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  1. Article ; Online: Sepsis-induced Coagulopathy Subphenotype Identification by Latent Class Analysis

    Cai, Dan / Greco, Massimiliano / Wu, Qin / Cheng, Yisong

    Balkan medical journal

    2023  Volume 40, Issue 4, Page(s) 244–251

    Abstract: Background: Recent studies have shown that anticoagulant therapy has heterogeneous treatment effects on patients with sepsis-induced coagulopathy (SIC).: Aims: To identify the latent phenotypes of patients with SIC.: Study design: Retrospective ... ...

    Abstract Background: Recent studies have shown that anticoagulant therapy has heterogeneous treatment effects on patients with sepsis-induced coagulopathy (SIC).
    Aims: To identify the latent phenotypes of patients with SIC.
    Study design: Retrospective cohort study.
    Methods: We obtained data of patients with SIC from the Medical Information Mart for Intensive Care IV database. SIC subphenotypes were identified by latent class analysis (LCA) and K-means clustering. Clinical and laboratory variables were obtained in patients who met the diagnostic criteria for SIC. The baseline characteristics of the patients and the association between the heterogeneity of anticoagulant therapy and clinical outcomes (28-day and in-hospital mortality) were compared between the subphenotypes.
    Results: We identified 4,993 patients with SIC. The LCA and K-means clustering analysis robustly identified three subphenotypes of SIC. Class 1 patients (n = 1,808) had the lowest blood cell counts (leukocytes, erythrocytes, and platelets). Class 2 patients (n = 1,157) had severe coagulopathy with a high prothrombin time and international normalized ratio, multiple-organ dysfunction, high lactate, sequential organ failure assessment score, and mortality. Class 3 (n = 2,028) were older, had more comorbidities, a higher fibrinogen concentration, and lower plasma and platelet infusion rates. After variable adjustments, heparin therapy reduced the 28-day mortality (odds ratio [OR] 0.39, 0.30-0.49,
    Conclusion: Three SIC subphenotypes were defined using clinical findings and laboratory variables. The effects of heparin treatment differ between the subphenotypes. This finding will facilitate the identification of target patients with SIC who should receive anticoagulant therapy.
    MeSH term(s) Humans ; Retrospective Studies ; Latent Class Analysis ; Anticoagulants/therapeutic use ; Heparin ; Sepsis/complications
    Chemical Substances Anticoagulants ; Heparin (9005-49-6)
    Language English
    Publishing date 2023-06-02
    Publishing country Turkey
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2612982-6
    ISSN 2146-3131 ; 2146-3131
    ISSN (online) 2146-3131
    ISSN 2146-3131
    DOI 10.4274/balkanmedj.galenos.2023.2023-4-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Management of hospital admission, patient information and education, and immediate preoperative care.

    Greco, Massimiliano / Calgaro, Giulio / Cecconi, Maurizio

    Saudi journal of anaesthesia

    2023  Volume 17, Issue 4, Page(s) 517–522

    Abstract: An increasing proportion of surgical procedures involves elderly and frail patients in high-income countries, leading to an increased risk of postoperative complications. Complications significantly impact patient outcomes and costs, due to prolonged ... ...

    Abstract An increasing proportion of surgical procedures involves elderly and frail patients in high-income countries, leading to an increased risk of postoperative complications. Complications significantly impact patient outcomes and costs, due to prolonged hospitalization and loss of autonomy. Consequently, it is crucial to evaluate preoperative functional status in older patients, to tailor the perioperative plan, and evaluate risks. The hospital environment often exacerbates cognitive impairments in elderly and frail patients, also increasing the risk of infection, falls, and malnutrition. Thus, it is essential to work on dedicated pathways to reduce hospital readmissions and favor discharges to a familiar environment. In this context, the use of wearable devices and telehealth has been promising. Telemedicine can be used for preoperative evaluations and to allow earlier discharges with continuous monitoring. Wearable devices can track patient vitals both preoperatively and postoperatively. Preoperative education of patient and caregivers can improve postoperative outcomes and is favored by technology-based approach that increases flexibility and reduce the need for in-person clinical visits and associated travel; moreover, such approaches empower patients with a greater understanding of possible risks, moving toward shared decision-making principles. Finally, caregivers play an integral role in patient improvement, for example, in the prevention of delirium. Hence, their inclusion in the care process is not only advantageous but essential to improve perioperative outcomes in this population.
    Language English
    Publishing date 2023-08-18
    Publishing country India
    Document type Journal Article ; Review
    ZDB-ID 2562174-9
    ISSN 0975-3125 ; 1658-354X
    ISSN (online) 0975-3125
    ISSN 1658-354X
    DOI 10.4103/sja.sja_592_23
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  3. Article ; Online: The Good, the Bad, and the Serum Creatinine: Exploring the Effect of Muscle Mass and Nutrition.

