Publications by authors named "Pozzi Matteo"
Introduction: A demand from the cardiac surgery and heart transplantation department of a French (Lyon) university hospital to adopt an ex-vivo perfusion system of human donor hearts was a chance to actively involve patients in our hospital-based health technology assessment (HB-HTA) process.
Material And Methods: We selected an existing framework for patient involvement in HB-HTA and involved patients at two stages of the HB-HTA process: evaluation and dissemination. Firstly, we conducted a consultation-oriented workshop to gather patient perspectives on the introduction of the technology in our hospital, based on their significant experience of healthcare.
Synthetic data is becoming a valuable tool for computational pathologists, aiding in tasks like data augmentation and addressing data scarcity and privacy. However, its use necessitates careful planning and evaluation to prevent the creation of clinically irrelevant artifacts.This manuscript introduces a comprehensive pipeline for generating and evaluating synthetic pathology data using a diffusion model.
View Article and Find Full Text PDF: To investigate the impact of patient characteristics and treatment factors on excessive respiratory drive, effort, and lung-distending pressure during transitioning from controlled to spontaneous assisted ventilation in patients with acute respiratory distress syndrome (ARDS). : Multicenter cohort observational study of patients with ARDS at four academic intensive care units. Respiratory drive (P), diaphragm electrical activity (EAdi), inspiratory effort derived from EAdi (∆Pmus) and from occlusion of airway pressure (∆Pocc) (Pmus), and dynamic transpulmonary driving pressure (ΔP) were measured at the first transition to assisted spontaneous breathing.
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- 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.*
Neurologic complications in patients receiving aortic versus subclavian versus femoral arterial cannulation for post-cardiotomy extracorporeal life support: results of the PELS observational multicenter study.
Crit Care
August 2024
Article Synopsis
- The study looks at how the location where doctors put tubes in the arteries for heart support affects brain health after surgery.
- They compared three methods: using the aorta, subclavian/axillary arteries, and femoral artery to see which had the least brain problems.
- Results showed that patients using the subclavian/axillary method had more major brain issues compared to the others, and also had more seizures after the surgery.
Article Synopsis
- * It analyzed data from 533 adult patients divided into two groups based on different CPB flow rate targets: a low group (>2.2 L/min/m²) and a high group (>2.4 L/min/m²).
- * Results showed significant reduction in major adverse kidney events (MAKE) at 30 days in the high flow rate group, which included lower mortality and fewer instances of renal replacement therapy compared to the low flow rate group.
Article Synopsis
- 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
- ECLS cannulation in post-cardiotomy patients is uncommon in general wards, with only 39 out of 2058 patients studied undergoing the procedure while at the hospital.
- The majority of these patients faced complications like acute kidney injury and arrhythmias, with a high in-hospital mortality rate of 84.6%, predominantly due to persistent heart failure.
- Findings suggest that ECLS cannulation mainly affects low-risk patients who experience cardiac arrest post-surgery, indicating a need for further research into improving outcomes.
Article Synopsis
- Type 2 diabetes (T2D) negatively impacts left ventricular (LV) remodeling and function in patients with severe aortic stenosis (AS), leading to worse cardiac outcomes despite similar AS severity compared to non-diabetics.
- The study combined clinical assessments and biological analyses between T2D and non-diabetic patients undergoing valve replacement, revealing significant differences in gene expression related to inflammation, cardiac hypertrophy, and mitochondrial function.
- Findings indicated that T2D is associated with reduced mitochondrial function and calcium signaling, contributing to adverse cardiac remodeling, which may inform future treatment strategies for these patients.
Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study.
Crit Care Med
October 2024
Article Synopsis
- * Conducted across 34 centers globally from 2000 to 2020, the study included over 2,000 adult patients split into different ECMO duration groups, revealing higher complications and mortality rates associated with longer ECMO durations.
- * The findings suggest that while most in-hospital complications increase with ECMO duration, post-discharge survival rates remain similar across groups, with specific risk factors like age and pre-existing conditions affecting long-term survival for those on ECMO longer than 7 days.
Article Synopsis
- Predicting outcomes for patients receiving Left Ventricular Assist Devices (LVADs) is crucial, but current methods focusing on right ventricular function are lacking in prognostic value.
- The study utilized data from the ASSIST-ICD registry to evaluate right ventriculoarterial coupling as a potential predictor of all-cause mortality upon LVAD implantation.
- Findings showed that while some measures like TAPSE/sPAP and PAPi were not linked to long-term survival, the ratio of right atrial pressure to pulmonary capillary wedge pressure (RAP/PCWP) was significantly associated with increased mortality, maintaining its relevance even after adjusting for other risk factors.
Objectives: Although cardiogenic shock requiring extracorporeal life support after cardiac surgery is associated with high mortality, the impact of sex on outcomes of postcardiotomy extracorporeal life support remains unclear with conflicting results in the literature. We compare patient characteristics, in-hospital outcomes, and overall survival between females and males requiring postcardiotomy extracorporeal life support.
Methods: This retrospective, multicenter (34 centers), observational study included adults requiring postcardiotomy extracorporeal life support between 2000 and 2020.
Article Synopsis
- - The study aims to determine if the preoperative pulmonary artery pulsatility index (PAPi) can predict mortality after left ventricular assist device (LVAD) implantation, as right ventricular failure is a significant concern following the procedure.
- - An analysis of 117 patients from 2007 to 2021 revealed that those with a PAPi of 2.84 or higher had a significantly better 3-month survival rate compared to those with lower PAPi levels.
- - Other factors influencing 2-year mortality included systemic hypertension, diabetes, and whether the LVAD was used as a bridge to transplant, with notable differences in survival outcomes between these groups.
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.*
Cancer is one of the major causes of death worldwide and the development of multidrug resistance (MDR) in cancer cells is the principal cause of chemotherapy failure. To gain insights into the specific mechanisms of MDR in cancer cell lines, we developed a novel method for the combined analysis of recently published datasets on drug sensitivity and CRISPR loss-of-function screens for the same set of cancer cell lines. For our analysis, we first selected cell lines that consistently exhibit drug resistance across several classes of compounds.
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- The study investigates the effectiveness of cardiac computed tomography (CT) in detecting complications of prosthetic heart valves (PHVs), focusing on advancements with photon-counting detectors (PCDs) compared to dual-energy dual-layer CT (DEDL-CT).
- Researchers used a thoracic phantom with various PHVs and lesions to perform scans, analyzing image quality and artifacts such as blooming and streaks.
- Results indicate that PCD-CT provides improved image clarity, with thinner metallic structures and significantly reduced artifacts compared to DEDL-CT.
Introduction: Over the last few decades, the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) support for severe respiratory failure has increased.
Aim: This study aimed to assess the long-term outcomes of patients treated with VV-ECMO for respiratory failure.
Methods: We performed a single-centre prospective evaluation of patients on VV-ECMO who were successfully discharged from the intensive care unit of an Italian University Hospital between January 2018 and May 2021.
Article Synopsis
- Frailty is a condition in older people that makes them more vulnerable to stress and can lead to worse health outcomes after surgery.
- As more older patients are having surgeries, healthcare teams need to work together to provide special care to these frail patients.
- It's important to measure frailty accurately before surgery because common assessments often miss it, and taking steps before and after surgery can help reduce complications and aid recovery.