1
|
Duggal A, Conrad SA, Barrett NA, Saad M, Cheema T, Pannu S, Romero RS, Brochard L, Nava S, Ranieri VM, May A, Brodie D, Hill NS. Extracorporeal Carbon Dioxide Removal to Avoid Invasive Ventilation During Exacerbations of Chronic Obstructive Pulmonary Disease: VENT-AVOID Trial - A Randomized Clinical Trial. Am J Respir Crit Care Med 2024; 209:529-542. [PMID: 38261630 DOI: 10.1164/rccm.202311-2060oc] [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] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/23/2024] [Indexed: 01/25/2024] Open
Abstract
Rationale: It is unclear whether extracorporeal CO2 removal (ECCO2R) can reduce the rate of intubation or the total time on invasive mechanical ventilation (IMV) in adults experiencing an exacerbation of chronic obstructive pulmonary disease (COPD). Objectives: To determine whether ECCO2R increases the number of ventilator-free days within the first 5 days postrandomization (VFD-5) in exacerbation of COPD in patients who are either failing noninvasive ventilation (NIV) or who are failing to wean from IMV. Methods: This randomized clinical trial was conducted in 41 U.S. institutions (2018-2022) (ClinicalTrials.gov ID: NCT03255057). Subjects were randomized to receive either standard care with venovenous ECCO2R (NIV stratum: n = 26; IMV stratum: n = 32) or standard care alone (NIV stratum: n = 22; IMV stratum: n = 33). Measurements and Main Results: The trial was stopped early because of slow enrollment and enrolled 113 subjects of the planned sample size of 180. There was no significant difference in the median VFD-5 between the arms controlled by strata (P = 0.36). In the NIV stratum, the median VFD-5 for both arms was 5 days (median shift = 0.0; 95% confidence interval [CI]: 0.0-0.0). In the IMV stratum, the median VFD-5 in the standard care and ECCO2R arms were 0.25 and 2 days, respectively; median shift = 0.00 (95% confidence interval: 0.00-1.25). In the NIV stratum, all-cause in-hospital mortality was significantly higher in the ECCO2R arm (22% vs. 0%, P = 0.02) with no difference in the IMV stratum (17% vs. 15%, P = 0.73). Conclusions: In subjects with exacerbation of COPD, the use of ECCO2R compared with standard care did not improve VFD-5. Clinical trial registered with www.clinicaltrials.gov (NCT03255057).
Collapse
Affiliation(s)
- Abhijit Duggal
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven A Conrad
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Nicholas A Barrett
- Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Mohamed Saad
- Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Tariq Cheema
- Division of Pulmonary Critical Care, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Sonal Pannu
- Division of Pulmonary Critical Care and Sleep, Department of Medicine, Ohio State University, Columbus, Ohio
| | - Ramiro Saavedra Romero
- Department of Critical Care Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stefano Nava
- Respiratory and Critical Care Unit, IRCCS Azienda Hospital, University of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - V Marco Ranieri
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Anesthesia and Intensive Care Medicine, IRCCS Azienda Hospital, University of Bologna, Bologna, Italy
| | - Alexandra May
- ALung Technologies, LivaNova PLC, Pittsburgh, Pennsylvania
| | - Daniel Brodie
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and
| | - Nicholas S Hill
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
2
|
Matthay MA, Arabi Y, Arroliga AC, Bernard G, Bersten AD, Brochard LJ, Calfee CS, Combes A, Daniel BM, Ferguson ND, Gong MN, Gotts JE, Herridge MS, Laffey JG, Liu KD, Machado FR, Martin TR, McAuley DF, Mercat A, Moss M, Mularski RA, Pesenti A, Qiu H, Ramakrishnan N, Ranieri VM, Riviello ED, Rubin E, Slutsky AS, Thompson BT, Twagirumugabe T, Ware LB, Wick KD. A New Global Definition of Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2024; 209:37-47. [PMID: 37487152 PMCID: PMC10870872 DOI: 10.1164/rccm.202303-0558ws] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [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: 03/20/2023] [Accepted: 07/24/2023] [Indexed: 07/26/2023] Open
Abstract
Background: Since publication of the 2012 Berlin definition of acute respiratory distress syndrome (ARDS), several developments have supported the need for an expansion of the definition, including the use of high-flow nasal oxygen, the expansion of the use of pulse oximetry in place of arterial blood gases, the use of ultrasound for chest imaging, and the need for applicability in resource-limited settings. Methods: A consensus conference of 32 critical care ARDS experts was convened, had six virtual meetings (June 2021 to March 2022), and subsequently obtained input from members of several critical care societies. The goal was to develop a definition that would 1) identify patients with the currently accepted conceptual framework for ARDS, 2) facilitate rapid ARDS diagnosis for clinical care and research, 3) be applicable in resource-limited settings, 4) be useful for testing specific therapies, and 5) be practical for communication to patients and caregivers. Results: The committee made four main recommendations: 1) include high-flow nasal oxygen with a minimum flow rate of ⩾30 L/min; 2) use PaO2:FiO2 ⩽ 300 mm Hg or oxygen saturation as measured by pulse oximetry SpO2:FiO2 ⩽ 315 (if oxygen saturation as measured by pulse oximetry is ⩽97%) to identify hypoxemia; 3) retain bilateral opacities for imaging criteria but add ultrasound as an imaging modality, especially in resource-limited areas; and 4) in resource-limited settings, do not require positive end-expiratory pressure, oxygen flow rate, or specific respiratory support devices. Conclusions: We propose a new global definition of ARDS that builds on the Berlin definition. The recommendations also identify areas for future research, including the need for prospective assessments of the feasibility, reliability, and prognostic validity of the proposed global definition.
Collapse
Affiliation(s)
- Michael A. Matthay
- Department of Medicine
- Department of Anesthesia
- Cardiovascular Research Institute, and
| | - Yaseen Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Gordon Bernard
- Division of Allergy, Pulmonary, and Critical Care Medicine, Center for Lung Research, and
| | | | - Laurent J. Brochard
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn S. Calfee
- Department of Medicine
- Department of Anesthesia
- Cardiovascular Research Institute, and
| | - Alain Combes
- Médecine Intensive – Réanimation, Sorbonne Université, APHP Hôpital Pitié-Salpêtrière, Paris, France
| | - Brian M. Daniel
- Respiratory Therapy, University of California, San Francisco, San Francisco, California
| | - Niall D. Ferguson
- Interdepartmental Division of Critical Care Medicine and
- Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michelle N. Gong
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Jeffrey E. Gotts
- Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | | | - John G. Laffey
- Anesthesia, University Hospital Galway, University of Galway, Galway, Ireland
| | | | - Flavia R. Machado
- Intensive Care Department, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thomas R. Martin
- Department of Medicine, University of Washington, Seattle, Washington
| | - Danny F. McAuley
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Alain Mercat
- Medical ICU, Angers University Hospital, Angers, France
| | - Marc Moss
- Department of Medicine, University of Colorado Denver, Aurora, Colorado
| | | | - Antonio Pesenti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Haibo Qiu
- Critical Care Medicine, Zhongda Hospital, Nanjing, China
| | | | - V. Marco Ranieri
- Emergency and Intensive Care Medicine, Alma Mater Studorium University of Bologna, Bologna, Italy
| | - Elisabeth D. Riviello
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Arthur S. Slutsky
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B. Taylor Thompson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Theogene Twagirumugabe
- Department of Anesthesia, Critical Care, and Emergency Medicine, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; and
| | - Lorraine B. Ware
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Katherine D. Wick
- Department of Medicine, University of California, Davis, Davis, California
| |
Collapse
|
3
|
Tonetti T, Zanella A, Pérez-Torres D, Grasselli G, Ranieri VM. Current knowledge gaps in extracorporeal respiratory support. Intensive Care Med Exp 2023; 11:77. [PMID: 37962702 PMCID: PMC10645840 DOI: 10.1186/s40635-023-00563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023] Open
Abstract
Extracorporeal life support (ECLS) for acute respiratory failure encompasses veno-venous extracorporeal membrane oxygenation (V-V ECMO) and extracorporeal carbon dioxide removal (ECCO2R). V-V ECMO is primarily used to treat severe acute respiratory distress syndrome (ARDS), characterized by life-threatening hypoxemia or ventilatory insufficiency with conventional protective settings. It employs an artificial lung with high blood flows, and allows improvement in gas exchange, correction of hypoxemia, and reduction of the workload on the native lung. On the other hand, ECCO2R focuses on carbon dioxide removal and ventilatory load reduction ("ultra-protective ventilation") in moderate ARDS, or in avoiding pump failure in acute exacerbated chronic obstructive pulmonary disease. Clinical indications for V-V ECLS are tailored to individual patients, as there are no absolute contraindications. However, determining the ideal timing for initiating extracorporeal respiratory support remains uncertain. Current ECLS equipment faces issues like size and durability. Innovations include intravascular lung assist devices (ILADs) and pumpless devices, though they come with their own challenges. Efficient gas exchange relies on modern oxygenators using hollow fiber designs, but research is exploring microfluidic technology to improve oxygenator size, thrombogenicity, and blood flow capacity. Coagulation management during V-V ECLS is crucial due to common bleeding and thrombosis complications; indeed, anticoagulation strategies and monitoring systems require improvement, while surface coatings and new materials show promise. Moreover, pharmacokinetics during ECLS significantly impact antibiotic therapy, necessitating therapeutic drug monitoring for precise dosing. Managing native lung ventilation during V-V ECMO remains complex, requiring a careful balance between benefits and potential risks for spontaneously breathing patients. Moreover, weaning from V-V ECMO is recognized as an area of relevant uncertainty, requiring further research. In the last decade, the concept of Extracorporeal Organ Support (ECOS) for patients with multiple organ dysfunction has emerged, combining ECLS with other organ support therapies to provide a more holistic approach for critically ill patients. In this review, we aim at providing an in-depth overview of V-V ECMO and ECCO2R, addressing various aspects of their use, challenges, and potential future directions in research and development.
