Publications by authors named "Flavia Petrini"

49 Publications

Metoclopramide and Propofol to Prevent Nausea and Vomiting during Cesarean Section under Spinal Anesthesia: A Randomized, Placebo-Controlled, Double-Blind Trial.

J Clin Med 2021 Dec 26;11(1). Epub 2021 Dec 26.

Department of Emergency, SS.ma Annunziata University Hospital, Via dei Vestini, 66100 Chieti, Italy.

Background: Intra-operative nausea, vomiting and retching (NVR) are frequently associated with subarachnoid anesthesia (SA) in women undergoing cesarean section (CS). In this study performed in women undergoing CS under SA with a risk factor control strategy, we compared saline (placebo), propofol, metoclopramide and both drugs to prevent NVR.

Methods: We recorded NVR events in 110 women undergoing CS who were randomized after umbilical cord clamping to receive saline (S; = 27), metoclopramide 10 mg (M; = 28), propofol 1 mg/kg/h (P; = 27) or both drugs (PM; = 28).

Results: The proportion of women with intra-operative nausea was: S: 17/27 (63%); P: 15/27 (56%); M: 13/28 (46%); PM: 6/28 (21%) ( = 0.012, Cramér's V = 0.31 (large effect). The proportion of women with intra-operative vomiting/retching was: S: 9/27 (33%); M: 7/27 (25%); P: 3/28 (11%); PM 2/28 (7%) ( = 0.049, Cramér's V = 0.26 (medium effect). Post-hoc multiple comparisons revealed a significant reduction in NVR episodes and NRS scores between the PM group and control. Sedation scores did not differ among groups.

Conclusion: In women undergoing CS under SA with a risk factor control strategy, combined propofol and metoclopramide reduce nausea and vomiting.
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http://dx.doi.org/10.3390/jcm11010110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8745529PMC
December 2021

Pursuing the Recovery of Severe Chronic Musculoskeletal Pain in Italy: Clinical and Organizational Perspectives from a SIAARTI Survey.

J Pain Res 2021 29;14:3401-3410. Epub 2021 Oct 29.

Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy.

Background: Increased attention to the functional impact of chronic pain (CP), as highlighted by the 11th revision of the International Classification of Diseases (ICD-11) and advocated by the International Classification of Functioning, Disability and Health (ICF), is an important step forward for optimizing its management. Evidence about perspectives of Italian physicians on the relevance of musculoskeletal (MSK) pain care to improve patients' functioning and Quality of Life is scant. The study aimed to investigate the physicians' perception of the value of functional recovery in severe MSK pain patients, their attitude towards its assessment and achievement in Italy.

Methods: A survey was conducted in Italy between October 2020 and January 2021. Specialist centers members of the SIAARTI (n = 395) were sent an online questionnaire encompassing the Italian pain therapy network. Participants rated their agreement to questionnaire items according to a 5-point Likert-type scale.

Results: A total of 305 centers (77%) completed the survey. Most physicians rated the recovery of functioning as very relevant in MSK pain treatment and, when they assessed it, devoted great attention to the ability to perform daily activities, pain, ability to ambulate and sleep quality. Multidimensional questionnaires were less employed in favor of physical examination and pain intensity scales. Pharmacological therapy, rehabilitation and lifestyle changes and/or physical exercise were all rated optimal strategies to pursue the recovery of patients' functioning. When considering pharmacological therapy, weak and strong opioids, either alone or combined with paracetamol, were the most frequently employed analgesics.

Conclusion: Clinicians seem to recognize the recovery of functioning as equally important as pain intensity reduction, but there is a need of streamlining available tools to effectively assess both across different MSK pain patients.
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http://dx.doi.org/10.2147/JPR.S328434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8565982PMC
October 2021

Level of Diffusion and Training of Lung Ultrasound during the COVID-19 Pandemic - A National Online Italian Survey (ITALUS) from the Lung Ultrasound Working Group of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI).

Ultraschall Med 2021 Nov 3. Epub 2021 Nov 3.

Anesthesia, Intensive Care and Pain Management, President Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), Rome Italy, Rome, Italy.

Purpose:  The goal of this survey was to describe the use and diffusion of lung ultrasound (LUS), the level of training received before and during the COVID-19 pandemic, and the clinical impact LUS has had on COVID-19 cases in intensive care units (ICU) from February 2020 to May 2020.

