1
|
De Cassai A, Andreatta G, Diana P, Geraldini F, Pasin L, Salvagno M, Panciera G, Navalesi P, Munari M. Nasal/orotracheal tube switch to reduce length of mechanical ventilation in neurocritical patients: A propensity score matched analysis. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:10-16. [PMID: 36621571 DOI: 10.1016/j.redare.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/17/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES Nasotracheal intubation was advocated to increase patients comfort and tube tolerance, but no study showed a clear benefit of nasotracheal intubation over orotracheal intubation. Neurocritically ill patients are a fragile group with specific requirements regarding ventilation and sedation. The aim of this study was to evaluate whether nasotracheal intubation might reduce length of mechanical ventilation in neurocritically ill patients. MATERIALS AND METHODS We conducted a retrospective cohort study with propensity matched analysis including all patients who underwent prolonged mechanical ventilation in the neurocritical Intensive Care Unit. RESULTS A total of 4030 patients were admitted during the period of interest and 312 entered the final analysis. Propensity score analysis identified 74 matched couples. Length of mechanical ventilation in patients who underwent early nasotracheal intubation resulted to be statistically significantly shorter than patients who underwent orotracheal intubation. Accordingly, length of sedation was significantly lower in patients with nasotracheal intubation, while no difference in complications occurred with similar length of stay. CONCLUSIONS In critical care units using nasotracheal intubation in the standard management of patients, the nasotracheal route was associated with lesser need for sedatives leading to shorter mechanical ventilation in neurocritical patients. However, causality has to be proven by future randomized controlled trials.
Collapse
Affiliation(s)
- A De Cassai
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy.
| | - G Andreatta
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - P Diana
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - F Geraldini
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - L Pasin
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - M Salvagno
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - G Panciera
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - P Navalesi
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy; Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - M Munari
- UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| |
Collapse
|
2
|
Bode J, Pasin L, Rieck D, Flick D, Ehrhardt K. Methane pyrolysis: CO
2
‐free production of hydrogen from natural gas. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255329] [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: 11/05/2022]
Affiliation(s)
- J. Bode
- BASF SE Group Research Carl-Bosch-Str. 38 67056 Ludwigshafen Germany
| | - L. Pasin
- BASF SE Group Research Carl-Bosch-Str. 38 67056 Ludwigshafen Germany
| | - D. Rieck
- BASF SE Group Research Carl-Bosch-Str. 38 67056 Ludwigshafen Germany
| | - D. Flick
- BASF SE Group Research Carl-Bosch-Str. 38 67056 Ludwigshafen Germany
| | - K. Ehrhardt
- BASF SE Group Research Carl-Bosch-Str. 38 67056 Ludwigshafen Germany
| |
Collapse
|
3
|
Pasin L, Boraso S, Golino G, Fakhr BS, Tiberio I, Trevisan C. The impact of frailty on mortality in older patients admitted to an Intensive Care Unit. Med Intensiva 2022; 46:23-30. [PMID: 34991871 DOI: 10.1016/j.medine.2020.05.015] [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: 01/25/2020] [Accepted: 05/24/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Frailty is a relatively new concept for intensivists, and is defined as a status of increased vulnerability to stressors associated with reduced reserve and function of different physiological systems. Supporting the hypothesis that frailty may be an important predictor of poor prognosis among older patients admitted to Intensive Care Unit (ICU), this study seeks to evaluate the association between frailty at ICU admission and short and long-term mortality. DESIGN An unmatched case-control study was carried out. SETTING Intensive Care Unit. PATIENTS OR PARTICIPANTS Patients≥80 years of age admitted to the ICU for medical reasons. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The primary outcome was 30-day mortality, while secondary outcomes were ICU mortality and mortality at one year. RESULTS Most of the patients were classified as frail at ICU admission (55.3%). The prevalence of frailty was higher among those who died than in those who were alive within 30 days from ICU admission (62.3% vs 48.3%, p=0.01). One-year mortality was higher in frail (84.4%) than in non-frail patients (65.2%, p<0.001). In the logistic regression analysis, after adjusting for potential confounders such as chronic diseases, clinical complexity, cause of ICU admission and use of advanced procedures, frailty was seen to be significantly associated to one-year mortality, but not with ICU mortality or 30-day mortality. DISCUSSION The admission of geriatric patients to the ICU is increasing. Frailty assessment may play an important role in the clinical evaluation of such individuals for triage, but should not be considered a priori as an exclusion criterion for admission.