    De Rosa, Silvia / Greco, Massimiliano / Rauseo, Michela / Annetta, Maria Giuseppina

    Blood purification

    2023  Volume 52, Issue 9-10, Page(s) 775–785

    Abstract: Muscle wasting (sarcopenia) is one of the hallmarks of critical illness. Patients admitted to intensive care unit develop sarcopenia through increased protein catabolism, a decrease in protein syntheses, or both. Among the factors known to promote ... ...

    Abstract Muscle wasting (sarcopenia) is one of the hallmarks of critical illness. Patients admitted to intensive care unit develop sarcopenia through increased protein catabolism, a decrease in protein syntheses, or both. Among the factors known to promote wasting are chronic inflammation and cytokine imbalance, insulin resistance, hypermetabolism, and malnutrition. Moreover, muscle wasting, known to develop in chronic kidney disease patients, is a harmful consequence of numerous complications associated with deteriorated renal function. Plenty of published data suggest that serum creatinine (SCr) reflects increased kidney damage and is also related to body weight. Based on the concept that urea and creatinine are nitrogenous end products of metabolism, the urea:creatinine ratio (UCR) could be applied but with limited clinical usability in case of kidney damage, hypovolemia, excessive, or protein intake, where UCR can be high and independent of catabolism. Recent data suggest that the sarcopenia index should be considered an alternative to serum creatinine. It is more reliable in estimating muscle mass than SCr. However, the optimal biomarker of catabolism is still an unresolved issue. The SCr is not a promising biomarker for renal function and muscle mass based on the influence of several factors. The present review highlights recent findings on the limits of SCr as a surrogate marker of renal function and the assessment modalities of nutritional status and muscle mass measurements.
    MeSH term(s) Humans ; Nutritional Status ; Creatinine ; Sarcopenia/diagnosis ; Sarcopenia/etiology ; Urea ; Muscles ; Biomarkers
    Chemical Substances Creatinine (AYI8EX34EU) ; Urea (8W8T17847W) ; Biomarkers
    Language English
    Publishing date 2023-09-22
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 605548-5
    ISSN 1421-9735 ; 0253-5068
    ISSN (online) 1421-9735
    ISSN 0253-5068
    DOI 10.1159/000533173
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1872: Show issues Location:
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  4. Article: The ESICM datathon and the ESICM and ICMx data science strategy.

    Elbers, Paul / Thoral, Patrick / Bos, Lieuwe D J / Greco, Massimiliano / Wendel-Garcia, Pedro D / Ercole, Ari

    Intensive care medicine experimental

    2024  Volume 12, Issue 1, Page(s) 29

    Language English
    Publishing date 2024-03-12
    Publishing country Germany
    Document type Editorial
    ZDB-ID 2740385-3
    ISSN 2197-425X
    ISSN 2197-425X
    DOI 10.1186/s40635-024-00615-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Implementing Artificial Intelligence: Assessing the Cost and Benefits of Algorithmic Decision-Making in Critical Care.

    Caruso, Pier Francesco / Greco, Massimiliano / Ebm, Claudia / Angelotti, Giovanni / Cecconi, Maurizio

    Critical care clinics

    2023  Volume 39, Issue 4, Page(s) 783–793

    Abstract: This article provides an overview of the most useful artificial intelligence algorithms developed in critical care, followed by a comprehensive outline of the benefits and limitations. We begin by describing how nurses and physicians might be aided by ... ...

    Abstract This article provides an overview of the most useful artificial intelligence algorithms developed in critical care, followed by a comprehensive outline of the benefits and limitations. We begin by describing how nurses and physicians might be aided by these new technologies. We then move to the possible changes in clinical guidelines with personalized medicine that will allow tailored therapies and probably will increase the quality of the care provided to patients. Finally, we describe how artificial intelligence models can unleash researchers' minds by proposing new strategies, by increasing the quality of clinical practice, and by questioning current knowledge and understanding.
    MeSH term(s) Humans ; Artificial Intelligence ; Cost-Benefit Analysis ; Algorithms ; Critical Care ; Precision Medicine
    Language English
    Publishing date 2023-04-26
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1006423-0
    ISSN 1557-8232 ; 0749-0704
    ISSN (online) 1557-8232
    ISSN 0749-0704
    DOI 10.1016/j.ccc.2023.03.007
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    Se 990: Show issues Location:
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  6. Article ; Online: Artificial Intelligence in the Intensive Care Unit.

