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Protti A, Tonelli R, Dalla Corte F, Grieco DL, Spinelli E, Spadaro S, Piovani D, Menga LS, Schifino G, Vega Pittao ML, Umbrello M, Cammarota G, Volta CA, Bonovas S, Cecconi M, Mauri T, Clini E. Development of clinical tools to estimate the breathing effort during high-flow oxygen therapy: A multicenter cohort study. Pulmonology 2024:S2531-0437(24)00054-0. [PMID: 38760225 DOI: 10.1016/j.pulmoe.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Quantifying breathing effort in non-intubated patients is important but difficult. We aimed to develop two models to estimate it in patients treated with high-flow oxygen therapy. PATIENTS AND METHODS We analyzed the data of 260 patients from previous studies who received high-flow oxygen therapy. Their breathing effort was measured as the maximal deflection of esophageal pressure (ΔPes). We developed a multivariable linear regression model to estimate ΔPes (in cmH2O) and a multivariable logistic regression model to predict the risk of ΔPes being >10 cmH2O. Candidate predictors included age, sex, diagnosis of the coronavirus disease 2019 (COVID-19), respiratory rate, heart rate, mean arterial pressure, the results of arterial blood gas analysis, including base excess concentration (BEa) and the ratio of arterial tension to the inspiratory fraction of oxygen (PaO2:FiO2), and the product term between COVID-19 and PaO2:FiO2. RESULTS We found that ΔPes can be estimated from the presence or absence of COVID-19, BEa, respiratory rate, PaO2:FiO2, and the product term between COVID-19 and PaO2:FiO2. The adjusted R2 was 0.39. The risk of ΔPes being >10 cmH2O can be predicted from BEa, respiratory rate, and PaO2:FiO2. The area under the receiver operating characteristic curve was 0.79 (0.73-0.85). We called these two models BREF, where BREF stands for BReathing EFfort and the three common predictors: BEa (B), respiratory rate (RE), and PaO2:FiO2 (F). CONCLUSIONS We developed two models to estimate the breathing effort of patients on high-flow oxygen therapy. Our initial findings are promising and suggest that these models merit further evaluation.
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Affiliation(s)
- A Protti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - R Tonelli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena-Reggio Emilia, Modena, Italy; Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena-Reggio Emilia, Modena, Italy
| | - F Dalla Corte
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - D L Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore Rome, Italy
| | - E Spinelli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Spadaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - D Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - L S Menga
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore Rome, Italy
| | - G Schifino
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - M L Vega Pittao
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - M Umbrello
- SC Rianimazioine e Anestesia, ASST Ovest Milanese, Ospedale Civile di Legnano, Legnano, Milan, Italy
| | - G Cammarota
- Department of Traslational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - C A Volta
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - S Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - M Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - T Mauri
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Clini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena-Reggio Emilia, Modena, Italy; Laboratory of Cell Therapies and Respiratory Medicine, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena-Reggio Emilia, Modena, Italy
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Pisciotta W, Passannante A, Arina P, Alotaibi K, Ambler G, Arulkumaran N. High-flow nasal oxygen versus conventional oxygen therapy and noninvasive ventilation in COVID-19 respiratory failure: a systematic review and network meta-analysis of randomised controlled trials. Br J Anaesth 2024; 132:936-944. [PMID: 38307776 PMCID: PMC11103093 DOI: 10.1016/j.bja.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/17/2023] [Accepted: 12/18/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Noninvasive methods of respiratory support, including noninvasive ventilation (NIV), continuous positive airway pressure (CPAP), and high-flow nasal oxygen (HFNO), are potential strategies to prevent progression to requirement for invasive mechanical ventilation in acute hypoxaemic respiratory failure. The COVID-19 pandemic provided an opportunity to understand the utility of noninvasive respiratory support among a homogeneous cohort of patients with contemporary management of acute respiratory distress syndrome. We performed a network meta-analysis of studies evaluating the efficacy of NIV (including CPAP) and HFNO, compared with conventional oxygen therapy (COT), in patients with COVID-19. METHODS PubMed, Embase, and the Cochrane library were searched in May 2023. Standard random-effects meta-analysis was used first to estimate all direct pairwise associations and the results from all studies were combined using frequentist network meta-analysis. Primary outcome was treatment failure, defined as discontinuation of HFNO, NIV, or COT despite progressive disease. Secondary outcome was mortality. RESULTS We included data from eight RCTs with 2302 patients, (756 [33%] assigned to COT, 371 [16%] to NIV, and 1175 [51%] to HFNO). The odds of treatment failure were similar for NIV (P=0.33) and HFNO (P=0.25), and both were similar to that for COT (reference category). The odds of mortality were similar for all three treatments (odds ratio for NIV vs COT: 1.06 [0.46-2.44] and HFNO vs COT: 0.97 [0.57-1.65]). CONCLUSIONS Noninvasive ventilation, high-flow nasal oxygen, and conventional oxygen therapy are comparable with regards to treatment failure and mortality in COVID-19-associated acute respiratory failure. PROSPERO REGISTRATION CRD42023426495.
