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Paganuzzi M, Nattino G, Ghilardi GI, Costantino G, Rossi C, Cortellaro F, Cosentini R, Paglia S, Migliori M, Mira A, Bertolini G. Assessing the heterogeneity of the impact of COVID-19 incidence on all-cause excess mortality among healthcare districts in Lombardy, Italy, to evaluate the local response to the pandemic: an ecological study. BMJ Open 2024; 14:e077476. [PMID: 38326265 PMCID: PMC10860029 DOI: 10.1136/bmjopen-2023-077476] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES The fragmentation of the response to the COVID-19 pandemic at national, regional and local levels is a possible source of variability in the impact of the pandemic on society. This study aims to assess how much of this variability affected the burden of COVID-19, measured in terms of all-cause 2020 excess mortality. DESIGN Ecological retrospective study. SETTING Lombardy region of Italy, 2015-2020. OUTCOME MEASURES We evaluated the relationship between the intensity of the epidemics and excess mortality, assessing the heterogeneity of this relationship across the 91 districts after adjusting for relevant confounders. RESULTS The epidemic intensity was quantified as the COVID-19 hospitalisations per 1000 inhabitants. Five confounders were identified through a directed acyclic graph: age distribution, population density, pro-capita gross domestic product, restriction policy and population mobility.Analyses were based on a negative binomial regression model with district-specific random effects. We found a strong, positive association between COVID-19 hospitalisations and 2020 excess mortality (p<0.001), estimating that an increase of one hospitalised COVID-19 patient per 1000 inhabitants resulted in a 15.5% increase in excess mortality. After adjusting for confounders, no district differed in terms of COVID-19-unrelated excess mortality from the average district. Minimal heterogeneity emerged in the district-specific relationships between COVID-19 hospitalisations and excess mortality (6 confidence intervals out of 91 did not cover the null value). CONCLUSIONS The homogeneous effect of the COVID-19 spread on the excess mortality in the Lombardy districts suggests that, despite the unprecedented conditions, the pandemic reactions did not result in health disparities in the region.
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Affiliation(s)
- Marco Paganuzzi
- University of Milan, Milan, Italy
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | - Giovanni Nattino
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | - Giulia Irene Ghilardi
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | - Giorgio Costantino
- University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlotta Rossi
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | | | | | | | | | - Antonietta Mira
- Università della Svizzera italiana, Lugano, Switzerland
- University of Insubria, Varese, Italy
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
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Nattino G, Paganuzzi MM, Ghilardi GI, Costantino G, Rossi C, Cortellaro F, Cosentini R, Paglia S, Migliori M, Bertolini G. Strategies to convert hospital beds for COVID-19 patients to minimize emergency department overcrowding. Health Serv Manage Res 2023:9514848231218648. [PMID: 38059353 DOI: 10.1177/09514848231218648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Background: The shortage of hospital beds for COVID-19 patients has been one critical cause of Emergency Department (ED) overcrowding. Purpose: We aimed at elaborating a strategy of conversion of hospital beds, from non-COVID-19 to COVID-19 care, minimizing both ED overcrowding and the number of beds eventually converted. Research Design: Observational retrospective study. Study Sample: We considered the centralized database of all ED admissions in the Lombardy region of Italy during the second "COVID-19 wave" (October to December 2020). Data collection and Analysis: We analyzed all admissions to 82 EDs. We devised a family of Monte Carlo simulations to evaluate the performance of hospital beds' conversion strategies triggered by ED crowding of COVID-19 patients, determining a critical number of beds to be converted when passing an ED-specific crowding threshold. Results: Our results suggest that the maximum number of patients waiting for hospitalization could have been decreased by 70% with the proposed strategy. Such a reduction would have been achieved by converting 30% more hospital beds than the total number converted in the region. Conclusions: The disproportion between reduction in ED crowding and additionally converted beds suggests that a wide margin to improve the efficiency of the conversions exists. The proposed simulation apparatus can be easily generalized to study management policies synchronizing ED output and in-hospital bed availability.
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Affiliation(s)
- Giovanni Nattino
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | | | | | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
- Università degli Studi di Milano, Milano, Italy
| | - Carlotta Rossi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | | | | | | | | | - Guido Bertolini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
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Cassano G, Nattino G, Belotti M, Cortellaro F, Cosentini R, Ghilardi GI, Paganuzzi M, Paglia S, Rossi C, Solbiati M, Bertolini G, Brambilla AM. Prognostic value of respiratory parameters for COVID-19 patients in the emergency department: results from the EC-COVID study. Intern Emerg Med 2023; 18:2075-2082. [PMID: 37338715 DOI: 10.1007/s11739-023-03324-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/23/2023] [Indexed: 06/21/2023]
Abstract
While several studies have evaluated the prognostic weight of respiratory parameters in patients with COVID-19, few have focused on patients' clinical conditions at the first emergency department (ED) assessment. We analyzed a large cohort of ED patients recruited within the EC-COVID study over the year 2020, and assessed the association between key bedside respiratory parameters measured in room air (pO2, pCO2, pH, and respiratory rate [RR]) and hospital mortality, after adjusting for key confounding factors. Analyses were based on a multivariable logistic Generalized Additive Model (GAM). After excluding patients who did not perform a blood gas analysis (BGA) test in room air or with incomplete BGA results, a total of 2458 patients were considered in the analyses. Most patients were hospitalized on ED discharge (72.0%); hospital mortality was 14.3%. Strong, negative associations with hospital mortality emerged for pO2, pCO2 and pH (p-values: < 0.001, < 0.001 and 0.014), while a significant, positive association was observed for RR (p-value < 0.001). Associations were quantified with nonlinear functions, learned from the data. No cross-parameter interaction was significant (all p-values were larger than 0.10), suggesting a progressive, independent effect on the outcome as the value of each parameter departed from normality. Our results collide with the hypothesized existence of patterns of breathing parameters with specific prognostic weight in the early stages of the disease.
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Affiliation(s)
- Giulio Cassano
- Emergency Medicine Unit, Luigi Sacco Hospital, ASST FBF Sacco, Milan, Italy
| | - Giovanni Nattino
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica (BG), Italy
| | - Mauro Belotti
- Emergency Medicine Unit, Luigi Sacco Hospital, ASST FBF Sacco, Milan, Italy
| | | | | | - Giulia Irene Ghilardi
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica (BG), Italy
| | - Marco Paganuzzi
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica (BG), Italy
| | | | - Carlotta Rossi
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica (BG), Italy.
| | - Monica Solbiati
- Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan (MI), Italy
- Università Degli Studi Di Milano, Milan (MI), Italy
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica (BG), Italy
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Novelli L, Raimondi F, Carioli G, Carobbio A, Pappacena S, Biza R, Trapasso R, Anelli M, Amoroso M, Allegri C, Malandrino L, Imeri G, Conti C, Beretta M, Gori M, D'Elia E, Senni M, Lorini FL, Rizzi M, Cosentini R, Rambaldi A, Masciulli A, Gavazzi A, Solidoro P, Sironi S, Fagiuoli S, Barbui T, Marco FD. One-year mortality in COVID-19 is associated with patients' comorbidities rather than pneumonia severity. Respir Med Res 2023; 83:100976. [PMID: 36473331 PMCID: PMC9691276 DOI: 10.1016/j.resmer.2022.100976] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/15/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In patients with pneumonia or acute respiratory distress syndrome who survived hospitalization, one-year mortality can affect up to one third of discharged patients. Therefore, significant long-term mortality after COVID-19 respiratory failure could be expected. The primary outcome of the present study was one-year all-cause mortality in hospitalized COVID-19 patients. METHODS Observational study of COVID-19 patients hospitalized at Papa Giovanni XXIII Hospital (Bergamo, Italy), during the first pandemic wave. RESULTS A total of 1326 COVID-19 patients were hospitalized. Overall one-year mortality was 33.6% (N 446/1326), with the majority of deaths occurring during hospitalization (N=412, 92.4%). Thirty-four patients amongst the 914 discharged (3.7%) subsequentely died within one year. A third of these patients died for advanced cancer, while death without a cause other than COVID-19 was uncommon (8.8% of the overall post-discharge mortality). In-hospital late mortality (i.e. after 28 days of admission) interested a population with a lower age, and fewer comorbidities, more frequentely admitted in ICU. Independent predictors of post-discharge mortality were age over 65 years (HR 3.19; 95% CI 1.28-7.96, p-value=0.013), presence of chronic obstructive pulmonary disease (COPD) (HR 2.52; 95% CI 1.09-5.83, p-value=0.031) or proxy of cardiovascular disease (HR 4.93; 95% CI 1.45-16.75, p-value=0.010), and presence of active cancer (HR 3.64; 95% CI 1.50-8.84, p-value=0.004), but not pneumonia severity. CONCLUSIONS One-year post-discharge mortality depends on underlying patients' comorbidities rather than COVID-19 pneumonia severity per se. Awareness among physicians of predictors of post-discharge mortality might be helpful in structuring a follow-up program for discharged patients.
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Affiliation(s)
- Luca Novelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Raimondi
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy,Corresponding author at: Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1 - 24127 Bergamo, Italy
| | - Greta Carioli
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Alessandra Carobbio
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Simone Pappacena
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Biza
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Trapasso
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Marisa Anelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Mariangela Amoroso
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Chiara Allegri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Malandrino
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianluca Imeri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Caterina Conti
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marta Beretta
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Gori
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Emilia D'Elia
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ferdinando Luca Lorini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Intensive Critical Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alessandro Rambaldi
- Department of Health Sciences, University of Milan, Milan, Italy,Hematology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Arianna Masciulli
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Antonello Gavazzi
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Paolo Solidoro
- Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Italy
| | - Sandro Sironi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Gastroenterlogy 1, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Tiziano Barbui
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
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Finazzi A, Tasca A, Margutti E, Cosentini R. Obstructive shock due to thoracic aortic aneurysm. Intern Emerg Med 2023; 18:1225-1226. [PMID: 36892798 DOI: 10.1007/s11739-023-03245-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Affiliation(s)
- Andrea Finazzi
- Scuola di Specializzazione in Medicina d'Emergenza-Urgenza, Università degli Studi di Milano, Milan, Italy.
- Emergency Department, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Alessandro Tasca
- Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Eliana Margutti
- Emergency Department, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Roberto Cosentini
- Emergency Department, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
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Finazzi A, Cosentini R. Papulopustular Rash in Behçet's Disease. N Engl J Med 2023; 388:e30. [PMID: 36876757 DOI: 10.1056/nejmicm2209759] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Piazza I, Esquinas A, Cosentini R. Hospital mortality and failure of non-invasive ventilation in COVID-19: looking inside the predictive scores. Intern Emerg Med 2023; 18:681-682. [PMID: 36542303 PMCID: PMC9769552 DOI: 10.1007/s11739-022-03133-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Isabelle Piazza
- Emergency Medicine Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Roberto Cosentini
- Emergency Medicine Department, ASST Papa Giovanni XXIII, Bergamo, Italy.
