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53. The PROVENT-C19 registry: A study protocol for international multicenter SIAARTI registry on the use of prone positioning in mechanically ventilated patients with COVID-19 ARDS

Author

De Rosa, S, Sella, N, Rezoagli, E, Lorenzoni, G, Gregori, D, Bellani, G, Foti, G, Pettenuzzo, T, Baratto, F, Fullin, G, Papaccio, F, Peta, M, Poole, D, Toffoletto, F, Maggiore, S, Navales, P, Navalesi, P, Tiberio, I, Pasin, L, Godi, I, Serra, E, Zarantonello, F, Andreatta, G, Boscolo, A, Persona, P, Cattin, L, Forin, E, Boni, E, Golino, G, Danzi, V, Vetrugno, L, Cornacchia, N, Donadello, K, Gottin, L, Polati, E, Campagnolo, M, Linassi, F, Panciera, G, Garofalo, E, Bruni, A, Carlon, R, Pipitone, M, Candosin, A, Badii, F, Role, S, Girardis, M, Busani, S, Gamberini, E, Tartivita, C, Gamberini, L, Cortegiani, A, Frisella, S, Ippolito, M, Salvo, F, Greco, M, Cecconi, M, Aceto, R, Langer, T, Repishti, M, Zeduri, A, Ottolina, D, Fossali, T, Colombo, R, Predonzani, N, Ferluga, M, Blasi, S, Zardin, M, Vergine, S, Luccarelli, G, Tritapepe, L, Francesconi, A, Pagani, M, Mojoli, F, Orlando, A, Mongodi, S, Bitondo, M, Johnathan, M, Maugeri, J, Bellissima, A, Guzzardella, A, Vallecoccia, M, Spadaro, S, Cricca, V, Andriolo, E, Bianchin, A, Alampi, D, Rocco, M, Anchisi, S, Tenaglia, T, Nicoletti, R, Antonini, B, Zanaty, M, Mogahed, M, Ali, A, Emara, M, Abdullah, E, Awad, A, Abdel-Maboud, M, Hussein, A, Mosleh, A, Ahmed, M, Aziz, M, Elsayed, A, Aldhalia, A, Elkhatid, A, Abodina, A, Khalleefah, A, Shalabi, L, Shamed, H, Bakeer, H, Hawad, A, Abuzaid, T, Alqandouz, R, Saliga, A, Haddud, A, Kredan, A, Shaban, M, Salama, A, Altabit, A, Alflite, A, Hashim, H, Kadhim, Q, Abd-Alreda, A, Al-Juifari, M, Al-Gburi, S, Akram, A, Laila, A, Bakri, A, Abdelmageed, A, Binnawara, M, Mohamed, M, Esaadi, H, Othman, E, Said, A, Alarabi, R, Alameen, H, Albouishi, N, Babaa, K, Salih, R, Elbakheet, D, Abuelyamen, A, Perez-Torres, D, Mattson, J, Al-Sadawi, M, Elseidy, S, De Rosa S., Sella N., Rezoagli E., Lorenzoni G., Gregori D., Bellani G., Foti G., Pettenuzzo T., Baratto F., Fullin G., Papaccio F., Peta M., Poole D., Toffoletto F., Maggiore S. M., Navales P., Navalesi P., Tiberio I., Pasin L., Godi I., Serra E., Zarantonello F., Andreatta G., Boscolo A., Persona P., Cattin L., Forin E., Boni E., Golino G., Danzi V., Vetrugno L., Cornacchia N., Donadello K., Gottin L., Polati E., Campagnolo M., Linassi F., Panciera G., Garofalo E., Bruni A., Carlon R., Pipitone M., Candosin A., Badii F., Role S. D., Girardis M., Busani S., Gamberini E., Tartivita C. N., Gamberini L., Cortegiani A., Frisella S., Ippolito M., Salvo F., Greco M., Cecconi M., Aceto R., Langer T., Repishti M., Zeduri A., Ottolina D., Fossali T., Colombo R., Predonzani N., Ferluga M., Blasi S. D., Zardin M., Vergine S., Luccarelli G., Tritapepe L., Francesconi A. G., Pagani M., Mojoli F., Orlando A., Mongodi S., Bitondo M., Johnathan M., Maugeri J., Bellissima A., Guzzardella A., Vallecoccia M. S., Spadaro S., Cricca V., Andriolo E., Bianchin A., Alampi D., Rocco M., Anchisi S., Tenaglia T., Nicoletti R., Antonini B., Zanaty M., Mogahed M., Ali A., Emara M., Abdullah E., Awad A. K., Abdel-Maboud M., Hussein A. M., Hussein A. A. R. M., Mosleh A. A., Ahmed M. G., Aziz M. G., Elsayed A., Aldhalia A., Elkhatid A., Abodina A. M., Khalleefah A., Shalabi L. E., Shamed H., Bakeer H. B., Hawad A., Abuzaid T., Alqandouz R. A. S., Saliga A. A., Haddud A., Kredan A. A., Shaban M. S., Salama A. A., Altabit A. E. R. M., Alflite A. O. S., Hashim H. T., Kadhim Q. M., Abd-Alreda A. H., Al-Juifari M. A., Al-Gburi S. M., Akram A., Laila A., Bakri A., Abdelmageed A., Binnawara M., Mohamed M., Esaadi H., Othman E., Said A., Alarabi R., Alameen H., Albouishi