Showing papers by "Massimo Antonelli published in 2007"
TL;DR: Interventions likely to improve survival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation.
Abstract: Design: Review. Objec- tive: Medical literature on in-hospital cardiac arrest (IHCA) was reviewed to summarise: (a) the incidence of and survival after IHCA, (b) major prognostic factors, (c) possible inter- ventions to improve survival. Results and conclusions: The incidence of IHCA is rarely reported in the literature. Values range between 1 and 5 events per 1,000 hospital admissions, or 0.175 events/bed annually. Reported survival to hos- pital discharge varies from 0% to 42%, the most common range being between 15% and 20%. Pre-arrest prognostic factors: the prognostic value of age is controversial. Among comorbidities, sepsis, cancer, renal failure and homebound lifestyle are significantly associated with poor survival. However, pre-arrest morbidity scores have not yet been prospectively validated as instruments to predict failure to survive after IHCA. Intra-arrest factors: ventricular fibrillation/ventricular tachycardia (VF/VT) as the first recorded rhythm and a shorter interval between IHCA and cardiopulmonary resuscitation or defibrillation are associated with higher survival. However, VF/VT is present in only 25-35% of IHCAs. Short-term survival is also higher in patients resuscitated with chest compression rates above 80/min. Interventions likely to improve sur- vival include: early recognition and stabilisation of patients at risk of IHCA to enable prevention, faster and better in-hospital resuscitation and early defibrillation. Mild ther- apeutic hypothermia is effective as post-arrest treatment of out-of- hospital cardiac arrest due to VF/VT, but its benefit after IHCA and af- ter cardiac arrest with non-VF/VT rhythms has not been clearly demon- strated.
608 citations
TL;DR: In expert centers, NPPV applied as first‐line intervention in ARDS avoided intubation in 54% of treated patients and was associated with less ventilator‐associated pneumonia and a lower intensive care unit mortality rate.
Abstract: Objective: In randomized studies of heterogeneous patients with hypoxemic acute respiratory failure, noninvasive positive pressure ventilation (NPPV) was associated with a significant reduction in endotracheal intubation. The role of NPPV in patients with acute respiratory distress syndrome (ARDS) is still unclear. The objective was to investigate the application of NPPV as a first-line intervention in patients with early ARDS, describing what happens in everyday clinical practice in centers having expertise with NPPV. Design: Prospective, multiple-center cohort study. Setting: Three European intensive care units having expertise with NPPV. Patients: Between March 2002 and April 2004, 479 patients with ARDS were admitted to the intensive care units. Three hundred and thirty-two ARDS patients were already intubated, so 147 were eligible for the study. Interventions: Application of NPPV. Measurements and Main Results: NPPV improved gas exchange and avoided intubation in 79 patients (54%). Avoidance of intubation was associated with less ventilator-associated pneumonia (2% vs. 20%; p 34 and a PaO2/FIO2 34 and the inability to improve PaO2/FIO2 after 1 hr of NPPV were predictors of failure. (Crit Care Med 2007; 35:18‐25)
475 citations
TL;DR: One of the most important recommendations was that hypotension is not required to define shock, and as a result, importance is assigned to the presence of inadequate tissue perfusion on physical examination.
Abstract: Objective
Shock is a severe syndrome resulting in multiple organ dysfunction and a high mortality rate. The goal of this consensus statement is to provide recommendations regarding the monitoring and management of the critically ill patient with shock.
455 citations
TL;DR: Compared with placebo, concomitant prophylactic heparin was not equivalent, did not increase 28-day mortality, and had an acceptable safety profile in patients with severe sepsis receiving DrotAA.
Abstract: Rationale: Patients with severe sepsis frequently receive prophylactic heparin during drotrecogin alfa (activated) (DrotAA) treatment due to risk of venous thromboembolic events (VTEs). Biological plausibility exists for heparin to reduce DrotAA efficacy and/or increase bleeding.Objectives: Primary: demonstrate in adult patients with severe sepsis receiving DrotAA treatment that 28-day mortality was equivalent for patients treated with concomitant prophylactic heparin compared with placebo; secondary: safety and VTE incidence.Methods: International, randomized, double-blind, phase 4, equivalence-design trial (n = 1994). Patients were eligible if indicated for and receiving DrotAA treatment under the country's approved label. Study drug (low molecular weight/unfractionated heparin) or placebo (saline) was administered every 12 hours during DrotAA infusion (24 ug/kg/hr for 96 hr). In patients on baseline heparin and randomized to placebo, heparin was stopped.Measurements and Main Results: Twenty-eight–day m...
