Nicola Latronico

Università degli Studi di Brescia | UNIBS · Department of Medical and Surgical Specialties Radiological Sciences and Public Health

Purpose: This work aimed to compare physical impairment in survivors of classic ARDS compared with COVID-19-associated ARDS (CARDS) survivors. Material and methods: This is a prospective observational cohort study on 248 patients with CARDS and compared them with a historical cohort of 48 patients with classic ARDS. Physical performance was eval...

Purpose of review: Sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a leading cause of hospital and ICU admission. The central and peripheral nervous system may be the first organ system to show signs of dysfunction, leading to clinical manifestations such as sepsis-associated encephalop...

This paper presents the first experimental results obtained with an event-based PID regulator for closed-loop control of general anesthesia. The control system exploits the bispectral index scale as feedback variable and regulates the coadministration of propofol and remifentanil. The experiments have been conducted on fourteen patients under condi...

Background To date cardiac arrest (CA) remains a frequent cause of morbidity and mortality: despite advances in cardiopulmonary resuscitation (CPR), survival is still burdened by hypoxic–ischemic brain injury (HIBI), and poor neurological outcome, eventually leading to withdrawal of life sustaining treatment (WLST). The aim of CPR is cardiac pump s...

Adult and pediatric palliative care (PC) share common aims and ethical principles but differ in many organizational and practical aspects. The aim of this narrative review is to analyze these differences and focus on which key aspects of pediatric palliative care could integrate adult services for a better care of suffering patients. Interventions...

Introduction Out-of-hospital cardiac arrest is burdened with a high rate of ineffective resuscitation and poor neurological outcome among survivors. To date, there are few perfusion assessment tools during cardiopulmonary resuscitation and none of them provide reliable data. Despite the lack of information, physicians must decide whether to extend...

The outcome for critically ill patients is burdened by a double mortality rate and a longer hospital stay in the case of sepsis or septic shock. The adequate use of antibiotics may impact on the outcome since they may affect the pharmacokinetics (Pk) and pharmacodynamics (Pd) of antibiotics in such patients. Acute renal failure (ARF) occurs in abou...

Excessive sedation is associated with poor outcome in critically ill acute respiratory distress syndrome (ARDS) patients. Whether this prognostic effect varies among ARDS patients with and without COVID-19 has yet to be determined. We compared the prognostic value of excessive sedation—in terms of delirium, length of stay in intensive care unit (IC...

Background Alternative noninvasive methods capable of excluding intracranial hypertension through use of transcranial Doppler (ICP tcd ) in situations where invasive methods cannot be used or are not available would be useful during the management of acutely brain-injured patients. The objective of this study was to determine whether ICP tcd can be...

Survival has been considered the cornerstone for clinical outcome evaluation in critically ill patients admitted to intensive care unit (ICU). There is evidence that ICU survivors commonly show impairments in long-term outcomes such as quality of life (QoL) considering them as the most relevant ones. In the last years, the concept of patient-import...

Background Long-term weakness is common in survivors of COVID-19–associated acute respiratory distress syndrome (CARDS). We assessed the predictors of muscle weakness in patients evaluated at 3, 6, and 12 months after intensive care unit discharge with in-person visits. Methods Muscle strength was measured by isometric maximal voluntary contractio...

The vital status of people with a destroyed brain is one of the most discussed topics in medical literature. According to the current legal narrative, people whose brain is destroyed are dead. Nevertheless, a clear biological rationale to support with certainty such a narrative is still lacking. The purported rational of the "the brain as the centr...

Background and Objective: The automatic control of anesthesia is a demanding task mostly due to the presence of nonlinearities, intra- and inter-patient variability and specific clinical requirements to be meet. The traditional approach to achieve the desired depth of hypnosis level is based on knowledge and experience of the anesthesiologist. In c...

Background: The evaluation of COVID-19 systemic consequences is a wide research field in which respiratory function assessment has a pivotal role. However, the available data in the literature are still sparse and need further strengthening. Aim: To assess the respiratory function 4-6 months after hospital discharge according to lung disease sev...

Background The current organizational structure of the Italian healthcare system does not include the institutionalization of clinical ethics services. To describe the need for structured clinical ethics consultation services for ICU staff members in the intensive care unit (ICU), a monocentric observational survey study was performed utilizing a p...

In this paper, a model predictive control system for the depth of hypnosis is proposed and analyzed. This approach considers simultaneous co-administration of the hypnotic and analgesic drugs and their effect on the Bispectral Index Scale (BIS). The control scheme uses the nonlinear multiple-input–single-output (MISO) model to predict the remifenta...

