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Article ; Online: Management of hospital admission, patient information and education, and immediate preoperative care

Massimiliano Greco / Giulio Calgaro / Maurizio Cecconi

Saudi Journal of Anaesthesia, Vol 17, Iss 4, Pp 517-

2023 Volume 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.
Keywords	geriatric anesthesia ; perioperative medicine frailty ; Anesthesiology ; RD78.3-87.3
Subject code	360
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Surviving Capnocytophaga Canimorsus Septic Shock

Fulvio Nisi / Andrea Dipasquale / Elena Costantini / Enrico Giustiniano / Umberto Ripani / Maurizio Cecconi

Diagnostics, Vol 12, Iss 260, p

Intertwining a Challenging Diagnosis with Prompt Treatment

2022 Volume 260

Abstract: Capnocytophaga canimorsus is zoonotic agent isolated from humans bitten by dogs or cats. Although rare, severe infection usually affects male patients over the age of 50, asplenic or immunocompromised. Diagnosis is often challenging, often missing a ... ...

Abstract	Capnocytophaga canimorsus is zoonotic agent isolated from humans bitten by dogs or cats. Although rare, severe infection usually affects male patients over the age of 50, asplenic or immunocompromised. Diagnosis is often challenging, often missing a history of contact with dogs or pre-existing wounds. Mortality rate is extremely high, since infection can lead to fulminant sepsis. We report a case of a patient admitted to ED for septic shock of unknown origin. Severe sepsis developed since our patient was asplenic and possessed multiple comorbidities. Due to hypoxia and respiratory failure, the patient was promptly intubated and mechanically ventilated. Supportive treatment for hemodynamic shock was administered. Cultures were obtained in the ED and empiric antibiotic therapy with piperacillin/tazobactam was started, aiming at infection control. As for source identification, common infectious etiologies, SARS-CoV-2 swab, bronchoalveolar lavage and urine cultures were negative. Blood cultures proved Gram-negative rods after 12 h incubation and C. canimorsus was identified on day 4. During ICU stay, clinical conditions gradually improved, and source control proved to be effective. Culture samples collection and starting empiric antibiotic treatment are the essential points in ensuring patient survival, especially in sepsis or septic shock of unknown origin or uncommon etiology, as in our case. Why should an emergency physician be aware of this? C. canimorsus bacteremia is rare and difficult to diagnose. Although considering patient history in such cases is crucial, laboratory results are often delayed. Hence, the chance of survival is dependent on prompt culture samples collection and start of empiric antibiotic treatment, along with supportive treatment.
Keywords	critical care medicine ; sepsis ; interesting cases in emergency medicine ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Variation in Communication and Family Visiting Policies in Italian Intensive Care Units during the COVID-19 Pandemic

Barbara Simone / Mariachiara Ippolito / Pasquale Iozzo / Francesco Zuccaro / Antonino Giarratano / Maurizio Cecconi / Alexis Tabah / Andrea Cortegiani

Healthcare, Vol 11, Iss 669, p

A Secondary Analysis of the COVISIT International Survey

2023 Volume 669

Abstract: Background: During COVID-19 pandemic, restrictions to in-person visiting of caregivers to patients admitted to intensive care units (ICU) were applied in many countries. Our aim was to describe the variations in communication and family visiting policies ...

Abstract	Background: During COVID-19 pandemic, restrictions to in-person visiting of caregivers to patients admitted to intensive care units (ICU) were applied in many countries. Our aim was to describe the variations in communication and family visiting policies in Italian ICUs during the pandemic. Methods: A secondary analysis from the COVISIT international survey was conducted, focusing on data from Italy. Results: Italian ICUs provided 118 (18%) responses out of 667 responses collected worldwide. A total of 12 Italian ICUs were at the peak of COVID-19 admissions at the time of the survey and 42/118 had 90% or more of patients admitted to ICU affected by COVID-19. During the COVID-19 peak, 74% of Italian ICUs adopted a no-in-person-visiting policy. This remained the most common strategy (67%) at the time of the survey. Information to families was provided by regular phone calls (81% in Italy versus 47% for the rest of the world). Virtual visiting was available for 69% and most commonly performed using devices provided by the ICU (71% in Italy versus 36% outside Italy). Conclusion: Our study showed that restrictions to the ICU applied during the COVID-19 pandemic were still in use at the time of the survey. The main means of communication with caregivers were telephone and virtual meetings.
Keywords	communication ; visiting policies ; Italy ; ICU ; COVID-19 ; Medicine ; R
Subject code	300
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy

Maurizio Cecconi / Daniele Piovani / Enrico Brunetta / Alessio Aghemo / Massimiliano Greco / Michele Ciccarelli / Claudio Angelini / Antonio Voza / Paolo Omodei / Edoardo Vespa / Nicola Pugliese / Tommaso Lorenzo Parigi / Marco Folci / Silvio Danese / Stefanos Bonovas

Journal of Clinical Medicine, Vol 9, Iss 1548, p

2020 Volume 1548

Abstract: We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; ... ...

Abstract	We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admission; used survival methods to identify factors associated with clinical deterioration (defined as intensive care unit (ICU) transfer or death), and developed a prognostic index. Overall; we analyzed 239 patients (29.3% females) with a mean age of 63.9 (standard deviation [SD]; 14.0) years. Clinical deterioration occurred in 70 patients (29.3%), including 41 (17.2%) ICU transfers and 36 (15.1%) deaths. The most common symptoms and signs at admission were cough (77.8%) and elevated respiratory rate (34.1%), while 66.5% of patients had at least one coexisting medical condition. Imaging frequently revealed ground-glass opacity (68.9%) and consolidation (23.8%). Age; increased respiratory rate; abnormal blood gas parameters and imaging findings; coexisting coronary heart disease; leukocytosis; lymphocytopenia; and several laboratory parameters (elevated procalcitonin; interleukin-6; serum ferritin; C-reactive protein; aspartate aminotransferase; lactate dehydrogenase; creatinine; fibrinogen; troponin-I; and D-dimer) were significant predictors of clinical deterioration. We suggested a prognostic index to assist risk-stratification (C-statistic; 0.845; 95% CI; 0.802‒0.887). These results could aid early identification and management of patients at risk, who should therefore receive additional monitoring and aggressive supportive care.
Keywords	SARS-CoV-2 ; 2019 novel coronavirus ; severe acute respiratory syndrome coronavirus 2 ; 2019-nCoV ; COVID-19 ; Medicine ; R ; covid19
Subject code	610 ; 616
Language	English
Publishing date	2020-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak

Elie Azoulay / Jan De Waele / Ricard Ferrer / Thomas Staudinger / Marta Borkowska / Pedro Povoa / Katerina Iliopoulou / Antonio Artigas / Stefan J. Schaller / Manu Shankar Hari / Mariangela Pellegrini / Michael Darmon / Jozef Kesecioglu / Maurizio Cecconi / ESICM

Annals of Intensive Care, Vol 10, Iss 1, Pp 1-

2020 Volume 8

Abstract: Abstract Background The COVID-19 pandemic has resulted in an unprecedented healthcare crisis with a high prevalence of psychological distress in healthcare providers. We sought to document the prevalence of burnout syndrome amongst intensivists facing ... ...

