Search

Your search keyword '"Gianluca, Paternoster"' showing total 65 results
Start Over Author "Gianluca, Paternoster"
65 results on '"Gianluca, Paternoster"'

1. The use of angiotensin II for the management of distributive shock: expert consensus statements

Author

Giovanni Landoni, Andrea Cortegiani, Elena Bignami, Gennaro De Pascale, Katia Donadello, Abele Donati, Giacomo Grasselli, Fabio Guarracino, Gianpaola Monti, Gianluca Paternoster, Luigi Tritapepe, and Massimo Girardis

Subjects
Angiotensin II, Refractory distributive shock, Vasopressors, Non-catecholaminergic agents, Consensus statements, Anesthesiology, RD78.3-87.3, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Despite the growing body of evidence supporting the use of angiotensin II (ATII) in distributive shock, its integration into existing treatment algorithms requires careful consideration of factors related to patient comorbidities, hemodynamic parameters, cost-effectiveness, and risk–benefit balance. Moreover, several questions regarding its use in clinical practice warrant further investigations. To address these challenges, a group of Italian intensive care specialists (the panel) developed a consensus process using a modified Delphi technique. Methods The panel defined five clinical questions during an online scoping workshop and then provided a short list of statements related to each clinical question based on literature review and clinical experience. A total of 20 statements were collected. Two coordinators screened and selected the final list of statements to be included in the online survey, which consisted of 17 statements. The consensus was reached when ≥ 75% of respondents assigned a score within the 3-point range of 1–3 (disagreement) or 7–9 (agreement). Results Overall, a consensus on agreement was reached on 13 statements defining the existing gaps in scientific evidence, the possibility of evaluating the addition of drugs with different mechanisms of action for the treatment of refractory shock, the utility of ATII in reducing the catecholamine requirements in the treatment of vasopressor-resistant septic shock, and the effectiveness of ATII in treating patients in whom angiotensin-converting enzyme activity is reduced or pharmacologically blocked. It was widely shared that renin concentration can be used to identify patients who most likely benefit from ATII to restore vascular tone. Thus, the patients who might benefit most from using ATII were defined. Lastly, some potential barriers to the use of ATII were described. Conclusions ATII was recognized as a useful treatment to reduce catecholamine requirements in treating vasopressor-resistant septic shock. At the same time, the need for additional clinical trials to further elucidate the efficacy and safety of ATII, as well as investigations into potential mechanisms of action and optimization of treatment protocols in patients with refractory distributive shock, emerged.

Published
2024
Full Text
View/download PDF

2. The use of extracorporeal blood purification therapies and sequential extracorporeal support in patients with septic shock (EROICASS): a study protocol for a national, non-interventional, observational multicenter, prospective study

Author

Silvia De Rosa, Fiorenza Ferrari, Massimiliano Greco, Vincenzo Pota, Michele Umbrello, Antonella Cotoia, Laura Pasin, Federico Nalesso, Gianluca Paternoster, Gianluca Villa, Sergio Lassola, Sara Miori, Andrea Sanna, Vicenzo Cantaluppi, Marita Marengo, Fabrizio Valente, Marco Fiorentino, Giuliano Brunori, Giacomo Bellani, and Antonino Giarratano

Subjects
Extracorporeal blood purification therapies, EROICASS, Sepsis, Sepsis-associated AKI, Sequential extracorporeal support, Anesthesiology, RD78.3-87.3, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Septic shock, a critical condition characterized by organ failure, presents a substantial mortality risk in intensive care units (ICUs), with the 28-day mortality rate possibly reaching 40%. Conventional management of septic shock typically involves the administration of antibiotics, supportive care for organ dysfunction, and, if necessary, surgical intervention to address the source of infection. In recent decades, extracorporeal blood purification therapies (EBPT) have emerged as potential interventions aimed at modulating the inflammatory response and restoring homeostasis in patients with sepsis. Likewise, sequential extracorporeal therapy in sepsis (SETS) interventions offer comprehensive organ support in the setting of multiple organ dysfunction syndrome (MODS). The EROICASS study will assess and describe the utilization of EBPT in patients with septic shock. Additionally, we will evaluate the potential association between EBPT treatment utilization and 90-day mortality in septic shock cases in Italy. Methods The EROICASS study is a national, non-interventional, multicenter observational prospective cohort study. All consecutive patients with septic shock at participating centers will be prospectively enrolled, with data collection extending from intensive care unit (ICU) admission to hospital discharge. Variables including patient demographics, clinical parameters, EBPT/SETS utilization, and outcomes will be recorded using a web-based data capture system. Statistical analyses will encompass descriptive statistics, hypothesis testing, multivariable regression models, and survival analysis to elucidate the associations between EBPT/SETS utilization and patient outcomes. Conclusions The EROICASS study provides valuable insights into the utilization and outcomes of EBPT and SETS in septic shock management. Through analysis of usage patterns and clinical data, this study aims to guide treatment decisions and enhance patient care. The implications of these findings may impact clinical guidelines, potentially improving survival rates and patient outcomes in septic shock cases.

Published
2024
Full Text
View/download PDF

3. Cryoglobulinemia: the 'cold' problem in cardiac surgery, a single-center experience and a literature review

Author

Pasquale Raimondo, Gianmarco Intini, Gianfranco Lauletta, Valentina Teora, Sergio Domenico Lenoci, Giovanni Rubino, Maria Arcangela Villani, Agnese Armenise, Antonia Stripoli, Giuseppe Colantuono, Nicola Di Bari, Giuseppe Fiore, Gianluca Paternoster, and Salvatore Grasso

Subjects
Cardiac anesthesia, Cardiac surgery, Cryoglobulinemia, Extracorporeal perfusion, Intraoperative complication, Anesthesiology, RD78.3-87.3, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Cardiac surgery with cardiopulmonary bypass (CBP) is essential for different cardiac procedures in order to perform surgery with a clear sight field. To safely perform surgery with CPB and preserve brain, kidney, and patient tissue from ischemic damage, cold cardioplegia, and mild to deep hypothermia are induced during the operation. Cryoglobulinemia is a hematological/infective-related disease (in certain cases idiopathic) in which temperature-dependent antibodies tend to aggregate and form emboli in the vascular system causing tissue damage if exposed to low temperature. The patient with cryoglobulinemia (known and unknown) can be at risk of a major ischemic event during CPB and induced hypothermia. This article’s aim is to evaluate the present scientific literature in order to understand how, in years, the therapeutic or preventive approach, is evolving, and to analyze and make improvements to the management of a cryoglobulinemic patient who must undergo elective or emergency cardiac surgery. In the last part of our article, we expose our single-center experience during a 32-month-long period of survey. In all cases, our medical team (anesthesiologists, perfusionists, and cardiac surgeons) opted for a normothermic cardiopulmonary bypass to lower the risk of cryoglobulin-associated complications. In our experience, along with therapeutic intervention to lower the cryoglobulin titer, normothermic management of cardiopulmonary bypass is as safe as hypothermic management. Notwithstanding our results, further studies with a larger population are needed to confirm this perioperative management in a cardiac surgery setting.

Published
2024
Full Text
View/download PDF

4. The role of beta-blocker drugs in critically ill patients: a SIAARTI expert consensus statement

Author

Fabio Guarracino, Andrea Cortegiani, Massimo Antonelli, Astrid Behr, Giandomenico Biancofiore, Alfredo Del Gaudio, Francesco Forfori, Nicola Galdieri, Giacomo Grasselli, Gianluca Paternoster, Monica Rocco, Stefano Romagnoli, Salvatore Sardo, Sascha Treskatsch, Vincenzo Francesco Tripodi, and Luigi Tritapepe

Subjects
β-blockers, Critically ill patient, ICU, Tachyarrhythmia, Sepsis, Adults, Anesthesiology, RD78.3-87.3, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The role of β-blockers in the critically ill has been studied, and data on the protective effects of these drugs on critically ill patients have been repeatedly reported in the literature over the last two decades. However, consensus and guidelines by scientific societies on the use of β-blockers in critically ill patients are still lacking. The purpose of this document is to support the clinical decision-making process regarding the use of β-blockers in critically ill patients. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient’s care process. Methods The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) selected a panel of experts and asked them to define key aspects underlying the use of β-blockers in critically ill adult patients. The methodology followed by the experts during this process was in line with principles of modified Delphi and RAND-UCLA methods. The experts developed statements and supportive rationales in the form of informative text. The overall list of statements was subjected to blind votes for consensus. Results The literature search suggests that adrenergic stress and increased heart rate in critically ill patients are associated with organ dysfunction and increased mortality. Heart rate control thus seems to be critical in the management of the critically ill patient, requiring careful clinical evaluation aimed at both the differential diagnosis to treat secondary tachycardia and the treatment of rhythm disturbance. In addition, the use of β-blockers for the treatment of persistent tachycardia may be considered in patients with septic shock once hypovolemia has been ruled out. Intravenous application should be the preferred route of administration. Conclusion β-blockers protective effects in critically ill patients have been repeatedly reported in the literature. Their use in the acute treatment of increased heart rate requires understanding of the pathophysiology and careful differential diagnosis, as all causes of tachycardia should be ruled out and addressed first.

Published
2023
Full Text
View/download PDF

5. Argipressin-norepinephrine association in the treatment of septic shock: the use of the polydistrectual resistance index as an assessment of vascular compliance

Author

Alessio Barile, Barbara Mazzotta, Antonio Izzi, Lucia Mirabella, Gilda Cinnella, Gianluca Paternoster, Giuseppe Mincolelli, Andreaserena Recchia, Maria Pia Tonti, Aldo Manuali, Massimiliano Copetti, Luciano Restivo, Mauro D’Amora, Aldo Di Fazio, Pasquale Innelli, and Alfredo Del Gaudio

Subjects
septic shock, association, argipressin, decatecholaminization, resistance index, echodynamic monitoring, Anesthesiology, RD78.3-87.3
Abstract

IntroductionThe hemodynamic management of septic patients involves initial fluid therapy, followed by the use of vasoconstrictors in case of treatment failure. The latest Surviving Sepsis Campaign guidelines suggest the synergistic use of argipressin in addition to norepinephrine when hemodynamic optimization is not achieved with norepinephrine alone.MethodsIn our single-center retrospective observational study, the primary endpoint is the safety of initial norepinephrine-argipressin association treatment, assessed through a reduction in Resistance Index. Our secondary endpoint includes the efficacy of this combination, measured by an increase in Mean Arterial Pressure and a reduction in Resistance Index as an indicator of organ perfusion. The Resistance Index (RI) is evaluated through Power Doppler ultrasound. RI is crucial for assessing multi-district vascular tone and multiorgan perfusion. Patients were categorized into three groups based on their treatment. In Group 1, we analyzed patients treated with norepinephrine alone in incremental doses; in Group 2, we analyzed patients receiving the initial norepinephrine-argipressin association treatment (norepinephrine 0.05 mcg/kg/min-argipressin 0.03 IU/min); in the third group (Group 3), we analyzed patients given argipressin (0.03 IU/min) after norepinephrine ( 65 mmHg). RI measurements were taken in the Renal Artery (ARE), Radial Artery (AR), Central Retinal Artery (CRA), and Superior Mesenteric Artery (AMS) at four different time points: T0 before vasopressor therapy, T1 at 1 h, T2 at 24 h, and T3 at 48 h after vasopressor infusion.ResultsA total of 48 patients were divided into three groups: 17 patients in Group 1, 16 in Group 2, and 15 in Group 3. In Group 1, an increase in Mean Arterial Pressure (MAP) was observed, but there was an increase in RIs in the right CRI and left ARE. In Group 2, there was an improvement in MAP and a reduction in RIs in the right/left CRI, left ARE, AMS, and right AR. In Group 3, there was an increase in MAP and a reduction in RIs in the right/left CRI, left ARE, AMS, and right AR.ConclusionEarly norepinephrine-argipressin association treatment appears to be a valid strategy for hemodynamic optimization in this patient population.

Published
2023
Full Text
View/download PDF

6. Dipeptidyl Amino-Peptidase 3 (DPP3) as an Early Marker of Severity in a Patient Population with Cardiogenic Shock

Author

Pasquale Innelli, Teresa Lopizzo, Giovanni Paternò, Noemi Bruno, Rosa Paola Radice, Pietro Bertini, Alberto Marabotti, Giampaolo Luzi, Eugenio Stabile, Aldo Di Fazio, Giuseppe Pittella, and Gianluca Paternoster

Subjects
DPP3, cardiogenic shock, mechanical ventilation, biomarker, Medicine (General), R5-920
Abstract

Dipeptidyl amino-peptidase 3 (DPP3) is an aminopeptidase that is released into circulation upon cell death. DPP3 is involved in the degradation of angiotensins, enkephalines, and endomorphines. It has been shown that circulating DPP3 (cDPP3) plasma concentration increases in cardiogenic shock (CS) patients and correlates with high mortality risk. Cardiogenic shock is a life-threatening syndrome associated with organ hypoperfusion. One of the common causes of CS is acute myocardial infarction (AMI). This study aimed to investigate if cDPP3 levels are associated with CS severity and the need for ventilation in patients suffering from CS. Fifteen patients with CS were included in this study. Six patients were invasively ventilated. The values of cDPP3 were higher in ventilated patients than in non-ventilated patients at admission, 3 h, and 24 h after admission in the intensive care unit. Patients with pulmonary hypertension at admission also showed high cDPP3 values at all time points. Furthermore, high cDPP3 levels were associated with reduced stroke volume. Our results suggest that cDPP3 could predict CS progression and guide therapy escalation.

Published
2023
Full Text
View/download PDF

7. Regional Cerebral Oxygen Saturation to Predict Favorable Outcome in Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis

Author

Pietro Bertini, Alberto Marabotti, Gianluca Paternoster, Giovanni Landoni, Fabio Sangalli, Adriano Peris, Manuela Bonizzoli, Sabino Scolletta, Federico Franchi, Antonio Rubino, Matteo Nocci, Niccolò Castellani Nicolini, and Fabio Guarracino

Subjects
Anesthesiology and Pain Medicine, Cardiology and Cardiovascular Medicine
Published
2023

8. Comparative Effectiveness of Combined IgM-Enriched Immunoglobulin and Extracorporeal Blood Purification Plus Standard Care Versus Standard Care for Sepsis and Septic Shock after Cardiac Surgery

Author

Gianluca Paternoster, Silvia De Rosa, Pietro Bertini, Pasquale Innelli, Rosaria Vignale, Vincenzo Francesco Tripodi, Giuseppe Buscaglia, Mariacristina Vadalà, Michele Rossi, Antonio Arena, Andrea Demartini, Giovanni Tripepi, Domenico Abelardo, Giuseppe Pittella, Aldo Di Fazio, Sabino Scolletta, Fabio Guarracino, and Blanca Martinez Lopez de Arroyabe

Subjects
blood purification therapy, cardiac surgery, igm-enriched immunoglobulin, sepsis, pentaglobin, hyper-inflammation, immunosuppression, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: The combination of surgery, bacterial spread-out, and artificial cardiopulmonary bypass surfaces results in a release of key inflammatory mediators leading to an overshooting systemic hyper-inflammatory condition frequently associated with compromised hemodynamics and organ dysfunction. A promising approach could be extracorporeal blood purification therapies in combination with IgM enriched immunoglobulin. This approach might perform a balanced control of both hyper and hypo-inflammatory phases as an immune-modulating intervention. Methods: We performed a retrospective observational study of patients with proven infection after cardiac surgery between January 2020 and December 2021. Patients were divided into two groups: (1) the first group (Control Group) followed a standard care approach as recommended by the Surviving Sepsis Campaign Guidelines; The second group (Active Group) underwent extracorporeal blood purification therapy (EBPT) in combination with intravenous administration of IgM enriched immunoglobulin 5 mL/kg die for at least three consecutive days, in conjunction with the standard approach (SSC Guidelines). In addition, ventriculo-arterial (V/A) coupling, Interleukin 6 (IL-6), Endotoxin Activity Assay (EAA), Procalcitonin, White Blood Cells (WBC) counts, Sequential Organ Failure Assessment (SOFA) Score and Inotropic Score were assessed in both two groups at different time points. Results: Fifty-four patients were recruited; 25 were in the Control Group, while 29 participants were in the Active Group. SOFA score significantly improved from baseline [12 (9–16)] until at T3 [8 (3–13)] in the active group; it was associated with a median EAA reduction from 1.03 (0.39–1.20) at T0 to 0.41 (0.2–0.9) at T3 in the active group compared with control group 0.70 (0.50–1.00) at T0 to 0.70 (0.50–1.00) at T3 (p < 0.001). V/A coupling tended to be lower in patients of the active arm ranging from 1.9 (1.2–2.7) at T0 to 0.8 (0.8–2.2) at T3 than in those of the control arm ranging from 2.1 (1.4–2.2) at T0 to 1.75 (1.45–2.1) at T3 (p = 0.099). The hemodynamic improvement over time was associated with evident but no significant decrease in inotropic score in the active group compared with the control group. Changes in EAA value from T0 to T4 were directly and significantly related (r = 0.39, p = 0.006) to those of V/A coupling. Conclusions: EBPT, in combination with IgM enriched immunoglobulin, was associated with a mitigated postoperative response of key cytokines with a significant decrease in IL-6, Procalcitonin, and EAA and was associated with improvement of clinical and metabolic parameters.