Materials And Methods:  The Italian Lung Ultrasound Survey (ITALUS) was a nationwide online survey proposed to Italian anesthesiologists and intensive care physicians carried out after the first wave of the COVID-19 pandemic. It consisted of 27 questions, both quantitative and qualitative.

Results:  807 responded to the survey. The median previous LUS experience was 3 years (IQR 1.0-6.0). 473 (60.9 %) reported having attended at least one training course on LUS before the COVID-19 pandemic. 519 (73.9 %) reported knowing how to use the LUS score. 404 (52 %) reported being able to use LUS without any supervision. 479 (68.2 %) said that LUS influenced their clinical decision-making, mostly with respect to patient monitoring. During the pandemic, the median of patients daily evaluated with LUS increased 3-fold (p < 0.001), daily use of general LUS increased from 10.4 % to 28.9 % (p < 0.001), and the daily use of LUS score in particular increased from 1.6 % to 9.0 % (p < 0.001).

Conclusion:  This survey showed that LUS was already extensively used during the first wave of the COVID-19 pandemic by anesthesiologists and intensive care physicians in Italy, and then its adoption increased further. Residency programs are already progressively implementing LUS teaching. However, 76.7 % of the sample did not undertake any LUS certification.
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http://dx.doi.org/10.1055/a-1634-4710DOI Listing
November 2021

The Italian document: decisions for intensive care when there is an imbalance between care needs and resources during the COVID-19 pandemic.

Ann Intensive Care 2021 Jun 29;11(1):100. Epub 2021 Jun 29.

President of SIAARTI, Chieti, Italy.

Background: In early 2020, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) published clinical ethics recommendations for the allocation of intensive care during COVID-19 pandemic emergency. Later the Italian National Institute of Health (ISS) invited SIAARTI and the Italian Society of Legal and Insurance Medicine to prepare a draft document for the definition of triage criteria for intensive care during the emergency, to be implemented in case of complete saturation of care resources.

Methods: Following formal methods, including two Delphi rounds, a multidisciplinary group with expertise in intensive care, legal medicine and law developed 12 statements addressing: (1) principles and responsibilities; (2) triage; (3) previously expressed wishes; (4) reassessment and shifting to palliative care; (5) collegiality and transparency of decisions. The draft of the statements, with their explanatory comments, underwent a public consultation opened to Italian scientific or technical-professional societies and other stakeholders (i.e., associations of citizens, patients and caregivers; religious communities; industry; public institutions; universities and research institutes). Individual healthcare providers, lay people, or other associations could address their comments by e-mail.

Results: Eight stakeholders (including scientific societies, ethics organizations, and a religious community), and 8 individuals (including medical experts, ethicists and an association) participated to the public consultation. The stakeholders' agreement with statements was on average very high (ranging from 4.1 to 4.9, on a scale from 1-full disagreement to 5-full agreement). The 4 statements concerning triage stated that in case of saturation of care resources, the intensive care triage had to be oriented to ensuring life-sustaining treatments to as many patients as possible who could benefit from them. The decision should follow full assessment of each patient, taking into account comorbidities, previous functional status and frailty, current clinical condition, likely impact of intensive treatment, and the patient's wishes. Age should be considered as part of the global assessment of the patient.

Conclusions: Lacking national guidelines, the document is the reference standard for healthcare professionals in case of imbalance between care needs and available resources during a COVID-19 pandemic in Italy, and a point of reference for the medico-legal assessment in cases of dispute.
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http://dx.doi.org/10.1186/s13613-021-00888-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241202PMC
June 2021

Acquisition of skills in critical emergency medicine: an experimental study on the SIAARTI Academy CREM experience.

Minerva Anestesiol 2021 11 25;87(11):1174-1182. Epub 2021 Jun 25.

SIAARTI President, Rome, Italy.

Background: In 2019 the SIAARTI developed a seven-days course for residents, focused on critical emergency medicine (CREM) in a hostile environment, that grounds on simulation-based education and training with hands-on simulation, high-fidelity simulators and part-task trainers. This project aimed to evaluate the efficacy of this course in comparison to traditional learning programs in term of technical (TS) and non-technical (NTS) skills. We assessed the improvement in TS and NTS over time, and the ability to involve trainees in corporate activities.

