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Misseri G, Pierucci P, Bellina D, Ippolito M, Ingoglia G, Gregoretti C. Early pronation, protective lung ventilation and use of awake-prone-HFNO therapy after extubation in near-fatal drowning. Pulmonology 2024; 30:198-201. [PMID: 36907818 DOI: 10.1016/j.pulmoe.2022.12.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 03/12/2023] Open
Affiliation(s)
- G Misseri
- Fondazione Istituto "G. Giglio" Cefalù, Palermo, Italy.
| | - P Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinico University Hospital, Italy; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari "Aldo Moro", Italy
| | - D Bellina
- Fondazione Istituto "G. Giglio" Cefalù, Palermo, Italy
| | - M Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy
| | - G Ingoglia
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy
| | - C Gregoretti
- Fondazione Istituto "G. Giglio" Cefalù, Palermo, Italy; Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy
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2
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Pierucci P, de Candia ML, Marzullo A, Mele F, Introna F, Agrisani C, Ingoglia G, Gregoretti C, Carpagnano GE. The eye may be the spy of injury related to NIV interface and prone positioning. Pulmonology 2024; 30:192-194. [PMID: 35798639 PMCID: PMC9252870 DOI: 10.1016/j.pulmoe.2022.05.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- P Pierucci
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - M L de Candia
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'.
| | - A Marzullo
- Pathology Division, Department of Emergency and Organ Transplantation, University of Bari
| | - F Mele
- Department of Interdisciplinary Medicine, Section of Legal Medicine, Policlinico di Bari Hospital, University of Bari, Italy
| | - F Introna
- Department of Interdisciplinary Medicine, Section of Legal Medicine, Policlinico di Bari Hospital, University of Bari, Italy
| | - C Agrisani
- Department of Interdisciplinary Medicine, Section of Legal Medicine, Policlinico di Bari Hospital, University of Bari, Italy
| | - G Ingoglia
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - C Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University, of Palermo, Palermo, Italy; G. Giglio Fundation, Cefal, Palermo, Italy
| | - G E Carpagnano
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
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3
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Resta E, Cuscianna E, Pierucci P, Custodero C, Solfrizzi V, Sabbà C, Palmisano CM, Barratta F, De Candia ML, Tummolo MG, Capozza E, Lomuscio S, De Michele L, Tafuri S, Resta O, Lenato GM. Significant burden of post-COVID exertional dyspnoea in a South-Italy region: knowledge of risk factors might prevent further critical overload on the healthcare system. Front Public Health 2023; 11:1273853. [PMID: 38179561 PMCID: PMC10764627 DOI: 10.3389/fpubh.2023.1273853] [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: 08/07/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Background Exertional dyspnoea in post-COVID syndrome is a debilitating manifestation, requiring appropriate comprehensive management. However, limited-resources healthcare systems might be unable to expand their healthcare-providing capacity and are expected to be overwhelmed by increasing healthcare demand. Furthermore, since post-COVID exertional dyspnoea is regarded to represent an umbrella term, encompassing several clinical conditions, stratification of patients with post-COVID exertional dyspnoea, depending on risk factors and underlying aetiologies might provide useful for healthcare optimization and potentially help relieve healthcare service from overload. Hence, we aimed to investigate the frequency, functional characterization, and predictors of post-COVID exertional dyspnoea in a large cohort of post-COVID patients in Apulia, Italy, at 3-month post-acute SARS-CoV-2 infection. Methods A cohort of laboratory-confirmed 318 patients, both domiciliary or hospitalized, was evaluated in a post-COVID Unit outpatient setting. Post-COVID exertional dyspnoea and other post-COVID syndrome manifestations were collected by medical history. Functional characterization of post-COVID exertional dyspnoea was performed through a 6-min walking test (6-mwt). The association of post-COVID exertional dyspnoea with possible risk factors was investigated through univariate and multivariate logistic regression analysis. Results At medical evaluation, post-COVID exertional dyspnoea was reported by as many as 190/318 patients (59.7%), showing relatively high prevalence also in domiciliary-course patients. However, functional characterization disclosed a 6-mwt-based desaturation walking drop in only 24.1% of instrumental post-COVID exertional dyspnoea patients. Multivariate analysis identified five independent predictors significantly contributing to PCED, namely post-COVID-fatigue, pre-existing respiratory co-morbidities, non-asthmatic allergy history, age, and acute-phase-dyspnoea. Sex-restricted multivariate analysis identified a differential risk pattern for males (pre-existing respiratory co-morbidities, age, acute-phase-dyspnoea) and females (post-COVID-fatigue and acute-phase-dyspnoea). Conclusion Our findings revealed that post-COVID exertional dyspnoea is characterized by relevant clinical burden, with potential further strain on healthcare systems, already weakened by pandemic waves. Sex-based subgroup analysis reveals sex-specific dyspnoea-underlying risk profiles and pathogenic mechanisms. Knowledge of sex-specific risk-determining factors might help optimize personalized care management and healthcare resources.
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Affiliation(s)
- Emanuela Resta
- University of Foggia – Doctorate School of Translational Medicine and Management of Health Systems, Foggia, Italy
| | - Eustachio Cuscianna
- Dipartimento Interdisciplinare di Medicina, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Paola Pierucci
- Policlinico Hospital, University of Bari Aldo Moro – Respiratory Medicine Unit, Bari, Italy
| | - Carlo Custodero
- Policlinico Hospital – University of Bari Aldo Moro – “Frugoni” Internal Medicine and Geriatric Unit, Bari, Italy
| | - Vincenzo Solfrizzi
- Policlinico Hospital – University of Bari Aldo Moro – “Frugoni” Internal Medicine and Geriatric Unit, Bari, Italy
| | - Carlo Sabbà
- Policlinico Hospital – University of Bari Aldo Moro – “Frugoni” Internal Medicine and Geriatric Unit, Bari, Italy
| | - Chiara Maria Palmisano
- Policlinico Hospital – University of Bari Aldo Moro – “Frugoni” Internal Medicine and Geriatric Unit, Bari, Italy
| | - Federica Barratta
- “POC Central-SS. Annunziata-Moscati” Taranto Hospital – Pulmonology Unit, Taranto, Italy
| | | | | | - Elena Capozza
- Terlizzi “Sarcone” Hospital – Pulmonology and Respiratory Rehabilitation Unit, Terlizzi, Italy
| | - Sonia Lomuscio
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Lucrezia De Michele
- Policlinico Hospital – University of Bari Aldo Moro – Cardiology Unit, Bari, Italy
| | - Silvio Tafuri
- Dipartimento Interdisciplinare di Medicina, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Onofrio Resta
- Policlinico Hospital – University of Bari Aldo Moro – Post-COVID Unit Service of Respiratory Medicine, Bari, Italy
| | - Gennaro Mariano Lenato
- Policlinico Hospital – University of Bari Aldo Moro – “Frugoni” Internal Medicine and Geriatric Unit, Bari, Italy
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Pierucci P, De Michele L, De Candia ML, Barratta F, Gregoretti C, Carpagnano GE, Misseri G. SARS-CoV-2 pneumonia and Eisenmenger's Syndrome: doubling the challenge. Monaldi Arch Chest Dis 2023. [PMID: 37930656 DOI: 10.4081/monaldi.2023.2741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
Eisenmenger's syndrome (ES) is the most severe phenotype of pulmonary arterial hypertension (PAH) secondary to congenital heart disease. In these cases, a significant systemic-to-pulmonary (left-to-right) shunting triggers the development of pulmonary vascular disease (PVD) and pulmonary hypertension. In cases of acute hypoxemic respiratory failure in patients with ES, high flow nasal cannula (HFNC) oxygen therapy should be considered as a first-line approach in order to avoid pulmonary complications and right ventricular overload related to positive pressure ventilation. Here, we report a case of HFNC use in a patient with COVID-19 infection and ES.
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Affiliation(s)
- Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari "Aldo Moro".
| | - Lucrezia De Michele
- Cardio Thoracic and Vascular Department, Cardiology Unit, Bari Policlinic University Hospital, Bari.
| | - Maria Luisa De Candia
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari "Aldo Moro".
| | - Federica Barratta
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari "Aldo Moro".
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science, University of Palermo; Fondazione Istituto "G. Giglio" Cefalù (PA) .
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari "Aldo Moro".
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Annunziata A, Calabrese C, Simioli F, Coppola A, Pierucci P, Mariniello DF, Fiorentino G. Psychological Factors Influencing Adherence to NIV in Neuromuscular Patients Dependent on Non Invasive Mechanical Ventilation: Preliminary Results. J Clin Med 2023; 12:5866. [PMID: 37762807 PMCID: PMC10531532 DOI: 10.3390/jcm12185866] [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: 07/30/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Non-invasive ventilation (NIV) is associated with improvement of both morbility and mortality in patients affected by neuromuscular diseases with chronic respiratory failure. Several studies have also shown that long-term NIV positively impacts the patient's quality of life and perception of disease status. Its effectiveness is likely related to the adherence to NIV. Several factors, patient- and not patient-related, may compromise adherence to NIV, such as physical, behavioral, familiar, and social issues. Few data are currently available on the role of psychological factors in influencing NIV adherence. MATERIALS AND METHODS In this pilot study, we evaluated the adherence to NIV in a group of 15 adult patients with neuromuscular diseases (Duchenne muscular dystrophy, myotonic dystrophy, and amyotrophic lateral sclerosis) in relation to their grade of depression assessed by the Beck Depression Inventory (BDI) questionnaire. Other data were collected, such as clinical features (age and sex), use of anxiolytic drugs, the presence of a family or professional caregiver, the quality of patient-physician relationship, the beginning of psychological support after BDI screening, and the family acceptance of NIV. NIV adherence was definied as the use of NIV for at least 4 h per night on 70% of nights in a month. RESULTS The overall rate of NIV adherence was 60%. Based on the BDI questionnaire, patients who were non-adherent to NIV had a higher rate of depression, mainly observed in the oldest patients. The acceptance of NIV by the family and positive physician-patient interaction seem to favor NIV adherence. CONCLUSION Depression can interfere with NIV adherence in patients with neuromuscolar diseases.
