La coagulopatia intravascolare disseminata in ostetricia ruolo degli inibitori naturalidella coagulazione e approccio terapeutico

Outcome of after-hours surgery: Setting, skill and timing may explain the outcome

Previously undiagnosed Reinke edema as a cause of immediate postextubation inspiratory stridor

Reinke edema (RE) is an uncommon lesion of the vocal folds and a potential cause of complications during airway management. We report the case of a woman with previously unknown RE admitted to the intensive care unit who experienced postextubation inspiratory stridor immediately after separation from mechanical ventilation. RE should be considered among causes of postextubation stridor.

Expert opinion document: “Electrical impedance tomography: applications from the intensive care unit and beyond”

Mechanical ventilation is a life-saving technology, but it can also inadvertently induce lung injury and increase morbidity and mortality. Currently, there is no easy method of assessing the impact that ventilator settings have on the degree of lung inssflation. Computed tomography (CT), the gold standard for visually monitoring lung function, can provide detailed regional information of the lung. Unfortunately, it necessitates moving critically ill patients to a special diagnostic room and involves exposure to radiation. A technique introduced in the 1980s, electrical impedance tomography (EIT) can non-invasively provide similar monitoring of lung function. However, while CT provides infor…

Antifungal prophylaxis: update on an old strategy.

Albumin replacement therapy in immunocompromised patients with sepsis - Secondary analysis of the ALBIOS trial

Abstract Background The best fluid replacement strategy and the role of albumin in immunocompromised patients with sepsis is unclear. Methods We performed a secondary analysis of immunocompromised patients enrolled in the ALBIOS trial which randomized patients with severe sepsis or septic shock to receive either 20% albumin (target 30 g per liter or more) and crystalloid or crystalloid alone during ICU stay. Results Of 1818 patients originally enrolled, 304 (16.4%) were immunocompromised. One-hundred-thirty-nine (45.7%) patients were randomized in the albumin while 165 (54.2%) in the crystalloid group. At 90 days, 69 (49.6%) in the albumin group and 89 (53.9%) in the crystalloids group died…

Additional file 12: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Table S8. Patientsâ characteristics and clinical endpoints of immunocompromised (study) patients, according to the cause of immunosuppression (known, unknown). (PDF 79Â kb)

TRANS-CRANIAL MRI-GUIDED FOCUSED ULTRASOUND SURGERY (TCMRGFUS): PRELIMINARY ITALIAN (AND WORLD-FIRST) EXPERIENCE AT 1,5 TESLA (first 3 cases treated)

PURPOSE: We present our preliminary results achieved with the first Italian installation of a trans-cranial MRI-guided Focused Ultrasound Surgery (tcMRgFUS) certified system for functional neurosurgery. Moreover, to our knowledge, this is the world-first tcMRgFUS system ever installed on a 1.5T MRI unit. TcMRgFUS is a promising new technology for the non-invasive treatment of neurologic disorders such as Essential Tremor (ET), tremor dominant idiopathic Parkinson's Disease (PD) and Neuropathic Pain (NP). This is a new method for focal targeting and lesioning of specific regions in the brain through intact skull by using high intensity focused ultrasound beam to achieve thermal ablation and …

Cigarette smoke alters IL-33 expression and release in airway epithelial cells

AbstractAirway epithelium is a regulator of innate immune responses to a variety of insults including cigarette smoke. Cigarette smoke alters the expression and the activation of Toll Like Receptor 4 (TLR4), an innate immunity receptor. IL-33, an alarmin, increases innate immunity Th2 responses. The aims of this study were to explore whether mini-bronchoalveolar lavage (mini-BAL) or sera from smokers have altered concentrations of IL-33 and whether cigarette smoke extracts (CSE) alter both intracellular expression (mRNA and protein) and release of IL-33 in bronchial epithelial cells. The role of TLR4 in the expression of IL-33 was also explored.Mini-BALs, but not sera, from smokers show red…

Untargeted Antifungal Treatment in the ICU: Changing Definitions and Labels Do Not Change the Evidence.

N/A

From bedside to bench: The missing brick for patients with fungal sepsis

We read with great interest the article by Spec et al. [1] investigating the immunophenotype of T cells from patients with Candida spp. sepsis. This is the first observational study describing the altered immune response of patients with candidemia. The authors included non-neutropenic critically ill patients with candidemia and non-septic controls, and excluded patients with human immunodeficiency virus infection, who had undergone solid or bone marrow transplantation or with other known causes of impaired immune response. The authors hypothesized that their findings may help explain why patients with fungal sepsis show a high mortality despite appropriate antifungal therapy. In our opinio…

High flow nasal therapy in immunocompromised patients with acute respiratory failure: A systematic review and meta-analysis.

Abstract Purpose The role of high-flow nasal therapy (HFNT) as compared to conventional oxygen therapy (COT) in immunocompromised patients admitted to intensive care unit (ICU) with acute respiratory failure (ARF) remains unclear. We conducted a systematic review and meta-analysis in order to address this issue. Methods We searched PubMed, Medline and Embase until November 7th, 2018. Randomized controlled trials (RCTs), non-randomized prospective and retrospective evidence were selected. Observational studies were considered for sensitivity analysis. Primary outcome was mortality rate; intubation rate was a secondary outcome. Results We included four studies in the primary analysis: one RCT…

Post-mortem findings in vaccine-induced thrombotic thrombocytopenia

Greinacher et al.1 and Schultz et al.2 were the first to independently report the main clinical and laboratory features of 11 and five respective patients from Germany, Austria and Norway who developed life-threatening thrombohemorrhagic complications 5 to 16 days after the administration of the first dose of the chimpanzee adenoviral vector vaccine ChAdOx1nCoV-19 against SARS-CoV-2 and COVID-19. Subsequently Scully et al.3 reported similar findings in 23 patients treated with the same vaccine in the United Kingdom. More recently, See et al.4 reported a case series of 12 patients from the USA with cerebral venous sinus thrombosis following the vaccination with Ad26.CoV2.S employing a human …

coagulation profile of septic patients under real time monitoring by thromboelastography

Effect of high-flow nasal therapy on dyspnea, comfort, and respiratory rate

Informazione non disponibile

Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial.

BackgroundRespiratory complications are an important cause of postoperative morbidity. We aimed to investigate whether continuous positive airway pressure (CPAP) administered immediately after major abdominal surgery could prevent postoperative morbidity.MethodsPRISM was an open-label, randomised, phase 3 trial done at 70 hospitals across six countries. Patients aged 50 years or older who were undergoing elective major open abdominal surgery were randomly assigned (1:1) to receive CPAP within 4 h of the end of surgery or usual postoperative care. Patients were randomly assigned using a computer-generated minimisation algorithm with inbuilt concealment. The primary outcome was a composite of…

Il Monitoraggio in corso di trattamento del paziente settico con inibitori della coagulazione

Should we continue to use prediction tools to identify patients at risk of Candida spp. infection? If yes, why?

Background Given the predominance of invasive fungal disease (IFD) amongst the non-immunocompromised adult critically ill population, the potential benefit of antifungal prophylaxis and the lack of generalisable tools to identify high risk patients, the aim of the current study was to describe the epidemiology of IFD in UK critical care units, and to develop and validate a clinical risk prediction tool to identify non-neutropenic, critically ill adult patients at high risk of IFD who would benefit from antifungal prophylaxis. Methods Data on risk factors for, and outcomes from, IFD were collected for consecutive admissions to adult, general critical care units in the UK participating in the…

Role of protein C in the modulation of inflammatory and coagulation response in high risk obstetric patients

Antithrombin III and activated protein C for the treatment of severe sepsis associated to coagulopathy

EVALUATION OF THE EFFECTS OF CONTI- NUOUS PREPERITONEAL WOUND INFILTRATION ON POSTOPERATIVE RESPIRATORY PERFORMANCE IN PATIENTS WHO UNDERWENT MAJOR ABDOMINAL SURGERY

Aim. According to the recent literature, continuous pre-perito- neal wound infiltration with local anaesthetics (CPWI) is an effective analgesic therapy in patients who undergo major abdominal surgery 1. Although it is not inferior to other com- monly used techniques in postoperative analgesia, many studies report conflictive results about its efficacy compared to them 2. The aim of our study was to evaluate the effects of CPWI on the postoperative respiratory performance in patients after major abdominal surgery. Materials and methods. From June 2011 to July 2012, a total of 14 patients have been evaluated. All patients were treated using the protocol generally used in our Department for t…

Procalcitonin levels in candidemia versus bacteremia: a systematic review

Background Procalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies. Its role in the in the differential diagnosis between candidemia and bacteremia is unclear. The aim of this systematic review was to summarize the current evidence about PCT values for differentiating candidemia from bacteremia. Methods PubMed and EMBASE were searched for studies reporting data on the diagnostic performance of serum PCT levels in intensive care unit (ICU) or non-ICU adult patients with candidemia, in comparison to patients with bacteremia. Results We included 16 studies for a total of 45.079 patients and 785 cases of candidemia. …

sj-pdf-1-tai-10.1177_2049936121998562 – Supplemental material for Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey

Supplemental material, sj-pdf-1-tai-10.1177_2049936121998562 for Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey by Mariachiara Ippolito, Mahesh Ramanan, Davide Bellina, Giulia Catalisano, Pasquale Iozzo, Andrea Di Guardo, Alessandra Moscarelli, Giacomo Grasselli, Antonino Giarratano, Matteo Bassetti, Alexis Tabah and Andrea Cortegiani in Therapeutic Advances in Infectious Disease

Linezolid in bolus vs linezolid in continous infusion. The host response in patients with severe sepsis.

INTRODUCTION AND AIMS: Severe sepsis by gram positive pathogens is commonly associated with high morbidity and mortalità in every ICU. During the sepsis the coagulation cascade, the complement system and the activation system are activated, in different moments, and this contributes to the development of multiple organ failure. This activation involves all system specially in late sepsis and contributes to the development of multiple organ failure associated with high mortality rate. Linezolid ia a one of a new class of antimicrobials (oxazolidinones) for the treatment of gram positive infection such as nosocomial pneumonia (including MRSA), community acquired pneumonia, complicate and unco…

MOESM1 of Comparisons of two diaphragm ultrasound-teaching programs: a multicenter randomized controlled educational study

Additional file 1. Theoretical test.

Strategies to build and maintain competence in pain management: insights from a SIAARTI survey on educational needs among Italian anesthesiologists

Purpose: Fulfilling educational needs in pain management should be a lifelong process, even involving physicians board certified in pain medicine such as the anesthesiologists/pain therapists. The aim of the study was to investigate Italian anesthesiologists' self-perceived competency, confidence, and interest to attend educational programs in relation to their seniority in pain management. Methods: SIAARTI members were sent an online questionnaire addressing the following items: education, skills (both soft and hard skills), technical expertise and engaged to participate between December 2020 and January 2021. Participants rated their competence based on the following range (no knowledge, …

screening della malattia coronarica in chirurgia maggiore non cardiaca

article is on the screeening of acute coronary disease in cardiac surgery from the preoperatory evaluation to the perioperative and postoperative treatment

sj-pdf-2-tai-10.1177_2049936121998562 – Supplemental material for Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey

Supplemental material, sj-pdf-2-tai-10.1177_2049936121998562 for Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey by Mariachiara Ippolito, Mahesh Ramanan, Davide Bellina, Giulia Catalisano, Pasquale Iozzo, Andrea Di Guardo, Alessandra Moscarelli, Giacomo Grasselli, Antonino Giarratano, Matteo Bassetti, Alexis Tabah and Andrea Cortegiani in Therapeutic Advances in Infectious Disease

Il Lightcycler Septifast® Test nella Diagnosi Eziologica Precoce in Unità di Terapia Intensiva

Coagulation Profile of Septic Patients Under Real Time Monitoring by Thromboelastography (TEG)

RUOLO DEI LATTATI E DELLA SATURAZIONE VENOSA CENTRALE NEL PAZIENTE CON SEPSI SEVERA E SHOCK SETTICO

Obiettivo. Nel paziente settico viene suggerito di monitorare la ScvO2 e di iniziare i resuscitation bundles quando i lattati hanno una concentrazione di 4 mmol/l. Sia la presenza di iperlattatemia al ricovero sia il successivo sviluppo di iperlat- tacidemia si associano ad una maggiore mortalità in UTI, mentre la rapida velocità di clearance dei lattati ad un aumen- to della sopravvivenza. Non esistono ad oggi studi che dimo- strino se l’inserimento della riduzione dei lattati come goal terapeutico, si associ ad una riduzione della mortalità. Pertan- to abbiamo condotto uno studio per verificare se, il raggiun- gimento di una concentrazione di lattati sierici al di sotto di 4 mmol/l come g…

Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review

Abstract Background Tocilizumab is an IL-6 receptor-blocking agent proposed for the treatment of severe COVID-19. The aim of this systematic review was to describe the rationale for the use of tocilizumab for the treatment of COVID-19 and to summarize the available evidence regarding its efficacy and safety. Methods MEDLINE, PubMed, EMBASE, pre-print repositories (bioRxiv and medRxiv) and two trial Registries were searched for studies on the use of tocilizumab in COVID-19 or SARS-CoV-2 infection, viral pneumonia, and/or sepsis until 20th June 2020. Results We identified 3 indirect pre-clinical studies and 28 clinical studies including 5776 patients with COVID-19 (13 with a comparison group,…

Reazioni avverse ai mezzi di contrasto:inquadramento

Relationship between background cancer pain, breakthrough pain, and analgesic treatment: a preliminary study for a better interpretation of epidemiological and clinical studies

Abstract Abstract Background: The different operational definitions of breakthrough cancer pain (BTcP) has generated unclear epidemiological data. Methods: A consecutive sample of patients was categorized on the basis of their background pain intensity, background analgesic treatment, and the presence of BTcP. Results: A total of 265 patients were surveyed; 117 patients had background pain and 91 patients presented peaks of pain intensity distinguishable from background pain. Of 117 patients with background pain, 49 patients were re-assessed after optimization of background analgesia (T1) within a mean of 8.2 days. Pain intensity significantly decreased in comparison with values recorded at…

Dying with or because of invasive fungal infection? The role of immunity exhaustion on patient outcome

De Rosa et al. considered clinical scores, biomarkers and their combination as useful aids for an early antifungal treatment and advocated the adoption of de-escalation therapy in an antifungal stewardship approach as a possible key for a better management of these patients. Authors considered the high burden of invasive fungal infections in terms of patient outcomes and costs and focused on current strategies for their optimization.

