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117 results on '"Giorgio Antonio Iotti"'

1. Airway opening pressure in an obese ARDS patient: just the start of airway recruitment

Author: Shinshu Katayama, Giorgio Antonio Iotti, and Ken Tonai
Subjects: Anesthesiology, RD78.3-87.3, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2023
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2. Combined ultrasound–CT approach to monitor acute exacerbation of interstitial lung disease

Author: Silvia Mongodi, Andrea Colombo, Anita Orlando, Lorenzo Cavagna, Bélaid Bouhemad, Giorgio Antonio Iotti, and Francesco Mojoli
Subjects: Interstitial lung disease, Lung ultrasound, High-resolution CT, ECMO, Lung monitoring, Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract: Abstract Background Lung ultrasound is a bedside non-irradiating tool for assessment and monitoring of lung diseases. A lung ultrasound score based on visualized artefacts allows reliable quantification of lung aeration, and is useful to monitor mechanical ventilation setting, fluid resuscitation and antibiotic response in critical care. In the context of interstitial lung diseases associated to connective tissue disorders, lung ultrasound has been integrated to computed tomography for diagnosis and follow-up monitoring of chronic lung disease progression. Case presentation This case describes a severe acute exacerbation of interstitial lung disease associated to dermatomyositis–polymyositis requiring prolonged extra-corporeal life support. Lung ultrasound score was performed daily and allowed monitoring and guiding both the need of advanced imaging as computed tomography and immunosuppressive therapy. Conclusions This case suggests lung ultrasound may be a useful monitoring tool for the response to immunosuppressive therapy in acute severe rheumatic interstitial lung disease, where chest X-ray is poorly informative, and transportation is at high risk.
Published: 2020
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3. Anterior cutaneous nerve block for analgesia in anterior chest trauma: is the parasternal approach necessary?

Author: Santi Di Pietro, Benedetta Mascia, Giuliano Lo Bianco, Stefano Perlini, and Giorgio Antonio Iotti
Subjects: rib fractures, sternum, nerve block, anesthesia and analgesia, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: In recent years, several techniques of regional anesthesia have been proposed to provide analgesia to the anterior thoracic cage; notably, most of these techniques require a parasternal approach. However, in this context, the potential role of a more common and well-established technique, namely the modified pectoral nerve block (known as PECS II block), has been poorly investigated. Here, we describe a case involving a patient with bilateral anterolateral multiple rib fractures associated with sternum fracture, who was successfully treated using bilateral PECS II blocks. Our experience indicates that the PECS II block can provide excellent analgesia in cases involving anterior rib and sternum fractures. Because it is easier to perform and may be safer than other parasternal techniques, the PECS II block should be considered when providing analgesia for traumatic injuries of the anterior thorax.
Published: 2020
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4. Impact of Coronavirus Disease 2019 Pandemic on Crowding: A Call to Action for Effective Solutions to 'Access Block'

Author: Gabriele Savioli, Iride Francesca Ceresa, Roberta Guarnone, Alba Muzzi, Viola Novelli, Giovanni Ricevuti, Giorgio Antonio Iotti, Maria Antonietta Bressan, and Enrico Oddone
Subjects: Medicine, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Introduction: Healthcare patterns change during disease outbreaks and pandemics. Identification of modified patterns is important for future preparedness and response. Emergency department (ED) crowding can occur because of the volume of patients waiting to be seen, which results in delays in patient assessment or treatment and impediments to leaving the ED once treatment is complete. Therefore, ED crowding has become a growing problem worldwide and represents a serious barrier to healthcare operations. Methods: This observational study was based on a retrospective review of the epidemiologic and clinical records of patients who presented to the Foundation IRCCS Policlinic San Matteo in Pavia, Italy, during the coronavirus disease 2019 (COVID-19) outbreak (February 21–May 1, 2020, pandemic group). The methods involved an estimation of the changes in epidemiologic and clinical data from the annual baseline data after the start of the COVID-19 pandemic. Results: We identified reduced ED visits (180 per day in the control period vs 96 per day in the pandemic period; P < 0.001) during the COVID-19 pandemic, irrespective of age and gender, especially for low-acuity conditions. However, patients who did present to the ED were more likely to be hemodynamically unstable, exhibit abnormal vital signs, and more frequently required high-intensity care and hospitalization. During the pandemic, ED crowding dramatically increased primarily because of an increased number of visits by patients with high-acuity conditions, changes in patient management that prolonged length of stay, and increased rates of boarding, which led to the inability of patients to gain access to appropriate hospital beds within a reasonable amount of time. During the pandemic, all crowding output indices increased, especially the rates of boarding (36% vs 57%; P < 0.001), “access block” (24% vs 47%; P < 0.001), mean boarding time (640 vs 1,150 minutes [min]; P 0.001), mean “access block” time (718 vs 1,223 min; P < 0.001), and “access block” total time (650,379 vs 1,359,172 min; P < 0.001). Conclusion: Crowding in the ED during the COVID-19 pandemic was due to the inability to access hospital beds. Therefore, solutions to this lack of access are required to prevent a recurrence of crowding due to a new viral wave or epidemic.
Published: 2021
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5. Our recommendations for acute management of COVID-19

Author: Francesco Mojoli, Silvia Mongodi, Anita Orlando, Eric Arisi, Marco Pozzi, Luca Civardi, Guido Tavazzi, Fausto Baldanti, Raffaele Bruno, Giorgio Antonio Iotti, and COVID-19 Pavia Crisis Unit
Subjects: ARDS, COVID-19, Acute respiratory failure, Lung ultrasound, Novel coronavirus, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Published: 2020
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6. Ten-year experience with standardized non-operating room anesthesia with Sevoflurane for MRI in children affected by neuropsychiatric disorders

Author: Silvia Mongodi, Gaia Ottonello, Raffaelealdo Viggiano, Paola Borrelli, Simona Orcesi, Anna Pichiecchio, Umberto Balottin, Francesco Mojoli, and Giorgio Antonio Iotti
Subjects: Non-operating room anesthesia, MRI sedation, Neuropsychiatric disorders anesthesia, Sevoflurane, NORA, Anesthesiology, RD78.3-87.3
Abstract: Abstract Background Children require anesthesia for MRI to maintain immobility and reduce discomfort; clear indications about the best anesthesiologic management are lacking and each center developed its own protocol. Moreover, children with neuropsychiatric disorders more likely require sedation and are described in literature as more prone to general and respiratory complications. Aim of this study was to analyze the applicability of a sevoflurane-based approach, to describe general and respiratory complications and to identify risk factors in a pediatric neuropsychiatric population. Methods Retrospective cohort study, university Hospital (January 2007–December 2016). All the 1469 anesthesiologic records of children addressed from Neuropsychiatric Unit to undergo MRI under general anesthesia were analyzed; 12 patients equal or older than 18-year-old were excluded. We identified post-hoc nine macro-categories: static encephalopathies, metabolic/evolutive encephalopathies, epileptic encephalopathies, neuromuscular diseases, autistic spectrum disorders, migraine, psychiatric disorders, intellectual disabilities, others. A logistic regression model for events with low frequency (Firth’s penalized likelihood approach) was carried out to identify the mutually adjusted effect among endpoints (complications) and the independent variables chosen on the basis of statistical significance (univariate analysis, p ≤ 0.05) and clinical judgment. Results Of 1457 anesthesiologic records (age 4.0 (IQR 2.0 to 7.0) year-old, males 891 (61.2%), weight 17.0 (IQR 12.0 to 24.9) kg), 18 were cancelled for high anesthesiologic risk, 50 were cooperative, 1389 were anesthetized. A sevoflurane-based anesthesia was feasible in 92.3%; these patients required significantly less mechanical ventilation (8.6 vs. 16.2%; p = 0.012). Complications’ rate was low (6.2%; 3.1% respiratory). The risk for general complications increases with ASA score > 1 (OR 2.22, 95 CI% 1.30 to 3.77, p = 0.003), male sex (OR 1.73, 95% CI 1.07 to 2.81, p = 0.025), multi-drug anesthesia (OR 2.98, 95 CI% 1.26 to 7.06, p = 0.013). For respiratory complications, it increases with ASA score > 1 (OR 2.34, 95 CI% 1.19 to 4.73, p = 0.017), autumn-winter (OR 2.01, 95 CI% 1.06 to 3.78, p = 0.030), neuromuscular disorders (OR 3.18, 95 CI% 1.20 to 8.41, p = 0.020). We had no major complications compromising patients’ outcome or requiring admission to ICU. Conclusions Sevoflurane anesthesia is feasible and safe for children affected by neuropsychiatric disorders undergoing MRI. Specific risk factors for general and respiratory complications should be considered.
Published: 2019
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7. Mild head trauma in elderly patients: experience of an emergency department

Author: Gabriele Savioli, Iride Francesca Ceresa, Luca Ciceri, Fabio Sciutti, Mirko Belliato, Giorgio Antonio Iotti, Sabino Luzzi, Mattia Del Maestro, Gianluca Mezzini, Elvis Lafe, Anna Simoncelli, Giovanni Ricevuti, Federica Manzoni, and Maria Antonietta Bressan
Subjects: Neurosurgery, Trauma, Emergency medicine, Internal medicine, Clinical research, Brain injury management, Science (General), Q1-390, Social sciences (General), H1-99
Abstract: Introduction: We evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma. The primary goal was to determine the difference in the incidence of posttraumatic intracranial hemorrhage (ICH) after minor head injury (MHI). The secondary objective was to assess worse outcome, such as: hospitalization rate, rate of re-admission, need of neurosurgery. We also assess the admission process times and length of hospital stay. The ultimate goal was to optimize the diagnostic-observational management of minor head trauma in elderly patients. Material and methods: We evaluated all patients with MHI who came to our emergency department during 2017 and 2018. All patients underwent computed tomography. Results: We enrolled 2325 patients, of whom 1094 were 75 years of age or older. The population was divided into two categories according to age: The “elderly population” was 75 or older, and the younger patients were younger than 75. The elderly population, in comparison with the younger patients, had a higher rate of ICH (12.1% versus 5.1%), a higher hospitalization rate (11.7% versus 5.5%), and a higher rate of readmission within 30 days (6.8% versus 3.2%). The elderly population also had longer admission process times (8 h, 25 min, versus 4 h, 09 min) and longer lengths of hospital stay (9 h, 41 min, versus 5 h, 29 min). Of the younger patients, 92% (versus 41% of the elderly population) did not take any drugs, 6% (versus 39%) were receiving antiplatelet therapy, 1% (versus 13%) took vitamin K antagonists, and 1% (versus 7%) took oral direct-acting anticoagulants. Logistic regression models revealed that a 1-year increase in age raised the risk of bleeding by 2% on average; this finding was statistically significant (odds ratio [OR], 1023/year, p < 0.001). The rate of ICH increased significantly after the age of 75, by 180% (OR, 2.82; p < 0.001). Conclusions: These data suggest that age is an independent risk factor for ICH, whereby the age of 75 entails a 180% increase in the risk of bleeding.
Published: 2020
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8. Development and validation of quick Acute Kidney Injury-score (q-AKI) to predict acute kidney injury at admission to a multidisciplinary intensive care unit.

Author: Fiorenza Ferrari, Mariangela Valentina Puci, Ottavia Eleonora Ferraro, Gregorio Romero-González, Faeq Husain-Syed, Lilia Rizo-Topete, Mara Senzolo, Anna Lorenzin, Eva Muraro, Antonio Baracca, Mara Serrano-Soto, Alejandra Molano Triviño, Ana Coutinho Castro, Massimo De Cal, Valentina Corradi, Alessandra Brendolan, Marta Scarpa, Maria Rosa Carta, Davide Giavarina, Raffaele Bonato, Giorgio Antonio Iotti, and Claudio Ronco
Subjects: Medicine, Science
Abstract: AKI is associated with increased risk of death, prolonged length of stay and development of de-novo chronic kidney disease. The aim of our study is the development and validation of prediction models to identify the risk of AKI in ICU patients up to 7 days. We retrospectively recruited 692 consecutive patients admitted to the ICU at San Bortolo Hospital (Vicenza, Italy) from 1 June 2016 to 31 March 2017: 455 patients were treated as the derivation group and 237 as the validation group. Candidate variables were selected based on a literature review and expert opinion. Admission eGFR< 90 ml/min /1.73 mq (OR 2.78; 95% CI 1.78-4.35; p
Published: 2019
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9. Levobupivacaine combined with dexamethasone for serratus plane block can provide long-lasting analgesia in multiple rib fractures

Author: Santi Di Pietro, Benedetta Mascia, Stefano Perlini, and Giorgio Antonio Iotti
Subjects: Serratus Plane Block, Rib fractures, Nerve blocks, Steroids in Nerve blocks, Medicine (General), R5-920
Abstract: Serratus plane block (SPB) is a technique of regional anesthesia that has recently been proposed to treat pain in rib fractures. In this context, SPB is currently performed using a variety of local anesthetics at different concentrations and dilutions, reporting a duration of pain control up to 12 hours following the procedure. To the best of our knowledge, the addition of dexamethasone to the local anesthetic for this specific regional block has never been documented. Here we report three patients that were treated for multiple rib fractures with SPB, which included combined dexamethasone and levobupivacaine. Interestingly, the obtained pain control lasted between 23 to 45 hours following the block, thus helping to minimize the opioid use in our patients.
Published: 2019
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10. Trauma Coagulopathy and Its Outcomes

