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Article ; Online: Kinetics of different blood biomarkers during Polymyxin-B extracorporeal hemoperfusion in abdominal sepsis.

Cotoia, Antonella / Parisano, Valeria / Mariotti, Paola Sara / Lizzi, Vincenzo / Netti, Giuseppe Stefano / Ranieri, Elena / Forfori, Francesco / Cinnella, Gilda

Blood purification

2024

Abstract: Introduction Comparison of the marker kinetics procalcitonin, presepsin and endotoxin during extracorporeal hemoperfusion with polymyxin B adsorbing cartridge (PMX-HA) have never been described in abdominal sepsis. We aim to compare the trend of three ... ...

Abstract	Introduction Comparison of the marker kinetics procalcitonin, presepsin and endotoxin during extracorporeal hemoperfusion with polymyxin B adsorbing cartridge (PMX-HA) have never been described in abdominal sepsis. We aim to compare the trend of three biomarkers in septic post-surgical abdominal patients in Intensive care Unit (ICU) treated with PMX-HA and their prognostic value. Methods Ninety abdominal postsurgical patients were enrolled into different groups according to the evidence of postoperative sepsis or not. Non-septic patients admitted in the surgical ward were included in C group (control group). ICU septic shock patients with endotoxin levels <0.6 EAA receiving conventional therapy were addressed in S group and those with endotoxin levels ≥0.6 EAA receiving treatment with PMX-HA, besides conventional therapy, were included in SPB group. Presepsin, procalcitonin, endotoxin and other clinical data were recorded at 24h (T0), 72h (T1) and 7 days (T2) after surgery. Clinical follow-up was performed on day 30. Results SPB group showed reduced levels of the three biomarkers on T2 vs T0 (P<0.001); presepsin, procalcitonin and endotoxin levels decreased respectively of 25%, 11% and 2% on T1 vs T0, and of 40%, 41%, 26% on T2 vs T0. All patients in C group, 73% of patients in SPB group vs 37% of patients in S group survived at follow-up. Moreover, procalcitonin had the highest predictive value for mortality at 30 days, followed by presepsin. Conclusion The present study showed the reliability of presepsin in monitoring PMX-HA treatment in septic shock patients. Procalcitonin showed better predicting power for the mortality risk.
Language	English
Publishing date	2024-04-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	605548-5
ISSN	1421-9735 ; 0253-5068
ISSN (online)	1421-9735
ISSN	0253-5068
DOI	10.1159/000538870
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Article ; Online: Modifications of lung microbiota structure in traumatic brain injury ventilated patients according to time and enteral feeding formulas: a prospective randomized study.

Cotoia, A / Paradiso, R / Ferrara, G / Borriello, G / Santoro, F / Spina, I / Mirabella, L / Mariano, K / Fusco, G / Cinnella, G / Singer, P

Critical care (London, England)

2023 Volume 27, Issue 1, Page(s) 244

Abstract: Background: Specialized diets enriched with immune nutrients could be an important supplement in patients (pts) with acute traumatic brain injury (TBI). Omega-3 and arginine may interact with immune response and microbiota. No data are available about ... ...

Abstract	Background: Specialized diets enriched with immune nutrients could be an important supplement in patients (pts) with acute traumatic brain injury (TBI). Omega-3 and arginine may interact with immune response and microbiota. No data are available about the role of the specialized diets in modulating the lung microbiota, and little is known about the influence of lung microbiota structure in development of ventilator-associated pneumonia (VAP) in TBI pts. The aims of this study are to evaluate the impact of specific nutrients on the lung microbiota and the variation of lung microbiota in TBI pts developing VAP. Methods: A cohort of 31 TBI pts requiring mechanical ventilation in ICU was randomized for treatment with specialized (16pts) or standard nutrition (15pts). Alpha and beta diversity of lung microbiota were analyzed from bronco Alveolar Lavage (BAL) samples collected at admission and 7 days post-ICU admission in both groups. A further analysis was carried out on the same samples retrospectively grouped in VAP or no VAP pts. Results: None developed VAP in the first week. Thereafter, ten out of thirty-one pts developed VAP. The BAL microbiota on VAP group showed significant differences in beta diversity and Staphylococcus and Acinetobacter Genera were high. The specialized nutrition had influence on beta diversity that reached statistical significance only in Bray-Curtis distance. Conclusion: Our data suggest that TBI patients who developed VAP during ICU stay have different structures of BAL microbiota either at admission and at 7 days post-ICU admission, while no correlation has been observed between different enteral formulas and microbiota composition in terms of richness and evenness. These findings suggest that targeting the lung microbiota may be a promising approach for preventing infections in critically ill patients.
MeSH term(s)	Humans ; Respiration, Artificial/adverse effects ; Prospective Studies ; Enteral Nutrition ; Retrospective Studies ; Lung ; Pneumonia, Ventilator-Associated/prevention & control ; Brain Injuries ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/therapy ; Microbiota ; Intensive Care Units
Language	English
Publishing date	2023-06-21
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-023-04531-5
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Article ; Online: Neuraxial anesthesia and septic meningitis: please be reminded.

