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  1. Article ; Online: Intracranial pressure for clinicians: it is not just a number.

    Cucciolini, Giada / Motroni, Virginia / Czosnyka, Marek

    Journal of anesthesia, analgesia and critical care

    2023  Volume 3, Issue 1, Page(s) 31

    Abstract: Background: Invasive intracranial pressure (ICP) monitoring is a standard practice in severe brain injury cases, where it allows to derive cerebral perfusion pressure (CPP); ICP-tracing can also provide additional information about intracranial dynamics, ...

    Abstract Background: Invasive intracranial pressure (ICP) monitoring is a standard practice in severe brain injury cases, where it allows to derive cerebral perfusion pressure (CPP); ICP-tracing can also provide additional information about intracranial dynamics, forecast episodes of intracranial hypertension and set targets for a tailored therapy to prevent secondary brain injury. Nevertheless, controversies about the advantages of an ICP clinical management are still debated.
    Findings: This article reviews recent research on ICP to improve the understanding of the topic and uncover the hidden information in this signal that may be useful in clinical practice. Parameters derived from time-domain as well as frequency domain analysis include compensatory reserve, autoregulation estimation, pulse waveform analysis, and behavior of ICP in time. The possibility to predict the outcome and apply a tailored therapy using a personalised perfusion pressure target is also described.
    Conclusions: ICP is a crucial signal to monitor in severely brain injured patients; a bedside computer can empower standard monitoring giving new metrics that may aid in clinical management, establish a personalized therapy, and help to predict the outcome. Continuous collaboration between engineers and clinicians and application of new technologies to healthcare, is vital to improve the accuracy of current metrics and progress towards better care with individualized dynamic targets.
    Language English
    Publishing date 2023-09-05
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2731-3786
    ISSN (online) 2731-3786
    DOI 10.1186/s44158-023-00115-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Improving Patient Outcomes in Abdominal Surgery.

    Brusasco, Claudia / Cucciolini, Giada / Barberis, Andrea / Introini, Carlo / Campodonico, Fabio / Corradi, Francesco

    Journal of clinical medicine

    2024  Volume 13, Issue 7

    Abstract: Post-operative acute kidney injury (PO-AKI) is a frequent complication described in 15% of non-cardiac surgeries, 30% of cardiac surgeries, and 52% of patients requiring intensive post-operative care [ ... ]. ...

    Abstract Post-operative acute kidney injury (PO-AKI) is a frequent complication described in 15% of non-cardiac surgeries, 30% of cardiac surgeries, and 52% of patients requiring intensive post-operative care [...].
    Language English
    Publishing date 2024-03-29
    Publishing country Switzerland
    Document type Editorial
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm13071993
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Analgesic Strategies for Urologic Videolaparoscopic or Robotic Surgery in the Context of an Enhanced Recovery after Surgery Protocol: A Prospective Study Comparing Erector Spinae Plane Block versus Transversus Abdominis Plane Block.

    Micali, Marco / Cucciolini, Giada / Bertoni, Giulia / Gandini, Michela / Lattuada, Marco / Santori, Gregorio / Introini, Carlo / Corradi, Francesco / Brusasco, Claudia

    Journal of clinical medicine

    2024  Volume 13, Issue 2

    Abstract: Regional anesthesia in postoperative pain management has developed in recent years, especially with the advent of fascial plane blocks. This study aims to compare the ultrasound-guided bilateral erector spinae plane block (ESPB) versus the ultrasound- ... ...

    Abstract Regional anesthesia in postoperative pain management has developed in recent years, especially with the advent of fascial plane blocks. This study aims to compare the ultrasound-guided bilateral erector spinae plane block (ESPB) versus the ultrasound-guided bilateral transversus abdominis plane block (TAPB) on postoperative analgesia after laparoscopic or robotic urologic surgery. This was a prospective observational study; 97 patients (ESPB-group) received bilateral ultrasound-guided ESPB with 20 mL of ropivacaine 0.375% plus 0.5 mcg/kg of dexmedetomidine in each side at the level of T7-T9 and 93 patients (TAPB-group) received bilateral ultrasound-guided TAPB with 20 mL ropivacaine 0.375% or 0.25%. The primary outcome was the postoperative numeric rating scale (NRS) pain score, which was significantly lower in the ESPB group on postoperative days 0, 1, 2, and 3 (
    Language English
    Publishing date 2024-01-10
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm13020383
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Red solid line: Patterns of terminal loss of cerebrovascular reactivity at the bedside.

    Beqiri, Erta / Czosnyka, Marek / Placek, Michal M / Cucciolini, Giada / Motroni, Virginia / Smith, Claudia A / Hutchinson, Peter / Smielewski, Peter

    Brain & spine

    2024  Volume 4, Page(s) 102760

    Abstract: Introduction: Continuous monitoring of the pressure reactivity index (PRx) provides an estimation of dynamic cerebral autoregulation (CA) at the bedside in traumatic brain injury (TBI) patients. Visualising the time-trend of PRx with a risk bar chart in ...

    Abstract Introduction: Continuous monitoring of the pressure reactivity index (PRx) provides an estimation of dynamic cerebral autoregulation (CA) at the bedside in traumatic brain injury (TBI) patients. Visualising the time-trend of PRx with a risk bar chart in ICM + software at the bedside allows for better real-time interpretability of the autoregulation status. When PRx>0.3 is sustained for long periods, typically of at least half an hour, the bar shows a pattern called "red solid line" (RSL). RSL was previously described to precede refractory intracranial hypertension and brain death.
    Research question: We aimed to describe pathophysiological changes in measured signals/parameters during RSL.
    Material and methods: Observation of time-trends of PRx, intracranial pressure, cerebral perfusion pressure, brain oxygenation and compensatory reserve of TBI patients with RSL.
    Results: Three pathophysiological patterns were identified: RSL precedes intracranial hypertension, RSL is preceded by intracranial hypertension, or RSL is preceded by brain hypoperfusion. In all cases, RSL was followed by death and the RSL onset was between 1 h and 1 day before the terminal event.
    Discussion and conclusion: RSL precedes death in intensive care and could represent a marker for terminal clinical deterioration in TBI patients. These findings warrant further investigations in larger cohorts to characterise pathophysiological mechanisms underlying the RSL pattern and whether RSL has a significant relationship with outcome after TBI.
    Language English
    Publishing date 2024-01-27
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2024.102760
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Exploration of uncertainty of PRx time trends.

