1
|
Montrucchio G, Balzani E, Sales G, Vaninetti A, Grillo F, Trompeo AC, Zanierato M, Fanelli V, Corcione S, De Rosa FG, Curtoni A, Costa C, Brazzi L. Multidrug-resistant pathogens and ventilator-associated pneumonia in critically ill COVID-19 and non-COVID-19 patients: a prospective observational monocentric comparative study. Respir Res 2024; 25:168. [PMID: 38637766 PMCID: PMC11027225 DOI: 10.1186/s12931-024-02779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has increased the incidence of ventilator-associated pneumonia (VAP) among critically ill patients. However, a comparison of VAP incidence in COVID-19 and non-COVID-19 cohorts, particularly in a context with a high prevalence of multidrug-resistant (MDR) organisms, is lacking. MATERIAL AND METHODS We conducted a single-center, mixed prospective and retrospective cohort study comparing COVID-19 patients admitted to the intensive care unit (ICU) of the "Città della Salute e della Scienza" University Hospital in Turin, Italy, between March 2020 and December 2021 (COVID-19 group), with a historical cohort of ICU patients admitted between June 2016 and March 2018 (NON-COVID-19 group). The primary objective was to define the incidence of VAP in both cohorts. Secondary objectives were to evaluate the microbial cause, resistance patters, risk factors and impact on 28 days, ICU and in-hospital mortality, duration of ICU stay, and duration of hospitalization). RESULTS We found a significantly higher incidence of VAP (51.9% - n = 125) among the 241 COVID-19 patients compared to that observed (31.2% - n = 78) among the 252 NON-COVID-19 patients. The median SOFA score was significantly lower in the COVID-19 group (9, Interquartile range, IQR: 7-11 vs. 10, IQR: 8-13, p < 0.001). The COVID-19 group had a higher prevalence of Gram-positive bacteria-related VAP (30% vs. 9%, p < 0.001), but no significant difference was observed in the prevalence of difficult-to-treat (DTR) or MDR bacteria. ICU and in-hospital mortality in the COVID-19 and NON-COVID-19 groups were 71% and 74%, vs. 33% and 43%, respectively. The presence of COVID-19 was significantly associated with an increased risk of 28-day all-cause hospital mortality (Hazard ratio, HR: 7.95, 95% Confidence Intervals, 95% CI: 3.10-20.36, p < 0.001). Tracheostomy and a shorter duration of mechanical ventilation were protective against 28-day mortality, while dialysis and a high SOFA score were associated with a higher risk of 28-day mortality. CONCLUSION COVID-19 patients with VAP appear to have a significantly higher ICU and in-hospital mortality risk regardless of the presence of MDR and DTR pathogens. Tracheostomy and a shorter duration of mechanical ventilation appear to be associated with better outcomes.
Collapse
Affiliation(s)
- Giorgia Montrucchio
- Department of Surgical Sciences, University of Turin, Turin, Italy.
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy.
| | - Eleonora Balzani
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Gabriele Sales
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Anna Vaninetti
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francesca Grillo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Anna Chiara Trompeo
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marinella Zanierato
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Vito Fanelli
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin, Turin, Italy
- Tufts University School of Medicine, Boston, MA, 02111, USA
| | | | - Antonio Curtoni
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
- Microbiology and Virology Laboratory, Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, Turin, 10126, Italy
| | - Cristina Costa
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
- Microbiology and Virology Laboratory, Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, Turin, 10126, Italy
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| |
Collapse
|
2
|
Agostini G, Vairo A, Montefusco A, Marro M, Costamagna A, La Torre MW, Trompeo AC, Pocar M, Rinaldi M, Salizzoni S. Transcatheter Mitral Valve Implantation in Failed Transventricular Mitral Valve Repair. JACC Case Rep 2024; 29:102273. [PMID: 38645293 PMCID: PMC11031677 DOI: 10.1016/j.jaccas.2024.102273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 04/23/2024]
Abstract
An 84-year-old man presented with dyspnea at rest due to severe mitral regurgitation. He first underwent transventricular mitral valve repair with the Harpoon system, which relapsed owing to rupture of neochords. He was definitively treated with transcatheter mitral valve implantation of the Tendyne system 8 months later.
