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  1. AU="Castelli, Antonio"
  2. AU="Yoon, Jong Hyun"
  3. AU="Ningaraj, Nagendra S"
  4. AU="Deegan, Patrick"
  5. AU="Jo, Doo Sin"
  6. AU="Adgey, A J"
  7. AU=Liu Hejun
  8. AU="Ferreira, Filipa C"
  9. AU="Losurdo, G"
  10. AU="Dorjsuren, Bilguujin"
  11. AU="Kilgore, Henry R"
  12. AU="Magee, Toni"
  13. AU="Jiang Gui"

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  1. Artikel ; Online: Awake pronation with helmet CPAP in early COVID-19 ARDS patients: effects on respiratory effort and distribution of ventilation assessed by EIT.

    Fossali, Tommaso / Locatelli, Martina / Colombo, Riccardo / Veronese, Alice / Borghi, Beatrice / Ballone, Elisabetta / Castelli, Antonio / Rech, Roberto / Catena, Emanuele / Ottolina, Davide

    Internal and emergency medicine

    2024  

    Abstract: Prone positioning with continuous positive airway pressure (CPAP) is widely used for respiratory support in awake patients with COVID-19-associated acute respiratory failure. We aimed to assess the respiratory mechanics and distribution of ventilation in ...

    Abstract Prone positioning with continuous positive airway pressure (CPAP) is widely used for respiratory support in awake patients with COVID-19-associated acute respiratory failure. We aimed to assess the respiratory mechanics and distribution of ventilation in COVID-19-associated ARDS treated by CPAP in awake prone position. We studied 16 awake COVID-19 patients with moderate-to-severe ARDS. The study protocol consisted of a randomized sequence of supine and prone position with imposed positive end-expiratory pressure (PEEP) of 5 and 10 cmH
    Sprache Englisch
    Erscheinungsdatum 2024-03-26
    Erscheinungsland Italy
    Dokumenttyp Journal Article
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-024-03572-0
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  2. Artikel ; Online: Cardiorespiratory coupling in mechanically ventilated patients studied via synchrogram analysis.

    Ottolina, Davide / Cairo, Beatrice / Fossali, Tommaso / Mazzucco, Claudio / Castelli, Antonio / Rech, Roberto / Catena, Emanuele / Porta, Alberto / Colombo, Riccardo

    Medical & biological engineering & computing

    2023  Band 61, Heft 6, Seite(n) 1329–1341

    Abstract: Respiration and cardiac activity are strictly interconnected with reciprocal influences. They act as weakly coupled oscillators showing varying degrees of phase synchronization and their interactions are affected by mechanical ventilation. The study aims ...

    Abstract Respiration and cardiac activity are strictly interconnected with reciprocal influences. They act as weakly coupled oscillators showing varying degrees of phase synchronization and their interactions are affected by mechanical ventilation. The study aims at differentiating the impact of three ventilatory modes on the cardiorespiratory phase coupling in critically ill patients. The coupling between respiration and heartbeat was studied through cardiorespiratory phase synchronization analysis carried out via synchrogram during pressure control ventilation (PCV), pressure support ventilation (PSV), and neurally adjusted ventilatory assist (NAVA) in critically ill patients. Twenty patients were studied under all the three ventilatory modes. Cardiorespiratory phase synchronization changed significantly across ventilatory modes. The highest synchronization degree was found during PCV session, while the lowest one with NAVA. The percentage of all epochs featuring synchronization regardless of the phase locking ratio was higher with PCV (median: 33.9%, first-third quartile: 21.3-39.3) than PSV (median: 15.7%; first-third quartile: 10.9-27.8) and NAVA (median: 3.7%; first-third quartile: 3.3-19.2). PCV induces a significant amount of cardiorespiratory phase synchronization in critically ill mechanically ventilated patients. Synchronization induced by patient-driven ventilatory modes was weaker, reaching the minimum with NAVA. Findings can be explained as a result of the more regular and powerful solicitation of the cardiorespiratory system induced by PCV. The degree of phase synchronization between cardiac and respiratory activities in mechanically ventilated humans depends on the ventilatory mode.
    Mesh-Begriff(e) Humans ; Respiration, Artificial ; Critical Illness/therapy ; Positive-Pressure Respiration ; Interactive Ventilatory Support ; Heart
    Sprache Englisch
    Erscheinungsdatum 2023-01-26
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 282327-5
    ISSN 1741-0444 ; 0025-696X ; 0140-0118
    ISSN (online) 1741-0444
    ISSN 0025-696X ; 0140-0118
    DOI 10.1007/s11517-023-02784-4
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  3. Artikel ; Online: The efficacy of venous-arterial membrane oxygenation for emergency extracorporeal life support: results from a single-center large series over 6 years.

