Bignami Elena

• San Raffaele Scientific Institute

Postoperative complications (PCs) are a major cause of mortality following elective major abdominal surgery (EMAS). The increasing complexity of abdominal procedures, particularly in oncology, may significantly affect patient outcomes. However, this has also introduced a higher variability in postoperative management, and the use of tailored approa...

The integration of artificial intelligence (AI) and all new technologies (NTs) into enhanced recovery after surgery (ERAS) protocols offers significant opportunities to address implementation challenges and improve patient care. Despite the proven benefits of ERAS, limitations such as resistance to change, resource constraints, and poor interdepart...

Background The prevalence of frailty is increasing as the global population continues to age. Frailty is associated with poor perioperative outcomes including increased morbidity and mortality. The purpose of this study is to examine current practices and perspectives of anesthesiogists in Italy on the provision of care for elderly surgical patient...

Background Despite the growing body of evidence supporting the use of angiotensin II (ATII) in distributive shock, its integration into existing treatment algorithms requires careful consideration of factors related to patient comorbidities, hemodynamic parameters, cost-effectiveness, and risk–benefit balance. Moreover, several questions regarding...

Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, un...

We are in the era of Health 4.0 when novel technologies are providing tools capable of improving the quality and safety of the services provided. Our project involves the integration of different technologies (AI, big data, robotics, and telemedicine) to create a unique system for patients admitted to intensive care units suffering from infectious...

Artificial intelligence (AI) algorithms, particularly deep learning, are automatic and sophisticated methods that recognize complex patterns in imaging data providing high qualitative assessments. Several machine-learning and deep-learning models using imaging techniques have been recently developed and validated to predict difficult airways. Despi...

Perioperative medicine is undergoing many changes with the introduction of new technologies. Wearable devices are among them. These novel tools are providing an additional possibility for perioperative monitoring. However, in order to ensure that the introduction of wearable device in surgical wards does not lead to additional challenges for health...

Within the domain of Natural Language Processing (NLP), Large Language Models (LLMs) represent sophisticated models engineered to comprehend, generate, and manipulate text resembling human language on an extensive scale. They are transformer-based deep learning architectures, obtained through the scaling of model size, pretraining of corpora, and c...

Close to 5% of patients undergoing noncardiac surgery suffer from major postoperative complications. 1 Preoperative evaluation, risk stratification, and modification of perioperative management are crucial components in the effort to improve patient outcomes. 2 In addition to known clinical risk factors, self-reported functional capacity has been s...

The development of artificial intelligence (AI) is disruptive and unstoppable, also in medicine. Because of the enormous quantity of data recorded during continuous monitoring and the peculiarity of our specialty where stratification and mitigation risk are some of the core aspects, anesthesiology and postoperative intensive care are fertile fields...

Objective: Large language models (LLMs) such as ChatGPT-4 have raised critical questions regarding their distinguishability from human-generated content. In this research, we evaluated the effectiveness of online detection tools in identifying ChatGPT-4 vs human-written text. Methods: A two texts produced by ChatGPT-4 using differing prompts and...

We are in the era of disruption. New technologies are all around us and they change our professional and non-professional life very quickly. Evidence-based medicine is changing accordingly. We propose a new version of the evidence pyramid that evolves through the changes of our novel perspective. New technologies are manipulating the pyramid, revea...

This systematic review of randomized-controlled trials (RCTs) with meta-analyses aimed to compare the effects on intraoperative arterial oxygen tension to inspired oxygen fraction ratio (PaO2/FiO2), exerted by positive end-expiratory pressure (PEEP) individualized trough electrical impedance tomography (EIT) or esophageal pressure (Pes) assessment...

Background: Postoperative pulmonary complications (PPCs) significantly contribute to postoperative morbidity and mortality. We conducted a study to determine the incidence of PPCs after major elective abdominal surgery and their association with early and 1-year mortality in patient without pre-existing respiratory disease. Methods: We conducted...

Background and Objectives: Pulmonary complications are a leading cause of morbidity after cardiac surgery. The aim of this study was to develop models to predict postoperative lung dysfunction and mortality. Materials and Methods: This was a single-center, observational, retrospective study. We retrospectively analyzed the data of 11,285 adult pati...

Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues require...