Collapse
Affiliation(s)
- Tommaso Tonetti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Anesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di S.Orsola, Bologna, Italy
| | - Alberto Zanella
- Department of Anesthesia, Critical Care and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - David Pérez-Torres
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Calle Dulzaina, 2, 47012, Valladolid, Spain
| | - Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - V Marco Ranieri
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Anesthesiology and General Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di S.Orsola, Bologna, Italy
| |
Collapse
|
4
|
Affiliation(s)
| | | | - Arthur S. Slutsky
- Unity Health TorontoToronto, Ontario, Canada
- University of TorontoToronto, Ontario, Canada
| |
Collapse
|
5
|
Finazzi S, Perego M, Tricella G, Poole D, Ranieri VM. SARS-CoV-2 breakthrough infections in vaccinated individuals requiring ventilatory support for severe acute respiratory failure. Intensive Care Med 2023; 49:248-250. [PMID: 36695834 PMCID: PMC9875173 DOI: 10.1007/s00134-022-06952-2] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Stefano Finazzi
- Laboratory of Clinical Data Science, Department of Public Health, Mario Negri Institute for Pharmacological Research IRCCS, Ranica, BG, Italy.
- GiViTi, Gruppo Italiano per la Valutazione Interventi in Terapia Intensiva, Ranica, BG, Italy.
| | - Matilde Perego
- Laboratory of Clinical Data Science, Department of Public Health, Mario Negri Institute for Pharmacological Research IRCCS, Ranica, BG, Italy
- GiViTi, Gruppo Italiano per la Valutazione Interventi in Terapia Intensiva, Ranica, BG, Italy
| | - Giovanni Tricella
- Laboratory of Clinical Data Science, Department of Public Health, Mario Negri Institute for Pharmacological Research IRCCS, Ranica, BG, Italy
| | - Daniele Poole
- GiViTi, Gruppo Italiano per la Valutazione Interventi in Terapia Intensiva, Ranica, BG, Italy
- Anesthesia and Intensive Care, San Martino Hospital, Belluno, Italy
| | - V Marco Ranieri
- Alma Mater Studiorum-Università di Bologna, IRCCS Policlinico di Sant'Orsola, Anesthesia and Intensive Care Medicine, Bologna, Italy.
| |
Collapse
|
6
|
Ranieri VM, Rubenfeld G, Slutsky AS. Rethinking Acute Respiratory Distress Syndrome after COVID-19: If a "Better" Definition Is the Answer, What Is the Question? Am J Respir Crit Care Med 2023; 207:255-260. [PMID: 36150099 PMCID: PMC9896638 DOI: 10.1164/rccm.202206-1048cp] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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] [Indexed: 02/03/2023] Open
Abstract
The definition of acute respiratory distress syndrome (ARDS) has a somewhat controversial history, with some even questioning the need for the term "ARDS." This controversy has been amplified by the coronavirus disease (COVID-19) pandemic given the marked increase in the incidence of ARDS, the relatively new treatment modalities that do not fit neatly with the Berlin definition, and the difficulty of making the diagnosis in resource-limited settings. We propose that attempts to revise the definition of ARDS should apply the framework originally developed by psychologists and social scientists and used by other medical disciplines to generate and assess definitions of clinical syndromes that do not have gold standards. This framework is structured around measures of reliability, feasibility, and validity. Future revisions of the definition of ARDS should contain the purpose, the methodology, and the framework for empirically testing any proposed definition. Attempts to revise critical illness syndromes' definitions usually hope to make them "better"; our recommendation is that future attempts use the same criteria used by other fields in defining what "better" means.
Collapse
Affiliation(s)
- V Marco Ranieri
- Alma Mater Studiorum - Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, IRCCS Policlinico di Sant'Orsola, Anesthesia and Intensive Care Medicine, Bologna, Italy
| | - Gordon Rubenfeld
- Department of Critical Care, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Arthur S Slutsky
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; and.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Dell'Olio A, Vocale C, Primavera A, Pisani L, Altavilla S, Roncarati G, Tumietto F, Viale P, Re MC, Lazzarotto T, Nava S, Ranieri VM, Tonetti T. Environmental Contamination by SARS-CoV-2 During Noninvasive Ventilation in COVID-19. Respir Care 2023; 68:1-7. [PMID: 36379641 PMCID: PMC9993510 DOI: 10.4187/respcare.10323] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Environmental contamination by SARS-CoV-2 from patients with COVID-19 undergoing noninvasive ventilation (NIV) in the ICU is still under investigation. This study set out to investigate the presence of SARS-CoV-2 on surfaces near subjects receiving NIV in the ICU under controlled conditions (ie, use of dual-limb circuits, filters, adequate room ventilation). METHODS This was a single-center, prospective, observational study in the ICU of a tertiary teaching hospital. Four surface sampling areas, at increasing distance from subject's face, were identified; and each one was sampled at fixed intervals: 6, 12, and 24 h. The presence of SARS-CoV-2 was detected with real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) test on environmental swabs; the RT-PCR assay targeted the SARS-CoV-2 virus nucleocapsid N1 and N2 genes and the human RNase P gene as internal control. RESULTS In a total of 256 collected samples, none were positive for SARS-CoV-2 genetic material, whereas 21 samples (8.2%) tested positive for RNase P, thus demonstrating the presence of genetic material unrelated to SARS-CoV-2. CONCLUSIONS Our data show that application of NIV in an appropriate environment and with correct precautions leads to no sign of surface environmental contamination. Accordingly, our data support the idea that use of NIV in the ICU is safe both for health care workers and for other patients.
Collapse
Affiliation(s)
- Alessio Dell'Olio
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Caterina Vocale
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandra Primavera
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lara Pisani
- Section of Pneumology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Pulmonology and Respiratory Critical Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Salvatore Altavilla
- Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Greta Roncarati
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fabio Tumietto
- Antimicrobial Stewardship Unit, Metropolitan Department Integrated Management Infectious Risk, AUSL Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Infectious Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Carla Re
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; and Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Nava
- Section of Pneumology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Pulmonology and Respiratory Critical Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - V Marco Ranieri
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tommaso Tonetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| |
Collapse
|
8
|
Maggiore SM, Jaber S, Grieco DL, Mancebo J, Zakynthinos S, Demoule A, Ricard JD, Navalesi P, Vaschetto R, Hraiech S, Klouche K, Frat JP, Lemiale V, Fanelli V, Chanques G, Natalini D, Ischaki E, Reuter D, Morán I, La Combe B, Longhini F, De Gaetano A, Ranieri VM, Brochard LJ, Antonelli M. High-Flow Versus VenturiMask Oxygen Therapy to Prevent Reintubation in Hypoxemic Patients after Extubation: A Multicenter Randomized Clinical Trial. Am J Respir Crit Care Med 2022; 206:1452-1462. [PMID: 35849787 DOI: 10.1164/rccm.202201-0065oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Indexed: 12/24/2022] Open
Abstract
Rationale: When compared with VenturiMask after extubation, high-flow nasal oxygen provides physiological advantages. Objectives: To establish whether high-flow oxygen prevents endotracheal reintubation in hypoxemic patients after extubation, compared with VenturiMask. Methods: In this multicenter randomized trial, 494 patients exhibiting PaO2:FiO2 ratio ⩽ 300 mm Hg after extubation were randomly assigned to receive high-flow or VenturiMask oxygen, with the possibility to apply rescue noninvasive ventilation before reintubation. High-flow use in the VenturiMask group was not permitted. Measurements and Main Results: The primary outcome was the rate of reintubation within 72 hours according to predefined criteria, which were validated a posteriori by an independent adjudication committee. Main secondary outcomes included reintubation rate at 28 days and the need for rescue noninvasive ventilation according to predefined criteria. After intubation criteria validation (n = 492 patients), 32 patients (13%) in the high-flow group and 27 patients (11%) in the VenturiMask group required reintubation at 72 hours (unadjusted odds ratio, 1.26 [95% confidence interval (CI), 0.70-2.26]; P = 0.49). At 28 days, the rate of reintubation was 21% in the high-flow group and 23% in the VenturiMask group (adjusted hazard ratio, 0.89 [95% CI, 0.60-1.31]; P = 0.55). The need for rescue noninvasive ventilation was significantly lower in the high-flow group than in the VenturiMask group: at 72 hours, 8% versus 17% (adjusted hazard ratio, 0.39 [95% CI, 0.22-0.71]; P = 0.002) and at 28 days, 12% versus 21% (adjusted hazard ratio, 0.52 [95% CI, 0.32-0.83]; P = 0.007). Conclusions: Reintubation rate did not significantly differ between patients treated with VenturiMask or high-flow oxygen after extubation. High-flow oxygen yielded less frequent use of rescue noninvasive ventilation. Clinical trial registered with www.clinicaltrials.gov (NCT02107183).
