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1. Follow-up short and long-term mortalities of tracheostomized critically ill patients in an Italian multi-center observational study

Author

Maria Vargas, Denise Battaglini, Massimo Antonelli, Ruggero Corso, Giulio Frova, Guido Merli, Flavia Petrini, Marco V. Ranieri, Massimiliano Sorbello, Ida Di Giacinto, Pierpaolo Terragni, Iole Brunetti, Giuseppe Servillo, and Paolo Pelosi

Subjects
Medicine, Science
Abstract

Abstract The effects of tracheostomy on outcome as well as on intra or post-operative complications is yet to be defined. Admission of patients with tracheostomy to rehabilitation facility is at higher risk of suboptimal care and increased mortality. The aim of the study was to investigate ICU mortality, clinical outcome and quality of life up to 12 months after ICU discharge in tracheostomized critically ill patients. This is a prospective, multi-center, cohort study endorsed by Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care (SIAARTI Prot. n° 643/13) registered in Clinicaltrial.gov (NCT01899352). Patients admitted to intensive care unit (ICU) and requiring elective tracheostomy according to physician in charge decision were included in the study. The primary outcome was ICU mortality. Secondary outcomes included risk factors for ICU mortality, prevalence of mortality at follow-up, rate of discharge from the hospital and rehabilitation, quality of life, performance status, and management of tracheostomy cannula at 3-, 6, 12-months from the day of tracheostomy. 694 critically ill patients who were tracheostomized in the ICU were included. ICU mortality was 15.8%. Age, SOFA score at the day of the tracheostomy, and days of endotracheal intubation before tracheostomy were risk factors for ICU mortality. The regression tree analysis showed that SOFA score at the day of tracheostomy and age had a preeminent role for the choice to perform the tracheostomy. Of the 694 ICU patients with tracheostomy, 469 completed the 12-months follow-up. Mortality was 33.51% at 3-months, 45.30% at 6-months, and 55.86% at 12-months. Patients with tracheostomy were less likely discharged at home but at hospital facilities or rehabilitative structures; and quality of life of patients with tracheostomy was severely compromised at 3–6 and 12 months when compared with patients without tracheostomy. In patients admitted to ICU, tracheostomy is associated with high mortality, difficult rehabilitation, and decreased quality of life. The choice to perform a tracheostomy should be carefully weighed on family burden and health-related quality of life. Clinical trial registration: Clinicaltrial.gov (NCT01899352).

Published
2024
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2. External validation of unsupervised COVID-19 clinical phenotypes and their prognostic impact

Author

Daniele Roberto Giacobbe, Emilio Di Maria, Alberto Stefano Tagliafico, Martina Bavastro, Carlo Simone Trombetta, Cristina Marelli, Gabriele Di Meco, Greta Cattardico, Sara Mora, Alessio Signori, Antonio Vena, Malgorzata Mikulska, Chiara Dentone, Bianca Bruzzone, Bianca Bignotti, Andrea Orsi, Chiara Robba, Lorenzo Ball, Iole Brunetti, Denise Battaglini, Antonio Di Biagio, Maria Pia Sormani, Paolo Pelosi, Mauro Giacomini, Giancarlo Icardi, and Matteo Bassetti

Subjects
COVID-19, SARS-CoV-2, phenotypes, pandemic, unsupervised clustering, external validation, Medicine
Abstract

AbstractBackground Hospitalized patients with coronavirus disease 2019 (COVID-19) can be classified into different clinical phenotypes based on their demographic, clinical, radiology, and laboratory features. We aimed to validate in an external cohort of hospitalized COVID-19 patients the prognostic value of a previously described phenotyping system (FEN-COVID-19) and to assess the reproducibility of phenotypes development as a secondary analysis.Methods Patients were classified in phenotypes A, B or C according to the severity of oxygenation impairment, inflammatory response, hemodynamic and laboratory tests according to the FEN-COVID-19 method.Results Overall, 992 patients were included in the study, and 181 (18%), 757 (76%) and 54 (6%) of them were assigned to the FEN-COVID-19 phenotypes A, B, and C, respectively. An association with mortality was observed for phenotype C vs. A (hazard ratio [HR] 3.10, 95% confidence interval [CI] 1.81–5.30, p

Published
2023
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3. Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial

Author

Chiara Robba, Rafael Badenes, Denise Battaglini, Lorenzo Ball, Filippo Sanfilippo, Iole Brunetti, Janus Christian Jakobsen, Gisela Lilja, Hans Friberg, Pedro David Wendel-Garcia, Paul J. Young, Glenn Eastwood, Michelle S. Chew, Johan Unden, Matthew Thomas, Michael Joannidis, Alistair Nichol, Andreas Lundin, Jacob Hollenberg, Naomi Hammond, Manoj Saxena, Annborn Martin, Miroslav Solar, Fabio Silvio Taccone, Josef Dankiewicz, Niklas Nielsen, Anders Morten Grejs, Florian Ebner, Paolo Pelosi, and TTM2 Trial collaborators

Subjects
Cardiac arrest, Hypoxemia, Hyperoxemia, Mortality, Neurological outcome, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients’ outcome. Methods Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). Conclusions In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration: clinicaltrials.gov NCT02908308 , Registered September 20, 2016.

Published
2022
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4. Effect of Automated Closed-loop ventilation versus convenTional VEntilation on duration and quality of ventilation in critically ill patients (ACTiVE) – study protocol of a randomized clinical trial

Author

Michela Botta, Anissa M. Tsonas, Jante S. Sinnige, Ashley J. R. De Bie, Alexander J. G. H. Bindels, Lorenzo Ball, Denise Battaglini, Iole Brunetti, Laura A. Buiteman–Kruizinga, Pim L. J. van der Heiden, Evert de Jonge, Francesco Mojoli, Chiara Robba, Abraham Schoe, Frederique Paulus, Paolo Pelosi, Ary Serpa Neto, Janneke Horn, Marcus J. Schultz, and The ACTiVE collaborative group

Subjects
Randomized controlled trial, Intensive care, ICU, Mechanical ventilation, Invasive ventilation, Automation, Medicine (General), R5-920
Abstract

Abstract Background INTELLiVENT–Adaptive Support Ventilation (ASV) is a fully automated closed-loop mode of ventilation for use in critically ill patients. Evidence for benefit of INTELLiVENT–ASV in comparison to ventilation that is not fully automated with regard to duration of ventilation and quality of breathing is largely lacking. We test the hypothesis that INTELLiVENT–ASV shortens time spent on a ventilator and improves the quality of breathing. Methods The “Effects of Automated Closed–loop VenTilation versus Conventional Ventilation on Duration and Quality of Ventilation” (ACTiVE) study is an international, multicenter, two-group randomized clinical superiority trial. In total, 1200 intensive care unit (ICU) patients with an anticipated duration of ventilation of > 24 h will be randomly assigned to one of the two ventilation strategies. Investigators screen patients aged 18 years or older at start of invasive ventilation in the ICU. Patients either receive automated ventilation by means of INTELLiVENT–ASV, or ventilation that is not automated by means of a conventional ventilation mode. The primary endpoint is the number of days free from ventilation and alive at day 28; secondary endpoints are quality of breathing using granular breath-by-breath analysis of ventilation parameters and variables in a time frame of 24 h early after the start of invasive ventilation, duration of ventilation in survivors, ICU and hospital length of stay (LOS), and mortality rates in the ICU and hospital, and at 28 and 90 days. Discussion ACTiVE is one of the first randomized clinical trials that is adequately powered to compare the effects of automated closed-loop ventilation versus conventional ventilation on duration of ventilation and quality of breathing in invasively ventilated critically ill patients. The results of ACTiVE will support intensivist in their choices regarding the use of automated ventilation. Trial registration ACTiVE is registered in clinicaltrials.gov (study identifier: NCT04593810 ) on 20 October 2020.

Published
2022
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5. Effects of positive end-expiratory pressure on lung ultrasound patterns and their correlation with intracranial pressure in mechanically ventilated brain injured patients

Author

Chiara Robba, Lorenzo Ball, Denise Battaglini, Francesca Iannuzzi, Iole Brunetti, Pietro Fiaschi, Gianluigi Zona, Fabio Silvio Taccone, Antonio Messina, Silvia Mongodi, and Paolo Pelosi

Subjects
Intracranial pressure, Lung ultrasound, Positive end expiratory pressure, Brain injured patients, Mechanical ventilation, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background The effects of positive end-expiratory pressure (PEEP) on lung ultrasound (LUS) patterns, and their relationship with intracranial pressure (ICP) in brain injured patients have not been completely clarified. The primary aim of this study was to assess the effect of two levels of PEEP (5 and 15 cmH2O) on global (LUStot) and regional (anterior, lateral, and posterior areas) LUS scores and their correlation with changes of invasive ICP. Secondary aims included: the evaluation of the effect of PEEP on respiratory mechanics, arterial partial pressure of carbon dioxide (PaCO2) and hemodynamics; the correlation between changes in ICP and LUS as well as respiratory parameters; the identification of factors at baseline as potential predictors of ICP response to higher PEEP. Methods Prospective, observational study including adult mechanically ventilated patients with acute brain injury requiring invasive ICP. Total and regional LUS scores, ICP, respiratory mechanics, and arterial blood gases values were analyzed at PEEP 5 and 15 cmH2O. Results Thirty patients were included; 19 of them (63.3%) were male, with median age of 65 years [interquartile range (IQR) = 66.7–76.0]. PEEP from 5 to 15 cmH2O reduced LUS score in the posterior regions (LUSp, median value from 7 [5–8] to 4.5 [3.7–6], p = 0.002). Changes in ICP were significantly correlated with changes in LUStot (rho = 0.631, p = 0.0002), LUSp (rho = 0.663, p

Published
2022
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6. Lung distribution of gas and blood volume in critically ill COVID-19 patients: a quantitative dual-energy computed tomography study

Author

Lorenzo Ball, Chiara Robba, Jacob Herrmann, Sarah E. Gerard, Yi Xin, Maura Mandelli, Denise Battaglini, Iole Brunetti, Giuseppe Minetti, Sara Seitun, Giulio Bovio, Antonio Vena, Daniele Roberto Giacobbe, Matteo Bassetti, Patricia R. M. Rocco, Maurizio Cereda, Rahim R. Rizi, Lucio Castellan, Nicolò Patroniti, Paolo Pelosi, and Collaborators of the GECOVID Group

Subjects
COVID-19, Dual energy computed tomography, ARDS, Lung imaging, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Critically ill COVID-19 patients have pathophysiological lung features characterized by perfusion abnormalities. However, to date no study has evaluated whether the changes in the distribution of pulmonary gas and blood volume are associated with the severity of gas-exchange impairment and the type of respiratory support (non-invasive versus invasive) in patients with severe COVID-19 pneumonia. Methods This was a single-center, retrospective cohort study conducted in a tertiary care hospital in Northern Italy during the first pandemic wave. Pulmonary gas and blood distribution was assessed using a technique for quantitative analysis of dual-energy computed tomography. Lung aeration loss (reflected by percentage of normally aerated lung tissue) and the extent of gas:blood volume mismatch (percentage of non-aerated, perfused lung tissue—shunt; aerated, non-perfused dead space; and non-aerated/non-perfused regions) were evaluated in critically ill COVID-19 patients with different clinical severity as reflected by the need for non-invasive or invasive respiratory support. Results Thirty-five patients admitted to the intensive care unit between February 29th and May 30th, 2020 were included. Patients requiring invasive versus non-invasive mechanical ventilation had both a lower percentage of normally aerated lung tissue (median [interquartile range] 33% [24–49%] vs. 63% [44–68%], p

Published
2021
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7. Bronchoalveolar lavage fluid characteristics and outcomes of invasively mechanically ventilated patients with COVID-19 pneumonia in Genoa, Italy

Author

Chiara Dentone, Antonio Vena, Maurizio Loconte, Federica Grillo, Iole Brunetti, Emanuela Barisione, Elisabetta Tedone, Sara Mora, Antonio Di Biagio, Andrea Orsi, Andrea De Maria, Laura Nicolini, Lorenzo Ball, Daniele Roberto Giacobbe, Laura Magnasco, Emanuele Delfino, Luca Mastracci, Rosa Mangerini, Lucia Taramasso, Chiara Sepulcri, Rachele Pincino, Martina Bavastro, Matteo Cerchiaro, Malgorzata Mikulska, Bianca Bruzzone, Giancarlo Icardi, Paolo Frisoni, Angelo Gratarola, Nicolò Patroniti, Paolo Pelosi, and Matteo Bassetti

Subjects
COVID-19, Bronchoalveolar lavage fluid, Macrophages, Lymphocytes, Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background The primary objective of the study is to describe the cellular characteristics of bronchoalveolar lavage fluid (BALF) of COVID-19 patients requiring invasive mechanical ventilation; the secondary outcome is to describe BALF findings between survivors vs non-survivors. Materials and methods Patients positive for SARS-CoV-2 RT PCR, admitted to ICU between March and April 2020 were enrolled. At ICU admission, BALF were analyzed by flow cytometry. Univariate, multivariate and Spearman correlation analyses were performed. Results Sixty-four patients were enrolled, median age of 64 years (IQR 58–69). The majority cells in the BALF were neutrophils (70%, IQR 37.5–90.5) and macrophages (27%, IQR 7–49) while a minority were lymphocytes, 1%, TCD3+ 92% (IQR 82–95). The ICU mortality was 32.8%. Non-survivors had a significantly older age (p = 0.033) and peripheral lymphocytes (p = 0.012) were lower compared to the survivors. At multivariate analysis the percentage of macrophages in the BALF correlated with poor outcome (OR 1.336, CI95% 1.014–1.759, p = 0.039). Conclusions In critically ill patients, BALF cellularity is mainly composed of neutrophils and macrophages. The macrophages percentage in the BALF at ICU admittance correlated with higher ICU mortality. The lack of lymphocytes in BALF could partly explain a reduced anti-viral response.

Published
2021
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8. Early effects of ventilatory rescue therapies on systemic and cerebral oxygenation in mechanically ventilated COVID-19 patients with acute respiratory distress syndrome: a prospective observational study

Author

Chiara Robba, Lorenzo Ball, Denise Battaglini, Danilo Cardim, Emanuela Moncalvo, Iole Brunetti, Matteo Bassetti, Daniele R. Giacobbe, Antonio Vena, Nicolò Patroniti, Patricia R. M. Rocco, Basil F. Matta, Paolo Pelosi, and collaborators

Subjects
Coronavirus, Cerebral oxygenation, Rescue therapies, Prone position, Recruitment maneuvers, Carbon dioxide removal, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background In COVID-19 patients with acute respiratory distress syndrome (ARDS), the effectiveness of ventilatory rescue strategies remains uncertain, with controversial efficacy on systemic oxygenation and no data available regarding cerebral oxygenation and hemodynamics. Methods This is a prospective observational study conducted at San Martino Policlinico Hospital, Genoa, Italy. We included adult COVID-19 patients who underwent at least one of the following rescue therapies: recruitment maneuvers (RMs), prone positioning (PP), inhaled nitric oxide (iNO), and extracorporeal carbon dioxide (CO2) removal (ECCO2R). Arterial blood gas values (oxygen saturation [SpO2], partial pressure of oxygen [PaO2] and of carbon dioxide [PaCO2]) and cerebral oxygenation (rSO2) were analyzed before (T0) and after (T1) the use of any of the aforementioned rescue therapies. The primary aim was to assess the early effects of different ventilatory rescue therapies on systemic and cerebral oxygenation. The secondary aim was to evaluate the correlation between systemic and cerebral oxygenation in COVID-19 patients. Results Forty-five rescue therapies were performed in 22 patients. The median [interquartile range] age of the population was 62 [57–69] years, and 18/22 [82%] were male. After RMs, no significant changes were observed in systemic PaO2 and PaCO2 values, but cerebral oxygenation decreased significantly (52 [51–54]% vs. 49 [47–50]%, p

Published
2021
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9. Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia

Author

Lorenzo Ball, Chiara Robba, Lorenzo Maiello, Jacob Herrmann, Sarah E. Gerard, Yi Xin, Denise Battaglini, Iole Brunetti, Giuseppe Minetti, Sara Seitun, Antonio Vena, Daniele Roberto Giacobbe, Matteo Bassetti, Patricia R. M. Rocco, Maurizio Cereda, Lucio Castellan, Nicolò Patroniti, Paolo Pelosi, and GECOVID (GEnoa COVID-19) group

Subjects
COVID-19, ARDS, Respiratory system mechanics, Mechanical ventilation, CT scan, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background There is a paucity of data concerning the optimal ventilator management in patients with COVID-19 pneumonia; particularly, the optimal levels of positive-end expiratory pressure (PEEP) are unknown. We aimed to investigate the effects of two levels of PEEP on alveolar recruitment in critically ill patients with severe COVID-19 pneumonia. Methods A single-center cohort study was conducted in a 39-bed intensive care unit at a university-affiliated hospital in Genoa, Italy. Chest computed tomography (CT) was performed to quantify aeration at 8 and 16 cmH2O PEEP. The primary endpoint was the amount of alveolar recruitment, defined as the change in the non-aerated compartment at the two PEEP levels on CT scan. Results Forty-two patients were included in this analysis. Alveolar recruitment was median [interquartile range] 2.7 [0.7–4.5] % of lung weight and was not associated with excess lung weight, PaO2/FiO2 ratio, respiratory system compliance, inflammatory and thrombophilia markers. Patients in the upper quartile of recruitment (recruiters), compared to non-recruiters, had comparable clinical characteristics, lung weight and gas volume. Alveolar recruitment was not different in patients with lower versus higher respiratory system compliance. In a subgroup of 20 patients with available gas exchange data, increasing PEEP decreased respiratory system compliance (median difference, MD − 9 ml/cmH2O, 95% CI from − 12 to − 6 ml/cmH2O, p

Published
2021
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10. Enterococcal bloodstream infections in critically ill patients with COVID-19: a case series

Author

Daniele Roberto Giacobbe, Laura Labate, Stefania Tutino, Federico Baldi, Chiara Russo, Chiara Robba, Lorenzo Ball, Silvia Dettori, Anna Marchese, Chiara Dentone, Laura Magnasco, Francesca Crea, Edward Willison, Federica Briano, Denise Battaglini, Nicolò Patroniti, Iole Brunetti, Paolo Pelosi, and Matteo Bassetti

Subjects
Enterococcus, VRE, BSI, COVID-19, SARS-CoV-2, Medicine
Abstract

AbstractBackground An unexpected high prevalence of enterococcal bloodstream infection (BSI) has been observed in critically ill patients with COVID-19 in the intensive care unit (ICU).Materials and methods The primary objective was to describe the characteristics of ICU-acquired enterococcal BSI in critically ill patients with COVID-19. A secondary objective was to exploratorily assess the predictors of 30-day mortality in critically ill COVID-19 patients with ICU-acquired enterococcal BSI.Results During the study period, 223 patients with COVID-19 were admitted to COVID-19-dedicated ICUs in our centre. Overall, 51 episodes of enterococcal BSI, occurring in 43 patients, were registered. 29 (56.9%) and 22 (43.1%) BSI were caused by Enterococcus faecalis and Enterococcus faecium, respectively. The cumulative incidence of ICU-acquired enterococcal BSI was of 229 episodes per 1000 ICU admissions (95% mid-p confidence interval [CI] 172–298). Most patients received an empirical therapy with at least one agent showing in vitro activity against the blood isolate (38/43, 88%). The crude 30-day mortality was 42% (18/43) and 57% (4/7) in the entire series and in patients with vancomycin-resistant E. faecium BSI, respectively. The sequential organ failure assessment (SOFA) score showed an independent association with increased mortality (odds ratio 1.32 per one-point increase, with 95% confidence interval 1.04–1.66, p = .021).Conclusions The cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19. Our results suggest a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.KEY MESSAGESThe cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19.The crude 30-day mortality of enterococcal BSI in critically ill patients with COVID-19 may be higher than 40%.There could be a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.

