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Prandoni P, Lensing AWA, Prins MH, Ciammaichella M, Pirillo S, Pace F, Zalunardo B, Bottino F, Ageno W, Muiesan ML, Forlin M, Depietri L, Bova C, Costantini N, Caviglioli C, Migliaccio L, Noventa F, Levi M, Davidson BL, Palareti G. Prevalence of pulmonary embolism among patients with recent onset of dyspnea on exertion. A cross-sectional study. J Thromb Haemost 2023; 21:68-75. [PMID: 36695397 DOI: 10.1016/j.jtha.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Exertional dyspnea is a frequently encountered complaint in clinical practice. However, the prevalence of pulmonary embolism (PE) among patients with dyspnea on exertion has not been reported. OBJECTIVE The objective of this study was to assess the prevalence of objectively confirmed PE among consecutive patients visiting an emergency department because of recent onset of exertional dyspnea. METHODS Patients aged ≤75 years with recent (<1 month) marked exertional dyspnea had a systematic workup for PE, irrespective of concomitant signs or symptoms of venous thromboembolism and alternative explanations for dyspnea. PE was excluded on the basis of a low pretest clinical probability and normal age-adjusted D-dimer. All other patients had computed tomography pulmonary angiography. An interim analysis after inclusion of 400 patients would stop recruitment if the 95% confidence interval (CI) of the PE prevalence had a lower limit exceeding 20%. RESULTS The study was prematurely terminated after the inclusion of 417 patients. In 134 patients (32.1%), PE was excluded based on low clinical probability and normal D-dimer. PE was found in 134 (47.3%) of the remaining 283 patients, for an overall prevalence of 32.1% (95% CI, 27.8-36.8). PE was present in 40 of 204 (19.6%) patients without other findings suspicious for PE and in 94 of 213 patients (44.1%) with such findings. PE involved a main pulmonary artery in 37% and multiple lobes in 87% of the patients. CONCLUSION The angiographic demonstration of PE is common in patients presenting with recent onset of marked exertional dyspnea, including 20% without other findings suggesting pulmonary embolism.
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Affiliation(s)
| | | | - Martin H Prins
- Department of Clinical Epidemiology, University of Maastricht, The Netherlands
| | | | - Silvana Pirillo
- Department of Radiology, S. Giovanni-Addolorata Hospital, Rome, Italy
| | | | - Beniamino Zalunardo
- Angiology Unit and Emergency Medicine Unit, San Giacomo Hospital, Castelfranco Veneto, Italy
| | | | - Walter Ageno
- Department of Internal Medicine, University of Insubria, Varese, Italy
| | - Maria L Muiesan
- Department of Internal Medicine, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - Marco Forlin
- Emergency Department, Civic Hospital, Pieve di Soligo, Italy
| | - Luca Depietri
- Cardiovascular Medicine, Civic Hospital, Reggio Emilia, Italy
| | - Carlo Bova
- Department of Internal Medicine, Civic Hospital, Cosenza, Italy
| | | | - Cosimo Caviglioli
- Emergency Department, University of Firenze Careggi, Florence, Italy
| | | | - Franco Noventa
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bruce L Davidson
- Washington State University Floyd College of Medicine, Seattle, Washington State, USA
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Vanni S, Nazerian P, Pecci R, Pepe G, Pavellini A, Casula C, de Curtis E, Ronchetti M, Vannucchi P, Bartolucci M, Vanni S, Casula C, Soldati V, Matteucci ML, Gargano U, Mirenda F, Nazerian P, Ottaviani M, Rocchetti M, Caviglioli C, Pavellini A, Vannucchi P, Pecci R, Pepe G, de Curtis E, Baldini A, Magazzini S, Sampieri A, Bartolucci M. Timing for nystagmus evaluation by STANDING or HINTS in patients with vertigo/dizziness in the emergency department. Acad Emerg Med 2022; 30:592-594. [PMID: 36448574 DOI: 10.1111/acem.14635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/18/2022] [Accepted: 11/27/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Simone Vanni
- Department of Emergency Medicine, Azienda USL Toscana Centro, Empoli, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rudi Pecci
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuseppe Pepe
- Department of Emergency Medicine, Azienda USL Nord-Ovest, Viareggio, Italy
| | - Andrea Pavellini
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Claudia Casula
- Department of Emergency Medicine, Azienda USL Toscana Centro, Empoli, Italy
| | - Ersilia de Curtis
- Department of Emergency Medicine, Azienda USL Toscana Centro, Prato, Italy
| | - Mattia Ronchetti
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Paolo Vannucchi
