Stefano Isgrò - Academia.edu (original) (raw)

Papers by Stefano Isgrò

Research paper thumbnail of The “Dolphin” Prone Position in Awake COVID-19 Patients

Dimensions of Critical Care Nursing

Research paper thumbnail of The “Helmet bundle” in COVID-2019 patients undergoing non invasive ventilation

Intensive and Critical Care Nursing

Research paper thumbnail of Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: a retrospective study

Journal of Critical Care, 2015

Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distre... more Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distress syndrome undergoing invasive ventilation. We evaluated feasibility and efficacy of PP in awake, non-intubated, spontaneously breathing patients with hypoxemic acute respiratory failure (ARF). We retrospectively studied non-intubated subjects with hypoxemic ARF treated with PP from January 2009 to December 2014. Data were extracted from medical records. Arterial blood gas analyses, respiratory rate, and hemodynamics were retrieved 1 to 2 hours before pronation (step PRE), during PP (step PRONE), and 6 to 8 hours after resupination (step POST). Fifteen non-intubated ARF patients underwent 43 PP procedures. Nine subjects were immunocompromised. Twelve subjects were discharged from hospital, while 3 died. Only 2 maneuvers were interrupted, owing to patient intolerance. No complications were documented. PP did not alter respiratory rate or hemodynamics. In the subset of procedures during which the same positive end expiratory pressure and Fio2 were utilized throughout the pronation cycle (n = 18), PP improved oxygenation (Pao2/Fio2 124 ± 50 mmHg, 187 ± 72 mmHg, and 140 ± 61 mmHg, during PRE, PRONE, and POST steps, respectively, P < .001), while pH and Paco2 were unchanged. PP was feasible and improved oxygenation in non-intubated, spontaneously breathing patients with ARF.

Research paper thumbnail of Performance of different PEEP valves and helmet outlets at increasing gas flow rates: a bench top study

Minerva anestesiologica, 2012

Aim of the paper was to assess the performance of different expiratory valves and the resistance ... more Aim of the paper was to assess the performance of different expiratory valves and the resistance of helmet outlet ports at increasing gas flow rates. A gas flow-meter was connected to 10 different expiratory peep valves: 1 water-seal valve, 4 precalibrated fixed PEEP valves and 5 adjustable PEEP valves. Three new valves of each brand, set at different pressure levels (5-7.5-10-12.5-15 cmH(2)O, if available), were tested at increasing gas flow rates (from 30 to 150 L/min). We measured the pressure generated just before the valves. Three different helmets sealed on a mock head were connected at the inlet port with a gas flow-meter while the outlet was left clear. We measured the pressure generated inside the helmet (due to the flow-resistance of the outlet port) at increasing gas flow rates. Adjustable valves showed a variable degree flow-dependency (increasing difference between the measured and the expected pressure at increasing flow rates), while pre-calibrated valves revealed a f...

Research paper thumbnail of Clinical management of severely hypoxemic patients

Current Opinion in Critical Care, 2011

Research paper thumbnail of Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: 5-year experience

The International Journal of Artificial Organs, 2011

Purpose Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal Membrane O... more Purpose Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal Membrane Oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO transportation program was instituted in 2004; here we report results after 5 years of activity. Methods This is a clinical observational study. Criteria for ECMO center activation were: potentially reversibile respiratory failure, PaO2 <50 mmHg with FiO2 >0.6 for >12 hours, PEEP >5 cmH20, Lung Injury Score (LIS) ≥3 or respiratory acidosis with pH <7.2, no intracranial bleeding, and no absolute contraindication to anticoagulation. If eligible, a skilled crew applied ECMO at the referral hospital. Transportation was performed with a specially equipped ambulance. Results Sixteen patients were possible candidates for ECMO transfer. Two patients were excluded while 14 (mean±SD, age 35.4±18.6, SOFA 8.4±3.7, Oxygenation Index 43.7±13.4) were transported to our institution (distance ...

