, Scolz, S, Stelian, E, Emmi, V, Caspani, M, Rosano, A, Abbruzzese, C, Colonna, S, Ceriani, R, De Blasi, R, Panella, L, Borrelli, F, Lorella, P, Ruatti, H, Munch, C, Sorbara, C, Fiore, G, Chieregato, A, Conti, V, Guadagnucci, A, Pizzamiglio, M, Locicero, Mt, Marri, I, Sicignano, A, Conte, V, Oggioni, R, De Gasperi, A, De negri, P, Santagostino, G, Roberto, F, Marino, G, Castiglione, G, Sforza, D, Camillo, S, Giuseppe, N, Bassetti, Matteo, Napoli, D, Ferraro, F, Clementi, S, Di Filippo, A, Cotogni, P, Ranieri, Mv, Antonelli, M, Martinelli, L, Gianesello, L, Gullo, A, Morelli, A, Biancofiore, G, DELLA ROCCA, Giorgio, Hashimoto, S, Onodera, M, Kobayashi, A, Shinozuka, T, Imanaka, H, Ikeda, T, Yaguchi, A, Misane, I, Piebalga, A, Moughaghab, A, Pilvinis, V, Vosylius, S, Balciunas, M, Kekstas, G, Margaret, H, Klop, M, Grozdanovski, K, Eftimova, B, Wafa, S, Lim, C, Mat nor, M, Tai, L, Syed Mohd Tahir, S, Idris, N, Tan, C, Borg, M, Manzo, E, Gutierrez Morales, H, Miguel, P, Villagomez, A, Bassols, A, Aguirre, G, Cerón, U, Lopez ramos, J, Monjardín, J, Bermudez Aceves, E, Gonzalez Salazar, F, Rodriguez Gonzalez, D, Poblano Morales, M, Ramirez, F, Cetina, M, Navarro, J, Villagomez Ortiz, A, Sanchez, V, Chavarria, U, Fernandez Ponce, O, Serna secundino, H, Leonardo, O, Diego Manuel, R, Mijangos, J, Vazquez de Anda, G, Martin, E, Gutierrez, P, López Islas, I, Soberanes, L, Pejakov, L, Sbihi, A, Ouahid, B, Naoufel, M, De Pont, A, Rosseel, P, Ten Cate, J, Van Berkel, G, Corsten, S, Bakker, J, Vogelaar, J, Blom, H, Kieft, H, Kuiper, M, Gille, A, Pickkers, P, Vet, J, Ammann, J, Den Boer, S, Wesselink, R, Speelberg, B, Pham, C, Rodgers, M, Bergmans, D, Groeneveld, J, Mcarthur, C, Parke, R, Mehrtens, J, Celi, L, Freebairn, R, Rankin, N, Heffernan, C, Mchugh, G, Beca, J, Van haren, F, Barry, B, Kalkoff, M, Loevstad, R, Klepstad, P, Erno, P, Junker, A, Naqvi, S, Javed, I, Sinclair, J, Rivera, R, Chavez, C, Donayre Taber, Z, Quispe Sierra, R, Muñoz, J, Galvez Ruiz, J, Fang Li, J, Candiotti Herrera, M, Arroyo, A, Becerra, R, Meza, J, Mayorga, M, Garba, P, Kot, J, Gaszynski, T, Piechota, M, Renata, S, Müller, P, Stepinska, J, Jacek, K, Cieniawa, T, Mikstacki, A, Tamowicz, B, Bartkowska Sniatkowska, A, Karpel, E, Kusza, K, Smuszkiewicz, P, Mikaszewska Sokolewicz, M, Goraj, R, Kubler, A, Bártolo, A, Castelo Branco Sousa, M, Esteves, F, Martins, A, João, Hs, Oliveira, T, Ponce, P, Mourão, L, Febra, C, Carmo, E, Lopes, V, Póvoa, P, Rezende, A, Costa, H, Moreira, P, Pádua, F, Leite, A, Almeida, E, Alves, M, Sousa, A, Telo, L, João, S, Dias, C, Paiva, J, Ribeiro, R, Amaro, P, Carneiro, A, Moreno, R, Matos, R, Afonso, S, Bouw, M, França, C, Ibrahim, A, Tabacaru, R, Ionita, V, Tulbure, D, Filipescu, D, Pascanu, S, Grigoras, I, Copotoiu, S, Popov, D, Lebedev, E, Olga, I, Yaroshetskiy, A, Lugovkina, T, Dmitry, B, Malinin, O, Lekmanov, A, Abulmagd, M, Arabi, Y, Alhashemi, J, Ali, A, Maghrabi, K, Debek, A, Malik, M, Jankovic, R, Palibrk, I, Maravic stojkovic, V, Malenkovic, V, Surbatovic, M, Bumbasirevic, V, Lim, N, Loh, T, Tan, H, Sekeresova, H, Koutun, J, Firment, J, Malik, P, Trenkler, S, Muzlovic, I, Kosec, L, Ozek, B, Kasnik, D, Tomic, V, Knafelj, R, Svigelj, V, Du Plessis, H, Raine, R, Bhagwanjee, S, Richards, G, Goosen, J, De Jager, J, Schleicher, G, Rubio, O, Mañez, R, Burgueño Campiñez, M, Alvarez, M, Jorda, R, Naveira Abeigón, E, Monedero, P, Alemparte Pardavila, E, Garcia del Valle, S, Perez Calvo, C, Palomar, M, Caballero Zirena, A, Arribas, M, Bustamante Munguira, E, Ruiz, J, Blanco Vicente, A, Zavala, E, Valencia, M, Blesa Malpica, A, Martinez Sagasti, F, Nieto, M, Aguilar, G, Martinon