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1. Phenotyping COVID-19 respiratory failure in spontaneously breathing patients with AI on lung CT-scan

Author

Rezoagli, E, Xin, Y, Signori, D, Sun, W, Gerard, S, Delucchi, K, Magliocca, A, Vitale, G, Giacomini, M, Mussoni, L, Montomoli, J, Subert, M, Ponti, A, Spadaro, S, Poli, G, Casola, F, Herrmann, J, Foti, G, Calfee, C, Laffey, J, Bellani, G, Cereda, M, Lorini, F, Bonaffini, P, Cazzaniga, M, Ottaviani, I, Tavola, M, Borgo, A, Ferraris, L, Serra, F, Gatti, S, Ippolito, D, Tamagnini, B, Gatti, M, Arlotti, M, Gamberini, E, Cavagna, E, Galbiati, G, De Ponti, D, Rezoagli E., Xin Y., Signori D., Sun W., Gerard S., Delucchi K. L., Magliocca A., Vitale G., Giacomini M., Mussoni L., Montomoli J., Subert M., Ponti A., Spadaro S., Poli G., Casola F., Herrmann J., Foti G., Calfee C. S., Laffey J., Bellani G., Cereda M., Lorini F. L., Bonaffini P., Cazzaniga M., Ottaviani I., Tavola M., Borgo A., Ferraris L., Serra F., Gatti S., Ippolito D., Tamagnini B., Gatti M., Arlotti M., Gamberini E., Cavagna E., Galbiati G., De Ponti D., Rezoagli, E, Xin, Y, Signori, D, Sun, W, Gerard, S, Delucchi, K, Magliocca, A, Vitale, G, Giacomini, M, Mussoni, L, Montomoli, J, Subert, M, Ponti, A, Spadaro, S, Poli, G, Casola, F, Herrmann, J, Foti, G, Calfee, C, Laffey, J, Bellani, G, Cereda, M, Lorini, F, Bonaffini, P, Cazzaniga, M, Ottaviani, I, Tavola, M, Borgo, A, Ferraris, L, Serra, F, Gatti, S, Ippolito, D, Tamagnini, B, Gatti, M, Arlotti, M, Gamberini, E, Cavagna, E, Galbiati, G, De Ponti, D, Rezoagli E., Xin Y., Signori D., Sun W., Gerard S., Delucchi K. L., Magliocca A., Vitale G., Giacomini M., Mussoni L., Montomoli J., Subert M., Ponti A., Spadaro S., Poli G., Casola F., Herrmann J., Foti G., Calfee C. S., Laffey J., Bellani G., Cereda M., Lorini F. L., Bonaffini P., Cazzaniga M., Ottaviani I., Tavola M., Borgo A., Ferraris L., Serra F., Gatti S., Ippolito D., Tamagnini B., Gatti M., Arlotti M., Gamberini E., Cavagna E., Galbiati G., and De Ponti D.

Abstract

Background: Automated analysis of lung computed tomography (CT) scans may help characterize subphenotypes of acute respiratory illness. We integrated lung CT features measured via deep learning with clinical and laboratory data in spontaneously breathing subjects to enhance the identification of COVID-19 subphenotypes. Methods: This is a multicenter observational cohort study in spontaneously breathing patients with COVID-19 respiratory failure exposed to early lung CT within 7 days of admission. We explored lung CT images using deep learning approaches to quantitative and qualitative analyses; latent class analysis (LCA) by using clinical, laboratory and lung CT variables; regional differences between subphenotypes following 3D spatial trajectories. Results: Complete datasets were available in 559 patients. LCA identified two subphenotypes (subphenotype 1 and 2). As compared with subphenotype 2 (n = 403), subphenotype 1 patients (n = 156) were older, had higher inflammatory biomarkers, and were more hypoxemic. Lungs in subphenotype 1 had a higher density gravitational gradient with a greater proportion of consolidated lungs as compared with subphenotype 2. In contrast, subphenotype 2 had a higher density submantellar–hilar gradient with a greater proportion of ground glass opacities as compared with subphenotype 1. Subphenotype 1 showed higher prevalence of comorbidities associated with endothelial dysfunction and higher 90-day mortality than subphenotype 2, even after adjustment for clinically meaningful variables. Conclusions: Integrating lung-CT data in a LCA allowed us to identify two subphenotypes of COVID-19, with different clinical trajectories. These exploratory findings suggest a role of automated imaging characterization guided by machine learning in subphenotyping patients with respiratory failure. Trial registration: ClinicalTrials.gov Identifier: NCT04395482. Registration date: 19/05/2020.