Author: Gabriele Savioli, Iride Francesca Ceresa, Sarah Macedonio, Sebastiano Gerosa, Mirko Belliato, Giorgio Antonio Iotti, Sabino Luzzi, Mattia Del Maestro, Gianluca Mezzini, Alice Giotta Lucifero, Elvis Lafe, Anna Simoncelli, Federica Manzoni, Lorenzo Cobianchi, Mario Mosconi, Fabrizio Cuzzocrea, Francesco Benazzo, Giovanni Ricevuti, and Maria Antonietta Bressan
Subjects: trauma, coagulopathy, hemodynamics, trauma management, Medicine (General), R5-920
Abstract: Background and Objectives: Trauma coagulopathy begins at the moment of trauma. This study investigated whether coagulopathy upon arrival in the emergency room (ER) is correlated with increased hemotransfusion requirement, more hemodynamic instability, more severe anatomical damage, a greater need for hospitalization, and hospitalization in the intensive care unit (ICU). We also analyzed whether trauma coagulopathy is correlated with unfavorable indices, such as acidemia, lactate increase, and base excess (BE) increase. Material and Methods: We conducted a prospective, monocentric, observational study of all patients (n = 503) referred to the Department of Emergency and Acceptance, IRCCS Fondazione Policlinico San Matteo, Pavia, for major trauma from 1 January 2018 to 30 January 2019. Results: Of the 503 patients, 204 had trauma coagulopathy (group 1), whereas 299 patients (group 2) did not. Group 1 had a higher hemotransfusion rate than group 2. In group 1, 15% of patients showed hemodynamic instability compared with only 8% of group 2. The shock index (SI) distribution was worse in group 1 than in group 2. Group 1 was more often hypotensive, tachycardic, and with low oxygen saturation, and had a more severe injury severity score than group 2. In addition, 47% of group 1 had three or more body districts involved compared with 23% of group 2. The hospitalization rate was higher in group 1 than in group 2 (76% vs. 58%). The length of hospitalization was >10 days for 45% of group 1 compared with 28% of group 2. The hospitalization rate in the ICU was higher in group 1 than in group 2 (22% vs. 14.8%). The average duration of ICU hospitalization was longer in group 1 than in group 2 (12.5 vs. 9.78 days). Mortality was higher in group 1 than in group 2 (3.92% vs. 0.98%). Group 1 more often had acidemia and high lactates than group 2. Group 1 also more often had BE Conclusions: Trauma coagulopathy patients, upon arrival in the ER, have greater hemotransfusion (p = 0.016) requirements and need hospitalization (p = 0.032) more frequently than patients without trauma coagulopathy. Trauma coagulopathy seems to be more present in patients with a higher injury severity score (ISS) (p = 0.000) and a greater number of anatomical districts involved (p = 0.000). Head trauma (p = 0.000) and abdominal trauma (p = 0.057) seem related to the development of trauma coagulopathy. Males seem more exposed than females in developing trauma coagulopathy (p = 0.018). Upon arrival in the ER, the presence of tachycardia or alteration of SI and its derivatives can allow early detection of patients with trauma coagulopathy.
Published: 2020
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11. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Author: Tài, Pham, Leo, Heunk, Giacomo, Bellani, Fabiana, Madotto, Irene, Aragao, Gaëtan, Beduneau, Ewan C, Goligher, Giacomo, Grasselli, Jon Henrik, Laake, Jordi, Mancebo, Oscar, Peñuela, Lise, Piquilloud, Antonio, Pesenti, Hannah, Wunsch, Frank, van Haren, Laurent, Brochard, John G, Laffey, Abrough, Fekri, P Acharya, Subhash, Amin, Pravin, Arabi, Yaseen, Aragao, Irene, Bauer, Philippe, Beduneau, Gaëtan, Beitler, Jeremy, Berkius, Johan, Bugedo, Guillermo, Camporota, Luigi, Cerny, Vladimir, Cho, Young-Jae, Clarkson, Kevin, Estenssoro, Elisa, Goligher, Ewan, Grasselli, Giacomo, Gritsan, Alexey, Mohammadreza Hashemian, Seyed, Hermans, Greet, M Heunks, Leo, Jovanovic, Bojan, Kurahashi, Kiyoyasu, Henrik Laake, Jon, Matamis, Dimitrio, Moerer, Onnen, Molnar, Zsolt, Ozyilmaz, Ezgi, Panka, Bernardo, Papali, Alfred, Peñuelas, Óscar, Perbet, Sébastien, Piquilloud, Lise, Qiu, Haibo, Abdel Razek, Assem, Rittayamai, Nuttapol, Roldan, Rollin, Serpa Neto, Ary, Szuldrzynski, Konstanty, Talmor, Daniel, Tomescu, Dana, Van Haren, Frank, Villagomez, Asisclo, Ali Zeggwagh, Amine, Abe, Toshikazu, Aboshady, Abdelrhman, Acampo-de Jong, Melanie, Acharya, Subhash, Adderley, Jane, Adiguzel, Nalan, Kumar Agrawal, Vijay, Aguilar, Gerardo, Aguirre, Gaston, Aguirre-Bermeo, Hernan, Ahlström, Björn, Akbas, Türkay, Akker, Mustafa, Al Sadeh, Ghamdan, Alamri, Sultan, Algaba, Angela, Ali, Muneeb, Aliberti, Anna, Manuel Allegue, Jose, Alvarez, Diana, Amador, Joaquin, H Andersen, Finn, Ansari, Sharique, Apichatbutr, Yutthana, Apostolopoulou, Olympia, Arellano, Daniel, Arica, Mestanza, Arikan, Huseyin, Arinaga, Koichi, Arnal, Jean-Michel, Asano, Kengo, Asín-Corrochano, Marta, Milagrito Avalos Cabrera, Jesu, Avila Fuentes, Silvia, Aydemir, Semih, Aygencel, Gulbin, Azevedo, Luciano, Bacakoglu, Feza, Badie, Julio, Baedorf Kassis, Elia, Bai, Gabriela, Balaraj, Govindan, Ballico, Bruno, Banner-Goodspeed, Valerie, Banwarie, Preveen, Barbieri, Rosella, Baronia, Arvind, Barrett, Jonathan, Barrot, Loïc, Emilio Barrueco-Francioni, Jesu, Barry, Jeffrey, Bawangade, Harshal, Beavis, Sarah, Beck, Eduardo, Beehre, Nina, Belenguer Muncharaz, Alberto, Bellani, Giacomo, Belliato, Mirko, Bellissima, Agrippino, Beltramelli, Rodrigo, Ben Souissi, Asma, Benitez-Cano, Adela, Benlamin, Mohamed, Benslama, Abdellatif, Bento, Lui, Benvenuti, Daniela, Bernabe, Laura, Bersten, Andrew, Berta, Giacomo, Bertini, Pietro, Bertram-Ralph, Elliot, Besbes, Mohamed, Roberto Bettini, Lisandro, Beuret, Pascal, Bewley, Jeremy, Bezzi, Marco, Bhakhtiani, Lakshay, Bhandary, Rakesh, Bhowmick, Kaushik, Bihari, Shailesh, Bissett, Bernie, Blythe, David, Bocher, Simon, Boedjawan, Narain, M Bojanowski, Christine, Boni, Elisa, Boraso, Sabrina, Borelli, Massimo, Borello, Silvina, Borislavova, Margarita, J Bosma, Karen, Bottiroli, Maurizio, Boyd, Owen, Bozbay, Suha, Briva, Arturo, Brochard, Laurent, Bruel, Cédric, Bruni, Andrea, Buehner, Ulrike, Bulpa, Pierre, Burt, Karen, Buscot, Mathieu, Buttera, Stefania, Cabrera, Jorge, Caccese, Roberta, Caironi, Pietro, Canchos Gutierrez, Ivan, Canedo, Nancy, Cani, Alma, Cappellini, Iacopo, Carazo, Jesu, Pablo Cardonnet, Lui, Carpio, David, Carriedo, Demetrio, Carrillo, Ramón, Carvalho, João, Caser, Eliana, Castelli, Antonio, Castillo Quintero, Manuel, Castro, Heloisa, Catorze, Nuno, Cengiz, Melike, Cereijo, Enrique, Ceunen, Helga, Chaintoutis, Christo, Chang, Youjin, Chaparro, Gustavogcha, Chapman, Carmel, Chau, Simon, Eugenia Chavez, Cecilia, Chelazzi, Cosimo, Chelly, Jonathan, Chemouni, Frank, Chen, Kai, Chena, Ariel, Chiarandini, Paolo, Chilton, Phil, Chiumello, Davide, Chou-Lie, Yvette, Chudeau, Nicola, Cinel, Ismail, Cinnella, Gilda, Clark, Michele, Clark, Thoma, Clementi, Stefano, Coaguila, Lui, Jaspe Codecido, Alexi, Collins, Amy, Colombo, Riccardo, Conde, Juan, Consales, Guglielmo, Cook, Tim, Coppadoro, Andrea, Cornejo, Rodrigo, Cortegiani, Andrea, Coxo, Cristina, Neville Cracchiolo, Andrea, Crespo Ramirez, Mónica, Crova, Philippe, Cruz, José, Cubattoli, Lucia, Çukurova, Zafer, Curto, Francesco, Czempik, Piotr, D'Andrea, Rocco, da Silva Ramos, Fernando, Dangers, Laurence, Danguy des Déserts, Marc, Danin, Pierre-Eric, Dantas, Fabianne, Daubin, Cédric, Dawei, Wu, de Haro, Candelaria, de Jesus Montelongo, Felipe, De Mendoza, Diego, de Pablo, Raúl, De Pascale, Gennaro, De Rosa, Silvia, Decavèle, Maxen, Declercq, Pierre-Loui, Deicas, Alberto, Del Carmen Campos Moreno, María, Dellamonica, Jean, Delmas, Benjamin, Demirkiran, Oktay, Demirkiran, Hilmi, Dendane, Tarek, di Mussi, Rossella, Diakaki, Chrysi, Diaz, Anatilde, Diaz, Willy, Dikmen, Yalim, Dimoula, Aikaterini, Doble, Patricia, Doha, Nagwa, Domingos, Guilherme, Dres, Martin, Dries, David, Duggal, Abhijit, Duke, Graeme, Dunts, Pavel, Dybwik, Knut, Dykyy, Maksym, Eckert, Philippe, Efe, Serdar, Elatrous, Souheil, Elay, Gülseren, S Elmaryul, Abubaker, Elsaadany, Mohamed, Elsayed, Hany, Elsayed, Samar, Emery, Malo, Ena, Sébastien, Eng, Kevin, A Englert, Joshua, Erdogan, Elif, Ergin Ozcan, Perihan, Eroglu, Ege, Escobar, Miguel, Esen, Figen, Esen Tekeli, Arzu, Esquivel, Alejandro, Esquivel Gallegos, Helbert, Ezzouine, Hanane, Facchini, Alberto, Faheem, Mohammad, Fanelli, Vito, Fernanda Farina, Maria, Fartoukh, Muriel, Fehrle, Lutz, Feng, Feng, Feng, Yufeng, Fernandez, Irene, Fernandez, Borja, Lorena Fernandez-Rodriguez, Maria, Ferrando, Carlo, João Ferreira da Silva, Maria, Ferreruela, Mireia, Ferrier, Janet, Jesús Flamm Zamorano, Matia, Flood, Laura, Floris, Leda, Fluckiger, Martin, Forteza, Catalina, Fortunato, Antonella, Frans, Eric, Frattari, Antonella, Fredes, Sebastian, Frenzel, Tim, Fumagalli, Roberto, Andres Furche, Mariano, Fusari, Maurizio, Fysh, Edward, Luis Galeas-Lopez, Juan, Galerneau, Louis-Marie, Garcia, Analía, Fernanda Garcia, María, Garcia, Elisabet, Garcia Olivares, Pablo, Garlicki, Jaroslaw, Garnero, Aude, Garofalo, Eugenio, Gautam, Prabha, Gazenkampf, Andrey, Gelinotte, Stéphanie, Gelormini, Domenico, Ghrenassia, Etienne, Giacomucci, Angelo, Giannoni, Robert, Gigante, Andrea, Glober, Nancy, Gnesin, Paolo, Gollo, Yari, Gomaa, Dina, Gomero Paredes, Rosita, Gomes, Rui, Alejandro Gomez, Raúl, Gomez, Oscar, Gomez, Aroa, Gondim, Louise, Gonzalez, Manuel, Gonzalez, Isabel, Gonzalez-Castro, Alejandro, Gordillo Romero, Orlando, Gordo, Federico, Gouin, Philippe, Graf Santos, Jerónimo, Grainne, Rooney, Grando, Matilde, Granov Grabovica, Sanja, Grasso, Salvatore, Grasso, Rinaldo, Grimmer, Lisa, Grissom, Colin, Gu, Qing, Guan, Xiang-Dong, Guarracino, Fabio, Guasch, Neu, Guatteri, Luca, Gueret, Renaud, Guérin, Claude, Guerot, Emmanuel, Guitard, Pierre-Gilda, Gül, Fethi, Gumus, Ayca, Gurjar, Mohan, Gutierrez, Patricia, Hachimi, Abdelhamid, Hadzibegovic, Adi, Hagan, Samantha, Hammel, Clare, Han Song, Joo, Hanlon, Gabrielle, Heines, Serge, Henriksson, Johanna, Herbrecht, Jean-Etienne, Omar Heredia Orbegoso, Gabriel, Hermon, Andrew, Hernandez, Rosana, Hernandez, Carmen, Herrera, Lui, Herrera-Gutierrez, Manuel, Heunks, Leo, Hidalgo, Juan, Hill, Dianne, Holmquist, Dagmar, Homez, Marcela, Hongtao, Xia, Hormis, Anil, Horner, Daniel, Carmen Hornos, M, Hou, Meihong, House, Stacy, Housni, Brahim, Hugill, Keith, Humphreys, Sally, Humbert, Loui, Hunter, Stephanie, Hwa Young, Lee, Iezzi, Nicola, Ilutovich, Santiago, Inal, Volkan, Innes, Richard, Ioannides, Panagioti, Antonio Iotti, Giorgio, Ippolito, Mariachiara, Irie, Hiromasa, Iriyama, Hiroki, Itagaki, Taiga, Izura, Javier, Izza, Santiago, Jabeen, Rakhshanda, Jamaati, Hamidreza, Jamadarkhana, Sunil, Jamoussi, Amira, Jankowski, Milosz, Alberto Jaramillo, Lui, Jeon, Kyeongman, Jeong Lee, Seok, Jeswani, Deepak, Jha, Simant, Jiang, Liangyan, Jing, Chen, Jochmans, Sébastien, Anders Johnstad, Bror, Jongmin, Lee, Joret, Aurélie, Junhasavasdikul, Detajin, Teresa Jurado, Maria, Kam, Elisa, Kamohara, Hidenobu, Kane, Caroline, Kara, Iskender, Karakurt, Sait, Karnjanarachata, Cherdkiat, Kataoka, Jun, Katayama, Shinshu, Kaushik, Shuchi, Kelebek Girgin, Nermin, Kerr, Kathryn, Kerslake, Ian, Khairnar, Prakash, Khalid, Abidi, Khan, Akram, K Khanna, Ashish, Khorasanee, Reza, Kienhorst, Dieneke, Kirakli, Cenk, Knafelj, Rihard, Kol Kol, Mark, Kongpolprom, Napplika, Kopitko, Csaba, Korkmaz Ekren, Pervin, Kubisz-Pudelko, Agnieszka, Kulcsar, Zoltan, Kumasawa, Junji, Kuriyama, Akira, Kutchak, Fernanda, Labarca, Eduardo, Labat, Françoise, Laborda, César, Alberto Laca Barrera, Manuel, Lagache, Laurie, Landaverde Lopez, Antonio, Lanspa, Michael, Lascari, Valeria, Le Meur, Matthieu, Hwan Lee, Su, Ju Lee, Young, Lee, Jinwoo, Lee, Won-Yeon, Lee, Jarone, Legernaes, Terje, Leiner, Tamaa, Lemiale, Virginie, Leonor, Tiago, M Lepper, Philipp, Li, Dahuan, Li, Hongbin, Li, Oleg, Raquel Lima, Ana, Lind, Dan, Litton, Edward, Liu, Ning, Liu, Ling, Liu, Jialin, Llitjos, Jean-Françoi, Llorente, Beatriz, Lopez, Rodolfo, Elizabeth Lopez, Claudia, Lopez Nava, Claudia, Lovazzano, Pablo, Lu, Min, Lucchese, Francesca, Lugano, Manuela, Lugo Goytia, Gustavo, Luo, Hua, Lynch, Ceri, Macheda, Sebastiano, Hugo Madrigal Robles, Victor, Maurizio Maggiore, Salvatore, Magret Iglesias, Mònica, Malaga, Peter, Mallapura Maheswarappa, Harish, Malpartida, Guillermo, Malyarchikov, Andrey, Mansson, Helena, Manzano, Anaid, Marey, Ismael, Marin, Nathalie, Del Carmen Marin, Maria, Markman, Eliana, Martin, Felix, Martin, Alex, Martin Dal Gesso, Cristina, Martinez, Felipe, Martínez-Fidalgo, Conchita, Martin-Loeches, Ignacio, Mas, Arantxa, Masaaki, Sakuraya, Maseda, Emilio, Massa, Eleni, Mattsson, Anna, Maugeri, Jessica, Mccredie, Victoria, Mccullough, Jame, Mcguinness, Shay, Mckown, Andrew, Medve, László, Mei, Chengqing, Mellado Artigas, Ricard, Mendes, Vitor, Khalaf Ebraheim Mervat, Mohamed, Michaux, Isabelle, Mikhaeil, Michael, Milagros, Olga, Milet, Igor, Teresa Millan, Maria, Minwei, Zhang, Mirabella, Lucia, Mishra, Sanghamitra, Mistraletti, Giovanni, Mochizuki, Katsunori, Moghal, Arif, Mojoli, Francesco, Molin, Alexandre, Montiel, Raquel, Montini, Luca, Monza, Gianmario, Mora Aznar, Maria, Morakul, Sunthiti, Morales, Maria, Moreno Torres, Daniel, Rolando Morocho Tutillo, Diego, Motherway, Catherine, Mouhssine, Doumiri, Mouloudi, Eleni, Muñoz, Tapia, Munoz de Cabo, Carlo, Mustafa, Mohamed, Muthuchellappan, Radhakrishnan, Muthukrishnan, Muraleekrishnan, Muttini, Stefano, Nagata, Isao, Nahar, Dick, Nakanishi, Misuzu, Nakayama, Izumi, Antonio Namendys-Silva, Silvio, Nanchal, Rahul, Nandakumar, Sivakumar, Nasi, Alessandra, Nasir, Kamal, Navalesi, Paolo, Naz Aslam, Tayyba, Nga Phan, Thuy, Nichol, Alistair, Niiyama, Shuhei, Nikolakopoulou, Sofia, Nikolic, Elena, Nitta, Kenichi, Noc, Marko, Nonas, Stephanie, Nseir, Saad, Nur Soyturk, Ayse, Obata, Yukako, Oeckler, Richard, Oguchi, Moe, Ohshimo, Shinichiro, Oikonomou, Marina, Ojados, Agueda, Teresa Oliveira, Maria, Oliveira