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1. Movement disorders following mechanical thrombectomy resulting in ischemic lesions of the basal ganglia: An emerging clinical entity

Author: Rigon, Leonardo, Genovese, Danilo, Piano, Carla, Brunetti, Valerio, Guglielmi, Valeria, Cimmino, Angelo Tiziano, Scala, Irene, Citro, Salvatore, Bentivoglio, Anna Rita, Rollo, Eleonora, Di Iorio, Riccardo, Broccolini, Aldobrando, Morosetti, Roberta, Monforte, Mauro, Frisullo, Giovanni, Caliandro, Pietro, Pedicelli, Alessandro, Caricato, Anselmo, Masone, Giovanna, Calabresi, Paolo, Della Marca, Giacomo, Bentivoglio, Anna Rita (ORCID:0000-0002-9663-095X), Broccolini, Aldobrando (ORCID:0000-0001-8295-9271), Caliandro, Pietro (ORCID:0000-0002-1190-4879), Pedicelli, Alessandro (ORCID:0000-0002-2558-8838), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Calabresi, Paolo (ORCID:0000-0003-0326-5509), Marca, Giacomo Della (ORCID:0000-0001-6914-799X), Rigon, Leonardo, Genovese, Danilo, Piano, Carla, Brunetti, Valerio, Guglielmi, Valeria, Cimmino, Angelo Tiziano, Scala, Irene, Citro, Salvatore, Bentivoglio, Anna Rita, Rollo, Eleonora, Di Iorio, Riccardo, Broccolini, Aldobrando, Morosetti, Roberta, Monforte, Mauro, Frisullo, Giovanni, Caliandro, Pietro, Pedicelli, Alessandro, Caricato, Anselmo, Masone, Giovanna, Calabresi, Paolo, Della Marca, Giacomo, Bentivoglio, Anna Rita (ORCID:0000-0002-9663-095X), Broccolini, Aldobrando (ORCID:0000-0001-8295-9271), Caliandro, Pietro (ORCID:0000-0002-1190-4879), Pedicelli, Alessandro (ORCID:0000-0002-2558-8838), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Calabresi, Paolo (ORCID:0000-0003-0326-5509), and Marca, Giacomo Della (ORCID:0000-0001-6914-799X)
Abstract: Background and purposePost-stroke movement disorders (PMDs) following ischemic lesions of the basal ganglia (BG) are a known entity, but data regarding their incidence are lacking. Ischemic strokes secondary to proximal middle cerebral artery (MCA) occlusion treated with thrombectomy represent a model of selective damage to the BG. The aim of this study was to assess the prevalence and features of movement disorders after selective BG ischemia in patients with successfully reperfused acute ischemic stroke (AIS).MethodsWe enrolled 64 consecutive subjects with AIS due to proximal MCA occlusion treated with thrombectomy. Patients were clinically evaluated by a movement disorders specialist for PMDs onset at baseline, and after 6 and 12 months.ResultsNone of the patients showed an identifiable movement disorder in the subacute phase of the stroke. At 6 and 12 months, respectively, 7/25 (28%) and 7/13 (53.8%) evaluated patients developed PMDs. The clinical spectrum of PMDs encompassed parkinsonism, dystonia and chorea, either isolated or combined. In most patients, symptoms were contralateral to the lesion, although a subset of patients presented with bilateral involvement and prominent axial signs.ConclusionPost-stroke movement disorders are not uncommon in long-term follow-up of successfully reperfused AIS. Follow-up conducted by a multidisciplinary team is strongly advisable in patients with selective lesions of the BG after AIS, even if asymptomatic at discharge.
Published: 2024

2. Clinical Impact and Predictors of Aneurysmal Rebleeding in Poor-Grade Subarachnoid Hemorrhage: Results From the National POGASH Registry

Author: Panni, P., Riccio, L., Cao, R., Pedicelli, Alessandro, Marchese, Enrico, Caricato, Anselmo, Feletti, A., Testa, M., Zanatta, P., Gitti, N., Piva, S., Mardighian, D., Semeraro, V., Nardin, G., Lozupone, Emilio, Paiano, G., Picetti, E., Montanaro, V., Petranca, M., Bortolotti, C., Scibilia, A., Cirillo, L., Lanterna, A. L., Mortini, P., Beretta, Carlo Luigi, Falini, A., Pedicelli A. (ORCID:0000-0002-2558-8838), Marchese E. (ORCID:0000-0001-8551-0357), Caricato A. (ORCID:0000-0001-5929-120X), Lozupone E., Beretta L. (ORCID:0000-0001-9924-2066), Panni, P., Riccio, L., Cao, R., Pedicelli, Alessandro, Marchese, Enrico, Caricato, Anselmo, Feletti, A., Testa, M., Zanatta, P., Gitti, N., Piva, S., Mardighian, D., Semeraro, V., Nardin, G., Lozupone, Emilio, Paiano, G., Picetti, E., Montanaro, V., Petranca, M., Bortolotti, C., Scibilia, A., Cirillo, L., Lanterna, A. L., Mortini, P., Beretta, Carlo Luigi, Falini, A., Pedicelli A. (ORCID:0000-0002-2558-8838), Marchese E. (ORCID:0000-0001-8551-0357), Caricato A. (ORCID:0000-0001-5929-120X), Lozupone E., and Beretta L. (ORCID:0000-0001-9924-2066)
Abstract: BACKGROUND: Scarce data are available regarding rebleeding predictors in poor-grade aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVES: To investigate predictors and clinical impact of rebleeding in a national multicentric poor-grade aSAH. METHODS: Retrospective analysis of prospectively collected data from the multicentric Poor Grade Aneurysmal Subarachnoid Hemorrhage Study Group (POGASH) registry of consecutive patients treated from January 1, 2015, to June 30th, 2021. Grading was defined as pretreatment World Federation of Neurological Surgeons grading scale IV-V. Ultra-early vasospasm (UEV) was defined as luminal narrowing of intracranial arteries not due to intrinsic disease. Rebleeding was defined as clinical deterioration with evidence of increased hemorrhage on subsequent computed tomography scans, fresh blood from the external ventricular drain, or deterioration before neuroradiological evaluation. Outcome was assessed by the modified Rankin Scale. RESULTS: Among 443 consecutive World Federation of Neurological Surgeons grades IV-V patients with aSAH treated within a median of 5 (IQR 4-9) hours since onset, rebleeding occurred in 78 (17.6%). UEV (adjusted odds ratio [OR] 6.8, 95% CI 3.2-14.4; P <.001) and presence of dissecting aneurysm (adjusted OR 3.5, 95% CI 1.3-9.3; P =.011) independently predicted rebleeding while history of hypertension (adjusted OR 0.4, 95% CI 0.2-0.8; P =.011) independently reduced its chances. 143 (32.3) patients died during hospitalization. Rebleeding emerged, among others, as an independent predictor of intrahospital mortality (adjusted OR 2.2, 95% CI 1.2-4.1; P =.009). CONCLUSION: UEV and presence of dissecting aneurysms are the strongest predictors of aneurysmal rebleeding. Their presence should be carefully evaluated in the acute management of poor-grade aSAH.
Published: 2023

3. Multisystemic involvement of post-traumatic fat embolism at a Pediatric Trauma Center: a clinical series and literature review

Author: Piastra, Marco, Picconi, Enzo, Morena, Tony Christian, Ferrari, Vittoria, Gelormini, Camilla, Caricato, Anselmo, Visconti, Federico, De Luca, Daniele, Conti, Giorgio, Piastra, Marco (ORCID:0000-0002-3144-8970), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Conti, Giorgio (ORCID:0000-0002-8566-9365), Piastra, Marco, Picconi, Enzo, Morena, Tony Christian, Ferrari, Vittoria, Gelormini, Camilla, Caricato, Anselmo, Visconti, Federico, De Luca, Daniele, Conti, Giorgio, Piastra, Marco (ORCID:0000-0002-3144-8970), Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Conti, Giorgio (ORCID:0000-0002-8566-9365)
Abstract: Post-traumatic fat embolism syndrome (FES) is a severe complication consequent to bone fractures. The authors describe its clinical features and management in a population of teenagers by detailing demographics, organ involvement, laboratory, and imaging findings, as well as outcome. Moreover, a systematic review of pediatric published case reports of post-traumatic FES is provided. First, a series of eight episodes of post-traumatic FES that occurred in seven patients (median age 16.0 years, IQR 16.0-17.5) admitted to a pediatric intensive care unit (PICU) in an 8-year period was analyzed through a retrospective chart review. Secondly, a systematic research was performed on PUBMED database. Trauma patients <= 18 years without comorbidities in a 20-year period (2002-2022) were included in the review. Neurological impairment was present in five out of seven patients, and a patent foramen ovale was found in four cases. Hemodynamic instability requiring vasoactive drugs was recorded in four patients. A severe form of acute respiratory distress syndrome (ARDS) occurred in five cases, with the evidence of hemorrhagic alveolitis in three of them. In the literature review, eighteen cases were examined. Most cases refer to adolescents (median age 17.0 years). More than half of patients experienced two or more long bone fractures (median: 2 fractures). Both respiratory and neurological impairment were common (77.8% and 83.3%, respectively). 88.9% of patients underwent invasive mechanical ventilation and 33.3% of them required vasoactive drugs support. Neurological sequelae were reported in 22.2% of patients.Conclusion: Post-traumatic FES is an uncommon multi-faceted condition even in pediatric trauma patients, requiring a high level of suspicion. Prognosis of patients who receive prompt support in an intensive care setting is generally favorable.
Published: 2023

4. Hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension?

Author: Gelormini, C., Ioannoni, E., Scavone, Angela, Pisapia, L., Signorelli, Francesco, Montano, Nicola, Piastra, M., Caricato, Anselmo, Scavone A., Signorelli F. (ORCID:0000-0001-8431-0433), Montano N. (ORCID:0000-0002-4965-1950), Caricato A. (ORCID:0000-0001-5929-120X), Gelormini, C., Ioannoni, E., Scavone, Angela, Pisapia, L., Signorelli, Francesco, Montano, Nicola, Piastra, M., Caricato, Anselmo, Scavone A., Signorelli F. (ORCID:0000-0001-8431-0433), Montano N. (ORCID:0000-0002-4965-1950), and Caricato A. (ORCID:0000-0001-5929-120X)
Abstract: Introduction: An increase in cerebral blood flow is frequent after traumatic brain injury (TBI) and can lead to brain swelling and refractory intracranial hypertension. We hypothesized that Transcranial EcoDoppler (TCD) monitoring could be useful to detect the cause of intracranial hypertension in these patients. Our main objective was to investigate if the increase of velocity in the middle cerebral artery (MCA) on TCD could be associated with intracranial hypertension.Methods: We retrospectively studied TBI patients consecutively monitored with TCD. Hyperemia was defined as MCA mean velocity higher than 80 cm/s. Intracranial hypertension was considered when hyperosmolar therapy, hyperventilation, or deep sedation was used.Results: We found hyperemia in 40 patients out of 118 (33.9%). On average, it started at day 2.1 +/- 0.9 from admission and significantly increased (MCA velocity at day 1: 74 +/- 25 cm/s vs. 109 +/- 36 cm/s at day 4; p < 0.001). Intracranial hypertension was significantly associated with hyperemia, occurring in 92.5% of hyperemic and 51.3% of non-hyperemic patients (p < 0.001). Moreover, we found that hyperemia preceded severe intracranial hypertension (p < 0.0001). In a logistic regression model, hyperemia was the only variable significantly correlated with intracranial hypertension (OR 10.64; p < 0.001).Discussion: Hyperemia was frequent in our population of TBI patients and preceded intracranial hypertension. TCD monitoring, if performed on a daily regular basis, can be a useful method to detect this phenomenon and to guide the therapy. It could be a tool for a cause-oriented therapy of intracranial hypertension.
Published: 2023

5. Bedside Ultrasound for Ventricular Size Monitoring in Patients with PEEK Cranioplasty: A Preliminary Experience of Technical Feasibility in Neurotrauma Setting

Author: Signorelli, Francesco, Della Pepa, Giuseppe Maria, Marziali, G., Ioannoni, E., Olivi, Alessandro, Caricato, Anselmo, Visocchi, Massimiliano, Montano, Nicola, Signorelli F. (ORCID:0000-0001-8431-0433), Della Pepa G. M. (ORCID:0000-0001-8698-3359), Olivi A. (ORCID:0000-0002-4489-7564), Caricato A. (ORCID:0000-0001-5929-120X), Visocchi M. (ORCID:0000-0003-1087-0491), Montano N. (ORCID:0000-0002-4965-1950), Signorelli, Francesco, Della Pepa, Giuseppe Maria, Marziali, G., Ioannoni, E., Olivi, Alessandro, Caricato, Anselmo, Visocchi, Massimiliano, Montano, Nicola, Signorelli F. (ORCID:0000-0001-8431-0433), Della Pepa G. M. (ORCID:0000-0001-8698-3359), Olivi A. (ORCID:0000-0002-4489-7564), Caricato A. (ORCID:0000-0001-5929-120X), Visocchi M. (ORCID:0000-0003-1087-0491), and Montano N. (ORCID:0000-0002-4965-1950)
Abstract: Background: Posttraumatic hydrocephalus is a known complication after traumatic brain injury, particularly affecting patients undergoing decompressive craniectomy. Posttraumatic hydrocephalus monitoring in these patients represents a common issue in neurosurgical practice. Patients require periodical assessments by means of computed tomography (CT) scans. This study presents a preliminary institutional series in which ultrasound was used as a bedside imaging technique to monitor ventricular size in patients harboring a polyetheretherketone (PEEK) cranioplasty. Exploiting the PEEK cranioplasty permeability to echoes, we evaluated the feasibility of this bedside imaging method in monitoring hydrocephalus evolution, determining effects of ventriculo-peritoneal shunt, and excluding complications. Methods: Eight patients with traumatic brain injury harboring PEEK cranioplasty following decompressive craniectomy were prospectively evaluated. Ultrasound measurements were compared with CT scan data taken the same day, and ventricular morphometry parameters were compared. Results: Ultrasound images through the PEEK cranioplasty were of high quality and intracranial anatomy was distinctly evaluated. A strong correlation was observed between ultrasound and CT measurements. Concerning distance between lateral ventricles frontal horns (IFH) and the diameter of the third ventricle (TV), we found a strong correlation between transcranial sonography and CT measurements in preventriculoperitoneal shunt (rho = 0.92 and p = 0.01 for IFH; rho = 0.99 and p = 0.008 for TV) and in postventriculoperitoneal shunt examinations (rho = 0.95 and p = 0.03 for IFH; rho = 0.97 and p = 0.03 for TV). The mean error rate between transcranial sonography and CT scan was 1.77 ± 0.91 mm for preoperative IFH, 0.65 ± 0.27 mm for preoperative TV, 2.18 ± 0.82 mm for postoperative IFH, and 0.48 ± 0.21 mm for postoperative TV. Conclusions: Transcranial ultrasound could represent a simplific
Published: 2022

6. Ultrasound-assessed lung aeration correlates with respiratory system compliance in adults and neonates with acute hypoxemic restrictive respiratory failure: an observational prospective study

