Cooccurrence of Problems in the PostIntensive Care Syndrome among 406 Survivors of Critical Illness

Purpose Post-Intensive Care Syndrome (PICS) is characterized by new or worse cognitive impairment, disability, and mental health impairment after critical illness. The frequency of co-occurring problems in PICS, along with factors associated with being PICS-free, is unclear. Methods We included patients with respiratory failure or shock, excluding those with preexisting cognitive impairment or disability in activities of daily living. At 3 and 12 months after hospital discharge, we assessed patients for cognitive impairment, disabilities in activities of daily living, and depression. We categorized patients into eight groups reflecting combinations of cognitive, disability, and mental health problems. We modeled the association between age, education, frailty, durations of mechanical ventilation, delirium, and severe sepsis with the odds of being PICS-free using multivariable regression. Results We analyzed 406 patients who were a median age of 61 years old with an APACHE II of 23. PICS was present in 64% and 56% of patients at 3 and 12 months, respectively. Co-occurring problems in all 3 domains were present in 6% at 3 months and 4% at 12 months. More years of education was associated with greater odds of being PICS-free (P<0.001 at 3 and 12 months). Frailty was associated with lower odds of being PICS-free at 3 months (P=0.005). Conclusions PICS was present in the majority of survivors of critical illness. Co-occurring problems in all 3 PICS domains was rare. Greater years of education were protective from PICS. Future studies are needed to understand better the heterogeneous subtypes of PICS and to identify modifiable risk factors for this syndrome

Compensazione ottica della miopia e controllo della progressione: l’ipotesi della non correzione

La miopia è una delle principali cause di disabilità visive in tutto il mondo e la sua progressione è in rapido aumento. Sono stati segnalati vari fattori ambientali, legati allo stato socioeconomico e allo stile di vita, e considerati responsabili dell’aumento della prevalenza nell’ultimo mezzo secolo. Negli ultimi decenni sono anche emerse prove crescenti riguardo ai possibili meccanismi biologici che determinano l'errore refrattivo, dando ulteriore evidenza alla teoria che la miopia sia il risultato di una complicata interazione tra predisposizione genetica ed esposizioni ambientali (Foster P.J.,2014). Anche se l’esatta eziologia del difetto miopico rimane elusiva, le tecniche di controllo della progressione risultano sempre più urgenti. La teoria invocata per molte strategie di controllo è quella del defocus periferico. Le teorie di E.L. Smith hanno evidenziato che l’ipermetropia periferica rappresenta un fattore di rischio importante per l’insorgenza e la progressione del difetto miopico. Tuttavia, questo modello è stato contestato da M. Campbell, E. Irving, le quali hanno riferito che la miopia e la sua progressione non possono essere interamente spiegate dalle condizioni di defocalizzazione periferica (Smith E.L., 2013) essendoci evidenze per molti altri fattori (Lag accomodativo, influenza di lenti, stato della foria prossimale ecc.). In seguito alla descrizione dei pro e dei contro delle strategie di controllo della progressione maggiormente utilizzate, questo elaborato propone una nuova ipotesi di lavoro, basata sugli studi di Antonio Medina. Egli, dopo aver dimostrato matematicamente che il processo che regola la refrazione oculare è un processo di feedback a loop chiuso, ha evidenziato che l’andamento esponenziale dell’errore refrattivo non corretto diventa lineare quando vengono utilizzate lenti correttive. Secondo tale teoria, le lenti pongono il sistema di feedback in una condizione di loop aperto ed esacerbano la miopia non corretta. Detto ciò, un’ipotetica strategia di lavoro potrebbe essere quella di ritardare la compensazione della miopia (Sun Y.Y., 2017) fino a quando l’acuità visiva non risulti significativamente compromessa. In questo modo potremmo ritardare la progressione lineare del difetto e ottenere, alla stabilizzazione, un valore di miopia finale inferiore, oppure potremmo affrontare preventivamente una compensazione parziale dell’ipermetropia, presente inizialmente in molti bambini (Medina A., 2018), per tutelare il feedback di emmetropizzazione. Data la rete di fattori e lo stato delle conoscenze, è evidente che ogni scelta riguardo la compensazione della miopia non può essere generalizzata ma deve essere individualizzata.ope

Preoperative anxiety during COVID-19 pandemic: A single-center observational study and comparison with a historical cohort