Collapse
Affiliation(s)
- Giulia Agostini
- Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alessandro Vairo
- Cardiac Division, Città della Salute e della Scienza, Turin, Italy
| | | | - Matteo Marro
- Cardiac Surgery, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Costamagna
- Anesthesiology and Intensive Care Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Anna Chiara Trompeo
- Cardiovascular Anesthesia and Intensive Care Division, Città della Salute e della Scienza, Turin, Italy
| | - Marco Pocar
- Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Stefano Salizzoni
- Cardiac Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
3
|
Dusi V, Angelini F, Baldi E, Toscano A, Gravinese C, Frea S, Compagnoni S, Morena A, Saglietto A, Balzani E, Giunta M, Costamagna A, Rinaldi M, Trompeo AC, Rordorf R, Anselmino M, Savastano S, De Ferrari GM. Continuous stellate ganglion block for ventricular arrhythmias: case series, systematic review, and differences from thoracic epidural anaesthesia. Europace 2024; 26:euae074. [PMID: 38531027 PMCID: PMC11020261 DOI: 10.1093/europace/euae074] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
AIMS Percutaneous stellate ganglion block (PSGB) through single-bolus injection and thoracic epidural anaesthesia (TEA) have been proposed for the acute management of refractory ventricular arrhythmias (VAs). However, data on continuous PSGB (C-PSGB) are scant. The aim of this study is to report our dual-centre experience with C-PSGB and to perform a systematic review on C-PSGB and TEA. METHODS AND RESULTS Consecutive patients receiving C-PSGB at two centres were enrolled. The systematic literature review follows the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Our case series (26 patients, 88% male, 60 ± 16 years, all with advanced structural heart disease, left ventricular ejection fraction 23 ± 11%, 32 C-PSGBs performed, with a median duration of 3 days) shows that C-PSGB is feasible and safe and leads to complete VAs suppression in 59% and to overall clinical benefit in 94% of cases. Overall, 61 patients received 68 C-PSGBs and 22 TEA, with complete VA suppression in 63% of C-PSGBs (61% of patients). Most TEA procedures (55%) were performed on intubated patients, as opposed to 28% of C-PSGBs (P = 0.02); 63% of cases were on full anticoagulation at C-PSGB, none at TEA (P < 0.001). Ropivacaine and lidocaine were the most used drugs for C-PSGB, and the available data support a starting dose of 12 and 100 mg/h, respectively. No major complications occurred, yet TEA discontinuation rate due to side effects was higher than C-PSGB (18 vs. 1%, P = 0.01). CONCLUSION Continuous PSGB seems feasible, safe, and effective for the acute management of refractory VAs. The antiarrhythmic effect may be accomplished with less concerns for concomitant anticoagulation compared with TEA and with a lower side-effect related discontinuation rate.
Collapse
Affiliation(s)
- Veronica Dusi
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Enrico Baldi
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Toscano
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Carol Gravinese
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Simone Frea
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Viale Golgi 19, 27100 Pavia, Italy
| | - Arianna Morena
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Eleonora Balzani
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Matteo Giunta
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Andrea Costamagna
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Mauro Rinaldi
- Department of Surgical Sciences, University of Turin, Torino, Italy
- Department of Cardiovascular and Thoracic Surgery, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Anna Chiara Trompeo
- Department of Anaesthesia, Critical Care and Emergency, ‘Città della Salute e della Scienza’ Hospital, Torino, Italy
| | - Roberto Rordorf
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Anselmino
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| | - Simone Savastano
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gaetano Maria De Ferrari
- Cardiology, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Città della Salute e della Scienza’ Hospital, Corso Bramante 88/90, 10126 Torino, Italy
| |
Collapse
|
4
|
Mornese Pinna S, Corcione S, Cavallone E, Shbaklo N, Vita D, De Benedetto I, Montrucchio G, Pasero D, Trompeo AC, Costamagna A, Brazzi L, Rinaldi M, Boffini M, De Rosa FG. Epidemiology and Risk Factors for Nosocomial Infections in Left Ventricular Assist Device Recipients. Life (Basel) 2024; 14:270. [PMID: 38398779 PMCID: PMC10890466 DOI: 10.3390/life14020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Left ventricular assist devices (LVADs) have been increasingly used as a valid option to improve the prognosis and reduce the symptoms of end-stage heart failure. However, long-term complications, mostly infections and coagulation disorders, are frequent. We described the epidemiology and risk factors for nosocomial infections (NIs) in a cohort of adult patients who underwent continuous-flow LVAD implant between January 2010 and December 2017 in Turin, Italy. Secondary outcomes were the prevalence of multidrug-resistant (MDR) bacteria and mortality. Results: Overall, 64 LVADs were implanted. A total of 32 (50%) patients experienced at least one episode of NI, with a total of 46 infectious events. VAD-related infections occurred in 22 patients (68.8%). Non VAD-related NIs occurred in 12 patients (37.5%), mainly low respiratory tract infections. Length of intensive care unit admission was a risk factor for NI (OR 1.224, 95%CI; 1.049, 1.429). Gram-negative bacilli were responsible for 58.8% of VAD-related infections and 79.5% of non-VAD related infections. In sixteen patients (50%), at least one episode of infection was related to an MDR strain. INTERMACS class and length of MV were independent risk factors for NIs by MDR strains (respectively, OR 2.12, 95%CI: 1.08, 6.80; p = 0.02 and OR 1.46, 95%CI: 1.07, 5.52, p = 0.047). In-hospital mortality was 6.3%. No differences in mortality were observed between infected and non-infected patients (p = 0.61) even when caused by MDR strains (p = 0.143). Conclusion: the rate of nosocomial infections in LVAD patients is associated with the length of ICU admission, and the etiology of nosocomial infection after LVAD implant is mainly due to GNB, including a high rate of MDR strains, especially KPC-KP and MDR PA.
