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Haemodynamic management in brain death donors:Influence of aetiology of brain death

World Journal of Transplantation 2023年第4期13卷 183-189页

作者： Chiara Lazzeri Manuela Bonizzoli stefano batacchi Cristiana Guetti Walter Vessella Alessandra Valletta Alessandra Ottaviano Adriano Peris Department of Emergency Intensive Care Unit and Extracorporeal Membrane Oxygenation CenterFlorence 50134Italy

BACKGROUND In brain death donors(BDDs),donor management is the key in the complex donation *** management goals,which are standards of care or clinical parameters,have been considered an acceptable barometer of successful donor *** To test the hypothesis that aetiology of brain death could influence haemodynamic management in *** Haemodynamic data(blood pressure,heart rate,central venous pressure,lactate,urine output,and vasoactive drugs)of BDDs were recorded on intensive care unit(ICU)admission and during the 6-h observation period(Time 1 at the beginning;Time 2 at the end).RESULTS The study population was divided into three groups according to the aetiology of brain death:Stroke(n=71),traumatic brain injury(n=48),and postanoxic encephalopathy(n=19).On ICU admission,BDDs with postanoxic encephalopathy showed the lowest values of systolic and diastolic blood pressure associated with higher values of heart rate and lactate and a higher need of norepinephrine and other vasoactive *** the beginning of the 6-h period(Time 1),BDDs with postanoxic encephalopathy showed higher values of heart rate,lactate,and central venous pressure together with a higher need of other vasoactive *** According to our data,haemodynamic management of BDDs is affected by the aetiology of brain *** with postanoxic encephalopathy have higher requirements for norepinephrine and other vasoactive drugs.

关键词： Brain death donor Postanoxic encephalopathy Stroke Acute traumatic injury Haemodynamic management Utilization rate

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Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support

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World Journal of Cardiology 2023年第4期15卷 165-173页

作者： Chiara Lazzeri Manuela Bonizzoli stefano batacchi Giovanni Cianchi Andrea Franci Filippo Socci Marco Chiostri Adriano Peris ICU and ECMO Center Florence 50134Italy

BACKGROUND The prognostic role of right ventricle dilatation and dysfunction(RVDD)has not been elucidated in patients with coronavirus disease(COVID)-related respiratory failure refractory to standard treatment needing extracorporeal membrane oxygenation(ECMO)*** To assess whether pre veno-venous(VV)ECMO RVDD were related to inintensive care unit(ICU)*** We enrolled 61 patients with COVID-related acute respiratory distress syndrome refractory to conventional treatment submitted to VV ECMO and consecutively admitted to our ICU(an ECMO referral center)from 31th March 2020 to 31th August *** echocardiographic exam was performed immediately before VV ECMO *** Males were prevalent(73.8%)and patients with a body mass index>30 kg/m^(2) were the majority(46/61,75%).The overall in-ICU mortality rate was 54.1%(33/61).RVDD was detectable in more than half of the population(34/61,55.7%)and associated with higher simplified organ functional assessment(SOFA)values(P=0.029)and a longer mechanical ventilation duration prior to ECMO support(P=0.046).Renal replacement therapy was more frequently needed in RVDD patients(P=0.002).A higher in-ICU mortality(P=0.024)was observed in RVDD *** echo variables were independent predictors of in-ICU *** In patients with COVID-related respiratory failure on ECMO support,RVDD(dilatation and dysfunction)is a common finding and identifies a subset of patients characterized by a more severe disease(as indicated by higher SOFA values and need of renal replacement therapy)and by a higher in-ICU ***(also when considered separately)did not result independently associated with in-ICU mortality in these patients.

关键词： Right ventricle Echocardiography Mortality COVID Acute respiratory distress syndrome Right ventricle-pulmonary circulation coupling

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Unexpected Hypertensive Pneumothorax after Digestive Upper Endoscopy: A Case Report

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Open Journal of Anesthesiology 2012年第4期2卷 183-184页

作者： Giovanni Zagli Rosario Spina stefano batacchi Giancarlo Freschi Manlio Acquafresca Antonio Taddei Adriano Peris Anesthesia and Intensive Care Unit of Emergency Department Careggi Teaching Hospital Florence Italy Department of Surgical Pathology University of Florence and Careggi Teaching Hospital Italy Diagnostic Imaging Department Careggi Teaching Hospital Florence Italy

We report an unexpected massive left pneumothorax at the end of a digestive upper endoscopy without evidences of perforation or airway over-pressure. The possible air passage through a diaphragmatic failing is discussed.

关键词： Upper Endoscopic Procedure Pneumothorax Diaphragmatic Failing

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