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Pierucci P, Crimi C, Carlucci A, Palma L, Noto A, Carpagnano GE, Scala R. Long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases: the Italian snapshot. Monaldi Arch Chest Dis 2022; 93. [PMID: 36445246 DOI: 10.4081/monaldi.2022.2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
Long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases was explored via the recently published international REINVENT ERS survey. The Italian subset of respondents (ITA-r), the highest above all participating nations, was analyzed and compared to non-Italian respondents (NO-ITA-r). The ITA-r represented 20% of the total answers examined. Ninety-four percent were physicians, whose half worked in a respiratory ICU (RICU). ITA-r mainly worked in community hospitals vs NO-ITA-r who are largely affiliated with university hospitals (p<0.0001). Amyotrophic lateral sclerosis (ALS) was considered the most common medical condition leading to NIV indication by both ITA-r and NO-ITA-r (93% vs 78%, p>0.5). A greater proportion of ITA-r considered MIP/MEP the most important test for NIV initiation as compared to NO-ITA-r (p<0.05). There was no significant difference for both ITA-r and NO-ITA-r as regards the other questions. This study illustrates Italian LTHNIV practices in patients with NMD and it shows some important differences with the other countries' practices but agreement in terms of goals to achieve, reasons to initiate NIV, and practices among the two communities.
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Affiliation(s)
- Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania.
| | - Annalisa Carlucci
- Department of Medicine and Surgery, University of Insubria, Varese-Como; ICS Maugeri IRCCS, Pavia.
| | - Lavinia Palma
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina; IPCF-CNR, Institute for Chemical and Physical Processes, National Research Council, Messina .
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, "Aldo Moro" University of Bari .
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo.
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Pierucci P, Portacci A, Carpagnano GE, Banfi P, Crimi C, Misseri G, Gregoretti C. The right interface for the right patient in noninvasive ventilation: a systematic review. Expert Rev Respir Med 2022; 16:931-944. [PMID: 36093799 DOI: 10.1080/17476348.2022.2121706] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Research in the field of noninvasive ventilation (NIV) has contributed to the development of new NIV interfaces. However, interface tolerance plays a crucial role in determining the beneficial effects of NIV therapy. AREAS COVERED This systematic review explores the most significant scientific research on NIV interfaces, with a focus on the potential impact that their design might have on treatment adherence and clinical outcomes. The rationale on the choice of the right interface among the wide variety of devices that are currently available is discussed here. EXPERT OPINION The paradigm "The right mask for the right patient" seems to be difficult to achieve in real life. Ranging from acute to chronic settings, the gold standard should include the tailoring of NIV interfaces to patients' needs and preferences. However, such customization may be hampered by issues of economic nature. High production costs and the increasing demand represent consistent burdens and have to be considered when dealing with patient-tailored NIV interfaces. New research focusing on developing advanced and tailored NIV masks should be prioritized; indeed, interfaces should be designed according to the specific patient and clinical setting where they need to be used.
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Affiliation(s)
- Paola Pierucci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Andrea Portacci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Giovanna Elisiana Carpagnano
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milano,Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | | | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy and Fondazione Istituto "G.Giglio" Cefalù', Palermo, Italy
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Pierucci P, Crimi C, Carlucci A, Carpagnano GE, Janssens JP, Lujan M, Noto A, Wijkstra PJ, Windisch W, Scala R. REINVENT: ERS International survey on REstrictive thoracic diseases IN long term home noninvasive VENTilation. ERJ Open Res 2021; 7:00911-2020. [PMID: 33898619 PMCID: PMC8053911 DOI: 10.1183/23120541.00911-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aim Little is known about the current use of long-term home noninvasive ventilation (LTHNIV) in restrictive thoracic diseases, including chest wall disorders and neuromuscular disorders (NMD). This study aimed to capture the pattern of LTHNIV in patients with restrictive thoracic diseases via a web-based international survey. Methods The survey involved European Respiratory Society (ERS) Assembly 2.02 (NIV-dedicated group), from October to December 2019. Results 166 (22.2%) out of 748 members from 41 countries responded; 80% were physicians, of whom 43% worked in a respiratory intermediate intensive care unit. The ratio of NMD to chest wall disorders was 5:1, with amyotrophic lateral sclerosis the most frequent indication within NMD (78%). The main reason to initiate LTHNIV was diurnal hypercapnia (71%). Quality of life/sleep was the most important goal to achieve. In 25% of cases, clinicians based their choice of the ventilator on patients' feedback. Among NIV modes, spontaneous-timed pressure support ventilation (ST-PSV) was the most frequently prescribed for day- and night-time. Mouthpieces were the preferred daytime NIV interface, whereas oro-nasal masks the first choice overnight. Heated humidification was frequently added to LTHNIV (72%). Single-limb circuits with intentional leaks (79%) were the most frequently prescribed. Follow-up was most often provided in an outpatient setting. Conclusions This ERS survey illustrates physicians' practices of LTHNIV in patients with restrictive thoracic diseases. NMD and, specifically, amyotrophic lateral sclerosis were the main indications for LTHNIV. NIV was started mostly because of diurnal hypoventilation with a primary goal of patient-centred benefits. Bi-level ST-PSV and oro-nasal masks were more likely to be chosen for providing NIV. LTHNIV efficacy was assessed mainly in an outpatient setting.
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Affiliation(s)
- Paola Pierucci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy.,"Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | - Annalisa Carlucci
- Reparto Pneumologia Riabilitativa Istituti Clinici Scientifici Maugeri Pavia, Pavia, Italy.,Dipartimento di Medicina e Chirurgia, Università Insubria Varese-Como, Varese, Italy
| | - Giovanna E Carpagnano
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy.,"Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Manel Lujan
- Pneumology Service, Hospital Universitari Parc Taulí de Sabadell, Universitat Autònoma de Barcelona, CIBERES, Sabadell, Spain
| | - Alberto Noto
- Dept of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Policlinico "G. Martino", Messina, Italy.,IPCF-CNR, Institute for Chemical and Physical Processes, National Research Council, Messina, Italy
| | - Peter J Wijkstra
- Dept of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wolfram Windisch
- Cologne Merheim Hospital, Dept of Pneumology, Kliniken der Stadt Köln; gGmbH Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S Donato Hospital, Arezzo, Italy
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