1
|
Chioma R, Amabili L, Ciarmoli E, Copetti R, Villani P, Stella M, Storti E, Pierro M. The importance of lung recruitability: A novel ultrasound pattern to guide lung recruitment in neonates. J Neonatal Perinatal Med 2022; 15:767-776. [PMID: 36189505 DOI: 10.3233/npm-221088] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND Lung Ultrasound (LUS)-guided Lung Recruitment Maneuver (LRM) has been shown to possibly reduce ventilator-induced lung injury in preterm infants. However, to avoid potential hemodynamic and pulmonary side effects, the indication to perform the maneuver needs to be supported by early signs of lung recruitability. Recently, a new LUS pattern (S-pattern), obtained during the reopening of collapsed parenchyma, has been described. This study aims to evaluate if this novel LUS pattern is associated with a higher clinical impact of the LUS-guided LRMs. METHODS All the LUS-guided rescue LRMs performed on infants with oxygen saturation/fraction of inspired oxygen (S/F) ratio below 200, were included in this cohort study. The primary outcome was to determine if the presence of the S-pattern is associated with the success of LUS-guided recruitment, in terms of the difference between the final and initial S/F ratio (Delta S/F). RESULTS We reported twenty-two LUS-guided recruitments, performed in nine patients with a median gestational age of 34 weeks, interquartile range (IQR) 28-35 weeks. The S-pattern could be obtained in 14 recruitments (64%) and appeared early during the procedure, after a median of 2 cmH2O (IQR 1-3) pressure increase. The presence of the S-pattern was significantly associated with the effectiveness of the maneuver as opposed to the cases in which the S-pattern could not be obtained (Delta S/F 110 +/- 47 vs 44 +/- 39, p = 0.01). CONCLUSIONS Our results suggest that the presence of the S-pattern may be an early sign of lung recruitability, predicting LUS-guided recruitment appropriateness and efficacy.
Collapse
Affiliation(s)
- R Chioma
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricoveroe Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, RM, Italy
| | - L Amabili
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, Netherland
| | - E Ciarmoli
- Department of Pediatrics, ASST Vimercate, Vimercate Hospital, Vimercate, MB, Italy
| | - R Copetti
- Emergency Department, Latisana General Hospital, Udine, UD, Italy
| | - P Villani
- Department of Critical Care, Maggiore Hospital, Cremona, Cremona, CR, Italy
| | - M Stella
- Neonatal and Paediatric Intensive Care Unit, M.Bufalini Hospital, AUSL Romagna, Cesena, FC, Italy
| | - E Storti
- Department of Critical Care, Maggiore Hospital, Cremona, Cremona, CR, Italy
| | - M Pierro
- Neonatal and Paediatric Intensive Care Unit, M.Bufalini Hospital, AUSL Romagna, Cesena, FC, Italy
| |
Collapse
|
2
|
Pierro M, Chioma R, Ciarmoli E, Villani P, Storti E, Copetti R. Lung ultrasound guided pulmonary recruitment during mechanical ventilation in neonates: A case series. J Neonatal Perinatal Med 2021; 15:357-365. [PMID: 34151867 DOI: 10.3233/npm-210722] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recently, the first report of lung ultrasound (LUS) guided recruitment during open lung ventilation in neonates has been published. LUS guided recruitment can change the approach to open lung ventilation, which is currently performed without any measure of lung function/lung expansion in the neonatal population. METHODS We included all the newborn infants that underwent a LUS-guided recruitment maneuver during mechanical ventilation as a rescue attempt for an extremely severe respiratory condition with oxygen saturation/fraction of inspired oxygen (SpO2/FIO2) ratio below 130 or the inability to wean off mechanical ventilation. RESULTS We report a case series describing 4 LUS guided recruitment maneuvers, underlying crucial aspects of this technique that can improve the effectiveness of the procedure. In particular, we describe a novel pattern (the S-pattern) that allows us to distinguish the recruitable from the unrecruitable lung and guide the pressure titration phase. Additionally, we describe the optimal LUS-guided patient positioning. CONCLUSIONS We believe that the inclusion of specifications regarding patient positioning and the S-pattern in the LUS-guided protocol may be beneficial for the success of the procedure.