Published
2024

2. Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Author

Langer, T, Depalo, F, Forlini, C, Landini, S, Mezzetti, A, Previtali, P, Monti, G, de Toma, C, Biscardi, D, Giannini, A, Fumagalli, R, Mistraletti, G, Lissoni, B, De Martini, A, Mareto, N, Rossitto, C, Zummo, U, Taverna, M, Machieraldo, P, Navarra, M, Parlanti Garbero, M, Scaletti, C, Perno, S, Amendolia, L, Montrucchio, G, Veliaj, D, Barbarello, G, Alesci, M, Bolgiaghi, L, Vailati, D, Pezzi, A, Boselli, E, Piccoli, F, Greco, M, Gemma, M, Resta, M, Crotti, S, Bottino, N, Abruzzese, C, Savioli, M, Migliorino, G, Muttini, S, Umbrello, M, Borghi, B, Greco, S, Dizeo, M, Bottiroli, M, Mondino, M, Prosepri, M, Casella, G, Curto, F, Zaniboni, M, Giudici, R, Gentile, C, Bombino, M, Rona, R, Cortinovis, B, Benini, A, Avalli, L, Tavola, M, Ferrario, M, Preda, R, Primerano, E, Russo, G, Porta, V, Valdambrini, F, Fassini, P, Orando, S, Beck, E, Pedeferri, M, Cogliati, G, Testini, D, Moroni, B, Codeluppi, V, Ruggeri, P, Milanesi, E, Belliato, M, Besozzi, A, Riccio, M, Zerbi, S, Corbella, D, Ferri, F, Grazioli, L, Bonanomi, E, Giacomini, M, Sacchi, N, Codognola, C, Ambrosini, A, Guatteri, L, Subert, M, Castelli, G, Borelli, M, Venier, E, Dittura, L, Buttera, S, Bigai, R, Magnoni, S, Rauch, S, Colombo, A, Fullin, G, Donolato, C, Cattin, S, State, V, Redeghieri, E, Russo, A, Pastorini, S, Allena, S, Munari, M, Turchet, F, Peta, M, De Santis, V, Scala, C, Facondini, F, Marangoni, E, Tassinati, T, Zanzani, C, Russo, E, Marchio, A, Barbagallo, M, Girardis, M, Taffache, P, Mordacci, M, Vincenzi, M, Pennica, M, Bracciotti, G, Iori, P, Gambi, D, Cappellini, I, Vegnuti, L, De Luca, A, Romagnoli, S, Mosti, G, Carla, R, Roticiani, V, Pelagalli, L, Fuselli, E, D’Avino, E, De Bellis, M, Gianni, G, Leonardis, F, Rossi, M, Lorusso, R, Magnanimi, E, Martelli, S, Baisi, F, Balsamo, D, Cotticelli, V, Mattei, A, Farinelli, I, Riccini, T, Cola, L, Jorio, A, Iacobone, E, Domizi, R, Pizzi, S, Nasso, A, Graziani, R, Monaco, A, Manno, M, Ottelio, C, Del Rio, M, Serra, A, Enna, B, Loddo, F, Galbiati, R, Mellea, S, Kimberly, M, Vissani, M, Romito, F, Baccari, L, Zarrillo, N, Esposito, C, Murino, P, Notaro, S, Ausiello, C, Marra, A, Policastro, C, Cafora, C, De Benedectis, G, Di Falco, V, Sciddurlo, M, Negro, G, Vetuschi, P, Recchia, A, Pasquariello, R, Squillace, R, Ciambrone, A, Bencivenga, C, Camiolo, M, Agozzino, C, Oliveri, F, Notarrigo, T, Castiglione, G, Mo, A, Condorelli, L, Favarato, M, Langer, Thomas, Depalo, Francesca Carmela, Forlini, Clarissa, Landini, Silvia, Mezzetti, Andrea, Previtali, Paola, Monti, Gianpaola, de Toma, Carolina, Biscardi, Davide, Giannini, Alberto, Fumagalli, Roberto, Mistraletti, Giovanni, Lissoni, Barbara, De Martini, Andrea, Mareto, Nadia, Rossitto, Concetta, Zummo, Ugo, Taverna, Martina, Machieraldo, Patrizia, Navarra, Mauro, Parlanti Garbero, Massimiliano, Scaletti, Chiara, Perno, Silvia, Amendolia, Luca, Montrucchio, Giuseppe, Veliaj, Deliana, Barbarello, Giuseppe, Alesci, Maria, Bolgiaghi, Luca, Vailati, Davide, Pezzi, Angelo, Boselli, Enrico, Piccoli, Francesca, Greco, Massimiliano, Gemma, Marco, Resta, Marco, Crotti, Stefania, Bottino, Nicola, Abruzzese, Chiara, Savioli, Monica, Migliorino, Giuseppina, Muttini, Stefano, Umbrello, Michele, Borghi, Beatrice, Greco, Stefano, Dizeo, Micaela, Bottiroli, Maurizio, Mondino, Michele Giovanni, Prosepri, Manlio, Casella, Giampaolo, Curto, Francesco, Zaniboni, Matteo, Giudici, Riccardo, Gentile, Carlo, Bombino, Michela, Rona, Roberto, Cortinovis, Barbara, Benini, Annalisa, Avalli, Leonello, Tavola, Mario, Ferrario, Matteo, Preda, Roberta, Primerano, Enzo, Russo, Gianluca, Porta, Virginia, Valdambrini, Federico, Fassini, Paola, Orando, Serena, Beck, Eduardo, Pedeferri, Matteo, Cogliati, Giacomina, Testini, Denise, Moroni, Benedetta, Codeluppi, Vito, Ruggeri, Patrizia, Milanesi, Elisa, Belliato, Mirko, Besozzi, Alessandra, Riccio, Mario, Zerbi, Silvia, Corbella, Davide, Ferri, Francesco, Grazioli, Lorenzo, Bonanomi, Ezio, Giacomini, Matteo, Sacchi, Noemi, Codognola, Cristian, Ambrosini, Alessandra, Guatteri, Luca, Subert, Matteo, Castelli, Gian Paolo, Borelli, Massimo, Venier, Erica, Dittura, Loredana, Buttera, Stefania, Bigai, Roberto, Magnoni, Sandra, Rauch, Simon, Colombo, Angelo, Fullin, Giorgio, Donolato, Caterina, Cattin, Silvia, State, Veronica, Redeghieri, Enrico, Russo, Alessandro, Pastorini, Simonetta, Allena, Sandra, Munari, Marina, Turchet, Federica, Peta, Mario, De Santis, Vincenzo, Scala, Cristina, Facondini, Francesca, Marangoni, Elisabetta, Tassinati, Tania, Zanzani, Chiara, Russo, Emanuele, Marchio, Annamaria, Barbagallo, Maria, Girardis, Massimo, Taffache, Paolo, Mordacci, Marco, Vincenzi, Matteo, Pennica, Michele, Bracciotti, Giovanna, Iori, Paola, Gambi, Davide, Cappellini, Iacopo, Vegnuti, Lara, De Luca, Alessandra, Romagnoli, Stefano, Mosti, Giamila, Carla, Rossella, Roticiani, Valeria, Pelagalli, Lorella, Fuselli, Ennio, D’Avino, Emilio, De Bellis, Massimo, Gianni, Giulia, Leonardis, Francesca, Rossi, Marzia, Lorusso, Rossana, Magnanimi, Eugenia, Martelli, Sabrina, Baisi, Floriana, Balsamo, Davide, Cotticelli, Virginia, Mattei, Alessia, Farinelli, Ivano, Riccini, Teresa, Cola, Luisanna, Jorio, Antonella, Iacobone, Emanuele, Domizi, Roberta, Pizzi, Simone, Nasso, Armando, Graziani, Romano, Monaco, Anna, Manno, Manuela, Ottelio, Carla Maria, Del Rio, Michela, Serra, Antonio, Enna, Barbara, Loddo, Francesco Marco, Galbiati, Rita, Mellea, Serena, Kimberly, Michelle Brozzi, Vissani, Matteo, Romito, Francesco Massimo, Baccari, Laura, Zarrillo, Nadia, Esposito, Clelia, Murino, Patrizia, Notaro, Salvatore, Ausiello, Carmine, Marra, Annachiara, Policastro, Carmela, Cafora, Chiara, De Benedectis, Giuseppe, Di Falco, Vincenzo, Sciddurlo, Maria, Negro, Giancarlo, Vetuschi, Paolo, Recchia, Andrea, Pasquariello, Rita, Squillace, Rosalba, Ciambrone, Antonio, Bencivenga, Carmela, Camiolo, Melania, Agozzino, Cristina, Oliveri, Francesco, Notarrigo, Tiziana, Castiglione, Giacomo, Mo, Antonella, Condorelli, Laura, Favarato, Martina, Langer, T, Depalo, F, Forlini, C, Landini, S, Mezzetti, A, Previtali, P, Monti, G, de