Collapse
Affiliation(s)
- Salvatore Maurizio Maggiore
- University Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine, and Emergency, SS Annunziata Hospital, Chieti, Italy
| | - Samir Jaber
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier; France
- PhyMedExp, INSERM U1046, CNRS UMR, 9214, University of Montpellier, Montpellier Cedex 5, France
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of The Sacred Heart, Rome, Italy
| | - Jordi Mancebo
- Servei de Medicina Intensiva, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Spyros Zakynthinos
- Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, Athens, Greece
| | - Alexandre Demoule
- Service de Pneumologie, Médecine Intensive-Réanimation (Département "R3S"), Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Jean-Damien Ricard
- Service de Médecine Intensive-Réanimatio, DMU ESPRIT, Hôpital Louis Mourier, AP-HP, Université de Paris, Colombes, France
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Rosanna Vaschetto
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Sami Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Aix-Marseille Université, Health Service Research and Quality of Life Center (CEReSS), Marseille, France
| | - Kada Klouche
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Jean-Pierre Frat
- Médecine Intensive Réanimation, CHU Poitiers, INSERM, CIC 1402, ALIVE, Université de Poitiers, Poitiers, France
- INSERM, CIC 1402, ALIVE, Université de Poitiers, Poitiers, France
| | | | - Vito Fanelli
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Anaesthesia, Critical Care, and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Gerald Chanques
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier; France
- PhyMedExp, INSERM U1046, CNRS UMR, 9214, University of Montpellier, Montpellier Cedex 5, France
| | - Daniele Natalini
- PhyMedExp, INSERM U1046, CNRS UMR, 9214, University of Montpellier, Montpellier Cedex 5, France
| | - Eleni Ischaki
- Servei de Medicina Intensiva, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Danielle Reuter
- Service de Pneumologie, Médecine Intensive-Réanimation (Département "R3S"), Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Indalecio Morán
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of The Sacred Heart, Rome, Italy
| | - Béatrice La Combe
- Service de Pneumologie, Médecine Intensive-Réanimation (Département "R3S"), Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, "Mater Domini" University Hospital, "Magna Graecia" University, Catanzaro, Italy
| | | | - V Marco Ranieri
- Dipartimento di Scienze Mediche e Chirurgiche, Anestesia e Rianimazione, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Laurent J Brochard
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; and
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Massimo Antonelli
- PhyMedExp, INSERM U1046, CNRS UMR, 9214, University of Montpellier, Montpellier Cedex 5, France
| | | |
Collapse
|
9
|
Benedetto M, Piccone G, Baiocchi M, Cerchierini E, Adversi M, Rossi A, Dell’Olio A, Di Luca D, Castelli A, Ranieri VM, Tonetti T. Increased duration and similar outcomes of
V‐V ECLS
in patients with Covid‐19 Ards compared to
non‐Covid
ards: single center experience. Artif Organs 2022; 47:731-739. [PMID: 36394379 DOI: 10.1111/aor.14463] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Veno-venous extracorporeal life support (V-V ECLS or V-V ECMO) has been adopted as a rescue support in severe cases of COVID-19 ARDS. Initial reports on the use of V-V ECLS in COVID-19 patients reported very high mortality rates (57%-94%), but subsequent studies showed much lower rates (30%-40%). The aim of this study is to analyze demographic features, clinical course and outcomes of COVID-19 treated with V-V ECLS during the Italian 'third wave', in which the alpha variant was prevalent in the country. METHODS Single-center, retrospective observational study conducted at the ECLS referral center of a teaching hospital in Italy from January 1st, 2021 and October 31st, 2021. RESULTS Between January and October 2021, 18 consecutive adult patients who underwent V-V ECLS for severe ARDS due to COVID-19 were enrolled. Thirteen patients (72.2%) were male, and their median age was 50 years; the median P/F ratio before V-V ECLS initiation was 43 mm Hg (IQR, 40; 56), and the median RESP score was 0.5 (IQR, -2.25; 1.0). The mortality rate at 90 days was 55.6, compared to 55.7% in non-COVID patients in our center (p > 0.05); the median duration of ECLS was 29 days (IQR, 11; 32), compared to 10 days (IQR, 8; 15), in non-COVID patients (p = 0.004). Incidence of complications was high. CONCLUSIONS In patients with COVID-19 ARDS receiving V-V ECLS, unadjusted mortality was similar to pre-pandemic V-V ECLS cases, while the duration of ECLS was almost three times longer and with frequent complications. This could be partly explained by the selection of very sick patients at the baseline that evolved to multiorgan failure during the course of ECLS.
Collapse
Affiliation(s)
- Maria Benedetto
- Anaesthesiology and Intensive Care, Cardiothoracic and Vascular Department. IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di S.Orsola. Bologna Italy
| | - Giulia Piccone
- Anaesthesiology and Intensive Care, Cardiothoracic and Vascular Department. IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di S.Orsola. Bologna Italy
| | - Massimo Baiocchi
- Anaesthesiology and Intensive Care, Cardiothoracic and Vascular Department. IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di S.Orsola. Bologna Italy
| | - Elisa Cerchierini
- Anaesthesiology and Intensive Care, Cardiothoracic and Vascular Department. IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di S.Orsola. Bologna Italy
| | - Marco Adversi
- Anaesthesiology and Intensive Care, Cardiothoracic and Vascular Department. IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di S.Orsola. Bologna Italy
| | - Agostino Rossi
- Anesthesiology and Intensive Care Medicine. IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di S.Orsola. Bologna Italy
| | - Alessio Dell’Olio
- Department of Medical and Surgical Sciences (DIMEC). Alma Mater Studiorum – University of Bologna. Bologna Italy
| | - Daniela Di Luca
- Anaesthesiology and Intensive Care, Cardiothoracic and Vascular Department. IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di S.Orsola. Bologna Italy
| | - Andrea Castelli
- Anaesthesiology and Intensive Care, Cardiothoracic and Vascular Department. IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di S.Orsola. Bologna Italy
| | - V. Marco Ranieri
- Anesthesiology and Intensive Care Medicine. IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di S.Orsola. Bologna Italy
- Department of Medical and Surgical Sciences (DIMEC). Alma Mater Studiorum – University of Bologna. Bologna Italy
| | - Tommaso Tonetti
- Anesthesiology and Intensive Care Medicine. IRCCS Azienda Ospedaliero‐Universitaria di Bologna, Policlinico di S.Orsola. Bologna Italy
- Department of Medical and Surgical Sciences (DIMEC). Alma Mater Studiorum – University of Bologna. Bologna Italy
| |
Collapse
|
10
|
Arina P, Sorge M, Gallo A, Di Mauro V, Vitale N, Cappello P, Brazzi L, Barandalla-Sobrados M, Cimino J, Ranieri VM, Altruda F, Singer M, Catalucci D, Brancaccio M, Fanelli V. Modulation of LTCC Pathways by a Melusin Mimetic Increases Ventricular Contractility During LPS-Induced Cardiomyopathy. Shock 2022; 57:318-325. [PMID: 35271535 DOI: 10.1097/shk.0000000000001926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Sepsis-induced cardiomyopathy is commonplace and carries an increased risk of death. Melusin, a cardiac muscle-specific chaperone, exerts cardioprotective function under varied stressful conditions through activation of the AKT pathway. The objective of this study was to determine the role of melusin in the pathogenesis of lipopolysaccharide (LPS)-induced cardiac dysfunction and to explore its signaling pathway for the identification of putative therapeutic targets. METHODS AND RESULTS Prospective, randomized, controlled experimental study in a research laboratory. Melusin overexpressing (MelOV) and wild-type (MelWT) mice were used. MelOV and MelWT mice were injected intraperitoneally with LPS. Cardiac function was assessed using trans-thoracic echocardiography. Myocardial expression of L-type calcium channel (LTCC), phospho-Akt and phospho-Gsk3-b were also measured. In separate experiments, wild-type mice were treated post-LPS challenge with the allosteric Akt inhibitor Arq092 and a mimetic peptide (R7W-MP) targeting the LTCC. The impact of these therapies on protein-protein interactions, cardiac function, and survival was assessed. MelOV mice had limited derangement in cardiac function after LPS challenge. Protection was associated with higher Akt and Gsk3-b phosphorylation and restored LTCC density. Pharmacological inhibition of Akt activity reversed melusin-dependent cardiac protection. Treatment with R7W-MP preserved cardiac function in wild-type mice after LPS challenge and significantly improved survival. CONCLUSIONS This study identifies AKT / Melusin as a key pathway for preserving cardiac function following LPS challenge. The cell-permeable mimetic peptide (R7W-MP) represents a putative therapeutic for sepsis-induced cardiomyopathy.
