Papers by Davide Corbella
Iranian Red Crescent Medical Journal, Aug 5, 2020
Background: The Coronavirus Disease 2019 (COVID-19) pandemic has necessitated the alteration of t... more Background: The Coronavirus Disease 2019 (COVID-19) pandemic has necessitated the alteration of the organization of entire hospitals to try to prevent them from becoming epidemiological clusters. The adopted diagnostic tools lack sensitivity or specificity. Objectives: The aim of the study was to create an easy-to-get risk score (Ri.S.I.Co., risk score for infection with the new coronavirus) developed on the field to stratify patients admitted to hospitals according to their risk of COVID-19 infection. Methods: In this prospective study, we included all patients who were consecutively admitted to the suspected COVID-19 department of the Bufalini Hospital, Cesena (Italy). All clinical, radiological, and laboratory predictors were included in the multivariate logistic regression model to create a risk model. A simplified model was internally and externally validated, and two score thresholds for stratifying the probability of COVID-19 infection were introduced. Results: From 11th March to 5th April 2020, 200 patients were consecutively admitted. A Ri.S.I.Co lower than 2 showed a higher sensitivity than SARS-Cov-2 nucleic acid detection (96.2% vs. 65.4%; P < 0.001). The presence of ground-glass pattern on the lung-CT scan had a lower sensitivity than a Ri.S.I.Co lower than 2 (88.5% vs. 96.2%; P < 0.001) and a lower specificity than a Ri.S.I.Co higher than 6 (75.0% vs. 96.9%; P < 0.001). Conclusions: We believe that the Ri.S.I.Co could allow to stratify admitted patients according to their risk, preventing hospitals from becoming the main COVID-19 carriers themselves. Furthermore, it could guide clinicians in starting therapies early in severeonset cases with a high probability of COVID-19, before molecular SARS-CoV-2 infection is confirmed.
Hot Topics in Acute Care Surgery and Trauma, Jun 23, 2017
Venous thromboembolism, pulmonary embolism, and deep venous thrombosis are severe complications o... more Venous thromboembolism, pulmonary embolism, and deep venous thrombosis are severe complications of surgical patients. Sepsis is associated with hemostatic changes leading to a subclinical activation of coagulation (hypercoagulability) that may contribute to localized venous thromboembolism. Patients with abdominal sepsis may be at increased risk of venous thromboembolism due to their premorbid conditions; surgical intervention; admitting diagnosis of sepsis, events, and exposures in the intensive care unit such as central venous catheterization and invasive tests and procedures; and drugs that potentiate immobility.
International Journal of Surgery, Dec 1, 2015
h i g h l i g h t s Acute cholecystitis should be attempted by laparoscopy at first. Post-operati... more h i g h l i g h t s Acute cholecystitis should be attempted by laparoscopy at first. Post-operative morbidity, mortality and hospital stay are reduced by laparoscopic cholecystectomy. Severe hemorrhage rate is not influenced by the operative technique.
Cancer and oncology research, Mar 1, 2014
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure have demonstrated t... more Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure have demonstrated their efficacy in treating patients with diffused peritoneal carcinomatosis. As a counterpart patients face major and life threatening derangements of their hemodynamic, respiratory and metabolic physiologic balance during the surgery and in the immediate postoperative period. All these derangements demonstrated to be mild and short-lived in the majority of patients when timely addressed. Anesthesiologists, intensive care physicians and surgeons are involved in providing surveillance and organ support till the patient is effectively weaned after the operation. Moreover they are involved in pain control, metabolic and nutritional support. A malnourished state is common due to wasting syndrome from the tumor, difficult feeding and massive ascites. Lastly physicians need to be aware of the quality of life impact of this procedure.
Hot Topics in Acute Care Surgery and Trauma, 2018
Despite the long-standing experience in staged closure and open abdomen treatment, there is a wid... more Despite the long-standing experience in staged closure and open abdomen treatment, there is a wide spread reluctance to implement these treatments in the pediatric pediatric patients. Whereas the open abdomen has a sound and recognized role in the adult literature, the pediatric one lags behind showing that: • Intra-abdominal pressure is not measured on a routine basis. • Cutoff of intra-abdominal hypertension is often not standardized in the clinical practice. • The definition of abdominal compartment syndrome appears to be not so well understood in the pediatric intensivist community. • Open abdomen treatment is often reserved for "hopeless" cases with poor results.
Pediatric Transplantation, Jul 5, 2017
Intraoperative transfusions seem associated with patient death and graft failure after PLTx. A re... more Intraoperative transfusions seem associated with patient death and graft failure after PLTx. A retrospective analysis of recipients' and donors' characteristics and transplantation data in a cohort of patients undergoing PLTx from 2002 to 2013 at the Bergamo General Hospital was performed. A two-stage hierarchical Cox proportional hazard regression with forward stepwise selection was used to identify the main risk factors for major complications. In addition, propensity score analysis was used to adjust risk estimates for possible selection biases in the use of blood products. Over the 12-year period, 232 pediatric cirrhotic patients underwent PLTx. One-year patient and graft survival rates were 92.3% and 83.7%, respectively. The Kaplan-Meier shows that the main decrease in both graft and patient survival occurs during the first months posttransplantation. At the same time, it appears that most of the complications occur during the first month post-transplantation. One-month and 1-year patient complication-free survival rates were 24.8% and 12.1%, respectively. Our study shows that intraoperative red blood cells and platelet transfusions are independent risk factors for developing one or more major complications in the first year after PLTx. Decreasing major complications will improve the health status and overall long-term patient survival after pediatric PLTx.
