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Article: Machine Learning and Antibiotic Management.

Maviglia, Riccardo / Michi, Teresa / Passaro, Davide / Raggi, Valeria / Bocci, Maria Grazia / Piervincenzi, Edoardo / Mercurio, Giovanna / Lucente, Monica / Murri, Rita

Antibiotics (Basel, Switzerland)

2022 Volume 11, Issue 3

Abstract: Machine learning and cluster analysis applied to the clinical setting of an intensive care unit can be a valuable aid for clinical management, especially with the increasing complexity of clinical monitoring. Providing a method to measure clinical ... ...

Abstract	Machine learning and cluster analysis applied to the clinical setting of an intensive care unit can be a valuable aid for clinical management, especially with the increasing complexity of clinical monitoring. Providing a method to measure clinical experience, a proxy for that automatic
Language	English
Publishing date	2022-02-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2681345-2
ISSN	2079-6382
ISSN	2079-6382
DOI	10.3390/antibiotics11030304
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Article: COVID-19 pandemic in the intensive care unit: Psychological implications and interventions, a systematic review.

Monti, Laura / Marconi, Elisa / Bocci, Maria Grazia / Kotzalidis, Georgios Demetrios / Mazza, Marianna / Galliani, Carolina / Tranquilli, Sara / Vento, Giovanni / Conti, Giorgio / Sani, Gabriele / Antonelli, Massimo / Chieffo, Daniela Pia Rosaria

World journal of psychiatry

2023 Volume 13, Issue 4, Page(s) 191–217

Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic produced changes in intensive care units (ICUs) in patient care and health organizations. The pandemic event increased patients' risk of developing psychological symptoms during and after ... ...

Abstract	Background: The coronavirus disease 2019 (COVID-19) pandemic produced changes in intensive care units (ICUs) in patient care and health organizations. The pandemic event increased patients' risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff; this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties. Aim: To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff. Methods: We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles, upon which we commented. Results: Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories. Conclusion: As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.
Language	English
Publishing date	2023-04-19
Publishing country	United States
Document type	Journal Article
ISSN	2220-3206
ISSN	2220-3206
DOI	10.5498/wjp.v13.i4.191
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Article ; Online: Bloodstream infections in COVID-19 patients undergoing extracorporeal membrane oxygenation in ICU: An observational cohort study.

Carelli, Simone / Dell'Anna, Antonio Maria / Montini, Luca / Bernardi, Giulia / Gozza, Mariangela / Cutuli, Salvatore Lucio / Natalini, Daniele / Bongiovanni, Filippo / Tanzarella, Eloisa Sofia / Pintaudi, Gabriele / Bocci, Maria Grazia / Bisanti, Alessandra / Bello, Giuseppe / Grieco, Domenico Luca / De Pascale, Gennaro / Antonelli, Massimo

Heart & lung : the journal of critical care

2023 Volume 62, Page(s) 193–199

Abstract: Background: COVID-19 patients undergoing ECMO are at highly increased risk of nosocomial infections.: Objectives: To study incidence, clinical outcomes and microbiological features of bloodstream infections (BSI) occurring during ECMO in COVID-19 ... ...

Abstract	Background: COVID-19 patients undergoing ECMO are at highly increased risk of nosocomial infections. Objectives: To study incidence, clinical outcomes and microbiological features of bloodstream infections (BSI) occurring during ECMO in COVID-19 patients. Methods: Observational prospective cohort study enrolling consecutive COVID-19 patients undergoing veno-venous-ECMO in an Italian ICU from March 2020 to March 2022. Results: In the study population of 68 patients (age 53 [49-60] years, 82% males), 30 (44%) developed bloodstream infections (BSI group) while 38 did not (N-BSI group) with an incidence of 32 events/1000 days of ECMO. In BSI group pre-ECMO respiratory support was shorter (6 [4-9] vs 9 [5-12] days, p = 0.02) and ECMO treatment was longer (18 [10-29] vs 11 [7-18] days, p = 0.03) than in N-BSI group. The overall ECMO and ICU mortality were 50% and 59%, respectively, without any inter-group difference (p = 1.00). A longer ECMO treatment was independently correlated with higher rate of BSI (p = 0.04, OR [95% CI] 1.06 [1.02-1.11]). Sixteen primary and 14 secondary infectious events were documented. Gram-positive pathogens were more common in primary than secondary BSI (88% vs 43%, p = 0.02) and Enterococcus faecalis (56%) was the most frequent one. Conversely, Gram-negative microorganisms were more often isolated in secondary rather than primary BSI (57% vs 13%, p = 0.02), with Acinetobacter baumannii (21%) and Pseudomonas aeruginosa (21%) as most represented species. The administration of Sars-CoV-2 antiviral drug showed independent correlation with a reduced rate of ICU mortality (p = 0.01, OR [95% CI] 0.22 [0.07-0.73]). Conclusions: Bloodstream infections represented a frequent complication without worsening clinical outcomes in our COVID-19 patients undergoing ECMO. Primary and secondary BSI events showed peculiar microbiological profiles.
Language	English
Publishing date	2023-08-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	193129-5
ISSN	1527-3288 ; 0147-9563
ISSN (online)	1527-3288
ISSN	0147-9563
DOI	10.1016/j.hrtlng.2023.07.012
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Zs.A 1035: Show issues