Associations of Antifungal Treatments With Prevention of Fungal Infection in Critically Ill Patients Without Neutropenia

BACKGROUND: Invasive fungal infections are important causes of morbidity and mortality among critically ill patients. Early institution of antifungal therapy is pivotal for mortality reduction. Starting a targeted antifungal therapy after culture positivity and fungi identification requires a long time. Therefore, alternative strategies (globally defined as 'untargeted antifungal treatments') for antifungal therapy institution in patients without proven microbiological evidence of fungal infections have been discussed by international guidelines. This review was originally published in 2006 and updated in 2016. This updated review provides additional evidence for the clinician dealing with …

Citations and metrics of journals discontinued from Scopus for publication concerns: the GhoS(t)copus Project

Background: Scopus is a leading bibliometric database. It contains a large part of the articles cited in peer-reviewed publications. The journals included in Scopus are periodically re-evaluated to ensure they meet indexing criteria and some journals might be discontinued for 'publication concerns'. Previously published articles may remain indexed and can be cited. Their metrics have yet to be studied. This study aimed to evaluate the main features and metrics of journals discontinued from Scopus for publication concerns, before and after their discontinuation, and to determine the extent of predatory journals among the discontinued journals. Methods: We surveyed the list of discontinued jo…

Coagulation profile of sepstic patients under real time monitoring by Thromboelastography

Cigarette smoke increases BLT2 receptor functions in bronchial epithelial cells: in vitro and ex vivo evidence

Summary Leukotriene B4 (LTB4) is a neutrophil chemotactic molecule with important involvement in the inflammatory responses of chronic obstructive pulmonary disease (COPD). Airway epithelium is emerging as a regulator of innate immune responses to a variety of insults including cigarette smoke, the major risk factor for COPD. In this study we have explored whether cigarette smoke extracts (CSE) or soluble mediators present in distal lung fluid samples (mini-bronchoalveolar lavages) from smokers alter the expression of the LTB4 receptor 2 (BLT2) and peroxisome proliferator-activated receptor-α (PPAR-α) in bronchial epithelial cells. We also evaluated the effects of CSE on the expression of i…

the expression of innate immunity and coagulative response in acute lung injury. septic verus non septic patients.

Additional file 11: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Table S7. Patient characteristics and clinical endpoints of immunocompetent patients, according to the type of ventilatory support. (PDF 88Â kb)

Bloodstream infections in intensive care unit patients: Distribution and antibiotic resistance of bacteria

Vincenzo Russotto,1 Andrea Cortegiani,1 Giorgio Graziano,2 Laura Saporito,2 Santi Maurizio Raineri,1 Caterina Mammina,2 Antonino Giarratano1 1Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy; 2Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo, Palermo, Italy Abstract: Bloodstream infections (BSIs) are among the leading infections in critically ill patients. The case-fatality rate associated with BSIs in patients admitted to intensive care units (ICUs) reaches 35%–50%. The emergence and diffusi…

(+)-Pentazocine reduces oxidative stress and apoptosis in microglia following hypoxia/reoxygenation injury

Abstract Background Sigma-1 receptors (σ 1 R) are highly expressed in neurons as well as microglia and have been shown to modulate the inflammatory response in the central nervous system and thus may serve as possible target for neuroprotective strategies. The aim of the present study was to test the effect of (+)-pentazocine, a putative σ 1 R agonist, in an in vitro model of microglia activation. Methods Microglia (BV2 cells) was exposed (3 h) to 1% oxygen and reoxygenation was allowed for 24 h. Cells were treated with different concentrations (1, 10, 25 and 50 μM) of (+)-pentazocine in the presence or absence of NE-100 (1 μM), a well established σ 1 R antagonist. Cell viability and apopto…

ESRA19-0239 Surgical treatment of femoral and knee injuries under peripheral regional anaesthesia: a case series

Background and aims Neuroaxial anaesthesia is gold standard for lower extremity surgeries. Nowadays the introduction of ultrasound guided peripheral nerves blocks (PBN) changed the approach to orthopaedic surgery. Methods This case series evaluates postoperative pain in 17 patients with femoral or knee fractures who received PNB because of contraindications to subarachnoid anaesthesia (eg. anticoagulation therapies, refusal). We performed femoral nerve block (levobupivacaine 0,5% 15 ml), obturators nerve block (levobupivacaine 0,5% 7 ml), lateral cutaneous nerve block (levobupivacaine 0.5% 3 ml) and sciatic nerve block (levobupivacaine 0,5% 20 ml) focusing on a lateral approach according to…

Efficacy and Safety of Using High-Flow Nasal Oxygenation in Patients Undergoing Rapid Sequence Intubation

Objective To assess the efficacy and safety of high-flow nasal oxygen (HFNO) therapy in patients undergoing rapid sequence intubation (RSI) for emergency abdominal surgery. Methods HFNO of 60 L.min-1 at an inspiratory oxygen fraction of 1 was delivered 4 min before laryngoscopy and maintained until the patient was intubated, and correct intubation was verified by the appearance of the end-tidal CO2 (EtCO2) waveform. Transcutaneous oxygenation (SpO2), heart rate and non-invasive mean arterial pressure were monitored at baseline (T0), after 4 min on HFNO (T1) and at the time of laryngoscopy (T2) and endotracheal intubation (ETI) (T3). An SpO2 of <3% from baseline was recorded at any sampled t…

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Contains fulltext : 252214.pdf (Publisher’s version ) (Open Access) BACKGROUND: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. METHODS: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to defi…

Two episodes of Taravana syndrome in a breath-hold diver with hyperhomocysteinemia

Key Clinical Message Taravana syndrome is a rare dysbaric disease characterized by neurologic signs and symptoms. Differently from others decompression illness, it has unspecified pathophysiology and unclear predisposing factors. Our cases suggest that thrombophilic state due to hyperhomocysteinemia could increase the risk to develop Taravana syndrome.

Effects of antithrombin III (ATIII) treatment (high dose) in severe pre-eclampsia and HELLP syndrome with alterations of coagulation inhibitors and inflammatory markers: a preliminary report.

Ceftolozane-Tazobactam Combination Therapy Compared to Ceftolozane-Tazobactam Monotherapy for the Treatment of Severe Infections: A Systematic Review and Meta-Analysis

Ceftolozane-tazobactam (C/T) is a combination of an advanced-generation cephalosporin (ceftolozane) with a &beta

Additional file 1 of High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-inferiority randomized trial

Additional file 1: Description of data: CONSORT (consolidated standards of reporting trials) Checklist for Non-inferiority and Equivalence Trials Checklist for Non-inferiority and Equivalence Trials.

The long and winding road of non steroidal antinflammatory drugs and paracetamol in cancer pain management: A critical review

The aim of this review was to assess the value of NSAIDs and paracetamol in patients with cancer pain to update a previous review performed ten years ago on this topic. The approach was analytic and based on clinical considerations, rather than on raw evidence, which often does not provide useful information in clinical practice. Both published reports from an extensive search of electronic data bases were collected from January 2001 to December 2011. A free-text search method was used including the following words and their combination: “Anti-inflammatory drugs OR paracetamol OR acetaminophen” AND/OR “cancer pain”. Any randomized-controlled trial was considered. Thirteen reports fulfitted …

DALI: Defining Antibiotic Levels in Intensive Care Unit Patients: Are Current -Lactam Antibiotic Doses Sufficient for Critically Ill Patients?

Background. Morbidity and mortality for critically ill patients with infections remains a global healthcare problem. We aimed to determine whether α-lactam antibiotic dosing in critically ill patients achieves concentrations associated with maximal activity and whether antibiotic concentrations affect patient outcome.Methods. This was a prospective, multinational pharmacokinetic point-prevalence study including 8 α-lactam antibiotics. Two blood samples were taken from each patient during a single dosing interval. The primary pharmacokinetic/pharmacodynamic targets were free antibiotic concentrations above the minimum inhibitory concentration (MIC) of the pathogen at both 50% (50% f TMIC) an…

Retracted papers on SARS-CoV-2 and COVID-19

Attitudes towards end-of-life issues in intensive care unit among Italian anesthesiologists: a nation-wide survey

Background: The aim of this paper is to collect data on the practice of palliative care, withholding and withdrawal of life-sustaining therapies, and management of end of life (EOL) in Italian intensive care units (ICUs). Methods: Web-based survey among Italian anesthesiologists endorsed by the Italian Society of Anesthesiology Analgesia Reanimation and Intensive Care (SIAARTI). The survey consists of 27 close-ended and 2 open-ended questions. Results: Eight hundred and five persons responded to the full list of questions. The highest proportion of respondents was of 36–45 years of age (34%) and catholic (66%). Almost 70% of responders declared that palliative/supportive care are applied …

Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of ventilator-associated pneumonia (VAP) among patients admitted to an intensive care unit with COVID-19 and mortality of those who developed VAP. We performed a systematic search on PubMed, EMBASE and Web of Science from inception to 2nd March 2021 for nonrandomized studies specifically addressing VAP in adult patients with COVID-19 and reporting data on at least one primary outcome of interest. Random effect single-arm meta-analysis was performed for the occurrence of VAP and mortality (at the longest follow up) and ICU length of stay. Twenty studies were included in the systematic review and meta-an…

Comparision Between the Expression of Innate Immunity and Coagulative Response in Patients with septic and No Septic Acute Lung Injury

ESRA19-0275 The efficacy and safety of ultrasound-guided superficial cervical plexus block (SCPB) in patient undergoing thyroid surgery: a case report

Background and aims The SCPB provides effective anesthesia and analgesia for the head and neck region. CPBs can be performed more safely and accurately under ultrasound guidance, which is used to easily identify various important landmarks. This case report was carried out to assess the efficacy of SCPB in reducing the intra and postoperative use of opioids/analgesics to control pain due to thyroidectomy. Methods Case report: 45-year-old woman, ASA II, underwent left hemithyroidectomy under general anesthesia (sevoflorane 2% and remifentanil TCI 0.7–1 ng/ml). Ultrasound-guided left superficial cervical plexus block (SCPB) was performed using levobupivacaine 10 ml 0.25%. Pain score was measu…

Sympathetic blocks for visceral cancer pain management: A systematic review and EAPC recommendations.

The neurolytic blocks of sympathetic pathways, including celiac plexus block (CPB) and superior hypogastric plexus block (SHPB) , have been used for years. The aim of this review was to assess the evidence to support the performance of sympathetic blocks in cancer patients with abdominal visceral pain. Only comparison studies were included. All data from the eligible trials were analyzed using the GRADE system. Twenty-seven controlled studies were considered. CPB, regardless of the technique used, improved analgesia and/or decrease opioid consumption, and decreased opioid-induced adverse effects in comparison with a conventional analgesic treatment. In one study patients treated with superi…

Untargeted Antifungal Treatment in Nonneutropenic Critically Ill Patients: Should Further Studies Be Performed Based on Trial Sequential Analysis Results?

Is it time to consider visual feedback systems the gold standard for chest compression skill acquisition?

Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris

Abstract Candida spp. infections are a major cause of morbidity and mortality in critically ill patients. Candida auris is an emerging multi-drug-resistant fungus that is rapidly spreading worldwide. Since the first reports in 2009, many isolates across five continents have been identified as agents of hospital-associated infections. Independent and simultaneous outbreaks of C. auris are becoming a major concern for healthcare and scientific community. Moreover, laboratory misidentification and multi-drug-resistant profiles, rarely observed for other non-albicans Candida species, result in difficult eradication and frequent therapeutic failures of C. auris infections. The aim of this review…

Cardiopulmonary resuscitation in prone position: A scoping review.

Introduction The ongoing pandemic of COVID-19 brought to the fore prone positioning as treatment for patients with acute respiratory failure. With the increasing number of patients in prone position, both spontaneously breathing and mechanically ventilated, cardiac arrest in this position is more likely to occur. This scoping review aimed to summarize the available evidence on cardiopulmonary resuscitation in prone position (‘reverse CPR’) and knowledge or research gaps to be further evaluated. The protocol of this scoping review was prospectively registered on 10th May 2020 in Open Science Framework (https://osf.io/nfuh9). Methods We searched PubMed, EMBASE, MEDLINE and pre-print repositor…

Additional file 8: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Figure S2. This figure shows a Kaplan-Meier curve for hospital survival of immunocompromised patients according to the ventilation subgroup. This figure shows a Kaplan-Meier curve for hospital survival of immunocompromised patients according to the ventilation subgroup. Mortality is defined as mortality at hospital discharge or at 90Â days after onset of acute hypoxemic respiratory failure, whichever event occurred first. We assumed that patients discharged alive from the hospital before 90Â days were alive on day 90. Type of ventilator support: IMV Patients invasively ventilated from day 1, independently of the type of support received after the eventual extubation; NIV Patients treated ex…

Predatory journals and conferences: why fake counts

Purpose of review Predatory publishing poses a serious educational end ethical threat to the credibility of science. The aim of this review is to discuss the main features of this deceptive open-access model, its potential consequences and relevance for the whole scientific community. Recent findings Recent reports showed that scholars and clinicians from all research fields, including anesthesiology, are facing an alarming invasion of predatory journals and, more recently, fake conferences. This review discusses key elements of these phenomena and proposes countermeasures to tackle the problem. Summary Predatory journals and conferences are two sides of the same coin. As here reviewed, the…

Concordance between blood culture and Septifast and correlation with resistance to antibiotics: a case controlled study.

