Publications by authors named "Massimo Antonelli"

Article Synopsis
  • The study aimed to compare the effects of personalized positive end-expiratory pressure (PEEP) versus a standard low PEEP/FiO2 table on patients with acute respiratory distress syndrome (ARDS) undergoing pressure support ventilation (PSV).
  • Researchers conducted a cross-over randomized trial with 30 ARDS patients, measuring how different PEEP settings affected lung mechanics and patient comfort.
  • Results showed that the personalized PEEP significantly improved lung function, reduced respiratory effort, and did not lead to lung overdistension, making it a promising approach for treating ARDS during ventilation.
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Article Synopsis
  • Acute hypercapnic respiratory failure is a serious condition primarily caused by insufficient breathing, often linked to chronic obstructive pulmonary disease and muscle dysfunction.
  • Noninvasive ventilation using a mask is the preferred first-line treatment to improve patient survival and outcomes, while high-flow nasal oxygen is considered a supportive option, although it has a higher failure rate compared to noninvasive ventilation.
  • The review discusses optimal settings for high-flow nasal oxygen and highlights its potential benefits when used after noninvasive ventilation or during weaning from mechanical ventilation.
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Background: Endotype classification becomes the cornerstone of understanding sepsis pathogenesis. Macrophage activation-like syndrome (MALS) and immunoparalysis are the best recognized major endotypes, so far. Interferon-gamma (IFNγ) action on tissue macrophages stimulates the release of the cytotoxic chemokine CXCL9.

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  • Colistin, specifically colistimethate (CMS), is still used in critically ill patients, particularly those on continuous renal replacement therapy (CRRT) for infections caused by carbapenem-resistant bacteria, despite limited real-life data on its effectiveness and safety.
  • A study involving 20 critically ill patients receiving a specific dosage of CMS showed high colistin levels in their blood but raised concerns about exceeding safety limits, as many patients experienced poor outcomes including a high mortality rate.
  • The findings suggest that while the recommended dosing achieves effective concentrations against bacteria, it poses risks of toxicity, and close monitoring is necessary to balance efficacy and safety.
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Lung-protective strategies using low Vt and moderate positive end-expiratory pressure (PEEP) are considered best practice in critical care, but interventional trials have never been conducted in patients with acute brain injuries because of concerns about carbon dioxide control and the effect of PEEP on cerebral hemodynamics. To test the hypothesis that ventilation with lower VT and higher PEEP compared to conventional ventilation would improve clinical outcomes in patients with acute brain injury. In this multicenter, open-label, controlled clinical trial, 190 adult patients with acute brain injury were assigned to receive either a lung-protective or a conventional ventilatory strategy.

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The management of patients with life-threatening respiratory disease in the ICU and at home has become increasingly of interest over the past decades. Growing knowledge supports the use of NRS, aimed at improving patient comfort and improving quality of life. However, its role during palliative care is not well defined, and evidence of support remains limited.

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Study Objective: During laparoscopic surgery, the role of PEEP to improve outcome is controversial. Mechanistically, PEEP benefits depend on the extent of alveolar recruitment, which prevents ventilator-induced lung injury by reducing lung dynamic strain. The hypotheses of this study were that pneumoperitoneum-induced aeration loss and PEEP-induced recruitment are inter-individually variable, and that the recruitment-to-inflation ratio (R/I) can identify patients who benefit from PEEP in terms of strain reduction.

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Background: The pseudo-Cushing's encompass several disorders that can occur in high-stress situations and that show biochemical features like those of Cushing's syndrome. We present a case with difficult differential diagnosis for overlapping laboratory findings.

Case Report: A 74-year-old man was admitted to our hospital for worsening dyspnoea for a month, 15 kilograms of weight loss in the previous months, asthenia, hypotonia, and muscle hypotrophy.

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Article Synopsis
  • The study analyzed intra-abdominal infections (IAI) in immunocompromised versus non-immunocompromised ICU patients using data from the "AbSeS" database, which included 2,589 patients across 309 ICUs in 42 countries.
  • Immunocompromised patients (9.2% of the cohort) showed different infection patterns, such as more frequent typhlitis and a higher incidence of healthcare-associated infections, but had similar mortality rates compared to immunocompetent patients (31.1% vs. 28.9%).
  • Key risk factors for mortality in immunocompromised patients included septic shock at presentation and ongoing inflammation after source control, indicating that despite presenting with more severe conditions
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In acute respiratory distress syndrome, the role of positive end-expiratory pressure (PEEP) to prevent ventilator-induced lung injury is controversial. Randomized trials comparing higher versus lower PEEP strategies failed to demonstrate a clinical benefit. This may depend on the inter-individually variable potential for lung recruitment (i.

