Publications by authors named "Landoni Giovanni"
Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for severe respiratory failure. Implantation of ECMO before invasive ventilation or extubation during ECMO has been reported and is becoming increasingly popular. Avoidance of sedation and invasive ventilation during ECMO (commonly referred to as "awake ECMO") may have potential advantages, including a lower rate of delirium, shorter mechanical ventilation time, and the possibility of undergoing early rehabilitation and/or physiotherapy.
View Article and Find Full Text PDFImportance: Perioperative bleeding is common in general surgery. The POISE-3 (Perioperative Ischemic Evaluation-3) trial demonstrated efficacy of prophylactic tranexamic acid (TXA) compared with placebo in preventing major bleeding without increasing vascular outcomes in noncardiac surgery.
Objective: To determine the safety and efficacy of prophylactic TXA, specifically in general surgery.
Objectives: To summarize evidence regarding intravenous angiotensin II administration in critical illness and provide an updated understanding of its effects on various organ dysfunction and renin-angiotensin system (RAS) biomarkers.
Design: A systematic review.
Setting: A search of PubMed, Embase, and the Cochrane Library from inception to May 3, 2024.
Background: The impact of noninvasive ventilation (NIV) managed outside the intensive care unit in patients with early acute respiratory failure remains unclear. We aimed to determine whether adding early NIV prevents the progression to severe respiratory failure.
Methods: In this multinational, randomised, open-label controlled trial, adults with mild acute respiratory failure (arterial oxygen partial pressure/fraction of inspiratory oxygen [Pao/FiO] ratio ≥200) were enrolled across 11 hospitals in Italy, Greece, and Kazakhstan.
Background: Excessive exposure to adrenergic vasopressors may be harmful. Non-adrenergic vasopressors may spare adrenergic agents and potentially improve outcomes. We aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of non-adrenergic vasopressors in adult patients receiving vasopressor therapy for vasodilatory shock or perioperative vasoplegia.
View Article and Find Full Text PDFBackground: In the PROTECTION trial, intravenous amino acids (AA) decreased the occurrence of acute kidney injury (AKI) in cardiac surgery patients with cardiopulmonary bypass (CPB). Recruitment of renal functional reserve may be responsible for such protection. However, patients with chronic kidney disease (CKD) have diminished renal functional reserve, and AA may be less protective in such patients.
View Article and Find Full Text PDFObjective: The combination of catecholamine-resistant vasodilatory shock and acute kidney injury (AKI) is associated with high morbidity and mortality. The role of angiotensin II (ANGII) in this setting is unclear. Methods: We conducted a post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock (ATHOS) 3 trial which assessed the effect of Intravenous ANG II or placebo in patients with refractory vasodilatory shock in 75 intensive care units across nine countries in North America, Australasia, and Europe.
View Article and Find Full Text PDFBackground: Acute kidney injury (AKI) is a frequent and important complication of cardiac surgery. Decreased perfusion is a key mechanism. This decreased perfusion may be attenuated by intravenous amino acids (AAs) through recruitment of renal functional reserve.
View Article and Find Full Text PDFObjectives: The Sequential Organ Failure Assessment (SOFA) score originated as a tool for assessing organ dysfunction in critical illness but has expanded to become an outcome measure in clinical trials. We aimed to assess how the SOFA score was used as the primary or secondary endpoint of major randomized controlled trials (RCTs).
Data Sources: Independent reviewers searched MEDLINE/PubMed, Scopus, and Embase databases.
Dysregulation of the renin-angiotensin-aldosterone-system (RAAS) in sepsis is a complex and early phenomenon with a likely significant contribution to organ failure and patient outcomes. A better understanding of the pathophysiology and intricacies of the RAAS in septic shock has led to the use of exogenous angiotensin II as a new therapeutic agent. In this review, we report a multinational and multi-disciplinary expert panel discussion on the role and implications of RAAS modulation in sepsis and the use of exogenous angiotensin II.
View Article and Find Full Text PDFIntroduction: Enhanced recovery after cardiac surgery in selected low-risk patients, has the potential to improve outcomes and reduce the burden of healthcare costs. Anesthesia-related challenges play a major role in the successful implementation of Enhanced Recovery After Surgery (ERAS) protocols, with particular emphasis placed on fast-track extubation. Acknowledging the importance of this practice, the Italian Association of Cardiac Anesthesiologists and Intensive Care (ITACTAIC) has advocated for an initiative to establish a consensus offering practical recommendations for fast-track extubation after adult cardiac surgery.
View Article and Find Full Text PDFArticle Synopsis
- The study investigated the use of alteplase thrombolysis in patients with severe hypoxemic respiratory failure caused by COVID-19, comparing it to standard care (SOC) alone.
