Publications by authors named "Sandra Rossi"

40 Publications

INTRACRANIAL PRESSURE MONITORING IN POOR-GRADE PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE TREATED BY COILING.

World Neurosurg 2021 Sep 11. Epub 2021 Sep 11.

Dipartimento di Scienze Medico-Chirurgiche, Diagnostiche e Pediatriche, Università di Pavia; UOC Anestesia e Rianimazione 1, Dipartimento di Medicina Intensiva.

Objectives: The main objective of this study was to analyze intracranial (ICP) and cerebral perfusion pressure (CPP) changes during coiling. We also evaluated the prevalence of rebleeding and outcome in patients monitored earlier (before coiling) and in patients monitored later, after coiling.

Methods: Ninety-nine consecutive poor-grade patients with aneurysmal subarachnoid hemorrhage (aSAH) (grades IV-V of the WFNS) were enrolled in this prospective observational study. In 31 patients ICP/CPP monitoring started immediately after diagnosis of aSAH and values were recorded every 15 minutes during coiling (early ICP group), while in 68 patients ICP/CPP were monitored after coiling (late ICP group). Outcome was evaluated at 90 days using the modified Rankin Scale.

Results: At the beginning of coiling, ICP was more than 20 mmHg in 10 (35.7%) patients, and median ICP was 18 mmHg (range 5-60); CPP was less than 60 mmHg in 6 patients (24%) and median CPP was 70 mmHg (range 30-101). Despite the medical treatment and/or cerebrospinal fluid drainage, 51.6% of patients monitored during coiling had at least one episode of intracranial hypertension (defined as ICP>20 mmHg) and 51.6% had at least one episode of reduced CPP (defined as CPP<60 mmHg). Early monitoring (before aneurysm repair) was not associated with rebleeding. At 90 days the functional recovery was better in the early ICP group (p=0.004).

Conclusions: During coiling, patients with poor-grade aSAH may develop episodes of intracranial hypertension and reduced CPP. Early and appropriate treatment of elevated ICP was not associated with rebleeding and might have improved the outcome.
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http://dx.doi.org/10.1016/j.wneu.2021.09.018DOI Listing
September 2021

Brain Temperature Influences Intracranial Pressure and Cerebral Perfusion Pressure After Traumatic Brain Injury: A CENTER-TBI Study.

Neurocrit Care 2021 Jul 30. Epub 2021 Jul 30.

Neurological Intensive Care Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Background: After traumatic brain injury (TBI), fever is frequent. Brain temperature (BT), which is directly linked to body temperature, may influence brain physiology. Increased body and/or BT may cause secondary brain damage, with deleterious effects on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and outcome.

Methods: Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI), a prospective multicenter longitudinal study on TBI in Europe and Israel, includes a high resolution cohort of patients with data sampled at a high frequency (from 100 to 500 Hz). In this study, simultaneous BT, ICP, and CPP recordings were investigated. A mixed-effects linear model was used to examine the association between different BT levels and ICP. We additionally focused on changes in ICP and CPP during the episodes of BT changes (Δ BT ≥ 0.5 °C lasting from 15 min to 3 h) up or downward. The significance of ICP and CPP variations was estimated with the paired samples Wilcoxon test (also known as Wilcoxon signed-rank test).

Results: Twenty-one patients with 2,435 h of simultaneous BT and ICP monitoring were studied. All patients reached a BT of 38 °C and experienced at least one episode of ICP above 20 mm Hg. The linear mixed-effects model revealed an association between BT above 37.5 °C and higher ICP levels that was not confirmed for lower BT. We identified 149 episodes of BT changes. During BT elevations (n = 79) ICP increased, whereas CPP was reduced; opposite ICP and CPP variations occurred during episodes of BT reduction (n = 70). All these changes were of moderate clinical relevance (increase of ICP of 4.5 and CPP decrease of 7.5 mm Hg for BT rise, and ICP reduction of 1.7 and CPP elevation of 3.7 mm Hg during BT defervescence), even if statistically significant (p < 0.0001). It has to be noted, however, that a number of therapeutic interventions against intracranial hypertension was documented during those episodes.

Conclusions: Patients after TBI usually develop BT > 38 °C soon after the injury. BT may influence brain physiology, as reflected by ICP and CPP. An association between BT exceeding 37.5 °C and a higher ICP was identified but not confirmed for lower BT ranges. The relationship between BT, ICP, and CPP become clearer during rapid temperature changes. During episodes of temperature elevation, BT seems to have a significant impact on ICP and CPP.
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http://dx.doi.org/10.1007/s12028-021-01294-1DOI Listing
July 2021

Nurse's identity role during Covid-19.