N., Babaa K. A., Salih R., Elbakheet D. E., Abuelyamen A., Perez-Torres D., Mattson J., Al-Sadawi M., Elseidy S., De Rosa, S, Sella, N, Rezoagli, E, Lorenzoni, G, Gregori, D, Bellani, G, Foti, G, Pettenuzzo, T, Baratto, F, Fullin, G, Papaccio, F, Peta, M, Poole, D, Toffoletto, F, Maggiore, S, Navales, P, Navalesi, P, Tiberio, I, Pasin, L, Godi, I, Serra, E, Zarantonello, F, Andreatta, G, Boscolo, A, Persona, P, Cattin, L, Forin, E, Boni, E, Golino, G, Danzi, V, Vetrugno, L, Cornacchia, N, Donadello, K, Gottin, L, Polati, E, Campagnolo, M, Linassi, F, Panciera, G, Garofalo, E, Bruni, A, Carlon, R, Pipitone, M, Candosin, A, Badii, F, Role, S, Girardis, M, Busani, S, Gamberini, E, Tartivita, C, Gamberini, L, Cortegiani, A, Frisella, S, Ippolito, M, Salvo, F, Greco, M, Cecconi, M, Aceto, R, Langer, T, Repishti, M, Zeduri, A, Ottolina, D, Fossali, T, Colombo, R, Predonzani, N, Ferluga, M, Blasi, S, Zardin, M, Vergine, S, Luccarelli, G, Tritapepe, L, Francesconi, A, Pagani, M, Mojoli, F, Orlando, A, Mongodi, S, Bitondo, M, Johnathan, M, Maugeri, J, Bellissima, A, Guzzardella, A, Vallecoccia, M, Spadaro, S, Cricca, V, Andriolo, E, Bianchin, A, Alampi, D, Rocco, M, Anchisi, S, Tenaglia, T, Nicoletti, R, Antonini, B, Zanaty, M, Mogahed, M, Ali, A, Emara, M, Abdullah, E, Awad, A, Abdel-Maboud, M, Hussein, A, Mosleh, A, Ahmed, M, Aziz, M, Elsayed, A, Aldhalia, A, Elkhatid, A, Abodina, A, Khalleefah, A, Shalabi, L, Shamed, H, Bakeer, H, Hawad, A, Abuzaid, T, Alqandouz, R, Saliga, A, Haddud, A, Kredan, A, Shaban, M, Salama, A, Altabit, A, Alflite, A, Hashim, H, Kadhim, Q, Abd-Alreda, A, Al-Juifari, M, Al-Gburi, S, Akram, A, Laila, A, Bakri, A, Abdelmageed, A, Binnawara, M, Mohamed, M, Esaadi, H, Othman, E, Said, A, Alarabi, R, Alameen, H, Albouishi, N, Babaa, K, Salih, R, Elbakheet, D, Abuelyamen, A, Perez-Torres, D, Mattson, J, Al-Sadawi, M, Elseidy, S, De Rosa S., Sella N., Rezoagli E., Lorenzoni G., Gregori D., Bellani G., Foti G., Pettenuzzo T., Baratto F., Fullin G., Papaccio F., Peta M., Poole D., Toffoletto F., Maggiore S. M., Navales P., Navalesi P., Tiberio I., Pasin L., Godi I., Serra E., Zarantonello F., Andreatta G., Boscolo A., Persona P., Cattin L., Forin E., Boni E., Golino G., Danzi V., Vetrugno L., Cornacchia N., Donadello K., Gottin L., Polati E., Campagnolo M., Linassi F., Panciera G., Garofalo E., Bruni A., Carlon R., Pipitone M., Candosin A., Badii F., Role S. D., Girardis M., Busani S., Gamberini E., Tartivita C. N., Gamberini L., Cortegiani A., Frisella S., Ippolito M., Salvo F., Greco M., Cecconi M., Aceto R., Langer T., Repishti M., Zeduri A., Ottolina D., Fossali T., Colombo R., Predonzani N., Ferluga M., Blasi S. D., Zardin M., Vergine S., Luccarelli G., Tritapepe L., Francesconi A. G., Pagani M., Mojoli F., Orlando A., Mongodi S., Bitondo M., Johnathan M., Maugeri J., Bellissima A., Guzzardella A., Vallecoccia M. S., Spadaro S., Cricca V., Andriolo E., Bianchin A., Alampi D., Rocco M., Anchisi S., Tenaglia T., Nicoletti R., Antonini B., Zanaty M., Mogahed M., Ali A., Emara M., Abdullah E., Awad A. K., Abdel-Maboud M., Hussein A. M., Hussein A. A. R. M., Mosleh A. A., Ahmed M. G., Aziz M. G., Elsayed A., Aldhalia A., Elkhatid A., Abodina A. M., Khalleefah A., Shalabi L. E., Shamed H., Bakeer H. B., Hawad A., Abuzaid T., Alqandouz R. A. S., Saliga A. A., Haddud A., Kredan A. A., Shaban M. S., Salama A. A., Altabit A. E. R. M., Alflite A. O. S., Hashim H. T., Kadhim Q. M., Abd-Alreda A. H., Al-Juifari M. A., Al-Gburi S. M., Akram A., Laila A., Bakri A., Abdelmageed A., Binnawara M., Mohamed M., Esaadi H., Othman E., Said A., Alarabi R., Alameen H., Albouishi N., Babaa K. A., Salih R., Elbakheet D. E., Abuelyamen A., Perez-Torres D., Mattson J., Al-Sadawi M., and Elseidy S.

