Browsing by Author "Birindelli, Arianna"

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    The 2023 WSES guidelines on the management of trauma in elderly and frail patients
    (2024-05-31) De Simone, Belinda; Chouillard, Elie; Podda, Mauro; Pararas, Nikolaos; de Carvalho Duarte, Gustavo; Fugazzola, Paola; Birindelli, Arianna; Coccolini, Federico; Polistena, Andrea; Sibilla, Maria G.; Kruger, Vitor; Fraga, Gustavo P.; Montori, Giulia; Russo, Emanuele; Pintar, Tadeja; Ansaloni, Luca; Avenia, Nicola; Di Saverio, Salomone; Leppäniemi, Ari; Lauretta, Andrea; Sartelli, Massimo; Puzziello, Alessandro; Carcoforo, Paolo; Agnoletti, Vanni; Bissoni, Luca; Isik, Arda; Kluger, Yoram; Moore, Ernest E.; Romeo, Oreste M.; Abu-Zidan, Fikri M.; Beka, Solomon G.; Weber, Dieter G.; Tan, Edward C. T. H.; Paolillo, Ciro; Cui, Yunfeng; Kim, Fernando; Picetti, Edoardo; Di Carlo, Isidoro; Toro, Adriana; Sganga, Gabriele; Sganga, Federica; Testini, Mario; Di Meo, Giovanna; Kirkpatrick, Andrew W.; Marzi, Ingo; déAngelis, Nicola; Kelly, Michael D.; Wani, Imtiaz; Sakakushev, Boris; Bala, Miklosh; Bonavina, Luigi; Galante, Joseph M.; Shelat, Vishal G.; Cobianchi, Lorenzo; Mas, Francesca D.; Pikoulis, Manos; Damaskos, Dimitrios; Coimbra, Raul; Dhesi, Jugdeep; Hoffman, Melissa R.; Stahel, Philip F.; Maier, Ronald V.; Litvin, Andrey; Latifi, Rifat; Biffl, Walter L.; Catena, Fausto
    Abstract Background The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. Methods Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. Results The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient’s directives, family feelings and representatives' desires, and all decisions should be shared. Conclusions The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes. Graphical abstract
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    The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections
    (2017-07-10) Sartelli, Massimo; Chichom-Mefire, Alain; Labricciosa, Francesco M; Hardcastle, Timothy; Abu-Zidan, Fikri M; Adesunkanmi, Abdulrashid K; Ansaloni, Luca; Bala, Miklosh; Balogh, Zsolt J; Beltrán, Marcelo A; Ben-Ishay, Offir; Biffl, Walter L; Birindelli, Arianna; Cainzos, Miguel A; Catalini, Gianbattista; Ceresoli, Marco; Che Jusoh, Asri; Chiara, Osvaldo; Coccolini, Federico; Coimbra, Raul; Cortese, Francesco; Demetrashvili, Zaza; Di Saverio, Salomone; Diaz, Jose J; Egiev, Valery N; Ferrada, Paula; Fraga, Gustavo P; Ghnnam, Wagih M; Lee, Jae G; Gomes, Carlos A; Hecker, Andreas; Herzog, Torsten; Kim, Jae I; Inaba, Kenji; Isik, Arda; Karamarkovic, Aleksandar; Kashuk, Jeffry; Khokha, Vladimir; Kirkpatrick, Andrew W; Kluger, Yoram; Koike, Kaoru; Kong, Victor Y; Leppaniemi, Ari; Machain, Gustavo M; Maier, Ronald V; Marwah, Sanjay; McFarlane, Michael E; Montori, Giulia; Moore, Ernest E; Negoi, Ionut; Olaoye, Iyiade; Omari, Abdelkarim H; Ordonez, Carlos A; Pereira, Bruno M; Pereira Júnior, Gerson A; Pupelis, Guntars; Reis, Tarcisio; Sakakushev, Boris; Sato, Norio; Segovia Lohse, Helmut A; Shelat, Vishal G; Søreide, Kjetil; Uhl, Waldemar; Ulrych, Jan; Van Goor, Harry; Velmahos, George C; Yuan, Kuo-Ching; Wani, Imtiaz; Weber, Dieter G; Zachariah, Sanoop K; Catena, Fausto
    Abstract Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.