Publications by authors named "Filippo Annoni"
Vasopressor therapy represents a key part of intensive care patient management, used to increase and maintain vascular tone and thus adequate tissue perfusion in patients with shock. Norepinephrine is the preferred first-line agent because of its reliable vasoconstrictor effects, with minimal impact on heart rate, and its mild inotropic effects, helping to maintain cardiac output. Whichever vasopressor is used, its effects on blood flow must be considered and excessive vasoconstriction avoided.
View Article and Find Full Text PDFIntroduction: In critically ill patients, individualised strategies for red blood cell transfusion (RBCT) are lacking. The objective of this study is to demonstrate the potential advantages of employing an individualised transfusion strategy compared with a restrictive approach, in unselected intensive care unit (ICU) patients.
Methods: This will be a randomised, multicentre, international trial.
Article Synopsis
- The study aimed to investigate changes in the renin-angiotensin system during septic shock, particularly looking at ACE activity and the levels of different angiotensin peptides using mass spectrometry.
- Experimental septic shock was induced in pigs, with further interventions like fluid resuscitation and antibiotics, while monitoring various time points.
- Results showed increased renin and angiotensin levels, decreased ACE activity, and a shift towards the angiotensin-(1-7) axis, indicating possible adaptive responses within the RAS that could inform future sepsis treatments.
Article Synopsis
- * Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an innovative technique that has shown effectiveness in controlling severe PPH, especially in high-risk pregnancies.
- * While REBOA offers promising benefits for reducing blood loss and improving outcomes, challenges like operator skill, potential complications, and the need for more research on guidelines remain important considerations.
Article Synopsis
- Cerebral complications following cardiac arrest (CA) pose significant challenges globally, prompting research on sodium-ß-hydroxybutyrate (SBHB) as a potential treatment for brain injury in a swine model.
- In an experiment with 20 adult swine, CA was induced, followed by 5 minutes of resuscitation, after which animals received either SBHB infusion or a control solution for 12 hours.
- Results showed that SBHB infusion led to lower plasma biomarkers of brain injury and increased sEEG amplitude, indicating potential protective effects against cerebral damage after resuscitation.
Article Synopsis
- - The study focuses on improving survival and reducing brain injuries in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) by developing experimental animal models due to challenges in human research.
- - Researchers conducted experiments on pigs, comparing two models of untreated ventricular fibrillation and standard CPR, finding significant brain blood flow issues and varying levels of brain injury across the models.
- - A systematic review of 52 studies showed discrepancies in methods and results of ECPR research, highlighting the need for standardized models to facilitate better comparisons and understanding of outcomes in future studies.
Background: The coronavirus-related disease (COVID-19) is mainly characterized by a respiratory involvement. The renin-angiotensin system (RAS) has a relevant role in the pathogenesis of COVID-19, as the virus enters host's cells via the angiotensin-converting enzyme 2 (ACE2).
Methods: This investigator-initiated, seamless phase 1-2 randomized clinical trial was conceived to test the safety and efficacy of continuous short-term (up to 7 days) intravenous administration of Angiotensin-(1-7) in COVID-19 patients admitted to two intensive care units (ICU).
Background: We aimed to estimate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) on neurological outcome and mortality, when compared to conventional cardiopulmonary resuscitation (CCPR), using an individual patient data meta-analysis (IPDMA).
Methods: A systematic literature search was performed up to the 20th of October 2022 in the PubMed, EMBASE and CENTRAL databases. For observational studies with unmatched populations, a propensity score including age, location of arrest and initial rhythm was used to match ECPR and CCPR patients in a 1:1 ratio.
Circulating nucleosome levels are commonly elevated in physiological and pathological conditions. Their potential as biomarkers for diagnosing and prognosticating sepsis remains uncertain due, in part, to technical limitations in existing detection methods. This scoping review explores the possible role of nucleosome concentrations in the diagnosis, prognosis, and therapeutic management of sepsis.
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- Dipeptidyl peptidase 3 (DPP3) is linked to worse outcomes in sepsis and can degrade angiotensin II; the study evaluates Procizumab (PCZ), an antibody targeting cDPP3's effects during septic shock.
- The research involved 16 pigs with induced peritonitis, comparing PCZ treatment to standard care, assessing various health indicators over a 12-hour period post-treatment.
- Results showed PCZ reduced cDPP3 levels, lowered the need for norepinephrine and fluids, decreased myocardial injury, and improved oxygenation, indicating its potential benefits in managing septic shock.
Cardiac arrest survivors suffer the repercussions of anoxic brain injury, a critical factor influencing long-term prognosis. This injury is characterised by profound and enduring metabolic impairment. Ketone bodies, an alternative energetic resource in physiological states such as exercise, fasting, and extended starvation, are avidly taken up and used by the brain.