Cinnella, Gilda / Cotoia, Antonella

Minerva anestesiologica

2018 Volume 84, Issue 3, Page(s) 294–296

MeSH term(s)	Anesthesia, Spinal ; Anesthesiology ; Humans ; Meningitis
Language	English
Publishing date	2018-01-29
Publishing country	Italy
Document type	Editorial ; Comment
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.18.12721-0
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Zs.A 516: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Nutritional support and prevention of post-intensive care syndrome: the Italian SIAARTI survey.

Cotoia, Antonella / Umbrello, Michele / Ferrari, Fiorenza / Pota, Vincenzo / Alessandri, Francesco / Cortegiani, Andrea / De Rosa, Silvia

Journal of anesthesia, analgesia and critical care

2023 Volume 3, Issue 1, Page(s) 45

Abstract: Background: Malnutrition and muscle wasting are common in ICU patients and predict adverse patient-centered outcomes. The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) conducted a nationwide survey to identify the ... ...

Abstract	Background: Malnutrition and muscle wasting are common in ICU patients and predict adverse patient-centered outcomes. The Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) conducted a nationwide survey to identify the nutritional practices in the Italian ICUs and to plan future, training interventions to improve the national clinical practice. Methods: Nationwide online survey, involving Italian ICUs, developed by experts affiliated with SIAARTI. Invitations to participate were distributed through emails and social networks. Data were collected over a period of three months (October 1 to December 31, 2022) during 2022. Results: One hundred full responses from participating ICUs were collected. The number of beds is < 10 in most ICUs and > 20 in 11 ICUs. Most ICUs (87%) are mixed, cardiac (5%), neurosurgical (4%), or pediatric ICUs (1%). Although the nutritional program is widely prescribed based on the patients' general evaluation, 52 ICUs (52%) do not perform nutritional risk evaluation at admission in case of > 24-h stay. Daily caloric intake is mainly based on the 25 kcal/kg equation; otherwise, the Harris-Benedict formula is mostly used, whereas indirect calorimetry is less used. Most clinicians apply a personalized nutritional approach to organ failure. Most ICUs have a nutritional management protocol, and enteral nutrition (EN) is frequently started within 2 days from admission, while supplemental parenteral nutrition is used when EN is insufficient by most clinicians. The EN administered seems to correspond to that prescribed, but it is stopped if the gastric residual gastric is > 300-500 ml in most ICUs. Conclusion: Prescription, route, and mode of administration of nutritional support seem to be in line with international recommendations, while suggestions on the tools for assessing the nutritional risk and monitoring efficacy and complications seem far less followed. Future national clinical studies are necessary to investigate the optimal nutritional and metabolic management of critically ill patients and the correspondence with the results of this survey on actual practices.
Language	English
Publishing date	2023-11-07
Publishing country	England
Document type	Journal Article
ISSN	2731-3786
ISSN (online)	2731-3786
DOI	10.1186/s44158-023-00132-4
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Article: Bioimpedance-assessed muscle wasting and its relation to nutritional intake during the first week of ICU: a pre-planned secondary analysis of Nutriti Study.

Deana, Cristian / Gunst, Jan / De Rosa, Silvia / Umbrello, Michele / Danielis, Matteo / Biasucci, Daniele Guerino / Piani, Tommaso / Cotoia, Antonella / Molfino, Alessio / Vetrugno, Luigi

Annals of intensive care

2024 Volume 14, Issue 1, Page(s) 29

Abstract: Background: Muscle mass evaluation in ICU is crucial since its loss is related with long term complications, including physical impairment. However, quantifying muscle wasting with available bedside tools (ultrasound and bioimpedance analysis) must be ... ...

