Fulvio Nisi
I graduated at Faculty of Medicine, University of Perugia, Perugia, Italy in 2013 with a final grade 110/110 and honors and a dissertation on “Rigid bronchoscopy in Adults: LMA vs face mask in periprocedural anesthetic management”
Afterwards I underwent my training in Anesthesia, resuscitation, intensive care and pain therapy (residency) at University of Perugia and Perugia's city hospital, between 2014 and 2019. During my residency I completed my formation attending as a clinical and research fellowship: the St George’s Hospital, London, UK (Cardio-thoracic Intensive Care Unit of the ), the Regional Centre for transplant coordination of Umbria in Italy, Perugia, Italy, and the “Le Molinette” hospital, Città della Salute e della Scienza, Turin, Italy (vascular surgery and renal transplant unit; liver transplant unit ; post- transplant intensive care unit; lung and hearth transplant and intensive care unit ). Postgraduate Specialization in Anesthesia, resuscitation, intensive care and pain therapy (CCT in anesthesia and intensive care) was awarded with a final grade 50/50 and honors and a dissertation on hemodynamic monitoring (Monitoring of Cardiac Output using a new smartphone application (Capstesia) versus Vigileo FloTrac system: a prospective study during Open Aortic Aneurysm Repair surgery). During my studies, I also gained some additional experience as a medical consultant fellow at the Faculty of Law of the University of Perugia, Perugia, Italy in 2018
Since 2014 I worked and a fellow at the Intensive care and anesthetic department of Perugia City Hospital, Italy and I am currently employed (since 2020) as a consultant in anesthesia and intensive care at a the Humanitas research hospital in Milan, Italy.
I am routinely involved in peri-operative and anesthetic management of urological, gynecological, abdominal and colorectal surgical patients, breast surgery, orthopedic and vascular surgery; acute and chronic pain management; emergency and intensive care management of trauma, sepsis, coma and neurological diseases, cardiovascular and respiratory diseases, intoxication, postoperative monitoring of surgical patients , and finally COVID-19 emergency and intensive care management.
In 2022 I was awarded with the European Diploma in Anaesthesiology and Intensive Care (EDAIC) from the European Society of Anaesthesiology and Intensive Care.
RESEARCH INTERESTS
My research and academic Interests are in :
Airways Management
Heamodynamic monitoring
Critical care epidemiology
Acute Pain Medicine
Perioperative safety
Medical Informatics and IT
Neural networks and machine learning
Forensic medicine
E-learning and Simulation
Afterwards I underwent my training in Anesthesia, resuscitation, intensive care and pain therapy (residency) at University of Perugia and Perugia's city hospital, between 2014 and 2019. During my residency I completed my formation attending as a clinical and research fellowship: the St George’s Hospital, London, UK (Cardio-thoracic Intensive Care Unit of the ), the Regional Centre for transplant coordination of Umbria in Italy, Perugia, Italy, and the “Le Molinette” hospital, Città della Salute e della Scienza, Turin, Italy (vascular surgery and renal transplant unit; liver transplant unit ; post- transplant intensive care unit; lung and hearth transplant and intensive care unit ). Postgraduate Specialization in Anesthesia, resuscitation, intensive care and pain therapy (CCT in anesthesia and intensive care) was awarded with a final grade 50/50 and honors and a dissertation on hemodynamic monitoring (Monitoring of Cardiac Output using a new smartphone application (Capstesia) versus Vigileo FloTrac system: a prospective study during Open Aortic Aneurysm Repair surgery). During my studies, I also gained some additional experience as a medical consultant fellow at the Faculty of Law of the University of Perugia, Perugia, Italy in 2018
Since 2014 I worked and a fellow at the Intensive care and anesthetic department of Perugia City Hospital, Italy and I am currently employed (since 2020) as a consultant in anesthesia and intensive care at a the Humanitas research hospital in Milan, Italy.
I am routinely involved in peri-operative and anesthetic management of urological, gynecological, abdominal and colorectal surgical patients, breast surgery, orthopedic and vascular surgery; acute and chronic pain management; emergency and intensive care management of trauma, sepsis, coma and neurological diseases, cardiovascular and respiratory diseases, intoxication, postoperative monitoring of surgical patients , and finally COVID-19 emergency and intensive care management.
In 2022 I was awarded with the European Diploma in Anaesthesiology and Intensive Care (EDAIC) from the European Society of Anaesthesiology and Intensive Care.