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8
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Finazzi A, Cosentini R. Man with periorbital edema, palms hyperkeratosis, and exertional dyspnea. J Am Coll Emerg Physicians Open 2022; 3:e12835. [PMID: 36514537 PMCID: PMC9731390 DOI: 10.1002/emp2.12835] [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: 09/01/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andrea Finazzi
- Postgraduate School of Emergency and Critical Care Medicine ‐ Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanoItaly,Department of Emergency MedicinePapa Giovanni XXIII Bergamo HospitalBergamoItaly
| | - Roberto Cosentini
- Department of Emergency MedicinePapa Giovanni XXIII Bergamo HospitalBergamoItaly
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9
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Zacchetti L, Longhi L, Bianchi I, Di Matteo M, Russo F, Gandini L, Manesso L, Monti M, Cosentini R, Di Marco F, Fagiuoli S, Grazioli L, Gritti P, Previdi F, Senni M, Ranieri M, Lorini L. Characterization of compliance phenotypes in COVID-19 acute respiratory distress syndrome. BMC Pulm Med 2022; 22:296. [PMID: 35915487 PMCID: PMC9341412 DOI: 10.1186/s12890-022-02087-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) seems to differ from the "classic ARDS", showing initial significant hypoxemia in the face of relatively preserved compliance and evolving later in a scenario of poorly compliant lungs. We tested the hypothesis that in patients with COVID-19 ARDS, the initial value of static compliance of respiratory system (Crs) (1) depends on the previous duration of the disease (i.e., the fewer days of illness, the higher the Crs and vice versa) and (2) identifies different lung patterns of time evolution and response to prone positioning. METHODS This was a single-center prospective observational study. We enrolled consecutive mechanically ventilated patients with a diagnosis of COVID-19 who met ARDS criteria, admitted to intensive care unit (ICU). Patients were divided in four groups based on quartiles of initial Crs. Relationship between Crs and the previous duration of the disease was evaluated. Respiratory parameters collected once a day and during prone positioning were compared between groups. RESULTS We evaluated 110 mechanically ventilated patients with a diagnosis of COVID-19 who met ARDS criteria admitted to our ICUs. Patients were divided in groups based on quartiles of initial Crs. The median initial Crs was 41 (32-47) ml/cmH2O. No association was found between the previous duration of the disease and the initial Crs. The Crs did not change significantly over time within each quartile. Positive end-expiratory pressure (PEEP) and driving pressure were respectively lower and greater in patients with lower Crs. Prone positioning significantly improved PaO2/FiO2 in the 4 groups, however it increased the Crs significantly only in patients in lower quartile of Crs. CONCLUSIONS In our cohort, the initial Crs is not dependent on the previous duration of COVID-19 disease. Prone positioning improves oxygenation irrespective to initial Crs, but it ameliorates respiratory mechanics only in patients with lower Crs.
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Affiliation(s)
- Lucia Zacchetti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.
| | - Luca Longhi
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Isabella Bianchi
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Maria Di Matteo
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Filippo Russo
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Lucia Gandini
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Leonardo Manesso
- Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Martina Monti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.,Department of Anesthesia and Critical Care Medicine, University of Milan, Milan, Italy
| | - Roberto Cosentini
- Emergency Medicine Department, Papa Giovanni XIII Hospital, Bergamo, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Milan, Italy.,Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.,Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Lorenzo Grazioli
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Paolo Gritti
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy
| | - Fabio Previdi
- Department of Bioengineering, University of Bergamo, Bergamo, Italy
| | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Ranieri
- Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Lorini
- Department of Anesthesia, Emergency and Critical Care Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy.,Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
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Cosentini R, Groff P, Brambilla AM, Camajori Todeschini R, Gangitano G, Ingrassia S, Marino R, Nori F, Pagnozzi F, Panero F, Ferrari R. SIMEU position paper on non-invasive respiratory support in COVID-19 pneumonia. Intern Emerg Med 2022; 17:1175-1189. [PMID: 35103926 PMCID: PMC8803573 DOI: 10.1007/s11739-021-02906-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022]
Abstract
The rapid worldwide spread of the Coronavirus disease (COVID-19) crisis has put health systems under pressure to a level never experienced before, putting intensive care units in a position to fail to meet an exponentially growing demand. The main clinical feature of the disease is a progressive arterial hypoxemia which rapidly leads to ARDS which makes the use of intensive care and mechanical ventilation almost inevitable. The difficulty of health systems to guarantee a corresponding supply of resources in intensive care, together with the uncertain results reported in the literature with respect to patients who undergo early conventional ventilation, make the search for alternative methods of oxygenation and ventilation and potentially preventive of the need for tracheal intubation, such as non-invasive respiratory support techniques particularly valuable. In this context, the Emergency Department, located between the area outside the hospital and hospital ward and ICU, assumes the role of a crucial junction, due to the possibility of applying these techniques at a sufficiently early stage and being able to rapidly evaluate their effectiveness. This position paper describes the indications for the use of non-invasive respiratory support techniques in respiratory failure secondary to COVID-19-related pneumonia, formulated by the Non-invasive Ventilation Faculty of the Italian Society of Emergency Medicine (SIMEU) on the base of what is available in the literature and on the authors' direct experience. Rationale, literature, tips & tricks, resources, risks and expected results, and patient interaction will be discussed for each one of the escalating non-invasive respiratory techniques: standard oxygen, HFNCO, CPAP, NIPPV, and awake self-repositioning. The final chapter describes our suggested approach to the failing patient.
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Affiliation(s)
| | - Paolo Groff
- Pronto Soccorso e Osservazione Breve, Perugia, AO, Italy
| | | | | | | | - Stella Ingrassia
- Emergency Medicine Unit, Luigi Sacco Hospital, ASST FBF Sacco, Milan, Italy
| | - Roberta Marino
- Emergency Medicine, Sant'Andrea Hospital, Vercelli, Italy
| | - Francesca Nori
- Emergency Room, Emergency Care Unit, Santa Maria Della Scaletta Hospital, Imola, Italy
| | | | - Francesco Panero
- MECAU 2, Pronto Soccorso e Area Critica, ASL Città di Torino, Turin, Italy
| | - Rodolfo Ferrari
- Emergency Room, Emergency Care Unit, Santa Maria Della Scaletta Hospital, Imola, Italy
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Piazza I, Burti C, Assolari A, Greco S, Benetti A, Cosentini R, Ferrero P. Acute myocarditis as first presentation of severe ulcerative colitis in a young man. Multidisciplinary management and long-term follow-up. J Cardiol Cases 2022; 26:46-50. [DOI: 10.1016/j.jccase.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/26/2022] [Accepted: 02/19/2022] [Indexed: 12/12/2022] Open
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Novelli L, Raimondi F, Ghirardi A, Galimberti C, Biza R, Trapasso R, Anelli M, Amoroso M, Allegri C, Imeri G, Conti C, Tarantini F, Beretta M, Gori M, D'Elia E, Senni M, Solidoro P, Lorini FL, Rizzi M, Tebaldi A, Barbui T, Taurino D, Cosentini R, Masciulli A, Gavazzi A, Sironi S, Fagiuoli S, DI Marco F. Frequency, characteristics, and outcome of patients with COVID-19 pneumonia and "silent hypoxemia" at admission: a severity-matched analysis. Panminerva Med 2022; 64:442-451. [PMID: 35191633 DOI: 10.23736/s0031-0808.22.04609-2] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND An aspect of COVID-19 baffling physicians is the presentation of patients with acute respiratory failure, but normal mental faculties and no perception of dyspnea (i.e. "silent hypoxemia"). The aim of this study was to investigate the frequency, characteristics, and outcome of COVID-19 patients with silent hypoxemic status and comparing them with a symptomatic severity-matched group. METHODS This is a retrospective monocentric observational study involving all patients with PCR confirmed SARS-CoV-2 pneumonia, admitted at Papa Giovanni XXIII Hospital, Bergamo (Italy) from Emergency Department due to acute respiratory failure, during the first Italian pandemic peak (February-April 2020). RESULTS Overall 28-day mortality in 1,316 patients was 26.9%. Patients who did not report dyspnea at admission (N 469, 35.6%) had a lower 28-day mortality (22.6 vs. 29.3%, p=0.009). The severity matching analysis (i.e. PaO2/FiO2 and imaging) led to the identification of two groups of 254 patients that did not differ for sex prevalence, age, BMI, smoking history, comorbidities, and PaCO2 at admission. The use of CPAP during the first 24 hours, such as the need of endotracheal intubation (ETI) during the overall admission were significantly lower in matched patients with silent hypoxemia, whereas 28-day mortality resulted similar (p=0.21). CONCLUSIONS Lack of dyspnea is common in patients suffering from severe COVID-19 pneumonia leading to respiratory failure, since up to a third of them could be asymptomatic on admission. Dyspnea per se correlates with pneumonia severity, and prognosis. However, dyspnea loses its predictive relevance once other findings to evaluate pneumonia severity are available such as PaO2/FiO2 and imaging. Silent hypoxemic patients are less likely to receive CPAP during the first 24 hours and ETI during the hospitalization, in spite of a comparable mortality to the dyspneic ones.
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Affiliation(s)
- Luca Novelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Raimondi
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy - .,Department of Health Sciences, University of Milan, Milan, Italy
| | - Arianna Ghirardi
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | | | - Roberta Biza
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Trapasso
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Marisa Anelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Mariangela Amoroso
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Chiara Allegri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianluca Imeri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Caterina Conti
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Marta Beretta
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Gori
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Emilia D'Elia
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Solidoro
- Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ferdinando L Lorini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Intensive Critical Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Tiziano Barbui
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | | | | | - Arianna Masciulli
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Antonello Gavazzi
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Sandro Sironi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Gastroenterlogy 1, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano DI Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
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13
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Preti C, Biza R, Novelli L, Ghirardi A, Conti C, Galimberti C, Della Bella L, Memaj I, Di Marco F, Cosentini R. Usefulness of CURB-65, pneumonia severity index and MULBSTA in predicting COVID-19 mortality. Monaldi Arch Chest Dis 2022; 92. [DOI: 10.4081/monaldi.2022.2054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/14/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of our study is to evaluate the accuracy of CURB-65 and Pneumonia Severity Index (PSI), the most widely used scores for community acquired pneumonia, and MuLBSTA, a viral pneumonia score, in predicting 28-day mortality in Coronavirus Disease 2019 (COVID-19) pneumonia.We retrospectively collected clinical data of consecutive patients with laboratory-confirmed COVID-19 pneumonia admitted at Papa Giovanni XXIII Hospital from February 23rd to March 14th, 2020. We calculated at Emergency Department (ED) presentation CURB-65, PSI and MuLBSTA and we compared their performances in discriminating between survivors and non-survivors at 28 days. Among 431 hospitalized patients, the majority presented with hypoxic respiratory failure: median (interquartile range, IQR) PaO2/FiO2 ratio at admission was 228.6 (142.0-278.1). In the first 24 hours, 111 (27%) patients were administered low-flow oxygen cannula, 50 (12%) Venturi Mask, 95 (23%) non-rebreather mask, 106 (26%) non-invasive ventilation, 12 (3%) mechanical ventilation and 41 (9%) were not administered oxygen therapy. Mortality rate at 28-day was 35% (150/431). Between survivors and non-survivors, median (IQR) scores were, respectively, 1.0 (1.0-2.0) and 2.0 (2.0-3.0) for CURB-65 (p<0.001); 90.5 (76.0-105.5) and 115.0 (100.0-129.0) for PSI (p<0.001); 7.0 (5.0-10.0) and 11.0 (9.0-13.0) for MuLBSTA (p<0.001). Areas under the receiver operating characteristic curve (AUCs) for each score were, respectively, 0.725 (0.662-0.787), 0.776 (0.693-0.859) and 0.743 (0.680-0.806) (p>0,05). PSI and MuLBSTA did not show a better performance when compared to CURB-65. Although CURB-65, PSI and MuLBSTA scores are useful tools to discriminate between survivors and non-survivors in COVID-19 pneumonia, their diagnostic accuracy in discriminating 28-day mortality in COVID-19 pneumonia is moderate, as confirmed by AUCs <0.80, and there is a potential underestimation of disease severity in the low-risk classes. For this reason, they should not be recommended in ED to decide between inpatient and outpatient management in patients affected by COVID-19 pneumonia.
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14
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Piazza I, Ferrero P, Marra A, Cosentini R. Early Diagnosis of Acute Myocarditis in the ED: Proposal of a New ECG-Based Protocol. Diagnostics (Basel) 2022; 12:diagnostics12020481. [PMID: 35204572 PMCID: PMC8870824 DOI: 10.3390/diagnostics12020481] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/29/2022] [Accepted: 02/11/2022] [Indexed: 01/27/2023] Open
Abstract
The diagnosis of acute myocarditis (AM) is based on a multi-parametric assessment including clinical presentation, ECG, imaging and biomarkers. Fragmented QRS (fQRS) might be an additional diagnostic sign in patients with proven AM. The main objective of this study was to assess the diagnostic yield of fQRS in patients with suspected AM presenting to the emergency department (ED). Patients admitted between January 2016 and March 2021 with a proven diagnosis of AM, according to clinical, cardiac magnetic resonance (CMR) and/or histologic criteria, were included in the analysis. In total, 51 patients were analyzed (41 men, 78%), with a median age of 36 (29–45) years. Thirty-three (65%) patients had prodromal flu-like symptoms. Patients presented to the ED mostly complaining of chest pain (68%) and palpitations (21%). Seven (14%) patients experienced cardiac arrest, one of whom died. At presentation, 40 patients (78%) displayed fQRS, and 10 (20%) presented ventricular arrhythmias. All the surviving patients underwent CMR and displayed late gadolinium enhancement (LGE). ECG leads showed that fQRS matched the LGE distribution in 38 patients (95%). The presence of fQRS is a simple clinical bedside tool to support the initial suspect of AM in the emergency department and to guide the most appropriate clinical workup.
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Affiliation(s)
- Isabelle Piazza
- Emergency Department, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (I.P.); (A.M.)
- Scuola di Specializzazione in Medicina d’Emergenza e Urgenza, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Paolo Ferrero
- Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Alessio Marra
- Emergency Department, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (I.P.); (A.M.)
| | - Roberto Cosentini
- Emergency Department, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (I.P.); (A.M.)
- Correspondence: ; Tel.: +39-035-267111; Fax: +39-035-267-4936
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15
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Gori M, Ghirardi A, D'Elia E, Imeri G, Di Marco F, Gavazzi A, Carobbio A, Balestrieri G, Giammarresi A, Trevisan R, Amoroso M, Raimondi F, Novelli L, Magro B, Mangia G, Lorini FL, Fagiuoli S, Barbui T, Rizzi M, Cosentini R, Sironi S, Senni M. Association between inhibitors of the renin-angiotensin system and lung function in elderly patients recovered from severe COVID-19. Eur J Prev Cardiol 2021; 29:e196-e199. [PMID: 34535993 DOI: 10.1093/eurjpc/zwab143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Mauro Gori
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Arianna Ghirardi
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Emilia D'Elia
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gianluca Imeri
- The Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- The Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Milan, Milan, Italy
| | | | - Alessandra Carobbio
- The Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Roberto Trevisan
- The Endocrinology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mariangela Amoroso
- The Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Milan, Milan, Italy
| | - Federico Raimondi
- The Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Milan, Milan, Italy
| | - Luca Novelli
- The Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Bianca Magro
- The Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gianpaolo Mangia
- The Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Stefano Fagiuoli
- The Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Tiziano Barbui
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- The Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Sandro Sironi
- The Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
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16
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Pagliari D, Marra A, Cosentini R. Atypical manifestations of COVID-19: to know signs and symptoms to recognize the whole disease in the Emergency Department. Intern Emerg Med 2021; 16:1407-1410. [PMID: 33389567 PMCID: PMC7778701 DOI: 10.1007/s11739-020-02574-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Danilo Pagliari
- Medical Officer of the Carabinieri Corps, Carabinieri Officers School, Rome, Italy.
- Department of Emergency Medicine, Ospedale Papa Giovanni XXIII, Piazza OMS-Organizzazione Mondiale Della Sanità, 1, 24127, Bergamo, Italy.
| | - Alessio Marra
- Department of Emergency Medicine, Ospedale Papa Giovanni XXIII, Piazza OMS-Organizzazione Mondiale Della Sanità, 1, 24127, Bergamo, Italy
| | - Roberto Cosentini
- Department of Emergency Medicine, Ospedale Papa Giovanni XXIII, Piazza OMS-Organizzazione Mondiale Della Sanità, 1, 24127, Bergamo, Italy
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17
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Cammarota G, Esposito T, Azzolina D, Cosentini R, Menzella F, Aliberti S, Coppadoro A, Bellani G, Foti G, Grasselli G, Cecconi M, Pesenti A, Vitacca M, Lawton T, Ranieri VM, Di Domenico SL, Resta O, Gidaro A, Potalivo A, Nardi G, Brusasco C, Tesoro S, Navalesi P, Vaschetto R, De Robertis E. Noninvasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease: a systematic review and meta-analysis. Crit Care 2021; 25:268. [PMID: 34330320 PMCID: PMC8324455 DOI: 10.1186/s13054-021-03697-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/21/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Noninvasive respiratory support (NIRS) has been diffusely employed outside the intensive care unit (ICU) to face the high request of ventilatory support due to the massive influx of patients with acute respiratory failure (ARF) caused by coronavirus-19 disease (COVID-19). We sought to summarize the evidence on clinically relevant outcomes in COVID-19 patients supported by NIV outside the ICU. METHODS We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials register, along with medRxiv and bioRxiv repositories for pre-prints, for observational studies and randomized controlled trials, from inception to the end of February 2021. Two authors independently selected the investigations according to the following criteria: (1) observational study or randomized clinical trials enrolling ≥ 50 hospitalized patients undergoing NIRS outside the ICU, (2) laboratory-confirmed COVID-19, and (3) at least the intra-hospital mortality reported. Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines were followed. Data extraction was independently performed by two authors to assess: investigation features, demographics and clinical characteristics, treatments employed, NIRS regulations, and clinical outcomes. Methodological index for nonrandomized studies tool was applied to determine the quality of the enrolled studies. The primary outcome was to assess the overall intra-hospital mortality of patients under NIRS outside the ICU. The secondary outcomes included the proportions intra-hospital mortalities of patients who underwent invasive mechanical ventilation following NIRS failure and of those with 'do-not-intubate' (DNI) orders. RESULTS Seventeen investigations (14 peer-reviewed and 3 pre-prints) were included with a low risk of bias and a high heterogeneity, for a total of 3377 patients. The overall intra-hospital mortality of patients receiving NIRS outside the ICU was 36% [30-41%]. 26% [21-30%] of the patients failed NIRS and required intubation, with an intra-hospital mortality rising to 45% [36-54%]. 23% [15-32%] of the patients received DNI orders with an intra-hospital mortality of 72% [65-78%]. Oxygenation on admission was the main source of between-study heterogeneity. CONCLUSIONS During COVID-19 outbreak, delivering NIRS outside the ICU revealed as a feasible strategy to cope with the massive demand of ventilatory assistance. REGISTRATION PROSPERO, https://www.crd.york.ac.uk/prospero/ , CRD42020224788, December 11, 2020.
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Affiliation(s)
- Gianmaria Cammarota
- Department of Medicine and Surgery, University of Perugia, Piazza Università 1, 06123, Perugia, Italy.
| | - Teresa Esposito
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Danila Azzolina
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Francesco Menzella
- Pneumology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Aliberti
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Giacomo Bellani
- ASST Monza, San Gerardo Hospital, Monza, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Giuseppe Foti
- ASST Monza, San Gerardo Hospital, Monza, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Vitacca
- Respiratory Rehabilitation Unit Lumezzane, ICS Maugeri IRCCS, Brescia, Italy
| | - Tom Lawton
- Department of Anesthesia and Critical Care, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - V Marco Ranieri
- Anesthesia and Intensive Care Medicine, Policlinico Di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Onofrio Resta
- Cardiothoracic Department, Respiratory Unit, University Hospital, Bari, Italy
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Ospedale Luigi Sacco, Milan, Italy
| | - Antonella Potalivo
- Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Della Romagna, Rimini, Italy
| | - Giuseppe Nardi
- Department of Anesthesia and Intensive Care, Infermi Hospital, AUSL Della Romagna, Rimini, Italy
| | - Claudia Brusasco
- Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy
| | - Simonetta Tesoro
- Department of Medicine and Surgery, University of Perugia, Piazza Università 1, 06123, Perugia, Italy
| | - Paolo Navalesi
- Department of Medicine-DIMED, Università Di Padova, Padua, Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Edoardo De Robertis
- Department of Medicine and Surgery, University of Perugia, Piazza Università 1, 06123, Perugia, Italy
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18
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Raimondi F, Novelli L, Ghirardi A, Russo FM, Pellegrini D, Biza R, Trapasso R, Giuliani L, Anelli M, Amoroso M, Allegri C, Imeri G, Sanfilippo C, Comandini S, Hila E, Manesso L, Gandini L, Mandelli P, Monti M, Gori M, Senni M, Lorini FL, Rizzi M, Barbui T, Paris L, Rambaldi A, Cosentini R, Guagliumi G, Cesa S, Colledan M, Sessa M, Masciulli A, Gavazzi A, Buoro S, Remuzzi G, Ruggenenti P, Callegaro A, Gianatti A, Farina C, Bellasi A, Sironi S, Fagiuoli S, Di Marco F. Covid-19 and gender: lower rate but same mortality of severe disease in women-an observational study. BMC Pulm Med 2021; 21:96. [PMID: 33743654 PMCID: PMC7980742 DOI: 10.1186/s12890-021-01455-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients. METHODS Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization. RESULTS 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO2/FiO2 was similar between men and women (228 [IQR, 134-273] vs 238 mmHg [150-281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan-Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687). CONCLUSION Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.
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Affiliation(s)
- Federico Raimondi
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Luca Novelli
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | | | - Filippo Maria Russo
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Dario Pellegrini
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberta Biza
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Roberta Trapasso
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Lisa Giuliani
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Marisa Anelli
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Mariangela Amoroso
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Chiara Allegri
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
- Università degli Studi di Milano, Milan, Italy
| | - Gianluca Imeri
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Claudia Sanfilippo
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Sofia Comandini
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - England Hila
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Leonardo Manesso
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lucia Gandini
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Pietro Mandelli
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Martina Monti
- Università degli Studi di Milano, Milan, Italy
- Intensive Care Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Gori
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Laura Paris
- Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Rambaldi
- Università degli Studi di Milano, Milan, Italy
- Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giulio Guagliumi
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Simonetta Cesa
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Colledan
- Department of Health and Social Care Professions, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Sessa
- Neurology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Sabrina Buoro
- Quality Management, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Mario Negri Institute for Pharmacological Research IRCCS, Anna Maria Astori Centre, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | | | | | | | - Claudio Farina
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio Bellasi
- Department of Research, Innovation, Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Sandro Sironi
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy.
- Università degli Studi di Milano, Milan, Italy.
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19
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Perico N, Fagiuoli S, Di Marco F, Laghi A, Cosentini R, Rizzi M, Gianatti A, Rambaldi A, Ruggenenti P, La Vecchia C, Bertolini G, Paglia S, Lorini FL, Remuzzi G. Bergamo and Covid-19: How the Dark Can Turn to Light. Front Med (Lausanne) 2021; 8:609440. [PMID: 33681246 PMCID: PMC7933506 DOI: 10.3389/fmed.2021.609440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
The novel coronavirus, SARS-CoV-2, continues to spread rapidly. Here we discuss the dramatic situation created by COVID-19 in Italy, particularly in the province of Bergamo (the most severely affected in the first wave), as an example of how, in the face of an unprecedented tragedy, acting (albeit belatedly)-including imposing a very strict lockdown-can largely resolve the situation within approximately 2 months. The measures taken here ensured that Bergamo hospital, which was confronted with rapidly rising numbers of severely ill COVID-19 patients requiring hospitalization, was able to meet the initial challenges of the pandemic. We also report that local organization and, more important, the large natural immunity against SARS-CoV-2 of the Bergamo population developed during the first wave of the epidemic, can explain the limited number of new COVID-19 cases during the more recent second wave compared to the numbers in other areas of Lombardy. Furthermore, we highlight the importance of coordinating the easing of containment measures to avoid what is currently observed in other countries, especially in the United States, Latin American and India, where this approach has not been adopted, and a dramatic resurgence of COVID-19 cases and an increase in the number of hospitalisations and deaths have been reported.