160 citations
TL;DR: Helmet and facial mask were equally tolerated and both were effective in ameliorating gas exchange and decreasing inspiratory effort, however, the helmet was less efficient in decreasingInspatory effort and worsened the patient–ventilator interaction.
Abstract: Rationale
The helmet is a new interface with the potential of increasing the success rate of non-invasive ventilation by improving tolerance.
131 citations
TL;DR: In this article, the authors measured the ratio R ϕ = BR ( ϕ → η ′ γ ) / BR (ϕ → π − 7 γ and 7γ, respectively, in a sample of ∼ 1.4 × 10 9 ϕ mesons produced at the Frascati ϕ factory.
98 citations
TL;DR: In COPD exacerbations with moderate to severe hypercapnic encephalopathy, the use of NPPV performed by an experienced team compared to CMV leads to similar short and long-term survivals with a reduced nosocomial infection rate and duration of ventilation.
Abstract: Objective
We recently reported a high success rate using noninvasive positive pressure ventilation (NPPV) to treat COPD exacerbations with hypercapnic encephalopathy. This study compared the hospital outcomes of NPPV vs. conventional mechanical ventilation (CMV) in COPD exacerbations with moderate to severe hypercapnic encephalopathy, defined by a Kelly score of 3 or higher.
65 citations
Journal Article•
TL;DR: NPPV can be an alternative to conventional ventilation in patients with ARF after major abdominal surgery, and helmet use is associated with a better tolerance and a lower rate of complications.
Abstract: BACKGROUND: Acute respiratory failure (ARF) is a relatively common complication after abdominal surgery. METHODS: We compared the efficacy of noninvasive positive-pressure ventilation (NPPV) delivered via helmet versus via face mask in patients with ARF after abdominal surgery in 2 intensive care units (31 beds) in the hospital affiliated with the Catholic University of Rome. Twenty-five patients with ARF after abdominal surgery were treated with NPPV via helmet, and the data from those patients were matched with 25 controls chosen from a historical group of 151 patients treated with face mask during the previous 2 years for respiratory complications after abdominal surgery. The matching was done according to age, Simplified Acute Physiology Score II, and the ratio of PaO2 to fraction of inspired oxygen (PaO2 /FIO2 ). NPPV was delivered in pressure support, starting with 10 cm H2O, and positive end-expiratory pressure (PEEP) was increased in steps of 2–3 cm H2O, up to a maximum of 12 cm H2O, in order to maintain an arterial oxygen saturation over 90% with the lowest possible FIO2 . RESULTS: NPPV significantly improved PaO2 /FIO2 in both groups. Five of 25 helmet patients (20%) and 12 of 25 mask patients (48%) were intubated (p < 0.036). The main cause for NPPV failure in both groups was intolerance (mask 32% vs helmet 12%, p 0.6). Heart rate, systolic blood pressure, respiratory rate, duration of NPPV, level of pressure support, and PEEP presented no differences between the 2 groups, nor did intensive-care-unit or hospital mortality. Both the helmet and mask interfaces were effective in improving gas exchange and respiratory rate. The global rate of NPPV complications (mask intolerance, major leaks that caused ventilator malfunction, and ventilator-associated pneumonia) was significantly higher in the mask group than in the helmet group (19 patients vs 4 patients, p < 0.03). CONCLUSIONS: NPPV can be an alternative to conventional ventilation in patients with ARF after major abdominal surgery, and helmet use is associated with a better tolerance and a lower rate
64 citations
TL;DR: In this paper, the authors studied the Dalitz plot of the e+e-→π0π0γ events (Nπ 0π 0γ∼65000) collected at \(\sqrt{s} \simeq{M}_{\phi}\) with the KLOE detector.
