Browsing by Author "Biffl, Walter"
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Item Open Access 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation(2018-01-24) deāAngelis, Nicola; Di Saverio, Salomone; Chiara, Osvaldo; Sartelli, Massimo; MartĆnez-PĆ©rez, Aleix; Patrizi, Franca; Weber, Dieter G; Ansaloni, Luca; Biffl, Walter; Ben-Ishay, Offir; Bala, Miklosh; Brunetti, Francesco; Gaiani, Federica; Abdalla, Solafah; Amiot, Aurelien; Bahouth, Hany; Bianchi, Giorgio; Casanova, Daniel; Coccolini, Federico; Coimbra, Raul; deāAngelis, Gian Luigi; De Simone, Belinda; Fraga, Gustavo P; Genova, Pietro; Ivatury, Rao; Kashuk, Jeffry L; Kirkpatrick, Andrew W; Le Baleur, Yann; Machado, Fernando; Machain, Gustavo M; Maier, Ronald V; Chichom-Mefire, Alain; Memeo, Riccardo; Mesquita, Carlos; Salamea Molina, Juan C; Mutignani, Massimiliano; Manzano-NĆŗƱez, Ramiro; OrdoƱez, Carlos; Peitzman, Andrew B; Pereira, Bruno M; Picetti, Edoardo; Pisano, Michele; Puyana, Juan C; Rizoli, Sandro; Siddiqui, Mohammed; Sobhani, Iradj; ten Broek, Richard P; Zorcolo, Luigi; Carra, Maria C; Kluger, Yoram; Catena, FaustoAbstract Iatrogenic colonoscopy perforation (ICP) is a severe complication that can occur during both diagnostic and therapeutic procedures. Although 45ā60% of ICPs are diagnosed by the endoscopist while performing the colonoscopy, many ICPs are not immediately recognized but are instead suspected on the basis of clinical signs and symptoms that occur after the endoscopic procedure. There are three main therapeutic options for ICPs: endoscopic repair, conservative therapy, and surgery. The therapeutic approach must vary based on the setting of the diagnosis (intra- or post-colonoscopy), the type of ICP, the characteristics and general status of the patient, the operatorās level of experience, and surgical device availability. Although ICPs have been the focus of numerous publications, no guidelines have been created to standardize the management of ICPs. The aim of this article is to present the World Society of Emergency Surgery (WSES) guidelines for the management of ICP, which are intended to be used as a tool to promote global standards of care in case of ICP. These guidelines are not meant to substitute providersā clinical judgment for individual patients, and they may need to be modified based on the medical teamās level of experience and the availability of local resources.Item Open Access 2023 WSES guidelines for the prevention, detection, and management of iatrogenic urinary tract injuries (IUTIs) during emergency digestive surgery(2023-09-09) deāAngelis, Nicola; Schena, Carlo A.; Marchegiani, Francesco; Reitano, Elisa; De Simone, Belinda; Wong, Geoffrey Y. M.; MartĆnez-PĆ©rez, Aleix; Abu-Zidan, Fikri M.; Agnoletti, Vanni; Aisoni, Filippo; Ammendola, Michele; Ansaloni, Luca; Bala, Miklosh; Biffl, Walter; Ceccarelli, Graziano; Ceresoli, Marco; Chiara, Osvaldo; Chiarugi, Massimo; Cimbanassi, Stefania; Coccolini, Federico; Coimbra, Raul; Di Saverio, Salomone; Diana, Michele; Dioguardi Burgio, Marco; Fraga, Gustavo; Gavriilidis, Paschalis; Gurrado, Angela; Inchingolo, Riccardo; Ingels, Alexandre; Ivatury, Rao; Kashuk, Jeffry L.; Khan, Jim; Kirkpatrick, Andrew W.; Kim, Fernando J.; Kluger, Yoram; Lakkis, Zaher; LeppƤniemi, Ari; Maier, Ronald V.; Memeo, Riccardo; Moore, Ernest E.; OrdoƱez, Carlos A.; Peitzman, Andrew B.; Pellino, Gianluca; Picetti, Edoardo; Pikoulis, Manos; Pisano, Michele; Podda, Mauro; Romeo, Oreste; Rosa, Fausto; Tan, Edward; Ten Broek, Richard P.; Testini, Mario; Tian Wei Cheng, Brian A.; Weber, Dieter; Sacco, Emilio; Sartelli, Massimo; Tonsi, Alfredo; Dal Moro, Fabrizio; Catena, FaustoAbstract Iatrogenic urinary tract injury (IUTI) is a severe complication of emergency digestive surgery. It can lead to increased postoperative morbidity and mortality and have a long-term impact on the quality of life. The reported incidence of IUTIs varies greatly among the studies, ranging from 0.3 to 1.5%. Given the high volume of emergency digestive surgery performed worldwide, there is a need for well-defined and effective strategies to prevent and manage IUTIs. Currently, there is a lack of consensus regarding the prevention, detection, and management of IUTIs in the emergency setting. The present guidelines, promoted by the World Society of Emergency Surgery (WSES), were developed following a systematic review of the literature and an international expert panel discussion. The primary aim of these WSES guidelines is to provide evidence-based recommendations to support clinicians and surgeons in the prevention, detection, and management of IUTIs during emergency digestive surgery. The following key aspects were considered: (1) effectiveness of preventive interventions for IUTIs during emergency digestive surgery; (2) intra-operative detection of IUTIs and appropriate management strategies; (3) postoperative detection of IUTIs and appropriate management strategies and timing; and (4) effectiveness of antibiotic therapy (including type and duration) in case of IUTIs.Item Open Access Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (the COOL trial): study protocol for a randomized controlled trial(2018-06-22) Kirkpatrick, Andrew W; Coccolini, Federico; Ansaloni, Luca; Roberts, Derek J; Tolonen, Matti; McKee, Jessica L; Leppaniemi, Ari; Faris, Peter; Doig, Christopher J; Catena, Fausto; Fabian, Timothy; Jenne, Craig N; Chiara, Osvaldo; Kubes, Paul; Manns, Braden; Kluger, Yoram; Fraga, Gustavo P; Pereira, Bruno M; Diaz, Jose J; Sugrue, Michael; Moore, Ernest E; Ren, Jianan; Ball, Chad G; Coimbra, Raul; Balogh, Zsolt J; Abu-Zidan, Fikri M; Dixon, Elijah; Biffl, Walter; MacLean, Anthony; Ball, Ian; Drover, John; McBeth, Paul B; Posadas-Calleja, Juan G; Parry, Neil G; Di Saverio, Salomone; Ordonez, Carlos A; Xiao, Jimmy; Sartelli, MassimoAbstract Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. Principles of treatment include early antibiotic administration and operative source control. A further therapeutic option may be open abdomen (OA) management with active negative peritoneal pressure therapy (ANPPT) to remove inflammatory ascites and ameliorate the systemic damage from SCIAS. Although there is now a biologic rationale for such an intervention as well as non-standardized and erratic clinical utilization, this remains a novel therapy with potential side effects and clinical equipoise. Methods The Closed Or Open after Laparotomy (COOL) study will constitute a prospective randomized controlled trial that will randomly allocate eligible surgical patients intra-operatively to either formal closure of the fascia or use of the OA with application of an ANPTT dressing. Patients will be eligible if they have free uncontained intra-peritoneal contamination and physiologic derangements exemplified by septic shock OR a Predisposition-Infection-Response-Organ Dysfunction Score ā„ā3 or a World-Society-of-Emergency-Surgery-Sepsis-Severity-Score ā„ā8. The primary outcome will be 90-day survival. Secondary outcomes will be logistical, physiologic, safety, bio-mediators, microbiological, quality of life, and health-care costs. Secondary outcomes will include days free of ICU, ventilation, renal replacement therapy, and hospital at 30 days from the index laparotomy. Physiologic secondary outcomes will include changes in intensive care unit illness severity scores after laparotomy. Bio-mediator