Published
2021
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11. Patients With Suspected Severe Adverse Reactions to COVID-19 Vaccination Admitted to Intensive Care Unit: A Case Report

Author

Denise Battaglini, Lorenzo Ball, Chiara Robba, Simona Maiani, Iole Brunetti, Luana Benedetti, Lucio Castellan, Gianluigi Zona, Giampaola Pesce, Patricia R. M. Rocco, and Paolo Pelosi

Subjects
COVID-19, vaccines, coronavirus disease 2019, vaccine-induced immune thrombotic thrombocytopenia, thrombosis with thrombocytopenia syndrome, Medicine (General), R5-920
Abstract

BackgroundSeveral cases of adverse reactions following vaccination for coronavirus disease 2019 (COVID-19) with adenoviral vector vaccines or mRNA-based vaccines have been reported to date. The underlying syndrome has been named “vaccine-induced immune thrombotic thrombocytopenia” (VITT) or “thrombosis with thrombocytopenia syndrome (TTS)” with different clinical manifestations.MethodsWe report the clinical course of five patients who had severe adverse reactions to COVID-19 vaccines, either with VITT/TTS, abdominal or pulmonary thrombosis after adenoviral vaccines, or Stevens' Johnson syndrome because of mRNA vaccination, all of whom required admission to the intensive care unit (ICU).ConclusionsAll patients with severe or life-threatening suspected reaction to different types of COVID-19 vaccination required ICU admission. A prompt evaluation of early symptoms and individualized clinical management is needed to improve outcomes.

Published
2022
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12. Ventilation management and outcomes in out-of-hospital cardiac arrest: a protocol for a preplanned secondary analysis of the TTM2 trial

Author

Jacob Hollenberg, Paul Young, Alistair Nichol, Chiara Robba, Andreas Lundin, Niklas Nielsen, Michael Joannidis, Rafael Badenes, Fabio Silvio Taccone, Matthew Thomas, Paolo Pelosi, Denise Battaglini, Naomi E Hammond, Gisela Lilja, Manoj Saxena, Janus Jakobsen, Johan Unden, Glenn Eastwood, Josef Dankiewicz, Lorenzo Ball, Iole Brunetti, Wendel-Garcia Pedro David, Michelle S Chew, Annborn Martin, Miroslav Solar, and Hans A Friberg

Subjects
Medicine
Abstract

Introduction Mechanical ventilation is a fundamental component in the management of patients post cardiac arrest. However, the ventilator settings and the gas-exchange targets used after cardiac arrest may not be optimal to minimise post-anoxic secondary brain injury. Therefore, questions remain regarding the best ventilator management in such patients.Methods and analysis This is a preplanned analysis of the international randomised controlled trial, targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (OHCA)–target temperature management 2 (TTM2). The primary objective is to describe ventilatory settings and gas exchange in patients who required invasive mechanical ventilation and included in the TTM2 trial. Secondary objectives include evaluating the association of ventilator settings and gas-exchange values with 6 months mortality and neurological outcome. Adult patients after an OHCA who were included in the TTM2 trial and who received invasive mechanical ventilation will be eligible for this analysis. Data collected in the TTM2 trial that will be analysed include patients’ prehospital characteristics, clinical examination, ventilator settings and arterial blood gases recorded at hospital and intensive care unit (ICU) admission and daily during ICU stay.Ethics and dissemination The TTM2 study has been approved by the regional ethics committee at Lund University and by all relevant ethics boards in participating countries. No further ethical committee approval is required for this secondary analysis. Data will be disseminated to the scientific community by abstracts and by original articles submitted to peer-reviewed journals.Trial registration number NCT02908308.

Published
2022
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13. The Use of Different Components of Brain Oxygenation for the Assessment of Cerebral Haemodynamics: A Prospective Observational Study on COVID-19 Patients

Author

Chiara Robba, Danilo Cardim, Lorenzo Ball, Denise Battaglini, Wojciech Dabrowski, Matteo Bassetti, Daniele Roberto Giacobbe, Marek Czosnyka, Rafael Badenes, Paolo Pelosi, Basil Matta, The GeCovid group, Iole Brunetti, Maurizio Loconte, Fabio Tarantino, Marco Sottano, Francesco Marramao, Angelo Gratarola, Paolo Frisoni, Elena Ciaravolo, Chiara Dentone, Lucia Taramasso, Laura Magnasco, Antonio Vena, Gianluigi Zona, and Pietro Fiaschi

Subjects
cerebral oxygenation, brain injury, autoregulation dysfunction, intensive care, NIRS (near infrared reflectance spectroscopy), Neurology. Diseases of the nervous system, RC346-429
Abstract

Introduction: The role of near-infrared spectroscopy (NIRS) for the evaluation of cerebral haemodynamics is gaining increasing popularity because of its noninvasive nature. The aim of this study was to evaluate the role of the integral components of regional cerebral oxygenation (rSO2) measured by NIRS [i.e., arterial-oxyhemoglobin (O2Hbi) and venous-deoxyhemoglobin (HHbi)-components], as indirect surrogates of cerebral blood flow (CBF) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19). We compared these findings to the gold standard technique for noninvasive CBF assessment, Transcranial Doppler (TCD).Methods: Mechanically ventilated patients with COVID-19 admitted to the Intensive Care Unit (ICU) of Policlinico San Martino Hospital, Genova, Italy, who underwent multimodal neuromonitoring (including NIRS and TCD), were included. rSO2 and its components [relative changes in O2Hbi, HHbi, and total haemoglobin (cHbi)] were compared with TCD (cerebral blood flow velocity, CBFV). Changes (Δ) in CBFV and rSO2, ΔO2Hbi, ΔHHbi, and ΔcHbi after systemic arterial blood pressure (MAP) modifications induced by different manoeuvres (e.g., rescue therapies and haemodynamic manipulation) were assessed using mixed-effect linear regression analysis and repeated measures correlation coefficients. All values were normalised as percentage changes from the baseline (Δ%).Results: One hundred and four measurements from 25 patients were included. Significant effects of Δ%MAP on Δ%CBF were observed after rescue manoeuvres for CBFV, ΔcHbi, and ΔO2Hbi. The highest correlation was found between ΔCBFV and ΔΔO2Hbi (R = 0.88, p < 0.0001), and the poorest between ΔCBFV and ΔΔHHbi (R = 0.34, p = 0.002).Conclusions: ΔO2Hbi had the highest accuracy to assess CBF changes, reflecting its role as the main component for vasomotor response after changes in MAP. The use of indexes derived from the different components of rSO2 can be useful for the bedside evaluation of cerebral haemodynamics in mechanically ventilated patients with COVID-19.

Published
2021
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14. T2Bacteria and T2Resistance Assays in Critically Ill Patients with Sepsis or Septic Shock: A Descriptive Experience

Author

Daniele Roberto Giacobbe, Francesca Crea, Paola Morici, Laura Magnasco, Vincenzo Di Pilato, Federica Briano, Edward Willison, Rachele Pincino, Silvia Dettori, Stefania Tutino, Simone Esposito, Erika Coppo, Chiara Dentone, Federica Portunato, Malgorzata Mikulska, Chiara Robba, Antonio Vena, Denise Battaglini, Iole Brunetti, Lorenzo Ball, Paolo Pelosi, Anna Marchese, and Matteo Bassetti

Subjects
T2, rapid tests, diagnosis, sepsis, septic shock, BSI, Therapeutics. Pharmacology, RM1-950
Abstract

The use of rapid molecular tests may anticipate the identification of causative agents and resistance determinants in the blood of critically ill patients with sepsis. From April to December 2021, all intensive care unit patients with sepsis or septic shock who were tested with the T2Bacteria and T2Resistance assays were included in a retrospective, single center study. The primary descriptive endpoints were results of rapid molecular tests and concomitant blood cultures. Overall, 38 combinations of T2Bacteria and T2Resistance tests were performed. One or more causative agent(s) were identified by the T2Bacteria assay in 26% of episodes (10/38), whereas negative and invalid results were obtained in 66% (25/38) and 8% (3/38) of episodes, respectively. The same pathogen detected by the T2Bacteria test grew from blood cultures in 30% of cases (3/10). One or more determinant(s) of resistance were identified by the T2Resistance assay in 11% of episodes (4/38). Changes in therapy based on T2Bacteria and/or T2Resistance results occurred in 21% of episodes (8/38). In conclusion, T2Bacteria/T2Resistance results can influence early treatment decisions in critically ill patients with sepsis or septic shock in real-life practice. Large, controlled studies remain necessary to confirm a favorable impact on patients’ outcomes and antimicrobial stewardship interventions.

Published
2022
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15. Effects of Different Levels of Variability and Pressure Support Ventilation on Lung Function in Patients With Mild–Moderate Acute Respiratory Distress Syndrome

Author

Lorenzo Ball, Yuda Sutherasan, Martina Fiorito, Antonella Dall'Orto, Lorenzo Maiello, Maria Vargas, Chiara Robba, Iole Brunetti, Davide D'Antini, Pasquale Raimondo, Robert Huhle, Marcus J. Schultz, Patricia R. M. Rocco, Marcelo Gama de Abreu, and Paolo Pelosi

Subjects
variable pressure support ventilation, acute respiratory distress (ARDS), asynchronies, respiratory mechanic, assisted ventilation, Physiology, QP1-981
Abstract

Background: Variable pressure support ventilation (vPSV) is an assisted ventilation mode that varies the level of pressure support on a breath-by-breath basis to restore the physiological variability of breathing activity. We aimed to compare the effects of vPSV at different levels of variability and pressure support (ΔPS) in patients with acute respiratory distress syndrome (ARDS).Methods: This study was a crossover randomized clinical trial. We included patients with mild to moderate ARDS already ventilated in conventional pressure support ventilation (PSV). The study consisted of two blocks of interventions, and variability during vPSV was set as the coefficient of variation of the ΔPS level. In the first block, the effects of three levels of variability were tested at constant ΔPS: 0% (PSV0%, conventional PSV), 15% (vPSV15%), and 30% (vPSV30%). In the second block, two levels of variability (0% and variability set to achieve ±5 cmH2O variability) were tested at two ΔPS levels (baseline ΔPS and ΔPS reduced by 5 cmH2O from baseline). The following four ventilation strategies were tested in the second block: PSV with baseline ΔPS and 0% variability (PSVBL) or ±5 cmH2O variability (vPSVBL), PSV with ΔPS reduced by 5 cmH2O and 0% variability (PSV−5) or ±5 cmH2O variability (vPSV−5). Outcomes included gas exchange, respiratory mechanics, and patient-ventilator asynchronies.Results: The study enrolled 20 patients. In the first block of interventions, oxygenation and respiratory mechanics parameters did not differ between vPSV15% and vPSV30% compared with PSV0%. The variability of tidal volume (VT) was higher with vPSV15% and vPSV30% compared with PSV0%. The incidence of asynchronies and the variability of transpulmonary pressure (PL) were higher with vPSV30% compared with PSV0%. In the second block of interventions, different levels of pressure support with and without variability did not change oxygenation. The variability of VT and PL was higher with vPSV−5 compared with PSV−5, but not with vPSVBL compared with PSVBL.Conclusion: In patients with mild-moderate ARDS, the addition of variability did not improve oxygenation at different pressure support levels. Moreover, high variability levels were associated with worse patient-ventilator synchrony.Clinical Trial Registration:www.clinicaltrials.gov, identifier: NCT01683669.

Published
2021
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16. Effects of Positive End-Expiratory Pressure on Lung Recruitment, Respiratory Mechanics, and Intracranial Pressure in Mechanically Ventilated Brain-Injured Patients

Author

Chiara Robba, Lorenzo Ball, Stefano Nogas, Denise Battaglini, Antonio Messina, Iole Brunetti, Giuseppe Minetti, Lucio Castellan, Patricia R. M. Rocco, and Paolo Pelosi

Subjects
positive end expiratory pressure, intracranial pressure, brain injured patients, quantitative computed tomography, mechanical ventilation, Physiology, QP1-981
Abstract

Background: The pathophysiological effects of positive end-expiratory pressure (PEEP) on respiratory mechanics, lung recruitment, and intracranial pressure (ICP) in acute brain-injured patients have not been completely elucidated. The primary aim of this study was to assess the effects of PEEP augmentation on respiratory mechanics, quantitative computed lung tomography (qCT) findings, and its relationship with ICP modifications. Secondary aims included the assessment of the correlations between different factors (respiratory mechanics and qCT features) with the changes of ICP and how these factors at baseline may predict ICP response after greater PEEP levels.Methods: A prospective, observational study included mechanically ventilated patients with acute brain injury requiring invasive ICP and who underwent two-PEEP levels lung CT scan. Respiratory system compliance (Crs), arterial partial pressure of carbon dioxide (PaCO2), mean arterial pressure (MAP), data from qCT and ICP were obtained at PEEP 5 and 15 cmH2O.Results: Sixteen examinations (double PEEP lung CT and neuromonitoring) in 15 patients were analyzed. The median age of the patients was 54 years (interquartile range, IQR = 39–65) and 53% were men. The median Glasgow Coma Scale (GCS) at intensive care unit (ICU) admission was 8 (IQR = 3–12). Median alveolar recruitment was 2.5% of total lung weight (−1.5 to 4.7). PEEP from 5 to 15 cmH2O increased ICP [median values from 14.0 (11.2–17.5) to 23.5 (19.5–26.8) mmHg, p < 0.001, respectively]. The amount of recruited lung tissue on CT was inversely correlated with the change (Δ) in ICP (rho = −0.78; p = 0.0006). Additionally, ΔCrs (rho = −0.77, p = 0.008), ΔPaCO2 (rho = 0.81, p = 0.0003), and ΔMAP (rho = −0.64, p = 0.009) were correlated with ΔICP. Baseline Crs was not predictive of ICP response to PEEP.Conclusions: The main factors associated with increased ICP after PEEP augmentation included reduced Crs, lower MAP and lung recruitment, and increased PaCO2, but none of these factors was able to predict, at baseline, ICP response to PEEP. To assess the potential benefits of increased PEEP in patients with acute brain injury, hemodynamic status, respiratory mechanics, and lung morphology should be taken into account.

Published
2021
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17. Early Effects of Passive Leg-Raising Test, Fluid Challenge, and Norepinephrine on Cerebral Autoregulation and Oxygenation in COVID-19 Critically Ill Patients

Author

Chiara Robba, Antonio Messina, Denise Battaglini, Lorenzo Ball, Iole Brunetti, Matteo Bassetti, Daniele R. Giacobbe, Antonio Vena, Nicolo' Patroniti, Maurizio Cecconi, Basil F. Matta, Xiuyun Liu, Patricia R. M. Rocco, Marek Czosnyka, and Paolo Pelosi

Subjects
fluid challenge, norepinephrine, passive leg raising test, cerebral oxygenation, cerebral autoregulation, Neurology. Diseases of the nervous system, RC346-429
Abstract

Background: Coronavirus disease 2019 (COVID-19) patients are at high risk of neurological complications consequent to several factors including persistent hypotension. There is a paucity of data on the effects of therapeutic interventions designed to optimize systemic hemodynamics on cerebral autoregulation (CA) in this group of patients.Methods: Single-center, observational prospective study conducted at San Martino Policlinico Hospital, Genoa, Italy, from October 1 to December 15, 2020. Mechanically ventilated COVID-19 patients, who had at least one episode of hypotension and received a passive leg raising (PLR) test, were included. They were then treated with fluid challenge (FC) and/or norepinephrine (NE), according to patients' clinical conditions, at different moments. The primary outcome was to assess the early effects of PLR test and of FC and NE [when clinically indicated to maintain adequate mean arterial pressure (MAP)] on CA (CA index) measured by transcranial Doppler (TCD). Secondary outcomes were to evaluate the effects of PLR test, FC, and NE on systemic hemodynamic variables, cerebral oxygenation (rSo2), and non-invasive intracranial pressure (nICP).Results: Twenty-three patients were included and underwent PLR test. Of these, 22 patients received FC and 14 were treated with NE. The median age was 62 years (interquartile range = 57–68.5 years), and 78% were male. PLR test led to a low CA index [58% (44–76.3%)]. FC and NE administration resulted in a CA index of 90.8% (74.2–100%) and 100% (100–100%), respectively. After PLR test, nICP based on pulsatility index and nICP based on flow velocity diastolic formula was increased [18.6 (17.7–19.6) vs. 19.3 (18.2–19.8) mm Hg, p = 0.009, and 12.9 (8.5–18) vs. 15 (10.5–19.7) mm Hg, p = 0.001, respectively]. PLR test, FC, and NE resulted in a significant increase in MAP and rSo2.Conclusions: In mechanically ventilated severe COVID-19 patients, PLR test adversely affects CA. An individualized strategy aimed at assessing both the hemodynamic and cerebral needs is warranted in patients at high risk of neurological complications.

Published
2021
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18. The Role of Dysbiosis in Critically Ill Patients With COVID-19 and Acute Respiratory Distress Syndrome

Author

Denise Battaglini, Chiara Robba, Andrea Fedele, Sebastian Trancǎ, Samir Giuseppe Sukkar, Vincenzo Di Pilato, Matteo Bassetti, Daniele Roberto Giacobbe, Antonio Vena, Nicolò Patroniti, Lorenzo Ball, Iole Brunetti, Antoni Torres Martí, Patricia Rieken Macedo Rocco, and Paolo Pelosi

Subjects
microbiota, dysbiosis, ARDS, critical care, infection, COVID-19, Medicine (General), R5-920
Abstract

In late December 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) quickly spread worldwide, and the syndrome it causes, coronavirus disease 2019 (COVID-19), has reached pandemic proportions. Around 30% of patients with COVID-19 experience severe respiratory distress and are admitted to the intensive care unit for comprehensive critical care. Patients with COVID-19 often present an enhanced immune response with a hyperinflammatory state characterized by a “cytokine storm,” which may reflect changes in the microbiota composition. Moreover, the evolution to acute respiratory distress syndrome (ARDS) may increase the severity of COVID-19 and related dysbiosis. During critical illness, the multitude of therapies administered, including antibiotics, sedatives, analgesics, body position, invasive mechanical ventilation, and nutritional support, may enhance the inflammatory response and alter the balance of patients' microbiota. This status of dysbiosis may lead to hyper vulnerability in patients and an inappropriate response to critical circumstances. In this context, the aim of our narrative review is to provide an overview of possible interaction between patients' microbiota dysbiosis and clinical status of severe COVID-19 with ARDS, taking into consideration the characteristic hyperinflammatory state of this condition, respiratory distress, and provide an overview on possible nutritional strategies for critically ill patients with COVID-19-ARDS.

Published
2021
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19. Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically Ill Mechanically Ventilated COVID-19 Patients

Author

Denise Battaglini, Gregorio Santori, Karthikka Chandraptham, Francesca Iannuzzi, Matilde Bastianello, Fabio Tarantino, Lorenzo Ball, Daniele Roberto Giacobbe, Antonio Vena, Matteo Bassetti, Matilde Inglese, Antonio Uccelli, Patricia Rieken Macedo Rocco, Nicolò Patroniti, Iole Brunetti, Paolo Pelosi, and Chiara Robba

Subjects
COVID-19, neurological complications, SARS-CoV-2, neuromonitoring, neurocritical care, Neurology. Diseases of the nervous system, RC346-429
Abstract

Purpose: The incidence and the clinical presentation of neurological manifestations of coronavirus disease-2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of patients are available.Methods: This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and the type of neurological complications in critically ill COVID-19 patients and their effect on survival as well as on hospital and intensive care unit (ICU) length of stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial Doppler, optic nerve sheath diameter (ONSD), and automated pupillometry.Results: Ninety-four patients with COVID-19 admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 50% of patients, with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8 ± 25.1 vs. 19.4 ± 16.9 days, p < 0.001) and ICU (31.5 ± 22.6 vs. 11.5±10.1 days, p < 0.001) stay. The duration of mechanical ventilation was independently associated with the risk of developing neurological complications (odds ratio 1.100, 95% CI 1.046–1.175, p = 0.001). Patients with increased intracranial pressure measured by ONSD (19% of the overall population) had longer ICU stay.Conclusions: Neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length of stay. Multimodal noninvasive neuromonitoring systems are useful tools for the early detection of variations in cerebrovascular parameters in COVID-19.