Toma, C, Biscardi, D, Giannini, A, Fumagalli, R, Mistraletti, G, Lissoni, B, De Martini, A, Mareto, N, Rossitto, C, Zummo, U, Taverna, M, Machieraldo, P, Navarra, M, Parlanti Garbero, M, Scaletti, C, Perno, S, Amendolia, L, Montrucchio, G, Veliaj, D, Barbarello, G, Alesci, M, Bolgiaghi, L, Vailati, D, Pezzi, A, Boselli, E, Piccoli, F, Greco, M, Gemma, M, Resta, M, Crotti, S, Bottino, N, Abruzzese, C, Savioli, M, Migliorino, G, Muttini, S, Umbrello, M, Borghi, B, Greco, S, Dizeo, M, Bottiroli, M, Mondino, M, Prosepri, M, Casella, G, Curto, F, Zaniboni, M, Giudici, R, Gentile, C, Bombino, M, Rona, R, Cortinovis, B, Benini, A, Avalli, L, Tavola, M, Ferrario, M, Preda, R, Primerano, E, Russo, G, Porta, V, Valdambrini, F, Fassini, P, Orando, S, Beck, E, Pedeferri, M, Cogliati, G, Testini, D, Moroni, B, Codeluppi, V, Ruggeri, P, Milanesi, E, Belliato, M, Besozzi, A, Riccio, M, Zerbi, S, Corbella, D, Ferri, F, Grazioli, L, Bonanomi, E, Giacomini, M, Sacchi, N, Codognola, C, Ambrosini, A, Guatteri, L, Subert, M, Castelli, G, Borelli, M, Venier, E, Dittura, L, Buttera, S, Bigai, R, Magnoni, S, Rauch, S, Colombo, A, Fullin, G, Donolato, C, Cattin, S, State, V, Redeghieri, E, Russo, A, Pastorini, S, Allena, S, Munari, M, Turchet, F, Peta, M, De Santis, V, Scala, C, Facondini, F, Marangoni, E, Tassinati, T, Zanzani, C, Russo, E, Marchio, A, Barbagallo, M, Girardis, M, Taffache, P, Mordacci, M, Vincenzi, M, Pennica, M, Bracciotti, G, Iori, P, Gambi, D, Cappellini, I, Vegnuti, L, De Luca, A, Romagnoli, S, Mosti, G, Carla, R, Roticiani, V, Pelagalli, L, Fuselli, E, D’Avino, E, De Bellis, M, Gianni, G, Leonardis, F, Rossi, M, Lorusso, R, Magnanimi, E, Martelli, S, Baisi, F, Balsamo, D, Cotticelli, V, Mattei, A, Farinelli, I, Riccini, T, Cola, L, Jorio, A, Iacobone, E, Domizi, R, Pizzi, S, Nasso, A, Graziani, R, Monaco, A, Manno, M, Ottelio, C, Del Rio, M, Serra, A, Enna, B, Loddo, F, Galbiati, R, Mellea, S, Kimberly, M, Vissani, M, Romito, F, Baccari, L, Zarrillo, N, Esposito, C, Murino, P, Notaro, S, Ausiello, C, Marra, A, Policastro, C, Cafora, C, De Benedectis, G, Di Falco, V, Sciddurlo, M, Negro, G, Vetuschi, P, Recchia, A, Pasquariello, R, Squillace, R, Ciambrone, A, Bencivenga, C, Camiolo, M, Agozzino, C, Oliveri, F, Notarrigo, T, Castiglione, G, Mo, A, Condorelli, L, Favarato, M, Langer, Thomas, Depalo, Francesca Carmela, Forlini, Clarissa, Landini, Silvia, Mezzetti, Andrea, Previtali, Paola, Monti, Gianpaola, de Toma, Carolina, Biscardi, Davide, Giannini, Alberto, Fumagalli, Roberto, Mistraletti, Giovanni, Lissoni, Barbara, De Martini, Andrea, Mareto, Nadia, Rossitto, Concetta, Zummo, Ugo, Taverna, Martina, Machieraldo, Patrizia, Navarra, Mauro, Parlanti Garbero, Massimiliano, Scaletti, Chiara, Perno, Silvia, Amendolia, Luca, Montrucchio, Giuseppe, Veliaj, Deliana, Barbarello, Giuseppe, Alesci, Maria, Bolgiaghi, Luca, Vailati, Davide, Pezzi, Angelo, Boselli, Enrico, Piccoli, Francesca, Greco, Massimiliano, Gemma, Marco, Resta, Marco, Crotti, Stefania, Bottino, Nicola, Abruzzese, Chiara, Savioli, Monica, Migliorino, Giuseppina, Muttini, Stefano, Umbrello, Michele, Borghi, Beatrice, Greco, Stefano, Dizeo, Micaela, Bottiroli, Maurizio, Mondino, Michele Giovanni, Prosepri, Manlio, Casella, Giampaolo, Curto, Francesco, Zaniboni, Matteo, Giudici, Riccardo, Gentile, Carlo, Bombino, Michela, Rona, Roberto, Cortinovis, Barbara, Benini, Annalisa, Avalli, Leonello, Tavola, Mario, Ferrario, Matteo, Preda, Roberta, Primerano, Enzo, Russo, Gianluca, Porta, Virginia, Valdambrini, Federico, Fassini, Paola, Orando, Serena, Beck, Eduardo, Pedeferri, Matteo, Cogliati, Giacomina, Testini, Denise, Moroni, Benedetta, Codeluppi, Vito, Ruggeri, Patrizia, Milanesi, Elisa, Belliato, Mirko, Besozzi, Alessandra, Riccio, Mario, Zerbi, Silvia, Corbella, Davide, Ferri, Francesco, Grazioli, Lorenzo, Bonanomi, Ezio, Giacomini, Matteo, Sacchi, Noemi, Codognola, Cristian, Ambrosini, Alessandra, Guatteri, Luca, Subert, Matteo, Castelli, Gian Paolo, Borelli, Massimo, Venier, Erica, Dittura, Loredana, Buttera, Stefania, Bigai, Roberto, Magnoni, Sandra, Rauch, Simon, Colombo, Angelo, Fullin, Giorgio, Donolato, Caterina, Cattin, Silvia, State, Veronica, Redeghieri, Enrico, Russo, Alessandro, Pastorini, Simonetta, Allena, Sandra, Munari, Marina, Turchet, Federica, Peta, Mario, De Santis, Vincenzo, Scala, Cristina, Facondini, Francesca, Marangoni, Elisabetta, Tassinati, Tania, Zanzani, Chiara, Russo, Emanuele, Marchio, Annamaria, Barbagallo, Maria, Girardis, Massimo, Taffache, Paolo, Mordacci, Marco, Vincenzi, Matteo, Pennica, Michele, Bracciotti, Giovanna, Iori, Paola, Gambi, Davide, Cappellini, Iacopo, Vegnuti, Lara, De Luca, Alessandra, Romagnoli, Stefano, Mosti, Giamila, Carla, Rossella, Roticiani, Valeria, Pelagalli, Lorella, Fuselli, Ennio, D’Avino, Emilio, De Bellis, Massimo, Gianni, Giulia, Leonardis, Francesca, Rossi, Marzia, Lorusso, Rossana, Magnanimi, Eugenia, Martelli, Sabrina, Baisi, Floriana, Balsamo, Davide, Cotticelli, Virginia, Mattei, Alessia, Farinelli, Ivano, Riccini, Teresa, Cola, Luisanna, Jorio, Antonella, Iacobone, Emanuele, Domizi, Roberta, Pizzi, Simone, Nasso, Armando, Graziani, Romano, Monaco, Anna, Manno, Manuela, Ottelio, Carla Maria, Del Rio, Michela, Serra, Antonio, Enna, Barbara, Loddo, Francesco Marco, Galbiati, Rita, Mellea, Serena, Kimberly, Michelle Brozzi, Vissani, Matteo, Romito, Francesco Massimo, Baccari, Laura, Zarrillo, Nadia, Esposito, Clelia, Murino, Patrizia, Notaro, Salvatore, Ausiello, Carmine, Marra, Annachiara, Policastro, Carmela, Cafora, Chiara, De Benedectis, Giuseppe, Di Falco, Vincenzo, Sciddurlo, Maria, Negro, Giancarlo, Vetuschi, Paolo, Recchia, Andrea, Pasquariello, Rita, Squillace, Rosalba, Ciambrone, Antonio, Bencivenga, Carmela, Camiolo, Melania, Agozzino, Cristina, Oliveri, Francesco, Notarrigo, Tiziana, Castiglione, Giacomo, Mo, Antonella, Condorelli, Laura, and Favarato, Martina