Collapse
Affiliation(s)
- Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy (N.S.); (I.D.B.); (F.G.D.R.)
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy (N.S.); (I.D.B.); (F.G.D.R.)
- Tufts University School of Medicine, Boston, MA 02111, USA
| | - Elena Cavallone
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy (N.S.); (I.D.B.); (F.G.D.R.)
| | - Davide Vita
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy (N.S.); (I.D.B.); (F.G.D.R.)
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy (N.S.); (I.D.B.); (F.G.D.R.)
| | - Giorgia Montrucchio
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (G.M.); (A.C.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, 10126 Turin, Italy;
| | - Daniela Pasero
- Department of Emergency, Anaesthesia and Intensive Care Unit, AOU Sassari, 07100 Sassari, Italy;
| | - Anna Chiara Trompeo
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, 10126 Turin, Italy;
| | - Andrea Costamagna
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (G.M.); (A.C.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, 10126 Turin, Italy;
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, 10124 Turin, Italy; (G.M.); (A.C.); (L.B.)
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, 10126 Turin, Italy;
| | - Mauro Rinaldi
- Department of Surgical Sciences, Cardiac Surgery Division, University of Turin, 10124 Turin, Italy (M.B.)
| | - Massimo Boffini
- Department of Surgical Sciences, Cardiac Surgery Division, University of Turin, 10124 Turin, Italy (M.B.)
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy (N.S.); (I.D.B.); (F.G.D.R.)
| |
Collapse
|
5
|
Burzio C, Balzani E, Corcione S, Montrucchio G, Trompeo AC, Brazzi L. Pneumocystis jirovecii Pneumonia after Heart Transplantation: Two Case Reports and a Review of the Literature. Pathogens 2023; 12:1265. [PMID: 37887781 PMCID: PMC10610317 DOI: 10.3390/pathogens12101265] [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: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Post-transplant Pneumocystis jirovecii pneumonia (PcP) is an uncommon but increasingly reported disease among solid organ transplantation (SOT) recipients, associated with significant morbidity and mortality. Although the introduction of PcP prophylaxis has reduced its overall incidence, its prevalence continues to be high, especially during the second year after transplant, the period following prophylaxis discontinuation. We recently described two cases of PcP occurring more than one year after heart transplantation (HT) in patients who were no longer receiving PcP prophylaxis according to the local protocol. In both cases, the disease was diagnosed following the diagnosis of a viral illness, resulting in a significantly increased risk for PcP. While current heart transplantation guidelines recommend Pneumocystis jirovecii prophylaxis for up to 6-12 months after transplantation, after that period they only suggest an extended prophylaxis regimen in high-risk patients. Recent studies have identified several new risk factors that may be linked to an increased risk of PcP infection, including medication regimens and patient characteristics. Similarly, the indication for PcP prophylaxis in non-HIV patients has been expanded in relation to the introduction of new medications and therapeutic regimens for immune-mediated diseases. In our experience, the first patient was successfully treated with non-invasive ventilation, while the second required tracheal intubation, invasive ventilation, and extracorporeal CO2 removal due to severe respiratory failure. The aim of this double case report is to review the current timing of PcP prophylaxis after HT, the specific potential risk factors for PcP after HT, and the determinants of a prompt diagnosis and therapeutic approach in critically ill patients. We will also present a possible proposal for future investigations on indications for long-term prophylaxis.
Collapse
Affiliation(s)
- Carlo Burzio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy; (C.B.); (G.M.); (A.C.T.); (L.B.)
| | - Eleonora Balzani
- Department of Surgical Science, University of Turin, 10124 Torino, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy;
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Giorgia Montrucchio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy; (C.B.); (G.M.); (A.C.T.); (L.B.)
- Department of Surgical Science, University of Turin, 10124 Torino, Italy
| | - Anna Chiara Trompeo
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy; (C.B.); (G.M.); (A.C.T.); (L.B.)
| | - Luca Brazzi
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy; (C.B.); (G.M.); (A.C.T.); (L.B.)
- Department of Surgical Science, University of Turin, 10124 Torino, Italy
| |
Collapse
|
6
|
Zanza C, Saglietti F, Giamello JD, Savioli G, Biancone DM, Balzanelli MG, Giordano B, Trompeo AC, Longhitano Y. Effectiveness of Intranasal Analgesia in the Emergency Department. Medicina (Kaunas) 2023; 59:1746. [PMID: 37893464 PMCID: PMC10608673 DOI: 10.3390/medicina59101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
In the Emergency Department (ED), pain is one of the symptoms that are most frequently reported, making it one of the most significant issues for the emergency physician, but it is frequently under-treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the standard methods for administering acute pain relief. Firstly, we compared the safety and efficacy of IN analgesia to other conventional routes of analgesia to assess if IN analgesia may be an alternative for the management of acute pain in ED. Secondly, we analyzed the incidence and severity of adverse events (AEs) and rescue analgesia required. We performed a narrative review-based keywords in Pubmed/Medline, Scopus, EMBASE, the Cochrane Library, and Controlled Trials Register, finding only twenty randomized Clinical trials eligible in the timeline 1992-2022. A total of 2098 patients were analyzed and compared to intravenous analgesia, showing no statistical difference in adverse effects. In addition, intranasal analgesia also has a rapid onset and quick absorption. Fentanyl and ketamine are two intranasal drugs that appear promising and may be taken simply and safely while providing effective pain relief. Intravenous is simple to administer, non-invasive, rapid onset, and quick absorption; it might be a viable choice in a variety of situations to reduce patient suffering or delays in pain management.