Collapse
Affiliation(s)
- L Pasin
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy.
| | - S Boraso
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - G Golino
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - B S Fakhr
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - I Tiberio
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - C Trevisan
- Department of Medicine (DIMED), Geriatric Unit, University of Padova, Italy
| |
Collapse
|
4
|
El-Boghdadly K, Wong DJN, Owen R, Neuman MD, Pocock S, Carlisle JB, Johnstone C, Andruszkiewicz P, Baker PA, Biccard BM, Bryson GL, Chan MTV, Cheng MH, Chin KJ, Coburn M, Jonsson Fagerlund M, Myatra SN, Myles PS, O'Sullivan E, Pasin L, Shamim F, van Klei WA, Ahmad I. Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study. Anaesthesia 2020; 75:1437-1447. [PMID: 32516833 PMCID: PMC7300828 DOI: 10.1111/anae.15170] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 01/25/2023]
Abstract
Healthcare workers involved in aerosol‐generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID‐19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID‐19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self‐reporting. The primary endpoint was the incidence of laboratory‐confirmed COVID‐19 diagnosis or new symptoms requiring self‐isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure‐related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow‐up of 32 (18–48 [0–116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID‐19 subsequently reported a COVID‐19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID‐19 transmission.
Collapse
Affiliation(s)
- K El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
| | - D J N Wong
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R Owen
- Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - M D Neuman
- Penn Centre for Peri-operative Outcomes Research and Transformation, University of Pennsylvania, USA
| | - S Pocock
- Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - J B Carlisle
- Department of Anaesthesia, Peri-operative Medicine and Intensive Care, Torbay Hospital, UK
| | - C Johnstone
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P Andruszkiewicz
- Department of Anaesthesiology and Intensive Care, Institute of Tuberculosis and Lung Diseases, Poland
| | | | - B M Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa
| | - G L Bryson
- Department of Anaesthesia and Pain Medicine, University of Ottawa, Canada
| | - M T V Chan
- The Chinese University of Hong Kong, Hong Kong
| | - M H Cheng
- Division of Anaesthesiology, Singapore General Hospital, Singapore
| | - K J Chin
- Department of Anaesthesia and Pain Medicine, University of Toronto, Canada
| | - M Coburn
- Department of Anaesthesia, University Hospital RWTH, Aachen, Germany
| | - M Jonsson Fagerlund
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Sweden
| | - S N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, India
| | - P S Myles
- Department of Anaesthesiology and Perioperative Medicine, Monash University, Australia
| | | | - L Pasin
- Department of Anaesthesia and Intensive Care, Azienda Ospedale-Università di Padova, Italy
| | - F Shamim
- Department of Anaesthesiology, Aga Khan University Hospital, Pakistan
| | - W A van Klei
- Division Anaesthesia, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Netherlands
| | - I Ahmad
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
| |
Collapse
|
5
|
Pasin L, Boraso S, Golino G, Fakhr BS, Tiberio I, Trevisan C. The impact of frailty on mortality in older patients admitted to an Intensive Care Unit. Med Intensiva 2020; 46:S0210-5691(20)30191-1. [PMID: 32654922 DOI: 10.1016/j.medin.2020.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/27/2020] [Accepted: 05/24/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Frailty is a relatively new concept for intensivists, and is defined as a status of increased vulnerability to stressors associated with reduced reserve and function of different physiological systems. Supporting the hypothesis that frailty may be an important predictor of poor prognosis among older patients admitted to Intensive Care Unit (ICU), this study seeks to evaluate the association between frailty at ICU admission and short and long-term mortality. DESIGN An unmatched case-control study was carried out. SETTING Intensive Care Unit. PATIENTS OR PARTICIPANTS Patients≥80 years of age admitted to the ICU for medical reasons. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The primary outcome was 30-day mortality, while secondary outcomes were ICU mortality and mortality at one year. RESULTS Most of the patients were classified as frail at ICU admission (55.3%). The prevalence of frailty was higher among those who died than in those who were alive within 30 days from ICU admission (62.3% vs 48.3%, p=0.01). One-year mortality was higher in frail (84.4%) than in non-frail patients (65.2%, p<0.001). In the logistic regression analysis, after adjusting for potential confounders such as chronic diseases, clinical complexity, cause of ICU admission and use of advanced procedures, frailty was seen to be significantly associated to one-year mortality, but not with ICU mortality or 30-day mortality. DISCUSSION The admission of geriatric patients to the ICU is increasing. Frailty assessment may play an important role in the clinical evaluation of such individuals for triage, but should not be considered a priori as an exclusion criterion for admission.
