Publications by authors named "Foti Giuseppe"
Incidence of hospital-acquired infections due to carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa in critically ill patients in Italy: a multicentre prospective cohort study.
Crit Care
January 2025
Background: Carbapenem-Resistant Gram-Negative Bacteria, including Carbapenem-Resistant Enterobacterales (CRE) and Carbapenem-Resistant Pseudomonas aeruginosa (CRPA), are common causes of infections in intensive care units (ICUs) in Italy.
Objective: This prospective observational study evaluated the epidemiology, management, microbiological characterization, and outcomes of hospital-acquired CRE or CRPA infections treated in selected ICUs in Italy.
Methods: The study included patients with hospital-acquired infections due to CRE and CRPA treated in 20 ICUs from June 2021 to February 2023.
Background: Epileptiform activity, including status epilepticus (SE), occurs in up to one-third of comatose survivors of cardiac arrest and may predict poor outcome. The relationship between SE and hypoxic-ischemic brain injury (HIBI) is not established.
Methods: This is a single-center retrospective study on consecutive patients with post-anoxic super-refractory SE.
Cranioplasty is a major surgical procedure typically performed in children under 1 year of age, often associated with significant complications. The scientific literature on perioperative management for children with craniosynostosis undergoing cranioplasty is limited. The authors' objective was to retrospectively evaluate the management, complication rates, and outcomes among children undergoing cranioplasty at our institution.
View Article and Find Full Text PDF: Although general thoracic surgery is usually focused on adult patients, there are some settings of pediatric diseases which can benefit from thoracic surgical procedures. In this study, we retrospectively reviewed the contribution of general thoracic surgeons to pediatric patients in a high-volume hospital. : From September 2002 to August 2024, 8897 consecutive patients were operated on; among them, 202 patients (2.
View Article and Find Full Text PDFPurpose: To describe the clinical characteristics and outcomes of patients with nosocomial pneumonia (NP) caused by carbapenem-resistant Gram-negative bacilli (CR-GNB) and to compare them to patients with NP caused by carbapenem-susceptible (CS)-GNB.
Methods: Prospective observational multicenter study including patients with bacteremic NP caused by GNB from the ALARICO Network (June 2018-January 2020). The primary outcome measure was 30-day mortality.
Pressure support ventilation (PSV) is a form of assisted ventilation which has become frequently used, with the aim of partially unloading the patient's inspiratory muscles. Both under- and over-assistance should be avoided to target a lung- and diaphragm- protective ventilation. Herein, we propose a conceptual model, supported by actual data, to describe how patient and ventilator share the generation of tidal volume (Vt) in PSV and how respiratory system compliance (Crs) affects this interaction.
View Article and Find Full Text PDFBackground: Sigh breaths may impact outcomes in acute hypoxemic respiratory failure (AHRF) during assisted mechanical ventilation. We investigated whether sigh breaths may impact mortality in predefined subgroups of patients enrolled in the PROTECTION multicenter clinical trial according to: 1.the physiological response in oxygenation to Sigh (responders versus non-responders) and 2.
View Article and Find Full Text PDFPurpose: The novel coronavirus disease (COVID-19) has revived the debate on the optimal tidal volume during acute respiratory distress syndrome (ARDS). Some experts recommend 6 mL/kg of predicted body weight (PBW) for all patients, while others suggest 7-9 mL/kg PBW for those with compliance >50 mL/cmHO. We investigated whether a tidal volume ≥ 7 ml/kg PBW may be safe in COVID-19 patients, particularly those with compliance >50 mL/cmHO.
View Article and Find Full Text PDFArticle Synopsis
- - The study investigated the effects of a new natural light-mimicking lighting technology on critically ill ICU patients, comparing it to conventional fluorescent lighting.
- - Conducted in a ten-bed Italian ICU with limited natural light, the study included 86 patients and measured outcomes like delirium, sedative use, and long-term mental health issues post-discharge.
- - Results showed no significant differences between the two groups in terms of delirium rates, sedation needs, or mental health issues, indicating the new lighting system did not improve patient outcomes.
Article Synopsis
- Researchers conducted a 7-year study in France and Italy to investigate the best timing and methods for weaning patients from venovenous ECMO (VV ECMO) after severe ARDS.
- The study analyzed 393 patients, comparing those who were weaned from controlled ventilation versus spontaneous breathing, but found no significant differences in their 90-day successful weaning rates.
- The study concluded that factors like age and existing health issues had a greater impact on weaning success than the ventilation strategy used during ECMO, indicating a need for more research in this area.
Article Synopsis
- Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is increasingly used for severe respiratory issues, but the study examines the impact of multi-drug resistant (MDR) bacteria on outcomes in these patients.
- The study involved 279 adults across five Italian hospitals and found 50% had MDR Gram-negative bacteria; 21% were detected before and 29% after V-V ECMO placement.
- Results indicated a 42% one-year mortality rate, with those having pre-existing MDR bacteria at higher risk, emphasizing that higher hospital V-V ECMO volumes could reduce the rate of acquiring MDR bacteria.*
Article Synopsis
- The study focused on creating models to predict the need for invasive mechanical ventilation (IMV) in ICU patients with COVID-19, comparing their efficacy to the existing ROX index.