    Beqiri, Erta / Placek, Michal M / Chu, Ka Hing / Donnelly, Joseph / Cucciolini, Giada / Motroni, Virginia / Smith, Claudia A / Czosnyka, Marek / Hutchinson, Peter / Smielewski, Peter

    Brain & spine

    2024  Volume 4, Page(s) 102795

    Abstract: Introduction: PRx can be used as surrogate measure of Cerebral Autoregulation (CA) in traumatic brain injury (TBI) patients. PRx can provide means for individualising cerebral perfusion pressure (CPP) targets, such as CPPopt. However, a recent Delphi ... ...

    Abstract Introduction: PRx can be used as surrogate measure of Cerebral Autoregulation (CA) in traumatic brain injury (TBI) patients. PRx can provide means for individualising cerebral perfusion pressure (CPP) targets, such as CPPopt. However, a recent Delphi consensus of clinicians concluded that consensus could not be reached on the accuracy, reliability, and validation of any current CA assessment method.
    Research question: We aimed to quantify the short-term uncertainty of PRx time-trends and to relate this to other physiological measurements.
    Material and methods: Intracranial pressure (ICP), arterial blood pressure (ABP), end-tidal CO
    Results: The time profile of variability of PRx decreases over the first 12h and was higher for average PRx ∼0. Increased variability of PRx was not linearly linked with average ABP, ICP, or CPP. For coherence between slow waves of ABP and ICP >0.7, the variability in PRx decreased (R = -0.47, p < 0.001).
    Discussion and conclusion: PRx is a highly variable parameter. PRx short-term dispersion was not related to average ICP, ABP or CPP. The determinants of uncertainty of PRx should be investigated to improve reliability of individualised CA assessment in TBI patients.
    Language English
    Publishing date 2024-03-31
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2024.102795
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Perioperative Intravenous Amino Acid Infusion in Major Urologic Surgery.

    Brusasco, Claudia / Valenzi, Fabio Maria / Micali, Marco / Ennas, Marco / Di Domenico, Antonia / Germinale, Federico / Dotta, Federico / Benelli, Andrea / Campodonico, Fabio / Cucciolini, Giada / Carbone, Antonio / Introini, Carlo / Corradi, Francesco

    Journal of clinical medicine

    2023  Volume 12, Issue 20

    Abstract: Post-operative acute kidney injury (PO-AKI) is a serious complication that may occur after major abdominal surgery. The administration of intravenous perioperative amino acids (AAs) has been proven to increase kidney function and has some beneficial ... ...

    Abstract Post-operative acute kidney injury (PO-AKI) is a serious complication that may occur after major abdominal surgery. The administration of intravenous perioperative amino acids (AAs) has been proven to increase kidney function and has some beneficial effects to prevent PO-AKI. The aim of this study was to establish if the perioperative infusion of AAs may reduce the incidence of PO-AKI in patients undergoing major urological minimally invasive surgery. From a total of 331 patients, the first 169 received perioperative crystalloid fluids and the following 162 received perioperative AA infusions. PO-AKIs were much higher in the crystalloid group compared to the AA group (34 vs. 17,
    Language English
    Publishing date 2023-10-19
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12206614
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Perioperative Renal Ultrasonography of Arterio-to-Venous Coupling Predicts Postoperative Complications after Major Laparoscopic Urologic Surgery.

    Brusasco, Claudia / Tavazzi, Guido / Cucciolini, Giada / Di Nicolò, Pierpaolo / Wong, Adrian / Di Domenico, Antonia / Germinale, Federico / Dotta, Federico / Micali, Marco / Coccolini, Federico / Santori, Gregorio / Dazzi, Federico / Introini, Carlo / Corradi, Francesco

    Journal of clinical medicine

    2023  Volume 12, Issue 15

    Abstract: Point-of-care ultrasonography (POCUS) with concomitant venous and arterial Doppler assessment enables clinicians to assess organ-specific blood supply. To date, no studies have investigated the usefulness of including a comprehensive perioperative POCUS ... ...

    Abstract Point-of-care ultrasonography (POCUS) with concomitant venous and arterial Doppler assessment enables clinicians to assess organ-specific blood supply. To date, no studies have investigated the usefulness of including a comprehensive perioperative POCUS assessment of patients undergoing major laparoscopic surgery. The primary aim of the present study was to evaluate whether the combined venous and arterial renal flow evaluation, measured at different time points of perioperative period, may represent a clinically useful non-invasive method to predict postoperative acute kidney injury (AKI) after major laparoscopic urologic surgery. The secondary outcome was represented by the development of any postoperative complication at day 7. We included 173 patients, subsequently divided for analysis depending on whether they did (n = 55) or did not (n = 118) develop postoperative AKI or any complications within the first 7 days. The main results of the present study were that: (1) the combination of arterial hypoperfusion and moderate-to-severe venous congestion inferred by POCUS were associated with worst outcomes (respectively, HR: 2.993, 95% CI: 1.522-5.884 and HR: 8.124, 95% CI: 3.542-18,
    Language English
    Publishing date 2023-07-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12155013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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