Published
2020
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20. Escalate and De-Escalate Therapies for Intracranial Pressure Control in Traumatic Brain Injury

Author

Denise Battaglini, Pasquale Anania, Patricia R. M. Rocco, Iole Brunetti, Alessandro Prior, Gianluigi Zona, Paolo Pelosi, and Pietro Fiaschi

Subjects
trauma, intracranial hypertension (ICH), escalation, traumatic brain injury, staircase algorithm, Neurology. Diseases of the nervous system, RC346-429
Abstract

Severe traumatic brain injury (TBI) is frequently associated with an elevation of intracranial pressure (ICP), followed by cerebral perfusion pressure (CPP) reduction. Invasive monitoring of ICP is recommended to guide a step-by-step “staircase approach” which aims to normalize ICP values and reduce the risks of secondary damage. However, if such monitoring is not available clinical examination and radiological criteria should be used. A major concern is how to taper the therapies employed for ICP control. The aim of this manuscript is to review the criteria for escalating and withdrawing therapies in TBI patients. Each step of the staircase approach carries a risk of adverse effects related to the duration of treatment. Tapering of barbiturates should start once ICP control has been achieved for at least 24 h, although a period of 2–12 days is often required. Administration of hyperosmolar fluids should be avoided if ICP is normal. Sedation should be reduced after at least 24 h of controlled ICP to allow neurological examination. Removal of invasive ICP monitoring is suggested after 72 h of normal ICP. For patients who have undergone surgical decompression, cranioplasty represents the final step, and an earlier cranioplasty (15–90 days after decompression) seems to reduce the rate of infection, seizures, and hydrocephalus.

Published
2020
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21. Neurological Manifestations of Severe SARS-CoV-2 Infection: Potential Mechanisms and Implications of Individualized Mechanical Ventilation Settings

Author

Denise Battaglini, Iole Brunetti, Pasquale Anania, Pietro Fiaschi, Gianluigi Zona, Lorenzo Ball, Daniele Roberto Giacobbe, Antonio Vena, Matteo Bassetti, Nicolò Patroniti, Angelo Schenone, Paolo Pelosi, Patricia R. M. Rocco, and Chiara Robba

Subjects
COVID-19, SARS-CoV-2, coronavirus, neurological manifestations, neurotropism, Neurology. Diseases of the nervous system, RC346-429
Abstract

In December 2019, an outbreak of illness caused by a novel coronavirus (2019-nCoV, subsequently renamed SARS-CoV-2) was reported in Wuhan, China. Coronavirus disease 2019 (COVID-19) quickly spread worldwide to become a pandemic. Typical manifestations of COVID-19 include fever, dry cough, fatigue, and respiratory distress. In addition, both the central and peripheral nervous system can be affected by SARS-CoV-2 infection. These neurological changes may be caused by viral neurotropism, by a hyperinflammatory and hypercoagulative state, or even by mechanical ventilation-associated impairment. Hypoxia, endothelial cell damage, and the different impacts of different ventilatory strategies may all lead to increased stress and strain, potentially exacerbating the inflammatory response and leading to a complex interaction between the lungs and the brain. To date, no studies have taken into consideration the possible secondary effect of mechanical ventilation on brain recovery and outcomes. The aim of our review is to provide an updated overview of the potential pathogenic mechanisms of neurological manifestations in COVID-19, discuss the physiological issues related to brain-lung interactions, and propose strategies for optimization of respiratory support in critically ill patients with SARS-CoV-2 pneumonia.

Published
2020
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22. Reactivation of Herpes Simplex Virus Type 1 (HSV-1) Detected on Bronchoalveolar Lavage Fluid (BALF) Samples in Critically Ill COVID-19 Patients Undergoing Invasive Mechanical Ventilation: Preliminary Results from Two Italian Centers

Author

Daniele Roberto Giacobbe, Stefano Di Bella, Silvia Dettori, Giorgia Brucci, Verena Zerbato, Riccardo Pol, Ludovica Segat, Pierlanfranco D’Agaro, Erik Roman-Pognuz, Federica Friso, Luigi Principe, Umberto Lucangelo, Lorenzo Ball, Chiara Robba, Denise Battaglini, Andrea De Maria, Iole Brunetti, Nicolò Patroniti, Federica Briano, Bianca Bruzzone, Giulia Guarona, Laura Magnasco, Chiara Dentone, Giancarlo Icardi, Paolo Pelosi, Roberto Luzzati, and Matteo Bassetti

Subjects
HSV-1, herpes simplex virus, reactivation, intensive care, COVID-19, SARS-CoV-2, Biology (General), QH301-705.5
Abstract

Reactivation of herpes simplex virus type 1 (HSV-1) has been described in critically ill patients with coronavirus disease 2019 (COVID-19) pneumonia. In the present two-center retrospective experience, we primarily aimed to assess the cumulative risk of HSV-1 reactivation detected on bronchoalveolar fluid (BALF) samples in invasively ventilated COVID-19 patients with worsening respiratory function. The secondary objectives were the identification of predictors for HSV-1 reactivation and the assessment of its possible prognostic impact. Overall, 41 patients met the study inclusion criteria, and 12/41 patients developed HSV-1 reactivation (29%). No independent predictors of HSV-1 reactivation were identified in the present study. No association was found between HSV-1 reactivation and mortality. Eleven out of 12 patients with HSV-1 reactivation received antiviral therapy with intravenous acyclovir. In conclusion, HSV-1 reactivation is frequently detected in intubated patients with COVID-19. An antiviral treatment in COVID-19 patients with HSV-1 reactivation and worsening respiratory function might be considered.

Published
2022
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24. Treatments for intracranial hypertension in acute brain-injured patients: grading, timing, and association with outcome. Data from the SYNAPSE-ICU study

Author

Robba, Chiara, Graziano, Francesca, Guglielmi, Angelo, Rebora, Paola, Galimberti, Stefania, Taccone, Fabio S, Citerio, Giuseppe, Walter Videtta, Gustavo Domeniconi, María Estrella Giménez, Mariela Fumale, Edgar Daniel Amundarain, Matias Casanova, Michael Reade, Elizabeth Hallt, David Pearson, Ian Seppelt, Raimund Helbok, Valery Davidovich, Geert Meyfroidt, Ilaria Alice Crippa, Liese Mebis, Patrick Biston, Stijn Van De Velde, Glorieux Denis, Pedro Kurtz, Samia Yasin Wayhs, Mypinder Sekhon, Donald Griesdale, Andrea Rigamonti, José Miguel Montes, Rodrigo Pérez-Araos, Jorge H Mejia-Mantilla, Andrés Gempeler, Ray Mendoza, Natasa Kovac, Hedgar Berty Gutiérrez, Vera Spatenkova, Marek Fencl, Roman Gal, Ondrej Hrdy, Kamil Vrbica, Josef Skola, Eva Provaznikova, Jakub Kletecka, Pavel Lavicka, Piergiorgio Bresil, Marianne Levin, Josefine Thomsen, Thomas Egmose Larsen, Henrik Westy Hoffmeyer, Morten Olskjaer Holm, Jesper Borg Andersen, Birgitte Majholm, Margit Smitt, Heidi Shil Eddelien, Manuel Jibaja, Freddy Maldonado, María Fernanda García, Karim Asehnoune, Bertrand Pons, Gérard Audibert, Manon Lucca, Guillaume Besch, Pierluigi Banco, Raphael Cinotti, Hervé Q Uintard, Benjamin Soyer, Anais Caillard, Clement Gakuba, Romain Sonneville, Stefan Wolf, Kristina Fuest, Lea Albrecht, Sarah Grotheer, Sandro M Krieg, Stefan J Schaller, Charikleia Vrettou, Eftychia Kontoudaki, Anna Efthymiou, Elena Palli, Demosthenes Makris, Chrysi Diakaki, Christina Iasonidou, Aikaterini Dimoula, Georgios Koukoulitsios, George Kyriazopoulos, Nikolas Pantelas, Syragoula Tsikriki, Electra Eleni Stamou, Achileas Giannopoulos, Eleni Mouloudi, Ping Shum Hoi, Yan Chan Cheuk, Hewa Kandamby Darshana, Krisztián Tánczos, Gabor Nardai, Zoltan Szentkereszty, Harsh Sapra, Deepak Gupta, Kaveri Sharma, Saurabh Anand, Ankur Luthra, Summit Bloria, Rajeev Chauhan, Nidhi Panda, Ahmad Ozair, Bram Kilapong, Anass Alsudani, Giuseppe Citerio, Alessandra Soragni, Alessandro Motta, Andrea Marudi, Elisabetta Bertellini, Anselmo Caricato, Camilla Gelormini, Eleonora Ioannoni, Eleonora Stival, Serena Silva, Federico Pozzi, Iole Brunetti, Andrea Cortegiani, Edoardo Picetti, Federico Villa, Italo Calamai, Maria Chiara Casadio, Maria Concetta Quartarone, Marzia Grandis, Federico Magni, Silvia Del Bianco, Claudia Bonetti, Virginia Buldini, Aimone Giugni, Simone Maria Zerbi, Marco Carbonara, Antonella Cotoia, Antonio Izzi, Olegs Sabelnikovs, Muhammed Elhadi, Hazem Ahmed, Silvio A Ñamendys Silva, Gilberto Adrian Gasca López, Gentle S Shrestha, Shirish Maskey, Tamanna Bajracharya, Khadka Nilam, Prakash Kafle, Laleet Rajbanshi, Yam Bahadur Roka, Olufemi Idowu, Khan Muhammad Mukhtar, Juan Luis Pinedo Portilla, Klaudyna Kojder, Irene Aragao, Ricardo Freitas, Marco Simoes, Dario Batista, Cecília Pacheco, Fátima Assunção, Luís Lencastre, Pedro Cavaleiro, Mohamed Abdelaty, Alex Gritsan, Sergey Khomiakov Sergey, Dovbysh Nikolay, Yaseen Arabi, Primoz Gradisek, Petra Forjan, Mara Škoti, Suada Filekovic Ribaric, Nataša Milivojevic, Sergeja Kozar, Rafael Badenes, Aaron Blandino Ortiz, Mikel Celaya Lopez, Laura Galarza, Luisa Corral, Africa Lores, Ricard Soley, Laura Pariente, Pablo López Ojeda, Maria Dolores Arias Verdu, Luis Javier Yuste Dominguez, Maria Isabel Gonzalez Perez, Mireia Anglada, Patricia Duque, Ainhoa Serrano, Berta Monleon, Vanessa Blazquez, Mauro Oddo, Samia Abed Maillard, Paola Morelli, John-Paul Miroz, Eva Favre, Walid Sellami, Massimo Lamperti, Jamil Dibu, Richard Sivities, Angelos Kolias, Chris Thompson, Christopher Hawthorne, Justin Roberts, Lara Prisco, Roger Lightfoot, Josè I Suarez, Luci Rivera-Lara, Susanne Muehlschlegel, Juan Padilla, Sanjeev Sivakumar, Daiwai Olson, Robba, C, Graziano, F, Guglielmi, A, Rebora, P, Galimberti, S, Taccone, F, Citerio, G, Robba, Chiara, Graziano, Francesca, Guglielmi, Angelo, Rebora, Paola, Galimberti, Stefania, Taccone, Fabio S, Citerio, Giuseppe, and Walter Videtta, Gustavo Domeniconi, María Estrella Giménez, Mariela Fumale, Edgar Daniel Amundarain, Matias Casanova, Michael Reade, Elizabeth Hallt, David Pearson, Ian Seppelt, Raimund Helbok, Valery Davidovich, Geert Meyfroidt, Ilaria Alice Crippa, Liese Mebis, Patrick Biston, Stijn Van De Velde, Glorieux Denis, Pedro Kurtz, Samia Yasin Wayhs, Mypinder Sekhon, Donald Griesdale, Andrea Rigamonti, José Miguel Montes, Rodrigo Pérez-Araos, Jorge H Mejia-Mantilla, Andrés Gempeler, Ray Mendoza, Natasa Kovac, Hedgar Berty Gutiérrez, Vera Spatenkova, Marek Fencl, Roman Gal, Ondrej Hrdy, Kamil Vrbica, Josef Skola, Eva Provaznikova, Jakub Kletecka, Pavel Lavicka, Vera Spatenkova, Piergiorgio Bresil, Marianne Levin, Piergiorgio Bresil, Josefine Thomsen, Thomas Egmose Larsen, Henrik Westy Hoffmeyer, Morten Olskjaer Holm, Jesper Borg Andersen, Birgitte Majholm, Margit Smitt, Heidi Shil Eddelien, Manuel Jibaja, Freddy Maldonado, María Fernanda García, Karim Asehnoune, Bertrand Pons, Gérard Audibert, Manon Lucca, Guillaume Besch, Pierluigi Banco, Karim Asehnoune, Raphael Cinotti, Hervé Q Uintard, Benjamin Soyer, Anais Caillard, Clement Gakuba, Romain Sonneville, Stefan Wolf, Kristina Fuest, Lea Albrecht, Sarah Grotheer, Sandro M Krieg, Stefan J Schaller, Charikleia Vrettou, Eftychia Kontoudaki, Anna Efthymiou, Elena Palli, Demosthenes Makris, Chrysi Diakaki, Christina Iasonidou, Aikaterini Dimoula, Georgios Koukoulitsios, George Kyriazopoulos, Nikolas Pantelas, Syragoula Tsikriki, Electra Eleni Stamou, Charikleia Vrettou, Achileas Giannopoulos, Eleni Mouloudi, Ping Shum Hoi, Yan Chan Cheuk, Hewa Kandamby Darshana, Krisztián Tánczos, Gabor Nardai, Zoltan Szentkereszty, Harsh Sapra, Deepak Gupta, Kaveri Sharma, Saurabh Anand, Ankur Luthra, Summit Bloria, Rajeev Chauhan, Nidhi Panda, Ahmad Ozair, Bram Kilapong, Anass Alsudani, Giuseppe Citerio, Alessandra Soragni, Alessandro Motta, Andrea Marudi, Elisabetta Bertellini, Anselmo Caricato, Camilla Gelormini, Eleonora Ioannoni, Eleonora Stival, Serena Silva, Federico Pozzi, Iole Brunetti, Andrea Cortegiani, Edoardo Picetti, Federico Villa, Italo Calamai, Maria Chiara Casadio, Maria Concetta Quartarone, Marzia Grandis, Federico Magni, Silvia Del Bianco, Claudia Bonetti, Virginia Buldini, Aimone Giugni, Simone Maria Zerbi, Marco Carbonara, Antonella Cotoia, Antonio Izzi, Olegs Sabelnikovs, Muhammed Elhadi, Hazem Ahmed, Silvio A Ñamendys Silva, Gilberto Adrian Gasca López, Gentle S Shrestha, Shirish Maskey, Tamanna Bajracharya, Khadka Nilam, Prakash Kafle, Laleet Rajbanshi, Yam Bahadur Roka, Olufemi Idowu, Khan Muhammad Mukhtar, Juan Luis Pinedo Portilla, Klaudyna Kojder, Irene Aragao, Ricardo Freitas, Marco Simoes, Dario Batista, Cecília Pacheco, Fátima Assunção, Luís Lencastre, Pedro Cavaleiro, Mohamed Abdelaty, Alex Gritsan, Sergey Khomiakov Sergey, Dovbysh Nikolay, Yaseen Arabi, Primoz Gradisek, Petra Forjan, Mara Škoti, Suada Filekovic Ribaric, Primoz Gradisek, Nataša Milivojevic, Sergeja Kozar, Rafael Badenes, Aaron Blandino Ortiz, Mikel Celaya Lopez, Laura Galarza, Luisa Corral, Africa Lores, Ricard Soley, Laura Pariente, Pablo López Ojeda, Maria Dolores Arias Verdu, Luis Javier Yuste Dominguez, Maria Isabel Gonzalez Perez, Mireia Anglada, Patricia Duque, Ainhoa Serrano, Berta Monleon, Vanessa Blazquez, Mauro Oddo, Samia Abed Maillard, Paola Morelli, John-Paul Miroz, Eva Favre, Walid Sellami, Massimo Lamperti, Jamil Dibu, Richard Sivities, Angelos Kolias, Chris Thompson, Christopher Hawthorne, Justin Roberts, Lara Prisco, Roger Lightfoot, Josè I Suarez, Luci Rivera-Lara, Susanne Muehlschlegel, Juan Padilla, Sanjeev Sivakumar, Daiwai Olson

Subjects
Subarachnoid haemorrhage, Traumatic brain injury, Intracranial pressure, Therapy intensity level, Critical Care and Intensive Care Medicine, Intracranial haemorrhage
Abstract

Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with sixmonths mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p

Published
2023
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25. The value of EEG attenuation in the prediction of outcome in COVID-19 patients

Author

Lucio Marinelli, Irene Pappalardo, Chiara Robba, Laura Saitta, Corrado Cabona, Denise Battaglini, Monia Casaleggio, Anna Bellini, Alessandra Ferrari, Iole Brunetti, and Flavio Villani

Subjects
Psychiatry and Mental health, SARS-CoV-2, Humans, COVID-19, Electroencephalography, Neurology (clinical), Dermatology, General Medicine, Pandemics, Retrospective Studies
Abstract

Abstract Introduction During the COVID-19 pandemic, electroencephalography (EEG) proved to be a useful tool to demonstrate brain involvement. Many studies reported non-reactive generalized slowing as the most frequent pattern and epileptiform activity in a minority of patients. Objective To investigate the prevalence of diffuse unreactive background attenuation or suppression and its correlation with outcome in a cohort of COVID-19 patients. Methods The EEGs recorded during the first year of the COVID-19 pandemic were retrospectively evaluated to identify the main pattern and focus on the occurrence of a low-voltage background, either attenuated (10–20 μV) or suppressed ( Results Among 98 EEG performed in 50 consecutive patients, diffuse unreactive slowing was the most prevalent pattern (54%), followed by unreactive attenuation or suppression pattern (26%), being the latter significantly correlated with an unfavourable outcome (p = 0.0004). Survivors showed significantly lower interleukine-6 values compared to non-survivors. Patients with attenuated EEG and non-survivors also showed lower PaO2/FiO2 values. Neuroradiological findings were very heterogeneous with a prevalence of lesions suggestive of a microangiopathic substrate. Conclusions EEG attenuation or suppression may be more frequent than previously reported and significantly associated with a poor outcome. SARS-CoV-2 infection may result in encephalopathy and reduced EEG voltage through mechanisms that are still unknown but deserve attention given its negative impact on prognosis.

Published
2022
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26. Novel Synthetic and Natural Therapies for Traumatic Brain Injury

Author

Dorota Siwicka-Gieroba, Denise Battaglini, Paolo Pelosi, Nicolò Patroniti, Fernanda F. Cruz, Iole Brunetti, Patricia Rm Rocco, Pedro L. Silva, Wojciech Dabrowski, and Chiara Robba

Subjects
Traumatic brain injury, Brain Edema, Inflammation, Clinical settings, Brain damage, Bioinformatics, Cerebral autoregulation, Brain Injuries, Traumatic, medicine, Humans, Pharmacology (medical), Pharmacology, Oxygen supply, Brain edema, business.industry, Mesenchymal stem cell, Brain, General Medicine, medicine.disease, Psychiatry and Mental health, Neuroprotective Agents, Neurology, Brain Injuries, Neurology (clinical), medicine.symptom, business
Abstract

Traumatic brain injury (TBI) is a major cause of disability and death worldwide. The initial mechanical insult results in tissue and vascular disruption with hemorrhages and cellular necrosis that is followed by dynamic secondary brain damage that presumably results in additional destruction of the brain. In order to minimize deleterious consequences of the secondary brain damage- such as inflammation, bleeding or reduced oxygen supply. The old concept of the -staircase approach- has been updated in recent years by most guidelines and should be followed as it is considered the only validated approach for the treatment of TBI. Besides, a variety of novel therapies have been proposed as neuroprotectants. The molecular mechanisms of each drug involved in the inhibition of secondary brain injury can result as a potential target for the early and late treatment of TBI. However, no specific recommendation is available on their use in the clinical setting. The administration of both synthetic and natural compounds, which act on specific pathways involved in the destructive processes after TBI, even if usually employed for the treatment of other diseases, can show potential benefits. This review represents a massive effort towards current and novel therapies for TBI that have been investigated in both pre-clinical and clinical settings. This review aims to summarize the advancement in therapeutic strategies based on specific and distinct -target of therapies-: brain edema, ICP control, neuronal activity and plasticity, anti-inflammatory and immunomodulatory effects, cerebral autoregulation, antioxidant properties, and future perspectives with the adoption of mesenchymal stromal cells.

