Laura Pasin - Academia.edu (original) (raw)

Papers by Laura Pasin

Research paper thumbnail of POISE-2 ASA suppl1

Research paper thumbnail of Methylene blue: between scylla (meta-analysis) and charybdis (propensity)

Journal of cardiothoracic and vascular anesthesia, 2014

Research paper thumbnail of Intrathecal lactate as a predictor of early- but not late-onset spinal cord injury in thoracoabdominal aneurysmectomy

Journal of cardiothoracic and vascular anesthesia, 2014

To evaluate the role of intrathecal lactate as an early predictor of spinal cord injury during th... more To evaluate the role of intrathecal lactate as an early predictor of spinal cord injury during thoracoabdominal aortic aneurysmectomy. Observational study. University hospital. Forty-four consecutive patients scheduled to undergo thoracoabdominal aortic aneurysmectomy. Two patients had a type-B dissecting aneurysm while the other 42 patients suffered from degenerative aneurysm. None. During surgery, samples of cerebrospinal fluid and arterial blood were withdrawn simultaneously to evaluate lactate concentration. Samples were collected at 4 fixed times during and after surgery: T1 (beginning of the intervention), T2 (15 minutes after aortic cross-clamping), T3 (just before unclamping), T4 (end of surgery). Mean lactate levels in cerebrospinal fluid rose consistently and steadily from the beginning of the intervention until after surgery (T1 = 1.83 mmol/L), T2 = 2.10 mmol/L, T3 = 2.72 mmol/L, T4 = 3.70 mmol/L). Seven patients developed spinal cord injury; two of them had delayed injur...

Research paper thumbnail of Vasopressin in Hemorrhagic Shock: A Systematic Review and Meta-Analysis of Randomized Animal Trials

BioMed Research International, 2014

Objective. The latest European guidelines for the management of hemorrhagic shock suggest the use... more Objective. The latest European guidelines for the management of hemorrhagic shock suggest the use of vasopressors (norepinephrine) in order to restore an adequate mean arterial pressure when fluid resuscitation therapy fails to restore blood pressure. The administration of arginine vasopressin (AVP), or its analogue terlipressin, has been proposed as an alternative treatment in the early stages of hypovolemic shock. Design. A meta-analysis of randomized controlled animal trials. Participants. A total of 433 animals from 15 studies were included. Interventions. The ability of AVP and terlipressin to reduce mortality when compared with fluid resuscitation therapy, other vasopressors (norepinephrine or epinephrine), or placebo was investigated. Measurements and Main Results. Pooled estimates showed that AVP and terlipressin consistently and significantly improve survival in hemorrhagic shock (mortality: 26/174 (15%) in the AVP group versus 164/259 (63%) in the control arms; OR = 0.09; 95% CI 0.05 to 0.15; for effect < 0.001; for heterogeneity = 0.30; 2 = 14%). Conclusions. Results suggest that AVP and terlipressin improve survival in the early phases of animal models of hemorrhagic shock. Vasopressin seems to be more effective than all other treatments, including other vasopressor drugs. These results need to be confirmed by human clinical trials.

Research paper thumbnail of Dexmedetomidine Reduces the Risk of Delirium, Agitation and Confusion in Critically Ill Patients: A Meta-analysis of Randomized Controlled Trials

Journal of Cardiothoracic and Vascular Anesthesia, 2014

Introduction: The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time ... more Introduction: The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation is still unclear.

Research paper thumbnail of Dexmedetomidine vs midazolam as preanesthetic medication in children: a meta-analysis of randomized controlled trials

Pediatric Anesthesia, 2015

• Premedication reduces perioperative anxiety in children.