Acta Biomed 2021 07 29;92(S2):e2021036. Epub 2021 Jul 29.

Azienda USL-IRCCS di Reggio Emilia, Italy.

Background And Aim Of The Work: The main purpose of the study is to investigate the experience of nurses who worked in the Covid-19 area focusing on the perception of their role. In particular, has been explored the nurses' perception of job satisfaction in relation to the images sent back by public opinion through the mass media and social communication channels. During the first wave of Covid-19 nurses have acquired media visibility , but their feeling is represented more by the discomfort of finding themselves suddenly glorified in the face of a lack of professional, social, and economic recognition.

Materials And Methods: A Mix-Method methodology and convenience sampling was adopted, on the population of professionals and students in post-graduate specializations, belonging to the Department of Medicine and Surgery of the University of Parma, and by nurses from the ASST-Bergamo Asst Bergamo Est, Lombardia Italy, who worked in the Covid emergency during the first wave of the pandemic, from February 2020 to May 2020.  In the quantitative phase Stamm's Professional Quality of Life Scale -  ProQOL was administered to 89 respondents through a Google Form, In the qualitative phase, 3 Focus Groups were conducted  on a total of 17 students .

Results: At the ProQol questionnaire, a moderate score was found in the Compassion Satisfaction scale (CF = 38.28) and in the Secondary Traumatic Stress subscale (STS-24.33), while low values emerged in the Burnout subscale (BO = 16.02). From the focus groups emerged five specific thematic: Professional collaboration, Job satisfaction, Nurse's personal skills, Failure to protect the public image and the nursing profession.

Conclusions: The professional collaboration, union with the work team, sense of solidarity, job satisfaction, professional growth and awareness of one's role seem to have worked favorably on Compassion Satisfaction, while keeping Compassion Fatigue levels under control.
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http://dx.doi.org/10.23750/abm.v92iS2.11959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383219PMC
July 2021

The medical therapy for cerebellar mutism syndrome: a case report and literature review.

Childs Nerv Syst 2021 09 14;37(9):2727-2734. Epub 2021 Jun 14.

Neurosurgery and Functional Neurosurgery Unit, Department of Neurosciences, Meyer Children's Hospital Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy.

Purpose: Cerebellar mutism syndrome (CMS) represents a major complication affecting many children that undergo surgery for posterior fossa lesions. Etiology and pathophysiology are still not fully understood. CMS deeply influences quality of life and recovery of these patients. An effective treatment has not been defined yet. This case-based review aims at analyzing the available evidence and knowledge to better delineate this phenomenon and to determine whether CMS can be successfully treated with pharmacological therapy.

Methods: Systematic research and retrieval of databases were conducted analyzing all papers where medical treatment of CMS was reported. A summary of the latest understanding and reports regarding definition, clinical manifestations, pathophysiology, management, and outcome of CMS has been conducted.

Results: Consensus on definition of this syndrome is lacking. CMS is the term accepted by the Posterior Fossa Society in 2016. Pathophysiology is still poorly understood but the most likely mechanism is injury along proximal components of the efferent cerebellar pathway. Nine papers describing positive effects of pharmacological therapy for CMS have been identified. Fluoxetine, zolpidem, bromocriptine, and midazolam are the drugs that seem to alleviate symptoms of CMS and improve recovery. To date, cognitive rehabilitation and physiotherapy are the only treatment options available.

Conclusion: CMS has deep impact on affected children and their families. Despite attempts to identify preventive measures and treatment, cases still occur on a regular basis. Pharmacological treatments have been proposed to help reduce the symptoms of CMS with some promising results, but reports are limited; therefore, further studies are needed.
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http://dx.doi.org/10.1007/s00381-021-05233-5DOI Listing
September 2021

The intervention of the emergency psychologist: the SIPEM SoS Emilia Romagna during the first lockdown from COVID-19.

Acta Biomed 2021 03 31;92(S2):e2021019. Epub 2021 Mar 31.

Italian Society of Emergency Psychology Social Support, SIPEM SoS Emilia Romagna and Sicily sections; Faculty of Human Sciences and Society, University of Enna "Kore";.

Background and purpose of this work: WHO 11 March 2020 declares that Sars-Cov-2 infection is not only a health emergency but must be considered a pandemic. Covid-19 required the urgency of a new psychological intervention model to better address the crisis and ensure a direct support response to the people involved in the pandemic. The present study aimed to detect the symptoms and reactions of the population with respect to the event. The survey was carried out by describing the clinical symptoms that emerged from the triage card used by SIPEM SoS Emilia Romagna (Italy), connoting the criteria of emergency psychology.

Methods: A retrospective quantitative study was conducted on 288 psychological triage cards.

