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Pavullo nel Frignano, Italy

Di Pasquale M.,University of Barcelona | Di Pasquale M.,Research Center Biomedica en Red Enfermedades Respiratorias | Di Pasquale M.,University of Milan | Ferrer M.,University of Barcelona | And 15 more authors.
Critical Care Medicine | Year: 2014

OBJECTIVES:: We evaluated the association between severity of illness and microbial etiology of ICU-acquired pneumonia to define if severity should be used to guide empiric antibiotic choices. DESIGN:: Prospective observational study. SETTING:: ICUs of a university hospital. PATIENTS:: Three hundredy forty-three consecutive patients with ICU-acquired pneumonia clustered, according to the presence of multidrug resistant pathogens. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Two hundred eight patients had ventilator-associated pneumonia and 135 had nonventilator ICU-acquired pneumonia. We determined etiology in 217 patients (63%). The most frequent pathogens were Pseudomonas aeruginosa, Enterobacteriaceae, and methicillin-sensitive and methicillin-resistant Staphylococcus aureus. Fifty-eight patients (17%) had a multidrug-resistant causative agent. Except for a longer ICU stay and a higher rate of microbial persistence at the end of the treatment in the multidrug-resistant group, no differences were found in clinical and inflammatory characteristics, severity criteria, and mortality or survival between patients with and without multidrug-resistant pathogens, even after adjusting for potential confounders. Patients with higher severity scores (Acute Physiology and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment) and septic shock at onset of pneumonia had significantly lower 28- and 90-day survival and higher systemic inflammatory response. The results were similar when only patients with microbial diagnosis were considered, as well as when stratified into ventilator-associated pneumonia and nonventilator ICU-acquired pneumonia. CONCLUSIONS:: In patients with ICU-acquired pneumonia, severity of illness seems not to affect etiology. Risk factors for multidrug resistant, but not severity of illness, should be taken into account in selecting empiric antimicrobial treatment. © 2013 by the Society of Critical Care Medicine and Lippincott.


Clini E.,University of Modena and Reggio Emilia | Crisafulli E.,Ospedale Villa Pineta | Radaeli A.,Spedali Civili | Malerba M.,University of Brescia
Internal and Emergency Medicine | Year: 2013

Chronic Obstructive Pulmonary Disease (COPD) has been recently recognized as a condition involving more than the lungs. The presence of common factors in COPD and in other chronic extra-pulmonary diseases, as well as the co-existence of these conditions in the same adult individual, supports the hypothesis of a shared pathogenetic pathway. We will here review the interplay between coexisting COPD and the metabolic syndrome (MS), based on the most updated knowledge. We will discuss this clinical condition from the definition, to the pathophysiology and to the clinical implications. Basically, MS is more likely to be present in a COPD patients, and increased levels of circulatory pro-inflammatory proteins from both the lung and adipose tissue coincide in these patients. The relative impact of the coexisting COPD and MS may depend on several factors: the presence of physical inactivity and of systemic inflammation related to a smoking habit, sedentary lifestyle, airway inflammation and obstruction, adipose tissue and inflammatory marker activation. More studies will be required to elucidate the association between COPD and MS and to formulate individualized management approaches for this specific disease phenotype. © 2011 SIMI.


Di Pasquale M.,University of Barcelona | Di Pasquale M.,Research Center Biomedica en Red Enfermedades Respiratorias CibeRes | Di Pasquale M.,University of Milan | Esperatti M.,University of Barcelona | And 14 more authors.
Intensive Care Medicine | Year: 2013