- Conducted in three hospitals in Rio de Janeiro, Brazil, the study analyzed data from 656 ICU patients, ultimately including 346 after applying various exclusion criteria.
- Key predictors for IMV identified were arterial hypertension, diabetes, obesity, and the SOFA score, with the SOFA score showing the strongest association; the ROX index was also notably lower in patients needing IMV.
Article Synopsis
- * Out of 191 adult ARDS patients on VV ECMO, 69% successfully switched to PSV, which led to better respiratory mechanics, increased compliance, and lower pulmonary shunt fraction.
- * The findings suggest that PSV during VV ECMO is not only possible but may improve patient outcomes, with 94% of those transitioned to PSV being weaned from ECMO and a high percentage being discharged alive from ICU.
Article Synopsis
- Automated analysis of lung CT scans can help classify different subphenotypes of acute respiratory illness in COVID-19 patients by combining CT features with clinical and lab data.
- A study of 559 spontaneously breathing COVID-19 patients identified two subphenotypes: one with older patients, higher inflammation, more severe hypoxemia, and a higher mortality rate, while the other had distinct lung imaging features and lower mortality.
- The findings emphasize the potential of using machine learning and lung-CT imaging to improve the understanding and treatment of respiratory failure in COVID-19 patients.
Cell-free hemoglobin (CFH) is used to detect hemolysis and was recently suggested to trigger acute lung injury. However, its role has not been elucidated in severe acute respiratory distress syndrome (ARDS) patients undergoing extracorporeal membrane oxygenation (ECMO). We investigated the association of carboxyhemoglobin (COHb) and haptoglobin-two indirect markers of hemolysis-with mortality in critically ill patients undergoing veno-venous ECMO (VV-ECMO) with adjusted and longitudinal models (primary aim).
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- Airway closure during mechanical ventilation can cause inaccuracies in respiratory pressure assessments, particularly in patients with severe ARDS, and can be identified using low-flow inflation techniques.
- The study observed a patient with ARDS on VV ECMO, noting that prone positioning improved airway closure, as indicated by a decrease in airway opening pressure from 23 cmHO in the supine position to 13 cmHO when prone.
- Post-prone positioning, airway closure remained lower at 17 cmHO compared to the supine baseline, suggesting that this therapeutic maneuver may be beneficial in managing respiratory mechanics in ARDS patients.
Article Synopsis
- Lung problems in COVID-19 can cause serious issues, like kidney injury, especially in patients on mechanical ventilation.
- In a study with 157 patients, nearly half developed acute kidney injury (AKI), with most having it persist over time.
- Higher ventilation levels were linked to more severe kidney issues, suggesting that problems with blood flow might connect the lung and kidney problems in COVID-19 patients.
Objective: To present characteristics, surgical variables, complications, and postoperative care in pediatric patients with craniofacial synostosis undergoing Le Fort III osteotomy.
Background: Craniofacial synostoses are a group of genetic syndromes that result in premature fusion of cranial and facial sutures, leading to craniofacial deformities and associated complications. Midface advancement through Le Fort III osteotomy is the most frequent surgical option for these conditions.
Article Synopsis
- - Blood flow rate during venovenous ECMO impacts mixed venous oxygenation (Sv), which can influence pulmonary circulation and right heart function in patients with severe acute respiratory distress syndrome (ARDS).
- - A study evaluated the physiological effects of varying ECMO blood flow levels on Sv in 20 ARDS patients, revealing that higher blood flow rates led to decreased cardiac output, pulmonary artery pressure, and right ventricular workload.
- - The results showed an inverse relationship between cardiac output and mixed venous oxygenation, indicating that as ECMO blood flow increased, overall cardiac efficiency and workload on the right heart decreased without affecting mismatching measures significantly.
Article Synopsis
- The study investigates the effects of helmet CPAP on oxygenation levels in hypoxemic patients, analyzing improvements linked to PEEP or oxygen fraction.
- A test called the "ZEEP-PEEP test" was developed to determine whether improvements in oxygenation after helmet application were due to PEEP or better oxygen delivery.
- Results showed significant oxygenation improvements in patients after applying helmet CPAP, with 41% of patients responding positively to PEEP, while the ZEEP-PEEP test could help identify those who would benefit from PEEP use.
Article Synopsis
- Sodium nitrite (NaNO) poisoning can lead to acute methemoglobinemia, which complicates emergency medical responses during cardiac arrest.
- A case is reported where a patient suffered cardiac arrest after deliberate self-intoxication, but methemoglobinemia went undetected during resuscitation efforts, contributing to the outcome.
- The case underscores the importance of quickly identifying the poison and administering the appropriate antidotes to improve survival chances in similar emergencies.
Pulmonary shunt in critical care: a practical approach with clinical scenarios.
J Anesth Analg Crit Care
March 2024
Article Synopsis
- Pulmonary shunt is the process where venous blood enters the arterial system without passing through the alveoli for oxygen exchange, leading to potential respiratory failure.* -
- The assessment of pulmonary shunt has often been overlooked, but it can be quantified by evaluating the mixing of oxygenated and deoxygenated blood through specific measurements of oxygen content in veins, capillaries, and arteries.* -
- The analysis of pulmonary shunt, especially in patients on ECMO, becomes critical because traditional arterial oxygen levels may not accurately reflect lung function, and this review discusses its clinical applications using an online simulator.*