Published
2021
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27. Neuromonitoring during general anesthesia in non-neurologic surgery

Author

Stefano Nogas, Chiara Robba, Maura Mandelli, Francesca Iannuzzi, Denise Battaglini, Marco Sottano, Giulia Bonatti, Iole Brunetti, Sara Amodio, and Paolo Pelosi

Subjects
medicine.medical_specialty, Intraoperative Neurophysiological Monitoring, Ultrasonography, Doppler, Transcranial, Sedation, Population, Anesthesia, General, Electroencephalography, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, 030202 anesthesiology, medicine, Humans, education, education.field_of_study, Spectroscopy, Near-Infrared, medicine.diagnostic_test, business.industry, Neurointensive care, Perioperative, medicine.disease, Transcranial Doppler, Surgery, Anesthesiology and Pain Medicine, Anesthesia, Bispectral index, medicine.symptom, business, Postoperative cognitive dysfunction, 030217 neurology & neurosurgery
Abstract

Cerebral complications are common in perioperative settings even in non-neurosurgical procedures. These include postoperative cognitive dysfunction or delirium as well as cerebrovascular accidents. During surgery, it is essential to ensure an adequate degree of sedation and analgesia, and at the same time, to provide hemodynamic and respiratory stability in order to minimize neurological complications. In this context, the role of neuromonitoring in the operating room is gaining interest, even in the non-neurolosurgical population. The use of multimodal neuromonitoring can potentially reduce the occurrence of adverse effects during and after surgery, and optimize the administration of anesthetic drugs. In addition to the traditional focus on monitoring hemodynamic and respiratory systems during general anesthesia, the ability to constantly monitor the activity and maintenance of brain homeostasis, creating evidence-based protocols, should also become part of the standard of care: in this challenge, neuromonitoring comes to our aid. In this review, we aim to describe the role of the main types of noninvasive neuromonitoring such as those based on electroencephalography (EEG) waves (EEG, Entropy module, Bispectral Index, Narcotrend Monitor), near-infrared spectroscopy (NIRS) based on noninvasive measurement of cerebral regional oxygenation, and Transcranial Doppler used in the perioperative settings in non-neurosurgical intervention. We also describe the advantages, disadvantage, and limitation of each monitoring technique.

Published
2021
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28. Bronchoalveolar lavage fluid characteristics and outcomes of invasively mechanically ventilated patients with COVID-19 pneumonia in Genoa, Italy

Author

Elisabetta Tedone, Angelo Gratarola, Lucia Taramasso, Maurizio Loconte, Emanuele Delfino, Luca Mastracci, Rachele Pincino, Chiara Sepulcri, Antonio Di Biagio, Nicolò Patroniti, Lorenzo Ball, Laura Magnasco, Giancarlo Icardi, Antonio Vena, Chiara Dentone, Paolo Pelosi, Paolo Frisoni, Malgorzata Mikulska, Laura Ambra Nicolini, Andrea De Maria, Martina Bavastro, Federica Grillo, Andrea Orsi, Emanuela Barisione, Rosa Mangerini, Bianca Bruzzone, Matteo Bassetti, Daniele Roberto Giacobbe, Iole Brunetti, Sara Mora, and Matteo Cerchiaro

Subjects
0301 basic medicine, Male, Multivariate analysis, Neutrophils, medicine.medical_treatment, Infectious and parasitic diseases, RC109-216, Gastroenterology, Leukocyte Count, 0302 clinical medicine, Medicine, Viral, Survivors, Lymphocytes, Bronchoalveolar lavage fluid, COVID-19, Macrophages, Adult, Aged, Bronchoalveolar Lavage Fluid, Critical Illness, Female, Humans, Intensive Care Units, Italy, Middle Aged, Pneumonia, Viral, SARS-CoV-2, Treatment Outcome, Respiration, Artificial, medicine.diagnostic_test, Respiration, respiratory system, Icu admission, Infectious Diseases, 030220 oncology & carcinogenesis, Artificial, Research Article, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 03 medical and health sciences, Internal medicine, Mechanical ventilation, business.industry, Critically ill, Pneumonia, medicine.disease, respiratory tract diseases, 030104 developmental biology, Bronchoalveolar lavage, business
Abstract

BackgroundThe primary objective of the study is to describe the cellular characteristics of bronchoalveolar lavage fluid (BALF) of COVID-19 patients requiring invasive mechanical ventilation; the secondary outcome is to describe BALF findings between survivors vs non-survivors.Materials and methodsPatients positive for SARS-CoV-2 RT PCR, admitted to ICU between March and April 2020 were enrolled. At ICU admission, BALF were analyzed by flow cytometry. Univariate, multivariate and Spearman correlation analyses were performed.ResultsSixty-four patients were enrolled, median age of 64 years (IQR 58–69). The majority cells in the BALF were neutrophils (70%, IQR 37.5–90.5) and macrophages (27%, IQR 7–49) while a minority were lymphocytes, 1%, TCD3+ 92% (IQR 82–95). The ICU mortality was 32.8%. Non-survivors had a significantly older age (p = 0.033) and peripheral lymphocytes (p = 0.012) were lower compared to the survivors. At multivariate analysis the percentage of macrophages in the BALF correlated with poor outcome (OR 1.336, CI95% 1.014–1.759,p = 0.039).ConclusionsIn critically ill patients, BALF cellularity is mainly composed of neutrophils and macrophages. The macrophages percentage in the BALF at ICU admittance correlated with higher ICU mortality. The lack of lymphocytes in BALF could partly explain a reduced anti-viral response.

Published
2021

29. Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

Author

Chiara, Robba, Rafael, Badenes, Denise, Battaglini, Lorenzo, Ball, Iole, Brunetti, Janus C, Jakobsen, Gisela, Lilja, Hans, Friberg, Pedro D, Wendel-Garcia, Paul J, Young, Glenn, Eastwood, Michelle S, Chew, Johan, Unden, Matthew, Thomas, Michael, Joannidis, Alistair, Nichol, Andreas, Lundin, Jacob, Hollenberg, Naomi, Hammond, Manoj, Saxena, Martin, Annborn, Miroslav, Solar, Fabio S, Taccone, Josef, Dankiewicz, Niklas, Nielsen, Paolo, Pelosi, Eelco F M, Wijdicks, and Collaborators, TTM2 Trial

Subjects
Mechanical power, Ventilators, Mechanical, Anestesi och intensivvård, Anesthesiology and Intensive Care, Hypothermia, Middle Aged, Cardiac arrest, Critical Care and Intensive Care Medicine, Respiration, Artificial, Ventilator settings, Mechanical ventilation, Outcome, Driving pressure, Tidal Volume, Humans, Out-of-Hospital Cardiac Arrest
Abstract

Purpose The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (V-T) was 7 (Interquartile range, IQR = 6.2-8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5-9) cmH(2)0, plateau pressure was 20 cmH(2)0 (IQR = 17-23), driving pressure was 12 cmH(2)0 (IQR = 10-15), mechanical power 16.2 J/min (IQR = 12.1-21.8), ventilatory ratio was 1.27 (IQR = 1.04-1.6), and respiratory rate was 17 breaths/minute (IQR = 14-20). Median partial pressure of oxygen was 87 mmHg (IQR = 75-105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36-45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003-1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001-1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes. Funding Agencies|Universita degli Studi di Genova; Swedish Research Council [Vetenskapsradet]; Swedish Heart-Lung Foundation; Stig and Ragna Gorthon Foundation; Knutsson Foundation; Laerdal Foundation; Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research; Region Skane; Swedish National Health Service

Published
2022
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30. Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials

Author

Niklas S. Campos, Thomas Bluth, Sabrine N.T. Hemmes, Julian Librero, Natividad Pozo, Carlos Ferrando, Lorenzo Ball, Guido Mazzinari, Paolo Pelosi, Marcelo Gama de Abreu, Marcus J. Schultz, A. Serpa Neto, Sabrine NT. Hemmes, Paolo Severgnini, Markus W. Hollmann, Jan M. Binnekade, Hermann Wrigge, Jaume Canet, Michael Hiesmayr, Werner Schmid, Edda Tschernko, Samir Jaber, Göran Hedenstierna, Christian Putensen, Agnes Marti, Alessandro Bacuzzi, Alexander Brodhun, Alexandre Molin, Alfred Merten, Ana Parera, Andrea Brunelli, Andrea Cortegiani, Andreas Güldner, Andreas W. Reske, Angelo Gratarola, Antonino Giarratano, Bea Bastin, Bjorn Heyse, Branka Mazul-Sunko, Bruno Amantea, Bruno Barberis, Christopher Uhlig, Conrado Minguez Marín, Cristian Celentano, Daniela La Bella, David D’Antini, David Velghe, Demet Sulemanji, Edoardo De Robertis, Eric Hartmann, Francesca Montalto, Francesco Tropea, Gary H. Mills, Gilda Cinnella, Giorgio Della Rocca, Girolamo Caggianelli, Giulia Pellerano, Giuseppina Mollica, Guillermo Bugedo, Jan-Paul Mulier, Jeroen Vandenbrande, Johann Geib, Jonathan Yaqub, Jorge Florez, Juan F. Mayoral, Juraj Sprung, Jurgen Van Limmen, Lieuwe DJ. Bos, Luc de Baerdemaeker, Luc Jamaer, Luigi Spagnolo, Lydia Strys, Manuel Granell Gil, Marcos F. Vidal Melo, Maria Carmen Unzueta, Maria Victoria Moral, Marion Ferner, Martin Weiss, Massimo Vanoni, Maximilian S. Schaefer, Mercè Prieto, Michele Grio, Peter Markus Spieth, Philipp Simon, Phoebe Bodger, Pilar Sierra, Rita Laufenberg-Feldmann, Roberta Rusca, Rodolfo Proietti, Santi Maurizio Raineri, Santo Caroleo, Sergi Sabaté, Stefan De Hert, Stefano Pezzato, Tanja A. Treschan, Tatjana Goranovic, Thea Koch, Thomas Kiss, Valter Perilli, Virginia Cegarra, Javier Belda, Marina Soro, Carmen Unzueta, Fernando Suarez-Sipmann, Julián Librero, Alicia Llombart, Lucas Rovira, Manuel Granell, César Aldecoa, Oscar Diaz-Cambronero, Jaume Balust, Ignacio Garutti, Rafael Gonzalez, Lucia Gallego, Santiago Garcia del Valle, Javier Redondo, David Pestaña, Aurelio Rodríguez, Javier García, Manuel de la Matta, Maite Ibáñez, Francisco Barrios, Samuel Hernández, Vicente Torres, Salvador Peiró, Abigail Villena, Albert Carramiñana, Alberto Gallego-Casilda, Alejandro Duca, Amalia Alcón, Amanda Miñana, Ana Asensio, Ana Colás, Ana Isabel Galve, Ana Izquierdo, Ana Jurado, Ana María Pérez, Ana Mugarra, Andrea Gutierrez, Ángeles De Miguel, Angels Lozano, Antonio Katime, Antonio Romero, Beatriz Garrigues, Begoña Ayas, Blanca Arocas, Carlos Delgado, Carmen Fernández, Carolina Romero, Clara Gallego, Cristina Garcés, Cristina Lisbona, Cristina Parrilla, Daniel López-Herrera, Domingo González, Eduardo Llamazares, Elena Del Rio, Elena Lozano, Ernesto Pastor, Estefanía Chamorro, Estefanía Gracia, Ester Sánchez, Esther Romero, Fernando Díez, Ferran Serralta, Francisco Daviu, Francisco Sandín, Gerardo Aguilar, Gerardo Tusman, Gonzalo Azparren, Graciela Martínez-Pallí, Inmaculada Benítez, Inmaculada Hernandéz, Inmaculada India, Irene León, Isabel Fuentes, Isabel Ruiz, Jaume Puig, Javie Ignacio Román, Jesús Acosta, Jesús Rico-Feijoo, Jonathan Olmedo, Jose A. Carbonell, Jose M. Alonso, Jose María Pérez, Jose Miguel Marcos, Jose Navarro, Jose Valdivia, Juan Carrizo, Laura Piqueras, Laura Soriano, Laura Vaquero, Lisset Miguel, Lorena Muñoz, Lucia Valencia, Luis Olmedilla, Mᵃ Justina Etulain, Manuel Tisner, María Barrio, María Dolores Alonso, María García, María J. Hernández, María José Alberola, María Parra, María Pilar Argente, María Vila, Mario De Fez, Marta Agilaga, Marta Gine, Mercedes Ayuso, Mercedes García, Natalia Bejarano, Natalia Peña, Nazario Ojeda, Nilda Martínez, Nuria García, Oto Padrón, Pablo García, Paola Valls, Patricia Cruz, Patricia Piñeiro, Pedro Charco, Rafael Anaya, Ramiro López, Rayco Rodríguez, Rocío Martínez, Roger Pujol, Rosa Dosdá, Rosa Lardies, Ruben Díaz, Rubén Villazala, Sara Zapatero, Sergio Cabrera, Sergio Sánchez, Silvia Martin, Suzana Diaz, Tania Franco, Tania Moreno, Tania Socorro, Vicente Gilabert, Victor Balandrón, Victoria Moral, Virgina Cegarra, Viviana Varón, Fernando Abelha, Sühayla Abitağaoğlu, Marc Achilles, Afeez Adebesin, Ine Adriaensens, Charles Ahene, Fatima Akbar, Mohammed Al Harbi, Rita Al Khoury al Kallab, Xavier Albanel, Florence Aldenkortt, Rawan Abdullah Saleh Alfouzan, Reef Alruqaie, Fernando Altermatt, Bruno Luís de Castro Araujo, Genaro Arbesú, Hanna Artsi, Caterina Aurilio, Omer Hilmi Ayanoglu, Harris Baig, Yolanda Baird, Konstantin Balonov, Samantha Banks, Xiaodong Bao, Mélanie Baumgartner, Isabel Belda Tortosa, Alice Bergamaschi, Lars Bergmann, Luca Bigatello, Elena Biosca Pérez, Katja Birr, Elird Bojaxhi, Chiara Bonenti, Iwona Bonney, Elke M.E. Bos, Sara Bowman, Leandro Gobbo Braz, Elisa Brugnoni, Sorin J. Brull, Iole Brunetti, Andrea Bruni, Shonie L. Buenvenida, Cornelius Johannes Busch, Giovanni Camerini, Beatrice Capatti, Javiera Carmona, Jaime Carungcong, Marta Carvalho, Anat Cattan, Carla Cavaleiro, Davide Chiumello, Stefano Ciardo, Mark Coburn, Umberto Colella, Victor Contreras, Pelin Corman Dincer, Elizabeth Cotter, Marcia Crovetto, William Darrah, Simon Davies, Enrique Del Cojo Peces, Ellise Delphin, John Diaper, Paulo do Nascimento Junior, Valerio Donatiello, Jing Dong, Maria do Socorro Dourado, Alexander Dullenkopf, Felix Ebner, Hamed Elgendy, Christoph Ellenberger, Dilek Erdoğan Arı, Thomas Ermert, Fadi Farah, Ana Fernandez-Bustamante, Cristina Ferreira, Marco Fiore, Ana Fonte, Christina Fortià Palahí, Andrea Galimberti, Najia Garofano, Luca Gregorio Giaccari, Fernando Gilsanz, Felix Girrbach, Luca Gobbi, Marc Bernard Godfried, Nicolai Goettel, Peter A. Goldstein, Or Goren, Andrew Gorlin, Juan Graterol, Pierre Guyon, Kevin Haire, Philippe Harou, Antonia Helf, Gunther Hempel, María José Hernández Cádiz, Björn Heyse, Ivan Huercio, Jasmina Ilievska, Lien Jakus, Vijay Jeganath, Yvonne Jelting, Minoa Jung, Barbara Kabon, Aalok Kacha, Maja Karaman Ilić, Arunthevaraja Karuppiah, Ayse Duygu Kavas, Gleicy Keli Barcelos, Todd A. Kellogg, Johann Kemper, Romain Kerbrat, Suraya Khodr, Peter Kienbaum, Bunyamin Kir, Selin Kivrak, Vlasta Klarić, Ceren Köksal, Ana Kowark, Peter Kranke, Bahar Kuvaki, Biljana Kuzmanovska, John Laffey, Mirko Lange, Marília Freitas de Lemos, Marc-Joseph Licker, Manuel López-Baamonde, Antonio López-Hernández, Mercedes Lopez-Martinez, Stéphane Luise, Mark MacGregor, Danielle Magalhães, Julien Maillard, Patrizia Malerbi, Natesan Manimekalai, Michael Margarson, Klaus Markstaller, Archer K. Martin, David P. Martin, Yvette N. Martin, Julia Martínez-Ocon, Ignacio Martin-Loeches, Emilio Maseda, Idit Matot, Niamh McAuliffe, Travis J. McKenzie, Paulina Medina, Melanie Meersch, Angelika Menzen, Els Mertens, Bernd Meurer, Tanja Meyer-Treschan, Changhong Miao, Camilla Micalizzi, Morena Milić, Norma Sueli Pinheiro Módolo, Pierre Moine, Patrick Mölders, Ana Montero-Feijoo, Enrique Moret, Markus K. Muller, Zoe Murphy, Pramod Nalwaya, Filip Naumovski, Paolo Navalesi, Lais Helena Navarro e Lima, Višnja Nesek Adam, Claudia Neumann, Christopher Newell, Zoulfira Nisnevitch, Junaid Nizamuddin, Cecilia Novazzi, Michael O'Connor, Günther Oprea, Mukadder Orhan Sungur, Şule Özbilgin, Maria Caterina Pace, Marcos Pacheco, Balaji Packianathaswamy, Estefania Palma Gonzalez, Fotios Papaspyros, Sebastián Paredes, Maria Beatrice Passavanti, Juan Cristobal Pedemonte, Sanja Peremin, Christoph Philipsenburg, Daniela Pinho, Silvia Pinho, Linda M. Posthuma, Vincenzo Pota, Benedikt Preckel, Paolo Priani, Mohamed Aymen Rached, Aleksandar Radoeshki, Riccardo Ragazzi, Tamilselvan Rajamanickam, Arthi Rajamohan, Harish Ramakrishna, Desikan Rangarajan, Christian Reiterer, J. Ross Renew, Thomas Reynaud, Rhidian Rhys, Eva Rivas, Luisa Robitzky, Rolf Rossaint, Francesca Rubulotta, Humberto S. Machado, Catarina S. Nunes, Giovanni Sabbatini, Jon D. Samuels, Josep Martí Sanahuja, Pasquale Sansone, Alice Santos, Mohamed Sayedalahl, Martin Scharffenberg, Eduardo Schiffer, Nadja Schliewe, Raoul Schorer, Roman Schumann, Gabriele Selmo, Mar Sendra, Mert Senturk, Kate Shaw, Mirjana Shosholcheva, Abdulrazak Sibai, Francesca Simonassi, Claudia Sinno, Nukhet Sivrikoz, Vasiliki Skandalou, Neil Smith, Maria Soares, Tania Socorro Artiles, Diogo Sousa Castro, Miguel Sousa, Savino Spadaro, Emmanouil Stamatakis, Luzius A. Steiner, Andrea Stevenazzi, Alejandro Suarez-de-la-Rica, Mélanie Suppan, Robert Teichmann, José Maria Tena Guerrero, Bram Thiel, Raquel Tolós, Gulbin Tore Altun, Michelle Tucci, Zachary A. Turnbull, Žana Turudić, Matthias Unterberg, Yves Van Nieuwenhove, Julia Van Waesberghe, Marcos Francisco Vidal Melo, Bibiana Vitković, Luigi Vivona, Marcela Vizcaychipi, Carlo Alberto Volta, Anne Weber, Toby N. Weingarten, Jakob Wittenstein, Piet Wyffels, Julio Yagüe, David Yates, Ayşen Yavru, Lilach Zac, Jing Zhong, Anesthesiology, Intensive Care Medicine, ACS - Pulmonary hypertension & thrombosis, ACS - Diabetes & metabolism, ACS - Microcirculation, Campos, Niklas S, Bluth, Thoma, Hemmes, Sabrine N T, Librero, Julian, Pozo, Natividad, Ferrando, Carlo, Ball, Lorenzo, Mazzinari, Guido, Pelosi, Paolo, Gama de Abreu, Marcelo, Schultz, Marcus J, Serpa Neto, A, investigators for the PROVHILO study including, Cortegiani, Andrea, Raineri, Santi Maurizio, and Giarratano, Antonino

Subjects
Adult, Lung Diseases, PEEP, postoperative pulmonary complications, mechanical ventilation, Positive-Pressure Respiration, surgery, Anesthesiology and Pain Medicine, Postoperative Complications, Tidal Volume, Humans, Postoperative Period, Lung, Randomized Controlled Trials as Topic
Abstract

BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperative pulmonary complications within the first week, analysed using mixed-effect logistic regression. Pre-specified subgroup analyses of nine patient characteristics and seven procedure and care-delivery characteristics were also performed. RESULTS: Complete datasets were available for 1913 participants ventilated with high PEEP and recruitment manoeuvres, compared with 1924 participants who received low PEEP. The primary outcome occurred in 562/1913 (29.4%) participants randomised to high PEEP, compared with 620/1924 (32.2%) participants randomised to low PEEP (unadjusted odds ratio [OR]=0.87; 95% confidence interval [95% CI], 0.75-1.01; P=0.06). Higher PEEP resulted in 87/1913 (4.5%) participants requiring interventions for desaturation, compared with 216/1924 (11.2%) participants randomised to low PEEP (OR=0.34; 95% CI, 0.26-0.45). Intraoperative hypotension was associated more frequently (784/1913 [41.0%]) with high PEEP, compared with low PEEP (579/1924 [30.1%]; OR=1.87; 95% CI, 1.60-2.17). CONCLUSIONS: High PEEP combined with recruitment manoeuvres during low tidal volume ventilation in patients undergoing major surgery did not reduce postoperative pulmonary complications. CLINICAL TRIAL REGISTRATION: NCT03937375 (Clinicaltrials.gov).