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Cozzi D, Moroni C, Cavigli E, Bindi A, Caviglioli C, Nazerian P, Vanni S, Miele V, Bartolucci M. Prognostic value of CT pulmonary angiography parameters in acute pulmonary embolism. Radiol Med 2021; 126:1030-1036. [PMID: 33961187 DOI: 10.1007/s11547-021-01364-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Computed tomographic pulmonary angiography (CTPA) is the first-line test in acute pulmonary embolism (APE) diagnostic algorithm, but its correlation with short-term outcome remains not clear at all. The aim is to determine whether CTPA findings can predict 30-day mortality of patients with APE in Emergency Department. METHODS This retrospective monocentric study involved 780 patients with APE diagnosed at the Emergency Department of our institution (period 2010-2019). These CTPA findings were evaluated: embolic obstruction burden score (Qanadli score), common pulmonary artery trunk diameter, right-to-left ventricular ratio, azygos vein and coronary sinus diameters. Comorbidities and fatal/nonfatal adverse outcomes within 30 days were recorded. Troponin I values were correlated with angiographic parameters with multiple logistic regression analysis. RESULTS The all-cause and APE-related 30-day mortality rates were 5.9% and 3.6%, respectively. Patients who died within 30 days were older with higher prevalence rates of malignancy. Qanadli score and all CTPA parameters correlate with Troponin I level and the presence of RVD at echocardiography (p values < 0.0001). Instead, RV/LV ratio and coronary sinus diameter correlate with 30-day mortality (p values < 0.05). At the multivariate logistic regression analysis, only coronary sinus and RVD remained significant with an HR = 2.5 (95% CI 1.1-5.6) and HR = 1.9 (95% CI 0.95-3.7), respectively. CONCLUSION CTPA quantification of right ventricular strain is an accurate predictor of 30-day mortality. In particular, it seems that a dilated coronary sinus (>9 mm) has an additional prognostic value in association with echocardiographic signs of right-heart disfunction and high Troponin I levels.
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Affiliation(s)
- Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy.
| | - Chiara Moroni
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
| | - Alessandra Bindi
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
| | - Cosimo Caviglioli
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Simone Vanni
- Department of Emergency Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
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Cupisti A, Trinchieri A, Lombardi M, Agostini S, Arcidiacono T, Beltrami P, Berri E, Bevilacqua L, Campo S, Cannavò R, Croppi E, Casarrubea G, Caviglioli C, Crisci A, D'Addessi A, Sio MD, Fantuzzi A, Fusaro M, Gambaro G, Garofalo M, Micali S, Marangella M, Petrarulo M, Piccinocchi G, Sessa A, Tasca A, Vezzoli G, Vitale C, Zattoni F. [A diagnostic-therapeutic pathway for patients with kidney stone disease: 2020 update]. G Ital Nefrol 2020; 37:37-S75-2020-4. [PMID: 32749084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The natural history of urinary kidney stone disease includes the risk of relapses and can be associated with the risk of chronic kidney disease, bone and cardiovascular disease. For this reason, a wide clinical-metabolic assessment of the kidney stone patient is of great importance since the first presentation of the stone, to set an appropriate preventive treatment. The proposed diagnostic-therapeutic pathway includes a careful medical history, in order to highlight a secondary kidney stone disease and the main risk factors for kidney stones, chronic renal disease, or cardiovascular and bone disease; a metabolic evaluation on multiple levels, according to the severity of the disease, and the presence or absence of risk factors, and appropriate instrumental investigations. Thus, the information collected makes it possible to set a preventive treatment consisting of general rules and, if necessary, specific pharmacological or nutritional interventions. This paper has been prepared by the Italian Multidisciplinary Study Group for Kidney Stone Disease, and it is addressed to the several professional figures involved in the management of patients suffering from nephrolithiasis, from the emergency doctor to the general practitioner, urologist, nephrologist, radiologist, and dietician. A diagnostic-therapeutic pathway for patients with kidney stone disease was first published on this Journal in 2010. The present contribution aims at amending and updating the article published exactly ten years ago, to serve as an easy-to-use reference and to guide good clinical practice in this field.