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Affiliation(s)
- Walter Pisciotta
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Alberto Passannante
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Pietro Arina
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Khalid Alotaibi
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Nishkantha Arulkumaran
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK.
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da Cruz AP, Martins G, Martins CM, Marques V, Christovam S, Battaglini D, Robba C, Pelosi P, Rocco PRM, Cruz FF, Dos Santos Samary C, Silva PL. Comparison between high-flow nasal oxygen (HFNO) alternated with non-invasive ventilation (NIV) and HFNO and NIV alone in patients with COVID-19: a retrospective cohort study. Eur J Med Res 2024; 29:248. [PMID: 38649940 PMCID: PMC11036698 DOI: 10.1186/s40001-024-01826-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Non-invasive respiratory support (conventional oxygen therapy [COT], non-invasive ventilation [NIV], high-flow nasal oxygen [HFNO], and NIV alternated with HFNO [NIV + HFNO] may reduce the need for invasive mechanical ventilation (IMV) in patients with COVID-19. The outcome of patients treated non-invasively depends on clinical severity at admission. We assessed the need for IMV according to NIV, HFNO, and NIV + HFNO in patients with COVID-19 according to disease severity and evaluated in-hospital survival rates and hospital and intensive care unit (ICU) lengths of stay. METHODS This cohort study was conducted using data collected between March 2020 and July 2021. Patients ≥ 18 years admitted to the ICU with a diagnosis of COVID-19 were included. Patients hospitalized for < 3 days, receiving therapy (COT, NIV, HFNO, or NIV + HFNO) for < 48 h, pregnant, and with no primary outcome data were excluded. The COT group was used as reference for multivariate Cox regression model adjustment. RESULTS Of 1371 patients screened, 958 were eligible: 692 (72.2%) on COT, 92 (9.6%) on NIV, 31 (3.2%) on HFNO, and 143 (14.9%) on NIV + HFNO. The results for the patients in each group were as follows: median age (interquartile range): NIV (64 [49-79] years), HFNO (62 [55-70] years), NIV + HFNO (62 [48-72] years) (p = 0.615); heart failure: NIV (54.5%), HFNO (36.3%), NIV + HFNO (9%) (p = 0.003); diabetes mellitus: HFNO (17.6%), NIV + HFNO (44.7%) (p = 0.048). > 50% lung damage on chest computed tomography (CT): NIV (13.3%), HFNO (15%), NIV + HFNO (71.6%) (p = 0.038); SpO2/FiO2: NIV (271 [118-365] mmHg), HFNO (317 [254-420] mmHg), NIV + HFNO (229 [102-317] mmHg) (p = 0.001); rate of IMV: NIV (26.1%, p = 0.002), HFNO (22.6%, p = 0.023), NIV + HFNO (46.8%); survival rate: HFNO (83.9%), NIV + HFNO (63.6%) (p = 0.027); ICU length of stay: NIV (8.5 [5-14] days), NIV + HFNO (15 [10-25] days (p < 0.001); hospital length of stay: NIV (13 [10-21] days), NIV + HFNO (20 [15-30] days) (p < 0.001). After adjusting for comorbidities, chest CT score and SpO2/FiO2, the risk of IMV in patients on NIV + HFNO remained high (hazard ratio, 1.88; 95% confidence interval, 1.17-3.04). CONCLUSIONS In patients with COVID-19, NIV alternating with HFNO was associated with a higher rate of IMV independent of the presence of comorbidities, chest CT score and SpO2/FiO2. Trial registration ClinicalTrials.gov identifier: NCT05579080.
