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  1. Article ; Online: Angiotensin ii therapy in refractory septic shock: which patient can benefit most? A narrative review.

    Coloretti, Irene / Genovese, Andrea / Teixeira, J Pedro / Cherian, Anusha / Ferrer, Ricard / Landoni, Giovanni / Leone, Marc / Girardis, Massimo / Nielsen, Nathan D

    Journal of anesthesia, analgesia and critical care

    2024  Volume 4, Issue 1, Page(s) 13

    Abstract: Patients with septic shock who experience refractory hypotension despite adequate fluid resuscitation and high-dose noradrenaline have high mortality rates. To improve outcomes, evidence-based guidelines recommend starting a second vasopressor, such as ... ...

    Abstract Patients with septic shock who experience refractory hypotension despite adequate fluid resuscitation and high-dose noradrenaline have high mortality rates. To improve outcomes, evidence-based guidelines recommend starting a second vasopressor, such as vasopressin, if noradrenaline doses exceed 0.5 µg/kg/min. Recently, promising results have been observed in treating refractory hypotension with angiotensin II, which has been shown to increase mean arterial pressure and has been associated with improved outcomes. This narrative review aims to provide an overview of the pathophysiology of the renin-angiotensin system and the role of endogenous angiotensin II in vasodilatory shock with a focus on how angiotensin II treatment impacts clinical outcomes and on identifying the population that may benefit most from its use.
    Language English
    Publishing date 2024-02-21
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2731-3786
    ISSN (online) 2731-3786
    DOI 10.1186/s44158-024-00150-w
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  2. Article ; Online: Difference in PaO

    Gatto, Ilenia / Biagioni, Emanuela / Coloretti, Irene / Viappiani, Serena / Busani, Stefano / Girardis, Massimo

    Journal of Anesthesia, Analgesia and Critical Care (Online)

    2022  Volume 2, Issue 1, Page(s) 23

    Abstract: The ratio between arterial blood partial pressure of oxygen and fraction of inspired oxygen ( ... ...

    Abstract The ratio between arterial blood partial pressure of oxygen and fraction of inspired oxygen (PaO
    Language English
    Publishing date 2022-05-24
    Publishing country England
    Document type Journal Article
    ISSN 2731-3786
    ISSN (online) 2731-3786
    DOI 10.1186/s44158-022-00051-w
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  3. Article: Oxygen: a powerful drug to handle with care.

    Coloretti, Irene / Tosi, Martina / Biagioni, Emanuela / Girardis, Massimo

    Journal of thoracic disease

    2019  Volume 11, Issue Suppl 3, Page(s) S226–S229

    Language English
    Publishing date 2019-04-09
    Publishing country China
    Document type Editorial ; Comment
    ZDB-ID 2573571-8
    ISSN 2077-6624 ; 2072-1439
    ISSN (online) 2077-6624
    ISSN 2072-1439
    DOI 10.21037/jtd.2019.01.84
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  4. Article ; Online: Advances and Challenges in Sepsis Management: Modern Tools and Future Directions.

    Santacroce, Elena / D'Angerio, Miriam / Ciobanu, Alin Liviu / Masini, Linda / Lo Tartaro, Domenico / Coloretti, Irene / Busani, Stefano / Rubio, Ignacio / Meschiari, Marianna / Franceschini, Erica / Mussini, Cristina / Girardis, Massimo / Gibellini, Lara / Cossarizza, Andrea / De Biasi, Sara

    Cells

    2024  Volume 13, Issue 5

    Abstract: Sepsis, a critical condition marked by systemic inflammation, profoundly impacts both innate and adaptive immunity, often resulting in lymphopenia. This immune alteration can spare regulatory T cells (Tregs) but significantly affects other lymphocyte ... ...

    Abstract Sepsis, a critical condition marked by systemic inflammation, profoundly impacts both innate and adaptive immunity, often resulting in lymphopenia. This immune alteration can spare regulatory T cells (Tregs) but significantly affects other lymphocyte subsets, leading to diminished effector functions, altered cytokine profiles, and metabolic changes. The complexity of sepsis stems not only from its pathophysiology but also from the heterogeneity of patient responses, posing significant challenges in developing universally effective therapies. This review emphasizes the importance of phenotyping in sepsis to enhance patient-specific diagnostic and therapeutic strategies. Phenotyping immune cells, which categorizes patients based on clinical and immunological characteristics, is pivotal for tailoring treatment approaches. Flow cytometry emerges as a crucial tool in this endeavor, offering rapid, low cost and detailed analysis of immune cell populations and their functional states. Indeed, this technology facilitates the understanding of immune dysfunctions in sepsis and contributes to the identification of novel biomarkers. Our review underscores the potential of integrating flow cytometry with omics data, machine learning and clinical observations to refine sepsis management, highlighting the shift towards personalized medicine in critical care. This approach could lead to more precise interventions, improving outcomes in this heterogeneously affected patient population.
    MeSH term(s) Humans ; Adaptive Immunity ; Biomarkers ; Inflammation ; Precision Medicine/methods ; Sepsis
    Chemical Substances Biomarkers
    Language English
    Publishing date 2024-03-02
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2661518-6
    ISSN 2073-4409 ; 2073-4409
    ISSN (online) 2073-4409
    ISSN 2073-4409
    DOI 10.3390/cells13050439
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  5. Article ; Online: Association between Pulmonary Aspergillosis and