Many patients admitted to the Intensive Care Unit (ICU) develop severe weakness, so called ICU-acquired weakness (ICUAW). This is a serious condition with both short- and long-term consequences for the patient. In this chapter, the current knowledge on pathophysiology is discussed. Furthermore, diagnostic criteria and important differential diagnos...

Purpose Limb intensive care unit (ICU)-acquired weakness (ICUAW) and ICU acquired diaphragm weakness (DW) occur frequently in mechanically ventilated (MV) patients; their coexistence in cooperative and uncooperative patients is unknown. This study was designed to (1) describe the co-occurrence of the two conditions (2) evaluate the impact of ICUAW...

Background: Many single cases and small series of Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection were reported during the COVID-19 outbreak worldwide. However, the debate regarding the possible role of infection in causing GBS is still ongoing. This multicenter study aimed to evaluate epidemiological and clinical findings of GB...

Objective In many institutions, intensive care unit (ICU) nurses assess their patients’ muscle function as part of their routine bedside examination. We tested the research hypothesis that this subjective examination of muscle function prior to extubation predicts tracheostomy requirement. Methods Adult, mechanically ventilated patients admitted t...

Importance: Trials often assess primary outcomes of traumatic brain injury at 6 months. Longer-term data are needed to assess outcomes for patients receiving surgical vs medical treatment for traumatic intracranial hypertension. Objective: To evaluate 24-month outcomes for patients with traumatic intracranial hypertension treated with decompress...

Background: Sports-related concussion (SRC) is a subset of mild traumatic brain injuries occurring in contact sports. Most people recover spontaneously, but in retired professional players, the risk for neurodegenerative diseases is increased. A biomarker, such as neurofilament light chains (NfL), would help to address this issue and demonstrate s...

We carried out a prospective and retrospective case series study to compare physical outcome performance with an in-person evaluation of 248 COVID-related ARDS (CARDS) patients and 48 classic ARDS patients. At 6 months, patients with classic ARDS compared to CARDS had lower MRCss, handgrip dynamometry, and 6 Minutes Walk Test. Fatigue was more freq...

In this paper we present a new model predictive control system for the depth of hypnosis in general anesthesia. The depth of hypnosis is measured by the Bispectral Index Scale signal and controlled through propofol administration. The proposed control scheme is based on an external predictor that, by exploiting the Wiener structure of the pharmacok...

Background and objective: Many methodologies have been proposed for the control of total intravenous anesthesia in general surgery, as this yields a reduced stress for the anesthesiologist and an increased safety for the patient. The objective of this work is to design a PID-based control system for the regulation of the depth of hypnosis by propo...

Background Lombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the...

In this paper we propose a methodology for a patient-individualized tuning of the parameters of a proportional–integral–derivative (PID) controller that regulates the depth of hypnosis in the maintenance phase of general anesthesia. In particular, we consider a PID controller employed in a closed-loop multiple-input–single-output (MISO) control sys...

The post-intensive care syndrome (PICS) is a major health problem which impairs the quality of life of patients surviving an acute illness and that of their families and has a huge impact on the whole society. With decreasing ICU mortality observed in the last decades, the number of surviving patients is anticipated to increase, as is the number of...

Intensive care survivors often experience post-intensive care sequelae, which are frequently gathered together under the term “post-intensive care syndrome” (PICS). The consequences of PICS on quality of life, health-related costs and hospital readmissions are real public health problems. In the present Viewpoint, we summarize current knowledge and...

Background: Tocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients. Methods: A multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days...

The exact incidence of neurological and cognitive sequelae of COVID-19 in the long term is yet unknown. The aim of this research is to investigate the type of neurological and cognitive impairment in COVID-19 cases of different severity. Two hundred fifteen patients, who had developed COVID-19, were examined 4 months after the diagnosis by means of...

Coronavirus disease 2019 (COVID-19) has caused more than 175 million persons infected and 3.8 million deaths so far and is having a devastating impact on both low and high-income countries, in particular on hospitals and intensive care units (ICU). The ICU mortality during the first pandemic wave ranged from 40% to 85% during the busiest ICU period...

We report on the outcome of 114 COVID-19-associated acute respiratory distress syndrome (ARDS) survivors evaluated at 3, 6 and 12 months after intensive care unit discharge with assessment of physical, mental and cognitive impairments. Critical illness polyneuromyopathy was diagnosed in 23 patients (39%). Handgrip dynamometry was 70% predicted at 3...