Collapse
Affiliation(s)
- Pietro Arina
- Department of Anesthesia and Critical Care, AOU Città Della Salute e della Scienza di Torino, University of Turin, Turin, Italy
- UCL, Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London WC1E 6BT, UK
| | - Matteo Sorge
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Andrea Gallo
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Vittoria Di Mauro
- IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
- National Research Council (CNR), Institute of Genetic and Biomedical Research (IRGB), UOS Milan, Milan, Italy
| | - Nicoletta Vitale
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Paola Cappello
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
- CeRMS-Lab di Immunologia dei Tumori, University of Turin, Turin, Italy
| | - Luca Brazzi
- Department of Anesthesia and Critical Care, AOU Città Della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Maria Barandalla-Sobrados
- IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
- National Research Council (CNR), Institute of Genetic and Biomedical Research (IRGB), UOS Milan, Milan, Italy
| | - James Cimino
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - V Marco Ranieri
- Department of Medical Sciences and Surgery, University of Bologna, Bologna, Italy
| | - Fiorella Altruda
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Mervyn Singer
- UCL, Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London WC1E 6BT, UK
| | - Daniele Catalucci
- IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
- National Research Council (CNR), Institute of Genetic and Biomedical Research (IRGB), UOS Milan, Milan, Italy
| | - Mara Brancaccio
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Vito Fanelli
- Department of Anesthesia and Critical Care, AOU Città Della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| |
Collapse
|
11
|
Tonetti T, Ranieri VM, Navalesi P, Nava S, Slutsky AS. Reply: High-Flow Oxygen Therapy for Severe Hypoxemia: Moving Towards a More Inclusive Definition of ARDS. Am J Respir Crit Care Med 2022; 206:515-516. [PMID: 35549642 DOI: 10.1164/rccm.202202-0332le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tommaso Tonetti
- Alma Mater Studiorum Università di Bologna, 9296, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Bologna, Italy
| | - V Marco Ranieri
- University of Bologna, 9296, Anesthesia and Intensive Care Medicine, Bologna, Italy
| | - Paolo Navalesi
- Università degli Studi di Padova, 9308, Anesthesia and Intensive Care, Padova, Italy
| | - Stefano Nava
- Universita degli Studi di Bologna Azienda Ospedaliera Sant'Orsola-Malpighi, 18508, Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, Bologna, Italy
| | - Arthur S Slutsky
- University of Toronto, 7938, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada;
| |
Collapse
|
12
|
Abstract
This cohort study examines admissions to intensive care units for COVID-19–associated acute respiratory distress syndrome by COVID-19 vaccination status among adults in the Veneto region of Italy from May to December 2021.
Collapse
Affiliation(s)
- Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Paolo Rosi
- Emergency Medical Services, Regional Department, AULSS 3, Venice, Italy
| | - Silvia De Rosa
- Department of Anesthesiology and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - V. Marco Ranieri
- Alma Mater Studiorum–Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), IRCCS Policlinico di Sant’Orsola, Anesthesia and Intensive Care Medicine, Bologna, Italy
| | - Paolo Navalesi
- Department of Medicine, University of Padova, Padova, Italy
- Institute of Anaesthesia and Intensive Care Unit, Padova University Hospital, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| |
Collapse
|
13
|
Ranieri VM, Tonetti T, Navalesi P, Nava S, Antonelli M, Pesenti A, Grasselli G, Grieco DL, Menga LS, Pisani L, Boscolo A, Sella N, Pasin L, Mega C, Pizzilli G, Dell’Olio A, Dongilli R, Rucci P, Slutsky AS. High-Flow Nasal Oxygen for Severe Hypoxemia: Oxygenation Response and Outcome in Patients with COVID-19. Am J Respir Crit Care Med 2022; 205:431-439. [PMID: 34861135 PMCID: PMC8886947 DOI: 10.1164/rccm.202109-2163oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: The "Berlin definition" of acute respiratory distress syndrome (ARDS) does not allow inclusion of patients receiving high-flow nasal oxygen (HFNO). However, several articles have proposed that criteria for defining ARDS should be broadened to allow inclusion of patients receiving HFNO. Objectives: To compare the proportion of patients fulfilling ARDS criteria during HFNO and soon after intubation, and 28-day mortality between patients treated exclusively with HFNO and patients transitioned from HFNO to invasive mechanical ventilation (IMV). Methods: From previously published studies, we analyzed patients with coronavirus disease (COVID-19) who had PaO2/FiO2 of ⩽300 while treated with ⩾40 L/min HFNO, or noninvasive ventilation (NIV) with positive end-expiratory pressure of ⩾5 cm H2O (comparator). In patients transitioned from HFNO/NIV to invasive mechanical ventilation (IMV), we compared ARDS severity during HFNO/NIV and soon after IMV. We compared 28-day mortality in patients treated exclusively with HFNO/NIV versus patients transitioned to IMV. Measurements and Main Results: We analyzed 184 and 131 patients receiving HFNO or NIV, respectively. A total of 112 HFNO and 69 NIV patients transitioned to IMV. Of those, 104 (92.9%) patients on HFNO and 66 (95.7%) on NIV continued to have PaO2/FiO2 ⩽300 under IMV. Twenty-eight-day mortality in patients who remained on HFNO was 4.2% (3/72), whereas in patients transitioned from HFNO to IMV, it was 28.6% (32/112) (P < 0.001). Twenty-eight-day mortality in patients who remained on NIV was 1.6% (1/62), whereas in patients who transitioned from NIV to IMV, it was 44.9% (31/69) (P < 0.001). Overall mortality was 19.0% (35/184) and 24.4% (32/131) for HFNO and NIV, respectively (P = 0.2479). Conclusions: Broadening the ARDS definition to include patients on HFNO with PaO2/FiO2 ⩽300 may identify patients at earlier stages of disease but with lower mortality.
Collapse
Affiliation(s)
- V. Marco Ranieri
- Department of Medical and Surgical Sciences
- Anesthesia and Intensive Care Medicine and
| | - Tommaso Tonetti
- Department of Medical and Surgical Sciences
- Anesthesia and Intensive Care Medicine and
| | - Paolo Navalesi
- Department of Medicine, University of Padova
, Padua, Italy
- Institute of Anesthesia and Intensive Care, Padova University Hospital, Padua, Italy
| | - Stefano Nava
- Department of Experimental, Diagnostic and Specialty Medicine
, and
- Pneumology and Respiratory Critical Care, Sant’Orsola Research Hospital IRCCS, Bologna, Italy
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
- Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation University of Milan
, Milan, Italy
- Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation University of Milan
, Milan, Italy
- Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
- Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Salvatore Menga
- Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lara Pisani
- Department of Experimental, Diagnostic and Specialty Medicine
, and
- Pneumology and Respiratory Critical Care, Sant’Orsola Research Hospital IRCCS, Bologna, Italy
| | - Annalisa Boscolo
- Institute of Anesthesia and Intensive Care, Padova University Hospital, Padua, Italy
| | - Nicolò Sella
- Department of Medicine, University of Padova
, Padua, Italy
- Institute of Anesthesia and Intensive Care, Padova University Hospital, Padua, Italy
| | - Laura Pasin
- Institute of Anesthesia and Intensive Care, Padova University Hospital, Padua, Italy
| | - Chiara Mega
- Department of Medical and Surgical Sciences
- Anesthesia and Intensive Care Medicine and
| | | | | | - Roberto Dongilli
- Division of Respiratory Diseases with Intermediate Respiratory Intensive Care Units, Central Hospital of Bolzano, Bolzano, Italy; and
| | - Paola Rucci
- Statistics and Epidemiology, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna
, Bologna, Italy
| | - Arthur S. Slutsky
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
14
|
Ranieri VM, Guérin C. The physiological foundations of critical care medicine: the contribution of Joseph Milic-Emili, a physiologist "by hook or by crook". Crit Care 2022. [PMID: 35135611 PMCID: PMC8822682 DOI: 10.1186/s13054-022-03919-z] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- V Marco Ranieri
- Department of Emergency and Intensive Care Medicine, Alma Mater Studiorum University of Bologna, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| | - Claude Guérin
- Service de Médecine Intensive-Réanimation, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69003, Lyon, France. .,Université de Lyon, Lyon, France. .,Institut Mondor de Recherche Biomédicales INSERM 955, Créteil, France.
| |
Collapse
|
15
|
Vincent JL, Singer M, Einav S, Moreno R, Wendon J, Teboul JL, Bakker J, Hernandez G, Annane D, de Man AME, Monnet X, Ranieri VM, Hamzaoui O, Takala J, Juffermans N, Chiche JD, Myatra SN, De Backer D. Equilibrating SSC guidelines with individualized care. Crit Care 2021; 25:397. [PMID: 34789298 PMCID: PMC8596086 DOI: 10.1186/s13054-021-03813-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070, Brussels, Belgium.