Research paper thumbnail of An International Survey on Noninvasive Ventilation Use for Acute Respiratory Failure in General Non-Monitored Wards

Respiratory care, Jan 18, 2014

Use of noninvasive ventilation (NIV) for the treatment of patients with acute respiratory failure... more Use of noninvasive ventilation (NIV) for the treatment of patients with acute respiratory failure (ARF) has greatly increased in the last decades. In contrast, the increasing knowledge of its effectiveness and physician confidence in managing this technique have been accompanied by a declining number of available ICU beds. As a consequence, the application of NIV outside the ICU has been reported as a growing phenomenon. Previously published surveys highlighted a great heterogeneity in NIV use, clinical indications, settings, and efficacy. Moreover, they revealed a marked heterogeneity with regard to staff training and technical and organizational aspects. We performed the first worldwide web-based survey focused on NIV use in general wards for ARF. A questionnaire to obtain data regarding hospital and ICU characteristics, settings and modalities of NIV application and monitoring, estimated outcomes, technical and organizational aspects, and observed complications was developed. The...

Research paper thumbnail of Perioperative aspirin and clonidine and risk of acute kidney injury: a randomized clinical trial

JAMA, Jan 3, 2014

Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high ... more Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain and each intervention has the potential for harm. To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury. A 2 × 2 factorial randomized, blinded, clinical trial of 6905 patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013. Patients were assigned to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days after surgery, and were assigned to take oral clonidine (0.2 mg) or placebo 2 to 4 hours before surgery, and then a transdermal clonidine patch (which provided clonidine a...

Research paper thumbnail of Aspirin and clonidine in non-cardiac surgery: acute kidney injury substudy protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised controlled trial

BMJ open, 2014

Perioperative Ischaemic Evaluation-2 (POISE-2) is an international 2×2 factorial randomised contr... more Perioperative Ischaemic Evaluation-2 (POISE-2) is an international 2×2 factorial randomised controlled trial of low-dose aspirin versus placebo and low-dose clonidine versus placebo in patients who undergo non-cardiac surgery. Perioperative aspirin (and possibly clonidine) may reduce the risk of postoperative acute kidney injury (AKI). After receipt of grant funding, serial postoperative serum creatinine measurements began to be recorded in consecutive patients enrolled at substudy participating centres. With respect to the study schedule, the last of over 6500 substudy patients from 82 centres in 21 countries were randomised in December 2013. The authors will use logistic regression to estimate the adjusted OR of AKI following surgery (compared with the preoperative serum creatinine value, a postoperative increase ≥26.5 μmol/L in the 2 days following surgery or an increase of ≥50% in the 7 days following surgery) comparing each intervention to placebo, and will report the adjusted ...

Research paper thumbnail of Dexmedetomidine as a Sedative Agent in Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials

PLoS ONE, 2013

The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation ... more The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation is still unclear. Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, and the Cochrane Central Register of clinical trials (updated February first 2013). Randomized studies (dexmedetomidine versus any comparator) were included if including patients mechanically ventilated in an intensive care unit (ICU). Co-primary endpoints were the length of ICU stay (days) and time to extubation (hours). Secondary endpoint was mortality rate at the longest follow-up available. The 27 included manuscripts (28 trials) randomized 3,648 patients (1,870 to dexmedetomidine and 1,778 to control). Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction in length of ICU stay (weighted mean difference (WMD) = -0.79 [-1.17 to -0.40] days, p for effect &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and of time to extubation (WMD = -2.74 [-3.80 to -1.65] hours, p for effect &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Mortality was not different between dexmedetomidine and controls (risk ratio = 1.00 [0.84 to 1.21], p for effect = 0.9). High heterogeneity between included studies was found. This meta-analysis of randomized controlled studies suggests that dexmedetomidine could help to reduce ICU stay and time to extubation, in critically ill patients even if high heterogeneity between studies might confound the interpretation of these results.