Pressure support ventilation (PSV) should be titrated considering the pressure developed by the respiratory muscles (Pmusc) to prevent under- and over-assistance. The esophageal pressure (Pes) is the clinical gold standard for Pmusc assessment, but its use is limited by alleged invasiveness and complexity. The least square fitting method and the en...

Backgrounds The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was...

OBJECTIVES:. To describe the epidemiology of superinfections (occurring > 48 hr after hospital admission) and their impact on the ICU and 28-day mortality in patients with coronavirus disease 2019 with acute respiratory distress syndrome, requiring mechanical ventilation. DESIGN:. Retrospective analysis of prospectively collected observational data...

Background The evaluation of patient effort is pivotal during pressure support ventilation, but a non-invasive, continuous, quantitative method to assess patient inspiratory effort is still lacking. We hypothesized that the concavity of the inspiratory flow-time waveform could be useful to estimate patient’s inspiratory effort. The purpose of this...

Background Previous studies unveiled a relation between the severity of COVID‐19 pneumonia and obesity. The aims of this multicenter retrospective cohort study were to disentangle the association of BMI and associated metabolic risk factors (diabetes, hypertension, hyperlipidemia, current smoking) in critically ill patients with COVID‐19. Methods...

Link to download: https://authors.elsevier.com/a/1d3l83kuropRla Introduction Neuromuscular impairment (NMI) affects almost half of critically ill patients. The purpose was to investigate the role of neuromuscular electrical stimulation (NMES) to gain more insight into the nature of the NMI associated with ICU admission. To this aim, we analyzed th...

Objective We propose the use of an optimization strategy for the determination of the initial propofol bolus for the induction phase of general anesthesia. Methods The optimized bolus minimizes the time-to-target and it is used as a feedforward action together with a specifically tuned PID feedback control system where the bispectral index is the...

Background although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality. Objective to examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect thes...

In this paper we present the preliminary clinical results obtained with a PID control scheme for propofol and remifentanil coadministration during general anesthesia. The bispectral index scale is the only process variable, and the extra degree of freedom in the control architecture is handled by introducing an appropriate ratio between the infusio...

Background: Pars Plana Vitrectomy (PPV), a surgical procedure used to treat different ophthalmic pathologies, could be associated with moderate to severe eye pain The aim of the present study was to evaluate the incidence of postoperative eye pain and its risk factors following Pars Plana Vitrectomy (PPV) in a selected population of patients with...

Background COVID-19 causes acute respiratory distress syndrome (ARDS) and depletes the lungs of surfactant, leading to prolonged mechanical ventilation and death. The feasibility and safety of surfactant delivery in COVID-19 ARDS patients have not been established. Methods We performed retrospective analyses of data from patients receiving off-lab...

Objectives: It is unclear whether early mobilization in the surgical ICU helps improve patients' functional recovery to a level that enables independent living. We assessed dose of mobilization (level + duration). We tested the research hypotheses that dose of mobilization predicts adverse discharge and that both duration of mobilization and maxim...

Rationale: Treatment with non-invasive ventilation (NIV) in COVID-19 is frequent. Shortage of Intensive care unit (ICU) beds led clinicians to deliver NIV also outside intensive care units (ICUs). Data about the use of NIV in COVID-19 is limited. Objective: To describe the prevalence and clinical characteristics of patients with COVID-19 treated w...

In this paper we investigate a novel tuning methodology for a patient-individualized selection of the parameters of a proportional-integral-derivative (PID) controller that regulates the maintenance phase of general anesthesia. In particular, the knowledge of demographic data is exploited to determine the values of the parameters for each specific...

In the practice of total intravenous anesthesia, the regulation of the balance between opioid and hypnotic drugs is fundamental since it has a significant impact on depth of hypnosis and hemodynamics. Therefore, in the implementation of a fully automated control system for anesthesia, this aspect must be considered. In a recently devised PID-based...

In this paper we propose the use of an optimization strategy for the computation of an optimized reference (command) input to be applied to a proportional-integral-derivative (PID) based closed-loop control system for the administration of propofol during the induction phase of general anesthesia. The bispectral index scale (BIS) is the controlled...

In this study, the authors present robust tuning rules for an event‐based control architecture for the automatic regulation of the depth of hypnosis in anaesthesia. The authors' control system uses propofol and remifentanil coadministration as control variables and the bispectral index as controlled variable. The control system is based on a PIDPlu...

With 63,098 confirmed cases on 17 April 2020 and 11,384 deaths, Lombardy has been the most affected region in Italy by coronavirus disease 2019 (coviD-19). to cope with this emergency, the coviD-19 lombardy intensive care units (ICU) network was created. The network identified the need of defining a list of clinical recommendations to standardize t...