Abstract

Background The worldwide use of prone position (PP) for invasively ventilated patients with COVID-19 is progressively increasing from the first pandemic wave in everyday clinical practice. Among the suggested treatments for the management of ARDS patients, PP was recommended in the Surviving Sepsis Campaign COVID-19 guidelines as an adjuvant therapy for improving ventilation. In patients with severe classical ARDS, some authors reported that early application of prolonged PP sessions significantly decreases 28-day and 90-day mortality. Methods and analysis Since January 2021, the COVID19 Veneto ICU Network research group has developed and implemented nationally and internationally the "PROVENT-C19 Registry", endorsed by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care. . .'(SIAARTI). The PROVENT-C19 Registry wishes to describe 1. The real clinical practice on the use of PP in COVID-19 patients during the pandemic at a National and International level; and 2. Potential baseline and clinical characteristics that identify subpopulations of invasively ventilated patients with COVID-19 that may improve daily from PP therapy. This web-based registry will provide relevant information on how the database research tools may improve our daily clinical practice. Conclusions This multicenter, prospective registry is the first to identify and characterize the role of PP on clinical outcome in COVID-19 patients. In recent years, data emerging from large registries have been increasingly used to provide real-world evidence on the effectiveness, quality, and safety of a clinical intervention. Indeed observation-based registries could be effective tools aimed at identifying specific clusters of patients within a large study population with widely heterogeneous clinical characteristics. Copyright

Published
2022

61. Platin-related Hearing Loss: Further Results from PanCareLIFE

Author

Parfitt, R, Matulat, P, Byrne, J, Langer, T, Deuster, D, Hesping, A, Clemens, E, Kaatsch, P, Grabow, D, O'Brien, K, Kaiser, M, Spix, C, Kremer, LC, van Dulmen-den Broeder, E, Calaminus, G, Baust, K, Kuehni, C, Weiss, A, Strebel, S, Kuonen, R, Elsner, S, Haupt, R, Garré, ML, Kepak, T, Kapakova, K, Falck Winther, J, Kenborg, L, Rechnitzer, C, Hasle, H, Kruseova, J, Luks, A, Lackner, H, Beilack, S, Hecker-Nolting, S, Beck, JD, van den Heuvel-Eibrink, M, Zolk, O, am Zehnhoff-Dinnesen, A, PanCareLIFE Consortium, Parfitt, R, Matulat, P, Byrne, J, Langer, T, Deuster, D, Hesping, A, Clemens, E, Kaatsch, P, Grabow, D, O'Brien, K, Kaiser, M, Spix, C, Kremer, LC, van Dulmen-den Broeder, E, Calaminus, G, Baust, K, Kuehni, C, Weiss, A, Strebel, S, Kuonen, R, Elsner, S, Haupt, R, Garré, ML, Kepak, T, Kapakova, K, Falck Winther, J, Kenborg, L, Rechnitzer, C, Hasle, H, Kruseova, J, Luks, A, Lackner, H, Beilack, S, Hecker-Nolting, S, Beck, JD, van den Heuvel-Eibrink, M, Zolk, O, am Zehnhoff-Dinnesen, A, and PanCareLIFE Consortium

Abstract

Background: Cisplatin and Carboplatin are widely-used in paediatric cancer treatment. Sensorineural hearing loss (SNHL) is one long-term side-effect. This study utilises a larger sample than previous research in order to investigate risk-factors for platin-related ototoxicity.Material and methods: Retrospective audiological and treatment data of 997 children and adolescents were gathered with the involvement of 18 pan-European institutions in 7 different countries as part of the PanCareLIFE consortium. Prior hearing loss was excluded. Conductive hearing losses were excluded where identified.Results: Prevalence rates of clinically-significant hearing loss (=> 2b Münster Classification) after treatment were 49 % (Cisplatin) and 15 % (Carboplatin). Where Cisplatin was administered prior to Carboplatin, prevalence rose to 76 %. Frequencies in the high and extended high-frequency range were predominantly affected, with mean threholds between 25-35 dB HL. Mean thresholds at frequencies below 3 kHz remained lower than 20 dB HL. No significant air-bone gap was apparent.50 % of clinically-significant hearing losses began within 3 years of start of treatment (Kaplan-Meier analysis). No significant difference in time-to-onset at different frequencies within the standard range was found. Further analyses, including multifactorial analysis to account for platin doses, presence of cranial radiotherapy, age and date of diagnosis will be conducted.Discussion: Analysis of this large sample was able to confirm the significant risk of SNHL posed by platin-based chemotherapeutics. Some quantitative and qualitative variation were present in this multi-centre retrospective dataset.Conclusion: This large sample confirms that platin-based chemotherapeutics, especially cisplatin, pose a significant risk of SNHL and underlines the necessity of audiological monitoring during and after end of chemotherapy.Acknowledgement: This work was supported by the PanCareLIFE consortium that has received