Abstract	Background: Muscle mass evaluation in ICU is crucial since its loss is related with long term complications, including physical impairment. However, quantifying muscle wasting with available bedside tools (ultrasound and bioimpedance analysis) must be more primarily understood. Bioimpedance analysis (BIA) provides estimates of muscle mass and phase angle (PA). The primary aim of this study was to evaluate muscle mass changes with bioimpedance analysis during the first 7 days after ICU admission. Secondary aims searched for correlations between muscular loss and caloric and protein debt. Methods: Patients with an expected ICU-stay ≥ 72 h and the need for artificial nutritional support were evaluated for study inclusion. BIA evaluation of muscle mass and phase angle were performed at ICU admission and after 7 days. Considering the difference between ideal caloric and protein targets, with adequate nutritional macronutrients delivered, we calculated the caloric and protein debt. We analyzed the potential correlation between caloric and protein debt and changes in muscle mass and phase angle. Results: 72 patients from September 1st to October 30th, 2019 and from August 1st to October 30th, 2021 were included in the final statistical analysis. Median age was 68 [59-77] years, mainly men (72%) admitted due to respiratory failure (25%), and requiring invasive mechanical ventilation for 7 [4-10] days. Median ICU stay was 8 [6-12] days. Bioimpedance data at ICU admission and after 7 days showed that MM and PA resulted significantly reduced after 7 days of critically illness, 34.3 kg vs 30.6 kg (p < 0.0001) and 4.90° vs 4.35° (p = 0.0004) respectively. Mean muscle loss was 3.84 ± 6.7 kg, accounting for 8.4% [1-14] MM reduction. Correlation between caloric debt (r = 0.14, p = 0.13) and protein debt (r = 0.18, p = 0.13) with change in MM was absent. Similarly, no correlation was found between caloric debt (r = -0.057, p = 0.631) and protein debt (r = -0.095, p = 0.424) with changes in PA. Conclusions: bioimpedance analysis demonstrated that muscle mass and phase angle were significantly lower after 7 days in ICU. The total amount of calories and proteins does not correlate with changes in muscle mass and phase angle.
Language	English
Publishing date	2024-02-17
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-024-01262-w
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Article ; Online: Posthumous sperm retrieval: a procreative revolution.

Negro, Francesca / Beck, Renata / Cotoia, Antonella / Varone, Maria Cristina

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina

2020 Volume 18, Issue 1, Page(s) 114–121

Abstract: Aim Postmortem sperm retrieval with consequent artificial insemination has become a technically possible option for future use in assisted reproductive technology (ART). The authors have set out to discuss the social and ethical significance of ... ...

Abstract	Aim Postmortem sperm retrieval with consequent artificial insemination has become a technically possible option for future use in assisted reproductive technology (ART). The authors have set out to discuss the social and ethical significance of posthumous sperm retrieval, and the laws currently in force in Italy, the United States and elsewhere. Methods International literature from 1997 to 2020 has been reviewed from Pubmed database, Google Scholar and Scopus, drawn upon American, Italian and international sources (an ethically acceptable solution can only be achieved through an overhaul of the laws currently in effect). One of the most contentious issues was about donor consent. In Italy, a donor's will to retrieve his sperm in the event of premature disappearance can be proven according to the Law 219/2017, through advance health care directives. Results A substantial increase, both in requests and protocols, was documented in the United States. In Italy, over the last two years, three rulings were issued concerning posthumous insemination. However, no official standardized protocols, guidelines or targeted legislation exist at the national level to regulate medical activity in that realm, whereas established laws often set implicit limitations. Conclusion Current legal frameworks appear to be inadequate, because in most cases they were conceived under conditions that have radically changed. The need for newly-updated regulatory frameworks to promptly bridge that gap is increasingly clear, if current social needs related to reproductive rights are to be met in the foreseeable future.
MeSH term(s)	Humans ; Posthumous Conception ; Reproductive Techniques, Assisted ; Sperm Retrieval ; United States
Language	English
Publishing date	2020-11-04
Publishing country	Bosnia and Herzegovina
Document type	Journal Article
ZDB-ID	2378942-6
ISSN	1840-2445 ; 1840-0132
ISSN (online)	1840-2445
ISSN	1840-0132
DOI	10.17392/1256-21
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review.