Monitoraggio del livello di analgo-sedazione nel paziente ricoverato in U.T.I. mediante la scala MSAT (Minnesota Sedation Assesment Tool) e il Narcotrend (NT). Nostra esperienza clinica.

Meaningful cut-off pain intensity for breakthrough pain changes in advanced cancer patients

Abstract OBJECTIVES: To assess the level of pain intensity at which patients feel the impetus to ask for a breakthrough cancer pain (BTcP) medication, and level of pain intensity at which patients consider they have achieved acceptable pain control after receiving a BTcP medication. METHODS: A consecutive sample of patients who were receiving oral morphine equivalents equal to or more than 60 mg daily, and were prescribed rapid onset opioids for the management of episodes of BTcP, were included in the study. Focused educational activities regarding BTcP and numerical scales were established during hospital admission. At discharge patients were interviewed to find out what was the pain inten…

Inflated citations and metrics of journals discontinued from Scopus for publication concerns: the GhoS(t)copus Project

AbstractBackgroundScopus is a leading bibliometric database. It contains the largest number of articles cited in peer-reviewed publications. The journals included in Scopus are periodically re-evaluated to ensure they meet indexing criteria and some journals might be discontinued for publication concerns. These journals remain indexed and can be cited. Their metrics have yet to be studied. This study aimed to evaluate the main features and metrics of journals discontinued from Scopus for publication concerns, before and after their discontinuation, and to determine the extent of predatory journals among the discontinued journals.MethodsWe surveyed the list of discontinued journals from Scop…

The burden of peri-operative work at night as perceived by anaesthesiologists: An international survey

Background: No international data are available on the night working conditions and workload of anaesthesiologists and their opinions about associated risks. Objective: The aim of this international survey was to describe the peri-operative night working conditions of anaesthesiologists and their perception of the impact these conditions have on patient outcomes and their own quality of life. Design: Cross-sectional survey. Setting: Not applicable. Participants: Anaesthesiologists providing peri-operative care during night shifts responded to an online survey promoted by the European Society of Anaesthesiology and Intensive Care (ESAIC). Interventions: None. Main outcome measure: Twenty-eig…

ICU-acquired infections: It is not only about the number of patients per room

LETTER TO EDITOR

High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial

BACKGROUND: The role of positive end-expiratory pressure in mechanical ventilation during general anaesthesia for surgery remains uncertain. Levels of pressure higher than 0 cm H(2)O might protect against postoperative pulmonary complications but could also cause intraoperative circulatory depression and lung injury from overdistension. We tested the hypothesis that a high level of positive end-expiratory pressure with recruitment manoeuvres protects against postoperative pulmonary complications in patients at risk of complications who are receiving mechanical ventilation with low tidal volumes during general anaesthesia for open abdominal surgery. METHODS: In this randomised controlled tri…

Evaluation of automated hematologic VCS parameters in severe sepsis and septic shock: a case-control study.

A cheap and quick hematologic diagnostic parameter for detection of sepsis would have both economic and therapeutic benefits. The Coulter LH series hematology analyzer uses the VCS technology (Volume, Conductivity, Laser Scatter) providing information about cell volume, size, internal structure, and surface morphology. Many authors analyzed the clinical usefulness of VCS parameters in reactive neutrophils for detection of sepsis. An increase in mean cell volume and a decrease in mean light scatter in septic patients have been described. Our aim is to verify the correlation between VCS parameters and sepsis.

Medical masks and Respirators for the Protection of Healthcare Workers from SARS-CoV-2 and other viruses

The use of medical masks and respirators as personal protective equipment is pivotal to reducing the level of biological hazard to which healthcare workers are exposed during the outbreak of highly diffusible pathogens, such as the recent novel coronavirus SARS-CoV-2. Unfortunately, during this pandemic, supplies are rapidly running out worldwide, with potential consequences for the rate of occupational infections. Also, knowledge about specific characteristics of respirators is of utmost importance to select the proper type according to the clinical setting. A wide variety of literature is available on the topic, but mostly based on Influenza viruses infection models. Clinical evidence on …

High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-inferiority randomized trial

Abstract Background The efficacy and safety of high flow nasal therapy (HFNT) in patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease (AECOPD) are unclear. Our aim was to evaluate the short-term effect of HFNT versus NIV in patients with mild-to-moderate AECOPD, with the hypothesis that HFNT is non-inferior to NIV on CO2 clearance after 2 h of treatment. Methods We performed a multicenter, non-inferiority randomized trial comparing HFNT and noninvasive ventilation (NIV) in nine centers in Italy. Patients were eligible if presented with mild-to-moderate AECOPD (arterial pH 7.25–7.35, PaCO2 ≥ 55 mmHg before ventilator support). Primary endpoint was the mean di…

Assessing age and gender in studies of breakthrough pain medications

AbstractObjective:The present review was performed to identify possible differences observed between adults and elderly patients and between males and females in randomized clinical trials of breakthrough pain (BTP).Methods:A systematic search of the existing literature from 1998 to September 2013 was performed. Randomized clinical trials reporting data on older patients were selected.Results:Sixteen comparative studies were selected. The age range of inclusion criteria patients was mainly between 18–80 or ≥18 years. In some cases this data was unreported. The mean age of patients was 48–64 years, but information regarding the number of elderly patients was present in three studies only. Ge…

Quality of Life in COVID-Related ARDS Patients One Year after Intensive Care Discharge (Odissea Study): A Multicenter Observational Study

Background: Investigating the health-related quality of life (HRQoL) after intensive care unit (ICU) discharge is necessary to identify possible modifiable risk factors. The primary aim of this study was to investigate the HRQoL in COVID-19 critically ill patients one year after ICU discharge. Methods: In this multicenter prospective observational study, COVID-19 patients admitted to nine ICUs from 1 March 2020 to 28 February 2021 in Italy were enrolled. One year after ICU discharge, patients were required to fill in short-form health survey 36 (SF-36) and impact of event-revised (IES-R) questionnaire. A multivariate linear or logistic regression analysis to search for factors associated wi…

Mortality after in-hospital cardiac arrest in patients with COVID-19: A systematic review and meta-analysis.

Abstract Aim To estimate the mortality rate, the rate of return of spontaneous circulation (ROSC) and survival with favorable neurological outcome in patients with COVID-19 after in-hospital cardiac arrest (IHCA) and attempted cardiopulmonary resuscitation (CPR). Methods PubMed, EMBASE, Web of Science, bioRxiv and medRxiv were surveyed up to 8th February 2021 for studies reporting data on mortality of patients with COVID-19 after IHCA. The primary outcome sought was mortality (in-hospital or at 30 days) after IHCA with attempted CPR. Additional outcomes were the overall rate of IHCA, the rate of non-shockable presenting rhythms, the rate of ROSC and the rate of survival with favorable neuro…

Le Reazioni da Mezzo di Contrasto: Il Trattamento.

Authors' Response.

What Is the Most Recent Evidence on the Prevention and Early Treatment of Invasive Fungal Infections in Nonneutropenic Critically Ill Patients?

: Invasive fungal infections (IFIs) are associated with high morbidity and mortality in intensive care units. Candida species are the most important fungal pathogens and among the most frequent causes of infection in critically ill patients. Studies have evaluated the correlation between the onset of antifungal treatment and survival. However, definitive diagnosis of IFI is time-consuming in clinical practice. Antifungal prophylaxis and preemptive or empirical treatments are among therapeutic strategies to prevent or treat early fungal infections in selected patients. Recently, new evidence from randomized controlled trials and systematic reviews has been published. Moreover, new clinical p…

Empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol: a systematic review and expert opinion statement

AbstractCarbapenem-resistant Gram-negative bacteria are frequent causes of sepsis and septic shock in intensive care unit (ICU) and thus considered a public health threat. Until now, the best available therapies consist of combinations of preexisting or new antibiotics with β-lactamase inhibitors (either new or preexisting). Several mechanisms of resistance, especially those mediated by metallo-β-lactamases (MBL), are responsible for the inefficacy of these treatments, leaving an unmet medical need. Intravenous cefiderocol has been recently approved by the American Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the treatment of complicated urinary tract infection…

Additional file 4: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Table S3. Ventilator settings during the first day of ARDS in the immunocompetent (Control) and immunocompromised (Study) groups. This table shows ventilator settings during the first day of ARDS in the immunocompetent (Control) and immunocompromised (Study) groups. (PDF 50Â kb)

Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial

Purpose: Noninvasive ventilation (NIV) may facilitate withdrawal of invasive mechanical ventilation (i-MV) and shorten intensive care unit (ICU) length of stay (LOS) in hypercapnic patients, while data are lacking on hypoxemic patients. We aim to determine whether NIV after early extubation reduces the duration of i-MV and ICU LOS in patients recovering from hypoxemic acute respiratory failure. Methods: Highly selected non-hypercapnic hypoxemic patients were randomly assigned to receive NIV after early or standard extubation. Co-primary end points were duration of i-MV and ICU LOS. Secondary end points were treatment failure, severe events (hemorrhagic, septic, cardiac, renal or neurologic …

Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome

Background: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point prevalence study, the Extended Prevalence of Infection in the ICU (EPIC) II.Methods: EPIC II included 13,796 adult patients from 1,265 ICUs in 75 countries. Infection was defined using the International Sepsis Forum criteria. Microbiological analyses were performed locally. Participating ICUs provided patient follow-up until hospital discharge or for 60 days.Results: Of the 7,087 infected patients, 1,…

MODIFICATION OF COAGULATION IMBALANCE DURING ANTITHROMBIN TREATMENT IN PREECLAMPTIC PATIENTS: OUR EXPERIENCE

Preeclamptic conditions are often associated with a natural inhibitor consumption. Many studies have evidenced validity of antithrombin (AT) treatment during preeclamptic conditions. The aim of the study is to restore a congruous coagulation imbalance with administration of AT under the guide of thromboelastographic monitoring (TEG).

Procalcitonin as a marker of Candida species detection by blood culture and polymerase chain reaction in septic patients

Background: The aim of our study is to test procalcitonin (PCT) as surrogate marker of identification of Candida spp. by blood culture (BC) and real-time-polymerase chain reaction (PCR), whether alone or in association with bacteria, in septic patients.Methods: We performed a single-centre retrospective study. We reviewed the clinical charts of patients with a diagnosis of severe sepsis or septic shock treated at our general intensive care unit from March 2009 to March 2013. We analysed all diagnostic episodes consisting of BC, real-time PCR assay and dosage of PCT. We registered age, sex, white blood count, sequential organ failure assessment score and type of admission between medical or …

Antithrombin III and Activated Protein C for the treatment of severe sepsis with coagulopathy

Predatory Open-Access Publishing in Anesthesiology.