Results: only 11% of users who ask for support say they are positive while 85% report not having contracted the virus. Of the total, 40.9% call for psychological support in the management of anxiety symptoms, a need also reported by 55% of the subsample who declared previous psychological problems. In reaction to the pandemic event, 51.1% of the total refers to coping resources and availability for help.

Discussions: the need for support of the population to manage symptoms highlights the need for early interventions, also to facilitate that slice of the population that does not have effective individual coping strategies and resources available to help.

Conclusions: it can be deduced that interventions during these types of emergencies must be timely and aimed not only at those affected but also at the general population.
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http://dx.doi.org/10.23750/abm.v92iS2.11440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138816PMC
March 2021

Fabric-Phase Sorptive Membrane Array As a Noninvasive Sampling Device For Human Exposure To Different Compounds.

Anal Chem 2021 02 20;93(4):1957-1961. Epub 2021 Jan 20.

Department of Chemistry and Biochemistry, Florida International University, 11200 SW Eighth Street, Miami, Florida 33199, United States.

This study introduces an innovative device for the noninvasive sampling and chromatographic analysis of different compounds present in exhaled breath aerosol (EBA). The new sampling device, especially in light of the recent COVID-19 pandemic that forced many countries to impose mandatory facemasks, allows an easy monitoring of the subject's exposure to different compounds they may come in contact with, actively or passively. The project combines the advantages of a fabric-phase sorptive membrane (FPSM) as an sampling device with a validated LC-MS/MS screening procedure able to monitor more than 739 chemicals with an overall analysis time of 18 min. The project involves the noninvasive sampling of the EBA using an FPSM array inserted inside an FFP2 mask. The study involved 15 healthy volunteers, and no restrictions were imposed during or prior to the sampling process regarding the consumption of drinks, food, or drugs. The FPSM array-LC-MS/MS approach allowed us to effectively exploit the advantages of the two complementary procedures (the convenient sampling by an FPSM array and the rapid analysis by LC-MS/MS), obtaining a powerful and green tool to carry out rapid screening analyses for human exposure to different compounds. The flexible fabric substrate, the sponge-like porous architecture of the high-efficiency sol-gel sorbent coating, the availability of a large cache of sorbent coatings, including polar, nonpolar, mixed mode, and zwitterionic phases, the easy installation into the facemask, and the possibility of sampling without interrupting regular activities provide FPSMs unparalleled advantages over other sampling techniques, and their applications are expected to expand to many other clinical or toxicological studies.
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http://dx.doi.org/10.1021/acs.analchem.0c04663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877698PMC
February 2021

A case of thrombotic thrombocytopenic purpura associated with COVID-19.

J Thromb Thrombolysis 2021 Jan 3. Epub 2021 Jan 3.

Cardiac Surgery Intensive Care Unit, Emergency-Urgency Department, Azienda Ospedaliero-Universitaria di Parma, 43126, Parma, Italy.

Acquired thrombotic thrombocytopenic purpura (TTP) is an autoimmune disease that can be triggered by different events, including viral infections. It presents as thrombotic microangiopathy and can lead to severe complications that often require management in the intensive care unit (ICU). We report a patient who presented with acquired TTP following COVID-19 infection. A 44-year-old woman presented to the emergency department with severe anemia, acute kidney injury and respiratory failure due to COVID-19. Clinical and laboratory findings were suggestive for thrombotic microangiopathy. On day 8 laboratory tests confirmed the diagnosis of acquired TTP. The patient needed 14 plasma exchanges, treatment with steroids, rituximab and caplacizumab and 18 days of mechanical ventilation. She completely recovered and was discharged home on day 51. Acquired TTP can be triggered by different events leading to immune stimulation. COVID-19 has been associated with different inflammatory and auto-immune diseases. Considering the temporal sequence and the lack of other possible causes, we suggest that COVID-19 infection could have been the triggering factor in the development of TTP. Since other similar cases have already been described, possible association between COVID and TTP deserves further investigation.
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http://dx.doi.org/10.1007/s11239-020-02362-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778714PMC
January 2021

The Effect of Temperature Increases on Brain Tissue Oxygen Tension in Patients with Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Substudy.

Ther Hypothermia Temp Manag 2021 Jun 17;11(2):122-131. Epub 2020 Nov 17.

Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.