BMC Anesthesiology, Sep 1, 2022
BMC Pulmonary Medicine
Background Coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS... more Background Coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) seems to differ from the “classic ARDS”, showing initial significant hypoxemia in the face of relatively preserved compliance and evolving later in a scenario of poorly compliant lungs. We tested the hypothesis that in patients with COVID-19 ARDS, the initial value of static compliance of respiratory system (Crs) (1) depends on the previous duration of the disease (i.e., the fewer days of illness, the higher the Crs and vice versa) and (2) identifies different lung patterns of time evolution and response to prone positioning. Methods This was a single-center prospective observational study. We enrolled consecutive mechanically ventilated patients with a diagnosis of COVID-19 who met ARDS criteria, admitted to intensive care unit (ICU). Patients were divided in four groups based on quartiles of initial Crs. Relationship between Crs and the previous duration of the disease was evaluated....
We present a case of an 11-years old child who underwent several plastic procedures for massive s... more We present a case of an 11-years old child who underwent several plastic procedures for massive skin necrosis of the right forearm. Pain control was achieved combining a thoracic epidural and a continuous brachial plexus block. The patient was successfully weaned from chronic opiates. Possible advantages (i.e. improved graft perfusion, speeded opiates weaning) and disadvantages (i.e. local anesthetic toxicity) of this combined approach are briefly discussed.
World Journal of Emergency Surgery, 2021
On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health ... more On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
World Journal of Emergency Surgery, Feb 15, 2019
Background: Trauma-induced coagulopathy is one of the most difficult issues to manage in severely... more Background: Trauma-induced coagulopathy is one of the most difficult issues to manage in severely injured patients. The plasma efficacy in treating haemorrhagic-shocked patients is well known. The debated issue is the timing at which it should be administered. Few evidences exist regarding the effects on mortality consequent to the use of plasma alone given in pre-hospital setting. Recently, two randomized trials reported interesting and discordant results. The present paper aims to analyse data from those two randomized trials in order to obtain more univocal results. Methods: A systematic review with meta-analysis of randomized controlled trials (RCTs) of pre-hospital plasma vs. usual care in patients with haemorrhagic shock. Results: Two high-quality RCTs have been included with 626 patients (295 in plasma and 331 in usual care arm). Twenty-four-hour mortality seems to be reduced in pre-hospital plasma group (RR = 0.69; 95% CI = 0.48-0.99). Pre-hospital plasma has no significant effect on 1-month mortality (RR = 0.86; 95% CI = 0.68-1.11) as on acute lung injury and on multi-organ failure rates (OR = 1.03; 95% CI = 0.71-1.50, and OR = 1.30; 95% CI = 0.92-1.86, respectively). Conclusions: Pre-hospital plasma infusion seems to reduce 24-h mortality in haemorrhagic shock patients. It does not seem to influence 1-month mortality, acute lung injury and multi-organ failure rates. Level of evidence: Level I Study type: Systematic review with Meta-analysis
World Journal of Emergency Surgery : WJES, 2021
An amendment to this paper has been published and can be accessed via the original article.
World journal of emergency surgery : WJES, 2014
Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging fr... more Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.
International Journal of Surgery, 2015
Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) i... more Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no definitive data on its use in AC has been published. CIAO and CIAOW studies demonstrated 48.7% of AC were still operated with the open technique. The aim of the present meta-analysis is to compare OC and LC in AC. A systematic-review with meta-analysis and meta-regression of trials comparing open vs. laparoscopic cholecystectomy in patients with AC was performed. Electronic searches were performed using Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR) and CINAHL. Ten trials have been included with a total of 1248 patients: 677 in the LC and 697 into the OC groups. The post-operative morbidity rate was half with LC (OR = 0.46). The post-operative wound infection and pneumonia rates were reduced by LC (OR 0.54 and 0.51 respectively). The post-operative mortality rate was reduced by LC (OR = 0.2). The mean postoperative hospital stay was significantly shortened in the LC group (MD = -4.74 days). There were no significant differences in the bile leakage rate, intraoperative blood loss and operative times. In acute cholecystitis, post-operative morbidity, mortality and hospital stay were reduced by laparoscopic cholecystectomy. Moreover pneumonia and wound infection rate were reduced by LC. Severe hemorrhage and bile leakage rates were not influenced by the technique. Cholecystectomy in acute cholecystitis should be attempted laparoscopically first.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure have demonstrated t... more Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure have demonstrated their efficacy in treating patients with diffused peritoneal carcinomatosis. As a counterpart patients face major and life threatening derangements of their hemodynamic, respiratory and metabolic physiologic balance during the surgery and in the immediate postoperative period. All these derangements demonstrated to be mild and short-lived in the majority of patients when timely addressed. Anesthesiologists, intensive care physicians and surgeons are involved in providing surveillance and organ support till the patient is effectively weaned after the operation. Moreover they are involved in pain control, metabolic and nutritional support. A malnourished state is common due to wasting syndrome from the tumor, difficult feeding and massive ascites. Lastly physicians need to be aware of the quality of life impact of this procedure.
Venous thromboembolism, pulmonary embolism, and deep venous thrombosis are severe complications o... more Venous thromboembolism, pulmonary embolism, and deep venous thrombosis are severe complications of surgical patients. Sepsis is associated with hemostatic changes leading to a subclinical activation of coagulation (hypercoagulability) that may contribute to localized venous thromboembolism. Patients with abdominal sepsis may be at increased risk of venous thromboembolism due to their premorbid conditions; surgical intervention; admitting diagnosis of sepsis, events, and exposures in the intensive care unit such as central venous catheterization and invasive tests and procedures; and drugs that potentiate immobility.
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Papers by Davide Corbella