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Affiliation(s)
- Amanda Pereira da Cruz
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Gloria Martins
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
- D'or Institute of Research and Teaching, Barra D'or Hospital, Rio de Janeiro, Brazil
| | | | - Victoria Marques
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samantha Christovam
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Chiara Robba
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Fernanda Ferreira Cruz
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Cynthia Dos Santos Samary
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculty of Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho, 273, Bloco G-014, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil.
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Musso G, Druetta M, Calabrese A. The authors reply. Crit Care Med 2024; 52:e158-e160. [PMID: 38381024 DOI: 10.1097/ccm.0000000000006147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Giovanni Musso
- Emergency Medicine Department, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Marta Druetta
- Emergency Medicine Department, HUMANITAS Gradenigo, Turin, Italy
| | - Anna Calabrese
- Emergency Medicine Department, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
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Bagnato G, Imbalzano E, Ioppolo C, La Rosa D, Chiappalone M, De Gaetano A, Viapiana V, Irrera N, Nassisi V, Tringali MC, Singh EB, Falcomatà N, Russo V, Neal Roberts W, Di Micco P, Versace AG. Stratification of COVID-19 Patients with Moderate-to-Severe Hypoxemic Respiratory Failure for Response to High-Flow Nasal Cannula: A Retrospective Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:71. [PMID: 38256332 PMCID: PMC10819134 DOI: 10.3390/medicina60010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: In patients with COVID-19, high-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are widely applied as initial treatments for moderate-to-severe acute hypoxemic respiratory failure. The aim of the study was to assess which respiratory supports improve 28-day mortality and to identify a predictive index of treatment response. Materials and Methods: This is a single-center retrospective observational study including 159 consecutive adult patients with COVID-19 and moderate-to-severe hypoxemic acute respiratory failure. Results: A total of 159 patients (82 in the CPAP group and 77 in the HFNC group) were included in the study. Mortality within 28 days was significantly lower with HFNC compared to CPAP (16.8% vs. 50%), while ICU admission and tracheal intubation within 28 days were significantly higher with CPAP compared to HFNC treatment (32% vs. 13%). We identified an index for survival in HFNC by including three variables easily available at admission (LDH, age, and respiratory rate) and the PaO2/FiO2 ratio at 48 h. The index showed high discrimination for survival with an AUC of 0.88, a negative predictive value of 86%, and a positive predictive value of 95%. Conclusions: Treatment with HFNC appears to be associated with greater survival and fewer ICU admission than CPAP. LDH, respiratory rate, age, and PaO2/FiO2 at 48 h were independently associated with survival and an index based on these variables allows for the prediction of treatment success and the assessment of patient allocation to the appropriate intensity of care after 48 h. Further research is warranted to determine effects on other outcomes and to assess the performance of the index in larger cohorts.
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Affiliation(s)
- Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Carmelo Ioppolo
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Daniela La Rosa
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Marianna Chiappalone
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Alberta De Gaetano
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Valeria Viapiana
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Veronica Nassisi
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Maria Concetta Tringali
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Emanuele Balwinder Singh
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Nicola Falcomatà
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Division of Cardiology, Monaldi Hospital, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | | | - Pierpaolo Di Micco
- Emergency Department, Rizzoli Hospital, Health Authority NA2, 80122 Napoli, Italy
| | - Antonio Giovanni Versace
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.B.); (E.I.); (C.I.); (D.L.R.); (M.C.); (A.D.G.); (N.I.); (V.N.); (M.C.T.); (E.B.S.); (N.F.); (A.G.V.)
