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Article ; Online: Refractory septic shock: who and how should we purify?

Donadello, K / Taccone, F S

2015 Volume 81, Issue 5, Page(s) 475–477

MeSH term(s)	Humans ; Shock ; Shock, Septic
Language	English
Publishing date	2015-05
Publishing country	Italy
Document type	Comment ; Editorial
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
Database	MEDical Literature Analysis and Retrieval System OnLINE

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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)
Zs.MO 192: Show issues

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Article ; Online: How to monitor the brain in septic patients?

Oddo, M / Taccone, F S

Minerva anestesiologica

2015 Volume 81, Issue 7, Page(s) 776–788

Abstract: Brain injury is frequently observed after sepsis and may be primarily related to the direct effects of the septic insult on the brain (e.g., brain edema, ischemia, seizures) or to secondary/indirect injuries (e.g., hypotension, hypoxemia, hypocapnia, ... ...

Abstract	Brain injury is frequently observed after sepsis and may be primarily related to the direct effects of the septic insult on the brain (e.g., brain edema, ischemia, seizures) or to secondary/indirect injuries (e.g., hypotension, hypoxemia, hypocapnia, hyperglycemia). Management of brain injury in septic patients is first focused to exclude structural intracranial complications (e.g., ischemic/hemorrhagic stroke) and possible confounders (e.g., electrolyte alterations or metabolic disorders, such as dysglycemia). Sepsis-associated brain dysfunction is frequently a heterogeneous syndrome. Despite increasing understanding of main pathophysiologic determinants, therapy is essentially limited to protect the brain against further cerebral damage, by way of "simple" therapeutic manipulations of cerebral perfusion and oxygenation and by avoiding over-sedation. Non-invasive monitoring of cerebral perfusion and oxygenation with transcranial Doppler (TCD) and near-infrared spectroscopy (NIRS) is feasible in septic patients. Electroencephalography (EEG) allows detection of sepsis-related seizures and holds promise also as sedation monitoring. Brain CT-scan detects intra-cerebral structural lesions, while magnetic resonance imaging (MRI) provides important insights into primary mechanisms of sepsis-related direct brain injury, (e.g., cytotoxic vs. vasogenic edema) and the development of posterior reversible encephalopathy. Together with EEG and evoked potentials (EP), MRI is also important for coma prognostication. Emerging clinical evidence suggests monitoring of the brain in septic patients can be implemented in the ICU. The objective of this review was to summarize recent clinical data about the role of brain monitoring - including TCD, NIRS, EEG, EP, CT, and MRI - in patients with sepsis and to illustrate its potential utility for the diagnosis, management and prognostication.
MeSH term(s)	Brain/diagnostic imaging ; Brain/physiopathology ; Humans ; Magnetic Resonance Imaging ; Monitoring, Physiologic/methods ; Sepsis/diagnostic imaging ; Sepsis/physiopathology ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Transcranial
Language	English
Publishing date	2015-07
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

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)
Zs.MO 192: Show issues

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Article ; Online: Is two (antibiotics) better than one?

Taccone, F S / Donadello, K

Minerva anestesiologica

2013 Volume 79, Issue 11, Page(s) 1300–1305

Abstract: The use of antibiotic therapy combining at least two drugs remains controversial in patients with severe sepsis and septic shock. Some studies have suggested an improvement in patients' outcome with combination therapy over monotherapy, especially in ... ...

Abstract	The use of antibiotic therapy combining at least two drugs remains controversial in patients with severe sepsis and septic shock. Some studies have suggested an improvement in patients' outcome with combination therapy over monotherapy, especially in those patients with expected mortality exceeding 25%. Nevertheless, a recent large randomized multicentric clinical trial, comparing the effects of meropenem and moxifloxacin to meropenem alone on the occurrence of sepsis-related organ dysfunction, found no significant advantage for combination therapy. Also, mortality rates were similar at 28 days and at 90 days in both groups. Considering some opposite observations coming from other recent non-randomized studies, we aimed to discuss the raisons of these conflicting findings on antimicrobials combination in patients with severe sepsis and septic shock.
MeSH term(s)	Anti-Bacterial Agents/administration & dosage ; Clinical Trials as Topic ; Drug Therapy, Combination ; Humans ; Practice Guidelines as Topic ; Sepsis/drug therapy ; Shock, Septic/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2013-11
Publishing country	Italy
Document type	Journal Article
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

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)
Zs.MO 192: Show issues

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Article ; Online: Extracorporeal membrane oxygenation during pregnancy and peripartal. An international retrospective multicenter study.