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Affiliation(s)
- Anna Annunziata
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.C.); (D.F.M.)
| | - Francesca Simioli
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
| | - Antonietta Coppola
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, 70121 Bari, Italy;
- Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70122 Bari, Italy
| | - Domenica Francesca Mariniello
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.C.); (D.F.M.)
| | - Giuseppe Fiorentino
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
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Volpato E, Pierucci P, De Candia ML, Casparrini M, Volpi V, Pagnini F, Carpagnano GE, Banfi P. Life Experiences in Neuromuscular Tracheotomized Patients in Times of Covid-19. J Neuromuscul Dis 2023:JND221597. [PMID: 37212066 DOI: 10.3233/jnd-221597] [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: 05/23/2023]
Abstract
BACKGROUND The management of tracheotomy at home can be very complex, affecting the patient's quality of life. OBJECTIVES This case series study aimed to explore the experiences of patients affected by neuromuscular diseases (NMD) concerning tracheostomy and Invasive Mechanical Ventilation (IMV) management at home during the COVID-19 health emergency in Italy. METHODS Semi-structured interviews and the following instruments were used: Connor and Davidson Resilience Scale (CD-RISC-25); Acceptance and Action Questionnaire-II (AAQ-II); State-Trait Anxiety Inventory (STAI); Langer Mindfulness Scale (LMS). Descriptive analyses, correlations, and qualitative analyses were carried out. RESULTS 22 patients [50% female, mean age = 50.2 (SD = 21.2)] participated in the study. Participants who showed high levels of dispositional mindfulness in terms of novelty-seeking (r = 0.736, p = 0.013) and novelty production (r = 0.644, p = 0.033) were those with higher resilience. The main emotion that emerged was the fear of contagion (19 patients, 86.36%), due to the previous fragile condition, leading to a significant sense of abandonment. The tracheostomy's perception is seen in extremes as a lifesaver or a condemnation. The relationship with the health professionals moves from satisfaction to a feeling of abandonment with a lack of preparation. CONCLUSIONS The relationship between resilience, flexibility, state anxiety and dispositional mindfulness offers ways to reinforce tracheostomy management at home, even in critical periods when going to the hospital may be difficult.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Maria Luisa De Candia
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Massimo Casparrini
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | | | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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Volpi V, Volpato E, Compalati E, Pierucci P, Nicolini A, Lax A, Fagetti L, Annunziata A, Cauteruccio R, Fiorentino G, Banfi P. Is Intermittent Abdominal Pressure Ventilation Still Relevant? A Multicenter Retrospective Pilot Study. J Clin Med 2023; 12:jcm12072453. [PMID: 37048537 PMCID: PMC10095348 DOI: 10.3390/jcm12072453] [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: 01/25/2023] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
Non-invasive ventilatory support (NVS) is a technique used to reduce respiratory work in neuromuscular diseases, preventing the progression of respiratory failure. NVS is usually administered via a nasal or an oronasal mask, causing discomfort, especially in patients ventilated for more than 16 h/day. Intermittent abdominal pressure ventilation (IAPV) differs completely from conventional NVS and consists of a portable ventilator and a corset with Velcro closures as the interface. In our study, the practicability and efficacy of IAPV were studied in three Italian centers monitoring 28 neuromuscular patients using IAPV who were then retrospectively analyzed. The primary outcomes were an improvement in hypoxemia and the normalization of hypercapnia, and the secondary outcome was an improvement in quality of life. Data were collected at baseline (T0) and after two hours of ventilation (T1), with follow-ups at three months (T2) and six months (T3). Statistical significance was found for PaCO2 over time (F (2.42) = 7.63, p = 0.001) and PaO2 (W = 0.539, p = 0.033). The time of NVS usage also significantly affected the quality of life (F (2.14) = 6.90, p = 0.010), as seen when comparing T0 and T3. As an alternative ventilation method, IAPV is still relevant today and could become a key part of daytime support, especially for patients who do not tolerate standard daytime NVS with an oral interface.
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Affiliation(s)
- Valeria Volpi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Eleonora Volpato
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Elena Compalati
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, 70121 Bari, Italy
- Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', 70122 Bari, Italy
| | | | - Agata Lax
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Laura Fagetti
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Anna Annunziata
- Department of Respiratory Pathophysiology and Rehabilitation Monaldi-A.O. Dei Colli, 80131 Naples, Italy
| | - Rosa Cauteruccio
- Department of Intensive Care, Azienda Ospedaliera di Rilievo Nazionale dei Colli, 80131 Naples, Italy
| | - Giuseppe Fiorentino
- Department of Respiratory Pathophysiology and Rehabilitation Monaldi-A.O. Dei Colli, 80131 Naples, Italy
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
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Pierucci P. Tele-consultation: A new promised land? Pulmonology 2023; 29:2-3. [PMID: 36182660 PMCID: PMC9805545 DOI: 10.1016/j.pulmoe.2022.08.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- P Pierucci
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, Italy; Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Italy.
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9
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Annunziata A, Pierucci P, Banfi PI, Carlucci A, Coppola A, Rao F, Schisano M, Simioli F, Crimi C, Esquinas AM, Karakurt Z, Mattei A, Marotta A, Bach JR, Fiorentino G. Intermittent abdominal pressure ventilation management in neuromuscular diseases: a Delphi panel Consensus. Expert Rev Respir Med 2023; 17:517-525. [PMID: 37323014 DOI: 10.1080/17476348.2023.2226391] [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: 10/19/2022] [Accepted: 06/13/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Intermittent abdominal pressure ventilator (IAPV) use started in the 1930s for ventilatory assistance with muscular dystrophy patients. Later, the device was perfected and expanded for other neuromuscular disorders (NMD). In recent years, the morbidity and mortality tracheotomies and trach tubes related renewed the interest around IAPV. However, there are no guidelines for its use. This study aimed to establish a consensus among physicians involved in its practice to provide IAPV suggestions for the treatment of patients with NMD. METHOD A 3-step modified Delphi method was used to establish consensus. Fourteen respiratory physicians and one psychiatrist with strong experience in IAPV use and/or who published manuscripts on the topic participated in the panel. A systematic review of the literature was carried out according to the PRISMA to identify existing evidence on IAPV for patients with neuromuscular disorders. RESULTS In the first round, 34 statements were circulated. Panel members marked 'agree' or 'disagree' for each statement and provided comments. The agreement was reached after the second voting session for all 34 statements. CONCLUSIONS Panel members agreed and IAPV indications, parameter settings (including procedure protocol), potential limitations, contraindications, complications, monitoring, and follow-up are described. This is the first expert consensus on IAPV.
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Affiliation(s)
- Anna Annunziata
- Unit of Respiratory Physiopathology and Rehabilitation, A.O.R.N. "Dei Colli" - Monaldi Hospital, Naples, Italy
| | - Paola Pierucci
- Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, Cardiothoracic Department, University of Bari 'Aldo Moro', Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari, Italy
| | - Paolo Innocente Banfi
- Respiratory rehabilitation department, IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Annalisa Carlucci
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Antonietta Coppola
- Sub-Intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, Naples, Italy
| | - Fabrizio Rao
- Respiratory Unit, NEuroMuscular OmniCentre (NeMo), Serena Onlus Foundation, Niguarda Hospital, Milan, Italy
| | - Matteo Schisano
- Respiratory Medicine Unit Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - Francesca Simioli
- Sub-Intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, Naples, Italy
| | - Claudia Crimi
- Respiratory Unit, NEuroMuscular OmniCentre (NeMo), Serena Onlus Foundation, Niguarda Hospital, Milan, Italy
| | - Antonio M Esquinas
- Intensive Care Unit, Hospital Morales Meseguer, Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain
| | - Zuhal Karakurt
- Department of Chest Diseases, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, İ̇stanbul, Turkey
| | - Alessio Mattei
- Department of Cardio-Thoracic Diseases, "Città della Salute E della Scienza" University Hospital, Turin, Italy
| | - Antonella Marotta
- Department of Physical Medicine and Rehabilitation, Rutgers University-New Jersey Medical School, Newark, New Jersey; Center for Ventilator Management Alternatives, University Hospital of Newark, Newark, New Jersey
| | - John R Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University-New Jersey Medical School, Newark, New Jersey; Center for Ventilator Management Alternatives, University Hospital of Newark, Newark, New Jersey
| | - Giuseppe Fiorentino
- Unit of Respiratory Physiopathology and Rehabilitation, A.O.R.N. "Dei Colli" - Monaldi Hospital, Naples, Italy
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Accurso G, Vetrugno L, Pierucci P. Editorial: New advances in bedside assessment and monitoring of acute respiratory failure patients. Front Med (Lausanne) 2023; 10:1154289. [PMID: 36936218 PMCID: PMC10018187 DOI: 10.3389/fmed.2023.1154289] [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: 01/30/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Giuseppe Accurso
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
- *Correspondence: Giuseppe Accurso
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences University of Chieti-Pescara, Chieti, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinico University Hospital, Bari, Italy
- Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
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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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12
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Portacci A, Pierucci P, Quaranta VN, Quaranta S, Iorillo I, Locorotondo C, Buonamico E, Dragonieri S, Carpagnano GE. A glimpse in post-COVID pathophysiology: the role of exhaled breath condensate pH as an early marker of residual alveolar inflammation. Expert Rev Respir Med 2022; 16:1093-1099. [PMID: 36170967 DOI: 10.1080/17476348.2022.2130764] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND . Residual alveolar inflammation seems to be paramount in post-COVID pathophysiology. Currently, we still lack a reliable marker to detect and track alveolar phlogosis in these patients. Exhaled Breath Condensate (EBC) pH has robust evidences highlighting its correlation with lung phlogosis in various diseases. We aim to define the reliability of alveolar and bronchial EBC pH in the assessment and in the follow up of post-COVID related inflammation. RESEARCH DESIGN AND METHODS We enrolled 10 patients previously hospitalized due to COVID-19 pneumonia. We performed a complete follow-up after 3 months and 6 months from discharge. Each visit included routine blood tests, arterial blood gas analysis, 6-minute walking test, spirometry, diffusing capacity and body plethysmography. Finally, bronchial and alveolar EBC were collected at the end of each visit. RESULTS Alveolar EBC pH was significantly lower than bronchial EBC pH at T1. Moreover, alveolar EBC pH tended to be more acid after 3 months from hospital discharge compared to the same sample 6 months later. Serum inflammatory biomarkers showed no significant differences from T1 to T2. However, alveolar EBC pH was positively correlated with neutrophil-lymphocyte ratio. CONCLUSIONS Collecting EBC pH could help to understand pathophysiologic mechanism as well as monitoring alveolar inflammation in the post-COVID syndrome.
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Affiliation(s)
- Andrea Portacci
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Paola Pierucci
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | | | - Sara Quaranta
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Ilaria Iorillo
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Cristian Locorotondo
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Enrico Buonamico
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Silvano Dragonieri
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Medicine "Aldo Moro", Bari, Italy
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13
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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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14
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Khan IA, Pierucci P, Ambrosino N. COPD patients’ pre-flight check: A narrative review. Monaldi Arch Chest Dis 2022; 92. [DOI: 10.4081/monaldi.2022.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
For most of the people with stable and well-controlled chronic obstructive pulmonary disease (COPD), air travel is safe and comfortable, but the flight environment may pose clinical challenges. This narrative review aims to update the requirements for allowance to fly of people with COPD without chronic respiratory failure. A literature review was performed on platforms: Pubmed, Scopus and Ovid, for citations in English from 2000 to 2021. The following key words were used: COPD AND: air-travel, in-flight hypoxemia, fitness to air travel. Official regulatory documents and guidelines were also examined. Current air travel statements recommend supplemental oxygen when in flight arterial oxygen tension (PaO2) is expected to fall below 6.6 or 7.3 kPa. Several lung function variables, prediction equations and algorithms have been proposed to estimate in-flight PaO2, the need for in-flight supplemental oxygen, and to select individuals needing more advanced pre-flight testing, such as the hypoxia-altitude simulation test. Exercise induced desaturation and aerobic capacity correlate significantly with in-flight PaO2. COPD patients with late intensification of disease, new changes in medications, recent acute exacerbation/ hospitalization or anticipated emotional and physical stress during the proposed air-travel should be carefully evaluated by the caring family or specialist physician.
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15
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De Michele L, Pierucci P, Giovannetti G, Scardapane A, D'agostino C, Carpagnano GE. Authors' response to the Letter to the Editor regarding: Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up. Monaldi Arch Chest Dis 2022; 92. [PMID: 35244355 DOI: 10.4081/monaldi.2022.2244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Abstract
To the Editor, we thank Dr Ruggeri et al. for their interest in our previously published manuscript focused on lung damages after severe respiratory COVID-19 infection...
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Affiliation(s)
- Lucrezia De Michele
- Cardio Thoracic and Vascular Department, University Hospital Policlinico of Bari, Bari.
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari.
| | - Guido Giovannetti
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School "Aldo Moro", Bari.
| | - Arnaldo Scardapane
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School "Aldo Moro", Bari.
| | - Carlo D'agostino
- Cardio Thoracic and Vascular Department, University Hospital Policlinico of Bari, Bari.