Abstract

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0-6]%, 0 [0-4]% and 11 [2-25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was wi

Published
2022

4. Noninvasive Ventilatory Support of COVID-19 Patients Outside the Intensive Care Units (WARd-COVID)

Author

Bellani, G, Grasselli, G, Cecconi, M, Antolini, L, Borelli, M, De Giacomi, F, Bosio, G, Latronico, N, Filippini, M, Gemma, M, Giannotti, C, Antonini, B, Petrucci, N, Zerbi, S, Maniglia, P, Castelli, G, Marino, G, Subert, M, Citerio, G, Radrizzani, D, Mediani, T, Lorini, F, Russo, F, Faletti, A, Beindorf, A, Covello, R, Greco, S, Bizzarri, M, Ristagno, G, Mojoli, F, Pradella, A, Severgnini, P, Da Macallè, M, Albertin, A, Ranieri, V, Rezoagli, E, Vitale, G, Magliocca, A, Cappelleri, G, Docci, M, Aliberti, S, Serra, F, Rossi, E, Valsecchi, M, Pesenti, A, Foti, G, Bellani, Giacomo, Grasselli, Giacomo, Cecconi, Maurizio, Antolini, Laura, Borelli, Massimo, De Giacomi, Federica, Bosio, Giancarlo, Latronico, Nicola, Filippini, Matteo, Gemma, Marco, Giannotti, Claudia, Antonini, Benvenuto, Petrucci, Nicola, Zerbi, Simone Maria, Maniglia, Paolo, Castelli, Gian Paolo, Marino, Giovanni, Subert, Matteo, Citerio, Giuseppe, Radrizzani, Danilo, Mediani, Teresa S, Lorini, Ferdinando Luca, Russo, Filippo Maria, Faletti, Angela, Beindorf, Andrea, Covello, Remo Daniel, Greco, Stefano, Bizzarri, Marta M, Ristagno, Giuseppe, Mojoli, Francesco, Pradella, Andrea, Severgnini, Paolo, Da Macallè, Marta, Albertin, Andrea, Ranieri, V Marco, Rezoagli, Emanuele, Vitale, Giovanni, Magliocca, Aurora, Cappelleri, Gianluca, Docci, Mattia, Aliberti, Stefano, Serra, Filippo, Rossi, Emanuela, Valsecchi, Maria Grazia, Pesenti, Antonio, Foti, Giuseppe, Bellani, G, Grasselli, G, Cecconi, M, Antolini, L, Borelli, M, De Giacomi, F, Bosio, G, Latronico, N, Filippini, M, Gemma, M, Giannotti, C, Antonini, B, Petrucci, N, Zerbi, S, Maniglia, P, Castelli, G, Marino, G, Subert, M, Citerio, G, Radrizzani, D, Mediani, T, Lorini, F, Russo, F, Faletti, A, Beindorf, A, Covello, R, Greco, S, Bizzarri, M, Ristagno, G, Mojoli, F, Pradella, A, Severgnini, P, Da Macallè, M, Albertin, A, Ranieri, V, Rezoagli, E, Vitale, G, Magliocca, A, Cappelleri, G, Docci, M, Aliberti, S, Serra, F, Rossi, E, Valsecchi, M, Pesenti, A, Foti, G, Bellani, Giacomo, Grasselli, Giacomo, Cecconi, Maurizio, Antolini, Laura, Borelli, Massimo, De Giacomi, Federica, Bosio, Giancarlo, Latronico, Nicola, Filippini, Matteo, Gemma, Marco, Giannotti, Claudia, Antonini, Benvenuto, Petrucci, Nicola, Zerbi, Simone Maria, Maniglia, Paolo, Castelli, Gian Paolo, Marino, Giovanni, Subert, Matteo, Citerio, Giuseppe, Radrizzani, Danilo, Mediani, Teresa S, Lorini, Ferdinando Luca, Russo, Filippo Maria, Faletti, Angela, Beindorf, Andrea, Covello, Remo Daniel, Greco, Stefano, Bizzarri, Marta M, Ristagno, Giuseppe, Mojoli, Francesco, Pradella, Andrea, Severgnini, Paolo, Da Macallè, Marta, Albertin, Andrea, Ranieri, V Marco, Rezoagli, Emanuele, Vitale, Giovanni, Magliocca, Aurora, Cappelleri, Gianluca, Docci, Mattia, Aliberti, Stefano, Serra, Filippo, Rossi, Emanuela, Valsecchi, Maria Grazia, Pesenti, Antonio, and Foti, Giuseppe