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Vega ML, Schifino G, Pisani L, Catalanotti V, Prediletto I, Nava S. Diaphragm thickening fraction and inspiratory effort in patients with SARS-COV II pneumonia receiving different non-invasive respiratory supports. Pulmonology 2023; 29:424-427. [PMID: 36906464 PMCID: PMC9922577 DOI: 10.1016/j.pulmoe.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Affiliation(s)
- M L Vega
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy
| | - G Schifino
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy
| | - L Pisani
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy
| | - V Catalanotti
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy
| | - I Prediletto
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy
| | - S Nava
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy.
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Jalil Y, Ferioli M, Dres M. The COVID-19 Driving Force: How It Shaped the Evidence of Non-Invasive Respiratory Support. J Clin Med 2023; 12:jcm12103486. [PMID: 37240592 DOI: 10.3390/jcm12103486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
During the COVID-19 pandemic, the use of non-invasive respiratory support (NIRS) became crucial in treating patients with acute hypoxemic respiratory failure. Despite the fear of viral aerosolization, non-invasive respiratory support has gained attention as a way to alleviate ICU overcrowding and reduce the risks associated with intubation. The COVID-19 pandemic has led to an unprecedented increased demand for research, resulting in numerous publications on observational studies, clinical trials, reviews, and meta-analyses in the past three years. This comprehensive narrative overview describes the physiological rationale, pre-COVID-19 evidence, and results of observational studies and randomized control trials regarding the use of high-flow nasal oxygen, non-invasive mechanical ventilation, and continuous positive airway pressure in adult patients with COVID-19 and associated acute hypoxemic respiratory failure. The review also highlights the significance of guidelines and recommendations provided by international societies and the need for further well-designed research to determine the optimal use of NIRS in treating this population.
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Affiliation(s)
- Yorschua Jalil
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Departamento de Ciencias de la Salud, Carrera de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Martina Ferioli
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy
| | - Martin Dres
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
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8
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Viegas P, Ageno E, Corsi G, Tagariello F, Razakamanantsoa L, Vilde R, Ribeiro C, Heunks L, Patout M, Fisser C. Highlights from the Respiratory Failure and Mechanical Ventilation 2022 Conference. ERJ Open Res 2023; 9:00467-2022. [PMID: 36949961 PMCID: PMC10026011 DOI: 10.1183/23120541.00467-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
The Respiratory Intensive Care Assembly of the European Respiratory Society gathered in Berlin to organise the second Respiratory Failure and Mechanical Ventilation Conference in June 2022. The conference covered several key points of acute and chronic respiratory failure in adults. During the 3-day conference, ventilatory strategies, patient selection, diagnostic approaches, treatment and health-related quality of life topics were addressed by a panel of international experts. Lectures delivered during the event have been summarised by Early Career Members of the Assembly and take-home messages highlighted.