Published
2023

75. Enhanced perioperative care in emergency general surgery: the WSES position paper.

Author

Ceresoli, M., Braga, M., Zanini, N., Abu-Zidan, F.M., Parini, D., Langer, T., Sartelli, M., Damaskos, D., Biffl, W.L., Amico, F., Ansaloni, L., Balogh, Z.J., Bonavina, L., Civil, I., Cicuttin, E., Chirica, M., Cui, Y., Simone, B. De, Carlo, I. Di, Fette, A., Foti, G., Fogliata, M., Fraga, G.P., Fugazzola, P., Galante, J.M., Beka, S.G., Hecker, A., Jeekel, J., Kirkpatrick, A.W., Koike, Kaoru, Leppäniemi, A., Marzi, I., Moore, E.E., Picetti, E., Pikoulis, E., Pisano, M., Podda, M., Sakakushev, B.E., Shelat, V.G., Tan, E.C.T.H., Tebala, G.D., Velmahos, G., Weber, D.G., Agnoletti, V., Kluger, Y., Baiocchi, G., Catena, F., Coccolini, F., Ceresoli, M., Braga, M., Zanini, N., Abu-Zidan, F.M., Parini, D., Langer, T., Sartelli, M., Damaskos, D., Biffl, W.L., Amico, F., Ansaloni, L., Balogh, Z.J., Bonavina, L., Civil, I., Cicuttin, E., Chirica, M., Cui, Y., Simone, B. De, Carlo, I. Di, Fette, A., Foti, G., Fogliata, M., Fraga, G.P., Fugazzola, P., Galante, J.M., Beka, S.G., Hecker, A., Jeekel, J., Kirkpatrick, A.W., Koike, Kaoru, Leppäniemi, A., Marzi, I., Moore, E.E., Picetti, E., Pikoulis, E., Pisano, M., Podda, M., Sakakushev, B.E., Shelat, V.G., Tan, E.C.T.H., Tebala, G.D., Velmahos, G., Weber, D.G., Agnoletti, V., Kluger, Y., Baiocchi, G., Catena, F., and Coccolini, F.

Abstract

Contains fulltext : 297347.pdf (Publisher’s version ) (Open Access), Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients' outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.

Published
2023

76. Monitoring and safe use of regional citrate anticoagulation for renal replacement therapy in patients with metformin intoxication: a case series and mathematical model

Author

Zadek, F, Brunoni, B, Mulazzani, F, Verza, G, Faraldi, L, Protti, A, Fumagalli, R, Langer, T, F. Zadek, B. Brunoni, F. Mulazzani, G. Verza, L. Faraldi, A. Protti, R. Fumagalli, T. Langer, Zadek, F, Brunoni, B, Mulazzani, F, Verza, G, Faraldi, L, Protti, A, Fumagalli, R, Langer, T, F. Zadek, B. Brunoni, F. Mulazzani, G. Verza, L. Faraldi, A. Protti, R. Fumagalli, and T. Langer

Published
2023

77. Sodium changes in trauma brain injury patients as a proxy of severity: modeling of trajectories fit for 1346 patients from CENTER‐TBI

Author

Mulazzani, F, Graziano, F, Rossi, A, Mangli, P, Addis, A, Zadek, F, Noè, B, Langer, T, Citerio, G, F. Mulazzani, F. Graziano, A. Rossi, P. Mangli, A. Addis, F. Zadek, B. Noè, T. Langer, G. Citerio, Mulazzani, F, Graziano, F, Rossi, A, Mangli, P, Addis, A, Zadek, F, Noè, B, Langer, T, Citerio, G, F. Mulazzani, F. Graziano, A. Rossi, P. Mangli, A. Addis, F. Zadek, B. Noè, T. Langer, and G. Citerio

Published
2023

78. PEEP titration is markedly affected by trunk inclination in mechanically ventilated patients with ARDS: a physiologic, cross‐over study

Author

Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, F. Marrazzo, S. Spina, F. Zadek, C. Forlini, G. Bassi, R. Giudici, G. Bellani, R. Fumagalli, T. Langer, Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, F. Marrazzo, S. Spina, F. Zadek, C. Forlini, G. Bassi, R. Giudici, G. Bellani, R. Fumagalli, and T. Langer

Published
2023

80. A Software for Extracting Quantitative Metrics and Radiomic Features in Ct Images of The Lung: Tool Development and Clinical Applications

Author

Berta, L, Zorzi, G, Rizzetto, F, Sala, A, Carrazza, S, Cicolari, D, De Mattia, C, Felisi, M, Zadek, F, Langer, T, Lizio, D, Lenardi, C, Vanzulli, A, Torresin, A, Colombo, P, Felisi, MMJ, Colombo, PE, Berta, L, Zorzi, G, Rizzetto, F, Sala, A, Carrazza, S, Cicolari, D, De Mattia, C, Felisi, M, Zadek, F, Langer, T, Lizio, D, Lenardi, C, Vanzulli, A, Torresin, A, Colombo, P, Felisi, MMJ, and Colombo, PE

Published
2023

81. Calcium-Citrate Anticoagulation during Continuous Renal Replacement Therapy in Patients with Metformin Intoxication: A Case Series, Mathematical Estimation of Citrate Accumulation, and Literature Review

Author

Brunoni, B, Zadek, F, Mulazzani, F, Verza, G, Marrazzo, F, Spina, S, Protti, A, Fumagalli, R, Langer, T, Brunoni, Beatrice, Zadek, Francesco, Mulazzani, Francesca, Verza, Giovanni, Marrazzo, Francesco, Spina, Stefano, Protti, Alessandro, Fumagalli, Roberto, Langer, Thomas, Brunoni, B, Zadek, F, Mulazzani, F, Verza, G, Marrazzo, F, Spina, S, Protti, A, Fumagalli, R, Langer, T, Brunoni, Beatrice, Zadek, Francesco, Mulazzani, Francesca, Verza, Giovanni, Marrazzo, Francesco, Spina, Stefano, Protti, Alessandro, Fumagalli, Roberto, and Langer, Thomas

