Pietro Tuo
Istituto Giannina Gaslini
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Featured researches published by Pietro Tuo.
Pediatrics International | 2007
Giancarlo Ottonello; Ilaria Ferrari; Ines Maria Grazia Pirroddi; Maria Cristina Diana; Giovanna Villa; Laura Nahum; Pietro Tuo; Andrea Moscatelli; Gilberto Silvestri
Background: Home care support is beneficial for children needing mechanical ventilation, when clinically stable.
Anesthesiology | 2015
Andrew Davidson; Neil S. Morton; Sarah J Arnup; Jurgen C. de Graaff; Nicola Disma; Davinia E. Withington; Geoff Frawley; Rodney W. Hunt; Pollyanna Hardy; Magda Khotcholava; Britta S von Ungern Sternberg; Niall Wilton; Pietro Tuo; Ida Salvo; Gillian D Ormond; Robyn Stargatt; Bruno Guido Locatelli; Mary Ellen McCann; Katherine Lee; Suzette Sheppard; Penelope L Hartmann; Philip Ragg; Marie Backstrom; David Costi; Britta S. von Ungern-Sternberg; Graham Knottenbelt; Giovanni Montobbio; Leila Mameli; Gaia Giribaldi; Alessio Pini Prato
Background:Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods:Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born less than 26 weeks gestation. The primary outcome of this analysis was any observed apnea up to 12 h postoperatively. Apnea assessment was unblinded. Results:Three hundred sixty-three patients were assigned to RA and 359 to GA. Overall, the incidence of apnea (0 to 12 h) was similar between arms (3% in RA and 4% in GA arms; odds ratio [OR], 0.63; 95% CI, 0.31 to 1.30, P = 0.2133); however, the incidence of early apnea (0 to 30 min) was lower in the RA arm (1 vs. 3%; OR, 0.20; 95% CI, 0.05 to 0.91; P = 0.0367). The incidence of late apnea (30 min to 12 h) was 2% in both RA and GA arms (OR, 1.17; 95% CI, 0.41 to 3.33; P = 0.7688). The strongest predictor of apnea was prematurity (OR, 21.87; 95% CI, 4.38 to 109.24), and 96% of infants with apnea were premature. Conclusions:RA in infants undergoing inguinal herniorrhaphy reduces apnea in the early postoperative period. Cardiorespiratory monitoring should be used for all ex-premature infants.
Digestive Diseases and Sciences | 2006
Girolamo Mattioli; Alessio Pini-Prato; Valerio Gentilino; Enrica Caponcelli; Stefano Avanzini; Stefano Parodi; Giovanni A. Rossi; Pietro Tuo; Paolo Gandullia; Claudio Vella; V. Jasonni
This paper describes multiple intraluminal impedance (MII) in 50 children with typical and atypical gastroesophageal reflux (GER) symptoms and discusses the possible clinical significance of objective numeric data provided by MII computed analysis. Patients underwent 24-hr pH/MII monitoring. Reflux parameters were analyzed with relation to age and reported symptoms. Nonacidic MII events occurred as frequently as acidic ones. A Pathologic Bolus Exposure Index associated with a normal pH Reflux Index was detected in 26% of our series. Significant correlations were found regarding acid and bolus clearing times and their ratio.We conclude that the low rate of symptom occurrence in the pediatric population represents a limit on MII evaluation. Our study confirmed that nonacid GER is at least as frequent as acid GER. As MII provides interesting objective data that could be used in clinical practice, we suggest further research to define normal ranges in the pediatric population.
Pediatric Critical Care Medicine | 2010
Andrea Moscatelli; Giancarlo Ottonello; Laura Nahum; Elisabetta Lampugnani; Franco Puncuh; Alessandro Simonini; Miriam Tumolo; Pietro Tuo
Objective: To report the successful management of end-stage hypercapnic respiratory failure through the association of noninvasive mechanical ventilation and a novel automated device (Decapsmart) of low-flow veno-venous extracorporeal CO2 removal. Design: Case report. Settings: Pediatric intensive care unit at a tertiary care childrens hospital. Patient: A pediatric patient affected by bronchiolitis obliterans with refractory hypercapnic respiratory failure. The patient received successful lung transplantation after respiratory support with noninvasive mechanical ventilation and a novel automated device of low-flow veno-venous extracorporeal CO2 removal. Interventions: Treatment of end-stage hypercapnic respiratory failure with the association of noninvasive ventilation and low-flow veno-venous extracorporeal CO2 removal as a bridge to lung transplantation. Measurements and Main Results: Respiratory support controlling hypercapnia, limiting volutrauma, barotraumas, and preventing the incidence of ventilator-associated pneumonia/lung colonization. Conclusion: Noninvasive mechanical ventilation and Decapsmart have proven efficacious in managing refractory hypercapnic respiratory failure in a pediatric patient awaiting lung transplantation.