Predatory publishing is an exploitative fraudulent open-access publishing model that applies charges under the pretense of legitimate publishing operations without actually providing the editorial services associated with legitimate journals. The aim of this study was to analyze this phenomenon in the field of anesthesiology and related specialties (intensive care, critical and respiratory medicine, pain medicine, and emergency care). Two authors independently surveyed a freely accessible, constantly updated version of the original Beall lists of potential, possible, or probable predatory publishers and standalone journals. We identified 212 journals from 83 publishers, and the total number…

A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19

Purpose COVID-19 (coronavirus disease 2019) is a public health emergency of international concern. As of this time, there is no known effective pharmaceutical treatment, although it is much needed for patient contracting the severe form of the disease. The aim of this systematic review was to summarize the evidence regarding chloroquine for the treatment of COVID-19. Methods PubMed, EMBASE, and three trial Registries were searched for studies on the use of chloroquine in patients with COVID-19. Results We included six articles (one narrative letter, one in-vitro study, one editorial, expert consensus paper, two national guideline documents) and 23 ongoing clinical trials in China. Chloroqui…

TLR4 Up-regulation and Reduced Foxp3 Expression in Mechanically Ventilated Smokers with Obstructive Chronic Bronchitis

Background: Chronic bronchitis (CB) is a risk factor in chronic obstructive pulmonary disease (COPD) for accelerated lung function decline and increased mortality. The lung and systemic inflammatory and immunological profile of COPD patients with CB which acutely experience respiratory failure upon a disease exacerbation is unknown. Methods: In this study, we explored the expression of Foxp3 by western blot analysis, TLR4 by immunocytochemistry and the concentrations of IP-10 and IL-8 by ELISA in the mini-bronchoalveolar lavages (mini-BAL) and in the peripheral blood of patients with respiratory failure requiring intubation and mechanical ventilation. The recruited subjects were separated i…

COVID-19 Vaccine and Death: Causality Algorithm According to the WHO Eligibility Diagnosis

The current challenge worldwide is the administration of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. Even if rarely, severe vascular adverse reactions temporally related to vaccine administration have induced diffidence in the population at large. In particular, researchers worldwide are focusing on the so-called “thrombosis and thrombocytopenia after COVID-19 vaccination”. This study aims to establish a practical workflow to define the relationship between adverse events following immunization (AEFI) and COVID-19 vaccination, following the basic framework of the World Health Organization (WHO). Post-mortem investigation plays a pivotal role to support this c…

Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives

Background Palliative care is a person-centered approach aiming to relieve patient's health-related suffering and it is often needed when caring for critically ill patients to manage symptoms and identify goals of care. Aim To describe the integration of palliative care principles in anesthesiology clinical practice, within and outside the ICU and to analyze the additional challenges that COVID-19 pandemic is posing in this context. Methods For the purpose of this review, PubMed database was searched for studies concerning palliative care and end of life care, in contexts involving anesthesiologists and intensivists, published in the last 5 years. Results Anesthesiologists and intensivists …

Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study

Background Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations in patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). Methods LUNG SAFE was done during 4 consecutive weeks in winter, 2014, in a convenience sample of 459 intensive-care units in 50 countries across six continents. Inclusion criteria were admission to a participating intensive-care unit (including transfers) within the enrolment window and receipt of invasive or non…

KPC-3 Klebsiella pneumoniae ST258 clone infection in postoperative abdominal surgery patients in an intensive care setting: analysis of a case series of 30 patients

Objective: We studied the clinical course, Intensive Care Unit (ICU) and hospital outcomes of 30 postoperative abdominal surgery patients who showed severe infections caused by Klebsiella pneumoniae Sequence Type 258 producing K. pneumoniae carbapenemase 3 (KPC-Kp). Methods: Patients with at least two positive blood cultures for KPC-Kp after admission to the ICU were recruited for a 12-month period and treated with a combination regimen of colistin plus tigecycline. They were started on a high-dose (initial dose of 200 mg then 100 q12) of tigecycline combined with colistin, taking into account intra-abdominal abscess severity and MCIs for tigecycline. Results: The average age of the patient…

Uncertainty about the evidence on untargeted antifungal treatment

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KPC - 3 Klebsiella pneumoniae ST258 clone infection in postoperative abdominal surgery patients in an intensive care setting: analysis of a case series of 30 patients.

Background: Abdominal surgery carries significant morbidity and mortality, which is in turn associated with an enormous use of healthcare resources. We describe the clinical course of 30 Intensive Care Unit (ICU) patients who underwent abdominal surgery and showed severe infections caused by Klebsiella pneumoniae sequence type (ST) 258 producing K. pneumoniae carbapenemase (KPC-Kp). The aim was to evaluate risk factors for mortality and the impact of a combination therapy of colistin plus recommended regimen or higher dosage of tigecycline. Methods: A prospective assessment of severe monomicrobial KPC-Kp infections occurring after open abdominal surgery carried out from August 2011 to Augus…

Intraoperative positive end-expiratory pressure and postoperative pulmonary complications: a patient-level meta-analysis of three randomised clinical trials

BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperati…

Is it time to combine untargeted antifungal strategies to reach the goal of 'early' effective treatment?

A recently published retrospective study by Posteraro et al. [1] investigated the use of (1–3)-β-D-glucan (BDG) as a strategy for antifungal drug administration in patients at high risk of candidemia. The strategy consisted of the administration of antifungals (anidulafungin in most cases) to septic patients with a Candida score ≥ 3a nd a positive BDG result (≥80 pg/ml). This untargeted strategy led to better selection of patients, avoiding exposure to antifungals in approximately 73 % of patients with negative BDG results and leading to shortened treatment duration in another 20 % of patients. Untargeted antifungal treatments (including prophylaxis, pre-emptive and empiric approaches) are …

Level of Diffusion and Training of Lung Ultrasound during the COVID-19 Pandemic - A National Online Italian Survey (ITALUS) from the Lung Ultrasound Working Group of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI)

 The goal of this survey was to describe the use and diffusion of lung ultrasound (LUS), the level of training received before and during the COVID-19 pandemic, and the clinical impact LUS has had on COVID-19 cases in intensive care units (ICU) from February 2020 to May 2020. The Italian Lung Ultrasound Survey (ITALUS) was a nationwide online survey proposed to Italian anesthesiologists and intensive care physicians carried out after the first wave of the COVID-19 pandemic. It consisted of 27 questions, both quantitative and qualitative. 807 responded to the survey. The median previous LUS experience was 3 years (IQR 1.0-6.0). 473 (60.9 %) reported having attended at least one training cour…

Role of prostaglandin E2 in the invasiveness, growth and protection of cancer cells in malignant pleuritis.

The recurrence of pleural effusions is a common event in a variety of neoplastic diseases. The objective of this study was to identify the mechanisms promoting the homing and growth of cancer cells within the pleural space. A cancer cell line recovered from malignant pleural fluids (lung adenocarcinoma cell line) that constitutively expresses cyclooxygenase 2 (COX-2) and all types of prostaglandin receptors was studied. It was first demonstrated using a matrigel system, that malignant pleural fluids increase the invasiveness of adenocarcinoma cells more than congestive heart failure (CHF) pleural fluids. Moreover, exposure to exudative malignant, but not to CHF pleural fluids, increased the…

Additional file 1: of High-flow nasal therapy versus noninvasive ventilation in COPD patients with mild-to-moderate hypercapnic acute respiratory failure: study protocol for a noninferiority randomized clinical trial

SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents (DOC 122 kb)

Objective Assessment of Pulmonary Embolism Can Be Deferred without Increased Risk

Abstract Background. Management of patients with suspected Pulmonary Embolism (PE) is problematic if diagnostic imaging is not available. Pretest Clinical Probability (PCP) and D-dimer (D-d) assessment were shown to be useful to identify those high risk patients for whom empirical, protective anticoagulation is indicated (Siragusa S et al. Arch Intern Med2004;164:2477–82). Objective of the study. In consecutive patients with suspected PE, we evaluated whether PCP and D-d assessment, together with the use of low molecular weight heparins (LMWHs), allow objective appraisal of PE to be deferred for up to 72 hours. Methods. In case of deferment of diagnostic imaging for PE, patients identified …

Neutrophil CD64 as a marker of infection in patients admitted to the emergency department with acute respiratory failure

Andrea Cortegiani, Vincenzo Russotto, Francesca Montalto, Grazia Foresta, Pasquale Iozzo, Santi Maurizio Raineri, Antonino Giarratano Department of Biopathology and Medical and Forensic Biotechnologies (DIBIMEF), Section of Anesthesiology, Analgesia, Emergency and Intensive Care, Policlinico &amp;ldquo;P Giaccone&amp;rdquo;, University of Palermo, Palermo, Italy Introduction: Cluster of differentiation 64 (CD64) is expressed on neutrophils during bacterial infections and sepsis. The aim of our study was to assess the CD64 expression in patients admitted to the emergency department (ED) with a triage diagnosis of acute respiratory failure (ARF) and/or dyspnea and to verify a relationship bet…

A New Configuration for Helmet Continuous Positive Airway Pressure Allowing Tidal Volume Monitoring

We performed a bench and human study to test the hypothesis that a ventilator can accurately estimate Vt when a helmet is used in CPAP mode in a single limb configuration with an intentional leak port placed at the helmet expiratory port. We have recently demonstrated the effectiveness of this setup in bilevel mode

Epidemiologia e microbiologia del cateterismo venoso centrale in una UTI polivalente: cateteri non medicati vs cateteri medicati.

Strengths and Weaknesses of Cancer Pain Management in Italy: Findings from a Nationwide SIAARTI Survey

Objectives: Despite guidelines, a large percentage of cancer patients continue to suffer from ineffectively treated pain. The authors undertook this survey to assess the strengths and weaknesses of cancer pain management in Italy. Design: This was a prospectively administered survey. Participants: The participants were anesthesiologists of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Intervention: A 58-item questionnaire covered the demographics and features of cancer pain management in the Italian context. Results: The authors received responses from 611 pain therapists of 279 centers. Only 22% of physicians are exclusively pain therapists. Seve…

Regional anticoagulation with heparin of an extracorporeal CO2 removal circuit: a case report

Abstract Background Extracorporeal carbon dioxide removal is an increasingly used respiratory support technique. As is true of all extracorporeal techniques, extracorporeal carbon dioxide removal needs proper anticoagulation. We report a case of a patient at risk of bleeding complications who was treated with extracorporeal carbon dioxide removal and anticoagulated with a regional technique. Case presentation A 56-year-old Caucasian man with a history of chronic obstructive pulmonary disease exacerbation required extracorporeal carbon dioxide removal for severe hypercapnia and acidosis despite mechanical ventilation. The extracorporeal circuit was anticoagulated using a regional heparin tec…

Procalcitonin for the diagnosis of invasive candidiasis: what is the evidence?

Abstracts Procalcitonin is a widely used marker for the evaluation of infection and sepsis and to guide antibiotic therapy. During the last decade, several studies evaluated its role and diagnostic performance as a surrogate marker for the identification of Candida spp. in suspected invasive candidiasis. A low serum level and a favorable negative predictive value are the main findings for procalcitonin in this setting. The aim of this report is to provide an updated brief summary of the evidence supporting the use of PCT for the management of invasive candidiasis.

The role of natural coagulation inhibitors in correlation with clinic scores in critical patients with obstetric diseases.

Fake news and patient-family-physician interaction in critical care: concepts, beliefs and potential countermeasures

Fake news has been defined as fabricated information mimicking media content in form but not in organizational process or intent. Science and medicine are deeply affected by this increasing phenomenon. Critical care represents a hot spot for fake news due to the high risk of conflictive communication, the rapid turnaround of clinical news and high prevalence of unpleasant information. Communication with patients' relatives is one of the hardest aspects. The relationship between physicians and families is pivotal to improve relatives' comfort, and reduce anxiety and pain. Fake news may undermine this relationship, posing an alternative truth between the critical care physician and relatives,…

High flow nasal therapy in perioperative medicine: from operating room to general ward

Abstract Background High flow nasal therapy (HFNT) is a technique in which humidified and heated gas is delivered to the airways through the nose via small nasal prongs at flows that are higher than the rates generally applied during conventional oxygen therapy. The delivered high flow rates combine mixtures of air and oxygen and enable different inspired oxygen fractions ranging from 0.21 to 1. HFNT is increasingly used in critically ill adult patients, especially hypoxemic patients in different clinical settings. Main body Noninvasive ventilation delivers positive pressure (end-expiratory and inspiratory pressures or continuous positive airway pressure) via different external interfaces. …

How to manage aspergillosis in non-neutropenic intensive care unit patients.

Invasive aspergillosis has been mainly reported among immunocompromised patients during prolonged periods of neutropenia. Recently, however, non-neutropenic patients in the ICU population have shown an increasing risk profile for aspergillosis. Associations with chronic obstructive pulmonary disease and corticosteroid therapy have been frequently documented in this cohort. Difficulties in achieving a timely diagnosis of aspergillosis in non-neutropenic patients is related to the non-specificity of symptoms and to lower yields with microbiological tests compared to neutropenic patients. Since high mortality rates are typical of invasive aspergillosis in critically ill patients, a high level …

Long-term functional and psychological recovery in a population of acute respiratory distress syndrome patients treated with VV-ECMO and in their caregivers.

Background Acute respiratory distress syndrome (ARDS) survivors are affected with long-term physical/mental impairments, with improvements limited mostly to the first year after intensive care (ICU) discharge. Furthermore, caregivers of ICU patients exhibit psychological problems after family-member recovery. We evaluated the long-term physical and mental recovery of ARDS survivors treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO), and the long-term psychological impact on their caregivers. Methods Single-center prospective evaluation of a retrospective cohort of 75 ARDS patients treated with VV-ECMO during a seven-year period (25.10.2009-11.08.2016). Primary outcomes w…

Update I. A systematic review on the efficacy and safety of chloroquine/hydroxychloroquine for COVID-19

Purpose To assess efficacy and safety of chloroquine (CQ)/hydroxychloroquine (HCQ) for treatment or prophylaxis of COVID-19 in adult humans. Materials and methods MEDLINE, PubMed, EMBASE and two pre-print repositories (bioRxiv, medRxiv) were searched from inception to 8th June 2020 for RCTs and nonrandomized studies (retrospective and prospective, including single-arm, studies) addressing the use of CQ/HCQ in any dose or combination for COVID-19. Results Thirty-two studies were included (6 RCTs, 26 nonrandomized, 29,192 participants). Two RCTs had high risk, two ‘some concerns’ and two low risk of bias (Rob2). Among nonrandomized studies with comparators, nine had high risk and five moderat…

Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey.