Filho, Wilson, Oliveri, Carlo, Olmos, Aitor, Omura, Kazuya, Cristina Orlandi, Maria, Orsenigo, Francesca, Ortiz-Ruiz De Gordoa, Laura, Ota, Kei, Ovalle Olmos, Rainier, Öveges, Nándo, Oziemski, Peter, Ozkan Kuscu, Ozlem, Özyilmaz, Ezgi, Pachas Alvarado, Fernando, Pagella, Gonzalo, Palaniswamy, Vijayanand, Luis Palazon Sanchez, Eugenio, Palmese, Salvatore, Pan, Guojun, Pan, Wensen, Papanikolaou, Metaxia, Papavasilopoulou, Theonymfi, Parekh, Ameet, Parke, Rachael, J Parrilla, Francisco, Parrilla, Dácil, Pasha, Taha, Pasin, Laura, Patão, Lui, Patel, Mayur, Patel, Grisma, Kumar Pati, Basanta, Patil, Jayaprakash, Pattnaik, Saroj, Paul, Daniel, Pavesi, Maurizio, Alejandra Pavlotsky, Vanesa, Paz, Graciela, Paz, Enrique, Pecci, Elisabetta, Pellegrini, Carlo, Gabriela Peña Padilla, Andrea, Perchiazzi, Gaetano, Pereira, Tiago, Pereira, Vera, Perez, Manuel, Perez Calvo, Cesar, Perez Cheng, Meisy, Perez Maita, Ronald, Pérez-Araos, Rodrigo, Perez-Teran, Purificación, Perez-Torres, David, Perkins, Gavin, Persona, Paolo, Petnak, Tananchai, Petrova, Marina, Pham, Tai, Philippart, Françoi, Picetti, Edoardo, Pierucci, Elisabetta, Piervincenzi, Edoardo, Pinciroli, 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Mandy, Tamasato, Tamasato, Tang, Zhanhong, Tangsujaritvijit, Viratch, Taniguchi, Leandro, Taniguchi, Daisuke, Tarantino, Fabio, Teerapuncharoen, Krittika, Temprano, Susana, Terragni, Pierpaolo, Terzi, Nicola, Thakur, Anand, Theerawit, Pongdhep, W Thille, Arnaud, Thomas, Matt, Thungtitigul, Poungrat, Thyrault, Martial, Tilouch, Nejla, Timenetsky, Karina, Tirapu, Juna, Todeschini, Manuel, Tomas, Roser, Tomaszewski, Christian, Tonetti, Tommaso, Tonnelier, Alexandre, Trinder, John, Trongtrakul, Konlawij, Truwit, Jonathon, Tsuei, Betty, Tulaimat, Aiman, Turan, Sema, Turkoglu, Melda, Tyagi, Sanjeev, Ubeda, Alejandro, Vagginelli, Federica, Florencia Valenti, María, Vallverdu, Imma, Van Axel, Alisha, van den Hul, Ingrid, van der Hoeven, Han, Van Der Meer, Nardo, Vanhoof, Marc, Vargas-Ordoñez, Mónica, Vaschetto, Rosanna, Vascotto, Ettore, Vatsik, Maria, Vaz, Ana, Vazquez-Sanchez, Antonia, Ventura, Sara, Wytze Vermeijden, Jan, Vidal, Anxela, Vieira, Jocyelle, Vilela Costa Pinto, Bruno, 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Maseda, Eleni Massa, Anna Mattsson, Jessica Maugeri, Victoria McCredie, James McCullough, Shay McGuinness, Andrew McKown, László Medve, Chengqing Mei, Ricard Mellado Artigas, Vitor Mendes, Mohamed Khalaf Ebraheim Mervat, Isabelle Michaux, Michael Mikhaeil, Olga Milagros, Igor Milet, Maria Teresa Millan, Zhang Minwei, Lucia Mirabella, Sanghamitra Mishra, Giovanni Mistraletti, Katsunori Mochizuki, Arif Moghal, Francesco Mojoli, Alexandre Molin, Raquel Montiel, Luca Montini (ORCID:0000-0003-4602-5134), Gianmario Monza, Maria Mora Aznar, Sunthiti Morakul, Maria Morales, Daniel Moreno Torres, Diego Rolando Morocho Tutillo, Catherine Motherway, Doumiri Mouhssine, Eleni Mouloudi, Tapia Muñoz, Carlos Munoz de Cabo, Mohamed Mustafa, Radhakrishnan Muthuchellappan, Muraleekrishnan Muthukrishnan, Stefano Muttini, Isao Nagata, Dick Nahar, Misuzu Nakanishi, Izumi Nakayama, Silvio Antonio Namendys-Silva, Rahul Nanchal, Sivakumar Nandakumar, Alessandra Nasi, Kamal Nasir, Paolo Navalesi, Tayyba Naz 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Carlos Pellegrini, Andrea Gabriela Peña Padilla, Gaetano Perchiazzi, Tiago Pereira, Vera Pereira, Manuel Perez, Cesar Perez Calvo, Meisy Perez Cheng, Ronald Perez Maita, Rodrigo Pérez-Araos, Purificación Perez-Teran, David Perez-Torres, Gavin Perkins, Paolo Persona, Tananchai Petnak, Marina Petrova, Tai Pham, François Philippart, Edoardo Picetti, Elisabetta Pierucci, Edoardo Piervincenzi, Riccardo Pinciroli, Maria-Consuelo Pintado, Thomas Piraino, Stephanie Piras, Claudio Piras, Pattarin Pirompanich, Luigi Pisani, Enrique Platas, Gustavo Plotnikow, Willy Porras, Virginia Porta, Mariana Portilla, José Portugal, Pedro Povoa, Gwenael Prat, Romina Pratto, Gabriel Preda, Isidro Prieto, Estefania Prol-Silva, Richard Pugh, Yupeng Qi, Chuanyun Qian, Tiehe Qin, Hongping Qu, Teobaldo Quintana, Rosari Quispe Sierra, Rocio Quispe Soto, Raihan Rabbani, Mohamed Rabee, Ahmed Rabie, Maria Augusta Rahe Pereira, Ashish Rai, Sundar Raj Ashok, Mostafa Rajab, Navin Ramdhani, Elizabeth Ramey, Marco Ranieri, Darshana Rathod, Banambar Ray, Shihan Mahmud Redwanul Huq, Adrian Regli, Rosa Reina, Natalia Resano Sarmiento, Faustine Reynaud, Gemma Rialp, Pilar Ricart, Todd Rice, Angus Richardson, Marcelo Rieder, Martin Rinket, Fernando Rios, Alejandro Risso Vazquez, Ivano Riva, Monaly Rivette, Oriol Roca, Ferran Roche-Campo, Covadonga Rodriguez, Gabriel Rodriguez, Daniel Rodriguez Gonzalez, Xandra Yanina Rodriguez Tucto, Angela Rogers, María Elena Romano, Linda Rørtveit, Alastair Rose, Damien Roux, Anahita Rouze, Paolo Nahuel Rubatto Birri, Wang Ruilan, Aldana Ruiz Robledo, Antonio Luis Ruiz-Aguilar, Tomohito Sadahiro, Ignacio Saez, Judith Sagardia, Rajnish Saha, Rohit Saha, Narongkorn Saiphoklang, Shigeki Saito, Maie Salem, Gabriele Sales, Patricia Salgado, Srinivas Samavedam, Mhamed Sami Mebazaa, Line Samuelsson, Nandyelly San Juan Roman, Patricia Sanchez, Jesus Sanchez-Ballesteros, Yazcitk Sandoval, Emanuele Sani, Martin Santos, Carla Santos, Masamitsu Sanui, Lakshmikanthcharan Saravanabavan, Sema Sari, Agnes Sarkany, Bertrand Sauneuf, Monica Savioli, Hilal Sazak, Riccardo Scano, Francis Schneider, Frédérique Schortgen, Marcus J Schultz, Gabriele Leonie Schwarz, Faruk Seçkin Yücesoy, Andrew Seely, Frederik Seiler, Yasemin Seker Tekdos, Kim Seok Chan, Luca Serano, Wojciech Serednicki, Mariano Setten, Asim Shah, Bhagyesh Shah, You Shang, Pradeep Shanmugasundaram, Konstantin Shapovalov, Eman Shebl, Takuya Shiga, Nobuaki Shime, Phil Shin, Jack Short, Chen Shuhua, Sughrat Siddiqui, Juan Ignacio Silesky Jimenez, Daniel Silva, Betania Silva Sales, Koen Simons, Brit Ågot Sjøbø, David Slessor, Jakub Smiechowicz, Nathan Smischney, Paul Smith, Tim Smith, Mark Smith, Sarah Snape, Lindi Snyman, Filiep Soetens, Kyung Sook Hong, Miguel Ángel Sosa Medellin, Giovanna Soto, Xavier Souloy, Elsa Sousa, Stefania Sovatzis, Didem Sozutek, Savino Spadaro, Marco Spagnoli, Martin Spångfors, Nick Spittle, Mike Spivey, Andrew Stapleton, Branislava Stefanovic, Lorraine Stephenson, Elizabeth Stevenson, Kristian Strand, Maria Teresa Strano, Slavenka Straus, Chenliang Sun, Rongqing Sun, Venkat Sundaram, Tai SunPark, Elisabeth Surlemont, Yuda Sutherasan, Zsuzsanna Szabo, Christopher Tainter, Akihiro Takaba, Mandy Tallott, Tamasato Tamasato, Zhanhong Tang, Viratch Tangsujaritvijit, Leandro Taniguchi, Daisuke Taniguchi, Fabio Tarantino, Krittika Teerapuncharoen, Susana Temprano, Pierpaolo Terragni, Nicolas Terzi, Anand Thakur, Pongdhep Theerawit, Arnaud W Thille, Matt Thomas, Poungrat Thungtitigul, Martial Thyrault, Nejla Tilouch, Karina Timenetsky, Juna Tirapu, Manuel Todeschini, Roser Tomas, Christian Tomaszewski, Tommaso Tonetti, Alexandre Tonnelier, John Trinder, Konlawij Trongtrakul, Jonathon Truwit, Betty Tsuei, Aiman Tulaimat, Sema Turan, Melda Turkoglu, Sanjeev Tyagi, Alejandro Ubeda, Federica Vagginelli, María Florencia Valenti, Imma Vallverdu, Alisha Van Axel, Ingrid van den Hul, Hans van der Hoeven, Nardo Van Der Meer, Marc Vanhoof, Mónica 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Elizabeth, Strand, Kristian, Teresa Strano, Maria, Straus, Slavenka, Sun, Chenliang, Sun, Rongqing, Sundaram, Venkat, Sunpark, Tai, Surlemont, Elisabeth, Sutherasan, Yuda, Szabo, Zsuzsanna, Tainter, Christopher, Takaba, Akihiro, Tallott, Mandy, Tamasato, Tamasato, Tang, Zhanhong, Tangsujaritvijit, Viratch, Taniguchi, Leandro, Taniguchi, Daisuke, Tarantino, Fabio, Teerapuncharoen, Krittika, Temprano, Susana, Terragni, Pierpaolo, Terzi, Nicola, Thakur, Anand, Theerawit, Pongdhep, W Thille, Arnaud, Thomas, Matt, Thungtitigul, Poungrat, Thyrault, Martial, Tilouch, Nejla, Timenetsky, Karina, Tirapu, Juna, Todeschini, Manuel, Tomas, Roser, Tomaszewski, Christian, Tonetti, Tommaso, Tonnelier, Alexandre, Trinder, John, Trongtrakul, Konlawij, Truwit, Jonathon, Tsuei, Betty, Tulaimat, Aiman, Turan, Sema, Turkoglu, Melda, Tyagi, Sanjeev, Ubeda, Alejandro, Vagginelli, Federica, Florencia Valenti, María, Vallverdu, Imma, Van Axel, Alisha, van den Hul, Ingrid, van der Hoeven, Han, Van Der Meer, 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Carmen Hornos, Meihong Hou, Stacy House, Brahim Housni, Keith Hugill, Sally Humphreys, Louis Humbert, Stephanie Hunter, Lee Hwa Young, Nicolas Iezzi, Santiago Ilutovich, Volkan Inal, Richard Innes, Panagiotis Ioannides, Giorgio Antonio Iotti, Mariachiara Ippolito, Hiromasa Irie, Hiroki Iriyama, Taiga Itagaki, Javier Izura, Santiago Izza, Rakhshanda Jabeen, Hamidreza Jamaati, Sunil Jamadarkhana, Amira Jamoussi, Milosz Jankowski, Luis Alberto Jaramillo, Kyeongman Jeon, Seok Jeong Lee, Deepak Jeswani, Simant Jha, Liangyan Jiang, Chen Jing, Sébastien Jochmans, Bror Anders Johnstad, Lee Jongmin, Aurélie Joret, Detajin Junhasavasdikul, Maria Teresa Jurado, Elisa Kam, Hidenobu Kamohara, Caroline Kane, Iskender Kara, Sait Karakurt, Cherdkiat Karnjanarachata, Jun Kataoka, Shinshu Katayama, Shuchi Kaushik, Nermin Kelebek Girgin, Kathryn Kerr, Ian Kerslake, Prakash Khairnar, Abidi Khalid, Akram Khan, Ashish K Khanna, Reza Khorasanee, Dieneke Kienhorst, Cenk Kirakli, Rihard Knafelj, Mark Kol Kol, Napplika Kongpolprom, Csaba Kopitko, Pervin Korkmaz Ekren, Agnieszka Kubisz-Pudelko, Zoltan Kulcsar, Junji Kumasawa, Akira Kuriyama, Fernanda Kutchak, Eduardo Labarca, Françoise Labat, César Laborda, Manuel Alberto Laca Barrera, Laurie Lagache, Antonio Landaverde Lopez, Michael Lanspa, Valeria Lascari, Matthieu Le Meur, Su Hwan Lee, Young Ju Lee, Jinwoo Lee, Won-Yeon Lee, Jarone Lee, Terje Legernaes, Tamaas Leiner, Virginie Lemiale, Tiago Leonor, Philipp M Lepper, Dahuan Li, Hongbin Li, Oleg Li, Ana Raquel Lima, Dan Lind, Edward Litton, Ning Liu, Ling Liu, Jialin Liu, Jean-François Llitjos, Beatriz Llorente, Rodolfo Lopez, Claudia Elizabeth Lopez, Claudia Lopez Nava, Pablo Lovazzano, Min Lu, Francesca Lucchese, Manuela Lugano, Gustavo Lugo Goytia, Hua Luo, Ceri Lynch, Sebastiano Macheda, Victor Hugo Madrigal Robles, Salvatore Maurizio Maggiore, Mònica Magret Iglesias, Peter Malaga, Harish Mallapura Maheswarappa, Guillermo Malpartida, Andrey Malyarchikov, Helena Mansson, Anaid Manzano, Ismael Marey, Nathalie Marin, Maria Del Carmen Marin, Eliana Markman, Felix Martin, Alex Martin, Cristina Martin Dal Gesso, Felipe Martinez, Conchita Martínez-Fidalgo, Ignacio Martin-Loeches, Arantxa Mas, Sakuraya Masaaki, Emilio Maseda, Eleni Massa, Anna Mattsson, Jessica Maugeri, Victoria McCredie, James McCullough, Shay McGuinness, Andrew McKown, László Medve, Chengqing Mei, Ricard Mellado Artigas, Vitor Mendes, Mohamed Khalaf Ebraheim Mervat, Isabelle Michaux, Michael Mikhaeil, Olga Milagros, Igor Milet, Maria Teresa Millan, Zhang Minwei, Lucia Mirabella, Sanghamitra Mishra, Giovanni Mistraletti, Katsunori Mochizuki, Arif Moghal, Francesco Mojoli, Alexandre Molin, Raquel Montiel, Luca Montini (ORCID:0000-0003-4602-5134), Gianmario Monza, Maria Mora Aznar, Sunthiti Morakul, Maria Morales, Daniel Moreno Torres, Diego Rolando Morocho Tutillo, Catherine Motherway, Doumiri Mouhssine, Eleni Mouloudi, Tapia Muñoz, Carlos Munoz de Cabo, Mohamed Mustafa, Radhakrishnan Muthuchellappan, Muraleekrishnan Muthukrishnan, Stefano Muttini, Isao Nagata, Dick Nahar, Misuzu Nakanishi, Izumi Nakayama, Silvio Antonio Namendys-Silva, Rahul Nanchal, Sivakumar Nandakumar, Alessandra Nasi, Kamal Nasir, Paolo Navalesi, Tayyba Naz Aslam, Thuy Nga Phan, Alistair Nichol, Shuhei Niiyama, Sofia Nikolakopoulou, Elena Nikolic, Kenichi Nitta, Marko Noc, Stephanie Nonas, Saad Nseir, Ayse Nur Soyturk, Yukako Obata, Richard Oeckler, Moe Oguchi, Shinichiro Ohshimo, Marina Oikonomou, Agueda Ojados, Maria Teresa Oliveira, Wilson Oliveira Filho, Carlo Oliveri, Aitor Olmos, Kazuya Omura, Maria Cristina Orlandi, Francesca Orsenigo, Laura Ortiz-Ruiz De Gordoa, Kei Ota, Rainier Ovalle Olmos, Nándo Öveges, Peter Oziemski, Ozlem Ozkan Kuscu, Ezgi Özyilmaz, Fernando Pachas Alvarado, Gonzalo Pagella, Vijayanand Palaniswamy, Eugenio Luis Palazon Sanchez, Salvatore Palmese, Guojun Pan, Wensen Pan, Metaxia Papanikolaou, Theonymfi Papavasilopoulou, Ameet Parekh, Rachael Parke, Francisco J 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Tulaimat, Sema Turan, Melda Turkoglu, Sanjeev Tyagi, Alejandro Ubeda, Federica Vagginelli, María Florencia Valenti, Imma Vallverdu, Alisha Van Axel, Ingrid van den Hul, Hans van der Hoeven, Nardo Van Der Meer, Marc Vanhoof, Mónica Vargas-Ordoñez, Rosanna Vaschetto, Ettore Vascotto, Maria Vatsik, Ana Vaz, Antonia Vazquez-Sanchez, Sara Ventura, Jan Wytze Vermeijden, Anxela Vidal, Jocyelle Vieira, Bruno Vilela Costa Pinto, Ana Villagra, Cristina Villegas Succar, Ole Georg Vinorum, Giovanni Vitale, Ramesh Vj, Ana Vochin, Guillaume Voiriot, Carlo Alberto Volta, Magnus von Seth, Maazouzi Wajdi, Don Walsh, Shouhong Wang, Gabriel Wardi, Nils Christian Ween-Velken, Bi-Lin Wei, Dolf Weller, Deborah Welsh, Ingeborg Welters, Michael Wert, Simon Whiteley, Elizabeth Wilby, Erin Williams, Karen Williams, Antoinette Wilson, Jadwiga Wojtas, Jin Won Huh, David Wrathall, Christopher Wright, Jian-Feng Wu, Guo Xi, Zheng-Jiang Xing, Hongyang Xu, Kotaro Yamamoto, Jie Yan, Julio Yáñez, Xiaobo Yang, Elliot Yates, Ozlem Yazicioglu Mocin, Zhenglong Ye, Fatma Yildirim, Norifumi Yoshida, Hector Higo Leon Yoshido, Bo Young Lee, Rongguo Yu, Gong Yu, Tao Yu, Boyun Yuan, Nadwipa Yuangtrakul, Tetsuya Yumoto, Xie Yun, Graciela Zakalik, Ahmad Zaki, Begoña Zalba-Etayo, Massimo Zambon, Bin Zang, Gianluca Zani, Jonathan Zarka, Simone Maria Zerbi, Avsar Zerman, Harald Zetterquist, Jiuzhi Zhang, Hongwen Zhang, Wei Zhang, Guoxiu Zhang, Weixin Zhang, Hongsheng Zhao, Jia Zheng, Bin Zhu, and Ronald Zumaran
Abstract: Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 d
Published: 2023