Torres, F, Lorente, C, Insausti, J, Vegas Pinto, R, Santos, I, Escriba, A, Olaechea, P, Muñoz, E, Antón Caraballo, E, Galdos Anuncibay, P, Lopez Camps, V, Esteban Reboll, F, Estella, A, Bocero, L, Ibañez, A, Yagüe, G, Pueyo, L, María Jesús, L, Iglesias Fraile, L, Silva, J, Garro, P, Palma, L, Ramos gómez, L, Rovira, A, Martin Delgado, M, Monton Dito, J, Garcia, F, Latour Perez, J, Albaya, A, Bustinza, A, Sole violán, J, Ugarte Peña, P, Yuste, I, De Rojas Román, J, Vallés, J, Esteban, E, Quintana Tort Martorell, E, Moreno, M, López Ciudad, V, Manzano Ramirez, A, Sánchez Olmedo, J, Borges, M, Amador Amerigo, J, Guerrero Gomez, F, Montejo González, J, Sirvent, J, Pujol, I, Mesalles Sanjuan, E, Barcenilla Gaite, F, Serrano, N, Cerdá, E, Lesmes Serrano, A, Garcia Fuentes, C, Macias Pingarrón, J, Espinosa, E, Sanchez Garcia, M, Felices, F, de la Torre Prados, M, Maria Jesus, H, Luis, V, Jara, R, Briones Lopez, M, Posada, P, Galvan, B, Mariscal, F, Rello, J, Gil, B, Sierra, R, Rico Feijoo, J, Izura, J, González, J, Soto Ibáñez, J, Agabani, H, Petersen, P, Johansson, L, Blomqvist, H, Peterzén, B, Wyon, N, Lindström, I, Paulsson, A, Agvald Ohman, C, Petersson, J, Friberg, H, Einar, V, Hammarskjöld, F, Schindele, M, Arvidsson, S, Sellgren, S, Hulting, J, Häggqvist, J, Rudenstam, J, Lind, D, Kokinsky, E, Owall, A, Jacobson, S, Stiernstrom, H, Nydahl, A, Eggimann, P, Stocker, R, Loderer, G, Loetscher, R, Heer, K, Zender, H, Cottini, S, Pagnamenta, A, Eich, G, Felleiter, P, Marco, M, Pugin, J, Shu Hui, W, Hsieh, K, Toomtong, P, Khwannimit, B, Kietdumrongwong, P, Khaldi, A, Messadi, A, Labbene, I, Frikha, N, Atalan, K, Ates, C, Kahveci, A, Ozgencil, E, Kizilkaya, M, Bosnak, M, Bodur, H, Akan, M, Guven, M, Turkoglu, M, Topeli, A, Togal, T, Uzel, N, Akinci, I, Cakar, N, Tugrul, S, Demirkiran, O, Adanir, T, Dogruer, K, Turkmen, A, Guven, H, Ulger, F, Kocak, S, Nalapko, Y, Rady, S, Alsabbah, A, Elahi, N, Al rahma, H, Rahman, M, Kashef, S, Cuthbertson, B, Gunning, K, Myint, Y, Bewley, J, Burnstein, R, Haji Michael, P, Wrathall, D, Folan, L, Nesbitt, I, Ratnaparkhi, A, Pambakian, S, Booth, M, Watters, M, Sherry, T, Buehner, U, Barrera Groba, C, Bothma, P, George, N, Frater, J, Hollos, L, Mclellan, S, Hunter, J, Garrioch, M, O'Keeffe, N, Divekar, N, Eggert, S, Smith, S, Vincent, A, Withington, P, Macmillan, C, Webster, R, Vuylsteke, A, Appadu, B, Barrera groba, C, Mcquillan, P, Blunt, M, Parekh, N, William, D, Jones, C, Krige, A, Schuster Bruce, M, Boyden, J, Boulanger, C, Swann, D, Walker, J, Wigmore, T, Law, R, Baldwin, F, Muench, C, Robinson, S, Crerar Gilbert, A, Rhodes, A, Mahambrey, T, Cameron, L, Thornton, J, Stotz, M, Russell, M, Longmate, A, Kitson, R, Browne, B, Thorniley, A, Gonzalez, I, Swart, M, Singer, M, Gautam, N, Prasad, V, Watson, D, Szakmany, T, Cardy, J, Binning, A, Loveland, R, Gannon, J, Martinelli, G, Nightingale, P, Howes, J, Steingrub, J, Ammons, L, Fisher, M, Gandhi, N, Martin, G, Deutschman, C, Dean, N, Michetti, C, Belzberg, H, Hutchinson, K, Van der kloot, T, Afessa, B, Kaufman, D, Iqbal, J, Ost, D, Afifi, S, West, M, Wunderink, R, Stein, S, Hagg, D, Jimenez, E, Blosser, S, Chhangani, S, Kleinpell, R, Reich, H, Fields, E, Willms, D, Castellanos Mateus, P, Melnik, L, Oud, L, Chi, E, Halfon, R, Badr, A, Restrepo, M, Pohlman, A, Branson, R, Simpson, S, Kett, D, Jacobs, T, Park, P, Wahl, W, Patricia, C, Hammersley, J, Papadimos, T, Sawyer, R, Freire, A, Rodriguez, W, Ryan, A, Margolis, B, Groth, M, Escanda, H, Baraibar, J, Paciel, D, Bagnulo, H, Hitta, F, Nadales, P, Albornoz, H, Salmen, Z, Pacheco, C, Bui, T, Potie, F, and Nguyen Huu, C.

