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Lionello F, Guarnieri G, Arcaro G, Bertagna De Marchi L, Molena B, Contessa C, Boscolo A, Rea F, Navalesi P, Vianello A. High-Flow Tracheal Oxygen for Tracheostomy Tube Removal in Lung Transplant Recipients. J Clin Med 2023; 12:7566. [PMID: 38137635 PMCID: PMC10743481 DOI: 10.3390/jcm12247566] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Because of a complicated intraoperative course and/or poor recovery of graft function, approximately 15% of lung transplant (LT) recipients require prolonged mechanical ventilation (PMV) and receive a tracheostomy. This prospective study aimed to assess the effect of High-Flow Tracheal Oxygen (HFTO) on tracheostomy tube removal in LT recipients receiving PMV postoperatively. (2) Methods: The clinical course of 14 LT recipients receiving HFTO was prospectively evaluated and compared to that of 13 comparable controls receiving conventional oxygen therapy (COT) via tracheostomy. The study's primary endpoint was the number of patients whose tracheostomy tube was removed at discharge from an Intermediate Respiratory Care Unit (IRCU). (3) Results: Setting up HFTO proved easy, and it was well tolerated by all the patients. The number of patients whose tracheostomy tube was removed was significantly higher in the HFOT group compared to the COT group [13/14 vs. 6/13 (p = 0.0128)]. (4) Conclusions: HFTO is an effective, safe therapy that facilitates tracheostomy tube removal in LT recipients after weaning from PMV.
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Affiliation(s)
- Federico Lionello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Gabriella Guarnieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Giovanna Arcaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Leonardo Bertagna De Marchi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Beatrice Molena
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Cristina Contessa
- Department of Directional Hospital Management, University of Padova, 35131 Padova, Italy;
| | - Annalisa Boscolo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
- Department of Medicine, University of Padova, 35131 Padova, Italy;
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Paolo Navalesi
- Department of Medicine, University of Padova, 35131 Padova, Italy;
| | - Andrea Vianello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
- Fisiopatologia Respiratoria, Ospedale-Università di Padova, Via Giustiniani, 2, 35128 Padova, Italy
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Lionello F, Guarnieri G, Arcaro G, Vianello A. High flow nasal oxygen as a "second-line" therapy for COVID-19 patients intolerant to noninvasive ventilation. A retrospective cohort study. Health Sci Rep 2023; 6:e1685. [PMID: 38028672 PMCID: PMC10647974 DOI: 10.1002/hsr2.1685] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/23/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Federico Lionello
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
| | - Gabriella Guarnieri
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
| | - Giovanna Arcaro
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
| | - Andrea Vianello
- Department of Cardiac, Thoracic and Vascular SciencesUniversity of PadovaPadovaItaly
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Vianello A, Guarnieri G, Achille A, Lionello F, Lococo S, Zaninotto M, Caminati M, Senna G. Serum biomarkers of remodeling in severe asthma with fixed airway obstruction and the potential role of KL-6. Clin Chem Lab Med 2023; 61:1679-1687. [PMID: 36989607 DOI: 10.1515/cclm-2022-1323] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Abstract
Over 3% of asthmatic patients are affected by a particularly severe form of the disease ("severe asthma", SA) which is often refractory to standard treatment. Airway remodeling (AR), which can be considered a critical characteristic of approximately half of all patients with SA and currently thought to be the main mechanism triggering fixed airway obstruction (FAO), seems to be a key factor affecting a patient's outcome. Despite the collective efforts of internationally renowned experts, to date only a few biomarkers indicative of AR and no recognizable biomarkers of lung parenchymal remodeling have been identified. This work examines the pathogenesis of airway and lung parenchymal remodeling and the serum biomarkers that may be able to identify the severe asthmatic patients who may develop FAO. The study also aims to examine if Krebs von den Lungen-6 (KL-6) could be considered a diagnostic biomarker of lung structural damage in SA.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessia Achille
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Federico Lionello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sara Lococo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona, Verona, Italy
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Lionello F, Lapia F, Molena B, Padoan A, Lococo S, Arcaro G, Guarnieri G, Vianello A. The Safety of a High-Flow Nasal Cannula in Neuromuscular Disease Patients with Acute Respiratory Failure: A Retrospective Case-Series Study. J Clin Med 2023; 12:6061. [PMID: 37763001 PMCID: PMC10531616 DOI: 10.3390/jcm12186061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/23/2023] [Revised: 09/04/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Although Non-Invasive Ventilation (NIV) is effective in preventing mortality and endotracheal intubation in patients with Acute Respiratory Failure (ARF) linked to a neuromuscular disorder, its efficacy can be affected by patient intolerance. A High-Flow Nasal Cannula (HFNC) appears to have a significant advantage over NIV as far as patient tolerance is concerned. The aim of the study was to investigate HFNC's safety profile in a group of consecutive Neuromuscular Disease (NMD) patients intolerant to NIV who were admitted to an Intermediate Respiratory Care Unit (IRCU) for ARF. (2) Methods: The clinical course of nine NMD patients intolerant to NIV and switched to HFNC was reported. HFNC was provided during daytime hours and NIV during the night-time to the NIV-intolerant patients. HFNC was utilized 24 h a day in those patients who were intolerant of even nocturnal NIV. (3) Results: HFNC was simple to use and it was well tolerated by all of the patients. Three out of nine patients experienced treatment failure, consisting of the need for ETI and/or death during their IRCU stay. The remaining 6 had a favorable outcome. Treatment failure was linked to the utilization of HFNC 24 h a day. (4) Conclusion: HFNC during the daytime hours, together with nocturnal NIV, seems to be a safe therapeutic approach for NMD patients with ARF. A round-the-clock use of HFNC tends to be linked to a high likelihood of failure.
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Affiliation(s)
- Federico Lionello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (F.L.); (B.M.); (S.L.); (G.A.); (G.G.)
| | - Francesco Lapia
- Department of Internal Medicine and Medical Therapy, University of Pavia, Piazza Golgi 19, 271000 Pavia, Italy;
| | - Beatrice Molena
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (F.L.); (B.M.); (S.L.); (G.A.); (G.G.)
| | - Andrea Padoan
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
| | - Sara Lococo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (F.L.); (B.M.); (S.L.); (G.A.); (G.G.)
| | - Giovanna Arcaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (F.L.); (B.M.); (S.L.); (G.A.); (G.G.)
| | - Gabriella Guarnieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (F.L.); (B.M.); (S.L.); (G.A.); (G.G.)
| | - Andrea Vianello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (F.L.); (B.M.); (S.L.); (G.A.); (G.G.)
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Vianello A, Lionello F, Guarnieri G. Electrical Impedance Tomography Used During Bronchoscopy in a Patient With Aspiration Pneumonia. Arch Bronconeumol 2023; 59:332. [PMID: 36803940 DOI: 10.1016/j.arbres.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova 35122, Italy.
| | - Federico Lionello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova 35122, Italy
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova 35122, Italy
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Guarnieri G, Lionello F, Giraudo C, Vianello A. Spontaneous pneumomediastinum in a young patient with acute asthma exacerbation. Pediatr Pulmonol 2023; 58:609-610. [PMID: 36251528 DOI: 10.1002/ppul.26210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Federico Lionello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Giraudo
- Institute of Radiology, Padova University Hospital, Padova, Italy
| | - Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Longato E, Morieri ML, Sparacino G, Di Camillo B, Cattelan A, Lo Menzo S, Trevenzoli M, Vianello A, Guarnieri G, Lionello F, Avogaro A, Fioretto P, Vettor R, Fadini GP. Time-series analysis of multidimensional clinical-laboratory data by dynamic Bayesian networks reveals trajectories of COVID-19 outcomes. Comput Methods Programs Biomed 2022; 221:106873. [PMID: 35588662 PMCID: PMC9091152 DOI: 10.1016/j.cmpb.2022.106873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE COVID-19 severity spans an entire clinical spectrum from asymptomatic to fatal. Most patients who require in-hospital care are admitted to non-intensive wards, but their clinical conditions can deteriorate suddenly and some eventually die. Clinical data from patients' case series have identified pre-hospital and in-hospital risk factors for adverse COVID-19 outcomes. However, most prior studies used static variables or dynamic changes of a few selected variables of interest. In this study, we aimed at integrating the analysis of time-varying multidimensional clinical-laboratory data to describe the pathways leading to COVID-19 outcomes among patients initially hospitalised in a non-intensive care setting. METHODS We collected the longitudinal retrospective data of 394 patients admitted to non-intensive care units at the University Hospital of Padova (Padova, Italy) due to COVID-19. We trained a dynamic Bayesian network (DBN) to encode the conditional probability relationships over time between death and all available demographics, pre-existing conditions, and clinical laboratory variables. We applied resampling, dynamic time warping, and prototyping to describe the typical trajectories of patients who died vs. those who survived. RESULTS The DBN revealed that the trajectory linking demographics and pre-existing clinical conditions to death passed directly through kidney dysfunction or, more indirectly, through cardiac damage. As expected, admittance to the intensive care unit was linked to markers of respiratory function. Notably, death was linked to elevation in procalcitonin and D-dimer levels. Death was associated with persistently high levels of procalcitonin from admission and throughout the hospital stay, likely reflecting bacterial superinfection. A sudden raise in D-dimer levels 3-6 days after admission was also associated with subsequent death, possibly reflecting a worsening thrombotic microangiopathy. CONCLUSIONS This innovative application of DBNs and prototyping to integrated data analysis enables visualising the patient's trajectories to COVID-19 outcomes and may instruct timely and appropriate clinical decisions.