12. Impact of Coronavirus Disease 2019 Pandemic on Crowding: A Call to Action for Effective Solutions to 'Access Block'

Author: Maria Antonietta Bressan, Giorgio Antonio Iotti, Alba Muzzi, Viola Novelli, Giovanni Ricevuti, Enrico Oddone, Iride Francesca Ceresa, Gabriele Savioli, and Roberta Guarnone
Subjects: Department Operations, medicine.medical_specialty, Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Pandemic, Humans, Medicine, Pandemics, Original Research, RC86-88.9, business.industry, COVID-19, Outbreak, Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, General Medicine, Emergency department, Crowding, Call to action, Hospitalization, Preparedness, Emergency medicine, Emergency Medicine, Observational study, Emergency Service, Hospital, business
Abstract: Introduction: Healthcare patterns change during disease outbreaks and pandemics. Identification of modified patterns is important for future preparedness and response. Emergency department (ED) crowding can occur because of the volume of patients waiting to be seen, which results in delays in patient assessment or treatment and impediments to leaving the ED once treatment is complete. Therefore, ED crowding has become a growing problem worldwide and represents a serious barrier to healthcare operations. Methods: This observational study was based on a retrospective review of the epidemiologic and clinical records of patients who presented to the Foundation IRCCS Policlinic San Matteo in Pavia, Italy, during the coronavirus disease 2019 (COVID-19) outbreak (February 21–May 1, 2020, pandemic group). The methods involved an estimation of the changes in epidemiologic and clinical data from the annual baseline data after the start of the COVID-19 pandemic. Results: We identified reduced ED visits (180 per day in the control period vs 96 per day in the pandemic period; P < 0.001) during the COVID-19 pandemic, irrespective of age and gender, especially for low-acuity conditions. However, patients who did present to the ED were more likely to be hemodynamically unstable, exhibit abnormal vital signs, and more frequently required high-intensity care and hospitalization. During the pandemic, ED crowding dramatically increased primarily because of an increased number of visits by patients with high-acuity conditions, changes in patient management that prolonged length of stay, and increased rates of boarding, which led to the inability of patients to gain access to appropriate hospital beds within a reasonable amount of time. During the pandemic, all crowding output indices increased, especially the rates of boarding (36% vs 57%; P < 0.001), “access block” (24% vs 47%; P < 0.001), mean boarding time (640 vs 1,150 minutes [min]; P 0.001), mean “access block” time (718 vs 1,223 min; P < 0.001), and “access block” total time (650,379 vs 1,359,172 min; P < 0.001). Conclusion: Crowding in the ED during the COVID-19 pandemic was due to the inability to access hospital beds. Therefore, solutions to this lack of access are required to prevent a recurrence of crowding due to a new viral wave or epidemic.
Published: 2021
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13. Carbon Dioxide Elimination During Veno-Venous Extracorporeal Membrane Oxygenation Weaning

Author: Anna Aliberti, Roberto Lorusso, Fiorenza Ferrari, Lars Mikael Broman, Mirko Belliato, Giorgio Antonio Iotti, Fabio Silvio Taccone, Maximilian V. Malfertheiner, Francesco Epis, Maria Giovanna Quattrone, Luca Cremascoli, CTC, MUMC+: MA Med Staf Spec CTC (9), and RS: Carim - V04 Surgical intervention
Subjects: Adult, Male, ARDS, DEAD-SPACE, medicine.medical_treatment, Biomedical Engineering, Biophysics, Bioengineering, Pilot Projects, 030204 cardiovascular system & hematology, mechanical ventilation, Pulmonary function testing, veno-venous extracorporeal membrane oxygenation, VOLUMETRIC CAPNOGRAPHY, Biomaterials, LESSONS, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, SUPPORT, medicine, Extracorporeal membrane oxygenation, Weaning, Humans, Prospective Studies, Lung, extracorporeal membrane oxygenation weaning, Aged, Mechanical ventilation, Respiratory Distress Syndrome, business.industry, General Medicine, Carbon Dioxide, Middle Aged, acute respiratory distress syndrome, medicine.disease, extracorporeal carbon dioxide removal, surgical procedures, operative, medicine.anatomical_structure, 030228 respiratory system, Respiratory failure, Anesthesia, Breathing, Female, ECMO, business, LUNG INJURY, GAS-EXCHANGE
Abstract: Veno-venous extracorporeal membrane oxygenation (V-V ECMO) represents a component of the treatment strategy for severe respiratory failure. Clinical evidence on the management of the lung during V-V ECMO are limited just as the consensus regarding timing of weaning. The monitoring of the carbon dioxide (CO2) removal (V ' CO2TOT) is subdivided into two components: the membrane lung (ML) and the native lung (NL) are both taken into consideration to evaluate the improvement of the function of the lung and to predict the time to wean off ECMO. We enrolled patients with acute respiratory distress syndrome (ARDS). The V ' CO2NL ratio (V ' CO2NL/V ' CO2TOT) value was calculated based on the distribution of CO2 between the NL and the ML. Of 18 patients, 15 were successfully weaned off of V-V ECMO. In this subgroup, we observed a significant increase in the V ' CO2NL ratio comparing the median values of the first and last quartiles (0.32 vs. 0.53, p = 0.0045), without observing any modifications in the ventilation parameters. An increase in the V ' CO2NL ratio, independently from any change in ventilation could, despite the limitations of the study, indicate an improvement in pulmonary function and may be used as a weaning index for ECMO.
Published: 2021

14. Increased prevalence of heparin induced thrombocytopenia in COVID-19 patients

Author: Carmine Spataro, G Testa, Mariaconcetta Russo, Giorgio Antonio Iotti, Paolo Grimaldi, Luca Caneva, Margherita Reduzzi, Francesca Calabretta, Paola Preti, Francesco Mojoli, Antonio Di Sabatino, and Mara De Amici
Subjects: 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Heparin, SARS-CoV-2, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Anticoagulants, COVID-19, Letter to the Editors-in-Chief, Hematology, medicine.disease, Thrombocytopenia, Virology, Heparin-induced thrombocytopenia, Prevalence, medicine, Humans, business
Published: 2021
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15. Lung Ultrasound in Patients with Acute Respiratory Failure Reduces Conventional Imaging and Health Care Provider Exposure to COVID-19

Author: Anita Orlando, Erminio Santangelo, Marco Pozzi, Lorenzo Preda, Stefano Perlini, Giuseppe Maggio, Guido Tavazzi, Eleonora Pariani, Silvia Mongodi, Giorgio Antonio Iotti, Eric Arisi, Giada Bettini, Luca Caneva, and Francesco Mojoli
Subjects: Male, medicine.medical_specialty, ARDS, Acoustics and Ultrasonics, Coronavirus disease 2019 (COVID-19), Pneumonia, Viral, Biophysics, 030204 cardiovascular system & hematology, Article, law.invention, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, law, Occupational Exposure, medicine, Humans, Radiology, Nuclear Medicine and imaging, Acute respiratory failure, Lung, Pandemics, Aged, Ultrasonography, Lung ultrasound, Radiological and Ultrasound Technology, SARS-CoV-2, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Ultrasound, COVID-19, 030208 emergency & critical care medicine, Middle Aged, Lung imaging, medicine.disease, Intensive care unit, Lung monitoring, Pneumonia, Pneumothorax, Radiology Nuclear Medicine and imaging, Female, Radiology, Coronavirus Infections, Respiratory Insufficiency, business
Abstract: — Lung ultrasound gained a leading position in the last year as an imaging technique for the assessment and management of patients with acute respiratory failure. In coronavirus disease 2019 (COVID-19), its role may be of further importance because it is performed bedside and may limit chest X-ray and the need for transport to radiology for computed tomography (CT) scan. Since February 21, we progressively turned into a coronavirus-dedicated intensive care unit and applied an ultrasound-based approach to avoid traditional imaging and limit contamination as much as possible. We performed a complete daily examination with lung ultrasound score computation and systematic search of complications (pneumothorax, ventilator-associated pneumonia); on-duty physicians were free to perform CT or chest X-ray when deemed indicated. We compared conventional imaging exams performed in the first 4 wk of the COVID-19 epidemic with those in the same time frame in 2019: there were 84 patients in 2020 and 112 in 2019; 64 and 22 (76.2% vs. 19.6%, p < 0.001) had acute respiratory failure, respectively, of which 55 (85.9%) were COVID-19 in 2020. When COVID-19 patients in 2020 were compared with acute respiratory failure patients in 2019, the median number of chest X-rays was 1.0 (1.0–2.0) versus 3.0 (1.0–4.0) (p = 0.0098); 2 patients 2 (3.6%) versus 7 patients (31.8%) had undergone at least one thoracic CT scan (p = 0.001). A self-imposed ultrasound-based approach reduces the number of chest X-rays and thoracic CT scans in COVID-19 patients compared with patients with standard acute respiratory failure, thus reducing the number of health care providers exposed to possible contamination and sparing personal protective equipment.
Published: 2020
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16. Radiographic findings in 240 patients with COVID-19 pneumonia: time-dependence after the onset of symptoms