Background: Italy was the first Western country to be heavily affected by COVID-19. Healthcare workers (HCWs) were exposed to a high risk of occupational infection, partially due to insufficient personal protective equipment (PPE) supplies. This study aimed to describe the practices, availability, training, confidence in PPE use and the adverse effects due to extended PPE use, as reported by HCWs in Italy. We also aimed to provide a comparison between Italian data and those from other countries. Methods: This study was a secondary analysis of a previously published international study, the PPE-SAFE Survey, conducted in April 2020. Data were analysed from the original study database. Results…

Hyperoxia in critically ill patients with sepsis and septic shock: a systematic review

Abstract Background In septic patients, hyperoxia may help with its bactericidal effects, but it may cause systemic impairments. The role of hyperoxia and the appropriate oxygen target in these patients is unknown. The aim of this systematic review was to summarize the available literature. Methods We conducted a systematic search screening PubMed and Cochrane Library. Studies on adult patients with sepsis or septic shock and admitted to ICU addressing the topic of hyperoxia were included and described. Results We included 12 studies, for a total of 15.782 included patients. Five studies were randomized controlled trials (RCTs) or analyses from RCTs, three were prospective observational stu…

Fibrinolysis Sistem, Monitored by Thromboelastography (TEG), and PAI-1 Activity in Septic Patients Undergoing Tight Glycemic Control

Comparisons of two diaphragm ultrasound-teaching programs: a multicenter randomized controlled educational study

Abstract Background This study aims to ascertain whether (1) an educational program is sufficient to achieve adequate Diaphragm Ultrasound (DUS) assessments on healthy volunteers and (2) combining a video tutorial with a practical session is more effective in making learners capable to obtain accurate DUS measurements, as opposed to sole video tutorial. Results We enrolledstep 1: 172 volunteers naïve to ultrasound. After watching a video tutorial, a questionnaire was administered and considered to be passed when at least 70% of the questions were correctly answered. Course participants who passed the theoretical test were randomized to either intervention or control group. Learners randomiz…

Association between night-time extubation and clinical outcomes in adult patients

Background: Whether night-time extubation is associated with clinical outcomes is unclear. Objective: The aim of this systematic review and meta-analysis was to evaluate the association between night-time extubation and the reintubation rate, mortality, ICU and in-hospital LOS in adult patients, compared with daytime extubation. Design: A systematic review and meta-analysis. Data sources: PubMed, EMBASE, CINAHL and Web of Science from inception to 2 January 2021 (PROSPERO registration - CRD42020222812). Eligibility criteria: Randomised, quasi and cluster randomised, and nonrandomised studies describing associations between adult patients' outcomes and time of extubation (daytime/night-time)…

Frequency and Indications of Parenteral Nutrition in an Acute Palliative Care Unit

The aim of this study was to estimate the use of parenteral nutrition (PN) in advanced cancer patients enrolled in an acute pain relief and palliative care unit of a comprehensive cancer center and the appropriateness of the criteria to select patients for PN. Fourteen out of 750 patients (1.8%) admitted to an acute palliative care unit were administered PN. Patients were referred from various settings. The mean age was 58 yr (range 37-79), and 9 were males. The mean hospital stay was 7.7 days (range 3-14), and the mean Karnofsky level was 35 (range 10-50). The principal indication was bowel obstruction. Ten patients (71%) were already receiving PN before admission, and 2 of them discontinu…

Building a continuous multicenter infection surveillance system in the intensive care unit: findings from the initial data set of 9,493 patients from 71 Italian intensive care units.

OBJECTIVE: To describe the epidemiology of infections in intensive care units (ICUs), whether present at admission or acquired during the stay. METHODS: Prospective data collection lasting 6 months in 71 Italian adult ICUs. Patients were screened for infections and risk factors at ICU admission and daily during their stay. MAIN RESULTS: Out of 9,493 consecutive patients admitted to the 71 ICUs, 11.6% had a community-acquired infection, 7.4% a hospital-acquired infection, and 11.4% an ICU-acquired infection. The risk curve of acquiring infection in the ICU was higher in patients who entered without infection than in those already infected (log-rank test, p < .0001; at 15 days, 44.0% vs. 34.6…

Bloodstream infections in intensive care unit patients: distribution and antibiotic resistance of bacteria

Vincenzo Russotto,1 Andrea Cortegiani,1 Giorgio Graziano,2 Laura Saporito,2 Santi Maurizio Raineri,1 Caterina Mammina,2 Antonino Giarratano1 1Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy; 2Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo, Palermo, Italy Abstract: Bloodstream infections (BSIs) are among the leading infections in critically ill patients. The case-fatality rate associated with BSIs in patients admitted to intensive care units (ICUs) reaches 35%&amp;ndash;50%. The emergence and dif…

Untargeted Antifungal Treatment Strategies for Invasive Candidiasis in Non-neutropenic Critically Ill Patients: Current Evidence and Insights

Purpose of Review: The purpose of this study was to provide an overview and insights on important new concepts on untargeted antifungal treatment strategies, namely prophylaxis pre-emptive and empiric treatments for the management of invasive candidiasis (IC) in non-neutropenic critically ill patients. Recent Findings: Recently, clinical practice guidelines provided recommendation for the management of IC. However, results from recent trials and systematic reviews questioned the effect of untargeted antifungal treatment strategies, especially in terms of survival benefits in non-neutropenic patients, even with septic shock. Summary: Widespread use of untargeted antifungal treatment strategi…

Simulation-based education for cardiopulmonary resuscitation and airway management protocols: a brief report of a systematic review and meta-analysis.

We aimed to summarize the efficacy of simulation-based education in cardiopulmonary resuscitation and airway management [1].

The challenge of the predatory open-access publishing outbreak

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Role of thromboelastography in septic patients treated by coagulation inhibitors

Minnesota Sedation Assessment Tool (MSAT) vs Narcotrend (NT) to monitorize analgo-sedation in ICU

Intracranial Venous Thrombosis in Peripartum: Case Report.

La risposta immune neella insufficienza respiratoria acuta in terapia intensiva: correlazione tra scores clinici e markers bioumorali

Should Reinke edema be considered a contributing factor to post-extubation failure?

We read with interest the recently published review in Critical Care about post-extubation laryngeal edema and stridor by Pluijms et al. [1]. The review considers in detail the risk factors for post-extubation respiratory failure and describes a post-extubation algorithm for its prevention and reduction. We recently published a case report describing the occurrence of post-extubation stridor leading to post-extubation respiratory failure in a woman with a previously undiagnosed Reinke edema (RE) [2]. RE is a progressive laryngeal soft-tissue swelling. The condition typically manifests in female gender as hoarseness and as a gradually deepening voice in patients with a history of smoking, vo…

Supplemental Material - Autologous conditioned serum for chronic pain in patients with osteoarthritis: A feasibility observational study

Supplemental Material for Autologous conditioned serum for chronic pain in patients with osteoarthritis: A feasibility observational study by Mariachiara Ippolito, Giulia Spurio, Viviana Compagno, Alessandra Rizzo, Marta Di Simone, Anna Maria Corsale, Giuseppina Mazzola, Antonino Giarratano, Serena Meraviglia, Andrea Cortegiani, and Antonietta Alongi in British Journal of Pain

Cancer pain management in an oncological ward in a comprehensive cancer center with an established palliative care unit

Abstract BACKGROUND: This survey was performed to draw information on pain prevalence, intensity, and management from a sample of patients who were admitted to an oncologic center where a palliative care unit (PCU) has been established for 13 years. METHODS: Cross-sectional survey in an oncological department performed 1 day per month for six consecutive months. RESULTS: Of the 385 patients, 69.1, 19.2, 8.6, and 3.1 % had no pain, mild, moderate, and severe pain, respectively. Inpatients and patients with a low Karnofsky score showed higher levels of pain intensity (p < 0.0005). One hundred twenty-eight patients with pain or receiving analgesics were analyzed for pain management index (PMI)…

High-flow nasal therapy versus noninvasive ventilation in COPD patients with mild-to-moderate hypercapnic acute respiratory failure: study protocol for a noninferiority randomized clinical trial

Background Noninvasive ventilation (NIV) is indicated to treat respiratory acidosis due to exacerbation of chronic obstructive pulmonary disease (COPD). Recent nonrandomized studies also demonstrated some physiological effects of high-flow nasal therapy (HFNT) in COPD patients. We designed a prospective, unblinded, multicenter, randomized controlled trial to assess the noninferiority of HFNT compared to NIV with respect to the reduction of arterial partial pressure of carbon dioxide (PaCO2) in patients with hypercapnic acute respiratory failure with mild-to-moderate respiratory acidosis. Methods We will enroll adult patients with acute hypercapnic respiratory failure, as defined by arterial…

Chronic Pain and COVID-19: pathophysiological, clinical and organizational issues

During the lockdown phase of the COVID-19 pandemic, a call not to neglect the continuum of care of patients who present with chronic diseases, including pain, was made. In the field of pain, COVID-19 had an impact both from a clinical (i.e., the influence of SARS-CoV-2 infection on pain) and organizational (i.e., how patients with chronic pain should be managed in the post-COVID-19 era) perspective. Furthermore, patients with chronic pain are also frequently frail subjects, affected from multiple comorbidities and hence are at increased risk of infection. On these bases, how the necessity to continue pain therapy will be pursued in the post-COVID-19 era? In this paper, we comment on the abo…

Rapid detection of carbapenem resistance: Targeting a zero level of inadequate empiric antibiotic exposure

Resistance to carbapenems is an increasingly encountered phenomenon in the ICU, complicating empiric and targeted antimicrobial therapy. Infections due to carbapenem-resistant microorganisms are characterized by high morbidity and mortality [1, 2]. Recently, there has been an increasing interest in rapid detection techniques, based on real time on-demand easy-to-use PCR, to detect genes responsible for carbapenem resistance. One of these techniques is the Cepheid Xpert Carba-R assay, which is able to detect and differentiate five of the most frequent genes associated with non-susceptibility to carbapenems in Gram-negative bacteria (bla KPC, bla VIM, bla OXA-48, bla IMP-1, bla NDM). The diag…

Additional file 2: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Table S1. Patient characteristics of immunocompromised patients according to the type of ventilator support. This table shows patient characteristics, including comorbidities, ARDS risk factors, and illness severity at ARDS onset of immunocompromised patients according to the type of ventilator support. (PDF 74Â kb)

Le Reazioni al Mezzo di Contrasto: il Ruolo del Radiologo nel Trattamento.

Cilomilast counteracts the effects of cigarette smoke in airway epithelial cells.

Abstract Cigarette smoke extracts (CSE) alter TLR4 expression and activation in bronchial epithelial cells. Cilomilast, a phosphodiesterase-4 inhibitor, inhibits cigarette smoke-induced neutrophilia. This study was aimed to explore whether cilomilast, in a human bronchial epithelial cell line (16-HBE), counteracted CSE effects. In particular, TLR4 expression, IP-10 and IL-8 release, lymphocyte and neutrophil chemotactic activity and ERK and IkBa phosphorylation in CSE and LPS-stimulated 16-HBE were assessed. CSE increased TLR4 expression, reduced IP-10 release and lymphocyte chemotactic activity and increased IL-8 release and neutrophil chemotactic activity. Cilomilast reduced TLR4 expressi…

Real-time feedback systems for cardiopulmonary resuscitation training: time for a paradigm shift.

Among the new tools to improve the quality of cardiopulmonary resuscitation (CPR), real-time feedback systems (FS) have been largely studied during the last decade (1). These systems permit the real-time analysis of CPR.

Citations and metrics of journals discontinued from Scopus for publication concerns: the GhoS(t)copus Project [version 2; peer review: 2 approved, 1 approved with reservations]

Background: Scopus is a leading bibliometric database. It contains a large part of the articles cited in peer-reviewed publications. The journals included in Scopus are periodically re-evaluated to ensure they meet indexing criteria and some journals might be discontinued for 'publication concerns'. Previously published articles may remain indexed and can be cited. Their metrics have yet to be studied. This study aimed to evaluate the main features and metrics of journals discontinued from Scopus for publication concerns, before and after their discontinuation, and to determine the extent of predatory journals among the discontinued journals. Methods: We surveyed the list of discontinued jo…

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (V(T)). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients. OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference. DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries. MAIN OUTCOME MEASURES: Women and men were compared with respect to use o…

Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: A systematic review and meta-analysis

Abstract Purpose To evaluate which respiratory support method for critically ill patients undergoing endotracheal intubation (ETI) is associated with less desaturation. Methods We searched PubMed, Cochrane Library, Scopus and CINAHL databases. We included randomized (RCT) and non-randomized (non-RCT) studies investigating any method of respiratory support before/during ETI compared to a reference control. Results Apneic oxygenation (ApOx) was the most commonly investigated respiratory support technique for critically ill patients undergoing intubation (4 RCTs, 358 patients). Three of these studies investigated high-flow nasal cannula (HFNC) for ApOx while standard nasal cannula was used in …

Modifications of coagulation imbalance during antithrombin treatment in preeclamptic patients

Successful treatment of KPC-3 Klebsiella Pneumoniae ST258 clone with a combination of high-dose tigecycline and colistin in ICU: a case series report.

