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  1. Article ; Online: Successful Needle Aspiration of a Traumatic Pneumothorax: A Case Report and Literature Review.

    Bettoni, Giuseppe / Gheda, Silvia / Altomare, Michele / Cioffi, Stefano Piero Bernardo / Ferrazzi, Davide / Cazzaniga, Michela / Bonacchini, Luca / Cimbanassi, Stefania / Aseni, Paolo

    Medicina (Kaunas, Lithuania)

    2024  Volume 60, Issue 4

    Abstract: Traumatic pneumothorax (PTX) occurs in up to 50% of patients with severe polytrauma and chest injuries. Patients with a traumatic PTX with clinical signs of tension physiology and hemodynamic instability are typically treated with an urgent decompressive ...

    Abstract Traumatic pneumothorax (PTX) occurs in up to 50% of patients with severe polytrauma and chest injuries. Patients with a traumatic PTX with clinical signs of tension physiology and hemodynamic instability are typically treated with an urgent decompressive thoracostomy, tube thoracostomy, or needle decompression. There is recent evidence that non-breathless patients with a hemodynamically stable traumatic PTX can be managed conservatively through observation or a percutaneous pigtail catheter. We present here a 52-year-old woman who presented to the emergency department with a 55 mm traumatic PTX. Following aspiration of 1500 mL of air, a clinical improvement was immediately observed, allowing the patient to be discharged shortly thereafter. In hemodynamically stable patients with a post-traumatic PTX, without specific risk factors or oxygen desaturation, observation or simple needle aspiration can be a reasonable approach. Although the recent medical literature supports conservative management of small traumatic PTXs, guidelines are lacking for hemodynamically stable patients with a significantly large PTX. This case report documents our successful experience with needle aspiration in such a setting of large traumatic PTX. We aimed in this article to review the available literature on needle aspiration and conservative treatment of traumatic pneumothorax. A total of 12 studies were selected out of 190 articles on traumatic PTX where conservative treatment and chest tube decompression were compared. Our case report offers a novel contribution by illustrating the successful resolution of a sizable pneumothorax through needle aspiration, suggesting that even a large PTX in a hemodynamically stable patient, without other risk conditions, can be successfully treated conservatively with simple needle aspiration in order to avoid tube thoracostomy complications.
    MeSH term(s) Humans ; Pneumothorax/therapy ; Pneumothorax/etiology ; Female ; Middle Aged ; Thoracic Injuries/complications ; Thoracostomy/methods ; Treatment Outcome
    Language English
    Publishing date 2024-03-28
    Publishing country Switzerland
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 2188113-3
    ISSN 1648-9144 ; 1010-660X
    ISSN (online) 1648-9144
    ISSN 1010-660X
    DOI 10.3390/medicina60040548
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  2. Article ; Online: Correlation between lung ultrasound and chest CT patterns with estimation of pulmonary burden in COVID-19 patients.

    Rizzetto, Francesco / Perillo, Noemi / Artioli, Diana / Travaglini, Francesca / Cuccia, Alessandra / Zannoni, Stefania / Tombini, Valeria / Di Domenico, Sandro Luigi / Albertini, Valentina / Bergamaschi, Marta / Cazzaniga, Michela / De Mattia, Cristina / Torresin, Alberto / Vanzulli, Angelo

    European journal of radiology

    2021  Volume 138, Page(s) 109650

    Abstract: Purpose: The capability of lung ultrasound (LUS) to distinguish the different pulmonary patterns of COVID-19 and quantify the disease burden compared to chest CT is still unclear.: Methods: PCR-confirmed COVID-19 patients who underwent both LUS and ... ...