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Article ; Online: A novel risk score predicting 30-day hospital re-admission of patients with acute stroke by machine learning model.

Mercurio, Giovanna / Gottardelli, Benedetta / Lenkowicz, Jacopo / Patarnello, Stefano / Bellavia, Simone / Scala, Irene / Rizzo, Pierandrea / de Belvis, Antonio Giulio / Del Signore, Anna Benedetta / Maviglia, Riccardo / Bocci, Maria Grazia / Olivi, Alessandro / Franceschi, Francesco / Urbani, Andrea / Calabresi, Paolo / Valentini, Vincenzo / Antonelli, Massimo / Frisullo, Giovanni

European journal of neurology

2023 Volume 31, Issue 3, Page(s) e16153

Abstract: Background: The 30-day hospital re-admission rate is a quality measure of hospital care to monitor the efficiency of the healthcare system. The hospital re-admission of acute stroke (AS) patients is often associated with higher mortality rates, greater ... ...

Abstract	Background: The 30-day hospital re-admission rate is a quality measure of hospital care to monitor the efficiency of the healthcare system. The hospital re-admission of acute stroke (AS) patients is often associated with higher mortality rates, greater levels of disability and increased healthcare costs. The aim of our study was to identify predictors of unplanned 30-day hospital re-admissions after discharge of AS patients and define an early re-admission risk score (RRS). Methods: This observational, retrospective study was performed on AS patients who were discharged between 2014 and 2019. Early re-admission predictors were identified by machine learning models. The performances of these models were assessed by receiver operating characteristic curve analysis. Results: Of 7599 patients with AS, 3699 patients met the inclusion criteria, and 304 patients (8.22%) were re-admitted within 30 days from discharge. After identifying the predictors of early re-admission by logistic regression analysis, RRS was obtained and consisted of seven variables: hemoglobin level, atrial fibrillation, brain hemorrhage, discharge home, chronic obstructive pulmonary disease, one and more than one hospitalization in the previous year. The cohort of patients was then stratified into three risk categories: low (RRS = 0-1), medium (RRS = 2-3) and high (RRS >3) with re-admission rates of 5%, 8% and 14%, respectively. Conclusions: The identification of risk factors for early re-admission after AS and the elaboration of a score to stratify at discharge time the risk of re-admission can provide a tool for clinicians to plan a personalized follow-up and contain healthcare costs.
MeSH term(s)	Humans ; Retrospective Studies ; Risk Factors ; Stroke/epidemiology ; Stroke/therapy ; Hospitals ; Machine Learning
Language	English
Publishing date	2023-11-28
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	1280785-0
ISSN	1468-1331 ; 1351-5101 ; 1471-0552
ISSN (online)	1468-1331
ISSN	1351-5101 ; 1471-0552
DOI	10.1111/ene.16153
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Zs.A 4738: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Thromboelastography Profile Is Associated with Lung Aeration Assessed by Point-of-Care Ultrasound in COVID-19 Critically Ill Patients: An Observational Retrospective Study.

Biasucci, Daniele Guerino / Bocci, Maria Grazia / Buonsenso, Danilo / Pisapia, Luca / Consalvo, Ludovica Maria / Vargas, Joel / Grieco, Domenico Luca / De Pascale, Gennaro / Antonelli, Massimo

Healthcare (Basel, Switzerland)

2022 Volume 10, Issue 7

Abstract: Background. To evaluate relationships between lung aeration assessed by lung ultrasound (LUS) with viscoelastic profiles obtained by thromboelastography (TEG) in COVID-19 respiratory failure. Methods. Retrospective analysis in a tertiary ICU in Rome, ... ...