Author: Adele Valentini, Raffaele Bruno, Giulia Maria Stella, Roberto Dore, Francesco Ballati, Giorgio Antonio Iotti, Stefano Perlini, Francesco Mojoli, Chandra Bortolotto, Costanza Canino, Angelo Corsico, Sergio Giuseppe Vancheri, Giovanni Savietto, Lorenzo Preda, and Alessia Maggi
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Adolescent, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Radiography, Pneumonia, Viral, Group A, Gastroenterology, Group B, 030218 nuclear medicine & medical imaging, Betacoronavirus, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Statistical significance, medicine, Severe acute respiratory syndrome coronavirus 2, Humans, Radiology, Nuclear Medicine and imaging, Symptom onset, Lung, Pandemics, Aged, Retrospective Studies, Aged, 80 and over, Chi-Square Distribution, SARS-CoV-2, business.industry, COVID-19, Pneumonia, General Medicine, Thorax, Middle Aged, Radiology Nuclear Medicine and imaging, 030220 oncology & carcinogenesis, Reticular connective tissue, Chest, Female, Radiography, Thoracic, Radiology, Coronavirus Infections, business
Abstract: Objective To analyze the most frequent radiographic features of COVID-19 pneumonia and assess the effectiveness of chest X-ray (CXR) in detecting pulmonary alterations. Materials and methods CXR of 240 symptomatic patients (70% male, mean age 65 ± 16 years), with SARS-CoV-2 infection confirmed by RT-PCR, was retrospectively evaluated. Patients were clustered in four groups based on the number of days between symptom onset and CXR: group A (0–2 days), 49 patients; group B (3–5), 75 patients; group C (6–9), 85 patients; and group D (> 9), 31 patients. Alteration’s type (reticular/ground-glass opacity (GGO)/consolidation) and distribution (bilateral/unilateral, upper/middle/lower fields, peripheral/central) were noted. Statistical significance was tested using chi-square test. Results Among 240 patients who underwent CXR, 180 (75%) showed alterations (group A, 63.3%; group B, 72%; group C, 81.2%; group D, 83.9%). GGO was observed in 124/180 patients (68.8%), reticular alteration in 113/180 (62.7%), and consolidation in 71/180 (39.4%). Consolidation was significantly less frequent (p 9 days from the onset of symptoms.
Published: 2020
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17. Combined ultrasound–CT approach to monitor acute exacerbation of interstitial lung disease

Author: Francesco Mojoli, Andrea Colombo, Belaid Bouhemad, Anita Orlando, Silvia Mongodi, Giorgio Antonio Iotti, and Lorenzo Cavagna
Subjects: lcsh:Medical physics. Medical radiology. Nuclear medicine, Resuscitation, medicine.medical_specialty, Exacerbation, medicine.medical_treatment, lcsh:R895-920, Context (language use), Case Report, Interstitial lung disease, 03 medical and health sciences, 0302 clinical medicine, Medicine, Radiology, Nuclear Medicine and imaging, Mechanical ventilation, Lung, Lung ultrasound, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Ultrasound, 030208 emergency & critical care medicine, Interventional radiology, respiratory system, medicine.disease, respiratory tract diseases, Lung monitoring, medicine.anatomical_structure, 030228 respiratory system, Radiology, High-resolution CT, ECMO, business
Abstract: Background Lung ultrasound is a bedside non-irradiating tool for assessment and monitoring of lung diseases. A lung ultrasound score based on visualized artefacts allows reliable quantification of lung aeration, and is useful to monitor mechanical ventilation setting, fluid resuscitation and antibiotic response in critical care. In the context of interstitial lung diseases associated to connective tissue disorders, lung ultrasound has been integrated to computed tomography for diagnosis and follow-up monitoring of chronic lung disease progression. Case presentation This case describes a severe acute exacerbation of interstitial lung disease associated to dermatomyositis–polymyositis requiring prolonged extra-corporeal life support. Lung ultrasound score was performed daily and allowed monitoring and guiding both the need of advanced imaging as computed tomography and immunosuppressive therapy. Conclusions This case suggests lung ultrasound may be a useful monitoring tool for the response to immunosuppressive therapy in acute severe rheumatic interstitial lung disease, where chest X-ray is poorly informative, and transportation is at high risk.
Published: 2020
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18. Anterior cutaneous nerve block for analgesia in anterior chest trauma: is the parasternal approach necessary?

Author: Giorgio Antonio Iotti, Giuliano Lo Bianco, Stefano Perlini, Benedetta Mascia, and Santi Di Pietro
Subjects: Thorax, Sternum, Rib cage, medicine.medical_specialty, Nerve block, business.industry, medicine.medical_treatment, Cutaneous nerve, Case Report, 030208 emergency & critical care medicine, Context (language use), 030204 cardiovascular system & hematology, Emergency Nursing, Rib fractures, Surgery, 03 medical and health sciences, 0302 clinical medicine, Anterior chest, Parasternal line, Anesthesia and analgesia, Emergency Medicine, medicine, business
Abstract: In recent years, several techniques of regional anesthesia have been proposed to provide analgesia to the anterior thoracic cage; notably, most of these techniques require a parasternal approach. However, in this context, the potential role of a more common and well-established technique, namely the modified pectoral nerve block (known as PECS II block), has been poorly investigated. Here, we describe a case involving a patient with bilateral anterolateral multiple rib fractures associated with sternum fracture, who was successfully treated using bilateral PECS II blocks. Our experience indicates that the PECS II block can provide excellent analgesia in cases involving anterior rib and sternum fractures. Because it is easier to perform and may be safer than other parasternal techniques, the PECS II block should be considered when providing analgesia for traumatic injuries of the anterior thorax.
Published: 2020
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19. Setup of a Dedicated Coronavirus Intensive Care Unit

Author: Giuseppina Grugnetti, Fausto Baldanti, Raffaele Bruno, Francesco Mojoli, Silvia Mongodi, Giorgio Antonio Iotti, Antonio Triarico, and Alba Muzzi
Subjects: 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), biology, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.disease_cause, biology.organism_classification, medicine.disease, Intensive care unit, law.invention, Anesthesiology and Pain Medicine, law, Pandemic, medicine, Medical emergency, business, Betacoronavirus, Coronavirus
Published: 2020
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20. An experimental model of veno-venous arterial extracorporeal membrane oxygenation

Author: Mirko Belliato, Luca Caneva, Silvia Mongodi, Antonella Degani, Giorgio Antonio Iotti, Lars Mikael Broman, Carlo Pellegrini, Alessandro Aina, and Lisa Prahl Wittberg
Subjects: medicine.medical_specialty, medicine.medical_treatment, Biomedical Engineering, Ischemia, Medicine (miscellaneous), Hemodynamics, Bioengineering, 030204 cardiovascular system & hematology, Extracorporeal, Catheterization, Veins, Biomaterials, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Internal medicine, Extracorporeal membrane oxygenation, medicine, Cannula, Humans, Vein, business.industry, Models, Cardiovascular, Central venous pressure, 030208 emergency & critical care medicine, General Medicine, medicine.disease, surgical procedures, operative, medicine.anatomical_structure, Respiratory failure, Cardiology, business
Abstract: Introduction: Veno-venous arterial extracorporeal membrane oxygenation is a hybrid-modality of extracorporeal membrane oxygenation combining veno-venous and veno-arterial extracorporeal membrane oxygenation. It may be applied to patients with both respiratory and cardio-circulatory failure. Aim: To describe a computational spreadsheet regarding an ex vivo experimental model of veno-venous arterial extracorporeal membrane oxygenation to determine the return of cannula pairs in a single pump–driven circuit. Methods: We developed an ex vivo model of veno-venous arterial extracorporeal membrane oxygenation with a single pump and two outflow cannulas, and a glucose solution was used to mimic the features of blood. We maintained a fixed aortic impedance and physiological pulmonary resistance. Both flow and pressure data were collected while testing different pairs of outflow cannulas. Six simulations of different cannula pairs were performed, and data were analysed by a custom-made spreadsheet, which was able to predict the flow partition at different flow levels. Results: In all simulations, the flow in the arterial cannula gradually increased differently depending on the cannula pair. The best cannula pair was a 19-Fr/18-cm arterial with a 17-Fr/50-cm venous cannula, where we observed an equal flow split and acceptable flow into the arterial cannula at a lower flow rate of 4 L/min. Conclusion: Our computational spreadsheet identifies the suitable cannula pairing set for correctly splitting the outlet blood flow into the arterial and venous return cannulas in a veno-venous arterial extracorporeal membrane oxygenation configuration without the use of external throttles. Several limitations were reported regarding fixed aortic impedance, central venous pressure and the types of cannulas tested; therefore, further studies are mandatory to confirm our findings
Published: 2019
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21. Intracranial Pressure Monitoring in Poor-Grade Patients with Aneurysmal Subarachnoid Hemorrhage Treated by Coiling

Author: Roberto Imberti, Francesco Cimino, Emanuela Crobeddu, Emanuele Capaccio, Catherine Klersy, Giovanni Accetta, Lara Frattini, Giorgio Antonio Iotti, Sergio Casagli, Edoardo Picetti, Elena Grappa, Luigi Pietrobono, Elvis Lafe, and Sandra Rossi
Subjects: Male, Subarachnoid hemorrhage, Intracranial Pressure, Intracranial Hypotension, Modified Rankin Scale, Recurrence, Medicine, Humans, Poor grade, Prospective Studies, Cerebral perfusion pressure, Intracranial pressure, Aged, Monitoring, Physiologic, integumentary system, business.industry, musculoskeletal, neural, and ocular physiology, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, Neurophysiological Monitoring, humanities, nervous system diseases, Treatment Outcome, Anesthesia, Cerebrovascular Circulation, Intracranial pressure monitoring, Surgery, Female, Stents, Neurology (clinical), Intracranial Hypertension, business
Abstract: The main objective of the present study was to analyze the intracranial pressure (ICP) and cerebral perfusion pressure (CPP) changes during coiling. We also evaluated the prevalence of rebleeding and outcomes for patients monitored before and after coiling.Ninety-nine consecutive poor-grade patients with aneurysmal subarachnoid hemorrhage (aSAH; World Federation of Neurological Surgeons grade IV and V) were enrolled in our prospective observational study. For 31 patients, ICP and CPP monitoring was started immediately after the diagnosis of aSAH, and the values were recorded every 15 minutes during coiling (early ICP group). For 68 patients, ICP and CPP monitoring began after coiling (late ICP group). The outcomes were evaluated at 90 days using the modified Rankin scale.At the beginning of coiling, the ICP was20 mm Hg in 10 patients (35.7%). The median ICP was 18 mm Hg (range, 5-60 mm Hg). The CPP was60 mm Hg in 6 patients (24%). The median CPP was 70 mm Hg (range, 30-101 mm Hg). Despite medical treatment and/or cerebrospinal fluid drainage, 51.6% of the patients monitored during coiling had at least one episode of intracranial hypertension (defined as ICP20 mm Hg), and 51.6% had at least one episode of reduced CPP (defined as CPP60 mm Hg). Early monitoring (before aneurysm repair) was not associated with rebleeding. At 90 days, the functional recovery was better in the early ICP group (P = 0.004).During coiling, patients with poor-grade aSAH can experience episodes of intracranial hypertension and reduced CPP. Early and appropriate treatment of elevated ICP was not associated with rebleeding and might have improved the outcomes.
Published: 2021

22. End-tidal carbon dioxide (ETCO2) and ventricular fibrillation amplitude spectral area (AMSA) for shock outcome prediction in out-of-hospital cardiac arrest. Are they two sides of the same coin?

Author: Laura Frigerio, Enrico Baldi, Elisabete Aramendi, Beatriz Chicote, Unai Irusta, Enrico Contri, Alessandra Palo, Sara Compagnoni, Rosa Fracchia, Giorgio Iotti, Luigi Oltrona Visconti, Simone Savastano, Antonio Cuzzoli, Andrea Pagliosa, Guido Matiz, Alessandra Russo, Andrea Lorenzo Vecchi, Cecilia Fantoni, Cristian Fava, Cinzia Franzosi, Claudio Vimercati, Dario Franchi, Enrico Storti, Erika Taravelli, Fulvio Giovenzana, Giovanni Buetto, Guido Garzena, Giorgio Antonio Iotti, Guido Francesco Villa, Marco Botteri, Salvatore Ivan Caico, Irene Raimondi Cominesi, Livio Carnevale, Matteo Caresani, Mario Luppi, Maurizio Migliori, Paola Centineo, Paola Genoni, Roberta Bertona, Roberto De Ponti, Riccardo Osti, Stefano Buratti, Gian Battista Danzi, Arianna Marioni, Antonella De Pirro, Simone Molinari, Vito Sgromo, Valeria Musella, Martina Paglino, Francesco Mojoli, Bruno Lusona, Michele Pagani, and Moreno Curti
Subjects: medicine.medical_specialty, 030204 cardiovascular system & hematology, Emergency Nursing, Return of spontaneous circulation, Out of hospital cardiac arrest, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, ETCO, medicine, Defibrillation success, Amplitude spectrum area (AMSA), Cardiac arrest, 2, ROSC, Receiver operating characteristic, business.industry, Area under the curve, 030208 emergency & critical care medicine, medicine.disease, End tidal, Shock (circulatory), Ventricular fibrillation, Emergency Medicine, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, Outcome prediction, business
Abstract: Aim Ventricular fibrillation amplitude spectral area (AMSA) and end-tidal carbon dioxide (ETCO2) are predictors of shock success, understood as restoration of an organized rhythm, and return of spontaneous circulation (ROSC). However, little is known about their combined use. We aimed to assess the prediction accuracy when combined, and to clarify if they are correlated in out of hospital cardiac arrest' victims. Materials and Methods Records acquired by external defibrillators in out-of-hospital cardiac arrest patients of the Lombardia Cardiac Arrest registry were processed. The 1-min pre-shock ETCO2 median value (METCO2) was computed from the capnogram and AMSA (2–48 mV.Hz range) computed applying the Fast Fourier Transform to a 2-second pre-shock filtered ECG interval (0.5−30 Hz). Support Vector Machine (SVM) predictive models based on METCO2, AMSA and their combination were fit; results were given as the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. Results We considered 112 patients with 391 shocks delivered. METCO2 and AMSA were predictors of shock success [AUC (IQR) of the ROC curve: 0.59 (0.56−0.62); 0.68 (0.65−0.72), respectively] and of ROSC [0.56 (0.53−0.59); 0.74 (0.71−0.78),]. Their combination in a SVM model increased the accuracy for predicting shock success [AUC (IQR) of the ROC curve: 0.71 (0.68−0.75)] and ROSC [0.77 (0.73−0.8)]. AMSA and METCO2 were significantly correlated only in patients who achieved ROSC (rho = 0.33 p = 0.03). Conclusions AMSA and ETCO2 predict shock success and ROSC after every shock, and their predictive power increases if combined. Notably, they were correlated only in patients who achieved ROSC.
Published: 2021

23. Trauma Coagulopathy and Its Outcomes

Author: Iride Francesca Ceresa, Mattia Del Maestro, F. Cuzzocrea, Gianluca Mezzini, Mario Mosconi, Maria Antonietta Bressan, Francesco Benazzo, Mirko Belliato, Federica Manzoni, Elvis Lafe, Anna Simoncelli, Sebastiano Gerosa, Giorgio Antonio Iotti, Alice Giotta Lucifero, Gabriele Savioli, Sabino Luzzi, Lorenzo Cobianchi, Giovanni Ricevuti, and Sarah Macedonio
Subjects: Adult, Male, Medicine (General), Time Factors, hemodynamics, Article, law.invention, Head trauma, coagulopathy, R5-920, Injury Severity Score, law, trauma, trauma management, medicine, Coagulopathy, Humans, Blood Transfusion, Prospective Studies, business.industry, Major trauma, General Medicine, Blood Coagulation Disorders, Length of Stay, Middle Aged, medicine.disease, Intensive care unit, Abdominal trauma, Case-Control Studies, Anesthesia, Wounds and Injuries, Female, Base excess, Observational study, Emergency Service, Hospital, business
Abstract: Background and Objectives: Trauma coagulopathy begins at the moment of trauma. This study investigated whether coagulopathy upon arrival in the emergency room (ER) is correlated with increased hemotransfusion requirement, more hemodynamic instability, more severe anatomical damage, a greater need for hospitalization, and hospitalization in the intensive care unit (ICU). We also analyzed whether trauma coagulopathy is correlated with unfavorable indices, such as acidemia, lactate increase, and base excess (BE) increase. Material and Methods: We conducted a prospective, monocentric, observational study of all patients (n = 503) referred to the Department of Emergency and Acceptance, IRCCS Fondazione Policlinico San Matteo, Pavia, for major trauma from 1 January 2018 to 30 January 2019. Results: Of the 503 patients, 204 had trauma coagulopathy (group 1), whereas 299 patients (group 2) did not. Group 1 had a higher hemotransfusion rate than group 2. In group 1, 15% of patients showed hemodynamic instability compared with only 8% of group 2. The shock index (SI) distribution was worse in group 1 than in group 2. Group 1 was more often hypotensive, tachycardic, and with low oxygen saturation, and had a more severe injury severity score than group 2. In addition, 47% of group 1 had three or more body districts involved compared with 23% of group 2. The hospitalization rate was higher in group 1 than in group 2 (76% vs. 58%). The length of hospitalization was &gt, 10 days for 45% of group 1 compared with 28% of group 2. The hospitalization rate in the ICU was higher in group 1 than in group 2 (22% vs. 14.8%). The average duration of ICU hospitalization was longer in group 1 than in group 2 (12.5 vs. 9.78 days). Mortality was higher in group 1 than in group 2 (3.92% vs. 0.98%). Group 1 more often had acidemia and high lactates than group 2. Group 1 also more often had BE &lt, &minus, 6. Conclusions: Trauma coagulopathy patients, upon arrival in the ER, have greater hemotransfusion (p = 0.016) requirements and need hospitalization (p = 0.032) more frequently than patients without trauma coagulopathy. Trauma coagulopathy seems to be more present in patients with a higher injury severity score (ISS) (p = 0.000) and a greater number of anatomical districts involved (p = 0.000). Head trauma (p = 0.000) and abdominal trauma (p = 0.057) seem related to the development of trauma coagulopathy. Males seem more exposed than females in developing trauma coagulopathy (p = 0.018). Upon arrival in the ER, the presence of tachycardia or alteration of SI and its derivatives can allow early detection of patients with trauma coagulopathy.
Published: 2020
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24. Radiographic findings in 240 patients with COVID-19 pneumonia

Author: Francesco Ballati, Sergio Giuseppe Vancheri, Angelo Corsico, Giovanni Savietto, Giorgio Antonio Iotti, Stefano Perlini, Francesco Mojoli, Roberto Dore, Alessia Maggi, Giulia Maria Stella, Adele Valentini, Costanza Canino, Chandra Bortolotto, Lorenzo Preda, and Raffaele Bruno
Subjects: Pneumonia, medicine.medical_specialty, Text mining, Coronavirus disease 2019 (COVID-19), business.industry, Radiography, Internal medicine, medicine, medicine.disease, business
Abstract: Objective: to analyze the most frequent radiographic features of COVID-19 pneumonia and assess the effectiveness of CXR in detecting pulmonary alterations.Materials and Methods: CXR of 240 symptomatic patients (70% male, mean age 65±16 years), with SARS-CoV-2 infection confirmed by RT-PCR were retrospectively evaluated. Patients were clustered in four groups based on the number of days between symptom onset and CXR: A (0-2 days) 49 patients, B (3-5) 75 patients, C (6- 9) 85 patients and D (>9) 31 patients. Alteration’s type (reticular/opacification/consolidation) and distribution (bilateral/unilateral, upper/middle/lower fields, peripheral/central) were noted. Statistical significance was tested using chi-squared test.Results: among 240 CXR, 60 (25%) were negative (A 36.7%, B 28%, C 18.8%, D 16.1%). Opacification was observed in 124/180 (68.8%), reticular alteration in 113/180 (62.7%), consolidation in 71/180 (39.4%). Consolidation was significantly less frequent (pConclusions: the most frequent lesions in COVID-19 patients were opacification (intermediate/late phase) and reticular alteration (early phase) while consolidation gradually increased over time. The most frequent distribution was bilateral, peripheral, with middle/lower predominance. Overall rate of negative CXR is 25%, progressively decreased over time.
Published: 2020
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25. Myocardial localization of coronavirus in COVID‐19 cardiogenic shock

Author: Giorgio Antonio Iotti, Paola Alessandra Sepe, Andrea Bottazzi, Raffaele Bruno, Rita Camporotondo, Fabio Sciutti, M. Maurelli, Francesco Mojoli, Guido Tavazzi, Mirko Belliato, Carlo Pellegrini, S Pelenghi, Stefania Paolucci, Tullia Resasco, Fausto Baldanti, and Eloisa Arbustini
Subjects: Mechanical ventilation, Cardiac function curve, medicine.medical_specialty, Lung, Respiratory distress, business.industry, medicine.medical_treatment, Cardiogenic shock, 030204 cardiovascular system & hematology, medicine.disease_cause, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Internal medicine, Heart failure, Extracorporeal membrane oxygenation, Cardiology, Medicine, business, Cardiology and Cardiovascular Medicine, Coronavirus
Abstract: We describe the first case of acute cardiac injury directly linked to myocardial localization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a 69-year-old patient with flu-like symptoms rapidly degenerating into respiratory distress, hypotension, and cardiogenic shock. The patient was successfully treated with venous-arterial extracorporeal membrane oxygenation (ECMO) and mechanical ventilation. Cardiac function fully recovered in 5 days and ECMO was removed. Endomyocardial biopsy demonstrated low-grade myocardial inflammation and viral particles in the myocardium suggesting either a viraemic phase or, alternatively, infected macrophage migration from the lung.
Published: 2020
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26. Setup of a Dedicated Coronavirus Intensive Care Unit: Logistical Aspects

Author: Francesco, Mojoli, Silvia, Mongodi, Giuseppina, Grugnetti, Alba, Muzzi, Fausto, Baldanti, Raffaele, Bruno, Antonio, Triarico, and Giorgio Antonio, Iotti
Subjects: Betacoronavirus, Intensive Care Units, Critical Care, Italy, Organization and Administration, SARS-CoV-2, Pneumonia, Viral, Correspondence, COVID-19, Humans, Coronavirus Infections, Pandemics, Personal Protective Equipment
Published: 2020

27. Brief Report: A Case of Tramadol Overdose: Extracorporeal Life Support and Hemoperfusion as Life-Saving Treatment

Author: Pasquale Esposito, Mirko Belliato, Francesco Mojoli, Fiorenza Ferrari, Nicola Peroni, Alessandro Carletti, Anita Orlando, Silvia Mongodi, Giorgio Antonio Iotti, and Claudio Ronco
Subjects: Continuous renal replacement therapy, medicine.medical_treatment, Multiple Organ Failure, Intoxication, 030232 urology & nephrology, Refractory shock, 030204 cardiovascular system & hematology, Blood purification, Extracorporeal, Extracorporeal life support, Brain ct, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, medicine, Humans, Life saving, Tramadol, business.industry, Hematology, General Medicine, Middle Aged, Hemoperfusion, Analgesics, Opioid, Nephrology, Life support, Anesthesia, Shock (circulatory), Quetiapine, Female, medicine.symptom, Drug Overdose, business, medicine.drug
Abstract: We describe the case of a 49-year-old woman with a Tramadol intoxication associated with multiorgan failure. Veno-arterial femoro-femoral extracorporeal life support (VA-ECLS) and hemoperfusion (HP) were used as rescue treatments. The emergency medical service found a woman at home unconscious. Once in the hospital, she was intubated and catecholamines support was immediately started for a severe shock. Brain CT was normal, whereas EEG revealed a metabolic encephalopathy pattern. Toxic levels of Tramadol and Quetiapine were detected. VA-ECLS was implanted due to persistent multiorgan failure, and HP with a charcoal cartridge was set to increase the Tramadol clearance. To quantify the charcoal cartridge’s removal efficiency of Tramadol, Tramadol concentration was measured before and after the cartridge and before and after the treatment in the patient’s blood. The charcoal cartridge showed good extraction ratio during the treatment and no significant rebound effect. VA-ECLS and HP allowed the patient to be weaned from vasoconstrictors and the resolution of the organ failures. These treatments might be lifesaving in the Tramadol intoxication.
Published: 2020

28. A COVID-19 pneumonia case report of autoimmune polyendocrine syndrome type 1 in Lombardy, Italy: letter to the editor

Author: V. Codullo, Lucia Ghizzoni, Guglielmo Beccuti, Giorgio Antonio Iotti, Francesco Mojoli, V. Cambria, P. Sacchi, S. Mongodi, and E. Lovati
Subjects: 2019-20 coronavirus outbreak, medicine.medical_specialty, Letter to the editor, Letter, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Endocrinology, Diabetes and Metabolism, medicine.disease, Dermatology, Pneumonia, Autoimmune polyendocrine syndrome type 1, Endocrinology, Medicine, Viral therapy, business
Published: 2020

29. EA-DIVA score (Enhanced Adult DIVA score): A new scale to predict difficult preoperative venous cannulation in adult surgical patients

Author: Sergio Cortesi, Luigia Scudeller, Alessandra Palo, Andrea Bottazzi, Marta Vischio, Giorgio Antonio Iotti, Antonella De Pirro, Mattia Mancardi, Giuseppe Civetta, and Marco Mazzocchi
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Clinical Decision-Making, 030232 urology & nephrology, 030204 cardiovascular system & hematology, Risk Assessment, Preoperative care, Decision Support Techniques, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Catheterization, Peripheral, Preoperative Care, medicine, Humans, Prospective Studies, Prospective cohort study, Aged, Receiver operating characteristic, business.industry, Reproducibility of Results, Middle Aged, Surgery, Diva, Nephrology, Intravenous therapy, Predictive value of tests, Female, Observational study, business, Cohort study
Abstract: Introduction: Providing peripheral intravenous access is one of the most commonly performed technical procedures in hospitals and it is mandatory for all patients undergoing surgery. Obtaining peripheral intravenous access may be difficult and this may cause delays in patient management, increased risk of adverse events and hospitalization costs. The aim of this study is to develop and validate a scale to identify patients at risk of peripheral difficult intravenous access, applicable to any adult patient undergoing surgery. Methods: A monocentric, observational study was conducted on adult surgical patients between September 2015 and April 2016. The primary outcome was the identification of parameters that could detect peripheral difficult intravenous access. Several parameters were taken into consideration, including patient details, healthcare professionals, and setting. The sample data were randomly divided into two subsets: a multivariate analysis was performed on the first one to define the Enhanced Adult DIVA score; the second subset was used for its validation. Results: We included 1006 patients (607 in the derivation, 399 in the validation cohorts respectively). The peripheral intravenous access was difficult in 127 patients (12.6%). The EA-DIVA score was devised with a score ranging from 0 to 12. The receiver operating characteristic (ROC) curve area under the curve (AUC) in the validation subset was 0.94. The validation study suggested a cut-off score of 8, which maximizes sensitivity (85.5%) and specificity (89.2%) in detecting difficult peripheral intravenous access, with a positive predictive value of 56% and a negative predictive value of 97.5%. Discussion: The EA-DIVA score is a simple tool to identify patients at high risk of peripheral difficult intravenous access. Its implementation is recommended in order to optimize peripheral intravenous access procedures.
Published: 2018
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30. Effects of combined spinal–epidural analgesia on first stage of labor: a cohort study

Author: Giorgio Mirabile, Elena Masserini, Silvia Zizzi, Giorgio Antonio Iotti, Maria Ciceri, Barbara Gardella, Luigia Scudeller, Maddalena Gerletti, Maria Paola Delmonte, Federica Broglia, Simona Pellicori, Marinella Fuardo, Chiara Verga, and Silvia Poma
Subjects: Adult, Anesthesia, Epidural, Anesthesia, Spinal, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Humans, Combined Modality Therapy, Medicine, 030212 general & internal medicine, Young adult, Stage (cooking), Anesthesia epidural, Labor, Obstetric, 030219 obstetrics & reproductive medicine, business.industry, Gold standard, Pregnancy Outcome, Obstetrics and Gynecology, Heart Rate, Fetal, medicine.disease, Analgesia, Epidural, Combined spinal epidural, Anesthesia, Pediatrics, Perinatology and Child Health, Analgesia, Obstetrical, Female, Labor Stage, First, business, Cohort study
Abstract: Background: Neuraxial anesthesia is considered as the gold standard in the control labor of pain. Its variants are epidural analgesia and combined spinal–epidural analgesia. Few studies, as yet, ha...
Published: 2018
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31. Veno-Venous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in a Patient With Acute Right Heart Failure

Author: Antonio Braschi, Silvia Mongodi, Giorgio Antonio Iotti, Marco Pozzi, Francesco Mojoli, Guido Tavazzi, Anita Orlando, and Giuseppe Maggio
Subjects: Adult, Male, medicine.medical_specialty, ARDS, medicine.medical_treatment, Acute respiratory distress, 030204 cardiovascular system & hematology, Acute cor pulmonale, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Internal medicine, Extracorporeal membrane oxygenation, medicine, Humans, Acute respiratory failure, Heart Failure, Respiratory Distress Syndrome, business.industry, Acute right heart failure, medicine.disease, Right ventricular dysfunction, Anesthesiology and Pain Medicine, 030228 respiratory system, Acute Disease, Cardiology, Hemofiltration, Cardiology and Cardiovascular Medicine, business
Published: 2017
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32. Letter to the Editor Regarding 'Intraarterial Dantrolene for Refractory Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage': Is Malignant Hyperthermia a Model for Showing Dantrolene Efficacy in Limiting Brain Damage?

Author: Antonella De Pirro, Roberto Assietti, Giorgio Antonio Iotti, and Daniele Bongetta
Subjects: Subarachnoid hemorrhage, Letter to the editor, business.industry, Malignant hyperthermia, Vasospasm, Brain damage, medicine.disease, Dantrolene, Cerebral vasospasm, Refractory, Anesthesia, medicine, Surgery, Neurology (clinical), medicine.symptom, business, medicine.drug
Published: 2020
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33. Ten-year experience with standardized non-operating room anesthesia with Sevoflurane for MRI in children affected by neuropsychiatric disorders

Author: Umberto Balottin, Simona Orcesi, Gaia Ottonello, Francesco Mojoli, Raffaelealdo Viggiano, Paola Borrelli, Silvia Mongodi, Giorgio Antonio Iotti, and Anna Pichiecchio
Subjects: Male, medicine.medical_specialty, Neuropsychiatric disorders anesthesia, Sedation, medicine.medical_treatment, Population, Non-operating room anesthesia, Sevoflurane, NORA, Cohort Studies, lcsh:RD78.3-87.3, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030202 anesthesiology, 030225 pediatrics, Anesthesiology, medicine, Humans, Child, education, Retrospective Studies, Mechanical ventilation, Univariate analysis, education.field_of_study, business.industry, Mental Disorders, Retrospective cohort study, medicine.disease, Magnetic Resonance Imaging, Anesthesiology and Pain Medicine, Migraine, lcsh:Anesthesiology, Child, Preschool, Anesthesia, Anesthetics, Inhalation, MRI sedation, Female, Nervous System Diseases, medicine.symptom, business, Research Article, medicine.drug
Abstract: BackgroundChildren require anesthesia for MRI to maintain immobility and reduce discomfort; clear indications about the best anesthesiologic management are lacking and each center developed its own protocol. Moreover, children with neuropsychiatric disorders more likely require sedation and are described in literature as more prone to general and respiratory complications. Aim of this study was to analyze the applicability of a sevoflurane-based approach, to describe general and respiratory complications and to identify risk factors in a pediatric neuropsychiatric population.MethodsRetrospective cohort study, university Hospital (January 2007–December 2016). All the 1469 anesthesiologic records of children addressed from Neuropsychiatric Unit to undergo MRI under general anesthesia were analyzed; 12 patients equal or older than 18-year-old were excluded. We identified post-hoc nine macro-categories: static encephalopathies, metabolic/evolutive encephalopathies, epileptic encephalopathies, neuromuscular diseases, autistic spectrum disorders, migraine, psychiatric disorders, intellectual disabilities, others. A logistic regression model for events with low frequency (Firth’s penalized likelihood approach) was carried out to identify the mutually adjusted effect among endpoints (complications) and the independent variables chosen on the basis of statistical significance (univariate analysis,p ≤ 0.05) and clinical judgment.ResultsOf 1457 anesthesiologic records (age 4.0 (IQR 2.0 to 7.0) year-old, males 891 (61.2%), weight 17.0 (IQR 12.0 to 24.9) kg), 18 were cancelled for high anesthesiologic risk, 50 were cooperative, 1389 were anesthetized. A sevoflurane-based anesthesia was feasible in 92.3%; these patients required significantly less mechanical ventilation (8.6 vs. 16.2%;p = 0.012). Complications’ rate was low (6.2%; 3.1% respiratory). The risk for general complications increases with ASA score > 1 (OR 2.22, 95 CI% 1.30 to 3.77,p = 0.003), male sex (OR 1.73, 95% CI 1.07 to 2.81,p = 0.025), multi-drug anesthesia (OR 2.98, 95 CI% 1.26 to 7.06,p = 0.013). For respiratory complications, it increases with ASA score > 1 (OR 2.34, 95 CI% 1.19 to 4.73,p = 0.017), autumn-winter (OR 2.01, 95 CI% 1.06 to 3.78,p = 0.030), neuromuscular disorders (OR 3.18, 95 CI% 1.20 to 8.41,p = 0.020). We had no major complications compromising patients’ outcome or requiring admission to ICU.ConclusionsSevoflurane anesthesia is feasible and safe for children affected by neuropsychiatric disorders undergoing MRI. Specific risk factors for general and respiratory complications should be considered.
Published: 2019
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34. Hyperbaric bupivacaine and sufentanil for spinal anaesthesia in caesarean section: A cohort study

Author: Simona Pellicori, Silvia Zizzi, Marinella Fuardo, Chiara Bossi, Maria Ciceri, Giorgio Antonio Iotti, Maria Paola Delmonte, Luigia Scudeller, Alessandra Della Giovanna, Federica Broglia, Chiara Baldi, and Silvia Poma
Subjects: Sufentanil, medicine.medical_treatment, Anesthesia, Spinal, Fentanyl, Cohort Studies, Double-Blind Method, Pregnancy, medicine, Anesthesia, Obstetrical, Humans, Caesarean section, Anesthetics, Local, Prospective cohort study, Bupivacaine, business.industry, Cesarean Section, Anesthesiology and Pain Medicine, Anesthesia, Nerve block, Apgar score, Female, business, medicine.drug, Cohort study
Published: 2019

35. ESRA19-0397 Serratus anterior plane block (SABP) for long-lasting analgesia and improvement of diaphragm function in multiple rib fractures (MRF): a pivotal study

Author: M Mazzocchi, A Pellegrini, Francesco Mojoli, D Passador, Giorgio Antonio Iotti, and MB Mascia
Subjects: Mechanical ventilation, Respiratory rate, business.industry, medicine.medical_treatment, Axillary lines, Diaphragmatic breathing, Hypoventilation, Diaphragm (structural system), Anesthesia, Breathing, medicine, medicine.symptom, business, Dexamethasone, medicine.drug
Abstract: Background and aims Approximately 21% of patients admitted to trauma centres with chest trauma present MRF.1 Severe pain associated can lead to hypoventilation and respiratory complications in 31% of cases.2 3 Epidural and multimodal analgesia versus opioids are recommended in pain management.2 Opioids present significant side effects. We hypothesized that SABP 4 5 could provide safe and effective analgesia, extended by addiction of dexamethasone to local anaesthetic solution, and reduce respiratory complications, enhancing recovery of a better mechanical lung function. Methods 4 patients (BMI 30±3, age 60±18) admitted to ED for politrauma with lateral and posterior MRF (6±2) and severe pain (NRS>5), impairing maximal inspiration and coughing, were treated with multimodal analgesia+ SAPB (ethics committee approval obtained). We injected 0,25%-levobupivacaine 30 ml and dexamethasone (8 mg) towards the serratus plane on the midaxillary line at 5th rib level with ultrasound guidance. We registered RR, PaO2/FiO2 and NRS at rest (NRSr), during maximal inspiration (NRSi) and coughing (NRSc) before SABP (T0), after 15 minutes (T1) and after 4h (T2). At T0 and T2 we performed diaphragmatic ultrasound (diaphragm thickening ratio%, DTRr and DTRi). Results All patients had benefits: NRSr, NRSi and NRSc strongly decreased at T1; benefits were maintained at T2 (Graph 1). Both DTRr and DTRi improved at T2 (Graph 2). Respiratory rate fell from 32±5 to 18±3 at T1, PaO2/FiO2 remained ≥270; deeper breathing allowed 20% reduction in FiO2. No patient asked for rescue analgesia. Analgesia duration was 43±6h. No patient had respiratory complication requiring mechanical ventilation. Conclusions Both clinical and instrumental patterns suggest that SAPB is safe and provides effective opioid-sparing analgesia in MRF. It improves diaphragm function and could reduce respiratory complications.
Published: 2019
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36. ESRA19-0410 Synergy between locoregional analgesia (LRA) and IV ozone (O3) therapy in microvascular recruitment: a challenge to save limb after femur nail infection. a case report

Author: C Perotti, Giorgio Antonio Iotti, M Mazzocchi, MB Mascia, P Quaretti, and G Ragni
Subjects: Nail Infection, business.industry, medicine.drug_class, medicine.medical_treatment, Antibiotics, Vasodilation, Lipid oxidation, Anesthesia, Medicine, Femur, Complication, Wound healing, business, Saline
Abstract: Background and aims Infection can seriously complicate surgical treatment of fractures (up to 30%)1; if significant tissue damage is involved, compromised vasculature impairs access of host defences and antibiotics to affected areas, leading to permanent functional loss. O3 is a gas that can be administered iv after melting with saline solution (10–80 mcg/mL); combination with biological water leads to formation of reactive oxygen and lipid oxidation products, thus activating biochemical pathways that increase: erythrocytes’ ATP and 2,3-DPG, NO release, platelets and neutrophil-phagocytic activity, antioxidant enzymes upregulation, staminal cells migration/differentiation at injured sites and re-endothelization.2 3 LRA allows post-operative pain control and vasodilation, improving microcirculation4 and antibiotic delivery to the infection site. Methods A 45-year-old woman (BMI 40) with severe femur nail infection, submitted to multiple surgical debridements and antibiotic therapies with poor effects during 3 weeks, was finally scheduled for hip disarticulation. as a last chance, lumbar epidural catheter was placed to optimize pain control and O3 was started (35 mcg/ml, 500 ml/day during 15 days) through CV access. No complication happened. Circulating endothelial progenitors cells (CEPs) were evaluated using monoclonal-antibodies labeled towards CD106+45- and CD90+45; blood samples were obtained at days 0, 7, and 15 after starting O3. Results At day 15 patient was free from infection: no clinical signs, wound healing (figure 1), negative cultural exams. Simultaneously increased levels of CEPs released from bone-marrow in response to flogosis fell, probably showing complete endothelial repair (figure 2). Conclusions Synergy between LRA and O3 in microvasculature recruitment is a challenge to heal severe infections after surgical treatment of fractures; CEPs levels could correlate with response to therapy.
Published: 2019
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37. Levobupivacaine combined with dexamethasone for serratus plane block can provide long-lasting analgesia in multiple rib fractures

Author: Stefano Perlini, Benedetta Mascia, Santi Di Pietro, and Giorgio Antonio Iotti
Subjects: Long lasting, lcsh:R5-920, Plane (geometry), business.industry, macromolecular substances, Rib fractures, Nerve blocks, Steroids in Nerve blocks, Levobupivacaine, Block (telecommunications), Anesthesia, medicine, Serratus Plane Block, lcsh:Medicine (General), business, Dexamethasone, medicine.drug
Abstract: Serratus plane block (SPB) is a technique of regional anesthesia that has recently been proposed to treat pain in rib fractures. In this context, SPB is currently performed using a variety of local anesthetics at different concentrations and dilutions, reporting a duration of pain control up to 12 hours following the procedure. To the best of our knowledge, the addition of dexamethasone to the local anesthetic for this specific regional block has never been documented. Here we report three patients that were treated for multiple rib fractures with SPB, which included combined dexamethasone and levobupivacaine. Interestingly, the obtained pain control lasted between 23 to 45 hours following the block, thus helping to minimize the opioid use in our patients.
Published: 2019
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38. Load distributing band device for mechanical chest compressions: An Utstein-categories based analysis of survival to hospital discharge

Author: S Buratti, Giorgio Antonio Iotti, Sara Compagnoni, Fabrizio Canevari, Simone Savastano, Gaetano M. De Ferrari, Elisa Cacciatore, Mirko Belliato, Alessandra Palo, Luigi Oltrona Visconti, Enrico Baldi, and Maurizio Raimondi
Subjects: Thorax, Male, Resuscitation, medicine.medical_specialty, Emergency Medical Services, Time Factors, Treatment outcome, MEDLINE, Heart Massage, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Hospital discharge, Medicine, Humans, 030212 general & internal medicine, Registries, Aged, Aged, 80 and over, business.industry, Equipment Design, Middle Aged, Patient Discharge, Survival Rate, Treatment Outcome, Multicenter study, Italy, Emergency medicine, Female, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest
Abstract: The role of load distributing band device (LDB, AutoPulse®, Zoll Medical Corporation, Chelmsford, MA, USA) in out-of-hospital cardiac arrest is still a matter of debate, with few studies reaching conflicting results available in literature. We sought to assess whether the use of the LBD device could affect survival to hospital discharge in the different Utstein categories.All consecutive patients enrolled in our provincial cardiac arrest registry (Pavia CARe) from January 2015 to December 2017 were included and pre-hospital data were computed as well as survival to hospital discharge.Among 1401 resuscitation attempts, the LDB device was used in 235 (17%) patients. The LDB device was significantly more used for shockable cardiac arrest (42.6% vs 13.7%, p 0.001). The rate of ROSC and of survival to hospital discharge in the LDB group compared to the manual group was 40% vs 17% (p 0.001) and 10% vs 7% (p = 0.2), respectively. However, after correction for independent predictors of LDB use, LDB device was a strong independent predictor of survival to hospital discharge only for non-shockable witnessed OHCA [n = 624/1401, OR 11.9 (95% CI 1.5-95.2), p = 0.02]. In this categories of patients LDB group showed longer resuscitation time [49.3 min (IQR 37-71) vs 23.6 (IQR 15-35), p 0.001] and a higher rate of conversion to a shockable rhythm (33/83 = 40% vs 29/541 = 5%, p 0.001).Utstein categories-based analysis showed that the LDB device positively affect survival to hospital discharge for non-shockable witnessed cardiac arrests with a neutral effect for shockable rhythms.
Published: 2019

39. Right ventricular total isovolumic time: Reference value study

Author: Giorgio Antonio Iotti, Stefano Ghio, Catherine Klersy, Paolo Barbier, Francesco Mojoli, Claudia Raineri, Andrea Boffi, Claudia Pavesi, Stefania Guida, Gabriele Savioli, Susanna Price, Gabriele Via, Alessandra Greco, Guido Tavazzi, Gaetano M. De Ferrari, University of Zurich, and Tavazzi, Guido
Subjects: Adult, Male, medicine.medical_specialty, Systole, Population, Diastole, 610 Medicine & health, 030204 cardiovascular system & hematology, right ventricle, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Heart rate, medicine, Humans, 2741 Radiology, Nuclear Medicine and Imaging, echocardiography, Radiology, Nuclear Medicine and imaging, education, education.field_of_study, Tricuspid valve, business.industry, diastolic function, Age Factors, 030208 emergency & critical care medicine, Forward flow, Middle Aged, reference values, Echocardiography, Doppler, total isovolumic time, Cardiovascular physiology, medicine.anatomical_structure, Italy, Ventricle, Pulmonary valve, Cardiology, Ventricular Function, Right, Female, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND There is lack of noninvasive indices to detail the right side cardiovascular physiology. Total isovolumic time (tIVT) is a sensitive marker of left ventricular electromechanical efficiency and systolic-diastolic interaction. The aim of the study was to evaluate normal reference value of the right ventricular tIVT with increasing age. METHODS AND RESULTS One hundred and eighty-one healthy volunteers (51% male) underwent transthoracic echocardiography. The population was divided into four categories according to age: A
Published: 2019

40. Development and validation of quick Acute Kidney Injury-score (q-AKI) to predict acute kidney injury at admission to a multidisciplinary intensive care unit

Author: Mara Serrano-Soto, Valentina Corradi, Antonio Baracca, Ana Castro, Ottavia Eleonora Ferraro, Marta Scarpa, Claudio Ronco, Mara Senzolo, Eva Muraro, Mariangela Valentina Puci, Alejandra Molano Triviño, Raffaele Bonato, Massimo de Cal, Lilia Rizo-Topete, Alessandra Brendolan, Fiorenza Ferrari, Davide Giavarina, Giorgio Antonio Iotti, Maria Rosa Carta, Anna Lorenzin, Gregorio Romero-González, and Faeq Husain-Syed
Subjects: Male, Physiology, 030232 urology & nephrology, Blood Pressure, Urine, Vascular Medicine, Biochemistry, law.invention, chemistry.chemical_compound, 0302 clinical medicine, law, Chronic Kidney Disease, Medicine and Health Sciences, Registries, Aged, 80 and over, Multidisciplinary, Framingham Risk Score, Acute kidney injury, Acute Kidney Injury, Middle Aged, Intensive care unit, Hospitals, Body Fluids, Intensive Care Units, Physiological Parameters, Nephrology, Creatinine, Medicine, Female, Anatomy, Research Article, Glomerular Filtration Rate, medicine.medical_specialty, Critical Care, Science, Renal function, 03 medical and health sciences, Internal medicine, medicine, Humans, Obesity, Derivation, Aged, Retrospective Studies, business.industry, Body Weight, Biology and Life Sciences, Kidneys, 030208 emergency & critical care medicine, Retrospective cohort study, Renal System, medicine.disease, Health Care, chemistry, Health Care Facilities, business, Biomarkers, Kidney disease
Abstract: AKI is associated with increased risk of death, prolonged length of stay and development of de-novo chronic kidney disease. The aim of our study is the development and validation of prediction models to identify the risk of AKI in ICU patients up to 7 days. We retrospectively recruited 692 consecutive patients admitted to the ICU at San Bortolo Hospital (Vicenza, Italy) from 1 June 2016 to 31 March 2017: 455 patients were treated as the derivation group and 237 as the validation group. Candidate variables were selected based on a literature review and expert opinion. Admission eGFR< 90 ml/min /1.73 mq (OR 2.78; 95% CI 1.78-4.35; p
Published: 2019

