Outcomes of COVID-19 patients intubated after failure of non-invasive ventilation: a multicenter observational study

The efficacy of non-invasive ventilation (NIV) in acute respiratory failure secondary to SARS-CoV-2 infection remains controversial. Current literature mainly examined efficacy, safety and potential predictors of NIV failure provided out of the intensive care unit (ICU). On the contrary, the outcomes of ICU patients, intubated after NIV failure, remain to be explored. The aims of the present study are: (1) investigating in-hospital mortality in coronavirus disease 2019 (COVID-19) ICU patients receiving endotracheal intubation after NIV failure and (2) assessing whether the length of NIV application affects patient survival. This observational multicenter study included all consecutive COVID-19 adult patients, admitted into the twenty-five ICUs of the COVID-19 VENETO ICU network (February-April 2020), who underwent endotracheal intubation after NIV failure. Among the 704 patients admitted to ICU during the study period, 280 (40%) presented the inclusion criteria and were enrolled. The median age was 69 [60-76] years; 219 patients (78%) were male. In-hospital mortality was 43%. Only the length of NIV application before ICU admission (OR 2.03 (95% CI 1.06-4.98), p = 0.03) and age (OR 1.18 (95% CI 1.04-1.33), p < 0.01) were identified as independent risk factors of in-hospital mortality; whilst the length of NIV after ICU admission did not affect patient outcome. In-hospital mortality of ICU patients intubated after NIV failure was 43%. Days on NIV before ICU admission and age were assessed to be potential risk factors of greater in-hospital mortality

Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS

Background Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS. Methods Observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28th-April 28th, 2020), who received controlled mechanical ventilation, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1st day of controlled mechanical ventilation were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients. Results A total of 704 COVID-19 patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: (1) Crs was not linearly associated with ICU mortality (p value for nonlinearity = 0.01), with a greater risk of death for values < 48 ml/cmH(2)O; (2) the association between DP and ICU mortality was linear (p value for nonlinearity = 0.68), and increasing DP from 10 to 14 cmH(2)O caused significant higher odds of in-ICU death (OR 1.45, 95% CI 1.06-1.99); (3) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95% CI 0.55-1.52). Multivariable analysis confirmed these findings. Conclusions Crs < 48 ml/cmH(2)O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death

Stress echo 2020 : the international stress echo study in ischemic and non-ischemic heart disease

Background: Stress echocardiography (SE) has an established role in evidence-based guidelines, but recently its breadth and variety of applications have extended well beyond coronary artery disease (CAD). We lack a prospective research study of SE applications, in and beyond CAD, also considering a variety of signs in addition to regional wall motion abnormalities. Methods: In a prospective, multicenter, international, observational study design, > 100 certified high-volume SE labs (initially from Italy, Brazil, Hungary, and Serbia) will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Cardiovascular Echography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure; hypertrophic cardiomyopathy; heart failure with preserved ejection fraction; mitral regurgitation after either transcatheter or surgical aortic valve replacement; outdoor SE in extreme physiology; right ventricular contractile reserve in repaired Tetralogy of Fallot; suspected or initial pulmonary arterial hypertension; coronary flow velocity, left ventricular elastance reserve and B-lines in known or suspected CAD; identification of subclinical familial disease in genotype-positive, phenotype- negative healthy relatives of inherited disease (such as hypertrophic cardiomyopathy). Results: We expect to recruit about 10,000 patients over a 5-year period (2016-2020), with sample sizes ranging from 5,000 for coronary flow velocity/ left ventricular elastance/ B-lines in CAD to around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of Fallot. This data-base will allow to investigate technical questions such as feasibility and reproducibility of various SE parameters and to assess their prognostic value in different clinical scenarios. Conclusions: The study will create the cultural, informatic and scientific infrastructure connecting high-volume, accredited SE labs, sharing common criteria of indication, execution, reporting and image storage of SE to obtain original safety, feasibility, and outcome data in evidence-poor diagnostic fields, also outside the established core application of SE in CAD based on regional wall motion abnormalities. The study will standardize procedures, validate emerging signs, and integrate the new information with established knowledge, helping to build a next-generation SE lab without inner walls

Quality control of B-lines analysis in stress Echo 2020

Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.info:eu-repo/semantics/publishedVersio

Drug-related falls in elderly patients in the hospitals of Ulss7: an experimental thesis