Cotoia, Antonella / Spadaro, Savino / Gambetti, Guido / Koulenti, Despoina / Cinnella, Gilda

Microorganisms

2020 Volume 8, Issue 6

Abstract: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit (ICU), accounting for relevant morbidity and mortality among critically ill patients, especially when caused by multidrug resistant (MDR) ... ...

Abstract	Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit (ICU), accounting for relevant morbidity and mortality among critically ill patients, especially when caused by multidrug resistant (MDR) organisms. The rising problem of MDR etiologies, which has led to a reduction in treatment options, have increased clinician's attention to the employment of effective prevention strategies. In this narrative review we summarized the evidence resulting from 27 original articles that were identified through a systematic database search of the last 15 years, focusing on several pathogenesis-targeted strategies which could help preventing MDR-VAP. Oral hygiene with Chlorhexidine (CHX), CHX body washing, selective oral decontamination (SOD) and/or digestive decontamination (SDD), multiple decontamination regimens, probiotics, subglottic secretions drainage (SSD), special cuff material and shape, silver-coated endotracheal tubes (ETTs), universal use of gloves and contact isolation, alcohol-based hand gel, vaporized hydrogen peroxide, and bundles of care have been addressed. The most convincing evidence came from interventions directly addressed against the key factors of MDR-VAP pathogenesis, especially when they are jointly implemented into bundles. Further research, however, is warranted to identify the most effective combination.
Language	English
Publishing date	2020-05-30
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2720891-6
ISSN	2076-2607
ISSN	2076-2607
DOI	10.3390/microorganisms8060821
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Article ; Online: Immunological effects of glutamine supplementation in polytrauma patients in intensive care unit.

Cotoia, Antonella / Cantatore, Leonarda Pia / Beck, Renata / Tullo, Livio / Fortarezza, Donatella / Marchese, Flavia / Ferrara, Giuseppe / Cinnella, Gilda

Journal of Anesthesia, Analgesia and Critical Care (Online)

2022 Volume 2, Issue 1, Page(s) 41

Abstract: Background: In polytrauma intensive care unit (ICU) patients, glutamine (GLN) becomes a "conditionally essential" amino acid; its role has been extensively studied in numerous clinical trials but their results are inconclusive. We evaluated the IgA- ... ...

Abstract	Background: In polytrauma intensive care unit (ICU) patients, glutamine (GLN) becomes a "conditionally essential" amino acid; its role has been extensively studied in numerous clinical trials but their results are inconclusive. We evaluated the IgA-mediated humoral immunity after GLN supplementation in polytrauma ICU patients. Methods: All consecutive patients with polytrauma who required mechanical ventilation and enteral nutrition (EN) provided within 24 h since the admission in ICU at the University Hospital of Foggia from September 2016 to February 2017 were included. Thereafter, two groups were identified: patients treated by conventional EN (25 kcal/kg/die) and patients who have received conventional EN enriched with 50 mg/kg/ideal body weight of alanyl-GLN 20% intravenously. We analysed the plasmatic concentration of IgA, CD3+/CD4+ T helper lymphocytes, CD3+/CD8+ T suppressor lymphocytes, CD3+/CD19+ B lymphocytes, IL-4 and IL-2 at admission and at 4 and 8 days. Results: We identified 30 patients, with 15 subjects per group. IgA levels increased significantly in GLN vs the control group at T0, T4 and T8. CD3+/CD4+ T helper lymphocyte and CD3+/CD8+ T suppressor lymphocyte levels significantly increased in GLN vs the control group at T4 and T8. CD3+/CD19+ B lymphocyte levels increased significantly in GLN vs the control group only at T8. IL-2 and IL-4 levels showed no significant differences when comparing GLN with the control group. Conclusions: Our study showed that there was an improvement in humoral and cell-mediated immunity with GLN supplementation in polytrauma ICU patients using recommended doses.
Language	English
Publishing date	2022-09-24
Publishing country	England
Document type	Journal Article
ISSN	2731-3786
ISSN (online)	2731-3786
DOI	10.1186/s44158-022-00068-1
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Article: Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review