Research paper thumbnail of The Effect of Statins on Mortality in Septic Patients: A Meta-Analysis of Randomized Controlled Trials

PLoS ONE, 2013

Objective: Statins are among the most prescribed drugs worldwide and their recently discovered an... more Objective: Statins are among the most prescribed drugs worldwide and their recently discovered anti-inflammatory effect seems to have an important role in inhibiting proinflammatory cytokine production, chemokines expression and counteracting the harmful effects of sepsis on the coagulation system. We decided to perform a meta-analysis of all randomized controlled trials ever published on statin therapy in septic patients to evaluate their effect on survival and length of hospital stay.

Research paper thumbnail of Randomized Evidence for Reduction of Perioperative Mortality

Journal of Cardiothoracic and Vascular Anesthesia, 2012

Objective: With more than 220 million major surgical procedures performed annually, perioperative... more Objective: With more than 220 million major surgical procedures performed annually, perioperative interventions leading to even minor mortality reductions would save thousands of lives per year. This international consensus conference aimed to identify all nonsurgical interventions that increase or reduce perioperative mortality as suggested by randomized evidence.

Research paper thumbnail of Reducing Mortality in Acute Kidney Injury Patients: Systematic Review and International Web-Based Survey

Journal of Cardiothoracic and Vascular Anesthesia, 2013

Research paper thumbnail of Preventing deaths related to percutaneous tracheostomy: safety is never too much!

Research paper thumbnail of Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery

British Journal of Anaesthesia, 2013

Editor's key points † Numerous studies have suggested that volatile agents provide myocardial pro... more Editor's key points † Numerous studies have suggested that volatile agents provide myocardial protection in cardiac surgery. † No adequately powered clinical trials have been conducted to evaluate the effect of volatile agents on mortality after cardiac surgery. † Bayesian network meta-analysis allows indirect comparisons of drugs not otherwise compared in head-to-head trials. † Volatile-based anaesthesia seems to reduce mortality after cardiac surgery when compared with TIVA.

Research paper thumbnail of POISE-2 ASA suppl1

Research paper thumbnail of Methylene blue: between scylla (meta-analysis) and charybdis (propensity)

Journal of cardiothoracic and vascular anesthesia, 2014

Research paper thumbnail of Intrathecal lactate as a predictor of early- but not late-onset spinal cord injury in thoracoabdominal aneurysmectomy

Journal of cardiothoracic and vascular anesthesia, 2014

To evaluate the role of intrathecal lactate as an early predictor of spinal cord injury during th... more To evaluate the role of intrathecal lactate as an early predictor of spinal cord injury during thoracoabdominal aortic aneurysmectomy. Observational study. University hospital. Forty-four consecutive patients scheduled to undergo thoracoabdominal aortic aneurysmectomy. Two patients had a type-B dissecting aneurysm while the other 42 patients suffered from degenerative aneurysm. None. During surgery, samples of cerebrospinal fluid and arterial blood were withdrawn simultaneously to evaluate lactate concentration. Samples were collected at 4 fixed times during and after surgery: T1 (beginning of the intervention), T2 (15 minutes after aortic cross-clamping), T3 (just before unclamping), T4 (end of surgery). Mean lactate levels in cerebrospinal fluid rose consistently and steadily from the beginning of the intervention until after surgery (T1 = 1.83 mmol/L), T2 = 2.10 mmol/L, T3 = 2.72 mmol/L, T4 = 3.70 mmol/L). Seven patients developed spinal cord injury; two of them had delayed injur...

Research paper thumbnail of Vasopressin in Hemorrhagic Shock: A Systematic Review and Meta-Analysis of Randomized Animal Trials