Collapse
Affiliation(s)
- Christian Zanza
- Italian Society of Prehospital Emergency Medicine-SIS 118-Taranto, 74121 Taranto, Italy
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Francesco Saglietti
- Department of Anesthesia and Critical Care, Santa Croce and Carle Hospital, 12100 Cuneo, Italy
| | | | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | | | | | - Benedetta Giordano
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Roma, Italy
| | - Anna Chiara Trompeo
- Department of Anesthesia and Critical Care, AOU Città della Scienza e della Salute, 10126 Torino, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA
- Department of Emergency Medicine, Humanitas University, 20089 Milan, Italy
| |
Collapse
|
7
|
Barbero C, Pocar M, Brenna D, Parrella B, Baldarelli S, Aloi V, Costamagna A, Trompeo AC, Vairo A, Alunni G, Salizzoni S, Rinaldi M. Minimally Invasive Surgery: Standard of Care for Mitral Valve Endocarditis. Medicina (Kaunas) 2023; 59:1435. [PMID: 37629726 PMCID: PMC10456514 DOI: 10.3390/medicina59081435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
Background. Minimally invasive surgery via right mini-thoracotomy has become the standard of care for the treatment of mitral valve disease worldwide, particularly at high-volume centers. In recent years, the spectrum of indications has progressively shifted and extended to fragile and higher-risk patients, also addressing more complex mitral valve disease and ultimately including patients with native or prosthetic infective endocarditis. The rationale for the adoption of the minimally invasive approach is to minimize surgical trauma, promote an earlier postoperative recovery, and reduce the incidence of surgical wound infection and other nosocomial infections. The aim of this retrospective observational study is to evaluate the effectiveness and the early and late outcome in patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Methods. Prospectively collected data regarding minimally invasive surgery in patients with mitral valve infective endocarditis were entered into a dedicated database for the period between January 2007 and December 2022 and retrospectively analyzed. All comers during the study period underwent a preoperative evaluation based on their clinical history and anatomy for the allocation to the most appropriate surgical strategy. The selection of the mini-thoracotomy approach was primarily driven by a thorough transthoracic and especially transesophageal echocardiographic evaluation, coupled with total body and vascular imaging. Results. During the study period, 92 patients underwent right mini-thoracotomy to treat native (80/92, 87%) or prosthetic (12/92, 13%) mitral valve endocarditis at our institution, representing 5% of the patients undergoing minimally invasive mitral surgery. Twenty-six (28%) patients had undergone previous cardiac operations, whereas 18 (20%) presented preoperatively with complications related to endocarditis, most commonly systemic embolization. Sixty-nine and twenty-three patients, respectively, underwent early surgery (75%) or were operated on after the completion of the targeted antibiotic treatment (25%). A conservative procedure was feasible in 16/80 (20%) patients with native valve endocarditis. Conversion to standard sternotomy was necessary in a single case (1.1%). No cases of intraoperative iatrogenic aortic dissection were reported. Four patients died perioperatively, accounting for a thirty-day mortality of 4.4%. The causes of death were refractory heart or multiorgan failure and/or septic shock. A new onset stroke was observed postoperatively in one case (1.1%). Overall actuarial survival rate at 1 and 5 years after operation was 90.8% and 80.4%, whereas freedom from mitral valve reoperation at 1 and 5 years was 96.3% and 93.2%, respectively. Conclusions. This present study shows good early and long-term results in higher-risk patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Total body, vascular, and echocardiographic screening represent the key points to select the optimal approach and allow for the extension of indications for minimally invasive surgery to sicker patients, including active endocarditis and sepsis.
Collapse
Affiliation(s)
- Cristina Barbero
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
| | - Marco Pocar
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Dario Brenna
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Barbara Parrella
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Sara Baldarelli
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Valentina Aloi
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Andrea Costamagna
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
- Division of Cardiac Intensive Care, Anesthesia, Intensive Care and Emergency Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, 10126 Turin, Italy;
| | - Anna Chiara Trompeo
- Division of Cardiac Intensive Care, Anesthesia, Intensive Care and Emergency Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, 10126 Turin, Italy;
| | - Alessandro Vairo
- Unit of Echocardiography, Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, 10126 Turin, Italy; (A.V.); (G.A.)
| | - Gianluca Alunni
- Unit of Echocardiography, Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, 10126 Turin, Italy; (A.V.); (G.A.)