Research paper thumbnail of Blood acidification enhances carbon dioxide removal of membrane lung: an experimental study

Intensive Care Medicine, 2009

Research paper thumbnail of Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study

Intensive Care Medicine, 2011

Research paper thumbnail of Respiratory pattern during neurally adjusted ventilatory assist in acute respiratory failure patients

Intensive Care Medicine, 2012

To investigate the effect of a wide range of assistance levels during neurally adjusted ventilato... more To investigate the effect of a wide range of assistance levels during neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) on respiratory pattern, breathing variability, and incidence of tidal volumes (V T) above 8 and 10 ml/kg in acute respiratory failure patients. Methods: Eight increasing NAVA levels (0.5, 1, 1.5, 2, 2.5, 3, 4, and 5 cmH 2 O/lV) and four increasing pressure support (PSV) levels (4, 8, 12, and 16 cmH 2 O) were applied to obtain 10 min of stable recordings in 15 patients. Results: One out of 15 patients did not sustain the NAVA levels of 3, 4, and 5 cmH 2 O/lV and was excluded. The 5 cmH 2 O/lV NAVA level was not tolerated by three patients and it was excluded. Increasing NAVA levels were associated with decreased diaphragm electrical activity (EAdi), and, at variance with PSV, with small

Research paper thumbnail of Interhospital ground transportation of severe acute respiratory distress syndrome patients on extracorporeal membrane oxygenation: Monza's experience

Research paper thumbnail of Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial

Research paper thumbnail of Helmet Continuous Positive Airway Pressure: Theory and Technology

… Mechanical Ventilation: Theory …, 2010

Research paper thumbnail of The “helmet bundle” in COVID-19 patients undergoing non invasive ventilation

Intensive and Critical Care Nursing

The ''helmet bundle" in COVID-19 patients undergoing non invasive ventilation

Research paper thumbnail of Percutaneous vascular cannulation for extracorporeal life support (ECLS): a modified technique

The International journal of artificial organs, 2010

Vascular access and cannulation are crucial issues to maximize the efficiency of extracorporeal c... more Vascular access and cannulation are crucial issues to maximize the efficiency of extracorporeal circulation techniques and to preserve patients' safety. Techniques of cannulation have changed over the years, from surgical cutdown to percutaneous approaches, which are now considered standard practice. We describe an original modified percutaneous cannulation technique developed in our Department and we report our clinical experience and complications observed. A Seldinger technique utilizing 3 guidewires with passage of a dilator over each guidewire was used. Two concentric pursestring sutures, prepared before cannulation, minimize procedure-associated bleeding. Cannulation is performed under direct fluoroscopic control. From 1997 to 2009, 38 patients (31 VV-ECLS, 7 VA-ECLS) have been cannulated using our technique, resulting in a total of 69 venous cannulations. Average external caliber of venous cannulae was 23 Fr (15-29 Fr). Mean duration of the entire cannulation procedure wa...

Research paper thumbnail of Ground Transport: Ambulance

ECMO-Extracorporeal Life Support in Adults, 2014

Research paper thumbnail of Extra-corporeal life support for near-fatal multi-drug intoxication: a case report

Journal of Medical Case Reports, 2011

Introduction: Severe mixed β-blocker and calcium channel blocker intoxication presents a signific... more Introduction: Severe mixed β-blocker and calcium channel blocker intoxication presents a significant risk for patient mortality. Although treatment is well-established, it sporadically fails to support the patient through massive overdoses, thus requiring non-conventional treatments. We report the use of extra-corporeal life support in a patient with refractory hemodynamic impairment due to multi-drug intoxication. Although sometimes used in clinical practice, extra-corporeal membrane oxygenation for intoxications has rarely been reported. Case presentation: A 36-year-old Caucasian man presented to our hospital with refractory hypotension, severe cardiac insufficiency and multi-organ failure due to mixed intoxication with atenolol, nifedipine, Lacidipine and sertraline. Together with standard treatment, we performed extra-corporeal membrane oxygenation to overcome refractory cardiogenic shock and lead the patient to achieve a full recovery.