BioMed Research International, 2014

Objective. The latest European guidelines for the management of hemorrhagic shock suggest the use... more Objective. The latest European guidelines for the management of hemorrhagic shock suggest the use of vasopressors (norepinephrine) in order to restore an adequate mean arterial pressure when fluid resuscitation therapy fails to restore blood pressure. The administration of arginine vasopressin (AVP), or its analogue terlipressin, has been proposed as an alternative treatment in the early stages of hypovolemic shock. Design. A meta-analysis of randomized controlled animal trials. Participants. A total of 433 animals from 15 studies were included. Interventions. The ability of AVP and terlipressin to reduce mortality when compared with fluid resuscitation therapy, other vasopressors (norepinephrine or epinephrine), or placebo was investigated. Measurements and Main Results. Pooled estimates showed that AVP and terlipressin consistently and significantly improve survival in hemorrhagic shock (mortality: 26/174 (15%) in the AVP group versus 164/259 (63%) in the control arms; OR = 0.09; 95% CI 0.05 to 0.15; for effect < 0.001; for heterogeneity = 0.30; 2 = 14%). Conclusions. Results suggest that AVP and terlipressin improve survival in the early phases of animal models of hemorrhagic shock. Vasopressin seems to be more effective than all other treatments, including other vasopressor drugs. These results need to be confirmed by human clinical trials.

Research paper thumbnail of Dexmedetomidine Reduces the Risk of Delirium, Agitation and Confusion in Critically Ill Patients: A Meta-analysis of Randomized Controlled Trials

Journal of Cardiothoracic and Vascular Anesthesia, 2014

Introduction: The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time ... more Introduction: The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation is still unclear.

Research paper thumbnail of Dexmedetomidine vs midazolam as preanesthetic medication in children: a meta-analysis of randomized controlled trials

Pediatric Anesthesia, 2015

• Premedication reduces perioperative anxiety in children.

Research paper thumbnail of An International Survey on Noninvasive Ventilation Use for Acute Respiratory Failure in General Non-Monitored Wards

Respiratory care, Jan 18, 2014

Use of noninvasive ventilation (NIV) for the treatment of patients with acute respiratory failure... more Use of noninvasive ventilation (NIV) for the treatment of patients with acute respiratory failure (ARF) has greatly increased in the last decades. In contrast, the increasing knowledge of its effectiveness and physician confidence in managing this technique have been accompanied by a declining number of available ICU beds. As a consequence, the application of NIV outside the ICU has been reported as a growing phenomenon. Previously published surveys highlighted a great heterogeneity in NIV use, clinical indications, settings, and efficacy. Moreover, they revealed a marked heterogeneity with regard to staff training and technical and organizational aspects. We performed the first worldwide web-based survey focused on NIV use in general wards for ARF. A questionnaire to obtain data regarding hospital and ICU characteristics, settings and modalities of NIV application and monitoring, estimated outcomes, technical and organizational aspects, and observed complications was developed. The...

Research paper thumbnail of Perioperative aspirin and clonidine and risk of acute kidney injury: a randomized clinical trial

JAMA, Jan 3, 2014

Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high ... more Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain and each intervention has the potential for harm. To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury. A 2 × 2 factorial randomized, blinded, clinical trial of 6905 patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013. Patients were assigned to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days after surgery, and were assigned to take oral clonidine (0.2 mg) or placebo 2 to 4 hours before surgery, and then a transdermal clonidine patch (which provided clonidine a...

Research paper thumbnail of Aspirin and clonidine in non-cardiac surgery: acute kidney injury substudy protocol of the Perioperative Ischaemic Evaluation (POISE) 2 randomised controlled trial

BMJ open, 2014

Perioperative Ischaemic Evaluation-2 (POISE-2) is an international 2×2 factorial randomised contr... more Perioperative Ischaemic Evaluation-2 (POISE-2) is an international 2×2 factorial randomised controlled trial of low-dose aspirin versus placebo and low-dose clonidine versus placebo in patients who undergo non-cardiac surgery. Perioperative aspirin (and possibly clonidine) may reduce the risk of postoperative acute kidney injury (AKI). After receipt of grant funding, serial postoperative serum creatinine measurements began to be recorded in consecutive patients enrolled at substudy participating centres. With respect to the study schedule, the last of over 6500 substudy patients from 82 centres in 21 countries were randomised in December 2013. The authors will use logistic regression to estimate the adjusted OR of AKI following surgery (compared with the preoperative serum creatinine value, a postoperative increase ≥26.5 μmol/L in the 2 days following surgery or an increase of ≥50% in the 7 days following surgery) comparing each intervention to placebo, and will report the adjusted ...