Methods: Three-hundred and twenty-seven trainees completed the study. Trainees were allocated into three groups: those who joined the SIAARTI-Academy-CREM course and received a study kit (SA-kit, N.=124), those who received only a study kit (kit, N.=108), and control (N.=95). Eighty-five tests were administered to investigate skills at three timepoints: T0 (baseline), T1 (post-training/kit), and T2 (four months later).

Results: TS differed among groups (P<0.0001), with the highest points in the SA-kit group at T1 (post-hoc comparison, P<0.0001 vs. kit; P<0.0001 vs. control), and T2 (post-hoc comparison, P<0.0001 vs. kit; P<0.0001 vs. control). NTS differed among groups (P=0.0406), with the highest points in the SA-kit group at T1 (post-hoc comparison, P=0.0337 vs. kit; P=0.0416 vs. control), and T2 (post-hoc comparison, P=0.0073 vs. kit; P=0.3308 vs. control). SA-kit group significantly improved TS (P<0.0001) and NTS (P=0.0006) over time. Involvement in corporate activities of SA-kit was significantly higher than kit and control (P=0.0012).

Conclusions: SA-kit improvement in TS and NTS was higher than kit and control and was maintained over time. Participation in this course implemented participation in corporate activities among attendees.
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http://dx.doi.org/10.23736/S0375-9393.21.15427-6DOI Listing
November 2021

Congestive heart failure and comorbidity as determinants of colorectal cancer perioperative outcomes.

Updates Surg 2021 Jun 11. Epub 2021 Jun 11.

Epidemiological Department (SER), Azienda Zero, Via Jacopo Avanzo 35, Veneto Region, 35132, Padua, Italy.

There has been an increase in surgical interventions in frailer elderly with concomitant chronic diseases. The purpose of this paper was to evaluate the impact of aging and comorbidities on outcomes in patients who underwent surgery for the treatment of colorectal cancer (CRC) in Veneto Region (Northeastern Italy). This is a retrospective cohort study in patients ≥ 40 years who underwent elective or urgent CRC surgical resection between January 2013 and December 2015. Independent variables included: age, sex, and comorbidities. We analyzed variables associated with the surgical procedure, such as stoma creation, hospitalization during the year before the index surgery, the surgical approach used, the American Society of Anesthesiologists (ASA) score, and the Charlson Comorbidity Index score. Eight thousand four hundred and forty-seven patients with CRC underwent surgical resection. Patient age affected both pre- and post-resection LOS as well as the overall survival (OS); however, it did not affect the 30-day readmission and reoperation rates. Multivariate analysis showed that age represented a risk factor for longer preoperative and postoperative LOS as well as for 30-day and 365-day mortality, but it was not associated with an increased risk of 30-day reoperation and 30-day readmission. Chronic Heart Failure increased the 30-day mortality risk by four times, the preoperative LOS by 51%, and the postoperative LOS by 33%. Chronic renal failure was associated with a 74% higher 30-day readmission rate. Advanced age and comorbidities require a careful preoperative evaluation and appropriate perioperative management to improve surgical outcomes in older patients undergoing elective or urgent CRC resection.
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http://dx.doi.org/10.1007/s13304-021-01086-4DOI Listing
June 2021

Why and how to open intensive care units to family visits during the pandemic.

Crit Care 2021 06 2;25(1):191. Epub 2021 Jun 2.

SIAARTI President - Retired Full Professor of Anesthesia and Intensive Care, Chieti-Pescara University, Chieti, Italy.

Since the lockdown because of the pandemic, family members have been prohibited from visiting their loved ones in hospital. While it is clearly complicated to implement protocols for the admission of family members, we believe precise strategic goals are essential and operational guidance is needed on how to achieve them. Even during the pandemic, we consider it a priority to share strategies adapted to every local setting to allow family members to enter intensive care units and all the other hospital wards.
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http://dx.doi.org/10.1186/s13054-021-03608-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171999PMC
June 2021

[Perioperative strategies: taking care of the elderly patient with severe advanced comorbidities needing acute surgery.]

