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Deana C, Biasucci DG, Aspide R, Brasil S, Vergano M, Leonardis F, Rica E, Cammarota G, Dauri M, Vetrugno G, Longhini F, Maggiore SM, Rasulo F, Vetrugno L. Transcranial Doppler and Color-Coded Doppler Use for Brain Death Determination in Adult Patients: A Pictorial Essay. J Ultrasound Med 2024; 43:979-992. [PMID: 38279568 DOI: 10.1002/jum.16421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
Transcranial Doppler (TCD) is a repeatable, at-the-bedside, helpful tool for confirming cerebral circulatory arrest (CCA). Despite its variable accuracy, TCD is increasingly used during brain death determination, and it is considered among the optional ancillary tests in several countries. Among its limitations, the need for skilled operators with appropriate knowledge of typical CCA patterns and the lack of adequate acoustic bone windows for intracranial arteries assessment are critical. The purpose of this review is to describe how to evaluate cerebral circulatory arrest in the intensive care unit with TCD and transcranial duplex color-coded doppler (TCCD).
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Daniele G Biasucci
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University, Rome, Italy
- Emergency Department, "Tor Vergata" University Hospital, Rome, Italy
- Catholic University of the Sacred Heart (UCSC), Rome, Italy
| | - Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, Istituto delle Scienze Neurologiche IRCCS, Bologna, Italy
| | - Sergio Brasil
- Neurosurgical Division, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Francesca Leonardis
- Emergency Department, "Tor Vergata" University Hospital, Rome, Italy
- Department of Surgical Science, "Tor Vergata" University, Rome, Italy
| | - Ermal Rica
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Gianmaria Cammarota
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Mario Dauri
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University, Rome, Italy
- Emergency Department, "Tor Vergata" University Hospital, Rome, Italy
| | - Giuseppe Vetrugno
- Catholic University of the Sacred Heart (UCSC), Rome, Italy
- Risk Management, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Salvatore Maurizio Maggiore
- Department of Innovative Technologies in Medicine & Dentistry, Section of Anesthesia and Intensive Care, "G. D'Annunzio" University, "SS. Annunziata" Hospital, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, "SS. Annunziata" Hospital, Chieti, Italy
| | - Frank Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, "SS. Annunziata" Hospital, Chieti, Italy
- Department of Medical, Oral and Biotechnological Science, "G. d'Annunzio" Chieti-Pescara University, Chieti, Italy
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Vetrugno L, Deana C, Spadaro S, Cammarota G, Grieco DL, Tullio A, Bove T, Di Loreto C, Maggiore SM, Orsaria M, Study Group D. Diaphragmatic morphological post-mortem findings in critically ill COVID-19 patients: an observational study. Monaldi Arch Chest Dis 2024. [PMID: 38656318 DOI: 10.4081/monaldi.2024.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Our study investigates the post-mortem findings of the diaphragm's muscular structural changes in mechanically ventilated COVID-19 patients. Diaphragm samples of the right side from 42 COVID-19 critically ill patients were analyzed and correlated with the type and length of mechanical ventilation (MV), ventilatory parameters, prone positioning, and use of sedative drugs. The mean number of fibers was 550±626. The cross-sectional area was 4120±3280 μm2, while the muscular fraction was 0.607±0.126. The overall population was clustered into two distinct populations (clusters 1 and 2). Cluster 1 showed a lower percentage of slow myosin fiber and higher fast fiber content than cluster 2, 68% versus 82%, p<0.00001, and 29.8% versus 18.8%, p=0.00045 respectively. The median duration of MV was 180 (41-346) hours. In cluster 1, a relationship between assisted ventilation and fast myosin fiber percentage (R2=-0.355, p=0.014) was found. In cluster 2, fast fiber content increased with increasing the length of the controlled MV (R2=0.446, p=0.006). A high grade of fibrosis was reported. Cluster 1 was characterized by fibers' atrophy and cluster 2 by hypertrophy, supposing different effects of ventilation on the diaphragm but without excluding a possible direct viral effect on diaphragmatic fibers.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti Pescara, Chieti; Department of Anesthesiology, Critical Care Medicine and Emergency, Annunziata Hospital, Chieti.
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine.
| | - Savino Spadaro
- Department of Translational Medicine, University of Ferrara; Intensive Care Unit, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara.
| | - Gianmaria Cammarota
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara; Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara.
| | - Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome.
| | - Annarita Tullio
- Health Integrated Agency Friuli Centrale, Academic Hospital of Udine.
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine; Department of Medicine, University of Udine.
| | - Carla Di Loreto
- Department of Medicine, University of Udine; Institute of Anatomic Pathology, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine.
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, Annunziata Hospital, Chieti; Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti.
| | - Maria Orsaria
- Institute of Anatomic Pathology, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine.
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Vetrugno L, Deana C, Colaianni-Alfonso N, Tritapepe F, Fierro C, Maggiore SM. Noninvasive respiratory support in the perioperative setting: a narrative review. Front Med (Lausanne) 2024; 11:1364475. [PMID: 38695030 PMCID: PMC11061466 DOI: 10.3389/fmed.2024.1364475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/08/2024] [Indexed: 05/04/2024] Open
Abstract
The application of preoperative noninvasive respiratory support (NRS) has been expanding with increasing recognition of its potential role in this setting as a physiological optimization for patients with a high risk of developing atelectasis and postoperative pulmonary complications (PPC). The increased availability of high-performance anesthesia ventilator machines providing an easy way for NRS support in patients with reduced lung function should not be under-evaluated. This support can reduce hypoxia, restore lung volumes and theoretically reduce atelectasis formation after general anesthesia. Therapeutic purposes should also be considered in the perioperative setting, such as preoperative NRS to optimize treatment of patients' pre-existing diseases, e.g., sleep-disordered breathing. Finally, the recent guidelines for airway management suggest preoperative NRS application before anesthesia induction in difficult airway management to prolong the time needed to secure the airway with an orotracheal tube. This narrative review aims to revise all these aspects and to provide some practical notes to maximize the efficacy of perioperative noninvasive respiratory support.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotecnological Science, “G. D’Annunzio” Chieti-Pescara University, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | | | - Fabrizio Tritapepe
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Carmen Fierro
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
- Department of Innovative Technologies in Medicine & Dentistry, Section of Anesthesia and Intensive Care, SS. Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
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Vetrugno L, Deana C, Barbariol F. Can arterial shape change with IABP play a role in comparing FlowTrac/EV 1000 vs. pulmonary cardiac output? Heart Vessels 2024; 39:273-274. [PMID: 38085331 DOI: 10.1007/s00380-023-02346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024]
Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Via Dei Vestini 33, 66100, Chieti, Italy.
| | - Cristian Deana
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Federico Barbariol
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
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Deana C, Vecchiato M, Bellocchio F, Tullio A, Martino A, Ziccarelli A, Patruno V, Pascolo M, Bassi F, Pontoni M, Raimondi P, Cereser L, Vetrugno L, Petri R, Uzzau A. High flow nasal oxygen vs. conventional oxygen therapy over respiratory oxygenation index after esophagectomy: an observational study. J Thorac Dis 2024; 16:997-1008. [PMID: 38505084 PMCID: PMC10944724 DOI: 10.21037/jtd-23-1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/06/2023] [Indexed: 03/21/2024]
Abstract
Background Postoperative pulmonary complications after esophagectomy still represent a matter of concern. High flow nasal cannula (HFNC) early after major abdominal and thoracic surgery has demonstrated some advantages over conventional oxygen therapy. Data about respiratory effect of HFNC after esophagectomy is scarce. The primary aim of this study is to investigate if the early use of HFNC after esophagectomy could enhance patients' postoperative respiratory oxygenation (ROX) index and, ultimately, reduce postoperative pneumonia. Methods In this single center retrospective study all patients undergoing to esophagectomy for cancer from May 2020 to November 2022 were evaluated. Historical cohort (HC) received postoperative oxygen supplementation with Venturi mask or nasal goggles, and a cohort was put under HFNC (HFNC cohort). ROX index, blood gas analysis, radiological atelectasis score (RAS), post-operative complications' data and information on hospital stay have been collected and analyzed. Results Seventy-one patients were included for the final statistical analysis, 31 in the HFNC and 40 in the HC cohort. Mean age was 64±10 years and body mass index (BMI) was 26 [24-29] kg/m2. ROX index was higher in the HFNC patients than in the HC, 20.8 [16.7-25.9] vs. 14.9 [10.8-18.2] (P<0.0001). In the HFNC cohort patients, pH was higher, 7.42 [7.40-7.44] vs. 7.39 [7.37-7.43] than HC, while PaCO2 was lower in HFNC cohort compared with HC, 39 [36-41] vs. 42 [39-45] mmHg, respectively (P=0.01). RAS was similar between the two cohorts of patients, 1.5±0.98 vs. 1.4±1.04 in the HFNC and the HC cohort, respectively (P=0.611). Lower acute respiratory failure (ARF) rate was recorded among HFNC than HC cohort, 0% vs. 13% respectively, P=0.06. No difference in pneumonia frequency between two cohorts was shown. Conclusions HFNC improved the ROX index after esophagectomy through significant respiratory rate reduction. This tool should be considered for early respiratory support after extubation in this category of patients, not only as a rescue therapy for ARF, but also to optimize early postoperative respiratory function. Whether this will improve patients' outcomes requires further large randomized controlled trials.