    Ottolina, Davide / Colombo, Riccardo / Fossali, Tommaso / Castelli, Antonio / Rech, Roberto / Borghi, Beatrice / Ballone, Elisabetta / Catena, Emanuele

    Internal and emergency medicine

    2023  Band 18, Heft 3, Seite(n) 897–906

    Abstract: The efficacy of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in supporting cardio-pulmonary resuscitation for cardiac arrest is still debated. This study aimed to evaluate the outcome of patients treated with VA-ECMO positioned according ...

    Abstract The efficacy of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in supporting cardio-pulmonary resuscitation for cardiac arrest is still debated. This study aimed to evaluate the outcome of patients treated with VA-ECMO positioned according to different clinical indications. The method is retrospective data analysis from patients admitted to a tertiary referral center for VA-ECMO in 6 years. The study population was divided into three groups based on the VA-ECMO indication: patients with refractory cardiac arrest (CA group), cardiogenic shock after return of spontaneous circulation (CS-ROSC group), and cardiogenic shock without cardiac arrest (CS group). Seventy-nine patients underwent emergency VA-ECMO, 49 patients (62.0%) were in the CA group, 14 (17.7%) in the CS-ROSC group, and 16 patients (20.3%) in the CS group. The overall survival at 28 days was different between the three groups (6.1% in the CA group, 64.2% in the CS-ROSC group, and 50.0% in the CS group, p < 0.001) and remained significant at 12 months (p < 0.001). Furthermore, the Cerebral Performance Category at 12 months differed between groups with good outcomes in 4.1% of patients in CA, 50.0% in CS-ROSC, and 31.2% in CS groups (p < 0.001). In the studied population, emergency VA-ECMO had negligible efficacy in refractory cardiac arrest, while it was correlated with a good outcome in cardiogenic shock after cardiac arrest, such as in cardiogenic shock alone. Patients with ROSC appear to benefit from VA-ECMO in the setting of persistent shock at rates comparable to cardiogenic shock patients who never sustained cardiac arrest.
    Mesh-Begriff(e) Humans ; Shock, Cardiogenic/therapy ; Retrospective Studies ; Heart Arrest/therapy ; Cardiopulmonary Resuscitation/methods ; Extracorporeal Membrane Oxygenation
    Sprache Englisch
    Erscheinungsdatum 2023-03-24
    Erscheinungsland Italy
    Dokumenttyp Journal Article
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-023-03198-8
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  4. Artikel ; Online: First imported case of Candida auris infection in Milan, Italy: genomic characterisation.

    Rimoldi, Sara Giordana / Nodari, Riccardo / Rizzo, Alberto / Tamoni, Alessandro / Longobardi, Concetta / Pagani, Cristina / Grosso, Silvia / Salari, Federica / Galimberti, Laura / Olivieri, Pietro / Rizzardini, Giuliano / Catena, Emanuele / Antinori, Spinello / Comandatore, Francesco / Castelli, Antonio / Gismondo, Maria Rita

    Infection

    2024  

    Abstract: Purpose: Candida auris, an emerging multidrug-resistant yeast, has been reported worldwide. In Italy, the first case was reported in 2019. We describe the first case of C. auris, imported from Greece, in Milan, using whole genome sequencing to ... ...