INFECTIONS CAUSED BY KLEBSIELLA PNEUMONIAE SEQUENCE TYPE 258 PRODUCING K. PNEUMONIAE CARBAPENEMASE 3 (KPC-Kp)HAVE WIDELY EMERGED AND BOTH INDIVIDUAL CASES AND OUTBREAKS OF COLONIZATION OR INFECTION HAVE BEEN REPORTED IN PALERMO, ITALY.OBIETTIVO: THIS IS A RETROSPECTIVE CASE SERIES THAT DESCRIBES THE CLINICAL AND MICROBIOLOGIC OUTCOMES OF 16 PATIENTS WHO RECEIVED A COMBINATION OF HIGH-DOSE TIGECYCLINE AND COLISTIN FOR TREATMENT OF VAP (4 CASES) AND SEVERE BACTERAEMIA (12 CASES) DURING THE YEARS 2009-2011. 11 OUT OF THE 16 CASES WERE POST SURGICAL PATIENTS WITH INTRABDOMINAL ABSCESSES DUE TO KPC-Kp. IN 5 CASES COMBINED KPC-Kp AND CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII INFECTION WAS ALSO…

ESRA19-0278 Sufentanil sublingual tablet system (SSTS) in post-operative pain: a case series

Background and aims SSTS is a preprogrammed, non invasive, patient-activated bed-side system that enables patients to manage moderate-severe acute pain in a hospital setting. Our aim is to evaluate efficacy, ease of use of SSTS, patients and nurses’ satisfaction. Methods We evaluate pain control and general satisfaction in patients treated with SSTS after general or orthopedic prosthetic surgery. Enrollment started on April the 1st at Policlinico Paolo Giaccone in Palermo and is still ongoing. SSTS allows patients to self-administer a 15-μg sufentanil tablet sublingually with a 20-minute lockout, up to 72 hours. We visit patients three times per day, recording pain control (NRS scale), arte…

La nuova visione dei processi emocoagulativi nel paziente critico

ROCURONIO/SUGAMMADEX VS ROCURONIO/ NEOSTIGMINA NELLA CHIRURGIA BARIATRICA PER BYPASS

Obiettivo. La chirurgia bariatrica è caratterizzata da un incre- mento di morbidità e mortalità post operatoria tre volte maggiore dei pazienti normopeso, in assenza di altri fattori di rischio. La decurarizzazione efficace, riduce il rischio di cura- rizzazione residua post operatoria, e le complicanze ad essa associate 1. Obiettivo del nostro studio è di valutare l’efficacia in termini di recupero dell’attività neuromuscolare all’accele- romiografia e in termini di ripresa clinicamente obiettivabile della Neostigmina vs Sugammadex. Materiali e metodi. Abbiamo arruolato 40 pazienti sottoposti a chirurgia bariatrica per bypass, suddivisi in due gruppi di età >18 anni, BMI >30 kg/m2, classe …

Use of Cepheid Xpert Carba-R® for rapid detection of carbapenemase-producing bacteria in critically ill, abdominal surgical patients: first report of an observational study

Introduction Xpert Carba-R® (Cepheid®, USA) is a PCR-based assay for rapid (&lt;1 hour) detection of bacteria carrying carbapenem-resistance genes (KPC, NDM, VIM, OXA-48, IMP-1). The aim of the study is to compare PCR with microbiological cultures in critically ill, abdominal surgical patients. Methods We performed an observational study at University Hospital 'P. Giaccone' Palermo. We enrolled abdominal surgical patients admitted to the ICU with suspected abdominal sepsis or developing sepsis during the ICU stay. We obtained two rectal swab specimens and two drainage samples to perform PCR assay and classic culture tests. We used Cohen's K to test concordance of results. We considered conc…

Noninvasive ventilation for acute hypoxemic respiratory failure/ARDS: The show must go on

Adenosine triphosphate bioluminescence in intensive care units: Be careful with its use

LETTER TO EDITOR

Should we administer antifungal drugs before the diagnosis of invasive fungal infection in non-neutropenic critically ill patients?

Pursuing the Recovery of Severe Chronic Musculoskeletal Pain in Italy: Clinical and Organizational Perspectives from a SIAARTI Survey

Alessandro Vittori,1 Emiliano Petrucci,2 Marco Cascella,3 Massimo Innamorato,4 Arturo Cuomo,3 Antonino Giarratano,5 Flavia Petrini,6 Franco Marinangeli7 1Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy; 2Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, L’Aquila, Italy; 3Department of Anesthesia and Critical Care, Istituto Nazionale Tumori - IRCCS, Fondazione Pascale, Naples, Italy; 4Department of Neuroscience, Pain Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy; 5Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Anal…

No-touch methods of terminal cleaning in the intensive care unit: results from the first large randomized trial with patient-centred outcomes

N/A

CAUSE DI OLIGOANALGESIA IN AREA D’EMERGENZA AL TEMPO DELLE GRANDI IMMIGRAZIONI

Obiettivo. L’AOU Policlinico di Palermo ha un centro dedi- cato ai bisogni sanitari degli immigrati regolari e clandestini, pertanto l’area di emergenza (PS) è il punto di riferimento di questa popolazione straniera. Il dolore, causa principale di accesso al PS, è sottotrattato. Le ipotesi delle differenze nella qualità del sollievo sono svariate, e comprendono anche etnia, razza, sesso ed età. Anche il modo in cui pazienti, di culture differenti, esprimono il proprio dolore e le interazioni tra medici e pazienti di diversa origine etnica possono influenza- re la valutazione. Abbiamo cercato di determinare se il sollie- vo dal dolore in PS è associato negativamente con la percezio- ne del m…

LyghtCycler Septifast in early diagnosis of sepsis: our experience.

Additional file 2 of High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-inferiority randomized trial

Additional file 2: Table S1: Characteristics of interventions in the high flow nasal therapy (HFNT) and noninvasive ventilation group (NIV); Table S2: Per-protocol 2 h. Patients’ characteristics in the noninvasive ventilation (NIV) and high flow nasal therapy (HFNT) groups at baseline; Table S3: Per-protocol 6 h. Patients’ characteristics in the noninvasive ventilation (NIV) and high flow nasal therapy (HFNT) groups at baseline; Figure S1: Absolute difference between HFNT and NIV treatment in mean PaCO2 reduction after 6 h (and 1-Sided 95% confidence interval), according to conducted analyses: intention-to-treat (ITT) and per-protocol on patients who completed the treatment originally alloc…

Postoperative pain management in non-traumatic emergency general surgery: WSES-GAIS-SIAARTI-AAST guidelines

Abstract Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management g…

Fomepizole and CRRT in Acute Methanol Poisoning. Are They Useful to Reduce Neurologic Damage?

Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care expert consensus statement on the use of lung ultrasound in critically ill patients with coronavirus disease 2019 (ITACO)

Abstract Background To produce statements based on the available evidence and an expert consensus (as members of the Lung Ultrasound Working Group of the Italian Society of Analgesia, Anesthesia, Resuscitation, and Intensive Care, SIAARTI) on the use of lung ultrasound for the management of patients with COVID-19 admitted to the intensive care unit. Methods A modified Delphi method was applied by a panel of anesthesiologists and intensive care physicians expert in the use of lung ultrasound in COVID-19 intensive critically ill patients to reach a consensus on ten clinical questions concerning the role of lung ultrasound in the following: COVID-19 diagnosis and monitoring (with and without i…

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiog…

Medical simulation for ICU staff: does it influence safety of care?

Dear Editor, We read with great interest the article by Garrouste-Orgeas et al. entitled ‘‘Understanding medical errors and adverse events in ICU patients’’ [1]. In particular, two sentences caught our attention: ‘‘medical errors are the consequence of multiple actions of a whole chain of organizational and humans interaction...’’ and ‘‘leadership, trust, respect, open communication, non-punitive actions and coordination of behavior are essential for a multidisciplinary ICU team to provide safe care’’. In a teamworking setting like the ICU, shared knowledge and non-technical skills are pivotal to deliver a high quality of care and to reduce medical errors. Medical simulation has been demons…

Cardiac arrest during a diving session: A case report and differential diagnosis

: We report a case of out-of-hospital cardiac arrest occurred in a 61-year-old recreational female diver. After resuscitation, the patient was referred to the hospital. With data provided by witnesses and appropriate medical investigations, drowning related to a failed rebreather system was the most plausible explanation. Patient outcome was favorable.

What is the risk of acquiring bacteria from prior intensive care unit bed occupants?

Bloodstream Infections in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Background: Little is known about the occurrence of bloodstream infections in hospitalized patients with COVID-19 and the related clinical consequences. The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of BSIs among hospitalized patients with COVID-19 and mortality of this patient population. Methods: A systematic search was performed on PubMed, EMBASE, and Web of Science from inception to 19 April 2021. The primary outcome was the occurrence of BSIs among hospitalized patients with COVID-19. The secondary outcome was mortality at the longest available follow-up. Results: Forty-six studies met the inclusion criteria, with a total of 42,694 patients e…

Concentrazione Citochimica e Markers Coagulativi nel BAL e nel Siero di Pazienti con ALI Settici vs non-Settici

Validation and utility of ARDS subphenotypes identified by machine-learning models using clinical data: an observational, multicohort, retrospective analysis

Item does not contain fulltext BACKGROUND: Two acute respiratory distress syndrome (ARDS) subphenotypes (hyperinflammatory and hypoinflammatory) with distinct clinical and biological features and differential treatment responses have been identified using latent class analysis (LCA) in seven individual cohorts. To facilitate bedside identification of subphenotypes, clinical classifier models using readily available clinical variables have been described in four randomised controlled trials. We aimed to assess the performance of these models in observational cohorts of ARDS. METHODS: In this observational, multicohort, retrospective study, we validated two machine-learning clinical classifie…

Survival of patients with hepatocellular carcinoma (HCC) treated by percutaneous radio-frequency ablation (RFA) is affected by complete radiological response.

Background: Radio-frequency ablation (RFA) has been employed in the treatment of Barcelona Clinic Liver Cancer (BCLC) early stage hepatocellular carcinoma (HCC) as curative treatments. Aim: To assess the effectiveness and the safety of RFA in patients with early HCC and compensated cirrhosis. Methods: A cohort of 151 consecutive patients with early stage HCC (122 Child-Pugh class A and 29 class B patients) treated with RFA were enrolled. Clinical, laboratory and radiological follow-up data were collected from the time of first RFA. A single lesion was observed in 113/151 (74.8%), two lesions in 32/151 (21.2%), and three lesions in 6/151 (4%) of patients. Results: The overall survival rates …

The global challenge of Candida auris in the intensive care unit

Since the first isolation of Candida auris in 2009, scientific community has witnessed an exponential emergence of infection episodes and outbreaks in different world regions. It is hard to predict future C. auris diffusion. By now, global surveillance, improving knowledge, and taking care of the A.U.R.I.S. major issues may be the best ways to face C. auris challenge

Additional file 6: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Table S6. Ventilator settings during the first day of ARDS in immunocompetent (Control) and immunocompromised (Study) patients, stratified by the type of ventilatory support (IMV, NIV, NIV failure). (PDF 60Â kb)

CLINICAL RESEARCH IN ITALY IN ADULT PATIENTS UNABLE TO CONSENT: AFTER IMPLEMENTATION OF THE EUROPEAN UNION'S DIRECTIVE 2001/20/CE.

Clinical research in Italy in adult patients unable to consent: after implementation of the European Union's Directive 2001/20/CE.

Emotional status and fear in patients scheduled for elective surgery during COVID-19 pandemic: a nationwide cross-sectional survey (COVID-SURGERY)

Abstract Background Fragmented data exist on the emotional and psychological distress generated by hospital admission during the pandemic in specific populations of patients, and no data exists on patients scheduled for surgery. The aim of this multicentre nationwide prospective cross-sectional survey was to evaluate the impact of pandemic on emotional status and fear of SARS-CoV-2 contagion in a cohort of elective surgical patients in Italy, scheduled for surgery during the COVID-19 pandemic. Results Twenty-nine Italian centres were involved in the study, for a total of 2376 patients surveyed (mean age of 58 years ± 16.61; 49.6% males). The survey consisted of 28 total closed questions, in…

Effect of High-Fidelity Simulation on Medical Students' Knowledge about Advanced Life Support: A Randomized Study

High-fidelity simulation (HFS) is a learning method which has proven effective in medical education for technical and non-technical skills. However, its effectiveness for knowledge acquisition is less validated. We performed a randomized study with the primary aim of investigating whether HFS, in association with frontal lessons, would improve knowledge about advanced life support (ALS), in comparison to frontal lessons only among medical students. The secondary aims were to evaluate the effect of HFS on knowledge acquisition of different sections of ALS and personal knowledge perception. Participants answered a pre-test questionnaire consisting of a subjective (evaluating personal percepti…

Lung Immune and Coagulative Host Response in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (aeocpd).

Deferral of assessment of pulmonary embolism

We evaluated a simplified algorithm for safely postponing diagnostic imaging for pulmonary embolism (PE). At the index visit, patients were identified as being at high or low risk of PE; the former received full dosage low molecular weight heparin while the latter were left untreated until performance of diagnostic imaging (max 72 hours). During this period, no thromboembolic events occurred in low-risk patients (0/211, 0.% [upper 95% CI 0.9%]); only one event occurred in those at high-risk (1/125, 0.8% [upper 95% CI, 1.2]). Our study demonstrates that diagnostic imaging for PE can be safely deferred for up to 3 days.

High dose of trimethoprim-sulfamethoxazole and daptomycin as a therapeutic option for MRSA endocarditis with large vegetation complicated by embolic stroke: a case report and literature review.

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

Supported by Centro de Investigación Biomédica en Red (CIBER)‑Enfermedades respiratorias, Madrid, Spain (CB17/06/00021) and Fundación para el Fomento en Asturias de la Investigación Científica aplicada y la tecnología (FICYT, AYUD2021/52014). RRG is the recipient of a grant from Instituto de Salud Carlos III, Madrid, Spain (CM20/00083).

Role of PGE2 in the invasiveness, growth and protection of cancer cells in malignant pleuritis

Abstract The recurrence of pleural effusions is a common event in a variety of neoplastic diseases. The objective of this study was to identify the mechanisms promoting the homing and growth of cancer cells within the pleural space. A cancer cell line recovered from malignant pleural fluids (lung adenocarcinoma cell line) that constitutively expresses cyclooxygenase 2 (COX-2) and all types of prostaglandin receptors was studied. It was first demonstrated using a matrigel system, that malignant pleural fluids increase the invasiveness of adenocarcinoma cells more than congestive heart failure (CHF) pleural fluids. Moreover, exposure to exudative malignant, but not to CHF pleural fluids, incr…

Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study

BackgroundCurrent incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in the intensive care unit (ICU) are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS).MethodsAn international, multicentre, prospective cohort study of patients presenting with hypoxaemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with arterial oxygen tension/inspiratory oxygen fraction ratio ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-e…

The expression of innate immunity and coagulative response in acute lung injury.Septic vs non sepstic patients.