Published
2022
Full Text
View/download PDF

9. The Effect of an Accelerated Renal Replacement Therapy Initiation Is Not Modified by Baseline Risk

Author

Federico Angriman, Bruno L. Ferreyro, Natalia Angeloni, Bruno R. da Costa, Ron Wald, Sean M. Bagshaw, Neill K.J. Adhikari, Rinaldo Bellomo, Didier Dreyfuss, Bin Du, Martin P. Gallagher, Stéphane Gaudry, François Lamontagne, Michael Joannidis, Kathleen D. Liu, Daniel F. McAuley, Shay P. McGuinness, Alistair D. Nichol, Marlies Ostermann, Paul M. Palevsky, Haibo Qiu, Ville Pettilä, Antoine G. Schneider, Orla M. Smith, Suvi T. Vaara, Matthew Weir, Glenn M. Eastwood, Leah Peck, Helen Young, Peter Kruger, Gordon Laurie, Emma Saylor, Jason Meyer, Ellen Venz, Krista Wetzig, Craig French, Forbes McGain, John Mulder, Gerard Fennessy, Sathyajith Koottayi, Samantha Bates, Miriam Towns, Rebecca Morgan, Anna Tippett, Andrew Udy, Chris Mason, Elisa Licari, Dashiell Gantner, Jason McClure, Alistair Nichol, Phoebe McCracken, Jasmin Board, Emma Martin, Shirley Vallance, Meredith Young, Chelsey Vladic, Steve McGloughlin, David Gattas, Heidi Buhr, Jennifer Coles, Debra Hutch, James Wun, Louise Cole, Christina Whitehead, Julie Lowrey, Kristy Masters, Rebecca Gresham, Victoria Campbell, David Gutierrez, Jane Brailsford, Loretta Forbes, Lauren Murray, Teena Maguire, Martina NiChonghaile, Neil Orford, Allison Bone, Tania Elderkin, Tania Salerno, Tim Chimunda, Jason Fletcher, Emma Broadfield, Sanjay Porwal, Cameron Knott, Catherine Boschert, Julie Smith, Angus Richardson, Dianne Hill, Graeme Duke, Peter Oziemski, Santiago Cegarra, Peter Chan, Deborah Welsh, Stephanie Hunter, Owen Roodenburg, John Dyett, Nicos Kokotsis, Max Moser, Yang Yang, Laven Padayachee, Joseph Vetro, Himangsu Gangopadhyay, Melissa Kaufman, Angaj Ghosh, Simone Said, Alpesh Patel, Shailesh Bihari, Elisha Matheson, Xia Jin, Tapaswi Shrestha, Kate Schwartz, Rosalba Cross, Winston Cheung, Helen Wong, Mark Kol, Asim Shah, Amanda Y. Wang, Zoltan Endre, Celia Bradford, Pierre Janin, Simon Finfer, Naomi Diel, Jonathan Gatward, Naomi Hammond, Anthony Delaney, Frances Bass, Elizabeth Yarad, Hergen Buscher, Claire Reynolds, Nerilee Baker, Romuald Bellmann, Andreas Peer, Julia Hasslacher, Paul Koglberger, Sebastian Klein, Klemens Zotter, Anna Brandtner, Armin Finkenstedt, Adelheid Ditlbacher, Frank Hartig, Dietmar Fries, Mirjam Bachler, Bettina Schenk, Martin Wagner, Philipp Eller, Thomas Staudinger, Esther Tiller, Peter Schellongowski, Andja Bojic, Eric A. Hoste, Stephanie Bracke, Luc De Crop, Daisy Vermeiren, Fernando Thome, Bianca Chiella, Lucia Fendt, Veronica Antunes, Frédérick D'Aragon, Charles St-Arnaud, Michael Mayette, Élaine Carbonnaeu, Joannie Marchand, Marie-Hélène Masse, Marilène Ladouceur, Alexis F. Turgeon, François Lauzier, David Bellemare, Charles Langis Francoeur, Guillaume LeBlanc, Gabrielle Guilbault, Stéphanie Grenier, Eve Cloutier, Annick Boivin, Charles Delisle-Thibault, Panagiota Giannakouros, Olivier Costerousse, Jean-François Cailhier, François-Martin Carrier, Ali Ghamraoui, Martine Lebrasseur, Fatna Benettaib, Maya Salamé, Dounia Boumahni, Ying Tung Sia, Jean-François Naud, Isabelle Roy, Henry T. Stelfox, Stacey Ruddell, Braden J. Manns, Shelley Duggan, Dominic Carney, Jennifer Barchard, Richard P. Whitlock, Emilie Belley-Cote, Nevena Savija, Alexandra Sabev, Troy Campbell, Thais Creary, Kelson Devereaux, Shira Brodutch, Claudio Rigatto, Bojan Paunovic, Owen Mooney, Anna Glybina, Oksana Harasemiw, Michelle Di Nella, John Harmon, Navdeep Mehta, Louis Lakatos, Nicole Haslam, Francois Lellouche, Mathieu Simon, Ying Tung, Patricia Lizotte, Pierre-Alexandre Bourchard, Bram Rochwerg, Tim Karachi, Tina Millen, John Muscedere, David Maslove, J. Gordon Boyd, Stephanie Sibley, John Drover, Miranda Hunt, Ilinca Georgescu, Randy Wax, Ilan Lenga, Kavita Sridhar, Andrew Steele, Kelly Fusco, Taneera Ghate, Michael Tolibas, Holly Robinson, Matthew A. Weir, Ravi Taneja, Ian M. Ball, Amit Garg, Eileen Campbell, Athena Ovsenek, Sean van Diepen, Nadia Baig, Sheldon Magder, Han Yao, Ahsan Alam, Josie Campisi, Erika MacIntyre, Ella Rokosh, Kimberly Scherr, Stephen Lapinsky, Sangeeta Mehta, Sumesh Shah, Daniel J. Niven, Michael Russell, Kym Jim, Gillian Brown, Kerry Oxtoby, Adam Hall, Luc Benoit, Colleen Sokolowski, Bhanu Prasad, Jag Rao, Shelley Giebel, Demetrios J. Kutsogiannis, Patricia Thompson, Tayne Thompson, Robert Cirone, Kanthi Kavikondala, Mark Soth, France Clarke, Alyson Takaoka, David Mazer, Karen Burns, Jan Friedrich, David Klein, Gyan Sandhu, Marlene Santos, Imrana Khalid, Jennifer Hodder, Peter Dodek, Najib Ayas, Victoria Alcuaz, Gabriel Suen, Oleksa Rewa, Gurmeet Singh, Sean Norris, Neil Gibson, Castro Arias, Aysha Shami, Celine Pelletier, Alireza Zahirieh, Andre Amaral, Nicole Marinoff, Navjot Kaur, Adic Perez, Jane Wang, Gregory Haljan, Christopher Condin, Lauralyn McIntyre, Brigette Gomes, Rebecca Porteous, Irene Watpool, Swapnil Hiremath, Edward Clark, Margaret S. Herridge, Felicity Backhouse, M. Elizabeth Wilcox, Karolina Walczak, Vincent Ki, Asheer Sharman, Martin Romano, R.T. Noel Gibney, Adam S. Romanovsky, Lorena McCoshen, Gordon Wood, Daniel Ovakim, Fiona Auld, Gayle Carney, Meili Duan, Xiaojun Ji, Dongchen Guo, Zhili Qi, Jin Lin, Meng Zhang, Lei Dong, Jingfeng Liu, Pei Liu, Deyuan Zhi, Guoqiang Bai, Yu Qiu, Ziqi Yang, Jing Bai, Zhuang Liu, Haizhou Zhuang, Haiman Wang, Jian Li, Mengya Zhao, Xiao Zhou, Xianqing Shi, Baning Ye, Manli Liu, Jing Wu, Yongjian Fu, Dali Long, Yu Pan, Jinlong Wang, Huaxian Mei, Songsong Zhang, Mingxiang Wen, Enyu Yang, Sijie Mu, Jianquan Li, Tingting Hu, Bingyu Qin, Min Li, Cunzhen Wang, Xin Dong, Kaiwu Wang, Haibo Wang, Jianxu Yang, Chuanyao Wang, Dongxin Wang, Nan Li, Zhui Yu, Song Xu, Lan Yao, Guo Hou, Zhou Liu, Liping Lu, Yingtao Lian, Chunting Wang, Jichen Zhang, Ruiqi Ding, Guoqing Qi, Qizhi Wang, Peng Wang, Zhaoli Meng, Man Chen, Xiaobo Hu, Xiandi He, Shibing Zhao, Lele Hang, Rui Li, Suhui Qin, Kun Lu, Shijuan Dun, Cheng Liu, Qi Zhou, Zhenzhen Chen, Jing Mei, Minwei Zhang, Hao Xu, Jincan Lin, Qindong Shi, Lijuan Fu, Qinjing Zeng, Hongye Ma, Jinqi Yan, Lan Gao, Hongjuan Liu, Lei Zhang, Hao Li, Xiaona He, Jingqun Fan, Litao Guo, Yu Liu, Xue Wang, Jingjing Sun, Zhongmin Liu, Juan Yang, Lili Ding, Lulu Sheng, Xingang Liu, Jie Yan, Quihui Wang, Yifeng Wang, Dan Zhao, Shuangping Zhao, Chenghuan Hu, Jing Li, Fuxing Deng, Haibo Qui, Yi Yang, Min Mo, Chun Pan, Changde Wu, Yingzi Huang, Lili Huang, Airan Liu, Anna-Maija Korhonen, Sanna Törnblom, Sari Sutinen, Leena Pettilä, Jonna Heinonen, Eliria Lappi, Taria Suhonen, Sari Karlsson, Sanna Hoppu, Ville Jalkanen, Anne Kuitunen, Markus Levoranta, Jaakko Långsjö, Sanna Ristimäki, Kaisa Malila, Anna Wootten, Simo Varila, Mikko J Järvisalo, Outi Inkinen, Satu Kentala, Keijo Leivo, Paivi Haltia, Jean-Damien Ricard, Jonathan Messika, Abirami Tiagarajah, Malo Emery, Aline Dechanet, Coralie Gernez, Damien Roux, Laurent Martin-Lefevre, Maud Fiancette, Isabelle Vinatier, Jean Claude Lacherade, Gwenhaël Colin, Christine Lebert, Marie-Ange Azais, Aihem Yehia, Caroline Pouplet, Matthieu Henry- Lagarrigue, Amélie Seguin, Laura Crosby, Julien Maizel, Dimitri Titeca-Beauport, Alain Combes, Ania Nieszkowska, Paul Masi, Alexandre Demoule, Julien Mayaux, Martin Dres, Elise Morawiec, Maxens Decalvele, Suela Demiri, Morgane Faure, Clémence Marios, Maxime Mallet, Marie Amélie Ordon, Laura Morizot, Marie Cantien, François Pousset, Florent Poirson, Yves Cohen, Laurent Argaud, Martin Cour, Laurent Bitker, Marie Simon, Romain Hernu, Thomas Baudry, Sylvie De La Salle, Adrien Robine, Nicholas Sedillot, Xavier Tchenio, Camille Bouisse, Sylvie Roux, Fabienne Tamion, Steven Grangé, Dorothée Carpentier, Guillaume Chevrel, Luis Ensenyat-Martin, Sophie Marque, Jean-Pierre Quenot, Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Chudeau, Mickael Landais, Benoit Derrien, Jean Christophe Callahan, Christophe Guitton, Charlène Le Moal, Alain Robert, Karim Asehnoune, Raphaël Cinotti, Nicolas Grillot, Dominique Demeure, Christophe Vinsonneau, Imen Rahmani, Mehdi Marzouk, Thibault Dekeyser, Caroline Sejourne, Mélanie Verlay, Fabienne Thevenin, Lucie Delecolle, Didier Thevenin, Bertrand Souweine, Elisabeth Coupez, Mireille Adda, Jean-Pierre Eraldi, Antoine Marchalot, Nicolas De Prost, Armand Mekontso Dessap, Keyvan Razazi, Ferhat Meziani, Julie Boisrame-Helms, Raphael Clere-Jehl, Xavier Delabranche, Christine Kummerlen, Hamid Merdji, Alexandra Monnier, Yannick Rabouel, Hassene Rahmani, Hayat Allam, Samir Chenaf, Vincenta Franja, Bertrand Pons, Michel Carles, Frédéric Martino, Régine Richard, Benjamin Zuber, Guillaume Lacave, Karim Lakhal, Bertrand Rozec, Hoa Dang Van, Éric Boulet, Fouad Fadel, Cedric Cleophax, Nicolas Dufour, Caroline Grant, Marie Thuong, Jean Reignier, Emmanuel Canet, Laurent Nicolet, Thierry Boulain, Mai-Anh Nay, Dalila Benzekri, François Barbier, Anne Bretagnol, Toufik Kamel, Armelle Mathonnet, Grégoire Muller, Marie Skarzynski, Julie Rossi, Amandine Pradet, Sandra Dos Santos, Aurore Guery, Lucie Muller, Luis Felix, Julien Bohé, Guillaume Thiéry, Nadia Aissaoui, Damien Vimpere, Morgane Commeureuc, Jean-Luc Diehl, Emmanuel Guerot, Orfeas Liangos, Monika Wittig, Alexander Zarbock, Mira Küllmar, Thomas van Waegeningh, Nadine Rosenow, Kathy Brickell, Peter Doran, Patrick T. Murray, Giovanni Landoni, Rosalba Lembo, Alberto Zangrillo, Giacomo Monti, Margherita Tozzi, Matteo Marzaroli, Gaetano Lombardi, Gianluca Paternoster, Michelangelo Vitiello, Shay McGuinness, Rachael Parke, Magdalena Butler, Eileen Gilder, Keri-Anne Cowdrey, Samantha Wallace, Jane Hallion, Melissa Woolett, Philippa Neal, Karina Duffy, Stephanie Long, Colin McArthur, Catherine Simmonds, Yan Chen, Rachael McConnochie, Lynette Newby, David Knight, Seton Henderson, Jan Mehrtens, Stacey Morgan, Anna Morris, Kymbalee Vander Hayden, Tara Burke, Matthew Bailey, Ross Freebairn, Lesley Chadwick, Penelope Park, Christine Rolls, Liz Thomas, Ulrike Buehner, Erin Williams, Jonathan Albrett, Simon Kirkham, Carolyn Jackson, Troy Browne, Jennifer Goodson, David Jackson, James Houghton, Owen Callender, Vicki Higson, Owen Keet, Clive Dominy, Paul Young, Anna Hunt, Harriet Judd, Cassie Lawrence, Shaanti Olatunji, Yvonne Robertson, Charlotte Latimer-Bell, Deborah Hendry, Agnes Mckay-Vucago, Nina Beehre, Eden Lesona, Leanlove Navarra, Chelsea Robinson, Ryan Jang, Andrea Junge, Bridget Lambert, Michel Thibault, Philippe Eckert, Sébastien Kissling, Erietta Polychronopoulos, Elettra Poli, Marco Altarelli, Madeleine Schnorf, Samia Abed Mallaird, Claudia Heidegger, Aurelie Perret, Philippe Montillier, Frederic Sangla, Seigenthaller Neils, Aude De Watteville, Mandeep-Kaur Phull, Aparna George, Nauman Hussain, Tatiana Pogreban, Steve Lobaz, Alison Daniels, Mishell Cunningham, Deborah Kerr, Alice Nicholson, Pradeep Shanmugasundaram, Judith Abrams, Katarina Manso, Geraldine Hambrook, Elizabeth McKerrow, Juvy Salva, Stephen Foulkes, Matthew Wise, Matt Morgan, Jenny Brooks, Jade Cole, Tracy Michelle Davies, Helen Hill, Emma Thomas, Marcela Vizcaychipi, Behrad Baharlo, Jaime Carungcong, Patricia Costa, Laura Martins, Ritoo Kapoor, Tracy Hazelton, Angela Moon, Janine Musselwhite, Ben Shelley, Philip McCall, Gill Arbane, Aneta Bociek, Martina Marotti, Rosario Lim, Sara Campos, Neus Grau Novellas, Armando Cennamo, Andrew Slack, Duncan Wyncoll, Luigi Camporota, Simon Sparkes, Rosalinde Tilley, Austin Rattray, Gayle Moreland, Jane Duffy, Elizabeth McGonigal, Philip Hopkins, Clare Finney, John Smith, Harriet Noble, Hayley Watson, Claire-Louise Harris, Emma Clarey, Eleanor Corcoran, James Beck, Clare Howcroft, Nora Youngs, Elizabeth Wilby, Bethan Ogg, Adam Wolverson, Sandra Lee, Susie Butler, Maryanne Okubanjo, Julia Hindle, Ingeborg Welters, Karen Williams, Emily Johnson, Julie Patrick-Heselton, David Shaw, Victoria Waugh, Richard Stewart, Esther Mwaura, Lynn Wren, Louise Mew, Sara-Beth Sutherland, Jane Adderley, Jim Ruddy, Margaret Harkins, Callum Kaye, Teresa Scott, Wendy Mitchell, Felicity Anderson, Fiona Willox, Vijay Jagannathan, Michele Clark, Sarah Purv, Andrew Sharman, Megan Meredith, Lucy Ryan, Louise Conner, Cecilia Peters, Dan Harvey, Ashraf Roshdy, Amy Collins, Malcolm Sim, Steven Henderson, Nigel Chee, Sally Pitts, Katie Bowman, Maria Dilawershah, Luke Vamplew, Elizabeth Howe, Paula Rogers, Clara Hernandez, Clara Prendergast, Jane Benton, Alex Rosenberg, Lui G. Forni, Alice Grant, Paula Carvelli, Ajay Raithatha, Sarah Bird, Max Richardson, Matthew Needham, Claire Hirst, Jonathan Ball, Susannah Leaver, Luisa Howlett, Carlos Castro Delgado, Sarah Farnell-Ward, Helen Farrah, Geraldine Gray, Gipsy Joseph, Francesca Robinson, Ascanio Tridente, Clare Harrop, Karen Shuker, Derek McLaughlan, Judith Ramsey, Sharon Meehan, Bernd Oliver Rose, Rosie Reece-Anthony, Babita Gurung, Tony Whitehouse, Catherine Snelson, Tonny Veenith, Andy Johnston, Lauren Cooper, Ron Carrera, Karen Ellis, Emma Fellows, Samanth Harkett, Colin Bergin, Elaine Spruce, Liesl Despy, Stephanie Goundry, Natalie Dooley, Tracy Mason, Amy Clark, Gemma Dignam, Geraldine Ward, Ben Attwood, Penny Parsons, Sophie Mason, Michael Margarson, Jenny Lord, Philip McGlone, Luke E. Hodgson, Indra Chadbourn, Raquel Gomez, Jordi Margalef, Rinus Pretorius, Alexandra Hamshere, Joseph Carter, Hazel Cahill, Lia Grainger, Kate Howard, Greg Forshaw, Zoe Guy, Kianoush B. Kashani, Robert C. Albright, Amy Amsbaugh, Anita Stoltenberg, Alexander S. Niven, Matthew Lynch, AnnMarie O'Mara, Syed Naeem, Sairah Sharif, Joyce McKenney Goulart, Ashita Tolwani, Claretha Lyas, Laura Latta, Azra Bihorac, Haleh Hashemighouchani, Philip Efron, Matthew Ruppert, Julie Cupka, Sean Kiley, Joshua Carson, Peggy White, George Omalay, Sherry Brown, Laura Velez, Alina Marceron, Javier A. Neyra, Juan Carlos Aycinena, Madona Elias, Victor M. Ortiz-Soriano, Caroline Hauschild, and Robert Dorfman

Subjects
Renal Replacement Therapy, Pulmonary and Respiratory Medicine, Critical Illness, Medicine and Health Sciences, Humans, Acute Kidney Injury
Published
2022

10. Different strategies for mechanical VENTilation during CardioPulmonary Bypass (CPBVENT 2014): study protocol for a randomized controlled trial

Author

Elena Bignami, Marcello Guarnieri, Francesco Saglietti, Enivarco Massimo Maglioni, Sabino Scolletta, Stefano Romagnoli, Stefano De Paulis, Gianluca Paternoster, Cinzia Trumello, Roberta Meroni, Antonio Scognamiglio, Alessandro Maria Budillon, Vincenzo Pota, Alberto Zangrillo, and Ottavio Alfieri

Subjects
Protective ventilation, Cardiopulmonary bypass, Respiratory insufficiency, Low tidal volume, CPAP, Postoperative pulmonary complications, Medicine (General), R5-920
Abstract

Abstract Background There is no consensus on which lung-protective strategies should be used in cardiac surgery patients. Sparse and small randomized clinical and animal trials suggest that maintaining mechanical ventilation during cardiopulmonary bypass is protective on the lungs. Unfortunately, such evidence is weak as it comes from surrogate and minor clinical endpoints mainly limited to elective coronary surgery. According to the available data in the academic literature, an unquestionable standardized strategy of lung protection during cardiopulmonary bypass cannot be recommended. The purpose of the CPBVENT study is to investigate the effectiveness of different strategies of mechanical ventilation during cardiopulmonary bypass on postoperative pulmonary function and complications. Methods/design The CPBVENT study is a single-blind, multicenter, randomized controlled trial. We are going to enroll 870 patients undergoing elective cardiac surgery with planned use of cardiopulmonary bypass. Patients will be randomized into three groups: (1) no mechanical ventilation during cardiopulmonary bypass, (2) continuous positive airway pressure of 5 cmH2O during cardiopulmonary bypass, (3) respiratory rate of 5 acts/min with a tidal volume of 2–3 ml/Kg of ideal body weight and positive end-expiratory pressure of 3–5 cmH2O during cardiopulmonary bypass. The primary endpoint will be the incidence of a PaO2/FiO2 ratio

Published
2017
Full Text
View/download PDF

11. Venovenous Extracorporeal Membrane Oxygenation in Awake Non-Intubated Patients With COVID-19 ARDS at High Risk for Barotrauma

Author

Gianluca Paternoster, Pietro Bertini, Alessandro Belletti, Giovanni Landoni, Serena Gallotta, Diego Palumbo, Alessandro Isirdi, Fabio Guarracino, Paternoster, Gianluca, Bertini, Pietro, Belletti, Alessandro, Landoni, Giovanni, Gallotta, Serena, Palumbo, Diego, Isirdi, Alessandro, and Guarracino, Fabio

Subjects
Respiratory Distress Syndrome, Extracorporeal Membrane Oxygenation, Anesthesiology and Pain Medicine, Barotrauma, Macklin effect, COVID-19, Humans, acute respiratory distress syndrome, extracorporeal membrane oxygenation, mechanical ventilation, Wakefulness, barotrauma, Cardiology and Cardiovascular Medicine
Abstract

Objectives: To assess the efficacy of an awake venovenous extracorporeal membrane oxygenation (VV-ECMO) management strategy in preventing clinically relevant barotrauma in patients with coronavirus disease 2019 (COVID-19) with severe acute respiratory distress syndrome (ARDS) at high risk for pneumothorax (PNX)/pneumomediastinum (PMD), defined as the detection of the Macklin-like effect on chest computed tomography (CT) scan. Design: A case series. Setting: At the intensive care unit of a tertiary-care institution. Participants: Seven patients with COVID-19-associated severe ARDS and Macklin-like radiologic sign on baseline chest CT. Interventions: Primary VV-ECMO under spontaneous breathing instead of invasive mechanical ventilation (IMV). All patients received noninvasive ventilation or oxygen through a high-flow nasal cannula before and during ECMO support. The study authors collected data on cannulation strategy, clinical management, and outcome. Failure of awake VV-ECMO strategy was defined as the need for IMV due to worsening respiratory failure or delirium/agitation. The primary outcome was the development of PNX/PMD. Measurements and main results: No patient developed PNX/PMD. The awake VV-ECMO strategy failed in 1 patient (14.3%). Severe complications were observed in 4 (57.1%) patients and were noted as the following: intracranial bleeding in 1 patient (14.3%), septic shock in 2 patients (28.6%), and secondary pulmonary infections in 3 patients (42.8%). Two patients died (28.6%), whereas 5 were successfully weaned off VV-ECMO and were discharged home. Conclusions: VV-ECMO in awake and spontaneously breathing patients with severe COVID-19 ARDS may be a feasible and safe strategy to prevent the development of PNX/PMD in patients at high risk for this complication.