Research paper thumbnail of The “Dolphin” Prone Position in Awake COVID-19 Patients

Dimensions of Critical Care Nursing

Research paper thumbnail of The “Helmet bundle” in COVID-2019 patients undergoing non invasive ventilation

Intensive and Critical Care Nursing

Research paper thumbnail of Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: a retrospective study

Journal of Critical Care, 2015

Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distre... more Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distress syndrome undergoing invasive ventilation. We evaluated feasibility and efficacy of PP in awake, non-intubated, spontaneously breathing patients with hypoxemic acute respiratory failure (ARF). We retrospectively studied non-intubated subjects with hypoxemic ARF treated with PP from January 2009 to December 2014. Data were extracted from medical records. Arterial blood gas analyses, respiratory rate, and hemodynamics were retrieved 1 to 2 hours before pronation (step PRE), during PP (step PRONE), and 6 to 8 hours after resupination (step POST). Fifteen non-intubated ARF patients underwent 43 PP procedures. Nine subjects were immunocompromised. Twelve subjects were discharged from hospital, while 3 died. Only 2 maneuvers were interrupted, owing to patient intolerance. No complications were documented. PP did not alter respiratory rate or hemodynamics. In the subset of procedures during which the same positive end expiratory pressure and Fio2 were utilized throughout the pronation cycle (n = 18), PP improved oxygenation (Pao2/Fio2 124 ± 50 mmHg, 187 ± 72 mmHg, and 140 ± 61 mmHg, during PRE, PRONE, and POST steps, respectively, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001), while pH and Paco2 were unchanged. PP was feasible and improved oxygenation in non-intubated, spontaneously breathing patients with ARF.

Research paper thumbnail of Performance of different PEEP valves and helmet outlets at increasing gas flow rates: a bench top study

Minerva anestesiologica, 2012

Aim of the paper was to assess the performance of different expiratory valves and the resistance ... more Aim of the paper was to assess the performance of different expiratory valves and the resistance of helmet outlet ports at increasing gas flow rates. A gas flow-meter was connected to 10 different expiratory peep valves: 1 water-seal valve, 4 precalibrated fixed PEEP valves and 5 adjustable PEEP valves. Three new valves of each brand, set at different pressure levels (5-7.5-10-12.5-15 cmH(2)O, if available), were tested at increasing gas flow rates (from 30 to 150 L/min). We measured the pressure generated just before the valves. Three different helmets sealed on a mock head were connected at the inlet port with a gas flow-meter while the outlet was left clear. We measured the pressure generated inside the helmet (due to the flow-resistance of the outlet port) at increasing gas flow rates. Adjustable valves showed a variable degree flow-dependency (increasing difference between the measured and the expected pressure at increasing flow rates), while pre-calibrated valves revealed a f...

Research paper thumbnail of Clinical management of severely hypoxemic patients

Current Opinion in Critical Care, 2011

Research paper thumbnail of Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: 5-year experience

The International Journal of Artificial Organs, 2011

Purpose Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal Membrane O... more Purpose Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal Membrane Oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO transportation program was instituted in 2004; here we report results after 5 years of activity. Methods This is a clinical observational study. Criteria for ECMO center activation were: potentially reversibile respiratory failure, PaO2 <50 mmHg with FiO2 >0.6 for >12 hours, PEEP >5 cmH20, Lung Injury Score (LIS) ≥3 or respiratory acidosis with pH <7.2, no intracranial bleeding, and no absolute contraindication to anticoagulation. If eligible, a skilled crew applied ECMO at the referral hospital. Transportation was performed with a specially equipped ambulance. Results Sixteen patients were possible candidates for ECMO transfer. Two patients were excluded while 14 (mean±SD, age 35.4±18.6, SOFA 8.4±3.7, Oxygenation Index 43.7±13.4) were transported to our institution (distance ...

