Publications by authors named "Sofia Spano"
Purpose: Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis.
Materials And Methods: We performed a two-center, pilot, open-label, randomized trial.
Introduction: Paracetamol (acetaminophen)-induced acute liver failure (ALF) with severe hyperammonemia (ammonia >100 µmol⋅L-1) is a life-threatening condition. A strategy based on high-intensity continuous renal replacement therapy (CRRT) without early (up to day seven) transplantation may enable clinicians to safely identify which patients can recover and survive and which patients require transplantation.
Methods: We conducted a single-center, retrospective cohort study of patients with severely hyperammonemic paracetamol-induced ALF.
Background: Normothermic machine perfusion (NMP) aims to reduce ischemia-reperfusion injury in donor livers and its clinical manifestation, early allograft dysfunction (EAD) by maintaining perfusion and oxygenation. However, there is limited data on which NMP perfusate biomarkers might be associated with such EAD and the role of perfusate hemoglobin has not been assessed.
Methods: We performed a pilot retrospective analysis of adult donor livers undergoing NMP between 2020 and 2022 at our center.
Article Synopsis
- Higher nitric oxide (NO) levels are linked to worse outcomes in sepsis, but measuring them is difficult; Methemoglobin (MetHb), a byproduct of NO, may provide a solution.
- In a study of 7,724 ICU patients with sepsis, 1,046 had MetHb measurements, revealing that those with levels of 1.6% or higher had significantly increased mortality rates and fewer days spent out of the hospital by day 28.
- The results indicate that MetHb levels of 1.6% or above can independently predict higher 28-day mortality, suggesting that MetHb measurement from arterial blood gases could improve sepsis risk assessment.
Introduction: Hypotension is common during intermittent hemodialysis (IHD) and may be due to a decreased cardiac index (CI). However, no study has simultaneously and continuously measured CI and mean arterial pressure (MAP) to understand the prevalence, severity, and duration of CI decreases or relate them to MAP, blood volume (BV), and net ultrafiltration (NUF) rate.
Methods: In a prospective, pilot and feasibility investigation, we studied 10 chronic IHD patients.
Introduction: Hematocrit monitoring during continuous renal replacement therapy (CRRT) allows the continuous estimation of relative blood volume (RBV). This may enable early detection of intravascular volume depletion prior to clinical sequelae. We aimed to investigate the feasibility of extended RBV monitoring and its epidemiology during usual CRRT management by clinicians unaware of RBV.
View Article and Find Full Text PDFCarboxyhemoglobin as Potential Biomarker for Cardiac Surgery Associated Acute Kidney Injury.
J Cardiothorac Vasc Anesth
October 2024
Objectives: Carboxyhemoglobin (CO-Hb) is a marker of hemolysis and inflammation, both risk factors for cardiac surgery-associated AKI (CSA-AKI). However, the association between CO-Hb and CSA-AKI remains unknown.
Design: A retrospective cohort study.
Article Synopsis
- The study investigates the link between renin levels, use of RAS inhibitors, responsiveness to angiotensin II (ANGII), and patient outcomes in those with vasopressor-dependent vasodilatory hypotension.
- Researchers conducted a single-center observational study involving 40 critically ill patients in an ICU setting in Melbourne to gather data on these relationships.
- Findings revealed that recent RAS inhibitor use led to significantly higher baseline renin levels, which correlated with decreased ANGII responsiveness and fewer days alive without the need for continuous renal replacement therapy at 24 hours post-ANGII treatment.
Article Synopsis
- Cardiac surgery using cardiopulmonary bypass (CPB) can cause hemolysis, and the study investigates carboxyhemoglobin (CO-Hb) as a potential marker for this condition.
- The research analyzed data from 1,735 patients and found that CO-Hb levels significantly increased post-surgery, peaking 2.1 times higher than baseline levels about 17 hours after the procedure.
- Several factors, such as age, respiratory disease, and amount of red blood cell transfusions, were associated with higher CO-Hb levels, which also correlated with increased bilirubin levels, suggesting CO-Hb's potential as a valuable biomarker for monitoring hemolysis in cardiac surgery patients.
Introduction: Liver failure is a life-threatening condition characterized by the accumulation of metabolic toxins. Extracorporeal albumin dialysis (ECAD) has been promoted as a possible therapy.
Methods: We employed bibliometric analysis to scrutinize the conceptual, intellectual, and social structure of the ECAD literature including its co-citation network and thematic analysis to explore its evolution and organization.
Purpose: Angiotensin II is approved for catecholamine-refractory vasodilatory shock but the conversion dose ratio from norepinephrine to angiotensin II remains unclear.
Methods: We conducted a post-hoc analysis of the Acute Renal effects of Angiotensin II Management in Shock (ARAMIS) trial involving patients with vasodilatory hypotension. We determined the norepinephrine equivalent dose immediately prior to angiotensin II initiation and calculated the conversion dose ratio between norepinephrine and angiotensin II.
Introduction: Renal replacement therapy (RRT) is associated with hypotension. However, its impact on cardiac output (CO) is less understood. We aimed to describe current knowledge of CO monitoring and changes during RRT.
View Article and Find Full Text PDFThe impact of blood pressure targets and surgical approach (laparoscopic or open) on continuous urinary oxygenation (PuO), a validated surrogate of renal medullary PO, during general surgery, is unclear. We aimed to assess the effects of different blood pressure targets and surgical procedures on PuO. We randomized patients receiving either laparoscopic or open surgery into two mean arterial pressure (MAP) target groups: usual MAP or a high MAP.
View Article and Find Full Text PDFBackground: Mega-dose sodium ascorbate (NaAscorbate) appears beneficial in experimental sepsis. However, its physiological effects in patients with septic shock are unknown.
Methods: We conducted a pilot, single-dose, double-blind, randomized controlled trial.
Background: Acute kidney injury (AKI) is highly prevalent in critical COVID-19 patients. The diagnosis and staging of AKI are based on serum creatinine (sCr) and urinary output criteria, with limitations in the functional markers. New cell-cycle arrest biomarkers [TIMP2]*[IGFBP7] have been proposed for early detection of AKI, but their role in critically ill COVID-19 patients is poorly understood.
View Article and Find Full Text PDFBackground: The Cardiac Power Index (CPI) measures the rate of energy output generated by the heart and correlates this with in-hospital mortality due to cardiogenic shock. In open aortic surgery, both aortic clamping and unclamping expose the heart to abrupt variations of the left ventricle afterload, preload, and contractility, with possible hemodynamic impairment. We investigated how aortic-cross clamping (Ao-XC) and unclamping (Ao-UC) procedures affect the CPI during open aortic surgery.
View Article and Find Full Text PDFBackground: The aim was to describe the incidence and risk factors of barotrauma in patients with the Coronavirus disease 2019 (COVID-19) on invasive mechanical ventilation, during the outbreak in our region (Lombardy, Italy).
Methods: The study was an electronic survey open from March 27 to May 2, 2020. Patients with COVID-19 who developed barotrauma while on invasive mechanical ventilation from 61 hospitals of the COVID-19 Lombardy Intensive Care Unit network were involved.