Published
2022

31. Candida auris Candidemia in Critically Ill, Colonized Patients: Cumulative Incidence and Risk Factors

Author

Federica Briano, Laura Magnasco, Chiara Sepulcri, Silvia Dettori, Chiara Dentone, Malgorzata Mikulska, Lorenzo Ball, Antonio Vena, Chiara Robba, Nicolò Patroniti, Iole Brunetti, Angelo Gratarola, Raffaele D’Angelo, Vincenzo Di Pilato, Erika Coppo, Anna Marchese, Paolo Pelosi, Daniele Roberto Giacobbe, and Matteo Bassetti

Subjects
Colonization, Microbiology (medical), Infectious Diseases, Candida auris, Candidemia, Candidiasis, ICU
Abstract

Candida auris (C. auris) is an emerging nosocomial pathogen, and a sharp rise in cases of colonization and infection has been registered in intensive care units (ICUs) during the ongoing coronavirus disease 2019 (COVID-19) pandemic. The unfavorable resistance profile of C. auris and the potential high mortality of C. auris infections represent an important challenge for physicians.We conducted a single-center retrospective study including all patients admitted to ICUs with isolation of C. auris in any non-sterile body site between February 20, 2020, and May 31, 2021. The primary aim of the study was to assess the cumulative incidence of C. auris candidemia in colonized patients. The secondary aim was to identify predictors of C. auris candidemia in the study population.During the study period, 157 patients admitted to ICUs in our hospital became colonized with C. auris; 59% of them were affected by COVID-19. Overall, 27 patients (17%) developed C. auris candidemia. The cumulative risk of developing C. auris candidemia was 25% at 60 days after first detection of C. auris colonization. Seven patients with C. auris candidemia (26%) also developed a late recurrent episode. All C. auris blood isolates during the first occurring episode were resistant to fluconazole and susceptible to echinocandins, while 15 (56%) were resistant to amphotericin B. During late recurrent episodes, emergent resistance to caspofungin and amphotericin B occurred in one case each. In the final multivariable model, only multisite colonization retained an independent association with the development of C. auris candidemia.Candida auris candidemia may occur in up to one fourth of colonized critically ill patients, and multisite colonization is an independent risk factor for the development of candidemia. Implementing adequate infection control measures remains crucial to prevent colonization with C. auris and indirectly the subsequent development of infection.

Published
2022

32. Early versus late intubation in COVID-19 patients failing helmet CPAP: A quantitative computed tomography study

Author

Lorenzo Ball, Chiara Robba, Jacob Herrmann, Sarah E. Gerard, Yi Xin, Maria Pigati, Andrea Berardino, Francesca Iannuzzi, Denise Battaglini, Iole Brunetti, Giuseppe Minetti, Sara Seitun, Antonio Vena, Daniele Roberto Giacobbe, Matteo Bassetti, Patricia R.M. Rocco, Maurizio Cereda, Lucio Castellan, Nicolò Patroniti, and Paolo Pelosi

Subjects
Pulmonary and Respiratory Medicine, Continuous Positive Airway Pressure, Physiology, General Neuroscience, COVID-19, CPAP, Computed tomography, Intubation, Mechanical ventilation, Humans, Intubation, Intratracheal, Retrospective Studies, Tomography, X-Ray Computed, X-Ray Computed, Intratracheal, Tomography
Abstract

To describe the effects of timing of intubation in COVID-19 patients that fail helmet continuous positive airway pressure (h-CPAP) on progression and severity of disease.COVID-19 patients that failed h-CPAP, required intubation, and underwent chest computed tomography (CT) at two levels of positive end-expiratory pressure (PEEP, 8 and 16 cmHFifty-two patients were included and classified in early (h-CPAP for ≤2 days, N = 26) and late groups (h-CPAP for2 days, N = 26). Patients in the late compared to early intubation group presented: 1) lower respiratory system compliance (median difference, MD -7 mL/cmHIn COVID-19 patients receiving h-CPAP, late intubation was associated with worse clinical presentation at ICU admission and more advanced disease. The possible detrimental effects of delaying intubation should be carefully considered in these patients.

Published
2022

33. Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

Author

Nijbroek, Sunny G, Hol, Liselotte, Swart, Pien, Hemmes, Sabrine N T, Serpa Neto, Ary, Binnekade, Jan M, Hedenstierna, Goran, Jaber, Samir, Hiesmayr, Michael, Hollmann, Markus W, Mills, Gary H, Vidal Melo, Marcos F, Putensen, Christian, Schmid, Werner, Severgnini, Paolo, Wrigge, Hermann, Gama de Abreu, Marcelo, Pelosi, Paolo, Schultz, Marcus J, Wolfgang Kroell, Helfried Metzler, Gerd Struber, Thomas Wegscheider, Hans Gombotz, Michael Hiesmayr, Werner Schmid, Bernhard Urbanek, David Kahn, Mona Momeni, Audrey Pospiech, Fernande Lois, Patrice Forget, Irina Grosu, Jan Poelaert, Veerle van Mossevelde, Marie-Claire van Malderen, Dimitri Dylst, Jeroen van Melkebeek, Maud Beran, Stefan de Hert, Luc De Baerdemaeker, Bjorn Heyse, Jurgen Van Limmen, Piet Wyffels, Tom Jacobs, Nathalie Roels, Ann De Bruyne, Stijn van de Velde, Brigitte Leva, Sandrine Damster, Benoit Plichon, Marina Juros-Zovko, Dejana Djonoviċ- Omanoviċ, Selma Pernar, Josip Zunic, Petar Miskovic, Antonio Zilic, Slavica Kvolik, Dubravka Ivic, Darija Azenic-Venzera, Sonja Skiljic, Hrvoje Vinkovic, Ivana Oputric, Kazimir Juricic, Vedran Frkovic, Jasminka Kopic, Ivan Mirkovic, Nenad Karanovic, Mladen Carev, Natasa Dropulic, Jadranka Pavicic Saric, Gorjana Erceg, Matea Bogdanovic Dvorscak, Branka Mazul-Sunko, Anna Marija Pavicic, Tanja Goranovic, Branka Maldini, Tomislav Radocaj, Zeljka Gavranovic, Inga Mladic-Batinica, Mirna Sehovic, Petr Stourac, Hana Harazim, Olga Smekalova, Martina Kosinova, Tomas Kolacek, Kamil Hudacek, Michal Drab, Jan Brujevic, Katerina Vitkova, Katerina Jirmanova, Ivana Volfova, Paula Dzurnakova, Katarina Liskova, Radovan Dudas, Radek Filipsky, Samir el Kafraw, Hisham Hosny Abdelwahab, Tarek Metwally, Ahmed Abdel-Razek, Ahmed Mostafa El-Shaarawy, Hany Yassin, Mohamed Magdy, Mahdy Abdelhady, Mohamed Mahran, Eiko Herodes, Peeter Kivik, Juri Oganjan, Annika Aun, Alar Sormus, Kaili Sarapuu, Merilin Mall, Juri Karjagin, Emmanuel Futier, Antoine Petit, Adeline Gerard, Emmanuel Marret, Marc Solier, Samir Jaber, Albert Prades, Jens Krassler, Simone Merzky, Marcel Gama de Abreu, Christopher Uhlig, Thomas Kiss, Anette Bundy, Thomas Bluth, Andreas Gueldner, Peter Spieth, Martin Scharffenberg, Denny Tran Thiem, Thea Koch, Tanja Treschan, Maximilian Schaefer, Bea Bastin, Johann Geib, Martin Weiss, Peter Kienbaum, Benedikt Pannen, Andre Gottschalk, Mirja Konrad, Diana Westerheide, Ben Schwerdtfeger, Hermann Wrigge, Philipp Simon, Andreas Reske, Christian Nestler, Dimitrios Valsamidis, Konstantinos Stroumpoulis, Georgios Antholopoulos, Antonis Andreou, Dimitris Karapanos, Kassiani Theodoraki, Georgios Gkiokas, Marios-Konstantinos Tasoulis, Tatiana Sidiropoulou, Foteini Zafeiropoulou, Panagiota Florou, Aggeliki Pandazi, Georgia Tsaousi, Christos Nouris, Chryssa Pourzitaki, Dmitri Bystritski, Reuven Pizov, Arieh Eden, Caterina Valeria Pesce, Annamaria Campanile, Antonella Marrella, Salvatore Grasso, Michele De Michele, Francesco Bona, Gianmarco Giacoletto, Elena Sardo, Luigi Giancarlo, Vicari Sottosanti, Maurizio Solca, Carlo Alberto Volta, Savino Spadaro, Marco Verri, Riccardo Ragazzi, Roberto Zoppellari, Gilda Cinnella, Pasquale Raimondo, Daniela La Bella, Lucia Mirabella, Davide D'antini, Paolo Pelosi, Alexandre Molin, Iole Brunetti, Angelo Gratarola, Giulia Pellerano, Rosanna Sileo, Stefano Pezzatto, Luca Montagnani, Laura Pasin, Giovanni Landoni, Alberto Zangrillo, Luigi Beretta, Ambra Licia Di Parma, Valentina Tarzia, Roberto Dossi, Marta Eugenia Sassone, Daniele Sances, Stefano Tredici, Gianluca Spano, Gianluca Castellani, Luigi Delunas, Sopio Peradze, Marco Venturino, Ines Arpino, Sara Sher, Concezione Tommasino, Francesca Rapido, Paola Morelli, Maria Vargas, Giuseppe Servillo, Andrea Cortegiani, Santi Maurizio Raineri, Francesca Montalto, Vincenzo Russotto, Antonino Giarratano, Marco Baciarello, Michela Generali, Giorgia Cerati, Yigal Leykin, Filippo Bressan, Vittoria Bartolini, Lucia Zamidei, Luca Brazzi, Corrado Liperi, Gabriele Sales, Laura Pistidda, Paolo Severgnini, Elisa Brugnoni, Giuseppe Musella, Alessandro Bacuzzi, Dalip Muhardri, Gecaj-Gashi Agreta, Fatos Sada, Adem Bytyqi, Aurika Karbonskiene, Ruta Aukstakalniene, Zivile Teberaite, Erika Salciute, Renatas Tikuisis, Povilas Miliauskas, Sipylaite Jurate, Egle Kontrimaviciute, Gabija Tomkute, John Xuereb, Maureen Bezzina, Francis Joseph Borg, Sabrine Hemmes, Marcus Schultz, Markus Hollmann, Irene Wiersma, Christa Boer, Anne Duvekot, Bas in ‘t Veld, Alice Werger, Paul Dennesen, Charlotte Severijns, Jasper De Jong, Jens Hering, Rienk van Beek, Stefan Ivars, Ib Jammer, Alena Breidablik, Katharina Skirstad Hodt, Frode Fjellanger, Manuel Vico Avalos, Jannicke Mellin-Olsen, Elisabeth Andersson, Amir Shafi-Kabir, Ruby Molina, Stanley Wutai, Erick Morais, Glória Tareco, Daniel Ferreira, Joana Amaral, Maria de Lurdes, Goncalves Castro, Susana Cadilha, Sofia Appleton, Suzana Parente, Mariana Correia, Diogo Martins, Angela Monteirosa, Ana Ricardo, Sara Rodrigues, Lucian Horhota, Ioana Marina Grintescu, Liliana Mirea, Ioana Cristina Grintescu, Dan Corneci, Silvius Negoita, Madalina Dutu, Ioana Popescu Garotescu, Daniela Filipescu, Alexandru Bogdan Prodan, Gabriela Droc, Ruxandra Fota, Mihai Popescu, Dana Tomescu, Ana Maria Petcu, Marian Irinel Tudoroiu, Alida Moise, Catalin-Traian Guran, Iorel Gherghina, Dan Costea, Iulia Cindea, Sanda-Maria Copotoiu, Ruxandra Copotoiu, Victoria Barsan, Zsolt Tolcser, Magda Riciu, Septimiu Gheorghe Moldovan, Mihaly Veres, Alexey Gritsan, Tatyana Kapkan, Galina Gritsan, Oleg Korolkov, Alexander Kulikov, Andrey Lubnin, Alexey Ovezov, Pavel Prokoshev, Alexander Lugovoy, Natalia Anipchenko, Andrey Babayants, Irina Komissarova, Karginova Zalina, Valery Likhvantsev, Sergei Fedorov, Aleksandra Lazukic, Jasmina Pejakovic, Dunja Mihajlovic, Zuzana Kusnierikova, Maria Zelinkova, Katarina Bruncakova, Lenka Polakovicova, Villiam Sobona, Barbka Novak-Supe, Ana Pekle-Golez, Miroljub Jovanov, Branka Strazisar, Jasmina Markovic-Bozi, Vesna Novak-Jankovic, Minca Voje, Andriy Grynyuk, Ivan Kostadinov, Alenka Spindler-Vesel, Victoria Moral, Mari Carmen Unzueta, Carlos Puigbo, Josep Fava, Jaume Canet, Enrique Moret, Mónica Rodriguez Nunez, Mar Sendra, Andrea Brunelli, Frederic Rodenas, Pablo Monedero, Francisco Hidalgo Martinez, Maria Jose Yepes Temino, Antonio Martínez Simon, Ana de Abajo Larriba, Alberto Lisi, Gisela Perez, Raquel Martinez, Manuel Granell, Jose Tatay Vivo, Cristina Saiz Ruiz, Jose Antonio de Andrés Ibañez, Ernesto Pastor, Marina Soro, Carlos Ferrando, Mario Defez, Cesar Aldecoa Alvares-Santullano, Rocio Perez, Jesus Rico, Monir Jawad, Yousif Saeed, Lars Gillberg, Zuleyha Kazak Bengisun, Baturay Kansu Kazbek, Nesil Coskunfirat, Neval Boztug, Suat Sanli, Murat Yilmaz, Necmiye Hadimioglu, Nuzhet Mert Senturk, Emre Camci, Semra Kucukgoncu, Zerrin Sungur, Nukhet Sivrikoz, Serpil Ustalar Ozgen, Fevzi Toraman, Onur Selvi, Ozgur Senturk, Mine Yildiz, Bahar Kuvaki, Ferim Gunenc, Semih Kucukguclu, Şule Ozbilgin, Jale Maral, Seyda Canli, Oguzhan Arun, Ali Saltali, Eyup Aydogan, Fatma Nur Akgun, Ceren Sanlikarip, Fatma Mine Karaman, Andriy Mazur, Sergiy Vorotyntsev, Guy Rousseau, Colin Barrett, Lucia Stancombe, Ben Shelley, Helen Scholes, James Limb, Amir Rafi, Lisa Wayman, Jill Deane, David Rogerson, John Williams, Susan Yates, Elaine Rogers, Mark Pulletz, Sarah Moreton, Stephanie Jones, Suresh Venkatesh, Maudrian Burton, Lucy Brown, Cait Goodall, Matthew Rucklidge, Debbie Fuller, Maria Nadolski, Sandeep Kusre, Michael Lundberg, Lynn Everett, Maka Zuleika, Peter Carvalho, Deborah Clements, Ben Creagh-Brown, Philip Watt, Parizade Raymode, Rupert Pearse, Otto Mohr, Ashok Raj, Thais Creary, Ahmed Chishti, Andrea Bell, Charley Higham, Alistair Cain, Sarah Gibb, Stephen Mowat, Danielle Franklin, Claire West, Gary Minto, Nicholas Boyd, Gary Mills, Emily Calton, Rachel Walker, Felicity Mackenzie, Branwen Ellison, Helen Roberts, Moses Chikungwa, Clare Jackson, Andrew Donovan, Jayne Foot, Elizabeth Homan, Jane Montgomery, David Portch, Pauline Mercer, Janet Palmer, Jonathan Paddle, Anna Fouracres, Amanda Datson, Alyson Andrew, Leanne Welch, Alastair Rose, Sandeep Varma, Karen Simeson, Mrutyunjaya Rambhatla, Jaysimha Susarla, Sudhakar Marri, Krishnan Kodaganallur, Ashok Das, Shivarajan Algarsamy, Julie Colley, Simon Davies, Margaret Szewczyk, Thomas Smith, Ana Fernandez- Bustamante, Elizabeth Luzier, Angela Almagro, Marcos Vidal Melo, Luiz Fernando, Demet Sulemanji, Juraj Sprung, Toby Weingarten, Daryl Kor, Federica Scavonetto, Yeo Tze, Nijbroek, Sunny G, Hol, Liselotte, Swart, Pien, Hemmes, Sabrine N T, Serpa Neto, Ary, Binnekade, Jan M, Hedenstierna, Goran, Jaber, Samir, Hiesmayr, Michael, Hollmann, Markus W, Mills, Gary H, Vidal Melo, Marcos F, Putensen, Christian, Schmid, Werner, Severgnini, Paolo, Wrigge, Hermann, Gama de Abreu, Marcelo, Pelosi, Paolo, Schultz, Marcus J,Wolfgang Kroell, Helfried Metzler, Gerd Struber, Thomas Wegscheider, Hans Gombotz, Michael Hiesmayr, Werner Schmid, Bernhard Urbanek, David Kahn, Mona Momeni, Audrey Pospiech, Fernande Lois, Patrice Forget, Irina Grosu, Jan Poelaert, Veerle van Mossevelde, Marie-Claire van Malderen, Dimitri Dylst, Jeroen van Melkebeek, Maud Beran, Stefan de Hert, Luc De Baerdemaeker, Bjorn Heyse, Jurgen Van Limmen, Piet Wyffels, Tom Jacobs, Nathalie Roels, Ann De Bruyne, Stijn van de Velde, Brigitte Leva, Sandrine Damster, Benoit Plichon, Marina Juros-Zovko, Dejana Djonoviċ- Omanoviċ, Selma Pernar, Josip Zunic, Petar Miskovic, Antonio Zilic, Slavica Kvolik, Dubravka Ivic, Darija Azenic-Venzera, Sonja Skiljic, Hrvoje Vinkovic, Ivana Oputric, Kazimir Juricic, Vedran Frkovic, Jasminka Kopic, Ivan Mirkovic, Nenad Karanovic, Mladen Carev, Natasa Dropulic, Jadranka Pavicic Saric, Gorjana Erceg, Matea Bogdanovic Dvorscak, Branka Mazul-Sunko, Anna Marija Pavicic, Tanja Goranovic, Branka Maldini, Tomislav Radocaj, Zeljka Gavranovic, Inga Mladic-Batinica, Mirna Sehovic, Petr Stourac, Hana Harazim, Olga Smekalova, Martina Kosinova, Tomas Kolacek, Kamil Hudacek, Michal Drab, Jan Brujevic, Katerina Vitkova, Katerina Jirmanova, Ivana Volfova, Paula Dzurnakova, Katarina Liskova, Radovan Dudas, Radek Filipsky, Samir el Kafraw, Hisham Hosny Abdelwahab, Tarek Metwally, Ahmed Abdel-Razek, Ahmed Mostafa El-Shaarawy, Hany Yassin, Mohamed Magdy, Mahdy Abdelhady, Mohamed Mahran, Eiko Herodes, Peeter Kivik, Juri Oganjan, Annika Aun, Alar Sormus, Kaili Sarapuu, Merilin Mall, Juri Karjagin, Emmanuel Futier, Antoine Petit, Adeline Gerard, Emmanuel Marret, Marc Solier, Samir Jaber, Albert Prades, Jens Krassler, Simone Merzky, Marcel Gama de Abreu, Christopher Uhlig, Thomas Kiss, Anette Bundy, Thomas Bluth, Andreas Gueldner, Peter Spieth, Martin Scharffenberg, Denny Tran Thiem, Thea Koch, Tanja Treschan, Maximilian Schaefer, Bea Bastin, Johann Geib, Martin Weiss, Peter Kienbaum, Benedikt Pannen, Andre Gottschalk, Mirja Konrad, Diana Westerheide, Ben Schwerdtfeger, Hermann Wrigge, Philipp Simon, Andreas Reske, Christian Nestler, Dimitrios Valsamidis, Konstantinos Stroumpoulis, Georgios Antholopoulos, Antonis Andreou, Dimitris Karapanos, Kassiani Theodoraki, Georgios Gkiokas, Marios-Konstantinos Tasoulis, Tatiana Sidiropoulou, Foteini Zafeiropoulou, Panagiota Florou, Aggeliki Pandazi, Georgia Tsaousi, Christos Nouris, Chryssa Pourzitaki, Dmitri Bystritski, Reuven Pizov, Arieh Eden, Caterina Valeria Pesce, Annamaria Campanile, Antonella Marrella, Salvatore Grasso, Michele De Michele, Francesco Bona, Gianmarco Giacoletto, Elena Sardo, Luigi Giancarlo, Vicari Sottosanti, Maurizio Solca, Carlo Alberto Volta, Savino Spadaro, Marco Verri, Riccardo Ragazzi, Roberto Zoppellari, Gilda Cinnella, Pasquale Raimondo, Daniela La Bella, Lucia Mirabella, Davide D'antini, Paolo Pelosi, Alexandre Molin, Iole Brunetti, Angelo Gratarola, Giulia Pellerano, Rosanna Sileo, Stefano Pezzatto, Luca Montagnani, Laura Pasin, Giovanni Landoni, Alberto Zangrillo, Luigi Beretta, Ambra Licia Di Parma, Valentina Tarzia, Roberto Dossi, Marta Eugenia Sassone, Daniele Sances, Stefano Tredici, Gianluca Spano, Gianluca Castellani, Luigi Delunas, Sopio Peradze, Marco Venturino, Ines Arpino, Sara Sher, Concezione Tommasino, Francesca Rapido, Paola Morelli, Maria Vargas, Giuseppe Servillo, Andrea Cortegiani, Santi Maurizio Raineri, Francesca Montalto, Vincenzo Russotto, Antonino Giarratano, Marco Baciarello, Michela Generali, Giorgia Cerati, Yigal Leykin, Filippo Bressan, Vittoria Bartolini, Lucia Zamidei, Luca Brazzi, Corrado Liperi, Gabriele Sales, Laura Pistidda, Paolo Severgnini, Elisa Brugnoni, Giuseppe Musella, Alessandro Bacuzzi, Dalip Muhardri, Gecaj-Gashi Agreta, Fatos Sada, Adem Bytyqi, Aurika Karbonskiene, Ruta Aukstakalniene, Zivile Teberaite, Erika Salciute, Renatas Tikuisis, Povilas Miliauskas, Sipylaite Jurate, Egle Kontrimaviciute, Gabija Tomkute, John Xuereb, Maureen Bezzina, Francis Joseph Borg, Sabrine Hemmes, Marcus Schultz, Markus Hollmann, Irene Wiersma, Christa Boer, Anne Duvekot, Bas in ‘t Veld, Alice Werger, Paul Dennesen, Charlotte Severijns, Jasper De Jong, Jens Hering, Rienk van Beek, Stefan Ivars, Ib Jammer, Alena Breidablik, Katharina Skirstad Hodt, Frode Fjellanger, Manuel Vico Avalos, Jannicke Mellin-Olsen, Elisabeth Andersson, Amir Shafi-Kabir, Ruby Molina, Stanley Wutai, Erick Morais, Glória Tareco, Daniel Ferreira, Joana Amaral, Maria de Lurdes, Goncalves Castro, Susana Cadilha, Sofia Appleton, Suzana Parente, Mariana Correia, Diogo Martins, Angela Monteirosa, Ana Ricardo, Sara Rodrigues, Lucian Horhota, Ioana Marina Grintescu, Liliana Mirea, Ioana Cristina Grintescu, Dan Corneci, Silvius Negoita, Madalina Dutu, Ioana Popescu Garotescu, Daniela Filipescu, Alexandru Bogdan Prodan, Gabriela Droc, Ruxandra Fota, Mihai Popescu, Dana Tomescu, Ana Maria Petcu, Marian Irinel Tudoroiu, Alida Moise, Catalin-Traian Guran, Iorel Gherghina, Dan Costea, Iulia Cindea, Sanda-Maria Copotoiu, Ruxandra Copotoiu, Victoria Barsan, Zsolt Tolcser, Magda Riciu, Septimiu Gheorghe Moldovan, Mihaly Veres, Alexey Gritsan, Tatyana Kapkan, Galina Gritsan, Oleg Korolkov, Alexander Kulikov, Andrey Lubnin, Alexey Ovezov, Pavel Prokoshev, Alexander Lugovoy, Natalia Anipchenko, Andrey Babayants, Irina Komissarova, Karginova Zalina, Valery Likhvantsev, Sergei Fedorov, Aleksandra Lazukic, Jasmina Pejakovic, Dunja Mihajlovic, Zuzana Kusnierikova, Maria Zelinkova, Katarina Bruncakova, Lenka Polakovicova, Villiam Sobona, Barbka Novak-Supe, Ana Pekle-Golez, Miroljub Jovanov, Branka Strazisar, Jasmina Markovic-Bozi, Vesna Novak-Jankovic, Minca Voje, Andriy Grynyuk, Ivan Kostadinov, Alenka Spindler-Vesel, Victoria Moral, Mari Carmen Unzueta, Carlos Puigbo, Josep Fava, Jaume Canet, Enrique Moret, Mónica Rodriguez Nunez, Mar Sendra, Andrea Brunelli, Frederic Rodenas, Pablo Monedero, Francisco Hidalgo Martinez, Maria Jose Yepes Temino, Antonio Martínez Simon, Ana de Abajo Larriba, Alberto Lisi, Gisela Perez, Raquel Martinez, Manuel Granell, Jose Tatay Vivo, Cristina Saiz Ruiz, Jose Antonio de Andrés Ibañez, Ernesto Pastor, Marina Soro, Carlos Ferrando, Mario Defez, Cesar Aldecoa Alvares-Santullano, Rocio Perez, Jesus Rico, Monir Jawad, Yousif Saeed, Lars Gillberg, Zuleyha Kazak Bengisun, Baturay Kansu Kazbek, Nesil Coskunfirat, Neval Boztug, Suat Sanli, Murat Yilmaz, Necmiye Hadimioglu, Nuzhet Mert Senturk, Emre Camci, Semra Kucukgoncu, Zerrin Sungur, Nukhet Sivrikoz, Serpil Ustalar Ozgen, Fevzi Toraman, Onur Selvi, Ozgur Senturk, Mine Yildiz, Bahar Kuvaki, Ferim Gunenc, Semih Kucukguclu, Şule Ozbilgin, Jale Maral, Seyda Canli, Oguzhan Arun, Ali Saltali, Eyup Aydogan, Fatma Nur Akgun, Ceren Sanlikarip, Fatma Mine Karaman, Andriy Mazur, Sergiy Vorotyntsev, Guy Rousseau, Colin Barrett, Lucia Stancombe, Ben Shelley, Helen Scholes, James Limb, Amir Rafi, Lisa Wayman, Jill Deane, David Rogerson, John Williams, Susan Yates, Elaine Rogers, Mark Pulletz, Sarah Moreton, Stephanie Jones, Suresh Venkatesh, Maudrian Burton, Lucy Brown, Cait Goodall, Matthew Rucklidge, Debbie Fuller, Maria Nadolski, Sandeep Kusre, Michael Lundberg, Lynn Everett, Maka Zuleika, Peter Carvalho, Deborah Clements, Ben Creagh-Brown, Philip Watt, Parizade Raymode, Rupert Pearse, Otto Mohr, Ashok Raj, Thais Creary, Ahmed Chishti, Andrea Bell, Charley Higham, Alistair Cain, Sarah Gibb, Stephen Mowat, Danielle Franklin, Claire West, Gary Minto, Nicholas Boyd, Gary Mills, Emily Calton, Rachel Walker, Felicity Mackenzie, Branwen Ellison, Helen Roberts, Moses Chikungwa, Clare Jackson, Andrew Donovan, Jayne Foot, Elizabeth Homan, Jane Montgomery, David Portch, Pauline Mercer, Janet Palmer, Jonathan Paddle, Anna Fouracres, Amanda Datson, Alyson Andrew, Leanne Welch, Alastair Rose, Sandeep Varma, Karen Simeson, Mrutyunjaya Rambhatla, Jaysimha Susarla, Sudhakar Marri, Krishnan Kodaganallur, Ashok Das, Shivarajan Algarsamy, Julie Colley, Simon Davies, Margaret Szewczyk, Thomas Smith, Ana Fernandez- Bustamante, Elizabeth Luzier, Angela Almagro, Marcos Vidal Melo, Luiz Fernando, Demet Sulemanji, Juraj Sprung, Toby Weingarten, Daryl Kor, Federica Scavonetto, Yeo Tze, Schultz, Marcus, J, Servillo, G, Vargas, M, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Anesthesiology research group, Supporting clinical sciences, Anesthesiology, Graduate School, AII - Amsterdam institute for Infection and Immunity, Intensive Care Medicine, AII - Inflammatory diseases, ACS - Heart failure & arrhythmias, APH - Quality of Care, ACS - Pulmonary hypertension & thrombosis, APH - Global Health, ACS - Diabetes & metabolism, ACS - Microcirculation, Marcus, J (LAS VEGAS study investigator, the PROVE Network and the Clinical Trial Network of the European Society of, Anaesthesiology), Zangrillo, A, Beretta, L, and Landoni, G