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Affiliation(s)
- Pedro Viegas
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Elisa Ageno
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gabriele Corsi
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Federico Tagariello
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Léa Razakamanantsoa
- Unité Ambulatoire d'Appareillage Respiratoire de Domicile (UAARD), Service de Pneumologie (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Paris, France
| | - Rudolfs Vilde
- Centre of Pulmonology and Thoracic Surgery, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Riga Stradiņš University, Riga, Latvia
| | - Carla Ribeiro
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Leo Heunks
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Corresponding author: Christoph Fisser ()
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9
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López-Ramírez VY, Sanabria-Rodríguez OO, Bottia-Córdoba S, Muñoz-Velandia OM. Delayed mechanical ventilation with prolonged high-flow nasal cannula exposure time as a risk factor for mortality in acute respiratory distress syndrome due to SARS-CoV-2. Intern Emerg Med 2023; 18:429-437. [PMID: 36792855 PMCID: PMC9931170 DOI: 10.1007/s11739-022-03186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/19/2022] [Indexed: 02/17/2023]
Abstract
In a high proportion of patients, infection by COVID-19 progresses to acute respiratory distress syndrome (ARDS), requiring invasive mechanical ventilation (IMV) and admission to an intensive care unit (ICU). Other devices, such as a high-flow nasal cannula (HFNC), have been alternatives to IMV in settings with limited resources. This study evaluates whether HFNC exposure time prior to IMV is associated with mortality. This observational, analytical study was conducted on a historical cohort of adults with ARDS due to SARS-CoV-2 who were exposed to HFNC and subsequently underwent IMV. Univariate and multivariate logistic regression was used to analyze the impact of HFNC exposure time on mortality, controlling for multiple potential confounders. Of 325 patients with ARDS, 41 received treatment with HFNC for more than 48 h before IMV initiation. These patients had a higher mortality rate (43.9% vs. 27.1%, p: 0.027) than those using HFNC < 48 h. Univariate analysis evidenced an association between mortality and HFNC ≥ 48 h (OR 2.16. 95% CI 1.087-4.287. p: 0.028). Such an association persisted in the multivariable analysis (OR 2.21. 95% CI 1.013-4.808. p: 0.046) after controlling for age, sex, comorbidities, basal severity of infection, and complications. This study also identified a significant increase in mortality after 36 h in HFNC (46.3%, p: 0.003). In patients with ARDS due to COVID-19, HFNC exposure ≥ 48 h prior to IMV is a factor associated with mortality after controlling multiple confounders. Physiological mechanisms for such an association are need to be defined.
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10
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Crimi C, Murphy P, Patout M, Sayas J, Winck JC. Lessons from COVID-19 in the management of acute respiratory failure. Breathe (Sheff) 2023; 19:230035. [PMID: 37378059 PMCID: PMC10292773 DOI: 10.1183/20734735.0035-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 06/29/2023] Open
Abstract
Accumulated evidence supports the efficacy of noninvasive respiratory support therapies in coronavirus disease 2019 (COVID-19)-related acute hypoxaemic respiratory failure, alleviating admissions to intensive care units. Noninvasive respiratory support strategies, including high-flow oxygen therapy, continuous positive airway pressure via mask or helmet and noninvasive ventilation, can be alternatives that may avoid the need for invasive ventilation. Alternating different noninvasive respiratory support therapies and introducing complementary interventions, like self-proning, may improve outcomes. Proper monitoring is warranted to ensure the efficacy of the techniques and to avoid complications while supporting transfer to the intensive care unit. This article reviews the latest evidence on noninvasive respiratory support therapies in COVID-19-related acute hypoxaemic respiratory failure.
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Affiliation(s)
- Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
| | - Patrick Murphy
- Lane Fox Respiratory Service, Guy's and St Thomas’ Hospitals NHS Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Javier Sayas
- Pulmonology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
| | - Joao Carlos Winck
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Centro De Reabilitação Do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova De Gaia, Portugal
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11
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Carratalá JM, Diaz-Lobato S, Brouzet B, Más-Serrano P, Rocamora JLS, Castro AG, Varela AG, Alises SM. Efficacy and safety of high-flow nasal cannula therapy in elderly patients with acute respiratory failure. Pulmonology 2023:S2531-0437(23)00007-7. [PMID: 36792391 PMCID: PMC9923444 DOI: 10.1016/j.pulmoe.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION To assess the efficacy and safety of high-flow nasal cannula (HFNC) in elderly patients with acute respiratory failure (ARF) not due to COVID-19, refractory to treatment with conventional oxygen therapy and/or intolerant to noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) and without criteria for admission to intensive care units (ICU). METHODS Prospective observational study of patients with ARF treated with HFNC who presented clinical and arterial blood gas deterioration after 24 h of medical treatment and oxygenation by conventional systems. The degree of dyspnoea, gas exchange parameters (arterial O2 pressure/inspired O2 fraction ratio (PaO2/FiO2); oxygen saturation measured by oximetry/ inspired fraction of oxygen (Sp02/Fi02), ROX index), degree of patient tolerance and mortality were evaluated. These were measured at discharge from the emergency department (ED), 24 h after treatment with conventional oxygenation and 60, 120 min and 24 h after initiation of HFNC. The results were analyzed for all patients as a whole and for patients with hypercapnia (arterial carbon dioxide tension (PaCO2) < 45 mmHg) separately. RESULTS 200 patients were included in the study between November 2019 and November 2020, with a mean age of 83 years, predominantly women (61.9%), obese (Body Mass Index (BMI) 31.1), with high comorbidity (Charlson index 4) and mild-moderate degree of dependence (Barthel 60). A number of 128 patients (64%) were hypercapnic. None had respiratory acidosis (pH 7.39). Evaluation at 60 min, 120 min and 24 h showed significant improvement in all patients and in the subgroup of hypercapnic patients with respect to baseline parameters in respiratory rate (RR), dyspnoea, ROX index, PaO2/FiO2, SpO2/FiO2 and patient comfort. No changes in PaCO2 or level of consciousness were observed. HFNC was well tolerated. Ten patients (5%) died due to progression of the disease causing ARF. CONCLUSIONS HFNC is an effective and safe alternative in elderly patients with ARF not due to COVID-19, refractory to treatment with conventional oxygen therapy and/or intolerant to NIV or CPAP and without criteria for admission to ICU.