Published
2022

13. European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC) Fellowship Curriculum: Second Edition

Author

Gabor Erdoes, Patrick F. Wouters, R. Peter Alston, Jan-Uwe Schreiber, Dominique Bettex, Theofani Antoniou, Maria Benedetto, Stefaan Bouchez, Laszlo Szegedi, Kirstin Wilkinson, Giovanni Landoni, Sascha Treskatsch, Purificación Matute, Vera von Dossow, Dieter Van Beersel, Dragana Unic-Stojanovic, Mona Momeni, Philippe Gaudard, Andrea Szekely, Philippe Burtin, Anna Flo-Forner, Caetano Nigro Neto, Jens Fassl, Manuel Granell, Joachim M. Erb, Ricard Navarro-Ripoll, Marc Vives, Fawzia Aboul Fetouh, Simon J. Howell, Nandor Marczin, Alberto Hernandez Martinez, Alain Vuylsteke, Hossam El-Ashmawi, Blanca Martinez Lopez de Arroyabe, Chirojit Mukherjee, Steffen Rex, Gianluca Paternoster, Fabio Guarracino, Mohamed R. El-Tahan, MUMC+: MA Anesthesiologie (9), RS: MHeNs - R3 - Neuroscience, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, Erdoes, Gabor, Wouters, Patrick F, Alston, R Peter, Schreiber, Jan-Uwe, Bettex, Dominique, Antoniou, Theofani, Benedetto, Maria, Bouchez, Stefaan, Szegedi, Laszlo, Wilkinson, Kirstin, Landoni, Giovanni, Treskatsch, Sascha, Matute, Purificación, von Dossow, Vera, Van Beersel, Dieter, Unic-Stojanovic, Dragana, Momeni, Mona, Gaudard, Philippe, Szekely, Andrea, Burtin, Philippe, Flo-Forner, Anna, Neto, Caetano Nigro, Fassl, Jen, Granell, Manuel, Erb, Joachim M, Navarro-Ripoll, Ricard, Vives, Marc, Fetouh, Fawzia Aboul, Howell, Simon J, Marczin, Nandor, Martinez, Alberto Hernandez, Vuylsteke, Alain, El-Ashmawi, Hossam, de Arroyabe, Blanca Martinez Lopez, Mukherjee, Chirojit, Rex, Steffen, Paternoster, Gianluca, Guarracino, Fabio, and El-Tahan, Mohamed R

Subjects
Critical Care, education, Internship and Residency, Cardiac Procedures, Anesthesiology and Pain Medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Anesthesiology, Medicine and Health Sciences, Anesthesia, Cardiac Procedures, Anesthesiology/education, Humans, Anesthesia, Curriculum, Fellowships and Scholarships, Cardiology and Cardiovascular Medicine
Abstract

International audience; This document represents the first update of the Cardiothoracic and Vascular Anaesthesia Fellowship Curriculum of the European Association of Cardiothoracic Anaesthesiology and Intensive Care. After obtaining feedback from exit interviews with fellows in training, graduate fellows, and program directors, 2 modified online Delphi procedures with questionnaires were conducted. A consensus was reached when two-thirds of responding committee members gave green or yellow ratings on a traffic light system, and >70% indicated strong agreement or agreement on a 5-point Likert scale. The new regulations include the following: (1) more flexibility in the fellows` rotation, as long as the total number of days, rotations, and cases are completed during the training year; (2) recommendation for strict compliance with national working-time guidelines; (3) no extension of fellowship training to compensate for annual and/or sick leave, unless the required minimum number of cases and rotations are not reached; (4) interruption of fellowship training for >12 months is allowed for personal or medical reasons; (5) introduction of a checklist for quantitative assessment of standard clinical skills; (6) recommendations for a uniform structure of exit interviews; (7) possibility of a 1-month training rotation in a postanesthesia care unit instead of an intensive care unit; and (8) provided all other requirements have been met, the allowance of progression from the basic training year to the advanced fellowship training year without first passing the transesophageal echocardiography examination.

Published
2022

15. Heparin Anticoagulation for Transcatheter Aortic Valve Implantation on ECMO

Author

Gianluca Paternoster, Marc O. Maybauer, and Filippo Sanfilippo

Subjects
surgical procedures, operative
Abstract

Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention option for critically ill patients with cardiac and/or respiratory failure. Worldwide many medical centers started to use ECMO as a rescue treatment option when conventional therapies failed. This chapter describes conventional strategies of anticoagulation for ECMO. Indeed, during ECMO support the continuous flow and the contact between the patient’s blood and nonbiological surfaces such as cannulae or the oxygenator triggers the activation of the coagulation cascade, with formation of clots and consumption of coagulation factors and platelets, leading to peculiar alteration in the hemostasis. Therefore, the activation of coagulation pathways increases the risk of both thrombosis and hemorrhage. Unfractionated heparin remains the anticoagulant of choice for several reasons in patients supported by ECMO, among them the consolidated experience in its use, its low cost, and the presence of protamine, which can be used as an antagonist, even though its use is very rare in ECMO patients. There are different methods of monitoring the anticoagulation level while on heparin infusion for patients supported by ECMO, and among them the two most common are the activated coagulation time (ACT) and the activated partial thromboplastin time (aPTT), while the routine uses of viscoelastic tests and levels of anti-Xa activity are less common.

Published
2022

16. Long-term outcome of perioperative low cardiac output syndrome in cardiac surgery: 1-year results of a multicenter randomized trial

Author

Luca Brazzi, Fabio Guarracino, Valery Likhvantsev, Rosalba Lembo, Giovanni Landoni, Martina Crivellari, Eugenio Garofalo, Gianluca Paternoster, A Mara Scandroglio, Vadim Pasyuga, Nora Di Tomasso, Alberto Zangrillo, Maria Grazia Calabrò, Antonio Pisano, Fabrizio Monaco, Alessandro Belletti, Vladimir V. Lomivorotov, Alessandro Bianchi, Evgeny Fominskiy, Marat N Abubakirov, Evgeny Grigoryev, Andrey Yavorovskiy, Alessandro Oriani, Zangrillo, Alberto, Lomivorotov, Vladimir V, Pisano, Antonio, Calabrò, Maria Grazia, Belletti, Alessandro, Brazzi, Luca, Grigoryev, Evgeny V, Guarracino, Fabio, Monaco, Fabrizio, Garofalo, Eugenio, Crivellari, Martina, Likhvantsev, Valery V, Fominskiy, Evgeny V, Paternoster, Gianluca, Yavorovskiy, Andrey, Pasyuga, Vadim V, Oriani, Alessandro, Lembo, Rosalba, Bianchi, Alessandro, Scandroglio, A Mara, Abubakirov, Marat N, Di Tomasso, Nora, and Landoni, Giovanni

Subjects
Male, medicine.medical_specialty, Mean arterial pressure, Cardiotonic Agents, Levosimendan, Cardiac Output, Low, Low-cardiac output syndrome, Critical Care and Intensive Care Medicine, Placebo, law.invention, 03 medical and health sciences, Postoperative Complications, Catecholamines, 0302 clinical medicine, Double-Blind Method, law, Internal medicine, medicine, Cardiopulmonary bypass, Humans, Hemodynamic management, Myocardial infarction, Mortality, Risk factor, Simendan, business.industry, Cardiovascular Surgical Procedures, Age Factors, 030208 emergency & critical care medicine, Perioperative, Middle Aged, Cardiac surgery, medicine.disease, Survival Analysis, Treatment Outcome, 030228 respiratory system, Catecholamine, Cardiology, Female, business, medicine.drug
Abstract

Purpose Perioperative myocardial dysfunction occurs frequently in cardiac surgery, and is a risk factor for morbidity and mortality. Levosimendan has been suggested to reduce mortality of patients with perioperative myocardial dysfunction. However, long-term outcome data on its efficacy in cardiac surgery are lacking. Materials and methods Cardiac surgery patients with perioperative myocardial dysfunction were randomized to levosimendan or placebo, in addition to standard inotropic care. One-year mortality data were collected. Results We randomized 506 patients (248 to levosimendan 258 to placebo). At 1-year follow-up, 41 patients (16.5%) died in the levosimendan group, while 47 (18.3%) died in the placebo group (absolute risk difference −1.8; 95% CI −8.4 to 4.9; P = .60). Female sex, history of chronic obstructive pulmonary disease, previous myocardial infarction, serum creatinine, hematocrit, mean arterial pressure, and duration of cardiopulmonary bypass were independently associated with 1-year mortality. Conclusions Levosimendan administration does not improve 1-year survival in cardiac surgery patients with perioperative myocardial dysfunction. One-year mortality in these patients is 17%. Six predictive factors for long-term mortality were identified. Study registration number NCT00994825 ( ClinicalTrials.gov ).

Published
2020

17. Comparative Effectiveness of Combined IgM-Enriched Immunoglobulin and Extracorporeal Blood Purification Plus Standard Care Versus Standard Care for Sepsis and Septic Shock after Cardiac Surgery

Author

Blanca Martinez Lopez de Arroyabe, Fabio Guarracino, Sabino Scolletta, Aldo Di Fazio, Giuseppe Pittella, Domenico Abelardo, Giovanni Tripepi, Andrea Demartini, Antonio Arena, Michele Rossi, Mariacristina Vadalà, Giuseppe Buscaglia, Vincenzo Francesco Tripodi, Rosaria Vignale, Pasquale Innelli, Pietro Bertini, Silvia De Rosa, and Gianluca Paternoster

Subjects
blood purification therapy; cardiac surgery; IgM-enriched immunoglobulin; sepsis; pentaglobin; hyper-inflammation; immunosuppression, General Medicine, Cardiology and Cardiovascular Medicine
Published
2022

18. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial. The PROTECTION trial

Author

Giovanni Landoni, Claudio Brambillasca, Martina Baiardo Redaelli, Nikola Bradić, Lian Kah Ti, Zdenko Povšić-Čevra, Valery A. Nepomniashchikh, Giuseppe Biondi Zoccai, Fabrizio D'Ascenzo, Enrico Romagnoli, Anna Mara Scandroglio, Andrea Ballotta, Nicola Rondello, Annalisa Franco, Cristiano Massaro, Cristina Viscido, Maria Grazia Calabrò, Eugenio Garofalo, Flaminia Canichella, Fabrizio Monaco, Luca Severi, Antonio Pisano, Gaia Barucco, Maria Venditto, Francesco Federici, Margherita Licheri, Gianluca Paternoster, Annachiara Trompeo, Alessandro Belletti, Lorenzo Filippo Mantovani, Romina Perone, Giuseppe Dalessandro, Daniel Kroeller, Dorela Haxhiademi, Carola Galbiati, Vincenzo Francesco Tripodi, Giuseppe Giardina, Rosalba Lembo, Cristina Nakhnoukh, Fabio Guarracino, Federico Longhini, Tiziana Bove, Alberto Zangrillo, Rinaldo Bellomo, Evgeny Fominskiy, Landoni, Giovanni, Brambillasca, Claudio, Redaelli, Martina Baiardo, Bradić, Nikola, Ti, Lian Kah, Povšić-Čevra, Zdenko, Nepomniashchikh, Valery A, Zoccai, Giuseppe Biondi, D'Ascenzo, Fabrizio, Romagnoli, Enrico, Scandroglio, Anna Mara, Ballotta, Andrea, Rondello, Nicola, Franco, Annalisa, Massaro, Cristiano, Viscido, Cristina, Calabrò, Maria Grazia, Garofalo, Eugenio, Canichella, Flaminia, Monaco, Fabrizio, Severi, Luca, Pisano, Antonio, Barucco, Gaia, Venditto, Maria, Federici, Francesco, Licheri, Margherita, Paternoster, Gianluca, Trompeo, Annachiara, Belletti, Alessandro, Mantovani, Lorenzo Filippo, Perone, Romina, Dalessandro, Giuseppe, Kroeller, Daniel, Haxhiademi, Dorela, Galbiati, Carola, Tripodi, Vincenzo Francesco, Giardina, Giuseppe, Lembo, Rosalba, Nakhnoukh, Cristina, Guarracino, Fabio, Longhini, Federico, Bove, Tiziana, Zangrillo, Alberto, Bellomo, Rinaldo, and Fominskiy, Evgeny

Subjects
Adult, Crystalloid Solutions, General Medicine, Cardiac surgery, Kidney, Acute kidney injury, Amino acids, Anesthesia, Intensive care, Randomized controlled trial, Clinical Trials, Phase III as Topic, Quality of Life, Humans, Multicenter Studies as Topic, Pharmacology (medical), Cardiac Surgical Procedures, Randomized Controlled Trials as Topic
Abstract

Postoperative acute kidney injury (AKI) is frequent in cardiac surgery patients. Its pathophysiology is complex and involves decreased renal perfusion. Preliminary clinical evidence in critically ill patients shows that amino acids infusion increases renal blood flow and may decrease the incidence and severity of AKI. We designed a study to evaluate the effectiveness of perioperative continuous infusion of amino acids in decreasing AKI.This is a phase III, multi-center, randomized, double-blind, placebo-controlled trial. Adults undergoing cardiac surgery with cardiopulmonary bypass (CPB) are included. Patients are randomly assigned to receive either continuous infusion of a balanced mixture of amino acids in a dose of 2 g/kg ideal body weight/day or placebo (balanced crystalloid solution) from the operating room up to start of renal replacement therapy (RRT), or ICU discharge, or 72 h after the first dose. The primary outcome is the incidence of AKI during hospital stay defined by KDIGO (Kidney Disease: Improving Global Outcomes). Secondary outcomes include the need for, and duration of, RRT, mechanical ventilation; ICU and hospital length of stay; all-cause mortality at ICU, hospital discharge, 30, 90, and 180 days after randomization; quality of life at 180 days. Data will be analyzed in 3500 patients on an intention-to-treat basis.The trial is ongoing and currently recruiting. It will be one of the first randomized controlled studies to assess the relationship between amino acids use and kidney injury in cardiac surgery. If our hypothesis is confirmed, this practice could reduce morbidity in the studied population.This trial was registered on ClinicalTrials.gov with the trial identification NCT03709264 in October 2018.

Published
2022

19. Macklin effect on baseline chest CT scan accurately predicts barotrauma in COVID-19 patients

Author

Gianluca Paternoster, Gianfranco Belmonte, Enrico Scarano, Pietro Rotondo, Diego Palumbo, Alessandro Belletti, Francesco Corradi, Pietro Bertini, Giovanni Landoni, Fabio Guarracino, Alessandro Isirdi, Diego Costanzo, Matteo Romani, Luigi De Simone, Roberto Mozzo, Alessia Palmaccio, Giorgia Guazzarotti, Renato Pennella, Francesca Calabrese, Paternoster, G., Belmonte, G., Scarano, E., Rotondo, P., Palumbo, D., Belletti, A., Corradi, F., Bertini, P., Landoni, G., Guarracino, F., Isirdi, A., Costanzo, D., Romani, M., De Simone, L., Mozzo, R., Palmaccio, A., Guazzarotti, G., Pennella, R., and Calabrese, F.

Subjects
Pulmonary and Respiratory Medicine, Mechanical ventilation, Acute respiratory distress syndrome, Barotrauma, Case-Control Studies, Intensive care, Pneumomediastinum, COVID-19, Humans, Pneumothorax, Tomography, X-Ray Computed, Computed tomography, Mediastinal Emphysema
Abstract

Purpose: To validate the role of Macklin effect on chest CT imaging in predicting subsequent occurrence of pneumomediastinum/pneumothorax (PMD/PNX) in COVID-19 patients. Materials and methods: This is an observational, case-control study. Consecutive COVID-19 patients who underwent chest CT scan at hospital admission during the study time period (October 1st, 2020–April 31st, 2021) were identified. Macklin effect accuracy for prediction of spontaneous barotrauma was measured in terms of sensitivity, specificity, positive (PPV) and negative predictive values (NPV). Results: Overall, 981 COVID-19 patients underwent chest CT scan at hospital arrival during the study time period; 698 patients had radiological signs of interstitial pneumonia and were considered for further evaluation. Among these, Macklin effect was found in 33 (4.7%), including all 32 patients who suffered from barotrauma lately during hospital stay (true positive rate: 96.9%); only 1/33 with Macklin effect did not develop barotrauma (false positive rate: 3.1%). No barotrauma event was recorded in patients without Macklin effect on baseline chest CT scan. Macklin effect yielded a sensitivity of 100% (95% CI: 89.1–100), a specificity of 99.85% (95% CI: 99.2–100), a PPV of 96.7% (95% CI: 80.8–99.5), a NPV of 100% and an accuracy of 99.8% (95% CI: 99.2–100) in predicting PMD/PNX, with a mean advance of 3.2 ± 2.5 days. Moreover, all Macklin-positive patients developed ARDS requiring ICU admission and, in 90.1% of cases, invasive mechanical ventilation. Conclusions: Macklin effect has high accuracy in predicting PMD/PNX in COVID-19 patients; it is also an excellent predictor of disease severity.

Published
2022

20. ECMO in COVID-19 patients: a systematic review and meta-analysis

Author

Pietro Bertini, Matteo Nocci, Fabio Guarracino, Pasquale Nardelli, Marco Falcone, Giovanni Landoni, Gianluca Paternoster, Bertini, P., Guarracino, F., Falcone, M., Nardelli, P., Landoni, G., Nocci, M., and Paternoster, G.

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), MEDLINE, Review Article, Extracorporeal Membrane Oxygenation, Influenza, Human, medicine, Clinical endpoint, Humans, Hospital Mortality, Pandemics, intensive care, business.industry, Mortality rate, COVID-19, mortality, Confidence interval, critical care, Anesthesiology and Pain Medicine, surgical procedures, operative, Supportive psychotherapy, Meta-analysis, Relative risk, Emergency medicine, ARDS, ECMO, Cardiology and Cardiovascular Medicine, business
Abstract

Objective: To analyze the survival rates of patients with COVID-19 supported with extracorporeal membrane oxygenation (ECMO) and compare the survival rates of patients with COVID-19 supported with ECMO to patients with influenza supported with ECMO. Design: A systematic review and meta-analysis to assess the impact of ECMO as supportive therapy of COVID-19. Setting: The authors performed a search through the Cochrane, EMBASE, and MEDLINE/PubMed databases from inception to February 19, 2021, for studies reporting hospitalized patients with COVID-19 managed with ECMO. Participants: A total of 134 studies were selected, including 6 eligible for the comparative meta-analysis of COVID-19 versus influenza. Interventions: The authors pooled the risk ratio and random effects model. Measurements and Main Results: The primary endpoint was the overall mortality of patients with COVID-19 receiving ECMO. Of the total number of 58,472 patients with COVID-19 reported, ECMO was used in 4,044 patients. The analysis suggested an overall in-hospital mortality of 39% (95% CI 0.34-0.43). In the comparative analysis, patients with COVID-19 on ECMO had a higher risk ratio (RR) for mortality when compared to influenza patients on ECMO: 72/164 (44%) v 71/186 (38%) RR 1.34; 95% CI 1.05-1.71; p = 0.03. Conclusions: ECMO could be beneficial in patients with COVID-19, according to the authors’ meta-analysis. The reported mortality rate was 39%. This systematic analysis can provide clinical advice in the current era and ongoing pandemic.