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| |
Collapse
|
8
|
Burzio C, Balzani E, Montrucchio G, Trompeo AC, Corcione S, Brazzi L. Trichoderma spp.-Related Pneumonia: A Case Report in Heart-Lung Transplantation Recipient and a Systematic Literature Review. J Fungi (Basel) 2023; 9:195. [PMID: 36836310 PMCID: PMC9961996 DOI: 10.3390/jof9020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Opportunistic and hospital-acquired infections are common among recipients of solid organ transplantation. New pathogens are increasingly reported in the intensive care unit (ICU) population. We report a case of a patient who developed Trichoderma spp.-related pneumonia (TRP) after heart-lung transplantation. In the absence of antifungal susceptibility testing, TRP was confirmed by histological examination, and empirical therapy with voriconazole and caspofungin was swiftly initiated. Complete resolution of pneumonia was obtained after prolonged combination therapy. Given the lack of guidelines, we conducted a systematic review to elucidate the diagnostic and therapeutic strategies to apply during Trichoderma infection. After deduplication and selection of full texts, we found 42 articles eligible for the systematic review. Pneumonia seems to be the most common clinical manifestation (31.8%). The most used antifungal therapy was amphotericin B, while combination therapy was also reported (27.3%). All the patients were immunocompromised except for one case. Despite the rarity of Trichoderma spp. infection, the increase in invasive fungal infections is of growing importance in ICU, considering their impact on mortality and the emergence of antifungal resistance. In the absence of prospective and multicenter studies, a review can provide useful insight regarding the epidemiology, clinical manifestations, and management of these unexpected challenges.
Collapse
Affiliation(s)
- Carlo Burzio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy
| | - Eleonora Balzani
- Department of Surgical Science, University of Turin, 10124 Torino, Italy
| | - Giorgia Montrucchio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy
- Department of Surgical Science, University of Turin, 10124 Torino, Italy
| | - Anna Chiara Trompeo
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Luca Brazzi
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza di Torino Hospital, 10126 Torino, Italy
- Department of Surgical Science, University of Turin, 10124 Torino, Italy
| |
Collapse
|
9
|
Dusi V, Pugliese L, Ruffinazzi M, Guerrera F, Sanzo A, Vicentini A, Savastano S, Greco A, Camporotondo R, Vairo A, Frea S, Proclemer A, Imazio M, Tritto M, Trompeo AC, Belliato M, Ghio S, Raineri C, Rordorf R, De Ferrari GM. 958 IMPACT OF CARDIAC SYMPATHETIC DENERVATION ON ELECTRICAL STORMS IN PATIENTS WITH CARDIOMIOPATHIES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.042] [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: 12/23/2022]
Abstract
Abstract
Background
Cardiac Sympathetic Denervation (CSD) has been recently proposed for the treatment of refractory ventricular arrhythmias (VAs) in patients with cardiomyopathy (CMP). A multicentric American and Indian case series suggested a greater efficacy of bilateral denervation (BCSD), compared to the left-side only procedure (LCSD), albeit with the potential prize of an increased need for atrial pacing due to the right-side innervation of the sinus node. The impact of CSD on the risk of electrical storms (ES) in CMP has never been evaluated.
Aim
To describe our multicenter Italian experience with CSD in CMP patients with drug and/or catheter ablation refractory VAs, with a specific focus on ES incidence.
Methods
Thirty patients with CMP and refractory VAs underwent either LCSD or BCSD between April 2016 and June 2022. Among them, one patient received first LCSD and then right-side denervation due to ES recurrence after LCSD: to properly assess the risk of ES after LCSD and BCSD he was included in both groups with the corresponding follow-up, leading to 5 cases of LCSD and 26 cases of BCSD. All patients had a Video–Assisted Thoracoscopic Surgery (VATS), in 8 cases associated with the robotic technique. The main reason (3/5 cases, 60%) to perform LCSD instead of BCSD since the beginning was sinus bradycardia in single ICD lead recipients.
Results
87% of pts were male, the mean age was 56 ± 16 yrs and the mean LVEF 31± 12%; most (n=26, 85%) suffered non-ischemic cardiomyopathy and 37% were in NYHA functional class ≥3. Main indications for CSD were represented by refractory polymorphic/fast VAs (cycle length <250 msec) in 60% of pts and by refractory monomorphic VAs episodes in the rest. Except for 5 patients (17%) with previous thyrotoxicosis, the majority were either on amiodarone (n=19, 63%) or on sotalol (n=3, 10%) before CSD and 53% had previously undergone ≥1 catheter ablation for VAs. The median follow-up (FU) after denervation was 15 months (IQR 5-42 months).
No major complication directly related to the procedure occurred. Overall, 11 patients (37%) either died during FU (n=8, 27%), mostly due to end-stage heart failure, or underwent heart transplant (n=3, 10%). After denervation, the percentage of patients with ES decreased from 77% to 40% (p<0.01), while patients with appropriate shocks decreased from 100% to 60%. The antiarrhythmic benefit was even more pronounced among the 26 patients who received BCSD: ES incidence decreased from 85% to 39% (p<0.01), appropriate shock incidence from 100% to 54% (p<0.01), while no significant changes in ES and ICD shock incidence were observed after the few LCSD procedures (n=5). A NYHA class <3 was associated with a trend toward a better response after BCSD (37% vs 54% incidence of ICD shock, p=0.05).