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Background: To determine whether a decrease in serum (1,3)-β-D-glucan (BDG) was associated with reduced mortality and to investigate the performance of BDG downslope in predicting clinical outcome in invasive candidiasis.

Methods: Observational cohort study in ICU patients over a ten-year period (2012-2022) in Italy. Proven invasive candidiasis with at least 2 BDG determinations were considered.

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Article Synopsis
  • Meropenem-vaborbactam is a new treatment option for infections caused by KPC-producing Klebsiella pneumoniae, particularly those resistant to ceftazidime-avibactam.
  • A study of 342 patients across 19 hospitals in Italy evaluated the outcomes of those treated with meropenem-vaborbactam, finding a 30-day mortality rate of 31.6%.
  • The research identified risk factors for higher mortality, including septic shock, significant comorbidities, and delayed treatment, while the administration of the drug within 48 hours of infection onset was linked to better outcomes.
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Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes.

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: Hepatic dysfunction (HD) after liver transplantation (LT) or extended hepatic resection (EHR) is associated with graft failure and high short-term mortality. We evaluated the safety and depurative efficacy of CytoSorb® in these settings. The primary endpoint was the change in serum total bilirubin at the end of the treatment compared to the baseline value.

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Background: In the last decades, several adjunctive treatments have been proposed to reduce mortality in septic shock patients. Unfortunately, mortality due to sepsis and septic shock remains elevated and NO trials evaluating adjunctive therapies were able to demonstrate any clear benefit. In light of the lack of evidence and conflicting results from previous studies, in this multidisciplinary consensus, the authors considered the rational, recent investigations and potential clinical benefits of targeted adjunctive therapies.

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Antimicrobial de-escalation (ADE) is defined as the discontinuation of one or more antimicrobials in empirical therapy, or the replacement of a broad-spectrum antimicrobial with a narrower-spectrum antimicrobial. The aim of this review is to provide an overview of the available literature on the effectiveness and safety of ADE in critically ill patients, with a focus on special conditions such as anti-fungal therapy and high-risk categories. Although it is widely considered a safe strategy for antimicrobial stewardship (AMS), to date, there has been no assessment of the effect of de-escalation on the development of resistance.

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Severe acute respiratory failure (ARF) is a major issue in patients with severe community-acquired pneumonia (CAP). Standard oxygen therapy is the first-line therapy for ARF in the less severe cases. However, respiratory supports may be delivered in more severe clinical condition.

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Article Synopsis
  • COVID-19 has been linked to increased cases of pneumothorax (PTX) and pneumomediastinum (PNM), leading to concerns about poor patient outcomes and factors affecting mortality.
  • This observational study, analyzing data from nearly 12,000 COVID-19 patients in central Italy, identified specific risk factors for 28-day mortality and need for intubation related to pulmonary barotrauma.
  • Key risk factors for higher mortality included elevated SOFA scores, use of vasopressors, hypercapnia, low PaO/FiO ratio, and existing cardiovascular disease, while variants of concern did not impact mortality rates.
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Unlabelled: Few data are available on the lung microbiota composition of patients with coronavirus disease 2019-related acute respiratory distress syndrome (C-ARDS) receiving invasive mechanical ventilation (IMV). Moreover, it has never been investigated whether there is a potential correlation between lung microbiota communities and respiratory mechanics. We performed a prospective observational study in two intensive care units of a university hospital in Italy.

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  • Myocardial injury is common in COVID-19 patients, but the impact of COVID-19 vaccines on this risk is not well understood.
  • A study involving 1019 hospitalized COVID-19 patients found that older age, chronic kidney disease, and hypertension were linked to myocardial injury, while vaccination status did not significantly impact risk.
  • In patients aged 76 and older, vaccines appeared to protect against myocardial injury, but in those aged 60 and younger, vaccination was associated with an increased risk of injury.
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This statement outlines a review of the literature and current practice concerning the prevalence, clinical significance, diagnosis and management of dyspnoea in critically ill, mechanically ventilated adult patients. It covers the definition, pathophysiology, epidemiology, short- and middle-term impact, detection and quantification, and prevention and treatment of dyspnoea. It represents a collaboration of the European Respiratory Society (ERS) and the European Society of Intensive Care Medicine (ESICM).

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