Abstract	Background. To evaluate relationships between lung aeration assessed by lung ultrasound (LUS) with viscoelastic profiles obtained by thromboelastography (TEG) in COVID-19 respiratory failure. Methods. Retrospective analysis in a tertiary ICU in Rome, Italy. Forty invasively ventilated adults with COVID-19 underwent LUS and TEG assessment. A simplified LUS protocol consisting in scanning six areas, three per side, was adopted. A score from 0 to 3 was assigned to each area. TEG®6s was used to obtain viscoelastic hemostatic assay parameters which were compared to LUS score. Results. There was a significant inverse correlation between LUS score and static compliance of the respiratory system (Crs, rs −0.75; p < 0.001). We found a significant association between LUS and functional fibrinogen maximum amplitude (FF-MA): among 18 patients with LUS score ≤ 12, median FF-MA was 31 mm [IQR 28−39] whilst, among 22 patients with LUS score > 12, it was 46.3 mm [IQR 40−53], p = 0.0004. Median of the citrated recalcified kaolin-activated maximum amplitude (CK-MA) was 66.1 mm [64.4−68] in the LUS score ≤ 12 group, and 69.6 [68.5−70.7] when LUS score > 12, p < 0.002. Conclusions. The hypercoagulable profile as defined by elevated FF-MA and CK-MA may be associated with a low degree of lung aeration as assessed by LUS.
Language	English
Publishing date	2022-06-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare10071168
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Article ; Online: Hemodynamic response to positive end-expiratory pressure and prone position in COVID-19 ARDS.

Dell'Anna, Antonio Maria / Carelli, Simone / Cicetti, Marta / Stella, Claudia / Bongiovanni, Filippo / Natalini, Daniele / Tanzarella, Eloisa Sofia / De Santis, Paolo / Bocci, Maria Grazia / De Pascale, Gennaro / Grieco, Domenico Luca / Antonelli, Massimo

Respiratory physiology & neurobiology

2022 Volume 298, Page(s) 103844

Abstract: Background: Use of high positive end-expiratory pressure (PEEP) and prone positioning is common in patients with COVID-19-induced acute respiratory failure. Few data clarify the hemodynamic effects of these interventions in this specific condition. We ... ...

Abstract	Background: Use of high positive end-expiratory pressure (PEEP) and prone positioning is common in patients with COVID-19-induced acute respiratory failure. Few data clarify the hemodynamic effects of these interventions in this specific condition. We performed a physiologic study to assess the hemodynamic effects of PEEP and prone position during COVID-19 respiratory failure. Methods: Nine adult patients mechanically ventilated due to COVID-19 infection and fulfilling moderate-to-severe ARDS criteria were studied. Respiratory mechanics, gas exchange, cardiac output, oxygen consumption, systemic and pulmonary pressures were recorded through pulmonary arterial catheterization at PEEP of 15 and 5 cmH Results: High PEEP improved PaO Conclusions: In patients with moderate-to-severe ARDS due to COVID-19, PEEP and prone position improve arterial oxygenation. Changes in cardiac output contribute to the effects of PEEP but not of prone position, which appears the most effective intervention to improve oxygenation with no hemodynamic side effects.
MeSH term(s)	Aged ; Aged, 80 and over ; Blood Pressure/physiology ; COVID-19/physiopathology ; COVID-19/therapy ; Female ; Heart Rate/physiology ; Hemodynamic Monitoring ; Humans ; Intensive Care Units ; Italy ; Male ; Middle Aged ; Outcome and Process Assessment, Health Care ; Oxygen Consumption/physiology ; Positive-Pressure Respiration ; Prone Position/physiology ; Vascular Resistance/physiology
Language	English
Publishing date	2022-01-14
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2077867-3
ISSN	1878-1519 ; 1569-9048
ISSN (online)	1878-1519
ISSN	1569-9048
DOI	10.1016/j.resp.2022.103844
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Zs.A 519: Show issues

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Article ; Online: Diaphragm thickening fraction predicts noninvasive ventilation outcome: a preliminary physiological study.