Abstract: We have studied the Dalitz plot of the e+e-→π0π0γ events (Nπ0π0γ∼65000) collected at \(\sqrt{s} \simeq{M}_{\phi}\) with the KLOE detector. In the dipion invariant mass (Mππ) region below 700 MeV, the process under study is dominated by the non-resonant process e+e-→ωπ0 with ω→π0γ whereas, for higher Mππ values, the radiative φ decay to the f0(980) is the dominant mechanism. Different theoretical models are used to fit the Dalitz plot, taking also into account a possible contribution of the σ(600). For each model, we extract the f0(980) mass and its coupling to ππ, KK and to the φ.
52 citations
TL;DR: In this paper, with the KLOE detector at the DA$\Phi$NE $\Phi $-Factory, the dynamics of the decay was studied using mesons from the decay for an integrated luminosity = 450 pb$^{-1}.
Abstract: We have studied, with the KLOE detector at the DA$\Phi$NE $\Phi$-Factory, the dynamics of the decay $\eta\to\pi^+\pi^-\pi^0$ using $\eta$ mesons from the decay $\phi\to\eta\gamma$ for an integrated luminosity ${\mathcal L}$ = 450 pb$^{-1}$. From a fit to the Dalitz plot density distribution we obtain a precise measurement of the slope parameters. An alternative parametrization relates the $\pi^+\pi^-\pi^0$ slopes to that for $\eta\to 3\pi^0$ showing the consistency of KLOE results for both channels. We also obtain the best confirmation of the $C$-invariance in the $\eta\to\pi^+\pi^-\pi^0$ decay.
36 citations
TL;DR: This review summarizes all articles published in Intensive Care Medicine in 2006, grouped by specific topic.
Abstract: This review summarizes all articles published in Intensive Care Medicine in 2006, grouped by specific topic.
TL;DR: In this paper, the structure of the K−π vector-current provided information about the dynamics of the strong interaction; its knowledge is necessary for evaluation of the phase-space integral required for measuring the CKM matrix element Vus and for testing lepton universality in kaon decays.
Abstract: Using 328 pb−1 of data collected at DAΦNE corresponding to ~1.8 million KL → πμν decays, we have measured the Kμ3 form factor parameters. The structure of the K−π vector-current provides information about the dynamics of the strong interaction; its knowledge is necessary for evaluation of the phase-space integral required for measuring the CKM matrix element Vus and for testing lepton universality in kaon decays. Using a new parametrization for the vector and scalar form factors, we find λ+ = (25.7 ± 0.6) × 10−3, and λ0 = (14.0 ± 2.1) × 10−3. Our result for λ0, together with recent lattice calculations of fπ, fK and f(0), satisfies the Callan-Treiman relation.
Posted Content•
TL;DR: In this article, a preliminary measurement of the slope parameter α = -0.027 \pm 0.004 (stat) ^{+0.004}_{-0.006} (syst)
Abstract: We report a preliminary measurement of the slope parameter $\alpha$ for the $\eta\to 3\piz$ decay carried out with KLOE at DA$\Phi$NE; where $\alpha$ is the parameter describing the energy dependence of the square of the matrix element for this decay. By fitting the event density in the Dalitz plot with a collected statistic of 420 pb$^{-1}$ we determine $\alpha = -0.027 \pm 0.004 (stat) ^{+0.004}_{-0.006} (syst)$. This result is consistent with current chiral perturbation theory calculations within the unitary approach.
Journal Article•
TL;DR: A case of leptospirosis without fever during the late stage of pregnancy in which the initial clinical presentation was more suggestive of a pregnancy-related liver dysfunction rather than an infectious disease is reported.