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, WC1E 6BT, UK
| | - Sharon Einav
- General Intensive Care Unit, Shaare Zedek Medical Centre, and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Rui Moreno
- Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
| | - Julia Wendon
- Department of Critical Care, Liver Sciences, Department of Inflammation Biology, King's College London, London, SE5 9RS, UK
| | - Jean-Louis Teboul
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, GHU APHP, Inserm UMR S_999, Université Paris-Saclay, 94270, Le Kremlin-Bicêtre, France
| | - Jan Bakker
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, 10016, USA.,Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.,Department of Intensive Care Adults, Erasmus MC University Medical Center, 3015 GD, Rotterdam, The Netherlands.,Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Glenn Hernandez
- Departmento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Djillali Annane
- School of Medicine Simone Veil, Raymond Poincaré Hospital (APHP), Department of Intensive Care Medicine, FHU SEPSIS, University of Versailles-University Paris Saclay, 92380, Garches, France
| | - Angélique M E de Man
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Xavier Monnet
- AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, 94270, Le Kremlin-Bicêtre, France
| | - V Marco Ranieri
- Department of Emergency and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, 40138, Bologna, Italy
| | - Olfa Hamzaoui
- Service de Réanimation Polyvalente, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 92140, Clamart, France
| | - Jukka Takala
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Nicole Juffermans
- Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Location Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands.,Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands
| | - Jean-Daniel Chiche
- Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, 400012, Mumbai, India
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospital, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
16
|
Ranieri VM, Tonetti T, Nava S. Transpulmonary Pressure to Guide Mechanical Ventilation: Art or Science? Am J Respir Crit Care Med 2021; 204:1120-1121. [PMID: 34672875 PMCID: PMC8759312 DOI: 10.1164/rccm.202109-2116ed] [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] [Indexed: 11/21/2022] Open
Affiliation(s)
- V Marco Ranieri
- Dipartimento di Scienze Mediche e Chirurgiche Alma Mater Studiorum - Università di Bologna Bologna, Italy
| | - Tommaso Tonetti
- Dipartimento di Scienze Mediche e Chirurgiche Alma Mater Studiorum - Università di Bologna Bologna, Italy
| | - Stefano Nava
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale Alma Mater Studiorum - Università di Bologna Bologna, Italy
| |
Collapse
|
17
|
Tonetti T, Pisani L, Cavalli I, Vega ML, Maietti E, Filippini C, Nava S, Ranieri VM. Extracorporeal carbon dioxide removal for treatment of exacerbated chronic obstructive pulmonary disease (ORION): study protocol for a randomised controlled trial. Trials 2021; 22:718. [PMID: 34666820 PMCID: PMC8524839 DOI: 10.1186/s13063-021-05692-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/07/2021] [Indexed: 02/08/2023] Open
Abstract
Background Hypercapnic exacerbations are severe complications of chronic obstructive pulmonary disease (COPD), characterized by negative impact on prognosis, quality of life and healthcare costs. The present standard of care for acute exacerbations of COPD is non-invasive ventilation; when it fails, the use of invasive mechanical ventilation is inevitable, but is associated with extremely poor prognosis. Extracorporeal circuits designed to remove CO2 (ECCO2R) may enhance the efficacy of NIV to remove CO2 and avoid the worsening of respiratory acidosis, which inevitably leads to failure of non-invasive ventilation. Although the use of ECCO2R for acute exacerbations of COPD is steadily increasing, solid evidence on its efficacy and safety is scarce, thus the need for a randomized controlled trial. Methods multicenter randomized controlled unblinded clinical trial including 284 (142 per arm) patients with acute hypercapnic respiratory failure caused by exacerbation of COPD, requiring respiratory support with NIV. The primary outcome is event free survival at 28 days, a composite outcome defined by survival in absence of prolonged mechanical ventilation, severe hypoxemia, septic shock and second episode of COPD exacerbation. Secondary outcomes are incidence of endotracheal intubation and tracheostomy, intensive care and hospital length-of-stay and 90-day mortality. Discussion Acute exacerbations of COPD represent a significant burden in terms of prognosis, quality of life and healthcare costs. Lack definite evidence despite increasing use of ECCO2R justifies a randomized trial to evaluate whether patients with acute hypercapnic acidosis not responsive to NIV should undergo invasive mechanical ventilation (with all serious related risks) or be treated with ECCO2R to avoid invasive ventilation but be exposed to possible adverse events of ECCO2R. Owing to its pragmatic nature, sample size and composite primary outcome, this trial aims at providing valuable answers to relevant questions for clinical treatment of acute exacerbations of COPD. Trial registration ClinicalTrials.gov, NCT04582799. Registered 12 October 2020, . Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05692-w.
Collapse
Affiliation(s)
- Tommaso Tonetti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Anesthesia and Intensive Care Medicine, Sant'Orsola Research Hospital, Bologna, Italy
| | - Lara Pisani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Pneumology and Respiratory Critical Care, Sant'Orsola Research Hospital, Bologna, Italy
| | - Irene Cavalli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Anesthesia and Intensive Care Medicine, Sant'Orsola Research Hospital, Bologna, Italy
| | - Maria Laura Vega
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Pneumology and Respiratory Critical Care, Sant'Orsola Research Hospital, Bologna, Italy
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Claudia Filippini
- Dipartimento di Scienze Chirurgiche, Università di Torino, Torino, Italy
| | - Stefano Nava
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Pneumology and Respiratory Critical Care, Sant'Orsola Research Hospital, Bologna, Italy
| | - V Marco Ranieri
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Bologna, Italy. .,Anesthesia and Intensive Care Medicine, Sant'Orsola Research Hospital, Bologna, Italy.
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Boscolo A, Sella N, Lorenzoni G, Pettenuzzo T, Pasin L, Pretto C, Tocco M, Tamburini E, De Cassai A, Rosi P, Polati E, Donadello K, Gottin L, De Rosa S, Baratto F, Toffoletto F, Ranieri VM, Gregori D, Navalesi P. Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS. Crit Care 2021; 25:263. [PMID: 34321047 PMCID: PMC8317138 DOI: 10.1186/s13054-021-03667-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/04/2021] [Indexed: 11/10/2022]
Abstract
Background Pathophysiological features of coronavirus disease 2019-associated acute respiratory distress syndrome (COVID-19 ARDS) were indicated to be somewhat different from those described in nonCOVID-19 ARDS, because of relatively preserved compliance of the respiratory system despite marked hypoxemia. We aim ascertaining whether respiratory system static compliance (Crs), driving pressure (DP), and tidal volume normalized for ideal body weight (VT/kg IBW) at the 1st day of controlled mechanical ventilation are associated with intensive care unit (ICU) mortality in COVID-19 ARDS. Methods Observational multicenter cohort study. All consecutive COVID-19 adult patients admitted to 25 ICUs belonging to the COVID-19 VENETO ICU network (February 28th–April 28th, 2020), who received controlled mechanical ventilation, were screened. Only patients fulfilling ARDS criteria and with complete records of Crs, DP and VT/kg IBW within the 1st day of controlled mechanical ventilation were included. Crs, DP and VT/kg IBW were collected in sedated, paralyzed and supine patients. Results A total of 704 COVID-19 patients were screened and 241 enrolled. Seventy-one patients (29%) died in ICU. The logistic regression analysis showed that: (1) Crs was not linearly associated with ICU mortality (p value for nonlinearity = 0.01), with a greater risk of death for values < 48 ml/cmH2O; (2) the association between DP and ICU mortality was linear (p value for nonlinearity = 0.68), and increasing DP from 10 to 14 cmH2O caused significant higher odds of in-ICU death (OR 1.45, 95% CI 1.06–1.99); (3) VT/kg IBW was not associated with a significant increase of the risk of death (OR 0.92, 95% CI 0.55–1.52). Multivariable analysis confirmed these findings. Conclusions Crs < 48 ml/cmH2O was associated with ICU mortality, while DP was linearly associated with mortality. DP should be kept as low as possible, even in the case of relatively preserved Crs, irrespective of VT/kg IBW, to reduce the risk of death. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03667-6.
Collapse
Affiliation(s)
- Annalisa Boscolo
- Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital, via V. Gallucci 13, 35125, Padua, Italy
| | - Nicolò Sella
- Department of Medicine (DIMED), Padua University School of Medicine, Padua, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University School of Medicine, Padua, Italy
| | - Tommaso Pettenuzzo
- Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital, via V. Gallucci 13, 35125, Padua, Italy
| | - Laura Pasin
- Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital, via V. Gallucci 13, 35125, Padua, Italy
| | - Chiara Pretto
- Department of Medicine (DIMED), Padua University School of Medicine, Padua, Italy
| | - Martina Tocco
- Department of Medicine (DIMED), Padua University School of Medicine, Padua, Italy
| | - Enrico Tamburini
- Department of Medicine (DIMED), Padua University School of Medicine, Padua, Italy
| | - Alessandro De Cassai
- Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital, via V. Gallucci 13, 35125, Padua, Italy
| | - Paolo Rosi
- Emergency Medical Services, Regional Department, AULSS 3, Venice, Italy
| | - Enrico Polati
- Anesthesia and Intensive Care Unit B, Verona University Hospital, Verona, Italy
| | - Katia Donadello
- Anesthesia and Intensive Care Unit B, Verona University Hospital, Verona, Italy
| | - Leonardo Gottin
- Anesthesia and Intensive Care Unit B, Verona University Hospital, Verona, Italy
| | - Silvia De Rosa
- Anesthesia and Critical Care Unit, San Bortolo Hospital, Vicenza, Italy
| | - Fabio Baratto
- Anesthesia and Intensive Care Unit, Ospedale Riuniti Padova Sud, Schiavonia, Italy
| | - Fabio Toffoletto
- Anesthesia and Intensive Care Unit, Ospedali di San Donà di Piave e Jesolo, San Donà di Piave, Italy
| | - V Marco Ranieri
- Anesthesia and Intensive Care Medicine, Department of Medical and Surgical Science, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University School of Medicine, Padua, Italy
| | - Paolo Navalesi
- Institute of Anaesthesia and Intensive Care Unit, Padua University Hospital, via V. Gallucci 13, 35125, Padua, Italy. .,Department of Medicine (DIMED), Padua University School of Medicine, Padua, Italy.