Pediatric Anesthesia | 2011
Nicola Disma; Geoff Frawley; Leila Mameli; Angela Pistorio; Ornella D. Casa Alberighi; G. Montobbio; Pietro Tuo
Background: Clonidine has the potential to significantly prolong the duration of caudal epidural anesthesia. We investigated the effect of the addition of clonidine to the MLAC of levobupivacaine in a randomized controlled dose–response trial.
Anesthesiology | 2015
Geoff Frawley; Graham Bell; Nicola Disma; Davinia E. Withington; Jurgen C. de Graaff; Neil S. Morton; Mary Ellen McCann; Sarah J Arnup; Oliver Bagshaw; Andrea Wolfler; David C. Bellinger; Andrew Davidson; Pollyanna Hardy; Rodney W. Hunt; Robyn Stargatt; Gillian D Ormond; Penelope L Hartmann; Philip Ragg; Marie Backstrom; David Costi; Britta S. von Ungern-Sternberg; Niall Wilton; Graham Knottenbelt; Giovanni Montobbio; Leila Mameli; Pietro Tuo; Gaia Giribaldi; Alessio Pini Prato; Girolamo Mattioli; Francesca Izzo
Background:Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia study compares neurodevelopmental outcomes after awake RA or GA in otherwise healthy infants. The aim of the study is to describe success and failure rates of RA and report factors associated with failure. Methods:This was a nested cohort study within a prospective, randomized, controlled, observer-blind, equivalence trial. Seven hundred twenty-two infants 60 weeks or less postmenstrual age scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural, or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, were analyzed. Possible predictors of failure were assessed including patient factors, technique, experience of site and anesthetist, and type of local anesthetic. Results:RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty-four patients required conversion to GA, and an additional 23 patients (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (odds ratio = 2.46). Conclusions:The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone.
Pediatric Anesthesia | 2009
Nicola Disma; Pietro Tuo; Marinella Astuto; Andrew Davidson
Background: Infants are noted to frequently sleep during spinal anesthesia, with a concomitant fall in Bispectral Index. However, there are suggestions that EEG derived anesthesia depth monitors have inferior performance in infants. The aim of this study was to quantify the degree of sedation during spinal anesthesia in infants using another EEG derived measure of anesthesia effect – the Cerebral State Index (CSI).
Journal of Clinical Anesthesia | 2009
Nicola Disma; Pietro Tuo; Sarah Pellegrino; Marinella Astuto
STUDY OBJECTIVE To compare the postoperative analgesia of three different concentrations of levobupivacaine for ilioinguinal/iliohypogastric (II/IH) block in children undergoing inguinal hernia repair. DESIGN Double-blind, prospective, randomized, controlled trial. SETTING Operating room and postoperative recovery area of a university hospital. PATIENTS 73 ASA physical status I and II children, aged one to 6 years, scheduled for outpatient inguinal hernia repair. INTERVENTIONS Patients were randomized to receive one of three levobupivacaine concentrations: 0.125% (L0.125), 0.25% (L0.25), or 0.375% (L0.375). All patients received standard anesthesia with sevoflurane and II/IH nerve block. MEASUREMENTS Heart rate (HR), non invasive blood pressure (NIBP), respiratory rate, end-tidal carbon dioxide concentration (ETCO(2)), and oxygen saturation via pulse oximetry (SpO(2)) were monitored during surgery. Postoperative pain scores with CHEOPS (Childrens Hospital of Eastern Ontario Pain Scale) and need for rescue analgesia postoperatively were measured and recorded. MAIN RESULTS 60 patients entered the postoperative observational period. The number of patients who received rescue analgesia was comparable in the three groups. In Group L0.125, mean CHEOPS score was significantly higher, and time to first administration of rescue analgesia was shorter, than in the other two groups (P < 0.05). Pain scores and time to first administration of rescue analgesia were comparable between Groups L0.25 and L0.375. CONCLUSIONS II/IH nerve block using 0.4 mL kg(-1) of 0.25% levobupivacaine provided satisfactory postoperative pain relief after inguinal herniorraphy.