    Abstract Purpose: Candida auris, an emerging multidrug-resistant yeast, has been reported worldwide. In Italy, the first case was reported in 2019. We describe the first case of C. auris, imported from Greece, in Milan, using whole genome sequencing to characterise mutations associated with antifungal resistance.
    Case presentation: On October 2022 an 80-year-old Italian man was hospitalised in Greece. In the absence of clinical improvement, the patient was transferred to our hospital, in Italy, where blood culture resulted positive for C. auris. Despite therapy, the patient died of septic shock. In a phylogenetic analysis the genome was assigned to Clade I with strains from Kenya, United Arab Emirates and India. D1/D2 region resulted identical to a Greek strain, as for many other strains from different World regions, highlighting the diffusion of this strain.
    Conclusion: Importation of C. auris from abroad has been previously described. We report the first case of C. auris imported into Italy from Greece, according to phylogenetic analysis. This case reinforces the need for monitoring critically ill hospitalised patients also for fungi and addresses the need for the standardisation of susceptibility testing and strategies for diagnosis and therapy.
    Sprache Englisch
    Erscheinungsdatum 2024-04-01
    Erscheinungsland Germany
    Dokumenttyp Journal Article
    ZDB-ID 185104-4
    ISSN 1439-0973 ; 0300-8126 ; 0173-2129
    ISSN (online) 1439-0973
    ISSN 0300-8126 ; 0173-2129
    DOI 10.1007/s15010-024-02232-x
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  5. Artikel ; Online: Autonomic biomarkers of shock in idiopathic systemic capillary leak syndrome.

    Wu, Maddalena Alessandra / Catena, Emanuele / Castelli, Antonio / Rech, Roberto / Borghi, Beatrice / Ottolina, Davide / Fossali, Tommaso / Cogliati, Chiara / Colombo, Riccardo

    PloS one

    2021  Band 16, Heft 6, Seite(n) e0251775

    Abstract: Objective: The term Idiopathic Systemic Capillary Leak Syndrome (ISCLS) refers to an uncommon condition of severe distributive shock, resulting from an abrupt shift of fluids and proteins from the intravascular to the interstitial compartment. We ... ...

    Abstract Objective: The term Idiopathic Systemic Capillary Leak Syndrome (ISCLS) refers to an uncommon condition of severe distributive shock, resulting from an abrupt shift of fluids and proteins from the intravascular to the interstitial compartment. We hypothesise that the autonomic nervous system (ANS) fails in regulating the response to hypovolemia in acute ISCLS and that ANS variables characterise the progression to the recovery.
    Design: Prospective cohort study of patients admitted to ICU for severe ISCLS flares.
    Setting: Single, referral center in Italy for ISCLS.
    Patients: Analysis of cardiovascular signals recorded during seven severe ISCLS attacks and one prodromal period in five patients.
    Interventions: ANS was studied non-invasively by means of heart rate variability (HRV) and blood pressure variability analysis, as an estimation of vagal and sympathetic modulation directed to the heart and vessels. Heart rate and systolic arterial pressure (SAP) variability were also used to assess baroreflex sensitivity. ANS variables were measured during the subsequent phases which characterise ISCLS flares, namely the acute phase, the post-acute phase, and the recovery phase.
    Measurements and main results: HRV was severely depressed during the acute phase accounting for the loss of ANS modulation during massive capillary extravasation. This phase was characterised by shock and impaired baroreflex control, which allowed SAP to oscillate driven by respiratory activity. Impending shock and transition from shock to a post-acute phase were marked by change of baroreflex spectral variables. The baroreflex control was fully restored during recovery.
    Conclusions: ANS modulation and baroreflex control are severely impaired during the acute haemodynamic instability which characterises ISCLS crises and their progressive restoration may be a clue of improvement. ANS indices during ISCLS flares might serve as useful biomarkers, able to timely announce the transition from one phase to the subsequent one, thus helping to adapt therapy accordingly.
    Mesh-Begriff(e) Adult ; Autonomic Nervous System/physiopathology ; Biomarkers/metabolism ; Blood Pressure ; Capillary Leak Syndrome/physiopathology ; Female ; Heart Rate ; Humans ; Male ; Middle Aged
    Chemische Substanzen Biomarkers
    Sprache Englisch
    Erscheinungsdatum 2021-06-01
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0251775
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  6. Artikel ; Online: Effects of Prone Position on Lung Recruitment and Ventilation-Perfusion Matching in Patients With COVID-19 Acute Respiratory Distress Syndrome: A Combined CT Scan/Electrical Impedance Tomography Study.