Abstract

Rationale: Treatment with noninvasive ventilation (NIV) in coronavirus disease (COVID-19) is frequent. Shortage of intensive care unit (ICU) beds led clinicians to deliver NIV also outside ICUs. Data about the use of NIV in COVID-19 is limited. Objectives: To describe the prevalence and clinical characteristics of patientswith COVID-19 treated with NIVoutside the ICUs. To investigate the factors associated with NIV failure (need for intubation or death). Methods: In this prospective, single-day observational study, we enrolled adult patients with COVID-19 who were treated with NIV outside the ICU from 31 hospitals in Lombardy, Italy. Results: We collected data on demographic and clinical characteristics, ventilatorymanagement, and patient outcomes.Of 8,753 patients with COVID-19 present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. A majority of patients (778/909; 85%) patients were treated with continuous positive airway pressure (CPAP), which was delivered by helmet in 617 (68%) patients. NIV failed in 300 patients (37.6%), whereas 498 (62.4%) patients were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with an arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FIO2) ratio ,150 mm Hg. Higher C-reactive protein and lower PaO2/FIO2 and platelet counts were independently associated with increased risk of NIV failure. Conclusions: The use of NIV outside the ICUs was common in COVID-19, with a predominant use of helmet CPAP, with a rate of success.60% and close to 75% in full-treatment patients. C-reactive protein, PaO2/FIO2, and platelet counts were independently associated with increased risk of NIV failure.

Published
2021

9. Equipment Leasing - A Flexible Technique for Tax Planning

Author

Subert, M.

Subjects
Tax Planning -- United Kingdom, Leases -- Equipment and supplies, Banking, finance and accounting industries, Business
Abstract

Equipment leases are generally finance leases meaning the lessor leases an asset for a given period, receives rental payments that cover his initial outlay plus earn him profits. At the end of the period, the equipment may be sold to the lessee or re-rented at a nominal rate. The after-tax return on the lease is higher than ivestment in the money market, in the United Kingdom. Legal ownership must be retained by the lessor for him to recieve capital allowances. First year allowances may be taken if the equipment is used for acceptable purposes - that is if the lessee could have taken the allowance if he had bought the machinery or plant. The ability to use losses in leasing to cover past years' profits makes it a pracitical tax planning tool. Isolated transactions do not qualify as a leasing trade therefore do not attract as beneficial tax circumstances. Documentation of entering the trade of leasing should be made by the company with a minimum of three transactions involving different lessers and types of equipment. A subsidiary for leasing may be appropriate but caution is wise.

Published
1984

13. Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Author

Langer, Thomas, Depalo, Francesca Carmela, Forlini, Clarissa, Landini, Silvia, Mezzetti, Andrea, Previtali, Paola, Monti, Gianpaola, de Toma, Carolina, Biscardi, Davide, Giannini, Alberto, Fumagalli, Roberto, Mistraletti, Giovanni, Lissoni, Barbara, De Martini, Andrea, Mareto, Nadia, Rossitto, Concetta, Zummo, Ugo, Taverna, Martina, Machieraldo, Patrizia, Navarra, Mauro, Parlanti Garbero, Massimiliano, Scaletti, Chiara, Perno, Silvia, Amendolia, Luca, Montrucchio, Giuseppe, Veliaj, Deliana, Barbarello, Giuseppe, Alesci, Maria, Bolgiaghi, Luca, Vailati, Davide, Pezzi, Angelo, Boselli, Enrico, Piccoli, Francesca, Greco, Massimiliano, Gemma, Marco, Resta, Marco, Crotti, Stefania, Bottino, Nicola, Abruzzese, Chiara, Savioli, Monica, Migliorino, Giuseppina, Muttini, Stefano, Umbrello, Michele, Borghi, Beatrice, Greco, Stefano, Dizeo, Micaela, Bottiroli, Maurizio, Mondino, Michele Giovanni, Prosepri, Manlio, Casella, Giampaolo, Curto, Francesco, Zaniboni, Matteo, Giudici, Riccardo, Gentile, Carlo, Bombino, Michela, Rona, Roberto, Cortinovis, Barbara, Benini, Annalisa, Avalli, Leonello, Tavola, Mario, Ferrario, Matteo, Preda, Roberta, Primerano, Enzo, Russo, Gianluca, Porta, Virginia, Valdambrini, Federico, Fassini, Paola, Orando, Serena, Beck, Eduardo, Pedeferri, Matteo, Cogliati, Giacomina, Testini, Denise, Moroni, Benedetta, Codeluppi, Vito, Ruggeri, Patrizia, Milanesi, Elisa, Belliato, Mirko, Besozzi, Alessandra, Riccio, Mario, Zerbi, Silvia, Corbella, Davide, Ferri, Francesco, Grazioli, Lorenzo, Bonanomi, Ezio, Giacomini, Matteo, Sacchi, Noemi, Codognola, Cristian, Ambrosini, Alessandra, Guatteri, Luca, Subert, Matteo, Castelli, Gian Paolo, Borelli, Massimo, Venier, Erica, Dittura, Loredana, Buttera, Stefania, Bigai, Roberto, Magnoni, Sandra, Rauch, Simon, Colombo, Angelo, Fullin, Giorgio, Donolato, Caterina, Cattin, Silvia, State, Veronica, Redeghieri, Enrico, Russo, Alessandro, Pastorini, Simonetta, Allena, Sandra, Munari, Marina, Turchet, Federica, Peta, Mario, De Santis, Vincenzo, Scala, Cristina, Facondini, Francesca, Marangoni, Elisabetta, Tassinati, Tania, Zanzani, Chiara, Russo, Emanuele, Marchio, Annamaria, Barbagallo, Maria, Girardis, Massimo, Taffache, Paolo, Mordacci, Marco, Vincenzi, Matteo, Pennica, Michele, Bracciotti, Giovanna, Iori, Paola, Gambi, Davide, Cappellini, Iacopo, Vegnuti, Lara, De Luca, Alessandra, Romagnoli, Stefano, Mosti, Giamila, Carla, Rossella, Roticiani, Valeria, Pelagalli, Lorella, Fuselli, Ennio, D’Avino, Emilio, De Bellis, Massimo, Gianni, Giulia, Leonardis, Francesca, Rossi, Marzia, Lorusso, Rossana, Magnanimi, Eugenia, Martelli, Sabrina, Baisi, Floriana, Balsamo, Davide, Cotticelli, Virginia, Mattei, Alessia, Farinelli, Ivano, Riccini, Teresa, Cola, Luisanna, Jorio, Antonella, Iacobone, Emanuele, Domizi, Roberta, Pizzi, Simone, Nasso, Armando, Graziani, Romano, Monaco, Anna, Manno, Manuela, Ottelio, Carla Maria, Del Rio, Michela, Serra, Antonio, Enna, Barbara, Loddo, Francesco Marco, Galbiati, Rita, Mellea, Serena, Kimberly, Michelle Brozzi, Vissani, Matteo, Romito, Francesco Massimo, Baccari, Laura, Zarrillo, Nadia, Esposito, Clelia, Murino, Patrizia, Notaro, Salvatore, Ausiello, Carmine, Marra, Annachiara, Policastro, Carmela, Cafora, Chiara, De Benedectis, Giuseppe, Di Falco, Vincenzo, Sciddurlo, Maria, Negro, Giancarlo, Vetuschi, Paolo, Recchia, Andrea, Pasquariello, Rita, Squillace, Rosalba, Ciambrone, Antonio, Bencivenga, Carmela, Camiolo, Melania, Agozzino, Cristina, Oliveri, Francesco, Notarrigo, Tiziana, Castiglione, Giacomo, Mo, Antonella, Condorelli, Laura, Favarato, Martina, Langer, T, Depalo, F, Forlini, C, Landini, S, Mezzetti, A, Previtali, P, Monti, G, de Toma, C, Biscardi, D, Giannini, A, Fumagalli, R, Mistraletti, G, Lissoni, B, De Martini, A, Mareto, N, Rossitto, C, Zummo, U, Taverna, M, Machieraldo, P, Navarra, M, Parlanti Garbero, M, Scaletti, C, Perno, S, Amendolia, L, Montrucchio, G, Veliaj, D, Barbarello, G, Alesci, M, Bolgiaghi, L, Vailati, D, Pezzi, A, Boselli, E, Piccoli, F, Greco, M, Gemma, M, Resta, M, Crotti, S, Bottino, N, Abruzzese, C, Savioli, M, Migliorino, G, Muttini, S, Umbrello, M, Borghi, B, Greco, S, Dizeo, M, Bottiroli, M, Mondino, M, Prosepri, M, Casella, G, Curto, F, Zaniboni, M, Giudici, R, Gentile, C, Bombino, M, Rona, R, Cortinovis, B, Benini, A, Avalli, L, Tavola, M, Ferrario, M, Preda, R, Primerano, E, Russo, G, Porta, V, Valdambrini, F, Fassini, P, Orando, S, Beck, E, Pedeferri, M, Cogliati, G, Testini, D, Moroni, B, Codeluppi, V, Ruggeri, P, Milanesi, E, Belliato, M, Besozzi, A, Riccio, M, Zerbi, S, Corbella, D, Ferri, F, Grazioli, L, Bonanomi, E, Giacomini, M, Sacchi, N, Codognola, C, Ambrosini, A, Guatteri, L, Subert, M, Castelli, G, Borelli, M, Venier, E, Dittura, L, Buttera, S, Bigai, R, Magnoni, S, Rauch, S, Colombo, A, Fullin, G, Donolato, C, Cattin, S, State, V, Redeghieri, E, Russo, A, Pastorini, S, Allena, S, Munari, M, Turchet, F, Peta, M, De Santis, V, Scala, C, Facondini, F, Marangoni, E, Tassinati, T, Zanzani, C, Russo, E, Marchio, A, Barbagallo, M, Girardis, M, Taffache, P, Mordacci, M, Vincenzi, M, Pennica, M, Bracciotti, G, Iori, P, Gambi, D, Cappellini, I, Vegnuti, L, De Luca, A, Romagnoli, S, Mosti, G, Carla, R, Roticiani, V, Pelagalli, L, Fuselli, E, D’Avino, E, De Bellis, M, Gianni, G, Leonardis, F, Rossi, M, Lorusso, R, Magnanimi, E, Martelli, S, Baisi, F, Balsamo, D, Cotticelli, V, Mattei, A, Farinelli, I, Riccini, T, Cola, L, Jorio, A, Iacobone, E, Domizi, R, Pizzi, S, Nasso, A, Graziani, R, Monaco, A, Manno, M, Ottelio, C, Del Rio, M, Serra, A, Enna, B, Loddo, F, Galbiati, R, Mellea, S, Kimberly, M, Vissani, M, Romito, F, Baccari, L, Zarrillo, N, Esposito, C, Murino, P, Notaro, S, Ausiello, C, Marra, A, Policastro, C, Cafora, C, De Benedectis, G, Di Falco, V, Sciddurlo, M, Negro, G, Vetuschi, P, Recchia, A, Pasquariello, R, Squillace, R, Ciambrone, A, Bencivenga, C, Camiolo, M, Agozzino, C, Oliveri, F, Notarrigo, T, Castiglione, G, Mo, A, Condorelli, L, and Favarato, M

Subjects
Adult, Pandemic, Patient-centered care, Communication, COVID-19, Professional-family relations, Intensive Care Units, Policy, Anesthesiology and Pain Medicine, Health communication, Professional-family relation, Surveys and Questionnaires, Communicable Disease Control, Intensive care units, Pandemics, Humans, Intensive care unit, Child
Abstract

Background During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p Conclusions Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted.