openRIASSUNTO INTRODUZIONE. L’evento della caduta coinvolge ogni anno circa un terzo delle persone con età superiore ai 65 anni. Uno dei fattori di rischio principali responsabili del fenomeno è l’assunzione di farmaci; in particolare, i trattamenti che aumentano il rischio caduta che vengono chiamati anche Fall-Risk-Increasing Drugs (FRIDs). L’infermiere dovrebbe essere formato e preparato a conoscere e gestire i FRIDs in modo tale da poter limitare o evitare la caduta. OBIETTIVI. La ricerca ha come fine quello di comprendere quanto sia esteso il fenomeno delle cadute nei pazienti anziani che assumono i FRIDs degenti presso gli ospedali dell’Ulss 7 Pedemontana (Asiago, Bassano del Grappa, Santorso). MATERIALI E METODI. Sono state analizzate le schede di segnalazione caduta del 2020 negli ospedali dell’Ulss 7 Pedemontana. Sono state indagate 6 specifiche aree ospedaliere: medica, chirurgica, critica, SPDC, ambulatoriale e Covid-19. RISULTATI. Sono state analizzate 440 schede totali; di queste, 327 sono state ritenute valide. Sono risultati maggiormente rischiosi per le cadute i farmaci sedativi del SNC, i diuretici, gli ipotensivi e le combinazioni di più di 4 farmaci. DISCUSSIONE. L’utilizzo dei farmaci incide nel 68,5% sul totale delle cadute analizzate nello studio (327). È stato possibile rilevare che ipotensivi, sedativi del SNC e i diuretici sono i farmaci più utilizzati e ritenuti maggiormente responsabili dell’evento della caduta. Si deduce in generale una forte correlazione tra i farmaci FRIDs e la caduta. CONCLUSIONI. La caduta è un grave problema a livello mondiale, specialmente per quanto riguarda le persone anziane. I farmaci FRIDs assunti da questa categoria di pazienti incidono in maniera importante sul fenomeno della caduta. Il professionista sanitario deve conoscere e saper gestire questa particolare tipologia di farmaci per prevenire l’evento avverso e per garantire una qualità di vita dignitosa al paziente anziano.ABSTRACT INTRODUCTION. The event of a fall affects approximately a third of people over the age of 65 every year. One of the main risk factors responsible for the phenomenon is the taking of drugs; in particular, treatments that increase the risk of falling which are also called Fall-Risk-Increasing Drugs (FRID). The nurse should be trained and prepared to know and manage FRIDs so that they can limit or avoid falls. GOALS. The aim of the research is to understand how extensive the phenomenon of falls is in elderly patients taking FRIDs admitted to the hospitals of Ulss 7 Pedemontana (Asiago, Bassano del Grappa, Santorso). MATERIALS AND METHODS. The 2020 fall reporting forms in the hospitals of Ulss 7 Pedemontana were analysed. 6 specific hospital areas were investigated: medical, surgical, critical, SPDC, outpatient and Covid-19. RESULTS. A total of 440 cards were analysed; of these, 327 were considered valid. CNS sedative drugs, diuretics, hypotensive drugs and combinations of more than 4 drugs were found to be most at risk for falls. DISCUSSION. The use of drugs accounts for 68.5% of the total falls analyzed in the study (327). It was possible to find that hypotensive drugs, CNS sedatives and diuretics are the most used drugs and considered most responsible for the event of the fall. In general, a strong convergence between FRID drugs and hair loss is deduced. CONCLUSIONS. Falling is a major problem worldwide, especially among older people. The FRID drugs taken by this category of patients have a significant impact on the phenomenon of falls. The healthcare professional must know and know how to manage this particular type of drugs to prevent the adverse event and to guarantee a dignified quality of life for the elderly patient

Versatile reversible cross-linking strategy to stabilize CCMV virus like particles for efficient siRNA delivery

Virus like particles obtained from the Cowpea Chlorotic Mottle Virus (CCMV) represent an innovative platform for drug delivery applications. Their unique reversible self-assembly properties as well as their suitability for both cargo loading and functionalization make them a versatile scaffold for numerous purposes. One of the main drawbacks of this platform is however its limited stability at physiological conditions. Herein, we report the development of a general reversible cross-linking strategy involving the homobifunctional cross-linker DTSSP (3,3'-dithiobis (sulfosuccinimidylpropionate)) which is suitable for particle stabilization. This methodology is adaptable to different CCMV variants in the presence or absence of a stabilizing cargo without varying neither particle shape nor size thus extending the potential use of these protein cages in nanomedical applications. Cross-linked particles are stable at neutral pH and 37 °C and they are capable of protecting loaded cargo against enzymatic digestion. Furthermore, the reversible nature of the cross-linking ensures particle disassembly when they are taken up by cells. This was demonstrated via the highly effective delivery of active siRNA into cells

Insight into N-terminal localization and dynamics of engineered virus-like particles

Virus-like particles composed of the cowpea chlorotic mottle virus (CCMV) capsid protein (CP) have been extensively studied as carrier systems in nanoscience. One well-established method to improve their stability under physiological conditions is to fuse a stimulus-responsive elastin-like polypeptide (ELP) to the N-terminus of the CPs. Even though the N-terminus should in principle be localized in the inner cavity of the protein cage, studies on the native CCMV revealed its accessibility on the particle surface. We verified that such phenomenon also applies to ELP-CCMVs, by exploiting the covalent functionalization of the CP N-terminal domain via a sortase A-mediated reaction. Western-blot analysis and Förster resonance energy transfer (FRET) experiments furthermore revealed this to be caused by both the external display of the N-termini and the interchange of CPs among preformed capsids. Our findings demonstrate the tunability of ELP-CCMV stability and dynamics and their potential effect on the exploitation of such protein cages as a drug delivery system

Deep Learning-Based Medical Images Segmentation of Musculoskeletal Anatomical Structures: A Survey of Bottlenecks and Strategies

By leveraging the recent development of artificial intelligence algorithms, several medical sectors have benefited from using automatic segmentation tools from bioimaging to segment anatomical structures. Segmentation of the musculoskeletal system is key for studying alterations in anatomical tissue and supporting medical interventions. The clinical use of such tools requires an understanding of the proper method for interpreting data and evaluating their performance. The current systematic review aims to present the common bottlenecks for musculoskeletal structures analysis (e.g., small sample size, data inhomogeneity) and the related strategies utilized by different authors. A search was performed using the PUBMED database with the following keywords: deep learning, musculoskeletal system, segmentation. A total of 140 articles published up until February 2022 were obtained and analyzed according to the PRISMA framework in terms of anatomical structures, bioimaging techniques, pre/post-processing operations, training/validation/testing subset creation, network architecture, loss functions, performance indicators and so on. Several common trends emerged from this survey; however, the different methods need to be compared and discussed based on each specific case study (anatomical region, medical imaging acquisition setting, study population, etc.). These findings can be used to guide clinicians (as end users) to better understand the potential benefits and limitations of these tools