Tissue Doppler Imaging in Acute and Critical Care: Enhancing Diagnostic Precision.

The introduction of portable ultrasound devices has transformed clinical practice in emergency medicine. Diagnostic accuracy and patient safety have been enhanced by point-of-care ultrasonography (POCUS), which has become a fundamental diagnostic and procedural tool. In addition to the standard clinical evaluation, POCUS provides quick patient assessments, allowing for the exclusion of life-threatening conditions and prognostication in different critical situations.

Low, Intermediate, and High Glutamine Levels Are Progressively Associated with Increased Lymphopenia, a Diminished Inflammatory Response, and Higher Mortality in Internal Medicine Patients with Sepsis.

The pathophysiological mechanisms underlying altered plasma glutamine concentrations in sepsis remain poorly understood. Identifying clinical, immunological, and metabolic correlates of glutamine fluctuations is crucial to advancing precision medicine, developing targeted therapies, and improving survival outcomes in septic patients. We enrolled 469 patients with sepsis and assessed inflammatory markers-including body temperature, white blood cell count, and C-reactive protein levels-upon admission to the internal medicine unit.

Pirfenidone to prevent fibrosis in acute respiratory distress syndrome: The PIONEER study protocol.

Background: Pulmonary fibrosis is a major complication of the Acute Respiratory Distress Syndrome (ARDS). Pirfenidone is an approved treatment for idiopathic pulmonary fibrosis. It may attenuate ARDS-related fibrosis and decrease the need for prolonged ventilation.

Intravenous amino acids for renal protection in patients receiving temporary mechanical circulatory support: a secondary subgroup analysis of the PROTECTION study.

Objectives: In cardiac surgery patients, acute kidney injury (AKI) frequently occurs in the setting of haemodynamic instability and treatment with temporary mechanical circulatory support (tMCS). Recent evidence suggests amino acids (AA) infusion may reduce AKI rate. However, the effect of AA infusion in patients requiring tMCS may be less effective.

Can nCD64 and mCD169 biomarkers improve the diagnosis of viral and bacterial respiratory syndromes in the emergency department? A prospective cohort pilot study.

Purpose: Differentiating infectious from non-infectious respiratory syndromes is critical in emergency settings. This study aimed to assess whether nCD64 and mCD169 exhibit specific distributions in patients with respiratory infections (viral, bacterial, or co-infections) and to evaluate their diagnostic accuracy compared to non-infectious conditions.

Methods: A prospective cohort study enrolled 443 consecutive emergency department patients with respiratory syndromes, categorized into four groups: no infection group (NOIG), bacterial infection group (BIG), viral infection group (VIG), and co-infection group (COING).

The Impact of Point-of-Care Ultrasound on the Diagnosis and Management of Small Bowel Obstruction in the Emergency Department: A Retrospective Observational Single-Center Study.

: Small bowel obstruction (SBO) requires prompt diagnosis and management. Due to its advantages, POCUS can be beneficial when assessing SBO. However, it is still doubtful whether POCUS performed by an emergency doctor can prolong the time of patients with SBO in the emergency department (ED).

Role of MR-proADM and Monocyte CD169 in Predicting In-Hospital and 60-Day Mortality in COVID-19 Patients.

Objectives: Mid-regional pro-adrenomedullin (MR-proADM) and monocyte CD169 (CD169) are valuable prognostic indicators of severe COVID-19.

Methods: We assessed the predictive ability of a single measurement of MR-proADM and CD169 at emergency department (ED) admission to forecast in-hospital and 60-day mortality in adult COVID-19 patients. We analyzed clinical and laboratory data, with in-hospital mortality as the primary endpoint and 60-day mortality as the secondary endpoint.

Do patients receiving extracorporeal membrane-oxygenation need antibiotic prophylaxis? A systematic review and meta-analysis on 7,996 patients.

Background: Patients undergoing Extracorporeal Membrane Oxygenation (ECMO) are particularly susceptible to infections: 42% experience sepsis and 26% develop a nosocomial infection (NI). Whether antibiotic prophylaxis is effective in reducing mortality and its effects on the rate of NIs is currently unclear.

Research Question: Can antibiotic prophylaxis decrease 30-day mortality for patients on ECMO? Can antibiotic prophylaxis prevent the occurrence of NIs in these patients?

Study Design And Methods: A systematic review and meta-analysis was conducted.

Has the role of troponin as a biomarker of cardiac complications after non-cardiac surgery been fully understood?

Myocardial injury after non-cardiac surgery is a major issue with a rate of almost 20%, as suggested by the literature. Guidelines recommend screening patients undergoing non-cardiac surgery who have at least one cardiovascular risk factor. Clinical trials are characterized by a high degree of heterogeneity.

Correlation Between Tissue Doppler Imaging Method (E/e') and Invasive Measurements of Left Ventricular Filling Pressures: A Systematic Review, Meta-Analysis, and Meta-Regression.

Objectives: Evaluation of pulmonary capillary wedge pressure (PCWP) through right heart catheterization can indirectly provide an estimation of the filling pressure of the left ventricle. Echocardiography can estimate left ventricular compliance using mitral annular tissue Doppler imaging (TDI). The E/e' ratio refers to the correlation between the peak mitral inflow (E-wave) velocity and early diastolic tissue Doppler mitral annular velocity (e').

Renal and Genitourinary Ultrasound Evaluation in Emergency and Critical Care: An Overview.