Recenti Prog Med 2021 Apr;112(4):250-261

In the common clinical practice the perioperative risk assessment of an acute surgical patient with advanced chronic comorbidities is carried out independently by surgeon and anesthesiologist, usually in two different steps. While the surgeon evaluates the risk mainly in relation to the surgical outcome, the perioperative risk assessment regarding the weight of the coexisting medical condition on the quality of recovery in the short- mid- and long-term is all about the anesthesiologist evaluation. When frailty and/or comorbidities are so serious that will make surgery seem futile, the patient's assessment on one hand, and the decisions regarding the further clinical waypoint on the other, have to be discussed firstly between surgeons and anesthesiologists before being shared with the patients and their relatives. This is mostly true in the event of an emergency surgical procedure. In regard, a consensus conference attended by a panel of experts respectively from the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) and the Italian Society of Surgery (SIC) was called for developing a shared clinical pathway aimed to select the best care option - operative vs palliative - in the best interest of the surgical patient with advanced chronic comorbidities, in emergency or elective condition. After two years, the panel of experts developed a position paper recommending, in case of potentially futile surgery, to assess the patient verifying two coexisting conditions ("Two Steps method"): Palliative Performance Scale <50%, and at least one of the following general clinical criteria: 1) more than one hospital admission within the last 12 months; 2) hospital admission from or awaiting admission to long-term care facilities, home care service, hospice; 3) chronic renal failure requiring weekly dialysis sessions; 4) home oxygen use and/or non-invasive ventilation. Under these conditions, the surgeon together with the anesthesiologist can share with the patient and/or his relatives the decision between palliative surgery or palliative care taking into account his wishes and preferences.
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http://dx.doi.org/10.1701/3584.35684DOI Listing
April 2021

The management of pediatric severe traumatic brain injury: Italian Guidelines.

Minerva Anestesiol 2021 05 12;87(5):567-579. Epub 2021 Jan 12.

Società Italiana di Pediatria (SIP), Rome, Italy.

Introduction: The aim of the work was to update the "Guidelines for the Management of Severe Traumatic Brain Injury" published in 2012, to reflect the new available evidence, and develop the Italian national guideline for the management of severe pediatric head injuries to reduce variation in practice and ensure optimal care to patients.

Evidence Acquisition: MEDLINE and EMBASE were searched from January 2009 to October 2017. Inclusion criteria were English language, pediatric populations (0-18 years) or mixed populations (pediatric/adult) with available age subgroup analyses. The guideline development process was started by the Promoting Group that composed a multidisciplinary panel of experts, with the representatives of the Scientific Societies, the independent expert specialists and a representative of the Patient Associations. The panel selected the clinical questions, discussed the evidence and formulated the text of the recommendations. The documentarists of the University of Florence oversaw the bibliographic research strategy. A group of literature reviewers evaluated the selected literature and compiled the table of evidence for each clinical question.

Evidence Synthesis: The search strategies identified 4254 articles. We selected 3227 abstract (first screening) and, finally included 67 articles (second screening) to update the guideline. This Italian update includes 25 evidence-based recommendations and 5 research recommendations.

Conclusions: In recent years, progress has been made on the understanding of severe pediatric brain injury, as well as on that concerning all major traumatic pathology. This has led to a progressive improvement in the clinical outcome, although the quantity and quality of evidence remains particularly low.
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http://dx.doi.org/10.23736/S0375-9393.20.14122-1DOI Listing
May 2021

Chronic pain and COVID-19: pathophysiological, clinical and organizational issues.

Minerva Anestesiol 2021 07 15;87(7):828-832. Epub 2020 Dec 15.

President of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care (SIAARTI), Rome, Italy.

During the lockdown phase of the COVID-19 pandemic, a call not to neglect the continuum of care of patients who present with chronic diseases, including pain, was made. In the field of pain, COVID-19 had an impact both from a clinical (i.e., the influence of SARS-CoV-2 infection on pain) and organizational (i.e., how patients with chronic pain should be managed in the post-COVID-19 era) perspective. Furthermore, patients with chronic pain are also frequently frail subjects, affected from multiple comorbidities and hence are at increased risk of infection. On these bases, how the necessity to continue pain therapy will be pursued in the post-COVID-19 era? In this paper, we comment on the above-mentioned topics, on the basis of available data and our experience as pain therapists.
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http://dx.doi.org/10.23736/S0375-9393.20.15029-6DOI Listing
July 2021

Recommendations from the Italian intersociety consensus on Perioperative Anesthesia Care in Thoracic surgery (PACTS) part 1: preadmission and preoperative care.

