Publications by authors named "Vito Fanelli"

Background: Sepsis is a condition with high mortality and morbidity, characterized by deregulation of the immune response against the pathogen. Current treatment strategies rely mainly on antibiotics and supportive care. However, there is growing interest in exploring cell-based therapies as complementary approaches.

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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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: 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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The key goal in lung donation remains the improvement of graft preservation with the ultimate objective of increasing the number and quality of lung transplants (LTx). Therefore, in recent years the field of graft preservation focused on improving outcomes related to solid organ regeneration and restoration. In this contest Ex-Vivo Lung Perfusion (EVLP) plays a crucial role with the purpose to increase the donor pool availability transforming marginal and/or declined donor lungs suitable for transplantation.

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  • High volume hemofiltration (HVHF) aimed to remove inflammatory substances linked to kidney injury from sepsis, but recent trials showed no improvement in patient outcomes compared to standard volume hemofiltration (SVHF).
  • This study investigated the effects of plasma from patients treated with HVHF or SVHF on various cell types related to inflammation and injury, focusing on leukocyte adhesion and cell damage over time.
  • Findings indicated that while both HVHF and SVHF reduced inflammatory markers temporarily, they did not differ significantly, and septic plasma consistently caused harmful effects on endothelial and tubular epithelial cells, indicating ongoing microvascular injury.
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The efficacy of veno-venous extracorporeal membrane oxygenation (VV-ECMO) as rescue therapy for refractory COVID-19-related ARDS (C-ARDS) is still debated. We describe the cohort of C-ARDS patients treated with VV-ECMO at our ECMO center, focusing on factors that may affect in-hospital mortality and describing the time course of lung mechanics to assess prognosis. We performed a prospective observational study in the intensive care unit at the "Città della Salute e della Scienza" University Hospital in Turin, Italy, between March 2020 and December 2021.

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  • * Among COVID-19 patients, there was a notable prevalence of Gram-positive bacteria-related VAP, but the rates of multidrug-resistant bacteria were similar between both groups.
  • * Patients with COVID-19 exhibited significantly higher ICU and in-hospital mortality rates, with a hazard ratio of 7.95 for 28-day hospital mortality, highlighting the severe impacts of the virus on critically ill patients.
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  • Anticoagulation management during veno-venous extracorporeal membrane oxygenation (VV ECMO) is challenging due to a lack of definitive guidelines, leading to significant bleeding complications.
  • A study involving 652 adult patients across 41 centers analyzed anticoagulation practices and bleeding events, finding that unfractionated heparin was the most commonly used anticoagulant and that bleeding occurred in 52.5% of patients.
  • Results showed that higher activated partial thromboplastin time (aPTT) levels were linked to an increased risk of bleeding, suggesting that future research could investigate whether lower aPTT targets might help minimize these complications.
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Reports of electromyography during hypoxic exercise are contrasting, due to protocol and muscle diversity. This work aimed to investigate alterations in muscle activation and myoelectrical fatigue during exercise at high-altitude in those muscles primarily involved in trekking. Twelve young adults balanced by gender and age were tested at low (1,667 m) and high (4,554 m, "Capanna Margherita", Italy) altitude, during an isometric squat lasting 60 seconds.

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Lung Perfusion (EVLP) can be potentially used to manipulate organs and to achieve a proper reconditioning process. During EVLP pro-inflammatory cytokines have been shown to accumulate in perfusate over time and their production is correlated with poor outcomes of the graft. Aim of the present study is to investigate the feasibility and safety of cytokine adsorption during EVLP.

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Sepsis-Associated Acute Kidney Injury is a life-threatening condition leading to high morbidity and mortality in critically ill patients admitted to the intensive care unit. Over the past decades, several extracorporeal blood purification therapies have been developed for both sepsis and sepsis-associated acute kidney injury management. Despite the widespread use of extracorporeal blood purification therapies in clinical practice, it is still unclear when to start this kind of treatment and how to define its efficacy.

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Renal replacement therapies (RRT) are essential to support critically ill patients with severe acute kidney injury (AKI), providing control of solutes, fluid balance and acid-base status. To maintain the patency of the extracorporeal circuit, minimizing downtime periods and blood losses due to filter clotting, an effective anticoagulation strategy is required.Regional citrate anticoagulation (RCA) has been introduced in clinical practice for continuous RRT (CRRT) in the early 1990s and has had a progressively wider acceptance in parallel to the development of simplified systems and safe protocols.

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Finding the right time for weaning from ventilator is a difficult clinical decision. Several systems based on machine or deep learning are reported in literature. However, the results of these applications are not completely satisfactory and may be improved.