Abstract

Introduction: Metformin intoxication causes lactic acidosis by inhibiting Krebs' cycle and oxidative phosphorylation. Continuous renal replacement therapy (CRRT) is recommended for metformin removal in critically ill patients. According to current guidelines, regional citrate anticoagulation (RCA) is the first-line strategy. However, since metformin also inhibits citrate metabolism, a risk of citrate accumulation could be hypothesized. In the present study, we monitored the potential citrate accumulation in metformin-associated lactic acidosis (MALA) patients treated with CRRT and RCA using the physical-chemical approach to acid-base interpretation. Methods: We collected a case series of 3 patients with MALA. Patients were treated with continuous venovenous hemofiltration (CVVH), and RCA was performed with diluted citrate solution. Citrate accumulation was monitored through two methods: the ratio between total and ionized plasma calcium concentrations (T/I calcium ratio) above 2.5 and the strong ion gap (SIG) to identify an increased concentration of unmeasured anions. Lastly, a mathematical model was developed to estimate the expected citrate accumulation during CVVH and RCA. Results: All 3 patients showed a resolution of MALA after the treatment with CVVH. The T/I calcium ratio was consistently below 2.5, and SIG decreased, reaching values lower than 6 mEq/L after 48 h of CVVH treatment. According to the mathematical model, the estimated SIG without citrate metabolism should have been around 21 mEq/L due to citrate accumulation. Conclusions: In our clinical management, no signs of citrate accumulation were recorded in MALA patients during treatment with CVVH and RCA. Our data support the safe use of diluted citrate to perform RCA during metformin intoxication.

Published
2023

84. Detection of patients with COVID-19 by the emergency medical services in Lombardy through an operator-based interview and machine learning models

Author

Spina, S, Gianquintieri, L, Marrazzo, F, Migliari, M, Sechi, G, Migliori, M, Pagliosa, A, Bonora, R, Langer, T, Caiani, E, Fumagalli, R, Redaelli, S, Sechi, GM, Caiani, EG, Spina, S, Gianquintieri, L, Marrazzo, F, Migliari, M, Sechi, G, Migliori, M, Pagliosa, A, Bonora, R, Langer, T, Caiani, E, Fumagalli, R, Redaelli, S, Sechi, GM, and Caiani, EG

Abstract

Background: The regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Machine learning (ML)-based models using additional clinical and geospatial epidemiological data may improve the identification of infected patients and guide EMS in detecting COVID-19 cases before confirmation with SARS-CoV-2 reverse transcriptase PCR (rtPCR). Methods: This was an observational, retrospective cohort study using data from October 2020 to July 2021 (training set) and October 2021 to December 2021 (validation set) from patients who underwent a SARS-CoV-2 rtPCR test within 7 days of an EMS call. The performance of an operator-based interview using close contact history and signs/symptoms of COVID-19 was assessed in the training set for its ability to determine which patients had an rtPCR in the 7 days before or after the call. The interview accuracy was compared with four supervised ML models to predict positivity for SARS-CoV-2 within 7 days using readily available prehospital data retrieved from both training and validation sets. Results: The training set includes 264 976 patients, median age 74 (IQR 55-84). Test characteristics for the detection of COVID-19-positive patients of the operator-based interview were: sensitivity 85.5%, specificity 58.7%, positive predictive value (PPV) 37.5% and negative predictive value (NPV) 93.3%. Contact history, fever and cough showed the highest association with SARS-CoV-2 infection. In the validation set (103 336 patients, median age 73 (IQR 50-84)), the best-performing ML model had an AUC of 0.85 (95% CI 0.84 to 0.86), sensitivity 91.4% (95 CI% 0.91 to 0.92), specificity 44.2% (95% CI 0.44 to 0.45) and accuracy 85% (95% CI 0.84 to 0.85). PPV and NPV were 13.3% (95% CI 0.13 to 0.14) and 98.2% (95% CI 0.98 to 0.98), respectively. Contact history, fever, call geographical distribution and cough

Published
2023

86. Helmet Continuous Positive Airway Pressure in the Emergency Department: A Practical Guide

Author

Privitera, D, Capsoni, N, Bellone, A, Langer, T, Privitera, Daniele, Capsoni, Nicolò, Bellone, Andrea, Langer, Thomas, Privitera, D, Capsoni, N, Bellone, A, Langer, T, Privitera, Daniele, Capsoni, Nicolò, Bellone, Andrea, and Langer, Thomas

Abstract

Helmet continuous positive airway pressure is a simple, noninvasive respiratory support strategy to treat several forms of acute respiratory failure, such as cardiogenic pulmonary edema and pneumonia. Recently, it has been largely used worldwide during the COVID-19 pandemic. Given the increased use of helmet continuous positive airway pressure in the emergency department, we aimed to provide an updated practical guide for nurses and clinicians based on the latest available evidence. We focus our attention on how to set the respiratory circuit. Moreover, we discuss the interactions between flow generators, filters, and positive end-expiratory pressure valves and the consequences regarding the delivered gas flow, fraction of inspired oxygen, positive end-expiratory pressure, and noise level.