Abstract: Here we report a case of leptospirosis without fever during the late stage of pregnancy in which the initial clinical presentation was more suggestive of a pregnancy-related liver dysfunction rather than an infectious disease. A 32-year-old primipara at 37 week of gestation was hospitalised with a 10-day history of nausea, vomiting, and abdominal pain without fever. Initial routine blood tests showed hyperbilirubinemia, a moderate increase in transaminase levels, severe coagulopathy and an increased creatinine level. On clinical suspicion of pregnancy-related liver dysfunction such as HELLP syndrome (hemolysis, elevated liver enzyme levels, low platelet count) or acute fatty liver of pregnancy (AFLP), emergency caesarean section was performed and a healthy baby was delivered. Postoperatively, the patient was stable, but 5 days later she developed clouding of consciousness, severe jaundice and respiratory failure. At this time, an infectious disease was considered and leptospirosis was confirmed by serological tests. In conjunction with intensive care management, antibiotic therapy was given; the patient was discharged in good condition and her baby did not develop signs of active leptospirosis. While leptospirosis is rare in pregnancy, this is the first report of acute infection without fever mimicking the clinical pattern of HELLP syndrome or AFLP
Journal Article•
TL;DR: Evaluated and resume the evidence for the use of non-invasive positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema according to recent literature in order to guide physicians in using CPAP and NPPV in patients affected by ACPE in clinical practice.
Abstract: The patient with acute heart failure may present with acute cardiogenic pulmonary edema (ACPE), a condition accompanied by severe respiratory distress, with crackles over the lung and orthopnea, and an O2 saturation usually < 90% on room air, prior to treatment. Non-invasive ventilation is the delivery of assisted ventilation without the need for endotracheal intubation and an invasive artificial airway. Two techniques are used for ventilatory support: continuous positive airway pressure (CPAP) and non-invasive positive-pressure ventilation (NPPV). There is a strong consensus that one of these two techniques should be used before endotracheal intubation and mechanical ventilation because non-invasive techniques dramatically reduce the need for mechanical ventilation via endotracheal intubation and its complications. The aim of this review is to evaluate and resume the evidence for the use of non-invasive positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema according recent literature in order to guide physicians in using CPAP and NPPV in patients affected by ACPE in clinical practice. Recent literature showed that CPAP and NPPV both significantly decrease the need for endotracheal intubation, and CPAP significantly decreases mortality when compared to standard medical treatment. These techniques resulted safe and there is no evidence of increased risk of acute myocardial infarction (AMI) with either of them. Although both CPAP and NPPV present similar efficacy, CPAP has been shown to be cheaper and easier to implement in clinical practice and it could be considered the preferred intervention in patients with ACPE especially in the Emergency Department setting.
TL;DR: A review of clinical studies: brain injury, renal failure and endocrinology.
Abstract: Peter Andrews Elie Azoulay Massimo Antonelli Laurent Brochard Christian Brun-Buisson Daniel De Backer Geoffrey Dobb Jean-Yves Fagon Herwig Gerlach Johan Groeneveld Duncan Macrae Jordi Mancebo Philipp Metnitz Stefano Nava Jerôme Pugin Michael Pinsky Peter Radermacher Christian Richard Year in review in Intensive Care Medicine, 2006. I. Experimental studies. Clinical studies: brain injury, renal failure and endocrinology
TL;DR: This review intends tosummarize all articles published in Intensive Care Medicine in2006, grouped by specific topics.