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari.
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16
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Pierucci P, Di Lecce V, Carpagnano GE, Banfi P, Bach JR. The Intermittent Abdominal Pressure Ventilator as an Alternative Modality of Noninvasive Ventilatory Support: A Narrative Review. Am J Phys Med Rehabil 2022; 101:179-183. [PMID: 34091472 DOI: 10.1097/phm.0000000000001804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Noninvasive ventilation has become the initial treatment for symptomatic ventilatory pump failure but, when used at ventilatory support settings, can be an alternative to tracheostomy mechanical ventilation. The intermittent abdominal pressure ventilator, a corset with an internal air sack inflated by a ventilator, allows to increase tidal volumes through the raising of the diaphragm and its consequent passive descent. It has been used for daytime support for more than 70 yrs, but its knowledge among clinicians is scarce. A narrative review was performed by searching PubMed, Medline, and the Cochrane Database of Systematic Reviews using the terms "IAPV" or "pneumobelt." One hundred forty patients were cited using the intermittent abdominal pressure ventilator from 1946 until it went off the market in the 1970s, although many continued to use it. There was only one publication on its use from 2003 to 2017, but three publications from 2017 through 2021. It has been used for full diurnal ventilatory support by some patients for more than 50 yrs and has even been used throughout the labor of a mother with no ventilator-free breathing ability. The intermittent abdominal pressure ventilator is a ventilatory support alternative for patients with ventilatory pump failure. It can be effective and well tolerated and maintain quality of life without facial interfaces. More widespread application is warranted.
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Affiliation(s)
- Paola Pierucci
- From the Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari "Aldo Moro," Bari, Italy (PP, VDL, GEC); Pulmonary Rehabilitation Unit, Don Carlo Gnocchi Foundation, Milan, Italy (PB); and Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, New Jersey (JRB)
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17
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Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, noninvasive respiratory support has played a central role in managing patients affected by moderate-to-severe acute hypoxemic respiratory failure, despite inadequate scientific evidence to support its usage. High-flow nasal cannula (HFNC) treatment has gained popularity because of its effectiveness in delivering a high fraction of humidified oxygen, which improves ventilatory efficiency and the respiratory pattern, as well as its reported high tolerability, ease of use, and application outside of ICUs. Nevertheless, the risk of infection transmission to health-care workers has raised some concerns about its use in the first wave of the pandemic outbreak, with controversial recommendations provided by different scientific societies. This narrative review provides an overview of the recent evidence on the physiologic rationale, risks, and benefits of using HFNC instead of conventional oxygen therapy and other types of noninvasive respiratory support devices, such as continuous positive airway pressure and noninvasive ventilation in patients affected by COVID-19 pneumonia with associated acute hypoxemic respiratory failure. It also summarizes the available evidence with regard to the clinical use of HFNC during the current pandemic and its reported outcomes, and highlights the risks of bioaerosol dispersion associated with HFNC use.
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Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele-San Marco," University Hospital, Catania, Italy.
| | - Paola Pierucci
- Respiratory Medicine Unit, Policlinico "Aldo Moro" University Hospital, Bari, Italy
| | - Teresa Renda
- Respiratory and Critical Care Unit, Cardio-thoracic and Vascular Department, Careggi Teaching Hospital, Florence, Italy
| | - Lara Pisani
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine, Alma Mater Studiorum University, Bologna, Italy
| | - Annalisa Carlucci
- Department of Medicine and Surgery, Università Insubria, Varese-Como, Italy
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
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18
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Loconsole D, Pierucci P, Casulli D, Barratta F, Chironna M, Carpagnano GE. Exhaled Breath Condensate (EBC) for SARS-CoV-2 diagnosis still an open debate. J Breath Res 2022; 16. [DOI: 10.1088/1752-7163/ac4dd3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/21/2022] [Indexed: 11/11/2022]
Abstract
Abstract
The real-time PCR (RT-PCR) on nasopharyngeal swabs (NPS) is the gold standard for the diagnosis of SARS-CoV-2. The exhaled breath condensate (EBC) is used to perform collection of biological fluid condensed in a refrigerated device from deep airways’ exhaled air. We aimed to verify the presence of SARS-CoV-2 virus in the EBC from patients with confirmed SARS-CoV-2 infection by RT-PCR, and to determine if the EBC may represent a valid alternative to the NPS. Methods: Seventeen consecutive patients admitted to the Emergency Department of the Policlinico were enrolled in the present study with RT-PCR, clinical and radiological evidence of SARS-CoV-2. Within 24 hours from the NPS collection the EBC collection was performed on SARS-CoV-2 positive patients. Informed written consent was gathered and the Ethic Committee approved the study. Results: The mean age of patients was 60 years (24-92) and 64.7% (11/17) were male. Patient n. 9 and n.17 died. All NPS resulted positive for SARS-CoV-2 at RT-PCR. RT-PCR on EBC resulted negative for all but one patients (patient n.12). Conclusion: In this study we did not find any correlation between positive NPS and the EBC in all but one patients enrolled. Based on these data which greatly differ from previous reports on the topic, this study opens several questions related to small differences in the complex process of EBC collection and how EBC could be really standardized for the diagnosis of SARS-CoV-2 infection. Further studies will be warranted to deepen this topic.
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19
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De Michele L, Pierucci P, Giovannetti G, De Ceglie M, Dimitri M, Mirabile A, Quaranta V, Scardapane A, D'Agostino C, Carpagnano GE. Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up. Monaldi Arch Chest Dis 2022; 92. [PMID: 35044135 DOI: 10.4081/monaldi.2022.2142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/16/2021] [Indexed: 11/23/2022] Open
Abstract
The correct type and time of follow-up for patients affected by COVID19 ARDS is still unclear. The aim of this study was to evaluate at the survivors to COVID19 ARDS requiring non-invasive respiratory support (NRS) admitted to a Respiratory Intensive care unit (RICU) from March 8th till May 31th 2020 looking at all sequelae via a comprehensive follow up. All patients underwent a multi-disciplinary instrumental and clinical assessment within three months form admission to evaluate all infection related sequelae. Thirty-eight patients were enrolled Lung-Ultrasound (LUS) showed an outstanding discrimination ability (ROC AUC: 0.95) and a substantial agreement rate (Cohen's K: 0.74) compared to chest CT-scan detecting improvement of lung consolidations. Youden's test showed a cut-off pressure of 11 cmH2O ExpiratoryPAP-Continuous-PAP-max (EPAP-CPAP) applied at the airways during hospitalization to be significantly correlated (p value: 0.026) to the increased pulmonary artery common trunk diameter. A total of 8/38 patients (21.8%), 2 of whom during follow-up, were diagnosed with Pulmonary Emboli (PE) and started anticoagulant treatment. Patients with PE had a statistically significant shorter length of time of hospitalization, time to negative swab, CPAP/NIV duration, P/F ratio and D-dimers at follow-up compared to non PE. A comprehensive approach to patients with ARDS COVID19 requiring NRS is necessary. This study highlighted cardiopulmonary impairment related to the ARDS and to the high-EPAP-CPAP-max greater than 11mmHg provided during admission, the usefulness of LUS in monitoring post-infection recovery and the correct identification and treatment of patients with PE during follow up.
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Affiliation(s)
- Lucrezia De Michele
- Cardio Thoracic and Vascular Department, University Hospital Policlinic of Bari.
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari; Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari.
| | - Guido Giovannetti
- Department of Biomedical Sciences and Human Oncology, University of Bari 'Aldo Moro' Medical School, Bari .
| | - Michele De Ceglie
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari 'Aldo Moro' Medical School, Bari .
| | - Michela Dimitri
- Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari.
| | - Alessandra Mirabile
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari 'Aldo Moro' Medical School, Bari .
| | | | - Arnaldo Scardapane
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari 'Aldo Moro' Medical School, Bari.
| | - Carlo D'Agostino
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari 'Aldo Moro' Medical School, Bari.
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20
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Vianello A, Racca F, Vita GL, Pierucci P, Vita G. Motor neuron, peripheral nerve, and neuromuscular junction disorders. Handb Clin Neurol 2022; 189:259-270. [PMID: 36031308 DOI: 10.1016/b978-0-323-91532-8.00014-8] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In amyotrophic lateral sclerosis (ALS), Guillain-Barré syndrome (GBS), and neuromuscular junction disorders, three mechanisms may lead, singly or together, to respiratory emergencies and increase the disease burden and mortality: (i) reduced strength of diaphragm and accessory muscles; (ii) oropharyngeal dysfunction with possible aspiration of saliva/bronchial secretions/drink/food; and (iii) inefficient cough due to weakness of abdominal muscles. Breathing deficits may occur at onset or more often along the chronic course of the disease. Symptoms and signs are dyspnea on minor exertion, orthopnea, nocturnal awakenings, excessive daytime sleepiness, fatigue, morning headache, poor concentration, and difficulty in clearing bronchial secretions. The "20/30/40 rule" has been proposed to early identify GBS patients at risk for respiratory failure. The mechanical in-exsufflator is a device that assists ALS patients in clearing bronchial secretions. Noninvasive ventilation is a safe and helpful support, especially in ALS, but has some contraindications. Myasthenic crisis is a clinical challenge and is associated with substantial morbidity including prolonged mechanical ventilation and 5%-12% mortality. Emergency room physicians and consultant pulmonologists and neurologists must know such respiratory risks, be able to recognize early signs, and treat properly.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Fabrizio Racca
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gian Luca Vita
- Unit of Neurology, Emergency Department, P.O. Piemonte, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Giuseppe Vita
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, Messina University Hospital, Messina, Italy.