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Affiliation(s)
- Enrico Longato
- Department of Information Engineering, University of Padova, 35128 Padova, Italy
| | | | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, 35128 Padova, Italy
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, 35128 Padova, Italy
| | - Annamaria Cattelan
- Infectious Disease Unit, University Hospital of Padova, 35128 Padova, Italy
| | - Sara Lo Menzo
- Infectious Disease Unit, University Hospital of Padova, 35128 Padova, Italy
| | - Marco Trevenzoli
- Infectious Disease Unit, University Hospital of Padova, 35128 Padova, Italy
| | - Andrea Vianello
- Unit of Respiratory Pathophysiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Gabriella Guarnieri
- Unit of Respiratory Pathophysiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Federico Lionello
- Unit of Respiratory Pathophysiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Paola Fioretto
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Roberto Vettor
- Department of Medicine, University of Padova, 35128 Padova, Italy
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Pettenuzzo T, Giraudo C, Fichera G, Della Paolera M, Tocco M, Weber M, Gorgi D, Carlucci S, Lionello F, Lococo S, Boscolo A, De Cassai A, Pasin L, Rossato M, Vianello A, Vettor R, Sella N, Navalesi P. Chest X-ray Does Not Predict the Risk of Endotracheal Intubation and Escalation of Treatment in COVID-19 Patients Requiring Noninvasive Respiratory Support. J Clin Med 2022; 11:jcm11061636. [PMID: 35329962 PMCID: PMC8950017 DOI: 10.3390/jcm11061636] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
Forms of noninvasive respiratory support (NIRS) have been widely used to avoid endotracheal intubation in patients with coronavirus disease-19 (COVID-19). However, inappropriate prolongation of NIRS may delay endotracheal intubation and worsen patient outcomes. The aim of this retrospective study was to assess whether the CARE score, a chest X-ray score previously validated in COVID-19 patients, may predict the need for endotracheal intubation and escalation of respiratory support in COVID-19 patients requiring NIRS. From December 2020 to May 2021, we included 142 patients receiving NIRS who had a first chest X-ray available at NIRS initiation and a second one after 48–72 h. In 94 (66%) patients, the level of respiratory support was increased, while endotracheal intubation was required in 83 (58%) patients. The CARE score at NIRS initiation was not predictive of the need for endotracheal intubation (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.96–1.06) or escalation of treatment (OR 1.01, 95% CI 0.96–1.07). In conclusion, chest X-ray severity, as assessed by the CARE score, did not allow predicting endotracheal intubation or escalation of respiratory support in COVID-19 patients undergoing NIRS.
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Affiliation(s)
- Tommaso Pettenuzzo
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Chiara Giraudo
- Institute of Radiology, Padua University Hospital, 2 Via Nicolò Giustiniani, 35128 Padua, Italy;
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Giulia Fichera
- Pediatric Radiology, Padua University Hospital, 2 Via Nicolò Giustiniani, 35128 Padua, Italy;
| | - Michele Della Paolera
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Martina Tocco
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Michael Weber
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 23 Spitalgasse, 1090 Vienna, Austria;
| | - Davide Gorgi
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Silvia Carlucci
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Federico Lionello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Sara Lococo
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Annalisa Boscolo
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Alessandro De Cassai
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Laura Pasin
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Marco Rossato
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Roberto Vettor
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Nicolò Sella
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Correspondence:
| | - Paolo Navalesi
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
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Vianello A, De Vita N, Scotti L, Guarnieri G, Confalonieri M, Bonato V, Molena B, Maestrone C, Airoldi G, Olivieri C, Sainaghi PP, Lionello F, Arcaro G, Della Corte F, Navalesi P, Vaschetto R. Clinical Outcomes in Patients Aged 80 Years or Older Receiving Non-Invasive Respiratory Support for Hypoxemic Acute Respiratory Failure Consequent to COVID-19. J Clin Med 2022; 11:jcm11051372. [PMID: 35268463 PMCID: PMC8911338 DOI: 10.3390/jcm11051372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 12/10/2022] Open
Abstract
As the clinical outcome of octogenarian patients hospitalised for COVID-19 is very poor, here we assessed the clinical characteristics and outcomes of patients aged 80 year or older hospitalised for COVID-19 receiving non-invasive respiratory support (NIRS). A multicentre, retrospective, observational study was conducted in seven hospitals in Northern Italy. All patients aged ≥80 years with COVID-19 associated hypoxemic acute respiratory failure (hARF) undergoing NIRS between 24 February 2020, and 31 March 2021, were included. Out of 252 study participants, 156 (61.9%) and 163 (64.6%) died during hospital stay and within 90 days from hospital admission, respectively. In this case, 228 (90.5%) patients only received NIRS (NIRS group), while 24 (9.5%) were treated with invasive mechanical ventilation (IMV) after NIRS failure (NIRS+IMV group). In-hospital mortality did not significantly differ between NIRS and NIRS+IMV group (61.0% vs. 70.8%, respectively; p = 0.507), while survival probability at 90 days was significantly higher for NIRS compared to NIRS+IMV patients (0.379 vs. 0.147; p = 0.0025). The outcome of octogenarian patients with COVID-19 receiving NIRS is quite poor. Caution should be used when considering transition from NIRS to IMV after NIRS failure.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
- Correspondence: ; Tel.: +39-049-821-8587; Fax: +39-049-821-7791
| | - Nello De Vita
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Lorenza Scotti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Marco Confalonieri
- Pneumologia, Azienda Sanitaria Universitaria Giuliano Isontina, Via Giacomo Puccini, 50, 34148 Trieste, Italy;
| | - Valeria Bonato
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia, 16, 15121 Alessandria, Italy;
| | - Beatrice Molena
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Carlo Maestrone
- Anestesia Rianimazione ASL VCO, Dipartimento Chirurgico, Presidio Ospedaliero Domodossola e Verbania, Largo Caduti Lager Nazisti, 1, 28845 Domodossola, Italy;
| | - Gianluca Airoldi
- Medicina Interna, Ospedale Ss. Trinità, Viale Zoppis, 10, 28021 Borgomanero, Italy;
| | - Carlo Olivieri
- Department of Anesthesia and Critical Care, Azienda Ospedaliera Sant’Andrea, Corso M. Abbiate, 21, 13100 Vercelli, Italy;
| | - Pier Paolo Sainaghi
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Federico Lionello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Giovanna Arcaro
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Via Gallucci, 13, 35121 Padova, Italy; (G.G.); (B.M.); (F.L.); (G.A.)
| | - Francesco Della Corte
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
| | - Paolo Navalesi
- Istituto di Anestesia e Rianimazione, Dipartimento di Medicina-DIMED-Università di Padova, Azienda Ospedale-Università di Padova, Via Gallucci, 13, 35121 Padova, Italy;
| | - Rosanna Vaschetto
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Via Solaroli, 17, 28100 Novara, Italy; (N.D.V.); (L.S.); (P.P.S.); (F.D.C.); (R.V.)