Published
2011

35. Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels

Author

Hanberger, H, Antonelli, M, Holmbom, M, Lipman, J, Pickkers, P, Leone, M, Rello, J, Sakr, Y, Walther, S, Vanhems, P, Vincent, J, Betsch, H, Fogh, B, Espersen, K, Jacobsen, K, Berezowicz, P, Harjola, V, Sofianos, E, Armaganidis, A, Routsi, C, Bitzani, M, Chalkiadaki, A, Michalopoulos, A, Mouloudi, E, Ioannidou, E, Myrianthefs, P, Koulenti, D, Karampela, I, Kyriazopoulos, G, Mandragos, K, Clouva molyvdas, P, Moraiti, A, Pneumatikos, I, Filos, K, Zakynthinos, E, Kotanidou, A, Vakalos, A, Sprung, C, Lev, A, Kishinevsky, E, Cohen, J, Sofer, S, Vesconi, S, Greco, S, Borelli, M, Cecilia, P, Sapuppo, M, Lazzero, A, Mangani, V, Petrucci, N, Minerva, M, De blasio, E, Marzorati, S, Rosi, R, Giarratano, A, Margarit, O, Guberti, A, Scolz, S, Stelian, E, Emmi, V, Caspani, M, Rosano, A, Abbruzzese, C, Colonna, S, Ceriani, R, De Blasi, R, Panella, L, Borrelli, F, Lorella, P, Ruatti, H, Munch, C, Sorbara, C, Fiore, G, Chieregato, A, Conti, V, Guadagnucci, A, Pizzamiglio, M, Locicero, M, Marri, I, Sicignano, A, Conte, V, Oggioni, R, De Gasperi, A, De Negri, P, Santagostino, G, Fumagalli, R, Marino, G, Castiglione, G, Sforza, D, Giuseppe, N, Bassetti, M, Ferraro, F, Clementi, S, Alessandro, D, Cotogni, P, Ranieri, M, Martinelli, L, Gianesello, L, Gullo, A, Morelli, A, Biancofiore, G, Della Rocca, G, Borg, M, De Pont, A, Rosseel, P, Ten Cate, J, Van Berkel, G, Corsten, S, Bakker, J, Vogelaar, J, Blom, H, Kieft, H, Kuiper, M, Gille, A, Vet, J, Ammann, J, Den Boer, S, Wesselink, R, Speelberg, B, Pham, C, Rodgers, M, Bergmans, D, Groeneveld, J, Loevstad, R, Klepstad, P, Erno, P, Junker, A, Bártolo, A, Castelo Branco Sousa, M, Esteves, F, Martins, A, Oliveira, T, Ponce, P, Mourão, L, Febra, C, Carmo, E, Lopes, V, Póvoa, P, Rezende, A, Costa, H, Moreira, P, Pádua, F, Leite, A, Almeida, E, Alves, M, Sousa, A, Telo, L, Dias, C, Paiva, J, Ribeiro, R, Amaro, P, Carneiro, A, Moreno, R, Matos, R, Afonso, S, Bouw, M, França, C, Rubio, O, Mañez, R, Campiñez, B, Alvarez, M, Jorda, R, Naveira Abeigón, E, Monedero, P, Alemparte Pardavila, E, Garcia del Valle, S, Perez Calvo, C, Palomar, M, Guerrero, F, Caballero Zirena, A, Arribas, M, Bustamante Munguira, E, Ruiz, J, Iglesias, L, Zavala, E, Valencia, M, Blesa Malpica, A, Martinez Sagasti, F, Nieto, M, Aguilar, G, Martinon Torres, F, Lorente, C, Insausti, J, Vegas Pinto, R, Santos, I, Escriba, A, Olaechea, P, Muñoz, E, Antón Caraballo, E, Galdos Anuncibay, P, Lopez Camps, V, Esteban Reboll, F, Estella, A, Bocero, L, Ibañez, A, Pueyo, L, María Jesús, L, Silva, J, Garro, P, Ramos gómez, L, Rovira, A, Martin Delgado, M, Monton Dito, J, Garcia, F, Navarro, J, Latour Perez, J, Albaya, A, Bustinza, A, Sole violán, J, Ugarte Peña, P, Yuste, I, De Rojas Román, J, Vallés, J, Esteban, E, Quintana Tort Martorell, E, Moreno, M, López Ciudad, V, Manzano Ramirez, A, Sánchez Olmedo, J, Borges, M, Amador Amerigo, J, Guerrero Gomez, F, Montejo González, J, Sirvent, J, Mesalles Sanjuan, E, Barcenilla Gaite, F, Serrano, N, Cerdá, E, Lesmes Serrano, A, Garcia Fuentes, C, Macias Pingarrón, J, Espinosa, E, Sanchez Garcia, M, Felices, F, de la Torre Prados, M, Maria Jesus, H, Luis, V, Jara, R, Briones Lopez, M, Posada, P, Galvan, B, Mariscal, F, Gil, B, Sierra, R, Rico Feijoo, J, Corcobado Márquez, C, Izura, J, González, J, Soto Ibáñez, J, Petersen, P, Johansson, L, Blomqvist, H, Peterzén, B, Wyon, N, Stiernstrom, H, Lindström, I, Paulsson, A, Agvald Ohman, C, Petersson, J, Friberg, H, Einar, V, Hammarskjöld, F, Schindele, M, Arvidsson, S, Sellgren, J, Hulting, J, Häggqvist, J, Rudenstam, J, Lind, D, Kokinsky, E, Owall, A, Jacobson, S, Nydahl, A, Atalan, K, Ates, C, Kahveci, A, Fistikci, H, Kaya, A, Ozgencil, E, Kizilkaya, M, Bosnak, M, Bodur, H, Akan, M, Guven, M, Turkoglu, M, Topeli, A, Togal, T, Uzel, N, Akinci, I, Cakar, N, Tugrul, S, Demirkiran, O, Adanir, T, Dogruer, K, Turkmen, A, Guven, H, Ulger, F, Kocak, S, Kocak, S., FUMAGALLI, ROBERTO, Hanberger, H, Antonelli, M, Holmbom, M, Lipman, J, Pickkers, P, Leone, M, Rello, J, Sakr, Y, Walther, S, Vanhems, P, Vincent, J, Betsch, H, Fogh, B, Espersen, K, Jacobsen, K, Berezowicz, P, Harjola, V, Sofianos, E, Armaganidis, A, Routsi, C, Bitzani, M, Chalkiadaki, A, Michalopoulos, A, Mouloudi, E, Ioannidou, E, Myrianthefs, P, Koulenti, D, Karampela, I, Kyriazopoulos, G, Mandragos, K, Clouva