Perioper Med (Lond) 2020 Dec 1;9(1):37. Epub 2020 Dec 1.

Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy.

Introduction: Anesthetic care in patients undergoing thoracic surgery presents specific challenges that necessitate standardized, multidisciplionary, and continuously updated guidelines for perioperative care.

Methods: A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, comprising 24 members from 19 Italian centers, was established to develop recommendations for anesthesia practice in patients undergoing thoracic surgery (specifically lung resection for cancer). The project focused on preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and PubMed and Embase literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventative Services Task Force criteria.

Results: Recommendations for preoperative care focus on risk assessment, patient preparation (prehabilitation), and the choice of procedure (open thoracotomy vs. video-assisted thoracic surgery).

Conclusions: These recommendations should help pulmonologists to improve preoperative management in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
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http://dx.doi.org/10.1186/s13741-020-00168-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704118PMC
December 2020

Choice and management of vascular access in the context of COVID-19 outbreak in Italy: Recommendations from clinical practice.

J Vasc Access 2020 Nov 16:1129729820968415. Epub 2020 Nov 16.

Anesthesia, Intensive Care and Emergency, 'Città della Salute e della Scienza' Hospital, Torino, Italy.

On April 2020, during the outburst of the COVID-19 pandemic in Italy, the SIAARTI ("Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva") Research Group on Vascular Access has formulated some essential recommendations for the optimization of the selection, insertion, and maintenance of the vascular access devices, with the aim of guarantee the operator safety, ensure the effectiveness of the maneuvers, and reduce the risk of complications. Here we describe the key elements of clinical management of vascular access in patients affected by COVID-19.
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http://dx.doi.org/10.1177/1129729820968415DOI Listing
November 2020

Protocol Implementation for Normothermia in Surgery Settings in Italy: Budget-Impact Analysis.

Risk Manag Healthc Policy 2020 30;13:2347-2356. Epub 2020 Oct 30.

Anestesia, Rianimazione e Terapia Intensiva, Università Gabriele d'Annunzio - ASL 2 Abruzzo, Chieti, Italy.

Introduction: Hypothermia is a well-known risk of the perioperative period and considered a preventable effect of anesthesia care. Nevertheless, it is not fully controlled, causing a number of adverse outcomes following surgical operations and thus increasing length of stay in hospital and treatment costs. The aim of this study was to assess the budget impact (BI) of the implementation of proactive strategies to prevent inadvertent perioperative hypothermia (IPH) in surgical patients in Italy, as recommended by international guidelines and by a good clinical practice (GCP) guideline of the Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care.

Methods: BI was calculated over a 3-year period from the perspective of the Italian National Health Service (NHS). Model inputs were extracted from national literature when available and otherwise from international sources. The reference analytic model was based on the cost-effectiveness analysis of the National Institute for Health and Care Excellence clinical guidance 65. Estimates were based on assessments made about current malpractice in Italy and on a hypothesis of how future practice might change by implementing the GCP. Model output included overall BI results, variations in the number of warmed patients, medical-device average costs and use of mix.

Results: The base-case estimate quantified a decrease of 35% in extra days of hospital stay due to IPH and a net BI of -€60.92 million.

Conclusion: Increasing protocol adoption for preventing IPH would lead to both clinical advantages and significant savings for the NHS. Its large diffusion in Italian hospitals is thus desirable.
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http://dx.doi.org/10.2147/RMHP.S267923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608003PMC
October 2020

Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care.

Perioper Med (Lond) 2020 23;9:31. Epub 2020 Oct 23.

Department of Anaesthesia, Perioperative Medicine, Pain Therapy, RRS and Critical Care Area - DEA ASL2 Abruzzo, Chieti University Hospital, Chieti, Italy.

Introduction: Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients.

Methods: A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria.

Results: Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis.

Conclusions: These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.
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http://dx.doi.org/10.1186/s13741-020-00159-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582032PMC
October 2020

How to communicate with families living in complete isolation.

BMJ Support Palliat Care 2020 Oct 15. Epub 2020 Oct 15.

UO Anestesia e Rianimazione 1, Ospedale Santa Chiara, Trento, Italy.