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Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Massimo Vecchiato
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | | | - Annarita Tullio
- Hygiene and Clinical Epidemiology Unit, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Antonio Martino
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Antonio Ziccarelli
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Unit, Cardiothoracic Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Marika Pascolo
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Flavio Bassi
- Anesthesia and Intensive Care Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Marta Pontoni
- Pulmonology Unit, Cardiothoracic Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Paola Raimondi
- Pulmonology Unit, Cardiothoracic Department, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Roberto Petri
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Alessandro Uzzau
- Department of Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
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Deana C, Vecchiato M, Vetrugno L, Petri R, Overbeek MC, Reijneveld EA, Valkenet K, van Adrichem EJ, Dronkers JJ, Ruurda JP, Veenhof C. Comment on The Association Between Preoperative Inspiratory Muscle Training Variables and Postoperative Pulmonary Complications in Subjects With Esophageal Cancer. Respir Care 2024; 69:376-378. [PMID: 38416657 PMCID: PMC10984593 DOI: 10.4187/respcare.11744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive CareAcademic Hospital of UdineUdine, Italy
| | - Massimo Vecchiato
- General Surgery UnitDepartment of SurgeryAcademic Hospital of UdineUdine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological SciencesUniversity of Chieti-PescaraChieti, ItalyDepartment of Anesthesiology, Critical Care Medicine and EmergencySS. Annunziata HospitalChieti, Italy
| | - Roberto Petri
- General Surgery UnitDepartment of SurgeryAcademic Hospital of UdineUdine, Italy
| | - Meike C Overbeek
- Department of Anesthesia and Intensive CareAcademic Hospital of UdineUdine, Italy
| | - Elja Ae Reijneveld
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the Netherlands
| | - Karin Valkenet
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the NetherlandsDepartment of Rehabilitation Physiotherapy Science and SportUniversity Medical Center UtrechtBrain CentreUtrecht, the Netherlands
| | | | - Jaap J Dronkers
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the Netherlands
| | - Jelle P Ruurda
- Department of SurgeryUniversity Medical Center UtrechtUtrecht, the Netherlands
| | - Cindy Veenhof
- Research Centre for Healthy and Sustainable LivingResearch Group Innovation of Movement CareHU University of Applied Sciences UtrechtUtrecht, the NetherlandsDepartment of Rehabilitation Physiotherapy Science and SportUniversity Medical Center UtrechtBrain CentreUtrecht, the Netherlands
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Deana C, Gunst J, De Rosa S, Umbrello M, Danielis M, Biasucci DG, Piani T, Cotoia A, Molfino A, Vetrugno L. Bioimpedance-assessed muscle wasting and its relation to nutritional intake during the first week of ICU: a pre-planned secondary analysis of Nutriti Study. Ann Intensive Care 2024; 14:29. [PMID: 38367198 PMCID: PMC10874356 DOI: 10.1186/s13613-024-01262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/12/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Muscle mass evaluation in ICU is crucial since its loss is related with long term complications, including physical impairment. However, quantifying muscle wasting with available bedside tools (ultrasound and bioimpedance analysis) must be more primarily understood. Bioimpedance analysis (BIA) provides estimates of muscle mass and phase angle (PA). The primary aim of this study was to evaluate muscle mass changes with bioimpedance analysis during the first 7 days after ICU admission. Secondary aims searched for correlations between muscular loss and caloric and protein debt. METHODS Patients with an expected ICU-stay ≥ 72 h and the need for artificial nutritional support were evaluated for study inclusion. BIA evaluation of muscle mass and phase angle were performed at ICU admission and after 7 days. Considering the difference between ideal caloric and protein targets, with adequate nutritional macronutrients delivered, we calculated the caloric and protein debt. We analyzed the potential correlation between caloric and protein debt and changes in muscle mass and phase angle. RESULTS 72 patients from September 1st to October 30th, 2019 and from August 1st to October 30th, 2021 were included in the final statistical analysis. Median age was 68 [59-77] years, mainly men (72%) admitted due to respiratory failure (25%), and requiring invasive mechanical ventilation for 7 [4-10] days. Median ICU stay was 8 [6-12] days. Bioimpedance data at ICU admission and after 7 days showed that MM and PA resulted significantly reduced after 7 days of critically illness, 34.3 kg vs 30.6 kg (p < 0.0001) and 4.90° vs 4.35° (p = 0.0004) respectively. Mean muscle loss was 3.84 ± 6.7 kg, accounting for 8.4% [1-14] MM reduction. Correlation between caloric debt (r = 0.14, p = 0.13) and protein debt (r = 0.18, p = 0.13) with change in MM was absent. Similarly, no correlation was found between caloric debt (r = -0.057, p = 0.631) and protein debt (r = -0.095, p = 0.424) with changes in PA. CONCLUSIONS bioimpedance analysis demonstrated that muscle mass and phase angle were significantly lower after 7 days in ICU. The total amount of calories and proteins does not correlate with changes in muscle mass and phase angle.
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Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Piazzale S. M. Della Misericordia 15, 33100, Udine, Italy.
| | - Jan Gunst
- Laboratory of Intensive-Care Medicine, Department of Cellular and Molecular Medicine, Louvain, Belgium
- Department of Intensive Care Medicine, University Hospitals Leuven, Louvain, Belgium
| | - Silvia De Rosa
- Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy
| | - Michele Umbrello
- Department of Intensive Care and Anaesthesia, ASST Ovest Milanese, Legnano Hospital, Milan, Italy
| | - Matteo Danielis
- Laboratory of Studies and Evidence Based Nursing, Department of Cardiac, Vascular Sciences and Public Health, University of Padua, ThoracicPadua, Italy
| | - Daniele Guerino Biasucci
- Department of Clinical Science and Translational Medicine, 'Tor Vergata' University of Rome, Rome, Italy
| | - Tommaso Piani
- Health Professions Staff, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Antonella Cotoia
- Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, Policlinico Riuniti Foggia, University of Foggia, Foggia, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
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Vetrugno L, Biasucci DG, Deana C, Spadaro S, Lombardi FA, Longhini F, Pisani L, Boero E, Cereser L, Cammarota G, Maggiore SM. Lung ultrasound and supine chest X-ray use in modern adult intensive care: mapping 30 years of advancement (1993-2023). Ultrasound J 2024; 16:7. [PMID: 38345653 PMCID: PMC10861418 DOI: 10.1186/s13089-023-00351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024] Open
Abstract
In critically ill patients with acute respiratory failure, thoracic images are essential for evaluating the nature, extent and progression of the disease, and for clinical management decisions. For this purpose, computed tomography (CT) is the gold standard. However, transporting patients to the radiology suite and exposure to ionized radiation limit its use. Furthermore, a CT scan is a static diagnostic exam for the thorax, not allowing, for example, appreciation of "lung sliding". Its use is also unsuitable when it is necessary to adapt or decide to modify mechanical ventilation parameters at the bedside in real-time. Therefore, chest X-ray and lung ultrasound are today's contenders for shared second place on the podium to acquire a thoracic image, with their specific strengths and limitations. Finally, electrical impedance tomography (EIT) could soon have a role, however, its assessment is outside the scope of this review. Thus, we aim to carry out the following points: (1) analyze the advancement in knowledge of lung ultrasound use and the related main protocols adopted in intensive care units (ICUs) over the latest 30 years, reporting the principal publications along the way, (2) discuss how and when lung ultrasound should be used in a modern ICU and (3) illustrate the possible future development of LUS.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100, Chieti, Via Dei Vestini, Italy
| | - Daniele Guerino Biasucci
- Department of Clinical Science and Translational Medicine, 'Tor Vergata' University of Rome, Rome, Italy
| | - Cristian Deana
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Piazzale S. M. Della Misericordia 15, 33100, Udine, Italy.
| | - Savino Spadaro
- Department of Translational Medicine, Anesthesia and Intensive Care Unit, University of Ferrara, Ferrara, Italy
| | | | - Federico Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Luigi Pisani
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Intensive Care Unit, Miulli Regional Hospital, Acquaviva Delle Fonti, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Gianmaria Cammarota
- Anesthesia and Intensive Care, Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100, Chieti, Via Dei Vestini, Italy
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
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Xu Z, Zhu L, Zhan J, Feng H, Deana C, Vetrugno L, Liu L, Lu J. Effect of high-flow nasal cannula oxygen therapy in combination with non-invasive ventilation on critically ill patients with acute respiratory failure: a retrospective study. J Thorac Dis 2023; 15:6821-6830. [PMID: 38249858 PMCID: PMC10797400 DOI: 10.21037/jtd-23-1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/17/2023] [Indexed: 01/23/2024]
Abstract
Background Acute respiratory failure (ARF) is a respiratory disease in which ventilation dysfunction of the lungs occurs at rest due to various factors, resulting in oxygen deprivation and carbon dioxide (CO2) retention. In recent years, high-flow nasal cannula (HFNC), as a new type of oxygen therapy, has attracted increasing attention. Compared with traditional oxygen therapy, HFNC adopts nasal catheter to make it more in line with the physiological and respiratory characteristics of the human body, and thus can provide a higher and more constant inhalation of oxygen. This retrospective study was conducted to explore the clinical effect of HFNC combined with non-invasive ventilation (NIV) in the treatment of critically ill patients with ARF. Methods A total of 532 critically ill patients with ARF treated in our hospital from January 2019 to December 2020 were screened for the suitability for being included in the study. Of these, 261 patients in this study received NIV. In total, 151 patients were included after applying the inclusion and exclusion criteria. NIV was generally given intermittently, and the daily duration of application was determined according to the patient's condition. The NIV-treated patients were assigned into two groups according to the oxygen inhalation mode during intermittent NIV: (I) standard group: normal oxygen inhalation was applied at the NIV interval; and (II) research group: patients treated with HFNC at the NIV interval. The respective basic data and outcome observation indices were collected. Results In terms of the clinical outcome, the number of NIV treatment days in the research group was lower (P<0.05). At 30 min, 1 h, and 24 h after treatment, the partial pressure of arterial oxygen (PaO2), arterial oxygen saturation (SaO2), oxygenation index (P/F) indices in the research group were higher, while the CO2 partial pressure (PaCO2) was lower (P<0.05). Finally, the 28- and 90-day survival rates were compared between the groups and the results indicated no significant difference in the 28-day survival rates, but the 90-day survival rates of the research group were considerably higher (P<0.05). Conclusions The use of HFNC combined with NIV to treat ARF in critically ill patients can effectively improve the ARF-related respiratory indicators in critically ill patients.
