Simone Zerbi - Academia.edu (original) (raw)
Papers by Simone Zerbi
Intensive Care Medicine
Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracrania... more Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243-2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823-1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome.
Toxicology and Environmental Health Sciences, 2019
Exposures to poisons are one of the most common causes of increased morbidity and mortality rate ... more Exposures to poisons are one of the most common causes of increased morbidity and mortality rate worldwide, especially among children. We want to analyze the distribution of children poisonings admitted to intensive care. Methods: We considered all pediatrics' poisoning cases through Milan Poison Control Centre during six years that required the intensive care monitoring. In case of major effects or death we calculated the Hazard Factor (HF). Descriptive statistic and Fisher exact test where indicated was adopted. We considered significant p value <0.05. Results: We analyzed 451 cases within 130.921 calls. Half of exposures were unintentional (52.3% n = 236). The most dangerous HF calculated amounted to 6.09 (range 0-12.2). The daily and the yearly distribution of accidental and voluntary intake of substances seemed to show some cluster of incidence. Drugs administration mistakes are the most frequent events in the first 2 years of life. Intentional exposure is frequent after 13 years old. Conclusion: The HF contributes to clinical triage, monitor setting and therapeutic strategies. The individuation of the most dangerous substances may be useful to develop future interventions to prevent these events and to inform the population about a strict surveillance in specific hours of the afternoon when dangerous substances are present.
A cura del Gruppo di Lavoro Farmaci di AREU L'esistenza di una parziale carenza di linee guid... more A cura del Gruppo di Lavoro Farmaci di AREU L'esistenza di una parziale carenza di linee guida (LG) standardizzate e universalmente riconosciute sull'utilizzo dei farmaci in Emergenza in ambito territoriale e la ridotta incidenza finora riscontrata nella programmazione universitaria e nei percorsi post-universitari dei medici professionisti dell'Emergenza Territoriale, comportano una grande variabilità di approccio terapeutico farmacologico nella pratica clinica di soccorso. Per superare questo problema si è pensato che fosse indispensabile fornire alcuni riferimenti standardizzati sui farmaci selezionati da AREU, per gestire la terapia farmacologica d'Emergenza nei pazienti soccorsi sul territorio per opera dei Mezzi di Soccorso Avanzato (MSA). Per alcune delle questioni affrontate in questo elaborato le evidenze scientifiche nella fase territoriale sono risultate limitate, per cui molte indicazioni hanno fatto riferimento ai principi fondamentali di fisiopatologia ...
Emergency Drugs "Boards of Use" in pre-hospital setting. Pharmacological Treatment by P... more Emergency Drugs "Boards of Use" in pre-hospital setting. Pharmacological Treatment by Physicians and Nurses according Italian pre-hospital Guidelines. Data Sheets for Helping EMS Medical Staff to a correct and rapid drug delivery in Emergency situations.
Compendium to AREU's Drugs Cards of Use for pre-hospital ALS Emergency Treatment by Physician... more Compendium to AREU's Drugs Cards of Use for pre-hospital ALS Emergency Treatment by Physicians and Nurses of Lombardy EMS.
Annals of the American Thoracic Society
Journal of Nuclear Medicine
Case Reports in Emergency Medicine, 2014
The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late te... more The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC) in the mother. This treatment, called Perimortem Cesarean Section (PMCS), is now termed as Resuscitative Hysterotomy (RH) to better address the issue of an early Cesarean section (C-section). This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR) maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C) section of a foetus at 36 weeks of gestation after the mother’s traumatic cardiac arrest. Despite the negative outcome...
Intensive Care Medicine
Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracrania... more Purpose: Uncertainties remain about the safety and efficacy of therapies for managing intracranial hypertension in acute brain injured (ABI) patients. This study aims to describe the therapeutical approaches used in ABI, with/without intracranial pressure (ICP) monitoring, among different pathologies and across different countries, and their association with six months mortality and neurological outcome. Methods: A preplanned subanalysis of the SYNAPSE-ICU study, a multicentre, prospective, international, observational cohort study, describing the ICP treatment, graded according to Therapy Intensity Level (TIL) scale, in patients with ABI during the first week of intensive care unit (ICU) admission. Results: 2320 patients were included in the analysis. The median age was 55 (I-III quartiles = 39-69) years, and 800 (34.5%) were female. During the first week from ICU admission, no-basic TIL was used in 382 (16.5%) patients, mild-moderate in 1643 (70.8%), and extreme in 295 cases (eTIL, 12.7%). Patients who received eTIL were younger (median age 49 (I-III quartiles = 35-62) vs 56 (40-69) years, p < 0.001), with less cardiovascular pre-injury comorbidities (859 (44%) vs 90 (31.4%), p < 0.001), with more episodes of neuroworsening (160 (56.1%) vs 653 (33.3%), p < 0.001), and were more frequently monitored with an ICP device (221 (74.9%) vs 1037 (51.2%), p < 0.001). Considerable variability in the frequency of use and type of eTIL adopted was observed between centres and countries. At six months, patients who received no-basic TIL had an increased risk of mortality (Hazard ratio, HR = 1.612, 95% Confidence Interval, CI = 1.243-2.091, p < 0.001) compared to patients who received eTIL. No difference was observed when comparing mild-moderate TIL with eTIL (HR = 1.017, 95% CI = 0.823-1.257, p = 0.873). No significant association between the use of TIL and neurological outcome was observed. Conclusions: During the first week of ICU admission, therapies to control high ICP are frequently used, especially mild-moderate TIL. In selected patients, the use of aggressive strategies can have a beneficial effect on six months mortality but not on neurological outcome.