Perioperative medicine is changing, and its goals are expanding. More and more attention is paid to the surgical experience and the patient's quality of life. Patient-reported data represent a useful tool in this context. Patient-reported outcomes measures (PROMs) and experience measures (PREMs) are among the most used categories. However, creating...

Background: Management of operating rooms is a critical point in health care organizations because surgical departments represent a significant cost in hospital budgets. Therefore, it is increasingly important that there is effective planning of elective, emergency, and day surgery and optimization of both the human and physical resources availabl...

The impact of left ventricular (LV) diastolic dysfunction (DD) on the outcome of patients with heart failure was established over three decades ago. Nevertheless, the relevance of LVDD for critically ill patients admitted to the intensive care unit has seen growing interest recently, and LVDD is associated with poor prognosis. Whilst an assessment...

The modern world runs all around hi-tech, which surrounds us in our everyday life. The medical field is no less; the introduction of the novel disruptive technologies are transforming every healthcare system. Anesthesia, intensive care, and pain medicine are fields in which the application of new technologies is proving to have great potential. How...

The use of AI-based algorithms is rapidly growing in healthcare, but there is still an ongoing debate about how to manage and ensure accountability for their clinical use. While most of the studies focus on demonstrating a good algorithm performance it is important to acknowledge that several additional steps are needed for reaching an effective im...

Premessa: "PENG" è un blocco pericapsulare dei rami nervosi sensoriali dell'articolazione dell'anca (femorale, otturatorio accessorio e del nervo otturatorio). Descritto per la prima volta nel 2018 come tecnica locoregionale per la gestione del dolore post-operatorio nell'artroplastica di totale di anca, il blocco ha mostrato immediatamente notevol...

Several studies exist in the literature regarding the exploitation of artificial intelligence in intensive care. However, an important gap between clinical research and daily clinical practice still exists that can only be bridged by robust validation studies carried out by multidisciplinary teams.

Artificial Intelligence (AI) and Machine Learning (ML) algorithms have several applications in everyday life and many scientific fields. Relatively recent in medicine physical and virtual use of AI implements classifications, diagnoses, therapies, and follow-ups. AI has been defined as the study of algorithms that give machines the ability to reaso...

This paper aims to highlight the potential applications and limits of a large language model (LLM) in healthcare. ChatGPT is a recently developed LLM that was trained on a massive dataset of text for dialogue with users. Although AI-based language models like ChatGPT have demonstrated impressive capabilities, it is uncertain how well they will perf...

Background Surgeons are exposed to high levels of intraoperative stress, which could compromise their psychological well-being in the long term. This study aimed at exploring the effects of real operations on the activity of stress response systems (i.e., cardiac autonomic function and hypothalamic–pituitary–adrenal axis) during and in the aftermat...

Modern medicine, both in clinical practice and research, has become more and more based on data, which is changing equally in type and quality with the advent and development of healthcare digitalization. The first part of the present paper aims to present the steps through which data, and subsequently clinical and research practice, have evolved f...

BACKGROUND Management of operating rooms is a critical point in health care organizations because surgical departments represent a significant cost in hospital budgets. Therefore, it is increasingly important that there is effective planning of elective, emergency, and day surgery and optimization of both the human and physical resources available,...

Background Risk stratification plays a central role in anesthetic evaluation. The use of Big Data and machine learning (ML) offers considerable advantages for collection and evaluation of large amounts of complex health-care data. We conducted a systematic review to understand the role of ML in the development of predictive post-surgical outcome mo...

Background Neuraxial anesthesia in obese parturients can be challenging due to anatomical and physiological modifications secondary to pregnancy; this led to growing popularity of spine ultrasound in this population for easing landmark identification and procedure execution. Integration of Artificial Intelligence with ultrasound (AI-US) for image e...

Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontr...

Background Point-of-care ultrasound (POCUS) has become an essential tool for anaesthesia and critical care physicians and dedicated training is mandatory. This survey describes the current state of Italian residency training programs through the comparison of residents’ and directors’ perspective. Methods Observational prospective cross-sectional...

The application of artificial intelligence technologies is growing in several fields of healthcare settings. The aim of this article is to review the current applications of artificial intelligence in bariatric surgery. We performed a review of the literature on Scopus, PubMed and Cochrane databases, screening all relevant studies published until S...