Collapse
Affiliation(s)
- M Pierro
- Neonatal and Paediatric Intensive Care Unit, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy.,Department of Mother's and Child's Health, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - R Chioma
- Department of Mother's and Child's Health, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.,Dipartimento Universitario Scienze della Vita e Sanitá Pubblica, Unitá Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - E Ciarmoli
- Department of Mother's and Child's Health, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.,Department of Pediatrics, ASST Vimercate, Vimercate Hospital, Vimercate, Italy
| | - P Villani
- Department of Critical Care, Maggiore Hospital, Lodi, Lodi, Italy
| | - E Storti
- Department of Critical Care, Maggiore Hospital, Lodi, Lodi, Italy
| | - R Copetti
- Emergency Department, Latisana General Hospital, Udine, Italy
| |
Collapse
|
3
|
|
4
|
Abstract
Lung hypoplasia and pulmonary hypertension are classical features of congenital diaphragmatic hernia (CDH) and represent the main determinants of survival. The mechanisms leading to pulmonary hypertension in this malformation are still poorly understood, but may combine altered vasoreactivity, pulmonary artery remodeling, and a hypoplastic pulmonary vascular bed. Efforts have been directed at correcting the "reversible" component of pulmonary hypertension of CDH. However, pulmonary hypertension in CDH is often refractory to pulmonary vasodilators. A new emerging pattern of late (months after birth) and chronic (months to years after birth) pulmonary hypertension are described in CDH survivors. The true incidence and implications for outcome and management need to be confirmed by follow-up studies from referral centers with high patient output. In order to develop more efficient strategies to treat pulmonary hypertension and improve survival in most severe cases, the ultimate therapeutic goal would be to promote lung and vascular growth.
Collapse
Affiliation(s)
- M Pierro
- Ottawa Hospital Research Institute, Regenerative Medicine Program, Sprott Center for Stem Cell Research, Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
| | - B Thébaud
- Ottawa Hospital Research Institute, Regenerative Medicine Program, Sprott Center for Stem Cell Research, Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
5
|
Esposito S, Daleno C, Baggi E, Ciarmoli E, Lavizzari A, Pierro M, Semino M, Groppo M, Scala A, Terranova L, Galeone C, Principi N. Circulation of different rhinovirus groups among children with lower respiratory tract infection in Kiremba, Burundi. Eur J Clin Microbiol Infect Dis 2012; 31:3251-6. [PMID: 22790539 DOI: 10.1007/s10096-012-1692-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
The purpose of this investigation was to collect information regarding rhinovirus (RV) circulation in children with lower respiratory tract infections (LRTIs) in Burundi, Central Africa. We enrolled all of the children aged between 1 month and 14 years who were admitted to the hospital of Kiremba, North Burundi, with fever and signs and symptoms of LRTI (i.e., cough, tachypnea, dyspnea or respiratory distress, and breathing with grunting or wheezing sounds with rales) between 1 November 2010 and 31 October 2011, and obtained nasopharyngeal swabs for RV detection by means of polymerase chain reaction (PCR). The VP4/VP2 region of the positive samples was sequenced to determine the species of RV (A, B, or C). Four hundred and sixty-two children were enrolled: 160 (34.6 %) with bronchitis, 35 (7.6 %) with infectious wheezing, and 267 (57.8 %) with community-acquired pneumonia (CAP). RV infection was demonstrated in 186 patients [40.3 %; mean age ± standard deviation (SD) 1.77 ± 2.14 years]. RV infection was detected in 78 patients aged <12 months (40.0 %), 102 aged 12-48 months (44.3 %), and six aged >48 months (16.7 %; p < 0.01 vs. the other age groups). The most frequently identified RV was RV-A (81 cases, 43.5 %), followed by RV-C (47, 25.3 %) and RV-B (18, 9.7 %); subtyping was not possible in 40 cases (21.5 %). RV-A was significantly associated with bronchitis and CAP (p < 0.01) and RV-C with wheezing (p < 0.05). In Burundi, RVs are frequently detected in children with LRTIs. RV-A seems to be the most important species and is identified mainly in patients with bronchitis and CAP.
