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Gouvêa Bogossian E, Taleb C, Aspide R, Badenes R, Battaglini D, Bilotta F, Blandino Ortiz A, Caricato A, Castioni CA, Citerio G, Ferraro G, Martino C, Melchionda I, Montanaro F, Monleon Lopez B, Nato CG, Piagnerelli M, Picetti E, Robba C, Simonet O, Thooft A, Taccone FS. Cerebro-spinal fluid glucose and lactate concentrations changes in response to therapies in patIents with primary brain injury: the START-TRIP study. Crit Care 2023; 27:130. [PMID: 37004053 PMCID: PMC10067218 DOI: 10.1186/s13054-023-04409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/20/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Altered levels of cerebrospinal fluid (CSF) glucose and lactate concentrations are associated with poor outcomes in acute brain injury patients. However, no data on changes in such metabolites consequently to therapeutic interventions are available. The aim of the study was to assess CSF glucose-to-lactate ratio (CGLR) changes related to therapies aimed at reducing intracranial pressure (ICP). METHODS A multicentric prospective cohort study was conducted in 12 intensive care units (ICUs) from September 2017 to March 2022. Adult (> 18 years) patients admitted after an acute brain injury were included if an external ventricular drain (EVD) for intracranial pressure (ICP) monitoring was inserted within 24 h of admission. During the first 48-72 h from admission, CGLR was measured before and 2 h after any intervention aiming to reduce ICP ("intervention"). Patients with normal ICP were also sampled at the same time points and served as the "control" group. RESULTS A total of 219 patients were included. In the intervention group (n = 115, 53%), ICP significantly decreased and CPP increased. After 2 h from the intervention, CGLR rose in both the intervention and control groups, although the magnitude was higher in the intervention than in the control group (20.2% vs 1.6%; p = 0.001). In a linear regression model adjusted for several confounders, therapies to manage ICP were independently associated with changes in CGLR. There was a weak inverse correlation between changes in ICP and CGRL in the intervention group. CONCLUSIONS In this study, CGLR significantly changed over time, regardless of the study group. However, these effects were more significant in those patients receiving interventions to reduce ICP.
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Affiliation(s)
- Elisa Gouvêa Bogossian
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
| | - Chahnez Taleb
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna, Italy
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, University of Valencia, Valencia, Spain
| | - Denise Battaglini
- Department of Surgical Science and Integrated Diagnostic, University of Genoa, Genoa, Italy
- IRRCS Policlinico San Martino, Genoa, Italy
| | - Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, Umberto I Policlinico Di Roma, Rome, Italy
| | - Aaron Blandino Ortiz
- Department of Intensive Care Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - Anselmo Caricato
- Intensive Care Unit, Department of Anesthesiology and Intensive Care Medicine, Gemelli Hospital, Sacro Cuore Catholic University, Rome, Italy
| | - Carlo Alberto Castioni
- Anesthesia and Neurointensive Care Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna, Italy
| | - Giuseppe Citerio
- Scuola di Medicina e Chirurgia, Azienda Socio Sanitaria Territoriale Monza, Università Milano Bicocca, Monza, Italy
| | - Gioconda Ferraro
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Costanza Martino
- Anesthesia and Intensive Care Unit, Azienda Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Isabella Melchionda
- Department of Anaesthesiology, Critical Care and Pain Medicine, Umberto I Policlinico Di Roma, Rome, Italy
| | - Federica Montanaro
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Berta Monleon Lopez
- Department of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínic Universitari de Valencia, University of Valencia, Valencia, Spain
| | - Consolato Gianluca Nato
- Department of Anaesthesiology, Critical Care and Pain Medicine, Umberto I Policlinico Di Roma, Rome, Italy
| | - Michael Piagnerelli
- Department of Intensive Care, CHU-Charleroi, Université Libre de Bruxelles, Charleroi, Belgium
- Experimental Medicine Laboratory, CHU-Charleroi, Montigny-Le-Tilleul, Belgium
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Chiara Robba
- Department of Surgical Science and Integrated Diagnostic, University of Genoa, Genoa, Italy
- IRRCS Policlinico San Martino, Genoa, Italy
| | - Olivier Simonet
- Department of Anaesthesia and Intensive Care, Centre Hospitalier de Wallonie Picarde, Tournai, Belgium
| | - Aurelie Thooft
- Department of Intensive Care, CHU-Charleroi, Université Libre de Bruxelles, Charleroi, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
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Gelormini C, Caricato A, Pastorino R, Guerino Biasucci D, Ioannoni E, Montano N, Stival E, Signorelli F, Melchionda I, Albanese A, Marchese E, Silva S, Antonelli M. Brain tissue oxygenation monitoring in subarachnoid hemorrhage for the detection of delayed ischemia: a systematic review and meta-analysis. Minerva Anestesiol 2023; 89:96-103. [PMID: 36745118 DOI: 10.23736/s0375-9393.22.16468-0] [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: 02/07/2023]
