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Article ; Online: The importance of identifying the direction of the association between preoperative inflammatory mediators and postoperative delirium. Comment on Br J Anaesth 2021; 127: 424-434.

Adembri, Chiara / Tofani, Lorenzo

2021 Volume 128, Issue 2, Page(s) e41–e42

MeSH term(s)	Delirium ; Humans ; Inflammation Mediators
Chemical Substances	Inflammation Mediators
Language	English
Publishing date	2021-11-06
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2021.10.005
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Article ; Online: Variations in Microcirculatory and Hemodynamic Parameters during Oncological Demolitive-Reconstructive Head and Neck Surgery: A Protocol for an Observational Study.

Adembri, Chiara / Ungar, Andrea / Cappellini, Iacopo / Romano, Salvatore Mario

Methods and protocols

2023 Volume 6, Issue 4

Abstract: 1) Background: Oncological demolitive-reconstructive surgeries in the head and neck region cause significant stress on patients' biohumoural, cardiac, and vascular systems, leading to disturbances in macrocirculatory and microcirculatory parameters. ... ...

Abstract	(1) Background: Oncological demolitive-reconstructive surgeries in the head and neck region cause significant stress on patients' biohumoural, cardiac, and vascular systems, leading to disturbances in macrocirculatory and microcirculatory parameters. Traditional monitoring addresses the symptoms, but not the underlying cause. Microcirculatory assessments complement macrocirculatory monitoring, and bladder-catheter-based technology offers a better representation of central microcirculation. Flap reconstruction surgeries involve demolitive and reconstructive phases, requiring optimal tissue perfusion. The literature lacks a consensus on macro-microcirculation coupling, and there is no agreement on the use of vasopressors during head and neck surgeries. Evidence-based guidelines are lacking, resulting in variations in vasopressor administration. (2) Methods: This is a 12-month observational, prospective study conducted in a single center. It aims to evaluate the impact of macro-microcirculation coupling on clinical complications in head and neck surgery. All consecutive patients undergoing oncologic surgery requiring flap reconstruction and meeting the inclusion criteria will be enrolled. The study will utilize standard hemodynamic monitoring and bladder catheterization for measuring urine output and temperature. (3) Conclusions: The study aims to evaluate the coupling of macro- and microcirculation in head and neck surgeries, assess hemodynamic parameters and microcirculatory changes, and investigate their association with postoperative complications. The results can enhance patient care and surgical outcomes.
Language	English
Publishing date	2023-07-21
Publishing country	Switzerland
Document type	Journal Article
ISSN	2409-9279
ISSN (online)	2409-9279
DOI	10.3390/mps6040067
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Article ; Online: The role of PK/PD-based strategies to preserve new molecules against multi-drug resistant gram-negative strains.

Adembri, Chiara / Cappellini, Iacopo / Novelli, Andrea

Journal of chemotherapy (Florence, Italy)

2020 Volume 32, Issue 5, Page(s) 219–225

Language	English
Publishing date	2020-07-06
Publishing country	England
Document type	Editorial
ZDB-ID	1036294-0
ISSN	1973-9478 ; 1120-009X
ISSN (online)	1973-9478
ISSN	1120-009X
DOI	10.1080/1120009X.2020.1786634
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Article ; Online: Anidulafungin biliary passage in liver transplant patients.

Adembri, Chiara / Nure, Erida / Tofani, Lorenzo / Agnes, Salvatore / Novelli, Andrea / Sganga, Gabriele

Transplant infectious disease : an official journal of the Transplantation Society

2022 Volume 24, Issue 4, Page(s) e13848

MeSH term(s)	Anidulafungin ; Antifungal Agents/therapeutic use ; Biliary Tract ; Echinocandins/therapeutic use ; Humans ; Liver Transplantation/adverse effects
Chemical Substances	Antifungal Agents ; Echinocandins ; Anidulafungin (9HLM53094I)
Language	English
Publishing date	2022-06-01
Publishing country	Denmark
Document type	Letter
ZDB-ID	1476094-0
ISSN	1399-3062 ; 1398-2273
ISSN (online)	1399-3062
ISSN	1398-2273
DOI	10.1111/tid.13848
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Article: Some Suggestions from PK/PD Principles to Contain Resistance in the Clinical Setting-Focus on ICU Patients and Gram-Negative Strains.