Research paper thumbnail of Blood acidification enhances carbon dioxide removal of membrane lung: an experimental study

Intensive Care Medicine, 2009

Research paper thumbnail of Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study

Intensive Care Medicine, 2011

Research paper thumbnail of Respiratory pattern during neurally adjusted ventilatory assist in acute respiratory failure patients

Intensive Care Medicine, 2012

To investigate the effect of a wide range of assistance levels during neurally adjusted ventilato... more To investigate the effect of a wide range of assistance levels during neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) on respiratory pattern, breathing variability, and incidence of tidal volumes (V T) above 8 and 10 ml/kg in acute respiratory failure patients. Methods: Eight increasing NAVA levels (0.5, 1, 1.5, 2, 2.5, 3, 4, and 5 cmH 2 O/lV) and four increasing pressure support (PSV) levels (4, 8, 12, and 16 cmH 2 O) were applied to obtain 10 min of stable recordings in 15 patients. Results: One out of 15 patients did not sustain the NAVA levels of 3, 4, and 5 cmH 2 O/lV and was excluded. The 5 cmH 2 O/lV NAVA level was not tolerated by three patients and it was excluded. Increasing NAVA levels were associated with decreased diaphragm electrical activity (EAdi), and, at variance with PSV, with small

Research paper thumbnail of Interhospital ground transportation of severe acute respiratory distress syndrome patients on extracorporeal membrane oxygenation: Monza's experience

Research paper thumbnail of Presepsin (soluble CD14 subtype) and procalcitonin levels for mortality prediction in sepsis: data from the Albumin Italian Outcome Sepsis trial

Research paper thumbnail of Helmet Continuous Positive Airway Pressure: Theory and Technology

… Mechanical Ventilation: Theory …, 2010

Research paper thumbnail of The “helmet bundle” in COVID-19 patients undergoing non invasive ventilation

Intensive and Critical Care Nursing

The ''helmet bundle" in COVID-19 patients undergoing non invasive ventilation

Research paper thumbnail of Percutaneous vascular cannulation for extracorporeal life support (ECLS): a modified technique

The International journal of artificial organs, 2010

Vascular access and cannulation are crucial issues to maximize the efficiency of extracorporeal c... more Vascular access and cannulation are crucial issues to maximize the efficiency of extracorporeal circulation techniques and to preserve patients' safety. Techniques of cannulation have changed over the years, from surgical cutdown to percutaneous approaches, which are now considered standard practice. We describe an original modified percutaneous cannulation technique developed in our Department and we report our clinical experience and complications observed. A Seldinger technique utilizing 3 guidewires with passage of a dilator over each guidewire was used. Two concentric pursestring sutures, prepared before cannulation, minimize procedure-associated bleeding. Cannulation is performed under direct fluoroscopic control. From 1997 to 2009, 38 patients (31 VV-ECLS, 7 VA-ECLS) have been cannulated using our technique, resulting in a total of 69 venous cannulations. Average external caliber of venous cannulae was 23 Fr (15-29 Fr). Mean duration of the entire cannulation procedure wa...

Research paper thumbnail of Ground Transport: Ambulance

ECMO-Extracorporeal Life Support in Adults, 2014

Research paper thumbnail of Extra-corporeal life support for near-fatal multi-drug intoxication: a case report

Journal of Medical Case Reports, 2011

Introduction: Severe mixed β-blocker and calcium channel blocker intoxication presents a signific... more Introduction: Severe mixed β-blocker and calcium channel blocker intoxication presents a significant risk for patient mortality. Although treatment is well-established, it sporadically fails to support the patient through massive overdoses, thus requiring non-conventional treatments. We report the use of extra-corporeal life support in a patient with refractory hemodynamic impairment due to multi-drug intoxication. Although sometimes used in clinical practice, extra-corporeal membrane oxygenation for intoxications has rarely been reported. Case presentation: A 36-year-old Caucasian man presented to our hospital with refractory hypotension, severe cardiac insufficiency and multi-organ failure due to mixed intoxication with atenolol, nifedipine, Lacidipine and sertraline. Together with standard treatment, we performed extra-corporeal membrane oxygenation to overcome refractory cardiogenic shock and lead the patient to achieve a full recovery.