Abstract
INTRODUCTION Subarachnoid hemorrhage (SAH) is a severe subtype of stroke which can be caused by the rupture of an intracranial aneurysm. Following SAH, about 30% of patients develop a late neurologic deterioration due to a delayed cerebral ischemia (DCI). This is a metanalysis and systematic review on the association between values of brain tissue oxygenation (PbtO2) and DCI in patients with SAH. EVIDENCE ACQUISITION The protocol was written according to the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and approved by the International Prospective Register of Systematic Reviews (PROSPERO registration number CRD42021229338). Relevant literature published up to August 1, 2022 was systematically searched throughout the databases MEDLINE, WEB OF SCIENCE, SCOPUS. A systematic review and metanalysis was carried out. The studies considered eligible were those published in English; that enrolled adult patients (≥18years) admitted to neurointensive care units with aneurysmal SAH (aSAH); that reported presence of multimodality monitoring including PbtO2 and detection of DCI during the period of monitoring. EVIDENCE SYNTHESIS We founded 286 studies, of which six considered eligible. The cumulative mean of PbtO2 was 19.5 mmHg in the ischemic group and 24.1mmHg in the non ischemic group. The overall mean difference of the values of PbtO2 between the patients with or without DCI resulted significantly different (-4.32 mmHg [IC 95%: -5.70, -2.94], without heterogeneity, I2 = 0%, and a test for overall effect with P<0.00001). CONCLUSIONS PbtO2 values were significantly lower in patients with DCI. Waiting for definitive results, monitoring of PbtO2 should be considered as a complementary parameter for multimodal monitoring of the risk of DCI in patients with SAH.
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Affiliation(s)
- Camilla Gelormini
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Anselmo Caricato
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Roberta Pastorino
- Department of Woman, Child, and Public Health, Gemelli University Hospital IRCCS, Rome, Italy
| | - Daniele Guerino Biasucci
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Eleonora Ioannoni
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Nicola Montano
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Eleonora Stival
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Francesco Signorelli
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Isabella Melchionda
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Alessio Albanese
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Enrico Marchese
- Section of Neurosurgery, Department of Neuroscience, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Serena Silva
- Unit of Neurointensive Care, Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Massimo Antonelli
- Department of Anesthesiology, Intensive Care and Emergency Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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Caricato A, Della Marca G, Ioannoni E, Silva S, Benzi Markushi T, Stival E, Biasucci DG, Montano N, Gelormini C, Melchionda I. Continuous EEG monitoring by a new simplified wireless headset in intensive care unit. BMC Anesthesiol 2020; 20:298. [PMID: 33287711 PMCID: PMC7720535 DOI: 10.1186/s12871-020-01213-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/25/2020] [Indexed: 01/03/2023] Open
Abstract
Background In critically ill patients continuous EEG (cEEG) is recommended in several conditions. Recently, a new wireless EEG headset (CerebAir®,Nihon-Kohden) is available. It has 8 electrodes, and its positioning seems to be easier than conventional systems. Aim of this study was to evaluate the feasibility of this device for cEEG monitoring, if positioned by ICU physician. Methods Neurological patients were divided in two groups according with the admission to Neuro-ICU (Study-group:20 patients) or General-ICU (Control-group:20 patients). In Study group, cEEG was recorded by CerebAir® assembled by an ICU physician, while in Control group a simplified 8-electrodes-EEG recording positioned by an EEG technician was performed. Results Time for electrodes applying was shorter in Study-group than in Control-group: 6.2 ± 1.1′ vs 10.4 ± 2.3′; p < 0.0001. Thirty five interventions were necessary to correct artifacts in Study-group and 11 in Control-group. EEG abnormalities with or without epileptic meaning were respectively 7(35%) and 7(35%) in Study-group, and 5(25%) and 9(45%) in Control-group;p > 0.05. In Study-group, cEEG was interrupted for risk of skin lesions in 4 cases after 52 ± 4 h. cEEG was obtained without EEG technician in all cases in Study-group; quality of EEG was similar. Conclusions Although several limitations should be considered, this simplified EEG system could be feasible even if EEG technician was not present. It was faster to position if compared with standard techniques, and can be used for continuous EEG monitoring. It could be very useful as part of diagnostic process in an emergency setting.