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Vianello A, Guarnieri G, Lionello F. Unvaccinated COVID-19 patients in the ICU: views from both sides of the barrier. Pulmonology 2022; 28:161-163. [PMID: 35140047 PMCID: PMC8776404 DOI: 10.1016/j.pulmoe.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- A Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, 35122, Italy.
| | - G Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, 35122, Italy
| | - F Lionello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, 35122, Italy
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11
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Vianello A, Guarnieri G, Braccioni F, Molena B, Lococo S, Achille A, Lionello F, Salviati L, Caminati M, Senna G. Correlation between α1-Antitrypsin Deficiency and SARS-CoV-2 Infection: Epidemiological Data and Pathogenetic Hypotheses. J Clin Med 2021; 10:4493. [PMID: 34640510 PMCID: PMC8509830 DOI: 10.3390/jcm10194493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/02/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 12/24/2022] Open
Abstract
The most common hereditary disorder in adults, α1-antitrypsin deficiency (AATD), is characterized by reduced plasma levels or the abnormal functioning of α1-antitrypsin (AAT), a major human blood serine protease inhibitor, which is encoded by the SERine Protein INhibitor-A1 (SERPINA1) gene and produced in the liver. Recently, it has been hypothesized that the geographic differences in COVID-19 infection and fatality rates may be partially explained by ethnic differences in SERPINA1 allele frequencies. In our review, we examined epidemiological data on the correlation between the distribution of AATD, SARS-CoV-2 infection, and COVID-19 mortality rates. Moreover, we described shared pathogenetic pathways that may provide a theoretical basis for our epidemiological findings. We also considered the potential use of AAT augmentation therapy in patients with COVID-19.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy; (G.G.); (F.B.); (B.M.); (S.L.); (A.A.); (F.L.)
| | - Gabriella Guarnieri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy; (G.G.); (F.B.); (B.M.); (S.L.); (A.A.); (F.L.)
| | - Fausto Braccioni
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy; (G.G.); (F.B.); (B.M.); (S.L.); (A.A.); (F.L.)
| | - Beatrice Molena
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy; (G.G.); (F.B.); (B.M.); (S.L.); (A.A.); (F.L.)
| | - Sara Lococo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy; (G.G.); (F.B.); (B.M.); (S.L.); (A.A.); (F.L.)
| | - Alessia Achille
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy; (G.G.); (F.B.); (B.M.); (S.L.); (A.A.); (F.L.)
| | - Federico Lionello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy; (G.G.); (F.B.); (B.M.); (S.L.); (A.A.); (F.L.)
| | - Leonardo Salviati
- Department of Pediatrics, University of Padova, 35122 Padova, Italy;
| | - Marco Caminati
- Asthma Center and Allergy Unit, University of Verona, 37129 Verona, Italy; (M.C.); (G.S.)
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona, 37129 Verona, Italy; (M.C.); (G.S.)
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12
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Vianello A, Turrin M, Guarnieri G, Molena B, Arcaro G, Turato C, Braccioni F, Bertagna De Marchi L, Lionello F, Subotic P, Masiero S, Giraudo C, Navalesi P. Prone Positioning Is Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-Flow Nasal Oxygen Therapy. J Clin Med 2021; 10:jcm10153404. [PMID: 34362185 PMCID: PMC8348451 DOI: 10.3390/jcm10153404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/03/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with COVID-19 may experience hypoxemic Acute Respiratory Failure (hARF) requiring O2-therapy by High-Flow Nasal Cannula (HFNO). Although Prone Positioning (PP) may improve oxygenation in COVID-19 non-intubated patients, the results on its clinical efficacy are controversial. The present study aims to prospectively investigate whether PP may reduce the need for endotracheal intubation (ETI) in patients with COVID-19 receiving HFNO. METHODS All consecutive unselected adult patients with bilateral lung opacities on chest X-ray receiving HFNO after admission to a SARS-CoV-2 Respiratory Intermediate Care Unit (RICU) were considered eligible. Patients who successfully passed an initial PP trial (success group) underwent PP for periods ≥ 2 h twice a day, while receiving HFNO. The study's primary endpoint was the intubation rate during the stay in the RICU. RESULTS Ninety-three patients were included in the study. PP was feasible and safe in 50 (54%) patients. Sixteen (17.2%) patients received ETI and 27 (29%) escalated respiratory support, resulting in a mortality rate of 9/93 (9.7%). The length of hospital stay was 18 (6-75) days. In 41/50 (80%) of subjects who passed the trial and underwent PP, its use was associated with clinical benefit and survival without escalation of therapy. CONCLUSIONS PP is feasible and safe in over 50% of COVID-19 patients receiving HFNO for hARF. Randomized trials are required to confirm that PP has the potential to reduce intubation rate.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy; (M.T.); (G.G.); (B.M.); (G.A.); (F.B.); (L.B.D.M.); (F.L.); (P.S.)