    Abstract Purpose: The capability of lung ultrasound (LUS) to distinguish the different pulmonary patterns of COVID-19 and quantify the disease burden compared to chest CT is still unclear.
    Methods: PCR-confirmed COVID-19 patients who underwent both LUS and chest CT at the Emergency Department were retrospectively analysed. In both modalities, twelve peripheral lung zones were identified and given a Severity Score basing on main lesion pattern. On CT scans the well-aerated lung volume (%WALV) was visually estimated. Per-patient and per-zone assessments of LUS classification performance taking CT findings as reference were performed, further revisioning the images in case of discordant results. Correlations between number of disease-positive lung zones, Severity Score and %WALV on both LUS and CT were assessed. The area under receiver operating characteristic curve (AUC) was calculated to determine LUS performance in detecting %WALV ≤ 70 %.
    Results: The study included 219 COVID-19 patients with abnormal chest CT. LUS correctly identified as positive 217 (99 %) patients, but per-zone analysis showed sensitivity = 75 % and specificity = 66 %. The revision of the 121 (55 %) cases with positive LUS and negative CT revealed COVID-compatible lesions in 42 (38 %) CT scans. Number of disease-positive zones, Severity Score and %WALV between LUS and CT showed moderate correlations. The AUCs for LUS Severity Score and number of LUS-positive zones did not differ in detecting %WALV ≤ 70 %.
    Conclusion: LUS in COVID-19 is valuable for case identification but shows only moderate correlation with CT findings as for lesion patterns and severity quantification. The number of disease-positive lung zones in LUS alone was sufficient to discriminate relevant disease burden.
    MeSH term(s) COVID-19 ; Humans ; Lung/diagnostic imaging ; Retrospective Studies ; SARS-CoV-2 ; Tomography, X-Ray Computed ; Ultrasonography
    Language English
    Publishing date 2021-03-11
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 138815-0
    ISSN 1872-7727 ; 0720-048X
    ISSN (online) 1872-7727
    ISSN 0720-048X
    DOI 10.1016/j.ejrad.2021.109650
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  3. Article ; Online: Clinical characteristics and respiratory support of 310 COVID-19 patients, diagnosed at the emergency room: a single-center retrospective study.

    Di Domenico, Sandro Luigi / Coen, Daniele / Bergamaschi, Marta / Albertini, Valentina / Ghezzi, Leonardo / Cazzaniga, Michela Maria / Tombini, Valeria / Colombo, Riccardo / Capsoni, Nicolò / Coen, Tommaso / Cazzola, Katia Barbara / Di Fiore, Marina / Angaroni, Laura / Strozzi, Marco Alberto

    Internal and emergency medicine

    2020  Volume 16, Issue 4, Page(s) 1051–1060

    Abstract: An ongoing outbreak of pneumonia associated with severe acute respiratory coronavirus 2 (SARS-CoV-2) occurred at the end of February 2020 in Lombardy, Italy. We analyzed data from a retrospective, single-center case series of 310 consecutive patients, ... ...

    Abstract An ongoing outbreak of pneumonia associated with severe acute respiratory coronavirus 2 (SARS-CoV-2) occurred at the end of February 2020 in Lombardy, Italy. We analyzed data from a retrospective, single-center case series of 310 consecutive patients, with confirmed SARS-CoV-2 infection, admitted to the emergency room. We aimed to describe the clinical course, treatment and outcome of a cohort of patients with COVID-19 pneumonia, with special attention to oxygen delivery and ventilator support. Throughout the study period, 310 consecutive patients, with confirmed SARS-CoV-2 infection, attended the Emergency Room (ER), of these, 34 were discharged home directly from the ER. Of the remaining 276 patients, the overall mortality was 30.4%: 7 patients died in the ER and 77 during hospitalization. With respect to oxygen delivery: 22 patients did not need any oxygen support (8.0%), 151 patients were treated with oxygen only (54.7%), and 49 (17.8%) were intubated. 90 patients (32.6%) were treated with CPAP (Continuous Positive Airway Pressure) or NIV (Non Invasive Ventilation); in this group, 27 patients had a Do Not Intubate (DNI) order and were treated with CPAP/NIV as an upper threshold therapy, showing high mortality rate (88.9%). Among the 63 patients treated with CPAP/NIV without DNI, NIV failure occurred in 36 patients (57.1%), with mortality rate of 47.2%. Twenty-seven (27) patients were treated with CPAP/NIV without needing mechanical ventilation and 26 were discharged alive (96.3%). The study documents the poor prognosis of patients with severe respiratory failure, although a considerable minority of patients treated with CPAP/NIV had a positive outcome.
    MeSH term(s) Adult ; Aged ; COVID-19/complications ; COVID-19/mortality ; COVID-19/therapy ; Emergency Service, Hospital ; Female ; Hospitalization ; Humans ; Italy ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Oxygen Inhalation Therapy ; Respiration, Artificial ; Retrospective Studies ; Survival Rate
    Keywords covid19
    Language English
    Publishing date 2020-11-11
    Publishing country Italy
    Document type Journal Article ; Observational Study
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-020-02548-0
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  4. Article: Clinical characteristics and respiratory support of 310 COVID-19 patients, diagnosed at the emergency room: a single-center retrospective study

    Di Domenico, Sandro Luigi / Coen, Daniele / Bergamaschi, Marta / Albertini, Valentina / Ghezzi, Leonardo / Cazzaniga, Michela Maria / Tombini, Valeria / Colombo, Riccardo / Capsoni, Nicolò / Coen, Tommaso / Cazzola, Katia Barbara / Di Fiore, Marina / Angaroni, Laura / Strozzi, Marco Alberto

    Intern. emerg. med

    Abstract: An ongoing outbreak of pneumonia associated with severe acute respiratory coronavirus 2 (SARS-CoV-2) occurred at the end of February 2020 in Lombardy, Italy. We analyzed data from a retrospective, single-center case series of 310 consecutive patients, ... ...