Conclusions
Our case series of CSD in cardiomyopathies represents the largest reported in Europe and the first ever to specifically evaluate the impact of denervation on electrical storms. The occurrence of electrical storm was more than halved by bilateral CSD confirming the powerful protective effect of BCSD also on this ominous phenomenon. The greater antiarrhythmic benefit observed among patients with better functional class suggests the opportunity to perform this procedure earlier on in the trajectory of patients with progressive heart failure.
Collapse
Affiliation(s)
- Veronica Dusi
- Divisione Di Cardiologia, Dipartimento Cardiovascolare E Toracico, Aou Citta’ Della Salute E Della Scienza. Dipartimento Di Scienze Mediche, Universita’ Di Torino
| | - Luigi Pugliese
- Dipartimento Di Chirurgia, Fondazione Irccs Policlinico San Matteo
| | - Marta Ruffinazzi
- Dipartimento Di Medicina Molecolare, Universita’ Degli Studi Di Pavia
| | - Francesco Guerrera
- Dipartimento Di Chirurgia Toracica, Aou Citta’ Della Salute E Della Scienza, Dipartimento Di Scienze Chirurgiche, Universita’ Degli Studi Di Torino
| | - Antonio Sanzo
- Dipartimento Di Cardiologia, Fondazione Irccs Policlinico San Matteo
| | | | - Simone Savastano
- Dipartimento Di Cardiologia, Fondazione Irccs Policlinico San Matteo
| | - Alessandra Greco
- Dipartimento Di Cardiologia, Fondazione Irccs Policlinico San Matteo
| | - Rita Camporotondo
- Dipartimento Di Cardiologia, Fondazione Irccs Policlinico San Matteo
| | - Alessandro Vairo
- Divisione Di Cardiologia, Dipartimento Cardiovascolare E Toracico , Aou Citta’ Della Salute E Della Scienza
| | - Simone Frea
- Divisione Di Cardiologia, Dipartimento Cardiovascolare E Toracico , Aou Citta’ Della Salute E Della Scienza
| | | | - Massimo Imazio
- Dipartimento Di Cardiologia , Aou Santa Maria Della Misericordia
| | | | - Anna Chiara Trompeo
- Dipartimento Di Anestesia , Terapia Intensiva Ed Emergenza, Aou Citta’ Della Salute E Della Scienza
| | - Mirko Belliato
- Uoc Anestesia E Rianimazione 2, Fondazione Irccs Policlinico San Matteo
| | - Stefano Ghio
- Dipartimento Di Cardiologia, Fondazione Irccs Policlinico San Matteo
| | - Claudia Raineri
- Divisione Di Cardiologia, Dipartimento Cardiovascolare E Toracico , Aou Citta’ Della Salute E Della Scienza
| | - Roberto Rordorf
- Dipartimento Di Cardiologia, Fondazione Irccs Policlinico San Matteo
| | - Gaetano Maria De Ferrari
- Divisione Di Cardiologia, Dipartimento Cardiovascolare E Toracico, Aou Citta’ Della Salute E Della Scienza. Dipartimento Di Scienze Mediche, Universita’ Di Torino
| |
Collapse
|
10
|
Marro M, Pocar M, Vairo A, Barbero C, Trompeo AC, Rinaldi M, Salizzoni S. ACUTE REVERSE REMODELING FOLLOWING COMBO TRANSVENTRICULAR AND PERCUTANEOUS MITRAL REPAIR. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04256-x] [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: 11/16/2022]
|
11
|
Fornaro G, Canavosio FG, Contristano ML, Pasero D, Izzo G, Centofanti P, Attisani M, Trompeo AC, Buono G, Martore M, Rinaldi M, Brazzi L. Extracorporeal life support programme for out-of-hospital cardiac arrest during competitive sport events: the experience of the Volleyball Men's World Championship Final Six in Turin (Italy). Emerg Med J 2021; 39:376-379. [PMID: 33858859 DOI: 10.1136/emermed-2019-209203] [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: 10/12/2019] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
The high incidence of out-of-hospital cardiac arrest refractory to standard resuscitation protocols, despite precompetitive screening, demonstrated the need for a prehospital team to provide an effective system for life support and resuscitation at the Volleyball Men's World Championship. The evolution of mechanical circulatory support suggests that current advanced cardiovascular life support protocols no longer represent the highest standard of care at competitive sporting events with large spectator numbers. Extracorporeal life support (ECLS) improves resuscitation strategies and offers a rescue therapy for refractory cardiac arrest that can no longer be ignored. We present our operational experience of an out-of-hospital ECLS cardiopulmonary resuscitation team at an international sporting event.