RESEARCH INTERESTS
My research and academic Interests are in :
Airways Management
Heamodynamic monitoring
Critical care epidemiology
Acute Pain Medicine
Perioperative safety
Medical Informatics and IT
Neural networks and machine learning
Forensic medicine
E-learning and Simulation
less
Related Authors
Interests
Uploads
Papers by Fulvio Nisi
Prior studies suggest an association of anemia and blood transfusion with increased morbidity and mortality in patients undergoing cardiac surgery. However, the impact of perioperative anemia and blood transfusion on clinical outcomes in patients undergoing major vascular surgery has been poorly defined yet. The primary objectives of this scoping review were to determine the extent of the evidence base that links anemia and blood transfusions to mortality and cardiovascular outcomes in patients undergoing major vascular surgery, and identify recurring themes or gaps in the literature to guide future research.
Methods
A scoping review of the literature from PubMed, Cochrane, and EMBASE databases was conducted up to December 2023 to identify articles related to the impact of anemia and blood transfusions on postoperative cardiovascular outcomes on patients undergoing vascular surgery. Methodology followed the PRISMA Protocols Extension for Scoping Reviews.
Results
Twenty-two articles met the inclusion criteria, including 15 retrospective and 6 observational prospective studies. Anemia definition varied across studies, mainly based on hemoglobin cut-off levels. An association with older age, coronary artery disease, hypertension, diabetes, and other comorbidities was reported. Particularly in peripheral and endovascular aortic surgery, anemia was linked consistently with higher mortality, major adverse cardiac events, and other postoperative complications, such as respiratory and renal issues, surgical site infections, and longer hospital stays, depending on hemoglobin levels. Anemia itself is an important predictor of transfusions. Transfusions in anemic patients were associated with increased mortality, postoperative complications, and increased need for major amputation.
Conclusions
The weight of the evidence suggests that anemia carries a substantial burden of cardiovascular complications, mortality, and multiorgan complications, resulting in increased health care costs. Peripheral and endovascular aortic surgery are affected deeply by the impact of anemia. Anemia itself stands out as a crucial predictor for requiring transfusions. In turn, the effect of transfusion of blood products is associated with worse outcomes and complications.
with a poor post-operative outcome. Consequently, it
seems important to reduce the incidence of hypotensive
events during anesthesia. The HemosphereTM (Edwards
Lifescience Co., Irwin, CA, USA) platform provides the
Hypotension Prediction Index (HPI), a predictive marker for
a drop in blood pressure within a few minutes. We report
the results of one year of application of a simple HPIalgorithm
aiming at reducing the incidence of IOH in open
abdominal aortic repair (oAAr), a type of surgery during
which hemodynamic stability is notably challenging.
Methods: We report the incidence of IOH in 40 patients
submitted to oAAr in our tertiary Humanitas Research
Hospital in Milan (Italy). The duration and severity of IOH
was calculated by mean the Time Weighted Average (TWA)
as follows: TWA = [(65-MAP) × time in hypotension]/Duration
of monitoring. We compared TWA in our cohort with our
preceding case series monitored by FloTrac/EV1000TM.
Results: TWA, expressed as median and IQR range, was
0.3 (0.00÷0.73) mmHg while the duration of an hypotensive
event was 2.0 (1.3÷3.1) minutes. The intra-operative
time spent in hypotension was 3.54% and the number of
hypotensive episodes for each patient was 1.5 (1÷3). TWA
resulted lower than the comparison ones and lower than the
value observed in the study performed by Wijnberge (TWA
= 0.44 mmHg × minute) conducted in major surgery.
Conclusions: In open abdominal aortic surgery, the
application of a simple algorithm based on HPI, seems to
be able to reduce the incidence, severity and duration of
arterial hypotension.
EJA 2023; 40: e-Suppl 61, A1:237-238
▪ Giustiniano E, Nisi F, Aceto R, Piccioni F, Cecconi M. Intraoperative hemodynamic management by AcumenTM Hypotension
Prediction Index in open abdominal aortic repair. Mind the DAP!, EJA 2023; 40: e-Suppl 61, A1:237-238
the hepatic hilum, has been pointed out as safe and useful for reducing
blood loss during liver resection, but it exposes the patient
the risk of ischemia-reperfusion liver injury. Serum lactate (sLac)
concentration depends on the balance between production and
clearance from the blood stream, and it has been reported to be a
predictor of outcome in critically ill patients, including those with
liver failure, sepsis and trauma.The patients undergoing to liver
resection differ from critically ill patients, but this type of hepatic
surgery may be somehow compared with critical illness, as major
surgery causes a certain degree of Systemic Inflammatory Reaction
Syndrome (SIRS). In such operations, postoperative acidosis
may be mainly due both to high level of serum chloride (in case of
large amount of NaCl 0.9% saline solution administered intra-operatively)
and to hyperlactatemia. We reviewed the most recent
Literature about this issue, in particular into the field of hepatic
resection surgery.