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Affiliation(s)
- Zhiping Xu
- Department of Emergency and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lingxia Zhu
- Department of Emergency and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingye Zhan
- Department of Emergency and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hui Feng
- Department of Emergency and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, ASUFC-Academic Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Lijun Liu
- Department of Emergency and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Juan Lu
- Department of Emergency and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, Suzhou, China
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10
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Vetrugno L, Castaldo N, Fantin A, Deana C, Cortegiani A, Longhini F, Forfori F, Cammarota G, Grieco DL, Isola M, Navalesi P, Maggiore SM, Bassetti M, Chetta A, Confalonieri M, De Martino M, Ferrari G, Francisi D, Luzzati R, Meini S, Scozzafava M, Sozio E, Tascini C, Bassi F, Patruno V, De Robertis E, Aldieri C, Ball L, Baratella E, Bartoletti M, Boscolo A, Burgazzi B, Catalanotti V, Confalonieri P, Corcione S, De Rosa FG, De Simoni A, Bono VD, Tria RD, Forlani S, Giacobbe DR, Granozzi B, Labate L, Lococo S, Lupia T, Matellon C, Mehrabi S, Morosi S, Mongodi S, Mura M, Nava S, Pol R, Pettenuzzo T, Quyen NH, Rescigno C, Righi E, Ruaro B, Salton F, Scabini S, Scarda A, Sibani M, Tacconelli E, Tartaglione G, Tazza B, Vania E, Viale P, Vianello A, Visentin A, Zuccon U, Meroi F, Buonsenso D. Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study). Pulmonology 2023; 29:457-468. [PMID: 36669936 PMCID: PMC9684110 DOI: 10.1016/j.pulmoe.2022.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication. METHODS This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death. RESULTS We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001). CONCLUSIONS C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality. TRIAL REGISTRATION this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.
| | - Nadia Castaldo
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Alberto Fantin
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy; Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, AOUP-Pisa, Italy
| | - Gianmaria Cammarota
- Anesthesia and Intensive Care Service 2, University Hospital of Perugia, Perugia, Italy; Department of Medicine and Surgery, Universiy of Perugia, Perugia, Italy
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Department of Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Miriam Isola
- Department of Medicine, University of Udine, Udine, Italy
| | - Paolo Navalesi
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy; Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alfredo Chetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | | | - Giovanni Ferrari
- Pneumologia e Unità di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano, Turin, Italy
| | - Daniela Francisi
- Department of Infectious Disease "S. Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Roberto Luzzati
- Infectious Disease Unit, University of Trieste, Trieste, Italy
| | - Simone Meini
- U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | | | - Emanuela Sozio
- Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy; Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Edoardo De Robertis
- Anesthesia and Intensive Care Service 2, University Hospital of Perugia, Perugia, Italy; Department of Medicine and Surgery, Universiy of Perugia, Perugia, Italy
| | - Chiara Aldieri
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Elisa Baratella
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Annalisa Boscolo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Barbara Burgazzi
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vito Catalanotti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy; Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy
| | - Alessandro De Simoni
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Valerio Del Bono
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
| | - Roberta Di Tria
- Pneumologia e Unità di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano, Turin, Italy
| | - Sara Forlani
- Pulmonary Medicine Unit, Lodi General Hospital, Lodi, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Bianca Granozzi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Laura Labate
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Sara Lococo
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Tommaso Lupia
- Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy
| | - Carola Matellon
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Sara Mehrabi
- Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, Verona, Italy
| | - Sabrina Morosi
- Department of Infectious Disease "S. Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy
| | - Silvia Mongodi
- Anaesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maddalena Mura
- U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy; Respiratory and Critical Care Unit, Sant Orsola University Hospital, Bologna, Italy
| | - Riccardo Pol
- Infectious Disease Unit, University of Trieste, Trieste, Italy
| | - Tommaso Pettenuzzo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Nguyen Hoang Quyen
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Carolina Rescigno
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
| | - Elda Righi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy
| | - Silvia Scabini
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Angelo Scarda
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - Marcella Sibani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Evelina Tacconelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gennaro Tartaglione
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - Beatrice Tazza
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Eleonora Vania
- Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Andrea Vianello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Visentin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Umberto Zuccon
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Deana C, Vecchiarelli P, Picetti E, Molfino A. Editorial: Intermittent feeding in critically ill patients. Front Nutr 2023; 10:1295405. [PMID: 37908298 PMCID: PMC10614014 DOI: 10.3389/fnut.2023.1295405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | | | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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12
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Danielis M, Mattiussi E, Piani T, Iacobucci A, Tullio A, Molfino A, Vetrugno L, Deana C. Diarrhoea and constipation during artificial nutrition in intensive care unit: A prospective observational study. Clin Nutr ESPEN 2023; 57:375-380. [PMID: 37739681 DOI: 10.1016/j.clnesp.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To describe the occurrence of gastrointestinal (GI) complications, specifically diarrhoea and constipation, in artificially (enterally or parenterally) fed critically ill patients within their first seven-day stay in Intensive Care Unit (ICU). METHODS Observational prospective study conducted from September 1st to October 30th, 2019 and from August 1st to October 30th, 2021, in an ICU of a 1000-bed third-level hospital. General characteristics, nutritional variables, and medications administered were recorded and analysed. This study was registered on ClinicalTrials.gov (Identifier: NCT05473546). RESULTS In total, 100 critically ill patients were included. Diarrhoea was present in 44 patients (44.0%), while constipation occurred in 22 (22.0%) patients. Patients with diarrhoea were generally those admitted for respiratory failure, whereas patients without diarrhoea were mostly affected by neurological disorders (22.7% vs 25%, respectively; p = 0.002). Likewise, patients with constipation were primarily those admitted for trauma (36.4%). Trauma patients were almost 24 times more likely to be constipated than patients with respiratory failure (OR 23.99, CI 1.38-418.0) and patients receiving diuretics were over 16 times more likely to have diarrhoea than patients not receiving diuretics (OR 16.25, IC 1.89-139.86). CONCLUSION GI complications of enteral nutrition represent still a very common issue in ICU. The main predictor of constipation was an admission for trauma whereas the main predictor of diarrhoea was the use of diuretics. Clinicians should consider and integrate these findings into more personalized nutritional and management protocols to avoid gastrointestinal complications.
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Affiliation(s)
- Matteo Danielis
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Piazzale Santa Maria della Misericordia 15, Udine, Italy; Laboratory of Studies and Evidence Based Nursing, Department of Medicine, University of Padua, Italy
| | - Elisa Mattiussi
- School of Nursing, Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100, Udine, Italy
| | - Tommaso Piani
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Anna Iacobucci
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Annarita Tullio
- Hygiene and Clinical Epidemiology Unit, Health Integrated Agency Friuli Centrale, Piazzale Santa Maria della Misericordia 15, Udine, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy; Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Piazzale Santa Maria della Misericordia 15, Udine, Italy.
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Vetrugno L, Sala A, Deana C, Meroi F, Grandesso M, Maggiore SM, Isola M, De Martino M, Restaino S, Vizzielli G, Bove T, Driul L. Quality of life 1 year after hospital discharge in unvaccinated pregnant women with COVID-19 respiratory symptoms: a prospective observational study (ODISSEA-PINK study). Front Med (Lausanne) 2023; 10:1225648. [PMID: 37746068 PMCID: PMC10516577 DOI: 10.3389/fmed.2023.1225648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Little is known about Quality of Life within the first court of unvaccinated COVID-19 pregnant women exposed to the pandemic stressor. Primary aim of this study was to evaluate 1 year after hospital discharge HRQoL in a cohort of COVID-19 unvaccinated pregnant patients with COVID-19. Methods in this prospective observational study, all COVID-19 positive pregnant women at any gestational age, admitted to the Obstetric Department at the University Hospital of Udine, Italy, from 1 March 2020 to 1 March 2021, requiring or not oxygen supplementation due to SARS-CoV2 pneumonia were evaluated. Patients with a history of neurological or psychiatric disease, those with a previous abortion, and those who refused to provide written informed consent were excluded from the study. We investigated pregnant positive COVID-19 women Health-related quality of life (HRQoL) with the Short-Form Health Survey-36 (SF-36) and Post-traumatic Stress-Disorder (PTSD) with the Impact of Event Scale-Revised (IES-R). Results 62 pregnant women respected the inclusion criteria of the study, and data from 33 patients were analyzed. The mean age was 32 ± 6 years, with a median gestational age of 38 weeks [IQR 34-40]. 15.2% of patients required oxygen therapy through noninvasive respiratory support (with high flow nasal cannula) for a median of 9 days [IQR 6-12]. The median Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were 50.2 [IQR 46.7-53.7] and 56.0 [IQR 46.8-60.6] respectively. Ten patients out of 33 (30%) tested positive for PTSD. Maternal age, gestational age, and history of cardiac-pulmonary-kidney disease significantly affected HRQoL at multivariable analysis. Discussion In COVID-19 pregnant unvaccinated women some physical impairments reducing HRQoL are still present 1 year after hospital discharge. Previous medical history such as history of cardiac-pulmonary-kidney disease significantly affected HRQoL. Long and repeated follow-up should be pursued in this category of patients.Clinical trial registration:ClinicalTrials.gov, Identifier NCT04860687.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral, and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Alessia Sala
- Department of Medical Area (DAME), University of Udine, Udine, Italy
- Department of Obstetrics and Gynaecology, ASUFC, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Francesco Meroi
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Maria Grandesso
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy
| | - Miriam Isola
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Maria De Martino
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Stefano Restaino
- Department of Obstetrics and Gynaecology, ASUFC, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Giuseppe Vizzielli
- Department of Medical Area (DAME), University of Udine, Udine, Italy
- Department of Obstetrics and Gynaecology, ASUFC, Ospedale Santa Maria Della Misericordia, Udine, Italy
| | - Tiziana Bove
- Department of Medical Area (DAME), University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Lorenza Driul
- Department of Medical Area (DAME), University of Udine, Udine, Italy
- Department of Obstetrics and Gynaecology, ASUFC, Ospedale Santa Maria Della Misericordia, Udine, Italy
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14
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Cherchi V, Vetrugno L, Terrosu G, Deana C, Ventin M, Zanini V, Barbariol F, Pravisani R, Bove T, Risaliti A, Lorenzin D, Baccarani U. Association between artificial nutrition in brain dead donors and early allograft function in liver transplant recipients: an observational study. Clin Transplant 2023; 37:e15034. [PMID: 37212369 DOI: 10.1111/ctr.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/23/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The role of nutrition in donor after brain deaths (DBDs) has yet to be adequately discussed. The primary aim of this study was to investigate whether the nutritional intake in the 48 h before organ retrieval may play a role on the graft functional recovery assessed with Model for Early Allograft Function (MEAF) Score. METHODS Single-center retrospective study evaluating all liver transplants performed at the University Hospital of Udine from January 2010 to August 2020. Patients receiving grafts from DBD donors fed with artificial enteral nutrition in the 48 h prior to organ procurement (EN-group) or who did not (No-EN-group). Caloric debt was calculated using the difference between the calculated caloric needs and the effective calories delivered through enteral nutrition. RESULTS Livers from EN-group presented a lower mean MEAF score compared to the no-EN-group: 3.39 ± 1.46 versus 4.15 ± 1.51, respectively (p = .04). A positive correlation between caloric debt and the MEAF score was found within the overall population (r = .227, p = .043) as well as in EN-group (r = .306, p = .049). CONCLUSIONS Donor's nutritional intake in the final 48 h before organ procurement correlates with MEAF score, and nutrition probably plays a positive role on the functional recovery of the graft. Large future randomized controlled trials are needed to confirm this preliminary results.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Victor Zanini
- Department of Medicine, University of Udine, Udine, Italy
| | - Federico Barbariol
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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15
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Janes F, Sozio E, Gigli GL, Ripoli A, Sbrana F, Kuris F, Nesi L, Semenzin T, Bertolino G, Deana C, Bagatto D, Ciardi C, Fabris M, Merlino G, Bax F, Nilo A, Pez S, Valente M, Tascini C. Ischemic strokes in COVID-19: risk factors, obesity paradox, and distinction between trigger and causal association. Front Neurol 2023; 14:1222009. [PMID: 37592943 PMCID: PMC10428626 DOI: 10.3389/fneur.2023.1222009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Background and purpose Stroke has been described as a COVID-19 complication. However, its occurrence rate, risk factors, and causal relationships are still not well established. Methods We describe the characteristics of confirmed COVID-19-related strokes among all cases of COVID-19 hospitalized in our health network, from November 1, 2020 to April 30, 2021. Risk factor analysis has been conducted for ischemic stroke (IS), which represents 92% of all confirmed cases of Covid-19-related strokes, and a "causal attribution to infection" classification is provided. Results In all, 62/4105 hospitalized COVID-19 patients had an acute stroke (1.51%). Severe COVID-19 (OR 2.27-CI 1.06-4.77; p = 0.032), atrial fibrillation (OR 3.65-CI 1.63-7.98; p = 0.001), and ischemic heart disease (OR 4.590-CI 1.714-12.137; p = 0.002) proved to be independent risk factors for IS, while obesity was a protective factor (OR 0.90-CI 0.82-0.97; p = 0.012). COVID-19 had a causal role in 32.1% of IS cases, was a relevant cofactor in 28.6% of cases of IS, and was a possible trigger in 39.3% of events. Conclusion Our stroke occurrence rate is consistent with other population-based reports (range 0.34-2.7%). Prespecified peculiar clinical and radiological features allow the distinction between "IS caused by COVID-19" and "IS triggered by COVID-19." Clinical history of vascular diseases and risk factors is crucial in determining the risk of IS in patients with COVID-19. However, the protective effect of a BMI > 30 kg/m2 seems to suggest an obesity paradox.