molyvdas, P, Moraiti, A, Pneumatikos, I, Filos, K, Zakynthinos, E, Kotanidou, A, Vakalos, A, Sprung, C, Lev, A, Kishinevsky, E, Cohen, J, Sofer, S, Vesconi, S, Greco, S, Borelli, M, Cecilia, P, Sapuppo, M, Lazzero, A, Mangani, V, Petrucci, N, Minerva, M, De blasio, E, Marzorati, S, Rosi, R, Giarratano, A, Margarit, O, Guberti, A, Scolz, S, Stelian, E, Emmi, V, Caspani, M, Rosano, A, Abbruzzese, C, Colonna, S, Ceriani, R, De Blasi, R, Panella, L, Borrelli, F, Lorella, P, Ruatti, H, Munch, C, Sorbara, C, Fiore, G, Chieregato, A, Conti, V, Guadagnucci, A, Pizzamiglio, M, Locicero, M, Marri, I, Sicignano, A, Conte, V, Oggioni, R, De Gasperi, A, De Negri, P, Santagostino, G, Fumagalli, R, Marino, G, Castiglione, G, Sforza, D, Giuseppe, N, Bassetti, M, Ferraro, F, Clementi, S, Alessandro, D, Cotogni, P, Ranieri, M, Martinelli, L, Gianesello, L, Gullo, A, Morelli, A, Biancofiore, G, Della Rocca, G, Borg, M, De Pont, A, Rosseel, P, Ten Cate, J, Van Berkel, G, Corsten, S, Bakker, J, Vogelaar, J, Blom, H, Kieft, H, Kuiper, M, Gille, A, Vet, J, Ammann, J, Den Boer, S, Wesselink, R, Speelberg, B, Pham, C, Rodgers, M, Bergmans, D, Groeneveld, J, Loevstad, R, Klepstad, P, Erno, P, Junker, A, Bártolo, A, Castelo Branco Sousa, M, Esteves, F, Martins, A, Oliveira, T, Ponce, P, Mourão, L, Febra, C, Carmo, E, Lopes, V, Póvoa, P, Rezende, A, Costa, H, Moreira, P, Pádua, F, Leite, A, Almeida, E, Alves, M, Sousa, A, Telo, L, Dias, C, Paiva, J, Ribeiro, R, Amaro, P, Carneiro, A, Moreno, R, Matos, R, Afonso, S, Bouw, M, França, C, Rubio, O, Mañez, R, Campiñez, B, Alvarez, M, Jorda, R, Naveira Abeigón, E, Monedero, P, Alemparte Pardavila, E, Garcia del Valle, S, Perez Calvo, C, Palomar, M, Guerrero, F, Caballero Zirena, A, Arribas, M, Bustamante Munguira, E, Ruiz, J, Iglesias, L, Zavala, E, Valencia, M, Blesa Malpica, A, Martinez Sagasti, F, Nieto, M, Aguilar, G, Martinon Torres, F, Lorente, C, Insausti, J, Vegas Pinto, R, Santos, I, Escriba, A, Olaechea, P, Muñoz, E, Antón Caraballo, E, Galdos Anuncibay, P, Lopez Camps, V, Esteban Reboll, F, Estella, A, Bocero, L, Ibañez, A, Pueyo, L, María Jesús, L, Silva, J, Garro, P, Ramos gómez, L, Rovira, A, Martin Delgado, M, Monton Dito, J, Garcia, F, Navarro, J, Latour Perez, J, Albaya, A, Bustinza, A, Sole violán, J, Ugarte Peña, P, Yuste, I, De Rojas Román, J, Vallés, J, Esteban, E, Quintana Tort Martorell, E, Moreno, M, López Ciudad, V, Manzano Ramirez, A, Sánchez Olmedo, J, Borges, M, Amador Amerigo, J, Guerrero Gomez, F, Montejo González, J, Sirvent, J, Mesalles Sanjuan, E, Barcenilla Gaite, F, Serrano, N, Cerdá, E, Lesmes Serrano, A, Garcia Fuentes, C, Macias Pingarrón, J, Espinosa, E, Sanchez Garcia, M, Felices, F, de la Torre Prados, M, Maria Jesus, H, Luis, V, Jara, R, Briones Lopez, M, Posada, P, Galvan, B, Mariscal, F, Gil, B, Sierra, R, Rico Feijoo, J, Corcobado Márquez, C, Izura, J, González, J, Soto Ibáñez, J, Petersen, P, Johansson, L, Blomqvist, H, Peterzén, B, Wyon, N, Stiernstrom, H, Lindström, I, Paulsson, A, Agvald Ohman, C, Petersson, J, Friberg, H, Einar, V, Hammarskjöld, F, Schindele, M, Arvidsson, S, Sellgren, J, Hulting, J, Häggqvist, J, Rudenstam, J, Lind, D, Kokinsky, E, Owall, A, Jacobson, S, Nydahl, A, Atalan, K, Ates, C, Kahveci, A, Fistikci, H, Kaya, A, Ozgencil, E, Kizilkaya, M, Bosnak, M, Bodur, H, Akan, M, Guven, M, Turkoglu, M, Topeli, A, Togal, T, Uzel, N, Akinci, I, Cakar, N, Tugrul, S, Demirkiran, O, Adanir, T, Dogruer, K, Turkmen, A, Guven, H, Ulger, F, Kocak, S, Kocak, S., and FUMAGALLI, ROBERTO