Background: Preoperative anxiety is a common sensation experienced by patients undergoing surgical interventions. It can influence intraoperative and postoperative management through the activation of the neuroendocrine system, leading to tachycardia, hypertension, pulmonary complications, higher consumption of anesthetic drugs, and increased postoperative pain. Our aim was to investigate the level of preoperative anxiety during the COVID-19 pandemic; we also compared it to the preoperative anxiety of a historical cohort before the outbreak. Methods: This is a single-center observational study. We enrolled 314 patients during the pandemic from May 2021 to November 2021, and our historical cohort consisted of 122 patients enrolled from July 2015 to May 2016 in the university hospital "Federico II" of Naples. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Inventory (STAI) were used to evaluate preoperative anxiety. In particular, APAIS measures preoperative anxiety and the need for information, and STAI assesses state and trait anxiety through STAI-Y1 and STAI-Y2, respectively. We analyzed APAIS and STAI scores in our population stratified on the basis of age, gender, marital status, previous surgical experiences, and type of surgery, and we compared them to our historical cohort. Statistical analysis was performed through a t-test and ANOVA for parametric data, and the Mann-Whitney and Kruskal-Wallis tests for non-parametric data. Linear regression was used to investigate the correlation between demographic data and the scores of STAI and APAIS in both groups. Results: Our results showed that state and preoperative anxiety remained stable, whereas trait anxiety increased in all the subgroups analyzed. Discussion: Even if state anxiety is considered a variable characteristic of the emotional sphere and trait anxiety a stable element, our findings suggested that COVID-19 deeply influenced trait anxiety, thus altering the patients' psychological foundations

Protocols of Anesthesia Management in Parturients with SARS-CoV-2 Infection

Background: Our hospital became a referral center for COVID-19-positive obstetric patients from 1 May 2020. The aim of our study is to illustrate our management protocols for COVID-19-positive obstetric patients, to maintain safety standards for patients and healthcare workers. Methods: Women who underwent vaginal or operative delivery and induced or spontaneous abortion with a SARS-CoV-2-positive nasopharyngeal swab using real-time PCR (RT-PCR) were included in the study. Severity and onset of new symptoms were carefully monitored in the postoperative period. All the healthcare workers received a nasopharyngeal swab for SARS-CoV-2 using RT-PCR serially every five days. Results: We included 152 parturients with COVID-19 infection. None of the included women had general anesthesia, an increase of severe symptoms or onset of new symptoms. The RT-PCR test was “negative” for the healthcare workers. Conclusions: In our study, neuraxial anesthesia for parturients’ management with SARS-CoV-2 infection has been proven to be safe for patients and healthcare workers. Neuraxial anesthesia decreases aerosolization during preoxygenation, face-mask ventilation, endotracheal intubation, oral or tracheal suctioning and extubation. This anesthesia management protocol can be generalizable

Compensazione ottica della miopia e controllo della progressione: l’ipotesi della non correzione

La miopia è una delle principali cause di disabilità visive in tutto il mondo e la sua progressione è in rapido aumento. Sono stati segnalati vari fattori ambientali, legati allo stato socioeconomico e allo stile di vita, e considerati responsabili dell’aumento della prevalenza nell’ultimo mezzo secolo. Negli ultimi decenni sono anche emerse prove crescenti riguardo ai possibili meccanismi biologici che determinano l'errore refrattivo, dando ulteriore evidenza alla teoria che la miopia sia il risultato di una complicata interazione tra predisposizione genetica ed esposizioni ambientali (Foster P.J.,2014). Anche se l’esatta eziologia del difetto miopico rimane elusiva, le tecniche di controllo della progressione risultano sempre più urgenti. La teoria invocata per molte strategie di controllo è quella del defocus periferico. Le teorie di E.L. Smith hanno evidenziato che l’ipermetropia periferica rappresenta un fattore di rischio importante per l’insorgenza e la progressione del difetto miopico. Tuttavia, questo modello è stato contestato da M. Campbell, E. Irving, le quali hanno riferito che la miopia e la sua progressione non possono essere interamente spiegate dalle condizioni di defocalizzazione periferica (Smith E.L., 2013) essendoci evidenze per molti altri fattori (Lag accomodativo, influenza di lenti, stato della foria prossimale ecc.). In seguito alla descrizione dei pro e dei contro delle strategie di controllo della progressione maggiormente utilizzate, questo elaborato propone una nuova ipotesi di lavoro, basata sugli studi di Antonio Medina. Egli, dopo aver dimostrato matematicamente che il processo che regola la refrazione oculare è un processo di feedback a loop chiuso, ha evidenziato che l’andamento esponenziale dell’errore refrattivo non corretto diventa lineare quando vengono utilizzate lenti correttive. Secondo tale teoria, le lenti pongono il sistema di feedback in una condizione di loop aperto ed esacerbano la miopia non corretta. Detto ciò, un’ipotetica strategia di lavoro potrebbe essere quella di ritardare la compensazione della miopia (Sun Y.Y., 2017) fino a quando l’acuità visiva non risulti significativamente compromessa. In questo modo potremmo ritardare la progressione lineare del difetto e ottenere, alla stabilizzazione, un valore di miopia finale inferiore, oppure potremmo affrontare preventivamente una compensazione parziale dell’ipermetropia, presente inizialmente in molti bambini (Medina A., 2018), per tutelare il feedback di emmetropizzazione. Data la rete di fattori e lo stato delle conoscenze, è evidente che ogni scelta riguardo la compensazione della miopia non può essere generalizzata ma deve essere individualizzata