Fever may aggravate secondary brain injury after traumatic brain injury (TBI). The aim of this study was to identify episodes of temperature increases through visual plot analysis and algorithm supported detection, and to describe associated patterns of changes in on brain tissue oxygen tension (PO). Data derive from the high-resolution cohort of the multicenter prospective Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. Temperature increases (≥0.5°C) were visually identified in 33 patients within the first 11 days of monitoring. Generalized estimating equations were used to detect significant changes of systemic and neuromonitoring parameters from baseline to the highest temperature. Patients were median 50 (interquartile range [IQR], 35-62) years old, and presented with a Glasgow Coma Scale (GCS) of 8 (IQR, 4-10). In 202 episodes of temperature increases, mean temperature rose by 1.0°C ± 0.5°C within 4 hours. Overall, PO slightly increased (ΔPO = 0.9 ± 6.1 mmHg,  = 0.022) during temperature increases. PO increased in 35% ( < 0.001), was stable in 49% ( = 0.852), and decreased in 16% ( < 0.001) of episodes. During episodes of temperature increases and simultaneous drops in PO, cerebral perfusion pressure (CPP) decreased (ΔCPP -6.3 ± 11.5 mmHg;  < 0.001). Brain tissue hypoxia (PO <20 mmHg) developed during 27/164 (17%) episodes of effervescences, in the remaining 38/202 episodes baseline PO was already <20 mmHg. Comparable results were found when using algorithm-supported detection of temperature increases. In conclusion, during effervescences, PO was mostly stable or slightly increased. A decrease of PO was observed in every sixth episode, where it was associated with a decrease in CPP. Our data highlight the need for special attention to CPP monitoring and maintenance during episodes of fever.
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http://dx.doi.org/10.1089/ther.2020.0027DOI Listing
June 2021

Use of critical care resources during the first 2 weeks (February 24-March 8, 2020) of the Covid-19 outbreak in Italy.

Ann Intensive Care 2020 Oct 12;10(1):133. Epub 2020 Oct 12.

Department of Clinical, Integrated, and Experimental Medicine (DIMES), Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Bologna, Italy.

Background: A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary.

Results: In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24-March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO/FiO ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively.

Conclusions: Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.
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http://dx.doi.org/10.1186/s13613-020-00750-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549086PMC
October 2020

Safety of bedside surgical tracheostomy during COVID-19 pandemic: A retrospective observational study.

PLoS One 2020 30;15(9):e0240014. Epub 2020 Sep 30.

Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.

Data regarding safety of bedside surgical tracheostomy in novel coronavirus 2019 (COVID-19) mechanically ventilated patients admitted to the intensive care unit (ICU) are lacking. We performed this study to assess the safety of bedside surgical tracheostomy in COVID-19 patients admitted to ICU. This retrospective, single-center, cohort observational study (conducted between February, 23 and April, 30, 2020) was performed in our 45-bed dedicated COVID-19 ICU. Inclusion criteria were: a) age over 18 years; b) confirmed diagnosis of COVID-19 infection (with nasopharyngeal/oropharyngeal swab); c) invasive mechanical ventilation and d) clinical indication for tracheostomy. The objectives of this study were to describe: 1) perioperative complications, 2) perioperative alterations in respiratory gas exchange and 3) occurrence of COVID-19 infection among health-care providers involved into the procedure. A total of 125 COVID-19 patients were admitted to the ICU during the study period. Of those, 66 (53%) underwent tracheostomy. Tracheostomy was performed after a mean of 6.1 (± 2.1) days since ICU admission. Most of tracheostomies (47/66, 71%) were performed by intensivists and the mean time of the procedure was 22 (± 4.4) minutes. No intraprocedural complications was reported. Stoma infection and bleeding were reported in 2 patients and 7 patients, respectively, in the post-procedure period, without significant clinical consequences. The mean PaO2 / FiO2 was significantly lower at the end of tracheostomy (117.6 ± 35.4) then at the beginning (133.4 ± 39.2) or 24 hours before (135.8 ± 51.3) the procedure. However, PaO2/FiO2 progressively increased at 24 hours after tracheostomy (142 ± 50.7). None of the members involved in the tracheotomy procedures developed COVID-19 infection. Bedside surgical tracheostomy appears to be feasible and safe, both for patients and for health care workers, during COVID-19 pandemic in an experienced center.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240014PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526872PMC
October 2020

Multiple Acute Ischemic Strokes in a COVID-19 Patient: a Case Report.

SN Compr Clin Med 2020 Jul 4:1-5. Epub 2020 Jul 4.

Department of Emergency, Anesthesia and Intensive Care Unit, University Hospital of Parma, Parma, Italy.

We describe a case of a 47-year-old Italian, immunocompromised, and obese woman infected by COVID-19 presenting with fever (39.6 °C) and respiratory symptoms. Neurological examination was normal. Chest CT findings consist of bilateral interstitial pneumonia (visual score extension: 30%). The patient was treated with antiviral drugs and anti-inflammatory drugs with supportive care. Seven days after admission to Covid-19 Unit, the patient rapidly developed worsening respiratory failure and acute respiratory distress syndrome (ARDS). She suddenly developed partial left hemispheric syndrome. A new HRCT scan of her thorax revealed diffuse ground-glass opacities in both lungs (visual score extension: 90%). Brain CT performed 2 h after sudden-onset left-sided weakness showed subtle low attenuation within the right insular ribbon and frontal lobe (ASPECT Score 8). Multiphasic CT angiography (MCTA) demonstrated occlusion of both the dominant inferior division of the right middle cerebral artery and the A2 segment of the right anterior cerebral artery. After 24 h, her pupils became dilated and unreactive, and brain CT demonstrated large bilateral infarctions of both the cerebellar and cerebral hemispheres. She had a rapid progression of interstitial pneumonia from COVID-19, developed multiple strokes, and died 1 day later. SARS-CoV-2 infection seems to predispose pluripathological subjects to cerebrovascular complications.
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http://dx.doi.org/10.1007/s42399-020-00388-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334131PMC
July 2020

Safety of Early Tracheostomy Performed by Intensivists in Acute Brain-injured Patients: A 1-Year Observational Study.

J Neurosurg Anesthesiol 2021 Oct;33(4):365-366

Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.

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http://dx.doi.org/10.1097/ANA.0000000000000707DOI Listing
October 2021

Bedside Surgical Tracheostomy in the Intensive Care Unit during Covid-19 Pandemic.

Ann Otol Rhinol Laryngol 2021 Mar 1;130(3):304-306. Epub 2020 Aug 1.

Department of Otolaryngology and Otoneurosurgery, Parma University Hospital, Parma, Italy.

Objectives: To describe Otolaryngologists' perspective in managing COVID-19 patients with acute respiratory distress syndrome (ARDS) requiring tracheostomy in the ICUs during the pandemic peak in a dramatic scenario with limited resources.

Setting: Tertiary referral university hospital, regional hub in northern Italy during SARS CoV 2 pandemic peak (March 9th to April 10th, 2020).

Methods: Technical description of open bedside tracheostomies performed in ICUs on COVID-19 patients during pandemic peak with particular focus on resource allocation and healthcare professionals coordination. A dedicated "airway team" was created in order to avoid transportation of critically ill patients and reduce facility contamination.

Results: During the COVID-19 pandemic, bedside minimally invasive tracheostomy in the ICU was selected by the Authors over conventional surgical technique or percutaneous procedures for both technical and operational reasons. Otolaryngologists' experience derived from direct involvement in 24 tracheostomies is reported.

Conclusions: Tracheostomies on COVID-19 patients should be performed in a safe and standardized setting. The limited resources available in the pandemic peak required meticulous organization and optimal allocation of the resources to grant safety of both patients and healthcare workers.
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http://dx.doi.org/10.1177/0003489420947767DOI Listing
March 2021

Point-of-Care Chest Ultrasonography as a Diagnostic Resource for COVID-19 Outbreak in Nursing Homes.

J Am Med Dir Assoc 2020 Jul 25;21(7):919-923. Epub 2020 May 25.

Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Medicine and Surgey, University of Parma, Parma, Italy.

Objective: Bedside chest ultrasonography, when integrated with clinical data, is an accurate tool for improving the diagnostic process of many respiratory diseases. This study aims to evaluate the feasibility of a chest ultrasonographic screening program in nursing homes for detecting coronavirus disease-19 (COVID-19)-related pneumonia and improving the appropriateness of hospital referral of residents.

Design: Pragmatic, descriptive, feasibility study from April 2 to April 9, 2020.

Setting And Participants: A total of 83 older residents (age 85 ± 8) presenting mild to moderate respiratory symptoms and not previously tested for COVID-19, residing in 5 nursing homes in Northern Italy.

Methods: Chest ultrasonography was performed at the bedside by a team of hospital specialists with certified expertise in thoracic ultrasonography, following a systematic approach exploring 4 different areas for each hemithorax, from the anterior and posterior side. Presence of ultrasonographic signs of interstitial pneumonia, including comet-tail artifacts (B-lines) with focal or diffuse distribution, subpleural consolidations, and pleural line indentation, was detected. The specialist team integrated ultrasonography data with clinical and anamnestic information, and gave personalized therapeutic advice for each patient, including hospital referral when needed.

Results: The most frequent reasons for ultrasonographic evaluation were fever (63% of participants) and mild dyspnea (40%). Fifty-six patients (67%) had abnormal ultrasonographic findings. The most common patterns were presence of multiple subpleural consolidations (32 patients) and diffuse B-lines (24 patients), with bilateral involvement. A diagnosis of suspect COVID-19 pneumonia was made in 44 patients, and 6 of them required hospitalization. Twelve patients had ultrasonographic patterns suggesting other respiratory diseases, and 2 patients with normal ultrasonographic findings were diagnosed with COPD exacerbation.

Conclusions And Implications: In nursing home residents, screening of COVID-19 pneumonia with bedside chest ultrasonography is feasible and may represent a valid diagnostic aid for an early detection of COVID-19 outbreaks and adequate patient management.
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http://dx.doi.org/10.1016/j.jamda.2020.05.050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247494PMC
July 2020

COVID-19 pneumonia: ARDS or not?

Crit Care 2020 Apr 16;24(1):154. Epub 2020 Apr 16.

Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.

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http://dx.doi.org/10.1186/s13054-020-02880-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160817PMC
April 2020

Myanmar health professionals' educational needs: a pilot study.

Acta Biomed 2020 03 13;91(2-S):35-44. Epub 2020 Mar 13.

University of Parma.

Background And Aim Of The Work: The main factor hindering the development of the Myanmar health system lies in the scarcity of financial and human resources attributed to the health system. This paper presents the preliminary results of a pilot study on the educational needs of Myanmar health professionals, addressing the empowerment of human resources as a strategic pillar for delivering the essential packages of health services.

Methods: An explorative study following a qualitative approach has been conducted through semi-structured interviews to a convenience sample of 15 persons, selected as authoritative key-informants.

Results: In addition to the lack of infrastructures, medicines, ambulances and health instruments, and the health disparities between the urban and rural areas, some widespread problems are reported as requiring health professionals' training empowerment: traumas due to road accidents, management of childbirth, non-communicable diseases' management and poor health education of the population.

Discussion: Some areas can be evidenced for an improvement of professionals, training: ​​maternal, neonatal and child health; communication between professionals and laypeople; Myanmar population's health education; inter-professional training between doctors and nurses, but also between health personnel and non-health personnel.

Conclusions: The educational needs of Myanmar health professionals emerge as closely related to the social and health needs of the Myanmar population, to the available resources and missing resources of the country's health system and to the role of professionals within professionals/patients' relationship. (www.actabiomedica.it).
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http://dx.doi.org/10.23750/abm.v91i2-S.9344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944656PMC
March 2020

WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours.

World J Emerg Surg 2019 29;14:53. Epub 2019 Nov 29.

1Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy.

The acute phase management of patients with severe traumatic brain injury (TBI) and polytrauma represents a major challenge. Guidelines for the care of these complex patients are lacking, and worldwide variability in clinical practice has been documented in recent studies. Consequently, the World Society of Emergency Surgery (WSES) decided to organize an international consensus conference regarding the monitoring and management of severe adult TBI polytrauma patients during the first 24 hours after injury. A modified Delphi approach was adopted, with an agreement cut-off of 70%. Forty experts in this field (emergency surgeons, neurosurgeons, and intensivists) participated in the online consensus process. Sixteen recommendations were generated, with the aim of promoting rational care in this difficult setting.
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http://dx.doi.org/10.1186/s13017-019-0270-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884766PMC
July 2020

The Case/Care Manager in Eating Disorders: the nurse's role and responsibilities.

Acta Biomed 2019 11 11;90(11-S):17-28. Epub 2019 Nov 11.

.

Background And Aim Of The Work: Despite its incidence, the Eating Disorder (ED) is underdiagnosed and, for its complexity, it requires multidisciplinary interventions. The Nurse and Case/Care Manager (CCM) have a central role in taking care of the patients with ED, even if the research concerning their role are lacking. Thus, the aim of the study was to investigate roles, activities and expectations of the nurse and the CCM in taking care of patients with ED.

Method: 25 Italian different professionals were interviewed (16 women, average age 43.4; SD = 9.23). The semi-structured interview has investigated: nurses' roles and activities; perceptions of nurses' evaluation; expectations on nurses' and CCM's roles; the interprofessional collaboration.

Results: The nurses analyse patients' care needs and coordinate the multi-professional care with empathic attitude. Their "professionalism, skills, sensitivity, ability to relate to the patient-family unit" are expectations shared by various professionals. About the interprofessional collaboration, the action of professionals is not always well coordinated, the decisions are often not shared and hospital-territory connection is not always realised. The CCM would be the reference in this process for all interviewees.

Conclusions: In the three examined contexts the figure of the CCM was not present, but his/her importance was acknowledged in the management of the patient's care path and as a point of reference for health professionals. It seems important that CCM is institutionally recognized, because the CCM would ensure an efficient management of the clinical pathway and would guarantee the continuity and appropriateness of care.
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http://dx.doi.org/10.23750/abm.v90i11-S.8989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233626PMC
November 2019

Interprofessionalism and interprofessional research: a challenge still to be won in Italy.