Adembri, Chiara / Novelli, Andrea / Nobili, Stefania

Antibiotics (Basel, Switzerland)

2020 Volume 9, Issue 10

Abstract: The containment of the phenomenon of resistance towards antimicrobials is a priority, especially in preserving molecules acting against Gram-negative pathogens, which represent the isolates more frequently found in the fragile population of patients ... ...

Abstract	The containment of the phenomenon of resistance towards antimicrobials is a priority, especially in preserving molecules acting against Gram-negative pathogens, which represent the isolates more frequently found in the fragile population of patients admitted to Intensive Care Units. Antimicrobial therapy aims to prevent resistance through several actions, which are collectively known as "antimicrobial stewardship", to be taken together, including the application of pharmacokinetic/pharmacodynamic (PK/PD) principles. PK/PD application has been shown to prevent the emergence of resistance in numerous experimental studies, although a straight translation to the clinical setting is not possible. Individualized antibiotic dosing and duration should be pursued in all patients, and even more especially when treating intensive care unit (ICU) septic patients in whom optimal exposure is both difficult to achieve and necessary. In this review, we report on the available data that support the application of PK/PD parameters to contain the development of resistance and we give some practical suggestions that can help to translate the benefit of PK/PD application to the bedside.
Language	English
Publishing date	2020-10-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2681345-2
ISSN	2079-6382
ISSN	2079-6382
DOI	10.3390/antibiotics9100676
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Article ; Online: A 5-year experience with midline catheters in the management of major head and neck surgery patients.

Locatello, Luca Giovanni / Saitta, Thomas / Maggiore, Giandomenico / Signorini, Patrizia / Pinelli, Fulvio / Adembri, Chiara

The journal of vascular access

2022 Volume 24, Issue 6, Page(s) 1412–1420

Abstract: Background: In the perioperative management of major head and neck surgery (HNS) patients, the performance of midline catheters (MCs) has been never tested. We present here our 5-year experience by reporting MC-related complications and by identifying ... ...

Abstract	Background: In the perioperative management of major head and neck surgery (HNS) patients, the performance of midline catheters (MCs) has been never tested. We present here our 5-year experience by reporting MC-related complications and by identifying the preoperative risk factors associated with their development. Methods: Clinical variables were extracted and the dwell time, the number, and the type of postprocedural complications of MCs were retrieved. Complications were classified into major (needing MCs removal and including catheter-related bloodstream infection or deep vein thrombosis or catheter occlusion) and into minor (accidental dislodgement, leaking, etc.). Descriptive statistics and logistic regression models were used in order to identify the predictors of complications. Results: A total of 265 patients were included, with a mean age of 67.4 years. Intraprocedural complications occurred in 1.1% of cases, while postprocedural complications occurred in 13.9% of cases (12.05/1000 days), but they were minor in more than 7.0% (5.4/1000 catheter-days). There were 19 minor complications (7.1% or 5.4/1000 catheter-days) while 18 (7%, 5.1/1000 catheter-days) patients experienced at least one major complication. Female sex (OR = 1.963, 95% CI 1.017-3.792), insertion in the right arm (OR = 2.473, 95% CI 1.150-5.318), and an ACE-27 score >1 (OR = 2.573, 95% CI 1.295-5.110) were independent predictors of major complications. Conclusions: MCs appear to represent an effective option in the setting of major HNS. The identification of patients most at risk for MC-related complications should prompt a postoperative watchful evaluation.
MeSH term(s)	Humans ; Female ; Aged ; Catheterization, Peripheral/adverse effects ; Catheters/adverse effects ; Risk Factors ; Vascular Diseases/etiology ; Device Removal/adverse effects ; Catheterization, Central Venous/adverse effects ; Catheter-Related Infections/etiology
Language	English
Publishing date	2022-04-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2252820-9
ISSN	1724-6032 ; 1129-7298
ISSN (online)	1724-6032
ISSN	1129-7298
DOI	10.1177/11297298221091141
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Article ; Online: The influence of psychological interventions on surgical outcomes: a systematic review.

Lanini, Iacopo / Amass, Timothy / Calabrisotto, Caterina Scirè / Fabbri, Sergio / Falsini, Silvia / Adembri, Chiara / Di Filippo, Alessandro / Romagnoli, Stefano / Villa, Gianluca

Journal of Anesthesia, Analgesia and Critical Care (Online)

2022 Volume 2, Issue 1, Page(s) 31

Abstract: Background: An amplified and/or prolonged surgical stress response might overcome the organs' functional reserve, thus leading to postoperative complications. The aim of this systematic literature review is to underline how specific psychological ... ...