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Affiliation(s)
- J M Carratalá
- Emergency Department, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante. Spain
| | - S Diaz-Lobato
- Pulmonology Department Hospital Universitario HLA Moncloa, Nippon Gases Healthcare, Universidad Europea, Madrid, Spain.
| | - B Brouzet
- Emergency Department, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante. Spain
| | - P Más-Serrano
- Pharmacy Department Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, Spain; División de Farmacia y Tecnología Farmacéutica, Universidad Miguel Hernández, Elche, Spain
| | - J L S Rocamora
- Emergency Department, Hospital de Villarrobledo, Albacete, Spain
| | - A G Castro
- Emergency Department, SAMU Asturias, Spain
| | - A G Varela
- Emergency Department, Hospital Universitario Central de Asturias HUCA, Oviedo, Spain
| | - S M Alises
- Pulmonology Department, Hospital Quironsalud San José, Madrid, Spain
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12
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Teran-Tinedo JR, Gonzalez-Rubio J, Najera A, Lorente-Gonzalez M, Cano-Sanz E, De La Calle-Gil I, Ortega-Fraile MÁ, Carballo-López D, Hernández-Nuñez J, Churruca-Arróspide M, Zevallos-Villegas A, López-Padilla D, Puente-Maestú L, Navarro-Lopez JD, Jimenez-Diaz L, Landete P. Effect of the Early Combination of Continuous Positive Airway Pressure and High-Flow Nasal Cannula on Mortality and Intubation Rates in Patients With COVID-19 and Acute Respiratory Distress Syndrome. The DUOCOVID Study. Arch Bronconeumol 2023; 59:288-294. [PMID: 36797139 PMCID: PMC9892311 DOI: 10.1016/j.arbres.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Non invasive respiratory support (NIRS) is useful for treating acute respiratory distress syndrome (ARDS) secondary to COVID-19, mainly in mild-moderate stages. Although continuous positive airway pressure (CPAP) seems superior to other NIRS, prolonged periods of use and poor adaptation may contribute to its failure. The combination of CPAP sessions and high-flow nasal cannula (HFNC) breaks could improve comfort and keep respiratory mechanics stable without reducing the benefits of positive airway pressure (PAP). Our study aimed to determine if HFNC+CPAP initiates early lower mortality and endotracheal intubation (ETI) rates. METHODS Subjects were admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital between January and September 2021. They were divided according to Early HFNC+CPAP (first 24h, EHC group) and Delayed HFNC+CPAP (after 24h, DHC group). Laboratory data, NIRS parameters, and the ETI and 30-day mortality rates were collected. A multivariate analysis was performed to identify the risk factors associated with these variables. RESULTS The median age of the 760 included patients was 57 (IQR 47-66), who were mostly male (66.1%). The median Charlson Comorbidity Index was 2 (IQR 1-3) and 46.8% were obese. The median PaO2/FiO2 upon IRCU admission was 95 (IQR 76-126). The ETI rate in the EHC group was 34.5%, with 41.8% for the DHC group (p=0.045), while 30-day mortality was 8.2% and 15.5%, respectively (p=0.002). CONCLUSIONS Particularly in the first 24h after IRCU admission, the HFNC+CPAP combination was associated with a reduction in the 30-day mortality and ETI rates in patients with ARDS secondary to COVID-19.