Author: Biasucci, Daniele Guerino, Loi, B., Centorrino, R., Raschetti, Roberto, Piastra, Marco, Pisapia, Luca, Consalvo, L. M., Caricato, Anselmo, Grieco, D. L., Conti, Giorgio, Antonelli, Massimo, De Luca, D., Biasucci D. G., Raschetti R., Piastra M. (ORCID:0000-0002-3144-8970), Pisapia L., Caricato A. (ORCID:0000-0001-5929-120X), Conti G. (ORCID:0000-0002-8566-9365), Antonelli M. (ORCID:0000-0003-3007-1670), Biasucci, Daniele Guerino, Loi, B., Centorrino, R., Raschetti, Roberto, Piastra, Marco, Pisapia, Luca, Consalvo, L. M., Caricato, Anselmo, Grieco, D. L., Conti, Giorgio, Antonelli, Massimo, De Luca, D., Biasucci D. G., Raschetti R., Piastra M. (ORCID:0000-0002-3144-8970), Pisapia L., Caricato A. (ORCID:0000-0001-5929-120X), Conti G. (ORCID:0000-0002-8566-9365), and Antonelli M. (ORCID:0000-0003-3007-1670)
Abstract: Background: Lung ultrasound allows lung aeration to be assessed through dedicated lung ultrasound scores (LUS). Despite LUS have been validated using several techniques, scanty data exist about the relationships between LUS and compliance of the respiratory system (Crs) in restrictive respiratory failure. Aim of this study was to investigate the relationship between LUS and Crs in neonates and adults affected by acute hypoxemic restrictive respiratory failure, as well as the effect of patients’ age on this relationship. Methods: Observational, cross-sectional, international, patho-physiology, bi-center study recruiting invasively ventilated, adults and neonates with acute respiratory distress syndrome (ARDS), neonatal ARDS (NARDS) or respiratory distress syndrome (RDS) due to primary surfactant deficiency. Subjects without lung disease (NLD) and ventilated for extra-pulmonary conditions were recruited as controls. LUS, Crs and resistances (Rrs) of the respiratory system were measured within 1 h from each other. Results: Forty adults and fifty-six neonates were recruited. LUS was higher in ARDS, NARDS and RDS and lower in control subjects (overall p < 0.001), while Crs was lower in ARDS, NARDS and RDS and higher in control subjects (overall p < 0.001), without differences between adults and neonates. LUS and Crs were correlated in adults [r = − 0.86 (95% CI − 0.93; − 0.76), p < 0.001] and neonates [r = − 0.76 (95% CI − 0.85; − 0.62), p < 0.001]. Correlations remained significant among subgroups with different causes of respiratory failure; LUS and Rrs were not correlated. Multivariate analyses confirmed the association between LUS and Crs both in adults [B = − 2.8 (95% CI − 4.9; − 0.6), p = 0.012] and neonates [B = − 0.045 (95% CI − 0.07; − 0.02), p = 0.001]. Conclusions: Lung aeration and compliance of the respiratory system are significantly and inversely correlated irrespective of patients’ age. A restrictive respiratory failure has the same ultra
Published: 2022

7. A systematic review and meta-analysis of factors involved in bone flap resorption after decompressive craniectomy

Author: Signorelli, Francesco, Giordano, M., Caccavella, V. M., Ioannoni, E., Gelormini, C., Caricato, Anselmo, Olivi, Alessandro, Montano, Nicola, Signorelli F. (ORCID:0000-0001-8431-0433), Caricato A. (ORCID:0000-0001-5929-120X), Olivi A. (ORCID:0000-0002-4489-7564), Montano N. (ORCID:0000-0002-4965-1950), Signorelli, Francesco, Giordano, M., Caccavella, V. M., Ioannoni, E., Gelormini, C., Caricato, Anselmo, Olivi, Alessandro, Montano, Nicola, Signorelli F. (ORCID:0000-0001-8431-0433), Caricato A. (ORCID:0000-0001-5929-120X), Olivi A. (ORCID:0000-0002-4489-7564), and Montano N. (ORCID:0000-0002-4965-1950)
Abstract: Decompressive craniectomy (DC) is effective in controlling increasing intracranial pressure determined by a wide range of conditions, mainly traumatic brain injury (TBI) and stroke, and the subsequent cranioplasty (CP) displays potential therapeutic benefit in terms of overall neurological function. While autologous bone flap (ABF) harvested at the time of DC is the ideal material for skull defect reconstruction, it carries several risks. Aseptic bone flap resorption (BFR) is one of the most common complications, often leading to surgical failure. The aim of our study was to systematically review the literature and carry out a meta-analysis of possible factors involved in BFR in patients undergoing ABF cranioplasty after DC. A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Different medical databases (PubMed, Embase, and Scopus) were screened for eligible scientific reports until April 30th 2021. The following data were collected for meta-analysis to assess their role in BFR: sex, age, the interval time between DC and CP, the presence of systemic factors, the etiology determining the DC, CP surgical time, CP features, VP shunt placement, CP infection. Studies including pediatric patients or with less than 50 patients were excluded. Fifteen studies were included. There was a statistically significant increased incidence of BFR in patients with CPF > 2 compared to patients with CPF ≤ 2 (54.50% and 22.76% respectively, p = 0.010). TBI was a significantly more frequent etiology in the BFR group compared to patients without BFR (61.95% and 47.58% respectively, p < 0.001). Finally, patients with BFR were significantly younger than patients without BFR (39.12 ± 15.36 years and 47.31 ± 14.78 years, respectively, p < 0.001). The funnel plots were largely symmetrical for all the studied factors. Bone flap fragmentation, TBI etiology, and young age significantly increase the risk of bone resorption. Further studie
Published: 2022

8. “tier-three” therapies in intracranial hypertension: Is it worthwhile?

Author: Gelormini, C., Caricato, Anselmo, Caricato A. (ORCID:0000-0001-5929-120X), Gelormini, C., Caricato, Anselmo, and Caricato A. (ORCID:0000-0001-5929-120X)
Published: 2021

9. Outcome Prognostication of Acute Brain Injury using the Neurological Pupil Index (ORANGE) study: protocol for a prospective, observational, multicentre, international cohort study

Author: Badenes, R, Bouzat, P, Caricato, Anselmo, Chesnut, Rm, Hemphill, C, Rasulo, F, Schwab, S, Sunde, K, Aaron, Blandino, Letterio, Malgeri, Eleonora, Rossi, Alessia, Vargiolu, Francesca, Elli, Francesca, Graziano, Caricato A (ORCID:0000-0001-5929-120X), Badenes, R, Bouzat, P, Caricato, Anselmo, Chesnut, Rm, Hemphill, C, Rasulo, F, Schwab, S, Sunde, K, Aaron, Blandino, Letterio, Malgeri, Eleonora, Rossi, Alessia, Vargiolu, Francesca, Elli, Francesca, Graziano, and Caricato A (ORCID:0000-0001-5929-120X)
Abstract: Introduction The pupillary examination is an important part of the neurological assessment, especially in the setting of acutely brain-injured patients, and pupillary abnormalities are associated with poor outcomes. Currently, the pupillary examination is based on a visual, subjective and frequently inaccurate estimation. The use of automated infrared pupillometry to measure the pupillary light reflex can precisely quantify subtle changes in pupillary functions. The study aimed to evaluate the association between abnormal pupillary function, assessed by the Neurological Pupil Index (NPi), and long-term outcomes in patients with acute brain injury (ABI). Methods and analysis The Outcome Prognostication of Acute Brain Injury using the Neurological Pupil Index study is a prospective, observational study including adult patients with ABI requiring admission at the intensive care unit. We aimed to recruit at least 420 patients including those suffering from traumatic brain injury or haemorrhagic strokes, over 12 months. The primary aim was to assess the relationship between NPi and 6-month mortality or poor neurological outcome, measured by the Extended Glasgow Outcome Score (GOS-E, poor outcome=GOS-E 1–4). Supervised and unsupervised methods and latent class mixed models will be used to identify patterns of NPi trajectories and Cox and logistic model to evaluate their association with outcome. Ethics and dissemination The study has been approved by the institutional review board (Comitato Etico Brianza) on 16 July 2020. Approved protocol V.4.0 dated 10 March 2020. The results of this study will be published in peer-reviewed journals and presented at conferences.
Published: 2021

10. Management of intracranial hypertension following traumatic brain injury: A best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy: Joint statements by the Traumatic Brain Injury Section of the Italian Society of Neurosurgery (SINch) and the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

Author: Iaccarino, C., Lippa, L., Munari, M., Castioni, C. A., Robba, C., Caricato, Anselmo, Pompucci, Angelo, Signoretti, S., Zona, G., Rasulo, F. A., Aimar, E., Amato, S., Angileri, F. F., Anile, Carmelo, Assietti, R., Baratto, V., Barbanera, A., Basile, L., Battaglia, R., Bellocchi, S., Bertuccio, A., Blanco, S., Bolognini, A., Boniferro, B., Bordi, L., Bortolotti, C., Brandini, V., Broger, Maximilian, Brollo, M., Caffarella, D. D., Caggiano, Cinzia, Cantisani, P. L., Capone, C., Cappelletto, B., Capuano, C., Carangelo, B., Caruselli, G., Chessa, M. A., Chiara, M., Chibbaro, S., Cioffi, V., Ciprianocecchi, P., Colistra, D., Conti, C., Contratti, F., Costella, G. B., Cuoci, A., D'Avella, D., D'Ercole, Manuela, Deangelis, M., Defalco, R., de Luca, G., de Marinis, P., Del Vecchio, C., Delfinis, C., Denaro, Luca, Deodato, F., Desogus, N., Disomma, A., Domenicucci, M., Dones, F., Fina, M., Fiori, L., Fricia, M., Gaetani, P., Gazzeri, R., Gentile, M., Germano, A., Ghadirpour, R., Gianfreda, C. D., Gigante, N., Gigli, R., Giorgetti, J., Giusa, M., Gravina, U. G., Grippi, L., Guida, F., Guizzardi, G., Iannuzzo, G., Kropp, M., Lattanzi, L., Lucantoni, D., Maffei, L., Magliulo, M., Marconi, F., Marruzzo, D., Martellotta, N., Marton, E., Maugeri, R., Mauro, G., Meli, F., Menniti, A., Merciadri, P., Milanese, L., Nardacci, B., Nasi, D., Orvieto, P., Pacca, P., Pansini, G., Panzarasa, G., Passanisi, M., Pavesi, G., Pizzoni, C., Pulera, F., Rapana, A., Ricci, A., Rispoli, R., Rotondo, M., Russo, N., Santilli, S., Scarano, E., Schwarz, A., Servadei, Franco, Simonetti, G., Stefini, R., Talamonti, G., Turrisi, A., Valente, V. M., Villa, A., Vindigni, M., Visocchi, Massimiliano, Vitali, M., Wierzbicki, V., Zambon, G., Zanotti, B., Zenga, F., Alampi, D., Alessandri, F., Aloj, F., Amigoni, A., Aspide, R., Bertuetti, R., Betti, V., Bilotta, F., Bonato, V., Bosco, E., Brita, M., Buscema, G., Cafiero, T., Cappuccio, D., Caradonna, M., Caria, C. G., Casartelliliviero, M., Ciritella, P., Cirrincione, S., Citerio, G., Colelli, S., Coletta, F., Concordia, L., Congedo, E., Covotta, M., Crimella, F., Dall'Acqua, G., De Cassai, A., Defulviis, S., Deperi, E., Deana, C., Delgaudio, A., Denittis, N., Dicolandrea, S., Divezza, F., Ferri, F., Flocco, R., Fontana, C., Forastierimolinari, A., Frangiosa, A., Fumagalli, P., Fuselli, E., Garbarino, M. M., Gelormini, D., Geraci, C., Geraldini, F., Giacomucci, A., Giampaoli, V., Giorgetti, D., Gritti, P., Gualdani, S., Iacovazzo, C., Iermano, C., Latronico, N., Lugari, S., Lusenti, F., Maglione, C., Magnoni, S., Maiarota, F., Malla, M., Marchesi, M., Martino, C., Matteotti, I., Mazzeo, A. T., Morello, G., Nardiello, I., Paticchio, F., Pegoli, M., Perotti, Valerio, Piazzolla, M., Picciafuochi, F., Rachedi, N., Radolovich, D. K., Recchia, A., Riccardi, S., Romagnoli, S., Sala, S., Scafuro, M. A., Sgarlata, P., Soragni, A., Stefani, F., Stival, Eleonora, Stofella, G., Terranova, F., Tinturini, R., Togni, T., Toto, R., Trapani, D., Tringali, E., Tullo, L., Valente, A., Valeo, T., Varelli, G., Villani, R., Zamacavicchi, F., Zanello, M., Zarrillo, N., Zugni, N., Caricato A. (ORCID:0000-0001-5929-120X), Pompucci A. (ORCID:0000-0002-5427-9719), Anile C. (ORCID:0000-0002-0481-9713), Broger M., Caggiano C., D'Ercole M., Denaro L., Servadei F., Visocchi M. (ORCID:0000-0003-1087-0491), Perotti V. (ORCID:0000-0001-9461-2101), Stival E., Iaccarino, C., Lippa, L., Munari, M., Castioni, C. A., Robba, C., Caricato, Anselmo, Pompucci, Angelo, Signoretti, S., Zona, G., Rasulo, F. A., Aimar, E., Amato, S., Angileri, F. F., Anile, Carmelo, Assietti, R., Baratto, V., Barbanera, A., Basile, L., Battaglia, R., Bellocchi, S., Bertuccio, A., Blanco, S., Bolognini, A., Boniferro, B., Bordi, L., Bortolotti, C., Brandini, V., Broger, Maximilian, Brollo, M., Caffarella, D. D., Caggiano, Cinzia, Cantisani, P. L., Capone, C., Cappelletto, B., Capuano, C., Carangelo, B., Caruselli, G., Chessa, M. A., Chiara, M., Chibbaro, S., Cioffi, V., Ciprianocecchi, P., Colistra, D., Conti, C., Contratti, F., Costella, G. B., Cuoci, A., D'Avella, D., D'Ercole, Manuela, Deangelis, M., Defalco, R., de Luca, G., de Marinis, P., Del Vecchio, C., Delfinis, C., Denaro, Luca, Deodato, F., Desogus, N., Disomma, A., Domenicucci, M., Dones, F., Fina, M., Fiori, L., Fricia, M., Gaetani, P., Gazzeri, R., Gentile, M., Germano, A., Ghadirpour, R., Gianfreda, C. D., Gigante, N., Gigli, R., Giorgetti, J., Giusa, M., Gravina, U. G., Grippi, L., Guida, F., Guizzardi, G., Iannuzzo, G., Kropp, M., Lattanzi, L., Lucantoni, D., Maffei, L., Magliulo, M., Marconi, F., Marruzzo, D., Martellotta, N., Marton, E., Maugeri, R., Mauro, G., Meli, F., Menniti, A., Merciadri, P., Milanese, L., Nardacci, B., Nasi, D., Orvieto, P., Pacca, P., Pansini, G., Panzarasa, G., Passanisi, M., Pavesi, G., Pizzoni, C., Pulera, F., Rapana, A., Ricci, A., Rispoli, R., Rotondo, M., Russo, N., Santilli, S., Scarano, E., Schwarz, A., Servadei, Franco, Simonetti, G., Stefini, R., Talamonti, G., Turrisi, A., Valente, V. M., Villa, A., Vindigni, M., Visocchi, Massimiliano, Vitali, M., Wierzbicki, V., Zambon, G., Zanotti, B., Zenga, F., Alampi, D., Alessandri, F., Aloj, F., Amigoni, A., Aspide, R., Bertuetti, R., Betti, V., Bilotta, F., Bonato, V., Bosco, E., Brita, M., Buscema, G., Cafiero, T., Cappuccio, D., Caradonna, M., Caria, C. G., Casartelliliviero, M., Ciritella, P., Cirrincione, S., Citerio, G., Colelli, S., Coletta, F., Concordia, L., Congedo, E., Covotta, M., Crimella, F., Dall'Acqua, G., De Cassai, A., Defulviis, S., Deperi, E., Deana, C., Delgaudio, A., Denittis, N., Dicolandrea, S., Divezza, F., Ferri, F., Flocco, R., Fontana, C., Forastierimolinari, A., Frangiosa, A., Fumagalli, P., Fuselli, E., Garbarino, M. M., Gelormini, D., Geraci, C., Geraldini, F., Giacomucci, A., Giampaoli, V., Giorgetti, D., Gritti, P., Gualdani, S., Iacovazzo, C., Iermano, C., Latronico, N., Lugari, S., Lusenti, F., Maglione, C., Magnoni, S., Maiarota, F., Malla, M., Marchesi, M., Martino, C., Matteotti, I., Mazzeo, A. T., Morello, G., Nardiello, I., Paticchio, F., Pegoli, M., Perotti, Valerio, Piazzolla, M., Picciafuochi, F., Rachedi, N., Radolovich, D. K., Recchia, A., Riccardi, S., Romagnoli, S., Sala, S., Scafuro, M. A., Sgarlata, P., Soragni, A., Stefani, F., Stival, Eleonora, Stofella, G., Terranova, F., Tinturini, R., Togni, T., Toto, R., Trapani, D., Tringali, E., Tullo, L., Valente, A., Valeo, T., Varelli, G., Villani, R., Zamacavicchi, F., Zanello, M., Zarrillo, N., Zugni, N., Caricato A. (ORCID:0000-0001-5929-120X), Pompucci A. (ORCID:0000-0002-5427-9719), Anile C. (ORCID:0000-0002-0481-9713), Broger M., Caggiano C., D'Ercole M., Denaro L., Servadei F., Visocchi M. (ORCID:0000-0003-1087-0491), Perotti V. (ORCID:0000-0001-9461-2101), and Stival E.
Abstract: No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from “TBI Section” of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the “T
Published: 2021

11. Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study

Author: Robba, C., Graziano, F., Rebora, P., Elli, F., Giussani, C., Oddo, M., Meyfroidt, G., Helbok, R., Taccone, F. S., Prisco, L., Vincent, J. -L., Suarez, J. I., Stocchetti, N., Citerio, G., Abdelaty, M., Abed Maillard, S., Ahmed, H., Albrecht, L., Alsudani, A., Amundarain, E. D., Anand, S., Andersen, J. B., Anglada, M., Arabi, Y., Aragao, I., Arias Verdu, M. D., Asehnoune, K., Assuncao, F., Audibert, G., Badenes, R., Bajracharya, T., Banco, P., Batista, D., Bertellini, E., Berty Gutierrez, H., Besch, G., Biston, P., Blandino Ortiz, A., Blazquez, V., Bloria, S., Bonetti, C., Bresil, P., Brunetti, I., Buldini, V., Caillard, A., Calamai, I., Carbonara, M., Caricato, Anselmo, Casadio, M. C., Casanova, M., Cavaleiro, P., Celaya Lopez, M., Chan, C. Y., Chauhan, R., Cinotti, R., Corral, L., Cortegiani, A., Cotoia, A., Crippa, I. A., Davidovich, V., Del Bianco, S., Diakaki, C., Dibu, J., Dimoula, A., Domeniconi, G., Dominguez, L. J. Y., Dovbysh, N., Duque, P., Eddelien, H. S., Efthymiou, A., Egmose Larsen, T., Elhadi, M., Favre Eva, E., Fencl, M., Forjan, P., Freitas, R., Fuest, K., Fumale, M., Gakuba, C., Galarza, L., Garcia, M. F., Gasca Lopez, G. A., Gelormini, C., Gempeler, A., Giannopoulos, A., Gimenez, M. E., Giugni, A., Glorieux, D., Gonzalez Perez, M. I., Gradisek, P., Grandis, M., Griesdale, D., Gritsan, A., Grotheer, S., Gupta, D., Hallt, E. D., Hawthorne, C., Holm, M. O., Iasonidou, C., Idowu, O., Ioannoni, E., Izzi, A., Jibaja, M., Kafle, P., Kandamby, D. H., Khan, M. M., Khomiakov, S., Kilapong, B., Kletecka, J., Kojder, K., Kolias, A., Kontoudaki, E., Koukoulitsios, G., Kovac, N., Kozar, S., Krieg, S. M., Kurtz, P., Kyriazopoulos, G., Lamperti, M., Lavicka, P., Lencastre, L., Levin, M., Lightfoot, R., Lindner, A., Lopez Ojeda, P., Lores, A., Lucca, M., Luthra, A., Magni, F., Majholm, B., Makris, D., Maldonado, F., Marudi, A., Maskey, S., Mebis, L., Mejia-Mantilla, J. H., Mendoza, R., Milivojevic, N., Miroz, J. P., Monleon, B., Montes, J. M., Morelli, P., Motta, A., Mouloudi, E., Muehlschlegel, S., Namendys Silva, S. A., Nardai, G., Nilam, K., Olson, D., Ozair, A., Pacheco, C., Padilla Juan, J., Palli, E., Panda, N., Pantelas, N., Pariente, L., Pearson, D., Perez-Araos, R., Picetti, E., Pinedo Portilla, J. L., Pons, B., Pozzi, F., Provaznikova, E., Quartarone, M. C., Quintard, H., Rajbanshi, L., Reade, M., Ribaric, S. F., Rigamonti, A., Rivera, L. L., Roberts, J., Roka, Y. B., Sabelnikovs, O., Sapra, H., Schaller, S. J., Sekhon, M., Sellami, W., Seppelt, I., Serrano, A., Sharma, K., Shrestha, G. S., Shum, H. P., Silva, S., Simoes, M., Sivakumar, S., Siviter, R., Skola, J., Skoti, M., Smitt, M., Soley, R., Sonneville, R., Soragni, A., Soyer, B., Spatenkova, V., Stamou, E. E., Stival, Eleonora, Olson, Z., Tanczos, K., Thompson, C., Thomsen, J., Tsikriki, S., Van De Velde, S., Videtta, W., Villa, F., Vrbica, K., Vrettou, C., Westy Hoffmeyer, H., Wolf, S., Yasin Wayhs, S., Zerbi, S. M., Caricato A. (ORCID:0000-0001-5929-120X), Stival E., Robba, C., Graziano, F., Rebora, P., Elli, F., Giussani, C., Oddo, M., Meyfroidt, G., Helbok, R., Taccone, F. S., Prisco, L., Vincent, J. -L., Suarez, J. I., Stocchetti, N., Citerio, G., Abdelaty, M., Abed Maillard, S., Ahmed, H., Albrecht, L., Alsudani, A., Amundarain, E. D., Anand, S., Andersen, J. B., Anglada, M., Arabi, Y., Aragao, I., Arias Verdu, M. D., Asehnoune, K., Assuncao, F., Audibert, G., Badenes, R., Bajracharya, T., Banco, P., Batista, D., Bertellini, E., Berty Gutierrez, H., Besch, G., Biston, P., Blandino Ortiz, A., Blazquez, V., Bloria, S., Bonetti, C., Bresil, P., Brunetti, I., Buldini, V., Caillard, A., Calamai, I., Carbonara, M., Caricato, Anselmo, Casadio, M. C., Casanova, M., Cavaleiro, P., Celaya Lopez, M., Chan, C. Y., Chauhan, R., Cinotti, R., Corral, L., Cortegiani, A., Cotoia, A., Crippa, I. A., Davidovich, V., Del Bianco, S., Diakaki, C., Dibu, J., Dimoula, A., Domeniconi, G., Dominguez, L. J. Y., Dovbysh, N., Duque, P., Eddelien, H. S., Efthymiou, A., Egmose Larsen, T., Elhadi, M., Favre Eva, E., Fencl, M., Forjan, P., Freitas, R., Fuest, K., Fumale, M., Gakuba, C., Galarza, L., Garcia, M. F., Gasca Lopez, G. A., Gelormini, C., Gempeler, A., Giannopoulos, A., Gimenez, M. E., Giugni, A., Glorieux, D., Gonzalez Perez, M. I., Gradisek, P., Grandis, M., Griesdale, D., Gritsan, A., Grotheer, S., Gupta, D., Hallt, E. D., Hawthorne, C., Holm, M. O., Iasonidou, C., Idowu, O., Ioannoni, E., Izzi, A., Jibaja, M., Kafle, P., Kandamby, D. H., Khan, M. M., Khomiakov, S., Kilapong, B., Kletecka, J., Kojder, K., Kolias, A., Kontoudaki, E., Koukoulitsios, G., Kovac, N., Kozar, S., Krieg, S. M., Kurtz, P., Kyriazopoulos, G., Lamperti, M., Lavicka, P., Lencastre, L., Levin, M., Lightfoot, R., Lindner, A., Lopez Ojeda, P., Lores, A., Lucca, M., Luthra, A., Magni, F., Majholm, B., Makris, D., Maldonado, F., Marudi, A., Maskey, S., Mebis, L., Mejia-Mantilla, J. H., Mendoza, R., Milivojevic, N., Miroz, J. P., Monleon, B., Montes, J. M., Morelli, P., Motta, A., Mouloudi, E., Muehlschlegel, S., Namendys Silva, S. A., Nardai, G., Nilam, K., Olson, D., Ozair, A., Pacheco, C., Padilla Juan, J., Palli, E., Panda, N., Pantelas, N., Pariente, L., Pearson, D., Perez-Araos, R., Picetti, E., Pinedo Portilla, J. L., Pons, B., Pozzi, F., Provaznikova, E., Quartarone, M. C., Quintard, H., Rajbanshi, L., Reade, M., Ribaric, S. F., Rigamonti, A., Rivera, L. L., Roberts, J., Roka, Y. B., Sabelnikovs, O., Sapra, H., Schaller, S. J., Sekhon, M., Sellami, W., Seppelt, I., Serrano, A., Sharma, K., Shrestha, G. S., Shum, H. P., Silva, S., Simoes, M., Sivakumar, S., Siviter, R., Skola, J., Skoti, M., Smitt, M., Soley, R., Sonneville, R., Soragni, A., Soyer, B., Spatenkova, V., Stamou, E. E., Stival, Eleonora, Olson, Z., Tanczos, K., Thompson, C., Thomsen, J., Tsikriki, S., Van De Velde, S., Videtta, W., Villa, F., Vrbica, K., Vrettou, C., Westy Hoffmeyer, H., Wolf, S., Yasin Wayhs, S., Zerbi, S. M., Caricato A. (ORCID:0000-0001-5929-120X), and Stival E.
Abstract: Background: The indications for intracranial pressure (ICP) monitoring in patients with acute brain injury and the effects of ICP on patients’ outcomes are uncertain. The aims of this study were to describe current ICP monitoring practises for patients with acute brain injury at centres around the world and to assess variations in indications for ICP monitoring and interventions, and their association with long-term patient outcomes. Methods: We did a prospective, observational cohort study at 146 intensive care units (ICUs) in 42 countries. We assessed for eligibility all patients aged 18 years or older who were admitted to the ICU with either acute brain injury due to primary haemorrhagic stroke (including intracranial haemorrhage or subarachnoid haemorrhage) or traumatic brain injury. We included patients with altered levels of consciousness at ICU admission or within the first 48 h after the brain injury, as defined by the Glasgow Coma Scale (GCS) eye response score of 1 (no eye opening) and a GCS motor response score of at least 5 (not obeying commands). Patients not admitted to the ICU or with other forms of acute brain injury were excluded from the study. Between-centre differences in use of ICP monitoring were quantified by using the median odds ratio (MOR). We used the therapy intensity level (TIL) to quantify practice variations in ICP interventions. Primary endpoints were 6 month mortality and 6 month Glasgow Outcome Scale Extended (GOSE) score. A propensity score method with inverse probability of treatment weighting was used to estimate the association between use of ICP monitoring and these 6 month outcomes, independently of measured baseline covariates. This study is registered with ClinicalTrial.gov, NCT03257904. Findings: Between March 15, 2018, and April 30, 2019, 4776 patients were assessed for eligibility and 2395 patients were included in the study, including 1287 (54%) with traumatic brain injury, 587 (25%) with intracranial haemorrhage, and 52
Published: 2021

12. Factors associated with cerebrospinal fluid leak after a retrosigmoid approach for cerebellopontine angle surgery

Author: Montano, Nicola, Signorelli, Francesco, Giordano, Marco, D'Onofrio, F. G., Izzo, A., D'Ercole, Manuela, Ioannoni, E., Pennisi, Giovanni, Caricato, Anselmo, Pallini, Roberto, Olivi, Alessandro, Montano N. (ORCID:0000-0002-4965-1950), Signorelli F. (ORCID:0000-0001-8431-0433), Giordano M., D'Ercole M., Pennisi G., Caricato A. (ORCID:0000-0001-5929-120X), Pallini R. (ORCID:0000-0002-4611-8827), Olivi A. (ORCID:0000-0002-4489-7564), Montano, Nicola, Signorelli, Francesco, Giordano, Marco, D'Onofrio, F. G., Izzo, A., D'Ercole, Manuela, Ioannoni, E., Pennisi, Giovanni, Caricato, Anselmo, Pallini, Roberto, Olivi, Alessandro, Montano N. (ORCID:0000-0002-4965-1950), Signorelli F. (ORCID:0000-0001-8431-0433), Giordano M., D'Ercole M., Pennisi G., Caricato A. (ORCID:0000-0001-5929-120X), Pallini R. (ORCID:0000-0002-4611-8827), and Olivi A. (ORCID:0000-0002-4489-7564)
Abstract: Background: The retrosigmoid approach represents a crucial surgical route to address different lesions in the cerebellopontine angle but cerebrospinal fluid (CSF) leak still remains the most frequent complication after this approach. Here, we analyzed the impact of different factors in CSF leak development after a retrosigmoid approach. Identifying risk factors related to a specific approach may help the surgeon to tailor the perioperative management and to appropriately counsel patients regarding their risk profile. Methods: We retrospectively reviewed the clinical, surgical, and outcome data of 103 consecutive patients (M/F, 47/56; mean follow-up 35.6 ± 23.9 months) who underwent a retrosigmoid approach for different cerebellopontine angle pathologies and studied the impact of different factors on the occurrence of a CSF leak to univariate and multivariate analysis. Results: Seventy-nine patients (76.7%) were operated for tumors growing in the cerebellopontine angle. Twenty-four patients (23.2%) underwent microvascular decompression to treat a drug-resistant trigeminal neuralgia. Sixteen patients (15.5%) developed CSF leak in the postoperative course of which six underwent surgical revision. Performing a craniectomy as surgical procedure (P = 0.0450) and performing a reopening procedure (second surgery; P = 0.0079) were significantly associated to a higher risk of developing CSF leak. Moreover, performing a reopening procedure emerged as an independent factor for CSF developing on multivariate analysis (P = 0.0156). Conclusion: Patients submitted to craniectomy and patients who underwent a second surgery showed an higher CSF leak rate. Ongoing improvement of biomaterial technology may help neurosurgeons to prevent this potentially life-threatening complication.
Published: 2021

13. 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., Caricato A. (ORCID:0000-0001-5929-120X), 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., and Caricato A. (ORCID:0000-0001-5929-120X)
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

14. The Impact of Neuronavigation on the Surgical Outcome of Microvascular Decompression for Trigeminal Neuralgia

Author: Legninda Sop, F. Y., D'Ercole, Manuela, Izzo, A., Rapisarda, Alessandro, Ioannoni, E., Caricato, Anselmo, Olivi, Alessandro, Montano, Nicola, D'Ercole M., Rapisarda A., Caricato A. (ORCID:0000-0001-5929-120X), Olivi A. (ORCID:0000-0002-4489-7564), Montano N. (ORCID:0000-0002-4965-1950), Legninda Sop, F. Y., D'Ercole, Manuela, Izzo, A., Rapisarda, Alessandro, Ioannoni, E., Caricato, Anselmo, Olivi, Alessandro, Montano, Nicola, D'Ercole M., Rapisarda A., Caricato A. (ORCID:0000-0001-5929-120X), Olivi A. (ORCID:0000-0002-4489-7564), and Montano N. (ORCID:0000-0002-4965-1950)
Abstract: Objective: Microvascular decompression (MVD) is considered the only etiological treatment for drug-resistant trigeminal neuralgia (TN). Nonetheless, despite the recent technological advances, the risks associated with MVD remain non-negligible. The aim of this study was to evaluate the impact of using neuronavigation on the surgical outcomes of patients with TN submitted for MVD. Methods: We analyzed 30 consecutive patients (11 men, 19 women) who underwent MVD for TN between January 2019 and December 2019. Patients were divided in 2 groups according to the use of neuronavigation (group A: MVD with neuronavigation; group B: MVD without neuronavigation). The impact of neuronavigation was assessed on the following parameters: craniotomy size, surgical duration, mastoid air cell opening, postoperative cerebrospinal fluid (CSF) leakage and other complications occurrence, and length of hospitalization. The acute pain relief and the Barrow Neurological Institute score at follow-up were used to evaluate the functional outcome. Results: The craniotomy size, the surgical duration, and the CSF leak incidence were significantly reduced in group A compared with group B (P = 0.0009, P = 0.0369, and P = 0.0406, respectively). The incidence of mastoid air cell opening, and the length of hospitalization were reduced in group A compared with group B, although these differences were not statistically significant. We obtained an acute pain relief in all cases, and the Barrow Neurological Institute score at follow-up was significantly reduced (P < 0.0001). Conclusions: Neuronavigation is a useful tool that significantly reduced craniotomy size, surgical duration, and CSF leak incidence in patients with TN submitted for MVD. We advise to routinely implement neuronavigation in this type of surgery.
Published: 2021