Collapse
Affiliation(s)
- Giancarlo Fornaro
- Department of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Federico Giovanni Canavosio
- Department of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Maria Luisa Contristano
- Department of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Daniela Pasero
- Department of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Gennaro Izzo
- Cardiovascular and Thoracic Department, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Paolo Centofanti
- Structural Surgical Department, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Matteo Attisani
- Cardiovascular and Thoracic Department, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Anna Chiara Trompeo
- Department of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | - Gabriella Buono
- Structural Surgical Department, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | | | - Mauro Rinaldi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy.,Department of Surgical Sciences, University of Turin, Torino, Piemonte, Italy
| | - Luca Brazzi
- Department of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Piemonte, Italy.,Department of Surgical Sciences, University of Turin, Torino, Piemonte, Italy
| |
Collapse
|
12
|
Toscano A, Capuano P, Bartoletti L, Trompeo AC, Salizzoni S, La Torre M, Rinaldi M, Brazzi L. Use of Pectoralis Type 2 Block (PECS II) for Awake Trans-subclavian Transcatheter Aortic Valve Replacement: First Experience in Two Cases. J Cardiothorac Vasc Anesth 2021; 36:1401-1405. [PMID: 33744110 DOI: 10.1053/j.jvca.2021.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Antonio Toscano
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' hospital, Turin, Italy.
| | - Paolo Capuano
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' hospital, Turin, Italy
| | - Lorenzo Bartoletti
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' hospital, Turin, Italy
| | - Anna Chiara Trompeo
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' hospital, Turin, Italy
| | - Stefano Salizzoni
- Department of cardiovascular and thoracic surgery, 'Città della Salute e della Scienza', Turin, Italy
| | - Michele La Torre
- Department of cardiovascular and thoracic surgery, 'Città della Salute e della Scienza', Turin, Italy
| | - Mauro Rinaldi
- Department of cardiovascular and thoracic surgery, 'Città della Salute e della Scienza', Turin, Italy
| | - Luca Brazzi
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' hospital, Turin, Italy
| |
Collapse
|
13
|
Toscano A, Capuano P, Trompeo AC, La Torre M, D'Amico M, Rinaldi M, Brazzi L. Awake Thoracic Epidural Anesthesia in Transapical Transcatheter Aortic Valve Implantation. J Cardiothorac Vasc Anesth 2019; 34:311-312. [PMID: 31383597 DOI: 10.1053/j.jvca.2019.07.124] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Antonio Toscano
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paolo Capuano
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Anna Chiara Trompeo
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Michele La Torre
- Division of Cardiac Surgery, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Luca Brazzi
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| |
Collapse
|
14
|
Benech CA, Perez R, Faccani G, Trompeo AC, Cavallo S, Beninati S, Berardino M. Adenosine-induced cardiac arrest in complex cerebral aneurysms surgery: an Italian single-center experience. J Neurosurg Sci 2014; 58:87-94. [PMID: 24819485] [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: 06/03/2023]
Abstract
AIM Even if endovascular techniques are improving, treatment of complex intracranial aneurysms still remains a neurosurgeon challenge. Adenosine administration, producing a brief and profound systemic hypotension, seems to improve surgical aneurysm visualization facilitating its exclusion with less risks of rupture. In our retrospective study we confirmed that adenosine advantages could be determinant for an optimal surgical result. METHODS We retrospectively reviewed all unruptured complex cerebral aneurysms surgically treated in our institution between August 2009 and April 2012. Treatment of those aneurysms was surgical, with proximal temporary artery occlusion or adenosine induced flow arrest. We compared the two different techniques, evaluating intra- and postoperative data; a three-month follow-up including a neurological assessment, cerebral angiography and echocardiography for the adenosine group was performed. RESULTS Twenty-four patients were collected in our study. Eleven patients underwent traditional temporary proximal clipping while in 13 patients intraoperative adenosine was used. Most common location was paraclinoid region. We did not observe any complication in the adenosine group. Adenosine was well tolerated, spontaneous recovery of sinusal cardiac rhythm was observed even at high and subsequent doses. The Intensive Care Unit and Hospital length of stay were shorter in adenosine group. A three-month follow-up did not show cardiac abnormalities with good angiographic aneurysms exclusion. CONCLUSION We observed that adenosine administration allowed an easier clipping thanks to a reduced wall tension in a clearer surgical field without cardiological adverse events. In our opinion adenosine induced arrest technique could be an efficacious, harmless and reliable alternative strategy for surgical treatment of complex cerebral aneurysms.