    Greco, Massimiliano / Caruso, Pier F / Cecconi, Maurizio

    Seminars in respiratory and critical care medicine

    2020  Volume 42, Issue 1, Page(s) 2–9

    Abstract: The diffusion of electronic health records collecting large amount of clinical, monitoring, and laboratory data produced by intensive care units (ICUs) is the natural terrain for the application of artificial intelligence (AI). AI has a broad definition, ...

    Abstract The diffusion of electronic health records collecting large amount of clinical, monitoring, and laboratory data produced by intensive care units (ICUs) is the natural terrain for the application of artificial intelligence (AI). AI has a broad definition, encompassing computer vision, natural language processing, and machine learning, with the latter being more commonly employed in the ICUs. Machine learning may be divided in supervised learning models (i.e., support vector machine [SVM] and random forest), unsupervised models (i.e., neural networks [NN]), and reinforcement learning. Supervised models require labeled data that is data mapped by human judgment against predefined categories. Unsupervised models, on the contrary, can be used to obtain reliable predictions even without labeled data. Machine learning models have been used in ICU to predict pathologies such as acute kidney injury, detect symptoms, including delirium, and propose therapeutic actions (vasopressors and fluids in sepsis). In the future, AI will be increasingly used in ICU, due to the increasing quality and quantity of available data. Accordingly, the ICU team will benefit from models with high accuracy that will be used for both research purposes and clinical practice. These models will be also the foundation of future decision support system (DSS), which will help the ICU team to visualize and analyze huge amounts of information. We plea for the creation of a standardization of a core group of data between different electronic health record systems, using a common dictionary for data labeling, which could greatly simplify sharing and merging of data from different centers.
    MeSH term(s) Artificial Intelligence ; Electronic Health Records ; Humans ; Intensive Care Units ; Machine Learning ; Sepsis
    Language English
    Publishing date 2020-11-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1183617-9
    ISSN 1098-9048 ; 1069-3424
    ISSN (online) 1098-9048
    ISSN 1069-3424
    DOI 10.1055/s-0040-1719037
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    Zs.A 1555: Show issues Location:
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  7. Article ; Online: Fitbit Data to Assess Functional Capacity in Patients Before Elective Surgery: Pilot Prospective Observational Study.

    Angelucci, Alessandra / Greco, Massimiliano / Canali, Stefano / Marelli, Giovanni / Avidano, Gaia / Goretti, Giulia / Cecconi, Maurizio / Aliverti, Andrea

    Journal of medical Internet research

    2023  Volume 25, Page(s) e42815

    Abstract: Background: Preoperative assessment is crucial to prevent the risk of complications of surgical operations and is usually focused on functional capacity. The increasing availability of wearable devices (smartwatches, trackers, rings, etc) can provide ... ...

    Abstract Background: Preoperative assessment is crucial to prevent the risk of complications of surgical operations and is usually focused on functional capacity. The increasing availability of wearable devices (smartwatches, trackers, rings, etc) can provide less intrusive assessment methods, reduce costs, and improve accuracy.
    Objective: The aim of this study was to present and evaluate the possibility of using commercial smartwatch data, such as those retrieved from the Fitbit Inspire 2 device, to assess functional capacity before elective surgery and correlate such data with the current gold standard measure, the 6-Minute Walk Test (6MWT) distance.
    Methods: During the hospital visit, patients were evaluated in terms of functional capacity using the 6MWT. Patients were asked to wear the Fitbit Inspire 2 for 7 days (with flexibility of -2 to +2 days) after the hospital visit, before their surgical operation. Resting heart rate and daily steps data were retrieved directly from the smartwatch. Feature engineering techniques allowed the extraction of heart rate over steps (HROS) and a modified version of Non-Exercise Testing Cardiorespiratory Fitness. All measures were correlated with 6MWT.
    Results: In total, 31 patients were enrolled in the study (n=22, 71% men; n=9, 29% women; mean age 76.06, SD 4.75 years). Data were collected between June 2021 and May 2022. The parameter that correlated best with the 6MWT was the Non-Exercise Testing Cardiorespiratory Fitness index (r=0.68; P<.001). The average resting heart rate over the whole acquisition period for each participant had r=-0.39 (P=.03), even if some patients did not wear the device at night. The correlation of the 6MWT distance with the HROS evaluated at 1% quantile was significant, with Pearson coefficient of -0.39 (P=.04). Fitbit step count had a fair correlation of 0.59 with 6MWT (P<.001).
    Conclusions: Our study is a promising starting point for the adoption of wearable technology in the evaluation of functional capacity of patients, which was strongly correlated with the gold standard. The study also identified limitations in the availability of metrics, variability of devices, accuracy and quality of data, and accessibility as crucial areas of focus for future studies.
    MeSH term(s) Male ; Humans ; Female ; Aged ; Fitness Trackers ; Wearable Electronic Devices ; Heart Rate/physiology ; Monitoring, Physiologic ; Walking
    Language English
    Publishing date 2023-04-13
    Publishing country Canada
    Document type Observational Study ; Journal Article
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1438-8871
    ISSN (online) 1438-8871
    ISSN 1438-8871
    DOI 10.2196/42815
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  8. Article ; Online: What should I use next if clinical evaluation and echocardiographic haemodynamic assessment is not enough?