Published
2022

14. Phenotyping COVID-19 respiratory failure in spontaneously breathing patients with AI on lung CT-scan.

Author

Rezoagli E, Xin Y, Signori D, Sun W, Gerard S, Delucchi KL, Magliocca A, Vitale G, Giacomini M, Mussoni L, Montomoli J, Subert M, Ponti A, Spadaro S, Poli G, Casola F, Herrmann J, Foti G, Calfee CS, Laffey J, Bellani G, and Cereda M

Subjects
Humans, Female, Male, Middle Aged, Aged, Cohort Studies, Adult, COVID-19 diagnostic imaging, COVID-19 physiopathology, Tomography, X-Ray Computed methods, Phenotype, Lung diagnostic imaging, Lung physiopathology, Respiratory Insufficiency diagnostic imaging, Respiratory Insufficiency etiology, Respiratory Insufficiency physiopathology
Abstract

Background: Automated analysis of lung computed tomography (CT) scans may help characterize subphenotypes of acute respiratory illness. We integrated lung CT features measured via deep learning with clinical and laboratory data in spontaneously breathing subjects to enhance the identification of COVID-19 subphenotypes., Methods: This is a multicenter observational cohort study in spontaneously breathing patients with COVID-19 respiratory failure exposed to early lung CT within 7 days of admission. We explored lung CT images using deep learning approaches to quantitative and qualitative analyses; latent class analysis (LCA) by using clinical, laboratory and lung CT variables; regional differences between subphenotypes following 3D spatial trajectories., Results: Complete datasets were available in 559 patients. LCA identified two subphenotypes (subphenotype 1 and 2). As compared with subphenotype 2 (n = 403), subphenotype 1 patients (n = 156) were older, had higher inflammatory biomarkers, and were more hypoxemic. Lungs in subphenotype 1 had a higher density gravitational gradient with a greater proportion of consolidated lungs as compared with subphenotype 2. In contrast, subphenotype 2 had a higher density submantellar-hilar gradient with a greater proportion of ground glass opacities as compared with subphenotype 1. Subphenotype 1 showed higher prevalence of comorbidities associated with endothelial dysfunction and higher 90-day mortality than subphenotype 2, even after adjustment for clinically meaningful variables., Conclusions: Integrating lung-CT data in a LCA allowed us to identify two subphenotypes of COVID-19, with different clinical trajectories. These exploratory findings suggest a role of automated imaging characterization guided by machine learning in subphenotyping patients with respiratory failure., Trial Registration: ClinicalTrials.gov Identifier: NCT04395482. Registration date: 19/05/2020., (© 2024. The Author(s).)

Published
2024
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15. Noninvasive Ventilatory Support of Patients with COVID-19 outside the Intensive Care Units (WARd-COVID).

Author

Bellani G, Grasselli G, Cecconi M, Antolini L, Borelli M, De Giacomi F, Bosio G, Latronico N, Filippini M, Gemma M, Giannotti C, Antonini B, Petrucci N, Zerbi SM, Maniglia P, Castelli GP, Marino G, Subert M, Citerio G, Radrizzani D, Mediani TS, Lorini FL, Russo FM, Faletti A, Beindorf A, Covello RD, Greco S, Bizzarri MM, Ristagno G, Mojoli F, Pradella A, Severgnini P, Da Macallè M, Albertin A, Ranieri VM, Rezoagli E, Vitale G, Magliocca A, Cappelleri G, Docci M, Aliberti S, Serra F, Rossi E, Valsecchi MG, Pesenti A, and Foti G

Subjects
Aged, Cannula, Female, Humans, Intensive Care Units, Italy, Male, Middle Aged, Oxygen Inhalation Therapy, Prospective Studies, SARS-CoV-2, Treatment Failure, COVID-19 therapy, Continuous Positive Airway Pressure methods, Hospital Mortality, Hypoxia therapy, Intubation, Intratracheal statistics & numerical data, Noninvasive Ventilation methods, Patients' Rooms, Respiratory Insufficiency therapy
Abstract

Rationale: Treatment with noninvasive ventilation (NIV) in coronavirus disease (COVID-19) is frequent. Shortage of intensive care unit (ICU) beds led clinicians to deliver NIV also outside ICUs. Data about the use of NIV in COVID-19 is limited. Objectives: To describe the prevalence and clinical characteristics of patients with COVID-19 treated with NIV outside the ICUs. To investigate the factors associated with NIV failure (need for intubation or death). Methods: In this prospective, single-day observational study, we enrolled adult patients with COVID-19 who were treated with NIV outside the ICU from 31 hospitals in Lombardy, Italy. Results: We collected data on demographic and clinical characteristics, ventilatory management, and patient outcomes. Of 8,753 patients with COVID-19 present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. A majority of patients (778/909; 85%) patients were treated with continuous positive airway pressure (CPAP), which was delivered by helmet in 617 (68%) patients. NIV failed in 300 patients (37.6%), whereas 498 (62.4%) patients were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with an arterial oxygen pressure (Pa O 2 )/fraction of inspired oxygen (Fi O 2 ) ratio <150 mm Hg. Higher C-reactive protein and lower Pa O 2 /Fi O 2 and platelet counts were independently associated with increased risk of NIV failure. Conclusions: The use of NIV outside the ICUs was common in COVID-19, with a predominant use of helmet CPAP, with a rate of success >60% and close to 75% in full-treatment patients. C-reactive protein, Pa O 2 /Fi O 2 , and platelet counts were independently associated with increased risk of NIV failure.Clinical trial registered with ClinicalTrials.gov (NCT04382235).

Published
2021
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16. European Society of Anaesthesiology and Intensive Care Guidelines on peri-operative use of ultrasound for regional anaesthesia (PERSEUS regional anesthesia): Peripheral nerves blocks and neuraxial anaesthesia.