Abstract	Abstract Background The COVID-19 pandemic has resulted in an unprecedented healthcare crisis with a high prevalence of psychological distress in healthcare providers. We sought to document the prevalence of burnout syndrome amongst intensivists facing the COVID-19 outbreak. Methods Cross-sectional survey among intensivists part of the European Society of Intensive Care Medicine. Symptoms of severe burnout, anxiety and depression were collected. Factors independently associated with severe burnout were assessed using Cox model. Results Response rate was 20% (1001 completed questionnaires were returned, 45 years [39–53], 34% women, from 85 countries, 12 regions, 50% university-affiliated hospitals). The prevalence of symptoms of anxiety and depression or severe burnout was 46.5%, 30.2%, and 51%, respectively, and varied significantly across regions. Rating of the relationship between intensivists and other ICU stakeholders differed significantly according to the presence of anxiety, depression, or burnout. Similar figures were reported for their rating of the ethical climate or the quality of the decision-making. Factors independently associated with anxiety were female gender (HR 1.85 [1.33–2.55]), working in a university-affiliated hospital (HR 0.58 [0.42–0.80]), living in a city of > 1 million inhabitants (HR 1.40 [1.01–1.94]), and clinician’s rating of the ethical climate (HR 0.83 [0.77–0.90]). Independent determinants of depression included female gender (HR 1.63 [1.15–2.31]) and clinician’s rating of the ethical climate (HR 0.84 [0.78–0.92]). Factors independently associated with symptoms of severe burnout included age (HR 0.98/year [0.97–0.99]) and clinician’s rating of the ethical climate (HR 0.76 [0.69–0.82]). Conclusions The COVID-19 pandemic has had an overwhelming psychological impact on intensivists. Follow-up, and management are warranted to assess long-term psychological outcomes and alleviate the psychological burden of the pandemic on frontline personnel.
Keywords	Coronavirus ; Pneumonia ; Acute respiratory distress syndrome ; Exhaustion ; Depersonalization ; Well-being ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; covid19
Subject code	150
Language	English
Publishing date	2020-08-01T00:00:00Z
Publisher	SpringerOpen
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: International variation in the management of severe COVID-19 patients

Elie Azoulay / Jan de Waele / Ricard Ferrer / Thomas Staudinger / Marta Borkowska / Pedro Povoa / Katerina Iliopoulou / Antonio Artigas / Stefan J. Schaller / Manu Shankar-Hari / Mariangela Pellegrini / Michael Darmon / Jozef Kesecioglu / Maurizio Cecconi

Critical Care, Vol 24, Iss 1, Pp 1-

2020 Volume 7

Abstract: Abstract Background There is little evidence to support the management of severe COVID-19 patients. Methods To document this variation in practices, we performed an online survey (April 30–May 25, 2020) on behalf of the European Society of Intensive Care ...

Abstract	Abstract Background There is little evidence to support the management of severe COVID-19 patients. Methods To document this variation in practices, we performed an online survey (April 30–May 25, 2020) on behalf of the European Society of Intensive Care Medicine (ESICM). A case vignette was sent to ESICM members. Questions investigated practices for a previously healthy 39-year-old patient presenting with severe hypoxemia from COVID-19 infection. Results A total of 1132 ICU specialists (response rate 20%) from 85 countries (12 regions) responded to the survey. The survey provides information on the heterogeneity in patient’s management, more particularly regarding the timing of ICU admission, the first line oxygenation strategy, optimization of management, and ventilatory settings in case of refractory hypoxemia. Practices related to antibacterial, antiviral, and anti-inflammatory therapies are also investigated. Conclusions There are important practice variations in the management of severe COVID-19 patients, including differences at regional and individual levels. Large outcome studies based on multinational registries are warranted.
Keywords	Coronavirus ; Acute respiratory distress syndrome ; Viral infection ; Remdesivir ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; covid19
Language	English
Publishing date	2020-08-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Clinical Outcomes in the Second versus First Pandemic Wave in Italy

Antonio Voza / Antonio Desai / Sabino Luzzi / Alice Giotta Lucifero / Elena Azzolini / Maria Kogan / Giulia Goretti / Daniele Piovani / Stefanos Bonovas / Giovanni Angelotti / Victor Savevski / Alessio Aghemo / Massimiliano Greco / Elena Costantini / Ana Lleo / Claudio Angelini / Mauro Giordano / Salvatore Badalamenti / Maurizio Cecconi

Applied Sciences, Vol 11, Iss 9342, p

Impact of Hospital Changes and Reorganization

2021 Volume 9342

Abstract: The region of Lombardy was the epicenter of the COVID-19 outbreak in Italy. Emergency Hospital 19 (EH19) was built in the Milan metropolitan area during the pandemic’s second wave as a facility of Humanitas Clinical and Research Center (HCRC). The ... ...