Lung ultrasound is a well-established diagnostic tool in acute respiratory failure, and it has been shown to be particularly suited for the management of COVID-19-associated respiratory failure. We present exploratory analyses on the diagnostic and prognostic performance of lung ultrasound score (LUS) in general ward patients with moderate-to-sever...

Introduction and importance: Chronic Obstructive Pulmonary Disease (COPD) leads to the development of postoperative pulmonary complications (PPC), such as atelectasis, pneumonia and respiratory failure. The use of epidural anesthesia, alone or combined with general anesthesia, is known to reduce the incidence of PPC and shorten tracheal intubation...

A 67-year-old lung transplant recipient with severe comorbidities was admitted for renal transplant. As anesthesia technique, combined spinal-epidural at the T11-T12 level was chosen, associated with intravenous sedation. Graft’s function initially results altered, bringing to pulmonary fluid overload. Beginning from the postoperative day 5 there w...

Aim to determine whether the duration of respiratory distress symptoms in severe COVID-19 pneumonia affects the need for invasive mechanical ventilation and clinical outcomes. Materials and methods an observational multicentre cohort study of patients hospitalised in five COVID-19–designated ICUs of the University Hospitals of Emilia-Romagna Regio...

Background The incidence of cerebral fat embolism (CFE) ranges from 0.9–11%, with a mean mortality rate of around 10%. Although no univocal explanation has been identified for the resulting fat embolism syndrome (FES), two hypotheses are widely thought: the ‘mechanical theory’, and the ‘chemical theory’. The present article provides a systematic re...

Background Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) h...

Background Awake prone position is an emerging rescue therapy applied in patients undergoing noninvasive ventilation (NIV) for acute hypoxemic respiratory failure (ARF) related to novel coronavirus disease (COVID-19). Although applied to stabilize respiratory status, in awake patients, the application of prone position may reduce comfort with a con...

Objective: The aim of this article is to review the current applications of artificial intelligence in thoracic surgery, from diagnosis and pulmonary disease management, to preoperative risk-assessment, surgical planning, and outcomes prediction. Background: Artificial intelligence implementation in healthcare settings is rapidly growing, though...

In recent years, thanks to digitalization in healthcare, large amounts of data have become available. With Artificial Intelligence techniques, these data can provide not only useful information, but also intelligent tools to support clinical decisions. This phenomenon is also occurring in perioperative medicine. The immediate postoperative period c...

Background and aim: During the first wave of the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) pandemic, we faced a massive clinical and organizational challenge having to manage critically ill patients outside the Intensive Care Unit (ICU). This was due to the significant imbalance between ICU bed availability and the number of pat...

Objective: This review summarizes the peri-operative anesthesiological approaches to esophagectomy considering the best up-to-date, evidence-based medicine, discussed from the anesthesiologist’s standpoint. Background: Esophagectomy is the only curative therapy for esophageal cancer. Despite the many advancements made in the surgical treatment of t...

BACKGROUND: Teeth and other intraoral structures are the most frequent sources of orofacial pain. Pulsed radiofrequency (PRF) is a treatment where an intermittent electrical pulse is applied to a painful nerve. CASE REPORT: Twelve patients who reported odontogenic were enrolled. After a positive anesthetic block test at the affected nerve, a PRF pr...

OBJECTIVE To determine whether driving pressure and expiratory flow limitation are associated with the development of postoperative pulmonary complications (PPCs) in cardiac surgery patients. DESIGN Prospective cohort study. SETTING University Hospital San Raffaele, Milan, Italy. PARTICIPANTS Patients undergoing elective cardiac surgery. MEASUR...

From February 2019 the World faces the Covid19 pandemic. The data in our possession are still insufficient to effectively combat this pathology. The gold standard for diagnosis remains molecular testing, while clinical and instrumental and serological diagnostics are highly nonspecific leading to a slowdown in the battle against covid19.[3] Can Art...

Background: The assessment of diaphragmatic kinetics through tissue Doppler imaging (dTDI) was recently proposed as a means to describe diaphragmatic activity in both healthy individuals and intubated patients undergoing weaning from mechanical ventilation. Our primary aim was to investigate whether the diaphragmatic excursion velocity measured wi...

