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Currò JM, Santonocito C, Merola F, Messina S, Sanfilippo M, Brancati S, Drago F, Sanfilippo F. Ciprofol as compared to propofol for sedation and general anesthesia: a systematic review of randomized controlled trials. J Anesth Analg Crit Care 2024; 4:24. [PMID: 38589912 PMCID: PMC11000282 DOI: 10.1186/s44158-024-00159-1] [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: 02/15/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Propofol is the most commonly used hypnotic agent used during sedation and general anesthesia (GA) practice, offering faster recovery compared to benzodiazepines. However, cardiovascular impact of propofol and pain at injection are commonly encountered side effects. Ciprofol is a novel disubstituted phenol derivative, and there is growing evidence regarding its clinical use. METHODS We conducted a systematic literature search (updated on 23 July 2023) to evaluate safety and efficacy of ciprofol in comparison to propofol in patients undergoing procedures under sedation or GA. We focused on randomized controlled trials (RCTs) only, extrapolating data on onset and offset, and on the side effects and the pain at injection. RESULTS The search revealed 14 RCTs, all conducted in China. Eight RCTs studied patients undergoing sedation, and six focused on GA. Bolus of ciprofol for sedation or induction of GA varied from 0.2 to 0.5 mg/kg. In four studies using ciprofol for maintenance of GA, it was 0.8-2.4 mg/kg/h. Ciprofol pharmacokinetics seemed characterized by slower onset and offset as compared to propofol. Pain during injection was less frequent in the ciprofol group in all the 13 studies reporting it. Eight studies reported "adverse events" as a pooled outcome, and in five cases, the incidence was higher in the propofol group, not different in the remaining ones. Occurrence of hypotension was the most commonly investigated side effects, and it seemed less frequent with ciprofol. CONCLUSION Ciprofol for sedation or GA may be safer than propofol, though its pharmacokinetics may be less advantageous.
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Affiliation(s)
- Jessica M Currò
- School of Anesthesia and Intensive Care, University Magna Graecia, Catanzaro, Italy
| | | | - Federica Merola
- Policlinico G. Rodolico - San Marco University Hospital, Catania, Italy
| | - Simone Messina
- School of Anesthesia and Intensive Care, University Magna Graecia, Catanzaro, Italy
- Policlinico G. Rodolico - San Marco University Hospital, Catania, Italy
| | - Marco Sanfilippo
- Policlinico G. Rodolico - San Marco University Hospital, Catania, Italy
| | - Serena Brancati
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", Catania, Italy
| | - Filippo Drago
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-S. Marco", Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Filippo Sanfilippo
- Policlinico G. Rodolico - San Marco University Hospital, Catania, Italy.
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
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Santonocito C, Dugar S, Sanfilippo F. Positive end-expiratory pressure and left ventricular function are key factors affecting right ventricular to pulmonary arterial coupling. Ann Intensive Care 2024; 14:50. [PMID: 38563888 PMCID: PMC10987446 DOI: 10.1186/s13613-024-01284-4] [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: 03/15/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Cristina Santonocito
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, Catania, 95123, Italy
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, Catania, 95123, Italy.
- Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy.
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Pruszczyk A, Zawadka M, Andruszkiewicz P, LaVia L, Herpain A, Sato R, Dugar S, Chew MS, Sanfilippo F. Mortality in patients with septic cardiomyopathy identified by longitudinal strain by speckle tracking echocardiography: An updated systematic review and meta-analysis with trial sequential analysis. Anaesth Crit Care Pain Med 2024; 43:101339. [PMID: 38128732 DOI: 10.1016/j.accpm.2023.101339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/02/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Septic cardiomyopathy is associated with poor outcomes but its definition remains unclear. In a previous meta-analysis, left ventricular (LV) longitudinal strain (LS) showed significant prognostic value in septic patients, but findings were not robust due to a limited number of studies, differences in effect size and no adjustment for confounders. METHODS We conducted an updated systematic review (PubMed and Scopus up to 14.02.2023) and meta-analysis to investigate the association between LS and survival in septic patients. We included studies reporting global (from three apical views) or regional LS (one or two apical windows). A secondary analysis evaluated the association between LV ejection fraction (EF) and survival using data from the selected studies. RESULTS We included fourteen studies (1678 patients, survival 69.6%) and demonstrated an association between better performance (more negative LS) and survival with a mean difference (MD) of -1.45%[-2.10, -0.80] (p < 0.0001;I2 = 42%). No subgroup differences were found stratifying studies according to number of views used to calculate LS (p = 0.31;I2 = 16%), severity of sepsis (p = 0.42;I2 = 0%), and sepsis criteria (p = 0.59;I2 = 0%). Trial sequential analysis and sensitivity analyses confirmed the primary findings. Grade of evidence was low. In the included studies, thirteen reported LVEF and we found an association between higher LVEF and survival (MD = 2.44% [0.44,4.45]; p = 0.02;I2 = 42%). CONCLUSIONS We confirmed that more negative LS values are associated with higher survival in septic patients. The clinical relevance of this difference and whether the use of LS may improve understanding of septic cardiomyopathy and prognostication deserve further investigation. The association found between LVEF and survival is of unlikely clinical meaning. REGISTRATION PROSPERO number CRD42023432354.
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Affiliation(s)
- Andrzej Pruszczyk
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Poland
| | - Mateusz Zawadka
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Poland
| | - Pawel Andruszkiewicz
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Poland
| | - Luigi LaVia
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
| | - Antoine Herpain
- Department of Intensive Care, St.-Pierre University Hospital, Université Libre de Bruxelles, 1050 Brussels, Belgium; Experimental Laboratory of Intensive Care, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Ryota Sato
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy; Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy.
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Santonocito C, Cassisi C, Chiarenza F, Caruso A, Murabito P, Maybauer MO, George S, Sanfilippo F. Morning or Afternoon Scheduling for Elective Coronary Artery Bypass Surgery: Influence of Longer Fasting Periods from Metabolic and Hemodynamic Perspectives. Ann Card Anaesth 2024; 27:136-143. [PMID: 38607877 DOI: 10.4103/aca.aca_204_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Prolonged preoperative fasting may worsen postoperative outcomes. Cardiac surgery has higher perioperative risk, and longer fasting periods may be not well-tolerated. We analysed the postoperative metabolic and hemodynamic variables in patients undergoing elective coronary artery bypass grafting (CABG) according to their morning or afternoon schedule. METHODS Single-centre retrospective study at University teaching hospital (1-year data collection from electronic medical records). Using a mixed-effects linear regression model adjusted for several covariates, we compared metabolic (lactatemia, pH, and base deficit [BD]) and haemodynamic values (patients on vasoactive support, and vasoactive inotropic score [VIS]) at 7 prespecified time-points (admission to intensive care, and 1st, 3rd, 6th, 12th, 18th, and 24th postoperative hours). RESULTS 339 patients (n = 176 morning, n = 163 afternoon) were included. Arterial lactatemia and BD were similar (overall P = 0.11 and P = 0.84, respectively), while pH was significantly lower in the morning group (overall P < 0.05; mean difference -0.01). Postoperative urine output, fluid balance, mean arterial pressure, and central venous pressure were similar (P = 0.59, P = 0.96, P = 0.58 and P = 0.53, respectively). A subgroup analysis of patients with diabetes (n = 54 morning, n = 45 afternoon) confirmed the same findings. The VIS values and the proportion of patients on vasoactive support was higher in the morning cases at the 18th (P = 0.002 and p=0.04, respectively) and 24th postoperative hours (P = 0.003 and P = 0.04, respectively). Mean intensive care length of stay was 1.94 ± 1.36 days versus 2.48 ± 2.72 days for the afternoon and morning cases, respectively (P = 0.02). CONCLUSIONS Patients undergoing elective CABG showed similar or better metabolic and hemodynamic profiles when scheduled for afternoon surgery.
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Affiliation(s)
- Cristina Santonocito
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Cesare Cassisi
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Federica Chiarenza
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Alessandro Caruso
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Paolo Murabito
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Marc O Maybauer
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL, United States
- Department of Anesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Shane George
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom
| | - Filippo Sanfilippo
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Moosavi SKR, Zafar MH, Sanfilippo F. Collaborative robots (cobots) for disaster risk resilience: a framework for swarm of snake robots in delivering first aid in emergency situations. Front Robot AI 2024; 11:1362294. [PMID: 38500802 PMCID: PMC10944857 DOI: 10.3389/frobt.2024.1362294] [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: 12/28/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Cobots are robots that are built for human-robot collaboration (HRC) in a shared environment. In the aftermath of disasters, cobots can cooperate with humans to mitigate risks and increase the possibility of rescuing people in distress. This study examines the resilient and dynamic synergy between a swarm of snake robots, first responders and people to be rescued. The possibility of delivering first aid to potential victims dispersed around a disaster environment is implemented. In the HRC simulation framework presented in this study, the first responder initially deploys a UAV, swarm of snake robots and emergency items. The UAV provides the first responder with the site planimetry, which includes the layout of the area, as well as the precise locations of the individuals in need of rescue and the aiding goods to be delivered. Each individual snake robot in the swarm is then assigned a victim. Subsequently an optimal path is determined by each snake robot using the A* algorithm, to approach and reach its respective target while avoiding obstacles. By using their prehensile capabilities, each snake robot adeptly grasps the aiding object to be dispatched. The snake robots successively arrive at the delivering location near the victim, following their optimal paths, and proceed to release the items. To demonstrate the potential of the framework, several case studies are outlined concerning the execution of operations that combine locomotion, obstacle avoidance, grasping and deploying. The Coppelia-Sim Robotic Simulator is utilised for this framework. The analysis of the motion of the snake robots on the path show highly accurate movement with and without the emergency item. This study is a step towards a holistic semi-autonomous search and rescue operation.
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Affiliation(s)
- Syed Kumayl Raza Moosavi
- School of Electrical Engineering and Computer Sciences, National University of Sciences and Technology, Islamabad, Pakistan
| | | | - Filippo Sanfilippo
- Department of Engineering Sciences, University of Agder, Grimstaad, Norway
- Department of Software Engineering, Kaunas University of Technology, Kaunas, Lithuania
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Noto A, Chalkias A, Madotto F, Ball L, Bignami EG, Cecconi M, Guarracino F, Messina A, Morelli A, Princi P, Sanfilippo F, Scolletta S, Tritapepe L, Cortegiani A. Correction: Continuous vs intermittent Non-Invasive blood pressure MONitoring in preventing postoperative organ failure (niMON): study protocol for an open-label, multicenter randomized trial. J Anesth Analg Crit Care 2024; 4:14. [PMID: 38389112 PMCID: PMC10882786 DOI: 10.1186/s44158-024-00151-9] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Alberto Noto
- Division of Anesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Policlinico "G. Martino", University of Messina, Messina, Italy.
| | - Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104-5158, USA
- Outcomes Research Consortium, Cleveland, OH, 44195, USA
| | - Fabiana Madotto
- Dipartimento Area Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Moltancini 4, Pieve Emanuele, 20072, Milan, Italy
| | - Fabio Guarracino
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Antonio Messina
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Moltancini 4, Pieve Emanuele, 20072, Milan, Italy
| | - Andrea Morelli
- Department Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome, "La Sapienza," Policlinico Umberto Primo, Rome, Italy
| | - Pietro Princi
- Consiglio Nazionale Delle Ricerche, CNR-IPCF, Messina, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco" University Hospital, Catania, Italy
| | - Sabino Scolletta
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Siena, Italy
| | - Luigi Tritapepe
- Unit of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Cortegiani
- Department of Surgical Oncological and Oral Science, University of Palermo, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
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Sanfilippo F, Uryga A, Ball L, Battaglini D, Iavarone IG, Smielewski P, Beqiri E, Czosnyka M, Patroniti N, Robba C. The Effect of Recruitment Maneuvers on Cerebrovascular Dynamics and Right Ventricular Function in Patients with Acute Brain Injury: A Single-Center Prospective Study. Neurocrit Care 2024:10.1007/s12028-024-01939-x. [PMID: 38351299 DOI: 10.1007/s12028-024-01939-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/03/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Optimization of ventilatory settings is challenging for patients in the neurointensive care unit, requiring a balance between precise gas exchange control, lung protection, and managing hemodynamic effects of positive pressure ventilation. Although recruitment maneuvers (RMs) may enhance oxygenation, they could also exert profound undesirable systemic impacts. METHODS The single-center, prospective study investigated the effects of RMs (up-titration of positive end-expiratory pressure) on multimodal neuromonitoring in patients with acute brain injury. Our primary focus was on intracranial pressure and secondarily on cerebral perfusion pressure (CPP) and other neurological parameters: cerebral autoregulation [pressure reactivity index (PRx)] and regional cerebral oxygenation (rSO2). We also assessed blood pressure and right ventricular (RV) function evaluated using tricuspid annular plane systolic excursion. Results are expressed as the difference (Δ) from baseline values obtained after completing the RMs. RESULTS Thirty-two patients were enrolled in the study. RMs resulted in increased intracranial pressure (Δ = 4.8 mm Hg) and reduced CPP (ΔCPP = -12.8 mm Hg) and mean arterial pressure (difference in mean arterial pressure = -5.2 mm Hg) (all p < 0.001). Cerebral autoregulation worsened (ΔPRx = 0.31 a.u.; p < 0.001). Despite higher systemic oxygenation (difference in partial pressure of O2 = 4 mm Hg; p = 0.001) and unchanged carbon dioxide levels, rSO2 marginally decreased (ΔrSO2 = -0.5%; p = 0.031), with a significant drop in arterial content and increase in the venous content. RV systolic function decreased (difference in tricuspid annular plane systolic excursion = -0.1 cm; p < 0.001) with a tendency toward increased RV basal diameter (p = 0.06). Grouping patients according to ΔCPP or ΔPRx revealed that those with poorer tolerance to RMs had higher CPP (p = 0.040) and a larger RV basal diameter (p = 0.034) at baseline. CONCLUSIONS In patients with acute brain injury, RMs appear to have adverse effects on cerebral hemodynamics. These findings might be partially explained by RM's impact on RV function. Further advanced echocardiography monitoring is required to prove this hypothesis.
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Affiliation(s)
- Filippo Sanfilippo
- Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Agnieszka Uryga
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Wrocław, Poland
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, IRCCS Policlinico San Martino, Largo Rosanna Benzi, 16100, Genoa, Italy
| | - Denise Battaglini
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Ida Giorgia Iavarone
- Anesthesia and Intensive Care, IRCCS Policlinico San Martino, Largo Rosanna Benzi, 16100, Genoa, Italy
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Nicolò Patroniti
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Wrocław, Poland
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
- Anesthesia and Intensive Care, IRCCS Policlinico San Martino, Largo Rosanna Benzi, 16100, Genoa, Italy.
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Noto A, Chalkias A, Madotto F, Ball L, Bignami EG, Cecconi M, Guarracino F, Messina A, Morelli A, Princi P, Sanfilippo F, Scolletta S, Tritapepe L, Cortegiani A. Continuous vs intermittent Non-Invasive blood pressure MONitoring in preventing postoperative organ failure (niMON): study protocol for an open-label, multicenter randomized trial. J Anesth Analg Crit Care 2024; 4:7. [PMID: 38321507 PMCID: PMC10845743 DOI: 10.1186/s44158-024-00142-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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Blood pressure has become one of the most important vital signs to monitor in the perioperative setting. Recently, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) recommended, with low level of evidence, continuous monitoring of blood pressure during the intraoperative period. Continuous monitoring allows for early detection of hypotension, which may potentially lead to a timely treatment. Whether the ability to detect more hypotension events by continuous noninvasive blood pressure (C-NiBP) monitoring can improve patient outcomes is still unclear. Here, we report the rationale, study design, and statistical analysis plan of the niMON trial, which aims to evaluate the effect of intraoperative C-NiBP compared with intermittent (I-NiBP) monitoring on postoperative myocardial and renal injury. METHODS The niMon trial is an investigator-initiated, multicenter, international, open-label, parallel-group, randomized clinical trial. Eligible patients will be randomized in a 1:1 ratio to receive C-NiBP or I-NiBP as an intraoperative monitoring strategy. The proportion of patients who develop myocardial injury in the first postoperative week is the primary outcome; the secondary outcomes are the proportions of patients who develop postoperative AKI, in-hospital mortality rate, and 30 and 90 postoperative days events. A sample size of 1265 patients will provide a power of 80% to detect a 4% absolute reduction in the rate of the primary outcome. CONCLUSIONS The niMON data will provide evidence to guide the choice of the most appropriate intraoperative blood pressure monitoring strategy. CLINICAL TRIAL REGISTRATION Clinical Trial Registration: NCT05496322, registered on the 5th of August 2023.
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Affiliation(s)
- Alberto Noto
- Division of Anesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Policlinico "G. Martino", University of Messina, Messina, Italy.
| | - Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104-5158, USA
- Outcomes Research Consortium, Cleveland, OH, 44195, USA
| | - Fabiana Madotto
- Dipartimento Area Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Moltancini 4, Pieve Emanuele, Milan, 20072, Italy
| | - Fabio Guarracino
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Antonio Messina
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Moltancini 4, Pieve Emanuele, Milan, 20072, Italy
| | - Andrea Morelli
- Department Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome, "La Sapienza," Policlinico Umberto Primo, Rome, Italy
| | - Pietro Princi
- Consiglio Nazionale Delle Ricerche, CNR-IPCF, Messina, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
| | - Sabino Scolletta
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Siena, Italy
| | - Luigi Tritapepe
- Unit of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Cortegiani
- Department of Surgical Oncological and Oral Science, University of Palermo, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
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Sato R, Sanfilippo F, Hasegawa D, Prasitlumkum N, Duggal A, Dugar S. Prevalence and prognosis of hyperdynamic left ventricular systolic function in septic patients: a systematic review and meta-analysis. Ann Intensive Care 2024; 14:22. [PMID: 38308701 PMCID: PMC10838258 DOI: 10.1186/s13613-024-01255-9] [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: 07/13/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
PURPOSE The prevalence of hyperdynamic left ventricular (LV) systolic function in septic patients and its impact on mortality remain controversial. In this systematic review and meta-analysis, we investigated the prevalence and association of hyperdynamic LV systolic function with mortality in patients with sepsis. METHODS We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. Primary outcomes were the prevalence of hyperdynamic LV systolic function in adult septic patients and the associated short-term mortality as compared to normal LV systolic function. Hyperdynamic LV systolic function was defined using LV ejection fraction (LVEF) of 70% as cutoff. Secondary outcomes were heart rate, LV end-diastolic diameter (LVEDD), and E/e' ratio. RESULTS Four studies were included, and the pooled prevalence of hyperdynamic LV systolic function was 18.2% ([95% confidence interval (CI) 12.5, 25.8]; I2 = 7.0%, P < 0.0001). Hyperdynamic LV systolic function was associated with higher mortality: odds ratio of 2.37 [95%CI 1.47, 3.80]; I2 = 79%, P < 0.01. No difference was found in E/e' (P = 0.43) between normal and hyperdynamic LV systolic function, while higher values of heart rate (mean difference: 6.14 beats/min [95%CI 3.59, 8.69]; I2 = 51%, P < 0.0001) and LVEDD (mean difference: - 0.21 cm [95%CI - 0.33, - 0.09]; I2 = 73%, P < 0.001) were detected in patients with hyperdynamic LV systolic function. CONCLUSION The prevalence of hyperdynamic LV systolic function is not negligible in septic patients. Such a finding is associated with significantly higher short-term mortality as compared to normal LV systolic function.
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Affiliation(s)
- Ryota Sato
- Division of Critical Care Medicine, Department of Medicine, The Queen's Medical Center, Honolulu, HI, USA
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
| | - Daisuke Hasegawa
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | | | - Abhijit Duggal
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
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Gonzalez FA, Santonocito C, Maybauer MO, Lopes LR, Almeida AG, Sanfilippo F. Diastology in the intensive care unit: Challenges for the assessment and future directions. Echocardiography 2024; 41:e15773. [PMID: 38380688 DOI: 10.1111/echo.15773] [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: 12/17/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/22/2024] Open
Abstract
Myocardial dysfunction is common in patients admitted to the intensive care unit (ICU). Septic disease frequently results in cardiac dysfunction, and sepsis represents the most common cause of admission and death in the ICU. The association between left ventricular (LV) systolic dysfunction and mortality is not clear for critically ill patients. Conversely, LV diastolic dysfunction (DD) seems increasingly recognized as a factor associated with poor outcomes, not only in sepsis but also more generally in critically ill patients. Despite recent attempts to simplify the diagnosis and grading of DD, this remains relatively complex, with the need to use several echocardiographic parameters. Furthermore, the current guidelines have several intrinsic limitations when applied to the ICU setting. In this manuscript, we discuss the challenges in DD classification when applied to critically ill patients, the importance of left atrial pressure estimates for the management of patients in ICU, and whether the study of cardiac dysfunction spectrum during critical illness may benefit from the integration of left ventricular and left atrial strain data to improve diagnostic accuracy and implications for the treatment and prognosis.
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Affiliation(s)
- Filipe A Gonzalez
- Intensive Care Department of Hospital Garcia de Orta, Almada, Portugal
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Santonocito
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
| | - Marc O Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Luís Rocha Lopes
- Inherited Cardiac Disease Unit, Bart's Heart Centre St Bartholomew's Hospital London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ana G Almeida
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Messina S, Merola F, Santonocito C, Sanfilippo M, Sanfilippo G, Lombardo F, Bruni A, Garofalo E, Murabito P, Sanfilippo F. Articulating Video Stylet Compared to Other Techniques for Endotracheal Intubation in Normal Airways: A Simulation Study in Consultants with No Prior Experience. J Clin Med 2024; 13:728. [PMID: 38337422 PMCID: PMC10856441 DOI: 10.3390/jcm13030728] [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: 12/18/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Simulation for airway management allows for acquaintance with new devices and techniques. Endotracheal intubation (ETI), most commonly performed with direct laryngoscopy (DL) or video laryngoscopy (VLS), can be achieved also with combined laryngo-bronchoscopy intubation (CLBI). Finally, an articulating video stylet (ProVu) has been recently introduced. A single-center observational cross-sectional study was performed in a normal simulated airway scenario comparing DL, VLS-Glidescope, VLS-McGrath, CLBI and ProVu regarding the success rate (SR) and corrected time-to-intubation (cTTI, which accounts for the SR). Up to three attempts/device were allowed (maximum of 60 s each). Forty-two consultants with no experience with ProVu participated (15 ± 9 years after training completion). The DL was significantly faster (cTTI) than all other devices (p = 0.033 vs. VLSs, and p < 0.001 for CLBI and Provu), no differences were seen between the two VLSs (p = 0.775), and the VLSs were faster than CLBI and ProVu. Provu had a faster cTTI than CLBI (p = 0.004). The DL and VLSs showed similar SRs, and all the laryngoscopes had a higher SR than CLBI and ProVu at the first attempt. However, by the third attempt, the SR was not different between the DL/VLSs and ProVu (p = 0.241/p = 0.616); ProVu was superior to CLBI (p = 0.038). In consultants with no prior experience, ProVu shows encouraging results compared to DL/VLSs under simulated normal airway circumstances and further studies are warranted.
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Affiliation(s)
- Simone Messina
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Federica Merola
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
| | - Cristina Santonocito
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
| | - Marco Sanfilippo
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Giulia Sanfilippo
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Federica Lombardo
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Andrea Bruni
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Eugenio Garofalo
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Paolo Murabito
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
- Section of Anesthesia, Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95124 Catania, Italy
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Santonocito C, Sato R, Dugar S, Sanfilippo F. The importance of assessing left ventricular longitudinal function in presence of increased afterload. Crit Care 2024; 28:21. [PMID: 38217007 PMCID: PMC10785471 DOI: 10.1186/s13054-024-04801-w] [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: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Affiliation(s)
- Cristina Santonocito
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
| | - Ryota Sato
- Division of Critical Care Medicine, Department of Medicine, The Queen's Medical Center, Honululu, HI, USA
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy.
- Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy.
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Tigano S, Caruso A, Liotta C, LaVia L, Vargas M, Romagnoli S, Landoni G, Sanfilippo F. Exposure to severe hyperoxemia worsens survival and neurological outcome in patients supported by veno-arterial extracorporeal membrane oxygenation: A meta-analysis. Resuscitation 2024; 194:110071. [PMID: 38061577 DOI: 10.1016/j.resuscitation.2023.110071] [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: 09/21/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a rescue treatment in refractory cardiogenic shock (CS) or refractory cardiac arrest (CA). Exposure to hyperoxemia is common during VA-ECMO, and its impact on patient's outcome remains unclear. METHODS We conducted a systematic review (PubMed and Scopus) and meta-analysis investigating the effects of exposure to severe hyperoxemia on mortality and poor neurological outcome in patients supported by VA-ECMO. When both adjusted and unadjusted Odds Ratio (OR) were provided, we used the adjusted one. Results are reported as OR and 95% confidence interval (CI). Subgroup analyses were conducted according to VA-ECMO indication and hyperoxemia thresholds. RESULTS Data from 10 observational studies were included. Nine studies reported data on mortality (n = 5 refractory CA, n = 4 CS), and 4 on neurological outcome. As compared to normal oxygenation levels, exposure to severe hyperoxemia was associated with higher mortality (nine studies; OR: 1.80 [1.16-2.78]; p = 0.009; I2 = 83%; low certainty of evidence) and worse neurological outcome (four studies; OR: 1.97 [1.30-2.96]; p = 0.001; I2 = 0%; low certainty of evidence). Magnitude and effect of these findings remained valid in subgroup analyses conducted according to different hyperoxemia thresholds (>200 or >300 mmHg) and VA-ECMO indication, although the association with mortality remained uncertain in the refractory CA population (p = 0.13). Analysis restricted to studies providing adjusted OR data confirmed an increased likelihood of poorer neurological outcome (three studies; OR: 2.11 [1.32-3.38]; p = 0.002) in patients exposed to severe hyperoxemia but did not suggest higher mortality (five studies; OR: 1.68 [0.89-3.18]; p = 0.11). CONCLUSIONS Severe hyperoxemia exposure after initiation of VA-ECMO may be associated with an almost doubled increased probability of poor neurological outcome and mortality. Clinical efforts should be made to avoid severe hyperoxemia during VA-ECMO support.
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Affiliation(s)
- Stefano Tigano
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Alessandro Caruso
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, Catania, Italy
| | - Calogero Liotta
- School of Anaesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Luigi LaVia
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Florence, Italy; Department of Anetshesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, Catania, Italy.
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Sanfilippo F, Via LL, Zanghì A, Cappellani A. Efficacy of postoperative buprenorphine in the first 12 hours after surgery. Saudi J Anaesth 2024; 18:148-150. [PMID: 38313737 PMCID: PMC10833006 DOI: 10.4103/sja.sja_367_23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 02/06/2024] Open
Affiliation(s)
- Filippo Sanfilippo
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Department of Anesthesia and Intensive Care, “Policlinico-San Marco” University Hospital, Catania, Italy
| | - Luigi La Via
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Department of Anesthesia and Intensive Care, “Policlinico-San Marco” University Hospital, Catania, Italy
| | - Antonio Zanghì
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Alessandro Cappellani
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Sanfilippo F, Messina A, Scolletta S, Bignami E, Morelli A, Cecconi M, Landoni G, Romagnoli S. The "CHEOPS" bundle for the management of Left Ventricular Diastolic Dysfunction in critically ill patients: an experts' opinion. Anaesth Crit Care Pain Med 2023; 42:101283. [PMID: 37516408 DOI: 10.1016/j.accpm.2023.101283] [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: 06/03/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
The impact of left ventricular (LV) diastolic dysfunction (DD) on the outcome of patients with heart failure was established over three decades ago. Nevertheless, the relevance of LVDD for critically ill patients admitted to the intensive care unit has seen growing interest recently, and LVDD is associated with poor prognosis. Whilst an assessment of LV diastolic function is desirable in critically ill patients, treatment options for LVDD are very limited, and pharmacological possibilities to rapidly optimize diastolic function have not been found yet. Hence, a proactive approach might have a substantial role in improving the outcomes of these patients. Recalling historical Egyptian parallelism suggesting that Doppler echocardiography has been the "Rosetta stone" to decipher the study of LV diastolic function, we developed a potentially useful acronym for physicians at the bedside to optimize the management of critically ill patients with LVDD with the application of the bundle. We summarized the bundle under the acronym of the famous ancient Egyptian pharaoh CHEOPS: Chest Ultrasound, combining information from echocardiography and lung ultrasound; HEmodynamics assessment, with careful evaluation of heart rate and rhythm, as well as afterload and vasoactive drugs; OPtimization of mechanical ventilation and pulmonary circulation, considering the effects of positive end-expiratory pressure on both right and left heart function; Stabilization, with cautious fluid administration and prompt fluid removal whenever judged safe and valuable. Notably, the CHEOPS bundle represents experts' opinion and are not targeted at the initial resuscitation phase but rather for the optimization and subsequent period of critical illness.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy; Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy.
| | - Antonio Messina
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center IRCCS, 20089, Rozzano, Milan, Italy.
| | - Sabino Scolletta
- Anesthesia and Intensive Care Unit, University Hospital of Siena, University of Siena, Siena, Italy.
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Andrea Morelli
- Department Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Roma, Italy.
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center IRCCS, 20089, Rozzano, Milan, Italy.
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Stefano Romagnoli
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Department of Anetshesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Recio-Pérez J, Miró Murillo M, Martin Mesa M, Silva García J, Santonocito C, Sanfilippo F, Asúnsolo A. Effect of Prewarming on Perioperative Hypothermia in Patients Undergoing Loco-Regional or General Anesthesia: A Randomized Clinical Trial. Medicina (Kaunas) 2023; 59:2082. [PMID: 38138185 PMCID: PMC10744774 DOI: 10.3390/medicina59122082] [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: 10/05/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Redistribution hypothermia occurs during anesthesia despite active intraoperative warming. Prewarming increases the heat absorption by peripheral tissue, reducing the central to peripheral heat gradient. Therefore, the addition of prewarming may offer a greater preservation of intraoperative normothermia as compared to intraoperative warming only. Materials and Methods: A single-center clinical trial of adults scheduled for non-cardiac surgery. Patients were randomized to receive or not a prewarming period (at least 10 min) with convective air devices. Intraoperative temperature management was identical in both groups and performed according to a local protocol. The primary endpoint was the incidence, the magnitude and the duration of hypothermia (according to surgical time) between anesthetic induction and arrival at the recovery room. Secondary outcomes were core temperature on arrival in operating room, surgical site infections, blood losses, transfusions, patient discomfort (i.e., shivering), reintervention and hospital stay. Results: In total, 197 patients were analyzed: 104 in the control group and 93 in the prewarming group. Core temperature during the intra-operative period was similar between groups (p = 0.45). Median prewarming lasted 27 (17-38) min. Regarding hypothermia, we found no differences in incidence (controls: 33.7%, prewarming: 39.8%; p = 0.37), duration (controls: 41.6% (17.8-78.1), prewarming: 45.2% (20.6-71.1); p = 0.83) and magnitude (controls: 0.19 °C · h-1 (0.09-0.54), prewarming: 0.20 °C · h-1 (0.05-0.70); p = 0.91). Preoperative thermal discomfort was more frequent in the prewarming group (15.1% vs. 0%; p < 0.01). The interruption of intraoperative warming was more common in the prewarming group (16.1% vs. 6.7%; p = 0.03), but no differences were seen in other secondary endpoints. Conclusions: A preoperative prewarming period does not reduce the incidence, duration and magnitude of intraoperative hypothermia. These results should be interpreted considering a strict protocol for perioperative temperature management and the low incidence of hypothermia in controls.
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Affiliation(s)
- Jesus Recio-Pérez
- Department of Anesthesia, Torrejon University Hospital, 28850 Torrejón de Ardoz, Spain; (M.M.M.)
| | - Miguel Miró Murillo
- Department of Anesthesia, Torrejon University Hospital, 28850 Torrejón de Ardoz, Spain; (M.M.M.)
| | - Marta Martin Mesa
- Department of Anesthesia, Torrejon University Hospital, 28850 Torrejón de Ardoz, Spain; (M.M.M.)
| | | | - Cristina Santonocito
- Department of Anesthesia and Intensive Care, University Hospital “Policlinico-San Marco”, 95124 Catania, Italy;
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, University Hospital “Policlinico-San Marco”, 95124 Catania, Italy;
- Department of Surgery and Medical-Surgical Specialties, University of Catania, 95124 Catania, Italy
| | - Angel Asúnsolo
- Department of Public Health, Alcala University, 28801 Alcala de Henares, Spain
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Putaggio A, Tigano S, Caruso A, La Via L, Sanfilippo F. Red Blood Cell Transfusion Guided by Hemoglobin Only or Integrating Perfusion Markers in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis With Trial Sequential Analysis. J Cardiothorac Vasc Anesth 2023; 37:2252-2260. [PMID: 37652848 DOI: 10.1053/j.jvca.2023.08.001] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Strategies for red blood cell (RBC) transfusion in patients undergoing cardiac surgery have been traditionally anchored to hemoglobin (Hb) targets. A more physiologic approach would consider markers of organ hypoperfusion. DESIGN The authors conducted a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials (RCTs). SETTING Cardiac surgery. PARTICIPANTS Adult patients. INTERVENTION RBC transfusion targeting only Hb levels compared with strategies combining Hb values with markers of organ hypoperfusion. MEASUREMENTS AND MAIN RESULTS Primary outcomes were the number of RBC units transfused, the number of patients transfused at least once, and the average number of transfusions. Secondary outcomes were postoperative complications, intensive care (ICU) and hospital lengths of stay, and mortality. Only 2 RCTs were included (n = 257 patients), and both used central venous oxygen saturation (ScvO2) as a marker of organ hypoperfusion (cut-off: <70% or ≤65%). A transfusion protocol combining Hb and ScvO2 reduced the overall number of RBC units transfused (risk ratio [RR]: 1.57 [1.33-1.85]; p < 0.0001, I2 = 0%), and the number of patients transfused at least once (RR: 1.33 [1.16-1.53]; p < 0.0001, I2 = 41%), but not the average number of transfusions (mean difference [MD]: 0.18 [-0.11 to 0.47]; p = 0.24, I2 = 66%), with moderate certainty of evidence. Mortality (RR: 1.29, [0.29-5.77]; p = 0.73, I2 = 0%), ICU length-of-stay (MD: -0.06 [-0.58 to 0.46]; p = 0.81, I2 = 0%), hospital length-of-stay (MD: -0.05 [-1.49 to 1.39];p = 0.95, I2 = 0%), and all postoperative complications were not affected. CONCLUSIONS In adult patients undergoing cardiac surgery, a restrictive protocol integrating Hb values with a marker of organ hypoperfusion (ScvO2) reduces the number of RBC units transfused and the number of patients transfused at least once without apparent signals of harm. These findings were preliminary and warrant further multicentric research.
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Affiliation(s)
- Antonio Putaggio
- School of Anesthesia and Intensive Care, University Magna Graecia, Catanzaro, Italy
| | - Stefano Tigano
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Alessandro Caruso
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Luigi La Via
- University Hospital Policlinico, G. Rodolico - San Marco, Catania, Italy
| | - Filippo Sanfilippo
- University Hospital Policlinico, G. Rodolico - San Marco, Catania, Italy; Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
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Lefrant JY, Benhamou D, Fischer MO, Pirracchio R, Allaouchiche B, Bastide S, Biais M, Blet A, Bouvet L, Brissaud O, Brull SJ, Capdevila X, Clausen N, Cuvillon P, Dadure C, David JS, Eley V, Forget P, Fujii T, Godier A, Gopalan D, Guinot PG, Hasanin A, Joannes-Boyau O, Kerever S, Kipnis É, Landau R, Le Guen M, Legrand M, Lorne E, Mercier F, Mongardon N, Myatra SN, Nicolas-Robin A, Peters MJ, Quintard H, Rello J, G Richebe P, Roberts JA, Sanfilippo F, Schneider A, T Sofonea M, Treggiari M, Veyckemans F, Von Ungern-Sternberg BR, Zeidan A, Zieleskiewicz L, Zielinska M, Milman A, Roquilly A. Comments on: Reducing the Risks of Nuclear War-The Role of Health Professionals. Anaesth Crit Care Pain Med 2023; 43:101314. [PMID: 37863196 DOI: 10.1016/j.accpm.2023.101314] [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: 10/22/2023]
Affiliation(s)
- Jean-Yves Lefrant
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Dan Benhamou
- Paris Sud University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | | | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Avenue, San Francisco, USA
| | | | | | - Matthieu Biais
- Société Heva, Lyon, France; University Hospital Centre Bordeaux, Department of Anaesthesiology and Critical Care Medicine, Bordeaux, France
| | - Alice Blet
- Lyon University Hospital, Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bouvet
- Lyon University Hospital, Department of Anaesthesiology and Intensive Care, Femme-Mère-Enfant Hospital, Lyon, France
| | - Olivier Brissaud
- University Hospital Centre Bordeaux, Pediatric Intensive Care Unit, Bordeaux, France
| | - Sorin J Brull
- Mayo Clinic, College of Medicine and Science, Department of Anesthesiology and Perioperative Medicine, Jacksonville, Florida, United States of America
| | - Xavier Capdevila
- Montpellier University Hospital Centre, Department of Anaesthesia and Intensive Care, Montpellier, France
| | - Nicola Clausen
- Department of Anesthesiology and Intensive Care, University Hospital Odense, Denmark
| | - Philippe Cuvillon
- Nîmes University Hospital, CHU Carémeau, Critical Care and Emergency Medicine, Pain Dept, Nîmes, France
| | - Christophe Dadure
- Lapeyronie Hospital, Pediatric Anesthesia Department, Montpellier, France
| | - Jean-Stéphane David
- Civil Hospices of Lyon, Department of Anaesthesiology and Critical Care Medicine, Lyon, France
| | - Victoria Eley
- Royal Brisbane and Women's Hospital, Department of Anaesthesia and Perioperative Medicine, Herston, Australia
| | - Patrice Forget
- University of Aberdeen Institute of Applied Health Sciences, Aberdeen, United Kingdom
| | | | - Anne Godier
- The Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Dean Gopalan
- University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | | | - Ahmed Hasanin
- Department of Anaesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Olivier Joannes-Boyau
- University Hospital Centre Bordeaux, Department of Anaesthesiology and Critical Care Medicine, Bordeaux, France
| | - Sébastien Kerever
- Paris University, Lariboisière University Hospital, Departments of Anaesthesiology and Critical Care, Paris, France
| | - Éric Kipnis
- Lille University School of Medicine, Loos, France
| | - Ruth Landau
- Columbia University Vagelos College of Physicians and Surgeons, New York, United States of America
| | - Morgan Le Guen
- Hospital Foch, Department of Anaesthesiology, Suresnes, France
| | - Matthieu Legrand
- University of California, Zuckerberg San Francisco General Hospital and Trauma Center, Department of Anaesthesia and Perioperative Medicine, San Francisco, California, United States of America
| | - Emmanuel Lorne
- Clinique du Millénaire, Department of Anesthesiology and Intensive Care (Akomé), Montpellier, France
| | - Frédéric Mercier
- Paris-Saclay University, Antoine-Béclère Hospital, Department of Anaesthesia and Critical Care Medicine, Clamart, France
| | | | - Sheila Nainan Myatra
- Homi Bhabha National Institute - Tata Memorial Hospital, Department of Anaesthesiology, Critical Care and Pain, Mumbai, India
| | - Armelle Nicolas-Robin
- Pediatric Palliative Care Mobile Team, University Hospital Robert-Debré, Assistance Publique - Hôpitaux de Paris, Paris University, Paris, France
| | - Mark John Peters
- Great Ormond Street Hospital for Children Paediatric Intensive Care Unit, London, United Kingdom
| | - Hervé Quintard
- Geneva University Hospitals Intensive Care Service, Genève, Switzerland
| | - Jordi Rello
- International University of Cataluna, Faculty of Medicine and Health Sciences, Sant Cugat del Valles, Spain
| | - Philippe G Richebe
- University of Montreal, Department of Anesthesiology and Pain Medicine, Montréal, Quebec, Canada
| | | | - Filippo Sanfilippo
- Policlinico, Department of Anaesthesia and Intensive Care, Catania, Italy
| | - Antoine Schneider
- Lausanne University Hospital Adult Intensive Care Unit, Vaud, Switzerland
| | - Mircea T Sofonea
- Infectious Diseases and Vectors Ecology Genetics Evolution and Control, Montpellier, France
| | - Miriam Treggiari
- Yale University School of Medicine, Department of Anesthesiology, New Haven, Connecticut, United States of America
| | - Francis Veyckemans
- Lille University Hospital, Department of Paediatric Resuscitation, Lille, France
| | | | - Ahed Zeidan
- King Fahad Specialist Hospital-Dammam, Department of Anesthesiology, Dammam, Saudi Arabia
| | - Laurent Zieleskiewicz
- Aix-Marseille University, University Hospital of Marseille, Department of Anaesthesia and Intensive Care Medicine, Marseille, France
| | - Marzena Zielinska
- Department of Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Alexandre Milman
- Editorial Office Anaesthesia Critical Care and Pain Medicine, Société Française d'Anesthésie et Réanimation, Paris, France
| | - Antoine Roquilly
- University of Nantes - Anaesthesiology and Intensive Care Unit, Nantes, France
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Sanfilippo F, Zeidan A, Hasanin A. Disposable versus reusable medical devices and carbon footprint: old is gold. Anaesth Crit Care Pain Med 2023; 42:101285. [PMID: 37517690 DOI: 10.1016/j.accpm.2023.101285] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Filippo Sanfilippo
- Anesthesia and Critical Care Medicine, University of Catania, Catania, Italy
| | - Ahed Zeidan
- Department of Anesthesiology, King Fahad Specialist Hospital-Dammam, Dammam Saudi Arabia
| | - Ahmed Hasanin
- Professor of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
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20
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Palella S, Muscarà L, La Via L, Sanfilippo F. Veno-venous extracorporeal membrane oxygenation for rescue support in pregnant patients with COVID-19: a systematic review. Br J Anaesth 2023; 131:e130-e132. [PMID: 37544839 DOI: 10.1016/j.bja.2023.07.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/13/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023] Open
Affiliation(s)
- Sofia Palella
- School of Anesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Liliana Muscarà
- School of Anesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Luigi La Via
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy; Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
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21
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Sanfilippo F, Messina A, Corradi F, Robba C. Artificial intelligence: a new editor limiting self-citation malpractice. Crit Care 2023; 27:333. [PMID: 37644459 PMCID: PMC10464015 DOI: 10.1186/s13054-023-04601-8] [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: 07/27/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy.
- Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy.
| | - A Messina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - F Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - C Robba
- Department of Surgical Science and Diagnostic Integrated, University of Genoa, Genoa, Italy
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22
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Huang S, Vieillard-Baron A, Evrard B, Prat G, Chew MS, Balik M, Clau-Terré F, De Backer D, Mekontso Dessap A, Orde S, Morelli A, Sanfilippo F, Charron C, Vignon P. Echocardiography phenotypes of right ventricular involvement in COVID-19 ARDS patients and ICU mortality: post-hoc (exploratory) analysis of repeated data from the ECHO-COVID study. Intensive Care Med 2023; 49:946-956. [PMID: 37436445 DOI: 10.1007/s00134-023-07147-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [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: 04/24/2023] [Accepted: 06/18/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Exploratory study to evaluate the association of different phenotypes of right ventricular (RV) involvement and mortality in the intensive care unit (ICU) in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). METHODS Post-hoc analysis of longitudinal data from the multicenter ECHO-COVID observational study in ICU patients who underwent at least two echocardiography examinations. Echocardiography phenotypes were acute cor pulmonale (ACP, RV cavity dilatation with paradoxical septal motion), RV failure (RVF, RV cavity dilatation and systemic venous congestion), and RV dysfunction (tricuspid annular plane systolic excursion ≤ 16 mm). Accelerated failure time model and multistate model were used for analysis. RESULTS Of 281 patients who underwent 948 echocardiography studies during ICU stay, 189 (67%) were found to have at least 1 type of RV involvements during one or several examinations: ACP (105/281, 37.4%), RVF (140/256, 54.7%) and/or RV dysfunction (74/255, 29%). Patients with all examinations displaying ACP had survival time shortened by 0.479 [0.284-0.803] times when compared to patients with all examinations depicting no ACP (P = 0.005). RVF showed a trend towards shortened survival time by a factor of 0.642 [0.405-1.018] (P = 0.059), whereas the impact of RV dysfunction on survival time was inconclusive (P = 0.451). Multistate analysis showed that patients might transit in and out of RV involvement, and those who exhibited ACP in their last critical care echocardiography (CCE) examination had the highest risk of mortality (hazard ratio (HR) 3.25 [2.38-4.45], P < 0.001). CONCLUSION RV involvement is prevalent in patients ventilated for COVID-19 ARDS. Different phenotypes of RV involvement might lead to different ICU mortality, with ACP having the worst outcome.
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Affiliation(s)
- Stephen Huang
- Intensive Care Medicine, Nepean Hospital, NBMLHD, The University of Sydney, Sydney, Australia
| | - Antoine Vieillard-Baron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France
- INSERM UMR 1018, Clinical Epidemiology Team, CESP, Université de Paris Saclay, Villejuif, France
| | - Bruno Evrard
- Medical-Surgical ICU, Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France
| | - Gwenaël Prat
- Service de Médecine Intensive Réanimation, CHU Cavale Blanche Brest, Brest, France
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Martin Balik
- Department of Anesthesiology and Intensive Care, General University Hospital and 1St Medical Faculty, Charles University, Prague, Czechia
| | - Fernando Clau-Terré
- Department of Anaesthesiology and Critical Care Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Daniel De Backer
- CHIREC Hospitals Université Libre de Bruxelles, Brussels, Belgium
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Inserm U955, Université Paris-Est Créteil, 94000, Créteil, France
| | - Sam Orde
- Intensive Care Medicine, Nepean Hospital, NBMLHD, The University of Sydney, Sydney, Australia
| | - Andrea Morelli
- Department Clinical Internal Anesthesiological and Cardiovascular Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico, Rome, Italy
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - Cyril Charron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France
- INSERM UMR 1018, Clinical Epidemiology Team, CESP, Université de Paris Saclay, Villejuif, France
| | - Philippe Vignon
- Medical-Surgical ICU, Inserm CIC 1435, Dupuytren Teaching Hospital, 87000, Limoges, France.
- Réanimation Polyvalente, CHU Dupuytren, 2 Ave. Martin Luther King, 87042, Limoges Cedex, France.
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23
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Sanfilippo F, La Via L, Dezio V, Amelio P, Genoese G, Franchi F, Messina A, Robba C, Noto A. Inferior vena cava distensibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: a prospective study on mechanically ventilated patients. Intensive Care Med Exp 2023; 11:40. [PMID: 37423948 DOI: 10.1186/s40635-023-00529-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 03/17/2023] [Accepted: 06/03/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Variation of inferior vena cava (IVC) is used to predict fluid-responsiveness, but the IVC visualization with standard sagittal approach (SC, subcostal) cannot be always achieved. In such cases, coronal trans-hepatic (TH) window may offer an alternative, but the interchangeability of IVC measurements in SC and TH is not fully established. Furthermore, artificial intelligence (AI) with automated border detection may be of clinical value but it needs validation. METHODS Prospective observational validation study in mechanically ventilated patients with pressure-controlled mode. Primary outcome was the IVC distensibility (IVC-DI) in SC and TH imaging, with measurements taken both in M-Mode or with AI software. We calculated mean bias, limits of agreement (LoA), and intra-class correlation (ICC) coefficient. RESULTS Thirty-three patients were included. Feasibility rate was 87.9% and 81.8% for SC and TH visualization, respectively. Comparing imaging from the same anatomical site acquired with different modalities (M-Mode vs AI), we found the following IVC-DI differences: (1) SC: mean bias - 3.1%, LoA [- 20.1; 13.9], ICC = 0.65; (2) TH: mean bias - 2.0%, LoA [- 19.3; 15.4], ICC = 0.65. When comparing the results obtained from the same modality but from different sites (SC vs TH), IVC-DI differences were: (3) M-Mode: mean bias 1.1%, LoA [- 6.9; 9.1], ICC = 0.54; (4) AI: mean bias 2.0%, LoA [- 25.7; 29.7], ICC = 0.32. CONCLUSIONS In patients mechanically ventilated, AI software shows good accuracy (modest overestimation) and moderate correlation as compared to M-mode assessment of IVC-DI, both for SC and TH windows. However, precision seems suboptimal with wide LoA. The comparison of M-Mode or AI between different sites yields similar results but with weaker correlation. Trial registration Reference protocol: 53/2022/PO, approved on 21/03/2022.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy.
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy.
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Veronica Dezio
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Paolo Amelio
- School of Anaesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Giulio Genoese
- Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Federico Franchi
- Anesthesia and Intensive Care Unit, University Hospital of Siena, University of Siena, Siena, Italy
| | - Antonio Messina
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Chiara Robba
- Department of Surgical Science and Diagnostic Integrated, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy
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24
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Chawla S, Sato R, Duggal A, Alwakeel M, Hasegawa D, Alayan D, Collier P, Sanfilippo F, Lanspa M, Dugar S. Correlation between tissue Doppler-derived left ventricular systolic velocity (S') and left ventricle ejection fraction in sepsis and septic shock: a retrospective cohort study. J Intensive Care 2023; 11:28. [PMID: 37400918 DOI: 10.1186/s40560-023-00678-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Accepted: 06/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Tissue Doppler-derived left ventricular systolic velocity (mitral S') has shown excellent correlation to left ventricular ejection fraction (LVEF) in non-critically patients. However, their correlation in septic patients remains poorly understood and its impact on mortality is undetermined. We investigated the relationship between mitral S' and LVEF in a large cohort of critically-ill septic patients. METHODS We conducted a retrospective cohort study between 01/2011 and 12/2020. All adult patients (≥ 18 years) who were admitted to the medical intensive care unit (MICU) with sepsis and septic shock that underwent a transthoracic echocardiogram (TTE) within 72 h were included. Pearson correlation test was used to assess correlation between average mitral S' and LVEF. Pearson correlation was used to assess correlation between average mitral S' and LVEF. We also assessed the association between mitral S', LVEF and 28-day mortality. RESULTS 2519 patients met the inclusion criteria. The study population included 1216 (48.3%) males with a median age of 64 (IQR: 53-73), and a median APACHE III score of 85 (IQR: 67, 108). The median septal, lateral, and average mitral S' were 8 cm/s (IQR): 6.0, 10.0], 9 cm/s (IQR: 6.0, 10.0), and 8.5 cm/s (IQR: 6.5, 10.5), respectively. Mitral S' was noted to have moderate correlation with LVEF (r = 0.46). In multivariable logistic regression analysis, average mitral S' was associated with an increase in both 28-day ICU and in-hospital mortality with odds ratio (OR) 1.04 (95% CI 1.01-1.08, p = 0.02) and OR 1.04 (95% CI 1.01-1.07, p = 0.02), respectively. CONCLUSIONS Even though mitral S' and LVEF may be related, they are not exchangeable and were only found to have moderate correlation in this study. LVEF is U-shaped, while mitral S' has a linear relation with 28-day ICU mortality. An increase in average mitral S' was associated with higher 28-day mortality.
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Affiliation(s)
- Sanchit Chawla
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ryota Sato
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Abhijit Duggal
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA
| | - Mahmoud Alwakeel
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daisuke Hasegawa
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Dina Alayan
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick Collier
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Filippo Sanfilippo
- Anaesthesiology and Intensive Care, University of Catania, Catania, Italy
- Policlinico-San Marco University Hospital, Catania, Italy
| | - Michael Lanspa
- Critical Care Echocardiography Service, Intermountain Medical Center, Murray, UT, USA
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA.
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25
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Cuttone G, Martucci G, Napoli R, Tigano S, Arcadipane A, Pappalardo F, Sanfilippo F. Anesthesiological management of Brugada syndrome patients: A systematic review. Saudi J Anaesth 2023; 17:394-400. [PMID: 37601502 PMCID: PMC10435784 DOI: 10.4103/sja.sja_205_23] [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: 03/19/2023] [Accepted: 03/24/2023] [Indexed: 08/22/2023] Open
Abstract
Brugada syndrome (BrS) is a major risk factor for sudden cardiac death and ventricular tachyarrhythmias. Several drugs are contraindicated in patients with BrS, including some commonly administered drugs during anesthesia or in the perioperative period; however, there is still a paucity of evidence regarding BrS and common anesthetic pharmaceuticals. We conducted a systematic literature search (PubMed, updated October 10, 2022), including all studies reporting pharmacological management of BrS patients during anesthesia or intensive care, with a specific focus on proarrhythmic effects and possible pharmacological interactions in the context of BrS. The search revealed 44 relevant items, though only three original studies. Two randomized controlled studies were identified, one comparing propofol and etomidate for the induction of general anesthesia and one investigating lidocaine with or without epinephrine for local anesthesia; there was also one prospective study without a control group. The other studies were case series (n = 5, for a total of 19 patients) or case reports (n = 36). Data are reported on a total population of 199 patients who underwent general or local anesthesia. None of the studies evaluated BrS patients in the intensive care unit (ICU). We found the studies focusing on the pharmacological management of BrS patients undergoing general or local anesthesia to be of generally poor quality. However, it appears that propofol can be used safely, without an increase in arrhythmic events. Regional anesthesia is possible, and lidocaine might be preferred over longer-acting local anesthetics. Considering the quality of the included studies and their anecdotal evidence, it seems increasingly important to conduct large multicenter studies or promote international registries with high-quality data on the anesthesiological management of these patients.
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Affiliation(s)
- Giuseppe Cuttone
- Department of Anesthesia and Intensive Care, ASP Trapani, S.A. Abate Hospital, Erice, Italy
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT/UPMC Italy, Palermo, Italy
| | - Ruggero Napoli
- Department of Anesthesia and Intensive Care, ASP Trapani, S.A. Abate Hospital, Erice, Italy
| | - Stefano Tigano
- Department of Anesthesia and Intensive Care, A.O.U. Policlinico-SanMarco, Catania, Italy
| | - Antonio Arcadipane
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT/UPMC Italy, Palermo, Italy
| | - Federico Pappalardo
- Cardio Thoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, A.O.U. Policlinico-SanMarco, Catania, Italy
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26
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Messina A, Sotgiu G, Saderi L, Puci M, Negri K, Robba C, Sanfilippo F, Romagnoli S, Cecconi M. Phenotypes of hemodynamic response to fluid challenge during anesthesia: a cluster analysis. Minerva Anestesiol 2023; 89:653-662. [PMID: 36943710 DOI: 10.23736/s0375-9393.23.16992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The fluid challenge (FC) response is usually evaluated as binary, which may be inadequate to describe the complex interactions between heart function and vascular tone response after fluid administration. We applied a clustering approach to assess the different phenotypes of cardiovascular responses to FC administration, considering the associations of all the baseline variables potentially influencing pressure and flow response to a FC. Secondarily, we evaluated the reliability of baseline hemodynamic variables in discriminating fluid responsiveness, which is considered the standard approach at the bedside. METHODS Five merged datasets from elective surgical patients receiving a FC dose ≥4 mL/kg, infused over 10 minutes. In a principal component approach, hierarchical clustering was used to define hemodynamic phenotypes of response to FC administration. Hierarchical cluster analysis with Ward linkage was carried out to define similar patient groups using the Gower distance for the mixed combination of continuous and categorical variables. No a priori criteria of fluid responsiveness were applied. The area (AUC) under the pre-FC variables' receiver operating characteristic curves (ROC) was also built to predict fluid responsiveness, defined as SVI ≥10% after FC. RESULTS We analyzed 223 patients. The cluster analysis identified three hemodynamic clusters of patients: cluster 1 (98 patients, 44.0%) showed an average increase of mean arterial pressure (MAP) and Stroke Volume Index (SVI) of 17.3% (11.9-23.1) and 13.1% (0.5-23.4) at the end of FC, respectively. These patients showed baseline flow and pressure variables slightly below physiological ranges, with high pulse pressure variation (PPV). Cluster 2 (68 patients, 30.5%) showed no increase of MAP and SVI at the end of FC. These patients showed baseline flow and pressure variables within physiological ranges, with low hear rate (HR) and PPV. Cluster 3 (57 patients, 25.5%) showed no MAP increase and an SVI increase of 13.1 (2.1-19.6). These patients showed baseline pressure variables within physiological ranges, low flow variables associated to high HR and PPV. The pulse pressure variation (PPV) showed an AUC of 0.82 (0.03), with a grey zone ranging from 6% to 12%, including 86 (38.5%) patients. CONCLUSIONS Clustering analysis identified three hemodynamic clusters with different response phenotypes to FC. This promising approach may enhance the ability to detect fluid responsiveness at the bedside, by considering the specific association of parameters and not the presence of a single one, such as the PPV. In fact, in our cohort the reliability of the PPV was limited, showing high sensibility and specificity only above 12% and below 6%, respectively, and a grey zone including 38.5% of patients.
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Affiliation(s)
- Antonio Messina
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy -
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy -
| | - Giovanni Sotgiu
- Unit of Clinical Epidemiology and Medical Statistics, Department of Medical, Surgical and Experimental, University of Sassari, Sassari, Italy
| | - Laura Saderi
- Unit of Clinical Epidemiology and Medical Statistics, Department of Medical, Surgical and Experimental, University of Sassari, Sassari, Italy
| | - Mariangela Puci
- Unit of Clinical Epidemiology and Medical Statistics, Department of Medical, Surgical and Experimental, University of Sassari, Sassari, Italy
| | - Katerina Negri
- Department of Anesthesia and Intensive Care, University of Milan, Milan, Italy
| | - Chiara Robba
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Stefano Romagnoli
- Department of Health Science, University of Florence, Florence, Italy
| | - Maurizio Cecconi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Zawadka M, La Via L, Wong A, Olusanya O, Andruszkiewicz P, Sanfilippo F. The authors reply. Crit Care Med 2023; 51:e146-e148. [PMID: 37318298 DOI: 10.1097/ccm.0000000000005922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Mateusz Zawadka
- Second Department of Anesthesia and Intensive Care, Medical University of Warsaw, Poland
- Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, Univeristy Hospital Policlinico-San Marco, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico," University of Catania, Catania, Italy
| | - Adrian Wong
- Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Olusegun Olusanya
- Department of Perioperative Medicine, St Bartholomew's Hospital, London, United Kingdom
| | - Pawel Andruszkiewicz
- Second Department of Anesthesia and Intensive Care, Medical University of Warsaw, Poland
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, Univeristy Hospital Policlinico-San Marco, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico," University of Catania, Catania, Italy
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Zawadka M, La Via L, Wong A, Olusanya O, Muscarà L, Continella C, Andruszkiewicz P, Sanfilippo F. Real-Time Ultrasound Guidance as Compared With Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis. Crit Care Med 2023; 51:642-652. [PMID: 36861982 DOI: 10.1097/ccm.0000000000005819] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis to assess the effectiveness of real-time dynamic ultrasound-guided subclavian vein cannulation as compared to landmark technique in adult patients. DATA SOURCES PubMed and EMBASE until June 1, 2022, with the EMBASE search restricted to the last 5 years. STUDY SELECTION We included randomized controlled trials (RCTs) comparing the two techniques (real-time ultrasound-guided vs landmark) for subclavian vein cannulation. The primary outcomes were overall success rate and complication rate, whereas secondary outcomes included success at first attempt, number of attempts, and access time. DATA EXTRACTION Independent extraction by two authors according to prespecified criteria. DATA SYNTHESIS After screening, six RCTs were included. Two further RCTs using a static ultrasound-guided approach and one prospective study were included in the sensitivity analyses. The results are presented in the form of risk ratio (RR) or mean difference (MD) with 95% CI. Real-time ultrasound guidance increased the overall success rate for subclavian vein cannulation as compared to landmark technique (RR = 1.14; [95% CI 1.06-1.23]; p = 0.0007; I2 = 55%; low certainty) and complication rates (RR = 0.32; [95% CI 0.22-0.47]; p < 0.00001; I2 = 0%; low certainty). Furthermore, ultrasound guidance increased the success rate at first attempt (RR = 1.32; [95% CI 1.14-1.54]; p = 0.0003; I2 = 0%; low certainty), reduced the total number of attempts (MD = -0.45 [95% CI -0.57 to -0.34]; p < 0.00001; I2 = 0%; low certainty), and access time (MD = -10.14 s; [95% CI -17.34 to -2.94]; p = 0.006; I2 = 77%; low certainty). The Trial Sequential Analyses on the investigated outcomes showed that the results were robust. The evidence for all outcomes was considered to be of low certainty. CONCLUSIONS Real-time ultrasound-guided subclavian vein cannulation is safer and more efficient than a landmark approach. The findings seem robust although the evidence of low certainty.
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Affiliation(s)
- Mateusz Zawadka
- 2nd Department of Anesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland
- Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy
- Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Adrian Wong
- Department of Critical Care, King's College Hospital, London, United Kingdom
| | - Olusegun Olusanya
- Department of Perioperative Medicine, St Bartholomew's Hospital, London, United Kingdom
| | - Liliana Muscarà
- Department of Medical and Surgical Sciences, School of Specialization in Anesthesia and Intensive Care, University "Magna Graecia," Catanzaro, Italy
| | - Carlotta Continella
- Department of Medical and Surgical Sciences, School of Specialization in Anesthesia and Intensive Care, University "Magna Graecia," Catanzaro, Italy
| | - Pawel Andruszkiewicz
- 2nd Department of Anesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy
- Department of General Surgery and Medico-Surgical Specialties, School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
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Messina A, Longhitano Y, Zanza C, Calabrò L, Villa F, Cammarota G, Sanfilippo F, Cecconi M, Robba C. Cardiac dysfunction in patients affected by subarachnoid haemorrhage affects in-hospital mortality: A systematic review and metanalysis. Eur J Anaesthesiol 2023; 40:442-449. [PMID: 37052065 DOI: 10.1097/eja.0000000000001829] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Subarachnoid haemorrhage (SAH) is a life-threatening condition with associated brain damage. Moreover, SAH is associated with a massive release of catecholamines, which may promote cardiac injury and dysfunction, possibly leading to haemodynamic instability, which in turn may influence a patient's outcome. OBJECTIVES To study the prevalence of cardiac dysfunction (as assessed by echocardiography) in patients with SAH and its effect on clinical outcomes. DESIGN Systematic review of observational studies. DATA SOURCES We performed a systematic search over the last 20 years on MEDLINE and EMBASE databases. ELIGIBILITY CRITERIA Studies reporting echocardiography findings in adult patients with SAH admitted to intensive care. Primary outcomes were in-hospital mortality and poor neurological outcome according to the presence or absence of cardiac dysfunction. RESULTS We included a total of 23 studies (4 retrospective) enrolling 3511 patients. The cumulative frequency of cardiac dysfunction was 21% (725 patients), reported as regional wall motion abnormality in the vast majority of studies (63%). Due to the heterogeneity of clinical outcome data reporting, a quantitative analysis was carried out only for in-hospital mortality. Cardiac dysfunction was associated with a higher in-hospital mortality [odds ratio 2.69 (1.64 to 4.41); P < 0.001; I2 = 63%]. The GRADE of evidence assessment resulted in very low certainty of evidence. CONCLUSION About one in five patients with SAH develops cardiac dysfunction, which seems to be associated with higher in-hospital mortality. The consistency of cardiac and neurological data reporting is lacking, reducing the comparability of the studies in this field.
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Affiliation(s)
- Antonio Messina
- From the IRCCS Humanitas Research Hospital, Rozzano (AM, LC, FV, MC), Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (AM, MC), Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA (YL, CZ), IRCCS Ospedale Policlinico San Martino (CR), Dipartimento di Medicina E Chirurgia, Universita' Degli Studi di Perugia, Perugia (GC) and Department of Anaesthesia and Intensive Care, A.O.U. 'Policlinico-San Marco', Catania, Italy (FS)
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Sanfilippo F, La Via L, Dezio V, Santonocito C, Amelio P, Genoese G, Astuto M, Noto A. Assessment of the inferior vena cava collapsibility from subcostal and trans-hepatic imaging using both M-mode or artificial intelligence: a prospective study on healthy volunteers. Intensive Care Med Exp 2023; 11:15. [PMID: 37009935 PMCID: PMC10068684 DOI: 10.1186/s40635-023-00505-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/22/2023] [Indexed: 04/04/2023] Open
Abstract
PURPOSE Assessment of the inferior vena cava (IVC) respiratory variation may be clinically useful for the estimation of fluid-responsiveness and venous congestion; however, imaging from subcostal (SC, sagittal) region is not always feasible. It is unclear if coronal trans-hepatic (TH) IVC imaging provides interchangeable results. The use of artificial intelligence (AI) with automated border tracking may be helpful as part of point-of-care ultrasound but it needs validation. METHODS Prospective observational study conducted in spontaneously breathing healthy volunteers with assessment of IVC collapsibility (IVCc) in SC and TH imaging, with measures taken in M-mode or with AI software. We calculated mean bias and limits of agreement (LoA), and the intra-class correlation (ICC) coefficient with their 95% confidence intervals. RESULTS Sixty volunteers were included; IVC was not visualized in five of them (n = 2, both SC and TH windows, 3.3%; n = 3 in TH approach, 5%). Compared with M-mode, AI showed good accuracy both for SC (IVCc: bias - 0.7%, LoA [- 24.9; 23.6]) and TH approach (IVCc: bias 3.7%, LoA [- 14.9; 22.3]). The ICC coefficients showed moderate reliability: 0.57 [0.36; 0.73] in SC, and 0.72 [0.55; 0.83] in TH. Comparing anatomical sites (SC vs TH), results produced by M-mode were not interchangeable (IVCc: bias 13.9%, LoA [- 18.1; 45.8]). When this evaluation was performed with AI, such difference became smaller: IVCc bias 7.7%, LoA [- 19.2; 34.6]. The correlation between SC and TH assessments was poor for M-mode (ICC = 0.08 [- 0.18; 0.34]) while moderate for AI (ICC = 0.69 [0.52; 0.81]). CONCLUSIONS The use of AI shows good accuracy when compared with the traditional M-mode IVC assessment, both for SC and TH imaging. Although AI reduces differences between sagittal and coronal IVC measurements, results from these sites are not interchangeable.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy.
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy.
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Veronica Dezio
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Cristina Santonocito
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
| | - Paolo Amelio
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Giulio Genoese
- Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site "Policlinico G. Rodolico", Via S. Sofia N 78, 95123, Catania, Italy
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania, 95123, Catania, Italy
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy
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Ini' C, Distefano G, Sanfilippo F, Castiglione DG, Falsaperla D, Giurazza F, Mosconi C, Tiralongo F, Foti PV, Palmucci S, Venturini M, Basile A. Embolization for acute nonvariceal bleeding of upper and lower gastrointestinal tract: a systematic review. CVIR Endovasc 2023; 6:18. [PMID: 36988839 DOI: 10.1186/s42155-023-00360-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Acute non-variceal gastrointestinal bleedings (GIBs) are pathological conditions associated with significant morbidity and mortality. Embolization without angiographic evidence of contrast media extravasation is proposed as an effective procedure in patients with clinical and/or laboratory signs of bleeding. The purpose of this systematic review is to define common clinical practice and clinical and technical outcomes of blind and preventive embolization for upper and lower gastrointestinal bleeding. MAIN BODY Through the PubMed, Embase and Google Scholar database, an extensive search was performed in the fields of empiric and preventive embolization for the treatment of upper and lower gastrointestinal bleedings (UGIB and LGIB). Inclusion criteria were: articles in English for which it has been possible to access the entire content; adults patients treated with empiric or blind transcatheter arterial embolization (TAE) for UGIB and/or LGIB. Only studies that analysed clinical and technical success rate of blind and empiric TAE for UGIB and/or LGIB were considered for our research. Exclusion criteria were: recurrent articles from the same authors, articles written in other languages, those in which the entire content could not be accessed and that articles were not consistent to the purposes of our research. We collected pooled data on 1019 patients from 32 separate articles selected according to the inclusion and exclusion criteria. 22 studies focused on UGIB (total 773 patients), one articles focused on LGIB (total 6 patients) and 9 studies enrolled patients with both UGIB and LGIB (total 240 patients). Technical success rate varied from 62% to 100%, with a mean value of 97.7%; clinical success rate varied from 51% to 100% with a mean value of 80%. The total number of complications was 57 events out of 1019 procedures analysed. CONCLUSION TAE is an effective procedure in the treatment of UGIB patients in which angiography does not demonstrate direct sign of ongoing bleeding. The attitude in the treatment of LGIBs must be more prudent in relation to poor vascular anastomoses and the high risk of intestinal ischemia. Blind and preventive procedures cumulatively present a relatively low risk of complications, compared to a relatively high technical and clinical success.
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Affiliation(s)
- Corrado Ini'
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Giulio Distefano
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. 'Policlinico-Vittorio Emanuele', Catania, Italy
| | - Davide Giuseppe Castiglione
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Daniele Falsaperla
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Francesco Tiralongo
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, Insubria University, Viale Luigi Borri 57, 21100, Varese, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania -Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
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La Via L, Merola F, Schembari G, Liotta C, Sanfilippo F. The interplay between left ventricular diastolic and right ventricular dysfunction: challenges in the interpretation of critical care echocardiography studies. Egypt Heart J 2023; 75:7. [PMID: 36692697 PMCID: PMC9872744 DOI: 10.1186/s43044-023-00333-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: 12/06/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Sepsis is a leading cause of death and it is characterized not only by profound vasoplegia but also by myocardial dysfunction. Critical care echocardiography is the preferred modality for the initial assessment of the cause of shock. Moreover, it can be extremely helpful in the identification of progressing myocardial dysfunction during the course of sepsis, also known as septic cardiomyopathy. MAIN BODY One of the issues in the identification of septic cardiomyopathy is that it can be manifest with different clinical phenotypes, from overt biventricular dysfunction to isolated left ventricular (LV) systolic and/or diastolic dysfunction, from right ventricular (RV) systolic dysfunction to RV failure and dilatation. However, the commonly used echocardiography parameters for the assessment of LV and/or RV function are not always entirely reliable. Indeed, these are influenced by variable preload and afterload conditions imposed by critical illness such as fluid shifts, sedation level and mechanical ventilation with positive pressure. CONCLUSIONS Strain echocardiography is a promising tool for the early identification of myocardial dysfunction in the context of sepsis. Studies reporting data on strain echocardiography should be particularly detailed in order to increase the reproducibility of results and to favor comparison with future studies.
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Affiliation(s)
- Luigi La Via
- grid.412844.f0000 0004 1766 6239Department of Anesthesia and Intensive Care, “Policlinico-San Marco” University Hospital, Catania, Italy ,grid.8158.40000 0004 1757 1969School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Federica Merola
- grid.8158.40000 0004 1757 1969School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Giovanni Schembari
- grid.411489.10000 0001 2168 2547School of Anesthesia and Intensive Care, University “Magna Graecia”, Catanzaro, Italy
| | - Calogero Liotta
- grid.411489.10000 0001 2168 2547School of Anesthesia and Intensive Care, University “Magna Graecia”, Catanzaro, Italy
| | - Filippo Sanfilippo
- grid.412844.f0000 0004 1766 6239Department of Anesthesia and Intensive Care, “Policlinico-San Marco” University Hospital, Catania, Italy ,grid.8158.40000 0004 1757 1969Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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La Via L, Sanfilippo F, Continella C, Triolo T, Messina A, Robba C, Astuto M, Hernandez G, Noto A. Agreement between Capillary Refill Time measured at Finger and Earlobe sites in different positions: a pilot prospective study on healthy volunteers. BMC Anesthesiol 2023; 23:30. [PMID: 36653739 PMCID: PMC9847031 DOI: 10.1186/s12871-022-01920-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 08/13/2022] [Accepted: 11/21/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Capillary Refill Time (CRT) is a marker of peripheral perfusion usually performed at fingertip; however, its evaluation at other sites/position may be advantageous. Moreover, arm position during CRT assessment has not been fully standardized. METHODS We performed a pilot prospective observational study in 82 healthy volunteers. CRT was assessed: a) in standard position with participants in semi-recumbent position; b) at 30° forearm elevation, c and d) at earlobe site in semi-recumbent and supine position. Bland-Altman analysis was performed to calculate bias and limits of agreement (LoA). Correlation was investigated with Pearson test. RESULTS Standard finger CRT values (1.04 s [0.80;1.39]) were similar to the earlobe semi-recumbent ones (1.10 s [0.90;1.26]; p = 0.52), with Bias 0.02 ± 0.18 s (LoA -0.33;0.37); correlation was weak but significant (r = 0.28 [0.7;0.47]; p = 0.01). Conversely, standard finger CRT was significantly longer than earlobe supine CRT (0.88 s [0.75;1.06]; p < 0.001) with Bias 0.22 ± 0.4 s (LoA -0.56;1.0), and no correlation (r = 0,12 [-0,09;0,33]; p = 0.27]. As compared with standard finger CRT, measurement with 30° forearm elevation was significantly longer (1.17 s [0.93;1.41] p = 0.03), with Bias -0.07 ± 0.3 s (LoA -0.61;0.47) and with a significant correlation of moderate degree (r = 0.67 [0.53;0.77]; p < 0.001). CONCLUSIONS In healthy volunteers, the elevation of the forearm significantly prolongs CRT values. CRT measured at the earlobe in semi-recumbent position may represent a valid surrogate when access to the finger is not feasible, whilst earlobe CRT measured in supine position yields different results. Research is needed in critically ill patients to evaluate accuracy and precision at different sites/positions.
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Affiliation(s)
- Luigi La Via
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria “Policlinico – San Marco”, 95123 Catania, Italy
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria “Policlinico – San Marco”, 95123 Catania, Italy ,grid.8158.40000 0004 1757 1969School of Specialization in Anesthesia and Intensive Care, University of Catania, 95123 Catania, Italy
| | - Carlotta Continella
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria “Policlinico – San Marco”, 95123 Catania, Italy ,grid.411489.10000 0001 2168 2547School of Specialization in Anesthesia and Intensive Care, University Magna Graecia, 88100 Catanzaro, Italy
| | - Tania Triolo
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria “Policlinico – San Marco”, 95123 Catania, Italy ,grid.411489.10000 0001 2168 2547School of Specialization in Anesthesia and Intensive Care, University Magna Graecia, 88100 Catanzaro, Italy
| | - Antonio Messina
- grid.417728.f0000 0004 1756 8807Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Milan, Italy
| | - Chiara Robba
- grid.410345.70000 0004 1756 7871Anesthesia and Intensive Care, IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, 16100 Genoa, Italy
| | - Marinella Astuto
- Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliero Universitaria “Policlinico – San Marco”, 95123 Catania, Italy ,grid.8158.40000 0004 1757 1969School of Specialization in Anesthesia and Intensive Care, University of Catania, 95123 Catania, Italy
| | - Glenn Hernandez
- grid.7870.80000 0001 2157 0406Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alberto Noto
- grid.10438.3e0000 0001 2178 8421Division of Anesthesia and Intensive Care, University of Messina, Policlinico’’G. Martino’’, 98121 Messina, Italy
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Aiello G, Cuocina M, La Via L, Messina S, Attaguile GA, Cantarella G, Sanfilippo F, Bernardini R. Melatonin or Ramelteon for Delirium Prevention in the Intensive Care Unit: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2023; 12:jcm12020435. [PMID: 36675363 PMCID: PMC9863078 DOI: 10.3390/jcm12020435] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [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: 11/10/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Melatonin modulates the circadian rhythm and has been studied as a preventive measure against the development of delirium in hospitalized patients. Such an effect may be more evident in patients admitted to the ICU, but findings from the literature are conflicting. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). We assessed whether melatonin or ramelteon (melatonin agonist) reduce delirium incidence as compared to a placebo in ICU patients. Secondary outcomes were ICU length of stay, duration of mechanical ventilation (MV) and mortality. Estimates are presented as risk ratio (RR) or mean differences (MD) with 95% confidence interval (CI). Nine RCTs were included, six of them reporting delirium incidence. Neither melatonin nor ramelteon reduced delirium incidence (RR 0.76 (0.54, 1.07), p = 0.12; I2 = 64%), although a sensitivity analysis conducted adding other four studies showed a reduction in the risk of delirium (RR = 0.67 (95%CI 0.48, 0.92), p = 0.01; I2 = 67). Among the secondary outcomes, we found a trend towards a reduction in the duration of MV (MD -2.80 (-6.06, 0.47), p = 0.09; I2 = 94%) but no differences in ICU-LOS (MD -0.26 (95%CI -0.89, 0.37), p = 0.42; I2 = 75%) and mortality (RR = 0.85 (95%CI 0.63, 1.15), p = 0.30; I2 = 0%). Melatonin and ramelteon do not seem to reduce delirium incidence in ICU patients but evidence is weak. More studies are needed to confirm this finding.
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Affiliation(s)
- Giuseppe Aiello
- Department Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Micol Cuocina
- Department Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Luigi La Via
- Department of Anesthesiology and Intensive Care, AOU “Policlinico-San Marco”, 95123 Catania, Italy
| | - Simone Messina
- School of Specialization in Anesthesiology and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy
| | - Giuseppe A. Attaguile
- Department Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
| | - Giuseppina Cantarella
- Department Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Correspondence:
| | - Filippo Sanfilippo
- Department of Anesthesiology and Intensive Care, AOU “Policlinico-San Marco”, 95123 Catania, Italy
| | - Renato Bernardini
- Department Biomedical and Biotechnological Sciences (BIOMETEC), Section of Pharmacology, University of Catania, 95123 Catania, Italy
- Clinical Toxicology Unit, University Hospital of Catania, 95123 Catania, Italy
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La Via L, Maniaci A, Albanese G, La Mantia I, Sanfilippo F. In Reference to Robustness of the Clinical Benefit of Mastoid Obliteration Technique for Cholesteatoma Surgery. Laryngoscope 2023; 133:E42. [PMID: 36597944 DOI: 10.1002/lary.30553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Luigi La Via
- Anesthesia and Intensive Care Unit, Department of Surgery and Medical-Surgical Specialties, AOU "Policlinico - San Marco", Catania, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Gianluca Albanese
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Filippo Sanfilippo
- Anesthesia and Intensive Care Unit, Department of Surgery and Medical-Surgical Specialties, AOU "Policlinico - San Marco", Catania, Italy
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Zawadka M, Wong A, Janiszewska A, Sanfilippo F, La Via L, Sobieraj P, Abramovich I, Andruszkiewicz P, Jammer I. Critical care echocardiography: barriers, competencies and solutions. A survey of over 600 participants. Anaesthesiol Intensive Ther 2023; 55:158-162. [PMID: 37728442 PMCID: PMC10496096 DOI: 10.5114/ait.2023.130294] [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: 06/04/2023] [Accepted: 07/30/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Critical care echocardiography (CCE) is at the core of point-of-care ultrasound (POCUS), and although a list of the necessary competencies has been created, most European countries do not have established training programmes to allow intensivists to gain such competencies. To address barriers to the implementation of CCE, we conducted an online European survey, and analysed the current barriers to this with the aim of providing novel, modern solutions to them including environmental considerations. MATERIAL AND METHODS A 23-item survey was distributed via email with support from the European Society of Intensive Care Medicine, national societies, and social media. Questions focused on bedside CCE prevalence, competencies, and barriers to its implementation. An additional questionnaire was sent to recognised experts in the field of CCE. RESULTS A total of 644 responses were recorded. Most respondents were anaesthesia and intensive care physicians [79% ( n = 468)], and younger, with 56% in their first five years after specialization ( n = 358). Most respondents [92% ( n = 594)] had access to an ultrasound machine with a cardiac probe, and 97% ( n = 623) reported being able to acquire basic CCE windows. The most common barriers identified by respondents to the implementation of CCE in practice were a lack of sufficient experience/skill [64% ( n = 343)], absence of formal qualifications [46% ( n = 246)] and lack of a mentor [45% ( n = 243)]. Twenty-eight experts responded and identified a lack of allocated time for teaching as a main barrier [60% ( n = 17)]. CONCLUSIONS We found that bedside CCE is perceived as a crucial skill for intensive care medicine, especially by younger physicians; however, there remain several obstacles to training and implementation. The most important impediments reported by respondents were inadequate training, absence of formal qualifications and difficulties in finding a suitable mentor.
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Affiliation(s)
- Mateusz Zawadka
- 2 Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Adrian Wong
- Department of Critical Care, King’s College Hospital, London, UK
| | - Anna Janiszewska
- Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco, site “Policlinico G. Rodolico”, Catania, Italy
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco, site “Policlinico G. Rodolico”, Catania, Italy
| | - Piotr Sobieraj
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Igor Abramovich
- Charité – Universitätsmedizin Berlin, Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany
| | - Paweł Andruszkiewicz
- 2 Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Ib Jammer
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
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La Via L, Palumbo G, Guccione G, Continella C, Cirica G, Tutino S, Nicosia T, Astuto M, Sanfilippo F. Effects of pneumoperitoneum on hemodynamics evaluated by continuous noninvasive arterial pressure monitoring. A single-center observational study. Ann Ital Chir 2023; 94:281-288. [PMID: 37530058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND AND OBJECTIVES The induction of pneumoperitoneum (PP) during laparoscopy may cause hemodynamic alterations, especially in patients with unknown cardiovascular diseases. While invasive arterial monitoring could be considered excessive, continuous noninvasive arterial pressure (CNAP) monitoring may allow careful evaluation of hemodynamic variations during laparoscopy. MATERIALS AND METHODS The objective of this single center observational study was to evaluate hemodynamic changes after insufflation and after deflation of PP with CNAP monitoring. Patients included where adults undergoing elective laparoscopic cholecystectomy (American Society of Anesthesiologists physical status classification II and III). The Hemodynamic data (blood-pressure, cardiac-index, heart-rate, stroke-volume index, stoke-volume variation and arterialelastance) were collected 30 seconds before pneumoperitoneum (t1), and compared to values at 2 (t2), 10 (t3) and 20 (t4) minutes after pneumoperitoneum insufflation. We also compared data 30 seconds before and 2 minutes after release of pneumoperitoneum. RESULTS 65 patients were included. Compared with reference values at t1, blood-pressure values increased at all timepoints (t2-t3-t4); cardiac-index augmented at t3 and t4 (p<0.05); heart-rate increased at t3 (p<0.005); stroke-volume index decreased at t2 (p<0.005) and was higher at t4 (p<0.005). While stoke-volume variation remained always stable after pneumoperitoneum induction, arterial-elastance increased significantly at all time-points (t2-t3-t4). The only difference at pneumoperitoneum deflation was a reduction in stoke-volume variation (p<0.05). CONCLUSIONS In patients undergoing elective cholecystectomy, CNAP monitoring showed significant hemodynamic changes that would have been underappreciated with standard non-invasive monitoring with increase in arterial elastance under stable preload conditions. Whether this effect is due to unknown cardiovascular diseases facilitating ventriculo-arterial decoupling remains to be determined. KEY WORDS Arterial Elastance, Cardiac Outp, Pneumoperitoneum, Stroke Volume, Stroke Volume Variation.
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La Via L, Dezio V, Santonocito C, Astuto M, Morelli A, Huang S, Vieillard‐Baron A, Sanfilippo F. Full and simplified assessment of left ventricular diastolic function in covid-19 patients admitted to ICU: Feasibility, incidence, and association with mortality. Echocardiography 2022; 39:1391-1400. [PMID: 36200491 PMCID: PMC9827986 DOI: 10.1111/echo.15462] [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: 07/12/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Left ventricular diastolic dysfunction (LVDD) is associated with poor outcomes in the intensive care unit (ICU). Nonetheless, precise reporting of LVDD in COVID-19 patients is currently lacking and assessment could be challenging. METHODS We performed an echocardiography study in COVID-19 patients admitted to ICU with the aim to describe the feasibility of full or simplified LVDD assessment and its incidence. We also evaluated the association of LVDD or of single echocardiographic parameters with hospital mortality. RESULTS Between 06.10.2020 and 18.02.2021, full diastolic assessment was feasible in 74% (n = 26/35) of patients receiving a full echocardiogram study. LVDD incidence was 46% (n = 12/26), while the simplified assessment produced different results (incidence 81%, n = 21/26). Nine patients with normal function on full assessment had LVDD with simplified criteria (grade I = 2; grade II = 3; grade III = 4). Nine patients were hospital-survivors (39%); the incidence of LVDD (full assessment) was not different between survivors (n = 2/9, 22%) and non-survivors (n = 10/17, 59%; p = .11). The E/e' ratio lateral was lower in survivors (7.4 [3.6] vs. non-survivors 10.5 [6.3], p = .03). We also found that s' wave was higher in survivors (average, p = .01). CONCLUSION In a small single-center study, assessment of LVDD according to the latest guidelines was feasible in three quarters of COVID-19 patients. Non-survivors showed a trend toward greater LVDD incidence; moreover, they had significantly worse s' values (all) and higher E/e' ratio (lateral).
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Affiliation(s)
- Luigi La Via
- Department of Anaesthesia and Intensive Care“Policlinico‐San Marco” University HospitalCataniaItaly
| | - Veronica Dezio
- Department of Anaesthesia and Intensive Care“Policlinico‐San Marco” University HospitalCataniaItaly
| | - Cristina Santonocito
- Department of Anaesthesia and Intensive Care“Policlinico‐San Marco” University HospitalCataniaItaly
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care“Policlinico‐San Marco” University HospitalCataniaItaly
| | - Andrea Morelli
- Department Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome“La Sapienza”, Policlinico Umberto PrimoRomaItaly
| | - Stephen Huang
- Intensive Care Medicine, Nepean HospitalThe University of SydneySydneyAustralia
| | - Antoine Vieillard‐Baron
- Service de Médecine Intensive Réanimation, Assistance Publique‐Hôpitaux de ParisUniversity Hospital Ambroise ParéBoulogne‐BillancourtFrance
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care“Policlinico‐San Marco” University HospitalCataniaItaly
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Robba C, Badenes R, Battaglini D, Ball L, Sanfilippo F, Brunetti I, Jakobsen JC, Lilja G, Friberg H, Wendel-Garcia PD, Young PJ, Eastwood G, Chew MS, Unden J, Thomas M, Joannidis M, Nichol A, Lundin A, Hollenberg J, Hammond N, Saxena M, Martin A, Solar M, Taccone FS, Dankiewicz J, Nielsen N, Grejs AM, Ebner F, Pelosi P. Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Crit Care 2022; 26:323. [PMID: 36271410 PMCID: PMC9585831 DOI: 10.1186/s13054-022-04186-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 07/21/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients' outcome. METHODS Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. RESULTS 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). CONCLUSIONS In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. TRIAL REGISTRATION clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
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Affiliation(s)
- Chiara Robba
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy
| | - Rafael Badenes
- grid.106023.60000 0004 1770 977XDepartment of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, Valencia, Spain ,grid.5338.d0000 0001 2173 938XDepartment of Surgery, University of Valencia, Valencia, Spain
| | - Denise Battaglini
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5841.80000 0004 1937 0247Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Lorenzo Ball
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. “Policlinico-San Marco”, Catania, Italy
| | - Iole Brunetti
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Janus Christian Jakobsen
- grid.475435.4Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Gisela Lilja
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Getingevägen 4, 222 41 Lund, Malmö, Sweden
| | - Hans Friberg
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Lund University, Lund, Sweden
| | - Pedro David Wendel-Garcia
- grid.412004.30000 0004 0478 9977Institute of Intensive Care Medicine, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Paul J. Young
- grid.415117.70000 0004 0445 6830Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand ,grid.416979.40000 0000 8862 6892Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand ,grid.1002.30000 0004 1936 7857Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XDepartment of Critical Care, University of Melbourne, Parkville, VIC Australia
| | - Glenn Eastwood
- grid.1002.30000 0004 1936 7857Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia ,grid.414094.c0000 0001 0162 7225Department of Intensive Care, Austin Hospital, Melbourne, Australia
| | - Michelle S. Chew
- grid.5640.70000 0001 2162 9922Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan Unden
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden ,grid.4514.40000 0001 0930 2361Department of Operation and Intensive Care, Hallands Hospital Halmstad, Lund University, Halland, Sweden
| | - Matthew Thomas
- grid.410421.20000 0004 0380 7336University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Alistair Nichol
- grid.1002.30000 0004 1936 7857Monash University, Melbourne, VIC Australia
| | - Andreas Lundin
- grid.8761.80000 0000 9919 9582Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 423 45 Gothenburg, Sweden
| | - Jacob Hollenberg
- grid.465198.7Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Solna, Sweden
| | - Naomi Hammond
- grid.1005.40000 0004 4902 0432Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Manoj Saxena
- grid.416398.10000 0004 0417 5393Intensive Care Unit, St George Hospital, Sydney, Australia
| | - Annborn Martin
- grid.4514.40000 0001 0930 2361Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
| | - Miroslav Solar
- grid.4491.80000 0004 1937 116XDepartment of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic ,grid.412539.80000 0004 0609 2284Department of Internal Medicine - Cardioangiology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Fabio Silvio Taccone
- grid.412157.40000 0000 8571 829XDepartment of Intensive Care Medicine, Université Libre de Bruxelles, Hopital Erasme, Brussels, Belgium
| | - Josef Dankiewicz
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Niklas Nielsen
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Anaesthesia and Intensive Care and Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Anders Morten Grejs
- grid.154185.c0000 0004 0512 597XDepartment of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Florian Ebner
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Anesthesia and Intensive Care, Helsingborg Hospital, Lund University, 251 87 Helsingborg, Sweden
| | - Paolo Pelosi
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Viale Benedetto XV 16, Genoa, Italy
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La Via L, Astuto M, Dezio V, Muscarà L, Palella S, Zawadka M, Vignon P, Sanfilippo F. Agreement between subcostal and transhepatic longitudinal imaging of the inferior vena cava for the evaluation of fluid responsiveness: A systematic review. J Crit Care 2022; 71:154108. [DOI: 10.1016/j.jcrc.2022.154108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/07/2022] [Accepted: 06/25/2022] [Indexed: 12/18/2022]
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La Via L, Santonocito C, Messina A, Robba C, Sanfilippo F. Characterization of septic cardiomyopathy: assessment of left ventricular diastolic function is paramount! ESC Heart Fail 2022; 10:746-747. [PMID: 36176052 PMCID: PMC9871687 DOI: 10.1002/ehf2.14181] [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: 07/07/2022] [Accepted: 09/15/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Luigi La Via
- Azienda Ospedaliero Universitaria “Policlinico‐San Marco”Via Santa Sofia, 7895123CataniaItaly
| | - Cristina Santonocito
- Azienda Ospedaliero Universitaria “Policlinico‐San Marco”Via Santa Sofia, 7895123CataniaItaly
| | - Antonio Messina
- Department of Anesthesia and Intensive Care MedicineHumanitas Clinical and Research Center‐IRCCSVia Alessandro Manzoni, 56‐20089, RozzanoMilanItaly
| | - Chiara Robba
- Policlinico San Martino, IRCCS for Oncology and NeuroscienceGenoaItaly,Dipartimento di Scienze Chirurgiche e Diagnostiche IntegrateUniversità di GenovaGenoaItaly
| | - Filippo Sanfilippo
- Azienda Ospedaliero Universitaria “Policlinico‐San Marco”Via Santa Sofia, 7895123CataniaItaly
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Pappalardo F, Sanfilippo F, Murabito P, Maj G, Astuto M. Too Bad to Be True: What Can We Reasonably Expect for Treatments of Multiple Organ Failure? Crit Care Med 2022; 50:e728-e729. [PMID: 35984066 DOI: 10.1097/ccm.0000000000005578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Federico Pappalardo
- Department of CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Paolo Murabito
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy
| | - Giulia Maj
- Department of CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy
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Longhitano L, Distefano A, Murabito P, Astuto M, Nicolosi A, Buscema G, Sanfilippo F, Lazzarino G, Amorini AM, Bruni A, Garofalo E, Tibullo D, Volti GL. Propofol and α2-Agonists Attenuate Microglia Activation and Restore Mitochondrial Function in an In Vitro Model of Microglia Hypoxia/Reoxygenation. Antioxidants (Basel) 2022; 11:antiox11091682. [PMID: 36139756 PMCID: PMC9495359 DOI: 10.3390/antiox11091682] [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: 08/06/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebrovascular ischemia is a common clinical disease encompassing a series of complex pathophysiological processes in which oxidative stress plays a major role. The present study aimed to evaluate the effects of Dexmedetomidine, Clonidine, and Propofol in a model of hypoxia/reoxygenation injury. Microglial cells were exposed to 1%hypoxia for 3 h and reoxygenated for 3 h, and oxidative stress was measured by ROS formation and the expression of inflammatory process genes. Mitochondrial dysfunction was assessed by membrane potential maintenance and the levels of various metabolites involved in energetic metabolism. The results showed that Propofol and α2-agonists attenuate the formation of ROS during hypoxia and after reoxygenation. Furthermore, the α2-agonists treatment restored membrane potential to values comparable to the normoxic control and were both more effective than Propofol. At the same time, Propofol, but not α2-agonists, reduces proliferation (Untreated Hypoxia = 1.16 ± 0.2, Untreated 3 h Reoxygenation = 1.28 ± 0.01 vs. Propofol hypoxia = 1.01 ± 0.01 vs. Propofol 3 h Reoxygenation = 1.12 ± 0.03) and microglial migration. Interestingly, all of the treatments reduced inflammatory gene and protein expressions and restored energy metabolism following hypoxia/reoxygenation (ATP content in hypoxia/reoxygenation 3 h: Untreated = 3.11 ± 0.8 vs. Propofol = 7.03 ± 0.4 vs. Dexmedetomidine = 5.44 ± 0.8 vs. Clonidine = 7.70 ± 0.1), showing that the drugs resulted in a different neuroprotective profile. In conclusion, our results may provide clinically relevant insights for neuroprotective strategies in intensive care units.
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Affiliation(s)
- Lucia Longhitano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, 95125 Catania, Italy
| | - Alfio Distefano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, 95125 Catania, Italy
| | - Paolo Murabito
- Unità Operativa Complessa Anestesia e Rianimazione 2, Azienda Universitaria “Policlinico G. Rodolico” Via S. Sofia 97, 95125 Catania, Italy
| | - Marinella Astuto
- Unità Operativa Complessa Anestesia e Rianimazione 2, Azienda Universitaria “Policlinico G. Rodolico” Via S. Sofia 97, 95125 Catania, Italy
| | - Anna Nicolosi
- Azienda Ospedaliera “Cannizzaro”, Via Messina 628, 95126 Catania, Italy
| | - Giovanni Buscema
- Unità Operativa Complessa Anestesia e Rianimazione 2, Azienda Universitaria “Policlinico G. Rodolico” Via S. Sofia 97, 95125 Catania, Italy
| | - Filippo Sanfilippo
- Unità Operativa Complessa Anestesia e Rianimazione 2, Azienda Universitaria “Policlinico G. Rodolico” Via S. Sofia 97, 95125 Catania, Italy
| | - Giuseppe Lazzarino
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, 95125 Catania, Italy
| | - Angela Maria Amorini
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, 95125 Catania, Italy
| | - Andrea Bruni
- Anesthesia and Intesive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Grecia University, 88100 Catanzaro, Italy
| | - Eugenio Garofalo
- Anesthesia and Intesive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Grecia University, 88100 Catanzaro, Italy
| | - Daniele Tibullo
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, 95125 Catania, Italy
| | - Giovanni Li Volti
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, 95125 Catania, Italy
- Correspondence:
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La Via L, Sanfilippo F, Cuttone G, Dezio V, Falcone M, Brancati S, Crimi C, Astuto M. Use of ketamine in patients with refractory severe asthma exacerbations: systematic review of prospective studies. Eur J Clin Pharmacol 2022; 78:1613-1622. [PMID: 36008492 PMCID: PMC9482594 DOI: 10.1007/s00228-022-03374-3] [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: 04/12/2022] [Accepted: 08/17/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Asthma is a heterogeneous disease with a wide range of symptoms. Severe asthma exacerbations (SAEs) are characterized by worsening symptoms and bronchospasm requiring emergency department visits. In addition to conventional strategies for SAEs (inhaled β-agonists, anticholinergics, and systemic corticosteroids), another pharmacological option is represented by ketamine. We performed a systematic review to explore the role of ketamine in refractory SAEs. METHODS We performed a systematic search on PubMed and EMBASE up to August 12th, 2021. We selected prospective studies only, and outcomes of interest were oxygenation/respiratory parameters, clinical status, need for invasive ventilation and effects on weaning. RESULTS We included a total of seven studies, five being randomized controlled trials (RCTs, population range 44-92 patients). The two small prospective studies (n = 10 and n = 11) did not have a control group. Four studies focused on adults, and three enrolled a pediatric population. We found a large heterogeneity regarding sample size, age and gender distribution, inclusion criteria (different severity scores, if any) and ketamine dosing (bolus and/or continuous infusion). Of the five RCTs, three compared ketamine to placebo, while one used fentanyl and the other aminophylline. The outcomes evaluated by the included studies were highly variable. Despite paucity of data and large heterogeneity, an overview of the included studies suggests absence of clear benefit produced by ketamine in patients with refractory SAE, and some signals towards side effects. CONCLUSION Our systematic review does not support the use of ketamine in refractory SAE. A limited number of prospective studies with large heterogeneity was found. Well-designed multicenter RCTs are desirable.
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Affiliation(s)
- Luigi La Via
- Department of Anesthesiology and Intensive Care, AOU "Policlinico - San Marco", 95123, Catania, Italy. .,School of Specialization in Anesthesia and Intensive Care, University of Catania, Catania, Italy.
| | - Filippo Sanfilippo
- Department of Anesthesiology and Intensive Care, AOU "Policlinico - San Marco", 95123, Catania, Italy
| | - Giuseppe Cuttone
- School of Specialization in Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Veronica Dezio
- Department of Anesthesiology and Intensive Care, AOU "Policlinico - San Marco", 95123, Catania, Italy.,School of Specialization in Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Monica Falcone
- School of Specialization in Anesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Serena Brancati
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Claudia Crimi
- Department of Pneumology, AOU "Policlinico - San Marco", Catania, Italy
| | - Marinella Astuto
- Department of Anesthesiology and Intensive Care, AOU "Policlinico - San Marco", 95123, Catania, Italy
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Sanfilippo F, La Via L, Schembari G, Tornitore F, Zuccaro G, Morgana A, Valenti MR, Oliveri F, Pappalardo F, Astuto M, Cassisi C, Castro A, Cocimano S, Criscione F, Cutuli C, Dezio V, Fallico G, Leonardi M, Mascari M, Paratore A, Perna F, Pulvirenti M, Tringali E, Vasile F, Agnello MT, Sanfilippo G, Messina S, Merola F. Implementation of video-calls between patients admitted to intensive care unit during the COVID-19 pandemic and their families: a pilot study of psychological effects. J Anesth Analg Crit Care 2022. [PMCID: PMC9397160 DOI: 10.1186/s44158-022-00067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has caused over 530 million infections to date (June 2022), with a high percentage of intensive care unit (ICU) admissions. In this context, relatives have been restricted from visiting their loved ones admitted to hospital. This situation has led to an inevitable separation between patients and their families. Video communication could reduce the negative effects of such phenomenon, but the impact of this strategy on levels of anxiety, depression, and PTSD disorder in caregivers is not well-known. Methods We conducted a prospective study (6 October 2020–18 February 2022) at the Policlinico University Hospital in Catania, including caregivers of both COVID-19 and non-COVID-19 ICU patients admitted during the second wave of the pandemic. Video-calls were implemented twice a week. Assessment of anxiety, depression, and PTSD was performed at 1-week distance (before the first, T1, and before the third, video-call, T2) using the following validated questionnaires: Impact of Event Scale (Revised IES-R), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). Results Twenty caregivers of 17 patients completed the study (T1 + T2). Eleven patients survived (n = 9/11 in the COVID-19 and n = 2/6 in the “non-COVID” group). The average results of the questionnaires completed by caregivers between T1 and T2 showed no significant difference in terms of CES-D (T1 = 19.6 ± 10, T2 = 22 ± 9.6; p = 0.17), HADS depression (T1 = 9.5 ± 1.6, T2 = 9 ± 3.9; p = 0.59), HADS anxiety (T1 = 8.7 ± 2.4, T2 = 8.4 ± 3.8; p = 0.67), and IES-R (T1 = 20.9 ± 10.8, T2 = 23.1 ± 12; p = 0.19). Similar nonsignificant results were observed in the two subgroups of caregivers (COVID-19 and “non-COVID”). However, at T1 and T2, caregivers of “non-COVID” patients had higher scores of CES-D (p = 0.01 and p = 0.04, respectively) and IES-R (p = 0.049 and p = 0.02, respectively), while HADS depression was higher only at T2 (p = 0.02). At T1, caregivers of non-survivors had higher scores of CES-D (27.6 ± 10.6 vs 15.3 ± 6.7, p = 0.005) and IES-R (27.7 ± 10.0 vs 17.2 ± 9.6, p = 0.03). We also found a significant increase in CES-D at T2 in ICU-survivors (p = 0.04). Conclusions Our preliminary results showed that a video-call implementation strategy between caregivers and patients admitted to the ICU is feasible. However, this strategy did not show an improvement in terms of the risk of depression, anxiety, and PTSD among caregivers. Our pilot study remains exploratory and limited to a small sample. Supplementary Information The online version contains supplementary material available at 10.1186/s44158-022-00067-2.
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Sanfilippo F, Dean Gopalan P, Hasanin A. The COVID-19 pandemic: A gateway between one world and the next! Anaesth Crit Care Pain Med 2022; 41:101131. [PMID: 35878869 PMCID: PMC9306261 DOI: 10.1016/j.accpm.2022.101131] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Catania, Italy.
| | - P Dean Gopalan
- Discipline of Anaesthesiology and Critical Care, University of KwaZulu Natal, Durban, South Africa
| | - Ahmed Hasanin
- Department of Anaesthesia and critical care medicine, Cairo University, Cairo, Egypt
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Frezzotti R, Gagliardi G, Lubicz V, Martinelli G, Sanfilippo F, Simula S. Lattice calculation of the pion mass difference
Mπ+−Mπ0
at order
O(αem). Int J Clin Exp Med 2022. [DOI: 10.1103/physrevd.106.014502] [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] [Indexed: 11/07/2022]
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48
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Zawadka M, La Via L, Sanfilippo F. Sharing clinical experience and achieving true knowledge: a great challenge when assessing right ventricular function. Anaesthesia 2022; 77:1308-1309. [PMID: 35737470 DOI: 10.1111/anae.15793] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 12/13/2022]
Affiliation(s)
- M Zawadka
- Medical University of Warsaw, Warsaw, Poland
| | - L La Via
- University of Catania, Catania, Italy
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Huang S, Vignon P, Mekontso-Dessap A, Tran S, Prat G, Chew M, Balik M, Sanfilippo F, Banauch G, Clau-Terre F, Morelli A, De Backer D, Cholley B, Slama M, Charron C, Goudelin M, Bagate F, Bailly P, Blixt PJ, Masi P, Evrard B, Orde S, Mayo P, McLean AS, Vieillard-Baron A. Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study). Intensive Care Med 2022; 48:667-678. [PMID: 35445822 PMCID: PMC9022062 DOI: 10.1007/s00134-022-06685-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [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: 01/19/2022] [Accepted: 03/16/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU). METHODS Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap). RESULTS Six hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU). CONCLUSION Almost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.
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Affiliation(s)
- Stephen Huang
- Intensive Care Medicine, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Philippe Vignon
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Inserm CIC 1435 and UMR 1092, 87000, Limoges, France
| | - Armand Mekontso-Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Inserm U955, Université Paris-Est Créteil, 94000, Créteil, France
| | - Ségolène Tran
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France
| | - Gwenael Prat
- Service de Médecine Intensive Réanimation, CHU Cavale Blanche Brest, Brest, France
| | - Michelle Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Martin Balik
- Department of Anesthesiology and Intensive Care, General University Hospital and 1st Medical Faculty, Charles University, Prague, Czechia
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, Policlinico-Vittorio Emanuele University Hospital, Catania, Italy
| | - Gisele Banauch
- Division of Pulmonary, Critical Care and Allergy, Department of Medicine, UmassMemorial Medical Center, The University Hospital for University of Massachusetts, Worcester, MA, USA
| | - Fernando Clau-Terre
- Department of Anaesthesiology and Critical Care Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Andrea Morelli
- Department Clinical Internal, Anesthesiological and Cardiovascular Sciences, University of Rome, "La Sapienza", Policlinico Umberto Primo, Viale del Policlinico, Rome, Italy
| | - Daniel De Backer
- CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Cholley
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP and Université de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Michel Slama
- Medical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Cyril Charron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France
| | - Marine Goudelin
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Inserm CIC 1435 and UMR 1092, 87000, Limoges, France
| | - Francois Bagate
- Service de Médecine Intensive Réanimation, Hôpitaux universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Inserm U955, Université Paris-Est Créteil, 94000, Créteil, France
| | - Pierre Bailly
- Service de Médecine Intensive Réanimation, CHU Cavale Blanche Brest, Brest, France
| | - Patrick-Johansson Blixt
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Paul Masi
- Service de Médecine Intensive Réanimation, Hôpitaux universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique CARMAS, Inserm U955, Université Paris-Est Créteil, 94000, Créteil, France
| | - Bruno Evrard
- Medical-Surgical ICU, Dupuytren Teaching Hospital, Inserm CIC 1435 and UMR 1092, 87000, Limoges, France
| | - Sam Orde
- Intensive Care Medicine, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Paul Mayo
- Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY, USA
| | - Anthony S McLean
- Intensive Care Medicine, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Antoine Vieillard-Baron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.
- INSERM, UMR 1018, Clinical Epidemiology Team, CESP, Université de Paris Saclay, Villejuif, France.
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Lefrant JY, Pirracchio R, Benhamou D, Fischer MO, Njeim R, Allaouchiche B, Bastide S, Biais M, Bouvet L, Brissaud O, Brull SJ, Capdevila X, Clausen N, Cuvillon P, Dadure C, David JS, Du B, Einav S, Eley V, Forget P, Fujii T, Godier A, Gopalan DP, Hamada S, Hasanin A, Joannes-Boyau O, Kerever S, Kipnis É, Kolodzie K, Landau R, Le Gall A, Le Guen M, Legrand M, Lorne E, Mercier FJ, Mongardon N, Myatra S, Nicolas-Robin A, John Peters M, Quintard H, Rello J, Richebé P, Roberts JA, Rocquilly A, Sanfilippo F, Schneider A, Sofonea MT, Veyckemans F, Zetlaoui P, Zeidan A, Zieleskiewicz L, Zielinska M, Von Ungern-Sternberg B, Abou Arab O, Blet A, Bounes F, Boisson M, Caillard A, Carillion A, Clavier T, Frasca D, James A, Sigaut S, Rozencwajg S, Albaladejo P, Bouaziz H. Peace, not war in Ukraine or anywhere else, please. Anaesth Crit Care Pain Med 2022; 41:101068. [PMID: 35460922 DOI: 10.1016/j.accpm.2022.101068] [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: 01/18/2023]
Affiliation(s)
- Jean-Yves Lefrant
- Department of Anaesthesiology, Critical Care and Emergency Medicine, Université de Montpellier-Nîmes, CHU de Nîmes, 30029 Nîmes, France; Editor-in-Chief of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France.
| | - Romain Pirracchio
- Department of Anaesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA; Deputy Editor-in-Chief of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France
| | - Dan Benhamou
- University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France; Advisory Editor of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France
| | - Marc-Olivier Fischer
- Advisory Editor of ACCPM, French Society of Anaesthesia and Critical Care (SFAR), 74, rue Raynouard, 75016 Paris, France; Caen University Hospital, Anaesthesiology and Critical Care Medicine Department, Caen, France
| | - Rosanna Njeim
- Editorial Assistant of ACCPM, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 74, rue Raynouard, 75016 Paris, France
| | | | | | - Matthieu Biais
- University Hospital Centre Bordeaux, Department of Anaesthesiology and Critical Care Medicine, 33300 Bordeaux, France; Univ. Bordeaux, INSERM, Biologie des Maladies Cardiovasculaires, U1034, F-33600 Pessac, France
| | - Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Groupement Hospitalier Est - Hôpital Femme Mère Enfant, 69500 Bron, France
| | - Olivier Brissaud
- University Hospital Centre Bordeaux, Paediatric Intensive Care Unit, 33300 Bordeaux, France
| | - Sorin J Brull
- Mayo Clinic, College of Medicine and Science, Department of Anaesthesiology and Perioperative Medicine, Jacksonville, United States
| | - Xavier Capdevila
- Montpellier University Hospital Centre, Department of Anaesthesia and Intensive Care, 34090 Montpellier, France
| | - Nicola Clausen
- Anæstesiologisk Intensiv Afdeling V, Odense, Odense Universitetshospital, J.B. Winsløws Vej 4, 5000 Odense C, Danmark
| | - Philippe Cuvillon
- Nîmes University Hospital, CHU Carémeau, Critical Care and Emergency Medicine, Pain Dept, 30029 Nîmes, France
| | - Christophe Dadure
- Lapeyronie Hospital, Paediatric Anaesthesia Department, 34090 Montpellier, France
| | - Jean-Stéphane David
- Civil Hospices of Lyon Department of Anaesthesiology and Critical Care Medicine, Lyon, France
| | - Bin Du
- State Key Laboratory of Rare, Complex and Critical Diseases, Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730, China
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Centre, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Victoria Eley
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Butterfield St, Herston 4006, Queensland, Australia; Faculty of Medicine, The University of Queensland, St Lucia 4067, Queensland, Australia
| | - Patrice Forget
- University of Aberdeen, Institute of Applied Health Sciences, Department of Anaesthesia, Aberdeen, United Kingdom
| | - Tomoko Fujii
- Jikei University Hospital, Intensive Care Unit, Tokyo, Japan
| | - Anne Godier
- Department of Anaesthesia and Intensive care, Hôpital Européen Georges Pompidou, Université de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Dean P Gopalan
- University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Sophie Hamada
- Department of Anaesthesia and Intensive care, Hôpital Européen Georges Pompidou, Université de Paris, 20 rue Leblanc, 75015 Paris, France
| | - Ahmed Hasanin
- epartment of Anesthesia and Critical Care, Cairo University, Cairo, Egypt
| | | | - Sébastien Kerever
- Department of Anesthesiology and Critical Care Medicine, Lariboisière University Hospital, DMU PARABOL, AP-HP. Nord, Paris, France; Fédération Hospitalo-Universitaire PROMICE, INSERM UMR-S 942 MASCOT, Université de Paris, Paris, France
| | - Éric Kipnis
- Department of Anaesthesia and Intensive Care, Lille University Hospital, 1, rue Michel-Polonowski, 59037 Lille, France
| | - Kerstin Kolodzie
- Department of Anaesthesia and & Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Ruth Landau
- Columbia University Vagelos College of Physicians and Surgeons, New York, United States
| | - Arthur Le Gall
- Department of Anaesthesia, Critical Care and Peri-operative Medicine, Rennes University Hospital, Rennes, France
| | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Matthieu Legrand
- Department of Anaesthesia and Perioperative Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, USA
| | - Emmanuel Lorne
- Department of Anaesthesia and Critical Care Medicine, Clinique du Millénaire, 34960 Montpellier Cedex 2, France
| | - Frédéric J Mercier
- Paris-Saclay University, Antoine-Béclère Hospital, Department of Anaesthesia and Critical Care Medicine, Clamart, France
| | - Nicolas Mongardon
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Faculté de Santé, F-94010 Créteil, France
| | - Sheila Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | - Mark John Peters
- Great Ormond Street Hospital for Children Paediatric Intensive Care Unit, London, United Kingdom
| | - Hervé Quintard
- University Hospital Centre Nice Anesthesia, Resuscitation Emergency Department, Nice, France
| | - Jordi Rello
- International University of Cataluna Faculty of Medicine and Health Sciences, Sant Cugat del Valles, Spain
| | - Philippe Richebé
- niversity of Montreal Department of Anaesthesiology and Pain Medicine, Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montreal, Montréal, Canada
| | | | - Antoine Rocquilly
- University of Nantes - Anaesthesiology and Intensive Care Unit, Nantes, France
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, Policlinico University Hospital, Catania, Italy
| | - Antoine Schneider
- Lausanne University Hospital Adult Intensive Care Unit, Vaud, Switzerland
| | | | - Francis Veyckemans
- Department of Paediatric Anaesthesia, Jeanne de Flandre hospital, University Hospitals of Lille, 59037 Lille, France
| | - Paul Zetlaoui
- University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Ahed Zeidan
- King Fahad Specialist Hospital, Anesthesiology Department, Dammam, Saudi Arabia
| | - Laurent Zieleskiewicz
- Aix-Marseille University, University Hospital of Marseille, Department of Anaesthesia and Intensive Care Medicine, Marseille, France
| | - Marzena Zielinska
- Wroclaw Medical University, Department of Paediatric Anaesthesiology and Intensive Care, Poland
| | - Britta Von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia; Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia; Team Perioperative Medicine, Telethon Kids Institute, Perth, WA, Australia
| | - Osama Abou Arab
- Anesthésie réanimation cardiovasculaire et thoracique, CHU Amiens, Laboratoire MP3CV, EA 7517, Université Picardie Jules Verne, 1 rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - Alice Blet
- Lyon University Hospital, Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fanny Bounes
- INSERM U1052, Cancer Research Center of Lyon, Lyon, France; Pôle Anesthesie Réanimation Médecine peri operatoire CHU Toulouse, 1av du Pr J Poulhes, 31000 Toulouse, France
| | - Matthieu Boisson
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, Poitiers, France; INSERM U1070, « Pharmacologie des anti-infectieux et résistances », Université de Poitiers, Poitiers, France
| | - Anaïs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical care and Perioperative medicine Department, Brest, France
| | - Aude Carillion
- Département d'Anesthésie-Réanimation, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013 Paris, France; UMR-S 1166 ICAN, Unité de recherche sur les maladies cardiovasculaires et métaboliques, Sorbonne Université, France
| | - Thomas Clavier
- Département de Réanimation, Anesthésie et Médecine Périopératoire, Unité de Réanimation Chirurgicale Polyvalente, CHU de Rouen, 37 Bd Gambetta, 76000 Rouen, France; Laboratoire INSERM U1096, Université de Rouen-Normandie, France
| | - Denis Frasca
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, CHU de Poitiers, Poitiers, France; INSERM U1246, SPHERE, Université de Nantes, France
| | - Arthur James
- Sorbonne Université, GRC 29, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013 Paris, France
| | - Stéphanie Sigaut
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Paris, France
| | - Sacha Rozencwajg
- Department of Anaesthesiology and Surgical Intensive Care, Bichat Claude-Bernard Hospital, AP-HP, DMU PARABOL, France
| | - Pierre Albaladejo
- Department of Anaesthesiology and Critical Care, Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France; Current President of the French Society of Anaesthesia and Intensive Care Medicine (SFAR), Paris, France
| | - Hervé Bouaziz
- Department of Anaesthesiology and Obstetric Critical Care Unit, University Maternity Hospital of Nancy, 54000 Nancy, France; Past President of the French Society of Anaesthesia and Intensive Care Medicine (SFAR), Paris, France
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