| | | |
Collapse
|
20
|
Grieco DL, Menga LS, Cesarano M, Rosà T, Spadaro S, Bitondo MM, Montomoli J, Falò G, Tonetti T, Cutuli SL, Pintaudi G, Tanzarella ES, Piervincenzi E, Bongiovanni F, Dell'Anna AM, Delle Cese L, Berardi C, Carelli S, Bocci MG, Montini L, Bello G, Natalini D, De Pascale G, Velardo M, Volta CA, Ranieri VM, Conti G, Maggiore SM, Antonelli M. Effect of Helmet Noninvasive Ventilation vs High-Flow Nasal Oxygen on Days Free of Respiratory Support in Patients With COVID-19 and Moderate to Severe Hypoxemic Respiratory Failure: The HENIVOT Randomized Clinical Trial. JAMA 2021; 325:1731-1743. [PMID: 33764378 PMCID: PMC7995134 DOI: 10.1001/jama.2021.4682] [Citation(s) in RCA: 248] [Impact Index Per Article: 82.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE High-flow nasal oxygen is recommended as initial treatment for acute hypoxemic respiratory failure and is widely applied in patients with COVID-19. OBJECTIVE To assess whether helmet noninvasive ventilation can increase the days free of respiratory support in patients with COVID-19 compared with high-flow nasal oxygen alone. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial in 4 intensive care units (ICUs) in Italy between October and December 2020, end of follow-up February 11, 2021, including 109 patients with COVID-19 and moderate to severe hypoxemic respiratory failure (ratio of partial pressure of arterial oxygen to fraction of inspired oxygen ≤200). INTERVENTIONS Participants were randomly assigned to receive continuous treatment with helmet noninvasive ventilation (positive end-expiratory pressure, 10-12 cm H2O; pressure support, 10-12 cm H2O) for at least 48 hours eventually followed by high-flow nasal oxygen (n = 54) or high-flow oxygen alone (60 L/min) (n = 55). MAIN OUTCOMES AND MEASURES The primary outcome was the number of days free of respiratory support within 28 days after enrollment. Secondary outcomes included the proportion of patients who required endotracheal intubation within 28 days from study enrollment, the number of days free of invasive mechanical ventilation at day 28, the number of days free of invasive mechanical ventilation at day 60, in-ICU mortality, in-hospital mortality, 28-day mortality, 60-day mortality, ICU length of stay, and hospital length of stay. RESULTS Among 110 patients who were randomized, 109 (99%) completed the trial (median age, 65 years [interquartile range {IQR}, 55-70]; 21 women [19%]). The median days free of respiratory support within 28 days after randomization were 20 (IQR, 0-25) in the helmet group and 18 (IQR, 0-22) in the high-flow nasal oxygen group, a difference that was not statistically significant (mean difference, 2 days [95% CI, -2 to 6]; P = .26). Of 9 prespecified secondary outcomes reported, 7 showed no significant difference. The rate of endotracheal intubation was significantly lower in the helmet group than in the high-flow nasal oxygen group (30% vs 51%; difference, -21% [95% CI, -38% to -3%]; P = .03). The median number of days free of invasive mechanical ventilation within 28 days was significantly higher in the helmet group than in the high-flow nasal oxygen group (28 [IQR, 13-28] vs 25 [IQR 4-28]; mean difference, 3 days [95% CI, 0-7]; P = .04). The rate of in-hospital mortality was 24% in the helmet group and 25% in the high-flow nasal oxygen group (absolute difference, -1% [95% CI, -17% to 15%]; P > .99). CONCLUSIONS AND RELEVANCE Among patients with COVID-19 and moderate to severe hypoxemia, treatment with helmet noninvasive ventilation, compared with high-flow nasal oxygen, resulted in no significant difference in the number of days free of respiratory support within 28 days. Further research is warranted to determine effects on other outcomes, including the need for endotracheal intubation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04502576.
Collapse
Affiliation(s)
- Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca S Menga
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Melania Cesarano
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tommaso Rosà
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Savino Spadaro
- Department of Morphology, Surgery, and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | | | - Jonathan Montomoli
- Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy
| | - Giulia Falò
- Department of Morphology, Surgery, and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Tommaso Tonetti
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Salvatore L Cutuli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Pintaudi
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eloisa S Tanzarella
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edoardo Piervincenzi
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Bongiovanni
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio M Dell'Anna
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Delle Cese
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cecilia Berardi
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simone Carelli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Grazia Bocci
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Montini
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Bello
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele Natalini
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro De Pascale
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Velardo
- European School of Obstetric Anesthesia, EESOA Simulation Center, Rome, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery, and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant'Anna, University of Ferrara, Ferrara, Italy
| | - V Marco Ranieri
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Giorgio Conti
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Maurizio Maggiore
- University Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine, and Emergency, SS Annunziata Hospital, Chieti, Italy
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario AGemelli IRCCS, Rome, Italy
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | | |
Collapse
|
21
|
Vincent JL, Juffermans NP, Burns KEA, Ranieri VM, Pourzitaki C, Rubulotta F. Addressing gender imbalance in intensive care. Crit Care 2021; 25:147. [PMID: 33863353 PMCID: PMC8051087 DOI: 10.1186/s13054-021-03569-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/07/2021] [Indexed: 12/02/2022]
Abstract
There is a large gender gap in critical care medicine with women underrepresented, particularly in positions of leadership. Yet gender diversity better reflects the current critical care community and has multiple beneficial effects at individual and societal levels. In this Viewpoint, we discuss some of the reasons for the persistent gender imbalance in critical care medicine, and suggest some possible strategies to help achieve greater equity and inclusion. An explicit and consistent focus on eliminating gender inequity is needed until gender diversity and inclusion become the norms in critical care medicine.
Collapse
Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| | - Nicole P Juffermans
- Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Location Academic Medical Centre, Amsterdam, The Netherlands.,Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - V Marco Ranieri
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Università di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Chryssa Pourzitaki
- Department of Anesthesiology and ICU, School of Health Sciences, Faculty of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Francesca Rubulotta
- Department of Anaesthesia and Intensive Care Medicine, Imperial College London, London, UK.,Chair of the International Women in Intensive & Critical Care Medicine Network, Catania, Italy
| |
Collapse
|
22
|
Costamagna A, Pivetta E, Goffi A, Steinberg I, Arina P, Mazzeo AT, Del Sorbo L, Veglia S, Davini O, Brazzi L, Ranieri VM, Fanelli V. Clinical performance of lung ultrasound in predicting ARDS morphology. Ann Intensive Care 2021; 11:51. [PMID: 33779834 PMCID: PMC8006629 DOI: 10.1186/s13613-021-00837-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/09/2021] [Indexed: 12/28/2022] Open
Abstract
Background To assess diagnostic performance of lung ultrasound (LUS) in identifying ARDS morphology (focal vs non-focal), compared with the gold standard computed tomography. Methods Mechanically ventilated ARDS patients undergoing lung computed tomography and ultrasound were enrolled. Twelve fields, were evaluated. LUS score was graded from 0 (normal) to 3 (consolidation) according to B-lines extent. Total and regional LUS score as the sum of the four ventral (LUSV), intermediate (LUSI) or dorsal (LUSD) fields, were calculated. Based on lung CT, ARDS morphology was defined as (1) focal (loss of aeration with lobar distribution); (2) non-focal (widespread loss of aeration or segmental loss of aeration distribution associated with uneven lung attenuation areas), and diagnostic accuracy of LUS in discriminating ARDS morphology was determined by AU-ROC in training and validation set of patients. Results Forty-seven patients with ARDS (25 training set and 22 validation set) were enrolled. LUSTOT, LUSV and LUSI but not LUSD score were significantly lower in focal than in non-focal ARDS morphologies (p < .01). The AU-ROC curve of LUSTOT, LUSV, LUSI and LUSD for identification of non-focal ARDS morphology were 0.890, 0.958, 0.884 and 0.421, respectively. LUSV value ≥ 3 had the best predictive value (sensitivity = 0.95, specificity = 1.00) in identifying non-focal ARDS morphology. In the validation set, an LUSV score ≥ 3 confirmed to be highly predictive of non-focal ARDS morphology, with a sensitivity and a specificity of 94% and 100%. Conclusions LUS had a valuable performance in distinguishing ARDS morphology. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00837-1.
Collapse
Affiliation(s)
- Andrea Costamagna
- Department of Anaesthesia and Critical Care, AOU Città della Salute e della Scienza di Torino, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Emanuele Pivetta
- Department of General and Specialized Medicine, Division of Emergency Medicine and High Dependency Unit, Cancer Epidemiology Unit - AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Critical Care Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Irene Steinberg
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Pietro Arina
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Anna Teresa Mazzeo
- Department of Surgical Sciences, University of Turin, Turin, Italy.,Dipartimento di Patologia Umana Dell'adulto e Dell'età Evolutiva, Anestesia e Rianimazione, Univesity of Messina, Messina, Italy
| | - Lorenzo Del Sorbo
- Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Respirology (Critical Care), University Health Network, Toronto, ON, Canada
| | - Simona Veglia
- Department of Diagnostic Imaging and Radiotherapy, AOU Città della Salute e della Scienza di Torino-University of Turin, Turin, Italy
| | - Ottavio Davini
- Department of Diagnostic Imaging and Radiotherapy, AOU Città della Salute e della Scienza di Torino-University of Turin, Turin, Italy
| | - Luca Brazzi
- Department of Anaesthesia and Critical Care, AOU Città della Salute e della Scienza di Torino, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - V Marco Ranieri
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Vito Fanelli
- Department of Anaesthesia and Critical Care, AOU Città della Salute e della Scienza di Torino, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy. .,Department of Surgical Sciences, University of Turin, Turin, Italy.
| |
Collapse
|
23
|
Sakr Y, François B, Solé-Violan J, Kotfis K, Jaschinski U, Estella A, Leone M, Jakob SM, Wittebole X, Fontes LE, de Melo Gurgel M, Midega T, Vincent JL, Ranieri VM. Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts. Crit Care 2021; 25:87. [PMID: 33632247 PMCID: PMC7906083 DOI: 10.1186/s13054-020-03455-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/27/2020] [Indexed: 12/15/2022]
Abstract
Background Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies.