Malfertheiner, S Fill / Brodie, D / Burrell, A / Taccone, F S / Broman, L M / Shekar, K / Agerstrand, C L / Serra, A L / Fraser, J / Malfertheiner, M V

Perfusion

2022 Volume 38, Issue 5, Page(s) 966–972

Abstract: Introduction: Extracorporeal Membrane Oxygenation (ECMO) may be used in the setting of pregnancy or the peripartal period, however its utility has not been well-characterized. This study aims to give an overview on the prevalence of peripartel ECMO ... ...

Abstract	Introduction: Extracorporeal Membrane Oxygenation (ECMO) may be used in the setting of pregnancy or the peripartal period, however its utility has not been well-characterized. This study aims to give an overview on the prevalence of peripartel ECMO cases and further assess the indications and outcomes of ECMO in this setting across multiple centers and countries. Methods: A retrospective, multicenter, international cohort study of pregnant and peripartum ECMO cases was performed. Data were collected from six ECMO centers across three continents over a 10-year period. Results: A total of 60 pregnany/peripartal ECMO cases have been identified. Most frequent indications are acute respiratory distress syndrome ( Conclusions: Various emergency scenarios during pregnancy and at time of delivery may require ECMO treatment. Peripartal mortality in a well-resourced setting is rare, however emergencies in the labor room occur and knowledge of available rescue therapy is essential to improve outcome. Obstetricians and obstetric anesthesiologists should be aware of the availability of ECMO resource at their hospital or region to ensure immediate contact when needed.
MeSH term(s)	Pregnancy ; Female ; Humans ; Retrospective Studies ; Cohort Studies ; Extracorporeal Membrane Oxygenation ; Respiratory Distress Syndrome/therapy ; Pulmonary Embolism
Language	English
Publishing date	2022-05-13
Publishing country	England
Document type	Multicenter Study ; Journal Article
ZDB-ID	645038-6
ISSN	1477-111X ; 0267-6591
ISSN (online)	1477-111X
ISSN	0267-6591
DOI	10.1177/02676591221090668
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Zs.A 2424: Show issues

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Article ; Online: Early-goal directed therapy for septic shock: is it the end?

Dell'Anna, A M / Taccone, F S

Minerva anestesiologica

2015 Volume 81, Issue 10, Page(s) 1138–1143

Abstract: Three randomized clinical trials have recently provided data on the lack of effectiveness of "early-goal directed therapy" (EGDT) (i.e. optimization of tissue oxygenation in the first 6 hours since sepsis diagnosis using different therapeutic ... ...

Abstract	Three randomized clinical trials have recently provided data on the lack of effectiveness of "early-goal directed therapy" (EGDT) (i.e. optimization of tissue oxygenation in the first 6 hours since sepsis diagnosis using different therapeutic interventions based on the assessment of the central venous oxygen saturation to titrate such interventions) in the initial management of patients with septic shock. In a first trial including 31 US hospitals (the ProCESS study, N.=1341), three different therapeutic strategies (EGDT vs. protocol-based therapy vs. usual care) were compared and no difference in the primary endpoint (60-day mortality) was found (EGDT 21%, protocol-based therapy 18% and usual care 19%). No significant difference in death by 90 days or in other secondary outcomes, including serious adverse events, was found, as well. A second trial (ARISE, N.=1600), mostly conducted in Australia and New Zealand, randomized patients to EGDT or usual care. Ninety-day mortality was similar between groups (19% vs. 19%, respectively; P=0.90) and no other differences in secondary endpoints were recorded between the two groups. A third study (ProMISe, N.=1260) included patients in 56 hospitals across England, randomly assigned to EGDT or usual care. By 90 days, mortality was similar between groups (29% vs. 29%, respectively; P=0.90). Moreover, EGDT significantly increased costs and was associated with a longer hospital length of stay. We discussed some issues related to the differences between these studies and the pivotal paper from Rivers et al. and how EGDT should be still considered in the treatment of sepsis.
MeSH term(s)	Combined Modality Therapy ; Goals ; Humans ; Oxygen/therapeutic use ; Randomized Controlled Trials as Topic ; Shock, Septic/therapy
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2015-10
Publishing country	Italy
Document type	Journal Article
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