    Abstract An ongoing outbreak of pneumonia associated with severe acute respiratory coronavirus 2 (SARS-CoV-2) occurred at the end of February 2020 in Lombardy, Italy. We analyzed data from a retrospective, single-center case series of 310 consecutive patients, with confirmed SARS-CoV-2 infection, admitted to the emergency room. We aimed to describe the clinical course, treatment and outcome of a cohort of patients with COVID-19 pneumonia, with special attention to oxygen delivery and ventilator support. Throughout the study period, 310 consecutive patients, with confirmed SARS-CoV-2 infection, attended the Emergency Room (ER), of these, 34 were discharged home directly from the ER. Of the remaining 276 patients, the overall mortality was 30.4%: 7 patients died in the ER and 77 during hospitalization. With respect to oxygen delivery: 22 patients did not need any oxygen support (8.0%), 151 patients were treated with oxygen only (54.7%), and 49 (17.8%) were intubated. 90 patients (32.6%) were treated with CPAP (Continuous Positive Airway Pressure) or NIV (Non Invasive Ventilation); in this group, 27 patients had a Do Not Intubate (DNI) order and were treated with CPAP/NIV as an upper threshold therapy, showing high mortality rate (88.9%). Among the 63 patients treated with CPAP/NIV without DNI, NIV failure occurred in 36 patients (57.1%), with mortality rate of 47.2%. Twenty-seven (27) patients were treated with CPAP/NIV without needing mechanical ventilation and 26 were discharged alive (96.3%). The study documents the poor prognosis of patients with severe respiratory failure, although a considerable minority of patients treated with CPAP/NIV had a positive outcome.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #919765
    Database COVID19

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  5. Article ; Online: Towards a less invasive approach to the early goal-directed treatment of septic shock in the ED.

    Coen, Daniele / Cortellaro, Francesca / Pasini, Simone / Tombini, Valeria / Vaccaro, Angelica / Montalbetti, Lorenzo / Cazzaniga, Michela / Boghi, Daniele

    The American journal of emergency medicine

    2014  Volume 32, Issue 6, Page(s) 563–568

    Abstract: Introduction: Early goal-directed therapy (EGDT) in septic shock defined by Rivers et al was proven to reduce mortality and validated by observational studies. However, criticism is centered in particular on the early requirement of a central venous ... ...

    Abstract Introduction: Early goal-directed therapy (EGDT) in septic shock defined by Rivers et al was proven to reduce mortality and validated by observational studies. However, criticism is centered in particular on the early requirement of a central venous catheter (CVC) and on central venous pressure (CVP) as an indicator of volume responsiveness. The present study is a pivotal study to investigate the reliability of a less invasive approach, which uses inferior vena cava (IVC) and lung ultrasounds (US) to guide the infusion of fluids and lactate clearance to monitor tissue perfusion.
    Methods: We enrolled 51 patients with septic shock. As a marker of preload optimization, we measured IVC collapse in place of CVP and serum lactate clearance in place of central venous oxygen saturation as a marker of tissue perfusion. As outcomes, we considered the accomplishment of the noninvasive EGDT goals, the number of patients treated without the need of a CVC, the amount of fluids administered in the first 6 hours, the development of pulmonary edema, and the overall mortality rate.
    Results: Inferior vena cava US evaluation resulted feasible in 92% of patients. Lung US was performed in 100% of cases. In the first 6 hours, only 61.7% of patients received a CVC, an average of 5.5 L of crystalloids were administered, and only 4 patients developed clinical overt pulmonary edema. Mortality was 34% at 28 days and 38.3% at 60 days.
    Conclusions: Our approach to resuscitation in septic shock appears feasible in the emergency department and needs further study with a randomized controlled trial.
    MeSH term(s) Aged ; Biomarkers/blood ; Blood Pressure/physiology ; Catheterization, Central Venous ; Clinical Protocols ; Emergency Service, Hospital ; Feasibility Studies ; Female ; Humans ; Isotonic Solutions/therapeutic use ; Lactates/blood ; Lung/diagnostic imaging ; Male ; Oxygen/blood ; Resuscitation/methods ; Shock, Septic/diagnostic imaging ; Shock, Septic/physiopathology ; Shock, Septic/therapy ; Ultrasonography ; Vena Cava, Inferior/physiopathology
    Chemical Substances Biomarkers ; Isotonic Solutions ; Lactates ; crystalloid solutions ; Oxygen (S88TT14065)
    Language English
    Publishing date 2014-06
    Publishing country United States
    Document type Clinical Trial ; Journal Article
    ZDB-ID 605890-5
    ISSN 1532-8171 ; 0735-6757
    ISSN (online) 1532-8171
    ISSN 0735-6757
    DOI 10.1016/j.ajem.2014.02.011
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  6. Article ; Online: Toward a noninvasive approach to early goal-directed therapy.