Collapse
Affiliation(s)
- Yasser Sakr
- Department of Anaesthesiology and Intensive Care, Uniklinikum Jena, Jena, Germany
| | - Bruno François
- Intensive Care Unit and Inserm CIC 1435 & UMR 1092, Dupuytren University Hospital, Limoges, France
| | - Jordi Solé-Violan
- Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Ulrich Jaschinski
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinik Augsburg, Universität Augsburg, Augsburg, Germany
| | - Angel Estella
- Intensive Care Unit, Hospital SAS Jerez, Jerez, Spain
| | - Marc Leone
- Service d'Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Marseille, France
| | - Stephan M Jakob
- Department of Intensive Care Medicine, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Xavier Wittebole
- Department of Critical Care, Cliniques Universitaires St Luc, UCLouvain, Brussels, Belgium
| | - Luis E Fontes
- Departamento de Medicina Baseada em Evidências, Medicina Intensiva, Urgência e Emergência - Faculdade de Medicina de Petrópolis, Petrópolis, Brazil
| | | | - Thais Midega
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
| | - V Marco Ranieri
- Department of Medical and Surgical Science, Anesthesia and Intensive Care, Policlinico di Sant'Orsola, Alma Mater, University of Bologna, Bologna, Italy
| | | |
Collapse
|
24
|
Gaibani P, Tonetti T, Bartoletti M, Re MC, Viale P, Ranieri VM. Antiviral activity of interferon-based combination therapy in critically ill patients with COVID-19: Preliminary observations. J Glob Antimicrob Resist 2020; 24:124-126. [PMID: 33385588 PMCID: PMC7833089 DOI: 10.1016/j.jgar.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/21/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Paolo Gaibani
- Operative Unit of Clinical Microbiology, IRCCS S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Tommaso Tonetti
- Alma Mater Studiorum-Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| | - Michele Bartoletti
- Operative Unit of Infectious Diseases, IRCCS S. Orsola-Malpighi University Hospital, 9 via G. Massarenti, 40138 Bologna, Italy.
| | - Maria Carla Re
- Operative Unit of Clinical Microbiology, IRCCS S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - PierLuigi Viale
- Operative Unit of Infectious Diseases, IRCCS S. Orsola-Malpighi University Hospital, 9 via G. Massarenti, 40138 Bologna, Italy
| | - V Marco Ranieri
- Alma Mater Studiorum-Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| |
Collapse
|
25
|
Gamberini L, Tonetti T, Spadaro S, Zani G, Mazzoli CA, Capozzi C, Giampalma E, Reggiani MLB, Bertellini E, Castelli A, Cavalli I, Colombo D, Crimaldi F, Damiani F, Fogagnolo A, Fusari M, Gamberini E, Gordini G, Laici C, Lanza MC, Leo M, Marudi A, Nardi G, Ottaviani I, Papa R, Potalivo A, Russo E, Taddei S, Volta CA, Ranieri VM. Correction to: Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs. J Intensive Care 2020; 8:96. [PMID: 33327950 PMCID: PMC7744254 DOI: 10.1186/s40560-020-00514-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Lorenzo Gamberini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Tommaso Tonetti
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy.
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Ferrara, Cona, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Carlo Alberto Mazzoli
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Chiara Capozzi
- Cardio-Anesthesiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Maria Letizia Bacchi Reggiani
- Alma Mater University, Department of Clinical, Integrated and Experimental Medicine (DIMES), Statistical Service, S. Orsola-Malpighi Hospital Bologna, Bologna, Italy
| | - Elisabetta Bertellini
- Department of Anaesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Andrea Castelli
- Cardio-Anesthesiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - Irene Cavalli
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Davide Colombo
- Anaesthesia and Intensive Care Department, SS. Trinità Hospital, ASL, Novara, Italy.,Translational Medicine Department, Eastern Piedmont University, Novara, Italy
| | - Federico Crimaldi
- Anaesthesia and Intensive Care Residency Program - Translational Medicine Department, Eastern Piedmont University, Novara, Italy
| | - Federica Damiani
- Department of Anaesthesia, Intensive Care and Pain Therapy - Imola Hospital, Imola, Italy
| | - Alberto Fogagnolo
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Ferrara, Cona, Italy
| | - Maurizio Fusari
- Department of Anesthesia and Intensive Care, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Emiliano Gamberini
- Anaesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy
| | - Giovanni Gordini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Cristiana Laici
- Division of Anesthesiology, Hospital S. Orsola Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maria Concetta Lanza
- Department of Anesthesia and Intensive Care, G.B. Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Mirco Leo
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Marudi
- Department of Anaesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Giuseppe Nardi
- Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy
| | - Irene Ottaviani
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Ferrara, Cona, Italy
| | - Raffaella Papa
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Antonella Potalivo
- Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy
| | - Emanuele Russo
- Anaesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy
| | - Stefania Taddei
- Anaesthesia and Intensive Care Unit, Bentivoglio Hospital, Bentivoglio, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Ferrara, Cona, Italy
| | - V Marco Ranieri
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | | |
Collapse
|
26
|
Goligher EC, Ranieri VM, Slutsky AS. Is severe COVID-19 pneumonia a typical or atypical form of ARDS? And does it matter? Intensive Care Med 2020; 47:83-85. [PMID: 33237346 PMCID: PMC7686835 DOI: 10.1007/s00134-020-06320-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada.,Toronto General Hospital Research Institute, Toronto, Canada
| | - V Marco Ranieri
- Dipartimento di scienze mediche e chirurgiche, Anesthesia and intensive care medicine, Policlinico di Sant'orsola, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. .,Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| |
Collapse
|
27
|
Grasselli G, Tonetti T, Filippini C, Slutsky AS, Pesenti A, Ranieri VM. Pathophysiology of COVID-19-associated acute respiratory distress syndrome - Authors' reply. Lancet Respir Med 2020; 9:e5-e6. [PMID: 33197387 PMCID: PMC7832136 DOI: 10.1016/s2213-2600(20)30525-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Giacomo Grasselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Tommaso Tonetti
- Alma Mater Studiorum-Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, 40138 Bologna, Italy
| | - Claudia Filippini
- Dipartimento di Scienze Chirurgiche, Università di Torino, Turin, Italy
| | - Arthur S Slutsky
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Antonio Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - V Marco Ranieri
- Alma Mater Studiorum-Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, 40138 Bologna, Italy.
| |
Collapse
|
28
|
Husain-Syed F, Birk HW, Wilhelm J, Ronco C, Ranieri VM, Karle B, Kuhnert S, Tello K, Hecker M, Morty RE, Herold S, Kehl O, Walmrath HD, Seeger W, Vadász I. Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome. Front Med (Lausanne) 2020; 7:598379. [PMID: 33304914 PMCID: PMC7693445 DOI: 10.3389/fmed.2020.598379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/07/2020] [Indexed: 01/20/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) is associated with high mortality. Lung-protective ventilation is the current standard of care in patients with ARDS, but it might lead to hypercapnia, which is independently associated with worse outcomes. Extracorporeal carbon dioxide removal (ECCO2R) has been proposed as an adjuvant therapy to avoid progression of clinical severity and limit further ventilator-induced lung injury, but its use in COVID-19 has not been described yet. Acute kidney injury requiring renal replacement therapy (RRT) is common among critically ill COVID-19 patients. In centers with available dialysis, low-flow ECCO2R (<500 mL/min) using RRT platforms could be carried out by dialysis specialists and might be an option to efficiently allocate resources during the COVID-19 pandemic for patients with hypercapnia as the main indication. Here, we report the feasibility, safety, and efficacy of ECCO2R using an RRT platform to provide either standalone ECCO2R or ECCO2R combined with RRT in four hypercapnic patients with moderate ARDS. A randomized clinical trial is required to assess the overall benefit and harm. Clinical Trial Registration:ClinicalTrials.gov. Unique identifier: NCT04351906.