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21
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Pierucci P, Quaranta VN, Dragonieri S, Portacci A, Tummolo MG, Carpagnano GE. Moderate to severe vitamin D deficiency increases the risk of mortality due to COVID‑19 in patients treated in a respiratory intensive care unit. Pol Arch Intern Med 2021; 131. [PMID: 34643077 DOI: 10.20452/pamw.16119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Paola Pierucci
- Section of Respiratory Diseases, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | | - Silvano Dragonieri
- Section of Respiratory Diseases, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
| | - Andrea Portacci
- Section of Respiratory Diseases, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Maria Grazia Tummolo
- Section of Respiratory Diseases, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giovanna Elisiana Carpagnano
- Section of Respiratory Diseases, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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22
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Carpagnano GE, Pierucci P, Migliore G, Minicucci AM, Aricò M, Marra M, Carpagnano LF. Tailored Post-Acute Care Coordination for Survivors of Moderate to Severe COVID-19 Infection. J Am Med Dir Assoc 2021; 23:447-449. [PMID: 34995511 PMCID: PMC8677462 DOI: 10.1016/j.jamda.2021.12.014] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 11/09/2022]
Affiliation(s)
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari, Italy
| | | | | | | | - Maurizio Marra
- Hospital Health Direction Office, Bari Policlinic University Hospital, Bari, Italy
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23
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De Michele L, Pierucci P, Carpagnano GE, Bonamonte D, Ambrogio F, Giovannetti G, Dimitri M, D'Agostino C. Late unexpected consequences of COVID-19 infection in survivors of acute hypoxic respiratory failure. Intern Med J 2021; 51:1363-1364. [PMID: 34423544 PMCID: PMC8652745 DOI: 10.1111/imj.15261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Lucrezia De Michele
- Cardio Thoracic Department, Cardiology Unit, Policlinico di Bari, Bari, Italy
| | - Paola Pierucci
- Cardio Thoracic Department, Respiratory and Sleep Disorders Unit, Policlinico di Bari, 'Aldo Moro' Bari University, Bari, Italy
| | - Giovanna E Carpagnano
- Cardio Thoracic Department, Respiratory and Sleep Disorders Unit, Policlinico di Bari, 'Aldo Moro' Bari University, Bari, Italy
| | - Domenico Bonamonte
- Department of Biomedical Science and Human Oncology, Dermatology Unit, University of Bari Medical School, Bari, Italy
| | - Francesca Ambrogio
- Department of Biomedical Science and Human Oncology, Dermatology Unit, University of Bari Medical School, Bari, Italy
| | - Guido Giovannetti
- Cardio Thoracic Department, Cardiology Unit, Policlinico di Bari, Bari, Italy
| | - Michela Dimitri
- Cardio Thoracic Department, Respiratory and Sleep Disorders Unit, Policlinico di Bari, 'Aldo Moro' Bari University, Bari, Italy
| | - Carlo D'Agostino
- Cardio Thoracic Department, Cardiology Unit, Policlinico di Bari, Bari, Italy
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Farì G, de Sire A, Giorgio V, Rizzo L, Bruni A, Bianchi FP, Zonno A, Pierucci P, Ranieri M, Megna M. Impact of COVID-19 on the mental health in a cohort of Italian rehabilitation healthcare workers. J Med Virol 2021; 94:110-118. [PMID: 34387886 PMCID: PMC8426878 DOI: 10.1002/jmv.27272] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic has had a strong impact on healthcare workers (HCWs), affecting their physical and mental health. In Italy, HCWs have been among the first exposed to unprecedented pressure, dealing with large numbers of infections during the first pandemic wave. However, the severe psychological consequences on HCWs find little evidence in the literature, especially in terms of comparison to the status quo ante pandemic. The aim of this study was to provide an assessment of the mental health burden in a cohort of Italian HCWs during the COVID-19 pandemic, comparing their condition with that before the emergency, to direct the promotion of mental well-being among HCWs worldwide. In this retrospective study, we included physicians, physical therapists, and nurses working in the Respiratory Intensive Care Unit, Neurology Unit, and Rehabilitation Unit from a Southern Italy University Hospital. All study participants underwent a battery of psychological tests, aimed at verifying their state of mental health during the COVID-19 emergency and before it. Depressive, anxiety, and burnout symptoms were assessed using the following questionnaires: Maslach Burnout Inventory, Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder-7. Depressive, anxiety, and burnout clinical relevance symptoms were present in HCWs during the COVID-19 pandemic more than those before the emergency. Fifty percent of the HCWs obtained a score clinically significant during the emergency. Moreover, a depersonalization factor showed a statistically significant increase in average scores (p < 0.0001). The PHQ-9 scale showed that 47.1% of the operators reported depressive state presence. The number of operators scoring above the cut-off for the anxiety scale tripled during the emergency (p < 0.0001). The female gender conferred greater risks for depression. Taken together, the findings of this study showed that our sample of Italian HCWs showed a greater risk for depression, anxiety, and stress during the COVID-19 pandemic. These data might be a starting point to plan mental health monitoring and prevention programs for HCWs, thus ensuring patients receive the best possible care performances even during healthcare crises such as the current pandemic.
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Affiliation(s)
- Giacomo Farì
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Vincenzo Giorgio
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - Laura Rizzo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - Antonella Bruni
- Neuropsychiatric Rehabilitation Unit, Villa Patrizia Hospital, Piossasco, Turin, Italy
| | - Francesco P Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Alessandra Zonno
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Sleep Medicine Unit, Aldo Moro University, Bari, Italy
| | - Maurizio Ranieri
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - Marisa Megna
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
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Pierucci P, Ambrosino N, Di Lecce V, Dimitri M, Battaglia S, Boniello E, Portacci A, Resta O, Carpagnano GE. Prolonged Active Prone Positioning in Spontaneously Breathing Non-intubated Patients With COVID-19-Associated Hypoxemic Acute Respiratory Failure With PaO 2/FiO 2 >150. Front Med (Lausanne) 2021; 8:626321. [PMID: 34368174 PMCID: PMC8336785 DOI: 10.3389/fmed.2021.626321] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/09/2021] [Indexed: 11/22/2022] Open
Abstract
Background: The COVID-19 pandemic has led to new approaches to manage patients outside the ICU, including prone positioning in non-intubated patients. Objectives: To report the use of prolonged active prone positioning in spontaneously breathing patients with COVID-19-associated acute respiratory failure. Spontaneously breathing vs non-invasive respiratory support for COVID19 associated acute respiratory failure. Methods: Patients with PaO2/FiO2 > 150, with lung posterior consolidations as assessed by means of lung ultrasound, and chest x-ray were studied. Under continuous pulse oximetry (SpO2) monitoring, patients maintained active prone position. A PaO2/FiO2 < 150 was considered as treatment failure and patients had to be switched to non-invasive respiratory support. Retrospectively, data of 16 patients undergoing who refused proning and underwent non-invasive respiratory support were used as controls. The primary outcome was the proportion of patients maintaining prolonged prone position and discharged home. Secondary outcomes included improvement in oxygenation, hospital length of stay, and 6-month survival. Results: Three out of 16 (18.7%) patients did not tolerate the procedure. Three more patients showed a worsening in PaO2/FiO2 to <150 and required non-invasive support, two of whom finally needing endotracheal intubation. After 72 h, 10 out of 16 (62.5%) patients improved oxygenation [PaO2/FiO2: from 194.6 (42.1) to 304.7 (79.3.2) (p < 0.001)] and were discharged home. In the control group, three out of 16 failed, required invasive ventilatory support, and died within 1 month in ICU. Thirteen were successful and discharged home. Conclusion: In non-intubated spontaneously breathing COVID-19 patients with PaO2/FiO2 >150, active prolonged prone positioning was feasible and tolerated with significant improvement in oxygenation.
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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, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy, University of Bari, Bari, Italy
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico Pneumologia Riabilitativa, Istituto di Montescano, Montescano, Italy
| | - Valentina Di Lecce
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy, University of Bari, Bari, Italy
| | - Michela Dimitri
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy, University of Bari, Bari, Italy
| | - Stefano Battaglia
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Esterina Boniello
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy, University of Bari, Bari, Italy
| | - Andrea Portacci
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy, University of Bari, Bari, Italy
| | - Onofrio Resta
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy, University of Bari, Bari, Italy
| | - Giovanna Elisiana Carpagnano
- A. Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy, University of Bari, Bari, Italy
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Buonamico E, Quaranta VN, Boniello E, Dimitri M, Di Lecce V, Labate L, Pierucci P, Capozza E, Carpagnano GE, Resta O. Risk factors for transfer from Respiratory Intermediate Care Unit to Intensive Care Unit in COVID-19. Respir Investig 2021; 59:602-607. [PMID: 34130948 PMCID: PMC8166522 DOI: 10.1016/j.resinv.2021.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients hospitalized for COVID-19-related pneumonia often need several degrees of ventilatory support, which are performed between Respiratory Intermediate Care Units (RICUs) and Intensive Care Units (ICUs), and which depend on the severity of acute respiratory distress syndrome. There is no firm consensus on transfer predictors from the RICU to the ICU. METHODS In this retrospective observational single center study, we evaluated 96 COVID-19 patients referred to the RICU for acute respiratory failure (ARF) according to their transferal to the ICU or their stay at the RICU. We compared demographic data, baseline laboratory profile, and final clinical outcomes to identify early risk factors for transfer. RESULTS The best predictors for transfer to the ICU were elevated C-reactive protein and lymphopenia. The mortality rate was lower in the RICU than in the ICU, where transferred patients who died were mostly younger men and with less comorbidities than those in the RICU. CONCLUSIONS Few inflammatory markers can predict the need for transfer from the RICU to the ICU. Due to the ongoing COVID-19 pandemic, we urge better clinical stratification by early and meaningful profiles in patients admitted to the RICU who are at risk of transferal to the ICU.
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Affiliation(s)
- Enrico Buonamico
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70125, Bari, Italy
| | | | - Esterina Boniello
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70125, Bari, Italy
| | - Michela Dimitri
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70125, Bari, Italy
| | - Valentina Di Lecce
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70125, Bari, Italy.
| | - Luciana Labate
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70125, Bari, Italy
| | - Paola Pierucci
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70125, Bari, Italy
| | - Elena Capozza
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70125, Bari, Italy
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70125, Bari, Italy
| | - Onofrio Resta
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70125, Bari, Italy
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Pierucci P, Vaschetto R, Carpagnano GE. Is it feasible to collect exhaled breath condensate in COVID-19 patients undergoing noninvasive ventilatory support? ERJ Open Res 2021; 7:00071-2021. [PMID: 34041296 PMCID: PMC8039504 DOI: 10.1183/23120541.00071-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/27/2021] [Indexed: 11/05/2022] Open
Abstract
The article recently published by Hjembaek-Brandtet al. [1] focused on humidification during the collection of exhaled breath condensate (EBC) in patients undergoing invasive mechanical ventilation (IMV). Indeed, in the current guidelines, it is still unclear which standard humidification setting and technique should be used [2, 3]. In some studies, the EBC has been performed with active humidification [4], while others have removed it before collection [5]. Hjembaek-Brandtet al. [1] demonstrated that diverse settings of active humidification may vary the amount of sample collected quite remarkably. The authors concluded that the EBC collection should be performed with no humidification, turning off the humidifier 10 min before starting the exam [1]. In patients with #COVID19-related acute hypoxic respiratory failure requiring noninvasive ventilatory support, EBC collection with adequate precautions may be feasible and future studies will be needed to explore this research fieldhttps://bit.ly/39OxufF
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Affiliation(s)
- Paola Pierucci
- Cardio Thoracic Dept, Respiratory and Intensive Care Unit, Policlinico di Bari, and "Aldo Moro" University School of Medicine, Bari, Italy
| | | | - Giovanna E Carpagnano
- Cardio Thoracic Dept, Respiratory and Intensive Care Unit, Policlinico di Bari, and "Aldo Moro" University School of Medicine, Bari, 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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Giovannetti G, De Michele L, De Ceglie M, Pierucci P, Mirabile A, Vita M, Palmieri VO, Carpagnano GE, Scardapane A, D'Agostino C. Lung ultrasonography for long-term follow-up of COVID-19 survivors compared to chest CT scan. Respir Med 2021; 181:106384. [PMID: 33839587 PMCID: PMC8010331 DOI: 10.1016/j.rmed.2021.106384] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
Background While lung ultrasonography (LUS) has utility for the evaluation of the acute phase of COVID-19 related lung disease, its role in long-term follow-up of this condition has not been well described. The objective of this study is to compare LUS and chest computed tomography (CT) results in COVID-19 survivors with the intent of defining the utility of LUS for long-term follow-up of COVID-19 respiratory disease. Methods Prospective observational study that enrolled consecutive survivors of COVID-19 with acute hypoxemic respiratory failure (HARF) admitted to the Respiratory Intensive Care Unit. Three months following hospital discharge, patients underwent LUS, chest CT, body plethysmography and laboratory testing, the comparison of which forms the basis of this report. Results 38 patients were enrolled, with a total of 190 lobes analysed: men 27/38 (71.1%), mean age 60.6 y (SD 10.4). LUS findings and pulmonary function tests outcomes were compared between patients with and without ILD, showing a statistically significant difference in terms of LUS score (p: 0.0002), FEV1 (p: 0.0039) and FVC (p: 0.012). ROC curve both in lobe by lobe and in patient's overall analysis revealed an outstanding ILD discrimination ability of LUS (AUC: 0.94 and 0.95 respectively) with a substantial Cohen's coefficient (K: 0.74 and 0.69). Conclusions LUS has an outstanding discrimination ability compared to CT in identifying an ILD of at least mild grade in the post COVID-19 follow-up. LUS should be considered as the first-line tool in follow-up programs, while chest CT could be performed based on LUS findings.