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Affiliation(s)
- Jose Rafael Teran-Tinedo
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, National Hospital for Paraplegics, Toledo, Spain; Complutense University of Madrid, Spain
| | - Jesus Gonzalez-Rubio
- Department of Medical Sciences, Faculty of Medicine of Albacete, University of Castilla-La Mancha, Albacete, Spain; Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain.
| | - Alberto Najera
- Department of Medical Sciences, Faculty of Medicine of Albacete, University of Castilla-La Mancha, Albacete, Spain; Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain.
| | - Miguel Lorente-Gonzalez
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, Infanta Leonor University Hospital, Madrid, Spain
| | - Eduardo Cano-Sanz
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - Isabel De La Calle-Gil
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Anesthesia Department, Octubre University Hospital, Madrid, Spain
| | - Maria Ángeles Ortega-Fraile
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Emergency Department, Fundación Alcorcon University Hospital, Madrid, Spain
| | - Daniel Carballo-López
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Anesthesia Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Joaquín Hernández-Nuñez
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, San Carlos University Hospital, Madrid, Spain
| | - Maria Churruca-Arróspide
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, San Carlos University Hospital, Madrid, Spain
| | - Annette Zevallos-Villegas
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Pneumology Department, San Carlos University Hospital, Madrid, Spain
| | - Daniel López-Padilla
- Complutense University of Madrid, Spain; Pneumology Department, Gregorio Marañon University Hospital, Madrid, Spain
| | - Luis Puente-Maestú
- Complutense University of Madrid, Spain; Pneumology Department, Gregorio Marañon University Hospital, Madrid, Spain
| | - Juan D Navarro-Lopez
- Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain; Department of Medical Sciences, Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Lydia Jimenez-Diaz
- Centre for Biomedical Research (CRIB), University of Castilla-La Mancha, Albacete, Spain; Department of Medical Sciences, Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Pedro Landete
- Intermediate Respiratory Care Unit, Isabel Zendal Emergency Hospital, Madrid, Spain; Department of Pneumology, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Pneumology department. Hospital Universitario La Princesa, Madrid, Spain.
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13
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Gordon DH, Bracey A. Noninvasive Ventilation Reduces Rates of Intubation Compared With High Flow Oxygenation in Patients With Severe COVID-19. Ann Emerg Med 2023; 81:158-159. [PMID: 36334959 PMCID: PMC9627532 DOI: 10.1016/j.annemergmed.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/07/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022]
Affiliation(s)
- David H Gordon
- Department of Emergency Medicine, University of Florida Jacksonville, Jacksonville, FL
| | - Alexander Bracey
- Department of Emergency Medicine, Albany Medical Center, Albany, NY
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14
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Schifino G, Vega ML, Pisani L, Nava S. Non-invasive respiratory supports on inspiratory effort in COVID-19: How and when is it matter of selection? Author's reply. Eur J Intern Med 2022; 104:109. [PMID: 36057528 PMCID: PMC9433312 DOI: 10.1016/j.ejim.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Gioacchino Schifino
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - Maria Laura Vega
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Lara Pisani
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Stefano Nava
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy.
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15
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Flora M, Mollica M, Fiorentino G, Esquinas AM. Non-invasive respiratory supports on inspiratory effort in Covid-19: how and when is it matter of selection? Eur J Intern Med 2022; 104:107-108. [PMID: 36055956 PMCID: PMC9393171 DOI: 10.1016/j.ejim.2022.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/21/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Martina Flora
- Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy.
| | - Mariano Mollica
- Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy
| | - Giuseppe Fiorentino
- Department of Respiratory Pathophysiology, Monaldi-Cotugno Hospital, Naples, Italy
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