Abstract	The region of Lombardy was the epicenter of the COVID-19 outbreak in Italy. Emergency Hospital 19 (EH19) was built in the Milan metropolitan area during the pandemic’s second wave as a facility of Humanitas Clinical and Research Center (HCRC). The present study aimed to assess whether the implementation of EH19 was effective in improving the quality of care of COVID-19 patients during the second wave compared with the first one. The demographics, mortality rate, and in-hospital length of stay (LOS) of two groups of patients were compared: the study group involved patients admitted at HCRC and managed in EH19 during the second pandemic wave, while the control group included patients managed exclusively at HCRC throughout the first wave. The study and control group included 903 (56.7%) and 690 (43.3%) patients, respectively. The study group was six years older on average and had more pre-existing comorbidities. EH19 was associated with a decrease in the intensive care unit admission rate (16.9% vs. 8.75%, p < 0.001), and an equal decrease in invasive oxygen therapy (3.8% vs. 0.23%, p < 0.001). Crude mortality was similar but overlap propensity score weighting revealed a trend toward a potential small decrease. The adjusted difference in LOS was not significant. The implementation of an additional COVID-19 hospital facility was effective in improving the overall quality of care of COVID-19 patients during the first wave of the pandemic when compared with the second. Further studies are necessary to validate the suggested approach.
Keywords	COVID-19 ; emergency department ; lean ; management algorithm ; SARS-CoV-2 ; Technology ; T ; Engineering (General). Civil engineering (General) ; TA1-2040 ; Biology (General) ; QH301-705.5 ; Physics ; QC1-999 ; Chemistry ; QD1-999
Subject code	610
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Quality of Life in COVID-Related ARDS Patients One Year after Intensive Care Discharge (Odissea Study)

Cristian Deana / Luigi Vetrugno / Andrea Cortegiani / Silvia Mongodi / Giulia Salve / Matteo Mangiagalli / Annalisa Boscolo / Tommaso Pettenuzzo / Sara Miori / Andrea Sanna / Sergio Lassola / Sandra Magnoni / Elena Ferrari / Emanuela Biagioni / Flavio Bassi / Nadia Castaldo / Alberto Fantin / Federico Longhini / Francesco Corradi /

Francesco Forfori / Gianmaria Cammarota / Edoardo De Robertis / Danilo Buonsenso / Savino Spadaro / Domenico Luca Grieco / Maria De Martino / Miriam Isola / Francesco Mojoli / Massimo Girardis / Antonino Giarratano / Elena Giovanna Bignami / Paolo Navalesi / Maurizio Cecconi / Salvatore Maurizio Maggiore / on behalf of the Italian Odissea Group

Journal of Clinical Medicine, Vol 12, Iss 1058, p

A Multicenter Observational Study

2023 Volume 1058

Abstract: Background: Investigating the health-related quality of life (HRQoL) after intensive care unit (ICU) discharge is necessary to identify possible modifiable risk factors. The primary aim of this study was to investigate the HRQoL in COVID-19 critically ... ...