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Affiliation(s)
- Francesco Janes
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Emanuela Sozio
- Clinic of Infectious Diseases, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Gian Luigi Gigli
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Andrea Ripoli
- Cardiology OU, Cardiothoracic Department, G. Monasterio Foundation, Pisa, Italy
| | - Francesco Sbrana
- Cardiology OU, Cardiothoracic Department, G. Monasterio Foundation, Pisa, Italy
| | - Fedra Kuris
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Lorenzo Nesi
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Tosca Semenzin
- Clinic of Infectious Diseases, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Giacomo Bertolino
- Clinic of Infectious Diseases, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Daniele Bagatto
- Institute of Neuroradiology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Chiara Ciardi
- Institute of Neuroradiology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Martina Fabris
- Institute of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Giovanni Merlino
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Francesco Bax
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Annacarmen Nilo
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Sara Pez
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Mariarosaria Valente
- Clinic of Neurology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
| | - Carlo Tascini
- Department of Medical Area (DAME), University of Udine (UNIUD), Udine, Italy
- Clinic of Infectious Diseases, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
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16
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Vetrugno L, Deana C, Cammarota G, Maggiore SM. Define Subclavian Vein Anatomy Before Comparing Cannulation With the Landmark Technique Versus Real-Time Ultrasound Guidance: A Plea for Honesty! Crit Care Med 2023; 51:e145-e146. [PMID: 37318297 DOI: 10.1097/ccm.0000000000005895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS, Annunziata Hospital, Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Gianmaria Cammarota
- Department of Medicine and Surgery, Università degli Studi di Perugia, Perugia, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS, Annunziata Hospital, Chieti, Italy
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy
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17
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Vetrugno L, Deana C, Castaldo N, Fantin A, Belletti A, Sozio E, De Martino M, Isola M, Palumbo D, Longhini F, Cammarota G, Spadaro S, Maggiore SM, Bassi F, Tascini C, Patruno V. Barotrauma during Noninvasive Respiratory Support in COVID-19 Pneumonia Outside ICU: The Ancillary COVIMIX-2 Study. J Clin Med 2023; 12:jcm12113675. [PMID: 37297869 DOI: 10.3390/jcm12113675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Noninvasive respiratory support (NIRS) has been extensively used during the COVID-19 surge for patients with acute respiratory failure. However, little data are available about barotrauma during NIRS in patients treated outside the intensive care unit (ICU) setting. METHODS COVIMIX-2 was an ancillary analysis of the previous COVIMIX study, a large multicenter observational work investigating the frequencies of barotrauma (i.e., pneumothorax and pneumomediastinum) in adult patients with COVID-19 interstitial pneumonia. Only patients treated with NIRS outside the ICU were considered. Baseline characteristics, clinical and radiological disease severity, type of ventilatory support used, blood tests and mortality were recorded. RESULTS In all, 179 patients were included, 60 of them with barotrauma. They were older and had lower BMI than controls (p < 0.001 and p = 0.045, respectively). Cases had higher respiratory rates and lower PaO2/FiO2 (p = 0.009 and p < 0.001). The frequency of barotrauma was 0.3% [0.1-1.3%], with older age being a risk factor for barotrauma (OR 1.06, p = 0.015). Alveolar-arterial gradient (A-a) DO2 was protective against barotrauma (OR 0.92 [0.87-0.99], p = 0.026). Barotrauma required active treatment, with drainage, in only a minority of cases. The type of NIRS was not explicitly related to the development of barotrauma. Still, an escalation of respiratory support from conventional oxygen therapy, high flow nasal cannula to noninvasive respiratory mask was predictive for in-hospital death (OR 15.51, p = 0.001). CONCLUSIONS COVIMIX-2 showed a low frequency for barotrauma, around 0.3%. The type of NIRS used seems not to increase this risk. Patients with barotrauma were older, with more severe systemic disease, and showed increased mortality.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Venezia Giulia, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Nadia Castaldo
- Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
| | - Alberto Fantin
- Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Emanuela Sozio
- Infectious Disease Unit, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
| | - Maria De Martino
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Miriam Isola
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater, Domini, Magna Graecia University, 88100 Catanzaro, Italy
| | - Gianmaria Cammarota
- Anesthesiology and Intensive Care, Department of Translational medicine, Faculty of Medicine and Surgery, University of Ferrara, 44121 Ferrara, Italy
| | - Savino Spadaro
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, 66100 Chieti, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Venezia Giulia, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Carlo Tascini
- Infectious Disease Unit, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
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18
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Vetrugno L, Barbariol F, Deana C. Comparison between FlowTrac and Pulmonary Arterial Catheter in Off-Pump Cardiac Surgery Patients: “Why Did We Miss Our Appointment?”. Comment on Oh et al. Comparison between Fourth-Generation FloTrac/Vigileo System and Continuous Thermodilution Technique for Cardiac Output Estimation after Time Adjustment during Off-Pump Coronary Artery Bypass Graft Surgery: A Retrospective Cohort Study. J. Clin. Med. 2022, 11, 6093. J Clin Med 2023; 12:jcm12062343. [PMID: 36983343 PMCID: PMC10056149 DOI: 10.3390/jcm12062343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023] Open
Abstract
We read with great interest the study by Chahyun Oh et al., which compared estimates of cardiac output (CO) provided by the FloTrac system (CO-FloTrac) with those obtained with continuous thermodilution (COcont) after time adjustments using continuous recordings of intraoperative physiological datal [...]
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Via Dei Vestini 33, 66100 Chieti, Italy
- Correspondence: ; Tel.: +39-0871357076
| | - Federico Barbariol
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, 33100 Udine, Italy
| | - Cristian Deana
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, 33100 Udine, Italy
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19
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Belletti A, Vetrugno L, Deana C, Palumbo D, Maggiore SM, Landoni G. P-SILI in critically ill COVID-19 patients: Macklin effect and the choice of noninvasive ventilatory support type. Crit Care 2023; 27:38. [PMID: 36694214 PMCID: PMC9873207 DOI: 10.1186/s13054-023-04313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/08/2023] [Indexed: 01/26/2023] Open
Affiliation(s)
- Alessandro Belletti
- grid.18887.3e0000000417581884Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Luigi Vetrugno
- grid.412451.70000 0001 2181 4941Department of Medical, Oral and Biotechnological Sciences, Gabriele d’Annunzio University of Chieti Pescara, Chieti, Italy
| | - Cristian Deana
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Health Integrated Agency Friuli Centrale, Udine, Italy
| | - Diego Palumbo
- grid.18887.3e0000000417581884Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Salvatore M. Maggiore
- grid.412451.70000 0001 2181 4941Department of Innovative Technologies in Medicine and Dentistry, Gabriele d’Annunzio University of Chieti Pescara, Chieti, Italy
| | - Giovanni Landoni
- grid.18887.3e0000000417581884Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy ,grid.15496.3f0000 0001 0439 0892School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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20
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Deana C, Pez S, Ius T, Furlan D, Nilo A, Isola M, De Martino M, Mauro S, Verriello L, Lettieri C, Tomasino B, Valente M, Skrap M, Vetrugno L, Pauletto G. Effect of Dexmedetomidine versus Propofol on Intraoperative Seizure Onset During Awake Craniotomy: A Retrospective Study. World Neurosurg 2023; 172:e428-e437. [PMID: 36682527 DOI: 10.1016/j.wneu.2023.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The effect of dexmedetomidine (DEX) compared with propofol on intraoperative seizures (IOSs) detected using electrocorticography during awake craniotomy for resection of brain tumors is unknown. This investigation aimed to compare IOS rate in patients receiving DEX versus propofol as sedative agent. METHODS In this retrospective single-center study, awake craniotomies performed from January 2014 to December 2019 were analyzed. All IOSs detected by electrocorticography along with vital signs were recorded. RESULTS Of 168 adults enrolled in the study, 58 were administered DEX and 110 were administered propofol. IOSs occurred more frequently in the DEX group (22%) versus the propofol group (11%) (P = 0.046). A higher incidence of bradycardia was also observed in the DEX group (P < 0.001). Higher incidence of hypertension and a higher mean heart rate were recorded in the propofol group (P = 0.006 and P < 0.001, respectively). No serious adverse events requiring active drug administration were noted in either group. At univariate regression analysis, DEX demonstrated a tendency to favor IOS onset but without statistical significance (odds ratio = 2.36, P = 0.051). Patients in both groups had a similar epilepsy outcome at the 1-year postoperative follow-up. CONCLUSIONS IOSs detected with electrocorticography during awake craniotomy occurred more frequently in patients receiving DEX than propofol. However, patients receiving DEX were not shown to be at a statistically significant greater risk for IOS onset. DEX is a valid alternative to propofol during awake craniotomy in patients affected by tumor-related epilepsy.