Mercurio, Giovanna / D'Arrigo, Sonia / Moroni, Rossana / Grieco, Domenico Luca / Menga, Luca Salvatore / Romano, Anna / Annetta, Maria Giuseppina / Bocci, Maria Grazia / Eleuteri, Davide / Bello, Giuseppe / Montini, Luca / Pennisi, Mariano Alberto / Conti, Giorgio / Antonelli, Massimo

Critical care (London, England)

2021 Volume 25, Issue 1, Page(s) 219

Abstract: Background: A correlation between unsuccessful noninvasive ventilation (NIV) and poor outcome has been suggested in de-novo Acute Respiratory Failure (ARF) patients. Consequently, it is of paramount importance to identify accurate predictors of NIV ... ...

Abstract	Background: A correlation between unsuccessful noninvasive ventilation (NIV) and poor outcome has been suggested in de-novo Acute Respiratory Failure (ARF) patients. Consequently, it is of paramount importance to identify accurate predictors of NIV outcome. The aim of our preliminary study is to evaluate the Diaphragmatic Thickening Fraction (DTF) and the respiratory rate/DTF ratio as predictors of NIV outcome in de-novo ARF patients. Methods: Over 36 months, we studied patients admitted to the emergency department with a diagnosis of de-novo ARF and requiring NIV treatment. DTF and respiratory rate/DTF ratio were measured by 2 trained operators at baseline, at 1, 4, 12, 24, 48, 72 and 96 h of NIV treatment and/or until NIV discontinuation or intubation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of DTF and respiratory rate/DTF ratio to distinguish between patients who were successfully weaned and those who failed. Results: Eighteen patients were included. We found overall good repeatability of DTF assessment, with Intra-class Correlation Coefficient (ICC) of 0.82 (95% confidence interval 0.72-0.88). The cut-off values of DTF for prediction of NIV failure were < 36.3% and < 37.1% for the operator 1 and 2 (p < 0.0001), respectively. The cut-off value of respiratory rate/DTF ratio for prediction of NIV failure was > 0.6 for both operators (p < 0.0001). Conclusion: DTF and respiratory rate/DTF ratio may both represent valid, feasible and noninvasive tools to predict NIV outcome in patients with de-novo ARF. Trial registration ClinicalTrials.gov Identifier: NCT02976233, registered 26 November 2016.
MeSH term(s)	Aged ; Aged, 80 and over ; Diaphragm/anatomy & histology ; Diaphragm/diagnostic imaging ; Female ; Humans ; Intensive Care Units/organization & administration ; Intensive Care Units/statistics & numerical data ; Italy/epidemiology ; Male ; Middle Aged ; Noninvasive Ventilation/methods ; Noninvasive Ventilation/standards ; Outcome Assessment, Health Care/methods ; Outcome Assessment, Health Care/statistics & numerical data ; Respiratory Distress Syndrome/epidemiology ; Respiratory Distress Syndrome/physiopathology ; Respiratory Distress Syndrome/therapy
Language	English
Publishing date	2021-06-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-021-03638-x
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Article: Predictors of Mortality and Orotracheal Intubation in Patients with Pulmonary Barotrauma Due to COVID-19: An Italian Multicenter Observational Study during Two Years of the Pandemic.

Tetaj, Nardi / De Pascale, Gennaro / Antonelli, Massimo / Vargas, Joel / Savino, Martina / Pugliese, Francesco / Alessandri, Francesco / Giordano, Giovanni / Tozzi, Pierfrancesco / Rocco, Monica / Biava, Anna Maria / Maggi, Luigi / Pisapia, Raffaella / Fusco, Francesco Maria / Stazi, Giulia Valeria / Garotto, Gabriele / Marini, Maria Cristina / Piselli, Pierluca / Beccacece, Alessia /

Mariano, Andrea / Giancola, Maria Letizia / Ianniello, Stefania / Vaia, Francesco / Girardi, Enrico / Antinori, Andrea / Bocci, Maria Grazia / Marchioni, Luisa / Nicastri, Emanuele

Journal of clinical medicine

2024 Volume 13, Issue 6

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2024-03-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13061707
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Article ; Online: We need to better recognise and value the contribution of nurses to end-of-life care (Bloomer, ICCN 2022).

