Sex-related mortality differences in young adult septic shock patients

Septic shock survival rate and host immune response are intimately interlaced. In the last years, biological and pre-clinical studies demonstrated sex-specific differences in the immune response to infection. In the hypothesis that survival rate is related to the hormonal framework, the aim of the present study was to observe sex-specific differences in 28-day mortality rate between women of childbearing potential and same-age men. This multicenter study was conducted in six Italian intensive care units (ICUs). We enrolled consecutive patients ≤ 55 years old admitted to the Intensive Care Unit from January 2011 to January 2020, who were diagnosed with septic shock at the time of ICU admission or during the ICU stay. We gathered baseline characteristics and outcomes. The primary outcome was 28-day mortality; secondary outcomes included ICU mortality, in-hospital mortality and length of stay in the ICU and in the hospital. Moreover, data from >55 years old patients were collected and analyzed. We enrolled 361 young patients with septic shock: 215 were males (60%) and 146 females (40%). While baseline and ICU characteristics were similar between the two groups, males had a higher 28-day mortality rate (39.5% vs. 29%, p = 0.035), ICU mortality rate (49% vs. 38%, p = 0.040) and hospital mortality rate (61% vs. 50%, p = 0.040) as compared to females. Findings were confirmed in patients with septic shock at ICU admission. Young adult females developed septic shock less frequently than young males, displaying a reduced mortality rate as compared to that of their same-age male counterpart. These findings may stimulate future research and therapies

Assessing vaccination intentions and perceptions among pregnant women in Italy: A multicenter cross-sectional study in the context of mandatory policies and the COVID-19 pandemic

Background/objectives: Vaccinations significantly reduce the incidence of preventable diseases. Despite their benefits, childhood vaccination rates have declined in Italy since the mid-2010s, prompting the government to mandate certain vaccinations. This cross-sectional study aims to assess the intention to vaccinate their children and the perception of mandatory vaccinations among pregnant women in Italy after the COVID-19 pandemic and post-mandatory vaccination policies. Methods: Participants over 18 years old recruited from 18 cities in Italy completed a questionnaire covering socio-demographic information, vaccination intentions, sources of information, and trust in vaccinations and the healthcare system. Descriptive analyses of the intention to vaccinate their children were carried out, and logistic regressions were performed to identify predictors of being in favor of mandatory vaccinations. Results: Out of 2472 women, 98.8 % intended to vaccinate their upcoming children. High intentions were reported for rubella (91.7 %), measles (91.0 %), hepatitis B (90.4 %), and pertussis (90.4 %), while only 30.3 % intended to vaccinate against COVID-19. Healthcare professionals were the most trusted source of information. A total of 89.1 % of the women were in favor of mandatory vaccinations. Multivariable regression indicated that higher knowledge, risk perception, and trust scores were significant predictors of support for mandatory vaccinations. Conclusions: These findings highlight the crucial role of healthcare professionals in shaping positive vaccination intentions, providing valuable insights for policymakers seeking to enhance vaccination coverage in the post-pandemic era

Survey of Thoracic Anesthetic Practice in Italy

OBJECTIVE: The object of this study was to conduct and analyze the output of a survey involving a cohort of all Italian hospitals performing thoracic surgery to gather data on anesthetic management, one-lung ventilation (OLV) management, and post-thoracotomy pain relief in thoracic anesthesia. DESIGN: Survey. SETTING: Italy. PARTICIPANTS: An invitation to participate in the survey was e-mailed to all the members of the Italian Society of Anesthesia and Intensive Care Medicine. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: A total of 62 responses were received from 47 centers. The key findings were: Double-lumen tube is still the first choice lung separation technique in current use; pressure-controlled ventilation and volume-controlled ventilation modes are homogenously distributed across the sample and, a tidal volumes (VT) of 4-6 mL/kg during OLV was preferred to all others; moderate or restrictive fluid management were the most used strategies of fluid administration in thoracic anesthesia; thoracic epidural analgesia represented the "gold standard" for post-thoracotomy pain relief in combination with intravenous analgesia. CONCLUSION: The results of this survey showed that Italian anesthesiologist follow the recommended standard of care for anesthetic management during OLV

Predictive Value of Intraoperative Doppler Flowmetry for Delayed Graft Function in Kidney Transplantation: A Pilot Study

Background: The delayed graft function (DGF) in kidney transplantation (KT) is a risk factor for long-term poor graft survival. The pathogenesis is multifactorial but mainly related to an ischemia-reperfusion injury. However, the graft hemodynamics have been recently identified as a key aspect for early DGF risk assessment and potential therapeutic intervention. Methods: A pilot study on 20 single kidney grafts from donor after brain death with intraoperative measurement of graft arterial flowmetry, 30 minutes after reperfusion. Exclusion criteria were grafts with multiple arteries or severe atherosclerosis of the recipient's external iliac artery. Results: KT recipients with DGF (n = 4, 20%) were homogenous with controls (n = 16) in terms of cold ischemia time, donor age, recipients' hemodynamic parameters, renal artery, and recipients' external iliac artery diameters. Nonetheless, at transplant, the kidney grafts that developed DGF were characterized by a significantly higher renal artery resistive index (DGF vs no-DGF 0.96 \ub1 0.04 vs 0.77 \ub1 0.13, P = .02), as well as lower flow extraction rate (24.8% \ub1 11.8 vs 59.2% \ub1 21.1, P < .01). Conclusions: Intraoperative arterial graft flowmetry seems to be an effective tool to identify grafts at high risk of DG