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy.
| | - Sara Pez
- Department of Medicine, University of Udine, Udine, Italy
| | - Tamara Ius
- Department of Neurological Sciences, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy; Department of Neuroscience, Mental Health and Sense Organs, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Davide Furlan
- Department of Medicine, University of Udine, Udine, Italy
| | - Annacarmen Nilo
- Department of Neurological Sciences, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Miriam Isola
- Division of Medical Statistic, Department of Medicine, University of Udine, Udine, Italy
| | - Maria De Martino
- Division of Medical Statistic, Department of Medicine, University of Udine, Udine, Italy
| | - Stefano Mauro
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Lorenzo Verriello
- Department of Neurological Sciences, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Christian Lettieri
- Department of Neurological Sciences, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Barbara Tomasino
- Department of Neurological Sciences, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy; Scientific Institute, IRCCS Eugenio Medea, San Vito al Tagliamento, Italy
| | - Mariarosaria Valente
- Department of Medicine, University of Udine, Udine, Italy; Department of Neurological Sciences, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Miran Skrap
- Department of Neurological Sciences, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Medical, Oral and Biotechnological Sciences, D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Giada Pauletto
- Department of Neurological Sciences, Health Integrated Agency of Friuli Centrale, Academic Hospital of Udine, Udine, Italy
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21
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Tomasino B, Guarracino I, Pauletto G, Pez S, Ius T, Furlan D, Nilo A, Isola M, De Martino M, Mauro S, Verriello L, Lettieri C, Gigli GL, Valente M, Deana C, Skrap M. Performing real time neuropsychological testing during awake craniotomy: are dexmedetomidine or propofol the same? A preliminary report. J Neurooncol 2022; 160:707-716. [DOI: 10.1007/s11060-022-04191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
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22
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Wang Y, Wu Z, Lu S, Yin L, Chen Y, Qiu C, Ng PY, Durak K, Deana C, Ding F, Zhang Z, Dai L. Effects of β-blockers therapy on the 28-day and 3-year survival rates of end-stage renal disease patients with cardiovascular disease: a retrospective cohort study. Ann Transl Med 2022; 10:1234. [PMID: 36544684 PMCID: PMC9761132 DOI: 10.21037/atm-22-5317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
Background β-blockers have been used in the treatment of end-stage renal disease (ESRD) patients and cardiovascular disease (CVD) patients, separately. However, the effects of β-blockers on ESRD patients with CVD have not been fully investigated. This study sought to investigate the effects of β-blockers therapy on the 28-day and 3-year survival rates of ESRD patients with pre-existing CVD who were admitted to the intensive care unit (ICU). Methods After excluding patients without CVD, receiving a kidney transplant, not admitted to the ICU, and with missing baseline data, this cohort study included 1081 ESRD participants with CVD from the Medical Information Mark for Intensive Care III database. Baseline characteristics, including demographic data and clinical data, were collected. The outcomes were 28-day and 3-year survival rates of the patients. At the 28-day of ICU hospitalization, patients had a mean inpatient hospital stay of 24.7 days. At 3-year, the patients had a median survival time of 489.2 days. Univariate and multivariate Cox regression analyses were used to evaluate the effects of β-blockers therapy on the 28-day and 3-year survival outcomes of ESRD patients with CVD. Results The 28-day and 3-year survival rates were 82.8% and 37.9%, respectively. The mean age of the all patients was 68 years, and 642 were male. After adjusting for age, race, hyperlipidemia, dialysis, simplified acute physiological score (SAPS) II, sequential organ failure assessment (SOFA) score, glucocorticoid, hemoglobin, diabetes, hypertension, the 28-day survival rate of the ESRD patients with CVD requiring intensive care who received β-blockers therapy was higher than that of the patients who did not receive the treatment. Similarly, after adjusting for age, race, hyperlipidemia, dialysis, SAPS II, SOFA score, glucocorticoid, hemoglobin, diabetes, hypertension, creatinine, the long-term survival rate of the patients who received β-blockers therapy was also higher than that of those who did not. Conclusions β-blockers therapy was associated with increased 28-day and 3-year survival rates in ESRD patients with CVD requiring intensive care. Our findings may provide a theoretical basis for the prognostic impact of β-blockers therapy among patients with ESRD and CVD who were admitted to the ICU.
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Affiliation(s)
- Yong Wang
- Department of Emergency, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Zheqian Wu
- Department of Emergency, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Shijie Lu
- Department of Emergency, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Lili Yin
- Department of Emergency, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Yuandong Chen
- Department of Emergency, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Canyi Qiu
- Department of Emergency, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Pauline Yeung Ng
- Critical Care Medicine Unit, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China;,Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China
| | - Koray Durak
- Department of Thoracic Surgery, RWTH University Hospital, Aachen, Germany;,Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, ASUFC-Academic Hospital of Udine, Udine, Italy
| | - Fei Ding
- Department of Emergency, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Zhiyan Zhang
- Department of Emergency, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Lihua Dai
- Department of Emergency, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
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Deana C, Vetrugno L, Bagatto D. Correlation does not mean causation: Proofs of COVID-19 associated strokes! Brain Hemorrhages 2022; 4:S2589-238X(22)00075-4. [PMID: 36339919 PMCID: PMC9616474 DOI: 10.1016/j.hest.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023] Open
Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Daniele Bagatto
- Department of Neuroradiology, Health Integrated Agency of Friuli Centrale, Udine, Italy
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Vetrugno L, Orso D, Corradi F, Zani G, Spadaro S, Meroi F, D’Andrea N, Bove T, Cammarota G, De Robertis E, Ferrari S, Guarnieri M, Ajuti M, Fusari M, Grieco DL, Deana C, Boero E, Franchi F, Scolletta S, Maggiore SM, Forfori F. Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study. Respir Res 2022; 23:210. [PMID: 35989352 PMCID: PMC9392990 DOI: 10.1186/s12931-022-02138-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction (DTF) could provide corroborating information for weaning COVID-19 patients from mechanical ventilation.
Methods
This was an observational, pragmatic, cross-section, multicenter study in 6 Italian intensive care units. DTF was assessed in COVID-19 patients undergoing weaning from mechanical ventilation from 1st March 2020 to 30th June 2021. Primary aim was to evaluate whether DTF is a predictive factor for weaning failure.
Results
Fifty-seven patients were enrolled, 25 patients failed spontaneous breathing trial (44%). Median length of invasive ventilation was 14 days (IQR 7–22). Median DTF within 24 h since the start of weaning was 28% (IQR 22–39%), RASS score (− 2 vs − 2; p = 0.031); Kelly-Matthay score (2 vs 1; p = 0.002); inspiratory oxygen fraction (0.45 vs 0.40; p = 0.033). PaO2/FiO2 ratio was lower (176 vs 241; p = 0.032) and length of intensive care stay was longer (27 vs 16.5 days; p = 0.025) in patients who failed weaning. The generalized linear regression model did not select any variables that could predict weaning failure. DTF was correlated with pH (RR 1.56 × 1027; p = 0.002); Kelly-Matthay score (RR 353; p < 0.001); RASS (RR 2.11; p = 0.003); PaO2/FiO2 ratio (RR 1.03; p = 0.05); SAPS2 (RR 0.71; p = 0.005); hospital and ICU length of stay (RR 1.22 and 0.79, respectively; p < 0.001 and p = 0.004).
Conclusions
DTF in COVID-19 patients was not predictive of weaning failure from mechanical ventilation, and larger studies are needed to evaluate it in clinical practice further.
Registered: ClinicalTrial.gov (NCT05019313, 24 August 2021).
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Deana C, Vetrugno L, Stefani F, Bassi F, Bove T. Transcranial Doppler in a child: A most valuable imaging modality. Ultrasound 2022; 30:167-172. [PMID: 35509297 PMCID: PMC9058393 DOI: 10.1177/1742271x21998059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/01/2021] [Indexed: 05/03/2023]
Abstract
Introduction Pediatric brain injury is a common cause of emergency department (ED) referral. Although severe traumatic brain damage is less frequent, it could be primarily managed by non-pediatric critical care physicians called in for advice. Clinical evaluation is important, but radiology is of particular value in the case of severe brain injury. Transcranial Doppler may help the physician through neuromonitoring. Case Report We report the case of a 3-year-old male child brought into the pediatric ED for a moderate head injury. His neurological status deteriorated rapidly, making endotracheal intubation and mechanical ventilation necessary. Computed tomography (CT) of the head revealed brain contusion and post-traumatic subarachnoidal hemorrhage. Discussion Transcranial Doppler was performed at the standard transtemporal evaluation window, and it showed normal vascularization of the entire anterior brain. This result permitted performance of the control CT scan to be postponed. In this case, basic knowledge of transcranial ultrasound proved to be useful, and we believe it could also be useful to other colleagues faced with similar situations even if they are not dedicated to pediatric critically ill patients. Conclusion Doppler ultrasound in the pediatric population is a valuable bedside tool. Together with clinical evaluation and radiology, it completes the set of techniques necessary for continuous neuromonitoring.
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Cristian Deana, Anesthesia and Intensive Care 1, Anesthesia and Intensive Care Department, Academic Hospital S. Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale S. M. della Misericordia, 15 - 33100 Udine, Italy.
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Medical Department, University of Udine, Udine, Italy
| | - Francesca Stefani
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Medical Department, University of Udine, Udine, Italy
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26
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Deana C, Bagatto D, Battezzi A, Pecori D, Lorenzut S, Tuniz F. Disseminated nocardiosis after cladribine treatment for relapsing remitting multiple sclerosis: a case report. J Neurol 2022; 269:4557-4559. [PMID: 35352170 DOI: 10.1007/s00415-022-11097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Piazzale S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Daniele Bagatto
- Department of Diagnostic Imaging, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Alessandra Battezzi
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Piazzale S. Maria della Misericordia 15, 33100, Udine, Italy
| | - Davide Pecori
- Infectious Disease Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Simone Lorenzut
- Department of Neurosciences, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Francesco Tuniz
- Department of Neurosciences, Health Integrated Agency of Friuli Centrale, Udine, Italy
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27
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Vetrugno L, Deana C, Maggiore SM. COVID-19 Hurricane: Recovering the Worldwide Health System with the RE.RE.RE. (REsponse–REstoration–REengineering) Approach—Who Will Get There First? Healthcare (Basel) 2022; 10:healthcare10040602. [PMID: 35455780 PMCID: PMC9029496 DOI: 10.3390/healthcare10040602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy;
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy;
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
- Correspondence: ; Tel.: +39-333-374-5660
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy;
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d’Annunzio University of ChietiPescara, 66100 Chieti, Italy
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28
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Xu SJ, Lin LQ, Chen C, Chen TY, You CX, Chen RQ, Deana C, Wakefield CJ, Shrager JB, Molena D, Yang CFJ, Lin JH, Chen SC. Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma. Ann Transl Med 2022; 10:161. [PMID: 35280418 PMCID: PMC8908120 DOI: 10.21037/atm-22-506] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/18/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Shao-Jun Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lan-Qin Lin
- Department of Operation, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ting-Yu Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Cheng-Xiong You
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rui-Qin Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, ASUFC-Academic Hospital of Udine, Udine, Italy
| | - Connor J. Wakefield
- Department of Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Joseph B. Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chi-Fu Jeffrey Yang
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Ji-Hong Lin
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shu-Chen Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
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Deana C, Vetrugno L, Fabris M, Curcio F, Sozio E, Tascini C, Bassi F. Pericardial Cytokine "Storm" in a COVID-19 Patient: the Confirmation of a Hypothesis. Inflammation 2022; 45:1-5. [PMID: 34533672 PMCID: PMC8446479 DOI: 10.1007/s10753-021-01563-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/22/2021] [Accepted: 09/07/2021] [Indexed: 12/30/2022]
Abstract
Novel Coronavirus Disease in most cases produces mild symptoms which resolve after a few days. Some authors hypothesized that SARS-CoV-2 infection could trigger excessive cytokine production leading to a severe multi-organ disease requiring intensive care admission. Respiratory and neurological symptoms are the most frequently reported manifestation of the disease. Indeed, cardiac involvement is reported mostly as a part of a systemic disease. Few isolated cardiac manifestations of COVID-19 infection have been described. We report herein a case of SARS-CoV-2 related severe isolated pericardial involvement requiring ICU admission due to cardiac tamponade needing urgent drainage. Analysis of pericardial fluid from drainage demonstrated a higher cytokine concentration than blood values. Other causes of pericardial disease, such as autoimmunity, bacterial or other than COVID-19 infection, neoplasms or acute myocardial infarction were also evaluated, but all tests confirmed negative results. The suspicion of isolated involvement of the pericardium was therefore demonstrated by the analysis of cytokines which strongly support our hypothesis.