    Caciagli, Valeria / Coloretti, Irene / Talamonti, Marta / Farinelli, Carlotta / Gatto, Ilenia / Biagioni, Emanuela / Sarti, Mario / Franceschini, Erica / Meschiari, Marianna / Mussini, Cristina / Tonelli, Roberto / Clini, Enrico / Girardis, Massimo / Busani, Stefano / Modena Covid-Working Group

    Viruses

    2023  Volume 15, Issue 11

    Abstract: COVID-19-associated invasive pulmonary aspergillosis (CAPA) is common and is associated with poor outcomes in critically ill patients. This prospective observational study aimed to explore the association between CAPA development and the incidence and ... ...

    Abstract COVID-19-associated invasive pulmonary aspergillosis (CAPA) is common and is associated with poor outcomes in critically ill patients. This prospective observational study aimed to explore the association between CAPA development and the incidence and prognosis of
    MeSH term(s) Adult ; Humans ; Cytomegalovirus/physiology ; Cytomegalovirus Infections/complications ; Cytomegalovirus Infections/epidemiology ; COVID-19/complications ; Critical Illness ; Prospective Studies ; Invasive Pulmonary Aspergillosis ; Bacterial Infections
    Language English
    Publishing date 2023-11-15
    Publishing country Switzerland
    Document type Observational Study ; Journal Article
    ZDB-ID 2516098-9
    ISSN 1999-4915 ; 1999-4915
    ISSN (online) 1999-4915
    ISSN 1999-4915
    DOI 10.3390/v15112260
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  6. Article: Critical COVID-19 patients through first, second, and third wave: retrospective observational study comparing outcomes in intensive care unit.

    Coloretti, Irene / Farinelli, Carlotta / Biagioni, Emanuela / Gatto, Ilenia / Munari, Elena / Dall'Ara, Lorenzo / Busani, Stefano / Meschiari, Marianna / Tonelli, Roberto / Mussini, Cristina / Guaraldi, Giovanni / Cossarizza, Andrea / Clini, Enrico / Girardis, Massimo

    Journal of thoracic disease

    2023  Volume 15, Issue 6, Page(s) 3218–3227

    Abstract: Background: The time-course of the coronavirus disease 2019 (COVID-19) pandemic was characterized by subsequent waves identified by peaks of intensive care unit (ICU) admission rates. During these periods, progressive knowledge of the disease led to the ...

    Abstract Background: The time-course of the coronavirus disease 2019 (COVID-19) pandemic was characterized by subsequent waves identified by peaks of intensive care unit (ICU) admission rates. During these periods, progressive knowledge of the disease led to the development of specific therapeutic strategies. This retrospective study investigates whether this led to improvement in outcomes of COVID-19 patients admitted to ICU.
    Methods: Outcomes were evaluated in consecutive adult COVID-19 patients admitted to our ICU, divided into three waves based on the admission period: the first wave from February 25
    Results: Overall, 428 patients were included in the analysis: 102, 169, and 157 patients in the first, second, and third wave. The ICU and in-hospital crude mortalities were lower by 7% and 10% in the third wave compared to the other two waves (P>0.05). A higher number of ICU- and hospital-free days at day 90 was found in the third wave when compared to the other two waves (P=0.001). Overall, 62.6% underwent invasive ventilation, with decreasing requirement during the waves (P=0.002). The adjusted Cox model showed no difference in the hazard ratio (HR) for mortality among the waves. In the propensity-matched analysis the hospital mortality rate was reduced by 11% in the third wave (P=0.044).
    Conclusions: With application of best practice as known by the time of the first three waves of the pandemic, our study failed to identify a significant improvement in mortality rate when comparing the different waves of the COVID-19 pandemic, notwithstanding, the sub-analyses showed a trend in mortality reduction in the third wave. Rather, our study identified a possible positive effect of dexamethasone on mortality rate reduction and the increased risk of death related to bacterial infections in the three waves.
    Language English
    Publishing date 2023-05-26
    Publishing country China
    Document type Journal Article
    ZDB-ID 2573571-8
    ISSN 2077-6624 ; 2072-1439
    ISSN (online) 2077-6624
    ISSN 2072-1439
    DOI 10.21037/jtd-22-764
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  7. Article: The Association of Procalcitonin and C-Reactive Protein with Bacterial Infections Acquired during Intensive Care Unit Stay in COVID-19 Critically Ill Patients.