Importance: During the SARS-CoV-2 pandemic, a complete physical isolation has been worldwide introduced. The impossibility of visiting their loved ones during the hospital stay causes additional distress for families: in addition to the worries about clinical recovery, they may feel exclusion and powerlessness, anxiety, depression, mistrust in the care team and post-traumatic stress disorder. The impossibility of conducting the daily meetings with families poses a challenge for healthcare professionals.

Objective: This paper aims to delineate and share consensus statements in order to enable healthcare team to provide by telephone or video calls an optimal level of communication with patient's relatives under circumstances of complete isolation.

Evidence Review: PubMed, Cochrane Database of Systematic Reviews, Database of Abstracts and Reviews of Effectiveness and the AHCPR Clinical Guidelines and Evidence Reports were explored from 1999 to 2019. Exclusion criteria were: poor or absent relevance regarding the aim of the consensus statements, studies prior to 1999, non-English language. Since the present pandemic context is completely new, unexpected and unexplored, there are not randomised controlled trials regarding clinical communication in a setting of complete isolation. Thus, a multiprofessional taskforce of physicians, nurses, psychologists and legal experts, together with some family members and former intensive care unit patients was established by four Italian national scientific societies. Using an e-Delphi methodology, general and specific questions were posed, relevant topics were argumented, until arriving to delineate position statements and practical checklist, which were set and evaluated through an evidence-based consensus procedure.

Findings: Ten statements and two practical checklists for phone or video calls were drafted and evaluated; they are related to who, when, why and how family members must be given clinical information under circumstances of complete isolation.

Conclusions And Relevance: The statements and the checklists offer a structured methodology in order to ensure a good-quality communication between healthcare team and family members even in isolation, confirming that time dedicated to communication has to be intended as a time of care.
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http://dx.doi.org/10.1136/bmjspcare-2020-002633DOI Listing
October 2020

Airway Management in COVID-19: In the Den of the Beast.

Anesth Analg 2020 07;131(1):e38-e40

Department of Emergency, Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria (AOU) Policlinico San Marco University Hospital, Catania, Italy, Department of Anaesthesia, Guy's and St Thomas' National Health System (NHS) Foundation Trust, London, United Kingdom Anesthesia and Intensive Care Dipartimento di Medicina Perioperatoria, Dolore, Terapia Intensiva e Rapid Response System, Ospedale di Chieti, Università "G. D'Annunzio", Chieti-Pescara, Italy.

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http://dx.doi.org/10.1213/ANE.0000000000004883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7179066PMC
July 2020

Italian publications on Pain Medicine in 2018.

Minerva Anestesiol 2021 02 5;87(2):250-251. Epub 2020 Aug 5.

Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy.

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http://dx.doi.org/10.23736/S0375-9393.20.15008-9DOI Listing
February 2021

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus.

Aging Clin Exp Res 2020 Sep 10;32(9):1647-1673. Epub 2020 Jul 10.

Università degli Studi di Ferrara, Ferrara, Italy.

Background: Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue.

Aims: To develop evidence-based recommendations for the integrated care of geriatric surgical patients.

Methods: A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria.

Results: A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items).

Conclusions: These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient's conditions.
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http://dx.doi.org/10.1007/s40520-020-01624-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508736PMC
September 2020

Surgery in COVID-19 patients: operational directives.

World J Emerg Surg 2020 04 7;15(1):25. Epub 2020 Apr 7.

Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy.

The current COVID-19 pandemic underlines the importance of a mindful utilization of financial and human resources. Preserving resources and manpower is paramount in healthcare. It is important to ensure the ability of surgeons and specialized professionals to function through the pandemic. A conscious effort should be made to minimize infection in this sector. A high mortality rate within this group would be detrimental.This manuscript is the result of a collaboration between the major Italian surgical and anesthesiologic societies: ACOI, SIC, SICUT, SICO, SICG, SIFIPAC, SICE, and SIAARTI. We aim to describe recommended clinical pathways for COVID-19-positive patients requiring acute non-deferrable surgical care. All hospitals should organize dedicated protocols and workforce training as part of the effort to face the current pandemic.
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http://dx.doi.org/10.1186/s13017-020-00307-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137852PMC
April 2020

SIAARTI recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances.