outcomes for participating centers will involve measurement of interleukin (IL)-6 and IL-10, procalcitonin, activated protein C (APC), high-mobility group box protein-1, complement factors, and mitochondrial DNA. Economic outcomes will comprise standard costing for utilization of health-care resources. Discussion Although facial closure after SCIAS is considered the current standard of care, many reports are suggesting that OA management may improve outcomes in these patients. This trial will be powered to demonstrate a mortality difference in this highly lethal and morbid condition to ensure critically ill patients are receiving the best care possible and not being harmed by inappropriate therapies based on opinion only. Trial registration ClinicalTrials.gov , NCT03163095 .Item Open Access Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria(2018-04-06) Tolonen, Matti; Coccolini, Federico; Ansaloni, Luca; Sartelli, Massimo; Roberts, Derek J; McKee, Jessica L; Leppaniemi, Ari; Doig, Christopher J; Catena, Fausto; Fabian, Timothy; Jenne, Craig N; Chiara, Osvaldo; Kubes, Paul; Kluger, Yoram; Fraga, Gustavo P; Pereira, Bruno M; Diaz, Jose J; Sugrue, Michael; Moore, Ernest E; Ren, Jianan; Ball, Chad G; Coimbra, Raul; Dixon, Elijah; Biffl, Walter; MacLean, Anthony; McBeth, Paul B; Posadas-Calleja, Juan G; Di Saverio, Salomone; Xiao, Jimmy; Kirkpatrick, Andrew WAbstract Background Severe complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. Open abdomen management with enhanced clearance of fluid and biomediators from the peritoneum is a potential therapy requiring prospective evaluation. Given the complexity of powering multi-center trials, it is essential to recruit an inception cohort sick enough to benefit from the intervention; otherwise, no effect of a potentially beneficial therapy may be apparent. An evaluation of abilities of recognized predictive systems to recognize SCIAS patients was conducted using an existing intra-abdominal sepsis (IAS) database. Methods All consecutive adult patients with a diffuse secondary peritonitis between 2012 and 2013 were collected from a quaternary care hospital in Finland, excluding appendicitis/cholecystitis. From this retrospectively collected database, a target population (93) of those with either ICU admission or mortality were selected. The performance metrics of the Third Consensus Definitions for Sepsis and Septic Shock based on both SOFA and quick SOFA, the World Society of Emergency Surgery Sepsis Severity Score (WSESSSS), the APACHE II score, Manheim Peritonitis Index (MPI), and the Calgary Predisposition, Infection, Response, and Organ dysfunction (CPIRO) score were all tested for their discriminant ability to identify this subgroup with SCIAS and to predict mortality. Results Predictive systems with an area under-the-receiving-operating characteristic (AUC) curve >ā0.8 included SOFA, Sepsis-3 definitions, APACHE II, WSESSSS, and CPIRO scores with the overall best for CPIRO. The highest identification rates were SOFA score ā„ā2 (78.4%), followed by the WSESSSS score ā„ā8 (73.1%), SOFA ā„ā3 (75.2%), and APACHE II ā„ā14 (68.8%) identification. Combining the Sepsis-3 septic-shock definition and WSESSS ā„ā8 increased detection to 80%. Including CPIRO score ā„ā3 increased this to 82.8% (Sensitivity-SN; 83% Specificity-SP; 74%. Comparatively, SOFA ā„ā4 and WSESSSS ā„ā8 with or without septic-shock had 83.9% detection (SN; 84%, SP; 75%, 25% mortality). Conclusions No one scoring system behaves perfectly, and all are largely dominated by organ dysfunction. Utilizing combinations of SOFA, CPIRO, and WSESSSS scores in addition to the Sepsis-3 septic shock definition appears to offer the widest