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)
Zs.MO 192: Show issues

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Article ; Online: Brain injury after cardiac surgery.

Scolletta, S / Taccone, F S / Donadello, K

Minerva anestesiologica

2015 Volume 81, Issue 6, Page(s) 662–677

Abstract: In patients undergoing cardiac surgery, postoperative brain injury significantly contributes to increase morbidity and mortality and has negative consequences on quality of life and costs. Moreover, over the past years, compelling medical and ... ...

Abstract	In patients undergoing cardiac surgery, postoperative brain injury significantly contributes to increase morbidity and mortality and has negative consequences on quality of life and costs. Moreover, over the past years, compelling medical and technological improvements have allowed an even older patients' population, with several comorbidities, to be treated with cardiac surgery; however, the risk of brain injury after such interventions is also increased in these patients. With the aim of improving post-operative neurological outcome, a variety of neuromonitoring methods and devices have been introduced in clinical practice. These techniques allow the assessment of a number of parameters, such as cerebral blood flow, brain embolic events, cerebral cortical activity, depth of anesthesia and brain oxygenation. Some of them have been used to optimize the hemodynamic management of such patients and to select specific therapeutic interventions. Also, various pharmacological and non-pharmacological approaches have been proposed to minimize the incidence of brain injury in this setting. In this review we describe the risk factors and mechanisms of cerebral injury after cardiac surgery and focus on monitoring techniques and clinical strategies that could help clinicians to minimize the incidence of brain injury.
MeSH term(s)	Brain Injury, Chronic/etiology ; Brain Injury, Chronic/therapy ; Cardiac Surgical Procedures/adverse effects ; Delirium/etiology ; Humans ; Postoperative Complications/therapy ; Stroke/etiology
Language	English
Publishing date	2015-06
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

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)
Zs.MO 192: Show issues

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Article ; Online: Can lactate levels and vasopressors use predict outcome in out-of-hospital cardiac arrest survivors?

Scolletta, S / Taccone, F S

Minerva anestesiologica

2011 Volume 77, Issue 11, Page(s) 1030–1033

MeSH term(s)	Female ; Heart Arrest/drug therapy ; Heart Arrest/mortality ; Humans ; Lactic Acid/blood ; Male ; Vasoconstrictor Agents/therapeutic use
Chemical Substances	Vasoconstrictor Agents ; Lactic Acid (33X04XA5AT)
Language	English
Publishing date	2011-11
Publishing country	Italy
Document type	Comment ; Editorial
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

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)
Zs.MO 192: Show issues

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Article ; Online: Lung biopsy as diagnostic tool for respiratory failure diagnosis in hematological ICU patients: is it time to adopt it into daily practice?

Dell'anna, A M / Taccone, F S

Minerva anestesiologica

2013 Volume 79, Issue 8, Page(s) 829–831

MeSH term(s)	Biopsy/methods ; Female ; Hematologic Neoplasms/pathology ; Humans ; Lung/pathology ; Male ; Respiratory Insufficiency/pathology
Language	English
Publishing date	2013-08
Publishing country	Italy
Document type	Comment ; Editorial
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

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)
Zs.MO 192: Show issues

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Article ; Online: How to target temperature after cardiac arrest: insights from a randomized clinical trial.

Dell'Anna, A M / Scolletta, S / Nobile, L / Taccone, F S

Minerva anestesiologica

2014 Volume 80, Issue 6, Page(s) 736–743

Abstract: Implementation of treatments able to improve survival and neurological recovery of cardiac arrest (CA) survivors is a major clinical challenge. More than ten years ago, two pivotal trials showed that application of therapeutic hypothermia (TH, 32-34 °C) ... ...