Published
2023

87. PEEP Titration Is Markedly Affected by Trunk Inclination in Mechanically Ventilated Patients with COVID-19 ARDS: A Physiologic, Cross-Over Study

Author

Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, Marrazzo, Francesco, Spina, Stefano, Zadek, Francesco, Forlini, Clarissa, Bassi, Gabriele, Giudici, Riccardo, Bellani, Giacomo, Fumagalli, Roberto, Langer, Thomas, Marrazzo, F, Spina, S, Zadek, F, Forlini, C, Bassi, G, Giudici, R, Bellani, G, Fumagalli, R, Langer, T, Marrazzo, Francesco, Spina, Stefano, Zadek, Francesco, Forlini, Clarissa, Bassi, Gabriele, Giudici, Riccardo, Bellani, Giacomo, Fumagalli, Roberto, and Langer, Thomas

Abstract

Background: Changing trunk inclination affects lung function in patients with ARDS. However, its impacts on PEEP titration remain unknown. The primary aim of this study was to assess, in mechanically ventilated patients with COVID-19 ARDS, the effects of trunk inclination on PEEP titration. The secondary aim was to compare respiratory mechanics and gas exchange in the semi-recumbent (40° head-of-the-bed) and supine-flat (0°) positions following PEEP titration. Methods: Twelve patients were positioned both at 40° and 0° trunk inclination (randomized order). The PEEP associated with the best compromise between overdistension and collapse guided by Electrical Impedance Tomography (PEEPEIT) was set. After 30 min of controlled mechanical ventilation, data regarding respiratory mechanics, gas exchange, and EIT parameters were collected. The same procedure was repeated for the other trunk inclination. Results: PEEPEIT was lower in the semi-recumbent than in the supine-flat position (8 ± 2 vs. 13 ± 2 cmH2O, p < 0.001). A semi-recumbent position with optimized PEEP resulted in higher PaO2:FiO2 (141 ± 46 vs. 196 ± 99, p = 0.02) and a lower global inhomogeneity index (46 ± 10 vs. 53 ± 11, p = 0.008). After 30 min of observation, a loss of aeration (measured by EIT) was observed only in the supine-flat position (−153 ± 162 vs. 27 ± 203 mL, p = 0.007). Conclusions: A semi-recumbent position is associated with lower PEEPEIT and results in better oxygenation, less derecruitment, and more homogenous ventilation compared to the supine-flat position.

Published
2023

88. Modulation of pulmonary blood flow in patients with acute respiratory failure

Author

Spina, S, Marrazzo, F, Morais, C, Victor, M, Forlini, C, Guarnieri, M, Bastia, L, Giudici, R, Bassi, G, Xin, Y, Cereda, M, Amato, M, Langer, T, Berra, L, Fumagalli, R, Spina, Stefano, Marrazzo, Francesco, Morais, CaioC A, Victor, Marcus, Forlini, Clarissa, Guarnieri, Marcello, Bastia, Luca, Giudici, Riccardo, Bassi, Gabriele, Xin, Yi, Cereda, Maurizio, Amato, Marcelo, Langer, Thomas, Berra, Lorenzo, Fumagalli, Roberto, Spina, S, Marrazzo, F, Morais, C, Victor, M, Forlini, C, Guarnieri, M, Bastia, L, Giudici, R, Bassi, G, Xin, Y, Cereda, M, Amato, M, Langer, T, Berra, L, Fumagalli, R, Spina, Stefano, Marrazzo, Francesco, Morais, CaioC A, Victor, Marcus, Forlini, Clarissa, Guarnieri, Marcello, Bastia, Luca, Giudici, Riccardo, Bassi, Gabriele, Xin, Yi, Cereda, Maurizio, Amato, Marcelo, Langer, Thomas, Berra, Lorenzo, and Fumagalli, Roberto

Abstract

Background: Impairment of ventilation and perfusion (V/Q) matching is a common mechanism leading to hypoxemia in patients with acute respiratory failure requiring intensive care unit (ICU) admission. While ventilation has been thoroughly investigated, little progress has been made to monitor pulmonary perfusion at the bedside and treat impaired blood distribution. The study aimed to assess real-time changes in regional pulmonary perfusion in response to a therapeutic intervention. Methods: Single-center prospective study that enrolled adult patients with ARDS caused by SARS-Cov-2 who were sedated, paralyzed, and mechanically ventilated. The distribution of pulmonary perfusion was assessed through electrical impedance tomography (EIT) after the injection of a 10-ml bolus of hypertonic saline. The therapeutic intervention consisted in the administration of inhaled nitric oxide (iNO), as rescue therapy for refractory hypoxemia. Each patient underwent two 15-min steps at 0 and 20 ppm iNO, respectively. At each step, respiratory, gas exchange, and hemodynamic parameters were recorded, and V/Q distribution was measured, with unchanged ventilatory settings. Results: Ten 65 [56–75] years old patients with moderate (40%) and severe (60%) ARDS were studied 10 [4-20] days after intubation. Gas exchange improved at 20 ppm iNO (PaO2/FiO2 from 86 ± 16 to 110 ± 30 mmHg, p = 0.001; venous admixture from 51 ± 8 to 45 ± 7%, p = 0.0045; dead space from 29 ± 8 to 25 ± 6%, p = 0.008). The respiratory system's elastic properties and ventilation distribution were unaltered by iNO. Hemodynamics did not change after gas initiation (cardiac output 7.6 ± 1.9 vs. 7.7 ± 1.9 L/min, p = 0.66). The EIT pixel perfusion maps showed a variety of patterns of changes in pulmonary blood flow, whose increase positively correlated with PaO2/FiO2 increase (R2 = 0.50, p = 0.049). Conclusions: The assessment of lung perfusion is feasible at the bedside and blood distribution can be modulated with effects tha

Published
2023

91. Flow generators for helmet CPAP: Which to prefer? A bench study

Author

Privitera, D, Capsoni, N, Zadek, F, Mazzone, A, Bellone, A, Fumagalli, R, Langer, T, Privitera, Daniele, Capsoni, Nicolò, Zadek, Francesco, Mazzone, Annamaria, Bellone, Andrea, Fumagalli, Roberto, Langer, Thomas, Privitera, D, Capsoni, N, Zadek, F, Mazzone, A, Bellone, A, Fumagalli, R, Langer, T, Privitera, Daniele, Capsoni, Nicolò, Zadek, Francesco, Mazzone, Annamaria, Bellone, Andrea, Fumagalli, Roberto, and Langer, Thomas