Purpose: To assess the impact of chronic liver disease (CLD) on ICU-acquired pneumonia. Methods: This was a prospective, observational study of the characteristics, microbiology, and outcomes of 343 consecutive patients with ICU-acquired pneumonia clustered according to the presence of CLD. Results: Sixty-seven (20 %) patients had CLD (67 % had liver cirrhosis, LC), MELD score 26 ± 9, 20 % Child-Pugh class C). They presented higher severity scores than patients without CLD both on admission to the ICU (APACHE II, LC 19 ± 6 vs. other CLD 18 ± 6 vs. no CLD 16 ± 6; p < 0.001; SOFA, 10 ± 3 vs. 8 ± 4 vs. 7 ± 3; p < 0.001) and at onset of pneumonia (APACHE II, 19 ± 6 vs. 17 ± 6 vs. 16 ± 5; p = 0.001; SOFA, 11 ± 4 vs. 9 ± 4 vs. 7 ± 3; p < 0.001). Levels of CRP were lower in patients with LC than in the other two groups (day 1, 6.5 [2.5-11.5] vs. 13 [6-23] vs. 15.5 [8-24], p < 0.001, day 3, 6 [3-12] vs. 16 [9-21] vs. 11 [5-20], p = 0.001); all the other biomarkers were higher in LC and other CLD patients. LC patients had higher 28- and 90-day mortality (63 vs. 28 %, p < 0.001; 72 vs. 38 %, p < 0.001, respectively) than non-CLD patients. Presence of LC was independently associated with decreased 28- and 90-day survival (95 % confidence interval [CI], 1.982-17.250; p = 0.001; 95 % confidence interval [CI], 2.915-20.699, p = 0.001, respectively). Conclusions: In critically ill patients with ICU-acquired pneumonia, CLD is associated with a more severe clinical presentation and poor clinical outcomes. Moreover, LC is independently associated with 28- and 90-day mortality. The results of this study are important for future trials focused on mortality. © 2013 Springer-Verlag Berlin Heidelberg and ESICM.


Crisafulli E.,Ospedale Villa Pineta | Beneventi C.,Ospedale Villa Pineta | Bortolotti V.,Ospedale Villa Pineta | Kidonias N.,Ospedale Villa Pineta | And 4 more authors.
PLoS ONE | Year: 2011

Background: Measurements of Energy Expenditure (EE) at rest (REE) and during physical activities are increasing in interest in chronic patients. In this study we aimed at evaluating the validity/reliability of the SenseWear®Armband (SWA) device in terms of REE and EE during assisted walking in Chronic Respiratory Failure (CRF) patients receiving long-term oxygen therapy (LTOT). Methodology/Principal Findings: In a two-phase prospective protocol we studied 40 severe patients and 35 age-matched healthy controls. In phase-1 we determined the validity and repeatability of REE measured by SWA (REEa) in comparison with standard calorimetry (REEc). In phase-2 we then assessed EE and Metabolic Equivalents-METs by SWA during the 6-minute walking test while breathing oxygen in both assisted (Aid) or unassisted (No-Aid) modalities. When compared with REEc, REEa was slightly lower in patients (1351±169 vs 1413±194 kcal/day respectively, p&<0.05), and less repeatable than in healthy controls (0.14 and 0.43 coefficient respectively). COPD patients with CRF patients reported a significant gain with Aid as compared with No-Aid modality in terms of meters walked, perceived symptoms and EE. Conclusions/Significance: SWA provides a feasible and valid method to assess the energy expenditure in CRF patients on LTOT, and it shows that aided walking results in a substantial energy saving in this population. © 2011 Crisafulli et al.


Venturelli E.,University of Modena and Reggio Emilia | Crisafulli E.,Ospedale Villa Pineta | Antoni F.D.,Ospedale Villa Pineta | Trianni L.,Ospedale Villa Pineta | Clini E.M.,University of Modena and Reggio Emilia
Annals of Respiratory Medicine | Year: 2011

Prolonged stay in the hospital and difficult response to pharmacotherapy can often lead to severe complications in critically ill patients for muscle weakness, physical deconditioning, recurrent symptoms, mood alterations, and poor quality of life. Rehabilitation is a treatment able to expand short- and long-term management of chronic patients admitted to intensive care. Recovery of individual's physical and respiratory functions are both aims of a rehabilitation course in this area. The purpose of this review article is to resume a "state of art"of the currently available evidence for a rehabilitation strategy in critically ill patients, with a description of the main activities and techniques adopted. Despite the use of several activities and techniques that have led to short-term beneficial effects on both pulmonary and physical functions, muscle retraining represents the most important evidence-based aspect of Intensive Care Unit-rehabilitation: indeed, it is associated with weaning success and helps patients to recover at their maximum at discharge.

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