- Correspondence: ; Tel.: +39-049-8218587; Fax: +39-049-8218590
| | - Martina Turrin
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy; (M.T.); (G.G.); (B.M.); (G.A.); (F.B.); (L.B.D.M.); (F.L.); (P.S.)
| | - Gabriella Guarnieri
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy; (M.T.); (G.G.); (B.M.); (G.A.); (F.B.); (L.B.D.M.); (F.L.); (P.S.)
| | - Beatrice Molena
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy; (M.T.); (G.G.); (B.M.); (G.A.); (F.B.); (L.B.D.M.); (F.L.); (P.S.)
| | - Giovanna Arcaro
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy; (M.T.); (G.G.); (B.M.); (G.A.); (F.B.); (L.B.D.M.); (F.L.); (P.S.)
| | - Cristian Turato
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Fausto Braccioni
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy; (M.T.); (G.G.); (B.M.); (G.A.); (F.B.); (L.B.D.M.); (F.L.); (P.S.)
| | - Leonardo Bertagna De Marchi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy; (M.T.); (G.G.); (B.M.); (G.A.); (F.B.); (L.B.D.M.); (F.L.); (P.S.)
| | - Federico Lionello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy; (M.T.); (G.G.); (B.M.); (G.A.); (F.B.); (L.B.D.M.); (F.L.); (P.S.)
| | - Pavle Subotic
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35128 Padova, Italy; (M.T.); (G.G.); (B.M.); (G.A.); (F.B.); (L.B.D.M.); (F.L.); (P.S.)
| | - Stefano Masiero
- Department of Neurosciences, University of Padova, 35128 Padova, Italy;
| | - Chiara Giraudo
- Department of Medicine DIMED, University of Padova, 35128 Padova, Italy; (C.G.); (P.N.)
| | - Paolo Navalesi
- Department of Medicine DIMED, University of Padova, 35128 Padova, Italy; (C.G.); (P.N.)
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Ferrara LA, Guida L, Iannuzzi R, Celentano A, Lionello F. Serum cholesterol affects blood pressure regulation. J Hum Hypertens 2002; 16:337-43. [PMID: 12082495 DOI: 10.1038/sj.jhh.1001388] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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: 10/30/2001] [Revised: 12/19/2001] [Accepted: 12/19/2001] [Indexed: 02/05/2023]
Abstract
A close relationship between abnormalities of the lipid metabolism and arterial hypertension has been observed in several epidemiological studies. The aim of the present study was to investigate whether serum cholesterol might affect blood pressure (BP) levels at rest, during ambulatory monitoring or during sympathetic stimulation-independently of other variables such as body weight or serum insulin-thus influencing the outcome of hypertensive complications. Seventy-three patients with sustained newly-discovered and never-treated hypertension were divided into tertiles according to their serum cholesterol levels and their resting BP, 24-h BP and BP during isometric exercise (handgrip) were compared. Cardiac mass and carotid wall thickness were measured by echographic technique. The results were that tertiles were similar for body weight, blood glucose and serum insulin, but different for serum cholesterol and triglycerides. BP at rest and during 24-h monitoring was similar in the three groups, whilst a significant difference was detected during sympathetic stimulation by handgrip, with systolic and diastolic BP increasing by 16/12, 28/19 and 30/23 mm Hg (P < 0.01) in lower, medium and higher tertiles, respectively. Intima-media layer of the carotid arteries was also significantly thickened in the groups with higher cholesterol levels (0.54 +/- 0.07, 0.67 +/- 0.14, 0.68 +/- 0.15, P < 0.05). These data support the conclusion that even in patients with recently discovered hypertension, cholesterol levels may influence the BP response to adrenergic stimulation as well as the outcome of target organ disease.
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Affiliation(s)
- L A Ferrara
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
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