Pubblicazioni - Calini Dott. Angelo Raffaele

• The repurposed use of anesthesia machines to ventilate critically ill patients with Coronavirus Disease 2019 (COVID-19).
  Res Sq

  2021 Feb;():. doi: rs.3.rs-228821.
  
  Bottiroli Maurizio, Calini Angelo, Pinciroli Riccardo, Mueller Ariel, Siragusa Antonio, Anelli Carlo, Urman Richard, Nozari Ala, Berra Lorenzo, Mondino Michele, Fumagalli Roberto
  
  Abstract
  
  BackgroundThe surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice.MethodsWe designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group.ResultsComplete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p?=?0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75-9.33, p?=?0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns.ConclusionsOur results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic.Clinical Trial NumberNot applicable.
  
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• Takotsubo syndrome as a complication in a critically ill COVID-19 patient.
  ESC Heart Fail

  2020 Sep;():. doi: 10.1002/ehf2.12912.
  
  Bottiroli Maurizio, De Caria Daniele, Belli Oriana, Calini Angelo, Andreoni Patrizia, Siragusa Antonio, Moreo Antonella, Ammirati Enrico, Mondino Michele, Fumagalli Roberto
  
  Abstract
  
  Coronavirus disease 2019 (COVID-19) patients with cardiac injury have an increased risk of mortality. It remains to be determined the mechanism of cardiac injury and the identification of specific conditions that affect the heart during COVID-19. We present the case of a 76-year-old woman with COVID-19 pneumonia that developed a takotsubo syndrome (TTS). Although the patient presented normal left ventricular ejection fraction and normal levels of troponin on admission, after 16 days in intensive care unit due to respiratory distress, she suddenly developed cardiogenic shock. Shock occurred few hours after a spontaneous breathing trial through her tracheostomy. Bed-side echocardiographic revealed apical ballooning promptly supporting the diagnosis of TTS. She was successfully treated with deep sedation and low dosage of epinephrine. The relevance of this case is that TTS can occur in the late phase of COVID-19. Awareness of late TTS and bed-side echocardiographic evaluation can lead to prompt identification and treatment.
  
  © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
  
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• Successful recovery from severe COVID-19 pneumonia after kidney transplantation: The interplay between immunosuppression and novel therapy including tocilizumab.
  Transpl Infect Dis

  2020 Oct;22(5):e13334. doi: 10.1111/tid.13334.
  
  Lauterio Andrea, Valsecchi Mila, Santambrogio Sara, De Carlis Riccardo, Merli Marco, Calini Angelo, Centonze Leonardo, Buscemi Vincenzo, Bottiroli Maurizio, Puoti Massimo, Fumagalli Roberto, De Carlis Luciano
  
  Abstract
  
  Although immunosuppressed patients may be more prone to SARS-CoV-2 infection with atypical presentation, long-term immunosuppression therapy may provide some sort of protection for severe clinical complications of COVID-19. The interaction between immunosuppression and new antiviral drugs in the treatment of transplanted patients contracting COVID-19 has not yet been fully investigated. Moreover, data regarding the optimal management of these patients are still very limited. We report a case of the successful recovery from severe COVID-19 of a kidney-transplanted patient treated with hydroxychloroquine, lopinavir/ritonavir, steroid, and tocilizumab.
  
  © 2020 Wiley Periodicals LLC.
  
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• A new access for transcatheter aortic valve implantation: Distal axillary artery.
  Int J Cardiol

  2016 Nov;223():810-812. doi: S0167-5273(16)32008-3.
  
  Bruschi Giuseppe, Colombo Paola, Merlanti Bruno, Nava Stefano, Belli Oriana, Musca Francesco, Soriano Francesco, Botta Luca, Calini Angelo, De Caria Daniele F, Oliva Fabrizio, Russo Claudio F
  
  
  
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• Validation of a novel index of hemorrhage using a lower body negative pressure shock model.
  Minerva Anestesiol

  2016 08;82(8):839-49.
  
  Vettorello Marco, Sher Sara, Santambrogio Sara, Calini Angelo, Tardini Francesca, Lippi Monica, Fumagalli Roberto
  
  Abstract
  
  BACKGROUND:
  Vital signs are late indicators of blood loss in trauma patients. Indexed Heart to Arm Time (iHAT) is a non-invasive index based on a modified pulse transit time (mPTT) indexed to the time between R waves on the electrocardiogram (RR interval). We aimed to investigate how early iHAT is able to detect central hypovolemia during the progression from mild to severe simulated hemorrhage induced by applying lower body negative pressure (LBNP).
  
  METHODS:
  Thirty healthy volunteers were enrolled. Central hypovolemia was induced by application of increasing LBNP from 0 to -80 mmHg. At every step, non-invasive blood pressure, heart rate, cardiac echo Doppler measurements and iHAT were recorded.
  
  RESULTS:
  Aortic flow Velocity Time Integral (VTI) reduction from 21.8±3.7 (baseline) to 11.2±3 cm (-70 mmHg) (P<0.001) was progressive with LBNP increase and represented a significant change in stroke volume and preload and induced an increase in heart rate from 69±2 to 107±4 bpm. iHAT increased from 34.2±4.65% (baseline) to 53.9±14.34% (-80 mmHg), P<0.001. The increase in iHAT became significant after -30 mmHg level was reached, corresponding to 500-1000 mL blood loss.
  
  CONCLUSIONS:
  iHAT measures both the reduction in preload and the parabolic heart rate increase due to the linear decrease in stroke volume. iHAT was able to detect a progressive central volume loss in a model of hemorrhage in healthy volunteers undergoing LBNP. A rising trend in iHAT can be a useful marker for progressive volume loss during moderate to severe bleeding.
  
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