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San Raffaele Anesthesia and Intensive Care Profile picture
@SRAnesthesiaICU
Apr 17, 2023 • 7 tweets • 7 min read • Read on X
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Our @MarinaPieri4 now presenting at @EACTAIC webinar: native heart recovery is the first choice option! ImageImageImageImage
2 RCTs are running on #levosimendan in VE #ECMO weaning @EACTAIC

Dieter Dauwe Image
In a patient with #ECPELLA #ECMELLA

Which device do you wean first?
#ECMO or #IMPELLA

Dieter Dauwe @DauweDieter
@EACTAIC @MarinaPieri4 Image
conclusions by @DauweDieter Image
Dr Evgeny Potapov from Berlin showing impressive numbers and interesting trends of #LVAD and #IMPELLA implantations in Germany ImageImageImageImage
Interesting trends in #ECMELLA #IMPELLA over the years
by Evgeny Potapov
@EACTAIC Image
Conclusions by Dr Evgeny Potapov

Hundreds of participants into this @EACTAIC seminar

thanks @tahan_dr for the perfect organization Image

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More from @SRAnesthesiaICU

San Raffaele Anesthesia and Intensive Care Profile picture
Jun 16, 2023
We've just presented and published a multicenter RCT at #CCR23 and in @JAMA_current!

Continuous vs Intermittent Meropenem Administration in Critically Ill Patients with Sepsis: The #MERCYtrial!

🔗 jamanetwork.com/journals/jama/…

This 🧵 will explain the study in detail /11

#FOAMcc Image
2/
β-lactams (e.g., #meropenem), are typically given intermittently, but continuous administration can provide constant serum levels and may improve outcomes.

In fact, several meta-analyses reported reduced mortality when administered continuously. Image
3/
Therefore, we conducted a multinational, double-blind, randomized controlled trial to test the hypothesis that continuous administration of #meropenem, compared with intermittent administration, would improve clinically relevant outcomes in critically ill pts with #sepsis Image
Read 11 tweets
San Raffaele Anesthesia and Intensive Care Profile picture
Apr 30, 2023
#Etomidate and mortality in critically ill patients

Etomidate is a common induction agent but controversy exists about its effects on outcomes

Our meta-analysis found a high probability that etomidate increases mortality (NNH 31)

🧵Thread 1/6 🔗sciencedirect.com/science/articl… #FOAMcc Image
2/
PICOS of this SR/MA

P: Critically ill patients
I: #Etomidate as an induction agent for intubation
C: Any comparator
O: Mortality at the main timepoint defined by authors
S: Randomized controlled trials

11 RCTs with 2704 patients were included

#FOAMcc Image
3/
#Etomidate was associated with significantly increased mortality (23% vs 20%; risk ratio = 1.16 [1.01–1.33]; P = 0.03)

The number needed to harm was 31

The probabilities of any increase and a 1% increase (NNH ≤100) in mortality were 98.1% and 92.1%, respectively.

#FOAMcc ImageImage
Read 6 tweets
San Raffaele Anesthesia and Intensive Care Profile picture
Apr 18, 2023
🚫 DON’T use glucocorticoids in oxygen-free #COVID19 pts

Just published @NEJMEvidence
 
Guidelines are against glucocorticoids in pts not on O2 but effect on survival remains unclear
 
Our meta-analysis found that glucocorticoids increase mortality

🔗eviden.cc/3MnrDSA 1/5 Image
2/
📝 STUDY SELECTION
 
P: adults with #COVID19 not receiving oxygen
I: intravenous or oral #glucocorticoids
C: any
O: all-cause mortality at the longest follow-up available
S: RCTs, matched studies
 
➡️ 5 RCTs and 1 propensity-matched study (total 6634 pts) were included Image
3/
🪦 MORTALITY: #Glucocorticoids vs comparator

14% vs 10% (OR=1.56; 95% CI=1.27 to 1.93)
Number needed to harm=27
 
Mortality increase was confirmed in RCTs only
16% vs 13% (OR=1.34; 95% CI=1.00 to 1.78)
 
Need for mechanical ventilation was also increased: 18% vs 15%

#FOAMcc Image
Read 5 tweets
San Raffaele Anesthesia and Intensive Care Profile picture
Jun 18, 2021
Inoperable patients can now be offered a potentially curative surgery.

🔗 Read @annalsthorsurg: pubmed.ncbi.nlm.nih.gov/34111383/ and the thread 👇 #FOAMcc #FOAMecmo
2/
Here we report the 1st case of intraoperative use of VA-#ECMO in a patient with resectable lung cancer and bivasal critical coronary artery disease with prohibitive low EF (23%), and describe the benefits of this new indication.

🔗 pubmed.ncbi.nlm.nih.gov/34111383/ #FOAMcc #FOAMecmo
3/
Cardiovascular comorbidities often prevent patients with otherwise resectable early-stage lung cancer from undergoing surgery due to prohibitive peri-operative risk.
Read 8 tweets
San Raffaele Anesthesia and Intensive Care Profile picture
Jan 21, 2021
1/

In non-COVID-19 pneumonia/ARDS filling defects are found in pulmonary arteries branches vascularizing healthy lung segments. Instead, in #COVID19 there is an almost perfect topographical overlap of filling defects distribution & pneumonia extent.

🔗 jcvaonline.com/article/S1053-…
2/
We demonstrated that pulmonary vascular thrombosis in #COVID19 is due to local inflammatory endothelial damage with a superimposed thrombotic late complication and not to recurrent thromboembolism from peripheral deep vein thrombosis.

#MicroCLOTS
3/
51% of pts showed pulmonary vascular thrombosis, with a median time from symptoms of 18 days.

We identified a specific radiological pattern of #COVID19 pneumonia with a unique spatial distribution of pulmonary vascular thrombosis overlapping areas of ground-glass opacities.
Read 7 tweets
San Raffaele Anesthesia and Intensive Care Profile picture
Aug 3, 2020
How we’ll we manage the first ten #COVID19 patients of 2021 (if any) hospitalized for #ARDS (compared to the first 10 patients we managed in February 2020). A multidisciplinary brain storming after managing approx 1000 such patients within the end of Apr 2020. A thread 1/ #FOAMed Image
2/
 Not all our clinical impressions have already published evidence (but the majority was published), but our hospital #COVID19 mortality went close to zero in late April 2020 and we hope medical management accounts for at least part of these results.
3/
 More, early ECMO. We put a dozen ECMO. We feel we should have put more of them and we should have done it earlier (eg after a couple of days of invasive mechanical ventilation with no improvement). @annamarascandro
@mgcalabroMD @md_monaco @MarinaPieri4
hsr.it/news/2020/magg…
Read 11 tweets

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