Acta Biomed 2019 11 11;90(11-S):5-7. Epub 2019 Nov 11.

University of Parma.

Public health and pedagogical institutions have long been calling for collaborative models of assistance and training that provide inter-professional synergy and there is a broad international consensus on the importance of inter-professionalism in the field of assessment and healthcare provision (1-10). [...].
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http://dx.doi.org/10.23750/abm.v90i11-S.8947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233633PMC
November 2019

How to manage fever in brain-injured patients.

Minerva Anestesiol 2020 Jan 13;86(1):88-94. Epub 2019 Sep 13.

Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy.

Fever represents a frequent and dangerous secondary insult for the injured brain and is often associated with worsened neurological outcomes. The identification of fever in the Neuro-Intensive Care Unit requires careful monitoring and rapid and effective treatment. The main objective of this article was to provide practical information regarding temperature monitoring, triggers for intervention and fever management in brain injured patients.
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http://dx.doi.org/10.23736/S0375-9393.19.13901-6DOI Listing
January 2020

Preserve encephalus in surgery of trauma: online survey. (P.E.S.T.O).

World J Emerg Surg 2019;14. Epub 2019 Mar 4.

11Department of Emergency Surgery, Parma University Hospital, Parma, Italy.

Background: Traumatic brain injury (TBI) is a global health problem. Extracranial hemorrhagic lesions needing emergency surgery adversely affect the outcome of TBI. We conducted an international survey regarding the acute phase management practices in TBI polytrauma patients.

Methods: A questionnaire was available on the World Society of Emergency Surgery website between December 2017 and February 2018. The main endpoints were the evaluation of (1) intracranial pressure (ICP) monitoring during extracranial emergency surgery (EES), (2) hemodynamic management without ICP monitoring during EES, (3) coagulation management, and (4) utilization of simultaneous multisystem surgery (SMS).

Results: The respondents were 122 representing 105 trauma centers worldwide. ICP monitoring was utilized in 10-30% of patients at risk of intracranial hypertension (IH) undergoing EES from about a third of the respondents [ = 35 (29%)]. The respondents reported that the safest values of systolic blood pressure during EES in patients at risk of IH were 90-100 mmHg [ = 35 (29%)] and 100-110 mmHg [ = 35 (29%)]. The safest values of mean arterial pressure during EES in patients at risk of IH were > 70 mmHg [ = 44 (36%)] and > 80 mmHg [ = 32 (26%)]. Regarding ICP placement, a large percentage of respondents considered a platelet (PLT) count > 50,000/mm [ = 57 (47%)] and a prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [ = 73 (60%)] to be the safest parameters. For craniotomy, the majority of respondents considered PLT count > 100,000/mm [ = 67 (55%)] and a PT/aPTT < 1.5 times the normal control [ = 76 (62%)] to be the safest parameters. Almost half of the respondents [ = 53 (43%)], reported that they transfused red blood cells (RBCs)/plasma (P)/PLTs at a ratio of 1/1/1 in TBI polytrauma patients. SMS was performed in 5-19% of patients, requiring both an emergency neurosurgical operation and EES, by almost half of the respondents [ = 49 (40%)].

Conclusions: A great variability in practices during the acute phase management of polytrauma patients with severe TBI was identified. These findings may be helpful for future investigations and educational purposes.
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http://dx.doi.org/10.1186/s13017-019-0229-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399949PMC
June 2019

Fluid Management in Acute Brain Injury.

Curr Neurol Neurosci Rep 2018 09 11;18(11):74. Epub 2018 Sep 11.

Neuro ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

Purpose Of The Review: The aims of fluid management in acute brain injury are to preserve or restore physiology and guarantee appropriate tissue perfusion, avoiding potential iatrogenic effects. We reviewed the literature, focusing on the clinical implications of the selected papers. Our purposes were to summarize the principles regulating the distribution of water between the intracellular, interstitial, and plasma compartments in the normal and the injured brain, and to clarify how these principles could guide fluid administration, with special reference to intracranial pressure control.

Recent Findings: Although a considerable amount of research has been published on this topic and in general on fluid management in acute illness, the quality of the evidence tends to vary. Intravascular volume management should aim for euvolemia. There is evidence of harm with aggressive administration of fluid aimed at achieving hypervolemia in cases of subarachnoid hemorrhage. Isotonic crystalloids should be the preferred agents for volume replacement, while colloids, glucose-containing hypotonic solutions, and other hypotonic solutions or albumin should be avoided. Osmotherapy seems to be effective in intracranial hypertension management; however, there is no clear evidence regarding the superiority of hypertonic saline over mannitol. Fluid therapy plays an important role in the management of acute brain injury patients. However, fluids are a double-edged weapon because of the potential risk of hyper-hydration, hypo- or hyper-osmolar conditions, which may unfavorably affect the clinical course and the outcome.
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http://dx.doi.org/10.1007/s11910-018-0885-8DOI Listing
September 2018

The course of intracranial pressure after antipyretic therapy in acute brain injury.