Renal and genitourinary ultrasound are fundamental resources employed by emergency and critical care healthcare providers to make prompt diagnoses and perform ultrasound-guided procedures. At the bedside, ultrasound can aid in the diagnosis of relevant pathologies, such as post-renal obstruction or kidney stones, and life-threatening conditions such as aortic dissection or hemoperitoneum. A narrative overview was performed, providing an updated review of renal and genitourinary ultrasound for emergency and critical care healthcare providers, emphasizing its advantages and the latest advances in the field.

Andexanet alpha versus four-factor prothrombin complex concentrate in DOACs anticoagulation reversal: an updated systematic review and meta-analysis.

Background: There is currently a lack of evidence for the comparative effectiveness of Andexanet alpha and four-factor prothrombin complex concentrate (4F-PCC) in anticoagulation reversal of direct oral anticoagulants (DOACs). The primary aim of our systematic review was to verify which drug is more effective in reducing short-term all-cause mortality. The secondary aim was to determine which of the two reverting strategies is less affected by thromboembolic events.

Hemodynamic goals in sepsis and septic shock resuscitation: An umbrella review of systematic reviews and meta-analyses with trial sequential analysis.

Objective: The objective of this study was to verify whether any parameter among those used as the target for haemodynamic optimisation (e.g., mean arterial pressure, central venous oxygen saturation, systolic or diastolic dysfunction, CO gap, lactates, right ventricular dysfunction, and PvaCO/CavO ratio) is correlated with mortality in an undifferentiated population with sepsis or septic shock.

Risk Factors Analysis for 90-Day Mortality of Adult Patients with Mild Traumatic Brain Injury in an Italian Emergency Department.

: The most prominent risk factors for mortality after mild traumatic brain injury (TBI) have not been established. This study aimed to establish risk factors related to 90-day mortality after a traumatic event. : A retrospective cohort study on adult patients entering the Emergency Department of the University Hospital of Trieste for mild TBI from 1 January 2020 to 31 December 2020 was conducted.

Pediatric ultrasound-guided dorsal penile nerve block and sedation in spontaneous breathing: a prospective observational study.

Background: Worldwide, one of the most common surgical procedures in the pediatric population is circumcision. There is no consent on the best anesthesiologic approach. This study aimed to investigate ultrasound-guided dorsal penile nerve block (DPNB) plus sedation in spontaneous breathing as a time-saving, safe, effective, and opioid-sparing technique.

Correlation and Agreement Between the CO2 Gap Obtained From Peripheral Venous Blood and From Mixed Venous Blood in Mechanically Ventilated Septic Patients.

Background: Venous-arterial CO2 difference (Pv-aCO2) is a valuable marker that can identify a subset of patients in shock with inadequate cardiac output to meet tissue metabolic requirements. Some authors have found that Pv-aCO2 levels calculated from mixed vs central venous blood demonstrate a linear relationship. The purpose of this study is to determine whether there is a linear relationship between Pv-aCO2 obtained with peripheral venous blood (Pv-aCO2p) and with mixed venous blood, and the agreement between the 2 measures.

Mortality predictors in hospitalised COVID-19 patients and the role of anti-SARS-CoV-2 IgG antibodies and remdesivir.

Background: In a pre-vaccination era serologic tests may be used to evaluate the seroprevalence and efficacy of containment strategies applied to the community. Subsequently, SARS-CoV-2 vaccination has successfully reduced hospitalization and admission to intensive care. The role of antiviral treatment for COVID-19 remains debated.

Bayesian Network Meta-analysis of Randomized Controlled Trials on the Efficacy of Antiarrhythmics in the Pharmacological Cardioversion of Paroxysmal Atrial Fibrillation.

Purpose: Since atrial fibrillation (AF) is one of the major arrhythmias managed in hospitals worldwide, it has a major impact on public health. The guidelines agree on the desirability of cardioverting paroxysmal AF episodes. This meta-analysis aims to answer the question of which antiarrhythmic agent is most effective in cardioverting a paroxysmal AF.

Home management of COVID-19 symptomatic patients: a safety study on COVID committed home medical teams.

To reduce the overburden in the hospital, during the COVID-19 pandemic, some "COVID Committed Home Medical Teams" (CCHTs) were created in Italy. These units consist of a small pool of general practitioners who aim to evaluate all patients with COVID-19 who require a medical examination directly at home. After the first visit (which can end with patient hospitalisation or home management), CCHTs periodically monitor the patients' clinical conditions and vital signs (usually a revaluation every 24-48 hours, except for a sudden worsening).

Diaphragm ultrasound evaluation during weaning from mechanical ventilation in COVID-19 patients: a pragmatic, cross-section, multicenter study.

Background: Diaphragmatic dysfunction is a major factor responsible for weaning failure in patients that underwent prolonged invasive mechanical ventilation for acute severe respiratory failure from COVID-19. This study hypothesizes that ultrasound measured diaphragmatic thickening fraction (DTF) could provide corroborating information for weaning COVID-19 patients from mechanical ventilation.

Methods: This was an observational, pragmatic, cross-section, multicenter study in 6 Italian intensive care units.

Antimicrobial Stewardship in the Covid-19 Pandemic.

During COVID-19 pandemic, implementing and maintaining an antimicrobial stewardship protocol obtained both low rates of MDR microorganisms and low antimicrobial use in an 800-bed hospital network in northern Italy. Infectious diseases specialist consulting was crucial to maintain this protocol active.