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Additional file 3. ICU-RER collaborators list.

SCOPO Il trattamento con oppiacei maggiori per il dolore moderato-severo di origine neoplastica prevede una delicata fase di titolazione iniziale.(1) La letteratura non prevede linee guida univoche per tale fase. L’approccio con morfina solfato a rilascio immediato, somministrata ad orari fissi ogni 4 ore e la doppia dose notturna (2) è gravato da diverse limitazioni gestionali, farmacocinetiche e di aderenza alla terapia. Scopo dello studio era di verificare l’efficacia e la fattibilità della titolazione, attraverso la somministrazione di un oppiaceo a rilascio prolungato ed uno a rilascio immediato; quest’ultimo somministrato su richiesta del paziente. METODI In questo studio, osservazionale e retrospettivo, sono stati analizzati i dati relativi a 98 pazienti, affetti da dolore cronico moderato-severo (NRSs>4) di origine neoplastica, seguiti in regime di consulenza intra-ospedaliera negli anni 2008-09. La titolazione della terapia in questi pazienti era data dalla somministrazione di ossicodone a lento rilascio (OS-SR≥5mg) due volte/die e morfina solfato a rilascio immediato (MS-IR, 30% dose die di OS-SR) somministrata come ‘rescue dose’, max 4 volte/die. I dati analizzati erano: dati anamnestici e socio-demografici, la dose iniziale di OS-SR, la dose iniziale di MS-IR, NRS iniziale e nei 7 giorni successivi, n° di dose rescue assunti nelle 24h, variazioni della dose di OS-SR ed effetti collaterali. RISULTATI La titolazione è stata soddisfacente nella maggioranza dei pazienti osservando, già nei primi giorni, un rapido decremento dell’intensità del dolore da una mediana di NRSs=5 e NRSd=7 a NRSs=2 e NRSd=4 al secondo giorno di terapia con scarsa presenza di effetti collaterali dimostratisi ininfluenti nel proseguo della terapia. DISCUSSIONE E NOTE CONCLUSIVE L’approccio utilizzato per la titolazione, oltre a garantire il raggiungimento di un buon controllo del dolore in breve tempo, può essere considerato una valida alternativa a quelli proposti in letteratura. Garantisce: miglioramento della qualità di vita del paziente, minor incidenza di effetti collaterali, un atteggiamento terapeutico più attento alle esigenze del paziente, maggior aderenza alla terapia sia da parte del paziente che del personale del reparto. Tutto ciò attraverso la diminuzione della frequenza di somministrazioni giornaliere dei farmaci. BIBLIOGRAFIA 1. Mercadante S. Opioid titration in cancer pain: a critical review. Eur.J.Pain 2007;11:823-30 2. Twycross R.G. Control of pain. J R Coll Physicians Lond 1984;18,1:32-39

Background: Outcome prediction allows patients and professionals to formulate a management plan and to identify risk for poor prognosis. The BPI measures pain and psychosocial outcomes of chronic pain (CP); the Mainz Pain Staging System (MPSS) is a multi-dimensional measure of the CP stage (I-III). Aims: to analyse the association of BPI measures and the MPSS stage and to verify whether the NPSS may predict outcome in Low Back CP. Methods: We enrolled N=242 patients with lumbosacral Pain who were followed for approx. 60 days. Follow up and treatments occurred at 20 days interval being T1 the admission day and T4 the 60th day after admission. The MPSS was administered at T1 while the BPI from T1 to T4. Measures for analysis were patients' demographics, MPSS stage and BPI item scores. Results: Mean age was 65,7 (±15,2) and 75,6% were females; lumbosacral pain was coupled with sciatica syndrome in 79,8%; MPSS stage (I-III) proportions were: 7,9%, 41,3% and 50,8%, respectively. Statistically significant associations were found between MPSS-III category, the female gender and advanced age (66-80 years); and between MPSS-I category and young adults (21-35 years). Among MPSS-II/III patients, pain interference with the patient's mood significantly decreased from T1 to T4 while scores of worst pain in the past 24h significantly decreased only among MPSS-I/II patients. Conclusions: Following Low Back CP treatment, caregiver may expect poor pain relief among MPSS-III patients. However, continuous multidisciplinary approach significantly improves these patient's quality of life. Prediction of prognosis has wide implications for public health initiatives.

Background A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation. The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. Methods This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. Results Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO2/FiO2 ratio during the first 5 days of MV, respiratory system compliance (CRS) lower than 40 mL/cmH2O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications. ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable. Conclusions Age, SOFA score at ICU admission, CRS, PaO2/FiO2, renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19. Trial registration NCT04411459