    Campani, Simone / Talamonti, Marta / Dall'Ara, Lorenzo / Coloretti, Irene / Gatto, Ilenia / Biagioni, Emanuela / Tosi, Martina / Meschiari, Marianna / Tonelli, Roberto / Clini, Enrico / Cossarizza, Andrea / Guaraldi, Giovanni / Mussini, Cristina / Sarti, Mario / Trenti, Tommaso / Girardis, Massimo

    Antibiotics (Basel, Switzerland)

    2023  Volume 12, Issue 10

    Abstract: In COVID-19 patients, procalcitonin (PCT) and C-reactive protein (CRP) performance in identifying bacterial infections remains unclear. Our study aimed to evaluate the association of PCT and CRP with secondary infections acquired during ICU stay in ... ...

    Abstract In COVID-19 patients, procalcitonin (PCT) and C-reactive protein (CRP) performance in identifying bacterial infections remains unclear. Our study aimed to evaluate the association of PCT and CRP with secondary infections acquired during ICU stay in critically ill COVID-19 patients. This observational study included adult patients admitted to three COVID-19 intensive care units (ICUs) from February 2020 to May 2022 with respiratory failure caused by SARS-CoV-2 infection and ICU stay ≥ 11 days. The values of PCT and CRP collected on the day of infection diagnosis were compared to those collected on day 11 after ICU admission, the median time for infection occurrence, in patients without secondary infection. The receiver operating characteristic curve (ROC) and multivariate logistic model were used to assess PCT and CRP association with secondary infections. Two hundred and seventy-nine patients were included, of whom 169 (60.6%) developed secondary infection after ICU admission. The PCT and CRP values observed on the day of the infection diagnosis were larger (
    Language English
    Publishing date 2023-10-12
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2681345-2
    ISSN 2079-6382
    ISSN 2079-6382
    DOI 10.3390/antibiotics12101536
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  8. Article: Role of Selective Digestive Decontamination in the Prevention of Ventilator-Associated Pneumonia in COVID-19 Patients: A Pre-Post Observational Study.

    Biagioni, Emanuela / Ferrari, Elena / Gatto, Ilenia / Serio, Lucia / Farinelli, Carlotta / Coloretti, Irene / Talamonti, Marta / Tosi, Martina / Meschiari, Marianna / Tonelli, Roberto / Venturelli, Claudia / Mussini, Cristina / Clini, Enrico / Sarti, Mario / Cossarizza, Andrea / Busani, Stefano / Girardis, Massimo

    Journal of clinical medicine

    2023  Volume 12, Issue 4

    Abstract: The aim of our study was to evaluate whether the introduction of SDD in a structured protocol for VAP prevention was effective in reducing the occurrence of ventilator-associated pneumonia (VAP) in COVID-19 patients without changes in the microbiological ...

    Abstract The aim of our study was to evaluate whether the introduction of SDD in a structured protocol for VAP prevention was effective in reducing the occurrence of ventilator-associated pneumonia (VAP) in COVID-19 patients without changes in the microbiological pattern of antibiotic resistance. This observational pre-post study included adult patients requiring invasive mechanical ventilation (IMV) for severe respiratory failure related to SARS-CoV-2 admitted in three COVID-19 intensive care units (ICUs) in an Italian hospital from 22 February 2020 to 8 March 2022. Selective digestive decontamination (SDD) was introduced from the end of April 2021 in the structured protocol for VAP prevention. The SDD consisted of a tobramycin sulfate, colistin sulfate, and amphotericin B suspension applied in the patient's oropharynx and the stomach via a nasogastric tube. Three-hundred-and-forty-eight patients were included in the study. In the 86 patients (32.9%) who received SDD, the occurrence of VAP decreased by 7.7% (
    Language English
    Publishing date 2023-02-10
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12041432
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  9. Article: Case report of a patient who survived after cardiac arrest and cardiogenic shock by anaphylactic reaction to gadolinium during magnetic resonance imaging.