Minerva Anestesiol 2020 05 3;86(5):469-472. Epub 2020 Apr 3.

Perioperative Medicine, Pain Therapy, Intra-Hospital Emergency and ICU - DEA ASL 2, University of Chieti-Pescara, Chieti, Italy.

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http://dx.doi.org/10.23736/S0375-9393.20.14619-4DOI Listing
May 2020

An Island-Wide Disaster Drill to Train the Next Generation of Anesthesiologists: The SIAARTI Academy Experience.

Disaster Med Public Health Prep 2020 Mar 2:1-4. Epub 2020 Mar 2.

Research Center in Emergency and Disaster Medicine (CRIMEDIM), Università del Piemonte Orientale, Novara, Italy.

Objective: Anesthesiologists play a pivotal role in mass-casualty incidents management. Disaster medicine is part of the anesthesiologist's core skills; however, dedicated training is still scarce and, often, it does not follow a standardized program.

Methods: We designed and delivered a crash course in disaster medicine for Italian anesthesiology residents participating in the nationwide program, Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) Academy Critical Emergency Medicine 2019. Residents totaling 145, from 39 programs, participated in a 75-minute workstation on the principles of disaster management. Following this, each participant was involved in a full-scale mass-casualty drill. A plenary debriefing followed to present simulation data, maximize feedback, and highlight all situations needing improvement.

Results: Overall, participant performance was good: Triage accuracy was 85% prehospital and 84% in-hospital. Evacuation flow respected triage priority. During the debriefing, residents were very open to share and reflect on their experiences. A narrative qualitative analysis of the debriefing highlights that many participants felt overwhelmed by events during the exercise. Participants in coordination positions shared how they appreciated the need to switch from a clinical mindset to a managerial role.

Conclusion: This was an invaluable experience for anesthesiology trainees, providing them with the skill set to understand the fundamental principles of a mass-casualty response.
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http://dx.doi.org/10.1017/dmp.2019.163DOI Listing
March 2020

Ventilatory support after extubation in critically ill patients.

Lancet Respir Med 2018 12;6(12):948-962

University Department of Medical, Oral and Biotechnological Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy; Clinical Department of Anaesthesiology and Intensive Care Medicine, SS. Annunziata Hospital, Chieti, Italy.

The periextubation period represents a crucial moment in the management of critically ill patients. Extubation failure, defined as the need for reintubation within 2-7 days after a planned extubation, is associated with prolonged mechanical ventilation, increased incidence of ventilator-associated pneumonia, longer intensive care unit and hospital stays, and increased mortality. Conventional oxygen therapy is commonly used after extubation. Additional methods of non-invasive respiratory support, such as non-invasive ventilation and high-flow nasal therapy, can be used to avoid reintubation. The aim of this Review is to describe the pathophysiological mechanisms of postextubation respiratory failure and the available techniques and strategies of respiratory support to avoid reintubation. We summarise and discuss the available evidence supporting the use of these strategies to achieve a tailored therapy for an individual patient at the bedside.
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http://dx.doi.org/10.1016/S2213-2600(18)30375-8DOI Listing
December 2018

Competences in bronchoscopy for Intensive Care Unit, anesthesiology, thoracic surgery and lung transplantation.

Panminerva Med 2019 Sep 31;61(3):367-385. Epub 2018 Oct 31.

Department of Anesthesiology, Resuscitation and Intensive Care, University of Chieti-Pescara, Pescara, Italy.

Over the last decades, the use of flexible bronchoscopy has greatly increased in intensive care, anesthesia and thoracic surgery for diagnostic purpose, management of critical patients and to facilitate airway management for tracheal intubation, one lung ventilation and lung transplant management. The huge availability of endoscopic instruments and devices for airway management has amplified indications and possibilities for bronchoscopic procedures performed by intensive care physicians, anesthesiologist, endoscopists, and surgeons too. These practices need adequate technical skills that can be acquired only through defined learning pathways. This manuscript summarizes the indications and the competencies needed to perform bronchoscopic procedures in intensive care, anesthesia and thoracic surgery settings.
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http://dx.doi.org/10.23736/S0031-0808.18.03565-6DOI Listing
September 2019

Experienced Use of Dexmedetomidine in the Intensive Care Unit: A Report of a Structured Consensus.