    Fossali, Tommaso / Pavlovsky, Bertrand / Ottolina, Davide / Colombo, Riccardo / Basile, Maria Cristina / Castelli, Antonio / Rech, Roberto / Borghi, Beatrice / Ianniello, Andrea / Flor, Nicola / Spinelli, Elena / Catena, Emanuele / Mauri, Tommaso

    Critical care medicine

    2022  Band 50, Heft 5, Seite(n) 723–732

    Abstract: Objectives: Prone positioning allows to improve oxygenation and decrease mortality rate in COVID-19-associated acute respiratory distress syndrome (C-ARDS). However, the mechanisms leading to these effects are not fully understood. The aim of this study ...

    Abstract Objectives: Prone positioning allows to improve oxygenation and decrease mortality rate in COVID-19-associated acute respiratory distress syndrome (C-ARDS). However, the mechanisms leading to these effects are not fully understood. The aim of this study is to assess the physiologic effects of pronation by the means of CT scan and electrical impedance tomography (EIT).
    Design: Experimental, physiologic study.
    Setting: Patients were enrolled from October 2020 to March 2021 in an Italian dedicated COVID-19 ICU.
    Patients: Twenty-one intubated patients with moderate or severe C-ARDS.
    Interventions: First, patients were transported to the CT scan facility, and image acquisition was performed in prone, then supine position. Back to the ICU, gas exchange, respiratory mechanics, and ventilation and perfusion EIT-based analysis were provided toward the end of two 30 minutes steps (e.g., in supine, then prone position).
    Measurements and main results: Prone position induced recruitment in the dorsal part of the lungs (12.5% ± 8.0%; p < 0.001 from baseline) and derecruitment in the ventral regions (-6.9% ± 5.2%; p < 0.001). These changes led to a global increase in recruitment (6.0% ± 6.7%; p < 0.001). Respiratory system compliance did not change with prone position (45 ± 15 vs 45 ± 18 mL/cm H2O in supine and prone position, respectively; p = 0.957) suggesting a decrease in atelectrauma. This hypothesis was supported by the decrease of a time-impedance curve concavity index designed as a surrogate for atelectrauma (1.41 ± 0.16 vs 1.30 ± 0.16; p = 0.001). Dead space measured by EIT was reduced in the ventral regions of the lungs, and the dead-space/shunt ratio decreased significantly (5.1 [2.3-23.4] vs 4.3 [0.7-6.8]; p = 0.035), showing an improvement in ventilation-perfusion matching.
    Conclusions: Several changes are associated with prone position in C-ARDS: increased lung recruitment, decreased atelectrauma, and improved ventilation-perfusion matching. These physiologic effects may be associated with more protective ventilation.
    Mesh-Begriff(e) COVID-19 ; Electric Impedance ; Humans ; Lung/diagnostic imaging ; Perfusion ; Positive-Pressure Respiration/methods ; Prone Position ; Respiratory Distress Syndrome/diagnostic imaging ; Respiratory Distress Syndrome/therapy ; Tomography, X-Ray Computed
    Sprache Englisch
    Erscheinungsdatum 2022-04-11
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005450
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  7. Artikel ; Online: The effects of severe hemoconcentration on acid-base equilibrium in critically ill patients: the forgotten role of buffers in whole blood.