La preeclampsia severa nella paziente critica ostetrica quale modello di patologia del sistema coagulativo-infiammatorio: presupposti teorici e risvolti terapeutici

Palliative Care and End-of-Life Issues in Patients with Brain Cancer Admitted to ICU

Background and Objectives: Palliative care is an interdisciplinary medical specialty focused on improving the quality of life of critically ill patients, including those with frailty, during their illness. Materials and Methods: We conducted an extensive literature review on Pubmed focusing on palliative care in neuro-oncology patients admitted to intensive care units (ICUs). Results: We identified 967 articles and, after excluding 952 articles in accordance with the PRISMA flow chart, we included a total of 15 articles in the final selection. The potential role of palliative care in neuro-oncology appears necessary to ensure comprehensive end-of-life patient care. However, this seems under…

Autologous conditioned serum for chronic pain in patients with osteoarthritis: A feasibility observational study

Background Autologous conditioned serum is a product of blood origin, with fragmented evidence of therapeutic properties in osteoarthritis chronic pain. This pilot observational prospective study aimed to evaluate the feasibility of a treatment with conditional autologous serum (ACS) in patients with severe chronic pain and grade I-III osteoarthritis and to describe its cytokine content. Methods We prospectively collected data on consecutive patients affected by osteoarthritis grade I to III and treated with four weekly injections of ACS at our outpatient pain service. The primary outcome was pain intensity, measured with the visual analogic scale (VAS). Additional outcomes were symptoms ev…

Mid-regional pro-adrenomedullin predicts poor outcome in non-selected patients admitted to an intensive care unit.

AbstractBackgroundMortality risk and outcome in critically ill patients can be predicted by scoring systems, such as APACHE and SAPS. The identification of prognostic biomarkers, simple to measure upon admission to an intensive care unit (ICU) is an open issue. The aim of this observational study was to assess the prognostic value of plasma mid-regional pro-adrenomedullin (MR-proADM) at ICU admission in non-selected patients in comparison to Acute Physiology and Chronic Health Evaluation II (APACHEII) and Simplified Acute Physiology Score II (SAPSII) scores.MethodsAPACHEII and SAPSII scores were calculated after 24 h from ICU admission. Plasma MR-proADM levels were measured by TRACE-Kryptor…

Pleural Mesothelial Cells Express Both BLT2 and PPAR and Mount an Integrated Response to Pleural Leukotriene B4

Leukotriene B(4) (LTB(4)) plays a crucial role in the recruitment of neutrophils into the pleural space. We identified for the first time the mechanisms by which LTB(4) interacts with mesothelial cells and recruits neutrophils in the pleural compartment. Primary pleural mesothelial cells express both the proinflammatory receptor for LTB(4) BLT2, and the anti-inflammatory receptor for LTB(4), PPARalpha. Parapneumonic pleural effusions highly increase BLT2 expression and, via BLT2 activation, increase the adhesion between mesothelial cells and neutrophils and the expression of ICAM-1 on mesothelial cells. The block of PPARalpha further increases both cell adhesion and ICAM-1 expression. BLT2 …

Additional file 1: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

List of LUNG SAFE investigators. Names and affiliations of the LUNG SAFE investigators. (PDF 172Â kb)

Healthcare-associated central nervous system infections.

Purpose of review The aim of this review is to provide a practical and updated summary on healthcare-associated central nervous system infections and their management. Recent findings The term ‘healthcare-associated ventriculitis and meningitis’ has recently been coined and clinical practical guidelines have been published on the management of these nosocomial infections. Many aspects have still to be further investigated (e.g. cerebrospinal fluid biomarkers, indications for novel antibiotics, intrathecal antimicrobial regimens). Summary Clinicians should maintain a high index of suspicion for healthcare-associated central nervous system infections in patients with specific risk factors (i.…

Lessons from uncertainty on antifungal treatment in ICU

We read with great interest the Editorial from Moghnieh et al. on the EMPIRICUS trial and antifungal use in intensive care unit (ICU) (1). Authors described nicely the trial and some background evidence on untargeted antifungal treatment in non-neutropenic critically ill patients in ICU (2,3). However, we believe that some points may be further clarified. First, it may be useful to cite the study from Knitsch et al. among those evaluating empiric antifungal treatment in ICU (4). Knitsch et al. enrolled 252 critically ill patients with localized/generalized intra-abdominal infection either of community or of nosocomial origin requiring emergency surgery.

Additional file 7: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Figure S1. Kaplan-Meier curve for hospital survival in immunocompromised patients according to ARDS severity. Kaplan-Meier curve for hospital survival in immunocompromised patients according to ARDS severity. Mortality is defined as mortality at hospital discharge or at 90Â days after onset of acute hypoxemic respiratory failure, whichever event occurred first. We assumed that patients discharged alive from the hospital before 90Â days were alive on day 90. Severity of ARDS was evaluated at the day of onset according to the Berlin definition. Note: The number of patients reported in the bottom of figure is referred to as the end of the corresponding day. (PDF 402Â kb)

The paradox of the evidence about invasive fungal infections prevention

Invasive fungal infections (IFIs) are characterized by high morbidity and mortality in non-neutropenic critically ill patients. Attributable mortality due to Candida spp. infections ranges from about 42 to 63 % [1, 2]. Data from large observational and retrospective studies show an association between early antifungal treatment and improved survival [3, 4]. Updated clinical practice guidelines for the management of candidiasis have been recently published [5]. In 2006, Playford et al. published a Cochrane systematic review investigating the use of antifungal agents for prevention of IFIs in non-neutropenic critically ill patients [6]. In that review, the outcome of proven IFI was defined as…

113) La coagulopatia intravascolare disseminata in ostetricia ruolo degli inibitori naturalidella coagulazione e approccio terapeutico

Minnesota sedation assesment too (MSAT) vs Narcotrend to monitorize analgo-sedation in ICU.

Additional file 1: of Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris

Flow diagram of the systematic search. (PDF 44Â kb)

Additional file 3: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Table S2. Factors associated with the use of noninvasive ventilation. Multivariate logistic regression model describing the factors associated with the use of noninvasive ventilation. (PDF 49Â kb)

Assessment of treatment response in hepatocellular carcinoma: a review of literature

Albumin replacement in patients with severe sepsis or septic shock.

BACKGROUND: Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established. METHODS: In this multicenter, open-label trial, we randomly assigned 1818 patients with severe sepsis, in 100 intensive care units (ICUs), to receive either 20% albumin and crystalloid solution or crystalloid solution alone. In the albumin group, the target serum albumin concentration was 30 g per liter or more until discharge from the ICU or 28 days after randomization. The primary outcome was death from any cause at 28 days. Secondary outcomes were death from any cause at 90 days, the number of patients with or…

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: Insights from the LUNG SAFE study

Abstract Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence o…

La Diagnosi Eziologia Precoce in UTI: il Ruolo della Biologia Molecolare.

Additional file 10: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Table S9. The most important factors leading to death in the ICU in immunocompetent and immunocompromised patients. (PDF 44Â kb)

Bacterial contamination of inanimate surfaces and equipment in the intensive care unit.

Intensive care unit (ICU)-acquired infections are a challenging health problem worldwide, especially when caused by multidrug-resistant (MDR) pathogens. In ICUs, inanimate surfaces and equipment (e.g., bedrails, stethoscopes, medical charts, ultrasound machine) may be contaminated by bacteria, including MDR isolates. Cross-transmission of microorganisms from inanimate surfaces may have a significant role for ICU-acquired colonization and infections. Contamination may result from healthcare workers' hands or by direct patient shedding of bacteria which are able to survive up to several months on dry surfaces. A higher environmental contamination has been reported around infected patients tha…

Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies.

Objective To compare the 2 most efficacious therapeutic regimens, intravenous immunoglobulin (IVIG) and anticoagulation with low molecular weight (LMW) heparin plus low-dose aspirin, in women with recurrent pregnancy loss associated with antiphospholipid antibodies (aPL). Methods We examined 40 women with recurrent abortion (at least 3 occurrences) and repeatedly positive test results for anticardiolipin or lupus anticoagulant. The subjects were randomly assigned to treatment with IVIG or LMW heparin plus low-dose aspirin. Both therapies were started when the women were pregnant as documented by a positive urine test. IVIG was stopped at the thirty-first week of gestation, aspirin at the th…

Rationale and clinical application of antimicrobial stewardship principles in the intensive care unit: a multidisciplinary statement

Abstract Background Antimicrobial resistance represents a major critical issue for the management of the critically ill patients hospitalized in the intensive care unit (ICU), since infections by multidrug-resistant bacteria are characterized by high morbidity and mortality, high rates of treatment failure, and increased healthcare costs worldwide. It is also well known that antimicrobial resistance can emerge as a result of inadequate antimicrobial therapy, in terms of drug selection and/or treatment duration. The application of antimicrobial stewardship principles in ICUs improves the quality of antimicrobial therapy management. However, it needs specific considerations related to the cri…

La Tigecyclina come Terapia Empirica nelle Sepsi Severe ad Origine Addominale. Case Report

Candida auris: An Overview of How to Screen, Detect, Test and Control This Emerging Pathogen

The multidrug-resistant yeast Candida auris is associated with invasive infections in critically ill patients and has been isolated in different countries worldwide. Ease of spread, prolonged persistence in the environment and antifungal drug resistance pose a significant concern for the prevention of transmission and management of patients with C. auris infections. Early and correct identification of patients colonized with C. auris is critical in containing its spread. However, this may be complicated by C. auris strains being misidentified as other phylogenetically related pathogens. In this review, we offer a brief overview highlighting some of the critical aspects of sample collection,…

Evolution Over Time of Ventilatory Management and Outcome of Patients With Neurologic Disease

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need fo…

Predatory open-access publishing in critical care medicine

Abstract Purpose To evaluate the characteristics and practice of predatory journals in critical care medicine (CCM). Methods We checked a freely accessible online and constantly updated version of the Beall lists of potential predatory publishers/journals in the field of CCM. We checked the journals' websites to retrieve the following data such as: 1) Country and address (checked by Google maps); 2) Article processing charges (APC); 3) Indexing; 4) Editor-in-chief and the Editorial Board (EB) members; 5) Number of published articles; 6) Review time (lapse submission-acceptance); 7) English form. Results We identified 86 CCM journals from 48 publishers. Most journals' reported address was in…

Managing cancer patients with acute venous thromboembolism: exploring safe alternatives to hospitalisation

Acute venous thromboembolism (VTE) is a common and potentially fatal complication that frequently occurs in cancer patients. Few data are currently available about the optimal management of this category of high-risk patients. In clinical practice, physicians have to deal with many problems related to cancer patients with acute VTE. For instance, cancer patients with deep vein thrombosis (DVT) are frequently admitted to the hospital since their high rate of recurrent thrombotic events and/or bleeding-related therapy; however, most of them would prefer alternatives to prolonged hospitalisation. Then, it is not clearly whether data coming from a non-cancer population (such as that regarding t…

Coronary artery disease . Screening in major non cardiac surgery

Additional file 5: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Table S4. Adjunctive measures/therapies during at least one day during follow-up in immunocompetent and immunocompromised patients. This table shows the proportions of adjunctive measures/therapies during at least one day during follow-up in immunocompetent and immunocompromised patients. (PDF 97Â kb)

Candida bloodstream infections in intensive care units: Analysis of the extended prevalence of infection in intensive care unit study

Objectives: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. Design: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. Setting: EPIC II included 1265 intensive care units in 76 countries. Patients: Patients in partic…

L’OSSIGENOTERAPIA IPERBARICA NELLE SEPSI SEVERA DA INFEZIONE DEI TESSUTI MOLLI

Obiettivo. La fascite necrotizzante (FN) è una rara infezione dei tessuti molli. È caratterizzata da una diffusa necrosi fascia- le principalmente causata da Streptococcus hemolyticus. Può essere fatale se non gestita correttamente, per cui diviene mandatoria una diagnosi precoce ed un trattamento multidi- sciplinare che includa l’ossigenoterapia iperbarica (HBOT), che viene utilizzata sia come trattamento primario o adiuvan- te nel trattamento di infezioni come la gangrena gassosa, la fascite necrotizzante. Materiali e metodi. Descriviamo tre casi clinici di FN. Il primo è un donna di 49 anni con diabete mellito di tipo II, che presentava una FN a livello della mammella sinistra. È stato a…

A perioperative uncontrollable bleeding in an elderly patient with acquired hemophilia A: a case report

Key Clinical Message Acquired hemophilia A should be taken into account in the differential diagnosis of perioperative bleeding in patients without any apparent reason for activated partial thromboplastin time prolongation.

PACE E. M. FERRARO, A. GIARRATANO, S. MANGIONE, M. GJOMARKAJ. Elevated expression of TLR4 and HBD2 but decreased levels of IP-10 in COPD with severe exacerbation

An intensive midsummer night’s dream

Additional file 1: of Effect of high-flow nasal therapy on dyspnea, comfort, and respiratory rate

List of included studies, search strategy, and risk of bias assessment. Detailed study methods, reference list of included studies, search strategy, risk of bias assessment. (DOCX 520 kb)

Raising Awareness on the Clinical and Social Relevance of Adequate Chronic Pain Care.