Published
2021

21. Mini-thoracotomy in redo mitral valve surgery: safety and efficacy of a standardized procedure

Author

Filippo Prestipino, Riccardo D’Ascoli, Erica Manzan, Gianluca Paternoster, Giampaolo Luzi, and Ádám Nagy

Subjects
Pulmonary and Respiratory Medicine, education.field_of_study, medicine.medical_specialty, Mitral valve repair, Tricuspid valve, business.industry, medicine.medical_treatment, Population, Mitral valve replacement, medicine.disease, law.invention, Surgery, medicine.anatomical_structure, law, Mitral valve, Ventricular fibrillation, medicine, Minimally invasive cardiac surgery, Cardiopulmonary bypass, Original Article, education, business
Abstract

BACKGROUND: Re-operative mitral valve surgery is sometimes burdened by a greater technical difficulty and a higher complications rate than the first operation. Minimally invasive cardiac surgery has become routine, and it could significantly reduce the surgical risk in redo surgery. The objective of our retrospective observational study is to assess the results of cardiac reoperations in patients with mitral valve disease approached trough a 5–7 cm right mini-thoracotomy. METHODS: From February 2017 to December 2019, 65 patients underwent re-operative mitral valve surgery in our institution. Cardiopulmonary bypass (CPB) was started by cannulation of the femoral and jugular vein and femoral artery or alternatively right axillary artery. Patients enrolled had a mean age of 66.6±11.5 years. Patients were divided into three groups based on the procedure adopted: external aortic cross-clamp (EAC), EndoAortic balloon occlusion (EABO) and ventricular fibrillation (VF). Major complications were evaluated and compared with a propensity matched population of patients undergoing elective isolated mitral valve surgery via right minithoracotomy (MVS). RESULTS: The average time between last operation and reoperation was 7.1±3.4 years. Fourteen patients (21%) underwent mitral valve repair and 51 patients (78%) underwent mitral valve replacement; 9 patients (14%) received tricuspid valve surgery. There was no statistically significant difference in CPB time between the groups. Seven patients (11%) had a postoperative renal failure, 5 patients (8%) underwent surgical reopening for bleeding; incidence of post-operative stroke and pace-maker implantation was 3% for both. No deaths were registered during in-hospital stay and at 30-days echocardiographic control all patients respect the criterions of device success according with MVARC. Propensity matched patients of group redo had a longer CPB time (100.8±42.7 versus 72.8±16.7 min, P

Published
2021

22. Thoracic Anesthesia during the 2019 Novel Coronavirus Infection Pandemic: 2021 Updated Recommendations for Airway Management by the EACTAIC Thoracic Subspecialty Committee

Author

Radu Stoica, Maria-Jose Jiménez, Mohamed R. El Tahan, Ben Shelley, Edmond Cohen, Steffen Rex, Balazs Paloczi, Manuel Granell Gil, Federico Piccioni, Guido Di Gregorio, Nandor Marczin, Waheedullah Karzai, Marc-Joseph Licker, Gianluca Paternoster, Carmen Unzueta, Chirojit Mukherjee, Mert Şentürk, Ahmed Salaheldin Morsy, Fabio Guarracino, Massimiliano Sorbello, Davud Yapici, Johan Bence MBChB, J.M.J. Mourisse, Laszlo L Szegedi, Vojislava Neskovic, Paolo Pelosi, Patrick Wouters, Izumi Kawagoe, Caroline Vanpeteghem, Tamás Végh, A. Brunelli, Ricard Navarro-Ripoll, and Mojca Drnvsek-Globoikar

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Critical Care, medicine.medical_treatment, coronavirus, Thoracic anesthesia, Subspecialty, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Special Article, Anesthesiology, Intensive care, Pandemic, medicine, Humans, Anesthesia, Lung cancer, Pandemics, business.industry, SARS-CoV-2, COVID-19, medicine.disease, Infectious period, Anesthesiology and Pain Medicine, lung separation, personal protective equipment, Airway management, Cardiology and Cardiovascular Medicine, business
Abstract

Contains fulltext : 244115.pdf (Publisher’s version ) (Closed access) The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled. The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.

Published
2021

23. European Association of Cardiothoracic Anesthesiology and Intensive Care Pediatric Cardiac Anesthesia Fellowship Curriculum: First Edition

Author

Ricard Navarro-Ripoll, Marc Vives, Steffen Rex, P. Matute, R. Peter Alston, Theofili Kousi, Simon J. Howell, Mona Momeni, Hossam El-Ashmawi, Fawzia Aboulfetouh, M. Granell, Aniruddha R. Janai, Gabor Erdoes, Caetano Nigro Neto, Alberto Hernandez Martinez, Sascha Treskatsch, Gianluca Paternoster, Theofani Antoniou, Anna Flo Forner, Kirstin Wilkinson, Giovanni Landoni, Joost M.A.A. van der Maaten, Joachim Erb, Philippe Gaudard, Philippe Burtin, E Schindler, Andrea Székely, Alain Vuylsteke, Laszlo L. Szegedi, Vera von Dossow, Jens Fassl, Chirojit Mukherjee, Mohamed R. El-Tahan, Fabio Guarracino, Dominique Bettex, Maria Benedetto, Dieter Van Beersel, Jan-Uwe Schreiber, Patrick Wouters, Dragana Unic-Stojanovic, Mansoura University [Egypt], University of Bern, University Medical Center Groningen [Groningen] (UMCG), University Hospital Southampton NHS Foundation Trust, Onassis Cardiac Surgery Center [Athens] (OCSC), Ruhr University Bochum (RUB), Instituto de Cardiologia Dante Pazzanese (IDPC), University Hospital Bonn, Semmelweis University [Budapest], University of Leipzig [Leipzig, Allemagne], University Department of Fundamental and Applied Medical Sciences and Clinical Department of Anesthesiology and Perioperative Medicine, Ghent, Belgium, Azienda Ospedaliera Universitaria Pisana, Clinique du Millénaire - Oc Santé [Montpellier], Oc Santé [Montpellier], University of Belgrade [Belgrade], Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Hospital Clinic [Barcelona, Spain], Misr University for Science & Technology (MUST), Technische Universität Dresden = Dresden University of Technology (TU Dresden), University hospital of Zurich [Zurich], Sant'Orsola-Malpighi Hospital [Bologna, Italy], Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), Royal Infirmary of Edinburgh, IRCCS San Raffaele Scientific Institute [Milan, Italie], University General Hospital of Valencia, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Charité Campus Benjamin Franklin, University Hospitals Leuven [Leuven], Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom., University of Leeds, Hospital Universitario de Bellvitge, University Hospital Basel [Basel], Hospital Dr Josep Trueta, Cairo University, Department of Anesthesia & Intensive Care, Helios Clinic for Cardiac Surgery, Karlsruhe, Germany., Hospital Clinico San Carlos, Hospital Clínico San Carlos, Cliniques Universitaires Saint-Luc [Bruxelles], Université Catholique de Louvain = Catholic University of Louvain (UCL), UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service d'anesthésiologie, El-Tahan, M. R., Erdoes, G., van der Maaten, J., Wilkinson, K., Kousi, T., Antoniou, T., von Dossow, V., Neto, C. N., Schindler, E., Szekely, A., Forner, A. F., Wouters, P. F., Guarracino, F., Burtin, P., Unic-Stojanovic, D., Schreiber, J. -U., Matute, P., Aboulfetouh, F., Navarro-Ripoll, R., Fassl, J., Bettex, D., Benedetto, M., Szegedi, L., Alston, R. P., Landoni, G., Granell, M., Gaudard, P., Treskatsch, S., Van Beersel, D., Vuylsteke, A., Howell, S., Janai, A. R., Martinez, A. H., Erb, J. M., Vives, M., El-Ashmawi, H., Rex, S., Mukherjee, C., Paternoster, G., Momeni, M., MUMC+: MA Anesthesiologie (9), and RS: MHeNs - R3 - Neuroscience

Subjects
medicine.medical_specialty, Critical Care, [SDV]Life Sciences [q-bio], education, MEDLINE, Subspecialty, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Pediatric anesthesiology, Anesthesiology, Intensive care, Anesthesia, Cardiac Procedures, Medicine, Humans, Fellowships and Scholarships, 610 Medicine & health, Child, Curriculum, Cardiothoracic anesthesiology, business.industry, General surgery, 030208 emergency & critical care medicine, 3. Good health, Cardiac Anesthesia, Anesthesiology and Pain Medicine, Perioperative care, cardiovascular system, Cardiology and Cardiovascular Medicine, business
Abstract

International audience; Pediatric cardiac anesthesia is a subspecialty of cardiac and pediatric anesthesiology dedicated to the perioperative care of patients with congenital heart disease. Members of the Congenital and Education Subcommittees of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) agreed on the necessity to develop an EACTAIC pediatric cardiac anesthesia fellowship curriculum. This manuscript represents a consensus on the composition and the design of the EACTAIC Pediatric Cardiac Anesthesia Fellowship program. This curriculum provides a basis for the training of future pediatric cardiac anesthesiologists by clearly defining the theoretical and practical requirements for fellows and host centers.

Published
2021

24. Right Ventricular Dysfunction in Patients With COVID-19: a systematic review and meta-analysis

Author

Pasquale Innelli, Pietro Bertini, Fabio Guarracino, Federico Franchi, Giovanni Landoni, Sabino Scolletta, Paolo Trambaiolo, Gianluca Paternoster, Paternoster, G., Bertini, P., Innelli, P., Trambaiolo, P., Landoni, G., Franchi, F., Scolletta, S., and Guarracino, F.

Subjects
medicine.medical_specialty, ARDS, Critical Care, Heart Ventricles, Hypertension, Pulmonary, Ventricular Dysfunction, Right, right ventricle, 030204 cardiovascular system & hematology, Cochrane Library, Article, Right Ventricle, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Internal medicine, medicine, echocardiography, Humans, SARS-CoV-2, business.industry, COVID-19, Odds ratio, medicine.disease, Pulmonary hypertension, Confidence interval, critical care, meta-analysis, Clinical trial, Meta-analysis, Anesthesiology and Pain Medicine, Echocardiography, Cardiology, Observational study, Cardiology and Cardiovascular Medicine, business
Abstract

OBJECTIVE: This systematic review and meta-analysis aimed to describe the features of right ventricular impairment and pulmonary hypertension in coronavirus disease (COVID-19) and assess their effect on mortality. DESIGN: The authors carried out a systematic review and meta-analysis of observational studies. SETTING: The authors performed a search through PubMed, the International Clinical Trials Registry Platform, and the Cochrane Library for studies reporting right ventricular dysfunction in patients with COVID-19 and outcomes. PARTICIPANTS: The search yielded nine studies in which the appropriate data were available. INTERVENTIONS: Pooled odds ratios were calculated according to the random-effects model. MEASUREMENTS AND MAIN RESULTS: Overall, 1,450 patients were analyzed, and half of them were invasively ventilated. Primary outcome was mortality at the longest follow-up available. Mortality was 48.5% versus 24.7% in patients with or without right ventricular impairment (n = 7; OR = 3.10; 95% confidence interval [CI] 1.72-5.58; p = 0.0002), 56.3% versus 30.6% in patients with or without right ventricular dilatation (n = 6; OR = 2.43; 95% CI 1.41-4.18; p = 0.001), and 52.9% versus 14.8% in patients with or without pulmonary hypertension (n = 3; OR = 5.75; 95% CI 2.67-12.38; p < 0.001). CONCLUSION: Mortality in patients with COVID-19 requiring respiratory support and with a diagnosis of right ventricular dysfunction, dilatation, or pulmonary hypertension is high. Future studies should highlight the mechanisms of right ventricular derangement in COVID-19, and early detection of right ventricular impairment using ultrasound might be important to individualize therapies and improve outcomes.

Published
2021

25. AN UNEXPECTED INTRAOPERATIVE UNUSUAL CASE OF AORTIC STENOSIS

Author

Andrea Colli, Pietro Bertini, Giosuè Falcetta, Michele Celiento, Fabio Guarracino, Gianluca Paternoster, and Giulia Brizzi

Subjects
Aortic valve, medicine.medical_specialty, business.industry, medicine.medical_treatment, Concentric hypertrophy, medicine.disease, Septal myectomy, Stenosis, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Valve replacement, Aortic valve replacement, Internal medicine, cardiovascular system, medicine, Cardiology, Ventricular outflow tract, Heart valve, Cardiology and Cardiovascular Medicine, business
Abstract

Introduction Aortic stenosis is the most frequent valvular pathology in the developed countries (1). It is most often due to the calcified or degenerated aortic valve as a manifestation of ageing. Sub-valvular aortic stenosis is rare in the adult population being more common in children accounting for 8-20% of left ventricular outflow tract (LVOT) obstructions (2). Stenosis degree may change depending on the malformation varying from a minor ridge to a complete fibrous ring or tunnel. Although proper timing for surgery is unclear, diagnosis might be more difficult in the adult patient with transthoracic echocardiography as subvalvular portions of the LVOT might be shaded by calcium and difficult to visualize. We report a case of a 65 years old lady diagnosed with severe aortic stenosis and scheduled for aortic valve surgery. Methods The patient presented to our department with recent history of shortness of breath and clinical and transthoracic echocardiographic diagnosis os severe aortic stenosis. The maximum blood velocity across the aortic valve was 4.8 m sec-1 at continuous Doppler sampling. She was scheduled for aortic valve replacement. After establishing hemodynamic monitoring, general anaesthesia induction was performed with remifentanil, propofol and cisatracurium and maintained as TIVA. According to our protocol, a transesophageal echocardiography (TEE) was positioned and a baseline TEE was performed. Results TEE demonstrated a massive concentric hypertrophy of the left ventricle, a membranous subaortic stenosis and a normal aortic valve (fig. 1A,1B,1C). Surgery was then halted as the patient's written consent had been obtained for a valve replacement. Then the patient was further investigated by ECG gated cardiac CT scan, which confirmed the subvalvular membrane. The patient was then operated to remove the subvalvular membrane and a partial septal myectomy was also executed (fig 1D). She completely recovered and was discharged home on p.o. day 5. Discussion Differential diagnosis between aortic valvular stenosis or stenosis due to a subvalvular obstruction might be tricky, but is crucial for the operation result. TEE 2D and 3D imaging recognised the anomaly prior to surgery and so allowed to properly address the cardiac disease leading to post-operative success. Perioperative TEE should be performed in a systematic manner according to the current guidelines (3), but beyond the level of re-confirming the expected findings prior to surgery. TEE allowed for rapid and thorough recognition of previously undiscovered pathology leading to proper patient's management and case resolution, so confirming the importance of perioperative TEE in the setting of surgical treatment of heart valve diseases.

Published
2021

26. COMBINED TREATMENT WITH IGM ENRICHED IMMONOGLOBULIN AND CYTOSORB IN INFECTIVE ENDOCARDITIS: CASE SERIES

Author

Sabino Scolletta, Pietro Bertini, Fabio Guarracino, Francesco Franchi, and Gianluca Paternoster

Subjects
medicine.medical_specialty, Septic shock, business.industry, medicine.medical_treatment, medicine.disease, Hemoperfusion, law.invention, Cardiac surgery, Anesthesiology and Pain Medicine, Valve replacement, law, Infective endocarditis, Anesthesia, medicine, Cardiopulmonary bypass, SOFA score, Cardiology and Cardiovascular Medicine, business, Adverse effect
Abstract

Introduction Infective endocarditis is a serious disease condition. Depending on the causative microorganism and clinical symptoms, cardiac surgery and valve replacement may be needed, posing additional risks to patients who may simultaneously suffer from septic shock. The combination of surgery bacterial spreadout and artificial cardiopulmonary bypass (CPB) surfaces results in a release of key inflammatory mediators leading to an overshooting systemic hyperinflammatory state frequently associated with compromised hemodynamic and organ function.(1) Combined use of hemoadsorption (2)and IgM enriched Immunoglobulin (3) might represent a potential approach to control the hyperinflammatory systemic reaction associated with the procedure itself and subsequent clinical conditions by reducing a broad range of immuno-regulatory mediators and endotoxemia. Methods We describe retrospectively 8 cardiac surgery patients with proven acute infective endocarditis obtaining valve replacement with CPB surgery in combination with intra e postoperative CytoSorb hemoadsorption and intravenous administration of IgM enriched Immunoglobulin (Pentaglobin®) 250 mg/kg die. for three consecutive days Results Combined treatment of hemoadsorption and IgM enriched Immunoglobulin was associated with a mitigated postoperative response of key cytokines (4) with a significative reduction of IL-6 and Endotoxemia (5) an increase of IL10 (6); an improvement of clinical metabolic parameters (WBC and SOFA score). Moreover, patients showed hemodynamic stability which possibly could be attributed to the additional combined treatment. Intraoperative hemoperfusion and Pentaglobin administration were well tolerated and safe without the occurrence of any related adverse event. Discussion Conclusion: This approach may open up potentially promising therapeutic options for infective endocarditis, with pro and antiflammatory modulation, improved hemodynamic stability and organ function as seen in our experience.

Published
2021

27. Continuous infusion versus intermittent administration of meropenem in critically ill patients (MERCY): A multicenter randomized double-blind trial. Rationale and design

Author

Ingrid Marcela Pabon, Barbara Azzali, Mattia Bozzetti, Vincenzo Pota, Antonio De Sio, Andrey Yavorovskiy, Natascia D'Andrea, Rosetta Lobreglio, Andrea Della Selva, Evgeny Fominskiy, Federico Canavosio, Barbara Ferrara, Vittorio Pazzanese, Francesca Gallicchio, Nicola Pasculli, Valery Likhvantsev, Eugenio Garofalo, Sergio Colombo, Anna Mara Scandroglio, Felice Eugenio Agrò, Margherita Tozzi, Gianluca Paternoster, Francesco Corradi, Tiziana Bove, Filippo Palmesino, Elena Momesso, Luigi Vetrugno, Francesco Giuseppe Nisi, Giorgia Montrucchio, Daniela Missio, Mara Bernasconi, Giacomo Monti, Mariano Ballestra, Marco Gemma, Giovanni Marino, Silvia Ajello, Alberto Zangrillo, Rosalba Lembo, Maria Grazia Calabrò, Romina Perone, Andrea Bruni, Pavel Nogtev, Alberto Cappelletti, Gabriele Finco, Daniele Cristadoro, Leonarda Pia Cantatore, Marina Pieri, Sofia Ananiadou, Italo Calamai, Chiara Millin, A. Mattei, Luca Cabrini, Marina Petrova, Valentina Paola Plumari, Nicoletta Boffa, Davide Maraggia, Elena Moizo, Gianna Curci, Giovanni Landoni, Giuseppe Biondi-Zoccai, Giuseppe Giardina, Giacomo Iapichino, Carola Galbiati, Fabio Guarracino, Antonella Cotoia, Matteo Marzaroli, Nikola Bradic, Umberto Benedetto, Giorgio Gallioli, Fabrizio D'Ascenzo, Francesco Forfori, Fabio Toffoletto, Milena Mucci, Manuela Mainetti, Monti, G., Galbiati, C., Toffoletto, F., Calabro, M. G., Colombo, S., Ferrara, B., Giardina, G., Lembo, R., Marzaroli, M., Moizo, E., Mucci, M., Pasculli, N., Plumari, V. P., Scandroglio, A. M., Tozzi, M., Momesso, E., Boffa, N., Lobreglio, R., Montrucchio, G., Guarracino, F., Benedetto, U., Biondi-Zoccai, G., D'Ascenzo, F., D'Andrea, N., Paternoster, G., Ananiadou, S., Ballestra, M., De Sio, A., Pota, V., Cotoia, A., Della Selva, A., Bruni, A., Iapichino, G., Bradic, N., Corradi, F., Gemma, M., Nogtev, P., Petrova, M., Agro, F. E., Cabrini, L., Forfori, F., Likhvantsev, V., Bove, T., Finco, G., Landoni, G., Zangrillo, A., Ajello, S., Cappelletti, A. M., Fominskiy, E., Nisi, F. G., Pazzanese, V., Pieri, M., Canavosio, F., Palmesino, F., Bernasconi, M., Gallioli, G., Marino, G., Vetrugno, L., Millin, C., Missio, D., Gallicchio, F., Azzali, B., Bozzetti, M., Cristadoro, D., Perone, R., Cantatore, L. P., Curci, G., Pabon, I. M., Garofalo, E., Mainetti, M., Calamai, I., Maraggia, D., Mattei, A., Yavorovskiy, A., Monti, Giacomo, Galbiati, Carola, Toffoletto, Fabio, Calabrò, Maria Grazia, Colombo, Sergio, Ferrara, Barbara, Giardina, Giuseppe, Lembo, Rosalba, Marzaroli, Matteo, Moizo, Elena, Mucci, Milena, Pasculli, Nicola, Plumari, Valentina, Scandroglio, Anna Mara, Tozzi, Margherita, Momesso, Elena, Boffa, Nicoletta, Lobreglio, Rosetta, Montrucchio, Giorgia, Guarracino, Fabio, Benedetto, Umberto, Biondi-Zoccai, Giuseppe, D'Ascenzo, Fabrizio, D'Andrea, Natascia, Paternoster, Gianluca, Ananiadou, Sofia, Ballestra, Mariano, De Sio, Antonio, Pota, Vincenzo, Cotoia, Antonella, Selva, Andrea Della, Bruni, Andrea, Iapichino, Giacomo, Bradić, Nikola, Corradi, Francesco, Gemma, Marco, Nogtev, Pavel, Petrova, Marina, Agrò, Felice Eugenio, Cabrini, Luca, Forfori, Francesco, Likhvantsev, Valery, Bove, Tiziana, Finco, Gabriele, Landoni, Giovanni, and Zangrillo, Alberto

Subjects
medicine.medical_specialty, Randomization, Critical Care, Antibiotic resistance, Critical patients, Critical Illness, Population, meropenem, intermitent or continuous infusion, critically ill, Intensive care unit, Meropenem, Mortality, Multi-drug resistant pathogens, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Sepsis, medicine, Clinical endpoint, polycyclic compounds, Humans, Pharmacology (medical), 030212 general & internal medicine, education, Antibacterial agent, education.field_of_study, 030505 public health, Septic shock, business.industry, Critical patient, General Medicine, medicine.disease, Anti-Bacterial Agents, Emergency medicine, 0305 other medical science, business, medicine.drug
Abstract

Objective Meropenem is a β-lactam, carbapenem antibacterial agent with antimicrobial activity against gram-negative, gram-positive and anaerobic micro-organisms and is important in the empirical treatment of serious infections in Intensive Care Unit (ICU) patients. Multi-drug resistant gram-negative organisms, coupled with scarcity of new antibiotic classes, forced healthcare community to optimize the therapeutic potential of available antibiotics. Our aim is to investigate the effect of continuous infusion of meropenem against bolus administration, as indicated by a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens in a population of ICU patients. Design Double blind, double dummy, multicenter randomized controlled trial (1:1 allocation ratio). Setting Tertiary and University hospitals. Interventions 600 ICU patients with sepsis or septic shock, needing by clinical judgment antibiotic therapy with meropenem, will be randomized to receive a continuous infusion of meropenem 3 g/24 h or an equal dose divided into three daily boluses (i.e. 1g q8h). Measurements The primary endpoint will be a composite outcome of reducing death and emergence of extensive or pan drug-resistant pathogens. Secondary endpoints will be death from any cause at day 90, antibiotic-free days at day 28, ICU-free days at day 28, cumulative SOFA-free (Sequential Organ Failure Assessment) score from randomization to day 28 and the two, separate, components of the primary endpoint. We expect a primary outcome reduction from 52 to 40% in the continuous infusion group. Conclusions The trial will provide evidence for choosing intermittent or continuous infusion of meropenem for critically ill patients with multi-drug resistant gram-negative infections.