    Coen, Daniele / Vaccaro, Angelica / Cazzaniga, Michela / Cortellaro, Francesca / Monti, Gianpaola / Tombini, Valeria

    Chest

    2011  Volume 139, Issue 3, Page(s) 726–727

    MeSH term(s) Catheterization, Central Venous ; Central Venous Pressure/physiology ; Emergency Service, Hospital/standards ; Emergency Service, Hospital/trends ; Fluid Therapy/methods ; Humans ; Patient Care Planning/standards ; Patient Care Planning/trends ; Resuscitation/methods ; Risk Assessment ; Sepsis/physiopathology ; Sepsis/therapy ; Ultrasonography
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    Publishing date 2011-03
    Publishing country United States
    Document type Comment ; Letter
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1378/chest.10-2632
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  7. Article ; Online: Incidence of pain after craniotomy in children.

    Bronco, Alfio / Pietrini, Domenico / Lamperti, Massimo / Somaini, Marta / Tosi, Federica / del Lungo, Laura Minguell / Zeimantz, Elena / Tumolo, Miriam / Lampugnani, Elisabetta / Astuto, Marinella / Perna, Francesco / Zadra, Nicola / Meneghini, Luisa / Benucci, Valentina / Bussolin, Leonardo / Scolari, Anna / Savioli, Alessandra / Locatelli, Bruno G / Prussiani, Viviana /
    Cazzaniga, Michela / Mazzoleni, Fabio / Giussani, Carlo / Rota, Matteo / Ferland, Catherine E / Ingelmo, Pablo M

    Paediatric anaesthesia

    2014  Volume 24, Issue 7, Page(s) 781–787

    Abstract: Background: There is very few information regarding pain after craniotomy in children.: Objectives: This multicentre observational study assessed the incidence of pain after major craniotomy in children.: Methods: After IRB approval, 213 infants ... ...

    Abstract Background: There is very few information regarding pain after craniotomy in children.
    Objectives: This multicentre observational study assessed the incidence of pain after major craniotomy in children.
    Methods: After IRB approval, 213 infants and children who were <10 years old and undergoing major craniotomy were consecutively enrolled in nine Italian hospitals. Pain intensity, analgesic therapy, and adverse effects were evaluated on the first 2 days after surgery. Moderate to severe pain was defined as a median FLACC or NRS score ≥ 4 points. Severe pain was defined as a median FLACC or NRS score ≥ 7 points.
    Results: Data of 206 children were included in the analysis. The overall postoperative median FLACC/NRS scores were 1 (IQR 0 to 2). Twenty-one children (16%) presented moderate to severe pain in the recovery room and 14 (6%) during the first and second day after surgery. Twenty-six children (19%) had severe pain in the recovery room and 4 (2%) during the first and second day after surgery. Rectal codeine was the most common weak opiod used. Remifentanil and morphine were the strong opioids widely used in PICU and in general wards, respectively. Longer procedures were associated with moderate to severe pain (OR 1.30; CI 1.07-1.57) or severe pain (OR 1.41; 1.09-1.84; P < 0.05). There were no significant associations between complications, pain intensity, and analgesic therapy.
    Conclusion: Children receiving multimodal analgesia experience little or no pain after major craniotomy. Longer surgical procedures correlate with an increased risk of having postoperative pain.
    MeSH term(s) Analgesics/adverse effects ; Analgesics/therapeutic use ; Child ; Child, Preschool ; Craniotomy/adverse effects ; Craniotomy/statistics & numerical data ; Female ; Humans ; Incidence ; Infant ; Italy/epidemiology ; Male ; Pain Measurement ; Pain, Postoperative/drug therapy ; Pain, Postoperative/epidemiology ; Risk Factors
    Chemical Substances Analgesics
    Language English
    Publishing date 2014-07
    Publishing country France
    Document type Journal Article ; Multicenter Study ; Observational Study
    ZDB-ID 1086049-6
    ISSN 1460-9592 ; 1155-5645
    ISSN (online) 1460-9592
    ISSN 1155-5645
    DOI 10.1111/pan.12351
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