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care Medicine, Academic Hospital of Udine, Piazzale S.M. della Misericordia, 15, 33100, Udine, Italy.
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Medicine, Academic Hospital of Udine, Piazzale S.M. della Misericordia, 15, 33100, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Martina Fabris
- Department of Medicine, University of Udine, Udine, Italy
- Institute of Clinical Pathology, Department of Laboratory Medicine, Academic Hospital of Udine, Udine, Italy
| | - Francesco Curcio
- Department of Medicine, University of Udine, Udine, Italy
- Institute of Clinical Pathology, Department of Laboratory Medicine, Academic Hospital of Udine, Udine, Italy
| | - Emanuela Sozio
- Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
| | - Carlo Tascini
- Department of Medicine, University of Udine, Udine, Italy
- Infectious Diseases Clinic, Udine University Hospital, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care Medicine, Academic Hospital of Udine, Piazzale S.M. della Misericordia, 15, 33100, Udine, Italy
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30
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Deana C, Vetrugno L, Stefani F, Bassi F. Bronchoscopic suspect of Herpesvirus infection in critically ill COVID-19 patients: two case reports and brief literature review. Acta Biomed 2022; 92:e2021514. [PMID: 35045066 PMCID: PMC10523049 DOI: 10.23750/abm.v92is1.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 06/14/2023]
Abstract
Herpesviridae infection in COVID-19 patients has been reported, particularly muco-cutaneous lesions. Little is known about Herpesviridae lung infection in critically ill COVID-19 patients. Typical scattered lesions seen through fiberoptic bronchoscopy in these patients should raise the question as to whether to start empirically acyclovir treatment while a Herpesviridae diagnostics result becomes available.
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Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care Unit 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
| | | | - Francesca Stefani
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine.
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine.
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31
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Pauletto G, Nilo A, Deana C, Verriello L, Del Negro I, Lettieri C, Vetrugno L, Valente M, Gigli GL. Reply letter to "COVID-19 and Recurrent Status Epilepticus". Acta Biomed 2022; 93:e2022074. [PMID: 35775750 PMCID: PMC9335440 DOI: 10.23750/abm.v93i3.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Giada Pauletto
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Cristian Deana
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Lorenzo Verriello
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Ilaria Del Negro
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Christian Lettieri
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Luigi Vetrugno
- Clinical Anesthesia and Intensive Care, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
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32
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Furlan D, Deana C, Orso D, Licari M, Cappelletto B, DE Monte A, Vetrugno L, Bove T. Perioperative management of spinal cord injury: the anesthesiologist's point of view. Minerva Anestesiol 2021; 87:1347-1358. [PMID: 34874136 DOI: 10.23736/s0375-9393.21.15753-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) is one of the most devastating events a person can experience. It may be life-threatening or result in long-term disability. This narrative review aims to delineate a systematic step-wise airways, breathing, circulation and disability (ABCD) approach to perioperative patient management during spinal cord surgery in order to fill some of the gaps in our current knowledge. METHODS We performed a comprehensive review of the literature regarding the perioperative management of traumatic spinal injuries from May 15, 2020, to December 13, 2020. We consulted the PubMed and Embase database libraries. RESULTS Videolaryngoscopy supplements the armamentarium available for airway management. Optical fiberscope use should be evaluated when intubating awake patients. Respiratory complications are frequent in the acute phase of traumatic spinal injury, with an estimated incidence of 36-83%. Early tracheostomy can be considered for expected difficult weaning from mechanical ventilation. Careful intraoperative management of administered fluids should be pursued to avoid complications from volume overload. Neuromonitoring requires investments in staff training and cooperation, but better outcomes have been obtained in centers where it is routinely applied. The prone position can cause rare but devastating complications, such as ischemic optic neuropathy; thus, the anesthetist should take the utmost care in positioning the patient. CONCLUSIONS A one-size fit all approach to spinal surgery patients is not applicable due to patient heterogeneity and the complexity of the procedures involved. The neurologic outcome of spinal surgery can be improved, and the incidence of complications reduced with better knowledge of patient-specific aspects and individualized perioperative management.
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Affiliation(s)
- Davide Furlan
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Daniele Orso
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Maurizia Licari
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Barbara Cappelletto
- Section of Spine and Spinal Cord Surgery, Department of Neurological Sciences, ASUFC University Hospital of Udine, Udine, Italy
| | - Amato DE Monte
- Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine (DAME), University of Udine, Udine, Italy - .,Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine (DAME), University of Udine, Udine, Italy.,Department of Anesthesia and Intensive Care Medicine, ASUFC University Hospital of Udine, Udine, Italy
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33
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Deana C, Vetrugno L, Bignami E, Bassi F. Peri-operative approach to esophagectomy: a narrative review from the anesthesiological standpoint. J Thorac Dis 2021; 13:6037-6051. [PMID: 34795950 PMCID: PMC8575828 DOI: 10.21037/jtd-21-940] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/19/2021] [Indexed: 12/16/2022]
Abstract
Objective This review summarizes the peri-operative anesthesiological approaches to esophagectomy considering the best up-to-date, evidence-based medicine, discussed from the anesthesiologist’s standpoint. Background Esophagectomy is the only curative therapy for esophageal cancer. Despite the many advancements made in the surgical treatment of this tumour, esophagectomy still carries a morbidity rate reaching 60%. Patients undergoing esophagectomy should be referred to high volume centres where they can receive a multidisciplinary approach to treatment, associated with better outcomes. The anesthesiologist is the key figure who should guide the peri-operative phase, from diagnosis through to post-surgery rehabilitation. We performed an updated narrative review devoted to the study of anesthesia management for esophagectomy in cancer patients. Methods We searched MEDLINE, Scopus and Google Scholar databases from inception to May 2021. We used the following terms: “esophagectomy”, “esophagectomy AND pre-operative evaluation”, “esophagectomy AND protective lung ventilation”, “esophagectomy AND hemodynamic monitoring” and “esophagectomy AND analgesia”. We considered only articles with abstract written in English and available to the reader. We excluded single case-reports. Conclusions Pre-operative anesthesiological evaluation is mandatory in order to stratify and optimize any medical condition. During surgery, protective ventilation and judicious fluid management are the cornerstones of intraoperative “protective anesthesia”. Post-operative care should be provided by an intensive care unit or high-dependency unit depending on the patient’s condition, the type of surgery endured and the availability of local resources. The provision of adequate post-operative analgesia favours early mobilization and rapid recovery. Anesthesiologist has an important role during the peri-operative care for esophagectomy. However, there are still some topics that need to be further studied to improve the outcome of these patients.
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, ASUFC-Academic Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care, ASUFC-Academic Hospital of Udine, Udine, Italy.,Department of Medical Area, University of Udine, Udine, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, ASUFC-Academic Hospital of Udine, Udine, Italy
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Pauletto G, Nilo A, Deana C, Verriello L, Del Negro I, Lettieri C, Vetrugno L, Valente M, Gigli GL. Recurrent Status Epilepticus and SARS-CoV-2 infection: the "perfect storm". Acta Biomed 2021; 92:e2021208. [PMID: 34738572 PMCID: PMC8689343 DOI: 10.23750/abm.v92i5.11593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022]
Abstract
Respiratory involvement is the most common clinical manifestation of COVID-19, but neurological symptoms and complications are increasingly being recognized. Seizures and status epilepticus (SE) have been described as possible consequences of hypoxia and metabolic derangements during SARS-CoV-2 infection, direct viral invasion of the central nervous system, or as para or post-infectious complications. Single episodes of SE have been described, occurring during the acute phase of COVID-19 or once the patients have been recovered. Herein, we present the case of a patient with a positive serology test for SARS-CoV-2 (IgG+, IgM-) and recurrent SE occurring within 36 days. Diagnostic work-up ruled out other known causes of SE. A post-COVID-19 infectious inflammatory/immune response is hypothesized as the possible trigger of SE.
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Affiliation(s)
- Giada Pauletto
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy.
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy.
| | - Cristian Deana
- Anesthesia and Intensive Care Unit 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
| | - Lorenzo Verriello
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy.
| | - Ilaria Del Negro
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy.
| | - Christian Lettieri
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy.
| | - Luigi Vetrugno
- Clinical Anesthesia and Intensive Care, Department of Medicine (DAME), University of Udine Medical School, Udine, Italy.
| | - Mariarosaria Valente
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy.
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy.