15. Effect of the COVID-19 pandemic and the lockdown measures on the local stroke network

Author: Brunetti, V., Broccolini, Aldobrando, Caliandro, Pietro, Di Iorio, Riccardo, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Pilato, Fabio, Bellavia, Simone, Marotta, J., Scala, Irene, Pedicelli, Alessandro, Pennisi, Mariano Alberto, Caricato, Anselmo, Roberti, Claudia, Altavista, M. C., Valenza, Alessandro, Distefano, Maria Grazia, Cecconi, E., Fanella, M., Roncacci, S., Tasillo, M., Calabresi, Paolo, Frisullo, Giovanni, Marca, G. D., Broccolini A. (ORCID:0000-0001-8295-9271), Caliandro P. (ORCID:0000-0002-1190-4879), Di Iorio R., Monforte M., Morosetti R., Piano C., Pilato F. (ORCID:0000-0002-7248-3916), Bellavia S., Scala I., Pedicelli A. (ORCID:0000-0002-2558-8838), Pennisi M. A. (ORCID:0000-0001-8761-5144), Caricato A. (ORCID:0000-0001-5929-120X), Roberti C., Valenza A., Distefano M., Calabresi P. (ORCID:0000-0003-0326-5509), Frisullo G., Brunetti, V., Broccolini, Aldobrando, Caliandro, Pietro, Di Iorio, Riccardo, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Pilato, Fabio, Bellavia, Simone, Marotta, J., Scala, Irene, Pedicelli, Alessandro, Pennisi, Mariano Alberto, Caricato, Anselmo, Roberti, Claudia, Altavista, M. C., Valenza, Alessandro, Distefano, Maria Grazia, Cecconi, E., Fanella, M., Roncacci, S., Tasillo, M., Calabresi, Paolo, Frisullo, Giovanni, Marca, G. D., Broccolini A. (ORCID:0000-0001-8295-9271), Caliandro P. (ORCID:0000-0002-1190-4879), Di Iorio R., Monforte M., Morosetti R., Piano C., Pilato F. (ORCID:0000-0002-7248-3916), Bellavia S., Scala I., Pedicelli A. (ORCID:0000-0002-2558-8838), Pennisi M. A. (ORCID:0000-0001-8761-5144), Caricato A. (ORCID:0000-0001-5929-120X), Roberti C., Valenza A., Distefano M., Calabresi P. (ORCID:0000-0003-0326-5509), and Frisullo G.
Abstract: Introduction: The COVID-19 outbreak highly impacted the acute ischemic stroke care management. The primary end point of the study was to evaluate the impact of the COVID-19 outbreak and the following lockdown measures on our hub-and-spoke network; the secondary end point was to evaluate if the impact of the COVID-19 outbreak was different in hub-and-spoke centers. Methods: This was a retrospective multicenter observational study conducted at the Stroke Units of Policlinico Gemelli, Ospedale San Filippo Neri, Ospedale di Belcolle, and Ospedale San Camillo de Lellis. We collected clinical reports of all consecutive patients admitted with diagnosis of acute ischemic stroke or transient ischemic attack (TIA) during the phase 1 of the lockdown period (11 March 2020–4 May 2020). As controls, we used all consecutive patients admitted for acute ischemic stroke or TIA in the same period of the previous year. Results: A total of 156 and 142 clinical reports were collected in 2019 and 2020, respectively. During the COVID-19 outbreak, we observed a reduction of number of thrombolysis, a reduction of the length of hospitalization, and an increase of pneumonia. Regarding performance indicators, we observed an increase in onset-to-door time and in door-to-groin time. We did not observe any statistically significant interaction between year (2019 vs 2020) and facility of admission (hub vs spoke) on all variables analyzed. Discussion: Our observational study, involving hub-and-spoke stroke network of a wide regional area, indicates that the COVID-19 outbreak impacted on the acute stroke management. This impact was equally observed in hub as well as in spoke centers.
Published: 2021

16. A systematic review and meta-analysis of factors affecting the outcome of the epidural blood patching in spontaneous intracranial hypotension

Author: Signorelli, Francesco, Caccavella, V. M., Giordano, M., Ioannoni, E., Caricato, Anselmo, Polli, Filippo Maria, Olivi, Alessandro, Montano, Nicola, Signorelli F. (ORCID:0000-0001-8431-0433), Caricato A. (ORCID:0000-0001-5929-120X), Polli F. M., Olivi A. (ORCID:0000-0002-4489-7564), Montano N. (ORCID:0000-0002-4965-1950), Signorelli, Francesco, Caccavella, V. M., Giordano, M., Ioannoni, E., Caricato, Anselmo, Polli, Filippo Maria, Olivi, Alessandro, Montano, Nicola, Signorelli F. (ORCID:0000-0001-8431-0433), Caricato A. (ORCID:0000-0001-5929-120X), Polli F. M., Olivi A. (ORCID:0000-0002-4489-7564), and Montano N. (ORCID:0000-0002-4965-1950)
Abstract: Spontaneous intracranial hypotension (SIH) is an often misdiagnosed condition resulting from non-iatrogenic cerebrospinal fluid (CSF) hypovolemia, typically secondary to spinal CSF leakage. Patients commonly present with posture-related headache, nausea, and vomiting. Following failure of conservative measures, epidural blood patching (EBP) is the most commonly performed intervention for spinal CSF leaks. The authors performed a systematic review and meta-analysis of existing literature to evaluate the role of different factors possibly affecting the efficacy of the EBP procedure. In accordance with the PRISMA guidelines, PubMed/Medline and SCOPUS databases were searched. Six eligible articles were retrieved. Five hundred patients were treated for SIH with EBP, of which 300 reported good response defined as complete remission of symptoms within 48 h after the first EBP requiring no further invasive treatment. Among the factors available for meta-analysis, none was found to be statistically significant in affecting the efficacy of the EBP procedure. A largely symmetrical funnel plot is reported for all the variables evaluated, indicating that publication bias did not play a significant role in the observed effects. The current knowledge about SIH and the EBP is scarce. The existing literature is contradictory and insufficient to aid in clinical practice. More studies are needed to draw significant conclusions that may help in the identification of patients at higher risk of EBP failure, who may benefit from different approaches.
Published: 2021

17. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study

Author: Pun, B. T., Badenes, R., Heras La Calle, G., Orun, O. M., Chen, W., Raman, R., Simpson, B. -G. K., Wilson-Linville, S., Hinojal Olmedillo, B., Vallejo de la Cueva, A., van der Jagt, M., Navarro Casado, R., Leal Sanz, P., Orhun, G., Ferrer Gomez, C., Nunez Vazquez, K., Pineiro Otero, P., Taccone, F. S., Gallego Curto, E., Caricato, Anselmo, Woien, H., Lacave, G., O'Neal, H. R., Peterson, S. J., Brummel, N. E., Girard, T. D., Ely, E. W., Pandharipande, P. P., Creteur, J., Bogossian, E. G., Peluso, L., Gonzalez-Seguel, F., Hidalgo-Calibin, V., Carreno-Montenegro, P., Rojas, V., Tobar, E., Ramirez-Palma, A., Herrera-Davis, K., Ferre, A., Legriel, S., Godet, T., Fraisse, U., Goncalves, B., Mazeraud, A., Tzimou, M., Rasulo, F., Beretta, S., Marchesi, M., Robba, C., Battaglini, D., Pelosi, P., Mazzeo, A. T., Noto, A., Servillo, G., Marra, A., Cutuli, S. L., Pintaudi, G., Stival, Eleonora, Tanzarella, E. S., Roman-Pognuz, E., Concetta Massaro, C. M., Elhadi, M., Smit, L., Olasveengen, T., Pereira, I. J., Teixeira, C. M., Santos, A., Valente, Marianna, Granja, C., Pereia, R., Silva, J., Furquet, B., Garcia Simon, M., Godoy Torres, D. A., Monleon, B., Morcillo, E., Romero, N., Serrano, Alessia, Torrico Sanchez, S., Perez Caballero, F. L., Pena Luna, I., Baeza Gomez, I., Calizaya Vargas, M., Morillas Perez, J., Carrasco Gomez, G., Molina Latorre, R., Moya Gutierrez, S., Baron Barrera, I. P., Delgado Palacios, C., Garcia Gongora, B., Labrador Romero, L., Galarza, L., Catalan-Monzon, I., Rodriguez-Martinez, E., Murcia Gubianas, C., Belles, A., Rodriguez Delgado, M. E., Caballero, J., Morales, D., Pujol, A., Rubio, J., Alvarez Torres, E., Carvajal Revuelta, E., de la Calle Gil, I., Fernandez Tomas, B., Gallego Rodriguez, B., Gonzalez Serrano, M., LaTorre Andreu, P., Perez Lucendo, A., Abril Palomares, E., Gonzalez Gonzalez, E., Martin Delgado, M. C., Munoz De Cabo, C., Aznar, P. T., Calvo, C. A., Garutti, I., Higuero, F., Martinez-Gascuena, D., Maseda, E., Insausti, I., Montero Feijoo, A., Suarez-de-la-Rica, A., Del Moral Barbudo, B., Garcia Blanco-Traba, Y., Gimenez Santamarina, M. C., Gonzalo Millan, A., Llorente Damas, S., Pestana Lagunas, D., Reyes Garcia, I., Ruiz Perea, A., Ortega Guerrero, A., Marmol Cubillo, M. J., Diaz Munoz, D., Garcia de Castrillon i Ramal, S., Andorra Sunyer, X., Noci Moreno, M. D. L. N., Perez Manrique, R. M., del Campo Molina, E., Martinez Quintana, M. E., Fernandez-Gonzalo, S., Goma Fernandez, G., Navarra-Ventura, G., Baro Serra, A., Fuster, C., Plans Galvan, O., Gil-Castillejos, D., Dalorzo Gonzalez, M., Moran Gallego, F. J., Paredes Borrachero, I., Rodriguez Villamizar, P., Romeu Prieto, J., Sanchez Carretero, M. J., Gallardo Sanchez, S., Bustos Molina, F., Garcia Perez, M. L., Castello-Mora, P., Puig, J., Sanchis-Martin, M. R., Sanchis-Veryser, C. A., Vicente-Fernandez, M. P., Zaragoza, R., Lizama, L., Torres, I., Alvarez, C., Ramirez, P., Martin Cerezuela, M., Montero, M. J., Garcia Cantos, J., Valls, P., Aretxabala Cortajarena, N., Garcia Domelo, P., Gonzalez Cubillo, L., Martin Martinez, M., Perez Francisco, I., Poveda Hernandez, Y., Quintano Rodero, A., Rodriguez Nunez, C., Siegemund, M., Estermann, A., Zellweger, N., Ben Saida, I., Boussarsar, M., Esen, F., Ergin Ozcan, P., Berkey, C., Harb, C., Tandy, M. H., Morgan, E., Shephard, K., Hyzy, R. C., Kenes, M., Nelson, K., Hosse, R. E., Vance, K. M., Austin, C. A., Lerner, A., Sanders, E., Balk, R. A., Bennett, D. A., Vogel, A. R., Chowdhury, L., Devulapally, K., Woodham, M., Cohen, S., Patel, N., Kuza, C. M., Sing, M., Roberson, S., Drumright, K., Sehgal, S., Lahue, S. C., Douglas, V. C., Sarwal, A., Caricato A. (ORCID:0000-0001-5929-120X), Stival E., Valente M., Serrano A. (ORCID:0000-0002-7622-0101), Pun, B. T., Badenes, R., Heras La Calle, G., Orun, O. M., Chen, W., Raman, R., Simpson, B. -G. K., Wilson-Linville, S., Hinojal Olmedillo, B., Vallejo de la Cueva, A., van der Jagt, M., Navarro Casado, R., Leal Sanz, P., Orhun, G., Ferrer Gomez, C., Nunez Vazquez, K., Pineiro Otero, P., Taccone, F. S., Gallego Curto, E., Caricato, Anselmo, Woien, H., Lacave, G., O'Neal, H. R., Peterson, S. J., Brummel, N. E., Girard, T. D., Ely, E. W., Pandharipande, P. P., Creteur, J., Bogossian, E. G., Peluso, L., Gonzalez-Seguel, F., Hidalgo-Calibin, V., Carreno-Montenegro, P., Rojas, V., Tobar, E., Ramirez-Palma, A., Herrera-Davis, K., Ferre, A., Legriel, S., Godet, T., Fraisse, U., Goncalves, B., Mazeraud, A., Tzimou, M., Rasulo, F., Beretta, S., Marchesi, M., Robba, C., Battaglini, D., Pelosi, P., Mazzeo, A. T., Noto, A., Servillo, G., Marra, A., Cutuli, S. L., Pintaudi, G., Stival, Eleonora, Tanzarella, E. S., Roman-Pognuz, E., Concetta Massaro, C. M., Elhadi, M., Smit, L., Olasveengen, T., Pereira, I. J., Teixeira, C. M., Santos, A., Valente, Marianna, Granja, C., Pereia, R., Silva, J., Furquet, B., Garcia Simon, M., Godoy Torres, D. A., Monleon, B., Morcillo, E., Romero, N., Serrano, Alessia, Torrico Sanchez, S., Perez Caballero, F. L., Pena Luna, I., Baeza Gomez, I., Calizaya Vargas, M., Morillas Perez, J., Carrasco Gomez, G., Molina Latorre, R., Moya Gutierrez, S., Baron Barrera, I. P., Delgado Palacios, C., Garcia Gongora, B., Labrador Romero, L., Galarza, L., Catalan-Monzon, I., Rodriguez-Martinez, E., Murcia Gubianas, C., Belles, A., Rodriguez Delgado, M. E., Caballero, J., Morales, D., Pujol, A., Rubio, J., Alvarez Torres, E., Carvajal Revuelta, E., de la Calle Gil, I., Fernandez Tomas, B., Gallego Rodriguez, B., Gonzalez Serrano, M., LaTorre Andreu, P., Perez Lucendo, A., Abril Palomares, E., Gonzalez Gonzalez, E., Martin Delgado, M. C., Munoz De Cabo, C., Aznar, P. T., Calvo, C. A., Garutti, I., Higuero, F., Martinez-Gascuena, D., Maseda, E., Insausti, I., Montero Feijoo, A., Suarez-de-la-Rica, A., Del Moral Barbudo, B., Garcia Blanco-Traba, Y., Gimenez Santamarina, M. C., Gonzalo Millan, A., Llorente Damas, S., Pestana Lagunas, D., Reyes Garcia, I., Ruiz Perea, A., Ortega Guerrero, A., Marmol Cubillo, M. J., Diaz Munoz, D., Garcia de Castrillon i Ramal, S., Andorra Sunyer, X., Noci Moreno, M. D. L. N., Perez Manrique, R. M., del Campo Molina, E., Martinez Quintana, M. E., Fernandez-Gonzalo, S., Goma Fernandez, G., Navarra-Ventura, G., Baro Serra, A., Fuster, C., Plans Galvan, O., Gil-Castillejos, D., Dalorzo Gonzalez, M., Moran Gallego, F. J., Paredes Borrachero, I., Rodriguez Villamizar, P., Romeu Prieto, J., Sanchez Carretero, M. J., Gallardo Sanchez, S., Bustos Molina, F., Garcia Perez, M. L., Castello-Mora, P., Puig, J., Sanchis-Martin, M. R., Sanchis-Veryser, C. A., Vicente-Fernandez, M. P., Zaragoza, R., Lizama, L., Torres, I., Alvarez, C., Ramirez, P., Martin Cerezuela, M., Montero, M. J., Garcia Cantos, J., Valls, P., Aretxabala Cortajarena, N., Garcia Domelo, P., Gonzalez Cubillo, L., Martin Martinez, M., Perez Francisco, I., Poveda Hernandez, Y., Quintano Rodero, A., Rodriguez Nunez, C., Siegemund, M., Estermann, A., Zellweger, N., Ben Saida, I., Boussarsar, M., Esen, F., Ergin Ozcan, P., Berkey, C., Harb, C., Tandy, M. H., Morgan, E., Shephard, K., Hyzy, R. C., Kenes, M., Nelson, K., Hosse, R. E., Vance, K. M., Austin, C. A., Lerner, A., Sanders, E., Balk, R. A., Bennett, D. A., Vogel, A. R., Chowdhury, L., Devulapally, K., Woodham, M., Cohen, S., Patel, N., Kuza, C. M., Sing, M., Roberson, S., Drumright, K., Sehgal, S., Lahue, S. C., Douglas, V. C., Sarwal, A., Caricato A. (ORCID:0000-0001-5929-120X), Stival E., Valente M., and Serrano A. (ORCID:0000-0002-7622-0101)
Abstract: Background: To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. Methods: This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged ≥18 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. Findings: Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40·0 (30·0 to 53·0). 1397 (66·9%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87·5%) were invasively mechanical ven
Published: 2021