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Affiliation(s)
- Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, Department of Medicine, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Unità di Pneumologia, Department of Medicine ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Laghi
- Dipartimento di Scienze Medico Chirurgiche e Medicina Traslazionale, Sapienza Università di Roma, AOU Sant'Andrea, Rome, Italy
| | | | - Marco Rizzi
- Infectious Diseases Department, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alessandro Rambaldi
- Hematology Unit, ASST-Papa Giovanni XXIII, Bergamo, Italy
- Department of Oncology and Oncohematology, Università degli Studi di Milano, Milan, Italy
| | - Piero Ruggenenti
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Guido Bertolini
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
| | | | | | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
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20
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Paglia S, Nattino G, Occhipinti F, Sala L, Targetti E, Cortellaro F, Cosentini R, Costantino G, Fichtner F, Mancarella M, Marinaro C, Sorlini C, Bertolini G, Acquistapace G, Agostinis M, Bonzi M, Brena N, Caruso S, Mascolo M, Massabò D, Scrignoli F. The Quick Walk Test: A Noninvasive Test to Assess the Risk of Mechanical Ventilation During COVID-19 Outbreaks. Acad Emerg Med 2021; 28:244-247. [PMID: 33249678 PMCID: PMC7753836 DOI: 10.1111/acem.14180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 01/20/2023]
Affiliation(s)
| | - Giovanni Nattino
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | - Federica Occhipinti
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | - Luca Sala
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | - Elena Targetti
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | | | - Roberto Cosentini
- Emergency Department and Medicine ASST Papa Giovanni XXIII Bergamo (BG)Italy
| | - Giorgio Costantino
- Pronto Soccorso e Medicina d’Urgenza Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico MilanoItaly
- and the Università degli Studi di Milano Milano (MI) Italy
| | | | - Marta Mancarella
- Pronto Soccorso e Medicina d’Urgenza Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico MilanoItaly
| | - Claudia Marinaro
- Emergency Department and Medicine ASST Papa Giovanni XXIII Bergamo (BG)Italy
| | - Cristina Sorlini
- Accident and Emergency Services ASST Santi Paolo e Carlo Milano (MI)Italy
| | - Guido Bertolini
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
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21
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Novelli L, Raimondi F, Ghirardi A, Pellegrini D, Capodanno D, Sotgiu G, Guagliumi G, Senni M, Russo FM, Lorini FL, Rizzi M, Barbui T, Rambaldi A, Cosentini R, Grazioli LS, Marchesi G, Sferrazza Papa GF, Cesa S, Colledan M, Civiletti R, Conti C, Casati M, Ferri F, Camagni S, Sessa M, Masciulli A, Gavazzi A, Falanga A, DA Pozzo LF, Buoro S, Remuzzi G, Ruggenenti P, Callegaro A, D'Antiga L, Pasulo L, Pezzoli F, Gianatti A, Parigi P, Farina C, Bellasi A, Solidoro P, Sironi S, DI Marco F, Fagiuoli S. At the peak of COVID-19 age and disease severity but not comorbidities are predictors of mortality: COVID-19 burden in Bergamo, Italy. Panminerva Med 2020; 63:51-61. [PMID: 33244949 DOI: 10.23736/s0031-0808.20.04063-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Findings from February 2020, indicate that the clinical spectrum of COVID-19 can be heterogeneous, probably due to the infectious dose and viral load of SARS-CoV-2 within the first weeks of the outbreak. The aim of this study was to investigate predictors of overall 28-day mortality at the peak of the Italian outbreak. METHODS Retrospective observational study of all COVID-19 patients admitted to the main hospital of Bergamo, from February 23 to March 14, 2020. RESULTS Five hundred and eight patients were hospitalized, predominantly male (72.4%), mean age of 66±15 years; 49.2% were older than 70 years. Most of patients presented with severe respiratory failure (median value [IQR] of PaO<inf>2</inf>/FiO<inf>2</inf>: 233 [149-281]). Mortality rate at 28 days resulted of 33.7% (N.=171). Thirty-nine percent of patients were treated with continuous positive airway pressure (CPAP), 9.5% with noninvasive ventilation (NIV) and 13.6% with endotracheal intubation. 9.5% were admitted to Semi-Intensive Respiratory Care Unit, and 18.9% to Intensive Care Unit. Risk factors independently associated with 28-day mortality were advanced age (≥78 years: odds ratio [OR], 95% confidence interval [CI]: 38.91 [10.67-141.93], P<0.001; 70-77 years: 17.30 [5.40-55.38], P<0.001; 60-69 years: 3.20 [1.00-10.20], P=0.049), PaO<inf>2</inf>/FiO<inf>2</inf><200 at presentation (3.50 [1.70-7.20], P=0.001), need for CPAP/NIV in the first 24 hours (8.38 [3.63-19.35], P<0.001), and blood urea value at admission (1.01 [1.00-1.02], P=0.015). CONCLUSIONS At the peak of the outbreak, with a probable high infectious dose and viral load, older age, the severity of respiratory failure and renal impairment at presentation, but not comorbidities, are predictors of 28-day mortality in COVID-19.
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Affiliation(s)
- Luca Novelli
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Raimondi
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Milan, Milan, Italy
| | | | - Dario Pellegrini
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Capodanno
- Unit of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | | | - Filippo M Russo
- University of Milan, Milan, Italy.,Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ferdinando L Lorini
- Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Unit of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alessandro Rambaldi
- University of Milan, Milan, Italy.,Department of Oncology and Hematology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Lorenzo S Grazioli
- Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Gianmariano Marchesi
- Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe F Sferrazza Papa
- University of Milan, Milan, Italy.,Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Simonetta Cesa
- Department of Health and Social Care Professions, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Colledan
- Unit of General Surgery 3, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberta Civiletti
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy.,Federico II University, Naples, Italy
| | - Caterina Conti
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Casati
- Department of Health and Social Care Professions, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesco Ferri
- Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefania Camagni
- Unit of General Surgery 3, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Sessa
- Unit of Neurology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Anna Falanga
- Unit of Immunohematology and Transfusion, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Milano-Bicocca, Milan, Italy
| | - Luigi F DA Pozzo
- University of Milano-Bicocca, Milan, Italy.,Unit of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Sabrina Buoro
- Unit of Quality Management, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Mario Negri Institute for Pharmacological Research IRCCS, Anna Maria Astori Centet, Kilometro Rosso Science and Technology Park, Bergamo, Italy
| | - Piero Ruggenenti
- Unit of Nephrology and Dialysis, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Lorenzo D'Antiga
- Unit of Pediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luisa Pasulo
- Unit of Gastroenterology 1, Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabio Pezzoli
- Medical Direction, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Gianatti
- Unit of Pathology, Department of Laboratory Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Piercarlo Parigi
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Claudio Farina
- Department of Laboratory Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio Bellasi
- Department of Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Solidoro
- Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sandro Sironi
- University of Milano-Bicocca, Milan, Italy.,Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano DI Marco
- Unit of Pulmonary Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy - .,University of Milan, Milan, Italy
| | - Stefano Fagiuoli
- Unit of Gastroenterology 1, Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
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22
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Duca A, Memaj I, Zanardi F, Preti C, Alesi A, Della Bella L, Ghezzi E, Di Marco F, Lorini FL, Venturelli S, Fagiuoli S, Cosentini R. Severity of respiratory failure and outcome of patients needing a ventilatory support in the Emergency Department during Italian novel coronavirus SARS-CoV2 outbreak: Preliminary data on the role of Helmet CPAP and Non-Invasive Positive Pressure Ventilation. EClinicalMedicine 2020; 24:100419. [PMID: 32766538 PMCID: PMC7301102 DOI: 10.1016/j.eclinm.2020.100419] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Novel Coronavirus SARS-CoV-2 pandemic is spreading around the world. At the end of February, the outburst of the pandemic has hit hard on northern Italian's hospitals. As of today, no data have been published regarding the severity of respiratory failure of patients presenting to the Emergency Departments. Moreover, the outcome the patients forced to undergo Continuous Positive Airway Pressure (CPAP) or Non-Invasive Positive Pressure Ventilation (NIPPV) due to lack of Intensive Care resources is unknown. "Papa Giovanni XXIII" hospital (HPG23) of Bergamo is one of the largest hospitals in the Country, with an Emergency Department (ED) managing over 100,000 patients per year. METHODS This is a retrospective observational study based on chart review of patients presenting to the Emergency Department of HPG23 from 29/02/2020 to 10/03/2020 with a clinical condition highly suspicious for COVID-19 infection. Registration of admission rates, severity of respiratory failure (ARDS classification), need of respiratory support, SARS-CoV-2 PCR test and outcome of patients treated with a ventilatory support were registered on 10th of May 2020. FINDINGS From 29/02 to 10/03 611 patients with a suspected diagnosis of COVID-19 infection were evaluated in our ED; 320 (52%) met the criteria for hospital admission and 99 (31%) needed to be immediately started on ventilatory support (81% CPAP, 7% NIPPV, 12% Invasive Mechanical Ventilation). Eighty-five (86%) of the 99 patients needing a ventilatory support eventually had SARS-CoV-2 infection confirmed by PCR test on nasal-pharyngeal swab. Their median PO2/FiO2 ratio was 128 (IQR 85-168), with 23 patients (29.5%) classified as severe ARDS. Mortality rate as of 10th of May was 76.5%, ranging from 44.4% within patients <60 years old to 85% within those older than 60 years (p = 0.001). NIPPV/CPAP failure occurred in 91.5% of patients. INTERPRETATION The population of patients suspected for COVID-19 infection presenting at our ED showed a very high rate of severe respiratory failure, with urgent need of a large amount of intensive care resources. Mortality rates of critically ill patients with confirmed COVID-19 (76.5%) are similar to previously reported studies with similar population. CPAP/NIPPV could be a valid strategy to treat severely hypoxic patients that cannot be intubated in the ED due to lack of intensive care resources. FUNDING No funds were received for this research project.