The ABCDEF Implementation Bundle

Long-term morbidity, long-term cognitive impairment and hospitalization-associated disability are common occurrence in the survivors of critical illness, with significant consequences for patients and for the caregivers. The ABCDEF bundle represents an evidence-based guide for clinicians to approach the organizational changes needed for optimizing ICU patient recovery and outcomes. The ABCDEF bundle includes: Assess, Prevent, and Manage Pain, Both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT), Choice of analgesia and sedation, Delirium: Assess, Prevent, and Manage, Early mobility and Exercise, and Family engagement. The purpose of this review is to describe the core features of the ABCDEF bundle

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

ICU delirium is a common medical problem occurring in patients admitted to the intensive care units (ICUs). Studieshave shown that ICU delirium is associated with increased mortality, prolonged hospitalization, prolonged mechanicalventilation, costs and the occurrence of cognitive disoders after discharge from ICU.The tools available for ICU delirium screening and diagnosis are validated tests available for all members if the medicalteam (physicians, nurses, physiotherapists). Their use for routine patient assessment is recommended by internationalmedical and scientific societies. They have been implemented as Pain, Agitation, Delirium (PAD) Guidelines by theSociety of Critical Care Medicine. Apart from monitoring, a strategy of prevention and treatment is recommended,based on non-pharmacological approach (restoration of senses, early mobilization, physiotherapy, improvement insleep hygiene and family involvement) as well as pharmacological treatment (typical and atypical antipsychoticsand dexmedetomidine). In this article, we present the risk factors of ICU delirium, available tools for monitoring, aswell as options for prevention and treatment of delirium that can be used to improve care over critically ill patients

Propensity score matched analysis of postoperative nausea and pain after one anastomosis gastric bypass (MGB/OAGB) versus sleeve gastrectomy (SG)

: The aim of our study was to assess and compare postoperative nausea and pain after one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (LSG). Patients undergoing OAGB and LSG at our institution between November 2018 and November 2021 have been prospectively asked to report postoperative nausea and pain on a numeric analogic scale. Medical records were retrospectively reviewed to collect scores of these symptoms at the 6th and 12th postoperative hour. One-way analysis of variance (ANOVA) was used to evaluate effect of type of surgery on postoperative nausea and pain scores. To adjust for baseline differences between cohorts, a propensity score algorithm was used to match LSG patients to MGB/OAGB patients in a 1:1 ratio with a 0.1 tolerance. A total number of 228 (119 SGs and 109 OAGBs) subjects were included in our study. Nausea after OAGB was significantly less severe than after LSG both at the 6th and 12th hour assessment; pain was less strong after OAGB at the 6th hour but not after 12 h. Fifty-three individuals had a rescue administration of metoclopramide after LSG and 34 after OAGB (44.5% vs 31.2%, p = 0.04); additional painkillers were required by 41 patients after LSG and 23 after OAGB (34.5% vs 21.1%, p = 0.04). Early postoperative nausea was significantly less severe after OAGB, while pain was comparable especially at the 12th hour