Toxicology and Environmental Health Sciences, 2019
Exposures to poisons are one of the most common causes of increased morbidity and mortality rate ... more Exposures to poisons are one of the most common causes of increased morbidity and mortality rate worldwide, especially among children. We want to analyze the distribution of children poisonings admitted to intensive care. Methods: We considered all pediatrics' poisoning cases through Milan Poison Control Centre during six years that required the intensive care monitoring. In case of major effects or death we calculated the Hazard Factor (HF). Descriptive statistic and Fisher exact test where indicated was adopted. We considered significant p value <0.05. Results: We analyzed 451 cases within 130.921 calls. Half of exposures were unintentional (52.3% n = 236). The most dangerous HF calculated amounted to 6.09 (range 0-12.2). The daily and the yearly distribution of accidental and voluntary intake of substances seemed to show some cluster of incidence. Drugs administration mistakes are the most frequent events in the first 2 years of life. Intentional exposure is frequent after 13 years old. Conclusion: The HF contributes to clinical triage, monitor setting and therapeutic strategies. The individuation of the most dangerous substances may be useful to develop future interventions to prevent these events and to inform the population about a strict surveillance in specific hours of the afternoon when dangerous substances are present.
A cura del Gruppo di Lavoro Farmaci di AREU L'esistenza di una parziale carenza di linee guid... more A cura del Gruppo di Lavoro Farmaci di AREU L'esistenza di una parziale carenza di linee guida (LG) standardizzate e universalmente riconosciute sull'utilizzo dei farmaci in Emergenza in ambito territoriale e la ridotta incidenza finora riscontrata nella programmazione universitaria e nei percorsi post-universitari dei medici professionisti dell'Emergenza Territoriale, comportano una grande variabilità di approccio terapeutico farmacologico nella pratica clinica di soccorso. Per superare questo problema si è pensato che fosse indispensabile fornire alcuni riferimenti standardizzati sui farmaci selezionati da AREU, per gestire la terapia farmacologica d'Emergenza nei pazienti soccorsi sul territorio per opera dei Mezzi di Soccorso Avanzato (MSA). Per alcune delle questioni affrontate in questo elaborato le evidenze scientifiche nella fase territoriale sono risultate limitate, per cui molte indicazioni hanno fatto riferimento ai principi fondamentali di fisiopatologia ...
Emergency Drugs "Boards of Use" in pre-hospital setting. Pharmacological Treatment by P... more Emergency Drugs "Boards of Use" in pre-hospital setting. Pharmacological Treatment by Physicians and Nurses according Italian pre-hospital Guidelines. Data Sheets for Helping EMS Medical Staff to a correct and rapid drug delivery in Emergency situations.
Compendium to AREU's Drugs Cards of Use for pre-hospital ALS Emergency Treatment by Physician... more Compendium to AREU's Drugs Cards of Use for pre-hospital ALS Emergency Treatment by Physicians and Nurses of Lombardy EMS.
Annals of the American Thoracic Society
Journal of Nuclear Medicine
Case Reports in Emergency Medicine, 2014
The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late te... more The optimal treatment of a severe hemodynamic instability from shock to cardiac arrest in late term pregnant women is subject to ongoing studies. However, there is an increasing evidence that early “separation” between the mother and the foetus may increase the restoration of the hemodynamic status and, in the cardiac arrest setting, it may raise the likelihood of a return of spontaneous circulation (ROSC) in the mother. This treatment, called Perimortem Cesarean Section (PMCS), is now termed as Resuscitative Hysterotomy (RH) to better address the issue of an early Cesarean section (C-section). This strategy is in contrast with the traditional treatment of cardiac arrest characterized by the maintenance of cardiopulmonary resuscitation (CPR) maneuvers without any emergent surgical intervention. We report the case of a prehospital perimortem delivery by Caesarean (C) section of a foetus at 36 weeks of gestation after the mother’s traumatic cardiac arrest. Despite the negative outcome...