    Colombo, Riccardo / Wu, Maddalena Alessandra / Castelli, Antonio / Fossali, Tommaso / Rech, Roberto / Ottolina, Davide / Cogliati, Chiara / Catena, Emanuele

    Journal of critical care

    2020  Band 57, Seite(n) 177–184

    Abstract: Purpose: Idiopathic Systemic Capillary Leak Syndrome (ISCLS) is a paroxysmal permeability disorder characterized by abrupt onset of shock and hemoconcentration due to massive shift of fluids and proteins from the intravascular to the interstitial ... ...

    Abstract Purpose: Idiopathic Systemic Capillary Leak Syndrome (ISCLS) is a paroxysmal permeability disorder characterized by abrupt onset of shock and hemoconcentration due to massive shift of fluids and proteins from the intravascular to the interstitial compartment. We hypothesize that increased hemoglobin concentration has a pivotal role in the acid-base imbalance during life-threatening crises.
    Materials and methods: Analysis of the acid-base balance fluctuations during six severe ISCLS flares admitted to ICU of a referral center for ISCLS.
    Results: Acid-base equilibrium was assessed for plasma and the whole blood by single and multicompartmental models. The acute phase of ISCLS was characterized by shock, hypoalbuminemia, severe hemoconcentration, and acidosis. The physical-chemical approach for plasma found a remarkable component of unmeasured anions (SIG) during the acute phase. After correction of the physical-chemical model for the whole blood, the SIG variations disappeared because the buffer role of hemoglobin was relevant.
    Conclusion: Hemoglobin has a remarkable role in buffering metabolic acidosis during the shock phase of ISCLS. In these circumstances, the assessment of acid-base equilibrium in plasma alone may overestimate unmeasured anions. On the contrary, the physical-chemical model corrected for whole blood better explains the metabolic component of acid-base imbalance when marked shift of hemoglobin concentration occurs.
    Mesh-Begriff(e) Acid-Base Equilibrium ; Acid-Base Imbalance/blood ; Acidosis/therapy ; Arterial Pressure ; Buffers ; Capillary Leak Syndrome/blood ; Capillary Leak Syndrome/diagnosis ; Critical Illness ; Hematocrit ; Hemoglobins/analysis ; Humans ; Hypoalbuminemia/complications ; Ions ; Male ; Plasma ; Retrospective Studies ; Shock/therapy
    Chemische Substanzen Buffers ; Hemoglobins ; Ions
    Sprache Englisch
    Erscheinungsdatum 2020-03-04
    Erscheinungsland United States
    Dokumenttyp Journal Article ; Observational Study
    ZDB-ID 632818-0
    ISSN 1557-8615 ; 0883-9441
    ISSN (online) 1557-8615
    ISSN 0883-9441
    DOI 10.1016/j.jcrc.2020.02.016
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  8. Artikel ; Online: Lung histopathologic clusters in severe COVID-19: a link between clinical picture and tissue damage.

    Wu, Maddalena Alessandra / Lopez, Gianluca / Nebuloni, Manuela / Ottolina, Davide / Montomoli, Jonathan / Carsana, Luca / Fossali, Tommaso / Castelli, Antonio / Rech, Roberto / Cogliati, Chiara / Catena, Emanuele / Colombo, Riccardo

    Critical care (London, England)

    2021  Band 25, Heft 1, Seite(n) 423

    Abstract: Background: Autoptic pulmonary findings have been described in severe COVID-19 patients, but evidence regarding the correlation between clinical picture and lung histopathologic patterns is still weak.: Methods: This was a retrospective cohort ... ...