āinclusion-criteriaā to recognize patients with a high chance of mortality and ICU admission. Trial registration https://clinicaltrials.gov/ct2/show/NCT03163095 ; Registered on May 22, 2017.Item Open Access Intra-abdominal infections survival guide: a position statement by the Global Alliance For Infections In Surgery(2024-06-08) Sartelli, Massimo; Barie, Philip; Agnoletti, Vanni; Al-Hasan, Majdi N.; Ansaloni, Luca; Biffl, Walter; Buonomo, Luis; Blot, Stijn; Cheadle, William G.; Coimbra, Raul; De Simone, Belinda; Duane, Therese M.; Fugazzola, Paola; Giamarellou, Helen; Hardcastle, Timothy C.; Hecker, Andreas; Inaba, Kenji; Kirkpatrick, Andrew W.; Labricciosa, Francesco M.; Leone, Marc; Martin-Loeches, Ignacio; Maier, Ronald V.; Marwah, Sanjay; Maves, Ryan C.; Mingoli, Andrea; Montravers, Philippe; OrdĆ³Ć±ez, Carlos A.; Palmieri, Miriam; Podda, Mauro; Rello, Jordi; Sawyer, Robert G.; Sganga, Gabriele; Tattevin, Pierre; Thapaliya, Dipendra; Tessier, Jeffrey; Tolonen, Matti; Ulrych, Jan; Vallicelli, Carlo; Watkins, Richard R.; Catena, Fausto; Coccolini, FedericoAbstract Intra-abdominal infections (IAIs) are an important cause of morbidity and mortality in hospital settings worldwide. The cornerstones of IAI management include rapid, accurate diagnostics; timely, adequate source control; appropriate, short-duration antimicrobial therapy administered according to the principles of pharmacokinetics/pharmacodynamics and antimicrobial stewardship; and hemodynamic and organ functional support with intravenous fluid and adjunctive vasopressor agents for critical illness (sepsis/organ dysfunction or septic shock after correction of hypovolemia). In patients with IAIs, a personalized approach is crucial to optimize outcomes and should be based on multiple aspects that require careful clinical assessment. The anatomic extent of infection, the presumed pathogens involved and risk factors for antimicrobial resistance, the origin and extent of the infection, the patientās clinical condition, and the hostās immune status should be assessed continuously to optimize the management of patients with complicated IAIs.Item Open Access Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines(2020-02-10) De Simone, Belinda; Sartelli, Massimo; Coccolini, Federico; Ball, Chad G; Brambillasca, Pietro; Chiarugi, Massimo; Campanile, Fabio C; Nita, Gabriela; Corbella, Davide; Leppaniemi, Ari; Boschini, Elena; Moore, Ernest E; Biffl, Walter; Peitzmann, Andrew; Kluger, Yoram; Sugrue, Michael; Fraga, Gustavo; Di Saverio, Salomone; Weber, Dieter; Sakakushev, Boris; Chiara, Osvaldo; Abu-Zidan, Fikri M; ten Broek, Richard; Kirkpatrick, Andrew W; Wani, Imtiaz; Coimbra, Raul; Baiocchi, Gian L; Kelly, Micheal D; Ansaloni, Luca; Catena, FaustoAbstract Background Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. Methods The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES. Results Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI. Conclusions The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.Item Open Access Kidney and uro-trauma: WSES-AAST guidelines(2019-12-02) Coccolini, Federico; Moore, Ernest E; Kluger, Yoram; Biffl, Walter; Leppaniemi, Ari; Matsumura, Yosuke; Kim, Fernando; Peitzman, Andrew B; Fraga, Gustavo P; Sartelli, Massimo; Ansaloni, Luca; Augustin, Goran; Kirkpatrick, Andrew; Abu-Zidan, Fikri; Wani, Imitiaz; Weber, Dieter; Pikoulis, Emmanouil; Larrea, Martha; Arvieux, Catherine; Manchev, Vassil; Reva, Viktor; Coimbra, Raul; Khokha, Vladimir; Mefire, Alain C; Ordonez, Carlos; Chiarugi, Massimo; Machado, Fernando; Sakakushev, Boris; Matsumoto, Junichi; Maier, Ron; di Carlo, Isidoro; Catena, FaustoAbstract Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.Item