Abstract: Received: 22 January 2007Accepted: 22 January 2007Published online: 14 February 2007© Springer-Verlag 2007This review intends tosummarize all articlespublished in Intensive Care Medicine in2006, grouped by specific topicsP. AndrewsWestern General Hospital, Intensive CareMedicine Unit,Edinburgh, UKE. AzoulaySaint Louis Hospital, Intensive CareMedicine Unit,Paris, FranceM. AntonelliUniversita Cattolica del Sacre Cuore,Department of Intensive Care andAnesthesiology,Rome, ItalyL. Brochard (✉)AP-HP, Hopital Henri Mondor, UniversiteParis 12, Reanimation Medicale, INSERMU 651,94000 Creteil, Francee-mail: laurent.brochard@hmn.aphp.frTel.: +33-1-49812545Fax: +33-1-42079943C. Brun-BuissonAP-HP, Hopital Henri Mondor, UniversiteParis 12, Reanimation Medicale,Creteil, FranceD. De BackerErasme Hospital, Service des SoinsIntensifs,Brussels, BelgiumG. DobbRoyal Perth Hospital, Intensive CareMedicine Unit,Perth, AustraliaJ.-Y. FagonEuropean Georges Pompidou Hospital,Intensive Care Medicine Unit,H. GerlachVivantes-Klinikum Neukoelln, Departmentof Anesthesiology,Berlin, GermanyJ. GroeneveldVUMC, Intensive Care Medicine Unit,Amsterdam, The NetherlandsD. MacraeRoyal Brompton Hospital, PediatricIntensive Care Unit,London, UKJ. ManceboHospital Sant Pau, Intensive Care MedicineUnit,Barcelona, SpainP. MetnitzUniversity Hospital of Vienna, Departmentof Anesthesia and General Intensive CareMedicine,Vienna, AustriaS. NavaFondazione S. Maugeri, Intensive CareMedicine Unit,Pavia, ItalyJ. PuginUniversity Hospital of Geneva, IntensiveCare Medicine Unit,Geneva, SwitzerlandM. PinskyUniversity of Pittsburgh Medical Center,Intensive Care Medicine Unit,Pittsburgh Pennsylvania, USAP. RadermacherUniversity Medical School of Ulm,Department of Anesthesia,Ulm, GermanyC. RichardUniversity Hospital of Le Kremlin-Bicetre,Intensive Care Unit,Le Kremlin-Bicetre, France
TL;DR: In this article, precise measurements of the η and K0 masses using the processes →ηγ, η→γγ and → KS K L, KS→π+π−.
Abstract: We present precise measurements of the η and K0 masses using the processes →ηγ, η→γγ and → KS K L, KS→π+π−. The K0 mass measurement, MK = 497.583±0.005stat±0.020syst MeV, is in acceptable agreement with the previous measurements but is more accurate. We find mη = 547.874±0.007stat±0.029syst MeV. Our value is the most accurate to date and is in agreement with two recent measurements based on η decays, but is inconsistent, by about 10σ, with a measurement of comparable precision based on η production at threshold.
TL;DR: In this article, the authors showed that multiple organ failure (MOF) is associated with a high rate of mortality in trauma patients, and that MOF is related to both in-hospital and late mortality and functional status.
Abstract: Multiple organ failure (MOF) is associated with a high rate of mortality in trauma patients. Several studies focused on long-term outcome in these patients, and showed that MOF is related to both in-hospital and late mortality and functional status. Exact mechanism of sequelae in MOF is still unclear. The distinction between early and late MOF probably helps to separate two different clinical conditions and find a stronger relationship with outcome.
Posted Content•
TL;DR: In this article, a preliminary result on the charged kaon lifetime, obtained by the KLOE experiment operating at DA$\Phi$NE, the Frascati $\phi$-factory, is presented.
Abstract: Preliminary result on the charged kaon lifetime, obtained by the KLOE experiment operating at DA$\Phi$NE, the Frascati $\phi$-factory, is presented
Posted Content•
TL;DR: In this article, the production cross section of pi+ pi-pi- pi- pi0 and p0p0 gamma final states in e+e- collisions at center of mass energies between 1000 and 1030 MeV was studied.
Abstract: Using ~600 pb-1 collected with the KLOE detector at DAPhiNE, we have studied the production cross section of pi+ pi- pi0 pi0 and p0p0 gamma final states in e+e- collisions at center of mass energies between 1000 and 1030 MeV. By fitting the observed interference pattern around Mphi for both final states, we extract a measurement (preliminary) for the ratio Gamma(omega -> pi0 gamma)/Gamma(omega -> pi+ pi- pi0) = 0.0934 +- 0.0022. Since these two final states represent the 98% of the omega decay channels, we use unitarity to derive BR(omega -> pi+pi-pi0)= (89.94 +- 0.23)% and BR(omega -> pi0 gamma) = (8.40 +- 0.19)%. Moreover, the parameters describing the e+e- -> pi+ pi- pi0 pi0 reaction around Mphi are used to extract the branching fraction for the OZI and G-parity violating phi -> omega pi0 decay: BR(phi -> omega pi0) = (5.63 +- 0.70) x 10^-5.