Research paper thumbnail of Dexmedetomidine as a Sedative Agent in Critically Ill Patients: A Meta-Analysis of Randomized Controlled Trials

PLoS ONE, 2013

The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation ... more The effect of dexmedetomidine on length of intensive care unit (ICU) stay and time to extubation is still unclear. Pertinent studies were independently searched in BioMedCentral, PubMed, Embase, and the Cochrane Central Register of clinical trials (updated February first 2013). Randomized studies (dexmedetomidine versus any comparator) were included if including patients mechanically ventilated in an intensive care unit (ICU). Co-primary endpoints were the length of ICU stay (days) and time to extubation (hours). Secondary endpoint was mortality rate at the longest follow-up available. The 27 included manuscripts (28 trials) randomized 3,648 patients (1,870 to dexmedetomidine and 1,778 to control). Overall analysis showed that the use of dexmedetomidine was associated with a significant reduction in length of ICU stay (weighted mean difference (WMD) = -0.79 [-1.17 to -0.40] days, p for effect &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and of time to extubation (WMD = -2.74 [-3.80 to -1.65] hours, p for effect &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Mortality was not different between dexmedetomidine and controls (risk ratio = 1.00 [0.84 to 1.21], p for effect = 0.9). High heterogeneity between included studies was found. This meta-analysis of randomized controlled studies suggests that dexmedetomidine could help to reduce ICU stay and time to extubation, in critically ill patients even if high heterogeneity between studies might confound the interpretation of these results.

Research paper thumbnail of The Effect of Statins on Mortality in Septic Patients: A Meta-Analysis of Randomized Controlled Trials

PLoS ONE, 2013

Objective: Statins are among the most prescribed drugs worldwide and their recently discovered an... more Objective: Statins are among the most prescribed drugs worldwide and their recently discovered anti-inflammatory effect seems to have an important role in inhibiting proinflammatory cytokine production, chemokines expression and counteracting the harmful effects of sepsis on the coagulation system. We decided to perform a meta-analysis of all randomized controlled trials ever published on statin therapy in septic patients to evaluate their effect on survival and length of hospital stay.

Research paper thumbnail of Randomized Evidence for Reduction of Perioperative Mortality

Journal of Cardiothoracic and Vascular Anesthesia, 2012

Objective: With more than 220 million major surgical procedures performed annually, perioperative... more Objective: With more than 220 million major surgical procedures performed annually, perioperative interventions leading to even minor mortality reductions would save thousands of lives per year. This international consensus conference aimed to identify all nonsurgical interventions that increase or reduce perioperative mortality as suggested by randomized evidence.

Research paper thumbnail of Reducing Mortality in Acute Kidney Injury Patients: Systematic Review and International Web-Based Survey

Journal of Cardiothoracic and Vascular Anesthesia, 2013

Research paper thumbnail of Preventing deaths related to percutaneous tracheostomy: safety is never too much!

Research paper thumbnail of Anaesthetic drugs and survival: a Bayesian network meta-analysis of randomized trials in cardiac surgery

British Journal of Anaesthesia, 2013

Editor's key points † Numerous studies have suggested that volatile agents provide myocardial pro... more Editor's key points † Numerous studies have suggested that volatile agents provide myocardial protection in cardiac surgery. † No adequately powered clinical trials have been conducted to evaluate the effect of volatile agents on mortality after cardiac surgery. † Bayesian network meta-analysis allows indirect comparisons of drugs not otherwise compared in head-to-head trials. † Volatile-based anaesthesia seems to reduce mortality after cardiac surgery when compared with TIVA.