Abstract	Implementation of treatments able to improve survival and neurological recovery of cardiac arrest (CA) survivors is a major clinical challenge. More than ten years ago, two pivotal trials showed that application of therapeutic hypothermia (TH, 32-34 °C) to patients resuscitated from an out-of-hospital CA (OHCA) with an initial shockable rhythm significantly ameliorated their outcome. Since then, TH has been used also for non-shockable rhythms and for in-hospital CA to some extent, even if the quality of evidence supporting TH in such situations remained very low. The objective of this randomized, controlled, multicenter study (named "Targeted Temperature Management" TTM study) was to compare two different strategies of temperature control after CA; patients were randomized to be treated either at 33 °C or at 36 °C for 24 hours, while fever was accurately avoided for the first 3 days since randomization. Inclusion criteria were: Glasgow Coma Score <8, presumed cardiac origin of arrest, randomization occurring within the first 4 hours from the return of spontaneous circulation. Patients were excluded if they had an unwitnessed arrest with asystole as the initial rhythm, suspected or known acute intracranial hemorrhage or stroke, and a body temperature of less than 30 °C. A specific algorithm was used to decide for withdrawal of care in patients remaining comatose after 72 hours since normothermia was achieved. The primary outcome was 6-month mortality. After the enrollment of 939 patients, the authors did not find any significant difference between groups in primary outcome (235/473 [50%] and 225/466 [48%] of patients died in 33 °C and 36 °C group, respectively; HR for death if in the 33 °C group, 1.06 [95% CI 0.89 to 1.28; P=0.51]). Similarly, the analysis of the composite outcome of death or poor neurologic function yielded similar results between the two groups. This is the largest study evaluating the effects of two different strategies of temperature management after CA. Some important concerns have been raised on the real benefit of keeping CA patients at 33 °C and major changes in clinical practice are expected. We discussed herein the main differences with previous randomized trials and tried to identify possible explanations for these findings.
MeSH term(s)	Body Temperature ; Female ; Heart Arrest/therapy ; Humans ; Male ; Middle Aged ; Survival Analysis ; Treatment Outcome
Language	English
Publishing date	2014-06
Publishing country	Italy
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

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)
Zs.MO 192: Show issues

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Article ; Online: Glucocorticoid administration in sepsis and septic shock: time for a paradigm change?

Antonucci, E / Fiaccadori, E / Taccone, F S / Vincent, J L

Minerva anestesiologica

2014 Volume 80, Issue 9, Page(s) 1058–1062

Abstract: The use of corticosteroids in patients with septic shock remains controversial. Questions remain regarding the more appropriate dose, the optimal timing to initiate therapy, the selection of patients who will benefit most from the treatment and the exact ...

Abstract	The use of corticosteroids in patients with septic shock remains controversial. Questions remain regarding the more appropriate dose, the optimal timing to initiate therapy, the selection of patients who will benefit most from the treatment and the exact mechanisms involved in their effectiveness. Recent studies have highlighted that, in critically ill patients, corticosteroid metabolism was reduced and associated with high circulating cortisol levels. Hence the required doses of hydrocortisone may be lower than the currently recommended doses in septic shock (i.e. 200 mg/day). However, altered expression and/or function of corticosteroid receptors may still suggest that higher hydrocortisone doses are necessary to overcome this so-called "steroid-resistance". In this article, we summarized these recent concepts and discussed how they could influence the administration of corticosteroids in such patients.
MeSH term(s)	Anti-Inflammatory Agents/administration & dosage ; Anti-Inflammatory Agents/therapeutic use ; Glucocorticoids/administration & dosage ; Glucocorticoids/therapeutic use ; Humans ; Sepsis/drug therapy ; Sepsis/metabolism ; Shock, Septic/drug therapy ; Shock, Septic/metabolism
Chemical Substances	Anti-Inflammatory Agents ; Glucocorticoids
Language	English
Publishing date	2014-09
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.MO 192: Show issues

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