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Affiliation(s)
- Guido Giovannetti
- Department of Biomedical Sciences and Human Oncology, University of Bari Medical School "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Lucrezia De Michele
- Cardio Thoracic and Vascular Department, University Hospital Policlinico of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Michele De Ceglie
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Italy; "Aldo Moro" Bari University School of Medicine, Italy.
| | - Alessandra Mirabile
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Marco Vita
- Ammagamma Artificial Intelligence Solutions, Via S. Orsola 37, 41121, Modena, Italy
| | - Vincenzo Ostilio Palmieri
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Italy; "Aldo Moro" Bari University School of Medicine, Italy
| | - Arnaldo Scardapane
- DIM, Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Medical School "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Carlo D'Agostino
- Cardio Thoracic and Vascular Department, University Hospital Policlinico of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Pierucci P, Santomasi C, Ambrosino N, Portacci A, Diaferia F, Hansen K, Odemyr M, Jones S, Carpagnano GE. Patient's treatment burden related to care coordination in the field of respiratory diseases. Breathe (Sheff) 2021; 17:210006. [PMID: 34295410 PMCID: PMC8291948 DOI: 10.1183/20734735.0006-2021] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/21/2021] [Indexed: 12/30/2022] Open
Abstract
The management of respiratory diseases requires various levels of care: multidisciplinary teams, educational and behavioural interventions, self-management and home-based technical support are vital to ensure adequate care management. However, it is often difficult to access these networks due to fragmentation of patient care and treatment burden. Care coordination aims to ensure patients have a central role and that there is continuity of care among various levels and professionals involved. Moreover, the coronavirus disease pandemic has caused strain on the global healthcare system, with care coordination becoming increasingly important in increasing the resilience of health systems, supporting healthcare professionals and ensuring the right treatment and adequate level of care for these patients.
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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
| | - Carla Santomasi
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Pneumologia Riabilitativa, Istituto di Montescano, Montescano, Italy
| | - Andrea Portacci
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Fabrizio Diaferia
- Cardiothoracic Dept, Respiratory and Critical Care Unit Bari Policlinic University Hospital, Bari, Italy
- "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Kjeld Hansen
- European Lung Foundation Chair, Sheffield, UK
- Dept of Technology, Kristiana University College Oslo, Norway
| | - Mikaela Odemyr
- European Lung Foundation Council Member and Patient Advisory Committee Chair, Sheffield, UK
| | - Steve Jones
- European Lung Foundation Council Member, Sheffield, UK
- Action for Pulmonary Fibrosis, Peterborough, UK
- EU IPFF, Brussels, Belgium
| | - 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
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Di Lecce V, Carpagnano GE, Pierucci P, Quaranta VN, Barratta F, Zito A, Buonamico E, Resta O. Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy. Multidiscip Respir Med 2020; 15:704. [PMID: 33282282 PMCID: PMC7662452 DOI: 10.4081/mrm.2020.704] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023] Open
Abstract
The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11th to May 31st 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO2/FiO2 ratio between 100 and 200 and 17% showed Pa02/FiO2 ratio <100. Mean Pa02/FiO2 ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% were transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.
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Affiliation(s)
- Valentina Di Lecce
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari
| | - Paola Pierucci
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari
| | | | - Federica Barratta
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari
| | - Annapaola Zito
- Cardiology Department, "SS Annunziata" Hospital, Taranto, Italy
| | - Enrico Buonamico
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari
| | - Onofrio Resta
- Institute of Respiratory Disease, Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari
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Pierucci P, Bach JR, Di Lecce Valentina V, Banfi P, Carpagnano GE, Resta O. Daytime non-invasive ventilatory support via intermittent abdominal pressure for a patient with Pompe disease. Pulmonology 2020; 27:182-184. [PMID: 32878744 DOI: 10.1016/j.pulmoe.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- P Pierucci
- Azienda Ospedaliero Universitaria di Bari, "Aldo Moro" University, Italy.
| | - J R Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, USA
| | | | - P Banfi
- Pulmonary Rehabilitation Unit, Don Carlo Gnocchi Foundation, Milan, Italy
| | - G E Carpagnano
- Azienda Ospedaliero Universitaria di Bari, "Aldo Moro" University, Italy
| | - O Resta
- Azienda Ospedaliero Universitaria di Bari, "Aldo Moro" University, Italy
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Aconiti Mandolini N, Perugini G, Filippini G, Pierucci P, Baiguini A, Vaccaro A, Pelagalli G, Marinelli F, Capuccella M. Evaluation of colistin consumption in swine and poultry of Marche region during the 2017-2019 period. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
In Italy, the National Plan against Antimicrobial Resistance (PNCAR 2017-2020) involves both human and veterinary sectors. The last one was requested to reduce colistin consumption, a first choice antibiotic for human health. Indeed, the Plan defines specific limits to reach within 2020. In Marche region, there is a project from 2017, consisting in monitoring antibiotic consumption in livestock, with particular reference to Critically Important Antimicrobials (CIAs), like colistin. The project represents an AMR stewardship, which involves regional Veterinary Services, veterinary professionals and the IZS Umbria e Marche, developing a specific training and education path ad hoc.
In this work, we have considered data coming from swine and poultry prescriptions of Marche region in the 2017-2019 period, using these for the calculation of ADDD (Animal Defined Daily Doses), a method already used in human. In practice, we have first established DDDvet values, as suggested by ESVAC, obtained from the Italian drugs containing colistin made for the considered species.
Colistin prescription in swine reduced of 97% (from 20.60 in 2017 to 0.69 DDD/1000 animals-die in 2019). In poultry, a reduction of 69% was obtained (from 5.07 in 2017 to 1.56 DDD/1000 animals-die in 2019). Then, there was an evidence of reduction more than 70% in colistin consumption, demonstrating the importance of the education and awareness program sponsored by Competent Authorities and the other stakeholders involved. The used method of calculation (ESVAC) is different from the currently applied one, as it consists of standardized unity of measures, using prescription data rather than sales ones.
Monitoring antibiotic consumption both in human and veterinary sector is essential to understand AMR, as well is important the possibility to compare the data to each other. The present work demonstrate that, also in veterinary, is possible to apply the DDD-method to evaluate antibiotic consumption, like colistin.
Key messages
Colistin consumption has reduced in swine and poultry sectors in the 2017-2019 period. A standardized method of calculation of antibiotic consumption in animals is strongly needed.
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Affiliation(s)
- N Aconiti Mandolini
- Laboratorio Diagnostica, Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Tolentino, Italy
| | - G Perugini
- Laboratorio Diagnostica, Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Tolentino, Italy
| | - G Filippini
- Direzione Sanitaria, Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
| | - P Pierucci
- PF Prevenzione Veterinaria e Sicurezza Alimentare, Regione Marche, Marche, Italy
| | - A Baiguini
- PF Prevenzione Veterinaria e Sicurezza Alimentare, Regione Marche, Marche, Italy
| | - A Vaccaro
- Servizi di Igiene degli All. e delle Prod. Zootecniche, Regione Marche, Marche, Italy
| | - G Pelagalli
- Servizi di Igiene degli All. e delle Prod. Zootecniche, Regione Marche, Marche, Italy
| | - F Marinelli
- Servizi di Igiene degli All. e delle Prod. Zootecniche, Regione Marche, Marche, Italy
| | - M Capuccella
- Centro di Farmacovigilanza Veterinaria dell'Umbria, Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche, Perugia, Italy
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Pierucci P, Ambrosino N, Carlucci A, Grasso S, Carpagnano GE, Resta O. Hemoptysis due to a large endobronchial mass successful regression after the use of high flow nasal cannula. Monaldi Arch Chest Dis 2020; 90. [PMID: 32672429 DOI: 10.4081/monaldi.2020.3121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/18/2020] [Indexed: 11/23/2022] Open
Abstract
In recent years, high flow nasal cannula is being increasingly used. Most studies showed positive results when used in hypoxaemic respiratory failure. Its use in a patient with a large endobronchial mass has not yet being described. We report a patient who presented with hemoptysis and hypoxaemic respiratory failure second to a large mass obstructing the right main bronchus. High flow oxygen via nasal cannula was initiated with a quick improvement of the hemoptysis and the oxygen saturation. Thus, allowing the patient to be rapidly stabilized.
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Affiliation(s)
- Paola Pierucci
- Department of Cardio Thoracic Medicine, Respiratory and Sleep Medicine Unit, "Aldo Moro" University of Bari, Policlinico Hospital, Bari.
| | - Nicolino Ambrosino
- Department of Respiratory Medicine, ICS Maugeri IRCCS, Institute of Montescano (PV).
| | | | - Salvatore Grasso
- Department of Emergency and Organ Transplantation, Anaesthesiology and Critical care Unit, "Aldo Moro" University of Bari.
| | - Giovanna Elisiana Carpagnano
- Department of Cardio Thoracic Medicine, Respiratory and Sleep Medicine Unit, "Aldo Moro" University of Bari, Policlinico Hospital, Bari.
| | - Onofrio Resta
- Department of Cardio Thoracic Medicine, Respiratory and Sleep Medicine Unit, "Aldo Moro" University of Bari, Policlinico Hospital, Bari.
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35
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Pierucci P, Ambrosino N, Carlucci A, Grasso S, Carpagnano GE, Resta O. Hemoptysis due to a large endobronchial mass successful regression after the use of high flow nasal cannula. Monaldi Arch Chest Dis 2020. [DOI: 10.4081/monaldi.2020.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In recent years, high flow nasal cannula is being increasingly used. Most studies showed positive results when used in hypoxaemic respiratory failure. Its use in a patient with a large endobronchial mass has not yet being described. We report a patient who presented with hemoptysis and hypoxaemic respiratory failure second to a large mass obstructing the right main bronchus. High flow oxygen via nasal cannula was initiated with a quick improvement of the hemoptysis and the oxygen saturation. Thus, allowing the patient to be rapidly stabilized.
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Karim HMR, Esquinas AM, Ziatabar S, Insalaco G, Skoczyński S, Šarc I, Ferini-Strambi L, Özyiğit LP, Hernández-Gilsoul T, Singha SK, Ciobanu L, Gutiérrez JLS, Szkulmowski Z, Piervincenzi E, Aguiar M, El-Khatib MF, Corcione N, Kaya AG, Çiledağ A, Kaya A, Valli G, Pierucci P, Resta O, Steiropoulos P, De Marco F, Caldeira V, Mina BA. Continuous Positive Airway Pressure (CPAP) in Non-Apneic Asthma: A Clinical Review of Current Evidence. Turk Thorac J 2020; 21:274-279. [PMID: 32687789 DOI: 10.5152/turkthoracj.2019.19049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/10/2019] [Indexed: 11/22/2022]
Abstract
The use of continuous positive airway pressure (CPAP) in asthma has been a point of debate over the past several years. Various studies, including those on animals and humans have attempted to understand the role and pathophysiology of CPAP in patients with either well controlled or poorly controlled asthma. The aim of this manuscript is to review the currently available literature on the physiologic and clinical effects of CPAP in animal models of asthma and on humans with stable asthma.