Abstract

Objective: To assess the different effect of filters’ application during helmet-CPAP delivered with three different flow generators on the delivered fresh gas flow, FiO2, and the noise level inside and outside the helmet. Methods: In a bench study, three flow generators (air-oxygen blender, turbine ventilator and Venturi system) were used to generate two different gas flows (60 L/min and 80 L/min), with a fixed FiO2 at 0.6, to perform a helmet-CPAP on a manikin. Three different fixed PEEP valves (7.5, 10, and 12.5 cmH2O) were applied at the expiratory port. Gas flow, FiO2 and noise were recorded for each Flow-generator/Flow/PEEP combination, first without filter interposition and then after positioning a heat and moister exchanger filter (HMEF) at the helmet inlet port. Results: The application of the HMEF lead to a significant difference in the flow variation among the three flow generators (p < 0.001). Compared to baseline, the highest flow reduction was observed with the VENTURI (−13.4 ± 1.2 %, p < 0.001), a slight increase with the BLENDER (1.2 ± 0.5 %, p < 0.001), whereas no difference was recorded with the TURBINE (0.1 ± 0.6 %, p = 0.12). After HMEF was interposed, a significant FiO2 variation was observed only with VENTURI (11.3 ± 1.8 %, p < 0.001). As for the noise, the TURBINE was the least noisy system, both with and without the filter interposition. Conclusions: Flow generators used to deliver helmet-CPAP have different characteristics and responses to HMEF interposition. Users should be aware of the effects on FiO2 and flow of the different devices in order to make a precise setup of the circuit.

Published
2023

93. Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

Author

Tonetti T., Grasselli G., Zanella A., Pizzilli G., Fumagalli R., Piva S., Lorini L., Iotti G., Foti G., Colombo S., Vivona L., Rossi S., Girardis M., Agnoletti V., Campagna A., Gordini G., Navalesi P., Boscolo A., Graziano A., Valeri I., Vianello A., Cereda D., Filippini C., Cecconi M., Locatelli F., Bartoletti M., Giannella M., Viale P., Antonelli M., Nava S., Pesenti A., Ranieri V. M., Albano G., Alborghetti A., Aldegheri G., Antonini B., Belgiorno N., Bellani G., Beretta E., Bonazzi S., Borelli M., Cabrini L., Carnevale L., Carnevale S., Castelli G., Catena E., Chiumello D., Coluccello A., Coppini D., Covello D., DeFilippi G., DeiPoli M., Dughi P., Gallioli G., Gnesin P., Greco S., Guatteri L., Guzzon D., Keim R., Landoni G., Langer T., Lombardo A., Marino G., Merli G., Merlo D., Mojoli F., Muttini S., Natalini G., Petrucci N., Pezzi A., Radrizzani D., Raimondi M., Riccio M., Storti E., Tavola M., Vitale G., Bosco E., Calo M. A., Danzi V., DeRosa S., Farnia A., Lazzari F., Meggiolaro M., Munari M., Saia M., Sella N., Serra E., Tiberio I., Baiocchi M., Benedetto M., Bordini M., Caramelli F., Cilloni N., DellaGiovampaola M., Fanelli A., Frascaroli G., Fusari M., Maitan S., Martino C., Melotti R. M., Merola R., Minardi F., Moro F., Nardi G., Nolli M., Pierucci E., Potalivo A., Repetti F., Salsi P., Terzitta M., Tosi M., Venturi S., Volta C. A., Zani G., Zanoni A (COVID-19 Northern Italian ICU Network), Landoni G, Tonetti, Tommaso, Grasselli, Giacomo, Zanella, Alberto, Pizzilli, Giacinto, Fumagalli, Roberto, Piva, Simone, Lorini, Luca, Iotti, Giorgio, Foti, Giuseppe, Colombo, Sergio, Vivona, Luigi, Rossi, Sandra, Girardis, Massimo, Agnoletti, Vanni, Campagna, Anselmo, Gordini, Giovanni, Navalesi, Paolo, Boscolo, Annalisa, Graziano, Alessandro, Valeri, Ilaria, Vianello, Andrea, Cereda, Danilo, Filippini, Claudia, Cecconi, Maurizio, Locatelli, Franco, Bartoletti, Michele, Giannella, Maddalena, Viale, Pierluigi, Antonelli, Massimo, Nava, Stefano, Pesenti, Antonio, Ranieri, V Marco, Tonetti, T, Grasselli, G, Zanella, A, Pizzilli, G, Fumagalli, R, Piva, S, Lorini, L, Iotti, G, Foti, G, Colombo, S, Vivona, L, Rossi, S, Girardis, M, Agnoletti, V, Campagna, A, Gordini, G, Navalesi, P, Boscolo, A, Graziano, A, Valeri, I, Vianello, A, Cereda, D, Filippini, C, Cecconi, M, Locatelli, F, Bartoletti, M, Giannella, M, Viale, P, Antonelli, M, Nava, S, Pesenti, A, Ranieri, V, Langer, T, Tonetti, T., Grasselli, G., Zanella, A., Pizzilli, G., Fumagalli, R., Piva, S., Lorini, L., Iotti, G., Foti, G., Colombo, S., Vivona, L., Rossi, S., Girardis, M., Agnoletti, V., Campagna, A., Gordini, G., Navalesi, P., Boscolo, A., Graziano, A., Valeri, I., Vianello, A., Cereda, D., Filippini, C., Cecconi, M., Locatelli, F., Bartoletti, M., Giannella, M., Viale, P., Antonelli, M., Nava, S., Pesenti, A., Ranieri, V. M., Albano, G., Alborghetti, A., Aldegheri, G., Antonini, B., Belgiorno, N., Bellani, G., Beretta, E., Bonazzi, S., Borelli, M., Cabrini, L., Carnevale, L., Carnevale, S., Castelli, G., Catena, E., Chiumello, D., Coluccello, A., Coppini, D., Covello, D., Defilippi, G., Deipoli, M., Dughi, P., Gallioli, G., Gnesin, P., Greco, S., Guatteri, L., Guzzon, D., Keim, R., Landoni, G., Langer, T., Lombardo, A., Marino, G., Merli, G., Merlo, D., Mojoli, F., Muttini, S., Natalini, G., Petrucci, N., Pezzi, A., Radrizzani, D., Raimondi, M., Riccio, M., Storti, E., Tavola, M., Vitale, G., Bosco, E., Calo, M. A., Danzi, V., Derosa, S., Farnia, A., Lazzari, F., Meggiolaro, M., Munari, M., Saia, M., Sella, N., Serra, E., Tiberio, I., Baiocchi, M., Benedetto, M., Bordini, M., Caramelli, F., Cilloni, N., Dellagiovampaola, M., Fanelli, A., Frascaroli, G., Fusari, M., Maitan, S., Martino, C., Melotti, R. M., Merola, R., Minardi, F., Moro, F., Nardi, G., Nolli, M., Pierucci, E., Potalivo, A., Repetti, F., Salsi, P., Terzitta, M., Tosi, M., Venturi, S., Volta, C. A., Zani, G., Zanoni, A (COVID-19 Northern Italian ICU Network), and Landoni, G