View Article and Find Full Text PDFIn patients with septic shock, compensatory tachycardia initially serves to maintain adequate cardiac output and tissue oxygenation but may persist despite appropriate fluid and vasopressor resuscitation. This sustained elevation in heart rate and altered heart rate variability, indicative of autonomic dysfunction, is a well-established independent predictor of adverse outcomes in critical illness. Elevated heart rate exacerbates myocardial oxygen demand, reduces ventricular filling time, compromises coronary perfusion during diastole, and impairs the isovolumetric relaxation phase of the cardiac cycle, contributing to ventricular-arterial decoupling.
View Article and Find Full Text PDFWe investigated independent factors predicting neurological outcome and death, comparing in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) patients. The study was conducted in the mixed 34-bed Intensive Care Department at the Hôpital Universitaire de Bruxelles (HUB), Belgium. All adult consecutive cardiac arrest (CA) survivors were included between 2004 and 2022.
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- The PRINCESS2-study aims to evaluate the effectiveness of ultrafast hypothermia (cooling initiated during or immediately after cardiac arrest) on neurologic recovery in patients who have suffered out-of-hospital cardiac arrest with shockable rhythms, compared to standard care without early cooling.
- The trial will involve randomly assigning 1022 patients to either receive trans-nasal cooling shortly after arrival of emergency medical services, followed by in-hospital hypothermia, or to receive standard care without cooling.
- The primary outcome measured will be survival with complete neurologic recovery at 90 days, with secondary outcomes including overall survival rates at hospital discharge and 90 days, and neurologic recovery scores.*
Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are critical neurological conditions that necessitate specialized care in the Intensive Care Unit (ICU). Managing cerebral perfusion pressure (CPP) and mean arterial pressure (MAP) is of primary importance in these patients. To maintain targeted MAP and CPP, vasopressors and/or inotropes are commonly used.
View Article and Find Full Text PDFAim: Although brain injury is the main determinant of poor outcome following cardiac arrest (CA), cardiovascular failure is the leading cause of death within the first days after CA. However, it remains unclear which hemodynamic parameter is most suitable for its early recognition. We investigated the association of cardiac power output (CPO) with early mortality in intensive care unit (ICU) after CA and with mortality related to post-CA cardiovascular failure.
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- The study investigated the effects of sodium-β-O-Methyl cellobioside sulfate (mCBS), a substance that neutralizes extracellular histones, on sepsis severity in sheep.
- It involved 24 female sheep with sepsis induced by fecal peritonitis, divided into three groups: control, early treatment, and late treatment, with treatment timing affecting outcomes.
- Results showed that early mCBS treatment led to better blood pressure maintenance, lower need for norepinephrine, and improved overall health markers compared to controls, with all mCBS-treated animals surviving.
Background And Purpose: Hyperoxia after return of spontaneous circulation is potentially harmful, and oxygen titration in a prehospital setting is challenging. This study aimed to compare outcomes of oxygen reserve index-supported prehospital oxygen titration during prehospital transport with those of standard oxygen titration.
Methods And Trial Design: We enrolled patients who experienced return of spontaneous circulation after cardiac arrest in a prospective randomized study.
Article Synopsis
- Delayed cerebral ischemia (DCI) is a problem that can cause serious brain issues after a brain bleed called aneurysmal subarachnoid hemorrhage (aSAH), but it can be identified earlier using a special imaging technique called cerebral perfusion CT (CTP).
- A study at Erasme Hospital looked at patients with aSAH and divided them into two groups: one group diagnosed DCI based on symptoms and the other group using CTP.
- Results showed that fewer patients in the CTP group had brain damage from DCI compared to those diagnosed by symptoms, suggesting that using CTP could help prevent serious complications, though more research is needed to understand the full effects.
Article Synopsis
- Out-of-hospital cardiac arrest (OHCA) varies in cause and prognosis, prompting a study to assess the effectiveness of the Cardiac Arrest Prognosis (CAHP) Score compared to traditional methods (Utstein style criteria) for predicting patient outcomes.
- The study collected data from 24 ICUs in France and Belgium on comatose patients with OHCA who had a stable return of spontaneous circulation, aiming to evaluate various predictive scores and their accuracy in anticipating neurological outcomes after 90 days.
- Among the 658 patients analyzed, results showed a 63% mortality rate and noted that while Utstein criteria had moderate predictive capability (AUROC of 0.79), other scores demonstrated a range of performance, with some showing
Background: The objective of this animal study was to evaluate the hemodynamic performance of a new centrifugal pump for extra-corporeal membrane oxygenation (ECMO) support in neonates.
Methods: Six healthy swines were supported with veno-venous ECMO with the New Born ECMOLife centrifugal pump (Eurosets, Medolla, Italy) at different flow rates: 0.25, 0.
Background: Cerebral hypoxia is a frequent cause of secondary brain damage in patients with acute brain injury. Although hypercapnia can increase intracranial pressure, it may have beneficial effects on tissue oxygenation. We aimed to assess the effects of hypercapnia on brain tissue oxygenation (PbtO).
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