18. Effect of the COVID-19 pandemic and the lockdown measures on the local stroke network

Author: Brunetti, Valerio, Broccolini, Aldobrando, Caliandro, Pietro, Di Iorio, Riccardo, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Pilato, Fabio, Bellavia, Simone, Marotta, Jessica, Scala, Irene, Pedicelli, Alessandro, Pennisi, Mariano Alberto, Caricato, Anselmo, Roberti, Cinzia, Altavista, Maria Concetta, Valenza, Alessandro, Distefano, Marisa, Cecconi, Emanuela, Fanella, Martina, Roncacci, Sabina, Tasillo, Miriam, Calabresi, Paolo, Frisullo, Giovanni, Della Marca, Giacomo, Broccolini, Aldobrando (ORCID:0000-0001-8295-9271), Caliandro, Pietro (ORCID:0000-0002-1190-4879), Pilato, Fabio (ORCID:0000-0002-7248-3916), Pedicelli, Alessandro (ORCID:0000-0002-2558-8838), Pennisi, Mariano Alberto (ORCID:0000-0001-8761-5144), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Calabresi, Paolo (ORCID:0000-0003-0326-5509), Marca, Giacomo Della (ORCID:0000-0001-6914-799X), Brunetti, Valerio, Broccolini, Aldobrando, Caliandro, Pietro, Di Iorio, Riccardo, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Pilato, Fabio, Bellavia, Simone, Marotta, Jessica, Scala, Irene, Pedicelli, Alessandro, Pennisi, Mariano Alberto, Caricato, Anselmo, Roberti, Cinzia, Altavista, Maria Concetta, Valenza, Alessandro, Distefano, Marisa, Cecconi, Emanuela, Fanella, Martina, Roncacci, Sabina, Tasillo, Miriam, Calabresi, Paolo, Frisullo, Giovanni, Della Marca, Giacomo, Broccolini, Aldobrando (ORCID:0000-0001-8295-9271), Caliandro, Pietro (ORCID:0000-0002-1190-4879), Pilato, Fabio (ORCID:0000-0002-7248-3916), Pedicelli, Alessandro (ORCID:0000-0002-2558-8838), Pennisi, Mariano Alberto (ORCID:0000-0001-8761-5144), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Calabresi, Paolo (ORCID:0000-0003-0326-5509), and Marca, Giacomo Della (ORCID:0000-0001-6914-799X)
Abstract: Introduction The COVID-19 outbreak highly impacted the acute ischemic stroke care management. The primary end point of the study was to evaluate the impact of the COVID-19 outbreak and the following lockdown measures on our hub-and-spoke network; the secondary end point was to evaluate if the impact of the COVID-19 outbreak was different in hub-and-spoke centers. Methods This was a retrospective multicenter observational study conducted at the Stroke Units of Policlinico Gemelli, Ospedale San Filippo Neri, Ospedale di Belcolle, and Ospedale San Camillo de Lellis. We collected clinical reports of all consecutive patients admitted with diagnosis of acute ischemic stroke or transient ischemic attack (TIA) during the phase 1 of the lockdown period (11 March 2020-4 May 2020). As controls, we used all consecutive patients admitted for acute ischemic stroke or TIA in the same period of the previous year. Results A total of 156 and 142 clinical reports were collected in 2019 and 2020, respectively. During the COVID-19 outbreak, we observed a reduction of number of thrombolysis, a reduction of the length of hospitalization, and an increase of pneumonia. Regarding performance indicators, we observed an increase in onset-to-door time and in door-to-groin time. We did not observe any statistically significant interaction between year (2019 vs 2020) and facility of admission (hub vs spoke) on all variables analyzed. Discussion Our observational study, involving hub-and-spoke stroke network of a wide regional area, indicates that the COVID-19 outbreak impacted on the acute stroke management. This impact was equally observed in hub as well as in spoke centers.
Published: 2021

19. Continuous EEG monitoring by a new simplified wireless headset in intensive care unit

Author: Caricato, Anselmo, Della Marca, Giacomo, Ioannoni, E., Silva, S., Benzi Markushi, T., Stival, E., Biasucci, D. G., Montano, Nicola, Gelormini, C., Melchionda, I., Caricato A. (ORCID:0000-0001-5929-120X), Della Marca G. (ORCID:0000-0001-6914-799X), Montano N. (ORCID:0000-0002-4965-1950), Caricato, Anselmo, Della Marca, Giacomo, Ioannoni, E., Silva, S., Benzi Markushi, T., Stival, E., Biasucci, D. G., Montano, Nicola, Gelormini, C., Melchionda, I., Caricato A. (ORCID:0000-0001-5929-120X), Della Marca G. (ORCID:0000-0001-6914-799X), and Montano N. (ORCID:0000-0002-4965-1950)
Abstract: Background: In critically ill patients continuous EEG (cEEG) is recommended in several conditions. Recently, a new wireless EEG headset (CerebAir®,Nihon-Kohden) is available. It has 8 electrodes, and its positioning seems to be easier than conventional systems. Aim of this study was to evaluate the feasibility of this device for cEEG monitoring, if positioned by ICU physician. Methods: Neurological patients were divided in two groups according with the admission to Neuro-ICU (Study-group:20 patients) or General-ICU (Control-group:20 patients). In Study group, cEEG was recorded by CerebAir® assembled by an ICU physician, while in Control group a simplified 8-electrodes-EEG recording positioned by an EEG technician was performed. Results: Time for electrodes applying was shorter in Study-group than in Control-group: 6.2 ± 1.1′ vs 10.4 ± 2.3′; p < 0.0001. Thirty five interventions were necessary to correct artifacts in Study-group and 11 in Control-group. EEG abnormalities with or without epileptic meaning were respectively 7(35%) and 7(35%) in Study-group, and 5(25%) and 9(45%) in Control-group;p > 0.05. In Study-group, cEEG was interrupted for risk of skin lesions in 4 cases after 52 ± 4 h. cEEG was obtained without EEG technician in all cases in Study-group; quality of EEG was similar. Conclusions: Although several limitations should be considered, this simplified EEG system could be feasible even if EEG technician was not present. It was faster to position if compared with standard techniques, and can be used for continuous EEG monitoring. It could be very useful as part of diagnostic process in an emergency setting.
Published: 2020

20. Delayed cerebral ischemia: is it time to change our practice?

Author: Caricato, Anselmo, Serena, Silva, Caricato Anselmo (ORCID:0000-0001-5929-120X), Caricato, Anselmo, Serena, Silva, and Caricato Anselmo (ORCID:0000-0001-5929-120X)
Published: 2020

21. Predicting factors of functional outcome in patients with acute ischemic stroke admitted to neuro-intensive care unit—A prospective cohort study

Author: Pilato, Fabio, Silva, S., Valente, I., Distefano, Maria Grazia, Broccolini, Aldobrando, Brunetti, V., Caliandro, Pietro, Marca, G. D., Di Iorio, Riccardo, Frisullo, Giovanni, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Calandrelli, Rosalinda, Capone, F., Alexandre, Andrea, Pedicelli, Alessandro, Colosimo, Cesare, Caricato, Anselmo, Pilato F. (ORCID:0000-0002-7248-3916), Distefano M., Broccolini A. (ORCID:0000-0001-8295-9271), Caliandro P. (ORCID:0000-0002-1190-4879), Di Iorio R., Frisullo G., Monforte M., Morosetti R., Piano C., Calandrelli R., Alexandre A., Pedicelli A. (ORCID:0000-0002-2558-8838), Colosimo C. (ORCID:0000-0003-3800-3648), Caricato A. (ORCID:0000-0001-5929-120X), Pilato, Fabio, Silva, S., Valente, I., Distefano, Maria Grazia, Broccolini, Aldobrando, Brunetti, V., Caliandro, Pietro, Marca, G. D., Di Iorio, Riccardo, Frisullo, Giovanni, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Calandrelli, Rosalinda, Capone, F., Alexandre, Andrea, Pedicelli, Alessandro, Colosimo, Cesare, Caricato, Anselmo, Pilato F. (ORCID:0000-0002-7248-3916), Distefano M., Broccolini A. (ORCID:0000-0001-8295-9271), Caliandro P. (ORCID:0000-0002-1190-4879), Di Iorio R., Frisullo G., Monforte M., Morosetti R., Piano C., Calandrelli R., Alexandre A., Pedicelli A. (ORCID:0000-0002-2558-8838), Colosimo C. (ORCID:0000-0003-3800-3648), and Caricato A. (ORCID:0000-0001-5929-120X)
Abstract: Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78; 95% confidence interval (CI), 1.20–11.90; p = 0.023) and early naso-gastric tube removal (OR, 3.32; 95% CI, 1.04–10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase; 95% CI, 0.61–0.85; p < 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase; 95% CI, 0.92–0.99; p = 0.020) and hemorrhagic transformation (OR, 0.31; 95% CI, 0.11–0.84; p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86; 95% CI, 1.65–37.39; p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short-and long-term neurologic independency.
Published: 2020

22. Factors affecting serum lactate in patients with intracranial tumors - A report of our series and review of the literature

Author: Ioannoni, E., Grande, G., Olivi, Alessandro, Antonelli, Massimo, Caricato, Anselmo, Montano, Nicola, Olivi A. (ORCID:0000-0002-4489-7564), Antonelli M. (ORCID:0000-0003-3007-1670), Caricato A. (ORCID:0000-0001-5929-120X), Montano N. (ORCID:0000-0002-4965-1950), Ioannoni, E., Grande, G., Olivi, Alessandro, Antonelli, Massimo, Caricato, Anselmo, Montano, Nicola, Olivi A. (ORCID:0000-0002-4489-7564), Antonelli M. (ORCID:0000-0003-3007-1670), Caricato A. (ORCID:0000-0001-5929-120X), and Montano N. (ORCID:0000-0002-4965-1950)
Abstract: Background: A hyperlactemia may occur in the presence of tissue hypoperfusion, in diseases affecting metabolism and in cases of malignant neoplasm. However, the factors affecting the serum lactate levels in patients submitted to craniotomy for the resection of an intracranial tumor have been investigated only marginally. Here, we assessed the factors possibly affecting the levels of serum lactate in intracranial tumors and carried out a thorough literature review on this topic. Methods: All patients submitted to elective craniotomy from January 2017 to August 2018 for the resection of a glioblastoma (GBM; 101 cases) and a benign meningioma (WHO I; 105 cases) were included in this study. The sex, age, histological diagnosis, body mass index (BMI), and diabetes were assessed as possible factors affecting the level of the preoperative and postoperative serum lactate in these patients. Results: We found that preoperative hyperlactemia (> 2 mmol/l) was more frequent in patients with GBM than in patients with meningioma (P = 0.0003). Moreover, a strong correlation between a preoperative lactemia and postoperative lactemia (P < 0.0001) was observed. On univariate analysis, we found increased preoperative serum lactate levels in GBM patients (P = 0.0022) and in patients with a BMI =30 (P = 0.0068). Postoperative serum lactate levels were significantly higher in GBM patients (P = 0.0003). On multivariate logistic regression analysis, a diagnosis of GBM was an independent factor for higher level of preoperative (P = 0.0005) and postoperative (P < 0.0001) serum lactate. Conclusion: The malignant phenotype of GBM is the strongest factor associated with a pre- and postoperative hyperlactemia in patients submitted to craniotomy for the resection of an intracranial tumor.
Published: 2020

23. Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Author: De Bus, L., Depuydt, P., Steen, J., Dhaese, S., De Smet, K., Tabah, A., Akova, M., Cotta, M. O., De Pascale, Gennaro, Dimopoulos, G., Fujitani, S., Garnacho-Montero, J., Leone, M., Lipman, J., Ostermann, M., Paiva, J. -A., Schouten, J., Sjovall, F., Timsit, J. -F., Roberts, J. A., Zahar, J. -R., Zand, F., Zirpe, K., De Waele, J. J., Rios, F., Vazquez, A. R., Vidal, M. G., Zakalik, G., Attokaran, A. G., Banakh, I., Dey-Chatterjee, S., Ewan, J., Ferrier, J., Forbes, L., Fourie, C., Leditschke, A., Murray, L., Eller, P., Biston, P., Bracke, S., De Crop, L., De Schryver, N., Frans, E., Spapen, H., Van Malderen, C., Vansteelandt, S., Vermeiren, D., Arevalo, E. P., Crespo, M., Flores, R. Z., Piza, P., Tutillo, D. M., Elme, A., Kallaste, A., Starkopf, J., Bourenne, J., Calypso, M., Cohen, Y., Dahyot-Fizelier, C., Depret, F., Guillot, M., Imzi, N., Jochmans, S., Kouatchet, A., Lepape, A., Martin, O., Heim, M., Schaller, S. J., Arvaniti, K., Bekridelis, A., Ioannidis, P., Mitrakos, C., Papanikolaou, M. N., Pouriki, S., Vemvetsou, A., Abraham, B., Bhattacharya, P. K., Budugu, A., Dixit, S., Gurav, S., Kandanuri, P., Prabhu, D. A., Rathod, D., Savaru, K., Udupa, A. N., Varghese, S. B., Bakhodaei, H. H., Dabiri, G., Fallahi, M. J., Feiz, F., Firoozifar, M., Khaloo, V., Maghsudi, B., Masjedi, M., Nikandish, R., Sabetian, G., Marsh, B., Martin-Loeches, I., Steiner, J., Barbagallo, M., Caricato, Anselmo, Cortegiani, A., D'Andrea, R., Deana, C., Donati, A., Girardis, M., Mandala, G., Panarello, G., Pasero, D., Pelagalli, L., Soave, Paolo Maurizio, Spadaro, S., Fujita, Y., Fujiwara, S., Hara, Y., Hashi, H., Hashimoto, S., Hashimoto, H., Hayakawa, K., Inoue, M., Isokawa, S., Kameda, S., Kamohara, H., Kanamoto, M., Katayama, S., Kawagishi, T., Kawano, Y., Kida, Y., Kita, M., Kobayashi, A., Kuriyama, A., Naito, T., Nashiki, H., Nishiyama, K., Shindo, S., Suzuki, T., Takaba, A., Tanaka, C., Tetsuya, K., Tomioka, Y., Yanagawa, Y., Yoshida, H., Adnan, S., Hasan, M. S., Sulaiman, H., Gasca Lopez, G. A., Hernandez-Cardenas, C. M., Namendys-Silva, S. A., Bethlehem, C., de Lange, D., Hunfeld, N., Numan, S., van Leeuwen, H., Owens, D., Almeida, M., Fragoso, E., Leonor, T., Pereira, J. -M., Filipescu, D., Grigoras, I., Popescu, M., Tomescu, D., Alshahrani, M. S., Alvarez-Gonzalez, M., Barrero-Garcia, I., Blasco-Navalpotro, M. A., Claverias, L., Estella, A., Espina, L. F., Garmendia, J. L. G., Prieto, E. G., Gomez-Prieto, G., Conde, C. J., Sagasti, F. M., Cantero, A. M., Orejas-Gallego, A., Papiol, E., Perez-Civantos, D., Laderas, J. C. P., Alvarez, J. T., Vera-Artazcoz, P., Cortes, P. V., Oldner, A., Spangfors, M., Alp, E., Koksal, I., Korten, V., Ozveren, A., Hall, A., Hatton, K. W., Laudanski, K., De Pascale G. (ORCID:0000-0002-8255-0676), Caricato A. (ORCID:0000-0001-5929-120X), Soave P. M., De Bus, L., Depuydt, P., Steen, J., Dhaese, S., De Smet, K., Tabah, A., Akova, M., Cotta, M. O., De Pascale, Gennaro, Dimopoulos, G., Fujitani, S., Garnacho-Montero, J., Leone, M., Lipman, J., Ostermann, M., Paiva, J. -A., Schouten, J., Sjovall, F., Timsit, J. -F., Roberts, J. A., Zahar, J. -R., Zand, F., Zirpe, K., De Waele, J. J., Rios, F., Vazquez, A. R., Vidal, M. G., Zakalik, G., Attokaran, A. G., Banakh, I., Dey-Chatterjee, S., Ewan, J., Ferrier, J., Forbes, L., Fourie, C., Leditschke, A., Murray, L., Eller, P., Biston, P., Bracke, S., De Crop, L., De Schryver, N., Frans, E., Spapen, H., Van Malderen, C., Vansteelandt, S., Vermeiren, D., Arevalo, E. P., Crespo, M., Flores, R. Z., Piza, P., Tutillo, D. M., Elme, A., Kallaste, A., Starkopf, J., Bourenne, J., Calypso, M., Cohen, Y., Dahyot-Fizelier, C., Depret, F., Guillot, M., Imzi, N., Jochmans, S., Kouatchet, A., Lepape, A., Martin, O., Heim, M., Schaller, S. J., Arvaniti, K., Bekridelis, A., Ioannidis, P., Mitrakos, C., Papanikolaou, M. N., Pouriki, S., Vemvetsou, A., Abraham, B., Bhattacharya, P. K., Budugu, A., Dixit, S., Gurav, S., Kandanuri, P., Prabhu, D. A., Rathod, D., Savaru, K., Udupa, A. N., Varghese, S. B., Bakhodaei, H. H., Dabiri, G., Fallahi, M. J., Feiz, F., Firoozifar, M., Khaloo, V., Maghsudi, B., Masjedi, M., Nikandish, R., Sabetian, G., Marsh, B., Martin-Loeches, I., Steiner, J., Barbagallo, M., Caricato, Anselmo, Cortegiani, A., D'Andrea, R., Deana, C., Donati, A., Girardis, M., Mandala, G., Panarello, G., Pasero, D., Pelagalli, L., Soave, Paolo Maurizio, Spadaro, S., Fujita, Y., Fujiwara, S., Hara, Y., Hashi, H., Hashimoto, S., Hashimoto, H., Hayakawa, K., Inoue, M., Isokawa, S., Kameda, S., Kamohara, H., Kanamoto, M., Katayama, S., Kawagishi, T., Kawano, Y., Kida, Y., Kita, M., Kobayashi, A., Kuriyama, A., Naito, T., Nashiki, H., Nishiyama, K., Shindo, S., Suzuki, T., Takaba, A., Tanaka, C., Tetsuya, K., Tomioka, Y., Yanagawa, Y., Yoshida, H., Adnan, S., Hasan, M. S., Sulaiman, H., Gasca Lopez, G. A., Hernandez-Cardenas, C. M., Namendys-Silva, S. A., Bethlehem, C., de Lange, D., Hunfeld, N., Numan, S., van Leeuwen, H., Owens, D., Almeida, M., Fragoso, E., Leonor, T., Pereira, J. -M., Filipescu, D., Grigoras, I., Popescu, M., Tomescu, D., Alshahrani, M. S., Alvarez-Gonzalez, M., Barrero-Garcia, I., Blasco-Navalpotro, M. A., Claverias, L., Estella, A., Espina, L. F., Garmendia, J. L. G., Prieto, E. G., Gomez-Prieto, G., Conde, C. J., Sagasti, F. M., Cantero, A. M., Orejas-Gallego, A., Papiol, E., Perez-Civantos, D., Laderas, J. C. P., Alvarez, J. T., Vera-Artazcoz, P., Cortes, P. V., Oldner, A., Spangfors, M., Alp, E., Koksal, I., Korten, V., Ozveren, A., Hall, A., Hatton, K. W., Laudanski, K., De Pascale G. (ORCID:0000-0002-8255-0676), Caricato A. (ORCID:0000-0001-5929-120X), and Soave P. M.
Abstract: Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60–1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14–1.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely.
Published: 2020

24. Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital

Author: Frisullo, Giovanni, Brunetti, V., Di Iorio, Riccardo, Broccolini, Aldobrando, Caliandro, Pietro, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Pilato, Fabio, Calabresi, Paolo, Della Marca, Giacomo, De Belvis, A. G., Angioletti, C., Scala, Irene, Marotta, J., Bellavia, Simone, Reale, Giovanni, Pennisi, Mariano Alberto, Franceschi, Francesco, Caricato, Anselmo, Pedicelli, Alessandro, D'Argento, Francesco, Valente, I., Lozupone, Emilio, Alexandre, Andrea, Frisullo G., Di Iorio R., Broccolini A. (ORCID:0000-0001-8295-9271), Caliandro P. (ORCID:0000-0002-1190-4879), Monforte M., Morosetti R., Piano C., Pilato F. (ORCID:0000-0002-7248-3916), Calabresi P. (ORCID:0000-0003-0326-5509), Della Marca G. (ORCID:0000-0001-6914-799X), Scala I., Bellavia S., Reale G., Pennisi Alberto Mariano. (ORCID:0000-0001-8761-5144), Franceschi F. (ORCID:0000-0001-6266-445X), Caricato A. (ORCID:0000-0001-5929-120X), Pedicelli A. (ORCID:0000-0002-2558-8838), D'Argento F., Lozupone E., Alexandre A., Frisullo, Giovanni, Brunetti, V., Di Iorio, Riccardo, Broccolini, Aldobrando, Caliandro, Pietro, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Pilato, Fabio, Calabresi, Paolo, Della Marca, Giacomo, De Belvis, A. G., Angioletti, C., Scala, Irene, Marotta, J., Bellavia, Simone, Reale, Giovanni, Pennisi, Mariano Alberto, Franceschi, Francesco, Caricato, Anselmo, Pedicelli, Alessandro, D'Argento, Francesco, Valente, I., Lozupone, Emilio, Alexandre, Andrea, Frisullo G., Di Iorio R., Broccolini A. (ORCID:0000-0001-8295-9271), Caliandro P. (ORCID:0000-0002-1190-4879), Monforte M., Morosetti R., Piano C., Pilato F. (ORCID:0000-0002-7248-3916), Calabresi P. (ORCID:0000-0003-0326-5509), Della Marca G. (ORCID:0000-0001-6914-799X), Scala I., Bellavia S., Reale G., Pennisi Alberto Mariano. (ORCID:0000-0001-8761-5144), Franceschi F. (ORCID:0000-0001-6266-445X), Caricato A. (ORCID:0000-0001-5929-120X), Pedicelli A. (ORCID:0000-0002-2558-8838), D'Argento F., Lozupone E., and Alexandre A.
Abstract: Objective: To evaluate the impact of the lockdown measures, consequent to the outbreak of COVID-19 pandemic, on the quality of pre-hospital and in-hospital care of patients with acute ischemic stroke. Methods: This is an observational cohort study. Data sources were the clinical reports of patients admitted during the first month of lockdown and discharged with a confirmed diagnosis of stroke or TIA. Data were collected in the interval ranging from March 11th to April 11th 2020. As controls, we evaluated the clinical reports of patients with stroke or TIA admitted in the same period of 2019. Results: The clinical reports of patients eligible for the study were 52 in 2020 (71.6 ± 12.2 years) and 41 in 2019 (73.7 ± 13.1 years). During the lockdown, we observed a significant increase in onset-to-door time (median = 387 vs 161 min, p = 0.001), a significant reduction of the total number of thrombolysis (7 vs 13, p = 0.033), a non-significant increase of thrombectomy (15 vs 9, p = 0.451), and a significant increase in door-to-groin time (median = 120 vs 93 min, p = 0.048). No relevant difference was observed between 2019 and 2020 in the total number of patients admitted. Conclusions: Due to the COVID-19 pandemic and lockdown measures, the stroke care pathway changed, involving both pre-hospital and in-hospital performances.
Published: 2020

25. Is It Really Third Ventricle? A Pitfall in the Diagnosis of Hydrocephalus by Brain Ultrasound

Author: Caricato, Anselmo, Ioannoni, E., Gelormini, C., Caricato A. (ORCID:0000-0001-5929-120X), Caricato, Anselmo, Ioannoni, E., Gelormini, C., and Caricato A. (ORCID:0000-0001-5929-120X)
Published: 2020

26. A “burn out” of occipital cortex

Author: Silva, S., Biasucci, Daniele Guerino, Stival, E., Melchionda, I., Caricato, Anselmo, Pilato, Fabio, Biasucci D. G., Caricato A. (ORCID:0000-0001-5929-120X), Pilato F. (ORCID:0000-0002-7248-3916), Silva, S., Biasucci, Daniele Guerino, Stival, E., Melchionda, I., Caricato, Anselmo, Pilato, Fabio, Biasucci D. G., Caricato A. (ORCID:0000-0001-5929-120X), and Pilato F. (ORCID:0000-0002-7248-3916)
Published: 2020

27. 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

28. Predicting Factors of Functional Outcome in Patients with Acute Ischemic Stroke Admitted to Neuro-Intensive Care Unit-A Prospective Cohort Study

Author: Pilato, Fabio, Silva, Serena, Valente, Iacopo, Distefano, Marisa, Broccolini, Aldobrando, Brunetti, Valerio, Caliandro, Pietro, Della Marca, Giacomo, Di Iorio, Riccardo, Frisullo, Giovanni, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Calandrelli, Rosalinda, Capone, Fioravante, Alexandre, Andrea, Pedicelli, Alessandro, Colosimo, Cesare, Caricato, Anselmo, Pilato, Fabio (ORCID:0000-0002-7248-3916), Broccolini, Aldobrando (ORCID:0000-0001-8295-9271), Caliandro, Pietro (ORCID:0000-0002-1190-4879), Marca, Giacomo Della (ORCID:0000-0001-6914-799X), Pedicelli, Alessandro (ORCID:0000-0002-2558-8838), Colosimo, Cesare (ORCID:0000-0003-3800-3648), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Pilato, Fabio, Silva, Serena, Valente, Iacopo, Distefano, Marisa, Broccolini, Aldobrando, Brunetti, Valerio, Caliandro, Pietro, Della Marca, Giacomo, Di Iorio, Riccardo, Frisullo, Giovanni, Monforte, Mauro, Morosetti, Roberta, Piano, Carla, Calandrelli, Rosalinda, Capone, Fioravante, Alexandre, Andrea, Pedicelli, Alessandro, Colosimo, Cesare, Caricato, Anselmo, Pilato, Fabio (ORCID:0000-0002-7248-3916), Broccolini, Aldobrando (ORCID:0000-0001-8295-9271), Caliandro, Pietro (ORCID:0000-0002-1190-4879), Marca, Giacomo Della (ORCID:0000-0001-6914-799X), Pedicelli, Alessandro (ORCID:0000-0002-2558-8838), Colosimo, Cesare (ORCID:0000-0003-3800-3648), and Caricato, Anselmo (ORCID:0000-0001-5929-120X)
Abstract: Although thrombectomy is beneficial for most stroke patients with large vessel occlusion (LVO), it has added new issues in acute management due to intensive care support. In this prospective cohort study, we described the patients admitted to our neuro-intensive care unit (NICU) after thrombectomy in order to assess factors linked to functional outcomes. The outcome was independency assessed for stroke patients consecutively admitted to NICU for an ischemic stroke due to LVO of the anterior cerebral circulation that underwent intra-arterial mechanical thrombectomy (IAMT), either in combination with intravenous thrombolysis (IVT) in eligible patients or alone in patients with contraindications for IVT. Overall, 158 patients were enrolled. IVT (odds ratio (OR), 3.78; 95% confidence interval (CI), 1.20-11.90; p = 0.023) and early naso-gastric tube removal (OR, 3.32; 95% CI, 1.04-10.59 p = 0.042) were associated with good outcomes, whereas a high baseline National Institutes of Health Stroke Scale (NIHSS) score (OR, 0.72 for each point of increase; 95% CI, 0.61-0.85; p < 0.001) was a predictor of poor outcomes at 3 months. Older age (OR, 0.95 for each year of increase; 95% CI, 0.92-0.99; p = 0.020) and hemorrhagic transformation (OR, 0.31; 95% CI, 0.11-0.84; p = 0.022) were predictors of poor outcomes after IAMT, whereas a modified Treatment in Cerebral Infarction (mTICI) score of 2b/3 was a predictor of good outcomes (OR, 7.86; 95% CI, 1.65-37.39; p = 0.010) at 6 months. Our results show that acute stroke patients with LVO who require NICU management soon after IAMT may show specific clinical factors influencing short- and long-term neurologic independency.
Published: 2020

29. Data on the application of early coagulation support protocol in the management of major trauma patients

Author: Bocci, Maria Grazia, Nardi, G., Veronesi, G., Rondinelli, M. B., Palma, Angelomaria, Fiore, V., De Candia, Erica, Bianchi, Maria, Maresca, Maddalena, Barelli, R., Tersali, A., Dell'Anna, Antonio Maria, De Pascale, Gennaro, Cutuli, S. L., Mercurio, Giovanna, Caricato, Anselmo, Grieco, D. L., Antonelli, Massimo, Cingolani, E., Bocci M. G., Palma A., De Candia E. (ORCID:0000-0003-0942-2819), Bianchi M., Maresca M., Dell'Anna A. M., De Pascale G. (ORCID:0000-0002-8255-0676), Mercurio G., Caricato A. (ORCID:0000-0001-5929-120X), Antonelli M. (ORCID:0000-0003-3007-1670), Bocci, Maria Grazia, Nardi, G., Veronesi, G., Rondinelli, M. B., Palma, Angelomaria, Fiore, V., De Candia, Erica, Bianchi, Maria, Maresca, Maddalena, Barelli, R., Tersali, A., Dell'Anna, Antonio Maria, De Pascale, Gennaro, Cutuli, S. L., Mercurio, Giovanna, Caricato, Anselmo, Grieco, D. L., Antonelli, Massimo, Cingolani, E., Bocci M. G., Palma A., De Candia E. (ORCID:0000-0003-0942-2819), Bianchi M., Maresca M., Dell'Anna A. M., De Pascale G. (ORCID:0000-0002-8255-0676), Mercurio G., Caricato A. (ORCID:0000-0001-5929-120X), and Antonelli M. (ORCID:0000-0003-3007-1670)
Abstract: This article provides additional data on the application of early coagulation support protocol in the management of major trauma patients. Data come from a retrospective analysis reported in the article “Early coagulation support protocol: a valid approach in real-life management of major trauma patients. Results from two Italian centres” [1]. Data contain information about the relationship between differences in resource use and mortality outcomes, and patient demographic and clinical features at presentation. Furthermore, a comparison between resource consumption, the probability of multiple transfusions and the mortality outcomes among propensity-score matched patients is reported.
Published: 2019

30. Pupillometry in critical care: A simple tool for a complex examination

Author: Caricato, Anselmo, Gelormini, C., Caricato A. (ORCID:0000-0001-5929-120X), Caricato, Anselmo, Gelormini, C., and Caricato A. (ORCID:0000-0001-5929-120X)
Published: 2019

31. The place of dexmedetomidine light sedation in patients with acute brain injury

Author: Carelli, Simone, De Pascale, Gennaro, Filetici, Nicoletta, Bocci, Maria Grazia, Maresca, Gian Marco, Cutuli, S. L., Pizzo, Cecilia Maria, Bello, Giuseppe, Montini, Luca, Caricato, Anselmo, Conti, Giorgio, Antonelli, Massimo, Carelli S., De Pascale G. (ORCID:0000-0002-8255-0676), Filetici N., Bocci M. G., Maresca G. M., Pizzo C. M., Bello G. (ORCID:0000-0003-2648-7235), Montini L. (ORCID:0000-0003-4602-5134), Caricato A. (ORCID:0000-0001-5929-120X), Conti G. (ORCID:0000-0002-8566-9365), Antonelli M. (ORCID:0000-0003-3007-1670), Carelli, Simone, De Pascale, Gennaro, Filetici, Nicoletta, Bocci, Maria Grazia, Maresca, Gian Marco, Cutuli, S. L., Pizzo, Cecilia Maria, Bello, Giuseppe, Montini, Luca, Caricato, Anselmo, Conti, Giorgio, Antonelli, Massimo, Carelli S., De Pascale G. (ORCID:0000-0002-8255-0676), Filetici N., Bocci M. G., Maresca G. M., Pizzo C. M., Bello G. (ORCID:0000-0003-2648-7235), Montini L. (ORCID:0000-0003-4602-5134), Caricato A. (ORCID:0000-0001-5929-120X), Conti G. (ORCID:0000-0002-8566-9365), and Antonelli M. (ORCID:0000-0003-3007-1670)
Abstract: An individualized titration of sedative and analgesic drugs is pivotal in the late phase management of acute brain injury (ABI) patients, when weaning from mechanical ventilation (MV) needs to be implemented [1]. Due to its pharmacologic profile, dexmedetomidine (Dex) represents a drug of choice in such setting. Nevertheless, its use in ABI patients has been recently debated mainly as a consequence of its hemodynamic effects [2, 3]. The present study aimed to evaluate clinical outcomes and safety profile of Dex administration in this patients’ category. We retrospectively analysed prospectively collected data on the main clinical features and adverse events observed during light sedation with dexmedetomidine (Dex-LS) in ICU patients with ABI. Light sedation was defined by the maintenance of a Richmond Agitation and Sedation Scale (RASS) score between 1 and − 2. The rate of potential side effects during Dex-LS was compared with the 6-h period before Dex initiation (see Additional file 1 for further details). Dexmedetomidine has been administered safely in our population of ABI patients. Dex infusion rate and duration were comparable with those previously described [2, 3]. The rate of systemic arterial hypotension was consistent with available findings [2, 3] and lower compared with the pre-infusion period. The 23% rate of bradycardia takes place in the wide range of occurrence reported in ABI patients [2]. Nevertheless, bradycardia never imposed dexmedetomidine interruption. These findings should be interpreted in the light of the relatively young age and low severity scores of our population, where Dex was frequently co-infused with other sedatives or opioids. Neither seizure rate nor intracranial pressure increased during Dex-LS, supporting the clinical absence of Dex impact on cerebral physiology [4]. During Dex-LS, the majority of patients were weaned from MV, including more than half who previously failed a weaning attempt. These observations are in line with th
Published: 2019