Published
2021

28. EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): study protocol for a multicentre, observational trial

Author

Weiss, Raphael, Saadat-Gilani, Khaschayar, Kerschke, Laura, Wempe, Carola, Meersch, Melanie, Zarbock, Alexander Hichem Makhloufi, Anis, Cherak, Lamine Lakhel Ghanem, Zohier, Gouaglia, Dina Nasrine Guadouri, Fayrouz Naouel Hama, Mustafa, Kara, Omayma, Saadi, Rachida, Sakhraoui, Fadila, Bourou, Abdelhadi, Cherifi, Rahmoune Ghania Sadaoui, Amel, Ouyahia, Ilhem, Ouahab, Souad, Bouaoud, Meriem, Abdoun, Anisse, Tidjane, Benali, Tabeti, Nabil, Boudjenan-Serradj, Carlos Jose Pérez Rivera, Paulo, Cabrer, Julián, Corso, Juan Pablo García, Sharon, Idarraga, Christopher, Montoya, Rafael, Figueroa, Eduar, Aldana, María Alejandra Torrado, Peng, Ke, Zheng-Min, Ma, Yu-Fan, Yang, Ya-Juan, Zhu, Peter, Sklienka, Michal, Frelich, Vojtech, Jarkulis, Pavel, Sevcik, Vojtech, Vodicka, Mohamed Gamal Elbahnasawy, Shady, Elsalhawy, Sara, Motawea, Zeinab, Othman, Mohamed, Sahma, Ahmed Mahmoud Nafea, Nermin, Ahmed, Doaa Ali Attia, Moataz Maher Emara, Mohamed Mamdouh Bonna, Mohamed Ahmed Gabr, Amany Ismail Tarbay, Ibrahim Abdelmonaem Abdehaleem, Esraa Elsayed Mohamed, Amr Mahmoud Eldeeb, Ahmed Mohamed Abbas, John Ashraf Magdy, Zyad Hassan Hamed, Hany Mostafa Esmaeil Osman, Mostafa Samy Abbas, Oliver, Joannes-Boyau, Nicolas, Barraud, Corentin, Berthelot, Thibault, Camus, Anissa, Dahmi, Mylène, Defaye, Sébastien, Derville, Younes, El-Boustani, Elsa, Deloge, Hélène, Jacob, Simon, Monziols, Fred, Priem, Jean-Jacques, Robin, Vincent, Legros, Therry, Floch, Salvatore, Muccio, Claire, Geneve, Marie Lim Legouge, Stéphanie Tao Mauny, Willy, Mfam, Léa, Pascot, Christophe, Aveline, Mireille, Chartier, Benjamin, Duteurtre, Jean Francois Gautier, Aidren Le Cousin, Pierre, Vautier, Julien, Nadaud, Nathalie, Begel, Claire-Annissa, Chekirine, Vincent, Derlon, Elodie, Grein, Marie-Annick, Lehair, Laurent, Magazzeni, Philippe, Magazzeni, Carsten, Potter, Catherine, Roth, Florence, Voivret, Thomas, Rimmelé, Valérie, Cerro, Stéphanie, Suria, Jamil, Elmawieh, Annabelle, Stoclin, Cédric, Cirenei, Gregoire, Andrieu, Sven, Couloumy, Jeremy, Falcone, Marion, Fajardy, Arsène, Gagneuil, Emeline, Girardet, Agnès, Mazereeuw, Sébastien, Ponsonnard, Pierre-Yves, Egreteau, Mélanie, Bertel, Simon, Bocher, Vanessa, Carn, Lenaïg Le Guen, Guillaume Le Loup, Montaine, Lefevre, Carole, Ichai, Amanita, Diop, Vanessa, Jean-Michel, Sylvie, Devlieger, Juliette, Duthoit, Mohamed El Kadiri, Maxime, Léger, Viviane, Cassisa, Sigismond, Lasocki, Charline, Masson, Emmanuel, Rineau, Pierre, Verrier, Axel, Coquerel, Philippe, Montravers, Enora, Atchade, Charles-Edouard, Rochon, Céline, Delerue, Vidal, Quentin, Vanessa, Latry, Nina, Queixalos, Vincent, Cottenceau, Thierry, Braun, Saad, Bouzoubaa, Basile, Christ, Audrey, Geiger, Joachim, Gomille, Vianney, Kieffer, Simone, Mangeant, Christelle, Prochilo, Christian, Schmitt, Stefan, Skwirba, Hubert, Grand, Frédérique, Boury, Nicolas, Mayeur, Marie, Pasquie, Pierre, Garçon, Vincent, Bruckert, Vincent, Arnould, Mona, Bonciu, Thibault, Chapelle, Luc, Facchino, Florence, Fagot-Gandet, Andrea, Iachim, Elena, Mannu, Olivier, Perus, Rémi, Plattier, Romain, Rozier, Gaël, Pradel, Michel, Boudinaud, Marie-Hélène, Hausermann, My Hue Nguyen, Andersen, Ramorasata, Amélie, Barreau, Anne-Hélène, Boivin, Céline, Ravry, Nicolas, Mottard, Johanne, Beuvelot, Florence Prunier Bossion, Olivier, Desebbe, Alexander, Zarbock, Christian, Dörr, Thilo Caspar von Groote, Mira, Küllmar, Christina, Massoth, Melanie, Meersch, Khaschayar, Saadat-Gilani, Raphael, Weiss, Carola, Wempe, Sebastian, Ziemann, Linda, Grüßer, Ana, Kowark, Pia, Wittig, Timo, Brandenburger, Thomas, Dimski, Niklas, Döhmen, Laura, Huthmann, Daniela, Kaierle, Claude, Pelletier, Manon, Schleß, Andreas, Hohn, Sebastian, Cleophas, Stephanie, Haunhorst, Marina, Jansen, Alexandra, Schmitt, Julia, Soisch, Kilian, Sturm, Peter, Rosenberger, Alexander, Bendig, Lena, Flohr, Helene, Häberle, Pascal, Hofmann, Jonathan, Kuhle, Nora Michaela Leser, Kathrin, Pfister, Stefanie, Prohaska, Franziska, Sennholz, Lena, Stetz, Kathrin, Weber, Sebastian, Stehr, Stephan, Klaus, Marco, Sadlo, Matthias, Boschin, Christian, Sengelhoff, Ulrich Michael Göbel, Jan Gerrit Haaker, Carina-Kristin, Göttker, Matthias, Gründel, Matthias, Heringlake, Romina, Baumgärtel, Astrid, Berggren, Madeleine, Gülzow, Lennart, Muras, Hauke, Paarmann, Serge, Thal, Alexander, Bentley, Dschamil, El-Masri, Anne, Sebastiani, Eleni, Arnaoutoglou, Maria, Ntalouka, Paula, Stratigopoulou, Anastasia, Analytis, Efthymios, Mavrommatis, Petros, Tzimas, Agathi, Karakosta, Danai, Pantazi, Antonia, Dimakopoulou, Katerina, Dimitropoulou, Orestis, Ioannidis, Humam, Jalaawiy, Aeshah, Anwar, Hashim Talib Hashim, Hogir Imad Rasheed Aldawoody, Andrea, Cortegiani, Giulia, Catalisano, Gilia, Ingoglia, Mariachiara, Ippolito, De Rosa, Silvia, Lucia, Cattin, Andrea, Bianchin, Marisa, Barone, Gianluca, Paternoster, Salvatore Lucio Cutuli, Andrea, Russo, Liliana, Sollazzi, Laura, Cascarano, Massimo, Antonelli, Paola, Aceto, Bruno, Romanò, Savino, Spadaro, Vincenzo Francesco Tripodi, Michele, Rossi, Rosamaria, Scappatura, Maria Cristina Vadalà, Diego, Fiume, Maria Teresa Strano, Giulia, Oddo, Clemente, Santorsola, Bilal Abu Hussain, Adnan Raed Alnaser, Anas Hassouneh Ghassan, Khaled, Hasanein, Mohammed, Theab, Seokyung, Shin, Seungho, Jung, Kyuho, Lee, Sung Mee Jung, Jongyoon, Baek, Muhammed, K Elhadi, Issa, Abuzeid, Mohammed, Albaraesi, Sarah, Aldressi, Wegdan, Khalel, Eman, Abdulwahed, Akram Abdulhamid Ashur Abujrad, Amer, Almaghrabi, Muhand Mohammed Alteleeb, Entisar Ahmed Ali Alshareea, Marwa Isa Biala, Abdulqudus, Deeknah, Dooua Ali Gheddim, Reem, Ghmagh, Nawras Salih Ali AbuIkhrays, Marwa, Sinan, Enas, Soula, Sumayyah Ghayth Bahroun, Khawla, Derwish, Aya Munir Mohamed, Eman Sayed Younes, Rayet Al Islam Benjouira, Mohamed, Aliwa, Najwa Abdullah Altashani, Mohammed Omar Alteb, Ahmed, Msherghi, Fatima, Alagelli, Sufyan, Albarouni, Ahmed, Albishti, Sarah, Aljamal, Mohamed, Alsori, Taha, Ekhuja, Suha, Elzwai, Mohammed, Ghula, Tahani, Mustafa, Ahmed, Tuwaib, Haifa, Zriba, Hamza Mahmoud Agilla, Toky Andriamahefa Rafanomezantsoa, Anne Marie Camilleri Podesta, Denise Mifsud Bonnici, Tiziana, Pirotta, Gilberto Adrián Gasca López, Maja Mojsova Mijovska, Tatjana, Davitkovska, Aleksandra, Gavrilovska, Sanja, Lukikj, Marija, Vesova, Dina, Zafirova, Sarah, Amro, Baraa N, F Hajjaj, Muawia, Alkhazendar, Yousuf, Barakat, Sewar Abdulaziz Elejla, Ahmed, Elhissi, Ahmed, Khader, Ali, Salem, Rita de Freitas Regufe, André Filipe de Oliveira Eloy, Lisbete Marisa Neto Cordeiro Perdigão, Evgeny, Grigoriev, Artem, Ivkin, Roman, Kornelyuk, Michael, Yaroustovsky, Marina, Abramyan, Ekaterina, Komardina, Nataliya, Lesteva, Medina, Aybazova, Elmira, Kumykova, Svetlana, Lesina, Gennady, Rybakov, Alexey, Shestov, Abdulnaser Ahmad Ahmad Barmou, Bushra Lotfi Altayeb Ahmed, Aisha Mohammad Eliyas, Yousra, Emadeldin, Alexander, Kaserer, Clara, Castellucci, Julian, Rössler, Samira, Akbas, Andreja Möller Petrun, Irena, Gregorcic, Vesna, Sok, Roman, Čičak, Elizabeth, Bárcena, Antonio, Guisado, Ismail, Wi, Javier Ripollés Melchor, Ángel, Becerra-Bolaños, Sergio, Cabrera-Doreste, Ancor, Domínguez-Arbelo, María Candelaria Delgado-Alonso, Virginia, Muiño-Palomar, Aurelio, Rodríguez-Pérez, Javier Mata Estévez, Maria Begona Covas Munoz, Juan Mulet Matas, Sara Perez Palao, Maria Dolores Mira Quirós, Alisia Cezara Teslev, Mercedes Garcia Alvarez, Marga, Argilaga, María, Campos, Albert, Bainac, Astrid, Batalla, Marta, Giné, Gracia, Herránz, Ignacio, Hinojal, Margarita Logroño Ejea, Noelia de la Rosa Ruiz, María Gastaca Abasolo, Carla Rosario Houhton Acuna, Ibai Iriarte Zaranton, Ana, Mendigurenmurua, María José Munoz Sanz, Erika Olea de la Fuente, María Pilar Pérez Vaquero, Ana Soto Iglesias, Ana Ugarte Mieres, Alaitz Urtiaga Urrestizala, Lourdes, Ferreira, Félix, Lobato, Marta Aguado Sevilla, Andres, Erazo, Pere, Miró, Sergi, Sabaté, Diana, Vernetta, Berta Castellano Paulis, Anabel Adell Perez, Marta Aseguinolaza Pagola, Elena delVal Peciña, Ainhoa Garmendia Odriozola, Amaia Lopetegi Aizpurua, Olatz Pavón Piquer, Pilar Plou Garcia, Paula Ortega Rezola, Antia Osorio Lopez, Isabel de la Calle Gil, Rosalía Navarro Casado, Peter, Adamove, Roser Bayona Domenge, Francho Miguel Blasco Blasco, Adriana Alexandra Rueda Villamizar, Maria Antonia Perelló Llaneras, Jose Ignacio García-Sánchez, Laura Fernandez Téllez, Sara García Zamorano, Natalia Gijón Herreros, Andrea Rodriguez Esteve, Pablo Monedero Rodríguez, Isabel García Trigo, Agustín, Alcaraz, Andrea Lara Jiménez, Iñigo, Rubio, Nuria, García, Raquel, Callejas, Angel Manuel Candela Toha, Eli, Claros, Pilar, Cobeta, Pascual, Crespo, Trini, Dorado, Elena, Elías, Javier, Felices, Diego, Gil, María, Gómez, Nuria, Mané, María, Martín, Adolfo, Martínez, Lucía, Pereira, Alberto Balvis Noemí Samaranch, Ana, Serrano, Carlos, Tiscar, Judith, Villahoz, Patricia Galán Menéndez, Elena, Cardona, Anna, Conesa, Veronica, Estepa, Patricia, Galán, Laura Llinares Espí, Yuri Loaiza Aldeán, Susana, Manrique, Víctor Morales Ariza, Laura Villarino Villa, Elfayadh Saidahmed Mohamed Amed Suliman, Hytham, Hamid, Ahmed Mohamed Ibrahim, Modather Mohamed Saeed, Orhan Sungur Mukadder, Demet, Altun, Nur, Canbolat, Müşerref Beril Dinçer, Tulay Özkan Seyhan, Serap Aktaş Yıldırım, Müzeyyen, İyigün, Davut, Yapıcı, Levent, Özdemir, Aslinur, Sagun, Neval, Boztug, Yesim, Cetintas, Bora, Dinc, Emel, Gündüz, Hakkı, Ünlügenç, Demet Lafli Tunay, Deniz, Karakaya, Burhan, Dost, Ozgur, Komurcu, Özlem Korkmaz Dilmen, Eren Fatma Akcil, Yusuf, Tunali, Gülay, Ok, Eda Tok Alsina, Özge, Hakli, Cengiz, Polat, Namigar, Turgut, Nurcan, Kızılcık, Özge, Köner, Öznur, Şen, Nurdan, Aydin, Burcu, Basaran, Emre Sertac Bingul, Yavuz, Gürkan, Kamil, Darcin, Semra, Ugur, Kemal Tolga Saracoglu, Asli, Demir, Özgök, Aysegül, Eda, Balci, Behic, Girgin, Aygun, Guler, Ümit, Karadeniz, Nihal, Özaslan, Yigit Özay Hülya, Namik, Ozcan, Aysun, Postaci, Mehmet, Sahap, Nevriye, Salman, Özlem, Sağır, Bulent, Atik, Murat, Bicakcioglu, Hafize Fisun Demir, Ugün, Fatih, Nazan, Kocaoglu, Hüseyin Ilksen Toprak, Duygu Demiröz Aslan, Yusuf Ziya Colak, Mustafa Soner Ozcan, Mehmet, Yilmaz, Umran, Karaca, Sevtap Hekimoglu Sahin, Özlem Ersoy Karka, Gizem Demir Şenoğlu, Süheyla Erkoç Karadağ, Neslihan, Alkis, Volkan, Baytaş, Engin, Erturk, Ali, Akdogan, Ahmet, Besir, Dilek, Kutanis, Sedat, Saylan, Ersagun, Tugcugil, Pinar, Ayvat, Berrin, Günaydın, Beyza Mehri Büyükgebiz, Omer Faruk Boran, Feyza, Calisir, Yavuz, Orak, Bahar Kuvaki Balkan, Sibel, Büyükcoban, Erol, Gökel, Sakize Ferim Günenc, Sule, Özbilgin, Suna, Göre, Selcan, Akesen, Seda, Cansabuncu, Natalia, Momot, Anna, Panchenko, Jean-Francois, Pittet, Kristen, Rutledge, Tıp Fakültesi, Weiss, R, Saadat-Gilani, K, Kerschke,L, Wempe,C, Meersch, M, Zarbock, A, Cortegiani, A, and Ippolito, M

Subjects
Epidemiology, urologic and male genital diseases, acute renal failure, Adult Intensive & Critical Care, Anaesthesia, Cohort Studies, surgery, chronic renal failure, Humans, Multicenter Studies as Topic, Prospective Studies, adult intensive & critical care, urogenital system, Incidence, General Medicine, Acute Kidney Injury, female genital diseases and pregnancy complications, critical care, Renal Replacement Therapy, Observational Studies as Topic, epidemiology, Acute Renal Failure, Surgery, adult intensive &amp, Chronic Renal Failure
Abstract

Sağır, Özlem (Balikesir Author), Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369. ©

Published
2021

29. Awake proning as an adjunctive therapy for refractory hypoxemia in non-intubated patients with COVID-19 acute respiratory failure: Guidance from an international group of healthcare workers

Author

Eva Åkerman, Luigi Pisani, Lieuwe D. J. Bos, Jean-Damien Ricard, Oriol Roca, Kathleen M. Vollman, Bairbre McNicholas, Laura A. Buiteman-Kruizinga, Jaques Sztajnbok, Antonio Artigas, Lisa M.N. Maduro, Paul Dark, Chiara Sartini, Weihua Lu, Rebecca Inglis, Vittorio Scaravilli, Mary Ellen Gilder, Diego De Mendoza, Frederique Paulus, Hendrik de Bruin, Eloi Prud'Homme, Peter E. Spronk, John G. Laffey, Alfred Papali, Gregg Chesney, Marcus J. Schultz, Margaretha C. E. van der Woude, Willemke Stilma, Luis Morales-Quinteros, Cindy S. Chu, Tobias Brummaier, Arjen M. Dondorp, Youssef Trigui, François Nosten, Chaisith Sivakorn, Harm J.H. Gijsbers, Domenico Luca Grieco, Gianluca Paternoster, Giovanni Landoni, Thomas J.C. Bosman, Francesco Carcò, Andrew Bentley, Rose McGready, Stilma, W., Akerman, E., Artigas, A., Bentley, A., Bos, L. D., Bosman, T. J. C., De Bruin, H., Brummaier, T., Buiteman-Kruizinga, L. A., Carco, F., Chesney, G., Chu, C., Dark, P., Dondorp, A. M., Gijsbers, H. J. H., Gilder, M. E., Grieco, D. L., Inglis, R., Laffey, J. G., Landoni, G., Lu, W., Maduro, L. M. N., Mcgready, R., Mcnicholas, B., De Mendoza, D., Morales-Quinteros, L., Nosten, F., Papali, A., Paternoster, G., Paulus, F., Pisani, L., Prud'Homme, E., Ricard, J. -D., Roca, O., Sartini, C., Scaravilli, V., Schultz, M. J., Sivakorn, C., Spronk, P. E., Sztajnbok, J., Trigui, Y., Vollman, K. M., Van Der Woude, M. C. E., Graduate School, Intensive Care Medicine, Nursing, Pulmonology, ACS - Heart failure & arrhythmias, AII - Infectious diseases, ACS - Pulmonary hypertension & thrombosis, ACS - Diabetes & metabolism, ACS - Microcirculation, Faculteit Gezondheid, Urban Vitality, Lectoraat Critical Care, and Pulmonary medicine

Subjects
medicine.medical_specialty, Supine position, Health Personnel, medicine.medical_treatment, 030231 tropical medicine, Hypoxemia, 03 medical and health sciences, Work of breathing, 0302 clinical medicine, Virology, Prone Position, medicine, Humans, Intubation, Wakefulness, Hypoxia, Intensive care medicine, Continuous Positive Airway Pressure, SARS-CoV-2, business.industry, COVID-19, Articles, medicine.disease, Pneumonia, Infectious Diseases, Acute Disease, Adjunctive treatment, Breathing, Parasitology, Observational study, medicine.symptom, Respiratory Insufficiency, business
Abstract

Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6–12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.