    Messina, Antonio / Greco, Massimiliano / Cecconi, Maurizio

    Current opinion in critical care

    2019  Volume 25, Issue 3, Page(s) 259–265

    Abstract: Purpose of review: To provide an integrated clinical approach to the critically ill patients in shock.: Recent findings: The complexity behind shock mechanism has improved in the last decades; as consequence, conventional generalized practices have ... ...

    Abstract Purpose of review: To provide an integrated clinical approach to the critically ill patients in shock.
    Recent findings: The complexity behind shock mechanism has improved in the last decades; as consequence, conventional generalized practices have been questioned, in favour of different approaches, titrated to patient's individual response. Bedside clinical examination has been demonstrated to be a reliable instrument to recognize the mismatch between cardiac function and peripheral oxygen demand. Mottling skin and capillary refill time have been recently proposed using a semi-quantitative approach as reliable tool to guide shock therapy; lactate, ΔCO2 and ScVO2 are also useful to track the effect of the therapies overtime. Critical care echocardiography is useful to assess the source of the shock, to choice the correct the therapy and to customize the therapy. Finally, a more sophisticated and invasive calibrated monitoring should be promptly adopted in case of refractory or mixed shock state to titrate the therapy on predefined goals, avoiding the inappropriate use of fluids and vasoactive drugs.
    Summary: Bedside haemodynamic assessment in critically ill patients should be considered an integrated approach supporting the decision-making process and should be based on clinical examination and critical care echocardiography.
    MeSH term(s) Critical Care ; Critical Illness ; Echocardiography ; Hemodynamics ; Humans ; Shock/congenital ; Shock/diagnostic imaging
    Language English
    Publishing date 2019-04-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000000603
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 4999: Show issues Location:
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  9. Article ; Online: In Response to Karim et al: Noninvasive Ventilation After Thoracoabdominal Aortic Surgery: More Trials? Yes, Please.

    Nardelli, Pasquale / Landoni, Giovanni / Greco, Massimiliano

    Journal of cardiothoracic and vascular anesthesia

    2019  Volume 33, Issue 11, Page(s) 3220–3221

    MeSH term(s) Aortic Aneurysm, Abdominal ; Aortic Aneurysm, Thoracic ; Humans ; Noninvasive Ventilation ; Pilot Projects
    Language English
    Publishing date 2019-08-02
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1067317-9
    ISSN 1532-8422 ; 1053-0770
    ISSN (online) 1532-8422
    ISSN 1053-0770
    DOI 10.1053/j.jvca.2019.07.146
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  10. Article: Thoracic UltrasONOgraphy Reporting: The TUONO Study.

    Calamai, Italo / Greco, Massimiliano / Finazzi, Stefano / Savi, Marzia / Vitiello, Gaia / Garbero, Elena / Spina, Rosario / Montisci, Andrea / Mongodi, Silvia / Bertolini, Guido

    Journal of clinical medicine

    2022  Volume 11, Issue 23

    Abstract: Lung ultrasound (LUS) is a validated technique for the prompt diagnosis and bedside monitoring of critically ill patients due to its availability, safety profile, and cost-effectiveness. The aim of this work is to detect similarities and differences ... ...

    Abstract Lung ultrasound (LUS) is a validated technique for the prompt diagnosis and bedside monitoring of critically ill patients due to its availability, safety profile, and cost-effectiveness. The aim of this work is to detect similarities and differences among LUS reports performed in ICUs and to provide a common ground for an integrated report form. We collected all LUS reports during an index week in 21 ICUs from the GiViTI network. First, we considered signs, chest areas, and terminology reported. Then, we compared different report structures and categorized them as structured reports (SRs), provided with a predefined model form, and free unstructured text reports (FTRs) that had no predetermined structure. We analyzed 171 reports from 21 ICUs, and 59 reports from 5 ICUs were structured. All the reports presented a qualitative description that mainly focused on the presence of B-lines, consolidations, and pleural effusion. Zones were defined in 66 reports (39%). In SRs, a complete examination of all the regions was more frequently achieved (96% vs. 74%), and a higher impact on therapeutic strategies was observed (17% vs. 6%). LUS reports vary significantly among different centers. Adopting an integrated SR seems to promote a systematic approach in scanning and reporting, with a potential impact on LUS clinical applications.
    Language English
    Publishing date 2022-11-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm11237126
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