32. Epidemiology of intra-abdominal infection and sepsis in critically ill patients: 'AbSeS', a multinational observational cohort study and ESICM Trials Group Project

Author: Carelli, Simone, De Pascale, Gennaro, Filetici, Nicoletta, Bocci, Maria Grazia, Maresca, Gian Marco, Cutuli, S. L., Pizzo, Cecilia Maria, Bello, Giuseppe, Montini, Luca, Caricato, Anselmo, Conti, Giorgio, Antonelli, Massimo, Carelli S., De Pascale G. (ORCID:0000-0002-8255-0676), Filetici N., Bocci M. G., Maresca G. M., Pizzo C. M., Bello G. (ORCID:0000-0003-2648-7235), Montini L. (ORCID:0000-0003-4602-5134), Caricato A. (ORCID:0000-0001-5929-120X), Conti G. (ORCID:0000-0002-8566-9365), Antonelli M. (ORCID:0000-0003-3007-1670), Carelli, Simone, De Pascale, Gennaro, Filetici, Nicoletta, Bocci, Maria Grazia, Maresca, Gian Marco, Cutuli, S. L., Pizzo, Cecilia Maria, Bello, Giuseppe, Montini, Luca, Caricato, Anselmo, Conti, Giorgio, Antonelli, Massimo, Carelli S., De Pascale G. (ORCID:0000-0002-8255-0676), Filetici N., Bocci M. G., Maresca G. M., Pizzo C. M., Bello G. (ORCID:0000-0003-2648-7235), Montini L. (ORCID:0000-0003-4602-5134), Caricato A. (ORCID:0000-0001-5929-120X), Conti G. (ORCID:0000-0002-8566-9365), and Antonelli M. (ORCID:0000-0003-3007-1670)
Abstract: PURPOSE: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). METHODS: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. RESULTS: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. CONCLUSION: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outco
Published: 2019

33. Early coagulation support protocol: A valid approach in real-life management of major trauma patients. Results from two Italian centres

Author: Bocci, Maria Grazia, Nardi, G., Veronesi, G., Rondinelli, M. B., Palma, A., Fiore, V., De Candia, Erica, Bianchi, M., Maresca, M., Barelli, R., Tersali, A., Dell'Anna, Antonio Maria, De Pascale, Gennaro, Cutuli, S. L., Mercurio, Giovanna, Caricato, Anselmo, Grieco, D. L., Antonelli, Massimo, Cingolani, E., Bocci M. G., De Candia E. (ORCID:0000-0003-0942-2819), Dell'Anna A. M., De Pascale G. (ORCID:0000-0002-8255-0676), Mercurio G., Caricato A. (ORCID:0000-0001-5929-120X), Antonelli M. (ORCID:0000-0003-3007-1670), Bocci, Maria Grazia, Nardi, G., Veronesi, G., Rondinelli, M. B., Palma, A., Fiore, V., De Candia, Erica, Bianchi, M., Maresca, M., Barelli, R., Tersali, A., Dell'Anna, Antonio Maria, De Pascale, Gennaro, Cutuli, S. L., Mercurio, Giovanna, Caricato, Anselmo, Grieco, D. L., Antonelli, Massimo, Cingolani, E., Bocci M. G., De Candia E. (ORCID:0000-0003-0942-2819), Dell'Anna A. M., De Pascale G. (ORCID:0000-0002-8255-0676), Mercurio G., Caricato A. (ORCID:0000-0001-5929-120X), and Antonelli M. (ORCID:0000-0003-3007-1670)
Abstract: Introduction: Early coagulation support (ECS) includes prompt infusion of tranexamic acid, fibrinogen concentrate, and packed red blood cells for initial resuscitation of major trauma patients. The aim of this study was to determine the effects, in terms of blood product consumption, length of stay, and in-hospital mortality, of the ECS protocol, compared to the massive transfusion protocol (MTP) in the treatment of major trauma patients. Patients and methods: A retrospective analysis was conducted using the registry data of two Italian trauma centres. Adult major trauma patients with, or at risk of, active bleeding who were managed according to the MTP during the years 2011–2012, or the ECS protocol during the years 2013–2014 and were considered at risk of multiple transfusions, were enrolled. The primary endpoint was to determine whether the ECS protocol reduces the use of blood products in the acute management of trauma patients. Secondary endpoints were the outcome measures of length of stay in ICU, length of stay in hospital, and mortality at 24-hours and 28-days after hospital admission. Results: Among the 518 major trauma patients admitted to the trauma centres during the study period, 235 patients (118 in the pre-ECS period and 117 in the ECS period) matched one of the inclusion criteria and were enrolled in the study. Compared with the pre-ECS period, the ECS period showed a reduction in the average consumption of packed red blood cells (−1.87 units, 95% confidence interval [CI], −2.40, −1.34), platelets (−1.28 units; 95% CI, −1.64, −0.91), and fresh frozen plasma (−1.69; 95% CI, −2.14, −1.25) in the first 24-hours. Furthermore, during the ECS period, we recorded a 10-day reduction in the hospital length of stay (−10 days, 95% CI, −11.6, −8.4) and a non-significant 28-day mortality increase. Conclusions: The ECS protocol was effective in reducing blood product consumption compared to the MTP and confirmed the importance of early fibrinogen administration as
Published: 2019

34. Continuous Electroencephalography Monitoring in Adults in the Intensive Care Unit

Author: Caricato, Anselmo, Melchionda, Isabella, Antonelli, Massimo, Caricato, Anselmo (ORCID:0000-0001-5929-120X), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Caricato, Anselmo, Melchionda, Isabella, Antonelli, Massimo, Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2018. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2018. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
Published: 2018

35. Colonization, contamination, or infection in perineural catheters: How to discriminate?

Author: Caricato, Anselmo, Antonelli, Massimo, Caricato, Anselmo (ORCID:0000-0001-5929-120X), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Caricato, Anselmo, Antonelli, Massimo, Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: How to consider microbiological data during removal of perineural catheter?
Published: 2018

36. Ultrasound assessment of rectus femoris and anterior tibialis muscles in young trauma patients

Author: Annetta, Maria Giuseppina, Pittiruti, Mauro, Silvestri, Davide, Grieco, Domenico Luca, Maccaglia, Alessio, La Torre, Michele Fabio, Magarelli, Nicola, Mercurio, Giovanna, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Magarelli, Nicola (ORCID:0000-0002-2521-086X), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Pittiruti, Mauro, Silvestri, Davide, Grieco, Domenico Luca, Maccaglia, Alessio, La Torre, Michele Fabio, Magarelli, Nicola, Mercurio, Giovanna, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Magarelli, Nicola (ORCID:0000-0002-2521-086X), Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: Purpose: Quantitative and qualitative changes of skeletal muscle are typical and early findings in trauma patients, being possibly associated with functional impairment. Early assessment of muscle changes—as evaluated by muscle ultrasonography—could yield important information about patient’s outcome. Methods: In this prospective observational study, we used ultrasonography to evaluate the morphological changes of rectus femoris (RF) and anterior tibialis (AT) muscles in a group of young, previously healthy trauma patients on enteral feeding. Results: We studied 38 severely injured patients (median Injury Severity Score = 34; median age = 40 y.o.) over the course of the ICU stay up to 3 weeks after trauma. We found a progressive loss of muscle mass from day 0 to day 20, that was more relevant for the RF (45%) than for the AT (22%); this was accompanied by an increase in echogenicity (up to 2.5 by the Heckmatt Scale, where normal echogenicity = 1), which is an indicator of myofibers depletion. Conclusions: Ultrasound evaluation of skeletal muscles is inexpensive, noninvasive, simple and easily repeatable. By this method, we were able to quantify the morphological changes of skeletal muscle in trauma patients. Further studies may rely on this technicque to evaluate the impact of different therapeutic strategies on muscle wasting.
Published: 2017

37. Pentraxin 3 in patients with severe sepsis or shock: the ALBIOS trial

Author: Caironi, Pietro, Masson, Serge, Mauri, Tommaso, Bottazzi, Barbara, Leone, Roberto, Magnoli, Michela, Barlera, Simona, Mamprin, Filippo, Fedele, Andrea, Mantovani, Alberto, Tognoni, Gianni, Pesenti, Antonio, Gattinoni, Luciano, Latini, Roberto, Bruzzone, Paola, Pagan, Francesca, Russo, Riccarda, Confalonieri, Andrea, Abbruzzese, Chiara, Vergnano, Beatrice, Faenza, Stefano, Siniscalchi, Antonio, Pierucci, Elisabetta, Noto, Andrea, Pezzi, Angelo, Spanu, Paolo, Parrini, Vieri, Oggioni, Roberto, Pasetti, Giovanni Stefano, Casadio, Maria Cinzia, Buontempo, Rosa, Carrer, Sara, Piccoli, Francesca, Rizzi, Tatiana, Caricato, Anselmo, La Sala, Monica, Antonaci, Alessandra, Fassini, Paola, Paganini, Silvia, Porta, Virginia, Moise, Gabriella, Marell, Silvia, Furia, Mirella, Urbano, Maria Cristina, Carobbi, Roberta, Poleni, Simona, Kandil, Hassan, Ballotta, Andrea, Bettini, Fabrizio, Sanseverino, Manlio, Gatta, Alessandro, Cecchini, Francesca, Guatteri, Luca, Ciceri, Gabriella, Raimondi, Ferdinando, Colombo, Roberto, Ferraris, Sandra, Borelli, Massimo, Bellato, Valentina, Cancellieri, Franco, Senni, Silvia, Bertocchi, Ester, Ferri, Paola, Moioli, Gianpietro, Molin, Alexandra, Salati, Giovanni, Salsi, Pierpaolo, Brunori, Emanuela, Elisei, Daniele, Maggio, Giuseppe, Nicola, Federico Guardia, Cavana, Marco, Morelli, Giacomo, Guarino, Arturo, Isetta, Michele, Tulli, Giorgio, Mangani, Valerio, Rossi, Nicola, Ferrari, Marta, Bona, Francesco, Vay, Monica, Bartoli, Teresa, Gallo, Mauro, Vettoretto, Katiuscia, Della Morte, Mauro, Boselli, Enrico, Puscio, Daniela, Bovo, Monia, Galzerano, Antonio, Carli, Manuela, Zagara, Giovanni, Caricato, Anselmo (ORCID:0000-0001-5929-120X), Colombo, Roberto (ORCID:0000-0003-0482-7542), Caironi, Pietro, Masson, Serge, Mauri, Tommaso, Bottazzi, Barbara, Leone, Roberto, Magnoli, Michela, Barlera, Simona, Mamprin, Filippo, Fedele, Andrea, Mantovani, Alberto, Tognoni, Gianni, Pesenti, Antonio, Gattinoni, Luciano, Latini, Roberto, Bruzzone, Paola, Pagan, Francesca, Russo, Riccarda, Confalonieri, Andrea, Abbruzzese, Chiara, Vergnano, Beatrice, Faenza, Stefano, Siniscalchi, Antonio, Pierucci, Elisabetta, Noto, Andrea, Pezzi, Angelo, Spanu, Paolo, Parrini, Vieri, Oggioni, Roberto, Pasetti, Giovanni Stefano, Casadio, Maria Cinzia, Buontempo, Rosa, Carrer, Sara, Piccoli, Francesca, Rizzi, Tatiana, Caricato, Anselmo, La Sala, Monica, Antonaci, Alessandra, Fassini, Paola, Paganini, Silvia, Porta, Virginia, Moise, Gabriella, Marell, Silvia, Furia, Mirella, Urbano, Maria Cristina, Carobbi, Roberta, Poleni, Simona, Kandil, Hassan, Ballotta, Andrea, Bettini, Fabrizio, Sanseverino, Manlio, Gatta, Alessandro, Cecchini, Francesca, Guatteri, Luca, Ciceri, Gabriella, Raimondi, Ferdinando, Colombo, Roberto, Ferraris, Sandra, Borelli, Massimo, Bellato, Valentina, Cancellieri, Franco, Senni, Silvia, Bertocchi, Ester, Ferri, Paola, Moioli, Gianpietro, Molin, Alexandra, Salati, Giovanni, Salsi, Pierpaolo, Brunori, Emanuela, Elisei, Daniele, Maggio, Giuseppe, Nicola, Federico Guardia, Cavana, Marco, Morelli, Giacomo, Guarino, Arturo, Isetta, Michele, Tulli, Giorgio, Mangani, Valerio, Rossi, Nicola, Ferrari, Marta, Bona, Francesco, Vay, Monica, Bartoli, Teresa, Gallo, Mauro, Vettoretto, Katiuscia, Della Morte, Mauro, Boselli, Enrico, Puscio, Daniela, Bovo, Monia, Galzerano, Antonio, Carli, Manuela, Zagara, Giovanni, Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Colombo, Roberto (ORCID:0000-0003-0482-7542)
Abstract: Background: The long pentraxin PTX3 is a key component of the humoral arm of innate immunity related to sepsis severity and mortality. We evaluated the clinical and prognostic significance of circulating PTX3 in the largest cohort ever reported of patients with severe sepsis or septic shock. Materials and methods: Plasma PTX3 was measured on days 1, 2 and 7 after randomization of 958 patients to albumin or crystalloids for fluid resuscitation in the multicentre Albumin Italian Outcome Sepsis (ALBIOS) trial. We tested the association of PTX3 and its changes over time with clinical severity, prevalent and incident organ dysfunctions, 90-day mortality and treatment. Results: PTX3 was high at baseline (72 [33–186] ng/mL) and rose with the severity and number of organ dysfunctions (P < 0·001) and the incidence of subsequent new failures. The PTX3 concentration dropped from day 1 to 7, but this decrease was less pronounced in patients with septic shock (P = 0·0004). Higher concentrations of PTX3 on day 1 predicted incident organ dysfunctions. Albumin supplementation was associated with lower levels of PTX3 in patients with septic shock (P = 0·005) but not in those without shock. In a fully adjusted multivariable model, PTX3 on day 7 predicted 90-day mortality. Smaller drops in PTX3 predicted higher 90-day mortality. Conclusions: In severe sepsis and septic shock, early high PTX3 predict subsequent new organ failures, while a smaller drop in circulating PTX3 over time predicts an increased risk of death. Patients with septic shock show lower levels of PTX3 when assigned to albumin than to crystalloids.
Published: 2017

38. Fat embolism syndrome.

Author: Caricato, Anselmo, Russo, Giovanni, Biasucci, Dg, Annetta, Ma, Caricato A (ORCID:0000-0001-5929-120X), Caricato, Anselmo, Russo, Giovanni, Biasucci, Dg, Annetta, Ma, and Caricato A (ORCID:0000-0001-5929-120X)
Abstract: Fat embolism syndrome is illustrated and discussed
Published: 2017

39. Italian COnsensus in Neuroradiological Anesthesia (ICONA)

Author: Castioni, Carlo A., Amadori, Andrea, Bilotta, Federico, Bolzon, Moreno, Barboni, Edoardo, Caricato, Anselmo, Dall'Acqua, Guido, Di Paola, Francesco, Molinari, Andrea Forastieri, Gritti, Paolo, La Rosa, Italia, Longo, Marcello, Maglione, Carla, Martorano, Pietro, Munari, Marina, Perotti, Valerio, Rasulo, Frank, Ruggiero, Maria, Santoro, Antonio, Scudeller, Luigia, Tumolo, Miriam, Mazzeo, Anna T., Caricato, Anselmo (ORCID:0000-0001-5929-120X), Perotti, Valerio (ORCID:0000-0001-9461-2101), Castioni, Carlo A., Amadori, Andrea, Bilotta, Federico, Bolzon, Moreno, Barboni, Edoardo, Caricato, Anselmo, Dall'Acqua, Guido, Di Paola, Francesco, Molinari, Andrea Forastieri, Gritti, Paolo, La Rosa, Italia, Longo, Marcello, Maglione, Carla, Martorano, Pietro, Munari, Marina, Perotti, Valerio, Rasulo, Frank, Ruggiero, Maria, Santoro, Antonio, Scudeller, Luigia, Tumolo, Miriam, Mazzeo, Anna T., Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Perotti, Valerio (ORCID:0000-0001-9461-2101)
Abstract: Anesthetic management of patients undergoing endovascular procedures for treating intracranial aneurysms or cerebrovascular malformations must consider a number of specific challenges, in addition to those associated with anesthesia for other specialties. In addition to maintenance of physiological stability, manipulation of systemic and cerebral hemodynamic parameters may be required to treat any sudden unexpected catastrophic neurological events. A multidisciplinary group including neuro- and pediatric anesthesiologists, interventional neuroradiologists, neurosurgeons, and a clinical methodologist contributed to this document. This consensus working group from 21 Italian institutions identified open questions regarding the best practices for management of anesthesia during endovascular neuroradiological procedures for intracranial aneurysms and cerebrovascular malformations, and addressed these by formulating practical consensus statements. At the first meeting in November 2015, nine key areas were identified regarding choice of anesthetic, patient monitoring, hemodynamic targets, postoperative care, and the management of neuromuscular blockade, anticoagulant and/or antiplatelet therapy, and special considerations for pediatric patients. Nine subgroups were established and a medical librarian performed literature searches in the Cochrane and MEDLINE/PubMed databases for each group. Groups drafted literature summaries and provisional responses in the form of candidate consensus statements based on evidence, when possible, and clinical experience, when this was lacking. Final wording was agreed at a meeting in April 2016 and where possible evidence was graded using United States Preventive Services Task Force criteria. Consensus (defined as >90% agreement) was based on evidence, clinical experience, clinician preference, feasibility in the Italian healthcare system, and cost/benefit considerations.
Published: 2017