Cotoia, Antonella / Spadaro, Savino / Gambetti, Guido / Koulenti, Despoina / Cinnella, Gilda

Microorganisms. 2020 May 30, v. 8, no. 6

2020

Abstract	Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit (ICU), accounting for relevant morbidity and mortality among critically ill patients, especially when caused by multidrug resistant (MDR) organisms. The rising problem of MDR etiologies, which has led to a reduction in treatment options, have increased clinician’s attention to the employment of effective prevention strategies. In this narrative review we summarized the evidence resulting from 27 original articles that were identified through a systematic database search of the last 15 years, focusing on several pathogenesis-targeted strategies which could help preventing MDR-VAP. Oral hygiene with Chlorhexidine (CHX), CHX body washing, selective oral decontamination (SOD) and/or digestive decontamination (SDD), multiple decontamination regimens, probiotics, subglottic secretions drainage (SSD), special cuff material and shape, silver-coated endotracheal tubes (ETTs), universal use of gloves and contact isolation, alcohol-based hand gel, vaporized hydrogen peroxide, and bundles of care have been addressed. The most convincing evidence came from interventions directly addressed against the key factors of MDR-VAP pathogenesis, especially when they are jointly implemented into bundles. Further research, however, is warranted to identify the most effective combination.
Keywords	chlorhexidine ; cross infection ; databases ; decontamination ; drainage ; gels ; hydrogen peroxide ; morbidity ; mortality ; multiple drug resistance ; oral hygiene ; pathogenesis ; pneumonia ; probiotics
Language	English
Dates of publication	2020-0530
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article
ZDB-ID	2720891-6
ISSN	2076-2607
ISSN	2076-2607
DOI	10.3390/microorganisms8060821
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: The use of extracorporeal blood purification therapies and sequential extracorporeal support in patients with septic shock (EROICASS): a study protocol for a national, non-interventional, observational multicenter, prospective study.

Journal of anesthesia, analgesia and critical care

2024 Volume 4, Issue 1, Page(s) 16

Abstract: Background: Septic shock, a critical condition characterized by organ failure, presents a substantial mortality risk in intensive care units (ICUs), with the 28-day mortality rate possibly reaching 40%. Conventional management of septic shock typically ... ...

Abstract	Background: Septic shock, a critical condition characterized by organ failure, presents a substantial mortality risk in intensive care units (ICUs), with the 28-day mortality rate possibly reaching 40%. Conventional management of septic shock typically involves the administration of antibiotics, supportive care for organ dysfunction, and, if necessary, surgical intervention to address the source of infection. In recent decades, extracorporeal blood purification therapies (EBPT) have emerged as potential interventions aimed at modulating the inflammatory response and restoring homeostasis in patients with sepsis. Likewise, sequential extracorporeal therapy in sepsis (SETS) interventions offer comprehensive organ support in the setting of multiple organ dysfunction syndrome (MODS). The EROICASS study will assess and describe the utilization of EBPT in patients with septic shock. Additionally, we will evaluate the potential association between EBPT treatment utilization and 90-day mortality in septic shock cases in Italy. Methods: The EROICASS study is a national, non-interventional, multicenter observational prospective cohort study. All consecutive patients with septic shock at participating centers will be prospectively enrolled, with data collection extending from intensive care unit (ICU) admission to hospital discharge. Variables including patient demographics, clinical parameters, EBPT/SETS utilization, and outcomes will be recorded using a web-based data capture system. Statistical analyses will encompass descriptive statistics, hypothesis testing, multivariable regression models, and survival analysis to elucidate the associations between EBPT/SETS utilization and patient outcomes. Conclusions: The EROICASS study provides valuable insights into the utilization and outcomes of EBPT and SETS in septic shock management. Through analysis of usage patterns and clinical data, this study aims to guide treatment decisions and enhance patient care. The implications of these findings may impact clinical guidelines, potentially improving survival rates and patient outcomes in septic shock cases.
Language	English
Publishing date	2024-02-26
Publishing country	England
Document type	Journal Article
ISSN	2731-3786
ISSN (online)	2731-3786
DOI	10.1186/s44158-024-00153-7
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