Appropriate pain care should be regarded as a right and effectively guaranteed to people with chronic pain (CP). Law 38, enacted in Italy in 2010, establishes the citizen’s right not to suffer. Twelve years later, such right appears still disregarded in Italy and the current access to adequate pain care reveals significant shortcomings. In addition, a mismatch between CP-associated burden and the available healthcare resources in the framework of our national health system has been observed. This article gathers the perspectives of a Board of Italian anesthesiologists on the state of the art of CP management in Italy and aims at strengthening the scientific rationale and clinical relevance …

Additional file 1: of Procalcitonin levels in candidemia versus bacteremia: a systematic review

Search output from PubMed. Full search output from PubMed. (DOCX 299 kb)

Additional file 2: of Procalcitonin levels in candidemia versus bacteremia: a systematic review

Search output from EMBASE. Full search output from EMBASE. (DOCX 88 kb)

Antifungal Stewardship in Light of the Updated Evidence on Untargeted Antifungal Treatment in Critically Ill Patients

Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study

Editor's Perspective What We Already Know about This Topic Hospital mortality in acute respiratory distress syndrome is approximately 40%, but mortality and trajectory in "mild" acute respiratory distress syndrome (classified only since 2012) are unknown, and many cases are not detected What This Article Tells Us That Is New Approximately 80% of cases of mild acute respiratory distress syndrome persist or worsen in the first week; in all cases, the mortality is substantial (30%) and is higher (37%) in those in whom the acute respiratory distress syndrome progresses Background: Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered …

Lo screening della malattia coronarica (Coronary Artery Disease) in chirurgia maggiore non cardiaca.

Use of Cepheid Xpert Carba-R® for Rapid Detection of Carbapenemase-Producing Bacteria in Abdominal Septic Patients Admitted to Intensive Care Unit.

Abstract Early institution of effective antibiotic therapy and source control are pivotal to improve survival of abdominal septic patients. Xpert® Carba-R is a real time polymerase chain reaction assay for rapid detection and differentiation of five genes (blaKPC, blaVIM, blaOXA-48, blaIMP-1, blaNDM) responsible for carbapenem resistance. We performed an observational study investigating the clinical usefulness and applicability of Xpert® Carba-R to detect carbapenem resistance in abdominal septic patients admitted to intensive care unit. We compared the results of Xpert® Carba-R with standard microbiological culture. We collected a set of two rectal/stomia swabs and two swabs from abdomina…

La diagnosi eziologica precoce in UTI:il ruolo della biologia molecolare

Association between night/after-hours surgery and mortality: a systematic review and meta-analysis

Abstract Background The association between night/after-hours surgery and patients' mortality is unclear. Methods The protocol of this systematic review was registered in PROSPERO (CRD42019128534). We searched Medline, PubMed, and EMBASE from inception until August 29, 2019 for studies examining an association between timing of surgical procedures (time of anaesthesia induction or surgery start) and mortality (within 30 days or in-hospital) in adult patients. Studies reporting patients' mortality after surgery performed during the weekend only were excluded. All analyses were done using the random-effects model. Results We included 40 observational studies (36 retrospective and four prospec…

Prevenzione e Trattamento delle Infezioni da Microrganismi Multiresistenti (MDR) in Terapia Intensiva: il Ruolo dell’Intensivista

Implementation Strategies for Preventing Healthcare-Associated Infections across the Surgical Pathway: An Italian Multisociety Document

Healthcare-associated infections (HAIs) result in significant patient morbidity and can prolong the duration of the hospital stay, causing high supplementary costs in addition to those already sustained due to the patient’s underlying disease. Moreover, bacteria are becoming increasingly resistant to antibiotics, making HAI prevention even more important nowadays. The public health consequences of antimicrobial resistance should be constrained by prevention and control actions, which must be a priority for all health systems of the world at all levels of care. As many HAIs are preventable, they may be considered an important indicator of the quality of patient care and represent an importan…

Accidental poisoning with Aconitum: Case report and review of the literature

Abstract Aconitine intoxication by ingestion of Aconitum roots can lead to ventricular tachycardia and cardiac arrest and provides an example of the potential effect of self‐medication. Educational campaigns should be implemented to contain acute intoxications caused by herbal‐derived products.

RISOLUZIONE DI UN’ENDOCARDITE DA MRSA CON VEGETAZIONE LARGA, MOBILE E COMPLICATA DA STROKE EMBOLICO TRATTATA CON SOLA TERAPIA ANTIBIOTICA COMBINATA

Low dosage liposomal amphotericin B in the treatment of Candida infections in critically ill patients.

What Healthcare Workers Should Know about Environmental Bacterial Contamination in the Intensive Care Unit

Intensive care unit- (ICU-) acquired infections are a major health problem worldwide. Inanimate surfaces and equipment contamination may play a role in cross-transmission of pathogens and subsequent patient colonization or infection. Bacteria contaminate inanimate surfaces and equipment of the patient zone and healthcare area, generating a reservoir of potential pathogens, including multidrug resistant species. Traditional terminal cleaning methods have limitations. Indeed patients who receive a bed from prior patient carrying bacteria are exposed to an increased risk (odds ratio 2.13, 95% confidence intervals 1.62–2.81) of being colonized and potentially infected by the same bacterial spec…

A Multicenter International Randomized Controlled Manikin Study on Different Protocols of Cardiopulmonary Resuscitation for Laypeople: The MANI-CPR Trial.

Background Compression-only cardiopulmonary resuscitation (CPR) is a suggested technique for laypeople facing out-of-hospital cardiac arrest (OHCA). However, it is difficult performing high-quality CPR until emergency medical services arrival with this technique. We aimed to verify whether incorporating intentional interruptions of different frequency and duration increases laypeople's CPR quality during an 8-minute scenario compared with compression-only CPR. Methods We performed a multicenter randomized manikin study selecting participants from 2154 consecutive laypeople who followed a basic life support/automatic external defibrillation course. People who achieved high-quality CPR in 1-m…

Il ruolo del monitoraggio globale dinamico nella sepsi: al confine tra fase procoagulante e fase proemorragica

Use of a real-Time training software (Laerdal QCPR®) compared to instructor-based feedback for high-quality chest compressions acquisition in secondary school students: A randomized trial

High-quality chest compressions are pivotal to improve survival from cardiac arrest. Basic life support training of school students is an international priority. The aim of this trial was to assess the effectiveness of a real-time training software (Laerdal QCPR®) compared to a standard instructor-based feedback for chest compressions acquisition in secondary school students. After an interactive frontal lesson about basic life support and high quality chest compressions, 144 students were randomized to two types of chest compressions training: 1) using Laerdal QCPR® (QCPR group– 72 students) for real-time feedback during chest compressions with the guide of an instructor who considered sof…

Additional file 9: of Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database

Table S5. Factors associated with hospital mortality in immunocompromised patients. Multivariate logistic regression model describing the factors associated with hospital mortality in immunocompromised patients. (PDF 49Â kb)

Management of Acute Kidney Injury and Extracorporeal Blood Purification Therapies During the COVID-19 Pandemic: The Italian SIN–SIAARTI Joint Survey (and Recommendations for Clinical Practice)

Background and AimThe novel coronavirus disease 2019 remains challenging. A large number of hospitalized patients are at a high risk of developing AKI. For this reason, we conducted a nationwide survey to assess the incidence and management of AKI in critically ill patients affected by the SARS-CoV-2 infection.MethodsThis is a multicenter, observational, nationwide online survey, involving the Italian Society of Nephrology and the critical care units in Italy, developed in partnership between the scientific societies such as SIN and SIAARTI. Invitations to participate were distributed through emails and social networks. Data were collected for a period of 1 week during the COVID-19 pandemic…

Monitoraggio del livello di analgosedazione nel paziente ricoverato in UTI mediante la scala MSAT e il Narcotrend. esperienza clinica.

TLR4 upregulation underpins airway neutrophilia in smokers with chronic obstructive pulmonary disease and acute respiratory failure

Activation of Toll-like receptors (TLR) seems to be involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). Upon TLR activation the release of defensins, including human beta defensin 2 (HBD-2), may occur. In this study, we explored the innate responses in patients with respiratory failure, with and without COPD, requiring intubation and mechanical ventilation. Mini-bronchoalveolar lavage (mini-BAL) samples were collected from nonsmoker subjects without COPD (n = 10), smokers without COPD (n = 6), and smokers with COPD (n = 15). TLR4, TLR2, and HBD-2 expression was evaluated by immunocytochemistry; interleukin (IL)-8, IP-10, and HBD-2 concentrations were evaluated by e…

Epidemiologia e microbiologia del cateterismo venoso centrale in una UTI polivalente: cateteri non medicati vs medicati

CARDIOPROTEZIONE ED ANESTESIA EPIDURA- LE TORACICA: UN CASO DI ISCHEMIA MIOCAR- DICA POSTOPERATORIA

Obiettivo. Analisi dell’effetto cardioprotettivo perioperatorio dell’anestesia peridurale toracica (TEA) in un paziente car- diopatico sottoposto a chirurgia non cardiaca. Materiali e metodi. Paziente di 59 anni affetto da patologia neoplastica, BPCO severa, insufficienza renale cronica e car- diopatia ipertensiva (ASA IV), viene sottoposto ad intervento chirurgico di cistectomia radicale e resezione duodeno-digiu- nale. In fase preoperatoria si posiziona un catetere epidurale (T10) e si somministra un bolo di Levobupivacaina (75 mg) e Fentanest (0,05 mg). Si procede a monitoraggio intraoperato- rio con CardioQ che evidenzia uno stato ipotensivo iniziale con bassa portata e basse resistenze…

Breakthrough pain in patients with abdominal cancer pain.

Abstract OBJECTIVE: Characterization of breakthrough cancer pain (BTcP) in patients with abdominal cancer is lacking. The aim of this study was to assess the characteristics of BTcP in patients with abdominal cancer pain. PATIENTS AND METHODS: In an observational cohort study, from a consecutive sample of patients admitted to a pain relief and supportive care unit for a period of 13 months, patients with abdominal disease due to cancer, including primary cancer or metastases, were assessed for the presence of chronic abdominal pain; its mechanism, intensity of background pain, and pain flares, which were distinguishable from the baseline pain, were recorded. Patients presenting with pain fl…

LightCycler SeptiFast in early diagnosis of sepsis: our experience.

The conventional sepsis diagnosis, using the cultivation technique, needs 24 hours for bacterial identification and 36 hours for fungal. The use of empiric therapy makes the growth of bacteria and fungi slower or may yield negative findings in many cases of septic shock. The molecular technique can contribute to a more rapid and specific diagnosis in septic patients. SeptiFast detects 26 bacterial and fungal species DNAs, using the PCR in real time and giving results after 6 hours. This is important for de-escalation therapy and beginning of appropriate antibiotic treatment. The aim of this study is to evaluate the sensibility and the specificity of the SeptiFast test versus traditional dia…

K. PNEUMONIAE E A. BAUMANNII PRODUTTORI DI CARBAPENEMASE. INCIDENZA, FATTORI DI RISCHIO ED IMPATTO SULL’OUTCOME

Obiettivo. L’incidenza di infezioni da Klebsiella pneumoniae (KP) produttori di carbapenemase e Acinetobacter bauman- nii (AB) resistente al carbapenemico è aumentata negli ultimi anni determinando limitazioni di opzioni di trattamento. Il presente studio è stato intrapreso per determinare la preva- lenza di KP e AB resistenti ai carbapenemici e la loro influen- za sull’outcome. Materiali e metodi. Nel periodo di 13 mesi preso in considera- zione, sono stati isolati 69 colture di KP e AB, da pazienti rico- verati per più di 72 ore, presso la Unità di Terapia Intensiva Polivalente del Policlinico “P. Giaccone” di Palermo. La pro- duzione di beta-lattamasi a spettro esteso è stata testata med…

Timing of surgery and elective perioperative management of patients with previous SARS-CoV-2 infection: a SIAARTI expert consensus statement

Abstract Background The appropriate timing of surgery and perioperative management of patients with previous SARS-CoV-2 infection are open issues. The purpose of this document is to support the clinical decision-making process regarding the patient with previous Sars-CoV-2 infection to undergo elective surgery. The recipients of this document are physicians, nurses, healthcare personnel, and other professionals involved in the patient’s surgical process. Methods The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) selected 11 experts to reach a consensus on key aspects of this theme in adult and pediatric population. The methods of this process document wer…

Antifungal agents for preventing fungal infections in non-neutropenic critically ill patients

Background Invasive fungal infections are important causes of morbidity and mortality among critically ill patients. Early institution of antifungal therapy is pivotal for mortality reduction. Starting a targeted antifungal therapy after culture positivity and fungi identification requires a long time. Therefore, alternative strategies (globally defined as 'untargeted antifungal treatments') for antifungal therapy institution in patients without proven microbiological evidence of fungal infections have been discussed by international guidelines. This review was originally published in 2006 and updated in 2016. This updated review provides additional evidence for the clinician dealing with s…

Additional file 1: of Is it time to consider visual feedback systems the gold standard for chest compression skill acquisition?

Shows the graphic interface of the Laerdal QCPRÂŽ feedback system. Screenshot representing how Laerdal QCPRÂŽ provides real-time visual feedback during training. In this case, compressions are too shallow, 40Â mm for the last one, with incomplete chest recoil (another yellow arrow suggests you should allow complete chest recoil), and the compression rate is too low, 84 compressions/minute (a continuous yellow line shows that the compressions are not in the correct range). The system recognizes as correct parameters those recommended by international guidelines. (TIFF 123 kb)