Published
2021

30. Nutrition

Author

Gianluca Paternoster, Giuseppina Opramolla, and Juan Carlos Lopez-Delgado

Published
2021

31. EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients With Suspected or Confirmed COVID-19 Infection: An Expert Consensus From the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists With Endorsement From the Chinese Society of Cardiothoracic and Vascular Anesthesiology

Author

Bessie Kachulis, Marc Stone, Steffen Rex, Fabio Guarracino, Chirojit Mukherjee, Stanton K. Shernan, Patrick Wouters, Pietro Bertini, Mohamed R. El Tahan, and Gianluca Paternoster

Subjects
safety, medicine.medical_specialty, China, Consensus, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, 030204 cardiovascular system & hematology, cardiac anesthesia, Article, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Anesthesiology, Pandemic, medicine, Anesthesia, Cardiac Procedures, Humans, Intensive care medicine, Cardiothoracic anesthesiology, Pandemics, business.industry, SARS-CoV-2, COVID-19, Perioperative, medicine.disease, Cardiac surgery, Anesthesiologists, PPE, safety, Anesthesiology and Pain Medicine, recommendations, Middle East respiratory syndrome, Airway management, SARS CoV 2, Cardiology and Cardiovascular Medicine, business, cardiac surgery
Abstract

The European Association of Cardiothoracic Anaesthesiology (EACTA) and the Society of Cardiovascular Anesthesiologists (SCA) aimed to create joint recommendations for the perioperative management of patients with suspected or proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection undergoing cardiac surgery or invasive cardiac procedures. To produce appropriate recommendations, the authors combined the evidence from the literature review, reevaluating the clinical experience of routine cardiac surgery in similar cases during the Middle East Respiratory Syndrome (MERS-CoV) outbreak and the current pandemic with suspected coronavirus disease 2019 (COVID-19) patients, and the expert opinions through broad discussions within the EACTA and SCA. The authors took into consideration the balance between established procedures and the feasibility during the present outbreak. The authors present an agreement between the European and US practices in managing patients during the COVID-19 pandemic. The recommendations take into consideration a broad spectrum of issues, with a focus on preoperative testing, safety concerns, overall approaches to general and specific aspects of preparation for anesthesia, airway management, transesophageal echocardiography, perioperative ventilation, coagulation, hemodynamic control, and postoperative care. As the COVID-19 pandemic is spreading, it will continue to present a challenge for the worldwide anesthesiology community. To allow these recommendations to be updated as long as possible, the authors provided weblinks to international public and academic sources providing timely updated data. This document should be the basis of future task forces to develop a more comprehensive consensus considering new evidence uncovered during the COVID-19 pandemic. ispartof: JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA vol:35 issue:7 pages:1953-1963 ispartof: location:United States status: published

Published
2020

32. Awake pronation with helmet continuous positive airway pressure for COVID-19 acute respiratory distress syndrome patients outside the ICU: a case series

Author

Giovanni Landoni, Gianluca Paternoster, F. Lisanti, E. Pennacchio, Chiara Sartini, Luca Cabrini, Paternoster, G., Sartini, C., Pennacchio, E., Lisanti, F., Landoni, G., and Luca, C.

Subjects
ARDS, Supine position, pronacion, medicine.medical_treatment, dexmedetomidine, Acute respiratory failure, Critical Care and Intensive Care Medicine, síndrome de dificultad respiratoria aguda, law.invention, Prone position, 0302 clinical medicine, law, Continuous positive airway pressure, Respiratory Distress Syndrome, Continuous Positive Airway Pressure, helmet, ARF, insuficiencia respiratoria aguda, Intensive care unit, Intensive Care Units, SDRA, Dexmedetomidina, Casco, COVID-19, CPAP, Dexmedetomidine, NIV, Pandemic, Pronation, SARS-COV-2, Anesthesia, Original Article, medicine.symptom, medicine.drug, circulatory and respiratory physiology, Respiratory rate, Sedation, pronation, Article, 03 medical and health sciences, Posición prona, medicine, casco, Humans, Wakefulness, acute respiratory failure, business.industry, posicion prona, pandemic, pandemia, 030208 emergency & critical care medicine, medicine.disease, respiratory tract diseases, Pronación, 030228 respiratory system, prone position, business
Abstract

Objective: Continuous positive airway pressure (CPAP) is an important therapeutic tool in COVID-19 acute respiratory distress syndrome (ARDS) since it improves oxygenation, reduces respiratory rate and can prevent intubation and intensive care unit (ICU) admission. CPAP during pronation has seldom been described and never during sedation. Design: Case series. Setting: High dependency unit of San Carlo University Hospital (Potenza, Italy). Patients: Eleven consecutive patients with COVID-19 ARDS. Intervention: Helmet CPAP in prone position after failing a CPAP trial in the supine position. Main variable of interest: Data collection at baseline and then after 24, 48 and 72 h of pronation. We measured PaO2/FIO2, pH, lactate, PaCO2, SpO2, respiratory rate and the status of the patients at 28-day follow up. Results: Patients were treated with helmet CPAP for a mean ± SD of 7 ± 2.7 days. Prone positioning was feasible in all patients, but in 7 of them dexmedetomidine improved comfort. PaO2/FIO2 improved from 107.5 ± 20.8 before starting pronation to 244.4 ± 106.2 after 72 h (p < .001). We also observed a significantly increase in Sp02 from 90.6 ± 2.3 to 96 ± 3.1 (p < .001) and a decrease in respiratory rate from 27.6 ± 4.3 to 20.1 ± 4.7 (p = .004). No difference was observed in PaCO2 or pH. At 28 days two patients died after ICU admission, one was discharged in the main ward after ICU admission and eight were discharged home after being successfully managed outside the ICU. Conclusions: Helmet CPAP during pronation was feasible and safe in COVID-19 ARDS managed outside the ICU and sedation with dexmedetomidine safely improved comfort. We recorded an increase in PaO2/FIO2, SpO2 and a reduction in respiratory rate.

Published
2020

33. Vasopressor Therapy in Cardiac Surgery-An Experts' Consensus Statement

Author

Erich Kilger, Uwe Schirmer, Johann Knotzer, Marit Habicher, Stephan Kettner, Andrea Székely, Lidia Lysenko, Helene Häberle, Michael Sander, Matthias Heringlake, Luca Salvi, Sascha Treskatsch, Ludhmila Abrahão Hajjar, Gianluca Paternoster, Fabio Guarracino, Jean Luc Fellahi, Amalia Rompola, Phillipe Gaudard, Perikles Giannakopoulos, Heinrich Groesdonk, University of Pisa - Università di Pisa, Justus-Liebig-University [Gießen, Germany], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Semmelweis University [Budapest], Hospital Clinico San Carlos, Hospital Clínico San Carlos, IRCCS Istituto Nazionale dei Tumori [Milano], Wroclaw Medical University [Wrocław, Pologne], Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Evangelismos Athens General Hospital, Ludwig Maximilians University of Munich, Onassis Cardiac Surgery Center [Athens] (OCSC), University of Tübingen, Ruhr University Bochum (RUB), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Hospital das Clinicas, University of Sao Paulo School of Medicine, and Helios Hospital

Subjects
Vasopressin, medicine.medical_specialty, Consensus, Vasopressins, [SDV]Life Sciences [q-bio], Hemodynamics, 030204 cardiovascular system & hematology, Norepinephrine (medication), 03 medical and health sciences, Norepinephrine, 0302 clinical medicine, 030202 anesthesiology, Medicine, Humans, Vasoconstrictor Agents, Cardiac Surgical Procedures, ComputingMilieux_MISCELLANEOUS, business.industry, Shock, medicine.disease, Pulmonary hypertension, 3. Good health, Cardiac surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Distributive shock, Anesthesia, Shock (circulatory), Vascular resistance, medicine.symptom, Cardiology and Cardiovascular Medicine, business, hormones, hormone substitutes, and hormone antagonists, medicine.drug
Abstract

Hemodynamic conditions with reduced systemic vascular resistance commonly are observed in patients undergoing cardiac surgery and may range from moderate reductions in vascular tone, as a side effect of general anesthetics, to a profound vasodilatory syndrome, often referred to as vasoplegic shock. Therapy with vasopressors is an important pillar in the treatment of these conditions. There is limited guidance on the appropriate choice of vasopressors to restore and optimize systemic vascular tone in patients undergoing cardiac surgery. A panel of experts in the field convened to develop statements and evidence-based recommendations on clinically relevant questions on the use of vasopressors in cardiac surgical patients, using a critical appraisal of the literature following the GRADE system and a modified Delphi process. The authors unanimously and strongly recommend the use of norepinephrine and/or vasopressin for restoration and maintenance of systemic perfusion pressure in cardiac surgical patients; despite that, the authors cannot recommend either of these drugs with respect to the risk of ischemic complications. The authors unanimously and strongly recommend against using dopamine for treating post-cardiac surgery vasoplegic shock and against using methylene blue for purposes other than a rescue therapy. The authors unanimously and weakly recommend that clinicians consider early addition of a second vasopressor (norepinephrine or vasopressin) if adequate vascular tone cannot be restored by a monotherapy with either norepinephrine or vasopressin and to consider using vasopressin as a first-line vasopressor or to add vasopressin to norepinephrine in cardiac surgical patients with pulmonary hypertension or right-sided heart dysfunction.

Published
2020

34. Perspectives on the Fellowship Training in Cardiac, Thoracic, and Vascular Anesthesia and Critical Care in Europe From Program Directors and Educational Leads Around Europe

Author

Gianluca Paternoster, Mohamed R. El Tahan, R. Peter Alston, Joachim Erb, Anna Flo Forner, Jan U. Schreiber, Donna Greenhalgh, Gabor Erdoes, Theofani Antoniou, Peter M. Rosseel, Bodil Steen Rasmussen, Vera von Dossow, Chirojit Mukherjee, Giovanni Landoni, Joerg Ender, Caetano Nigro Neto, Fabio Guarracino, Luis Eduardo Mendoza Vasquez, Arafat Heba, Jens Fassl, Kirstin Wilkinson, Marie-Jo Plamondon, Simon J. Howell, RS: MHeNs - R3 - Neuroscience, MUMC+: MA Anesthesiologie (9), El Tahan, M. R., Vasquez LE, M., Rp, A., Erdoes, G., Schreiber, J. U., Fassl, J., Wilkinson, K., A, F. F., von Dossow, V., Greenhalgh, D., Plamondon, M. -J., Neto C, N., Paternoster, G., Landoni, G., Erb, J. M., Guarracino, F., Mukherjee, C., Rosseel, P., Howell, S., Ender, J., Rasmussen, B. S., Heba, A., and Antoniou, T.

Subjects
Adult, Critical Care, postgraduate education, education, cardiothoracic anesthesiology, Program structure, Europe fellowship, Context (language use), Certification, 030204 cardiovascular system & hematology, anesthesia, cardiac anesthesia, program director, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, 030202 anesthesiology, Intensive care, Humans, Medicine, Fellowships and Scholarships, 610 Medicine & health, Cardiothoracic anesthesiology, Fellowship training, Accreditation, intensive care, business.industry, fellowship structure, Europe, Anesthesiology and Pain Medicine, Education, Medical, Graduate, europe fellowship, Anesthesia, Cardiology and Cardiovascular Medicine, business, Educational program, Brazil
Abstract

This article reviews fellowship training in adult cardiac, thoracic, and vascular anesthesia and critical care from the perspective of European program initiators and educational leaders in these subspecialties together with current training fellows. Currently, the European Association of Cardiothoracic Anaesthesiology (EACTA) network has 20 certified fellowship positions each year in 10 hosting centers within 7 European countries, with 2 positions outside Europe (Sao Paulo, Brazil). Since 2009, 42 fellows have completed the fellowship training. The aim of this article is to provide an overview of the rationale, requirements, and contributions of the fellows, in the context of the developmental progression of the EACTA fellowship in adult cardiac, thoracic, and vascular anesthesia and critical care from inception to present. A summary of the program structure, accreditation of host centers, requirements to join the program, teaching and assessment tools, certification, and training requirements in transesophageal electrocardiography is outlined. In addition, a description of the current state of EACTA fellowships across Europe, and a perspective for future steps and challenges to the educational program, is provided. (C) 2019 Elsevier Inc. All rights reserved.

Published
2020

35. Thoracic Anesthesia of Patients With Suspected or Confirmed 2019 Novel Coronavirus Infection: Preliminary Recommendations for Airway Management by the European Association of Cardiothoracic Anaesthesiology Thoracic Subspecialty Committee

Author

J.M.J. Mourisse, Ricard Navarro, Steffen Rex, Nandor Marczin, W. Karzai, Ahmed Salaheldeen, Gianluca Paternoster, Ben Shelley, Chirojit Mukherjee, Federico Piccioni, Vojislava Neskovic, Edmond Cohen, Tamás Végh, Mohamed R. El Tahan, Carmen Unzueta, Paolo Pelosi, Patrick Wouters, Caroline Vanpeteghem, Laszlo L Szegedi, Marc Licker, Mert Şentürk, Izumi Kawagoe, Massimiliano Sorbello, Fabio Guarracino, Johan Bence, Davud Yapici, Manuel Granell Gil, Jiménez Mj, Guido Di Gregorio, Mojca Drnovsek Globokar, Radu Stoica, and Balazs Paloczi

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Advisory Committees, coronavirus, Subspecialty, medicine.disease_cause, Cardiac Procedures, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Betacoronavirus, Anesthesiology, Pandemic, medicine, Humans, Anesthesia, Viral, Airway Management, Pandemics, Coronavirus, thoracic anesthesia, business.industry, COVID-19, Pneumonia, lung separation, personal protective equipment, Anesthesia, Cardiac Procedures, Coronavirus Infections, Europe, Pneumonia, Viral, Practice Guidelines as Topic, Anesthesiology and Pain Medicine, Cardiothoracic surgery, Infected patient, Airway management, Cardiology and Cardiovascular Medicine, business
Abstract

Contains fulltext : 225360.pdf (Publisher’s version ) (Closed access) The novel coronavirus has caused a pandemic around the world. Management of patients with suspected or confirmed coronavirus infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. The thoracic subspecialty committee of European Association of Cardiothoracic Anaesthesiology (EACTA) has conducted a survey of opinion in order to create recommendations for the anesthetic approach to these challenging patients. It should be emphasized that both the management of the infected patient with COVID-19 and the self-protection of the anesthesia team constitute a complicated challenge. The text focuses therefore on both important topics.

Published
2020

36. European Association of Cardiothoracic Anesthesiology (EACTA) Cardiothoracic and Vascular Anesthesia Fellowship Curriculum: First Edition

Author

R. Peter Alston, Dragana Unic-Stojanovic, P. Matute, Fabio Guarracino, Kirstin Wilkinson, Rajni Singh, Vera von Dossow, Simon J. Howell, Joachim Erb, Laszlo L. Szegedi, Mohamed R. El-Tahan, Manfred D. Seeberger, Jan-Uwe Schreiber, Jiménez Mj, M. Granell, Paul Diprose, Alberto Hernandez Martinez, Theofani Antoniou, Joost M.A.A. van der Maaten, Gabor Erdoes, Giovanni Landoni, Alain Vuylsteke, Andrea Székely, Nandor Marczin, Gianluca Paternoster, Philippe Gaudard, Chirojit Mukherjee, Patrick Wouters, Marc Vives, Philippe Burtin, Peter M. Rosseel, Dominique Bettex, University of Bern [Bern, Switzerland] (University Hospital Bern ), Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom., Department of Anesthesia and Pain Medicine, Maastricht UMC, Maastricht, The Netherlands, Royal Infirmary of Edinburgh, St. James's, University of Leeds, St. James's University Hospital, Leeds, United Kingdom, University Department of Fundamental and Applied Medical Sciences and Clinical Department of Anesthesiology and Perioperative Medicine, Ghent, Belgium, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy., University of Belgrade [Belgrade], Department of Anesthesia and Intensive Care, Hospital Universitari Bellvitge, Barcelona, Grupo Policlinica, Ibiza, Spain, Department of Anesthesia and Critical Care, Hospital Dr. Josep Trueta, Girona, Spain, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Department of Anesthesia, University of Basel (Unibas), Vita-Salute San Raffaele University and Center for Translational Genomics and Bioinformatics, Department of Anesthesia & Intensive Care, Helios Clinic for Cardiac Surgery, Karlsruhe, Germany., Servicio de Anestesiología y Reanimación, Hospital Clínic, University of Barcelona, Barcelona, Spain, Departments of Anesthesia and Intensive Care, University Hospital Brussels, Brussels, Belgium, Department of Anesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom., Erdoes, G., Vuylsteke, A., Schreiber, J. -U., Alston, R. P., Howell, S. J., Wouters, P. F., Guarracino, F., Unic-Stojanovic, D., Martinez, A. H., Vives, M., Gaudard, P., Burtin, P., Bettex, D., Granell, M., Szekely, A., van der Maaten, J., Antoniou, T., Jimenez, M. J., Szegedi, L., Seeberger, M., Erb, J. M., Singh, R., von Dossow, V., Matute, P., Rosseel, P., Marczin, N., Landoni, G., Wilkinson, K., Diprose, P., Mukherjee, C., Paternoster, G., El-Tahan, M. R., MUMC+: MA Anesthesiologie (9), and RS: MHeNs - R3 - Neuroscience

Subjects
medicine.medical_specialty, thoracic, cardiac, [SDV]Life Sciences [q-bio], education, Certification, 030204 cardiovascular system & hematology, anesthesia, 03 medical and health sciences, 0302 clinical medicine, vascular, Anesthesiology, 030202 anesthesiology, Health care, Anesthesia, Cardiac Procedures, Humans, Medicine, Fellowships and Scholarships, Curriculum, Cardiothoracic anesthesiology, Training period, training, business.industry, fellowship, Perioperative, Vascular surgery, 3. Good health, Anesthesiology and Pain Medicine, Anesthesia, Cardiology and Cardiovascular Medicine, business
Abstract

This special article summarizes the design and certification process of the European Association of Cardiothoracic Anesthesiology (EACTA) Cardiothoracic and Vascular Anesthesia (CTVA) Fellowship Program.The CTVA fellowship training includes a two-year curriculum at an EACTA-accredited educational facility. Before fellows are accepted into the program, they must meet a number of requirements, including evidence of a valid license to practice medicine, a specialist degree examination in anesthesiology, and appropriate language skills as required in the host centers. The CVTA Fellowship Program has 2 sequential and complementary levels of training-both with a modular structure that allows for individual planning and also takes into account the differing national healthcare needs and requirements of the 36 countries represented in EACTA. The basic training period focuses on the anesthetic management of patients undergoing cardiac, thoracic, and vascular surgery and related procedures. The advanced training period is intended to deepen and to extend the clinical and nontechnical skills that fellows have acquired during the basic training.The goal of the EACTA fellowship is to produce highly trained and competent perioperative physicians who are able to care for patients undergoing cardiac, thoracic, and vascular anesthesia. (C) 2019 Elsevier Inc. All rights reserved.