Open Access Pelvic trauma: WSES classification and guidelines(2017-01-18) Coccolini, Federico; Stahel, Philip F; Montori, Giulia; Biffl, Walter; Horer, Tal M; Catena, Fausto; Kluger, Yoram; Moore, Ernest E; Peitzman, Andrew B; Ivatury, Rao; Coimbra, Raul; Fraga, Gustavo P; Pereira, Bruno; Rizoli, Sandro; Kirkpatrick, Andrew; Leppaniemi, Ari; Manfredi, Roberto; Magnone, Stefano; Chiara, Osvaldo; Solaini, Leonardo; Ceresoli, Marco; Allievi, NiccolĆ²; Arvieux, Catherine; Velmahos, George; Balogh, Zsolt; Naidoo, Noel; Weber, Dieter; Abu-Zidan, Fikri; Sartelli, Massimo; Ansaloni, LucaAbstract Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.Item Open Access Splenic trauma: WSES classification and guidelines for adult and pediatric patients(2017-08-18) Coccolini, Federico; Montori, Giulia; Catena, Fausto; Kluger, Yoram; Biffl, Walter; Moore, Ernest E; Reva, Viktor; Bing, Camilla; Bala, Miklosh; Fugazzola, Paola; Bahouth, Hany; Marzi, Ingo; Velmahos, George; Ivatury, Rao; Soreide, Kjetil; Horer, Tal; ten Broek, Richard; Pereira, Bruno M; Fraga, Gustavo P; Inaba, Kenji; Kashuk, Joseph; Parry, Neil; Masiakos, Peter T; Mylonas, Konstantinos S; Kirkpatrick, Andrew; Abu-Zidan, Fikri; Gomes, Carlos A; Benatti, Simone V; Naidoo, Noel; Salvetti, Francesco; Maccatrozzo, Stefano; Agnoletti, Vanni; Gamberini, Emiliano; Solaini, Leonardo; Costanzo, Antonio; Celotti, Andrea; Tomasoni, Matteo; Khokha, Vladimir; Arvieux, Catherine; Napolitano, Lena; Handolin, Lauri; Pisano, Michele; Magnone, Stefano; Spain, David A; de Moya, Marc; Davis, Kimberly A; De Angelis, Nicola; Leppaniemi, Ari; Ferrada, Paula; Latifi, Rifat; Navarro, David C; Otomo, Yashuiro; Coimbra, Raul; Maier, Ronald V; Moore, Frederick; Rizoli, Sandro; Sakakushev, Boris; Galante, Joseph M; Chiara, Osvaldo; Cimbanassi, Stefania; Mefire, Alain C; Weber, Dieter; Ceresoli, Marco; Peitzman, Andrew B; Wehlie, Liban; Sartelli, Massimo; Di Saverio, Salomone; Ansaloni, LucaAbstract Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.Item Open Access Trauma quality indicators: internationally approved core factors for trauma management quality evaluation(2021-02-23) Coccolini, Federico; Kluger, Yoram; Moore, Ernest E.; Maier, Ronald V.; Coimbra, Raul; OrdoƱez, Carlos; Ivatury, Rao; Kirkpatrick, Andrew W.; Biffl, Walter; Sartelli, Massimo; Hecker, Andreas; Ansaloni, Luca; Leppaniemi, Ari; Reva, Viktor; Civil, Ian; Vega, Felipe; Chiarugi, Massimo; Chichom-Mefire, Alain; Sakakushev, Boris; Peitzman, Andrew; Chiara, Osvaldo; Abu-Zidan, Fikri; Maegele, Marc; Miccoli, Mario; Chirica, Mircea; Khokha, Vladimir; Sugrue, Michael; Fraga, Gustavo P.; Otomo, Yasuhiro; Baiocchi, Gian L.; Catena, FaustoAbstract Introduction Quality in medical care must be measured in order to be improved. Trauma management is part of health care, and by definition, it must be checked constantly. The only way to measure quality and outcomes is to systematically accrue data and analyze them. Material and methods A systematic revision of the literature about quality indicators in trauma associated to an international consensus conference Results An internationally approved base core set of 82 trauma quality indicators was obtained: Indicators were divided into 6 fields: prevention, structure, process, outcome, post-traumatic management, and society integrational effects. Conclusion Present trauma quality indicator core set represents the result of an international effort aiming to provide a useful tool in quality evaluation and improvement. Further improvement may only be possible through international trauma registry development. This will allow for huge international data accrual permitting to evaluate results and compare outcomes.