Collapse
Affiliation(s)
- C A Benech
- Division of Neurosurgery, Department of Surgery CTO Hospital, Turin, Italy -
| | | | | | | | | | | | | |
Collapse
|
15
|
Trompeo AC, Vidi Y, Locane MD, Braghiroli A, Mascia L, Bosma K, Ranieri VM. Sleep disturbances in the critically ill patients: role of delirium and sedative agents. Minerva Anestesiol 2011; 77:604-612. [PMID: 21617624] [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: 05/30/2023]
Abstract
BACKGROUND Impairment of sleep quality and quantity has been described in critically ill patients. Delirium, an organ dysfunction that affects outcome of the critically ill patients, is characterized by an acute onset of impaired cognitive function, visual hallucinations, delusions, and illusions. These symptoms resemble the hypnagogic hallucinations and wakeful dreams seen in patients with neurological degenerative disorders and suffering of disorders of rapid eye movement (REM) sleep. We assessed the characteristics of sleep disruption in a cohort of surgical critically ill patients examining the hypothesis that severe impairments of rapid eyes movement (REM) sleep are associated to delirium. METHODS Surgical patients admitted to the intensive care units of the San G. Battista Hospital (University of Turin) were enrolled. Once weaning was initiated, sleep was recorded for one night utilizing standard polysomnography. Clinical status, laboratory data on admission, co-morbidities and duration of mechanical ventilation were recorded. Patients were a priori classified as having a "severe REM reduction" or "REM reduction" if REM was higher or lower than 6% of the total sleep time (TST), respectively. Occurrence of delirium during intensive care unit (ICU) stay was identified by CAM-ICU twice a day. Multivariate forward stepwise logistic regression analysis was performed with sleep ("severe REM reduction" vs. "REM reduction") as the a priori dependent factor. RESULTS REM sleep amounted to 44 (16-72) minutes [11 (8-55) % of the TST] in 14 patients ("REM reduction") and to 2.5 (0-36) minutes [1 (0-6) % of the TST] in the remaining 15 patients ("severe REM reduction") (P = 0.0004). SAPS II on admission was higher in " severely REM deprived" then in "REM deprived" patients. Delirium was present in 11 patients (73.3%) of the patients with "severe REM reduction" and lasted for a median of 3 (0-11) days before sleep assessment, while only one patient having "REM reduction" developed delirium that lasted for 1 day. The factors independently associated with a higher risk of developing "severe REM reduction" were delirium and daily dosage of lorazepam. CONCLUSION The present study shows that while all critically ill patients present a profound fragmentation of sleep with a high frequency of arousals and awakenings and a reduction of REM sleep, a percentage of patients present an extremely severe reduction of REM sleep. Delirium and daily dosage of lorazepam are the factors independently associated to extremely severe REM sleep reduction.
Collapse
Affiliation(s)
- A C Trompeo
- Department on Anesthesiology and Resuscitation, University of Turin, S. Giovanni Battista-Molinette Hospital, Corso Dogliotti 14, Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
16
|
Morandi A, Pandharipande P, Trabucchi M, Rozzini R, Mistraletti G, Trompeo AC, Gregoretti C, Gattinoni L, Ranieri MV, Brochard L, Annane D, Putensen C, Guenther U, Fuentes P, Tobar E, Anzueto AR, Esteban A, Skrobik Y, Salluh JIF, Soares M, Granja C, Stubhaug A, de Rooij SE, Ely EW. Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients. Intensive Care Med 2008; 34:1907-15. [PMID: 18563387 DOI: 10.1007/s00134-008-1177-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 05/21/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Delirium (acute brain dysfunction) is a potentially life threatening disturbance in brain function that frequently occurs in critically ill patients. While this area of brain dysfunction in critical care is rapidly advancing, striking limitations in use of terminology related to delirium internationally are hindering cross-talk and collaborative research. In the English literature, synonyms of delirium such as the Intensive Care Unit syndrome, acute brain dysfunction, acute brain failure, psychosis, confusion, and encephalopathy are widely used. This often leads to scientific "confusion" regarding published data and methodology within studies, which is further exacerbated by organizational, cultural and language barriers. OBJECTIVE We undertook this multinational effort to identify conflicts in terminology and phenomenology of delirium to facilitate communication across medical disciplines and languages. METHODS The evaluation of the terminology used for acute brain dysfunction was determined conducting communications with 24 authors from academic communities throughout countries/regions that speak the 13 variants of the Romanic languages included into this manuscript. RESULTS In the 13 languages utilizing Romanic characters, included in this report, we identified the following terms used to define major types of acute brain dysfunction: coma, delirium, delirio, delirium tremens, délire, confusion mentale, delir, delier, Durchgangs-Syndrom, acute verwardheid, intensiv-psykose, IVA-psykos, IVA-syndrom, akutt konfusion/forvirring. Interestingly two terms are very consistent: 100 % of the selected languages use the term coma or koma to describe patients unresponsive to verbal and/or physical stimuli, and 100% use delirium tremens to define delirium due to alcohol withdrawal. Conversely, only 54% use the term delirium to indicate the disorder as defined by the DSM-IV as an acute change in mental status, inattention, disorganized thinking and altered level of consciousness. CONCLUSIONS Attempts towards standardization in terminology, or at least awareness of differences across languages and specialties, will help cross-talk among clinicians and researchers.
Collapse
Affiliation(s)
- A Morandi
- Center for Health Services Research, 6100 Medical Center East, Nashville, TN 37232-8300, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|