TL;DR: In this article, the eta and K0 masses were measured using the processes phi to eta gamma, eta to gamma gamma and phi-to Ks Kl, Ks to pi+ pi-.
Abstract: We present precise measurements of the eta and K0 masses using the processes phi to eta gamma, eta to gamma gamma and phi to Ks Kl, Ks to pi+ pi-. The K0 mass measurement, M_K=497.583 +/- 0.005 (stat) +/- 0.020 (syst) MeV, is in acceptable agreement with the previous measurements but is more accurate. We find m(eta) = 547.874 +/- 0.007 (stat) +/- 0.031 (syst) MeV. Our value is the most accurate to date and is in agreement with two recent measurements based on eta decays, but is inconsistent, by about 10 sigma, with a measurement of comparable precision based on eta production at threshold.
TL;DR: This research presents a novel and exciting new approach to intensive care and anesthesiology called “informed decision-making” that aims to provide real-time information about the Kessler-Gemelli Score and its applications in the field of Intensive Care and Anesthesiology.
Abstract: Received: 19 February 2007Accepted: 19 February 2007Published online: 9 March 2007© Springer-Verlag 2007M. Antonelli (✉)Universita Cattolica del Sacro Cuore, Department of Intensive Careand Anesthesiology, Policlinico Universitario A. Gemelli,Largo A. Gemelli, 8, 00168 Rome, Italye-mail: m.antonelli@rm.unicatt.itTel.: +39 06 30 15 4889; +39 06 30 15 4990
Posted Content•
TL;DR: In this paper, the authors used the KLOE detector at DA$\Phi$NE to study the production cross section of the OZI and G-parity violating OZI decay channels.
Abstract: Using $\sim$ 600 pb$^{-1}$ collected with the KLOE detector at DA$\Phi$NE, we have studied the production cross section of $\pi^+\pi^-\pi^0\pi^0$ and $\pi^0\pi^0\gamma$ final states in $e^+ e^-$ collisions at center of mass energies between 1000 and 1030 MeV. By fitting the observed interference pattern around $M_\phi$ for both final states, we extract a measurement (preliminary) for the ratio $\Gamma(\omega\to\pi^0\gamma)/\Gamma(\omega\to\pi^+\pi^-\pi^0) = 0.0934\pm 0.0022$. Since these two final states represent the 98% of the $\omega$ decay channels, we use unitarity to derive $BR(\omega\to\pi^+\pi^-\pi^0)= (89.94\pm 0.23)%$ and $BR(\omega\to\pi^0\gamma) = (8.40\pm 0.19)%$. % Moreover, the parameters describing the \eeto\wpc reaction around $M_\phi$ are used to extract the branching fraction for the OZI and G-parity violating $\phi\to\omega\pi^0$ decay: $BR(\phi\to\omega\pi^0) = (5.63\pm 0.70)\times 10^{-5}$.
01 Jan 2007
TL;DR: The distinction between early and late MOF probably helps to separate two different clinical conditions and find a stronger relationship with outcome.
Abstract: Multiple organ failure (MOF) is associated with a high rate of mortality in trauma patients. Several studies focused on long-term outcome in these patients, and showed that MOF is related to both in-hospital and late mortality and functional status. Exact mechanism of sequelae in MOF is still unclear. The distinction between early and late MOF probably helps to separate two different clinical conditions and find a stronger relationship with outcome.
TL;DR: The KLOE experiment at the e+e-collider DAΦNE in Frascati as discussed by the authors collected 2.5 fb-1 at the peak of the ϕ resonance, and 250 pb1 at $\sqrt{s}=1~{\rm GeV}$.
Abstract: The KLOE experiment has finished its data taking at the e+e- collider DAΦNE in Frascati. KLOE has collected 2.5 fb-1 at the peak of the ϕ resonance, and 250 pb-1 at $\sqrt{s}=1~{\rm GeV}$. The latest experimental results based on a sample of 450 pb-1 are presented in this paper: they mainly concern the neutral and charged kaon decays, and the radiative ϕ decays into scalar and pseudoscalar mesons.