Background: Excessive sedation has been associated with poor outcome in critically-ill patients with acute respiratory Distress Syndrome (ARDS). The on-going pandemic has seen many critically-ill COVID-19 with ARDS, yet the incidence of excessive sedation and its association to delirium in these patients has to date not been assessed. We aimed at c...

Background: The diagnosis of healthcare-associated ventriculitis and meningitis (HAVM) is challenging in the ICU setting. Traditional cerebrospinal fluid (CSF) markers and clinical signs of infection fail to diagnose HAVM in the critically ill setting. We sought to determine the diagnostic accuracy of measuring levels of high-mobility group box 1...

Objective Single cases and small series of Guillain-Barré syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19. Methods GBS cases diagnosed in 12 referral hospitals...

Background and Objective: Cerebral microdialysis (CMD) enables monitoring brain tissue metabolism and risk factors for secondary brain injury such as an imbalance of consumption, altered utilization, and delivery of oxygen and glucose, frequently present following spontaneous intracerebral hemorrhage (SICH). The aim of this study was to evaluate th...

Background. COVID-19 causes acute respiratory distress syndrome (ARDS) and depletes the lungs of surfactant, leading to prolonged mechanical ventilation and death. The feasibility and safety of surfactant delivery in COVID-19 ARDS patients have not been established. Methods. We performed retrospective analyses of data from patients receiving off-la...

Importance Many patients with coronavirus disease 2019 (COVID-19) are critically ill and require care in the intensive care unit (ICU). Objective To evaluate the independent risk factors associated with mortality of patients with COVID-19 requiring treatment in ICUs in the Lombardy region of Italy. Design, Setting, and Participants This retrospec...

Coronavirus disease 2019 emergency has created an enormous stress on providers that have been transformed into coronavirus disease hospitals. This article presents the experience of the clinical laboratory of Spedali Civili in Brescia (a teaching hospital in Lombardy with over 1500 beds) in managing the crisis, and to offer practical considerations...

A hyperinflammatory syndrome (HIS) may cause a life-threatening acute respiratory distress syndrome (ARDS) in patients with COVID-19 pneumonia. A prospective series of 100 consecutive patients admitted to the Spedali Civili University Hospital in Brescia (Italy) between March 9th and March 20th with confirmed COVID-19 pneumonia and ARDS requiring v...

The Brescia-COVID respiratory severity scale/algorithm is a stepwise management approach to COVID-19 patients based on clinical severity. The BCRSS was rapidly developed in Brescia, Italy, during that nation's COVID-19 crisis. The scale has not been validated or tested in other populations. The BCRSS uses patient examination features along with the...

Importance In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited. Objective To characterize patients with coronavirus disease 2019 (C...

Objectives Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design This is a cross-sectional study nested in the “Delirium Day” study, a nationwide Italian poin...

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease (COVID-19) is a major pandemic challenging health care systems around the world. The optimal management of COVID-19 infected patients is still unclear, although the consensus is moving towards the need of a biphasic approach. During the first phase o...

Purpose An ongoing pandemic of COVID-19 that started in Hubei, China has resulted in massive strain on the healthcare infrastructure in Lombardy, Italy. The management of these patients is still evolving. Materials and methods This is a single-center observational cohort study of critically ill patients infected with COVID-19. Bedside clinicians a...

Intensive care unit-acquired weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients. We discuss critical aspects of ICU-AW that have not been completely defined or that are still under discussion. Critical illness polyneuropathy, myopathy, and muscle atrophy contribute in various proportions to ICU-AW. Diagnosis of...

Critically ill patients often acquire neuropathy and/or myopathy labeled ICU-acquired weakness. The current insights into incidence, pathophysiology, diagnostic tools, risk factors, short- and long-term consequences and management of ICU-acquired weakness are narratively reviewed. PubMed was searched for combinations of “neuropathy”, “myopathy”, “n...

Background: Post-traumatic cerebral infarction (PTCI) is common after traumatic brain injury (TBI). It is unclear what the occurrence of a PTCI is, how it impacts the long-term outcome, and whether it adds incremental prognostic value to established outcome predictors. Methods: This was a prospective multicenter cohort study of moderate and seve...

Acute neuromuscular complications are common during critical illness, particularly among the most severe intensive care unit (ICU) patients with prolonged stay and mechanical ventilation, and those developing sepsis and multiple organ dysfunctions [1]. Lung, kidney, brain, and the circulatory and coagulation systems are traditionally reported as th...