Published
2019

37. A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Increasing Mortality

Author

Francesco Corradi, Massimiliano Conte, L A Hajjar, Mario Musu, Simona Silvetti, Alberto Zangrillo, Daniela Pasero, Salvatore Sardo, Gordana Gazivoda, Luca Severi, Rosetta Lobreglio, Paolo Mura, Chiara Sartini, G Mancino, Marina Pieri, Nikola Bradic, Andrey Yavorovskiy, Chew Yin Wang, Claudia Brusasco, Alessandro Belletti, CY Yong, Juan Carlos Lopez-Delgado, Agostino Roasio, Claudio Riefolo, Maxim Novikov, Emanuela Saporito, Simona Tamà, M Baiardo Redaelli, Gabriele Alvaro, Laura Ruggeri, Savino Spadaro, Rosalba Lembo, D Di Fraja, Chengbin Wang, Luca Cabrini, Fabrizio Monaco, Hynek Riha, Carmine D. Votta, Giovanni Landoni, Vladimir N. Lomivorotov, Laura Pasin, Evgeniy V. Fominskiy, Valery Likhvantsev, Rinaldo Bellomo, Alessandro Ortalda, D Avancini, Gianluca Paternoster, Antonio Pisano, A D'Amico, Sartini, Chiara, Lomivorotov, Vladimir, Pisano, Antonio, Riha, Hynek, Baiardo Redaelli, Martina, Lopez-Delgado, Juan Carlo, Pieri, Marina, Hajjar, Ludhmila, Fominskiy, Evgeny, Likhvantsev, Valery, Cabrini, Luca, Bradic, Nikola, Avancini, Daniele, Wang, Chew Yin, Lembo, Rosalba, Novikov, Maxim, Paternoster, Gianluca, Gazivoda, Gordana, Alvaro, Gabriele, Roasio, Agostino, Wang, Chengbin, Severi, Luca, Pasin, Laura, Mura, Paolo, Musu, Mario, Silvetti, Simona, Votta, Carmine Domenico, Belletti, Alessandro, Corradi, Francesco, Brusasco, Claudia, Tamà, Simona, Ruggeri, Laura, Yong, Chow-Yen, Pasero, Daniela, Mancino, Giuseppe, Spadaro, Savino, Conte, Massimiliano, Lobreglio, Rosetta, Di Fraja, Diana, Saporito, Emanuela, D'Amico, Alessandro, Sardo, Salvatore, Ortalda, Alessandro, Yavorovskiy, Andrey, Riefolo, Claudio, Monaco, Fabrizio, Bellomo, Rinaldo, Zangrillo, Alberto, and Landoni, Giovanni

Subjects
medicine.medical_specialty, Critical Care, consensus conference, critically ill, Critical Illness, Psychological intervention, anesthesia, Perioperative Care, law.invention, NO, Care setting, Randomized controlled trial, law, Physicians, Surveys and Questionnaires, medicine, Humans, perioperative, Cardiac Surgical Procedures, Mortality, Intensive care medicine, Web based survey, democracy-based medicine, Randomized Controlled Trials as Topic, mortality, Internet, anesthesia, consensus conference, critically ill, democracy-based medicine, mortality, perioperative, business.industry, Perioperative, Anesthesiology and Pain Medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Objective: Reducing mortality is a key target in critical care and perioperative medicine. The authors aimed to identify all nonsurgical interventions (drugs, techniques, strategies) shown by randomized trials to increase mortality in these clinical settings. Design: A systematic review of the literature followed by a consensus-based voting process. Setting: A web-based international consensus conference. Participants: Two hundred fifty-one physicians from 46 countries. Interventions: The authors performed a systematic literature search and identified all randomized controlled trials (RCTs) showing a significant increase in unadjusted landmark mortality among surgical or critically ill patients. The authors reviewed such studies during a meeting by a core group of experts. Studies selected after such review advanced to web-based voting by clinicians in relation to agreement, clinical practice, and willingness to include each intervention in international guidelines. Measurements and main results: The authors selected 12 RCTs dealing with 12 interventions increasing mortality: diaspirin-crosslinked hemoglobin (92% of agreement among web voters), overfeeding, nitric oxide synthase inhibitor in septic shock, human growth hormone, thyroxin in acute kidney injury, intravenous salbutamol in acute respiratory distress syndrome, plasma- derived protein C concentrate, aprotinin in high-risk cardiac surgery, cysteine prodrug, hypothermia in meningitis, methylprednisolone in traumatic brain injury, and albumin in traumatic brain injury (72% of agreement). Overall, a high consistency (ranging from 80% to 90%) between agreement and clinical practice was observed. Conclusion: The authors identified 12 clinical interventions showing increased mortality supported by randomized controlled trials with nonconflicting evidence, and wide agreement upon clinicians on a global scale.

Published
2019

38. A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality

Author

Francesco Corradi, Valery Likhvantsev, Maxim Novikov, Alessandro Belletti, Agostino Roasio, Giovanni Landoni, Massimiliano Conte, Nikola Bradic, Vladimir V. Lomivorotov, Alessandro D'Amico, Juan Carlos Lopez-Delgado, Luca Severi, Mario Musu, Claudio Riefolo, Antonio Pisano, Diana Di Fraja, Gabriele Alvaro, Simona Tamà, Savino Spadaro, Salvatore Sardo, Ludhmila Abrahão Hajjar, Daniele Avancini, Simona Silvetti, Martina Baiardo Redaelli, Gianluca Paternoster, Chengbin Wang, Luca Cabrini, Andrey Yavorovskiy, Chew Yin Wang, Claudia Brusasco, Evgeny Fominskiy, Chow-Yen Yong, Daniela Pasero, Rinaldo Bellomo, Gordana Gazivoda, Hynek Riha, Rosetta Lobreglio, Alessandro Ortalda, Fabrizio Monaco, Carmine D. Votta, Laura Ruggeri, Rosalba Lembo, Laura Pasin, Chiara Sartini, Alberto Zangrillo, Paolo Mura, Emanuela Saporito, Giuseppe Mancino, Marina Pieri, Sartini, Chiara, Lomivorotov, Vladimir, Pieri, Marina, Delgado, Juan Carlos Lopez, Baiardo Redaelli, Martina, Hajjar, Ludhmila, Pisano, Antonio, Likhvantsev, Valery, Fominskiy, Evgeny, Bradic, Nikola, Cabrini, Luca, Novikov, Maxim, Avancini, Daniele, Riha, Hynek, Lembo, Rosalba, Gazivoda, Gordana, Paternoster, Gianluca, Wang, Chengbin, Tamà, Simona, Alvaro, Gabriele, Wang, Chew Yin, Roasio, Agostino, Ruggeri, Laura, Yong, Chow-Yen, Pasero, Daniela, Severi, Luca, Pasin, Laura, Mancino, Giuseppe, Mura, Paolo, Musu, Mario, Spadaro, Savino, Conte, Massimiliano, Lobreglio, Rosetta, Silvetti, Simona, Votta, Carmine Domenico, Belletti, Alessandro, Di Fraja, Diana, Corradi, Francesco, Brusasco, Claudia, Saporito, Emanuela, D'Amico, Alessandro, Sardo, Salvatore, Ortalda, Alessandro, Riefolo, Claudio, Fabrizio, Monaco, Zangrillo, Alberto, Bellomo, Rinaldo, and Landoni, Giovanni

Subjects
medicine.medical_specialty, Critical Care, consensus conference, Critical Illness, critically ill, Psychological intervention, Specialty, 030204 cardiovascular system & hematology, anesthesia, survival, law.invention, NO, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, law, Physicians, Surveys and Questionnaires, Intensive care, Anesthesiology, Humans, Medicine, perioperative, Intensive care medicine, Randomized Controlled Trials as Topic, democracy-based medicine, intensive care, Internet, anesthesia, consensus conference, critically ill, democracy-based medicine, intensive care, mortality, perioperative, survival, business.industry, mortality, Perioperative, Intensive care unit, Clinical trial, Intensive Care Units, Anesthesiology and Pain Medicine, Cardiology and Cardiovascular Medicine, business
Abstract

The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians' opinions and routine practices to understand the clinicians' response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement ≥67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to "do you agree" and "do you use") showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location.

Published
2019

39. History and Pioneers of Cardiac Anesthesia in Italy

Author

Giovanni Landoni, Gianluca Paternoster, Landoni, G., and Paternoster, G.

Subjects
medicine.medical_specialty, Cardiology, pioneers, 030204 cardiovascular system & hematology, anesthesia, Subspecialty, History, 21st Century, cardiac anesthesia, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, 030202 anesthesiology, Intensive care, Anesthesia, Cardiac Procedures, medicine, Humans, Italian anesthesia, intensive care, Health professionals, business.industry, General surgery, Extracorporeal circulation, History, 20th Century, humanities, Cardiac Anesthesia, Cardiac surgery, Anesthesiology and Pain Medicine, Italy, history, Cardiology and Cardiovascular Medicine, business, cardiac surgery
Abstract

The first use of extracorporeal circulation in Italy occurred in 1951 in Turin. In the 1960s only 12 heart surgery centers were using extracorporeal circulation to treat patients, and health professionals had to complete their training abroad. During the last 50 years, Italian cardiac anesthesia has become a branch of major importance, and it has experienced a constantly growing number of active centers and professionals. Today, about 50,000 cardiac surgeries are performed every year in approximately 100 centers. Many results have been achieved during this period, thanks to the contribution of several pioneers. In this article, the history of Italian cardiac anesthesia and the role of Italian anesthesiologists in the development of this subspecialty in Italy and Europe are reviewed.

Published
2019

40. Sepsis After Cardiac Surgery: From Pathophysiology to Management

Author

Gianluca Paternoster and Fabio Guarracino

Subjects
medicine.medical_specialty, business.industry, Septic shock, MEDLINE, 030208 emergency & critical care medicine, 030204 cardiovascular system & hematology, medicine.disease, Pathophysiology, Cardiac surgery, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Fluid therapy, medicine, Fluid Therapy, Humans, Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine, Intensive care medicine, business, Biomarkers
Published
2016

41. Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac Surgery: An Updated Consensus Process

Author

Miriam Labonia, Rosalba Lembo, Cristiano Amarelli, Giuseppe Bono, Remo Daniel Covello, Nora Di Tomasso, Daniela Pasero, Hynek Riha, Anna Mara Scandroglio, Claudio Riefolo, Nesrin Ahu Aslan, Carlo Leggieri, Rosetta Lobreglio, Giovanni Landoni, Valery V. Likhvantsev, Vladimir V. Lomivorotov, Gabriele Alvaro, Ludmilla Abrahao Hajjar, Alberto Zangrillo, Chiara Sartini, Martina Baiardo Redaelli, Massimo Baiocchi, Fabrizio Monaco, Giacomo Monti, Carmine D. Votta, Valentina Camarda, Paolo Mura, Evgeny Fominskiy, Alessandro Putzu, Emanuela Saporito, Antonio Pisano, Gianluca Paternoster, Rinaldo Bellomo, Simona Silvetti, Luca Brazzi, Giovanni Affronti, Stefano Turi, Agostino Roasio, Andrea Székely, Jun Ma, Caetano Nigro Neto, Landoni, Giovanni, Lomivorotov, Vladimir, Silvietti, Simona, Nigro Neto, Caetano, Pisano, Antonio, Alvaro, Gabriele, Hajjar, Ludmilla Abrahao, Paternoster, Gianluca, Riha, Hynek, Monaco, Fabrizio, Szekely, Andrea, Lembo, Rosalba, Aslan, Nesrin A., Affronti, Giovanni, Likhvantsev, Valery, Amarelli, Cristiano, Fominskiy, Evgeny, Baiardo Redaelli, Martina, Putzu, Alessandro, Baiocchi, Massimo, Ma, Jun, Bono, Giuseppe, Camarda, Valentina, Covello, Remo Daniel, Di Tomasso, Nora, Labonia, Miriam, Leggieri, Carlo, Lobreglio, Rosetta, Monti, Giacomo, Mura, Paolo, Scandroglio, Anna Mara, Pasero, Daniela, Turi, Stefano, Roasio, Agostino, Votta, Carmine D., Saporito, Emanuela, Riefolo, Claudio, Sartini, Chiara, Brazzi, Luca, Bellomo, Rinaldo, and Zangrillo, Alberto

Subjects
medicine.medical_specialty, Consensus, Cardiac Surgery, Consensus Development Conferences as Topic, Psychological intervention, MEDLINE, Consensu, Review, 030204 cardiovascular system & hematology, Perioperative Care, law.invention, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Anesthesiology, Intensive care, medicine, Humans, 030212 general & internal medicine, Perioperative, Cardiac Surgical Procedures, Mortality, Intensive care medicine, cardiac surgery, consensus, mortality, mortality reduction, perioperative, review, Cardiology and Cardiovascular Medicine, Anesthesiology and Pain Medicine, Randomized Controlled Trials as Topic, Internet, business.industry, Congresses as Topic, Cardiac surgery, Mortality reduction, Bypass surgery, TERAPÊUTICA MÉDICA, business, Mortality Reduction
Abstract

Objective: A careful choice of perioperative care strategies is pivotal to improve survival in cardiac surgery. However, there is no general agreement or particular attention to which nonsurgical interventions can reduce mortality in this setting. The authors sought to address this issue with a consensus-based approach. Design: A systematic review of the literature followed by a consensus-based voting process. Setting: A web-based international consensus conference. Participants: More than 400 physicians from 52 countries participated in this web-based consensus conference. Interventions: The authors identified all studies published in peer-reviewed journals that reported on interventions with a statistically significant effect on mortality in the setting of cardiac surgery through a systematic Medline/PubMed search and contacts with experts. These studies were discussed during a consensus meeting and those considered eligible for inclusion in this study were voted on by clinicians worldwide. Measurements and Main Results: Eleven interventions finally were selected: 10 were shown to reduce mortality (aspirin, glycemic control, high-volume surgeons, prophylactic intra-aortic balloon pump, levosimendan, leuko-depleted red blood cells transfusion, noninvasive ventilation, tranexamic acid, vacuum-assisted closure, and volatile agents), whereas 1 (aprotinin) increased mortality. A significant difference in the percentages of agreement among different countries and a variable gap between agreement and clinical practice were found for most of the interventions. Conclusions: This updated consensus process identified 11 nonsurgical interventions with possible survival implications for patients undergoing cardiac surgery. This list of interventions may help cardiac anesthesiologists and intensivists worldwide in their daily clinical practice and can contribute to direct future research in the field. Orion Pharma ; Abbott Laboratories ; Pall ; Tenax

Published
2018

42. Effect of Levosimendan on Renal Outcome in Cardiac Surgery Patients With Chronic Kidney Disease and Perioperative Cardiovascular Dysfunction: A Substudy of a Multicenter Randomized Trial

Author

Rosalba Lembo, Evgeny Grigoryev, Anna Mara Scandroglio, Vladimir A. Boboshko, Gabriele Alvaro, Marco Comis, Fabrizio Monaco, Antonio Pisano, Fabio Guarracino, Alessandro Belletti, Alberto Zangrillo, Gianluca Paternoster, Valery V. Likhvantsev, Vladimir V. Lomivorotov, Maria Grazia Calabrò, Vadim Pasyuga, Paolo Navalesi, Luca Brazzi, Samuele Frassoni, Tiziana Bove, Zangrillo, A, Alvaro, G, Belletti, A, Pisano, A, Brazzi, L, Calabro, M, Guarracino, F, Bove, T, Grigoryev, E, Monaco, F, Boboshko, V, Likhvantsev, V, Scandroglio, A, Paternoster, G, Lembo, R, Frassoni, S, Comis, M, Pasyuga, V, Navalesi, P, Lomivorotov, V, Zangrillo, Alberto, Alvaro, Gabriele, Belletti, Alessandro, Pisano, Antonio, Brazzi, Luca, Calabrò, Maria G., Guarracino, Fabio, Bove, Tiziana, Grigoryev, Evgeny V., Monaco, Fabrizio, Boboshko, Vladimir A., Likhvantsev, Valery V., Scandroglio, Anna M., Paternoster, Gianluca, Lembo, Rosalba, Frassoni, Samuele, Comis, Marco, Pasyuga, Vadim V., Navalesi, Paolo, and Lomivorotov, Vladimir V.

Subjects
Male, Heart Valve Diseases, inotropes, 030204 cardiovascular system & hematology, Russia, Postoperative Complications, 0302 clinical medicine, Cardiac Surgical Procedure, low cardiac output syndrome, education.field_of_study, Incidence, Acute kidney injury, Middle Aged, hemodynamic support, Cardiac surgery, Heart Valve Disease, Treatment Outcome, Italy, acute kidney injury, Anesthesia, Mitral Valve, inotrope, Female, Cardiology and Cardiovascular Medicine, Brazil, cardiac surgery, Glomerular Filtration Rate, Human, medicine.drug, medicine.medical_specialty, Cardiotonic Agents, Population, Placebo, 03 medical and health sciences, levosimendan, Double-Blind Method, Intensive care, medicine, Humans, Cardiotonic Agent, Cardiac Surgical Procedures, Renal Insufficiency, Chronic, Perioperative Period, education, Simendan, Aged, Dose-Response Relationship, Drug, business.industry, 030208 emergency & critical care medicine, Levosimendan, Perioperative, medicine.disease, chronic kidney disease, mitral valve surgery, Anesthesiology and Pain Medicine, Postoperative Complication, business, Kidney disease
Abstract

Objective: Acute kidney injury (AKI) occurs frequently after cardiac surgery. Levosimendan might reduce the incidence of AKI in patients undergoing cardiac surgery. The authors investigated whether levosimendan administration could reduce AKI incidence in a high-risk cardiac surgical population. Design: Post hoc analysis of a multicenter randomized trial. Setting: Cardiac surgery operating rooms and intensive care units of 14 centers in 3 countries. Participants: The study comprised 90 patients who underwent mitral valve surgery with an estimated glomerular filtration rate

Published
2018

43. Experienced use of dexmedetomidine in the intensive care unit: A report of a structured consensus

Author

Giorgio Deste, Massimo Girardis, Marco Moltrasio, Paolo Feltracco, Fabio Sangalli, Patrizia Murrino, Elisabetta Auci, Daniela Pasero, Ilaria Blangetti, Gianluca Paternoster, Flavia Petrini, Massimo Baiocchi, Sergio Cattaneo, Luigi Tritapepe, Ester Forastiere, Maria Giovanna De Cristofaro, and Francesco Forfori

Subjects
medicine.medical_specialty, medicine.drug_class, Sedation, law.invention, Analgesia, Critically ill patients, Delirium, Intensive care, 03 medical and health sciences, 0302 clinical medicine, law, medicine, In patient, 030212 general & internal medicine, Dexmedetomidine, Intensive care medicine, business.industry, 030208 emergency & critical care medicine, Cognition, Intensive care unit, Anesthesiology and Pain Medicine, Sedative, Emergency Medicine, Original Article, analgesia, critically ill patients, delirium, intensive care, sedation, emergency medicine, anesthesiology and pain medicine, medicine.symptom, business, hormones, hormone substitutes, and hormone antagonists, medicine.drug
Abstract

Objective Management of pain, agitation and delirium (PAD) remains to be a true challenge in critically ill patients. The pharmacological proprieties of dexmedetomidine (DEX) make it an ideal candidate drug for light and cooperative sedation, but many practical questions remain unanswered. This structured consensus from 17 intensivists well experienced on PAD management and DEX use provides indications for the appropriate use of DEX in clinical practice. Methods A modified RAND/UCLA appropriateness method was used. In four predefined patient populations, the clinical scenarios do not properly cope by the current recommended pharmacological strategies (except DEX), and the possible advantages of DEX use were identified and voted for agreement, after reviewing literature data. Results Three scenarios in medical patients, five scenarios in patients with acute respiratory failure undergoing non-invasive ventilation, three scenarios in patients with cardiac surgery in the early postoperative period and three scenarios in patients with overt delirium were identified as challenging with the current PAD strategies. In these scenarios, the use of DEX was voted as potentially useful by most of the panellists owing to its specific pharmacological characteristics, such as conservation of cognitive function, lack of effects on the respiratory drive, low induction of delirium and analgesia effects. Conclusion DEX might be considered as a first-line sedative in different scenarios even though conclusive data on its benefits are still lacking.