- Results showed that patients receiving alteplase experienced a median time to clinical improvement of 25 days compared to more than 28 days for those on SOC, along with a lower mortality rate (12% vs. 29%).
- However, 26.1% of the alteplase group had to stop treatment due to adverse effects, and major bleeding incidents were more common in the alteplase group, although no fatalities occurred.
Objective: To systematically evaluate the impact of the Trendelenburg position on hemodynamic parameters in adult patients.
Design: Systematic literature review and meta-analysis using PubMed and Medline.
Setting: All prospective interventional studies comparing the hemodynamic characteristics of patients in the horizontal supine position and Trendelenburg position.
Purpose Of Review: Acute kidney injury (AKI) is common in hospitalized patients and is independently associated with morbidity and mortality. Moreover, AKI increases the risk of chronic kidney disease, which is a major healthcare problem. Currently, no single therapy has been proven to be effective in preventing AKI.
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- Machine learning (ML) is increasingly important for predicting sepsis, a critical condition where timely intervention is crucial; this study explores the effectiveness of ML models in clinical settings.
- Researchers analyzed 73 studies involving nearly 458,000 patients and found that ML models, particularly Neural Networks and Decision Trees, performed better than traditional scoring systems, achieving a pooled AUC of 0.825.
- The study emphasizes the need for standardized practices in reporting and validating ML models to enhance their clinical application and effectiveness in predicting sepsis across diverse patient populations.
2024 EACTS Guidelines on perioperative medication in adult cardiac surgery.
Eur J Cardiothorac Surg
December 2024
Amino Acid Infusion for Perioperative Functional Renal Protection: A Meta-analysis.
J Cardiothorac Vasc Anesth
December 2024
Article Synopsis
- Acute kidney injury (AKI) is a frequent complication that can occur during surgery, and currently, there's no proven single method for its prevention; intravenous amino acids (AA) might help protect kidney function during this period.
- A meta-analysis of 15 studies (involving over 4,500 patients) showed that patients receiving AA had a lower incidence of AKI (24.7%) compared to those who didn't (30.1%), indicating a significant potential benefit of AA infusion.
- The findings also revealed that AA administration not only lowered the risk of AKI but also reduced serum creatinine levels and hospital stays while improving kidney function.
Article Synopsis
- Barotrauma is a common issue in patients with severe respiratory failure, often leading to bad outcomes, but ECMO (Extracorporeal Membrane Oxygenation) may help reduce this risk through lung-protective ventilation.
- A review of studies found that ECMO was used in 45 patients, with 46.7% receiving it before invasive ventilation; it allowed for safer ventilation strategies in many cases.
- The incidence of barotrauma was under 10% among these patients, and overall mortality was 17.8%, suggesting that ECMO can be a viable option to prevent barotrauma in respiratory failure.
Protective hemodynamics: a novel strategy to manage blood pressure.
Curr Opin Crit Care
December 2024
Purpose Of Review: This editorial aims to highlight the evolving concept of protective hemodynamics in the management of critically ill patients.
Recent Findings: Recent literature underscores the limitations of rigid blood pressure targets, particularly in the context of critical care and perioperative management. High blood pressure targets, especially when coupled with high-dose vasopressors, can lead to poor outcomes.
Article Synopsis
- The study aimed to evaluate whether mechanical left ventricular unloading could lower mortality rates in patients with cardiogenic shock who were receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO).
- A meta-analysis included data from two randomized controlled trials and eleven propensity score-matched studies, involving a total of 9,858 patients, and found that mechanical unloading significantly decreased mortality rates (RR, 0.89; P = 0.0001).
- While mechanical unloading showed benefits in reducing mortality and improving outcomes, it also resulted in increased risks of major bleeding and hemolysis, indicating a need for careful consideration in clinical practice.
Article Synopsis
- A panel of Italian intensive care specialists explored the use of angiotensin II (ATII) in treating distributive shock, considering patient factors and the effectiveness of existing treatment protocols.
- They employed a modified Delphi technique to establish consensus on clinical questions and statements related to ATII, resulting in agreement on 13 key statements from a survey.
- The panel concluded that ATII could be beneficial for specific patients, particularly those with reduced angiotensin-converting enzyme activity or high renin levels, while also noting potential barriers to its use.
Objective: Cardiac surgery can be complicated by the development of a systemic inflammatory response syndrome related to cardiopulmonary bypass. This potentially contributes to the occurrence of postoperative morbidity and mortality. Corticosteroids can be used to reduce such inflammation, but the overall balance between potential harm and benefit is unknown and may be age-dependent.
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