Abstract

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.Conclusions: Being hospitalized in an ICU in a region with high level

Published
2014

36. ECMO: An alternative support for acute respiratory failure caused by tuberculosis?

Author

Cogliandro, V, Lapadula, G, Bandera, A, Muscatello, A, Marcolin, R, Abbruzzese, C, Rona, R, Gori, A, LAPADULA, GIUSEPPE, BANDERA, ALESSANDRA, MUSCATELLO, ANTONIO, GORI, ANDREA, Cogliandro, V, Lapadula, G, Bandera, A, Muscatello, A, Marcolin, R, Abbruzzese, C, Rona, R, Gori, A, LAPADULA, GIUSEPPE, BANDERA, ALESSANDRA, MUSCATELLO, ANTONIO, and GORI, ANDREA

Abstract

Late diagnosis of tuberculosis (TB) may result in the development of severe acute respiratory failure. High mortality rates with conventional ventilation have been reported. Extracorporeal membrane oxygenation (ECMO) may represent an effective alternative treatment. We report a case of complicated pulmonary TB in a man who successfully underwent 3 months of ECMO. © 2014 The Union

Published
2014

37. Biohydrometallurgical processes for heavy metals removal from acid mine drainage

Author

Ubaldini S., Luptakova A., Macingova E., Abbruzzese C., and Fornari P.