Abstract	Background: An amplified and/or prolonged surgical stress response might overcome the organs' functional reserve, thus leading to postoperative complications. The aim of this systematic literature review is to underline how specific psychological interventions may contribute to improve surgical outcomes through the positive modulation of the surgical stress response in surgical patients. Methods: We conducted a comprehensive literature search in the Cochrane Register of Controlled Trials, PubMed, EMBASE, Scopus, PsycINFO, and CINAHL databases. Only studies published in English from Jan 2000 to Apr 2022 and reporting pain and/or anxiety among outcome measures were included in the review. The following psychological interventions were considered: (1) relaxation techniques, (2) cognitive-behavioral therapies, (3) mindfulness, (4) narrative medicine, (5) hypnosis, and (6) coping strategies. Results: Among 3167 records identified in the literature, 5 papers were considered eligible for inclusion in this review because reporting the effects that psychological features have on neurochemical signaling during perioperative metabolic adaptation and those metabolic and clinical effects that the psychological interventions had on the observed population. Conclusion: Our findings confirm that psychological interventions may contribute to improve surgical outcomes via the positive influence on patients' metabolic surgical stress response. A multidisciplinary approach integrating physical and non-physical therapies can be considered a good strategy to successfully improve surgical outcomes in the perioperative period.
Language	English
Publishing date	2022-07-09
Publishing country	England
Document type	Journal Article ; Review
ISSN	2731-3786
ISSN (online)	2731-3786
DOI	10.1186/s44158-022-00057-4
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Article ; Online: Evaluation of diaphragm thickening by diaphragm ultrasonography: a reproducibility and a repeatability study.

Cappellini, Iacopo / Picciafuochi, Fabio / Bartolucci, Maurizio / Matteini, Simona / Virgili, Gianni / Adembri, Chiara

Journal of ultrasound

2020 Volume 24, Issue 4, Page(s) 411–416

Abstract: Purpose: We have focused on the two-dimensional (B-mode) and the time-motion (M-mode) analysis of the zone of apposition to determine the reliability of diaphragm ultrasonography in the clinical environment.: Methods: Ten healthy volunteers were ... ...

Abstract	Purpose: We have focused on the two-dimensional (B-mode) and the time-motion (M-mode) analysis of the zone of apposition to determine the reliability of diaphragm ultrasonography in the clinical environment. Methods: Ten healthy volunteers were enrolled and studied by three operators with different skills in ultrasonography. For every volunteer, each operator acquired three images of the diaphragm for each side, both in B-mode and in M-mode. Then a fourth operator calculated the thickening fraction (TF), by means of the formula TF = (TEI - TEE)/TEE (TEI is the thickness at end inspiration and TEE the thickness at end expiration). Afterwards, intraclass correlation coefficients (ICCs) were computed on TF to establish reproducibility and repeatability both in the B- and M-modes. A Coefficient of Repeatability or repeatability (CR) ≤ 0.3 was considered acceptable. Results: Both B-mode (CRs 0.16-0.26) and M-mode (CRs 0.10-0.15) were sufficiently repeatable to assess TF, except for the less experienced operator (CRs B-Mode 0.20-0.32). Reproducibility was moderate to good between operators with CRs much narrower for the M-Mode (0.13-0.14). Conclusions: The results of our study have shown that diaphragm ultrasound is repeatable and reproducible when carried out by a radiologist or an intensivist with a basic curriculum in ultrasonography. The method is more accurate when using the M-mode for less experienced operators, and in this case, repeatability and reproducibility are not sufficient to make clinical decisions. No TF value lower than 36% was obtained using both techniques. This suggests the existence of a cut-off value that could be used as an initial tool to discriminate healthy subjects from those affected by diaphragmatic dysfunction. Clinical trial registration: EUDRACT 2015-004635-12.
MeSH term(s)	Diaphragm/diagnostic imaging ; Healthy Volunteers ; Humans ; Reproducibility of Results ; Ultrasonography
Language	English
Publishing date	2020-05-01
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2365426-0
ISSN	1876-7931 ; 1971-3495
ISSN (online)	1876-7931
ISSN	1971-3495
DOI	10.1007/s40477-020-00462-x
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Article ; Online: A New Solution for Routine Endoscopic Aerosol-Generating Procedures (AGPs) in the COVID-19 Pandemic.