Prior studies suggest an association of anemia and blood transfusion with increased morbidity and mortality in patients undergoing cardiac surgery. However, the impact of perioperative anemia and blood transfusion on clinical outcomes in patients undergoing major vascular surgery has been poorly defined yet. The primary objectives of this scoping review were to determine the extent of the evidence base that links anemia and blood transfusions to mortality and cardiovascular outcomes in patients undergoing major vascular surgery, and identify recurring themes or gaps in the literature to guide future research.
Methods
A scoping review of the literature from PubMed, Cochrane, and EMBASE databases was conducted up to December 2023 to identify articles related to the impact of anemia and blood transfusions on postoperative cardiovascular outcomes on patients undergoing vascular surgery. Methodology followed the PRISMA Protocols Extension for Scoping Reviews.
Results
Twenty-two articles met the inclusion criteria, including 15 retrospective and 6 observational prospective studies. Anemia definition varied across studies, mainly based on hemoglobin cut-off levels. An association with older age, coronary artery disease, hypertension, diabetes, and other comorbidities was reported. Particularly in peripheral and endovascular aortic surgery, anemia was linked consistently with higher mortality, major adverse cardiac events, and other postoperative complications, such as respiratory and renal issues, surgical site infections, and longer hospital stays, depending on hemoglobin levels. Anemia itself is an important predictor of transfusions. Transfusions in anemic patients were associated with increased mortality, postoperative complications, and increased need for major amputation.
Conclusions
The weight of the evidence suggests that anemia carries a substantial burden of cardiovascular complications, mortality, and multiorgan complications, resulting in increased health care costs. Peripheral and endovascular aortic surgery are affected deeply by the impact of anemia. Anemia itself stands out as a crucial predictor for requiring transfusions. In turn, the effect of transfusion of blood products is associated with worse outcomes and complications.
with a poor post-operative outcome. Consequently, it
seems important to reduce the incidence of hypotensive
events during anesthesia. The HemosphereTM (Edwards
Lifescience Co., Irwin, CA, USA) platform provides the
Hypotension Prediction Index (HPI), a predictive marker for
a drop in blood pressure within a few minutes. We report
the results of one year of application of a simple HPIalgorithm
aiming at reducing the incidence of IOH in open
abdominal aortic repair (oAAr), a type of surgery during
which hemodynamic stability is notably challenging.
Methods: We report the incidence of IOH in 40 patients
submitted to oAAr in our tertiary Humanitas Research
Hospital in Milan (Italy). The duration and severity of IOH
was calculated by mean the Time Weighted Average (TWA)
as follows: TWA = [(65-MAP) × time in hypotension]/Duration
of monitoring. We compared TWA in our cohort with our
preceding case series monitored by FloTrac/EV1000TM.
Results: TWA, expressed as median and IQR range, was
0.3 (0.00÷0.73) mmHg while the duration of an hypotensive
event was 2.0 (1.3÷3.1) minutes. The intra-operative
time spent in hypotension was 3.54% and the number of
hypotensive episodes for each patient was 1.5 (1÷3). TWA
resulted lower than the comparison ones and lower than the
value observed in the study performed by Wijnberge (TWA
= 0.44 mmHg × minute) conducted in major surgery.
Conclusions: In open abdominal aortic surgery, the
application of a simple algorithm based on HPI, seems to
be able to reduce the incidence, severity and duration of
arterial hypotension.
EJA 2023; 40: e-Suppl 61, A1:237-238
▪ Giustiniano E, Nisi F, Aceto R, Piccioni F, Cecconi M. Intraoperative hemodynamic management by AcumenTM Hypotension
Prediction Index in open abdominal aortic repair. Mind the DAP!, EJA 2023; 40: e-Suppl 61, A1:237-238
the hepatic hilum, has been pointed out as safe and useful for reducing
blood loss during liver resection, but it exposes the patient
the risk of ischemia-reperfusion liver injury. Serum lactate (sLac)
concentration depends on the balance between production and
clearance from the blood stream, and it has been reported to be a
predictor of outcome in critically ill patients, including those with
liver failure, sepsis and trauma.The patients undergoing to liver
resection differ from critically ill patients, but this type of hepatic
surgery may be somehow compared with critical illness, as major
surgery causes a certain degree of Systemic Inflammatory Reaction
Syndrome (SIRS). In such operations, postoperative acidosis
may be mainly due both to high level of serum chloride (in case of
large amount of NaCl 0.9% saline solution administered intra-operatively)
and to hyperlactatemia. We reviewed the most recent
Literature about this issue, in particular into the field of hepatic
resection surgery.