Subjects
Adult, Male, medicine.medical_specialty, Intra operative, health care facilities, manpower, and services, [SDV]Life Sciences [q-bio], Critical Illness, Las Vegas Study, Article, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Internal medicine, Tidal Volume, medicine, Humans, General anaesthesia, Lung, Tidal volume, Female, Respiration, Artificial, Sex Characteristics, Las vegas, business.industry, Respiration, respiratory failure, sex, respiratory system, Sex difference, respiratory tract diseases, Anesthesiology and Pain Medicine, 030228 respiratory system, Relative risk, Artificial, Cohort, Breathing, Observational study, business, intra-operative tidal volume, circulatory and respiratory physiology
Abstract

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (V(T)). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients. OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference. DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries. MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as V(T) of 8 ml kg(−1) or less predicted bodyweight (PBW). A V(T) was deemed ‘default’ if the set V(T) was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation. RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default V(T) was often set, both in women and men; mode V(T) was 500 ml. Median [IQR] V(T) was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg(−1) PBW, P*** < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P*** < 0.001]. In the mediation analysis, patients’ height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default V(T). CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher V(T) than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV. TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Published
2021
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34. Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study

Author

Michele Mirabella, Irene Coloretti, Novella Carannante, Luca Monastra, Giuseppe Fiorentino, Francesco Menichetti, Lucia Taramasso, Giorgia Montrucchio, Michele Bartoletti, Matteo Bassetti, Elisa Martina Enrile, Fiorentino Fraganza, Paolo Pelosi, Denise Battaglini, Chiara Robba, Antonio Vena, Stefano Di Bella, Renato Pascale, Giacomo Paluzzano, Laura Magnasco, Marco Falcone, Emanuela Biagioni, Malgorzata Mikulska, Tommaso Tonetti, Erik Roman-Pognuz, Vito Marco Ranieri, Giusy Tiseo, Giacomo Fornaro, Daniele Roberto Giacobbe, Iole Brunetti, Massimo Girardis, Alberto Enrico Maraolo, Antonio Di Biagio, Matteo Rinaldi, Lorenzo Ball, Maddalena Giannella, Pierluigi Viale, Nicolò Patroniti, Linda Bussini, Francesco Giuseppe De Rosa, Silvia Corcione, Chiara Dentone, Antonio Corcione, Andrea De Maria, Giacobbe, Daniele Roberto, Battaglini, Denise, Enrile, Elisa Martina, Dentone, Chiara, Vena, Antonio, Robba, Chiara, Ball, Lorenzo, Bartoletti, Michele, Coloretti, Irene, Di Bella, Stefano, Di Biagio, Antonio, Brunetti, Iole, Mikulska, Malgorzata, Carannante, Novella, De Maria, Andrea, Magnasco, Laura, Maraolo, Alberto Enrico, Mirabella, Michele, Montrucchio, Giorgia, Patroniti, Nicolò, Taramasso, Lucia, Tiseo, Giusy, Fornaro, Giacomo, Fraganza, Fiorentino, Monastra, Luca, Roman-Pognuz, Erik, Paluzzano, Giacomo, Fiorentino, Giuseppe, Corcione, Antonio, Bussini, Linda, Pascale, Renato, Corcione, Silvia, Tonetti, Tommaso, Rinaldi, Matteo, Falcone, Marco, Biagioni, Emanuela, Ranieri, Vito Marco, Giannella, Maddalena, De Rosa, Francesco Giuseppe, Girardis, Massimo, Menichetti, Francesco, Viale, Pierluigi, Pelosi, Paolo, and Bassetti, Matteo

Subjects
VAP, COVID-19, SARS-CoV-2, coronavirus, ventilation, medicine.medical_specialty, lcsh:Medicine, Article, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Internal medicine, Coronavirus, Ventilation, Medicine, 030212 general & internal medicine, business.industry, Septic shock, Incidence (epidemiology), lcsh:R, Ventilator-associated pneumonia, Retrospective cohort study, General Medicine, Odds ratio, medicine.disease, bacterial infections and mycoses, Confidence interval, respiratory tract diseases, coronaviru, Pneumonia, 030228 respiratory system, business
Abstract

The primary objective of this multicenter, observational, retrospective study was to assess the incidence rate of ventilator-associated pneumonia (VAP) in coronavirus disease 2019 (COVID-19) patients in intensive care units (ICU). The secondary objective was to assess predictors of 30-day case-fatality of VAP. From 15 February to 15 May 2020, 586 COVID-19 patients were admitted to the participating ICU. Of them, 171 developed VAP (29%) and were included in the study. The incidence rate of VAP was of 18 events per 1000 ventilator days (95% confidence intervals [CI] 16–21). Deep respiratory cultures were available and positive in 77/171 patients (45%). The most frequent organisms were Pseudomonas aeruginosa (27/77, 35%) and Staphylococcus aureus (18/77, 23%). The 30-day case-fatality of VAP was 46% (78/171). In multivariable analysis, septic shock at VAP onset (odds ratio [OR] 3.30, 95% CI 1.43–7.61, p = 0.005) and acute respiratory distress syndrome at VAP onset (OR 13.21, 95% CI 3.05–57.26, p &lt, 0.001) were associated with fatality. In conclusion, VAP is frequent in critically ill COVID-19 patients. The related high fatality is likely the sum of the unfavorable prognostic impacts of the underlying viral and the superimposed bacterial diseases.

Published
2021
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35. Enterococcal bloodstream infections in critically ill patients with COVID-19: a case series

Author

Francesca Crea, Nicolò Patroniti, Lorenzo Ball, Denise Battaglini, Silvia Dettori, Chiara Russo, Federico Baldi, Edward Willison, Iole Brunetti, Paolo Pelosi, Matteo Bassetti, Federica Briano, Chiara Dentone, Daniele Roberto Giacobbe, Laura Magnasco, Stefania Tutino, Anna Marchese, Laura Labate, and Chiara Robba

Subjects
Male, 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), VRE, Organ Dysfunction Scores, Critical Illness, Enterococcus faecium, Bacteremia, Microbial Sensitivity Tests, BSI, law.invention, Vancomycin-Resistant Enterococci, law, Bloodstream infection, Enterococcus faecalis, Medicine, Humans, Mortality, Intensive care medicine, Gram-Positive Bacterial Infections, Aged, Retrospective Studies, Cross Infection, High prevalence, business.industry, Critically ill, SARS-CoV-2, COVID-19, Retrospective cohort study, General Medicine, Enterococcus, Female, Intensive Care Units, Middle Aged, bacterial infections and mycoses, medicine.disease, Intensive care unit, Original Article, business, human activities, Research Article
Abstract

Background An unexpected high prevalence of enterococcal bloodstream infection (BSI) has been observed in critically ill patients with COVID-19 in the intensive care unit (ICU). Materials and methods The primary objective was to describe the characteristics of ICU-acquired enterococcal BSI in critically ill patients with COVID-19. A secondary objective was to exploratorily assess the predictors of 30-day mortality in critically ill COVID-19 patients with ICU-acquired enterococcal BSI. Results During the study period, 223 patients with COVID-19 were admitted to COVID-19-dedicated ICUs in our centre. Overall, 51 episodes of enterococcal BSI, occurring in 43 patients, were registered. 29 (56.9%) and 22 (43.1%) BSI were caused by Enterococcus faecalis and Enterococcus faecium, respectively. The cumulative incidence of ICU-acquired enterococcal BSI was of 229 episodes per 1000 ICU admissions (95% mid-p confidence interval [CI] 172–298). Most patients received an empirical therapy with at least one agent showing in vitro activity against the blood isolate (38/43, 88%). The crude 30-day mortality was 42% (18/43) and 57% (4/7) in the entire series and in patients with vancomycin-resistant E. faecium BSI, respectively. The sequential organ failure assessment (SOFA) score showed an independent association with increased mortality (odds ratio 1.32 per one-point increase, with 95% confidence interval 1.04–1.66, p = .021). Conclusions The cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19. Our results suggest a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.KEY MESSAGESThe cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19.The crude 30-day mortality of enterococcal BSI in critically ill patients with COVID-19 may be higher than 40%.There could be a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.