Subjects
Biohydrometallurgical processes, microorganisms, Acid Mine Drainage, heavy metals
Abstract

The present experimental work has been carried out in the framework of the agreement of scientific cooperation between the Institute of Environmental Geology and Geoengineering of the CNR, Italy and the Institute of Geotechnics of Slovak Academy of Sciences, Slovakia (years 2007-2009). The main scope was to remediate Acid Mine Drainage (AMD) by application of biohydrometallurgical processes, environmentally friendly, to remove heavy metals such as Zn, Cu, Mn, Cd, Al and Fe. The processes studied have been electrowinning and bioprecipitation. The samples utilised were collected from a zinc mine located in Italy and from a cooper - iron ore deposit in Slovakia. By electrochemical experiments, high metals removal, with a low energetic consumption, has been achieved: in particular, by Zn electrodeposition, it was possible to achieve 95-99% Zn removal. Culture of sulphate-reducing bacteria (SRB) of genera Desulfovibrio sp. was used for the bioprecipitation tests. The kinetic of the selective precipitation of Cu and Zn of AMD by SRB has been investigated. This method has been performed in two interconnected reactors. Achieved results demonstrate the about 98-99% elimination of Cu and Zn by bacterially produced H2S. Both the electrowinning and bioprecipitation processes have been demonstrated the technical feasibility to decrease the heavy metals concentration.

Published
2009

39. Electrohydrometallurgical recovery of Zinc and Manganese from spent batteries

Author

Ubaldini S., Abbruzzese C., Fornari P., Luptakova A., Massidda R., and Vegliò F.

Subjects
Zinc, Manganese, Electrowinning, Hydrometallurgy, Spent batteries
Abstract

The present experimental work involves the application of electrohydrometallurgical processes for Mn-Zn recovery from wastes originated by spent batteries. Disposal of spent batteries constitutes a serious environmental problem in terms of heavy metals content when these devices are disposed off under inadequate way. Alkaline and zinc-carbon batteries represent about 80% of the market. In particular, alkaline batteries have an average content of manganese dioxide (MnO2) of 35%, while zinc content is of 14%. The high Mn and Zn content justify the interest to recover the metals. Main processes applied are the pyrometallurgical processes, that involve high energetic consumption and pollution problems; and hydrometallurgical processes, chipper and at low energetic cost. In this work, hydrometallurgical processes have been applied, starting from spent alkaline batteries. Zn and Mn recovery from the aqueous solutions has been carried out electrochemically. The composition of the alkaline batteries utilised was 14 % Zn and 27 % Mn, as MnO2. Main aim of the research was the development of an experimental work to recover selectively MnO2 and Zn from leaching solution containing Mn and Zn, both at concentration of 10 g dm-3, by electrolysis, with the scope to apply electrochemical technologies for Zn and Mn recovery from exhaust batteries. The results have demonstrated the technical feasibility of the application of the mentioned technologies; in fact, high recovery of manganese and zinc dissolved in solution were achieved (96% MnO2 and 98% Zn).

Published
2008

40. Valorisation of agro-industrial wastes by hydrometallurgical processes

Author

Ubaldini S., Vegliò F., Fornari P., and Abbruzzese C.

Subjects
Manganese, Electrowinning, Agro-industrial wastes, Hydrometallurgical, Lactose
Abstract

Main aim of the present experimental work was the development of hydrometallurgical innovative and environmentally friendly technologies, to re-use agro-industrial wastes. Manganese is an important commodity for application in the steel industry, in the battery manufacturing and as a fine chemical. The processes of manganiferous minerals are carried out by means of pyrometallurgical and hydrometallurgical treatments: the first ones present a more serious environmental impact especially considering the atmospheric emissions. The study started to develop a production process of manganiferous products of industrial interest, such as MnO2, by using an innovative chemical leaching, at low environmental impact, in presence of waste biomasses coming from agro-industrial activities (milk whey, molasses, vegetation waters and paper mill sludges). Important goal of this experimental work is to achieve products of industrial interest, such as electrolytic manganese dioxide (EMD), starting from manganiferous ores not treatable by conventional processes. The application of a chemical leaching in presence of carbohydrates as lactose was carried out. The study of the electrolytic process has been conducted utilising synthetic leaching solutions. The results show that it is possible to achieve high MnO2 recovery by hydrometallurgical processes (90%).

Published
2008

41. New applications for Remediation of Acid Mine Drainage from Italian and Slovak deposits

Author

Ubaldini S., Luptakova A., Kusnierova M., Macingova E., Abbruzzese C., and Fornari P.