Published
2018

44. Different strategies for mechanical VENTilation during CardioPulmonary Bypass (CPBVENT 2014): study protocol for a randomized controlled trial

Author

Sabino Scolletta, Stefano Romagnoli, Roberta Meroni, E Maglioni, Vincenzo Pota, Marcello Guarnieri, Cinzia Trumello, Antonio Scognamiglio, Ottavio Alfieri, Alessandro Maria Budillon, Alberto Zangrillo, Francesco Saglietti, Gianluca Paternoster, Stefano De Paulis, Elena Bignami, Bignami, Elena, Guarnieri, Marcello, Saglietti, Francesco, Maglioni, Enivarco Massimo, Scolletta, Sabino, Romagnoli, Stefano, De Paulis, Stefano, Paternoster, Gianluca, Trumello, Cinzia, Meroni, Roberta, Scognamiglio, Antonio, Budillon, Alessandro Maria, Pota, Vincenzo, Zangrillo, Alberto, Alfieri, Ottavio, Bignami, E., Guarnieri, M., Saglietti, F., Maglioni, E. M., Scolletta, S., Romagnoli, S., De Paulis, S., Paternoster, G., Trumello, C., Meroni, R., Scognamiglio, A., Budillon, A. M., Pota, V., Zangrillo, A., and Alfieri, O.

Subjects
Time Factors, medicine.medical_treatment, Medicine (miscellaneous), 030204 cardiovascular system & hematology, law.invention, Pulmonary function testing, Study Protocol, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, Clinical Protocols, law, Risk Factors, Clinical endpoint, Cardiac Surgical Procedure, Pharmacology (medical), Single-Blind Method, Continuous positive airway pressure, Lung, lcsh:R5-920, Cardiopulmonary Bypass, Postoperative pulmonary complications, Cardiopulmonary bypass, CPAP, Low tidal volume, Protective ventilation, Respiratory insufficiency, Systemic inflammatory response, Intensive care unit, Cardiac surgery, Treatment Outcome, Italy, Research Design, Anesthesia, lcsh:Medicine (General), Human, medicine.medical_specialty, Time Factor, Cardiopulmonary bypa, 03 medical and health sciences, medicine, Humans, Cardiac Surgical Procedures, Clinical Protocol, Mechanical ventilation, Respiratory Mechanic, business.industry, Risk Factor, Respiration, Artificial, 030228 respiratory system, Respiratory Mechanics, Postoperative Complication, business, Postoperative pulmonary complication
Abstract

Background There is no consensus on which lung-protective strategies should be used in cardiac surgery patients. Sparse and small randomized clinical and animal trials suggest that maintaining mechanical ventilation during cardiopulmonary bypass is protective on the lungs. Unfortunately, such evidence is weak as it comes from surrogate and minor clinical endpoints mainly limited to elective coronary surgery. According to the available data in the academic literature, an unquestionable standardized strategy of lung protection during cardiopulmonary bypass cannot be recommended. The purpose of the CPBVENT study is to investigate the effectiveness of different strategies of mechanical ventilation during cardiopulmonary bypass on postoperative pulmonary function and complications. Methods/design The CPBVENT study is a single-blind, multicenter, randomized controlled trial. We are going to enroll 870 patients undergoing elective cardiac surgery with planned use of cardiopulmonary bypass. Patients will be randomized into three groups: (1) no mechanical ventilation during cardiopulmonary bypass, (2) continuous positive airway pressure of 5 cmH2O during cardiopulmonary bypass, (3) respiratory rate of 5 acts/min with a tidal volume of 2–3 ml/Kg of ideal body weight and positive end-expiratory pressure of 3–5 cmH2O during cardiopulmonary bypass. The primary endpoint will be the incidence of a PaO2/FiO2 ratio

Published
2017

45. Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Author

Caetano Nigro Neto, Luigi Verniero, Marta Mucchetti, Massimiliano Paltenghi, Gordana Gazivoda, Fabrizio Monaco, Nicola Latronico, Alberto Zangrillo, Antonella Vezzani, Vladimir V. Lomivorotov, Paolo Mura, Rosetta Lobreglio, Laura Ruggeri, Francesco Santini, Rosalba Lembo, Rinaldo Bellomo, Marco Ganzaroli, Eugenio Garofalo, Adele Conte, Daniele Marianello, Gabriele Finco, Andrea Székely, Mario Musu, Desiderio Piras, Valentina Tarzia, Evgeny Fominskiy, Giovanni Landoni, Ludhmila Abrahão Hajjar, Claudio Riefolo, Marco Comis, Martina Baiardo Redaelli, Gianluca Paternoster, Antonio Pisano, Laura Pasin, Massimiliano Conte, Gabriele Alvaro, Giuseppe Buscaglia, Erika Dal Checco, Giovanni De Vuono, Vadim Pasyuga, Giovanni Pala, Maria Luisa Azzolini, Alessandro Belletti, Agostino Roasio, Francesco Corradi, Alberto Castella, Landoni, Giovanni, Pisano, A, Lomivorotov, V, Alvaro, G, Hajjar, L, Paternoster, G, Nigro Neto, C, Latronico, N, Fominskiy, E, Pasin, L, Finco, G, Lobreglio, R, Azzolini, Ml, Buscaglia, G, Castella, A, Comis, M, Conte, A, Conte, M, Corradi, F, Checco, Ed, De Vuono, G, Ganzaroli, M, Garofalo, E, Gazivoda, G, Lembo, R, Marianello, D, Baiardo Redaelli, M, Monaco, F, Tarzia, V, Mucchetti, M, Belletti, A, Mura, P, Musu, M, Pala, G, Paltenghi, M, Pasyuga, V, Piras, D, Riefolo, C, Roasio, A, Ruggeri, L, Santini, F, Székely, A, Verniero, L, Vezzani, A, Zangrillo, Alberto, and Bellomo, R.

Subjects
medicine.medical_specialty, Consensus, perioperative care, Selective decontamination, anesthesia, consensus, intensive care, mortality, Congresses as Topic, Humans, Perioperative Care, Postoperative Complications, Randomized Controlled Trials as Topic, Cardiology and Cardiovascular Medicine, Anesthesiology and Pain Medicine, Psychological intervention, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Intensive care, medicine, Intensive care medicine, Glycemic, business.industry, Perioperative, Levosimendan, Surgical procedures, business, Tranexamic acid, medicine.drug
Abstract

Objective Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality. Design and Setting A web-based international consensus conference. Participants The study comprised 500 clinicians from 61 countries. Interventions A systematic literature search was performed to identify published literature about nonsurgical interventions, supported by randomized evidence, showing a statistically significant impact on mortality. A consensus conference of experts discussed eligible papers. The interventions identified by the conference then were submitted to colleagues worldwide through a web-based survey. Measurements and Main Results The authors identified 11 interventions contributing to increased survival (perioperative hemodynamic optimization, neuraxial anesthesia, noninvasive ventilation, tranexamic acid, selective decontamination of the gastrointestinal tract, insulin for tight glycemic control, preoperative intra-aortic balloon pump, leuko-depleted red blood cells transfusion, levosimendan, volatile agents, and remote ischemic preconditioning) and 2 interventions showing increased mortality (beta-blocker therapy and aprotinin). Interventions then were voted on by participating clinicians. Percentages of agreement among clinicians in different countries differed significantly for 6 interventions, and a variable gap between evidence and clinical practice was noted. Conclusions The authors identified 13 nonsurgical interventions that may decrease or increase perioperative mortality, with variable agreement by clinicians. Such interventions may be optimal candidates for investigation in high-quality trials and discussion in international guidelines to reduce perioperative mortality.

Published
2017

46. Association between Endotoxin Activity and Acute Kidney Injury in Cardiac Patients Undergoing Cardiopulmonary Bypass

Author

Gianni Rubino, Gianluca Paternoster, Antonio Balducci, Nicola Brienza, and Rosmunda Maiorano

Subjects
Male, medicine.medical_specialty, law.invention, chemistry.chemical_compound, law, Internal medicine, Cardiopulmonary bypass, Humans, Medicine, Aged, Creatinine, Cardiopulmonary Bypass, business.industry, Endotoxin activity, Organ dysfunction, Acute kidney injury, Thoracic Surgery, Hematology, General Medicine, Acute Kidney Injury, Middle Aged, medicine.disease, Cardiac surgery, Endotoxins, surgical procedures, operative, chemistry, Nephrology, Cardiothoracic surgery, Anesthesia, Cardiology, Female, Creatinine blood, medicine.symptom, business, circulatory and respiratory physiology
Abstract

Background/Aims: Cardiopulmonary bypass (CPB) has been thought to promote endotoxin translocation from the gut. Increased endotoxin activity (EA) has been related to a worsening of organ dysfunction, particularly acute kidney injury (AKI). This study aims to determine if CPB could influence EA after cardiac surgery, and if EA variations are associated with renal dysfunction following CPB. Methods: This was an observational study of patients subjected to complex cardiac surgery, likely to last for >120 min. Blood samples were obtained before, during and after CPB for EA analysis. AKI occurrence defined by the Acute Kidney Injury Network criteria was evaluated. Results: Eighteen patients were enrolled. EA significantly increased after 12 h following CPB. Variations of EA from baseline were significantly associated with variations of creatinine, i.e. AKI. Conclusion: Complex cardiac surgery requiring long CPB promotes EA increases that could be associated with variations of serum creatinine and AKI occurrence.

Published
2014

47. Levosimendan

Author

Massimiliano Greco, Gianluca Paternoster, and Daniela Mamo

Published
2016

48. Reducing Mortality in Acute Kidney Injury Patients: Systematic Review and International Web-Based Survey

Author

Giovanni, Landoni, Tiziana, Bove, Andrea, Székely, Marco, Comis, Reitze N, Rodseth, Daniela, Pasero, Martin, Ponschab, Marta, Mucchetti, Maria L, Azzolini, Fabio, Caramelli, Gianluca, Paternoster, Giovanni, Pala, Luca, Cabrini, Daniele, Amitrano, Giovanni, Borghi, Antonella, Capasso, Claudia, Cariello, Anna, Carpanese, Paolo, Feltracco, Leonardo, Gottin, Rosetta, Lobreglio, Lorenzo, Mattioli, Fabrizio, Monaco, Francesco, Morgese, Mario, Musu, Laura, Pasin, Antonio, Pisano, Agostino, Roasio, Gianluca, Russo, Giorgio, Slaviero, Nicola, Villari, Annalisa, Vittorio, Mariachiara, Zucchetti, Fabio, Guarracino, Andrea, Morelli, Vincenzo, De Santis, Paolo A, Del Sarto, Antonio, Corcione, Marco, Ranieri, Gabriele, Finco, Alberto, Zangrillo, Rinaldo, Bellomo, Landoni, G., Bove, T., Székely, A., Comis, M., Rodseth, R.N., Pasero, D., Ponschab, M., Mucchetti, M., Azzolini, M.L., Caramelli, F., Paternoster, G., Pala, G., Cabrini, L., Amitrano, D., Borghi, G., Capasso, A., Cariello, C., Carpanese, A., Feltracco, P., Gottin, L., Lobreglio, R., Mattioli, L., Monaco, F., Morgese, F., Musu, M., Pasin, L., Pisano, A., Roasio, A., Russo, G., Slaviero, G., Villari, N., Vittorio, A., Zucchetti, M., Guarracino, F., Morelli, A., De Santis, V., Del Sarto, P.A., Corcione, A., Ranieri, M., Finco, G., Zangrillo, A., Bellomo, R., Landoni, G, Bove, T, Székely, A, Comis, M, Rodseth, Rn, Pasero, D, Ponschab, M, Mucchetti, M, Azzolini, Ml, Caramelli, F, Paternoster, G, Pala, G, Cabrini, L, Amitrano, D, Borghi, G, Capasso, A, Cariello, C, Carpanese, A, Feltracco, P, Gottin, L, Lobreglio, R, Mattioli, L, Monaco, F, Morgese, F, Musu, M, Pasin, L, Pisano, A, Roasio, A, Russo, G, Slaviero, G, Villari, N, Vittorio, A, Zucchetti, M, Guarracino, F, Morelli, A, De Santis, V, Del Sarto, Pa, Corcione, A, Ranieri, M, Finco, G, Zangrillo, A, and Bellomo, R

Subjects
renal failure, short term survival, patient monitoring, medicine.medical_treatment, health care survey, acute renal injury, hetastarch, bacterial peritoniti, Comorbidity, hemodynamic monitoring, health belief, law.invention, hemofiltration, contrast induced nephropathy, burn patient, law, consensu, burn, web vote, angiography, randomized controlled trial (topic), hepatorenal syndrome, physician, continuous hemodiafiltration, article, Acute kidney injury, Acute Kidney Injury, continuous infusion, Intensive care unit, human immunoglobulin, clinical practice, vasopressin, acute kidney failure, multiple myeloma, perioperative hemodynamic optimization, priority journal, human albumin, meta analysis (topic), nadroparin, multicenter study (topic), sepsi, Cardiology and Cardiovascular Medicine, renal replacement therapy, Reducing mortality in acute kidney injury patients: systematic review and international web-based surve, radiation injury, Human, medicine.drug, medicine.medical_specialty, consensus conference, Contrast-induced nephropathy, self report, anesthesia, survival, Perioperative Care, acute kidney failure, acute renal injury, anesthesia, consensus, consensus conference, critical care, mortality, renal failure, survival, web vote, terlipressin, critically ill patient, acute kidney failure, Monitoring, Intraoperative, acetylcysteine, Hemofiltration, medicine, Humans, systematic review, acute kidney failure, fenoldopam, furosemide, Hemodynamic, Renal replacement therapy, Intensive care medicine, plasmapheresi, Internet, continuous hemofiltration, liver cirrhosi, Septic shock, business.industry, hepatorenal syndrome type 1, Hemodynamics, Perioperative, citric acid, bleeding, medicine.disease, mortality, web vote, Acute Kidney Injury, fluid balance, heart surgery, drug efficacy, critical care, early intervention, Anesthesiology and Pain Medicine, hemodialysi, consensus, Health Care Surveys, septic shock, Terlipressin, business, periangiography hemofiltration
Abstract

"OBJECTIVE: To identify all interventions that increase or reduce mortality in patients with acute kidney injury (AKI) and to establish the agreement between stated beliefs and actual practice in this setting.. . DESIGN AND SETTING: Systematic literature review and international web-based survey.. . PARTICIPANTS: More than 300 physicians from 62 countries.. . INTERVENTIONS: Several databases, including MEDLINE/PubMed, were searched with no time limits (updated February 14, 2012) to identify all the drugs/techniques/strategies that fulfilled all the following criteria: (a) published in a peer-reviewed journal, (b) dealing with critically ill adult patients with or at risk for acute kidney injury, and (c) reporting a statistically significant reduction or increase in mortality.. . MEASUREMENTS AND MAIN RESULTS: Of the 18 identified interventions, 15 reduced mortality and 3 increased mortality. Perioperative hemodynamic optimization, albumin in cirrhotic patients, terlipressin for hepatorenal syndrome type 1, human immunoglobulin, peri-angiography hemofiltration, fenoldopam, plasma exchange in multiple-myeloma-associated AKI, increased intensity of renal replacement therapy (RRT), CVVH in severely burned patients, vasopressin in septic shock, furosemide by continuous infusion, citrate in continuous RRT, N-acetylcysteine, continuous and early RRT might reduce mortality in critically ill patients with or at risk for AKI; positive fluid balance, hydroxyethyl starch and loop diuretics might increase mortality in critically ill patients with or at risk for AKI. Web-based opinion differed from consensus opinion for 30% of interventions and self-reported practice for 3 interventions.. . CONCLUSION: The authors identified all interventions with at least 1 study suggesting a significant effect on mortality in patients with or at risk of AKI and found that there is discordance between participant stated beliefs and actual practice regarding these topics.. . "

Published
2013

49. Worldwide Opinion on Multicenter Randomized Interventions Showing Mortality Reduction in Critically Ill Patients: A Democracy-Based Medicine Approach

Author

Fabio Guarracino, Gordana Gazivoda, Fabrizio Monaco, Rosetta Lobreglio, Francesco Santini, Alberto Zangrillo, Valery V. Likhvantsev, Vladimir V. Lomivorotov, Martina Baiardo Redaelli, Jan Kunstýř, Luca Cabrini, Laura Pasin, Gabriele Alvaro, Giovanni Borghi, Rinaldo Bellomo, Nazar Bukamal, Laura Ruggeri, Massimo Zambon, Luca Lucchetta, Massimiliano Conte, Rosalba Lembo, Antonio Pisano, Alberto Castella, Simona Silvetti, Giovanni Landoni, Marta Mucchetti, Ludhmila Abrahão Hajjar, Gianluca Paternoster, Miomir Jovic, Giovanni De Vuono, Giovanni Pala, Massimiliano Greco, Jun Ma, Andrea Montisci, Gabriele Finco, Vadim Pasyuga, Marina Pieri, Marco Comis, Pisano, A, Landoni, Giovanni, Lomivorotov, V, Comis, M, Gazivoda, G, Conte, M, Hajjar, L, Finco, G, Jovic, M, Mucchetti, M, Kunstýř, J, Paternoster, G, Likhvantsev, V, Ruggeri, L, Ma, J, Alvaro, G, Bukamal, N, Borghi, G, Pasyuga, V, Cabrini, L, Greco, M, Guarracino, F, Lembo, R, Lobreglio, R, Monaco, F, Montisci, A, Pala, G, Pasin, L, Pieri, M, Santini, F, Silvetti, S, Zambon, M, Baiardo Redaelli, M, Castella, A, De Vuono, G, Lucchetta, L, Zangrillo, Alberto, and Bellomo, R.

Subjects
medicine.medical_specialty, Internationality, Critical Care, consensus conference, media_common.quotation_subject, critically ill, Critical Illness, Placebo-controlled study, MEDLINE, Psychological intervention, 030204 cardiovascular system & hematology, anesthesia, survival, law.invention, 03 medical and health sciences, intensive care, mortality, 0302 clinical medicine, Randomized controlled trial, law, Intensive care, Voting, Physicians, medicine, Humans, Multicenter Studies as Topic, 030212 general & internal medicine, Hospital Mortality, Intensive care medicine, media_common, Randomized Controlled Trials as Topic, Evidence-Based Medicine, business.industry, Evidence-based medicine, Systematic review, Anesthesiology and Pain Medicine, Family medicine, business, Cardiology and Cardiovascular Medicine
Abstract

Objectives Democracy-based medicine is a combination of evidence-based medicine (systematic review), expert assessment, and worldwide voting by physicians to express their opinions and self-reported practice via the Internet. The authors applied democracy-based medicine to key trials in critical care medicine. Design and Setting A systematic review of literature followed by web-based voting on findings of a consensus conference. Participants A total of 555 clinicians from 61 countries. Interventions The authors performed a systematic literature review (via searching MEDLINE/PubMed, Scopus, and Embase) and selected all multicenter randomized clinical trials in critical care that reported a significant effect on survival and were endorsed by expert clinicians. Then they solicited voting and self-reported practice on such evidence via an interactive Internet questionnaire. Relationships among trial sample size, design, and respondents’ agreement were investigated. The gap between agreement and use/avoidance and the influence of country origin on physicians’ approach to interventions also were investigated. Measurements and Main Results According to 24 multicenter randomized controlled trials, 15 interventions affecting mortality were identified. Wide variabilities in both the level of agreement and reported practice among different interventions and countries were found. Moreover, agreement and reported practice often did not coincide. Finally, a positive correlation among agreement, trial sample size, and number of included centers was found. On the contrary, trial design did not influence clinicians’ agreement. Conclusions Physicians’ clinical practice and agreement with the literature vary among different interventions and countries. The role of these interventions in affecting survival should be further investigated to reduce both the gap between evidence and clinical practice and transnational differences.

Published
2016

50. Can Intravenous Human Immunoglobulins Reduce Mortality in Patients with (Septic) Acute Kidney Injury?

Author

Lisa Mathiasen, Gianluca Paternoster, and Roberta Maj

Subjects
medicine.medical_specialty, Septic shock, business.industry, Acute kidney injury, medicine.disease, law.invention, Systemic inflammatory response syndrome, Clinical trial, Sepsis, Randomized controlled trial, law, medicine, Primary immunodeficiency, In patient, Intensive care medicine, business
Abstract

Acute kidney injury (AKI) is most commonly caused by sepsis and septic shock and it is associated with high mortality. Intravenous immunoglobulin (IVIG) therapy has been used for many years as replacement therapy in primary immunodeficiency disorders and has more recently been proposed to be beneficial in sepsis and septic shock. Many studies have been conducted in order to test this hypothesis. However, the results of clinical trials are conflicting and there is a high degree of heterogeneity among studies. We have reviewed the available literature, and we conclude that the current evidence to recommend IVIG therapy to reduce mortality in septic patients with AKI is limited.

Published
2016

Catalog

Books, media, physical & digital resources
See catalog results