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Affiliation(s)
- Andrea Duca
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy
- Corresponding author.
| | - Irdi Memaj
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Carlo Preti
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Alesi
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Elena Ghezzi
- Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | | | - Stefano Fagiuoli
- Internal Medicine Department, ASST Papa Giovanni XXIII, Bergamo, Italy
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23
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Longhini F, Bruni A, Garofalo E, Navalesi P, Grasselli G, Cosentini R, Foti G, Mattei A, Ippolito M, Accurso G, Vitale F, Cortegiani A, Gregoretti C. Helmet continuous positive airway pressure and prone positioning: A proposal for an early management of COVID-19 patients. Pulmonology 2020; 26:186-191. [PMID: 32386886 PMCID: PMC7190517 DOI: 10.1016/j.pulmoe.2020.04.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- F Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
| | - A Bruni
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - E Garofalo
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - P Navalesi
- Anesthesia and Intensive Care, Padua Hospital, Department of Medicine - DIMED, University of Padua, Italy
| | - G Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Italy; Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - R Cosentini
- Emergency Medicine Department, ASST Papa Giovanni XIII, Bergamo, Italy
| | - G Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - A Mattei
- Department of Pneumology, A.O.U. Città della Salute e della Scienza of Turin, Turin, Italy
| | - M Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - G Accurso
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - F Vitale
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - A Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
| | - C Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Italy
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24
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Brambilla AM, Prina E, Ferrari G, Bozzano V, Ferrari R, Groff P, Petrelli G, Scala R, Causin F, Noto P, Bresciani E, Voza A, Aliberti S, Cosentini R. Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit: An Italian multicenter observational study. Eur J Intern Med 2019; 59:21-26. [PMID: 30528840 DOI: 10.1016/j.ejim.2018.09.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Non-Invasive Ventilation (NIV) represents a standard of care to treat some acute respiratory failure (ARF). Data on its use in pneumonia are lacking, especially in a setting outside the Intensive Care Unit (ICU). The aims of this study were to evaluate the use of NIV in ARF due to pneumonia outside the ICU, and to identify risk factors for in-hospital mortality. METHODS Prospective, observational study performed in 19 centers in Italy. Patients with ARF due to pneumonia treated outside the ICU with either continuous positive airway pressure (CPAP) or noninvasive positive pressure ventilation (NPPV) were enrolled over a period of at least 3 consecutive months in 2013. Independent factors related to in-hospital mortality were evaluated. RESULTS Among the 347 patients enrolled, CPAP was applied as first treatment in 176 (50.7%) patients,NPPV in 171 (49.3%). The NPPV compared with CPAP group showed a significant higher PaCO2 (55 [47-78] vs 37 [32-43] mmHg, p < 0.001), a lower arterial pH (7.30 [7.21-7.37] vs 7.43 [7.35-7.47], p < 0.001), higher HCO3- (28 [24-33] vs 24 [21-27] mmol/L, p < 0.001). De-novo ARF was more prevalent in CPAP group than in NPPV group (86/176 vs 31/171 patients,p < 0.001). In-hospital mortality was 23% (83/347). Do Not Intubate (DNI) order and Charlson Comorbidity Index (CCI) ≥3 were independent risk factors for in-hospital mortality. CONCLUSIONS Outside ICU setting, CPAP was used mainly for hypoxemic non-hypercapnic ARF, NPPV for hypercapnic ARF. In-hospital mortality was mainly associated to patients' basal status (DNI status, CCI) rather than the baseline degree of ARF.
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Affiliation(s)
- Anna Maria Brambilla
- Department of Emergency Medicine, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Elena Prina
- Servei de Pneumologia, Hospital Corporació Parc Tauli de Sabadell, Barcelona, Spain
| | | | - Viviana Bozzano
- University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rodolfo Ferrari
- U.O. Medicina d'Urgenza e Pronto Soccorso, Policlinico Sant'Orsola, Malpighi Azienda Ospedaliero, Universitaria di Bologna, Italy
| | - Paolo Groff
- ASUR Marche Area Vasta 5 U.O., Pronto Soccorso-Medicina d'urgenza Ospedale Civile di San Benedetto del Tronto, Italy
| | - Giuseppina Petrelli
- ASUR Marche Area Vasta 5 U.O., Pronto Soccorso-Medicina d'urgenza Ospedale Civile di San Benedetto del Tronto, Italy
| | - Raffaele Scala
- Unita' Operativa di Pneumologia e UTIP, Ospedale S Donato Arezzo, Italy
| | - Fabio Causin
- Pronto Soccorso e Medicina d'Urgenza ULSS 9, Treviso, Italy
| | - Paola Noto
- U.O.C. M.C.A.U. Azienda Ospedaliero, Universitaria Policlinico Vittorio Emanuele di Catania, Italy
| | | | - Antonio Voza
- Pronto Soccorso-EAS, IRCCS Istituto Clinico Humanitas, Milan, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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25
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Affiliation(s)
- Andrea Duca
- EAS, Emergenza di Alta Specializzazione, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Valentina Rosti
- EAS, Emergenza di Alta Specializzazione, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Maria Brambilla
- Emergency Medicine Department, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Cosentini
- EAS, Emergenza di Alta Specializzazione, ASST Papa Giovanni XXIII, Bergamo, Italy.
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26
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Aliberti S, Rosti VD, Travierso C, Brambilla AM, Piffer F, Petrelli G, Minelli C, Camisa D, Voza A, Guiotto G, Cosentini R. A real life evaluation of non invasive ventilation in acute cardiogenic pulmonary edema: a multicenter, perspective, observational study for the ACPE SIMEU study group. BMC Emerg Med 2018; 18:61. [PMID: 30594135 PMCID: PMC6310941 DOI: 10.1186/s12873-018-0216-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/11/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND During the past three decades conflicting evidences have been published on the use of non-invasive ventilation (NIV) in patients with acute cardiogenic pulmonary edema (ACPE). The aim of this study is to describe the management of acute respiratory failure (ARF) due to ACPE in twelve Italian emergency departments (EDs). We evaluated prevalence, characteristics and outcomes of ACPE patients treated with oxygen therapy, continuous positive airway pressure (CPAP) or Bi-level positive airway pressure (BiPAP) on admission to the EDs. METHODS In this multicenter, prospective, observational study, consecutive adult patients with ACPE were enrolled in 12 EDs in Italy from May 2009 to December 2013. Three study groups were identified according to the initial respiratory treatment: patients receiving oxygen therapy, those treated with CPAP and those treated with BiPAP. Treatment failure was evaluated as study outcome. RESULTS We enrolled 1293 patients with acute cardiogenic pulmonary edema. 273 (21%) began with oxygen, 788 (61%) with CPAP and 232 (18%) with BiPAP. One out of four patient who began with oxygen was subsequently switched to NIV and initial treatment with oxygen therapy had an odds ratio for treatment failure of 3.65 (95% CI: 2.55-5.23, p < 0.001). CONCLUSIONS NIV seems to be the first choice for treatment of ARF due to ACPE, showing high clinical effectiveness and representing a rescue option for patients not improving with conventional oxygen therapy.
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Affiliation(s)
- Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Cardio-Thoracic Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Chiara Travierso
- Respiratory Unit, ASST Rhodense Ospedale Salvini, Viale Forlanini 95, 20024 Garbagnate Milanese, Italy
| | - Anna Maria Brambilla
- Emergency Department, IRCCS Fondazione Ospedale Maggiore Policlinico Ca’ Granda, Milan, Italy
| | - Federico Piffer
- Department of Pulmonology, Hospital of Arco, APSS, Trento, Italy
| | - Giuseppina Petrelli
- Emergency Department, Presidio Ospedaliero Madonna del Soccorso, San Benedetto del Tronto, Ascoli Piceno, Italy
| | | | - Daniele Camisa
- Emergency Department, Vizzolo Predabissi Hospital, AO Melegnano, Milan, Italy
| | - Antonio Voza
- Emergency Department, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | | | - Roberto Cosentini
- Emergency Medicine Department, ASST Papa Giovanni XIII, Bergamo, Italy
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Schreiber A, Yıldırım F, Ferrari G, Antonelli A, Delis PB, Gündüz M, Karcz M, Papadakos P, Cosentini R, Dikmen Y, Esquinas AM. Non-Invasive Mechanical Ventilation in Critically Ill Trauma Patients: A Systematic Review. Turk J Anaesthesiol Reanim 2018; 46:88-95. [PMID: 29744242 DOI: 10.5152/tjar.2018.46762] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/28/2017] [Accepted: 12/20/2017] [Indexed: 12/23/2022] Open
Abstract
There is limited literature on non-invasive mechanical ventilation (NIMV) in patients with polytrauma-related acute respiratory failure (ARF). Despite an increasing worldwide application, there is still scarce evidence of significant NIMV benefits in this specific setting, and no clear recommendations are provided. We performed a systematic review, and a search of clinical databases including MEDLINE and EMBASE was conducted from the beginning of 1990 until today. Although the benefits in reducing the intubation rate, morbidity and mortality are unclear, NIMV may be useful and does not appear to be associated with harm when applied in properly selected patients with moderate ARF at an earlier stage of injury by experienced teams and in appropriate settings under strict monitoring. In the presence of these criteria, NIMV is worth attempting, but only if endotracheal intubation is promptly available because non-responders to NIMV are burdened by an increased mortality when intubation is delayed.
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Affiliation(s)
- Annia Schreiber
- Fondazione Salvatore Maugeri, IRCCS, Respiratory Intensive Care Unit and Pulmonary Rehabilitation Unit, Pavia, Italy
| | - Fatma Yıldırım
- Ankara Dışkapı Yıldırım Beyazıt Research and Education Hospital, Intensive Care Unit, Ankara, Turkey
| | - Giovanni Ferrari
- Ospedale Mauriziano, Department of Respiratory Medicine, Turin Italy
| | - Andrea Antonelli
- Allergologia e Fisiopatologia Respiratoria, ASO S. Croce e Carle Cuneo, Cuneo, Italy
| | | | - Murat Gündüz
- Department of Anaesthesiology and Reanimation, Intensive Care Unit, Çukurova University School of Medicine, Adana, Turkey
| | - Marcin Karcz
- University of Rochester, Department of Anesthesiology, Critical Care Medicine, Rochester, New York, USA
| | - Peter Papadakos
- University of Rochester, Department of Anesthesiology, Surgery and Neurosurgery, Critical Care Medicine, Rochester, New York, USA
| | - Roberto Cosentini
- Emergency Medicine Department, Gruppo NIV, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Yalım Dikmen
- Department of Anaesthesiology and Reanimation, Intensive Care Unit, İstanbul University, Cerrahpaşa School of Medicine, İstanbul, Turkey
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Maraffi T, Brambilla AM, Cosentini R. Non-invasive ventilation in acute cardiogenic pulmonary edema: how to do it. Intern Emerg Med 2018; 13:107-111. [PMID: 28952011 DOI: 10.1007/s11739-017-1751-4] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Tommaso Maraffi
- Réanimation Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anna Maria Brambilla
- Emergency Medicine Department, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Cosentini
- EAS Emergenza ad Alta Specializzazione, ASST-Papa Giovanni XXIII, SIMEU (Società Italiana di Medicina d'Emergenza e Urgenza), Bergamo, Italy.
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Margutti E, Greco I, Brambilla AM, Maraffi T, Cosentini R. Non-invasive ventilation in acute respiratory failure: the key "W" questions. Intern Emerg Med 2017; 12:1307-1311. [PMID: 28808980 DOI: 10.1007/s11739-017-1721-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Eliana Margutti
- Emergenza ad Alta Specializzazione-ASST-Papa Giovanni XXIII, SIMEU Centro Studi, Bergamo, Italy
| | - Ilaria Greco
- Emergenza ad Alta Specializzazione-ASST-Papa Giovanni XXIII, SIMEU Centro Studi, Bergamo, Italy
| | - Anna Maria Brambilla
- Emergency Medicine Department, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Tommaso Maraffi
- Réanimation Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Roberto Cosentini
- Emergenza ad Alta Specializzazione-ASST-Papa Giovanni XXIII, SIMEU Centro Studi, Bergamo, Italy.
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Schreiber A, Domínguez Petit AJ, Groff P, Purro A, Ferrari R, Antonelli A, Stieglitz S, Cosentini R, Koksal G, Delis PB, Fiorentino G, Dalar L, Esquinas AM. Intra-Hospital Transport of Patients on Non-Invasive Ventilation: Review, Analysis, and Key Practical Recommendations by the International NIV Committee. Eurasian J Pulmonol 2017. [DOI: 10.5152/ejp.2017.73745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Fabbri A, Marchesini G, Carbone G, Cosentini R, Ferrari A, Chiesa M, Bertini A, Rea F. Acute Heart Failure in the Emergency Department: the SAFE-SIMEU Epidemiological Study. J Emerg Med 2017; 53:178-185. [PMID: 28501384 DOI: 10.1016/j.jemermed.2017.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 10/18/2016] [Accepted: 03/27/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Patients with acute heart failure (AHF) have high rates of attendance to emergency departments (EDs), with significant health care costs. OBJECTIVES We aimed to describe the clinical characteristics of patients attending Italian EDs for AHF and their diagnostic and therapeutic work-up. METHODS We carried out a retrospective analysis on 2683 cases observed in six Italian EDs for AHF (January 2011 to June 2012). RESULTS The median age of patients was 84 years (interquartile range 12), with females accounting for 55.8% of cases (95% confidence interval [CI] 53.5-57.6%). A first episode of AHF was recorded in 55.3% (95% CI 55.4-57.2%). Respiratory disease was the main precipitating factor (approximately 30% of cases), and multiple comorbidities were recorded in > 50% of cases (history of acute coronary syndrome, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, valvular heart disease). The treatment was based on oxygen (69.7%; 67.9-71.5%), diuretics (69.2%; 67.9-71.5%), nitroglycerin (19.7%; 18.3-21.4%), and noninvasive ventilation (15.2%; 13.8-16.6%). Death occurred within 6 h in 2.5% of cases (2.0-3.1%), 6.4% (5.5-7.3%) were referred to the care of their general practitioners within a few hours from ED attendance or after short-term (< 24 h) observation 13.9% (12.6-15.2%); 60.4% (58.5-62.2%) were admitted to the hospital, and 16.8% (15.4-18.3%) were cared for in intensive care units according to disease severity. CONCLUSIONS Our study reporting the "real-world" clinical activity indicates that subjects attending the Italian EDs for AHF are rather different from those reported in international registries. Subjects are older, with a higher proportion of females, and high prevalence of cardiac and noncardiac comorbidities.
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Affiliation(s)
- Andrea Fabbri
- Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, Clinical Dietetics, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giorgio Carbone
- Department of Emergency Medicine, Gradenigo Hospital, Torino, Torino, Italy
| | - Roberto Cosentini
- Department of Emergency Medicine, Osp. Maggiore Policlinico, fondazione Cà Granda, Milano, Italy
| | - Annamaria Ferrari
- Department of Emergency Medicine, Ospedale S. Maria Nuova, Reggio Emilia, Italy
| | - Mauro Chiesa
- Department of Emergency Medicine, Ospedale S. Antonio, Azienda Ospedaliera, Padova, Italy
| | - Alessio Bertini
- Department of Emergency Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Federico Rea
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milano, Italy
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Aliberti S, Morlacchi LC, Faverio P, Fernandez-Botran R, Cosentini R, Mantero M, Peyrani P, Ramirez J, Bordon J, Blasi F. Serum and exhaled breath condensate inflammatory cytokines in community-acquired pneumonia: a prospective cohort study. Pneumonia (Nathan) 2016; 8:8. [PMID: 28702287 PMCID: PMC5471930 DOI: 10.1186/s41479-016-0009-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 10/20/2015] [Accepted: 06/06/2016] [Indexed: 01/17/2023] Open
Abstract
Background The role and relationship between pro- and anti-inflammatory cytokines represents one of the least studied aspects of the pathogenesis of community-acquired pneumonia (CAP). The aim of the present study was to evaluate pro- and anti-inflammatory cytokines at both local (lung) and systemic (blood) levels and their relationship with the severity of the disease on admission and time for a patient to reach clinical stability during hospitalisation. Methods This was an observational, prospective, cohort study of hospitalised patients with a diagnosis of CAP at the IRCCS Policlinico Hospital, Milan, Italy, between April 2010 and January 2012. Ten pro-inflammatory cytokines (interleukin [IL]-1, IL-1α, IL-1β, IL-2, IL-6, IL-8, tumor necrosis factor [TNF]α and interferon [IFN]γ) and anti-inflammatory cytokines (IL-4 and IL-10) were measured in both serum and exhaled breath condensate within 24 h after hospital admission. Results A total of 74 patients (median age: 76 years; gender: 61 % male) were enrolled. The anti- to pro-inflammatory cytokine ratio was reduced in patients with severe disease on admission and prolonged time to reach clinical stability. This was due to lower levels of anti-inflammatory cytokines in the exhaled breath condensate and higher levels of pro-inflammatory cytokines in serum. Conclusions Dis-regulation between pro- and anti-inflammatory pathways might be a part of the pathogenic mechanisms that lead to severe infection and worse early clinical outcomes in CAP patients. Electronic supplementary material The online version of this article (doi:10.1186/s41479-016-0009-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Letizia Corinna Morlacchi
- Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Faverio
- School of Medicine and Surgery, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy
| | - Rafael Fernandez-Botran
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, Kentucky USA
| | - Roberto Cosentini
- Emergency Medicine Department, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Mantero
- Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paula Peyrani
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky USA
| | - Julio Ramirez
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky USA
| | - Jose Bordon
- Department of Medicine, Section of Infectious Diseases, Providence Hospital, Georgetown University Medical Center, Washington, DC USA
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Fabbri A, Marchesini G, Carbone G, Cosentini R, Ferrari A, Chiesa M, Bertini A, Rea F. Acute heart failure in the emergency department: a follow-up study. Intern Emerg Med 2016; 11:115-22. [PMID: 26506831 DOI: 10.1007/s11739-015-1336-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/30/2015] [Indexed: 12/13/2022]
Abstract
Acute heart failure (AHF) is a major public health issue due to high incidence and poor prognosis. Only a few studies are available on the long-term prognosis and on outcome predictors in the unselected population attending the emergency department (ED) for AHF. We carried out a 1-year follow-up analysis of 1234 consecutive patients from selected Italian EDs from January 2011 to June 2012 for an episode of AHF. Their prognosis and outcome-associated factors were tested by Cox proportional hazard model. Patients' mean age was 84, with 66.0% over 80 years and 56.2% females. Comorbidities were present in over 50% of cases, principally a history of acute coronary syndrome, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, valvular heart disease. Death occurred within 6 h in 24 cases (1.9%). At 30-day follow-up, death was registered in 123 cases (10.0%): 110 cases (89.4%) died of cardiovascular events and 13 (10.6%) of non-cardiovascular causes (cancer, gastrointestinal hemorrhages, sepsis, trauma). At 1-year follow-up, all-cause death was recorded in 50.1% (over 3 out of 4 cases for cardiovascular origin). Six variables (older age, diabetes, systolic arterial pressure <110 mm/Hg, high NT pro-BNP, high troponin levels and impaired cognitive status) were selected as outcome predictors, but with limited discriminant capacity (AUC = 0.649; SE 0.015). Recurrence of AHF was registered in 31.0%. The study identifies a cluster of variables associated with 1-year mortality in AHF, but their predictive capacity is low. Old age and the presence of comorbidities, in particular diabetes are likely to play a major role in dictating the prognosis.
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Affiliation(s)
- Andrea Fabbri
- Department of Emergency Medicine, Presidio Ospedaliero Morgagni-Pierantonio, AUSL della Romagna - Forlì, Via Forlanini 34, 47121, Forlì, Italy.
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, Clinical Dietetics, University of Bologna, S. Orsola-Malpighi Hospital, via Massarenti 9, 40138, Bologna, Italy
| | - Giorgio Carbone
- Department of Emergency Medicine, Gradenigo Hospital, Corso Regina Margherita 8/10, 10100, Torino, Italy
| | - Roberto Cosentini
- Department of Emergency Medicine, Osp. Maggiore Policlinico, fondazione Cà Granda, via F. Sforza 35, 20122, Milan, Italy
| | - Annamaria Ferrari
- Department of Emergency Medicine, Ospedale S. Maria Nuova, via Risorgimento 80, 4100, Reggio Emilia, Italy
| | - Mauro Chiesa
- Department of Emergency Medicine, Ospedale S. Antonio, Azienda Ospedaliera, via Facciolati 71, 36124, Padua, Italy
| | - Alessio Bertini
- Department of Emergency Medicine, Azienda Ospedaliera Universitaria Pisana, via Roma 67, 56126, Pisa, Italy
| | - Federico Rea
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, via Bicocca degli Arcimboldi 8, 20126, Milan, Italy
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Aliberti S, Ramirez J, Cosentini R, Valenti V, Voza A, Rossi P, Stolz D, Legnani D, Pesci A, Richeldi L, Peyrani P, Massari FM, Blasi F. Acute myocardial infarction versus other cardiovascular events in community-acquired pneumonia. ERJ Open Res 2015; 1:00020-2015. [PMID: 27730139 PMCID: PMC5005139 DOI: 10.1183/23120541.00020-2015] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/21/2015] [Indexed: 11/29/2022] Open
Abstract
The aim of the present study was to define the prevalence, characteristics, risk factors and impact on clinical outcomes of acute myocardial infarction (AMI) versus other cardiovascular events (CVEs) in patients with community-acquired pneumonia (CAP). This was an international, multicentre, observational, prospective study of CAP patients hospitalised in eight hospitals in Italy and Switzerland. Three groups were identified: those without CVEs, those with AMI and those with other CVEs. Among 905 patients, 21 (2.3%) patients experienced at least one AMI, while 107 (11.7%) patients experienced at least one other CVE. Patients with CAP and either AMI or other CVEs showed a higher severity of the disease than patients with CAP alone. Female sex, liver disease and the presence of severe sepsis were independent predictors for the occurrence of AMI, while female sex, age >65 years, neurological disease and the presence of pleural effusion predicted other CVEs. In-hospital mortality was significantly higher among those who experienced AMI in comparison to those experiencing other CVEs (43% versus 21%, p=0.039). The presence of AMI showed an adjusted odds ratio for in-hospital mortality of 3.57 (p=0.012) and for other CVEs of 2.63 (p=0.002). These findings on AMI versus other CVEs as complications of CAP may be important when planning interventional studies on cardioprotective medications. Acute myocardial infarction is associated with specific risk factors and accounts for worse outcomes in CAP patientshttp://ow.ly/QhT2t
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Affiliation(s)
- Stefano Aliberti
- Health Science Department, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy
| | - Julio Ramirez
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Roberto Cosentini
- Emergency Medicine Unit, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy
| | - Vincenzo Valenti
- Pulmonary Unit, University of Milan, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Voza
- Emergency Department, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Paolo Rossi
- Internal Medicine Department, Azienda Ospedaliero-Universitaria "S. Maria della Misericordia", Udine, Italy
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Delfino Legnani
- Department of Biomedical and Clinical Sciences, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Alberto Pesci
- Health Science Department, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy
| | - Luca Richeldi
- National Institute for Health Research Respiratory Biomedical Research Unit, Southampton, UK; Centre for Rare Lung Disease, University of Modena and Reggio Emilia, AO Policlinico, Modena, Italy
| | - Paula Peyrani
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Fernando Maria Massari
- UOC Malattie Cardiovascolari, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy
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Pisani L, Mega C, Vaschetto R, Bellone A, Scala R, Cosentini R, Musti M, Del Forno M, Grassi M, Fasano L, Navalesi P, Nava S. Oronasal mask versus helmet in acute hypercapnic respiratory failure. Eur Respir J 2014; 45:691-9. [PMID: 25504992 DOI: 10.1183/09031936.00053814] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The choice of the interface for noninvasive ventilation (NIV) is a key factor in NIV success. We hypothesised that a new helmet specifically design to improve performance in hypercapnic patients would be clinically equivalent to a standard oronasal mask. In a multicentre, short-term, physiological, randomised trial in chronic obstructive pulmonary disease patients facing an acute hypercapnic respiratory failure episode, we compared the changes in arterial blood gases (ABGs) and tolerance score obtained using the helmet or mask, and, as secondary end-points, dyspnoea, vital signs, early NIV discontinuation and rate of intubation. 80 patients were randomly assigned to receive NIV either with the helmet (n=39) or mask (n=41), using an intensive care unit ventilator. Compared with baseline, in the first 6 h, NIV improved ABGs, dyspnoea and respiratory rate (p<0.05) in both groups. Changes in ABGs and discomfort were similar with the two groups, while dyspnoea decreased more (p<0.005) using the mask. The rate of intubation and the need for interface change during the whole period of NIV were very low and not different between groups. The new helmet may be a valid alternative to a mask in improving ABGs and achieving a good tolerance during an episode of acute hypercapnic respiratory failure.