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Affiliation(s)
| | - Antonio M Esquinas
- Department of Intensive Care Unit, Hospital General University Morales Meseguer, Murcia, Spain
| | - Sally Ziatabar
- Department of Internal Medicine, Northwell Health - Lenox Hill Hospital, New York, USA
| | - Giuseppe Insalaco
- Institute of Biomedicine and Molecular Immunology, Italian National Research Council, Palermo, Italy
| | - Szymon Skoczyński
- Department of Pulmonology, Medical University of Silesia, Katowice, Poland
| | - Irena Šarc
- Department for Noninvasive Ventilation, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | | | - Leyla Pur Özyiğit
- Department of Respiratory Medicine, Allergy and Immunology, Koç University Hospital, İstanbul, Turkey
| | | | - Subrata Kumar Singha
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India
| | - Laura Ciobanu
- Department of Internal Medicine and Pulmonology, Clinical Hospital of Rehabilitation Lasi, Lasi, Romania
| | - José Luis Sandoval Gutiérrez
- Department of Pulmonary and Critical Care, Instituto Nacional de Enfermedades Respiratorias, México City, Mexico
| | - Zbigniew Szkulmowski
- Department of Anesthesia and Intensive Care Unit, University Hospital No 1 In Bydgoszcz Collegium Medicum in Bydgoszcz University Nicolaus Copernicus in Torun, Bydgoszcz, Poland
| | - Edoardo Piervincenzi
- Department of Anesthesia and Intensive Carei, Sapienza University of Rome, Rome, Italy
| | - Margarida Aguiar
- Department of Pulmonology, Hospital Beatriz Angelo, Lisbon, Portugal
| | - Mohamad F El-Khatib
- Department of Anesthesiology, American University of Beirut, Beirut, Lebanon
| | - Nadia Corcione
- Department of Anesthesia, Critical Care and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aslıhan Gürün Kaya
- Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Aydın Çiledağ
- Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Akın Kaya
- Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Gabriele Valli
- Department of Emergency Medicine, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - Paola Pierucci
- Department of Cardiothoracic, Respiratory and Sleep Medicine, Policlinico University Hospital, Bari, Italy
| | - Onofrio Resta
- Department of Cardiothoracic, Respiratory and Sleep Medicine, Policlinico University Hospital, Bari, Italy
| | | | | | - Vania Caldeira
- Department of Pulmonology, Hospital de Santa Marta-Centro Hospital, Lisboa, Portugal
| | - Bushra A Mina
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Northwell Health - Lenox Hill Hospital, New York, USA
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Pierucci P, Ambrosino N, Dimitri M, Liotino V, Battaglia S, Carlucci A, Carpagnano GE, Carratu P, Dragonieri S, Logroscino G, Simone IL, Resta O. The importance of maintaining the same order of performance of lung function and SNIP tests in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:337-343. [PMID: 32515990 DOI: 10.1080/21678421.2020.1771733] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: Sniff nasal inspiratory pressure (SNIP), a useful tool for the assessment of diaphragm function in patients with Amyotrophic Lateral Sclerosis (ALS), is usually performed together with lung function tests. The aim of this study was to evaluate whether SNIP results are influenced by the order of performance of the tests. Methods: 103 consecutive patients (65% males, 80% spinal onset) were recruited. The highest value of up to 10 sniffs, was recorded before (SNIPT0) and after (SNIPT1) the assessment of lung function, peak cough (PCF), and peak expiratory flow (PEF). Results: Mean and median values were respectively 31.10 and 26.00 cm H2O for SNIPT0 and 28.93 and 25.00 cm H2O for SNIPT1 (p < 0.001). The median value of (SNIPT1 - SNIPT0)/SNIPT0% was -7.10. Patients showing post lung function SNIP values above the median were included in Group 1 (51%), the others in group 2 (49%). Group 2 showed more severe baseline ventilatory restriction and reduction in PCF than Group 1. Positive direct relationships were found between SNIPT0 and SNIPT1 (coefficient β = 0.95, p < 0.001), and forced vital capacity and forced expiratory volume at one second. Conclusions: 50/103(49%) patients with ALS show a significant reduction in SNIP when assessed shortly after the performance of lung function tests. These patients suffer from more severe ventilatory restriction than patients not showing the reduction. Our findings suggest standardizing the order of respiratory tests during the follow up in order to avoid to misestimate the real strength of inspiratory muscles.
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Affiliation(s)
- Paola Pierucci
- Cardio Thoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, University of Bari Aldo Moro, Bari, Italy
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Pneumologia Riabilitativa, Istituto di Montescano, Montescano, Italy
| | - Michela Dimitri
- Cardio Thoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, University of Bari Aldo Moro, Bari, Italy
| | - Vito Liotino
- Cardio Thoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, University of Bari Aldo Moro, Bari, Italy
| | | | - Annalisa Carlucci
- Istituti Clinici Scientifici Maugeri IRCCS, Pneumologia Riabilitativa, Istituto di Pavia, Pavia, Italy, and
| | - Giovanna Elisiana Carpagnano
- Cardio Thoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, University of Bari Aldo Moro, Bari, Italy
| | - Pierluigi Carratu
- Cardio Thoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, University of Bari Aldo Moro, Bari, Italy
| | - Silvano Dragonieri
- Cardio Thoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Department of Basic Medical Sciences, Neurology Unit, Neurosciences and Senses, Policlinico University Hospital, Bari, Italy
| | - Isabella Laura Simone
- Department of Basic Medical Sciences, Neurology Unit, Neurosciences and Senses, Policlinico University Hospital, Bari, Italy
| | - Onofrio Resta
- Cardio Thoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, University of Bari Aldo Moro, Bari, Italy
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Banfi P, Pierucci P, Volpato E, Nicolini A, Lax A, Robert D, Bach J. Daytime noninvasive ventilatory support for patients with ventilatory pump failure: a narrative review. Multidiscip Respir Med 2019; 14:38. [PMID: 31798866 PMCID: PMC6884796 DOI: 10.1186/s40248-019-0202-7] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
Over the past three decades, the use of noninvasive ventilation or "NIV" to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechanical ventilation. NVS, along with mechanical insufflation-exsufflation, now provides a noninvasive option for the management of both chronic and acute respiratory failure for these patients. The most common diagnoses for which these methods are useful include chest wall deformities, neuromuscular diseases, morbid obesity, high level spinal cord injury and idiopathic, primary or secondary disorders of the ventilatory control. Thus, NVS is being used in diverse settings: critical care units, medical wards, at home, and in extended care. The aim of this review is to examine the techniques used for daytime support.
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Affiliation(s)
- Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Paola Pierucci
- Cardio Thoracic Department, Respiratory and Sleep Disorders Unit, Bari Policlinic, Bari, Italy
| | - Eleonora Volpato
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Antonello Nicolini
- Respiratory Rehabilitation Unit, ASL 4 Chiavarese, Hospital of Sestri Levante, Sestri Levante, Italy
| | - Agata Lax
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Dominique Robert
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - John Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, USA
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Banfi P, Pierucci P, Volpato E, Nicolini A, Lax A, Robert D, Bach J. Daytime noninvasive ventilatory support for patients with ventilatory pump failure: a narrative review. Multidiscip Respir Med 2019. [DOI: 10.4081/mrm.2019.486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Over the past three decades, the use of noninvasive ventilation or “NIV” to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechanical ventilation. NVS, along with mechanical insufflation-exsufflation, now provides a noninvasive option for the management of both chronic and acute respiratory failure for these patients. The most common diagnoses for which these methods are useful include chest wall deformities, neuromuscular diseases, morbid obesity, high level spinal cord injury and idiopathic, primary or secondary disorders of the ventilatory control. Thus, NVS is being used in diverse settings: critical care units, medical wards, at home, and in extended care. The aim of this review is to examine the techniques used for daytime support.
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Pierucci P, Di Lecce V, Marra L, Resta O. Is there a threat of an increase in the rates of obesity hypoventilation syndrome? Expert Rev Respir Med 2019; 14:117-119. [PMID: 31709854 DOI: 10.1080/17476348.2020.1690992] [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] [Indexed: 10/25/2022]
Affiliation(s)
- Paola Pierucci
- Cardio-Thoracic Department, Respiratory and Sleep disorders Unit, Policlinic University hospital, UNIBA, Bari, Italy
| | - Valentina Di Lecce
- Cardio-Thoracic Department, Respiratory and Sleep disorders Unit, Policlinic University hospital, UNIBA, Bari, Italy
| | - Lorenzo Marra
- Cardio-Thoracic Department, Respiratory and Sleep disorders Unit, Policlinic University hospital, UNIBA, Bari, Italy
| | - Onofrio Resta
- Cardio-Thoracic Department, Respiratory and Sleep disorders Unit, Policlinic University hospital, UNIBA, Bari, Italy
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Karim HMR, Burns KEA, Ciobanu LD, El-Khatib M, Nicolini A, Vargas N, Hernández-Gilsoul T, Skoczyński S, Falcone VA, Arnal JM, Bach J, De Santo LS, Lucchini A, Steier J, Purro A, Petroianni A, Sassoon CS, Bambi S, Aguiar M, Soubani AO, Taniguchi C, Mollica C, Berlin DA, Piervincenzi E, Rao F, Luigi FS, Ferrari R, Garuti G, Laier-Groeneveld G, Fiorentino G, Ho KM, Alqahtani JS, Luján M, Moerer O, Resta O, Pierucci P, Papadakos P, Steiner S, Stieglitz S, Dikmen Y, Duan J, Bhakta P, Iglesias AU, Corcione N, Caldeira V, Karakurt Z, Valli G, Kondili E, Ruggieri MP, Raposo MS, Bottino F, Soler-González R, Gurjar M, Sandoval-Gutierrez JL, Jafari B, Arroyo-Cozar M, Noval AR, Corcione N, Barjaktarevic I, Sarc I, Mina B, Szkulmowski Z, Taniguchi C, Esquinas AM. Noninvasive ventilation: education and training. A narrative analysis and an international consensus document. Adv Respir Med 2019; 87:36-45. [PMID: 30830962 DOI: 10.5603/arm.a2019.0006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/12/2018] [Revised: 01/22/2019] [Accepted: 02/05/2019] [Indexed: 11/25/2022]
Abstract
Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients' lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries.
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Affiliation(s)
- Habib Mohammad Reazaul Karim
- Department of Anesthesiology and Critical Care. All India Institute of Medical Sciences, Raipur, Great Eastern Road, Tatibandh, Raipur (CG)., 492099 Raipur, India
| | - Karen E A Burns
- Associate Professor, Clinician Scientist. Critical Care Medicine, Li Ka Shing Knowledge Insitute, St. Michael's Hospital,, 30 Bond Street, 4-045 Donnelly Wing. Toronto,, M5B 1W8 Ontario, Canada
| | - Laura D Ciobanu
- Assoc Professor, University of Medicine and Pharmacy, Romania, Romania
| | - Mohamad El-Khatib
- Department of Anesthesiology, American University of Beirut-Medical Center. School of Medicine,, Beirut-Lebanon, Lebanon
| | | | - Nicola Vargas
- Geriatric and Intensive Geriatric Cares,, Avelllino, Italy
| | - Thierry Hernández-Gilsoul
- Head of Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Critical Care, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas., Mexico
| | - Szymon Skoczyński
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia,, Katowice, Poland
| | - Vito Antonio Falcone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs - Section of Respiratory Disease, University of Bari Aldo Moro,, Bari, Italy
| | | | - John Bach
- Rutgers University New Jersey Medical School, New Jersey, United States
| | - Luca Salvatore De Santo
- Università della Campania Luigi Vanvitelli, Napoli and Cardiac Surgery Unit,, AORN dei Colli, Naples, Italy
| | - Alberto Lucchini
- General intensive care unit - San Gerardo Hospital, Milano-Bicocca University,, Milan, Italy
| | - Joerg Steier
- Professor of Respiratory and Sleep Medicine, King's College London, Faculty of Life Sciences and Medicine,, London, United Kingdom
| | - Andrea Purro
- Head of Intensive Care Unit, Humanitas Gradenigo Hospital., Turin, Italy
| | - Angelo Petroianni
- Respiratory Diseases Unit, Department of Cardiovascular and Respiratory Diseases, Policlinico Umberto I, Sapienza University of Rome,, Rome, Italy
| | - Catherine S Sassoon
- Professor of Medicine, Division of Pulmonary and Critical Care Medicine University of California, Irvine, CA,; VA Long Beach Healthcare System,, Long Beach, CA, United States
| | - Stefano Bambi
- Medical & Surgical Intensive Care Unit, Careggi University Hospital,, Florence, Italy
| | - Margarida Aguiar
- Pulmonologist, Pulmonary service, Hospital Beatriz Ângelo,, Loures, Portugal
| | - Ayman O Soubani
- Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine. Wayne State University School of Medicine, 3990 John R-3 Hudson, Detroit, MI, 48201, United States
| | - Corinne Taniguchi
- Physiotherapist Specialized in Intenvise Care and Pneumology- FMUSP/HCSão,, Paulo-SP, Brazil
| | | | - David A Berlin
- Department of Medicine, Weill Cornell Medicine New York, New York, United States
| | | | - Fabrizio Rao
- Respiratory Unit, Neuromuscular OmniCentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital,, Milan, Italy
| | | | - Rodolfo Ferrari
- Emergency Department, University Hospital Sant'Orsola, Malpighi,, Bologna, Italy
| | - Giancarlo Garuti
- Respiratory Unit, Santa Maria Bianca Hospital, Mirandola (MO),, ASL Modena, Modena, Italy
| | | | | | - Kwok M Ho
- Department of Intensive Care Medicine, Royal Perth Hospital; School of Population & Global Health, University of Western Australia; and School of Veterinary & Life Sciences, Murdoch University., Perth, Australia
| | - Jaber Saud Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences,, Dhahran, P.O. Box 33048, Dammam 31448, Saudi Arabia
| | - Manuel Luján
- Pneumology Service. Hospital of Sabadell, Universitat Autónoma de Barcelona., Sabadell, Spain
| | - Onnen Moerer
- Dept. of Anaesthesiology, Georg-August-University, University Medical Center Göttingen, Germany
| | - Onofrio Resta
- Cardiothoracic department, Respiratory and Sleep medicine Unit, Policlinic, Bari "Aldo Moro" University,, Italy
| | - Paola Pierucci
- Cardiothoracic department, Respiratory and Sleep medicine Unit, Policlinic, Bari "Aldo Moro" University,, Italy
| | - Peter Papadakos
- Department of Anesthesiology and Surgery. Director CCM. University of Rochester,, Rochester, New York, United States
| | - Stephan Steiner
- Departement of Cardiology, Pneumology and Intensive care, St Vincenz Hospital Limburg,, Limburg, Germany
| | - Sven Stieglitz
- Petrus Hospital Wuppertal, Academic Teaching Hospital of the University of Duesseldorf, Carnaper Str. 48, Clinic for Pneumology, Allergology, Sleep- and Intensive Care,, 42283 Wuppertal, Germany
| | - Yalim Dikmen
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Intensive Care,, Fatih, Istanbul, Turkey
| | - Jun Duan
- Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University,, Youyi Road 1, Yuzhong District, Chongqing, 400016, China
| | - Pradipta Bhakta
- Department of Anaesthesia and Intensive Care, University Hospital Limerick,, Dooradoyle, Limerick, Ireland
| | - Alejandro Ubeda Iglesias
- Intensive Care Unit, Hospital Punta de Europa, Algeciras Ctra, Getares,, s/n, 11207 Algeciras, Cádiz, Spain
| | - Nadia Corcione
- Departement of Anesthesia, Critical Care and Emergency. Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico., Milano, Italy
| | - Vânia Caldeira
- Pneumology Department, Hospital Santa Marta,, Lisboa, Portugal
| | - Zuhal Karakurt
- Assoc Prof, Pulmonary and Critical Care Department, Pulmonology and Intensivist, Dean in Hospital, University of Health Sciences,, Istanbul, Turkey
| | - Gabriele Valli
- Department of Emergency Medicine, San Giovanni Addolorata,, Rome, Italy
| | - Eumorfia Kondili
- Associate Professor of Intensive Care Medicine, Medical School , University of Crete Greece, ICU University Hospital of Heraklion,, Crete, Greece
| | - Maria Pia Ruggieri
- Direttore UOC PS-Breve Osservazione DEAI II livello AO San Giovanni Addolorata, Roma, Italy
| | - Margarida Simões Raposo
- Pulmonologist. Centro Hospitalar de Lisboa Ocidental Egas, Moniz Hospital,, Lisboa, Portugal
| | | | | | - Mohan Gurjar
- Department of Critical Care Medicine. Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS),, Rae Bareli Road, Lucknow (UP), 226014 Lucknow, India
| | | | - Behrouz Jafari
- Director, VALBHCS Sleep Program, Asst Professor of Medicine, Section of Pulmonary and Critical Care Medicine. University of California, Irvine. VA Long Beach Healthcare System 5901 East 7th Street (11/111P), Long Beach, CA, United States
| | | | - Ana Roca Noval
- Servicio de neumologia, Hospital Universitario La Princesa,, Madrid, Spain
| | - Nadia Corcione
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Irena Sarc
- Noninvasive ventilation department, University clinic for pulmonary and allergic diseases, Golnik, Slovenia
| | - Bushra Mina
- Department of Medicine, Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY USA
| | - Zbigniew Szkulmowski
- Departament of Anesthesia and ICU. University Hospital No 1 in Bydgoszcz. Collegium Medicum in Bydgoszcz. University Nicolaus Copernicus in Toruń. Bydgoszcz. Poland
| | | | - Antonio M Esquinas
- Intensive Care Unit. Hospital Morales Meseguer Murcia, Murcia, 30008, Spain.
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Crimi C, Pierucci P, Carlucci A, Cortegiani A, Gregoretti C. Long-Term Ventilation in Neuromuscular Patients: Review of Concerns, Beliefs, and Ethical Dilemmas. Respiration 2019; 97:185-196. [PMID: 30677752 DOI: 10.1159/000495941] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 10/09/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Noninvasive mechanical ventilation (NIV) is an effective treatment in patients with neuromuscular diseases (NMD) to improve symptoms, quality of life, and survival. SUMMARY NIV should be used early in the course of respiratory muscle involvement in NMD patients and its requirements may increase over time. Therefore, training on technical equipment at home and advice on problem solving are warranted. Remote monitoring of ventilator parameters using built-in ventilator software is recommended. Telemedicine may be helpful in reducing hospital admissions. Anticipatory planning and palliative care should be carried out to lessen the burden of care, to maintain or withdraw from NIV, and to guarantee the most respectful management in the last days of NMD patients' life. Key Message: Long-term NIV is effective but challenging in NMD patients. Efforts should be made by health care providers in arranging a planned transition to home and end-of-life discussions for ventilator-assisted individuals and their families.
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Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Sleep Medicine Unit, Policlinico University Hospital, Bari, Italy
| | - Annalisa Carlucci
- Respiratory Intensive Care Unit, Pulmonary Rehabilitation Unit, IRCCS Fondazione S. Maugeri, Pavia, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy,
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
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Stripoli T, Spadaro S, Di Mussi R, Volta CA, Trerotoli P, De Carlo F, Iannuzziello R, Sechi F, Pierucci P, Staffieri F, Bruno F, Camporota L, Grasso S. High-flow oxygen therapy in tracheostomized patients at high risk of weaning failure. Ann Intensive Care 2019; 9:4. [PMID: 30617626 PMCID: PMC6323064 DOI: 10.1186/s13613-019-0482-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 10/15/2018] [Accepted: 01/02/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose High-flow oxygen therapy delivered through nasal cannulae improves oxygenation and decreases work of breathing in critically ill patients. Little is known of the physiological effects of high-flow oxygen therapy applied to the tracheostomy cannula (T-HF). In this study, we compared the effects of T-HF or conventional low-flow oxygen therapy (conventional O2) on neuro-ventilatory drive, work of breathing, respiratory rate (RR) and gas exchange, in a mixed population of tracheostomized patients at high risk of weaning failure. Methods This was a single-center, unblinded, cross-over study on fourteen patients. After disconnection from the ventilator, each patient received two 1-h periods of T-HF (T-HF1 and T-HF2) alternated with 1 h of conventional O2. The inspiratory oxygen fraction was titrated to achieve an arterial O2 saturation target of 94–98% (88–92% in COPD patients). We recorded neuro-ventilatory drive (electrical diaphragmatic activity, EAdi), work of breathing (inspiratory muscular pressure–time product per breath and per minute, PTPmusc/b and PTPmusc/min, respectively) respiratory rate and arterial blood gases. Results The EAdipeak remained unchanged (mean ± SD) in the T-HF1, conventional O2 and T-HF2 study periods (8.8 ± 4.3 μV vs 8.9 ± 4.8 μV vs 9.0 ± 4.1 μV, respectively, p = 0.99). Similarly, PTPmusc/b and PTPmusc/min, RR and gas exchange remained unchanged. Conclusions In tracheostomized patients at high risk of weaning failure from mechanical ventilation, T-HF did not improve neuro-ventilatory drive, work of breathing, respiratory rate and gas exchange compared with conventional O2 after disconnection from the ventilator. The present findings might suggest that physiological effects of high-flow therapy through tracheostomy substantially differ from nasal high flow.
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Affiliation(s)
- Tania Stripoli
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari "Aldo Moro", Ospedale Policlinico, Piazza Giulio Cesare 11, Bari, Italy
| | - Savino Spadaro
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Sezione di Anestesiologia e Terapia Intensiva Universitaria, Università degli studi di Ferrara, Ferrara, Italy
| | - Rosa Di Mussi
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari "Aldo Moro", Ospedale Policlinico, Piazza Giulio Cesare 11, Bari, Italy
| | - Carlo Alberto Volta
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Sezione di Anestesiologia e Terapia Intensiva Universitaria, Università degli studi di Ferrara, Ferrara, Italy
| | - Paolo Trerotoli
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Cattedra di Statistica Medica, Università degli Studi Aldo Moro, Bari, Italy
| | - Francesca De Carlo
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari "Aldo Moro", Ospedale Policlinico, Piazza Giulio Cesare 11, Bari, Italy
| | - Rachele Iannuzziello
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari "Aldo Moro", Ospedale Policlinico, Piazza Giulio Cesare 11, Bari, Italy
| | - Fabio Sechi
- Dipartimento di Scienze Chirurgiche e Microchirurgiche, Università degli Studi di Sassari, Sassari, Italy
| | - Paola Pierucci
- Dipartimento di Medicina Respiratoria e del Sonno, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Francesco Staffieri
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Chirurgia Veterinaria, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Francesco Bruno
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari "Aldo Moro", Ospedale Policlinico, Piazza Giulio Cesare 11, Bari, Italy
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, King's College London, London, UK.,Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK
| | - Salvatore Grasso
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari "Aldo Moro", Ospedale Policlinico, Piazza Giulio Cesare 11, Bari, Italy.