Abstract	Background: Investigating the health-related quality of life (HRQoL) after intensive care unit (ICU) discharge is necessary to identify possible modifiable risk factors. The primary aim of this study was to investigate the HRQoL in COVID-19 critically ill patients one year after ICU discharge. Methods: In this multicenter prospective observational study, COVID-19 patients admitted to nine ICUs from 1 March 2020 to 28 February 2021 in Italy were enrolled. One year after ICU discharge, patients were required to fill in short-form health survey 36 (SF-36) and impact of event-revised (IES-R) questionnaire. A multivariate linear or logistic regression analysis to search for factors associated with a lower HRQoL and post-traumatic stress disorded (PTSD) were carried out, respectively. Results: Among 1003 patients screened, 343 (median age 63 years [57–70]) were enrolled. Mechanical ventilation lasted for a median of 10 days [2–20]. Physical functioning (PF 85 [60–95]), physical role (PR 75 [0–100]), emotional role (RE 100 [33–100]), bodily pain (BP 77.5 [45–100]), social functioning (SF 75 [50–100]), general health (GH 55 [35–72]), vitality (VT 55 [40–70]), mental health (MH 68 [52–84]) and health change (HC 50 [25–75]) describe the SF-36 items. A median physical component summary (PCS) and mental component summary (MCS) scores were 45.9 (36.5–53.5) and 51.7 (48.8–54.3), respectively, considering 50 as the normal value of the healthy general population. In all, 109 patients (31.8%) tested positive for post-traumatic stress disorder, also reporting a significantly worse HRQoL in all SF-36 domains. The female gender, history of cardiovascular disease, liver disease and length of hospital stay negatively affected the HRQoL. Weight at follow-up was a risk factor for PTSD (OR 1.02, p = 0.03). Conclusions: The HRQoL in COVID-19 ARDS (C-ARDS) patients was reduced regarding the PCS, while the median MCS value was slightly above normal. Some risk factors for a lower HRQoL have been identified, the presence of PTSD is one of ...
Keywords	COVID-19 ; health related quality of life ; post-traumatic stress disorder ; ICU ; ARDS ; SF-36 ; Medicine ; R
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Hemodynamic Monitoring Today

Christoph K. Hofer / Maxime Cannesson / Jamal A. Alhashemi / Maurizio Cecconi

Anesthesiology Research and Practice, Vol

2011 Volume 2011

Keywords	Anesthesiology ; RD78.3-87.3 ; Surgery ; RD1-811 ; Medicine ; R ; DOAJ:Anesthesiology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2011-01-01T00:00:00Z
Publisher	Hindawi Publishing Corporation
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mini invasive hemodynamic monitoring

GIORGIO DELLA ROCCA / MAURIZIO CECCONI / MARIA GABRIELLA COSTA

Signa Vitae, Vol 3, Iss Suppl. 1, Pp S 7-

from arterial pressure to cardiac output

2008 Volume 9

Abstract: To evaluate the Cardiac Output (CO) the standard invasive pulmonary artery catheter (PAC) is considered today the gold standard. The major criticism to the PAC is that its level of invasiveness is not supported by an improvement in patient's outcome. The ...

Abstract	To evaluate the Cardiac Output (CO) the standard invasive pulmonary artery catheter (PAC) is considered today the gold standard. The major criticism to the PAC is that its level of invasiveness is not supported by an improvement in patient's outcome. The interest to lesser and lesser invasive techniques is high. Therefore, the alternative techniques have been recently developed.Cardiac Output can be monitored continuously by different devices that analyze the arterial waveform to track changes in stroke volume (SV) and CO. The analysis of the arterial pressure wave to determine cardiac output is classified as Pulse Contour analysis or Pulse Pressure Analysis. Starting from a similar principle three main devices are now available on the market, with different algorithms and features:• PiCCO System (Pulsion Medical System, Munich, Germany)• LiDCOTM plus System (LidCO, Cambridge, UK)• Flotrac technology and Vigileo Monitor (Edwards Lifesciences, Irvine, CA, USA).The algorithm used by all these devices has been also implemented even with the analysis of the variation of stroke volume (SVV) and of the pulse pressure (PPV). SVV and PPV represent the variation of stroke volume and of the pulse pressure during the respiratory cycle. In sedated ventilated patients these indexes have proven to predict the response to a fluid challenge. A high variation (>10-12%) identifies with good sensitivity and specificity responders and not responders.
Keywords	cardiac output ; arterial pressure ; stroke volume variation ; pulse pressure variation ; Pediatrics ; RJ1-570 ; Medicine ; R ; DOAJ:Pediatrics ; DOAJ:Medicine (General) ; DOAJ:Health Sciences ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; Internal medicine ; RC31-1245 ; DOAJ:Internal medicine
Subject code	600
Language	English
Publishing date	2008-02-01T00:00:00Z
Publisher	Pharmamed Mado
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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