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Respiratory rate, Socio-culturale, Critical Care and Intensive Care Medicine, Acute respiratory failure, acute respiratory failure, COVID-19, ICU, non-invasive ventilation, rationing, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, Intensive care, Retrospective analysis, Medicine, 030212 general & internal medicine, Non-invasive ventilation, Rationing, Case report form, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Outbreak, lcsh:RC86-88.9, Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, 030228 respiratory system, Emergency medicine, Base excess, business
Abstract

Background A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.

Published
2020

96. Das CARE-for-CAYA-Programm: Präventionskonzept für junge Menschen nach Krebserkrankung

Author

Quidde, J., Koch, B., Salchow, J., Jensen, W., von Grundherr, J., Escherich, G., Rutkowski, S., Schulz-Kindermann, F., Bergelt, C., Bokemeyer, C., Sokalska-Duhme, M., Bielack, S., Calaminus, G., Classen, C. F., Rössig, C., Faber, J., Faller, H., Hilgendorf, I., Langer, T., Metzler, M., Schuster, S., Niemeyer, C., Pierce, A., Reinhardt, D., Sander, A., Köhler, M., and Stein, A.

Published
2017
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98. Nutzung und Anwendbarkeit von Patientenleitlinien in der Onkologie aus Sicht der Leistungserbringenden – eine qualitative Interviewstudie

Author

Wahlen, S, Breuing, J, Becker, M, Bühn, S, Hauprich, J, Könsgen, N, Meyer, N, Bloedt, S, Carl, EG, Follmann, M, Frenz, S, Langer, T, Nothacker, M, Schaefer, C, and Pieper, D

Subjects
ddc: 610, Medicine and health
Abstract

Hintergrund und Stand (inter)nationaler Forschung: Menschen mit einer Krebserkrankung haben sowohl während als auch nach der Behandlung ein hohes Informationsbedürfnis, welches aber häufig nicht ausreichend erfüllt wird. Patientenleitlinien (PatLL), eine besondere Form der evidenzbasierten [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Published
2022
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99. (Inter-)nationale Erfahrungen bei der Erstellung und Dissemination von PatientInnenleitlinien – eine Interviewstudie

Author

Hauprich, J, Breuing, J, Becker, M, Bühn, S, Könsgen, N, Meyer, N, Bloedt, S, Carl, EG, Follmann, M, Frenz, S, Langer, T, Nothacker, M, Schaefer, C, Wahlen, S, and Pieper, D

Subjects
ddc: 610, Medicine and health
Abstract

Hintergrund und Stand (inter)nationaler Forschung: Menschen mit einer Krebserkrankung weisen ein hohes Informationsbedürfnis auf, welches aktuell unzureichend erfüllt wird. Patientenleitlinien (PatLL) kommen diesem Bedürfnis nach, indem sie, basierend auf evidenzbasierten Leitlinien, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Published
2022
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100. VersKiK – Versorgung, Versorgungsbedarf und Versorgungsbedürfnisse von Personen nach einer Krebserkrankung im Kindes- oder Jugendalter: Studiendesign

Author

Aleshchenko, E, Trocchi, P, Swart, E, Spix, C, Langer, T, Baust, K, Calaminus, G, Ihle, P, Küpper-Nybelen, J, Dröge, P, Horenkamp-Sonntag, D, Marschall, U, Klein, M, Lüpkes, C, and Apfelbacher, C

Subjects
ddc: 610, Medicine and health
Abstract

About 2,100 children and young adults below age 18 are diagnosed with cancer in Germany each year [ref:1]. Around two-thirds of all childhood cancer survivors suffer from at least one late effect in the course of their lives, directly or indirectly associated with the cancer itself or its [for full text, please go to the a.m. URL]

Published
2022
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