Collapse
Affiliation(s)
- S Esposito
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Mercadante D, Condò V, Vendettuoli V, Pierro M, Vanzati M, Weissmann G, Perniciaro S, Colnaghi M, Mosca F. [Non invasive ventilation in the preterm infant]. Pediatr Med Chir 2011; 33:120-123. [PMID: 22145294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- D Mercadante
- UO di Neonatologia e Terapia Intensiva Neonatale, Fondazione IRCCS-Cà Granda, Ospedale Maggiore Policlinico Università di Milano
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Genovese D, Di Filippo A, Ventola AM, Storti G, Iossa C, Pierro M. [Cephalosporins in childhood]. Minerva Pediatr 1987; 39:71-7. [PMID: 3600562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
8
|
Pierro M, Parenti G, Di Filippo A, Ventola AM. [Case of mild-type Ehlers-Danlos syndrome]. Minerva Pediatr 1986; 38:493-6. [PMID: 3736529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
9
|
Pierro M, Di Filippo A, Schiattarella F, Sorgente S, Guida S. [Immunoprophylaxis for newborn infants of HBsAg-positive mothers]. Minerva Pediatr 1985; 37:449-51. [PMID: 2415806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
10
|
Abstract
Cefotaxime, a third generation cephalosporin antibiotic, was evaluated in 26 infants and children for the treatment of documented or suspected bacterial infections, including pneumonia (10 cases), soft tissue skin infection (13 cases), and urinary tract infection (3 cases). An average daily dose of 60 mg/kg in 3 to 4 divided doses was administered parenterally for an average of 7 days. In 14 of the cases, primary pathogens, including Haemophilus influenzae b (resistant to ampicillin), Staphylococcus aureus, Staphylococcus pyogenes, Streptococcus pneumoniae and Escherichia coli, were eradicated. Clinical recovery occurred in each case. Blood levels at different time intervals and biological half-life were similar to those reported for adults. Mild and transient side effects observed were elevation of SGOT in two cases, alkaline phosphatase in one, and eosinophilia in one case.
Collapse
|
11
|
Guarino A, Pierro M, Taccone W, de Vito B. [Study of a family with cystinuria and criticism of the screening methods]. Minerva Pediatr 1979; 31:885-92. [PMID: 470869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
12
|
Pierro M, Pastore AR, Bonavita R, Festa R. [Phenobarbital-nicotinamide combination in the therapy of neonatal jaundice]. G Clin Med 1976; 57:126-35. [PMID: 137159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
13
|
Rubino A, Vetrella M, Pierro M, Rey J, Jos J, Auricchio S. Intestinal glutaminyl-proline dipeptidase activity in children with treated coeliac disease. Rev Eur Etud Clin Biol 1972; 17:993-7. [PMID: 4660001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
14
|
Auricchio S, Pierro M, Andria G, De Ritis G. Enzymic activities of the brush border membrane of rat intestine hydrolyzing -naphthylamides of amino acids, leucinamide and dipeptides. Biochim Biophys Acta 1972; 274:420-5. [PMID: 5049004 DOI: 10.1016/0005-2736(72)90188-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
15
|
Buffa V, Pierro M, Tarallo S. [Chondrodystrophia calcificans congenita]. Pediatria (Napoli) 1971; 79:502-16. [PMID: 5142980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
16
|
Vetrella M, Pierro M. [Enzymatic defects of erythrocytes and hemolysis in the newborn]. Pediatria (Napoli) 1971; 79:517-26. [PMID: 4401200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
17
|
|
18
|
Auricchio S, Pierro M, Andria G, De Ritis G. Arylamidase activities of brush border membrane of rat intestine. Acta Paediatr Scand 1971; 60:366. [PMID: 5579870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
19
|
|
20
|
Pierro M, Orsatti M. [On intestinal hydrolysis of pyrrolidonylpeptides]. Boll Soc Ital Biol Sper 1969; 45:1630-1. [PMID: 5400869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
21
|
Rubino A, Pierro M, Vetrella M, Provenzale L, Auricchio S. Studies on intestinal hydrolysis of peptides. I. L-glutaminyl-L-proline dipeptide hydrolase activity in the human small intestine. Biochim Biophys Acta 1969; 191:663-7. [PMID: 5363988 DOI: 10.1016/0005-2744(69)90359-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
22
|
Rubino A, Pierro M, La Torretta G, Vetrella M, Di Martino D, Auricchio S. Studies on intestinal hydrolysis of peptides. II. Dipeptidase activity toward L-glutaminyl-L-proline and glycyl-L-proline in the small intestine of the human fetus. Pediatr Res 1969; 3:313-9. [PMID: 5817414 DOI: 10.1203/00006450-196907000-00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
23
|
Rubino A, Pierro M, De Palma A, Lagonigro F. [On a case of exudative enteropathy]. Minerva Pediatr 1968; 20:2586-92. [PMID: 4305135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
24
|
Rubino A, Barbieri A, Pierro M. [Therapeutic use of Luminal in Crigler-Najjar type icterus]. Pediatria (Napoli) 1968; 76:358-65. [PMID: 5740396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|