Published
2021

36. Coagulative Disorders in Critically Ill COVID-19 Patients with Acute Distress Respiratory Syndrome: A Critical Review

Author

Nicolò Patroniti, Claudia Lucia Martins Silva, Daniele Roberto Giacobbe, Paolo Pelosi, Patricia R. M. Rocco, Italo Porto, Denise Battaglini, Antonio Vena, Lorenzo Ball, Roberta Della Bona, Chiara Robba, Maurizio Loconte, Iole Brunetti, Giovanni La Malfa, Alberto Valbusa, and Matteo Bassetti

Subjects
medicine.medical_specialty, ARDS, acute distress respiratory syndrome, lcsh:Medicine, Review, 030204 cardiovascular system & hematology, heparin, Gastroenterology, coagulopathy, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Coagulopathy, Coagulation testing, 030212 general & internal medicine, Platelet activation, Coagulation Disorder, thrombosis, Disseminated intravascular coagulation, medicine.diagnostic_test, business.industry, lcsh:R, COVID-19, General Medicine, medicine.disease, bleeding, Thromboelastography, Thromboelastometry, platelets, business
Abstract

In critically ill patients with acute respiratory distress syndrome (ARDS) coronavirus disease 2019 (COVID-19), a high incidence of thromboembolic and hemorrhagic events is reported. COVID-19 may lead to impairment of the coagulation cascade, with an imbalance in platelet function and the regulatory mechanisms of coagulation and fibrinolysis. Clinical manifestations vary from a rise in laboratory markers and subclinical microthrombi to thromboembolic events, bleeding, and disseminated intravascular coagulation. After an inflammatory trigger, the mechanism for activation of the coagulation cascade in COVID-19 is the tissue factor pathway, which causes endotoxin and tumor necrosis factor-mediated production of interleukins and platelet activation. The consequent massive infiltration of activated platelets may be responsible for inflammatory infiltrates in the endothelial space, as well as thrombocytopenia. The variety of clinical presentations of the coagulopathy confronts the clinician with the difficult questions of whether and how to provide optimal supportive care. In addition to coagulation tests, advanced laboratory tests such as protein C, protein S, antithrombin, tissue factor pathway inhibitors, D-dimers, activated factor Xa, and quantification of specific coagulation factors can be useful, as can thromboelastography or thromboelastometry. Treatment should be tailored, focusing on the estimated risk of bleeding and thrombosis. The aim of this review is to explore the pathophysiology and clinical evidence of coagulation disorders in severe ARDS-related COVID-19 patients.

Published
2021

37. Mechanical ventilation in neurocritical care setting: A clinical approach

Author

Patricia R. M. Rocco, Paolo Pelosi, Denise Battaglini, Nicolò Patroniti, Iole Brunetti, Giulia Bonatti, Chiara Robba, and Dorota Siwicka Gieroba

Subjects
medicine.medical_specialty, Subarachnoid hemorrhage, Critical Care, Traumatic brain injury, medicine.medical_treatment, tracheostomy, Brain damage, mechanical ventilation, medicine, Intubation, Intratracheal, Tidal Volume, acute brain injury, Humans, Respiratory system, Airway Management, Intensive care medicine, Intracerebral hemorrhage, Mechanical ventilation, Extubation failure, business.industry, weaning, Neurointensive care, medicine.disease, Respiration, Artificial, Anesthesiology and Pain Medicine, neurocritical care, medicine.symptom, Nervous System Diseases, business
Abstract

Neuropatients often require invasive mechanical ventilation. Ideal ventilator settings and respiratory targets in neuro patients are unclear. Current knowledge suggests maintaining protective tidal volumes of 6-8 ml/kg of predicted body weight in neuropatients. This approach may reduce the rate of pulmonary complications, although it cannot be easily applied in neuro setting due to the need for special care to minimize the risk of secondary brain damage. Additionally, the weaning process from mechanical ventilation is particularly challenging in these patients who cannot control the brain respiratory patterns and protect airways from aspiration. Indeed, extubation failure in neuropatients is very high, while tracheostomy is needed in one third of them. The aim of this manuscript is to review and describe the current management of invasive mechanical ventilation, weaning and tracheostomy for the main four sub-populations of neuropatients: traumatic brain injury, acute ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage.

Published
2020

38. Neurological Complications and Noninvasive Multimodal Neuromonitoring in Critically ill COVID-19 Patients

Author

Matteo Bassetti, Gregorio Santori, Patricia R. M. Rocco, Chiara Robba, Lorenzo Ball, Fabio Tarantino, Francesca Iannuzzi, Daniele Roberto Giacobbe, Matilde Bastianello, Iole Brunetti, Paolo Pelosi, Karthikka Chandraptham, Antonio Vena, Nicolò Patroniti, and Denise Battaglini

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Critically ill, business.industry, medicine, Intensive care medicine, business
Abstract

Background: The incidence and clinical presentation of neurological manifestations of coronavirus disease 2019 (COVID-19) remain unclear. No data regarding the use of neuromonitoring tools in this group of patients are available. Methods: This is a retrospective study of prospectively collected data. The primary aim was to assess the incidence and type of neurological complications in critically ill COVID-19 patients and their effect on survival, as well as on hospital and intensive care unit (ICU) length-of-stay. The secondary aim was to describe cerebral hemodynamic changes detected by noninvasive neuromonitoring modalities such as transcranial doppler (TCD), optic nerve sheath diameter (ONSD), and pupillometry. Results: Ninety-four patients with COVID-19 receiving mechanical ventilation and admitted to an ICU from February 28 to June 30, 2020, were included in this study. Fifty-three patients underwent noninvasive neuromonitoring. Neurological complications were detected in 47/94 patients (50%), with delirium as the most common manifestation. Patients with neurological complications, compared to those without, had longer hospital (36.8±25.1 vs. 19.4±16.9 days, p Conclusions: In conclusion, neurological complications are common in critically ill patients with COVID-19 receiving invasive mechanical ventilation and are associated with prolonged ICU length-of-stay. Multimodal noninvasive neuromonitoring systems are useful tools for early detection of cerebrovascular changes in COVID-19. Registration number: 163/2020

Published
2020
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39. Prevalence of Antibodies to SARS-CoV-2 in Italian Adults and Associated Risk Factors

Author

Laura Magnasco, Paolo Pelosi, Andrea Adessi, Renato Colognato, Marco Varelli, Chiara Robba, Michele Brignole, Matteo Bassetti, Denise Battaglini, Nicoletta Vendola, Alessio Signori, Marco Berruti, Luisa Bracci-Laudiero, Daniele Roberto Giacobbe, Lorenzo Ball, Lucia Taramasso, Antonio Vena, Pietro Blumetti, Iole Brunetti, and Germano Gaggioli

Subjects
medicine.medical_specialty, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), viruses, lcsh:Medicine, SARS-CoV-2, COVID-19, antibodies, serological test, 030204 cardiovascular system & hematology, Immunoglobulin G, Article, Serology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Seroprevalence, Medical history, 030212 general & internal medicine, skin and connective tissue diseases, Generalized estimating equation, biology, business.industry, fungi, lcsh:R, virus diseases, General Medicine, Confidence interval, body regions, biology.protein, Antibody, business
Abstract

We aimed to assess the prevalence of and factors associated with anti- severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positivity in a large population of adult volunteers from five administrative departments of the Liguria and Lombardia regions. A total of 3609 individuals were included in this analysis. Participants were tested for anti-SARS-CoV-2 antibodies [Immunoglobulin G (IgG) and M (IgM) class antibodies] at three private laboratories (Istituto Diganostico Varelli, Medical Center, and Casa della Salute di Genova). Demographic data, occupational or private exposure to SARS-CoV-2-infected patients, and prior medical history consistent with SARS-CoV-2 infection were collected according to a preplanned analysis. The overall seroprevalence of anti-SARS-CoV-2 antibodies (IgG and/or IgM) was 11.0% [398/3609; confidence interval (CI) 10.0%–12.1%]. Seroprevalence was higher in female inmates than in male inmates (12.5% vs. 9.2%, respectively, p = 0.002), with the highest rate observed among adults aged >55 years (13.2%). A generalized estimating equations model showed that the main risk factors associated with SARS-CoV-2 seroprevalence were the following: an occupational exposure to the virus [Odd ratio (OR) = 2.36; 95% CI 1.59–3.50, p = 0.001], being a long-term care facility resident (OR = 4.53; 95% CI 3.19–6.45, p = 0.001), and reporting previous symptoms of influenza-like illness (OR = 4.86; 95% CI 3.75–6.30, p = 0.001) or loss of sense of smell or taste (OR = 41.00; 95% CI 18.94–88.71, p = 0.001). In conclusion, we found a high prevalence (11.0%) of SARS-CoV-2 infection that is significantly associated with residing in long-term care facilities or occupational exposure to the virus. These findings warrant further investigation into SARS-CoV-2 antibody prevalence among the Italian population.

Published
2020
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40. Distinct phenotypes require distinct respiratory management strategies in severe COVID-19

Author

Denise Battaglini, Chiara Robba, Matteo Bassetti, Lorenzo Ball, Daniele Roberto Giacobbe, Paolo Pelosi, Antonio Vena, Maurizio Loconte, Patricia R. M. Rocco, Iole Brunetti, and Nicolò Patroniti

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, ARDS, Physiology, medicine.medical_treatment, Population, Atelectasis, Non-Invasive ventilation, Respiratory physiology, Positive end expiratory pressure, Prone position, 03 medical and health sciences, Mechanical ventilation, 0302 clinical medicine, medicine, Respiratory system, Intensive care medicine, education, education.field_of_study, SARS-CoV-2, business.industry, General Neuroscience, COVID-19, medicine.disease, Pulmonary embolism, 030228 respiratory system, Respiratory failure, business, 030217 neurology & neurosurgery
Abstract

Coronavirus disease 2019 (COVID-19) can cause severe respiratory failure requiring mechanical ventilation. The abnormalities observed on chest computed tomography (CT) and the clinical presentation of COVID-19 patients are not always like those of typical acute respiratory distress syndrome (ARDS) and can change over time. This manuscript aimed to provide brief guidance for respiratory management of COVID-19 patients before, during, and after mechanical ventilation, based on the recent literature and on our direct experience with this population. We identify that chest CT patterns in COVID-19 may be divided into three main phenotypes: 1) multiple, focal, possibly overperfused ground-glass opacities; 2) inhomogeneously distributed atelectasis; and 3) a patchy, ARDS-like pattern. Each phenotype can benefit from different treatments and ventilator settings. Also, peripheral macro- and microemboli are common, and attention should be paid to the risk of pulmonary embolism. We suggest use of personalized mechanical ventilation strategies based on respiratory mechanics and chest CT patterns. Further research is warranted to confirm our hypothesis.

Published
2020
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41. Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19

Author

Antonio Vena, Nicolò Patroniti, Denise Battaglini, Antoni Torres, Daniele Roberto Giacobbe, Salvatore Caiffa, Lorenzo Ball, Patricia Rm Rocco, Matteo Bassetti, Iole Brunetti, Maurizio Loconte, Paolo Pelosi, and Chiara Robba

Subjects
Male, VAP, ventilator-associated pneumonia, CPT, chest physiotherapy, COVID-19, coronavirus disease-19, Physiology, medicine.medical_treatment, RMs, recruitment maneuvers, RR, relative risk, PEEP, positive end-expiratory pressure, WST, water swallow test, Disease, VT, tidal volume, medicine.disease_cause, Mechanical ventilation, Extubation, SSD, subglottic secretion drainage, Health care, Pandemic, Medicine, FET, forced expiration technique, HFNO, high-flow nasal oxygen, Coronavirus, SpO2, peripheral oxygen saturation, General Neuroscience, Respiratory disease, ICU, intensive care unit, medicine.anatomical_structure, Female, Coronavirus Infections, Pulmonary and Respiratory Medicine, medicine.medical_specialty, VILI, ventilator-induced lung injury, Critical Illness, Pneumonia, Viral, Chest physiotherapy, COVID-19, SARS-CoV-2, Article, Betacoronavirus, ARIR, Italian Association of Respiratory Physiotherapists, Humans, Intensive care medicine, ACBT, active cycle of breathing techniques, Pandemics, Physical Therapy Modalities, ARDS, acute respiratory distress syndrome, SBT, spontaneous breathing trial, VALI, ventilator-associated lung injury, Lung, business.industry, NIV, non-invasive ventilation, medicine.disease, Respiration, Artificial, PSV, pressure support ventilation, CI, confidence interval, CPAP, continuous positive airway pressure, business, PAP, positive airway pressure, PBW, predicted body weight, SARS-CoV-2, severe acute respiratory syndrome coronavirus-2
Abstract

Highlights • Physiotherapy may help prevent or mitigate sequelae related to bed rest, thus improving physical function and outcomes and reducing length of stay by increasing ventilator free-days. • Before starting chest physiotherapy, we recommend the use of adequate personal protective equipment, limiting healthcare workers in the room to one physician and one physiotherapist, as well as choosing a negative-pressure chamber if available. • Chest physiotherapy should be tailored to the specific phenotype of COVID-19 patients. • Patients who might be eligible for a spontaneous breathing trial should receive chest physiotehrapy before and after extubation. • NIV, CPAP, and HFNO should also be considered for short periods after extubation, until complete respiratory autonomy is reached., In late 2019, an outbreak of a novel human coronavirus causing respiratory disease was identified in Wuhan, China. The virus spread rapidly worldwide, reaching pandemic status. Chest computed tomography scans of patients with coronavirus disease-2019 (COVID-19) have revealed different stages of respiratory involvement, with extremely variable lung presentations, which require individualized ventilatory strategies in those who become critically ill. Chest physiotherapy has proven to be effective for improving long-term respiratory physical function among ICU survivors. The ARIR recently reported the role of chest physiotherapy in the acute phase of COVID-19, pointing out limitation of some procedures due to the limited experience with this disease in the ICU setting. Evidence on the efficacy of chest physiotherapy in COVID-19 is still lacking. In this line, the current review discusses the important role of chest physiotherapy in critically ill mechanically ventilated patients with COVID-19, around the weaning process, and how it can be safely applied with careful organization, including the training of healthcare staff and the appropriate use of personal protective equipment to minimize the risk of viral exposure.

Published
2020

42. Bloodstream infections in critically ill patients with COVID-19

Author

Francesca Crea, Antonio Di Biagio, Lorenzo Ball, Antonio Vena, Chiara Dentone, Daniele Roberto Giacobbe, Anna Marchese, Iole Brunetti, Andrea Orsi, Alessio Signori, Giulia Codda, Denise Battaglini, Giancarlo Icardi, Lucia Taramasso, Nicolò Patroniti, Malgorzata Mikulska, Laura Magnasco, Bianca Bruzzone, Andrea De Maria, Paolo Pelosi, Matteo Bassetti, and Chiara Robba

Subjects
Male, Enterococcus faecium, Clinical Biochemistry, Anti-Inflammatory Agents, coronavirus, Bacteremia, 030204 cardiovascular system & hematology, BSI, Biochemistry, SARS‐CoV‐2, law.invention, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, law, Enterococcus faecalis, 030212 general & internal medicine, Cross Infection, Incidence, Incidence (epidemiology), Hazard ratio, steroid, Enterobacteriaceae Infections, Enterobacter aerogenes, General Medicine, Middle Aged, Staphylococcal Infections, Original Papers, Intensive care unit, Intensive Care Units, Streptococcus pneumoniae, Italy, Methylprednisolone, Pseudomonas aeruginosa, Female, Coronavirus Infections, medicine.drug, Staphylococcus aureus, medicine.medical_specialty, Critical Illness, Pneumonia, Viral, Antibodies, Monoclonal, Humanized, Pneumococcal Infections, Betacoronavirus, 03 medical and health sciences, tocilizumab, Tocilizumab, COVID‐19, Internal medicine, medicine, Humans, Pseudomonas Infections, Pandemics, Gram-Positive Bacterial Infections, Aged, Proportional Hazards Models, Retrospective Studies, Original Paper, business.industry, Proportional hazards model, SARS-CoV-2, Candidemia, COVID-19, Retrospective cohort study, bacterial infections and mycoses, Confidence interval, COVID-19 Drug Treatment, chemistry, business, human activities
Abstract

Background Little is known about the incidence and risk of intensive care unit (ICU)-acquired bloodstream infections (BSI) in critically ill patients with coronavirus disease 2019 (COVID-19). Materials and methods This retrospective, single-centre study was conducted in Northern Italy. The primary study objectives were as follows: (a) to assess the incidence rate of ICU-acquired BSI and (b) to assess the cumulative risk of developing ICU-acquired BSI. Results Overall, 78 critically ill patients with COVID-19 were included in the study. Forty-five episodes of ICU-acquired BSI were registered in 31 patients, with an incidence rate of 47 episodes (95% confidence interval [CI] 35-63) per 1000 patient-days at risk. The estimated cumulative risk of developing at least one BSI episode was of almost 25% after 15 days at risk and possibly surpassing 50% after 30 days at risk. In multivariable analysis, anti-inflammatory treatment was independently associated with the development of BSI (cause-specific hazard ratio [csHR] 1.07 with 95% CI 0.38-3.04 for tocilizumab, csHR 3.95 with 95% CI 1.20-13.03 for methylprednisolone and csHR 10.69 with 95% CI 2.71-42.17 for methylprednisolone plus tocilizumab, with no anti-inflammatory treatment as the reference group; overall P for the dummy variable = 0.003). Conclusions The incidence rate of BSI was high, and the cumulative risk of developing BSI increased with ICU stay. Further study will clarify if the increased risk of BSI we detected in COVID-19 patients treated with anti-inflammatory drugs is outweighed by the benefits of reducing any possible pro-inflammatory dysregulation induced by SARS-CoV-2.

Published
2020

43. Clinical characteristics, management and in-hospital mortality of patients with coronavirus disease 2019 in Genoa, Italy

Author

Antonio Vena, Daniele Roberto Giacobbe, Antonio Di Biagio, Malgorzata Mikulska, Lucia Taramasso, Andrea De Maria, Lorenzo Ball, Iole Brunetti, Maurizio Loconte, Nicolò A. Patroniti, Chiara Robba, Emanuele Delfino, Chiara Dentone, Laura Magnasco, Laura Nicolini, Federica Toscanini, Martina Bavastro, Matteo Cerchiaro, Emanuela Barisione, Mauro Giacomini, Sara Mora, Federico Baldi, Elisa Balletto, Marco Berruti, Federica Briano, Chiara Sepulcri, Silvia Dettori, Laura Labate, Michele Mirabella, Federica Portunato, Rachele Pincino, Chiara Russo, Stefania Tutino, Paolo Pelosi, Matteo Bassetti, Anna Alessandrini, Marco Camera, Ferdinando Dodi, Antonio Ferrazin, Giovanni Mazzarello, Daniele R. Giacobbe, Eva Schenone, Nirmala Rosseti, Chiara russo, Giovanni Sarteschi, Chiara sepulcri, Roberto Pontremoli, Valentina Beccati, Salvatore Casciaro, Massimo Casu, Francesco Gavaudan, Maria Ghinatti, Elisa Gualco, Giovanna Leoncini, Paola pitto, Kassem salam, Angelo Gratarola, Mattia Bixio, Annalisa Amelia, Andrea Balestra, Paola Ballarino, Nicholas Bardi, Roberto Boccafogli, Francesca Caserza, Elisa Calzolari, Marta Castelli, Elisabetta Cenni, Paolo Cortese, Giuseppe Cuttone, Sara Feltrin, Stefano Giovinazzo, Patrizia Giuntini, Letizia Natale, Davide Orsi, Matteo Pastorino, Tommaso Perazzo, Fabio Pescetelli, Federico Schenone, Maria G. Serra, Marco Sottano, Roberto Tallone, Massimo Amelotti, Marie J. Majabò, Massimo Merlini, Federica Perazzo, Nidal Ahamd, Paolo Barbera, Marta Bovio, Paola Campodonico, Andrea Collidà, Ombretta Cutuli, Agnese Lomeo, Francesca Fezza, Nicola Gentilucci, Nadia Hussein, Emanuele Malvezzi, Laura Massobrio, Giula Motta, Laura Pastorino, Nicoletta Pollicardo, Stefano Sartini, Paola Vacca, Valentina Virga, Italo Porto, Giampaolo Bezante, Roberta Della Bona, Giovanni La Malfa, Alberto Valbusa, Vered G. Ad, Michele Bellotti, Aloe’ Teresita, Alessandro Blanco, Marco Grosso, Maria Grazia Piroddi, Paolo Moscatelli, Matteo Caiti, Ottavia Magnani, Samir Sukkar, Ludovica Cogorno, Raffaella Gradaschi, Erica Guiddo, Eleonora Martino, Livia Pisciotta, Bruno Cavagliere, Rossi Cristina, Farina Francesca, Giacomo Garibotto, Pasquale Esposito, Carmen Bellezza, Emirjona Harusha, Francesca Rossi, Eleonora Arboscello, Laura Arzani, Laura De Mattei, Marzia Spadaro, Giovanni Passalacqua, Diego Bagnasco, Fulvio Braido, Annamaria Riccio, Elena Tagliabue, Claudio Gustavino, Antonella Ferraiolo, Fiammetta Monacelli, Mona Mahmoud, Luca Tagliafico, Armando Napolitano, Maria Fiorio, Monica Pizzonia, Chiara Giannotti, Alessio Nencioni, Salvatore Giuffrida, Nicola Rosso, Alessandra Morando, Riccardo Papalia, Donata Passerini, Gabriella Tiberio, Giovanni Orengo, Alberto Battaglini, Silvano Ruffoni, and Sergio Caglieris