40. qEEG by neurointensivists: research agenda and implications for training

Author: Biasucci, Daniele G., Caricato, Anselmo, Citerio, Giuseppe, Caricato, Anselmo (ORCID:0000-0001-5929-120X), Biasucci, Daniele G., Caricato, Anselmo, Citerio, Giuseppe, and Caricato, Anselmo (ORCID:0000-0001-5929-120X)
Abstract: Neurointensivist can read and interpret EEG with a short period of training.
Published: 2017

41. Defining needs and goals of post-ICU care for trauma patients: preliminary study

Author: Bocci, Mg, Grieco, Domenico Luca, Lochi, S, Minguell Del Lungo, Laura, Pintaudi, G, Caricato, Anselmo, Murri, Rita, Calabrese, C, De Belvis, Antonio, Avolio, Maria, Sandroni, Claudio, Antonelli, Massimo, Grieco, Dl (ORCID:0000-0002-4557-6308), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Murri, Rita (ORCID:0000-0003-4263-7854), De Belvis, Antonio (ORCID:0000-0003-4456-1937), Sandroni, Claudio (ORCID:0000-0002-8878-2611), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Bocci, Mg, Grieco, Domenico Luca, Lochi, S, Minguell Del Lungo, Laura, Pintaudi, G, Caricato, Anselmo, Murri, Rita, Calabrese, C, De Belvis, Antonio, Avolio, Maria, Sandroni, Claudio, Antonelli, Massimo, Grieco, Dl (ORCID:0000-0002-4557-6308), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Murri, Rita (ORCID:0000-0003-4263-7854), De Belvis, Antonio (ORCID:0000-0003-4456-1937), Sandroni, Claudio (ORCID:0000-0002-8878-2611), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: The aim of this study was to assess the long-term physical and psychological disabilities and their economic impact in severe trauma survivors.
Published: 2016

42. Taking Care of Relationships in the Intensive Care Unit: Positive Impact on Family Consent for Organ Donation

Author: Bocci, M. G, D'Alo', Ciro, Barelli, Roberta, Inguscio, Simona, Prestifilippo, Alessia, Di Paolo, S, Lochi, S, Fanfarillo, M, Grieco, D. L, Maviglia, Riccardo, Caricato, Anselmo, Mistraletti, G, Pulitano', Silvia Maria, Antonelli, Massimo, Sandroni, Claudio, D'Alo', Ciro (ORCID:0000-0003-2868-0928), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Pulitano', Silvia Maria Modesta (ORCID:0000-0002-8496-379X), Antonelli, M (ORCID:0000-0003-3007-1670), Sandroni, Claudio (ORCID:0000-0002-8878-2611), Bocci, M. G, D'Alo', Ciro, Barelli, Roberta, Inguscio, Simona, Prestifilippo, Alessia, Di Paolo, S, Lochi, S, Fanfarillo, M, Grieco, D. L, Maviglia, Riccardo, Caricato, Anselmo, Mistraletti, G, Pulitano', Silvia Maria, Antonelli, Massimo, Sandroni, Claudio, D'Alo', Ciro (ORCID:0000-0003-2868-0928), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Pulitano', Silvia Maria Modesta (ORCID:0000-0002-8496-379X), Antonelli, M (ORCID:0000-0003-3007-1670), and Sandroni, Claudio (ORCID:0000-0002-8878-2611)
Abstract: Background Organ donation refusal from relatives of potential donors with brain death significantly reduces organ availability. The need for organ donation has increased over time, but the shortage of available donors is the major limiting factor in transplantation. We analyzed the impact of a new systematic communication approach between medical staff and patients' relatives on the rate of consent to organ donation. Methods The study was conducted as a single-center, non-randomized, controlled, before-and-after study at an 18-bed intensive care unit (ICU) of a university hospital. We compared the rate of consent for organ donation before and after the introduction of the new communication approach. Results A total of 291 brain-dead patients were studied. The consent rate increased from 71% in the pre-intervention period (2007–2012) to 78.4% in the post-intervention period (2013–2015), with an 82.75% increase in the 2014 to 2015 period. During these periods, no significant variation of consent to organ donation was recorded at the national and regional levels. Conclusions The introduction of a new communication approach between medical staff and relatives of brain-dead patients was associated with a significant increase in the rate of consent to donation. Our results highlight the importance of empathy with relatives in the ICU. The need for organ transplants has increased over recent decades; nevertheless, the number of donors is insufficient [1]. The major factor limiting the number of donations from brain-dead potential donors is the low rate of consent from their families [2], [3], [4] and [5].
Published: 2016

43. Sequential N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin Measurements During Albumin Replacement in Patients With Severe Sepsis or Septic Shock

Author: Masson, S, Caironi, P, Fanizza, C, Carrer, S, Caricato, Anselmo, Fassini, P, Vago, T, Romero, M, Tognoni, G, Gattinoni, L, Latini, R, Caricato, A (ORCID:0000-0001-5929-120X), Masson, S, Caironi, P, Fanizza, C, Carrer, S, Caricato, Anselmo, Fassini, P, Vago, T, Romero, M, Tognoni, G, Gattinoni, L, Latini, R, and Caricato, A (ORCID:0000-0001-5929-120X)
Abstract: Myocardial dysfunction is a frequent complication in patients with severe sepsis and can worsen the prognosis. We investigated whether circulating biomarkers related to myocardial function and injury predicted outcome and were associated with albumin replacement.
Published: 2016

44. a new a promising tool to evaluate mass and structural changes of skeletal muscle in trauma patients

Author: Annetta, Maria Giuseppina, Silvestri, Davide, Grieco, Domenico Luca, La Torre, Michele Fabio, Magarelli, Nicola, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Grieco, Domenico Luca (ORCID:0000-0002-4557-6308), Magarelli, Nicola (ORCID:0000-0002-2521-086X), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Silvestri, Davide, Grieco, Domenico Luca, La Torre, Michele Fabio, Magarelli, Nicola, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Grieco, Domenico Luca (ORCID:0000-0002-4557-6308), Magarelli, Nicola (ORCID:0000-0002-2521-086X), Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: Loss of mass and function of skeletal muscle during critical illness is associated with poor clinical outcome, reduced ventilator-free days, increased length of ICU stay, increased mortality, high costs of health care, and delay of rehabilitation [1]. The magnitude of muscle impairment correlates with the severity of the illness, the entity of the inflammation, and the appropriateness of nutritional support [2, 3]. Recent papers have advocated the use of ultrasound evaluation of skeletal muscle [2, 4, 5] to get information about its thickness and structural changes, which can be related to the degree of myopathy and to the final functional outcome [5]. We are investigating the morphological changes of skeletal muscle in trauma patients during their stay in our ICU, by ultrasound evaluation of the rectus femuris (RF) and anterior tibialis (AT) muscles (transverse scan 15 cm above the patella and 5 cm below the fibular head, respectively), on day 0 (within 24 h after admission to ICU) and on day 21. We adopted a 5–7 MHz linear transducer and a well-defined setting for all patients (overall gain 67 %; time gain compensation in neutral position; focal zone set in the middle of the muscle). Muscle echogenicity is rated according to Heckmatt’s scale [6], which is a semiquantitative, four-rank score, the higher rank (D) corresponding to reduced visualization of bone surface and thus to a more severe degree of muscle fibrosis. In this preliminary study, we evaluated six severe trauma patients: three women/three men; age range 44–61 years; body mass index ranging from 23.1 to 28.2; injury severity score 29–52; all but one had brain injury, with Glasgow Coma Scale at admission ranging from 3 to 11; ICU stay was 25–52 days and survival was 100 %. In all patients, we found a progressive decrease in the muscle mass and a progressive increase of echogenicity, suggesting not only protein depletion but degenerative changes: during the ICU stay, the anterior–posterior diameters decr
Published: 2015

45. Muscle wasting in icu trauma patients: Quantitative and qualitative changes

Author: Annetta, Maria Giuseppina, Silvestri, D., Grieco, D. L., La Torre, M. F., Magarelli, Nicola, Policola, Caterina, Caricato, Anselmo, Della Casa, Silvia, Antonelli, Massimo, Annetta M. G. (ORCID:0000-0001-7574-1311), Magarelli N. (ORCID:0000-0002-2521-086X), Policola C., Caricato A. (ORCID:0000-0001-5929-120X), Della Casa S. (ORCID:0000-0003-4796-9217), Antonelli M. (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Silvestri, D., Grieco, D. L., La Torre, M. F., Magarelli, Nicola, Policola, Caterina, Caricato, Anselmo, Della Casa, Silvia, Antonelli, Massimo, Annetta M. G. (ORCID:0000-0001-7574-1311), Magarelli N. (ORCID:0000-0002-2521-086X), Policola C., Caricato A. (ORCID:0000-0001-5929-120X), Della Casa S. (ORCID:0000-0003-4796-9217), and Antonelli M. (ORCID:0000-0003-3007-1670)
Published: 2015

46. A new and promising tool to evaluate mass and structural changes of skeletal muscle in trauma patients

Author: Annetta, Maria Giuseppina, Silvestri, D, Grieco, D, La Torre, M, Magarelli, Nicola, Caricato, Anselmo, Antonelli, Massimo, Annetta, Mg (ORCID:0000-0001-7574-1311), Magarelli, N (ORCID:0000-0002-2521-086X), Caricato, A (ORCID:0000-0001-5929-120X), Antonelli, M. (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Silvestri, D, Grieco, D, La Torre, M, Magarelli, Nicola, Caricato, Anselmo, Antonelli, Massimo, Annetta, Mg (ORCID:0000-0001-7574-1311), Magarelli, N (ORCID:0000-0002-2521-086X), Caricato, A (ORCID:0000-0001-5929-120X), and Antonelli, M. (ORCID:0000-0003-3007-1670)
Published: 2015

47. A new and promising tool to evaluate mass and structural changes of skeletal muscle in trauma patients

Author: Annetta, Mg, Silvestri, D, Grieco, Dl, La Torre, M, Magarelli, Nicola, Caricato, Anselmo, Antonelli, Massimo, Magarelli, Nicola (ORCID:0000-0002-2521-086X), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Annetta, Mg, Silvestri, D, Grieco, Dl, La Torre, M, Magarelli, Nicola, Caricato, Anselmo, Antonelli, Massimo, Magarelli, Nicola (ORCID:0000-0002-2521-086X), Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: N/A
Published: 2015

48. Hypothermia for Intracranial Hypertension after Traumatic Brain Injury

Author: Andrews, Pjd, Sinclair, Hl, Rodriguez, A, Harris, Ba, Battison, Cg, Rhodes, Jkj, Murray, Gd, Caricato, Anselmo, Caricato A (ORCID:0000-0001-5929-120X), Andrews, Pjd, Sinclair, Hl, Rodriguez, A, Harris, Ba, Battison, Cg, Rhodes, Jkj, Murray, Gd, Caricato, Anselmo, and Caricato A (ORCID:0000-0001-5929-120X)
Abstract: In patients with traumatic brain injury, hypothermia can reduce intracranial hypertension. The benefit of hypothermia on functional outcome is unclear.
Published: 2015

49. Defining needs and goals of post-ICU care for trauma patients: preliminary study

Author: Bocci, Maria Grazia, Grieco, Domenico Luca, Lochi, Serena, Minguell Del Lungo, Laura, Pintaudi, Gabriele, Caricato, Anselmo, Murri, Rita, Calabrese, Claudia, Avolio, Maria, Sandroni, Claudio, Antonelli, Massimo, De Belvis, Ag, Grieco, Domenico Luca (ORCID:0000-0002-4557-6308), Lochi, S, Caricato, Anselmo (ORCID:0000-0001-5929-120X), Murri, Rita (ORCID:0000-0003-4263-7854), Sandroni, Claudio (ORCID:0000-0002-8878-2611), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Bocci, Maria Grazia, Grieco, Domenico Luca, Lochi, Serena, Minguell Del Lungo, Laura, Pintaudi, Gabriele, Caricato, Anselmo, Murri, Rita, Calabrese, Claudia, Avolio, Maria, Sandroni, Claudio, Antonelli, Massimo, De Belvis, Ag, Grieco, Domenico Luca (ORCID:0000-0002-4557-6308), Lochi, S, Caricato, Anselmo (ORCID:0000-0001-5929-120X), Murri, Rita (ORCID:0000-0003-4263-7854), Sandroni, Claudio (ORCID:0000-0002-8878-2611), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: Background: The aim of this study was to assess the long-term physical and psychological disabilities and their economic impact in severe trauma survivors. Methods: adult patients with injury severity score >15 and Abbreviated Injury Scale ≤3 admitted to the ICU of a level 1 trauma centre in the lazio region and discharged alive from hospital underwent a structured interview 12-24 months after the event. self-reported somatic symptoms, autonomy, anxiety and depression were evaluated using a Likert-type Scale, Barthel Index and Hospital Anxiety and Depression Score (HADS), respectively. Patients’ working and economic status were also investigated. Results: A total of 32/58 patients matching the inclusion criteria were included in the final analysis. eighteen patients (56%) reported at least a partial restriction in daily activities. Most common symptoms included muscle or joint pain, fatigue, and headache. All patients were receiving rehabilitation 1-2 years after the event. Fifty-eight percent of the patients spent more than €3600/year from their family budget for rehabilitation and medical care, however only 25% were receiving financial support from regional social services and 44% were unemployed at the time of the interview. thirty patients (94%) had HADS Depression Score≥11. Conclusion: Survivors of severe trauma in our cohort had limited autonomy and need long-term rehabilitation. Most of them rely on private healthcare services with a significant financial impact on their family budget. Almost all patients had moderate to severe depression. Future post-ICU counseling services should facilitate access to rehabilitation and psychological support for these patients
Published: 2015

50. Immunonutrients in critically ill patients: an analysis of the most recent literature

Author: Annetta, Maria Giuseppina, Pittiruti, Mauro, Vecchiarelli, P, Silvestri, Daniela, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Caricato, Anselmo (ORCID:0000-0001-5929-120X), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Annetta, Maria Giuseppina, Pittiruti, Mauro, Vecchiarelli, P, Silvestri, Daniela, Caricato, Anselmo, Antonelli, Massimo, Annetta, Maria Giuseppina (ORCID:0000-0001-7574-1311), Pittiruti, Mauro (ORCID:0000-0003-4541-7566), Caricato, Anselmo (ORCID:0000-0001-5929-120X), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)
Abstract: Modulation of inflammatory and immune response to critical illness has been the goal of much research in the last decade and a variety of drugs and nutrients (so called 'immunonutrients') have been tested in experimental models with promising results. Though, in the clinical setting of intensive care, their efficacy have been inconsistently proven, most likely because the effects of each drug may vary in relation to the timing, the dose, the route of administration, the interaction with other nutrients, the severity of illness and many other factors. Though the early studies of the beginning of this century (2000-2009) have shown some clinical benefits, recent multicenter trials (2011-2015) have failed to prove a consistent benefit of immunonutrition in terms of mortality or other clinical endpoints. Reviewing the latest evidence-based documents on this subject (multicenter trials, systematic reviews, meta-analyses and international guidelines), there is no convincing evidence that immunonutrients may be beneficial in the critically ill. Considering that these substances invariably increase the costs of health care and may be unsafe or even harmful in some subgroups, particularly in septic patients, we conclude that routine administration of immune-nutrients (glutamine, arginine, omega-3 fatty acids, selenium, etc.) cannot be currently recommended in the critically ill.
Published: 2015

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