Collapse
Affiliation(s)
- Faeq Husain-Syed
- Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Horst-Walter Birk
- Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - Jochen Wilhelm
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.,The Cardio-Pulmonary Institute, Giessen, Germany.,Institute for Lung Health, Justus Liebig University Giessen, Giessen, Germany
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy.,Department of Medicine (DIMED), Università di Padova, Padua, Italy
| | - V Marco Ranieri
- Department of Medical and Surgical Sciences (DIMEC), Anaesthesia and Intensive Care Medicine, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Bianka Karle
- Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - Stefan Kuhnert
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - Khodr Tello
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.,The Cardio-Pulmonary Institute, Giessen, Germany
| | - Matthias Hecker
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany
| | - Rory E Morty
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.,The Cardio-Pulmonary Institute, Giessen, Germany.,Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Susanne Herold
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.,The Cardio-Pulmonary Institute, Giessen, Germany
| | - Oliver Kehl
- Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - Hans-Dieter Walmrath
- Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - Werner Seeger
- Divison of Nephrology, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.,The Cardio-Pulmonary Institute, Giessen, Germany.,Institute for Lung Health, Justus Liebig University Giessen, Giessen, Germany.,Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - István Vadász
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany.,Universities of Giessen and Marburg Lung Center, Justus Liebig University Giessen, Giessen, Germany.,The Cardio-Pulmonary Institute, Giessen, Germany
| |
Collapse
|
29
|
Franco C, Facciolongo N, Tonelli R, Dongilli R, Vianello A, Pisani L, Scala R, Malerba M, Carlucci A, Negri EA, Spoladore G, Arcaro G, Tillio PA, Lastoria C, Schifino G, Tabbì L, Guidelli L, Guaraldi G, Ranieri VM, Clini E, Nava S. Feasibility and clinical impact of out-of-ICU noninvasive respiratory support in patients with COVID-19-related pneumonia. Eur Respir J 2020; 56:13993003.02130-2020. [PMID: 32747398 PMCID: PMC7397952 DOI: 10.1183/13993003.02130-2020] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [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: 06/03/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023]
Abstract
Introduction The severe acute respiratory syndrome-coronavirus 2 outbreak spread rapidly in Italy and the lack of intensive care unit (ICU) beds soon became evident, forcing the application of noninvasive respiratory support (NRS) outside the ICU, raising concerns over staff contamination. We aimed to analyse the safety of the hospital staff and the feasibility and outcomes of NRS applied to patients outside the ICU. Methods In this observational study, data from 670 consecutive patients with confirmed coronavirus disease 2019 referred to pulmonology units in nine hospitals between March 1 and May 10, 2020 were analysed. Data collected included medication, mode and usage of NRS (i.e. high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), noninvasive ventilation (NIV)), length of stay in hospital, endotracheal intubation (ETI) and deaths. Results 42 (11.1%) healthcare workers tested positive for infection, but only three of them required hospitalisation. Data are reported for all patients (69.3% male), whose mean±sd age was 68±13 years. The arterial oxygen tension/inspiratory oxygen fraction ratio at baseline was 152±79, and the majority (49.3%) of patients were treated with CPAP. The overall unadjusted 30-day mortality rate was 26.9%, with 16%, 30% and 30% for HFNC, CPAP and NIV, respectively, while the total ETI rate was 27%, with 29%, 25% and 28%, respectively; the relative probability of death was not related to the NRS used after adjustment for confounders. ETI and length of stay were not different among the groups. Mortality rate increased with age and comorbidity class progression. Conclusions The application of NRS outside the ICU is feasible and associated with favourable outcomes. Nonetheless, it was associated with a risk of staff contamination. In patients with SARS-CoV-2 infection and acute respiratory failure, this study demonstrates that the utilisation of noninvasive respiratory support delivered outside the ICU was feasible and effective, but associated with a risk of staff contaminationhttps://bit.ly/33mrJTU
Collapse
Affiliation(s)
- Cosimo Franco
- Respiratory Intensive Care Unit - AUSL, Piacenza, Italy.,Contributed equally to the work and should both be considered as first author
| | - Nicola Facciolongo
- Respiratory Unit AUSL Reggio Emilia, IRCCS di Reggio Emilia, Modena, Italy.,Contributed equally to the work and should both be considered as first author
| | - Roberto Tonelli
- Clinical and Experimental Medicine PhD Programme, University of Modena Reggio Emilia, Modena, Italy.,University Hospital of Modena, Respiratory Diseases Unit, Dept of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy
| | - Roberto Dongilli
- Division of Respiratory Diseases with Intermediate Respiratory Intensive Care Units, Central Hospital of Bolzano, Bolzano, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division University of Padova, Padova, Italy
| | - Lara Pisani
- Respiratory and Critical Care Unit, Sant'Orsola Hospital, Bologna Dept of Specialist, Diagnostic, and Experimental Medicine, School of Medicine, University di Bologna, Bologna, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Mario Malerba
- Dept of Translational Medicine, Università Piemonte Orientale, Respiratory Unit, Ospedale S. Andrea, Vercelli, Italy
| | - Annalisa Carlucci
- Dipartimento di Medicina e Chirurgia, Università Insubria Varese-Como, ICS Maugeri, Pavia, Italy
| | | | - Greta Spoladore
- Division of Infectious Diseases, Central Hospital of Bolzano, Bolzano, Italy
| | - Giovanna Arcaro
- Respiratory Pathophysiology Division University of Padova, Padova, Italy
| | - Paolo Amedeo Tillio
- Dept of Translational Medicine, Università Piemonte Orientale, Respiratory Unit, Ospedale S. Andrea, Vercelli, Italy
| | | | - Gioachino Schifino
- Respiratory and Critical Care Unit, Sant'Orsola Hospital, Bologna Dept of Specialist, Diagnostic, and Experimental Medicine, School of Medicine, University di Bologna, Bologna, Italy
| | - Luca Tabbì
- University Hospital of Modena, Respiratory Diseases Unit, Dept of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy
| | - Luca Guidelli
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Giovanni Guaraldi
- Infectious Diseases Unit, University Hospital of Modena Policlinico. University of Modena Reggio Emilia, Modena, Italy
| | - V Marco Ranieri
- Alma Mater Studiorum - Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Bologna, Italy
| | - Enrico Clini
- University Hospital of Modena, Respiratory Diseases Unit, Dept of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.,Contributed equally to the work and should both be considered as senior author
| | - Stefano Nava
- Alma Mater Studiorum - Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Infectious Diseases Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Contributed equally to the work and should both be considered as senior author
| |
Collapse
|
30
|
Gamberini L, Tonetti T, Spadaro S, Zani G, Mazzoli CA, Capozzi C, Giampalma E, Bacchi Reggiani ML, Bertellini E, Castelli A, Cavalli I, Colombo D, Crimaldi F, Damiani F, Fogagnolo A, Fusari M, Gamberini E, Gordini G, Laici C, Lanza MC, Leo M, Marudi A, Nardi G, Ottaviani I, Papa R, Potalivo A, Russo E, Taddei S, Volta CA, Ranieri VM. Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs. J Intensive Care 2020; 8:80. [PMID: 33078076 PMCID: PMC7558552 DOI: 10.1186/s40560-020-00499-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation.The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. METHODS This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. RESULTS Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO2/FiO2 ratio during the first 5 days of MV, respiratory system compliance (CRS) lower than 40 mL/cmH2O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications.ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable. CONCLUSIONS Age, SOFA score at ICU admission, CRS, PaO2/FiO2, renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19. TRIAL REGISTRATION NCT04411459.
Collapse
Affiliation(s)
- Lorenzo Gamberini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Tommaso Tonetti
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Università di Bologna, Bologna, Italy
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121 Ferrara, Cona Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Carlo Alberto Mazzoli
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Chiara Capozzi
- Cardio-Anesthesiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Maria Letizia Bacchi Reggiani
- Alma Mater University, Department of Clinical, Integrated and Experimental Medicine (DIMES), Statistical Service, S. Orsola-Malpighi Hospital Bologna, Bologna, Italy
| | - Elisabetta Bertellini
- Department of Anaesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Andrea Castelli
- Cardio-Anesthesiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - Irene Cavalli
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Università di Bologna, Bologna, Italy
| | - Davide Colombo
- Anaesthesia and Intensive Care Department, SS. Trinità Hospital, ASL, Novara, Italy
- Translational Medicine Department, Eastern Piedmont University, Novara, Italy
| | - Federico Crimaldi
- Anaesthesia and Intensive Care Residency Program – Translational Medicine Department, Eastern Piedmont University, Novara, Italy
| | - Federica Damiani
- Department of Anaesthesia, Intensive Care and Pain Therapy – Imola Hospital, Imola, Italy
| | - Alberto Fogagnolo
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121 Ferrara, Cona Italy
| | - Maurizio Fusari
- Department of Anesthesia and Intensive Care, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Emiliano Gamberini
- Anaesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy
| | - Giovanni Gordini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Cristiana Laici
- Division of Anesthesiology, Hospital S. Orsola Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maria Concetta Lanza
- Department of Anesthesia and Intensive Care, G.B. Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Mirco Leo
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Marudi
- Department of Anaesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Giuseppe Nardi
- Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy
| | - Irene Ottaviani
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121 Ferrara, Cona Italy
| | - Raffaella Papa
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Antonella Potalivo
- Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy
| | - Emanuele Russo
- Anaesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy
| | - Stefania Taddei
- Anaesthesia and Intensive Care Unit, Bentivoglio Hospital, Bentivoglio, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121 Ferrara, Cona Italy
| | - V. Marco Ranieri
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Università di Bologna, Bologna, Italy
| |
Collapse
|
31
|
Tonetti T, Grasselli G, Zanella A, Pizzilli G, Fumagalli R, Piva S, Lorini L, Iotti G, Foti G, Colombo S, Vivona L, Rossi S, Girardis M, Agnoletti V, Campagna A, Gordini G, Navalesi P, Boscolo A, Graziano A, Valeri I, Vianello A, Cereda D, Filippini C, Cecconi M, Locatelli F, Bartoletti M, Giannella M, Viale P, Antonelli M, Nava S, Pesenti A, Ranieri VM. Use of critical care resources during the first 2 weeks (February 24-March 8, 2020) of the Covid-19 outbreak in Italy. Ann Intensive Care 2020; 10:133. [PMID: 33044646 PMCID: PMC7549086 DOI: 10.1186/s13613-020-00750-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.
Collapse
Affiliation(s)
- Tommaso Tonetti
- Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Anesthesia and Intensive Care Medicine, Università Di Bologna, Policlinico Di Sant'Orsola, Via Massarenti, 9 40138, Bologna, Italy.
| | - Giacomo Grasselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alberto Zanella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacinto Pizzilli
- Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Anesthesia and Intensive Care Medicine, Università Di Bologna, Policlinico Di Sant'Orsola, Via Massarenti, 9 40138, Bologna, Italy
| | - Roberto Fumagalli
- Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, University of Milano-Bicocca, