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Vargas M, Battaglini D, Antonelli M, Corso R, Frova G, Merli G, Petrini F, Ranieri MV, Sorbello M, Di Giacinto I, Terragni P, Brunetti I, Servillo G, Pelosi P. Follow-up short and long-term mortalities of tracheostomized critically ill patients in an Italian multi-center observational study. Sci Rep 2024; 14:2319. [PMID: 38281994 PMCID: PMC10822864 DOI: 10.1038/s41598-024-52785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/23/2024] [Indexed: 01/30/2024] Open
Abstract
The effects of tracheostomy on outcome as well as on intra or post-operative complications is yet to be defined. Admission of patients with tracheostomy to rehabilitation facility is at higher risk of suboptimal care and increased mortality. The aim of the study was to investigate ICU mortality, clinical outcome and quality of life up to 12 months after ICU discharge in tracheostomized critically ill patients. This is a prospective, multi-center, cohort study endorsed by Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care (SIAARTI Prot. n° 643/13) registered in Clinicaltrial.gov (NCT01899352). Patients admitted to intensive care unit (ICU) and requiring elective tracheostomy according to physician in charge decision were included in the study. The primary outcome was ICU mortality. Secondary outcomes included risk factors for ICU mortality, prevalence of mortality at follow-up, rate of discharge from the hospital and rehabilitation, quality of life, performance status, and management of tracheostomy cannula at 3-, 6, 12-months from the day of tracheostomy. 694 critically ill patients who were tracheostomized in the ICU were included. ICU mortality was 15.8%. Age, SOFA score at the day of the tracheostomy, and days of endotracheal intubation before tracheostomy were risk factors for ICU mortality. The regression tree analysis showed that SOFA score at the day of tracheostomy and age had a preeminent role for the choice to perform the tracheostomy. Of the 694 ICU patients with tracheostomy, 469 completed the 12-months follow-up. Mortality was 33.51% at 3-months, 45.30% at 6-months, and 55.86% at 12-months. Patients with tracheostomy were less likely discharged at home but at hospital facilities or rehabilitative structures; and quality of life of patients with tracheostomy was severely compromised at 3-6 and 12 months when compared with patients without tracheostomy. In patients admitted to ICU, tracheostomy is associated with high mortality, difficult rehabilitation, and decreased quality of life. The choice to perform a tracheostomy should be carefully weighed on family burden and health-related quality of life.Clinical trial registration: Clinicaltrial.gov (NCT01899352).
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Affiliation(s)
- Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, 80100, Naples, Italy.
| | | | - Massimo Antonelli
- Dip Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ruggero Corso
- Dipartimento delle Terapie Intensive, Anestesiologia e Terapia del Dolore, Ospedale "Guglielmo da Saliceto"-Piacenza, Piacenza, Italy
| | - Giulio Frova
- Università degli Studi di Milano and Dipartimento Anestesia e Rianimazione Spedai Civili si Brescia, Brescia, Italy
| | - Guido Merli
- U.O.C. Anestesia e Rianimazione Ospedale Maggiore di Crema, Asst Crema, Italy
| | - Flavia Petrini
- Coordinamento Strutturale Medicina Perioperatoria, Terapia Dolore, Emergenze Intraospedaliere, Terapia Intensiva - ASL2 Abruzzo, Università di Chieti-Pescara, Pescara, Italy
| | - Marco V Ranieri
- Alma Mater Studiorum-Università di Bologna, IRCCS Policlinico di Sant'Orsola, Anesthesia and Intensive Care Medicine, Bologna, Italy
| | | | - Ida Di Giacinto
- Anesthesia and Intensive Care, Mazzoni Hospital, Ascoli Piceno, Italy
| | - Pierpaolo Terragni
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Iole Brunetti
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, 80100, Naples, Italy
| | - Paolo Pelosi
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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2
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Rossi M, Tritapepe L, Conigliaro R, Fanti L, Monzani R, De Robertis E, Martino R, Pietrini L, Sbaraglia F, Pasquale L, Petrini F. Rethink analgo-sedation in digestive endoscopy: the role of scientific societies in tracing training path. Eur Rev Med Pharmacol Sci 2023; 27:4670-4677. [PMID: 37259750 DOI: 10.26355/eurrev_202305_32478] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The Italian Society of Anesthesia, Analgesia, Reanimation and Intensive Care Medicine (SIAARTI) and the Italian Society of Digestive Endoscopy (SIED) worked together to produce a joint Good Clinical Practice (GCP) on analgo-sedation in digestive endoscopy and launched a survey to support the document. The aim was to identify and describe the actual clinical practice of sedation in Italian digestive endoscopy units and offer material for a wider and more widespread discussion among anesthetists and endoscopists. SUBJECTS AND METHODS A national survey was planned, in order to support the statements of the GCP. Twelve thousand and five hundred questionnaires were sent to the members of SIAARTI and SIED in June 2020. RESULTS A total of 662 forms (5.3%) returned completed. Highly complex procedures are performed according to 70% of respondents; daily anesthesiologist's assistance is guaranteed in 26%, for scheduled sessions in 14.5% and as needed in 8%. 69% of respondents declared not to have a dedicated team of anesthesiologists, while just 5% reported an anesthesiologist in charge. A complete monitoring system was assured by 70% of respondents. Dedicated pathways for COVID-19-positive patients were confirmed in <40% of the answers. With regard to moderate/deep sedation, 90% of respondents stated that an anesthetist decides timing and doses. Propofol was exclusively administered by anesthetists according to 94% of answers, and for 6% of respondents the endoscopist is allowed to administer propofol in presence of a dedicated nurse, but with a readily available anesthetist. Only 32.8% of respondents reported institutional training courses on procedural analgo-sedation. CONCLUSIONS The need to provide patients scheduled for endoscopy procedures with an adequate analgo-sedation is becoming an increasing concern, well-known in almost all countries, but many factors compromise the quality of patient care. Results of a national survey would give strength to the need for a shared GCP in gastrointestinal endoscopy. Training and certification of non-anesthetist professionals should be one of the main ways to center the objective.
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Affiliation(s)
- M Rossi
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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Michela DT, Rachele M, Alessia R, Daniela DB, Marco R, Luigi T, Petrini F, Grazia FM. COVID-19 pandemic burnout in an Italian sample of anaesthesiologists: coping strategies, resilience and the capability of tolerating the uncertainty as preventing factors. PSYCHOL HEALTH MED 2023; 28:648-659. [PMID: 36053014 DOI: 10.1080/13548506.2022.2119484] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The present study aims to explore the prevalence of burnout characteristics and their association with resilience, coping strategies, and the intolerance of uncertainty dimensions. It also aims to explore the predictive effect of these variables on burnout dimensions, separately. Through the SurveyMonkey platform, 1,009 anaesthesiologists completed the Maslach Burnout Inventory (MBI), Resilience Scale, Intolerance of Uncertainty Scale Short Form (IU), and the Coping Inventory for Stressful Situations (CISS). According to the MBI cut-off, 39.7% and 25.8% of participants scored high in Emotional Exhaustion and Depersonalization, respectively, and 44.2% scored low in Personal Accomplishment. Several significant correlations between burnout dimensions and resilience, coping strategies, and the intolerance of uncertainty emerged. Regarding the linear regression models tested, coping strategies, resilience, and age showed a significant predictive effect on all three of the burnout dimensions. In conclusion, the results showed that individual levels of resilience and one's ability to tolerate uncertainty and task-oriented coping strategies represent significant factors for lower burnout levels in Italian anaesthesiologists during COVID-19 pandemic. These findings highlight the importance of intervention aimed at promoting useful coping strategies and enhancing resilience among healthcare workers.
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Affiliation(s)
- Di Trani Michela
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Mariani Rachele
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Renzi Alessia
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | | | - Rossi Marco
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care SIAARTI, Italy.,Department Emergency, Anesthesiology and Intensive Care, Catholic University of Holy Heart, Policlinico A. Gemelli IRCCS Foundation, Rome, Italy
| | - Tritapepe Luigi
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care SIAARTI, Italy.,U.O. of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Rome, Italy
| | - Flavia Petrini
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care SIAARTI, Italy
| | - Frigo Maria Grazia
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care SIAARTI, Italy.,U.O. of Obstetric Anesthesia, Clinical Risk, Fatebenefratelli Hospital, Rome, Italy
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Frigo MG, Petrini F, Tritapepe L, Rossi M, DE Berardinis D, Renzi A, Mariani R, DI Trani M. Burnout in Italian anesthesiologists and intensivists during the COVID-19 pandemic: a national survey. Minerva Anestesiol 2023; 89:188-196. [PMID: 36282228 DOI: 10.23736/s0375-9393.22.16737-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND COVID-19 pandemic added additional burden upon healthcare systems and anesthesiology and intensive care physicians (AI) who possessed crucial expertise for dealing with the pandemic. Aim of the study was to uncover specific burnout patterns among Italian AI, exploring the hypothesis that burnout has a multicluster structure. Differences in social and professional characteristics between burnout patterns were explored. METHODS One thousand and nine AI (658 women) members of the Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) working during COVID-19 pandemic participated. Sociodemographic, working information and burnout levels evaluated through Maslach Burnout Inventory (MBI) were collected. RESULTS According to the MBI cutoff, 39.7% and 25.8% of participants scored high in emotional exhaustion and depersonalization respectively, and 44.2% scored low in personal accomplishment. Cluster analysis highlighted four burnout profiles: resilience, detachment, burnout, and emotional reserve. The results showed that AI in the Resilience and Emotional Reserve groups were significantly older and more experienced than those in the Detachment and Burnout groups. Additionally, more of the individuals in the Resilience group were working in intensive care units and departments dedicated to COVID-19 patients. The Detachment group was comprised of more AI working in operating units, while the Burnout group contained a higher number of AI working in COVID-19 departments. CONCLUSIONS These findings highlight different burnout patterns in Italian AI: older age, more professional experience, and work in intensive care units and departments dedicated to COVID-19 seemed to be protective factors during the pandemic. This appears a first step to promote focused interventions.
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Affiliation(s)
- Maria G Frigo
- Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva - SIAARTI, Rome, Italy.,Unit of Obstetric Anesthesia and Clinical Risk, Fatebenefratelli Hospital, Rome, Italy
| | - Flavia Petrini
- Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva - SIAARTI, Rome, Italy
| | - Luigi Tritapepe
- Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva - SIAARTI, Rome, Italy.,Unit of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Rome, Italy
| | - Marco Rossi
- Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva - SIAARTI, Rome, Italy.,Department of Emergency, Anesthesiology and Intensive Care, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | - Alessia Renzi
- Department of Dynamic, Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Rachele Mariani
- Department of Dynamic, Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Michela DI Trani
- Department of Dynamic, Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy -
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Vittori A, Cascella M, Petrucci E, Cortegiani A, Bignami EG, Innamorato MA, Cuomo A, Torrano V, Petrini F, Giarratano A, Natoli S, Marinangeli F. Strategies to build and maintain competence in pain management: Insights from a SIAARTI survey on educational needs among Italian anesthesiologists. Pain Pract 2023. [PMID: 36690597 DOI: 10.1111/papr.13207] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self-perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management. METHODS SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, knowledge, competence) while their agreement to attend educational courses was assessed using a 5-point Likert-type scale. RESULTS Less than one in four participants declare to be dedicated to pain medicine activity with greater proportion among older (over 61 years) compared to younger ones (31-40 years). Regarding cancer and chronic noncancer pain a positive gradient of self-perceived competence has been observed in relation to seniority. In contrast, no gradient of self-perceived competence was reported about musculoskeletal and low back pain. Participants self-perceived competent in both opioid use and prevention of opioid-related adverse event while feeling less competent when managing drugs with abuse potential. The lowest competence has been observed in pediatric pain along with the lowest interest to attend educational courses. Participants were much and very much interested to education regarding cancer, noncancer, musculoskeletal, and low back pain, invasive analgesic procedures but less regarding items for which they declared less competence, such as use of pain scales, pain management in children, and use of drugs with abuse potential. CONCLUSION This work provides first evidence of a summative assessment of competency and related educational needs' profile of anesthesiologists/pain therapists thus paving the way for developing a nationwide educational program to improve chronic pain care in Italy.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Marco Cascella
- Unit of Pain Medicine and Research, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy.,Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | | | | | - Arturo Cuomo
- Unit of Pain Medicine and Research, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Vito Torrano
- Department of Anesthesia, Critical Care and Pain Medicine, Asst Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Flavia Petrini
- Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), President 2019-2021, Rome, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science, Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy.,Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS Maugeri, Pavia, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
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Centore M, Silverio A, Scudiero F, Di Maio M, Muraca I, Dossi F, Petrini F, Brenca D, Maiellaro F, Attisano T, Parodi G, Musumeci G, Galasso G. Intravenous antiplatelet therapy with cangrelor vs. tirofiban in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Intravenous antiplatelet drugs provide rapid and sustained inhibition of platelet aggregation and can mitigate the ischemic risk of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). However, there are few real-world studies comparing cangrelor to tirofiban in this patient population.
Purpose
The aim of this study was to evaluate the effectiveness and the safety of cangrelor compared to tirofiban in a real-world population of STEMI patients undergoing pPCI.
Methods
This was a prospective, multicenter, observational study including consecutive STEMI patients who received either cangrelor or tirofiban during pPCI at six Italian high-volume pPCI centers from January 2020 to January 2022. The study population was divided into two groups according the antiplatelet treatment received (cangrelor or tirofiban). The primary study outcome was impaired myocardial revascularization assessed by post-procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade <3. The secondary outcome measures were major bleeding, defined as Bleeding Academic Research Consortium (BARC) type 3 or 5, and all-cause mortality during the hospitalization.
Results
A total of 478 STEMI patients received intravenous antiplatelet therapy during pPCI. Of them, 16 patients were excluded since they received both cangrelor and tirofiban as bailout strategy. Thus, the final study population included 462 patients (mean age 63.9±11.8 years; 79.7% males): 223 patients received cangrelor (48.3%), and 239 tirofiban (51.7%). Patients treated with tirofiban had higher prevalence of prior myocardial infarction (p=0.016) and prior PCI (p=0.048) than patients receiving cangrelor (Table 1); also, they showed higher SYNTAX score (p=0.038) than patients receiving cangrelor, and a higher proportion of stent thrombosis as culprit lesion (p=0.047; Table 2). Conversely, patients treated with cangrelor had worse Killip class (p<0.001), and underwent more frequently pPCI via femoral access. Post-procedural TIMI flow<3 was reported in 114 (24.7%) patients. At propensity score adjusted regression analysis, the use of cangrelor was associated with a lower probability of post-procedural TIMI flow<3 (aOR: 0.530; 95% CI: 0.313–0.900; p=0.019) than tirofiban. Major bleeding and all-cause death occurred in 28 (6.1%) and 19 (4.1%) patients. There was no difference in the risk of major bleeding (aOR: 1.626; 95% CI: 0.618–4.279; p=0.324) and death (aOR: 2.724; 95% CI: 0.719–10.318; p=0.140) between groups.
Conclusions
In this real-world population of STEMI patients undergoing pPCI, periprocedural use of cangrelor was associated with improved myocardial reperfusion compared to tirofiban, but with no differences in terms of major bleeding or death during the hospitalization.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Centore
- University of Salerno School of Medicine , Salerno , Italy
| | - A Silverio
- University of Salerno School of Medicine , Salerno , Italy
| | - F Scudiero
- Ospedali Riuniti - Bergamo United Hospitals , Bergamo , Italy
| | - M Di Maio
- University of Salerno School of Medicine , Salerno , Italy
| | - I Muraca
- Careggi University Hospital , Florence , Italy
| | - F Dossi
- ASL4 Chiavarese Hospital , Lavagna , Italy
| | - F Petrini
- Careggi University Hospital , Florence , Italy
| | - D Brenca
- University of Salerno School of Medicine , Salerno , Italy
| | | | - T Attisano
- University of Salerno School of Medicine , Salerno , Italy
| | - G Parodi
- ASL4 Chiavarese Hospital , Lavagna , Italy
| | - G Musumeci
- Mauriziano Umberto Hospital , Turin , Italy
| | - G Galasso
- University of Salerno School of Medicine , Salerno , Italy
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Cerillo A, Petrini F, Bugetti M, Iannone L, De Cillis P, Paduvakis J, Marchionni N, Stefano P. Are severe mitral annular calcification still a contraindication to open surgery? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mitral annular calcifications are considered a contraindication to open mitral valve repair/replacement, being associated with a significant risk of rupture of the atrioventricular groove or prosthesis detachment/paraprosthetic leak. Recently a scoring system has been proposed, to quantify the severity of MAC and predict the success of transcatheter valve in MAC implantation.
Objective
We present a series of consecutive patients with MAC undergoing sugical mitral valve replacement in recent years.
Patients and methods
82 consecutive patients with MAC underwent open surgical correction from January 2019 at our centre. This was a complex cohort of patients with a high surgical risk profile (STS 5.3±3.2). The degree of MAC was moderate in 60 and severe in 22. Annular decalcification was required in 16 patients, and patch reconstruction of the AV groove in 4. The main predictor of the need for annular decalcification and reconstruction was the depth of calcium infiltration in the ventricular wall at CT. At intraoperative TEE only one patient had a significant paraprosthetic leak, that was repaired during a second short period of aortic cross-clamping. 30 days mortality was 1.2% (one patient), and 87% of patients were alive and well at one year.
Comment
The presence of significant mitral annular calcificaion per se should not be considered a contraindication to open mitral valve surgery. The depth of the calcifications in the ventricular wall, as measured at CT 3D multiplanar reconstructions is the best predictor of the need to decalcify/reconstruct the AV groove. Detailed imaging analysis is crucial for the success of the procedure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Cerillo
- CAREGGI University hospital , Florence , Italy
| | - F Petrini
- CAREGGI University hospital , Florence , Italy
| | - M Bugetti
- CAREGGI University hospital , Florence , Italy
| | - L Iannone
- CAREGGI University hospital , Florence , Italy
| | - P De Cillis
- CAREGGI University hospital , Florence , Italy
| | - J Paduvakis
- CAREGGI University hospital , Florence , Italy
| | | | - P Stefano
- CAREGGI University hospital , Florence , Italy
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Vetrugno L, Mojoli F, Boero E, Berchialla P, Bignami EG, Orso D, Cortegiani A, Forfori F, Corradi F, Cammarota G, De Robertis E, Mongodi S, Chiumello D, Poole D, Ippolito M, Biasucci DG, Persona P, Bove T, Ball L, Pelosi P, Navalesi P, Antonelli M, Corcione A, Giarratano A, Petrini F. Level of Diffusion and Training of Lung Ultrasound during the COVID-19 Pandemic - A National Online Italian Survey (ITALUS) from the Lung Ultrasound Working Group of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI). Ultraschall Med 2022; 43:464-472. [PMID: 34734405 PMCID: PMC9534595 DOI: 10.1055/a-1634-4710] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE The goal of this survey was to describe the use and diffusion of lung ultrasound (LUS), the level of training received before and during the COVID-19 pandemic, and the clinical impact LUS has had on COVID-19 cases in intensive care units (ICU) from February 2020 to May 2020. MATERIALS AND METHODS The Italian Lung Ultrasound Survey (ITALUS) was a nationwide online survey proposed to Italian anesthesiologists and intensive care physicians carried out after the first wave of the COVID-19 pandemic. It consisted of 27 questions, both quantitative and qualitative. RESULTS 807 responded to the survey. The median previous LUS experience was 3 years (IQR 1.0-6.0). 473 (60.9 %) reported having attended at least one training course on LUS before the COVID-19 pandemic. 519 (73.9 %) reported knowing how to use the LUS score. 404 (52 %) reported being able to use LUS without any supervision. 479 (68.2 %) said that LUS influenced their clinical decision-making, mostly with respect to patient monitoring. During the pandemic, the median of patients daily evaluated with LUS increased 3-fold (p < 0.001), daily use of general LUS increased from 10.4 % to 28.9 % (p < 0.001), and the daily use of LUS score in particular increased from 1.6 % to 9.0 % (p < 0.001). CONCLUSION This survey showed that LUS was already extensively used during the first wave of the COVID-19 pandemic by anesthesiologists and intensive care physicians in Italy, and then its adoption increased further. Residency programs are already progressively implementing LUS teaching. However, 76.7 % of the sample did not undertake any LUS certification.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Italy
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Italy, Udine, Italy
- Correspondence Dr. Luigi Vetrugno Department of Medicine, University of UdineVia Colugna 5033100 UdineItaly+39/4 32/55 95 01
| | - Francesco Mojoli
- Anesthesiology, Intensive Care and Pain Medicine, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
- Anesthesia and Intensive Care, University Hospital of Pavia, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care, Hospital Saint-Giovanni Bosco Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin Faculty of Medicine and Surgery, Torino, Italy
| | - Elena Giovanna Bignami
- Department of Medicine and Surgery, University of Parma Department of Medicine and Surgery, Parma, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine Department of Biological and Medical Sciences, Udine, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Francesco Forfori
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Francesco Corradi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa School of Medicine, Pisa, Italy
| | - Gianmaria Cammarota
- Department of Medicine and Surgery, University of Perugia School of Medicine and Surgery, Perugia, Italy
| | - Edoardo De Robertis
- Department of Medicine and Surgery, University of Perugia Department of Medicine, Perugia, Italy
| | - Silvia Mongodi
- Anesthesiology and Intensive Care, University Hospital of Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, University of Pavia Faculty of Medicine and Surgery, Pavia, Italy
| | - Davide Chiumello
- Department of Anesthesiology and Intensive Care, University of Milan, Milano, Italy
| | - Daniele Poole
- Anesthesia and Intensive Care Operative Unit, Hospital Saint-Martinus, Belluno, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
| | - Daniele Guerino Biasucci
- Department of Anesthesia and Intensive Care, University Hospital Agostino Gemelli Department of Surgical and Medical Sciences, Rome, Italy
| | - Paolo Persona
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy, Padua, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University Hospital of Udine, Italy, Udine, Italy
- Department of Medicine, University of Udine Department of Biological and Medical Sciences, Udine, Italy
| | - Lorenzo Ball
- Department of Anesthesia and Intensive Care, University of Genoa School of Medical and Pharmaceutical Sciences, Genova, Italy
| | - Paolo Pelosi
- Department of Anesthesia and Intensive Care, University of Genoa School of Medical and Pharmaceutical Sciences, Genova, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy, Padua, Italy
| | - Massimo Antonelli
- Department of Anesthesia and Intensive Care, University Hospital Agostino Gemelli Department of Surgical and Medical Sciences, Rome, Italy
| | - Antonio Corcione
- Unit of Anaesthesia and intensive Care, Monaldi Hospital Naples, Italy, Naples, Italy
| | - Antonino Giarratano
- Department of Anesthesia Intensive Care and Emergency, University Hospital Policlinic Paolo Giaccone, Palermo, Italy
- Department of Surgical, Oncological and Oral Science, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
| | - Flavia Petrini
- Anesthesia, Intensive Care and Pain Management, President Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), Rome Italy, Rome, Italy
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9
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Testoni I, Brondolo E, Ronconi L, Petrini F, Navalesi P, Antonellini M, Biancalani G, Crupi R, Capozza D. Burnout following moral injury and dehumanization: A study of distress among Italian medical staff during the first COVID-19 pandemic period. Psychol Trauma 2022; 15:2022-88064-001. [PMID: 35925698 DOI: 10.1037/tra0001346] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Italy was the first country outside Asia to deal with the early phase of the COVID-19 pandemic, and health care facilities and medical staff were not fully prepared. Research worldwide has documented the enormous effect of the COVID-19 pandemic on health care providers' mental health, including experiences of dehumanization, but less work has focused on factors which may influence the development of these outcomes in response to COVID-19-related stress. OBJECTIVE This study examined the association of dehumanization, self-efficacy, and alienation to burnout, depression, and PTSD among medical staff. Potential moderators included moral injury, professional role, COVID workload, and work in a critical care unit (CCU). METHOD Participants were recruited through the Internet. The sample consisted of 270 medical staff members who completed a self-report survey online. Instruments included: Human Traits Attribution Scale for dehumanization; NYP-Queens Survey-Self-Efficacy Subscale for self-efficacy; Moral Injury Events Scale for moral injury; Alienation Scale for alienation; PTSD-8 for posttraumatic stress disorder; Patient Health Questionnaire-9 for depression; and a single item for burnout. The analytic plan included ANOVAs, zero-order correlations, logistic regression analyses, multiple linear regression models, and parallel mediation. RESULTS Results show that dehumanization was associated with higher levels of burnout, PTSD, and depressive symptoms and effects were consistent across professional role and work context. Dehumanization was significantly associated with PTSD symptoms only among those who had increased COVID-19-related caseloads. Moral injury was positively associated with dehumanization, displayed an independent association with all 3 mental health outcomes, over and above dehumanization, and tended to exacerbate the effects of dehumanization. The effect sizes across analyses were small to medium. CONCLUSION This research confirms that the COVID-19 pandemic stressed Italian medical staff in a way not documented in the prepandemic literature. There is a need to support staff in their complex relationships and communication with patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA)
| | | | - Lucia Ronconi
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA)
| | - Flavia Petrini
- Complex Operative Unit of Anaesthesia, Resuscitation and Intensive Care
| | | | - Marco Antonellini
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA)
| | | | | | - Dora Capozza
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA)
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10
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Beretta GD, Casolino R, Corsi DC, Perrone F, Di Maio M, Cinieri S, Gobber G, Bellani M, Petrini F, Zocchi MT, Traclò F, Zagonel V. Position paper of the Italian Association of Medical Oncology on the impact of COVID-19 on Italian oncology and the path forward: the 2021 Matera Statement. ESMO Open 2022; 7:100538. [PMID: 35921761 PMCID: PMC9222406 DOI: 10.1016/j.esmoop.2022.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/03/2022] Open
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11
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Basso C, Gennaro N, Dotto M, Ferroni E, Noale M, Avossa F, Schievano E, Aceto P, Tommasino C, Crucitti A, Incalzi RA, Volpato S, Petrini F, Carron M, Pace MC, Bettelli G, Chiumiento F, Corcione A, Montorsi M, Trabucchi M, Maggi S, Corti MC. Congestive heart failure and comorbidity as determinants of colorectal cancer perioperative outcomes. Updates Surg 2022; 74:609-617. [PMID: 34115323 PMCID: PMC8995267 DOI: 10.1007/s13304-021-01086-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022]
Abstract
There has been an increase in surgical interventions in frailer elderly with concomitant chronic diseases. The purpose of this paper was to evaluate the impact of aging and comorbidities on outcomes in patients who underwent surgery for the treatment of colorectal cancer (CRC) in Veneto Region (Northeastern Italy). This is a retrospective cohort study in patients ≥ 40 years who underwent elective or urgent CRC surgical resection between January 2013 and December 2015. Independent variables included: age, sex, and comorbidities. We analyzed variables associated with the surgical procedure, such as stoma creation, hospitalization during the year before the index surgery, the surgical approach used, the American Society of Anesthesiologists (ASA) score, and the Charlson Comorbidity Index score. Eight thousand four hundred and forty-seven patients with CRC underwent surgical resection. Patient age affected both pre- and post-resection LOS as well as the overall survival (OS); however, it did not affect the 30-day readmission and reoperation rates. Multivariate analysis showed that age represented a risk factor for longer preoperative and postoperative LOS as well as for 30-day and 365-day mortality, but it was not associated with an increased risk of 30-day reoperation and 30-day readmission. Chronic Heart Failure increased the 30-day mortality risk by four times, the preoperative LOS by 51%, and the postoperative LOS by 33%. Chronic renal failure was associated with a 74% higher 30-day readmission rate. Advanced age and comorbidities require a careful preoperative evaluation and appropriate perioperative management to improve surgical outcomes in older patients undergoing elective or urgent CRC resection.
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Affiliation(s)
- Cristina Basso
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy.
| | - Nicola Gennaro
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Matilde Dotto
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Eliana Ferroni
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Marianna Noale
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
- Consorzio di Ricerca "Luigi Amaducci", Padua, Italy
| | - Francesco Avossa
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Elena Schievano
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
| | - Paola Aceto
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Concezione Tommasino
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Department of Biomedical, Surgical and Odontoiatric Sciences, University of Milano, Anaesthesia and Intensive Care, Polo Universitario Ospedale San Paolo, Milan, Italy
| | - Antonio Crucitti
- SICG, Società Italiana di Chirurgia Geriatrica, Naples, Italy
- Cristo Re Hospital, Catholic University Rome, Rome, Italy
| | - Raffaele Antonelli Incalzi
- SIGG, Società Italiana di Geriatria e Gerontologia, Florence, Italy
- AIP, Società Italiana di Psicogeriatria, Brescia, Italy
- Cattedra di Medicina Interna e Geriatria, Università Campus Bio-Medico, Rome, Italy
| | - Stefano Volpato
- SIGG, Società Italiana di Geriatria e Gerontologia, Florence, Italy
- AIP, Società Italiana di Psicogeriatria, Brescia, Italy
- Dipartimento di Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Flavia Petrini
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Perioperative Medicine, Pain Therapy, ICU and Emergency Department, Chieti-Pescara University, Pescara, Italy
| | - Michele Carron
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Department of Medicine, DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padua, Italy
| | - Maria Caterina Pace
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontostomatologiche, Università di Milano, Milan, Italy
| | - Gabriella Bettelli
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- University of San Marino, San Marino, San Marino
- Department of Anaestesia, Intensive Care, Day Surgery and Pain Therapy and Geriatric Surgery Area, IRCCS INRCA, Italian National Research Centres on Aging, Ancona, Italy
| | - Fernando Chiumiento
- SIAARTI, Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care, Rome, Italy
- Dipartimento Area Critica, ASL Salerno, Salerno, Italy
| | - Antonio Corcione
- Dipartimento di Area Critica UOC Anestesia e TIPO, AORN dei Colli-Monaldi, Naples, Italy
| | - Marco Montorsi
- SIC, Società Italiana di Chirurgia, Rome, Italy
- Humanitas University and Research Hospital IRCCS, Milan, Italy
| | | | - Stefania Maggi
- National Research Council (CNR), Neuroscience Institute, Aging Branch, Padua, Italy
- Consorzio di Ricerca "Luigi Amaducci", Padua, Italy
| | - Maria Chiara Corti
- Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy
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12
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Mokini Z, Genocchio V, Forget P, Petrini F. Metoclopramide and Propofol to Prevent Nausea and Vomiting during Cesarean Section under Spinal Anesthesia: A Randomized, Placebo-Controlled, Double-Blind Trial. J Clin Med 2021; 11:jcm11010110. [PMID: 35011852 PMCID: PMC8745529 DOI: 10.3390/jcm11010110] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Intra-operative nausea, vomiting and retching (NVR) are frequently associated with subarachnoid anesthesia (SA) in women undergoing cesarean section (CS). In this study performed in women undergoing CS under SA with a risk factor control strategy, we compared saline (placebo), propofol, metoclopramide and both drugs to prevent NVR. Methods: We recorded NVR events in 110 women undergoing CS who were randomized after umbilical cord clamping to receive saline (S; n = 27), metoclopramide 10 mg (M; n = 28), propofol 1 mg/kg/h (P; n = 27) or both drugs (PM; n = 28). Results: The proportion of women with intra-operative nausea was: S: 17/27 (63%); P: 15/27 (56%); M: 13/28 (46%); PM: 6/28 (21%) (p = 0.012, Cramér’s V = 0.31 (large effect). The proportion of women with intra-operative vomiting/retching was: S: 9/27 (33%); M: 7/27 (25%); P: 3/28 (11%); PM 2/28 (7%) (p = 0.049, Cramér’s V = 0.26 (medium effect). Post-hoc multiple comparisons revealed a significant reduction in NVR episodes and NRS scores between the PM group and control. Sedation scores did not differ among groups. Conclusion: In women undergoing CS under SA with a risk factor control strategy, combined propofol and metoclopramide reduce nausea and vomiting.
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Affiliation(s)
- Zhirajr Mokini
- Independent Researcher, European Society of Anaesthesiology and Intensive Care Mentorship Programme, B-1000 Brussels, Belgium
- Correspondence:
| | - Valentina Genocchio
- Ospedale San Maurizio di Bolzano, Via Lorenz Böhler 5, 39100 Bolzano, Italy;
| | - Patrice Forget
- Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK;
- Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZN, UK
| | - Flavia Petrini
- Department of Emergency, SS.ma Annunziata University Hospital, Via dei Vestini, 66100 Chieti, Italy;
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13
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Vetrugno L, Mojoli F, Cortegiani A, Bignami EG, Ippolito M, Orso D, Corradi F, Cammarota G, Mongodi S, Boero E, Iacovazzo C, Vargas M, Poole D, Biasucci DG, Persona P, Bove T, Ball L, Chiumello D, Forfori F, de Robertis E, Pelosi P, Navalesi P, Giarratano A, Petrini F. Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO). J Anesth Analg Crit Care 2021. [PMCID: PMC8611396 DOI: 10.1186/s44158-021-00015-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without invasive mechanical ventilation), positive end expiratory pressure titration, the use of prone position, the early diagnosis of pneumothorax- or ventilator-associated pneumonia, the process of weaning from invasive mechanical ventilation, and the need for radiologic chest imaging. Results A total of 20 statements were produced by the panel. Agreement was reached on 18 out of 20 statements (scoring 7–9; “appropriate”) in the first round of voting, while 2 statements required a second round for agreement to be reached. At the end of the two Delphi rounds, the median score for the 20 statements was 8.5 [IQR 8.9], and the agreement percentage was 100%. Conclusion The Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care produced 20 consensus statements on the use of lung ultrasound in COVID-19 patients admitted to the ICU. This expert consensus strongly suggests integrating lung ultrasound findings in the clinical management of critically ill COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s44158-021-00015-6.
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14
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Vittori A, Petrucci E, Cascella M, Innamorato M, Cuomo A, Giarratano A, Petrini F, Marinangeli F. Pursuing the Recovery of Severe Chronic Musculoskeletal Pain in Italy: Clinical and Organizational Perspectives from a SIAARTI Survey. J Pain Res 2021; 14:3401-3410. [PMID: 34744457 PMCID: PMC8565982 DOI: 10.2147/jpr.s328434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/13/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Increased attention to the functional impact of chronic pain (CP), as highlighted by the 11th revision of the International Classification of Diseases (ICD-11) and advocated by the International Classification of Functioning, Disability and Health (ICF), is an important step forward for optimizing its management. Evidence about perspectives of Italian physicians on the relevance of musculoskeletal (MSK) pain care to improve patients’ functioning and Quality of Life is scant. The study aimed to investigate the physicians’ perception of the value of functional recovery in severe MSK pain patients, their attitude towards its assessment and achievement in Italy. Methods A survey was conducted in Italy between October 2020 and January 2021. Specialist centers members of the SIAARTI (n = 395) were sent an online questionnaire encompassing the Italian pain therapy network. Participants rated their agreement to questionnaire items according to a 5-point Likert-type scale. Results A total of 305 centers (77%) completed the survey. Most physicians rated the recovery of functioning as very relevant in MSK pain treatment and, when they assessed it, devoted great attention to the ability to perform daily activities, pain, ability to ambulate and sleep quality. Multidimensional questionnaires were less employed in favor of physical examination and pain intensity scales. Pharmacological therapy, rehabilitation and lifestyle changes and/or physical exercise were all rated optimal strategies to pursue the recovery of patients’ functioning. When considering pharmacological therapy, weak and strong opioids, either alone or combined with paracetamol, were the most frequently employed analgesics. Conclusion Clinicians seem to recognize the recovery of functioning as equally important as pain intensity reduction, but there is a need of streamlining available tools to effectively assess both across different MSK pain patients.
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Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Massimo Innamorato
- Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Arturo Cuomo
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Flavia Petrini
- SIAARTI (Italian Society of Anaesthesia, Analgesia, Reanimation and Intensive Care Medicine), Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
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15
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Riccioni L, Ingravallo F, Grasselli G, Mazzon D, Cingolani E, Forti G, Zagrebelsky V, Zoja R, Petrini F. The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic. Ann Intensive Care 2021; 11:100. [PMID: 34189634 PMCID: PMC8241202 DOI: 10.1186/s13613-021-00888-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/16/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In early 2020, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) published clinical ethics recommendations for the allocation of intensive care during COVID-19 pandemic emergency. Later the Italian National Institute of Health (ISS) invited SIAARTI and the Italian Society of Legal and Insurance Medicine to prepare a draft document for the definition of triage criteria for intensive care during the emergency, to be implemented in case of complete saturation of care resources. METHODS Following formal methods, including two Delphi rounds, a multidisciplinary group with expertise in intensive care, legal medicine and law developed 12 statements addressing: (1) principles and responsibilities; (2) triage; (3) previously expressed wishes; (4) reassessment and shifting to palliative care; (5) collegiality and transparency of decisions. The draft of the statements, with their explanatory comments, underwent a public consultation opened to Italian scientific or technical-professional societies and other stakeholders (i.e., associations of citizens, patients and caregivers; religious communities; industry; public institutions; universities and research institutes). Individual healthcare providers, lay people, or other associations could address their comments by e-mail. RESULTS Eight stakeholders (including scientific societies, ethics organizations, and a religious community), and 8 individuals (including medical experts, ethicists and an association) participated to the public consultation. The stakeholders' agreement with statements was on average very high (ranging from 4.1 to 4.9, on a scale from 1-full disagreement to 5-full agreement). The 4 statements concerning triage stated that in case of saturation of care resources, the intensive care triage had to be oriented to ensuring life-sustaining treatments to as many patients as possible who could benefit from them. The decision should follow full assessment of each patient, taking into account comorbidities, previous functional status and frailty, current clinical condition, likely impact of intensive treatment, and the patient's wishes. Age should be considered as part of the global assessment of the patient. CONCLUSIONS Lacking national guidelines, the document is the reference standard for healthcare professionals in case of imbalance between care needs and available resources during a COVID-19 pandemic in Italy, and a point of reference for the medico-legal assessment in cases of dispute.
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Affiliation(s)
- Luigi Riccioni
- Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy.
| | - Francesca Ingravallo
- Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giacomo Grasselli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Mazzon
- UOC Anesthesia and Intensive Care, Belluno Hospital, Belluno, Italy
| | - Emiliano Cingolani
- Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152, Rome, Italy
| | - Gabrio Forti
- Criminal Law, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Riccardo Zoja
- Institute of Legal Medicine, Department of Biomedical Sciences of Health, University of Milan, President of SIMLA, Milan, Italy
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16
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Battaglini D, Ionescu Maddalena A, Caporusso RR, Garofalo E, Bruni A, Bocci MG, Cingolani E, Giarratano A, Petrini F. Acquisition of skills in Critical Emergency Medicine: an experimental study on the SIAARTI Academy CREM experience. Minerva Anestesiol 2021; 87:1174-1182. [PMID: 34170097 DOI: 10.23736/s0375-9393.21.15427-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In 2019 the SIAARTI developed a seven-days course for residents, focused on critical emergency medicine (CREM) in a hostile environment, that grounds on simulation-based education and training with hands-on simulation, high-fidelity simulators and part-task trainers. This project aimed to evaluate the efficacy of this course in comparison to traditional learning programs in term of technical (TS) and non-technical (NTS) skills. We assessed the improvement in TS and NTS over time, and the ability to involve trainees in corporate activities. METHODS Three-hundred and twenty-seven trainees completed the study. Trainees were allocated into 3 groups: those who joined the SIAARTI-Academy-CREM course and received a study kit (SAKit, n=124), those who received only a study kit (Kit, n=108), and Control (n=95). Eighty-five tests were administered to investigate skills at 3 timepoints: T0=baseline, T1=post-training/kit, and T2=4-months later. RESULTS TS differed among groups (p<0.0001), with the highest points in the SA-Kit group at T1 (post-hoc comparison, p<0.0001 vs Kit; p<0.0001 vs Control), and T2 (post-hoc comparison, p<0.0001 vs Kit; p<0.0001 vs Control). NTS differed among groups (p=0.0406), with the highest points in the SA-Kit group at T1 (post-hoc comparison, p=0.0337 vs Kit; p=0.0416 vs Control), and T2 (post-hoc comparison, p=0.0073 vs Kit; p=0.3308 vs Control). SA-Kit group significantly improved TS (p<0.0001) and NTS (p=0.0006) over time. Involvement in corporate activities of SAkit was significantly higher than Kit and Control (p=0.0012). CONCLUSIONS SA-Kit improvement in TS and NTS was higher than Kit and Control and was maintained over time. Participation in this course implemented participation in corporate activities among attendees.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy - .,Department of Medicine, University of Barcelona, Barcelona, Spain -
| | - Alessandra Ionescu Maddalena
- UOC Anestesia e Rianimazione, Polo Ospedaliero Balcolle ASL, Viterbo, Italy.,Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Istituto di Anestesiologia e Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del sacro Cuore, Rome, Italy
| | - Roberta R Caporusso
- Sezione anestesia e rianimazione, Dipartimento di Scienze mediche e chirurgiche, Università degli Studi di Foggia, Foggia, Italy
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, Mater Domini University Hospital, Catanzaro, Italy
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, Mater Domini University Hospital, Catanzaro, Italy
| | - Maria Grazia Bocci
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Istituto di Anestesiologia e Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del sacro Cuore, Rome, Italy
| | - Emiliano Cingolani
- Dipartimento di Emergenza Accettazione e delle Chirurgie specialistiche, UOSD Shock e Trauma, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Antonino Giarratano
- Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - Flavia Petrini
- Department of Anesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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17
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Mistraletti G, Giannini A, Gristina G, Malacarne P, Mazzon D, Cerutti E, Galazzi A, Giubbilo I, Vergano M, Zagrebelsky V, Riccioni L, Grasselli G, Scelsi S, Cecconi M, Petrini F. Why and how to open intensive care units to family visits during the pandemic. Crit Care 2021; 25:191. [PMID: 34078445 PMCID: PMC8171999 DOI: 10.1186/s13054-021-03608-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
Since the lockdown because of the pandemic, family members have been prohibited from visiting their loved ones in hospital. While it is clearly complicated to implement protocols for the admission of family members, we believe precise strategic goals are essential and operational guidance is needed on how to achieve them. Even during the pandemic, we consider it a priority to share strategies adapted to every local setting to allow family members to enter intensive care units and all the other hospital wards.
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Affiliation(s)
- Giovanni Mistraletti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. .,SC Anesthesia and Intensive Care, San Paolo Hospital - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Giuseppe Gristina
- Italian Society of Anaesthesia, Analgesia, Reanimation, and Intensive Care Medicine (SIAARTI) Ethics, Rome, Italy
| | | | - Davide Mazzon
- UOC Anesthesia and Intensive Care, Belluno Hospital, Belluno, Italy
| | - Elisabetta Cerutti
- Department of Anesthesia and Transplant, Surgical Intensive Care, AOU Ospedali Riuniti, Ancona, Italy
| | - Alessandro Galazzi
- Direction of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Giubbilo
- General and Neurosurgical ICU, Ospedale dell'Angelo, AULSS 3 Serenissima Veneto, Venice, Italy
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Turin, Italy
| | - Vladimiro Zagrebelsky
- Director, Laboratorio dei Diritti Fondamentali, Collegio Carlo Alberto, Turin, Italy
| | | | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Scelsi
- Chair Aniarti, Director of Health Profession Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Flavia Petrini
- SIAARTI President - Retired Full Professor of Anesthesia and Intensive Care, Chieti-Pescara University, Chieti, Italy
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18
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Giusti A, Zambri F, Marchetti F, Corsi E, Preziosi J, Sampaolo L, Pizzi E, Taruscio D, Salerno P, Chiantera A, Colacurci N, Davanzo R, Mosca F, Petrini F, Ramenghi L, Vicario M, Villani A, Viora E, Zanetto F, Chapin EM, Donati S. COVID-19 and pregnancy, childbirth, and breastfeeding: the interim guidance of the Italian National Institute of Health. Epidemiol Prev 2021; 45:14-16. [PMID: 33884834 DOI: 10.19191/ep21.1-2.p014.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Angela Giusti
- Surveillance of Risk Factors and Health Promotion Strategies Unit, National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome (Italy)
| | - Francesca Zambri
- Surveillance of Risk Factors and Health Promotion Strategies Unit, National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome (Italy);
| | - Francesca Marchetti
- Surveillance of Risk Factors and Health Promotion Strategies Unit, National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome (Italy)
| | - Edoardo Corsi
- Woman child and adolescent health Unit, National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome (Italy)
| | - Jessica Preziosi
- Surveillance of Risk Factors and Health Promotion Strategies Unit, National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome (Italy)
| | - Letizia Sampaolo
- Woman child and adolescent health Unit, National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome (Italy)
| | - Enrica Pizzi
- Woman child and adolescent health Unit, National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome (Italy)
| | - Domenica Taruscio
- National Centre of Rare Diseases, Italian National Institute of Health, Rome (Italy)
| | - Paolo Salerno
- National Centre of Rare Diseases, Italian National Institute of Health, Rome (Italy)
| | - Antonio Chiantera
- President of the Italian Society of Gynaecology and Obstetrics (SIGO)
| | - Nicola Colacurci
- President of the Association of Italian University Gynaecologists (AGUI)
| | - Riccardo Davanzo
- President of the Breastfeeding Task Force of the Ministry of Health (TAS).,Italian Society of Neonatology (SIN)
| | - Fabio Mosca
- President of the Italian Society of Neonatology (SIN)
| | - Flavia Petrini
- President of the Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)
| | - Luca Ramenghi
- President of the Italian Society of Perinatal Medicine (SIMP)
| | - Maria Vicario
- President of the National Federation of the Professional Associations of Midwives (FNOPO)
| | | | - Elsa Viora
- President of the Association of Italian Hospital Obstetricians and Gynaecologists (AOGOI)
| | | | | | - Serena Donati
- Woman child and adolescent health Unit, National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome (Italy)
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19
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Bussolin L, Falconi M, Leo MC, Parri N, DE Masi S, Rosati A, Cecchi C, Spacca B, Grandoni M, Bettiol A, Lucenteforte E, Lubrano R, Falsaperla R, Melosi F, Agostiniani R, Mangiantini F, Talamonti G, Calderini E, Mancino A, DE Luca M, Conti G, Petrini F. The management of pediatric severe traumatic brain injury: Italian Guidelines. Minerva Anestesiol 2021; 87:567-579. [PMID: 33432789 DOI: 10.23736/s0375-9393.20.14122-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of the work was to update the "Guidelines for the Management of Severe Traumatic Brain Injury" published in 2012, to reflect the new available evidence, and develop the Italian national guideline for the management of severe pediatric head injuries to reduce variation in practice and ensure optimal care to patients. EVIDENCE ACQUISITION MEDLINE and EMBASE were searched from January 2009 to October 2017. Inclusion criteria were English language, pediatric populations (0-18 years) or mixed populations (pediatric/adult) with available age subgroup analyses. The guideline development process was started by the Promoting Group that composed a multidisciplinary panel of experts, with the representatives of the Scientific Societies, the independent expert specialists and a representative of the Patient Associations. The panel selected the clinical questions, discussed the evidence and formulated the text of the recommendations. The documentarists of the University of Florence oversaw the bibliographic research strategy. A group of literature reviewers evaluated the selected literature and compiled the table of evidence for each clinical question. EVIDENCE SYNTHESIS The search strategies identified 4254 articles. We selected 3227 abstract (first screening) and, finally included 67 articles (second screening) to update the guideline. This Italian update includes 25 evidence-based recommendations and 5 research recommendations. CONCLUSIONS In recent years, progress has been made on the understanding of severe pediatric brain injury, as well as on that concerning all major traumatic pathology. This has led to a progressive improvement in the clinical outcome, although the quantity and quality of evidence remains particularly low.
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Affiliation(s)
- Leonardo Bussolin
- Neuroanesthesiology, Intensive Care and Trauma Center, A. Meyer University Hospital, Florence, Italy
| | - Martina Falconi
- Techical-Scientific Secretary, Pediatric Regional and Ethical Committee, A. Meyer University Hospital, Florence, Italy
| | - Maria C Leo
- Techical-Scientific Secretary, Pediatric Regional and Ethical Committee, A. Meyer University Hospital, Florence, Italy
| | - Niccolò Parri
- Emergency Department and Trauma Center, A. Meyer University Hospital, Florence, Italy -
| | - Salvatore DE Masi
- Clinical Trial Office, A. Meyer University Hospital, Florence, Italy
| | - Anna Rosati
- Neurosciences Excellence Center, A. Meyer University Hospital, Florence, Italy
| | - Costanza Cecchi
- Anestesiology and Intensive Care Unit, A. Meyer University Hospital, Florence, Italy
| | - Barbara Spacca
- Unit of Neurosurgery, A. Meyer University Hospital, Florence, Italy
| | - Manuela Grandoni
- Unit of Neurosurgery, A. Meyer University Hospital, Florence, Italy
| | | | | | - Riccardo Lubrano
- Società Italiana di Medicina Emergenza Urgenza Pediatrica (SIMEUP), Milan, Italy.,Pediatrics Unit, Pediatric Emergency Department, Neonatology and Neonatal Intensive Care, "Rodolico-San Marco" University Hospital, Catania, Italy
| | - Raffaele Falsaperla
- Società Italiana di Medicina Emergenza Urgenza Pediatrica (SIMEUP), Milan, Italy.,Pediatrics and Neonatology Unit, Department of Maternal and Urological Sciences, Sapienza University, Latina, Rome, Italy
| | - Francesca Melosi
- Anestesiology and Intensive Care Unit, A. Meyer University Hospital, Florence, Italy.,Società Italiana di Neurosonologia ed Emodinamica Cerebrale (SINSEC), Bologna, Italy
| | | | | | | | - Edoardo Calderini
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Rome, Italy
| | - Aldo Mancino
- Società di Anestesia e Rianimazione Neonatale e Pediatrica Italiana (S.A.R.N.eP.I), Rome, Italy
| | - Marco DE Luca
- Accademia Medica ed Infermieristica di Emergenza e Terapia Intensiva Pediatrica (AMIETIP), Bologna, Italy
| | - Giorgio Conti
- Accademia Medica ed Infermieristica di Emergenza e Terapia Intensiva Pediatrica (AMIETIP), Bologna, Italy.,IRCCS A. Gemelli, Catholic University, Rome, Italy
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20
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Abstract
During the lockdown phase of the COVID-19 pandemic, a call not to neglect the continuum of care of patients who present with chronic diseases, including pain, was made. In the field of pain, COVID-19 had an impact both from a clinical (i.e., the influence of SARS-CoV-2 infection on pain) and organizational (i.e., how patients with chronic pain should be managed in the post-COVID-19 era) perspective. Furthermore, patients with chronic pain are also frequently frail subjects, affected from multiple comorbidities and hence are at increased risk of infection. On these bases, how the necessity to continue pain therapy will be pursued in the post-COVID-19 era? In this paper, we comment on the above-mentioned topics, on the basis of available data and our experience as pain therapists.
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Affiliation(s)
- Franco Marinangeli
- Department of Anesthesiology, Pain Treatment and Palliative Care, University of L'Aquila, L'Aquila, Italy -
| | - Antonio Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Paolo Giaccone Polyclinic Hospital, University of Palermo, Palermo, Italy
| | - Flavia Petrini
- President of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care (SIAARTI), Rome, Italy.,Unit of Anesthesia, Resuscitation, and Intensive Care, SS. Annunziata Hospital, Chieti, Italy.,School of Specialization in Anesthesia, Resuscitation, Intensive Care, and Pain Management, Department of Oral and Medical Sciences and Biotechnologies, Chieti-Pescara University, Chieti, Italy
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21
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Piccioni F, Droghetti A, Bertani A, Coccia C, Corcione A, Corsico AG, Crisci R, Curcio C, Del Naja C, Feltracco P, Fontana D, Gonfiotti A, Lopez C, Massullo D, Nosotti M, Ragazzi R, Rispoli M, Romagnoli S, Scala R, Scudeller L, Taurchini M, Tognella S, Umari M, Valenza F, Petrini F. Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care. Perioper Med (Lond) 2020; 9:37. [PMID: 33292657 PMCID: PMC7704118 DOI: 10.1186/s13741-020-00168-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care. METHODS A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventative Services Task Force criteria. RESULTS Recommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery). CONCLUSIONS These recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
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Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, 20133, Milan, Italy.
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Carlo Curcio
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Carlo Del Naja
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Padua, Italy
| | - Diego Fontana
- Thoracic Surgery Unit - San Giovanni Bosco Hospital - Torino, Turin, Italy
| | | | - Camillo Lopez
- Thoracic Surgery Unit, V Fazzi Hospital, Lecce, Italy
| | - Domenico Massullo
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria S. Andrea, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy
- Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Pneumology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Taurchini
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Silvia Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - Marzia Umari
- Combined Department of Emergency, Urgency and Admission, Cattinara University Hospital, Trieste, Italy
| | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Flavia Petrini
- Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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22
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Vailati D, Montrucchio G, Cerotto V, Capozzoli G, Gori F, Petrini F, Brazzi L. Choice and management of vascular access in the context of COVID-19 outbreak in Italy: Recommendations from clinical practice. J Vasc Access 2020; 23:18-23. [PMID: 33198573 DOI: 10.1177/1129729820968415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
On April 2020, during the outburst of the COVID-19 pandemic in Italy, the SIAARTI ("Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva") Research Group on Vascular Access has formulated some essential recommendations for the optimization of the selection, insertion, and maintenance of the vascular access devices, with the aim of guarantee the operator safety, ensure the effectiveness of the maneuvers, and reduce the risk of complications. Here we describe the key elements of clinical management of vascular access in patients affected by COVID-19.
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Affiliation(s)
- Davide Vailati
- Anesthesia and Intensive Care Unit, Melegnano Hospital, Milano, Italy
| | - Giorgia Montrucchio
- Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy
| | - Vittorio Cerotto
- Anesthesia and Intensive Care Unit, Città di Castello Hospital, Perugia, Italy
| | | | - Fabio Gori
- Anesthesia and Intensive Care 1, 'Azienda Ospedaliera di Perugia', Perugia, Italy
| | - Flavia Petrini
- Anesthesia and Intensive Care, Chieti Hospital, Chieti, Italy.,Department of Medical Oral and Biotechnological Sciences, University of Chieti Pescara, Italy
| | - Luca Brazzi
- Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy.,Department of Surgical Sciences, University of Turin, Torino, Italy
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23
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Vailati D, Montrucchio G, Cerotto V, Capozzoli G, Gori F, Petrini F, Brazzi L. Choice and management of vascular access in the context of COVID-19 outbreak in Italy: Recommendations from clinical practice. J Vasc Access 2020. [PMID: 33198573 DOI: 10.1177/1129729820968415.] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
On April 2020, during the outburst of the COVID-19 pandemic in Italy, the SIAARTI ("Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva") Research Group on Vascular Access has formulated some essential recommendations for the optimization of the selection, insertion, and maintenance of the vascular access devices, with the aim of guarantee the operator safety, ensure the effectiveness of the maneuvers, and reduce the risk of complications. Here we describe the key elements of clinical management of vascular access in patients affected by COVID-19.
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Affiliation(s)
- Davide Vailati
- Anesthesia and Intensive Care Unit, Melegnano Hospital, Milano, Italy
| | - Giorgia Montrucchio
- Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy
| | - Vittorio Cerotto
- Anesthesia and Intensive Care Unit, Città di Castello Hospital, Perugia, Italy
| | | | - Fabio Gori
- Anesthesia and Intensive Care 1, 'Azienda Ospedaliera di Perugia', Perugia, Italy
| | - Flavia Petrini
- Anesthesia and Intensive Care, Chieti Hospital, Chieti, Italy.,Department of Medical Oral and Biotechnological Sciences, University of Chieti Pescara, Italy
| | - Luca Brazzi
- Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy.,Department of Surgical Sciences, University of Turin, Torino, Italy
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24
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Monzani R, Barbera G, Restelli U, Galeone C, Petrini F. Protocol Implementation for Normothermia in Surgery Settings in Italy: Budget-Impact Analysis. Risk Manag Healthc Policy 2020; 13:2347-2356. [PMID: 33154686 PMCID: PMC7608003 DOI: 10.2147/rmhp.s267923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Hypothermia is a well-known risk of the perioperative period and considered a preventable effect of anesthesia care. Nevertheless, it is not fully controlled, causing a number of adverse outcomes following surgical operations and thus increasing length of stay in hospital and treatment costs. The aim of this study was to assess the budget impact (BI) of the implementation of proactive strategies to prevent inadvertent perioperative hypothermia (IPH) in surgical patients in Italy, as recommended by international guidelines and by a good clinical practice (GCP) guideline of the Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care. Methods BI was calculated over a 3-year period from the perspective of the Italian National Health Service (NHS). Model inputs were extracted from national literature when available and otherwise from international sources. The reference analytic model was based on the cost-effectiveness analysis of the National Institute for Health and Care Excellence clinical guidance 65. Estimates were based on assessments made about current malpractice in Italy and on a hypothesis of how future practice might change by implementing the GCP. Model output included overall BI results, variations in the number of warmed patients, medical-device average costs and use of mix. Results The base-case estimate quantified a decrease of 35% in extra days of hospital stay due to IPH and a net BI of –€60.92 million. Conclusion Increasing protocol adoption for preventing IPH would lead to both clinical advantages and significant savings for the NHS. Its large diffusion in Italian hospitals is thus desirable.
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Affiliation(s)
- Roberta Monzani
- Day Hospital Chirurgico, IRCCS Humanitas Research Hospital Rozzano, Rozzano, Italy
| | | | - Umberto Restelli
- Centre for Health Economics, Social and Health Care Management Carlo Cattaneo University, Castellanza, Italy.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Flavia Petrini
- Anestesia, Rianimazione e Terapia Intensiva, Università Gabriele d'Annunzio - ASL 2 Abruzzo, Chieti, Italy
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25
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Piccioni F, Droghetti A, Bertani A, Coccia C, Corcione A, Corsico AG, Crisci R, Curcio C, Del Naja C, Feltracco P, Fontana D, Gonfiotti A, Lopez C, Massullo D, Nosotti M, Ragazzi R, Rispoli M, Romagnoli S, Scala R, Scudeller L, Taurchini M, Tognella S, Umari M, Valenza F, Petrini F. Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care. Perioper Med (Lond) 2020; 9:31. [PMID: 33106758 PMCID: PMC7582032 DOI: 10.1186/s13741-020-00159-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/22/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria. Results Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis. Conclusions These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
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Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Alessandro Bertani
- Division of Thoracic Surgery and Lung Transplantation, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT - UPMC, Palermo, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute "Regina Elena"-IRCCS, Rome, Italy
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Angelo Guido Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy
| | - Carlo Curcio
- Thoracic Surgery, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Carlo Del Naja
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG Italy
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Padova, Italy
| | - Diego Fontana
- Thoracic Surgery Unit - San Giovanni Bosco Hospital, Turin, Italy
| | | | - Camillo Lopez
- Thoracic Surgery Unit, 'V Fazzi' Hospital, Lecce, Italy
| | - Domenico Massullo
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria S. Andrea, Rome, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Ragazzi
- Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Rispoli
- Anesthesia and Intensive Care, AORN dei Colli Vincenzo Monaldi Hospital, Naples, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anesthesia and Critical Care, University of Florence, Florence, Italy.,Department of Anesthesia and Critical Care, Careggi University Hospital, Florence, Italy
| | - Raffaele Scala
- Pneumology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | - Luigia Scudeller
- Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Marco Taurchini
- Department of Thoracic Surgery, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG Italy
| | - Silvia Tognella
- Respiratory Unit, Orlandi General Hospital, Bussolengo, Verona, Italy
| | - Marzia Umari
- Combined Department of Emergency, Urgency and Admission, Cattinara University Hospital, Trieste, Italy
| | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Flavia Petrini
- Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy
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Affiliation(s)
- Massimiliano Sorbello
- Department of Emergency, Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria (AOU) Policlinico San Marco University Hospital, Catania, Italy, Department of Anaesthesia, Guy's and St Thomas' National Health System (NHS) Foundation Trust, London, United Kingdom Anesthesia and Intensive Care Dipartimento di Medicina Perioperatoria, Dolore, Terapia Intensiva e Rapid Response System, Ospedale di Chieti, Università "G. D'Annunzio", Chieti-Pescara, Italy
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Mistraletti G, Gristina G, Mascarin S, Iacobone E, Giubbilo I, Bonfanti S, Fiocca F, Fullin G, Fuselli E, Bocci MG, Mazzon D, Giusti GD, Galazzi A, Negro A, De Iaco F, Gandolfo E, Lamiani G, Del Negro S, Monti L, Salvago F, Di Leo S, Gribaudi MN, Piccinni M, Riccioni L, Giannini A, Livigni S, Maglione C, Vergano M, Marinangeli F, Lovato L, Mezzetti A, Drigo E, Vegni E, Calva S, Aprile A, Losi G, Fontanella L, Calegari G, Ansaloni C, Pugliese FR, Manca S, Orsi L, Moggia F, Scelsi S, Corcione A, Petrini F. How to communicate with families living in complete isolation. BMJ Support Palliat Care 2020:bmjspcare-2020-002633. [PMID: 33060189 DOI: 10.1136/bmjspcare-2020-002633] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
Abstract
IMPORTANCE During the SARS-CoV-2 pandemic, a complete physical isolation has been worldwide introduced. The impossibility of visiting their loved ones during the hospital stay causes additional distress for families: in addition to the worries about clinical recovery, they may feel exclusion and powerlessness, anxiety, depression, mistrust in the care team and post-traumatic stress disorder. The impossibility of conducting the daily meetings with families poses a challenge for healthcare professionals. OBJECTIVE This paper aims to delineate and share consensus statements in order to enable healthcare team to provide by telephone or video calls an optimal level of communication with patient's relatives under circumstances of complete isolation. EVIDENCE REVIEW PubMed, Cochrane Database of Systematic Reviews, Database of Abstracts and Reviews of Effectiveness and the AHCPR Clinical Guidelines and Evidence Reports were explored from 1999 to 2019. Exclusion criteria were: poor or absent relevance regarding the aim of the consensus statements, studies prior to 1999, non-English language. Since the present pandemic context is completely new, unexpected and unexplored, there are not randomised controlled trials regarding clinical communication in a setting of complete isolation. Thus, a multiprofessional taskforce of physicians, nurses, psychologists and legal experts, together with some family members and former intensive care unit patients was established by four Italian national scientific societies. Using an e-Delphi methodology, general and specific questions were posed, relevant topics were argumented, until arriving to delineate position statements and practical checklist, which were set and evaluated through an evidence-based consensus procedure. FINDINGS Ten statements and two practical checklists for phone or video calls were drafted and evaluated; they are related to who, when, why and how family members must be given clinical information under circumstances of complete isolation. CONCLUSIONS AND RELEVANCE The statements and the checklists offer a structured methodology in order to ensure a good-quality communication between healthcare team and family members even in isolation, confirming that time dedicated to communication has to be intended as a time of care.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milano, Italy
| | - Giuseppe Gristina
- Società Italiana Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Roma, Italy
| | - Sara Mascarin
- Educational Services for Health and Social Development, Officina Comunicativa, Treviso, Italy
| | - Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
| | - Ilaria Giubbilo
- General and Neurosurgical ICU, Ospedale dell'Angelo, Aulss 3 Serenissima Veneto, Venezia, Italy
| | - Silvia Bonfanti
- Department of Palliative Care, Azienda USL di Piacenza, Piacenza, Italy
| | - Federico Fiocca
- Anestesia e Rianimazione 1, ASST Spedali Civili, Brescia, Italy
| | - Giorgio Fullin
- General and Neurosurgical ICU, Ospedale dell'Angelo, Aulss 3 Serenissima Veneto, Venezia, Italy
| | - Ennio Fuselli
- UOC Anestesia Rianimazione 1 Dip.to Emergenza Accettazione, A. O. San Camillo-Forlanini, Roma, Italy
| | - Maria Grazia Bocci
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Terapia Intensiva, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Davide Mazzon
- UOC Anestesia e Rianimazione, Ospedale di Belluno, Aulss 1 Dolomiti, Belluno, Italy
| | | | - Alessandro Galazzi
- Direction of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Fabio De Iaco
- Emergency Department, Martini Hospital, ASL Città di Torino, Torino, Italy
| | - Enrico Gandolfo
- Emergency Department, Martini Hospital, ASL Città di Torino, Torino, Italy
| | - Giulia Lamiani
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Silvia Del Negro
- UOC Clinical Psychology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Laura Monti
- Servizio Psicologia Ospedaliera, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Fabrizia Salvago
- Dipartimento di Neuroscienze, Azienda Ospedaliera G Brotzu, Cagliari, Italy
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Mariassunta Piccinni
- Department of Political Science, Law and International Studies, Università degli Studi di Padova, Padova, Italy
| | | | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Sergio Livigni
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Carla Maglione
- Società Italiana Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Napoli, Italy
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Franco Marinangeli
- Department of Anesthesiology and Intensive Care, University of L'Aquila, L'Aquila, Italy
| | - Luisa Lovato
- UO Anestesia e Rianimazione 1, Ospedale Santa Chiara, Trento, Italy
| | | | - Elio Drigo
- Associazione Nazionale Infermieri di Area Critica (Aniarti), Udine, Italy
| | - Elena Vegni
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
- UOC Clinical Psychology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Sally Calva
- Educational Services for Health and Social Development, Officina Comunicativa, Torino, Italy
| | - Anna Aprile
- Department of Molecular Medicine, Università degli Studi di Padova, Padova, Italy
| | | | - Lucia Fontanella
- Dipartimento di Scienze del Linguaggio e Letterature moderne e comparate, Università degli Studi di Torino, Torino, Italy
| | | | | | | | - Salvatore Manca
- SC Medicina e Chirurgia di Accettazione e di Urgenza, Ospedale di Oristano, Oristano, Italy
| | - Luciano Orsi
- Società Italiana di Cure Palliative (SICP), Milano, Italy
| | - Fabrizio Moggia
- DATeR Processo Assistenziale nelle Cure Palliative, Azienda USL di Bologna, Bologna, Italy
| | - Silvia Scelsi
- Dipartimento Infermieristico e delle professioni tecnico sanitarie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Antonio Corcione
- UOC Anestesia e TIPO, Azienda dei Colli, Ospedale Monaldi-Cotugno, Napoli, Italy
| | - Flavia Petrini
- Perioperative Medicine, Pain Therapy, ICU and Emergency Department, ASL2 - Chieti Pescara University, Chieti, Italy
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Aceto P, Antonelli Incalzi R, Bettelli G, Carron M, Chiumiento F, Corcione A, Crucitti A, Maggi S, Montorsi M, Pace MC, Petrini F, Tommasino C, Trabucchi M, Volpato S. Correction to: Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2020; 32:1907. [PMID: 32910423 PMCID: PMC7508731 DOI: 10.1007/s40520-020-01701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The article Perioperative Management of Elderly patients (PriME).
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Affiliation(s)
- Paola Aceto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Gabriella Bettelli
- Past Director Geriatric Surgery Area and Anaesthesia Dpt., INRCA, Italian National Research Centre on Aging, Ancona, Italy
| | | | | | | | - Antonio Crucitti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Maggi
- CNR, Institute of Neuroscience, Aging Branch, Padua, Italy
| | - Marco Montorsi
- Humanitas University and Research Hospital IRCCS, Milan, Italy
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29
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Cascella M, Vittori A, Miceli L, Bednarova R, Guardamagna VA, Bimonte S, Petrini F, Crispo A, Cuomo A, Marinangeli F. Italian publications on Pain Medicine in 2018. Minerva Anestesiol 2020; 87:250-251. [PMID: 32756547 DOI: 10.23736/s0375-9393.20.15008-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marco Cascella
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy -
| | - Alessandro Vittori
- Department of Anesthesiology and Critical Care, ARCO, Bambino Gesù Children's Hospital, Rome, Italy
| | - Luca Miceli
- Unit of Pain Medicine, IRCCS Centro di Riferimento Oncologico (CRO), Aviano, Pordenone, Italy
| | - Rym Bednarova
- Unit of Anesthesiology, Division of Intensive Care and Pain, Hospital of Latisana, Udine, Italy
| | | | - Sabrina Bimonte
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Flavia Petrini
- Department of Anesthesiology, Resuscitation and Intensive Care, University of Chieti-Pescara, Pescara, Italy
| | - Anna Crispo
- SC of Epidemiology and Biostatistics, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesiology and Pain Medicine, Istituto Nazionale Tumori- IRCCS Fondazione G. Pascale, Naples, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
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Vergano M, Bertolini G, Giannini A, Gristina GR, Livigni S, Mistraletti G, Riccioni L, Petrini F. SIAARTI recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances. Minerva Anestesiol 2020; 86:469-472. [DOI: 10.23736/s0375-9393.20.14619-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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31
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Vergano M, Bertolini G, Giannini A, Gristina GR, Livigni S, Mistraletti G, Riccioni L, Petrini F. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic. Crit Care 2020; 24:165. [PMID: 32321562 PMCID: PMC7175451 DOI: 10.1186/s13054-020-02891-w] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/14/2020] [Indexed: 01/30/2023] Open
Affiliation(s)
- Marco Vergano
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva, Viale dell'Università 11, 00185, Rome, Italy.
| | - Guido Bertolini
- Laboratorio di Epidemiologia Clinica, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alberto Giannini
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva, Viale dell'Università 11, 00185, Rome, Italy
| | - Giuseppe R Gristina
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva, Viale dell'Università 11, 00185, Rome, Italy
| | - Sergio Livigni
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva, Viale dell'Università 11, 00185, Rome, Italy
| | - Giovanni Mistraletti
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva, Viale dell'Università 11, 00185, Rome, Italy
| | - Luigi Riccioni
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva, Viale dell'Università 11, 00185, Rome, Italy
| | - Flavia Petrini
- Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva, Viale dell'Università 11, 00185, Rome, Italy
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32
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Coccolini F, Perrone G, Chiarugi M, Di Marzo F, Ansaloni L, Scandroglio I, Marini P, Zago M, De Paolis P, Forfori F, Agresta F, Puzziello A, D’Ugo D, Bignami E, Bellini V, Vitali P, Petrini F, Pifferi B, Corradi F, Tarasconi A, Pattonieri V, Bonati E, Tritapepe L, Agnoletti V, Corbella D, Sartelli M, Catena F. Surgery in COVID-19 patients: operational directives. World J Emerg Surg 2020; 15:25. [PMID: 32264898 PMCID: PMC7137852 DOI: 10.1186/s13017-020-00307-2] [Citation(s) in RCA: 271] [Impact Index Per Article: 67.8] [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: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
The current COVID-19 pandemic underlines the importance of a mindful utilization of financial and human resources. Preserving resources and manpower is paramount in healthcare. It is important to ensure the ability of surgeons and specialized professionals to function through the pandemic. A conscious effort should be made to minimize infection in this sector. A high mortality rate within this group would be detrimental.This manuscript is the result of a collaboration between the major Italian surgical and anesthesiologic societies: ACOI, SIC, SICUT, SICO, SICG, SIFIPAC, SICE, and SIAARTI. We aim to describe recommended clinical pathways for COVID-19-positive patients requiring acute non-deferrable surgical care. All hospitals should organize dedicated protocols and workforce training as part of the effort to face the current pandemic.
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Affiliation(s)
- Federico Coccolini
- Emergency Surgery Unit & Trauma Center, Pisa University Hospital, Pisa, Italy
- General, Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia 1, 56100 Pisa, Italy
| | - Gennaro Perrone
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit & Trauma Center, Pisa University Hospital, Pisa, Italy
| | | | - Luca Ansaloni
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy
| | - Ildo Scandroglio
- General Surgery Dept., Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Pierluigi Marini
- General Surgery Dept., Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Mauro Zago
- General and Emergency Surgery Dept., A. Manzoni Hospital, Lecco, Italy
| | | | | | | | | | - Domenico D’Ugo
- General Surgery Dept., Policlinico Gemelli University Hospital, Rome, Italy
| | | | | | - Pietro Vitali
- Igiene and Public Health Dept., Parma University Hospital, Parma, Italy
| | | | | | | | | | | | - Elena Bonati
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | | | | | - Davide Corbella
- Neuro ICU Dept., Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
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33
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Sorbello M, El-Boghdadly K, Di Giacinto I, Cataldo R, Esposito C, Falcetta S, Merli G, Cortese G, Corso RM, Bressan F, Pintaudi S, Greif R, Donati A, Petrini F. The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Anaesthesia 2020; 75:724-732. [PMID: 32221973 DOI: 10.1111/anae.15049] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
Abstract
Novel coronavirus 2019 is a single-stranded, ribonucleic acid virus that has led to an international pandemic of coronavirus disease 2019. Clinical data from the Chinese outbreak have been reported, but experiences and recommendations from clinical practice during the Italian outbreak have not. We report the impact of the coronavirus disease 2019 outbreak on regional and national healthcare infrastructure. We also report on recommendations based on clinical experiences of managing patients throughout Italy. In particular, we describe key elements of clinical management, including: safe oxygen therapy; airway management; personal protective equipment; and non-technical aspects of caring for patients diagnosed with coronavirus disease 2019. Only through planning, training and team working will clinicians and healthcare systems be best placed to deal with the many complex implications of this new pandemic.
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Affiliation(s)
- M Sorbello
- Anesthesia and Intensive Care, AOU Policlinico San Marco University Hospital, Catania, Italy
| | - K El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - I Di Giacinto
- Anesthesia and Intensive Care, Anestesia e Terapia Intensiva Polivalente, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi - Alma Mater Studiorum, Bologna, Italy
| | - R Cataldo
- Anesthesia and Intensive Care, Anestesia, Terapia Intensiva e Terapia del Dolore, Università Campus, Bio-Medico, Roma, Italy
| | - C Esposito
- Anesthesia and Intensive Care, Dipartimento di Area Critica Ospedale Monaldi, Ospedali dei Colli, Napoli, Italy
| | - S Falcetta
- Anesthesia and Intensive Care, Clinica di Anestesia e Rianimazione Ospedali Riuniti Ancona, Ancona, Italy
| | - G Merli
- Anesthesia and Intensive Care, Dipartimento di Anestesia e Terapia Intensiva, Ospedale Maggiore Crema, Milano, Italy
| | - G Cortese
- Anesthesia and Intensive Care, Dipartimento di Anestesia, Rianimazione ed Emergenze AOU Città della salute e della scienza Torino, Italy
| | - R M Corso
- Anesthesia and Intensive Care, Dipartimento di Chirurgia, Anestesia e Rianimazione, Ospedale GB Morgagni-L. Pierantoni, Forlì, Italy
| | - F Bressan
- Anesthesia and Intensive Care, Anestesia e Rianimazione Ospedale Santo Stefano di Prato, Prato, Italy
| | - S Pintaudi
- Anesthesia and Intensive Care, Past Head of Dipartimento di Emergenza, ARNAS Garibaldi Catania, Past Bio-containment coordinator for Sicily, Italian Military Navy scientific consultant, Italy
| | - R Greif
- Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Switzerland
| | - A Donati
- Università Politecnica delle Marche, Ancona, Italy
| | - F Petrini
- Anesthesia and Intensive Care Dipartimento di Medicina Perioperatoria, Dolore, Terapia Intensiva e Rapid Response System, Ospedale di Chieti, Università di Chieti Pescara, Chieti, Italy
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Ciancetta P, M Maggiore S, Petrini F, De Caterina R. [Diagnosis and treatment of blood volume changes in acute heart failure - a brief practical guide]. G Ital Cardiol (Rome) 2019; 19:44-53. [PMID: 29451509 DOI: 10.1714/2852.28778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The correct management of acute heart failure continues to pose diagnostic and therapeutic challenges. In particular, administering the right type and dose of fluids and drugs, thus avoiding fluid overload while establishing organ perfusion, is of key importance in stabilizing critical patients and improving prognosis. A correct estimate of the fluid volume status, however, may be difficult, as the invasive evaluation of cardiac filling pressures by cardiac catheterization is limited in routine medical practice, and there is no universal consensus on the best tools for its non-invasive evaluation. Here we review current evidence about diagnosis and treatment of fluid volume abnormalities in acute heart failure according to the most recent guidelines.
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Affiliation(s)
| | - Salvatore M Maggiore
- Istituto di Anestesia e Rianimazione, Università degli Studi "G. d'Annunzio" - Chieti-Pescara, Chieti
| | - Flavia Petrini
- Istituto di Anestesia e Rianimazione, Università degli Studi "G. d'Annunzio" - Chieti-Pescara, Chieti
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35
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Maggiore SM, Battilana M, Serano L, Petrini F. Ventilatory support after extubation in critically ill patients. Lancet Respir Med 2019; 6:948-962. [PMID: 30629933 DOI: 10.1016/s2213-2600(18)30375-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/29/2022]
Abstract
The periextubation period represents a crucial moment in the management of critically ill patients. Extubation failure, defined as the need for reintubation within 2-7 days after a planned extubation, is associated with prolonged mechanical ventilation, increased incidence of ventilator-associated pneumonia, longer intensive care unit and hospital stays, and increased mortality. Conventional oxygen therapy is commonly used after extubation. Additional methods of non-invasive respiratory support, such as non-invasive ventilation and high-flow nasal therapy, can be used to avoid reintubation. The aim of this Review is to describe the pathophysiological mechanisms of postextubation respiratory failure and the available techniques and strategies of respiratory support to avoid reintubation. We summarise and discuss the available evidence supporting the use of these strategies to achieve a tailored therapy for an individual patient at the bedside.
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Affiliation(s)
- Salvatore Maurizio Maggiore
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy; Clinical Department of Anaesthesiology and Intensive Care Medicine, SS. Annunziata Hospital, Chieti, Italy.
| | - Mariangela Battilana
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Luca Serano
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Flavia Petrini
- University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy; Clinical Department of Anaesthesiology and Intensive Care Medicine, SS. Annunziata Hospital, Chieti, Italy
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Solidoro P, Corbetta L, Patrucco F, Sorbello M, Piccioni F, D'amato L, Renda T, Petrini F. Competences in bronchoscopy for Intensive Care Unit, anesthesiology, thoracic surgery and lung transplantation. Panminerva Med 2019; 61:367-385. [DOI: 10.23736/s0031-0808.18.03565-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Di Giannatale P, Spagnuolo A, De Nuzzo D, Dell'atti I, Petrini F, Maggiore SM. Incidence of complications during intubation in high risk patients undergoing elective surgery: An observational, single-center, prospective study. Trends in Anaesthesia and Critical Care 2018. [DOI: 10.1016/j.tacc.2018.09.059] [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: 10/27/2022]
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Ferrieri A, Buca D, Spadano S, Ricciardulli A, Liberati M, Petrini F, Maggiore SM. Spontaneous coronary artery dissection complicated by cardiac arrest in pregnancy. Minerva Anestesiol 2018; 84:1326-1327. [PMID: 29808975 DOI: 10.23736/s0375-9393.18.12869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandro Ferrieri
- Department of Anesthesiology and Intensive Care, SS. Annunziata Hospital, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Danilo Buca
- Department of Obstetrics and Gynecology, SS. Annunziata Hospital, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Stefania Spadano
- Department of Anesthesiology and Intensive Care, SS. Annunziata Hospital, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alessandra Ricciardulli
- Department of Obstetrics and Gynecology, SS. Annunziata Hospital, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Liberati
- Department of Obstetrics and Gynecology, SS. Annunziata Hospital, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Flavia Petrini
- Department of Anesthesiology and Intensive Care, SS. Annunziata Hospital, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Salvatore M Maggiore
- Department of Anesthesiology and Intensive Care, SS. Annunziata Hospital, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy -
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Affiliation(s)
- M. Sorbello
- AOU Policlinico Vittorio Emanuele; Catania Italy
| | - F. Petrini
- University of Chieti-Pescara; Chieti Italy
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Affiliation(s)
- S. Faenza
- Department of Anaesthesia and Intensive Care University of Bologna - Italy
| | - S. Baroncini
- Department of Anaesthesia and Intensive Care University of Bologna - Italy
| | - F. Petrini
- Department of Anaesthesia and Intensive Care University of Bologna - Italy
| | - G. Martinelli
- Department of Anaesthesia and Intensive Care University of Bologna - Italy
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Barra FL, Carenzo L, Franc J, Montagnini C, Petrini F, Della Corte F, Ingrassia PL. Anesthesiology Resident Induction Month: a pilot study showing an effective and safe way to train novice residents through simulation. Minerva Anestesiol 2018; 84:1377-1386. [PMID: 29338143 DOI: 10.23736/s0375-9393.18.12087-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The transition of new residents from medical school to the post-graduate clinical environment remains challenging. We hypothesized that an introductory simulation course could improve new residents' performance in anesthesiology. METHODS The Anesthesiology Residents Induction Month (ARIM) program was designed as a non-clinical simulation training program aiming at providing the theoretical and practical skills to safely approach, as junior anesthesiologists, the operating rooms. For each participant, specific knowledge, procedural skills and non-technical performance were assessed with a pre and post-test approach, before and immediately after the participation in the study. RESULTS Fifteen first-month residents participated in the study. As compared to pre-test, residents significantly improved in all three evaluated areas. Pre-test knowledge assessment mean improved from 56% to 73% in the post-test (P<0.001). In the procedural skills assessment, pre-test mean improved from 43% to 77% (P<0.001) and non-technical skills assessment improved from 3.17 to 4.61 (in a scale out of seven points) in the post-test (P<0.001). CONCLUSIONS Data suggest that an intensive simulation-based program can be an effective way for first-year residents to rapidly acquire and develop basic skills specific to anesthesiology. There might be benefits to begin residency with a training program aiming at developing and standardizing technical and non-technical skills.
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Affiliation(s)
- Federico L Barra
- SIMNOVA Interdepartmental Center for Innovative Learning and Simulation in Medicine and Allied Health Professions, University of Eastern Piedmont, Novara, Italy.,Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Luca Carenzo
- SIMNOVA Interdepartmental Center for Innovative Learning and Simulation in Medicine and Allied Health Professions, University of Eastern Piedmont, Novara, Italy
| | - Jeffrey Franc
- SIMNOVA Interdepartmental Center for Innovative Learning and Simulation in Medicine and Allied Health Professions, University of Eastern Piedmont, Novara, Italy.,Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Claudia Montagnini
- SIMNOVA Interdepartmental Center for Innovative Learning and Simulation in Medicine and Allied Health Professions, University of Eastern Piedmont, Novara, Italy
| | - Flavia Petrini
- Department of Perioperative Medicine, Pain, Intensive Care and Rapid Response Systems, Chieti University Hospital, ASL 2 Abruzzo, Chieti, Italy
| | - Francesco Della Corte
- Anesthesia and Intensive Care, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Pier Luigi Ingrassia
- SIMNOVA Interdepartmental Center for Innovative Learning and Simulation in Medicine and Allied Health Professions, University of Eastern Piedmont, Novara, Italy -
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Limongelli P, Petrini F, Docimo L. Risk management training programme: A perspective from the European side of the Atlantic. Am J Surg 2017; 216:1028-1029. [PMID: 29241948 DOI: 10.1016/j.amjsurg.2017.11.035] [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: 11/16/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Paolo Limongelli
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, XI Division of General and Obesity Surgery, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Flavia Petrini
- Department of Perioperative Medicine, Pain, ICU and RRS, Chieti University Hospital, ASL 2 Abruzzo, Chieti Pescara, Italy
| | - Ludovico Docimo
- Department of Medical, Surgical, Neurologic, Metabolic and Aging Sciences, XI Division of General and Obesity Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
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Pasero D, Sangalli F, Baiocchi M, Blangetti I, Cattaneo S, Paternoster G, Moltrasio M, Auci E, Murrino P, Forfori F, Forastiere E, De Cristofaro MG, Deste G, Feltracco P, Petrini F, Tritapepe L, Girardis M. Experienced Use of Dexmedetomidine in the Intensive Care Unit: A Report of a Structured Consensus. Turk J Anaesthesiol Reanim 2017; 46:176-183. [PMID: 30140512 DOI: 10.5152/tjar.2018.08058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/06/2018] [Accepted: 05/28/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Management of pain, agitation and delirium (PAD) remains to be a true challenge in critically ill patients. The pharmacological proprieties of dexmedetomidine (DEX) make it an ideal candidate drug for light and cooperative sedation, but many practical questions remain unanswered. This structured consensus from 17 intensivists well experienced on PAD management and DEX use provides indications for the appropriate use of DEX in clinical practice. Methods A modified RAND/UCLA appropriateness method was used. In four predefined patient populations, the clinical scenarios do not properly cope by the current recommended pharmacological strategies (except DEX), and the possible advantages of DEX use were identified and voted for agreement, after reviewing literature data. Results Three scenarios in medical patients, five scenarios in patients with acute respiratory failure undergoing non-invasive ventilation, three scenarios in patients with cardiac surgery in the early postoperative period and three scenarios in patients with overt delirium were identified as challenging with the current PAD strategies. In these scenarios, the use of DEX was voted as potentially useful by most of the panellists owing to its specific pharmacological characteristics, such as conservation of cognitive function, lack of effects on the respiratory drive, low induction of delirium and analgesia effects. Conclusion DEX might be considered as a first-line sedative in different scenarios even though conclusive data on its benefits are still lacking.
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Affiliation(s)
- Daniela Pasero
- Department of Anaesthesia and Intensive Care, AOU Città della Salute e della Scienza, Turin, Italy
| | - Fabio Sangalli
- Department of Perioperative Medicine and Intensive Care, Cardiothoracic And Vascular Anaesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Massimo Baiocchi
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Bologna "s. Orsola-malpighi", Bologna, Italy
| | - Ilaria Blangetti
- Department of Cardiovascular and Thoracic Surgery, Azienda Ospedaliera Santa Croce E Carle, Cuneo, Italy
| | - Sergio Cattaneo
- Department of Anaesthesia and Intensive Care Medicine, Aziende Socio Sanitarie Territoriali Papa Giovanni Xxiii, Bergamo, Italy
| | - Gianluca Paternoster
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Marco Moltrasio
- Cardiac Intensive Care Unit, Centro Cardiologico Monzino, Milan, Italy
| | - Elisabetta Auci
- Department of Anesthesiology and Intensive Care, S. Maria Della Misericordia Hospital, Udine, Italy
| | - Patrizia Murrino
- Department of Anaesthesia and Critical Care Medicine, Aorn Ospedali Dei Colli, Naples, Italy
| | - Francesco Forfori
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Pisana, Pisa, Italy
| | - Ester Forastiere
- Department of Anaesthesiology, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giorgio Deste
- Uoc Anestesia E Rianimazione, Policlinico Casilino, Roma
| | - Paolo Feltracco
- Department of Medicine, Anaesthesia and Intensive Care, University Hospital of Padova, Italy
| | - Flavia Petrini
- Department of Anaesthesia and Intensive Care, University Hospital of Chieti, Chieti, Italy
| | - Luigi Tritapepe
- Department of Anaesthesiology and Intensive Care Medicine, Umberto I Hospital, "sapienza" University, Rome, Italy
| | - Massimo Girardis
- Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
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Sorbello M, Petrini F. Supraglottic Airway Devices: the Search for the Best Insertion Technique or the Time to Change Our Point of View? Turk J Anaesthesiol Reanim 2017; 45:76-82. [PMID: 28439437 DOI: 10.5152/tjar.2017.67764] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 12/13/2022] Open
Abstract
In the crowded world of supraglottic airway devices (SADs), many papers compare the easiness of insertion based on the different endpoints of an operator's satisfaction: first pass success, ventilation effectiveness, complications and morbidity. Proseal LMA™ (Laryngeal Mask Airway, Teleflex Medical, Dublin, Ireland) has been extensively studied because on one hand it has a steeper learning curve and more complex insertion when compared with other SADs and on the other hand many alternative techniques are available to facilitate insertion. This research is part of a larger body of studies exploring the issue that some devices are more difficult to insert because of many features related to sizing, constructive material, airway conduit and cuff design, performance and last but not least experience. Nevertheless, the biggest question might be the search for a systematic categorization of insertion difficulty features and identification of criteria allowing the choice for the best device and consequently for the best insertion technique. Given that, as a result of many intrinsic characteristics of the device we are using, insertion might become the secondary issue to be considered only after we clearly identify what makes it difficult, and to be counterbalanced on the results we expect from the device, performance we can achieve and degree of airway protection it could grant. The aim of this narrative review is to consider which factors might affect or condition SAD insertion difficulty and to try identifying some criteria addressing physicians pertaining to the use of SADs in clinical practice.
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Affiliation(s)
| | - Flavia Petrini
- Department of Perioperative Medicine, Pain, ICU and RRS, Chieti University Hospital, ASL 2 Abruzzo, Italy
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45
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Corso RM, Sorbello M, Buccioli M, Carretta E, Nanni O, Piraccini E, Merli G, Petrini F, Guarino A, Frova G. Survey of Knowledge and Attitudes about Obstructive Sleep Apnoea Among Italian Anaesthetists. Turk J Anaesthesiol Reanim 2017; 45:146-152. [PMID: 28752004 DOI: 10.5152/tjar.2017.51423] [Citation(s) in RCA: 21] [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] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/06/2017] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE As the care of Obstructive Sleep Apnoea (OSA) patients remains heterogeneous, we hypothesized that it may reflect insufficient OSA knowledge/awareness among clinicians. METHODS OSA Knowledge/Attitude Questionnaire (OSAKA) was translated into Italian and distributed to anaesthetists attending SIAARTI National Congress and Airways courses and Hands-on Workshops from October 2012 to June 2013. RESULTS In total, 370 anaesthetists returned the questionnaires (response rate, 62%); the median (interquartile range [IQR]) knowledge score was 12 (10-14), and the range was 1-17 with no difference by gender, age, professional title or years of practice. The knowledge items achieved a mean rate of corrected response of 66%±0.14%. With regard to attitude items, median (IQR) score was 15 (13-17) and range was 0-20. Females and anaesthetists with >15 years of practice reached higher scores, while anaesthesia residents showed a lower attitude score. Gender and professional title were statistically associated with the attitude score (gender: F=14.6, p=0.0002; professional title: F=4.72, p=0.0099), whereas a weak association was observed within years in practice and attitude score (F=2.6, p=0.0519). Knowledge score correlated positively with attitude score (r=0.4, p<0.0001). For knowledge domains, there was a positive correlation between pathophysiology (mid-grade: r=0.3, p<0.0001), symptoms (low grade: r=0.2, p<0.0001), diagnosis (mid grade: r=0.3, p<0.0001) and the attitude score. Correlation close to zero was observed for epidemiology and treatment domains (r=0.09, p=0.06; r=-0.01, p=0.78, respectively). CONCLUSION The results of our survey demonstrate lack of knowledge about OSA and its treatment, revealing the need to update the syllabus of teaching in medical practice and in national health care policies to improve perioperative care.
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Affiliation(s)
- Ruggero Massimo Corso
- Department of Emergency, Anaesthesia and Intensive Care Section "G.B. Morgagni-pierantoni" Hospital, Forlì, Italy
| | - Massimiliano Sorbello
- Department of Anaesthesia and Intensive Care Unit, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Matteo Buccioli
- Department of Emergency, Anaesthesia and Intensive Care Section "G.B. Morgagni-pierantoni" Hospital, Forlì, Italy
| | - Elisa Carretta
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo Per Lo Studio E La Cura Dei Tumori (irst), Meldola, Italy
| | - Oriana Nanni
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo Per Lo Studio E La Cura Dei Tumori (irst), Meldola, Italy
| | - Emanuele Piraccini
- Department of Emergency, Anaesthesia and Intensive Care Section "G.B. Morgagni-pierantoni" Hospital, Forlì, Italy
| | - Guido Merli
- Department of Anaesthesia and Intensive Ospedale Maggiore Crema, Milano, Italy
| | - Flavia Petrini
- Department Perioperative Medicine, Pain, ICU and RRS Chieti University Hospital, ASL 2 Abruzzo, Italy
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Affiliation(s)
- Antonio Corcione
- Department of Anaesthesia and Critical Care, AORN Dei Colli, Naples, Italy
| | - Flavia Petrini
- Department of Perioperative Medicine, Pain, ICU, RRS, Chieti University Hospital, ASL 2 Abruzzo, Chieti Pescara, Italy.
| | | | - Edoardo De Robertis
- Section of Anaesthesia and Intensive Care Medicine, University of Naples Federico II, Naples, Italy
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47
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Torricelli P, Palareti G, Poggi M, Faenza S, Petrini F, Zanoni A, Coccheri S. Intraoperative autotransfusion does not induce deterioration in haemorheologic conditions during and after cardiopulmonary by-pass surgery. Clin Hemorheol Microcirc 2016. [DOI: 10.3233/ch-1988-8614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P. Torricelli
- Department of Angiology and Blood Coagulation, University Hospital S. Orsola, Bologna, Italy
| | - G. Palareti
- Department of Angiology and Blood Coagulation, University Hospital S. Orsola, Bologna, Italy
| | - M. Poggi
- Department of Angiology and Blood Coagulation, University Hospital S. Orsola, Bologna, Italy
| | - S. Faenza
- Department of Anesthesiology and Intensive Care, University Hospital S. Orsola, Bologna, Italy
| | - F. Petrini
- Department of Anesthesiology and Intensive Care, University Hospital S. Orsola, Bologna, Italy
| | - A. Zanoni
- Department of Anesthesiology and Intensive Care, University Hospital S. Orsola, Bologna, Italy
| | - S. Coccheri
- Department of Angiology and Blood Coagulation, University Hospital S. Orsola, Bologna, Italy
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Petrini F, Di Giacinto I, Cataldo R, Esposito C, Pavoni V, Donato P, Trolio A, Merli G, Sorbello M, Pelosi P. Perioperative and periprocedural airway management and respiratory safety for the obese patient: 2016 SIAARTI Consensus. Minerva Anestesiol 2016; 82:1314-1335. [PMID: 27759743] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose Body Mass Index (BMI) is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population. Obesity is a multisystem, chronic, proinflammatory disorder. Unfortunately many countries are facing a marked increase in the obese population, defined as "globesity". Obesity presents an added risk in hospital, leading health care organizations to call for action to avoid adverse events and preventable complications. Periprocedural assessment and critical care strategies designed specifically for obese patients are crucial for reducing morbidity and mortality during surgery and in emergency settings, critical care and other particular settings (e.g., obstetrics). Specific care is needed for airway management, as are proactive strategies to reduce the risk of cardiovascular, endocrine, metabolic and infective complications; any effort can be fruitful, including special attention to the science of human factors. The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) organized a consensus project involving other national scientific societies to increase risk awareness, define the best multidisciplinary approach for treating obese patients in election and emergency, and enable every hospital to provide appropriate levels of care and good clinical practices. The Obesity Project Task Force, a section of the SIAARTI Airway Management Study Group, used a formal consensus process to identify a series of notes, alerts and statements, to be adopted as bundles, to define appropriate clinical pathways for hospitalized obese patients. The consensus, approved by the Task Force and endorsed by several European scientific societies actively operating in this field, is presented herein.
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Affiliation(s)
- Flavia Petrini
- Department of Perioperative Medicine, Pain Therapy, Rapid Response Systems and Intensive Care, DEA, University of Chieti-Pescara, ASL2 Abruzzo, Chieti, Italy
| | - Ida Di Giacinto
- Anesthesia, Polyvalent Intensive Care and Transplantation Unit, Department of Organ Failure and Transplantation, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University, Bologna, Italy -
| | - Rita Cataldo
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Clelia Esposito
- Department of Anesthesia and Postoperative Intensive Care, Ospedali dei Colli, Monaldi Hospitals, Naples, Italy
| | - Vittorio Pavoni
- Anesthesia and Intensive Care Unit, Department of Emergency and Critical Care, Santa Maria Nuova Hospital, Florence, Italy
| | - Paolo Donato
- Intensive Care Unit, Department of Anesthesia, Maggiore della Carità University Hospital, Novara, Italy
| | - Antonella Trolio
- Anesthesia and Critical Care Medicine Unit, Department of Perioperative Medicine, Pain Therapy, Rapid Response Systems and Intensive Care, DEA, University of Chieti-Pescara, ASL2 Abruzzo, Vasto, Italy
| | - Guido Merli
- Department of Anesthesia and Intensive Care Unit, Maggiore Hospital, Crema, Italy
| | | | - Paolo Pelosi
- Anesthesia and Intensive Care Unit, AOU Policlinico Vittorio Emanuele University Hospital, Catania, Italy
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Venturoli N, Venturi S, Taddei S, Ridolfi L, Pugliese MR, Petrini F, Monti M, Costa AN, Martinelli G. Organ Donation and Transplantation as Health Programs in Italy. Prog Transplant 2016; 10:60-4. [PMID: 10941329 DOI: 10.1177/152692480001000111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/16/2022]
Abstract
Organ and tissue donation and transplantation have a role in public health programs as organizational projects designed by public health departments to increase the quality and number of donations and transplantations. These programs serve as communication projects to inform public opinion on cerebral death, organ and tissue shortages, procurement and allocation rules, and the quality of life of transplanted patients. The health department of Emilia-Romagna created a regional law and a multimedia communication program for these purposes, resulting in a 95% increase of cadaver donor in 4 years. In 1995, regional activity reached the European mean level and afterwards surpassed it. In 1997, the bone bank was activated, followed in 1998 by the heart valve and vascular segment bank. The regional health department now considers transplant activities a primary goal; human and professional relations between intensive care units and the transplant reference center are considered crucial; cooperation among health departments, medical teams involved in organ procurement and transplant activities has been fostered, and the local coordination network has been active and efficient. The public information campaign has proven important in providing information both to professionals and citizens.
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Affiliation(s)
- N Venturoli
- Transplant Reference Center, Emilia-Romagna Region, Italy
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50
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Venturoli N, Costa AN, Ridolfi L, Pugliese MR, Taddei S, Petrini F, Bolondi L, Martinelli G. Reliability of Ultrasound Screening of Liver and Kidney Donors: A Retrospective Study. Prog Transplant 2016; 10:182-5. [PMID: 11216278 DOI: 10.1177/152692480001000309] [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: 11/16/2022]
Abstract
The reliability of abdominal ultrasound in screening liver and kidney donors was assessed by correlating ultrasound findings with the suitability of organs for transplantation as determined by direct examination of the organs. We evaluated 100 multiorgan donors (100 livers, 200 kidneys) during a 15-month period. Abdominal ultrasound showed the following results for liver and kidney, respectively: specificity, 95.6% and 98.9%; sensitivity, 62.5% and 66.6%; and accuracy, 93% and 97%. These results show that abdominal ultrasound is a valuable tool for determining suitability of organs for transplantation when the ultrasound findings are normal. When ultrasound findings are abnormal, further studies are necessary to determine the suitability of the organs for transplantation.
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Affiliation(s)
- N Venturoli
- Transplant Reference Center, Emilia-Romagna Region, Italy
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