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Background: Mid-regional pro-adrenomedullin (MR-proADM), an endothelium-related peptide, is a predictor of death and multi-organ failure in respiratory infections and sepsis and seems to be effective in identifying COVID-19 severe forms. The study aims to evaluate the effectiveness of MR-proADM in comparison to routine inflammatory biomarkers, lymphocyte subpopulations, and immunoglobulin (Ig) at an intensive care unit (ICU) admission and over time in predicting mortality in patients with severe COVID-19.

Methods: All adult patients with COVID-19 pneumonia admitted between March 2020 and June 2021 in the ICUs of a university hospital in Italy were enrolled.

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  • Proportional assist ventilation with load-adjustable gain factors (PAV+) is a modern mechanical ventilation method that adjusts assistance based on a patient’s breathing efforts, potentially offering benefits like better patient-ventilator synchrony compared to traditional pressure support ventilation (PSV).
  • A multi-centre randomized controlled trial aims to find out if PAV+ leads to faster successful extubation in patients with acute respiratory failure compared to PSV, involving around 20 hospitals worldwide.
  • The study will randomize participants who struggle with weaning onto either ventilation method, measuring primary outcomes like the time to extubation and other recovery metrics.
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  • The study investigates in-hospital mortality and post-discharge outcomes for patients with COVID-19 who received ECMO during the pandemic's first wave (March 1 - Sept 13, 2020).
  • Conducted by the European Extracorporeal Life Support Organization, it included 1215 patients from 21 countries and focused on various patient-related factors affecting survival rates.
  • Findings revealed a 50% in-hospital mortality rate, with factors like age, pre-ECMO complications, and delays in ECMO initiation linked to higher mortality.
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Extracellular vesicles form a complex intercellular communication network, shuttling a variety of proteins, lipids, and nucleic acids, including regulatory RNAs, such as microRNAs. Transfer of these molecules to target cells allows for the modulation of sets of genes and mediates multiple paracrine and endocrine actions. EVs exert broad pro-inflammatory, pro-oxidant, and pro-apoptotic effects in sepsis, mediating microvascular dysfunction and multiple organ damage.

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Background: In patients receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO) packed red blood cell (PRBC) transfusion thresholds are usually higher than in other patients who are critically ill. Available guidelines suggest a restrictive approach, but do not provide specific recommendations on the topic. The main aim of this study was, in a short timeframe, to describe the actual values of haemoglobin and the rate and the thresholds for transfusion of PRBC during VV ECMO.

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The aim of this retrospective multicenter observational study is to test the feasibility and safety of a combined extracorporeal CO 2 removal (ECCO 2 R) plus renal replacement therapy (RRT) system to use an ultraprotective ventilator setting while maintaining (1) an effective support of renal function and (2) values of pH within the physiologic limits in a cohort of coronavirus infectious disease 2019 (COVID-19) patients. Among COVID-19 patients admitted to the intensive care unit of 9 participating hospitals, 27 patients with acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) requiring invasive mechanical ventilation undergoing ECCO 2 R-plus-RRT treatment were included in the analysis. The treatment allowed to reduce V T from 6.

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To evaluate whether lung ultrasound is reliable bedside tool to monitor changes of lung aeration at the early and late stages of ARDS. LUS was performed in ARDS patients that underwent at least two consecutive CT scan at ICU admission and at least 1 week after admission. Twelve fields were evaluated and graded from 0 (normal) to 3 (consolidation).

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  • A multicenter randomized trial compared the effectiveness of high-flow nasal oxygen versus VenturiMask in preventing reintubation after extubation in hypoxemic patients.
  • Although the overall reintubation rates within 72 hours and at 28 days were similar between both oxygen delivery methods, the high-flow group had a significantly lower need for rescue noninvasive ventilation.
  • The study concluded that while high-flow oxygen didn't reduce reintubation rates, it did show advantages in minimizing the use of rescue ventilation.
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Background: Ex vivo lung perfusion (EVLP) is a relevant procedure to increase the lung donor pool but could potentially increase the airway tree ischemic injury risk.

Methods: This study aimed to evaluate the direct effect of EVLP on the airway tree by evaluating bronchial cell vitality and tissue signs of injury on a series of 117 bronchial rings collected from 40 conventional and 19 EVLP-treated lung grafts. Bronchial rings and related scraped bronchial epithelial cells were collected before the EVLP procedure and surgical anastomosis.

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Background And Aim: The novel coronavirus disease 2019 remains challenging. A large number of hospitalized patients are at a high risk of developing AKI. For this reason, we conducted a nationwide survey to assess the incidence and management of AKI in critically ill patients affected by the SARS-CoV-2 infection.

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