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Deana C, Vetrugno L, Tonizzo A, Orso D, Piani T, Bove T, De Monte A. Drug Supply During COVID-19 Pandemic: Remember Not to Run With Your Tank Empty. Hosp Pharm 2021; 56:405-407. [PMID: 34720135 DOI: 10.1177/0018578720931749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Cristian Deana
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luigi Vetrugno
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,University of Udine, Udine, Italy
| | | | | | - Tommaso Piani
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Tiziana Bove
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,University of Udine, Udine, Italy
| | - Amato De Monte
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Vetrugno L, Divella M, Orso D, Deana C, Vaccher G, Drovandi P, Beltrame A, Causero A, Bove T. Tracheal lesion during shoulder surgery: a case report and systemic review of the literature. J Anesth Analg Crit Care 2021; 1:11. [PMID: 37386524 DOI: 10.1186/s44158-021-00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 07/01/2023]
Abstract
Pneumomediastinum (PNM) and pneumothorax (PNX) are documented complications of arthroscopic shoulder surgery (ATS). Plexus anesthetic block and tracheal lesions during endotracheal intubation are hypothesized to be the underlying risk factors; however, the actual evidence supporting this hypothesis is scarce.A case of bilateral laterocervical emphysema, subcutaneous edema, and signs of PNM after ATS performed under general anesthesia and supra-scapular nerve block is presented. An up-to-date systematic review of PNM/PNX during orthopedic surgery was performed, involving six databases: PubMed (1996-present), Embase (1974-present), Scopus (2004-present), SpringerLink (1950-present), Ovid Emcare (1995-present), and Google Scholar (2004-present).Twenty-five case studies met the eligibility criteria. In 24 cases, the patient underwent general anesthesia and orotracheal intubation; in 9 of these, a plexus anesthetic block was also performed. One case involved ATS under plexus anesthetic block only. In 10 cases, the diagnostic finding was PNM. In 5 cases, the diagnostic finding was associated with PNX. PNX was detected in 17 cases. In 2 cases, SE was found in the absence of any evidence of either PNM or PNX. A tracheal lesion was identified in 3 cases.Endotracheal intubation and loco-regional anesthesia are not the only predisposing risk factors at play in the pathogenesis of PNM/PNX. Rather, multi-factorial pathogenesis seems more probable, necessitating that specific attention is paid during ATS to the change in patient position on the operating bed, to any slipping of the endotracheal tube, to patient monitoring whilst under the drapes, and to the cuff pressure. PROSPERO registration number: CRD42021260370.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Michele Divella
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Cristian Deana
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Giulia Vaccher
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Pietro Drovandi
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Alessandro Beltrame
- Orthopedic and Trauma Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Araldo Causero
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Orthopedic and Trauma Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
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Barbariol F, Deana C, Guadagnin GM, Cammarota G, Vetrugno L, Bassi F. Ultrasound diaphragmatic excursion during non-invasive ventilation in ICU: a prospective observational study. Acta Biomed 2021; 92:e2021269. [PMID: 34212900 PMCID: PMC8343726 DOI: 10.23750/abm.v92i3.11609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
Background and Aim: Diaphragmatic dysfunction is seen in up to 60% of critically ill patients with respiratory failure, and it is associated with worse outcomes. The functionality of the diaphragm can be studied with simple and codified bedside ultrasound evaluation. Diaphragm excursion is one of the most studied parameters. The aim of this study was to assess the prevalence of diaphragmatic dysfunction in critically ill non-intubated patients admitted to a general intensive care unit with acute respiratory failure. Methods: We collected data, including ultrasound diaphragm excursion, at 2 time points: at T0 (at the time of recruitment, just before starting NIV) and at T1 (after one hour of NIV). Results: A total of 47 patients were enrolled. The prevalence of diaphragm dysfunction was 42.5% (95% CI 28, 3 - 57,8). Surgical patients showed a higher incidence (relative risk of 1.97) than medical patients. Mean DE was not significantly different between NIV responders (1,35 ± 0.78 cm) and non-responders (1.21 ± 0.85 cm, p 0,6). Patients with diaphragmatic dysfunction responded positively to NIV in 60% (95% CI 36.0 - 80.9%) of cases, while patients without diaphragmatic dysfunction responded positively to the NIV trial in 70.4% (95% CI 49.8 - 86.2%) of cases (p = 0.54). Taking the use of ultrasound diaphragm excursion as a potential predictor of NIV response, the corresponding ROC curve had an area under the curve of 0.53; the best balance between sensitivity (58.1%) and specificity (62.5%) was obtained with a cut-off diaphragm excursion of 1.37 cm. Conclusions: Diaphragm dysfunction is particularly frequent in critically ill patients with respiratory failure. The functionality of the diaphragm can be effectively and easily tested by bedside ultrasound examination. Overall, our results point towards tentative evidence of a trend of a different response to NIV in patients with vs without diaphragmatic dysfunction. (www.actabiomedica.it)
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Affiliation(s)
- Federico Barbariol
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
| | - Cristian Deana
- Anesthesia and Intensive Care Unit 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
| | - Giovanni Maria Guadagnin
- Anesthesia and Intensive Care, Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
| | | | - Luigi Vetrugno
- Department of Medical Area, University of Udine, Udine, Italy..
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy..
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Barbariol F, Deana C, Lucchese F, Cataldi G, Bassi F, Bove T, Vetrugno L, De Monte A. Evaluation of Drug Wastage in the Operating Rooms and Intensive Care Units of a Regional Health Service. Anesth Analg 2021; 132:1450-1456. [PMID: 33667211 DOI: 10.1213/ane.0000000000005457] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pharmacological treatments for critical processes in patients need to be initiated as rapidly as possible; for this reason, it is a standard of care to prepare the main anesthesia and emergency drugs in advance. As a result, 20%-50% of the prepared drugs remain unused and are then discarded. Decreasing waste by optimizing drug use is an attractive strategy for meeting both cost containment and environmental sustainability. The primary end point of this study was to measure the actual amount of drug wastage in the operating rooms (ORs) and intensive care units (ICUs) of a Regional Health Service (RHS). The secondary end point was to analyze and estimate the economic implications of this waste for the Health Service and to suggest possible measures to reduce it. METHODS This prospective observational multicenter study was conducted across 12 hospitals, all of which belong to the same RHS in the north-east of Italy. Data collection took place in March 2018 and included patients admitted to ICUs, emergency areas, and ORs of the participating hospitals. Data concerning drug preparation and administration were collected for all consecutive patients, independent of case types and of whether operations were scheduled or unscheduled. Drug wastage was defined as follows: drugs prepared in ready-to-use syringes but not administered at all and discarded untouched. We then estimated the costs of wasted drugs for a 1-year period using the data from this study and the yearly regional pharmacy orders of drugs provided to the ORs and ICUs. We also performed a sensitivity analysis to validate the robustness of our assumptions and qualitative conclusions. RESULTS We collected data for a total of 13,078 prepared drug syringes. Drug wastage varied from 7.8% (Urapidil, an alpha-1 antagonist antihypertensive) to 85.7% (epinephrine) of prepared syringes, with an overall mean wastage rate of 38%. The estimated yearly waste was 139,531 syringes, for a total estimated financial cost of €78,060 ($92,569), and an additional quantity of medical waste amounting to 4968 kg per year. The total provider time dedicated to the preparation of unused drugs was predicted to be 1512 working hours per year. CONCLUSIONS The overall extent of drug wastage in ORs and ICUs is concerning. Interventions aimed at minimizing waste-related costs and improving the environmental sustainability of our practice are paramount. Effort should be put into designing a more efficient workflow that reduces this waste while providing for the emergency availability of these medications in the OR and ICU.
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Affiliation(s)
- Federico Barbariol
- From the Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, Udine, Italy
| | - Cristian Deana
- From the Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, Udine, Italy
| | - Francesca Lucchese
- From the Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, Udine, Italy
| | - Giuseppe Cataldi
- Department of Anesthesia and Intensive Care Medicine, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy
| | - Flavio Bassi
- From the Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care Medicine, University of Udine, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Medicine, University of Udine, University-Hospital of Udine, Udine, Italy
| | - Amato De Monte
- From the Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, Udine, Italy
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Deana C, Rovida S, Orso D, Bove T, Bassi F, De Monte A, Vetrugno L. Learning from the Italian experience during COVID-19 pandemic waves: be prepared and mind some crucial aspects. Acta Biomed 2021; 92:e2021097. [PMID: 33988143 PMCID: PMC8182622 DOI: 10.23750/abm.v92i2.11159] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
COVID-19 pandemic has rapidly spread worldwide causing a serious challenge to the global medical community. Italy was struck hard during the first wave earlier this year and several weaknesses as well as general unpreparedness of the national healthcare system were acknowledged. Learning essential lessons from the past, we realized how implementing contingency response measures, human resources and social dynamics could have changed the outcome if promptly adopted. This review translates the previous experience into strategic actions that has to be considered when developing appropriate national and regional operational plans to respond to a pandemic.
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Affiliation(s)
| | - Serena Rovida
- 2Department of Anesthesia and Intensive Care Unit, Saint Bartholomew's Hospital, Barts NHS Trust, London, UK..
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy..
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy..
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Amato De Monte
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy..
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Vetrugno L, Bignami E, Deana C, Bassi F, Vargas M, Orsaria M, Bagatto D, Intermite C, Meroi F, Saglietti F, Sartori M, Orso D, Robiony M, Bove T. Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports. Scand J Trauma Resusc Emerg Med 2021; 29:47. [PMID: 33712051 PMCID: PMC7953582 DOI: 10.1186/s13049-021-00861-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background The incidence of cerebral fat embolism (CFE) ranges from 0.9–11%, with a mean mortality rate of around 10%. Although no univocal explanation has been identified for the resulting fat embolism syndrome (FES), two hypotheses are widely thought: the ‘mechanical theory’, and the ‘chemical theory’. The present article provides a systematic review of published case reports of FES following a bone fracture. Methods We searched MEDLINE, Web of Science and Scopus to find any article related to FES. Inclusion criteria were: trauma patients; age ≥ 18 years; and the clinical diagnosis of CFE or FES. Studies were excluded if the bone fracture site was not specified. Results One hundred and seventy studies were included (268 cases). The male gender was most prominent (81.6% vs. 18.4%). The average age was 33 years (±18). The mean age for males (29 ± 14) was significantly lower than for females (51 ± 26) (p < 0.001). The femur was the most common fracture site (71% of cases). PFO was found in 12% of all cases. Univariate and multivariate regression analyses showed the male gender to be a risk factor for FES: RR 1.87 and 1.41, respectively (95%CI 1.27–2.48, p < 0.001; 95%CI 0.48–2.34, p < 0.001). Conclusions FES is most frequent in young men in the third decades of life following multiple leg fractures. FES may be more frequent after a burst fracture. The presence of PFO may be responsible for the acute presentation of cerebral embolisms, whereas FES is mostly delayed by 48–72 h. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00861-x.