Subjects
Electrowinning, Heavy metals, Remediation, Bioprecipitation, Acid Mine Drainage
Abstract

The main aim of the present experimental work - carried out in the framework of the S&T Cooperation Programme between Italy and Slovakia (years 2004-2007) - was to remediate Acid Mine Drainage (AMD) by the application of new technologies, chip and environmentally friendly, to eliminate the heavy metals content (Zn, Cu, Mn, Al and Fe). The processes studied have been electrowinning and bioprecipitation. The samples utilised were collected from the abandoned and flooded deposit of Smolník, located in Slovak Republic and from the zinc mine located in Montevecchio (Italy). Electrowinning tests have been carried out after chemical iron-aluminum precipitation, that permitted a complete Fe-Al removal. By electrochemical experiments, high metals removal, with a low energetic consumption, has been achieved: in particular, by Zn electrodeposition, it was possible to achieve about 95% Zn removal. The culture of sulphate-reducing bacteria (SRB) of genera Desulfovibrio sp. was used for the bioprecipitation tests. The treatment of AMD by SRB is based on the ability of SRB to reduce sulphates to hydrogen sulphide, which binds readily with metals to form sparingly soluble precipitates. The kinetic of the selective precipitation of Cu and Zn has been investigated. This method has been performed in two interconnected reactors. Achieved results demonstrate the 98-99% elimination of Cu and Zn by bacterially produced H2S. Both the electrowinning and bioprecipitation processes have been demonstrated the technical feasibility to decrease the heavy metals concentration.

Published
2007

42. Bioprecipitation for heavy metals removal from Acid Mine Drainage

Author

Ubaldini S., Abbruzzese C., Çiço S., and Boçi S.

Subjects
genetic structures, Heavy metals, Bioprecipitation, Acid Mine Drainage, eye diseases
Abstract

Main aim of this paper was to perform a feasibility analysis of a bioremediation process by sulphate-reducing bacteria (SRB) for toxic metals removal from acid mine drainage (AMD) samples, in a relatively cheap and environmentally friendly way. The treatment of AMD by the SRB is based on the ability of these bacteria to reduce sulphates to hydrogen sulphide, which binds readily with most metals to form an insoluble precipitate. It was investigated the kinetic of Cd precipitation by SRB of Desulfovibrio sp. The present experimental work was carried out in the framework of the S&T Cooperation Programme between Italy and Albania (years 2005-2007). The study represents a preliminary investigation on AMD coming from an Italian mine, with the main aim to transfer this technology - very interesting under the environmental point of view to treatment of Albanian AMD samples. Preliminary results have been encouraging and have demonstrated that strains of Desulfovibrio are able to bioleach Cd from AMD; in fact, about 90% elimination of Cd by bacterially produced H2S after 45 minutes. Experimental tests data have been used in order to perform a preliminary techno-economic feasibility analysis of the process, aimed at metal removal from AMD. A treatment cost of about 0.7 EUR/m3 AMD has been estimated, for a plant capacity of 1 m3/h AMD inlet flowrate.

Published
2007

43. Solubilization and immobilization of toxic metals by bacteria

Author

Luptakova A., Macingova E., Slesarova A., Ubaldini S., and Abbruzzese C.

Subjects
toxic metals, immobilization, bacteria, solubilization
Abstract

Microorganisms play important roles in the biogeochemical cycling of metals. Some microbial processes release metals thereby increasing their mobility, which may increase bioavailability and potential toxicity, whereas other processes result in immobilization and reduce bioavailability. The relative balance between mobilization and immobilization varies depending on the microorganisms, their environment and changing physico-chemical conditions. As well as being a key component of natural biogeochemical cycles for metals, these processes may be exploited for the treatment of contaminated solid and liquid wastes. This paper describes two selected aspects, which illustrate the key importance in effecting changes in metal solubility, namely bioleaching by aerobic chemoautotrophic sulphur and ferrous oxidisers (bacteria genera Thiobacillus) and metal sulphide precipitation by anaerobic dissimilatory sulphate reducers (bacteria genera Desulfovibrio and Desulfotomaculum).

Published
2007

44. Valorisation of residue organic substances by electrochemical applications

Author

Ubaldini S., Fornari P., Abbruzzese C., and Vegliò F.