Turk J Anaesthesiol Reanim 2018 Jun 1;46(3):176-183. Epub 2017 Jun 1.

Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy.

Objective: Management of pain, agitation and delirium (PAD) remains to be a true challenge in critically ill patients. The pharmacological proprieties of dexmedetomidine (DEX) make it an ideal candidate drug for light and cooperative sedation, but many practical questions remain unanswered. This structured consensus from 17 intensivists well experienced on PAD management and DEX use provides indications for the appropriate use of DEX in clinical practice.

Methods: A modified RAND/UCLA appropriateness method was used. In four predefined patient populations, the clinical scenarios do not properly cope by the current recommended pharmacological strategies (except DEX), and the possible advantages of DEX use were identified and voted for agreement, after reviewing literature data.

Results: Three scenarios in medical patients, five scenarios in patients with acute respiratory failure undergoing non-invasive ventilation, three scenarios in patients with cardiac surgery in the early postoperative period and three scenarios in patients with overt delirium were identified as challenging with the current PAD strategies. In these scenarios, the use of DEX was voted as potentially useful by most of the panellists owing to its specific pharmacological characteristics, such as conservation of cognitive function, lack of effects on the respiratory drive, low induction of delirium and analgesia effects.

Conclusion: DEX might be considered as a first-line sedative in different scenarios even though conclusive data on its benefits are still lacking.
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http://dx.doi.org/10.5152/TJAR.2018.08058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097863PMC
June 2018

Spontaneous coronary artery dissection complicated by cardiac arrest in pregnancy.

Minerva Anestesiol 2018 11 28;84(11):1326-1327. Epub 2018 May 28.

Department of Anesthesiology and Intensive Care, SS. Annunziata Hospital, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy -

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http://dx.doi.org/10.23736/S0375-9393.18.12869-0DOI Listing
November 2018

[Diagnosis and treatment of blood volume changes in acute heart failure - a brief practical guide].

G Ital Cardiol (Rome) 2018 Jan;19(1):44-53

Istituto di Cardiologia.

The correct management of acute heart failure continues to pose diagnostic and therapeutic challenges. In particular, administering the right type and dose of fluids and drugs, thus avoiding fluid overload while establishing organ perfusion, is of key importance in stabilizing critical patients and improving prognosis. A correct estimate of the fluid volume status, however, may be difficult, as the invasive evaluation of cardiac filling pressures by cardiac catheterization is limited in routine medical practice, and there is no universal consensus on the best tools for its non-invasive evaluation. Here we review current evidence about diagnosis and treatment of fluid volume abnormalities in acute heart failure according to the most recent guidelines.
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http://dx.doi.org/10.1714/2852.28778DOI Listing
January 2018

Anesthesiology Resident Induction Month: a pilot study showing an effective and safe way to train novice residents through simulation.

Minerva Anestesiol 2018 12 16;84(12):1377-1386. Epub 2018 Jan 16.

SIMNOVA Interdepartmental Center for Innovative Learning and Simulation in Medicine and Allied Health Professions, University of Eastern Piedmont, Novara, Italy -

Background: The transition of new residents from medical school to the post-graduate clinical environment remains challenging. We hypothesized that an introductory simulation course could improve new residents' performance in anesthesiology.

Methods: The Anesthesiology Residents Induction Month (ARIM) program was designed as a non-clinical simulation training program aiming at providing the theoretical and practical skills to safely approach, as junior anesthesiologists, the operating rooms. For each participant, specific knowledge, procedural skills and non-technical performance were assessed with a pre and post-test approach, before and immediately after the participation in the study.

Results: Fifteen first-month residents participated in the study. As compared to pre-test, residents significantly improved in all three evaluated areas. Pre-test knowledge assessment mean improved from 56% to 73% in the post-test (P<0.001). In the procedural skills assessment, pre-test mean improved from 43% to 77% (P<0.001) and non-technical skills assessment improved from 3.17 to 4.61 (in a scale out of seven points) in the post-test (P<0.001).

Conclusions: Data suggest that an intensive simulation-based program can be an effective way for first-year residents to rapidly acquire and develop basic skills specific to anesthesiology. There might be benefits to begin residency with a training program aiming at developing and standardizing technical and non-technical skills.
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http://dx.doi.org/10.23736/S0375-9393.18.12087-6DOI Listing
December 2018
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