Gallo, Oreste / Locatello, Luca Giovanni / Orlando, Pietro / Bruno, Chiara / Maggiore, Giandomenico / Signorini, Patrizia / Adembri, Chiara

The Journal of craniofacial surgery

2020 Volume 32, Issue 3, Page(s) e309–e311

Abstract: Introduction: There is urgent need to find a swift and cheap way to safely perform routine endoscopic procedures during the otolaryngological and anesthesiological practice. We want to share our experience of a novel device, inspired by the pediatric ... ...

Abstract	Introduction: There is urgent need to find a swift and cheap way to safely perform routine endoscopic procedures during the otolaryngological and anesthesiological practice. We want to share our experience of a novel device, inspired by the pediatric head box experience. Materials and methods: Five otolaryngologists and four anesthesiologists were asked to visualize the glottic plane by using the device. A total of 15 attempts was allowed to reach the vocal folds within 60 seconds after entering the box. Student's t-test for unpaired samples was used to compare groups. Results: Transnasal laryngoscopy through our endobox could be successfully performed by all the physicians involved and the mean number of attempts before visualizing and passing the glottis for the first time was 2.8 (range 1-5) in the otolaryngologists' group versus 3.2 (range 1-6) in the anesthesiologists' group (P=0.583). Out of the 15 attempts, the group of otolaryngologists reached the glottis 10.2 times, on average, against 9.7 in the other group (P=0.692). Conclusions: Our endobox seems a practical and feasible strategy to control droplets diffusion during standard ear, nose, and throat and anesthesiological practice.
MeSH term(s)	Aerosols ; COVID-19 ; Child ; Glottis ; Humans ; Laryngoscopy ; Otolaryngologists ; Pandemics ; SARS-CoV-2
Chemical Substances	Aerosols
Keywords	covid19
Language	English
Publishing date	2020-10-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1159501-2
ISSN	1536-3732 ; 1049-2275
ISSN (online)	1536-3732
ISSN	1049-2275
DOI	10.1097/SCS.0000000000007117
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Article ; Online: Risk factors for difficult Laryngeal Mask Airway LMA-Supreme™ (LMAS) placement in adults: a multicentric prospective observational study in an Italian population.

DI Filippo, Alessandro / Adembri, Chiara / Paparella, Laura / Esposito, Clelia / Tofani, Lorenzo / Perez, Ylenia / DI Giacinto, Ida / Micaglio, Massimo / Sorbello, Massimiliano

Minerva anestesiologica

2021 Volume 87, Issue 5, Page(s) 533–540

Abstract: Background: Supraglottic airway devices (SADs) are precious tools for airway management in both routine and rescue situations; few studies have analyzed the risk factors for their difficult insertion.: Methods: The aim of this study was to identify ... ...

Abstract	Background: Supraglottic airway devices (SADs) are precious tools for airway management in both routine and rescue situations; few studies have analyzed the risk factors for their difficult insertion. Methods: The aim of this study was to identify the risk factors for difficult insertion for a specific SAD, the Laryngeal Mask Airway LMA-Supreme™ (LMAS). This was a prospective multicentric observational study on a cohort of Italian adult patients receiving general anesthesia for elective surgery. The possible causes of difficulty in LMAS placement (difficulty in insertion or unsatisfactory ventilation) were identified based on literature and on the opinion of international airway management experts. A dedicated datasheet was prepared to collect patients' data, including anthropometric-parameters and parameters for the prediction of difficult airway management, as well as technical choices for the use of LMAS. Data were analyzed to discover the risk factors for difficult LMAS placement and the association between each risk factor and the proportion of incorrect positioning was evaluated through the relative risk and its confidence interval. Results: Four hundred thirty-two patients were enrolled; seventy required two or more attempts to insert the LMAS; nine required a change of strategy. At multivariate analysis, the following factors were significantly associated with difficult LMAS placement: Mallampati III-IV with either phonation or not; inter-incisor distance < 3 cm; reduced neck mobility; no administration of neuromuscular blocking agents (NMBAs). Conclusions: The alignment of the laryngeal and pharyngeal axes seems to facilitate the procedure, together with NMBA administration; on the contrary, Mallampati grade III-IV are associated with difficult LMAS placement.
MeSH term(s)	Adult ; Airway Management ; Humans ; Italy ; Laryngeal Masks ; Prospective Studies ; Risk Factors
Language	English
Publishing date	2021-02-16
Publishing country	Italy
Document type	Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.20.15001-6
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