    Abstract Background: Autoptic pulmonary findings have been described in severe COVID-19 patients, but evidence regarding the correlation between clinical picture and lung histopathologic patterns is still weak.
    Methods: This was a retrospective cohort observational study conducted at the referral center for infectious diseases in northern Italy. Full lung autoptic findings and clinical data of patients who died from COVID-19 were analyzed. Lung histopathologic patterns were scored according to the extent of tissue damage. To consider coexisting histopathologic patterns, hierarchical clustering of histopathologic findings was applied.
    Results: Whole pulmonary examination was available in 75 out of 92 full autopsies. Forty-eight hospitalized patients (64%), 44 from ICU and four from the medical ward, had complete clinical data. The histopathologic patterns had a time-dependent distribution with considerable overlap among patterns. Duration of positive-pressure ventilation (p < 0.0001), mean positive end-expiratory pressure (PEEP) (p = 0.007), worst serum albumin (p = 0.017), interleukin 6 (p = 0.047), and kidney SOFA (p = 0.001) differed among histopathologic clusters. The amount of PEEP for long-lasting ventilatory treatment was associated with the cluster showing the largest areas of early and late proliferative diffuse alveolar damage. No pharmacologic interventions or comorbidities affected the lung histopathology.
    Conclusions: Our study draws a comprehensive link between the clinical and pulmonary histopathologic findings in a large cohort of COVID-19 patients. These results highlight that the positive end-expiratory pressures and the duration of the ventilatory treatment correlate with lung histopathologic patterns, providing new clues to the knowledge of the pathophysiology of severe SARS-CoV-2 pneumonia.
    Mesh-Begriff(e) Autopsy ; COVID-19 ; Humans ; Lung/pathology ; Patient Acuity ; Retrospective Studies
    Sprache Englisch
    Erscheinungsdatum 2021-12-13
    Erscheinungsland England
    Dokumenttyp Journal Article ; Observational Study
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/s13054-021-03846-5
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  9. Artikel ; Online: Tuscany consensus for the treatment of moderate-severe psoriasis: update and focus on practical guidelines for place in therapy of anti-IL-17 and anti-IL-23 biologics.

    Prignano, Francesca / Pescitelli, Leonardo / Trovato, Emanuele / DI Cesare, Antonella / Cuccia, Aldo / Mazzatenta, Carlo / Pellegrino, Michele / Marsili, Franco / Castelli, Antonio / Brandini, Luca / Niccoli, Maria C / Taviti, Franca / Ricceri, Federica / Panduri, Salvatore / Buggiani, Gionata / Ghilardi, Alberto / Rubegni, Pietro / Romanelli, Marco / Pimpinelli, Nicola

    Italian journal of dermatology and venereology

    2022  Band 157, Heft 6, Seite(n) 469–479

    Abstract: Psoriasis is a common chronic skin disease characterized by a worldwide distribution and a natural tendency towards progression. According to the many clinical forms, the extension of the disease and the many comorbidities, almost the 20% of the patients ...

    Abstract Psoriasis is a common chronic skin disease characterized by a worldwide distribution and a natural tendency towards progression. According to the many clinical forms, the extension of the disease and the many comorbidities, almost the 20% of the patients require a systemic treatment. Biologics have greatly changed the ongoing of psoriasis and the quality of life of psoriasis patients. After the anti-TNF-alpha, which were the first biologics in use for psoriasis, the improvement in knowledge of the pathogenetic mechanisms underlying the disease has led to the development of a series of more specific therapies for psoriasis. This "second generation" of biologics includes the interleukin (IL)-12/23 inhibitor ustekinumab, IL-17 inhibitors (secukinumab and ixekizumab), the IL-17 receptor A (IL-17RA) antagonist brodalumab, and the IL-23 inhibitors guselkumab, risankizumab and tildrakizumab. This study represents an update of the Tuscany consensus focused on the use of new drugs, such as anti-IL-17 and anti-IL-23 in moderate-to-severe psoriasis and their correct place in therapy according to specific clinical requests and in full respect of the current financial restrictions.
    Mesh-Begriff(e) Humans ; Biological Factors/therapeutic use ; Biological Products/therapeutic use ; Consensus ; Interleukin-23/therapeutic use ; Psoriasis/drug therapy ; Quality of Life ; Tumor Necrosis Factor Inhibitors/therapeutic use ; Interleukin-17/immunology
    Chemische Substanzen Biological Factors ; Biological Products ; Interleukin-23 ; Tumor Necrosis Factor Inhibitors ; Interleukin-17
    Sprache Englisch
    Erscheinungsdatum 2022-07-05
    Erscheinungsland Italy
    Dokumenttyp Journal Article
    ZDB-ID 3065415-4
    ISSN 2784-8450
    ISSN (online) 2784-8450
    DOI 10.23736/S2784-8671.22.07355-8
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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  10. Artikel ; Online: Acute kidney injury (AKI) in patients with Covid-19 infection is associated with ventilatory management with elevated positive end-expiratory pressure (PEEP).