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Affiliation(s)
- Adamasco Cupisti
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italia
| | - Alberto Trinchieri
- Scuola di Specializzazione in Urologia, Università di Milano, Milano, Italia
| | - Marco Lombardi
- UOC Nefrologia e Dialisi, Firenze-2, Ospedale SM Annunziata e del Mugello ASL Toscana Centro, Firenze, Italia
| | - Simone Agostini
- SOD Radiodiagnostica Emergenza e Urgenza, Azienda Ospedaliero Universitaria Careggi, Firenze, Italia
| | - Teresa Arcidiacono
- Unità di Nefrologia e Dialisi, IRCCS, Ospedale San Raffaele e Università Vita Salute San Raffaele, Milano, Italia
| | - Paolo Beltrami
- Clinica Urologica, Università di Padova, c/o Ospedale Civile, Padova, Italia
| | | | - Luigi Bevilacqua
- Cattedra di Urologia, Università di Modena e Reggio Emilia, Emilia Romagna, Italia
| | - Salvatore Campo
- Responsabile Area Urologica della Società Italiana di Medicina Generale, Firenze, Italia
| | - Rossella Cannavò
- UOC Nefrologia e Dialisi, Ospedale SM Annunziata - Firenze-2, ASL Toscana Centro, Firenze, Italia
| | - Emanuele Croppi
- Medico di Medicina Generale ASL 10, Firenze, Specialista in Nefrologia e Professore A.C. Università di Firenze, Firenze, Italia
| | | | - Cosimo Caviglioli
- SOD Medicina e Chirurgia d'Urgenza e Accettazione, Azienda Ospedaliero Universitaria Careggi, Firenze, Italia
| | - Alfonso Crisci
- Clinica Urologica, Università degli Studi di Firenze, Firenze, Italia
| | | | - Marco De Sio
- UO e Cattedra di Urologia Università degli Studi della Campania "L. Vanvitelli", Caserta, Italia
| | - Annalaura Fantuzzi
- Referente ambulatorio di Dietetica delle Malattie Renali, Ospedale di Sassuolo spa, Sassuolo (MO), Italia
| | - Maria Fusaro
- Istituto di Fisiologia Clinica CNR, Pisa, Italia; Dipartimento di Medicina Università di Padova, Padova, Italia
| | | | - Marco Garofalo
- Policlinico S. Orsola, Clinica Urologica, Università di Bologna, Bologna, Italia
| | - Salvatore Micali
- Cattedra di Urologia, Università di Modena e Reggio Emilia, Emilia Romagna, Italia
| | | | - Michele Petrarulo
- Laboratorio Analisi-Chimico Cliniche e Microbiologia, A.O. Ordine Mauriziano di Torino, Torino, Italia
| | | | - Alberto Sessa
- Presidente Regionale Società Italiana di Medicina Generale Lombardia, Italia
| | - Andrea Tasca
- Università Internazionale per la Pace, Roma, Italia
| | - Giuseppe Vezzoli
- Unità di Nefrologia e Dialisi, IRCCS, Ospedale San Raffaele e Università Vita Salute San Raffaele, Milano, Italia
| | - Corrado Vitale
- S.C. Nefrologia e Dialisi, A.O. Ordine Mauriziano di Torino, Torino, Italia
| | - Filiberto Zattoni
- Clinica Urologica, Università di Padova, c/o Ospedale Civile, Padova, Italia
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Vanni S, Becattini C, Nazerian P, Bova C, Stefanone VT, Cimini LA, Viviani G, Caviglioli C, Sanna M, Pepe G, Grifoni S. Early discharge of patients with pulmonary embolism in daily clinical practice: A prospective observational study comparing clinical gestalt and clinical rules. Thromb Res 2018; 167:37-43. [DOI: 10.1016/j.thromres.2018.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 04/23/2018] [Accepted: 05/06/2018] [Indexed: 01/26/2023]
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Vanni S, Pecci R, Edlow JA, Nazerian P, Santimone R, Pepe G, Moretti M, Pavellini A, Caviglioli C, Casula C, Bigiarini S, Vannucchi P, Grifoni S. Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm. Front Neurol 2017; 8:590. [PMID: 29163350 PMCID: PMC5682038 DOI: 10.3389/fneur.2017.00590] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/23/2017] [Indexed: 12/05/2022] Open
Abstract
Objective We investigated the reliability and accuracy of a bedside diagnostic algorithm for patients presenting with vertigo/unsteadiness to the emergency department. Methods We enrolled consecutive adult patients presenting with vertigo/unsteadiness at a tertiary hospital. STANDING, the acronym for the four-step algorithm we have previously described, based on nystagmus observation and well-known diagnostic maneuvers includes (1) the discrimination between SponTAneous and positional nystagmus, (2) the evaluation of the Nystagmus Direction, (3) the head Impulse test, and (4) the evaluation of equilibrium (staNdinG). Reliability of each step was analyzed by Fleiss’ K calculation. The reference standard (central vertigo) was a composite of brain disease including stroke, demyelinating disease, neoplasm, or other brain disease diagnosed by initial imaging or during 3-month follow-up. Results Three hundred and fifty-two patients were included. The incidence of central vertigo was 11.4% [95% confidence interval (CI) 8.2–15.2%]. The leading cause was ischemic stroke (70%). The STANDING showed a good reliability (overall Fleiss K 0.83), the second step showing the highest (0.95), and the third step the lowest (0.74) agreement. The overall accuracy of the algorithm was 88% (95% CI 85–88%), showing high sensitivity (95%, 95% CI 83–99%) and specificity (87%, 95% CI 85–87%), very high-negative predictive value (99%, 95% CI 97–100%), and a positive predictive value of 48% (95% CI 41–50%) for central vertigo. Conclusion Using the STANDING algorithm, non-sub-specialists achieved good reliability and high accuracy in excluding stroke and other threatening causes of vertigo/unsteadiness.
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Affiliation(s)
- Simone Vanni
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Rudi Pecci
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Jonathan A Edlow
- Department of Emergency Medicine, BIDMC, Boston, MA, United States
| | - Peiman Nazerian
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Rossana Santimone
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Giuseppe Pepe
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Marco Moretti
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Andrea Pavellini
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Cosimo Caviglioli
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Claudia Casula
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Sofia Bigiarini
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
| | - Paolo Vannucchi
- Audiology Clinic, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Ospedale Versilia, Azienda USL Toscana Nord Ovest, Firenze, Italy
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Liedl G, Nazerian P, Pepe G, Caviglioli C, Grifoni S, Vanni S. Different time course of plasma lactate, troponin I and Nt-proBNP concentrations in patients with acute pulmonary embolism. Thromb Res 2017; 156:26-28. [DOI: 10.1016/j.thromres.2017.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/23/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
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Casati C, Castelli M, Pavellini A, Caviglioli C, Pecci R. An unusual case of vertigo: the usefulness of nystagmus examination. Intern Emerg Med 2016; 11:1131-1133. [PMID: 27644705 DOI: 10.1007/s11739-016-1538-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/09/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Carlotta Casati
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
| | - Matteo Castelli
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Andrea Pavellini
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Cosimo Caviglioli
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Rudi Pecci
- Department of Surgical Sciences and Translational Medicine, Unit of Audiology Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Dani C, Bertini G, Pezzati M, Filippi L, Pratesi S, Caviglioli C, Rubaltelli FF. Effects of pressure support ventilation plus volume guarantee vs. high-frequency oscillatory ventilation on lung inflammation in preterm infants. Pediatr Pulmonol 2006; 41:242-9. [PMID: 16397875 DOI: 10.1002/ppul.20350] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of the present study was to evaluate if high-frequency oscillatory ventilation (HFOV) might reduce lung inflammation in preterm infants with infant respiratory distress syndrome (RDS) in comparison with the early application of another potentially lung-protective ventilation strategy, such as pressure support ventilation plus volume guarantee (PSV + VG). Infants at less than 30 weeks of gestation with RDS were enrolled consecutively in the study if they required mechanical ventilation, and were randomly allocated to receive HFOV or PSV + VG. Bronchial aspirate samples for the measurement of interleukin (IL)-1beta, IL-8, and IL-10 were obtained before surfactant treatment (T1), after 6-18 hr of ventilation (T2), after 24-48 hr of ventilation (T3), and before extubation (T4). Thirteen patients were enrolled in the HFOV group, and 12 in the PSV + VG group. The mean values of IL-1beta, IL-8, and IL-10 at T4 were lower in the HFOV group than in the PSV + VG group. The present study demonstrates that early treatment with HFOV is associated with a reduction of lung inflammation in comparison with PSV + VG in preterm infants with RDS.
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Affiliation(s)
- Carlo Dani
- Section of Neonatology, Department of Surgical and Medical Critical Care, Careggi University Hospital of Florence, Florence, Italy.
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Dani C, Bertini G, Pezzati M, Cecchi A, Caviglioli C, Rubaltelli FF. Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratory distress syndrome among preterm infants <30 weeks' gestation. Pediatrics 2004; 113:e560-3. [PMID: 15173537 DOI: 10.1542/peds.113.6.e560] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To test the hypothesis that preterm infants with infant respiratory distress syndrome who are treated with nasal continuous positive airway pressure (NCPAP) and surfactant administration followed by immediate extubation and NCPAP application (SURF-NCPAP group) demonstrate less need for mechanical ventilation (MV), compared with infants who receive MV after surfactant administration (SURF-MV group). METHODS A prospective randomized study was conducted, in which infants <30 weeks' gestation were randomized to the SURF-NCPAP group or the SURF-MV group. RESULTS At 7 days of life, no patient in the SURF-NCPAP group but 6 patients (43%) in the SURF-MV group still were undergoing MV. The duration of oxygen therapy, NCPAP, and MV, the need for a second dose of surfactant, and the length of stay in the intensive care unit were significantly greater in the SURF-MV group. CONCLUSIONS The immediate reinstitution of NCPAP after surfactant administration for infants with infant respiratory distress syndrome is safe and beneficial, as indicated by the lesser need for MV and the briefer requirement for respiratory supports, compared with the institution of MV after surfactant treatment. Moreover, this strategy contributed to reducing the need for surfactant treatment and reducing the time and costs involved in keeping the infants in the neonatal intensive care unit.
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Affiliation(s)
- Carlo Dani
- Department of Surgical and Medical Critical Care, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy.
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