Journal of Chemotherapy | 2009
Elio Castagnola; A. Franceschi; A.R. Natalizia; E. Mantero; Pietro Tuo
Disseminated Candida infection is a major cause of morbidity and mortality in neonatal intensive care units 1,2. Extremely Low Birth Weight (ELBW) infants are especially vulnerable to this infection, with the risk of multiple-organ localizations (heart, lung, brain, eye, kidney, liver and spleen) and death or severe sequelae 1. Appropriate antifungal therapy and prompt removal of the central venous catheter (CVC) are recommended to improve the patient’s prognosis 2-4. However, CVC removal may be a matter of concern in patients with a life-threatening clinical condition who require high-concentration total parenteral nutrition (TPn) and drugs for supportive care 4,5, and with concomitant limited availability of alternative vascular sites where a new CVC can be placed. We report here about two ELBW infants who had persistent candidemia and who had prompt removal of CVC been performed would have been placed at high risk without any vascular access available, and who were treated with a combination of caspofungin plus liposomal amphotericin B. Case 1. B.G. was born at 24 weeks, weighing 700 g, with persistent patent arteriosus duct and respiratory distress. she was not receiving fluconazole prophylaxis. At day 20 of life Candida glabrata was isolated from blood cultures taken from the CVC. Liposomal amphotericin B at 3 mg/kg/day was promptly started. Unfortunately CVC removal was not possible because of her poor clinical condition, the need for high-concentration TPn and drugs for supportive care and the difficulty in locating other vascular accesses. After 5 days of this treatment blood cultures were still positive and the patient’s condition was worsening. After parental consent caspofungin at 50 mg/m2 was added to her therapy. The patient began to improve and after 7 days her CVC was removed and another one inserted in a different place. Unfortunately, blood cultures drawn from the new access still yielded C. glabrata. Extensive diagnostic work-up for detection of meningitis, endocarditis, deep venous thrombophlebitis, endophthalmitis or other deep organ localization was performed but resulted negative. The patient still needed the catheter for therapy and therefore we decided to continue the same antifungal treatment and diagnostic work-up until the patient could feed orally or the detection of deep organ infection. The treatment was administered for another 18 days (all in the presence of positive blood cultures, but with no sign of deep organ involvement), while the patient improved, started oral feeding and therefore the CVC could be removed. in the 2 weeks after the end of therapy no positive blood culture was obtained and no signs of deep organ infection were detected. Case 2. M.J. was born at 23 week, weighing 710 g, with persistent patent arteriosus duct and respiratory distress. she was not receiving fluconazole prophylaxis. At day 19 of life Candida parapsilosis was isolated from blood cultures taken from the CVC. Liposomal amphotericin B at 3 mg/kg/day was then started. The CVC was removed and another one inserted in a different place. Unfortunately, after 3 days of treatment two sets of blood cultures still resulted positive, as was culture of the removed catheter tip. Therefore the CVC was replaced again while the patient was still receiving liposomal amphotericin B. However, even after this CVC change her clinical condition worsened and blood cultures were still positive, even in the absence of signs of deep organ localization of the infection. in the wake of our previous experience and since the patient still needed supportive care, after achieving parental consent we added caspofungin at 50 mg/m2. After this change in antifungal therapy her clinical condition started to improve even if blood cultures were still positive. The CVC was still necessary because the patient needed high-concentration TPn and therefore antifungal therapy was continued for another 44 days in the presence of persistent positive blood cultures. During this period the patient improved, grew in weight and could feed orally. The diagnostic work-up performed weekly did not show any deep organ localization of Candida spp. When the CVC could be removed the blood cultures remained negative during the following 2 weeks. Discussion: in ELBW infants candidemia represents a life-threatening infection and the persistence of REpRInt
Pediatric Cardiology | 1988
Giacomo Pongiglione; Maurizio Marasini; Gilberto Silvestri; Pietro Tuo; Dionigi Ribaldone; Bertolini A; Luigi Garello-Cantoni
SummaryIn 1983, a US National Collaborative Study (NCS) proposed criteria for the diagnosis of hemodynamically significant patent ductus arteriosus (PDA) in premature infants with respiratory distress syndrome (RDS), but the widespread use of pulsed Doppler cross-sectional echocardiography (PD-CSE) in neonatal intensive care units has made direct assessment of the ductus possible thus providing more timely therapy. We have compared the results in 30 premature infants with severe RDS, assessed according to the guidelines of the US NCS, with those in 51 infants whose PDA was diagnosed by PD-CSE. Together with a significant reduction in the age at treatment (7.8±3.9 vs 2.4±1.1 days), there was a reduced dependence on artificial ventilation (14.8±11.0 vs 7.8±2.7 days), a reduction in the number requiring surgical ligation of PDA (9 vs 2), a decreased incidence of bronchopulmonary-dysplasia (BPD) (40% vs 16%), and a reduction of unfavorable outcome of treatment (death or BPD) (76% vs 49%).