Collapse
Affiliation(s)
- L Pasin
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy.
| | - S Boraso
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - G Golino
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - B S Fakhr
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - I Tiberio
- Department of anesthesia and Intensive Care, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - C Trevisan
- Department of Medicine (DIMED), Geriatric Unit, University of Padova, Italy
| |
Collapse
|
6
|
Pasin L, Fominskiy E, Paternoster G, Nardelli P, Belletti A, Dalessandro V, Manfredini L, Lembo R, Zangrillo A. Open thoracoabdominal aortic aneurysm repair in the modern era: results from a 6-year single-centre experience. J Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/j.jvca.2016.03.063] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
7
|
Cabrini L, Pasin L. Non invasive ventilation in surgical patients: Definitely yes, but wisely please. Rev Esp Anestesiol Reanim 2015; 62:485-486. [PMID: 25899826 DOI: 10.1016/j.redar.2015.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 06/04/2023]
Affiliation(s)
- L Cabrini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy.
| | - L Pasin
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| |
Collapse
|
8
|
Belletti A, Castro ML, Silvetti S, Greco T, Biondi-Zoccai G, Pasin L, Zangrillo A, Landoni G. The Effect of inotropes and vasopressors on mortality: a meta-analysis of randomized clinical trials. Br J Anaesth 2015; 115:656-75. [PMID: 26475799 DOI: 10.1093/bja/aev284] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- A Belletti
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - M L Castro
- Anaesthesiology Department, Centro Hospitalar Lisboa Central, EPE - Hospital de Santa Marta, Rua de Santa Marta 50, Lisbon 1169-024, Portugal
| | - S Silvetti
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - T Greco
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy Laboratorio di Statistica Medica, Biometria ed Epidemiologia "G. A. Maccacaro", Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Via Festa del Perdono 7, Milan 20122, Italy
| | - G Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 04100, Italy
| | - L Pasin
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy
| | - A Zangrillo
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy Vita-Salute San Raffaele University, via Olgettina 58, Milan 20132, Italy
| | - G Landoni
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, via Olgettina 60, Milan 20132, Italy Vita-Salute San Raffaele University, via Olgettina 58, Milan 20132, Italy
| |
Collapse
|
9
|
Greco T, Calabrò M, Covello R, Greco M, Pasin L, Morelli A, Landoni G, Zangrillo A. A Bayesian network meta-analysis on the effect of inodilatory agents on mortality. Br J Anaesth 2015; 114:746-756. [DOI: 10.1093/bja/aeu446] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
10
|
Landoni G, Nobile L, Febres D, Frati E, Villari N, Di Prima AL, Dossi R, Pasin L. A meta-analysis of randomized controlled trials on the use of statins in septic patients. Crit Care 2014. [PMCID: PMC4068713 DOI: 10.1186/cc13437] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
11
|
Landoni G, Greco T, Biondi-Zoccai G, Nigro Neto C, Febres D, Pintaudi M, Pasin L, Cabrini L, Finco G, Zangrillo A. Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery. Br J Anaesth 2013; 111:886-96. [PMID: 23852263 DOI: 10.1093/bja/aet231] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- G Landoni
- Anesthesia and Intensive Care Department, San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Cabrini L, Plumari VP, Nobile L, Olper L, Pasin L, Bocchino S, Landoni G, Beretta L, Zangrillo A. Non-invasive ventilation in cardiac surgery: a concise review. Heart Lung Vessel 2013; 5:137-41. [PMID: 24364004 PMCID: PMC3848671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Mild to severe respiratory dysfunction is still a common issue after cardiac surgery. Postoperative respiratory complications are associated with prolonged hospitalization and worse survival. In this high-risk surgery, non-invasive ventilation could have relevant positive effects. The present narrative concise review aims to summarize available data on the role of non-invasive ventilation before and after cardiac surgery. Non-invasive ventilation exerts its main effects on the pulmonary and on the cardiovascular systems. Non-invasive ventilation can be applied to prevent acute respiratory failure; it can also be prescribed as a curative tool to treat an established postoperative acute respiratory failure. Non-invasive ventilation could also be applied to wean patients from mechanical ventilation. When applied as a preventive tool, the main scope is the prevention of pneumonia by resolving or preventing atelectasis. So far, limited (but encouraging) data are available: its routine use in all patients to prevent postoperative acute respiratory failure cannot be recommended. Non-invasive ventilation to treat postoperative acute respiratory failure has been evaluated more extensively. A failure rate from 10 to 55% was reported. Safety appears preserved, with no relevant hemodynamic complication reported. Non-invasive ventilation has also been applied during percutaneous aortic valve implant in patients unable to lie supine due to severe respiratory limitation and orthopnea. In conclusion, non-invasive ventilation has the potential to be very useful before and after cardiac surgery. So far, results are promising but available data are limited. Training and experience are essential to obtain positive results and to avoid complications.
Collapse
|
13
|
Landoni G, Pasin L, Monti G, Cabrini L, Beretta L, Zangrillo A. Towards zero perioperative mortality. Heart Lung Vessel 2013; 5:133-6. [PMID: 24364003 PMCID: PMC3848670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|