Subjects
0301 basic medicine, Male, ARDS, medicine.medical_treatment, Disease, law.invention, 0302 clinical medicine, COVID-19 Testing, law, Risk Factors, Cause of Death, 80 and over, Severe acute respiratory syndrome coronavirus 2, 030212 general & internal medicine, Hospital Mortality, Viral, Cause of death, Acute respiratory distress syndrome, Coronavirus disease 2019, General Medicine, Middle Aged, Intensive care unit, Hospitalization, Infectious Diseases, Italy, Vomiting, Female, medicine.symptom, Coronavirus Infections, Interleukin-6, Mortality, Aged, Aged, 80 and over, Betacoronavirus, COVID-19, Clinical Laboratory Techniques, Humans, Pandemics, Pneumonia, Viral, Retrospective Studies, SARS-CoV-2, Microbiology (medical), medicine.medical_specialty, Nausea, 030106 microbiology, 03 medical and health sciences, Internal medicine, medicine, Mechanical ventilation, business.industry, Retrospective cohort study, Pneumonia, medicine.disease, business
Abstract

Objectives To describe clinical characteristics, management and outcome of individuals with coronavirus disease 2019 (COVID-19); and to evaluate risk factors for all-cause in-hospital mortality. Methods This retrospective study from a University tertiary care hospital in northern Italy, included hospitalized adult patients with a diagnosis of COVID-19 between 25 February 2020 and 25 March 2020. Results Overall, 317 individuals were enrolled. Their median age was 71 years and 67.2% were male (213/317). The most common underlying diseases were hypertension (149/317; 47.0%), cardiovascular disease (63/317; 19.9%) and diabetes (49/317; 15.5%). Common symptoms at the time of COVID-19 diagnosis included fever (285/317; 89.9%), shortness of breath (167/317; 52.7%) and dry cough (156/317; 49.2%). An ‘atypical' presentation including at least one among mental confusion, diarrhoea or nausea and vomiting was observed in 53/317 patients (16.7%). Hypokalaemia occurred in 25.8% (78/302) and 18.5% (56/303) had acute kidney injury. During hospitalization, 111/317 patients (35.0%) received non-invasive respiratory support, 65/317 (20.5%) were admitted to the intensive care unit (ICU) and 60/317 (18.5%) required invasive mechanical ventilation. All-cause in-hospital mortality, assessed in 275 patients, was 43.6% (120/275). On multivariable analysis, age (per-year increase OR 1.07; 95% CI 1.04–1.10; p Conclusions COVID-19 mainly affected elderly patients with predisposing conditions and caused severe illness, frequently requiring non-invasive respiratory support or ICU admission. Despite supportive care, COVID-19 remains associated with a substantial risk of all-cause in-hospital mortality.

Published
2020

44. Effects of in-hospital low targeted temperature after out of hospital cardiac arrest: A systematic review with meta-analysis of randomized clinical trials

Author

Maria Vargas, Giuseppe Servillo, Paolo Pelosi, Yuda Sutherasan, Raquel Rodríguez-González, Iole Brunetti, Vargas, Maria, Servillo, Giuseppe, Sutherasan, Yuda, Rodríguez González, Raquel, Brunetti, Iole, and Pelosi, Paolo

Subjects
Adult, Emergency Medical Services, medicine.medical_specialty, MEDLINE, Emergency Nursing, Neurologic performance, Ventricular tachycardia, Out of hospital cardiac arrest, law.invention, Randomized controlled trial, Hypothermia, Induced, law, Internal medicine, medicine, Hospital discharge, Humans, Meta-analysi, Mortality, Intensive care medicine, Data source, business.industry, Cardiac arrest, medicine.disease, Hospitals, Patient Discharge, In hospital, Meta-analysis, Targeted temperature, Survival Rate, Ventricular fibrillation, Emergency Medicine, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest
Abstract

We performed this systematic review to evaluate the effectiveness of in-hospital low targeted temperature in adult patients after out of hospital cardiac arrest on survival and neurologic performance.We systematically searched MEDLINE and PUBMED from inception to April 2014.Citations were screened for studies evaluating the effect of in-hospital low targeted temperature in patients following out of hospital cardiac arrest.We analyzed randomized control trials (RCTs) that included adult patients resuscitated from out of hospital cardiac arrest, reporting mortality at hospital discharge and comparing in-hospital low targeted temperature with a control group.This meta-analysis included 6 RCTs and 1418 adult patients. In-hospital low targeted (low T) temperature was associated to a reduction in mortality at hospital discharge and at 6 months when compared with in-hospital targeted and not targeted temperature while there was no reduction in mortality comparing low and high targeted temperature. In patients with initial ventricular fibrillation/ventricular tachycardia rhythm of out of hospital cardiac arrest, low T was associated with a reduction in short and long-term mortality when compared with no targeted temperature while not when compared to high targeted temperature. Low T was associated with good neurologic performance at hospital discharge compared with in-hospital high or not targeted temperature.In-hospital low targeted temperature (4 °C) improved short and long-term mortality when compared to no targeted temperature. In contrast, low T did not improve outcome compared with a slightly higher targeted temperature (≈ 36 °C).

Published
2015
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45. Percutaneous Dilatational Tracheostomy With a Double-Lumen Endotracheal Tube

Author

F. Aloj, Gaetano Tessitore, Maria Vargas, Paolo Pelosi, Enrico Arditi, Iole Brunetti, Giuseppe Servillo, Dorino Salami, and Robert M. Kacmarek

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Percutaneous, Airway pressures, business.industry, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Double-lumen endobronchial tube, eye diseases, Surgery, law.invention, Laryngeal mask airway, law, Anesthesia, Ventilation (architecture), medicine, Airway management, Cardiology and Cardiovascular Medicine, business, Tidal volume, Respiratory minute volume
Abstract

OBJECTIVE Gas exchange and airway pressures are markedly altered during percutaneous dilatational tracheostomy (PDT). A double-lumen endotracheal tube (DLET) has been developed for better airway management during PDT. The current study prospectively evaluated the in vivo feasibility, gas exchange, and airway pressures during PDT with DLET compared with a conventional endotracheal tube (ETT). METHODS According to eligibility criteria, patients were divided into a case group (those receiving PDT with DLET) and a control group (those receiving PDT with a conventional ETT). The Ciaglia single-dilator technique was used for PDT in both groups. The primary end point of this study was the feasibility of tracheostomy with DLET. The secondary end points were a comparison of gas exchange, airway pressures, minute volume, and tidal volume before, during, and after PDT performed with DLET and conventional ETT. RESULTS Ten patients meeting the inclusion criteria were assigned to each group. PDTs were performed without difficulties in nine patients in the DLET group and 10 patients in the conventional ETT group. During PDT, gas exchange, airway pressures, and minute ventilation remained more stable in the DLET group and were significantly different from those in the conventional ETT group. CONCLUSIONS PDT with DLET can be performed safely without difficulties limiting the technique. Furthermore, during PDT, the use of the DLET resulted in more stable gas exchange, airway pressures, and ventilation than PDT with a conventional ETT. TRIAL REGISTRY ClinicalTrials.gov ; No.: NCT01691222; URL: www.clinicaltrials.gov

Published
2015
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46. Cognitive Function in Survivors of Out-of-Hospital Cardiac Arrest After Target Temperature Management at 33°C Versus 36°C

Author

Hans Friberg, Tobias Cronberg, Jørn Wetterslev, Caisa Hofgren, Michael Wanscher, Gisela Lilja, Janneke Horn, Helen L Watkins, Matt P. Wise, Azul Forti Buratti, Jesper Kjaergaard, Fredrik Nilsson, Christian Hassager, Frank H. Bosch, Iole Brunetti, Niklas Nielsen, Christian Rylander, Nicki Palmer, Malin Rundgren, Alice Martini, Tommaso Pellis, John Bro-Jeppesen, Michael A. Kuiper, Annelou L.I.P. van der Veen, Angelo Insorsi, AII - Amsterdam institute for Infection and Immunity, ANS - Amsterdam Neuroscience, Intensive Care Medicine, and Other departments

Subjects
Male, Oncology, medicine.medical_specialty, Resuscitation, Myocardial Infarction, Out of hospital cardiac arrest, Body Temperature, Electrocardiography, Cognition, Hypothermia, Induced, Risk Factors, Physiology (medical), Internal medicine, Humans, Medicine, Myocardial infarction, Cognitive impairment, Aged, business.industry, Follow up studies, Rivermead Behavioural Memory Test, Middle Aged, Executive functions, medicine.disease, Europe, Patient Outcome Assessment, Treatment Outcome, Physical therapy, Female, Cardiology and Cardiovascular Medicine, business, Out-of-Hospital Cardiac Arrest, Follow-Up Studies
Abstract

Background— Target temperature management is recommended as a neuroprotective strategy after out-of-hospital cardiac arrest. Potential effects of different target temperatures on cognitive impairment commonly described in survivors have not been investigated sufficiently. The primary aim of this study was to evaluate whether a target temperature of 33°C compared with 36°C was favorable for cognitive function; the secondary aim was to describe cognitive impairment in cardiac arrest survivors in general. Methods and Results— Study sites included 652 cardiac arrest survivors originally randomized and stratified for site to temperature control at 33°C or 36°C within the Target Temperature Management trial. Survival until 180 days after the arrest was 52% (33°C, n=178/328; 36°C, n=164/324). Survivors were invited to a face-to-face follow-up, and 287 cardiac arrest survivors (33°C, n=148/36°C, n=139) were assessed with tests for memory (Rivermead Behavioural Memory Test), executive functions (Frontal Assessment Battery), and attention/mental speed (Symbol Digit Modalities Test). A control group of 119 matched patients hospitalized for acute ST-segment–elevation myocardial infarction without cardiac arrest performed the same assessments. Half of the cardiac arrest survivors had cognitive impairment, which was mostly mild. Cognitive outcome did not differ ( P >0.30) between the 2 temperature groups (33°C/36°C). Compared with control subjects with ST-segment–elevation myocardial infarction, attention/mental speed was more affected among cardiac arrest patients, but results for memory and executive functioning were similar. Conclusions— Cognitive function was comparable in survivors of out-of-hospital cardiac arrest when a temperature of 33°C and 36°C was targeted. Cognitive impairment detected in cardiac arrest survivors was also common in matched control subjects with ST-segment–elevation myocardial infarction not having had a cardiac arrest. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01946932.

Published
2015
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47. Tracheostomy in intensive care: Patients and families will never walk alone!

Author

Nicolò Patroniti, Maria Vargas, Lorenzo Ball, Paolo Pelosi, Iole Brunetti, Pelosi, Paolo, Ball, Lorenzo, Brunetti, Iole, Vargas, Maria, and Patroniti, Nicolò

Subjects
Quality of life, medicine.medical_specialty, Critical Care, medicine.medical_treatment, Intensive Care Unit, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Tracheotomy, Tracheostomy, 030202 anesthesiology, Intensive care, medicine, Humans, Anesthesia, Intensive care medicine, business.industry, General Medicine, Intensive Care Units, Anesthesiology and Pain Medicine, 030228 respiratory system, Critically ill patient, business, Human
Published
2018

48. Mortality and long-term quality of life after percutaneous tracheotomy in Intensive Care Unit: a prospective observational study

Author

Paolo Pelosi, Marta Folentino, Camilla Micalizzi, Francesco Mora, Rosanna Sileo, Yuda Sutherasan, Arduino De Lucia, Angelo Gratarola, Lorenzo Ball, Iole Brunetti, Domenico De Lisi, Giorgio Peretti, Maria Vargas, Angelo Insorsi, Giuseppe Servillo, Manuela Cerana, Alessandro Accattatis, Vargas, Maria, Sutherasan, Yuda, Brunetti, Iole, Micalizzi, Camilla, Insorsi, Angelo, Ball, Lorenzo, Folentino, Marta, Sileo, Rosanna, DE Lucia, Arduino, Cerana, Manuela, Accattatis, Alessandro, DE Lisi, Domenico, Gratarola, Angelo, Mora, Francesco, Peretti, Giorgio, Servillo, Giuseppe, and Pelosi, Paolo

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Subgroup analysis, law.invention, 03 medical and health sciences, 0302 clinical medicine, Tracheotomy, Quality of life, law, medicine, Humans, Hospital Mortality, Prospective Studies, 030223 otorhinolaryngology, Prospective cohort study, Depression (differential diagnoses), Aged, business.industry, Middle Aged, Intensive care unit, Intensive Care Units, Anesthesiology and Pain Medicine, 030228 respiratory system, SAPS II, Emergency medicine, Quality of Life, Female, business, Cohort study
Abstract

Background Quality of life and mortality after percutaneous dilatational tracheotomy (PDT) has been poorly investigated. The aims of this study were to evaluate the independent risk factors for Intensive Care Unit (ICU) mortality and investigate quality of life over the first year after PDT in critically ill patients. Methods This was a prospective, single-center, cohort study performed in a tertiary care University Hospital, enrolling consecutive ICU patients requiring elective PDT, collecting data during the tracheotomy procedure and the ICU stay. Follow-up was performed at three, six and twelve months after PDT. The medical interview included the Euro Quality of Life questionnaire comprising five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Results A total of 137 patients were included in the study. In the multivariate analysis, ICU mortality was independently associated with age (OR 1.089; P=0.003) and SAPS II (OR 1.047; P=0.003), and inversely with neurologic disease (OR 0.162; P=0.004). Mortality increased over time (ICU mortality 26.7%; in-hospital mortality 43.1%; 3-months mortality 47.4%; 6-months mortality 61.3%; and 1-year mortality 70.8%; P=0.0001). Tracheostomized patients due to respiratory disease had a higher ICU mortality (50%) compared to those with neurological disease (13.6%). quality of life (QoL) of tracheostomized patients was severely compromised at 3-months (QoL: 17, 15-19), 6-months (QoL: 17; 16-19), while moderately compromised at 1-year (QoL: 13; 9-16). A subgroup analysis showed better QoL at 3-months, 6-months and 1-year in respiratory compared to neurological tracheostomized patients (P=0.01). Conclusions Patients baseline characteristics and indication for PDT procedure are important determinants of in-ICU mortality and QoL in tracheostomized patients.

Published
2018

49. Double Lumen Endotracheal Tube for Percutaneous Tracheostomy

Author

Robert M. Kacmarek, Gaetano Tessitore, F. Aloj, Dorino Salami, Giuseppe Servillo, Iole Brunetti, Maria Vargas, Paolo Pelosi, Enrico Arditi, Vargas, Maria, Servillo, Giuseppe, Tessitore, Gaetano, Aloj, Fulvio, Brunetti, Iole, Arditi, Enrico, Salami, Dorino, Kacmarek M., Robert, Pelosi, Paolo, Tessitore, G, Aloj, F, Brunetti, I, Arditi, E, Salami, D, Kacmarek, Rm, and Pelosi, P.

Subjects
Pulmonary and Respiratory Medicine, Mechanical ventilation, Pressure drop, airway management, double lumen endotracheal tube, intensive care, tracheostomy, airway management, Pulmonary gas pressures, business.industry, medicine.medical_treatment, tracheostomy, General Medicine, Critical Care and Intensive Care Medicine, Double-lumen endobronchial tube, law.invention, Airway resistance, law, Intensive care, Anesthesia, Ventilation (architecture), Medicine, Airway management, business, double lumen endotracheal tube, intensive care
Abstract

BACKGROUND: Percutaneous dilational tracheostomy is normally a bronchoscope-guided procedure. The insertion of a bronchoscope into an endotracheal tube (ETT) affects resistance, flow, and alveolar pressure. To improve airway management and ventilation during percutaneous tracheostomy, we developed a double lumen endotracheal tube (DLET). The aim of this in vitro study was to compare the linear constant of the Rohrer equation (K1), the nonlinear constant of the Rohrer equation (K2), the inspiratory and expiratory airway resistance, and ventilatory and airway pressures using the DLET with different standard sized ETTs. METHODS: A trachea and lung model was used to compare the DLET to ETTs with 7, 7.5, and 8 mm inner diameters with and without a bronchoscope (4.5 mm external diameter), and 4 and 5 mm inner diameter ventilation tubes (F4, F5) of a translaryngeal tracheostomy. For each device, the pressure drop across the device and the Rohrer equation linear constant (K1) and nonlinear constant (K2) were calculated during a continuous flow of 10–90 L/min, the inspiratory and expiratory airway resistance values were calculated during volume controlled mechanical ventilation, and respiratory airway pressure values were calculated during volume and pressure controlled mechanical ventilation. RESULTS: DLET had lower K2, pressure drop, and inspiratory and expiratory airway resistance compared with conventional ETTs plus fiberoptic bronchoscope. Furthermore, during mechanical ventilation, DLET had a lower value of peak pressure, mean pressure, and intrinsic PEEP than the other ETTs plus fiberoptic bronchoscope. CONCLUSIONS: Use of the DLET during percutaneous dilational tracheostomy allows fiberoptic bronchoscopy without imposing excessive airway resistance. Reduced tube resistance during this procedure may confer additional safety in what is well known to be a hazardous procedure.

Published
2014
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50. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest

Author

Michael Wanscher, Jørund Langørgen, Michael A. Kuiper, Janneke Horn, Gisela Lilja, David Erlinge, Tommaso Pellis, Søren Boesgaard, Lars Køber, Pascal Stammet, Jacob E. Møller, Malin Rundgren, Christian Rylander, Yvan Gasche, John Bro-Jeppesen, Jesper Kjaergaard, Christopher D. Hingston, Ondrej Smid, Abstr Act, Iole Brunetti, Jan Hovdenes, Tobias Cronberg, Jørn Wetterslev, Per Winkel, Nicole P. Juffermans, Christophe Werer, J. F. Bugge, Matty Koopmans, Nawaf Al-Subaie, Matt P. Wise, Christian Hassager, Niklas Nielsen, Anders Aneman, Hans Friberg, AII - Amsterdam institute for Infection and Immunity, ANS - Amsterdam Neuroscience, Intensive Care Medicine, and Other departments

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Kaplan-Meier Estimate, cardiac arrest, Targeted temperature management, Body Temperature, law.invention, Randomized controlled trial, Hypothermia, Induced, Modified Rankin Scale, law, Internal medicine, Humans, Medicine, Treatment Failure, Aged, Models, Statistical, ddc:617, business.industry, Hazard ratio, Unconsciousness/etiology, General Medicine, Middle Aged, Hypothermia, Confidence interval, Surgery, Institutional repository, Withholding Treatment, Relative risk, Female, Cardiopulmonary Resuscitation/methods, medicine.symptom, Out-of-Hospital Cardiac Arrest/complications/mortality/therapy, business, Follow-Up Studies
Abstract

Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale. In total, 939 patients were included in the primary analysis. At the end of the trial, 50% of the patients in the 33°C group (235 of 473 patients) had died, as compared with 48% of the patients in the 36°C group (225 of 466 patients) (hazard ratio with a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51). At the 180-day follow-up, 54% of the patients in the 33°C group had died or had poor neurologic function according to the CPC, as compared with 52% of patients in the 36°C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P=0.78). In the analysis using the modified Rankin scale, the comparable rate was 52% in both groups (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar. In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C. (Funded by the Swedish Heart-Lung Foundation and others; TTM ClinicalTrials.gov number, NCT01020916.)

Published
2013
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