Subjects
Manganese, Electrowinning, Carbohydrates, Waste biomasses, Chemical leaching
Abstract

The main goal of the experimental activity was the electrolytic manganese dioxide (EMD) recovery, at high degree of purity, from leaching solutions containing Mn, by electrowinning process, also considering the effect of the presence of the organic substances, such as carbohydrates and impurities. Electrochemical kinetics studies have been conducted at laboratory scale utilising synthetic solutions, of characteristics similar to the real process solutions, containing Mn, Mn + Fe+3, Mn + lactose, Mn + lactose + Fe+3 respectively. Synthetic process solutions have been prepared taking into account the characteristics of an italian manganiferous ore and supposing the use of sulphuric acid and carbohydrates (waste biomasses) as leaching agents: lactose was added to simulate the presence of waste biomasses. The results show that, also in presence of iron and lactose in solutions, it is possible to achieve a quantitative EMD recovery after electrowinning process (about 99%). Diffractometric analyses (RXD) demonstrate the high degree of purity of the EMD deposited on the cylindrical platinum mesh anode (> 93 %). The faradic efficiency (?) decreases from 91% (pure solution containing only Mn) to 78% in presence of Mn and Fe3+ and to 69% when Mn, Fe3+ and lactose are presents. Consequently, energetic consumption increases from 1.4 kWh/kg (pure solution containing only Mn) to 2.2 kWh/kg, in the case of contemporaneous presence of Mn, Fe3+ and lactose in leaching solution. The further work will consists in the scale up of the process in continue system, utilising molasses from agro-industrial activities to perform the leaching tests.

Published
2006

46. Heavy metals removal from Acid Mine Drainage by innovative technologies

Author

Ubaldini S., Abbruzzese C., Luptakova A., Prascakova M., Kusnierova M., and Slesarova A.

Subjects
sulphate-reducing bacteria, electrowinning, bioprecipitation, heavy metals
Abstract

Main aim of the experimental work was to apply innovative technologies, such as electrowinning and bioprecipitation, to remove heavy metals from Italian Acid Mine Drainage (AMD) samples. The experimental activity carried out during the investigation was aimed to decrease the heavy metals content and has been conducted by synthetic solutions. A cylindrical glass laboratory cell of 200 cm3 volume has been used for electrowinning tests, while bioprecipitation tests have been performed in two interconnected reactors with a volume 250 cm3. By electrowinning process, it was possible to achieve over 90 % metals removal. A high grade of purity of the metal deposit has been achieved (about 95 %), while bioprecipitation permitted only the Cd elimination. On the basis of the experimental results achieved, the processes at laboratory scale will be optimised.

Published
2006

47. Electrowinning and bioremediation processes for toxic metals removal from Acid Mine Drainage

Author

Ubaldini S., Abbruzzese C., Fornari P., Luptakova A., and Prascakova M.

Subjects
sulphate-reducing bacteria, bio-precipitation, electrowinning, heavy metals, acid mine drainage
Abstract

One of the most important problems affecting mining companies around the world is the treatment of acid mine drainage (AMD) which contain sulphuric acid, dissolved heavy metals, sulphates, iron precipitates and their pH can be very low. The presence of heavy metals in the AMD excludes the possibility for re-use and involves environmental problems. Main aim of the present experimental work was to compare and to interpret two different innovative technologies such as the electrowinning and the bioremediation by sulphate-reducing bacteria (SRB), applied for toxic metals removal (Zn, Ni, Cd, Cu, Mn and Fe) from AMD samples. The AMD under study coming from the zinc mine located in Montevecchio Mine (Italy). The present study consists in a preliminary work: the experimental tests have been conducted by synthetic solutions. The application of the electrowinning process demonstrates the technical feasibility to remove toxic metals from AMD samples; in fact, at the end of the process, all the metal concentrations decrease under the recommended limit suggested from EC. In particular, as far as Zn electrowinning, it was possible to achieve high Zn removal: 98% Zn after 90 minutes and 99% Zn after 2 hours with an energetic consumption of 20 kWh/kg and 33 kWh/kg, respectively. The treatment of AMD by the SRB is based on the ability of these bacteria to reduce sulphates to hydrogen sulphide, which binds readily with most metals to form an insoluble precipitate. Investigated was the kinetics of the Cd precipitation by SRB of genera Desulfovibrio and Desulfotomaculum. Achieved results demonstrate the 98-99% elimination of Cd by bacterially produced H2S after 30 minutes.

Published
2006

49. Application of hydrometallurgical technologies to valorise polymetallic industrial wastes

Author

Ubaldini S., Massidda R., Abbruzzese C., Ventura M., Bonifati M., and Veglio' F.

Subjects
hydrometallurgical technologies, precious metals, polymetallic industrial wastes
Abstract

The present experimental study was carried out to apply hydrometallurgical technologies to valorise polymetallic industrial wastes. Precious metals content of the samples was very high (about 50 g/t Au). However, elemental and mineralogical composition hinders an economical treatment by standard process (cyanidation) finalised to precious metals recovery. In order to eliminate the refractoriness of the samples, pretreatments such as roasting and ultra fine grinding have been carried out before cyanidation. Moreover, an alternative leaching process of gold-bearing industrial wastes has been studied by using chlorine dissolved in brine solutions. Some results have been reported, to highlight limits and advantages of the proposed process.

Published
2005

Catalog

Books, media, physical & digital resources
See catalog results