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Affiliation(s)
- Lara Pisani
- Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Chiara Mega
- Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Rosanna Vaschetto
- "Maggiore Della Carità" Hospital, Dept of Anesthesia and Intensive Care, Novara, Italy
| | | | - Raffaele Scala
- U.O. Pneumologia, Ospedale S. Donato, ASL 8, Arezzo, Italy
| | - Roberto Cosentini
- IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Emergency Medicine Dept, Milan, Italy
| | - Muriel Musti
- Public Health-Care, Dept of Epidemiology, Bologna, Italy
| | - Manuela Del Forno
- Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Mario Grassi
- Dept of Brain and Behavioural Sciences, Medical and Genomic Statistics Unit, Università degli Studi di Pavia, Pavia, Italy
| | - Luca Fasano
- S. Orsola-Malpighi Hospital, Respiratory and Critical Care Unit, Bologna, Italy
| | - Paolo Navalesi
- Dept of Translational Medicine, Eastern Piedmont University "A. Avogadro", Novara, Italy CRRF Mons. L. Novarese, Moncrivello, Italy
| | - Stefano Nava
- Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
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Aliberti S, Messinesi G, Gamberini S, Maggiolini S, Visca D, Galavotti V, Giuliani F, Cosentini R, Brambilla AM, Blasi F, Scala R, Carone M, Luisi F, Harari S, Voza A, Esquinas A, Pesci A. Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases. BMC Pulm Med 2014; 14:194. [PMID: 25476922 PMCID: PMC4269964 DOI: 10.1186/1471-2466-14-194] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 12/23/2013] [Accepted: 12/01/2014] [Indexed: 11/28/2022] Open
Abstract
Background To evaluate noninvasive ventilation (NIV) in diffuse interstitial lung diseases (DILD) patients with acute respiratory failure (ARF) according to baseline radiological patterns and the etiology of ARF. Methods In a multicenter, observational, retrospective study, consecutive DILD patients undergoing NIV because of an episode of ARF were evaluated in six Italian high dependency units. Three groups of patients were identified based on the etiology of ARF: those with pneumonia (Group A), those with acute exacerbation of fibrosis, (Group B) and those with other triggers (Group C). Clinical failure was defined as any among in-hospital mortality, endotracheal intubation and extra-corporeal membrane oxygenation use. Results Among the 60 patients enrolled (63% males; median age: 71 years), pneumonia (42%) and acute exacerbation of fibrosis (39%) were the two most frequent causes of ARF. A significant increase of PaO2/FiO2 ratio during NIV treatment was detected in Group A (p = 0.010), but not in Group B. No significant difference in PaO2/FiO2 ratio, PaCO2 and pH values during NIV treatment was detected in patients with a radiological pattern of usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). 22 patients (37%) suffered for a clinical failure. No significant differences in the study outcome were detected in Group A vs. Group B, as well as among patients with a radiological pattern of UIP vs. NSIP. Conclusions NIV treatment should be individualized in DILD patients with ARF according to the etiology, but not the baseline radiological pattern, in order to improve oxygenation.
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Affiliation(s)
- Stefano Aliberti
- Department of Health Science, Clinica Pneumologica, AO San Gerardo, University of Milan Bicocca, Via Pergolesi 33, Monza, Italy.
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Brambilla AM, Aliberti S, Prina E, Nicoli F, Del Forno M, Nava S, Ferrari G, Corradi F, Pelosi P, Bignamini A, Tarsia P, Cosentini R. Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Med 2014; 40:942-9. [PMID: 24817030 DOI: 10.1007/s00134-014-3325-5] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/28/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The efficacy of noninvasive continuous positive airway pressure (CPAP) to improve outcomes in severe hypoxemic acute respiratory failure (hARF) due to pneumonia has not been clearly established. The aim of this study was to compare CPAP vs. oxygen therapy to reduce the risk of meeting criteria for endotracheal intubation (ETI). METHODS In a multicenter randomized controlled trial conducted in four Italian centers patients with severe hARF due to pneumonia were randomized to receive helmet CPAP (CPAP group) or oxygen delivered with a Venturi mask (control group). The primary endpoint was the percentage of patients meeting criteria for ETI, including either one or more major criteria (respiratory arrest, respiratory pauses with unconsciousness, severe hemodynamic instability, intolerance) or at least two minor criteria (reduction of at least 30% of basal PaO2/FiO2 ratio, increase of 20% of PaCO2, worsening of alertness, respiratory distress, SpO2 less than 90%, exhaustion). RESULTS Between February 2010 and 2013, 40 patients were randomized to CPAP and 41 to Venturi mask. The proportion of patients meeting ETI criteria in the CPAP group was significantly lower compared to those in the control group (6/40 = 15% vs. 26/41 = 63%, respectively, p < 0.001; relative risk 0.24, 95% CI 0.11-0.51; number needed to treat, 2) two patients were intubated in the CPAP group and one in the control group. The CPAP group showed a faster and greater improvement in oxygenation in comparison to controls (p < 0.001). In either study group, no relevant adverse events were detected. CONCLUSIONS Helmet CPAP reduces the risk of meeting ETI criteria compared to oxygen therapy in patients with severe hARF due to pneumonia.
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Affiliation(s)
- Anna Maria Brambilla
- Emergency Medicine Department, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Aliberti S, Brambilla AM, Chalmers JD, Cilloniz C, Ramirez J, Bignamini A, Prina E, Polverino E, Tarsia P, Pesci A, Torres A, Blasi F, Cosentini R. Phenotyping community-acquired pneumonia according to the presence of acute respiratory failure and severe sepsis. Respir Res 2014; 15:27. [PMID: 24593040 PMCID: PMC4015148 DOI: 10.1186/1465-9921-15-27] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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: 12/17/2013] [Accepted: 02/20/2014] [Indexed: 01/16/2023] Open
Abstract
Background Acute respiratory failure (ARF) and severe sepsis (SS) are possible complications in patients with community-acquired pneumonia (CAP). The aim of the study was to evaluate prevalence, characteristics, risk factors and impact on mortality of hospitalized patients with CAP according to the presence of ARF and SS on admission. Methods This was a multicenter, observational, prospective study of consecutive CAP patients admitted to three hospitals in Italy, Spain, and Scotland between 2008 and 2010. Three groups of patients were identified: those with neither ARF nor SS (Group A), those with only ARF (Group B) and those with both ARF and SS (Group C) on admission. Results Among the 2,145 patients enrolled, 45% belonged to Group A, 36% to Group B and 20% to Group C. Patients in Group C were more severe than patients in Group B. Isolated ARF was correlated with age (p < 0.001), COPD (p < 0.001) and multilobar infiltrates (p < 0.001). The contemporary occurrence of ARF and SS was associated with age (p = 0.002), residency in nursing home (p = 0.007), COPD (p < 0.001), multilobar involvement (p < 0.001) and renal disease (p < 0.001). 4.2% of patients in Group A died, 9.3% in Group B and 26% in Group C, p < 0.001. After adjustment, the presence of only ARF had an OR for in-hospital mortality of 1.85 (p = 0.011) and the presence of both ARF and SS had an OR of 6.32 (p < 0.001). Conclusions The identification of ARF and SS on hospital admission can help physicians in classifying CAP patients into three different clinical phenotypes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Francesco Blasi
- Department of Pathophysiology and Transplantation, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via F, Sforza 35, Milan, Italy.
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Aliberti S, Cilloniz C, Chalmers JD, Zanaboni AM, Cosentini R, Tarsia P, Pesci A, Blasi F, Torres A. Multidrug-resistant pathogens in hospitalised patients coming from the community with pneumonia: a European perspective. Thorax 2013; 68:997-9. [PMID: 23774884 DOI: 10.1136/thoraxjnl-2013-203384] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [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: 11/04/2022]
Abstract
BACKGROUND Probabilistic scores have been recently suggested to identify pneumonia caused by multidrug-resistant (MDR) bacteria. The aim of the study was to validate both Aliberti and Shorr scores in predicting MDR pneumonia, comparing them with healthcare associated pneumonia (HCAP) classification. METHODS Two independent European cohorts of consecutive patients hospitalised with pneumonia were prospectively evaluated in Barcelona, Spain (BC) and Edinburgh, UK (EC). Data on admission and during hospitalisation were collected. The predictive value of the three scores was explored for correctly indicating the presence of MDR pneumonia via a receiver-operating characteristic (ROC) curve. RESULTS A total of 1591 patients in the BC and 1883 patients in the EC were enrolled. The prevalence of patients with MDR pathogen among those with isolated bacteria was 7.6% in the BC and 3.3% in the EC. The most common MDR pathogen found in both cohorts was MRSA, followed by MDR P aeruginosa. A significantly higher prevalence of MDR bacteria was found among patients in the intensive care unit (ICU). The two probabilistic scores, and particularly the Aliberti one, showed an area under the ROC curve higher than the HCAP classification in predicting MDR pneumonia, especially in the ICU. CONCLUSIONS Risk scores able to identify MDR pneumonia could help in developing strategies for antimicrobial stewardship.
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Affiliation(s)
- Stefano Aliberti
- Department of Health Science, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, , Monza, Italy
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Carron M, Freo U, BaHammam AS, Dellweg D, Guarracino F, Cosentini R, Feltracco P, Vianello A, Ori C, Esquinas A. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials. Br J Anaesth 2013; 110:896-914. [PMID: 23562934 DOI: 10.1093/bja/aet070] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Non-invasive ventilation (NIV) has become a common treatment for acute and chronic respiratory failure. In comparison with conventional invasive mechanical ventilation, NIV has the advantages of reducing patient discomfort, procedural complications, and mortality. However, NIV is associated with frequent uncomfortable or even life-threatening adverse effects, and patients should be thoroughly screened beforehand to reduce potential severe complications. We performed a detailed review of the relevant medical literature for NIV complications. All major NIV complications are potentially life-threatening and can occur in any patient, but are strongly correlated with the degree of pulmonary and cardiovascular involvement. Minor complications can be related to specific structural features of NIV interfaces or to variable airflow patterns. This extensive review of the literature shows that careful selection of patients and interfaces, proper setting of ventilator modalities, and close monitoring of patients from the start can greatly reduce NIV complications.
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Affiliation(s)
- M Carron
- Department of Pharmacology and Anesthesiology, University of Padua, Padua, Italy
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Prina E, Ferrer M, Ranzani OT, Polverino E, Cillóniz C, Moreno E, Mensa J, Montull B, Menéndez R, Cosentini R, Torres A. Thrombocytosis Is a Marker of Poor Outcome in Community-Acquired Pneumonia. Chest 2013. [DOI: 10.1378/chest.12-1235] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Rovellini A, Graziadei G, Folli C, Brambilla AM, Cosentini R, Canetta C, Monzani V. Causes and correlates of anemia in 200 patients with acute cardiogenic pulmonary edema. Eur J Intern Med 2012; 23:733-7. [PMID: 22818627 DOI: 10.1016/j.ejim.2012.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 06/07/2012] [Accepted: 06/14/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute heart failure has a poor prognosis and the presence of anemia may increase the risk of adverse outcomes. However, the clinical and laboratory characteristics of anemia in acute heart failure are poorly known. We aimed to assess the causes and the clinical and laboratory correlates of anemia in patients with acute cardiogenic pulmonary edema (ACPE). METHODS This observational study, performed in an Emergency Unit, enrolled 200 patients treated with medical therapy and continuous positive airway pressure. RESULTS Anemia was found in 36% of patients (38.5% of females and 32.5% of males) and was severe (hemoglobin <9 g/dL) in 6.9% of cases. The most frequent causes of anemia were chronic renal failure (27.8%), chronic inflammatory states (27.8%) and the clustering of multiple factors (18.1%). A wider spectrum of etiological factors was found in females than in males. Microcytic anemia was observed only in females (20% of those anemic), mainly due to iron deficiency/chronic blood loss. Glomerular filtration rate, serum iron, serum albumin, total cholesterol and diastolic blood pressure were independently associated with hemoglobin levels. CONCLUSIONS The etiology of anemia in ACPE is heterogeneous, with several causal factors besides impaired renal function. The pattern of anemia is different between genders, suggesting that sex-specific diagnostic and therapeutic targets should be implemented.
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Affiliation(s)
- Angelo Rovellini
- Emergency Medicine Unit, Department of Medicine and Medical Specialties, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.
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Nicolini A, Tonveronachi E, Navalesi P, Antonelli M, Valentini I, Melotti RM, Pigna A, Carrassi A, Righini P, Ferrari Bravo M, Pelosi P, Nicoli F, Cosentini R, Vaschetto R, Faenza S, Nava S. Effectiveness and predictors of success of noninvasive ventilation during H1N1 pandemics: a multicenter study. Minerva Anestesiol 2012; 78:1333-1340. [PMID: 23032930] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The use of non-invasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF) due to H1N1 virus infection is controversial. In this multicenter study we aimed to assess the efficacy of NIV in avoiding endotracheal intubation (ETI) and to identify predictors of success or failure. METHODS In this prospective multicenter study, 98 patients with new pulmonary infiltrate(s) sustained by H1N1 virus and a PaO(2)/FiO2<300 were eligible for study; 38/98 required immediate ETI, while the others received NIV as a first line therapy; 13/60 patients failed NIV and were intubated after 5.8+5.5 hours from enrolment. The remaining 47/60 patients were successfully ventilated with NIV. RESULTS Hospital mortality was significantly higher in those patients who failed NIV vs. those who succeeded (53.8% vs. 2.1%; OR=0.52, P<0.001). ETI was associated with higher number of infectious complications, mainly sepsis and septic shock. The OR of having one of these events in the NIV failure group vs. NIV success was 16.7, P<0.001. According to logistic regression model, a SAPS II>29 and a PaO(2)/FIO(2)≤127 at admission and PaO2/FIO(2)≤149 after 1 hr of NIV were independently associated with the need for ETI. CONCLUSION The early application of NIV, with the aim to avoid invasive ventilation, during the H1N1 pandemics was associated with an overall success rate of 47/98 (48%). Patients presenting at admission with an high SAPS II score and a low PaO(2)/FiO(2) ratio and/or unable to promptly correct gas exchange are at high risk of intubation and mortality.
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Affiliation(s)
- A Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
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Ferrer M, Cosentini R, Nava S. The use of non-invasive ventilation during acute respiratory failure due to pneumonia. Eur J Intern Med 2012; 23:420-8. [PMID: 22726370 PMCID: PMC7126754 DOI: 10.1016/j.ejim.2012.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 11/29/2022]
Abstract
The use of non-invasive ventilation in patients with community-acquired pneumonia is controversial since this is associated with high rates of treatment failure, compared with other causes of severe acute respiratory failure. The populations of patients with community-acquired pneumonia who have demonstrated better response to non-invasive ventilation are those with previous cardiac or respiratory disease, particularly chronic obstructive pulmonary disease. By contrast, the use of non-invasive ventilation in patients with community-acquired pneumonia without these pre-existing diseases should be very cautious and under strict monitoring conditions, since there are increasing evidences that the unnecessary delay in intubation of those patients who fail treatment with non-invasive ventilation is associated with lower survival. Pulmonary complications of immunosuppressed patients are associated with high rates of intubation and mortality. The use of non-invasive ventilation in these patients may decrease the need for intubation and improve the poor outcome associated with these complications. Continuous positive airway pressure has been used to treat acute respiratory failure in several conditions characterised by alveolar collapse. While this is extremely useful in patients with acute cardiogenic pulmonary oedema, the efficacy in pneumonia seems limited to immunosuppressed patients with pulmonary complications. Conversely, there are no sufficient evidences on the efficacy of continuous positive airway pressure in immunocompetent patients with pneumonia and severe acute respiratory failure.
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Affiliation(s)
- Miquel Ferrer
- UVIIR, Servei de Pneumologia, Institut del Tòrax, Hospital Clinic, IDIBAPS, (CibeRes, CB06/06/0028)-ISCiii, Barcelona, Spain.
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Esquinas Rodriguez AM, Cosentini R, Papadakos PJ. Mechanical ventilation in emergency departments: non invasive or invasive mechanical ventilation. Where is the answer? Scand J Trauma Resusc Emerg Med 2012; 20:40. [PMID: 22734972 PMCID: PMC3629699 DOI: 10.1186/1757-7241-20-40] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 06/17/2012] [Indexed: 12/03/2022] Open
Abstract
The Emergency Department length of stay for patients requiring mechanical ventilation paper in this issue is very illustrative of many variables that still confound the way we treat patients that may not require endotracheal intubation (ETI) but may benefit from non-invasive mechanical ventilation (NIV) [1].
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Affiliation(s)
- Antonio M Esquinas Rodriguez
- International Fellow AARC, Intensive Care Unit, Hospital Morales Meseguer, Avenida Marques de Los Velez s/n, Murcia 30500, Spain.
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Aliberti S, Di Pasquale M, Zanaboni AM, Cosentini R, Brambilla AM, Seghezzi S, Tarsia P, Mantero M, Blasi F. Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis 2011; 54:470-8. [PMID: 22109954 DOI: 10.1093/cid/cir840] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Not all risk factors for acquiring multidrug-resistant (MDR) organisms are equivalent in predicting pneumonia caused by resistant pathogens in the community. We evaluated risk factors for acquiring MDR bacteria in patients coming from the community who were hospitalized with pneumonia. Our evaluation was based on actual infection with a resistant pathogen and clinical outcome during hospitalization. METHODS An observational, prospective study was conducted on consecutive patients coming from the community who were hospitalized with pneumonia. Data on admission and during hospitalization were collected. Logistic regression models were used to evaluate risk factors for acquiring MDR bacteria independently associated with the actual presence of a resistant pathogen and in-hospital mortality. RESULTS Among the 935 patients enrolled in the study, 473 (51%) had at least 1 risk factor for acquiring MDR bacteria on admission. Of all risk factors, hospitalization in the preceding 90 days (odds ratio [OR], 4.87 95% confidence interval {CI}, 1.90-12.4]; P = .001) and residency in a nursing home (OR, 3.55 [95% CI, 1.12-11.24]; P = .031) were independent predictors for an actual infection with a resistant pathogen. A score able to predict pneumonia caused by a resistant pathogen was computed, including comorbidities and risk factors for MDR. Hospitalization in the preceding 90 days and residency in a nursing home were also independent predictors for in-hospital mortality. CONCLUSIONS Risk factors for acquiring MDR bacteria should be weighted differently, and a probabilistic approach to identifying resistant pathogens among patients coming from the community with pneumonia should be embraced.
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Affiliation(s)
- Stefano Aliberti
- Dipartimento di Medicina Clinica e Prevenzione, University of Milan-Bicocca, Clinica Pneumologica, AO San Gerardo, Monza, Italy.
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Aliberti S, Brambilla AM, Cosentini R. Noninvasive ventilation or continuous positive airway pressure in pulmonary edema patients with respiratory acidosis? Look at the bicarbonates. Intensive Care Med 2011; 37:2050-1. [DOI: 10.1007/s00134-011-2361-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2011] [Indexed: 10/17/2022]
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Aliberti S, Andrisani MC, Tarsia P, Trevisan R, Cosentini R, Longhi L, Pappalettera M, Nosotti M, Blasi F. Non-invasive continuous positive airway pressure in monolateral lung transplant patient with pneumonia and IPF. Monaldi Arch Chest Dis 2011; 73:169-75. [PMID: 21434566 DOI: 10.4081/monaldi.2010.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients who undergo lung transplantation are prone to develop lower respiratory tract infections, leading to severe acute respiratory failure (ARF). Endotracheal intubation may not be indicated in these patients in light of a higher rate of mortality due to infections. The application of non-invasive ventilation could play a role in bridging these patients through the episode of ARF waiting for medical treatment to have effect. We report the evidence of morphological and physiological effects of the application of non-invasive continuous positive airway pressure during ARF sustained by pneumonia in a patient who underwent left lung transplantation because of idiopathic pulmonary fibrosis (IPF). We studied the effects of the application of positive end-expiratory pressure on both the right native lung affected by IPF and the transplanted lung affected by pneumonia.
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Affiliation(s)
- S Aliberti
- Dipartimento toraco-polmonare e cardio-circolatorio, University of Milan, IRCCS Fondazione Po.Ma.Re, Milan, Italy.
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Maraffi T, Ruvolo L, Aliberti S, Piffer F, Cosentini R. Early application of non-invasive continuous positive airway pressure in acute respiratory distress syndrome due to a drug overdose: a case report. Intern Emerg Med 2011; 6:275-6. [PMID: 20596798 DOI: 10.1007/s11739-010-0428-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 06/16/2010] [Indexed: 11/30/2022]
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Riquelme R, Jiménez P, Videla AJ, Lopez H, Chalmers J, Singanayagam A, Riquelme M, Peyrani P, Wiemken T, Arbo G, Benchetrit G, Rioseco ML, Ayesu K, Klotchko A, Marzoratti L, Raya M, Figueroa S, Saavedra F, Pryluka D, Inzunza C, Torres A, Alvare P, Fernandez P, Barros M, Gomez Y, Contreras C, Rello J, Bordon J, Feldman C, Arnold F, Nakamatsu R, Riquelme J, Blasi F, Aliberti S, Cosentini R, Lopardo G, Gnoni M, Welte T, Saad M, Guardiola J, Ramirez J. Predicting mortality in hospitalized patients with 2009 H1N1 influenza pneumonia. Int J Tuberc Lung Dis 2011; 15:542-6. [PMID: 21396216 DOI: 10.5588/ijtld.10.0539] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) severity scores can identify patients at low risk for mortality who may be suitable for ambulatory care. Here, we follow the clinical course of hospitalized patients with CAP due to 2009 H1N1 influenza. OBJECTIVE To evaluate the role of CAP severity scores as predictors of mortality. METHODS This was a secondary data analysis of patients hospitalized with CAP due to 2009 H1N1 influenza confirmed by reverse transcriptase polymerase chain reaction enrolled in the CAPO (Community-Acquired Pneumonia Organization) international cohort study. CAP severity scores PSI (Pneumonia Severity Index), CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥ 65 years) and CRB-65 (confusion, respiratory rate, blood pressure, age ≥ 65 years) were calculated. Actual and predicted mortality rates were compared. A total of 37 predictor variables were evaluated to define those associated with mortality. RESULTS Data from 250 patients with CAP due to 2009 H1N1 influenza were analyzed. Patients with low predicted mortality rates (0-1.5%) had actual mortality rates ranging from 2.6% to 17.5%. Obesity and wheezing were the only novel variables associated with mortality. CONCLUSIONS The decision to hospitalize a patient with CAP due to 2009 H1N1 influenza should not be based on current CAP severity scores, as they underestimate mortality rates in a significant number of patients. Patients with obesity or wheezing should be considered at an increased risk for mortality.
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Affiliation(s)
- R Riquelme
- Puerto Montt Hospital, Puerto Montt, Chile
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