Author

Boselli E, Hopkins P, Lamperti M, Estèbe JP, Fuzier R, Biasucci DG, Disma N, Pittiruti M, Traškaitė V, Macas A, Breschan C, Vailati D, and Subert M

Subjects
Critical Care, Humans, Peripheral Nerves diagnostic imaging, Anesthesia, Conduction, Anesthesia, Spinal, Anesthesiology
Abstract

Nowadays, ultrasound-guidance is commonly used in regional anaesthesia (USGRA) and to locate the spinal anatomy in neuraxial analgesia. The aim of this second guideline on the PERi-operative uSE of UltraSound (PERSEUS-RA) is to provide evidence as to which areas of regional anaesthesia the use of ultrasound guidance should be considered a gold standard or beneficial to the patient. The PERSEUS Taskforce members were asked to define relevant outcomes and rank the relative importance of outcomes following the GRADE process. Whenever the literature was not able to provide enough evidence, we decided to use the RAND method with a modified Delphi process. Whenever compared with alternative techniques, the use of USGRA is considered well tolerated and effective for some nerve blocks but there are certain areas, such as truncal blocks, where a lack of robust data precludes useful comparison. The new frontiers for further research are represented by the application of USG during epidural analgesia or spinal anaesthesia as, in these cases, the evidence for the value of the use of ultrasound is limited to the preprocedure identification of the anatomy, providing the operator with a better idea of the depth and angle of the epidural or spinal space. USGRA can be considered an essential part of the curriculum of the anaesthesiologist with a defined training and certification path. Our recommendations will require considerable changes to some training programmes, and it will be necessary for these to be phased in before compliance becomes mandatory., (Copyright © 2020 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.)

Published
2021
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17. European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access).

Author

Lamperti M, Biasucci DG, Disma N, Pittiruti M, Breschan C, Vailati D, Subert M, Traškaitė V, Macas A, Estebe JP, Fuzier R, Boselli E, and Hopkins P

Subjects
Adult, Catheterization, Humans, Societies, Medical, Ultrasonography, Interventional, Anesthesia, Anesthesiology standards, Catheterization, Central Venous standards, Practice Guidelines as Topic
Abstract

: Ultrasound for diagnostic and procedural purposes is becoming a standard in daily clinical practice including anaesthesiology and peri-operative medicine. The project of European Society of Anaesthesiology (ESA) Task Force for the development of clinical guidelines on the PERioperative uSE of Ultra-Sound (PERSEUS) project has focused on the use of ultrasound in two areas that account for the majority of procedures performed routinely in the operating room: vascular access and regional anaesthesia. Given the extensive literature available in these two areas, this paper will focus on the use of ultrasound-guidance for vascular access. A second part will be dedicated to peripheral nerve/neuraxial blocks. The Taskforce identified three main domains of application in ultrasound-guided vascular cannulation: adults, children and training. The literature search were performed by a professional librarian from the Cochrane Anaesthesia and Critical and Emergency Care Group in collaboration with the ESA Taskforce. The Grading of Recommendation Assessment (GRADE) system for assessing levels of evidence and grade of recommendations were used. For the use of ultrasound-guided cannulation of the internal jugular vein, femoral vein and arterial access, the level evidence was classified 1B. For other accesses, the evidence remains limited. For training in ultrasound guidance, there were no studies. The importance of proper training for achieving competency and full proficiency before performing any ultrasound-guided vascular procedure must be emphasised.

Published
2020
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19. Is a neutral head position safer than 45-degree neck rotation during ultrasound-guided internal jugular vein cannulation? Results of a randomized controlled clinical trial.

Author

Lamperti M, Subert M, Cortellazzi P, Vailati D, Borrelli P, Montomoli C, D'Onofrio G, and Caldiroli D

Subjects
Adult, Aged, Catheterization, Central Venous adverse effects, Female, Head, Humans, Male, Middle Aged, Neck, Posture, Prospective Studies, Rotation, Ultrasonography, Catheterization, Central Venous methods, Jugular Veins diagnostic imaging
Abstract

Background: The optimal degree of neck rotation during internal jugular vein (IJV) cannulation remains undetermined because previous studies suggested using sonography, but without puncturing the vein. We assessed whether a neutral position (NP) of the head (0 degrees) during ultrasound-guided cannulation of the IJV was safer than rotating the neck to 45 degrees head turned. The effect of these 2 positions during ultrasound-guided cannulation on major complications was the primary outcome. Overall complications, venous access time, and perception of difficulty during the procedure were also evaluated., Methods: A prospective, randomized, controlled, nonblinded study was conducted in a tertiary neurosurgical hospital. Patients undergoing major elective neurosurgical procedures requiring a central venous line were randomly allocated to 2 groups; ultrasound-guided cannulation of the IJV was then performed using an out-of-plane orientation., Results: One thousand four hundred twenty-four patients were evaluated, but 92 were excluded; 670 were allocated to the head turned group and 662 to the NP group. Cannulation was 100% successful. Demographic data were similar in the 2 groups except for IJV positions. There were only 10 major complications: 6 in the 0-degree NP group and 4 in the 45-degree head turned group. The frequency of these complications was not different between the 2 groups. The overall complication rate was 13%, and was higher in women, in patients with ASA physical status ≥II, and in patients with a smaller diameter vein, or when the vein was located deeper and lateral or in the anterolateral position. An increased venous access time was associated with an increased rate of overall complications. The perception of difficulty performing the procedure with the head placed in the 2 positions was not statistically different in either group., Conclusion: A head NP was as safe as a 45-degree neck rotation during ultrasound-guided IJV cannulation with regard to both major and minor complications, and venous access time was similar. Ultrasound guidance helps determine optimal head rotation for IJV cannulation.

Published
2012
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20. An ultrasound study of cerebral venous drainage after internal jugular vein catheterization.

Author

Vailati D, Lamperti M, Subert M, and Sommariva A

Abstract

Objectives. It has been advocated that internal jugular vein (IJV) cannulation in patients at risk for intracranial hypertension could impair cerebral venous return. Aim of this study was to demonstrate that ultrasound-guided IJV cannulation in elective neurosurgical patients is safe and does not impair cerebral venous return. Methods. IJV cross-sectional diameter and flow were measured using two-dimensional ultrasound and Doppler function bilaterally before and after IJV cannulation with the head supine and elevated at 30°. Results. Fifty patients with intracranial lesions at risk for intracranial hypertension were enrolled in this observational prospective study. IJV diameters before and after ultrasound-guided cannulation were not statistically different during supine or head-up position and the absolute variation of the venous flow revealed an average reduction of the venous flow after cannulation without a significant reduction of the venous flow rate after cannulation. Conclusions. Ultrasound-guided IJV cannulation in neurosurgical patients at risk for intracranial hypertension does not impair significantly jugular venous flow and indirectly cerebral venous return.

Published
2012
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