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Di Mussi R, Spadaro S, Stripoli T, Volta CA, Trerotoli P, Pierucci P, Staffieri F, Bruno F, Camporota L, Grasso S. High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease. Crit Care 2018; 22:180. [PMID: 30071876 PMCID: PMC6091018 DOI: 10.1186/s13054-018-2107-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/22/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The physiological effects of high-flow nasal cannula O2 therapy (HFNC) have been evaluated mainly in patients with hypoxemic respiratory failure. In this study, we compared the effects of HFNC and conventional low-flow O2 therapy on the neuroventilatory drive and work of breathing postextubation in patients with a background of chronic obstructive pulmonary disease (COPD) who had received mechanical ventilation for hypercapnic respiratory failure. METHODS This was a single center, unblinded, cross-over study on 14 postextubation COPD patients who were recovering from an episode of acute hypercapnic respiratory failure of various etiologies. After extubation, each patient received two 1-h periods of HFNC (HFNC1 and HFNC2) alternated with 1 h of conventional low-flow O2 therapy via a face mask. The inspiratory fraction of oxygen was titrated to achieve an arterial O2 saturation target of 88-92%. Gas exchange, breathing pattern, neuroventilatory drive (electrical diaphragmatic activity (EAdi)) and work of breathing (inspiratory trans-diaphragmatic pressure-time product per minute (PTPDI/min)) were recorded. RESULTS EAdi peak increased from a mean (±SD) of 15.4 ± 6.4 to 23.6 ± 10.5 μV switching from HFNC1 to conventional O2, and then returned to 15.2 ± 6.4 μV during HFNC2 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). Similarly, the PTPDI/min increased from 135 ± 60 to 211 ± 70 cmH2O/s/min, and then decreased again during HFNC2 to 132 ± 56 (conventional O2: p < 0.05 versus HFNC1 and HFNC2). CONCLUSIONS In patients with COPD, the application of HFNC postextubation significantly decreased the neuroventilatory drive and work of breathing compared with conventional O2 therapy.
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Affiliation(s)
- Rosa Di Mussi
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy
| | - Savino Spadaro
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Sezione di Anestesiologia e Terapia Intensiva Universitaria, Università degli studi di Ferrara, Ferrara, Italy
| | - Tania Stripoli
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy
| | - Carlo Alberto Volta
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Sezione di Anestesiologia e Terapia Intensiva Universitaria, Università degli studi di Ferrara, Ferrara, Italy
| | - Paolo Trerotoli
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Cattedra di Statistica Medica, Università degli Studi Aldo Moro, Bari, Italy
| | - Paola Pierucci
- Dipartimento di Medicina Respiratoria e del Sonno, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Francesco Staffieri
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Chirurgia Veterinaria, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Francesco Bruno
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, and Division of Centre of Human Applied Physiological Sciences, King's College London, London, UK
| | - Salvatore Grasso
- Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Ospedale Policlinico, Università degli Studi di Bari "Aldo Moro", Piazza Giulio Cesare 11, Bari, Italy.
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Pierucci P, Malouf M, Glanville AR, Beagley L, Smith C, Khanna R. Novel autologous T-cell therapy for drug-resistant cytomegalovirus disease after lung transplantation. J Heart Lung Transplant 2016; 35:685-7. [DOI: 10.1016/j.healun.2015.12.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 11/04/2015] [Accepted: 12/21/2015] [Indexed: 11/29/2022] Open
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Carlucci A, Vitacca M, Malovini A, Pierucci P, Guerrieri A, Barbano L, Ceriana P, Balestrino A, Santoro C, Pisani L, Corcione N, Nava S. End-of-Life Discussion, Patient Understanding and Determinants of Preferences in Very Severe COPD Patients: A Multicentric Study. COPD 2016; 13:632-8. [PMID: 27027671 DOI: 10.3109/15412555.2016.1154034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 11/13/2022]
Abstract
Discussion about patients' end-of-life (E-o-L) preferences should be part of the routine practice. Using a semi-structured interview with a scenario-based decision, we performed a prospective multicentre study to elicit the patients' E-o-L preferences in very severe chronic obstructive pulmonary disease (COPD). We also checked their ability to retain this information and the respect of their decisions when they die. Forty-three out of ninety-one of the eligible patients completed the study. The choice of E-o-L practice was equally distributed among the three proposed options: endotracheal intubation (ETI), 'ceiling' non-invasive ventilation (NIV), and palliation of symptoms with oxygen and morphine. NIV and ETI were more frequently chosen by patients who already experienced them. ETI preference was also associated with the use of anti-depressant drugs and a low educational level, while a higher educational level and a previous discussion with a pneumologist significantly correlated with the preference for oxygen and morphine. Less than 50% of the patients retained a full comprehension of the options at 24 hours. About half of the patients who died in the follow-up period were not treated according to their wishes. In conclusion, in end-stage COPD more efforts are needed to improve communication, patients' knowledge of the disease and E-o-L practice.
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Affiliation(s)
- Annalisa Carlucci
- a Pulmonary Rehabilitation Unit , IRCCS Fondazione S. Maugeri , Pavia , Italy
| | - Michele Vitacca
- b Pulmonary Rehabilitation Unit IRCCS Fondazione S. Maugeri , Lumezzane , Italy
| | - Alberto Malovini
- c Laboratorio di Informatica e Sistemica per la Ricerca Clinica , IRCCS Fondazione S. Maugeri , Pavia , Italy
| | - Paola Pierucci
- d Respiratory Unit , Concord Hospital , University of Sydney , NSW , Australia
| | - Aldo Guerrieri
- e Respiratory and Critical Care Unit , S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Luca Barbano
- b Pulmonary Rehabilitation Unit IRCCS Fondazione S. Maugeri , Lumezzane , Italy
| | - Piero Ceriana
- a Pulmonary Rehabilitation Unit , IRCCS Fondazione S. Maugeri , Pavia , Italy
| | | | - Carmen Santoro
- a Pulmonary Rehabilitation Unit , IRCCS Fondazione S. Maugeri , Pavia , Italy
| | - Lara Pisani
- f Alma Mater University Department of Clinical , Integrated and Experimental Medicine (DIMES) , Respiratory and Critical Care Unit , S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Nadia Corcione
- f Alma Mater University Department of Clinical , Integrated and Experimental Medicine (DIMES) , Respiratory and Critical Care Unit , S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Stefano Nava
- f Alma Mater University Department of Clinical , Integrated and Experimental Medicine (DIMES) , Respiratory and Critical Care Unit , S. Orsola-Malpighi Hospital , Bologna , Italy
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Carlucci A, Ceriana P, Mancini M, Cirio S, Pierucci P, D'Artavilla Lupo N, Gadaleta F, Morrone E, Fanfulla F. Efficacy of Bilevel-auto Treatment in Patients with Obstructive Sleep Apnea Not Responsive to or Intolerant of Continuous Positive Airway Pressure Ventilation. J Clin Sleep Med 2015; 11:981-5. [PMID: 25902825 DOI: 10.5664/jcsm.5008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 10/22/2014] [Accepted: 03/08/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Ventilation with continuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnea (OSA). However, it was recently suggested that a novel mode of ventilation, Bilevel-auto, could be equally effective in treating patients unable to tolerate CPAP. The aim of this study was to investigate the ability of Bilevel-auto to treat OSA patients whose nocturnal ventilatory disturbances are not completely corrected by CPAP. METHODS We enrolled 66 consecutive OSA patients, not responsive to (group A) or intolerant of (group B) CPAP treatment, after a full night of manual CPAP titration in a laboratory. Full polysomnography data and daytime sleepiness score were compared for each group in the three different conditions: basal, during CPAP, and during Bilevel-auto. RESULTS The apnea-hypopnea index decreased significantly during CPAP in both groups; however, in the group A, there was a further significant improvement during Bilevel-auto. The same trend was observed for oxygenation indices, while the distribution and the efficiency of sleep did not differ following the switch from CPAP to Bilevel-auto. CONCLUSIONS This study confirmed the role of Bilevel-auto as an effective therapeutic alternative to CPAP in patients intolerant of this latter mode of ventilation. Moreover, extending the use of Bilevel-auto to those OSA patients not responsive to CPAP, we showed a significantly better correction of nocturnal respiratory disturbances.
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Affiliation(s)
- Annalisa Carlucci
- Pulmonary Rehabilitation, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy
| | - Piero Ceriana
- Pulmonary Rehabilitation, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy
| | - Marco Mancini
- Pulmonary Rehabilitation, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy
| | - Serena Cirio
- Pulmonary Rehabilitation, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy
| | - Paola Pierucci
- Department of Thoracic Medicine, St. Vincent's Hospital, Darlinghurst NSW, Australia
| | - Nadia D'Artavilla Lupo
- Sleep Medicine Unit, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy
| | - Felice Gadaleta
- Sleep Medicine Unit, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy
| | - Elisa Morrone
- Sleep Medicine Unit, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy
| | - Francesco Fanfulla
- Sleep Medicine Unit, Fondazione Salvatore Maugeri IRCCS - Scientific Institute of Pavia, Pavia, Italy
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Abstract
During the past 20 years, lung transplantation (LTX) has evolved and it is now accepted as a mainstream modality for care of patients with severe life-threatening respiratory diseases that are refractory to maximal conventional therapies. Improvements in surgical techniques and in antirejection medications have resulted in prolonged survival in these patients. Several studies have explored quality of life after LTX and its improvement has been noted especially in the early period between 3 and 6 months. This article discusses the salient features of the physiology of breathing and sleep disturbances before and after LTX and its alterations during sleep.
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Affiliation(s)
- Paola Pierucci
- Lung Transplant Unit, St Vincents Hospital, 390 Victoria Street, Darlinghurst, Sydney 2010, Australia
| | - Monique Malouf
- Lung Transplant Unit, St Vincents Hospital, 390 Victoria Street, Darlinghurst, Sydney 2010, Australia.
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Pierucci P, Misciagna G, Ventura MT, Inguaggiato R, Cisternino AM, Guerra VMB, Suppressa P, Resta F, Sabbà C. Diet and myocardial infarction: a nested case-control study in a cohort of elderly subjects in a Mediterranean area of southern Italy. Nutr Metab Cardiovasc Dis 2012; 22:727-733. [PMID: 21482083 DOI: 10.1016/j.numecd.2010.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Received: 03/16/2010] [Revised: 12/07/2010] [Accepted: 12/09/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIM We evaluated the incidence of myocardial infarction (MI) in a population of Southern Italy and the relationship of dietary macronutrients with incident MI. METHODS AND RESULTS The ONCONUT cohort included 5632 subjects followed-up, over 50 years, recruited in 1992. At baseline, they completed a validated semi-quantitative food frequency questionnaire and gave details of their medical history. After 5years they were traced by their family physician, who found 108 incident MI. Ninety-seven of them and 194 controls, sampled from the noncases at baseline and paired for diabetes to the cases, entered this nested case-control study. MI rate per 1000 person-years was 9.6 in males and 3.7 in females. In non-diabetics, saturated fat were associated with MI directly (odds ratio (OR): tertile 2 vs. 1 = 2.32, tertile 3 vs. 1 = 2.82; chi-square for trend, p = 0.03) and polyunsaturated fats inversely (OR: tertile 2 vs. 1 = 0.80, tertile 3 vs. 1 = 0.37; chi-square for trend, p = 0.05), while in diabetics, starchy carbohydrates (OR: tertile 2 vs. 1 = 1.51, tertile 3 vs. 1 = 6.73; chi-square for trend, p = 0.01) and glycaemic index (OR: tertile 2 vs. 1 = 2.74, tertile 3 vs. 1 = 5.34; chi-square for trend, p = 0.01) were associated directly with MI. CONCLUSIONS MI incidence in this population was lower than that found in northern countries. In non-diabetics, saturated fats were associated directly and polyunsaturated fat inversely with MI; in diabetics, starchy carbohydrates and high-glycaemic-index foods were associated directly with MI.
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Affiliation(s)
- P Pierucci
- Department of Geriatrics and Rare Diseases, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
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