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy. .,Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy.
| | - Elena Bignami
- Department of Medicine and Surgery, Unit of Anesthesiology, Parma University Hospital, Parma, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Unit 1, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Unit 2, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Orsaria
- Department of Medicine, Surgical Pathology Section, University of Udine, Udine, Italy
| | - Daniele Bagatto
- Department of Diagnostic Imaging, Neuroradiology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Cristina Intermite
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | - Francesco Meroi
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | | | - Marco Sartori
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | - Daniele Orso
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
| | - Massimo Robiony
- Department of Medicine, Maxillofacial Surgery, University of Udine, Udine, Italy.,Azienda Sanitaria Universitaria Friuli Centrale, Maxillofacial Surgery, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, Anesthesia and Intensive Care Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy
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Deana C, Vetrugno L, Bove T, De Monte A. Imagine a Giant Aneurysm in the Posterior Cerebral Artery: More Ultrasound Than Words. J Ultrasound Med 2021; 40:637-639. [PMID: 32748965 DOI: 10.1002/jum.15416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luigi Vetrugno
- Anesthesia and Intensive Care Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Tiziana Bove
- Anesthesia and Intensive Care Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Amato De Monte
- Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Deana C. Immunonutrition in perioperative care of COVID-19 patients: an old weapon for a new disease? Braz J Anesthesiol 2021; 71:197. [PMID: 33612882 PMCID: PMC7886633 DOI: 10.1016/j.bjane.2020.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care 1, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Deana C, Sermann G, De Monte A. Intensive care unit discharge: mind the gap! BMC Anesthesiol 2021; 21:40. [PMID: 33557753 PMCID: PMC7868305 DOI: 10.1186/s12871-021-01251-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
Mortality after intensive care discharge is a hot topic in critical care medicine. Many factors probably play a role: patient's comorbidities and severity of the disease may have great impact on mortality. However it should be taken into account also the level of care that characterizes the ward in which the patient is discharged to. A soft transition from intensive care units to the other hospital wards is desirable to avoid the traumatic step that the fragile post-ICU patient has to face with.
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Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care Medicine, Academic Hospital "S. Maria della Misericordia", Piazzale S. M. della Misericordia, 15, 33100, Udine, Italy.
| | - Giovanni Sermann
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care Medicine, Academic Hospital "S. Maria della Misericordia", Piazzale S. M. della Misericordia, 15, 33100, Udine, Italy
| | - Amato De Monte
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care Medicine, Academic Hospital "S. Maria della Misericordia", Piazzale S. M. della Misericordia, 15, 33100, Udine, Italy
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Deana C, Verriello L, Pauletto G, Corradi F, Forfori F, Cammarota G, Bignami E, Vetrugno L, Bove T. Insights into neurological dysfunction of critically ill COVID-19 patients. Trends Anaesth Crit Care 2021; 36:30-38. [PMID: 38620281 PMCID: PMC7490585 DOI: 10.1016/j.tacc.2020.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 12/29/2022]
Abstract
Novel coronavirus spread rapidly around the world infecting millions of people. It was thus declared a pandemic. This new virus damages the lungs. In the most severe cases, it leads to acute respiratory failure that requires intensive care treatment. However, many clinical reports have listed different neurological symptoms, leading to increased interest in the neurological involvement of COVID-19. Various pathophysiological mechanisms have been proposed to explain these neurological aspects. Direct viral invasion of the nervous system, systemic cytokine storm and severe hypoxemia are key factors in the development of symptoms. Critically ill patients present several additional risk factors for nervous system damage. Reasons for these include deep sedation and extended muscular paralysis, bed rest for several days, and the inability to receive proper physical rehabilitation. After ICU treatment, COVID-19 patients generally require an extensive rehabilitation program. However, distancing restrictions mean that in many cases physiotherapists are unable to enter ICUs, delaying the process of rehabilitation. The role of telemedicine should be considered as an adjunctive tool in the rehabilitation of critically ill COVID-19 patients.
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Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care Department, Santa Maria della Misericordia Academic Hospital, ASUFC, Udine, Italy
| | - Lorenzo Verriello
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia Academic Hospital, ASUFC, Udine, Italy
| | - Giada Pauletto
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia Academic Hospital, ASUFC, Udine, Italy
| | - Francesco Corradi
- Department of Anesthesiology, Ente Ospedaliero Ospedali Galliera, Genova, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care, Maggiore della Carità University Hospital, Novara, Italy
| | - Elena Bignami
- Anesthesia, Intensive Care and Pain Therapy Service, University-Hospital of Parma, Parma, Italy
| | - Luigi Vetrugno
- Anesthesia and Intensive Care Department, Santa Maria della Misericordia Academic Hospital, ASUFC, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
| | - Tiziana Bove
- Anesthesia and Intensive Care Department, Santa Maria della Misericordia Academic Hospital, ASUFC, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
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Piani T, Zanardo D, Deana C. Sliding Doors During COVID-19: Choose the Right One! Journal of Emergency Medicine, Trauma and Acute Care 2021. [DOI: 10.5339/jemtac.2020.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Tommaso Piani
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy E-mail:
| | - Davide Zanardo
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy E-mail:
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy E-mail:
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Deana C, Vetrugno L, Stefani F, Basso A, Matellon C, Barbariol F, Vecchiato M, Ziccarelli A, Valent F, Bove T, Bassi F, Petri R, De Monte A. Postoperative complications after minimally invasive esophagectomy in the prone position: any anesthesia-related factor? Tumori 2020; 107:525-535. [PMID: 33323061 DOI: 10.1177/0300891620979358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the incidence of postoperative complications arising within 30 days of minimally invasive esophagectomy in the prone position with total lung ventilation and their relationship with 30-day and 1-year mortality. Secondary outcomes included possible anesthesia-related factors linked to the development of complications. METHODS The study is a retrospective single-center observational study at the Anesthesia and Surgical Department of a tertiary care center in the northeast of Italy. Patients underwent cancer resection through esophagectomy in the prone position without one-lung ventilation. RESULTS We included 110 patients from January 2010 to December 2017. A total of 54% of patients developed postoperative complications that increased mortality risk at 1 year of follow-up. Complications postponed first oral intake and delayed patient discharge to home. Positive intraoperative fluid balance was related to increased mortality and the risk to develop postoperative complications. C-reactive protein at third postoperative day may help detect complication onset. CONCLUSIONS Complication onset has a great impact on mortality after esophagectomy. Some anesthesia-related factors, mainly fluid balance, may be associated with postoperative mortality and morbidity. These factors should be carefully taken into account to obtain better outcomes after esophagectomy in the prone position without one-lung ventilation.
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Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luigi Vetrugno
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Francesca Stefani
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Andrea Basso
- Department of Medicine, University of Udine, Udine, Italy
| | - Carola Matellon
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Federico Barbariol
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Massimo Vecchiato
- General Surgery, Department of Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Antonio Ziccarelli
- General Surgery, Department of Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Francesca Valent
- Institute of Epidemiology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Tiziana Bove
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Flavio Bassi
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Roberto Petri
- General Surgery, Department of Surgery, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Amato De Monte
- Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Buttera S, Deana C, Beltrame F, Bassi F, Vetrugno L, Bove T. An 84-Year-Old Woman with Shortness of Breath and Low Oxygen Saturation: “Think Outside the Box”. Turk J Anaesthesiol Reanim 2020; 48:505-508. [PMID: 33313592 PMCID: PMC7720821 DOI: 10.5152/tjar.2020.53323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 09/19/2019] [Indexed: 11/22/2022] Open
Abstract
An 84-year-old woman, who had been admitted to the emergency department (ED) several times because of dyspnoea, was treated for acute exacerbation of chronic respiratory failure without satisfactory clinical improvement. According to her medical history, 8 years earlier, she underwent a complicated cardiosurgical procedure that required tracheostomy and mechanical ventilation in the post-operative period for 45 days. Traditional X-Ray did not show any abnormal findings; however, high resolution thorax computed tomography (HRCT) scan revealed a severe tracheal stenosis, which was confirmed with bronchoscopy, and required immediate tracheostomy. Tracheal stenosis is a rare but severe complication that should be suspected when a patient with previous tracheostomy presents to the ED with dyspnoea even if tracheostomy had been closed many years before, because adaptive mechanism results in asymptomatic life for a long period.
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Affiliation(s)
- Stefania Buttera
- Anaesthesia and Intensive Care Unit 2, Department of Anaesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
| | - Cristian Deana
- Anaesthesia and Intensive Care Unit 1, Department of Anaesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
| | - Fabio Beltrame
- Anaesthesia and Intensive Care Unit 2, Department of Anaesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
| | - Flavio Bassi
- Anaesthesia and Intensive Care Unit 2, Department of Anaesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Anaesthesia and Intensive Care Clinic, Department of Anaesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Anaesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Tiziana Bove
- Anaesthesia and Intensive Care Clinic, Department of Anaesthesia and Intensive Care, Academic Hospital of Udine, Udine, Italy
- Anaesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
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Delrio S, Vetrugno L, Orso D, Deana C, D'Andrea N, Bove T. Lung ultrasound signs and cytokine profile in Covid-19 patients: a case series. Eur Rev Med Pharmacol Sci 2020; 24:8632-8634. [PMID: 32964950 DOI: 10.26355/eurrev_202009_22799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- S Delrio
- Department of Medicine, University of Udine, Udine, Italy.
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Vetrugno L, Orso D, Deana C, Bassi F, Bove T. COVID-19 Diagnostic Imaging: Caution Need Before the End of the Game. Acad Radiol 2020; 27:1331. [PMID: 32593539 PMCID: PMC7305904 DOI: 10.1016/j.acra.2020.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/25/2022]
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50
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Deana C, Baron D, Barbariol F, Negri K, Vecil M, Vetrugno L, Bove T, Monte AD. A Complex Coronary Artery Fistula as a Potential Cause of Sudden Intraoperative Hemodynamic Compromise: A Case Report. Semin Cardiothorac Vasc Anesth 2020; 24:369-373. [PMID: 32456533 DOI: 10.1177/1089253220922329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A patient with coronary artery fistula should be considered as high risk for intraoperative hemodynamic decompensation. In this article, we report the case of a 70-year-old man affected by a complex congenital coronary artery fistula defect. The patient underwent general anesthesia for spine surgery with permissive hypotension. The development of sudden intraoperative tachyarrhythmia with hemodynamic instability required immediate resuscitation and interruption of surgery. The claim advanced is that in patients with a coronary artery fistula permissive hypotension might be considered an option only if strictly necessary and real-time cardiac monitoring including transesophageal echocardiography is available to immediately detect and treat acute cardiac impairment.
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Affiliation(s)
- Cristian Deana
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Daniele Baron
- Department of Medicine, University of Udine, Udine, Italy
| | - Federico Barbariol
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | | | - Marco Vecil
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Luigi Vetrugno
- Anesthesia and Intensive Care Clinic, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Tiziana Bove
- Anesthesia and Intensive Care Clinic, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.,Anesthesia and Intensive Care Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Amato De Monte
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
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