Benbenishty, Julie / Ganz, Freda DeKeyser / Anstey, Matthew H / Barbosa-Camacho, Francisco Jose / Bocci, Maria Grazia / Çizmeci, Elif Ayşe / Dybwik, Knut / Ingels, Catherine / Lautrette, Alexandre / Miranda-Ackerman, Roberto Carlos / Estebanez-Montiel, Belén / Plowright, Catherine / Ricou, Bara / Robertsen, Annette / Sprung, Charles L

Intensive & critical care nursing

2022 Volume 70, Page(s) 103225

MeSH term(s)	Humans ; Nurses ; Terminal Care
Language	English
Publishing date	2022-02-23
Publishing country	Netherlands
Document type	Letter ; Comment
ZDB-ID	1105892-4
ISSN	1532-4036 ; 0964-3397
ISSN (online)	1532-4036
ISSN	0964-3397
DOI	10.1016/j.iccn.2022.103225
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Zs.B 2818: Show issues

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Article: Long-term outcome of COVID-19 patients treated with helmet noninvasive ventilation vs. high-flow nasal oxygen: a randomized trial.

Michi, Teresa / Mattana, Chiara / Menga, Luca S / Bocci, Maria Grazia / Cesarano, Melania / Rosà, Tommaso / Gualano, Maria Rosaria / Montomoli, Jonathan / Spadaro, Savino / Tosato, Matteo / Rota, Elisabetta / Landi, Francesco / Cutuli, Salvatore L / Tanzarella, Eloisa S / Pintaudi, Gabriele / Piervincenzi, Edoardo / Bello, Giuseppe / Tonetti, Tommaso / Rucci, Paola /

De Pascale, Gennaro / Maggiore, Salvatore M / Grieco, Domenico Luca / Conti, Giorgio / Antonelli, Massimo

Journal of intensive care

2023 Volume 11, Issue 1, Page(s) 21

Abstract: Background: Long-term outcomes of patients treated with helmet noninvasive ventilation (NIV) are unknown: safety concerns regarding the risk of patient self-inflicted lung injury and delayed intubation exist when NIV is applied in hypoxemic patients. We ...

Abstract	Background: Long-term outcomes of patients treated with helmet noninvasive ventilation (NIV) are unknown: safety concerns regarding the risk of patient self-inflicted lung injury and delayed intubation exist when NIV is applied in hypoxemic patients. We assessed the 6-month outcome of patients who received helmet NIV or high-flow nasal oxygen for COVID-19 hypoxemic respiratory failure. Methods: In this prespecified analysis of a randomized trial of helmet NIV versus high-flow nasal oxygen (HENIVOT), clinical status, physical performance (6-min-walking-test and 30-s chair stand test), respiratory function and quality of life (EuroQoL five dimensions five levels questionnaire, EuroQoL VAS, SF36 and Post-Traumatic Stress Disorder Checklist for the DSM) were evaluated 6 months after the enrollment. Results: Among 80 patients who were alive, 71 (89%) completed the follow-up: 35 had received helmet NIV, 36 high-flow oxygen. There was no inter-group difference in any item concerning vital signs (N = 4), physical performance (N = 18), respiratory function (N = 27), quality of life (N = 21) and laboratory tests (N = 15). Arthralgia was significantly lower in the helmet group (16% vs. 55%, p = 0.002). Fifty-two percent of patients in helmet group vs. 63% of patients in high-flow group had diffusing capacity of the lungs for carbon monoxide < 80% of predicted (p = 0.44); 13% vs. 22% had forced vital capacity < 80% of predicted (p = 0.51). Both groups reported similar degree of pain (p = 0.81) and anxiety (p = 0.81) at the EQ-5D-5L test; the EQ-VAS score was similar in the two groups (p = 0.27). Compared to patients who successfully avoided invasive mechanical ventilation (54/71, 76%), intubated patients (17/71, 24%) had significantly worse pulmonary function (median diffusing capacity of the lungs for carbon monoxide 66% [Interquartile range: 47-77] of predicted vs. 80% [71-88], p = 0.005) and decreased quality of life (EQ-VAS: 70 [53-70] vs. 80 [70-83], p = 0.01). Conclusions: In patients with COVID-19 hypoxemic respiratory failure, treatment with helmet NIV or high-flow oxygen yielded similar quality of life and functional outcome at 6 months. The need for invasive mechanical ventilation was associated with worse outcomes. These data indicate that helmet NIV, as applied in the HENIVOT trial, can be safely used in hypoxemic patients. Trial registration Registered on clinicaltrials.gov NCT04502576 on August 6, 2020.
Language	English
Publishing date	2023-05-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2739853-5
ISSN	2052-0492
ISSN	2052-0492
DOI	10.1186/s40560-023-00669-0
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