J Neurosurg Sci 2018 Apr 4. Epub 2018 Apr 4.

Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.

Background: The present study was performed to evaluate intracranial pressure (ICP) variations after antipyretic therapy and their relationship to ICP at baseline (ICPbas) in acute brain injury (ABI) patients.

Methods: We completed a retrospective analysis on data derived from 2 previously published prospective observational studies. The first study involved 32 ABI patients and was performed to elucidate the cerebral and hemodynamic effects of intravenous (IV) paracetamol. The second study involved 30 ABI patients and was performed to investigate cerebral and hemodynamic effects of intramuscular IM diclofenac sodium (DCF). Overall patient population was divided into 2 groups: 1) Group A (G-A) when ICPbas was ≤ 15 mmHg and 2) Group B (G-B) when ICPbas was > 15 mmHg. The main objective was to evaluate if ICPbas affects the time course of ICP after antipyretics administration.

Results: Data from 62 ABI patients were analyzed. We failed to observe a significant change in ICP after antipyretic treatment in the overall group of patients (P1 = 0.486). A significant difference, however, was found between the two groups (P2 < 0.001). We observed that in the G-A, ICP increased in response to antipyretic administration, whereas in the G-B, ICP decreased. These opposite responses are reflected in the statistically significant interaction (P3 < 0.001).

Conclusions: Variation in ICP after antipyretic therapy is influenced by ICPbas. Specifically, patients with ICPbas ≤ 15 mmHg showed a significant increase in ICP after antipyretic therapy, while a significant reduction in ICP was observed in patients with ICPbas > 15 mmHg.
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http://dx.doi.org/10.23736/S0390-5616.18.04397-7DOI Listing
April 2018

Pulse contour analysis of arterial waveform in a high fidelity human patient simulator.

J Clin Monit Comput 2018 Aug 3;32(4):677-681. Epub 2017 Oct 3.

Emergency Department, Azienda Ospedaliera di Padova, Via V. Gallucci 13, 35121, Padova, Italy.

The measurement of cardiac output (CO) may be useful to improve the assessment of hemodynamics during simulated scenarios. The purpose of this study was to evaluate the feasibility of introducing an uncalibrated pulse contour device (MostCare, Vytech, Vygon, Padova, Italy) into the simulation environment. MostCare device was plugged to a clinical monitor and connected to the METI human patient simulator (HPS) to obtain a continuous arterial waveform analysis and CO calculation. In six different simulated clinical scenarios (baseline, ventricular failure, vasoplegic shock, hypertensive crisis, hypovolemic shock and aortic stenosis), the HPS-CO and the MostCare-CO were simultaneously recorded. The level of concordance between the two methods was assessed by the Bland and Altman analysis. 150-paired CO values were obtained. The HPS-CO values ranged from 2.3 to 6.6 L min and the MostCare-CO values from 2.8 to 6.4 L min. The mean difference between HPS-CO and MostCare-CO was - 0.3 L min and the limits of agreement were - 1.5 and 0.9 L min. The percentage of error was 23%. A good correlation between HPS-CO and MostCare-CO was observed in each scenario of the study (r = 0.88). Although MostCare-CO tended to underestimate the CO over the study period, good agreements were found between the two methods. Therefore, a pulse contour device can be integrated into the simulation environment, offering the opportunity to create new simulated clinical settings.
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http://dx.doi.org/10.1007/s10877-017-0066-3DOI Listing
August 2018

Images in Anesthesiology: Bronchopleural Fistula Caused by the Incorrect Placement of the Enteral Feeding Tube.

Anesthesiology 2016 Oct;125(4):805

From the Istituto Anestesia e Rianimazione, Azienda Ospedaliera di Padova, Padova, Italy (E.S., A.B., S.R.); and Unità Operativa di Radiologia, Azienda Ospedaliera di Padova, Padova, Italy (R.V.).

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http://dx.doi.org/10.1097/ALN.0000000000001137DOI Listing
October 2016

Anticoagulation with citrate for hemodiafiltration in an acute bleeding trauma.

Int J Artif Organs 2015 Jun 3;38(6):343-4. Epub 2015 Aug 3.

1 Emergency Department, Azienda Ospedaliera di Padova, Padova - Italy.

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http://dx.doi.org/10.5301/ijao.5000421DOI Listing
June 2015
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