    Ottolina, Davide / Zazzeron, Luca / Trevisi, Letizia / Agarossi, Andrea / Colombo, Riccardo / Fossali, Tommaso / Passeri, Mattia / Borghi, Beatrice / Ballone, Elisabetta / Rech, Roberto / Castelli, Antonio / Catena, Emanuele / Nebuloni, Manuela / Gallieni, Maurizio

    Journal of nephrology

    2021  Band 35, Heft 1, Seite(n) 99–111

    Abstract: Background: Acute kidney injury (AKI) in Covid-19 patients admitted to the intensive care unit (ICU) is common, and its severity may be associated with unfavorable outcomes. Severe Covid-19 fulfills the diagnostic criteria for acute respiratory distress ...

    Abstract Background: Acute kidney injury (AKI) in Covid-19 patients admitted to the intensive care unit (ICU) is common, and its severity may be associated with unfavorable outcomes. Severe Covid-19 fulfills the diagnostic criteria for acute respiratory distress syndrome (ARDS); however, it is unclear whether there is any relationship between ventilatory management and AKI development in Covid-19 ICU patients.
    Purpose: To describe the clinical course and outcomes of Covid-19 ICU patients, focusing on ventilatory management and factors associated with AKI development.
    Methods: Single-center, retrospective observational study, which assessed AKI incidence in Covid-19 ICU patients divided by positive end expiratory pressure (PEEP) tertiles, with median levels of 9.6 (low), 12.0 (medium), and 14.7 cmH
    Results: Overall mortality was 51.5%. AKI (KDIGO stage 2 or 3) occurred in 38% of 101 patients. Among the AKI patients, 19 (53%) required continuous renal replacement therapy (CRRT). In AKI patients, mortality was significantly higher versus non-AKI (81% vs. 33%, p < 0.0001). The incidence of AKI in low-, medium-, or high-PEEP patients were 16%, 38%, and 59%, respectively (p = 0.002). In a multivariate analysis, high-PEEP patients showed a higher risk of developing AKI than low-PEEP patients (OR = 4.96 [1.1-21.9] 95% CI p < 0.05). ICU mortality rate was higher in high-PEEP patients, compared to medium-PEEP or low-PEEP patients (69% vs. 44% and 42%, respectively; p = 0.057).
    Conclusion: The use of high PEEP in Covid-19 ICU patients is associated with a fivefold higher risk of AKI, leading to higher mortality. The cause and effect relationship needs further analysis.
    Mesh-Begriff(e) Acute Kidney Injury/diagnosis ; Acute Kidney Injury/epidemiology ; Acute Kidney Injury/therapy ; COVID-19 ; Humans ; Intensive Care Units ; Positive-Pressure Respiration/adverse effects ; SARS-CoV-2
    Sprache Englisch
    Erscheinungsdatum 2021-06-25
    Erscheinungsland Italy
    Dokumenttyp Journal Article ; Observational Study
    ZDB-ID 1093991-x
    ISSN 1724-6059 ; 1120-3625 ; 1121-8428
    ISSN (online) 1724-6059
    ISSN 1120-3625 ; 1121-8428
    DOI 10.1007/s40620-021-01100-3
    Datenquelle MEDical Literature Analysis and Retrieval System OnLINE

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