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Affiliation(s)
- Anselmo Caricato
- Department of Anesthesia and Intensive Care, Catholic University School of Medicine, Largo F. Vito, 1, 00168, Rome, Italy. .,Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
| | - Giacomo Della Marca
- Stroke Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Department of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Ioannoni
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Serena Silva
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Eleonora Stival
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Daniele Guerino Biasucci
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Camilla Gelormini
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Isabella Melchionda
- Neurosurgical Intensive Care, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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Silva S, Biasucci DG, Stival E, Melchionda I, Caricato A, Pilato F. A "burn out" of occipital cortex. Minerva Anestesiol 2020; 86:575-576. [PMID: 31922380 DOI: 10.23736/s0375-9393.19.14287-3] [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)
- Serena Silva
- Department of Emergency, Anesthesiology and Resuscitation Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Daniele G Biasucci
- Department of Emergency, Anesthesiology and Resuscitation Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Eleonora Stival
- Department of Emergency, Anesthesiology and Resuscitation Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Isabella Melchionda
- Department of Emergency, Anesthesiology and Resuscitation Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Anselmo Caricato
- Department of Emergency, Anesthesiology and Resuscitation Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Fabio Pilato
- Department of Neurosciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2018. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2018. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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Affiliation(s)
- Anselmo Caricato
- Università Cattolica del Sacro Cuore, Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
| | - Isabella Melchionda
- Università Cattolica del Sacro Cuore, Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Massimo Antonelli
- Università Cattolica del Sacro Cuore, Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Gaspari R, Cavaliere F, Sollazzi L, Perilli V, Melchionda I, Agnes S, Gasbarrini A, Avolio AW. Molecular adsorbent recirculating system (Mars) in patients with primary nonfunction and other causes of graft dysfunction after liver transplantation in the era of extended criteria donor organs. Transplant Proc 2009; 41:253-8. [PMID: 19249528 DOI: 10.1016/j.transproceed.2008.10.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 09/09/2008] [Accepted: 10/15/2008] [Indexed: 02/06/2023]
Abstract
Liver dysfunction is an important cause of morbidity and mortality after orthotopic liver transplantation (OLT). The Molecular Adsorbent Recirculating System (MARS) is an albumin-based dialysis system designed to enhance the excretory function of a failing liver. MARS has been successfully used in patients affected by advanced liver disease and presenting with severe cholestasis. The aim of this study was to evaluate the safety and clinical efficacy of MARS in patients with liver dysfunction after OLT. Seven patients (primary nonfunction, 2 patients; graft dysfunction, 5 patients) fulfilled the inclusion criteria of serum bilirubin level >15 mg/dL and least 1 of the following clinical signs: hepatic encephalopathy (HE) > or = grade II, hepatorenal syndrome (HRS), and intractable pruritus. Graft and patient survival rates at 6 months were 42.8% and 57.1%, respectively. All patients tolerated MARS treatment, with no adverse event. In all patients, a decrease in serum bilirubin (P < .05), bile acids (P < .05), serum creatinine, and ammonia levels was observed after treatment with MARS. A considerable improvement of HE, as well as renal and synthetic liver functions, was observed in 4 of 5 patients with graft dysfunction, but not among those with primary nonfunction. The patients with intractable pruritus showed significant improvement of this symptom after MARS therapy. Thus, MARS is a safe, therapeutic option for the treatment of liver dysfunction after OLT. Further studies are necessary to confirm whether this treatment is able to improve both graft and patient survival.
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Affiliation(s)
- R Gaspari
- Department of Anaesthesia and Intensive Care, Catholic University of Rome, Rome, Italy
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