41. The Potential Organ Donor: Current Trends and Management

Author: Marinella Zanierato, Riccardo De Carlis, Giorgio Antonio Iotti, Luciano De Carlis, and Paolo Aseni
Subjects: Neurologic injury, medicine.medical_specialty, business.industry, Major trauma, medicine, Intensive care medicine, business, medicine.disease
Abstract: Increasing numbers of trauma patients receive immediate and appropriate control of life-threatening injuries, but some of them eventually progress to brain death. Establishment of the best therapeutic strategies for patients with extensive and major trauma has led to significant improvement in donor conversion rates and increased utilization of deceased donors. Approximately 30% of all deceased organ donors are trauma patients who have suffered devastating neurologic injury and have progressed to brain death.
Published: 2019
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42. A case of veno‐venous extracorporeal membrane oxygenation for severe respiratory failure in a superobese patient

Author: Anna Aliberti, Mirko Belliato, Giorgio Antonio Iotti, Carlo Pellegrini, Michele Pagani, and Luca Cremascoli
Subjects: obesity, medicine.medical_specialty, Sedation, medicine.medical_treatment, awake extracorporeal membrane oxygenation, Case Report, Case Reports, 03 medical and health sciences, 0302 clinical medicine, medicine, Extracorporeal membrane oxygenation, Acute respiratory failure, Intensive care medicine, Acute distress respiratory syndrome, Mechanical ventilation, acute respiratory failure, business.industry, 030208 emergency & critical care medicine, General Medicine, extracorporeal membrane oxygenation, surgical procedures, operative, 030228 respiratory system, Respiratory failure, Anesthesia, medicine.symptom, business
Abstract: Key Clinical Message After risk assessment, veno‐venous extracorporeal membrane oxygenation (ECMO) has been achieved in a superobese adult patient as a bridge to recovery of respiratory failure, despite the weight‐related difficulties. Early v‐v ECMO implantation could be considered to support and to conduct weaning both from sedation and from invasive mechanical ventilation, with the goal to perform physiokinesitherapy during awake ECMO.
Published: 2016
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43. Results of a prospective study (CATS) on the effects of thalamic stimulation in minimally conscious and vegetative state patients

Author: Giorgio Maggioni, Caterina Pistarini, Lorenzo Magrassi, Stefano Bastianello, Roberto Imberti, Gabriele Biella, Antonio G. Zippo, Giorgio Antonio Iotti, and Carol Di Perri
Subjects: Adult, Male, 0301 basic medicine, medicine.medical_specialty, Deep brain stimulation, Adolescent, Deep Brain Stimulation, medicine.medical_treatment, Thalamus, Stimulation, Unconsciousness, Young Adult, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Prospective Studies, Child, Prospective cohort study, Thalamic stimulator, Aged, Coma, business.industry, Persistent Vegetative State, Minimally conscious state, General Medicine, Middle Aged, medicine.disease, Surgery, 030104 developmental biology, Anesthesia, Female, Wakefulness, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: OBJECTIVE Deep brain stimulation of the thalamus was introduced more than 40 years ago with the objective of improving the performance and attention of patients in a vegetative or minimally conscious state. Here, the authors report the results of the Cortical Activation by Thalamic Stimulation (CATS) study, a prospective multiinstitutional study on the effects of bilateral chronic stimulation of the anterior intralaminar thalamic nuclei and adjacent paralaminar regions in patients affected by a disorder of consciousness. METHODS The authors evaluated the clinical and radiological data of 29 patients in a vegetative state (unresponsive wakefulness syndrome) and 11 in a minimally conscious state that lasted for more than 6 months. Of these patients, 5 were selected for bilateral stereotactic implantation of deep brain stimulating electrodes into their thalamus. A definitive consensus for surgery was obtained for 3 of the selected patients. All 3 patients (2 in a vegetative state and 1 in a minimally conscious state) underwent implantation of bilateral thalamic electrodes and submitted to chronic stimulation for a minimum of 18 months and a maximum of 48 months. RESULTS In each case, there was an increase in desynchronization and the power spectrum of electroencephalograms, and improvement in the Coma Recovery Scale–Revised scores was found. Furthermore, the severity of limb spasticity and the number and severity of pathological movements were reduced. However, none of these patients returned to a fully conscious state. CONCLUSIONS Despite the limited number of patients studied, the authors confirmed that bilateral thalamic stimulation can improve the clinical status of patients affected by a disorder of consciousness, even though this stimulation did not induce persistent, clinically evident conscious behavior in the patients. Clinical trial registration no.: NCT01027572 (ClinicalTrials.gov)
Published: 2016
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44. Are Neurogenic Stress Cardiomyopathy and Takotsubo Different Syndromes With Common Pathways?

Author: Francesco Procaccio, Guido Tavazzi, Giorgio Antonio Iotti, Gabriele Via, and Marinella Zanierato
Subjects: medicine.medical_specialty, Heart disease, business.industry, Cardiomyopathy, Dysfunctional family, 030204 cardiovascular system & hematology, medicine.disease, Transplantation, 03 medical and health sciences, 0302 clinical medicine, Heart failure, Health care, Medicine, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Intensive care medicine
Abstract: The imbalance between the number of organ donors and the demand is currently a major health care problem, although improved technology and experience with long-term mechanical support are increasingly providing alternative solutions to end-stage heart disease. There are strict criteria to assess
Published: 2017
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45. A 70-Year-Old Develops Refractory Hypotension in the ICU

Author: Francesco Mojoli, Anita Orlando, Silvia Mongodi, Giorgio Antonio Iotti, Luca Civardi, and Emanuela Maria Roldi
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, MEDLINE, 030204 cardiovascular system & hematology, Refractory hypotension, Critical Care and Intensive Care Medicine, Cardiac Tamponade, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Text mining, 030202 anesthesiology, medicine, Humans, Female, Hypotension, Cardiology and Cardiovascular Medicine, business, Intensive care medicine, Aged
Published: 2017
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46. Mild head trauma in elderly patients: experience of an emergency department

Author: Elvis Lafe, Luca Ciceri, Maria Antonietta Bressan, Federica Manzoni, Mattia Del Maestro, Anna Simoncelli, Giorgio Antonio Iotti, Gianluca Mezzini, Iride Francesca Ceresa, Giovanni Ricevuti, Mirko Belliato, Gabriele Savioli, Sabino Luzzi, and Fabio Sciutti
Subjects: 0301 basic medicine, medicine.medical_specialty, Population, Neurosurgery, Hemorrhage, Posttraumatic intracranial hemorrhage, Logistic regression, Trauma, Article, Clinical research, Head trauma, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, lcsh:Social sciences (General), Mild traumatic brain injury, Risk factor, lcsh:Science (General), education, education.field_of_study, Multidisciplinary, business.industry, Incidence (epidemiology), Brain injury management, Emergency department, Odds ratio, Elderly patients, 030104 developmental biology, Emergency medicine, lcsh:H1-99, business, 030217 neurology & neurosurgery, lcsh:Q1-390
Abstract: Introduction We evaluated the risk profile of elderly patients who came to the emergency department for mild head trauma. The primary goal was to determine the difference in the incidence of posttraumatic intracranial hemorrhage (ICH) after minor head injury (MHI). The secondary objective was to assess worse outcome, such as: hospitalization rate, rate of re-admission, need of neurosurgery. We also assess the admission process times and length of hospital stay. The ultimate goal was to optimize the diagnostic-observational management of minor head trauma in elderly patients. Material and methods We evaluated all patients with MHI who came to our emergency department during 2017 and 2018. All patients underwent computed tomography. Results We enrolled 2325 patients, of whom 1094 were 75 years of age or older. The population was divided into two categories according to age: The “elderly population” was 75 or older, and the younger patients were younger than 75. The elderly population, in comparison with the younger patients, had a higher rate of ICH (12.1% versus 5.1%), a higher hospitalization rate (11.7% versus 5.5%), and a higher rate of readmission within 30 days (6.8% versus 3.2%). The elderly population also had longer admission process times (8 h, 25 min, versus 4 h, 09 min) and longer lengths of hospital stay (9 h, 41 min, versus 5 h, 29 min). Of the younger patients, 92% (versus 41% of the elderly population) did not take any drugs, 6% (versus 39%) were receiving antiplatelet therapy, 1% (versus 13%) took vitamin K antagonists, and 1% (versus 7%) took oral direct-acting anticoagulants. Logistic regression models revealed that a 1-year increase in age raised the risk of bleeding by 2% on average; this finding was statistically significant (odds ratio [OR], 1023/year, p < 0.001). The rate of ICH increased significantly after the age of 75, by 180% (OR, 2.82; p < 0.001). Conclusions These data suggest that age is an independent risk factor for ICH, whereby the age of 75 entails a 180% increase in the risk of bleeding., Neurosurgery; Trauma; Emergency medicine; Internal medicine; Clinical research; Brain injury management; Elderly patients; Hemorrhage; Mild traumatic brain injury; Posttraumatic intracranial hemorrhage.
Published: 2020
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47. Lung ultrasound for daily monitoring of ARDS patients on extracorporeal membrane oxygenation: preliminary experience

Author: Andrea Stella, Anita Orlando, Bã©laid Bouhemad, Marco Pozzi, Silvia Mongodi, Giorgio Antonio Iotti, Guido Tavazzi, Gabriele Via, Francesco Mojoli, University of Zurich, and Mongodi, Silvia
Subjects: ARDS, medicine.medical_specialty, medicine.medical_treatment, Pain medicine, MEDLINE, 610 Medicine & health, Critical Care and Intensive Care Medicine, 11171 Cardiocentro Ticino, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal Membrane Oxygenation, Anesthesiology, medicine, Extracorporeal membrane oxygenation, Humans, Intensive care medicine, Lung, Ultrasonography, Respiratory Distress Syndrome, business.industry, 030208 emergency & critical care medicine, medicine.disease, Lung ultrasound, 030228 respiratory system, business, 2706 Critical Care and Intensive Care Medicine
Published: 2018
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48. A 67-Year-Old Man With Severe Posttraumatic ARDS in Extracorporeal Membrane Oxygenation Presents Sudden Desaturation

Author: Aaron Venti, Antonio Braschi, Silvia Mongodi, Giorgio Antonio Iotti, Marta Luperto, Anita Orlando, and Francesco Mojoli
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, ARDS, Thoracic Injuries, medicine.medical_treatment, Computed tomography, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, Fatal Outcome, 0302 clinical medicine, Extracorporeal membrane oxygenation, Humans, Medicine, RESPIRATORY DISTRESS SYNDROME ADULT, Aged, Respiratory Distress Syndrome, Lung, medicine.diagnostic_test, business.industry, Pneumothorax, 030208 emergency & critical care medicine, medicine.disease, Surgery, medicine.anatomical_structure, 030228 respiratory system, Anesthesia, Cardiology and Cardiovascular Medicine, business
Published: 2016
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49. Modified lung ultrasound score for assessing and monitoring pulmonary aeration

Author: Andrea Stella, Gabriele Via, Antonio Braschi, Silvia Mongodi, Giorgio Antonio Iotti, Guido Tavazzi, Belaid Bouhemad, Francesco Mojoli, Anita Orlando, University of Zurich, and Mongodi, Silvia
Subjects: medicine.medical_specialty, Icu patients, 610 Medicine & health, 11171 Cardiocentro Ticino, 03 medical and health sciences, 0302 clinical medicine, X ray computed, medicine, Humans, 2741 Radiology, Nuclear Medicine and Imaging, Radiology, Nuclear Medicine and imaging, Lung, Ultrasonography, Coalescence (physics), business.industry, Ultrasound, 030208 emergency & critical care medicine, Lung ultrasound, medicine.anatomical_structure, 030228 respiratory system, Pleura, Tomography, Radiology, Intercostal space, Tomography, X-Ray Computed, business
Abstract: Purpose Lung Ultrasound Score (LUSS) is a useful tool for lung aeration assessment but presents two theoretical limitations. First, standard LUSS is based on longitudinal scan and detection of number/coalescence of B lines. In the longitudinal scan pleura visualization is limited by intercostal space width. Moreover, coalescence of B lines to define severe loss of aeration is not suitable for non-homogeneous lung pathologies where focal coalescence is possible. We therefore compared longitudinal vs. transversal scan and also cLUSS (standard coalescence-based LUSS) vs. qLUSS (quantitative LUSS based on % of involved pleura). Materials and methods 38 ICU patients were examined in 12 thoracic areas in longitudinal and transversal scan. B lines (number, coalescence), subpleural consolidations (SP), pleural length and pleural involvement (> or ≤ 50 %) were assessed. cLUSS and qLUSS were computed in longitudinal and transversal scan. Results Transversal scan visualized wider (3.9 [IQR 3.8 – 3.9] vs 2.0 [1.6 – 2.5] cm, p 50 % was observed in 17 % and coalescence in 33 % of cases. Focal coalescence accounted for 52 % of cases of coalescence. qLUSS-transv generated a different distribution of aeration scores compared to cLUSS-long (p Conclusion In unselected ICU patients, variability of pleural length in longitudinal scans is high and focal coalescence is frequent. Transversal scan and quantification of pleural involvement are simple measures to overcome these limitations of LUSS.
Published: 2017

50. Veno-venous ECMO during surgical repair of tracheal perforation: A case report

Author: Filippo Antonacci, Carlo Pellegrini, Giorgio Antonio Iotti, Fabio Silvio Taccone, Chiara De Tisi, Ilaria Donadoni, Giulio Orlandoni, M. Maurelli, and Mirko Belliato
Subjects: Physique de l'état condense [struct. électronique, etc.], medicine.medical_specialty, medicine.medical_treatment, Physique de l'état condense [struct. propr. thermiques, etc.], 030204 cardiovascular system & hematology, Extracorporeal, Article, 03 medical and health sciences, 0302 clinical medicine, Bronchoscopy, Case report, medicine, Extracorporeal membrane oxygenation, Intubation, Physique de l'état condense [supraconducteur], Surgical repair, medicine.diagnostic_test, business.industry, respiratory system, Surgery, surgical procedures, operative, 030228 respiratory system, Cardiothoracic surgery, Anesthesia, medicine.symptom, ECMO, business, Airway, Tracheal perforation, Subcutaneous emphysema
Abstract: Introduction Extracorporeal membrane oxygenation (ECMO) is used extensively in cardiothoracic surgery both for hemodynamic and respiratory support. It has proven to be a valuable tool to maintain adequate oxygenation during tracheal surgery. Airway lesion may be an indication for veno-venous ECMO both in case of conservative management and in case of surgical repair. Here we report the case of a patient with a iatrogenic tracheal injury, successfully operated with the support of veno-venous extracorporeal oxygenation. Presentation of case A 39-year-old female underwent an elective laparoscopic adhesiolysis. At the end of the procedure, the patient had developed subcutaneous emphysema. A CT-scan showed mediastinal and subcutaneous emphysema and left pneumothorax with a laceration of the membranous portion of the middle third of the trachea. A left pleural drain was inserted and a bronchoscopy showed a 2-cm long tear of the membranous portion in the middle third of the trachea. Veno-venous ECMO was established and surgical repair of the tracheal lesion was performed. Post-operative recovery was uneventful and the patient was discharged on 8th postoperative day. Discussion The use of Veno-venous ECMO allowed a safe intubation with optimal oxygenation. A selective intubation with a small tube was performed to prevent further tracheal injury and allow an adequate surgical space for tracheal repair. Conclusion The use of ECMO support represents a safe and effective way to manage patients with ITI when surgical repair with minimally invasive ventilation is needed. Since this is a case report larger studies are needed to validate the technique., SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2017

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