BACKGROUND: Endocrine surgery recent evolution has been characterized by introduction of mini-invasive video-assisted technique. When a new technique is introduced in surgical use the rate of adverse events must be the same of previous standardized technique. In MlVAT procedure complication rate and in particular nerve injury risk is associated sur...

Acute Respiratory Distress Syndrome (ARDS) after cardiac surgery is reported with a widely variable incidence (from 0.4 to 8.1%). Cardiac surgery patients are usually affected by several comorbidities, and the development of ARDS significantly impact on their prognosis. We summarize evidence regarding the current knowledge in the field of ARDS in c...

Background Driving pressure can be readily measured during assisted modes of ventilation such as pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA). The present prospective randomized crossover study aimed to assess the changes in driving pressure in response to variations in the level of assistance delivered by PSV...

SARS-CoV-2 pandemic has profoundly changed everyday life throughout the world. Like most scientific journals, Minerva Anestesiologica has given space to a series of articles on the epidemic's problems. First, we published a consensus on intensive care resources' rational use by a panel of intensivists who worked in Lombardy during the SARS-CoV-2 ep...

Objective To assess whether the administration of the ultra-short–acting β-blocker esmolol in cardiac surgery could have a cardioprotective effect that translates into improved postoperative outcomes. Design Single-center, double-blinded, parallel-group randomized controlled trial. Setting A tertiary care referral center. Participants Patients u...

Vasopressors and inotropic agents are widely used in critical care. However, strong evidence supporting their use in critically ill patients is lacking in many clinical scenarios. Thus, the Italian Society of Anesthesia and Intensive Care (SIAARTI) promoted a project aimed to provide indications for good clinical practice on the use of vasopressors...

Background Pulmonary complications after cardiac surgery are a leading cause of morbidity and mortality. The aim of this study was to develop predictive models for postoperative lung dysfunction and mortality. Methods This was a single-center, observational, retrospective study, which took place in a tertiary care University Hospital. We retrospect...

Background: Carotid endarterectomy (CEA) can be performed both under general anesthesia (GA) or local anesthesia (LA) with good results. General anesthesia with preserved consciousness (GAPC) using remifentanil infusion has been already reported in literature and could potentially merge the advantages of GA and LA overcoming the disadvantages of t...

Background and objective: The aim of this narrative review is to analyze whether or not artificial intelligence (AI) and its subsets are implemented in current clinical anesthetic practice, and to describe the current state of the research in the field. AI is a general term which refers to all the techniques that enable computers to mimic human in...

The current COVID-19 pandemic underlines the importance of a mindful utilization of financial and human resources. Preserving resources and manpower is paramount in healthcare. It is important to ensure the ability of surgeons and specialized professionals to function through the pandemic. A conscious effort should be made to minimize infection in...

Background: Weaning from mechanical ventilation is a challenging step during recovery from critical illness. Weaning failure or early reintubation are associated with increased morbidity and mortality, exposing patients to life-threatening complications. Cardiac dysfunction represents the most common cause of weaning failure. We conducted a system...

Exosomes are extracellular microvesicles implicated in intercellular communication with ability to transfer cargo molecules, including protein, lipids, and nucleic acids, at both close and distant target sites. It has been shown that exosomes are implicated in physiological and pathological processes. In recent years, the interest on exosomes' role...

Introduction Breakage and fragment embolization is a rare but feared complication of peripherally inserted central catheter use. While chest radiographs are no longer the gold standard for determining peripherally inserted central catheter tip position, their use in diagnosing complications is still warranted. We report a case of occult catheter em...

Coronavirus disease of 2019 (COVID-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has rapidly spread to a global pandemic in March 2020. This emergency condition has been putting a severe strain on healthcare systems worldwide, and a prompt, dynamic response is instrumental in its ma...

Introduction Fibroblastic sheath formation is a well-known complication of long-term central venous catheters. When calcified, fibroblastic (formerly known as “fibrin”) sheaths may be easily mistaken for retained catheter fragments. We describe one such case and how imaging was used to recognize the sheath and avoid unnecessary interventions. Case...

This corrects the article DOI:10.23736/S0375-9393.20.14384-0.

Background: Endocrine surgery recent evolution has been characterized by introduction of mini-invasive video-assisted technique. When a new technique is introduced in surgical use the rate of adverse events must be the same of previous standardized technique. In MIVAT procedure complication rate and in particular nerve injury risk is associated su...