    Biagioni, Emanuela / Coloretti, Irene / Disalvo, Fabrizio / Andreotti, Alberto / Sani, Francesco / Torricelli, Pietro / Gelmini, Roberta / Girardis, Massimo

    Radiology case reports

    2020  Volume 15, Issue 3, Page(s) 266–268

    Abstract: We report the case of a young adult which survived to anaphylactic shock caused by gadolinium-based contrast agent (GBCA) contrast agent infusion. The patient had no comorbidities and previous history of allergic reactions to contrast agents and ... ...

    Abstract We report the case of a young adult which survived to anaphylactic shock caused by gadolinium-based contrast agent (GBCA) contrast agent infusion. The patient had no comorbidities and previous history of allergic reactions to contrast agents and underwent elective magnetic resonance imaging (MRI) for parotid swelling. Seven years before he received intravenous GBCA administration during an MRI, which exact chemical composition is unknown, without any allergic reaction. After intravenous injection of GBCA for MRI the patient developed anaphylactic shock, causing respiratory failure, cardiac arrest, and cardiogenic shock after return of spontaneous circulation. Because of the rarity of the described event, this report has the aim to raise awareness in the healthcare personnel of the possibility of these life-threatening adverse reactions from GBCAs also in a patient without history of allergy to contrast agents and suggest a possible clinical management of these patients.
    Language English
    Publishing date 2020-01-13
    Publishing country Netherlands
    Document type Case Reports
    ZDB-ID 2406300-9
    ISSN 1930-0433
    ISSN 1930-0433
    DOI 10.1016/j.radcr.2019.12.006
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  10. Article ; Online: Adjunctive therapy with vitamin c and thiamine in patients treated with steroids for refractory septic shock: A propensity matched before-after, case-control study.

    Coloretti, Irene / Biagioni, Emanuela / Venturelli, Sophie / Munari, Elena / Tosi, Martina / Roat, Erika / Brugioni, Lucio / Gelmini, Roberta / Venturelli, Claudia / Girardis, Massimo

    Journal of critical care

    2020  Volume 59, Page(s) 37–41

    Abstract: Purpose: Triple therapy with steroids, vitamin C and thiamine has been recently proposed as a safe and beneficial in patients with sepsis. In 2017, we added the use of intravenous vitamin C and thiamine in septic shock patients receiving low dose ... ...

    Abstract Purpose: Triple therapy with steroids, vitamin C and thiamine has been recently proposed as a safe and beneficial in patients with sepsis. In 2017, we added the use of intravenous vitamin C and thiamine in septic shock patients receiving low dose hydrocortisone because poorly responsive to vasopressors. Aim of this study is to verify whether triple therapy rather than steroids alone can improve outcome in patients with refractory shock.
    Materials and methods: In this before-after retrospective analysis, we compared septic shock patients admitted to our intensive care unit (ICU) who received triple therapy from June 2017 to November 2019 to septic shock patients who received only hydrocortisone from January 2015 to June 2017. Patients of the two study periods were matched 1:1 using a propensity score model.
    Results: A final cohort of 56 patients treated with triple therapy were matched to 56 patients treated only with steroids. Triple therapy reduced the length of mechanical ventilation (p = 0,01) and showed a trend in lowering the 30-day and hospital mortality compared to therapy with only hydrocortisone.
    Conclusions: Although with significant limitations, our experience indicated that triple therapy seems to provide an improvement of clinical outcomes in patients with refractory septic shock.
    MeSH term(s) Administration, Intravenous ; Adult ; Aged ; Anti-Inflammatory Agents/administration & dosage ; Ascorbic Acid/administration & dosage ; Case-Control Studies ; Drug Therapy, Combination ; Female ; Hospital Mortality ; Humans ; Hydrocortisone/administration & dosage ; Intensive Care Units ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies ; Sepsis/drug therapy ; Shock, Septic/drug therapy ; Shock, Septic/mortality ; Thiamine/administration & dosage ; Treatment Outcome ; Vasoconstrictor Agents/administration & dosage ; Vitamin B Complex/administration & dosage ; Vitamins/administration & dosage
    Chemical Substances Anti-Inflammatory Agents ; Vasoconstrictor Agents ; Vitamins ; Vitamin B Complex (12001-76-2) ; Ascorbic Acid (PQ6CK8PD0R) ; Hydrocortisone (WI4X0X7BPJ) ; Thiamine (X66NSO3N35)
    Language English
    Publishing date 2020-05-05
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 632818-0
    ISSN 1557-8615 ; 0883-9441
    ISSN (online) 1557-8615
    ISSN 0883-9441
    DOI 10.1016/j.jcrc.2020.04.014
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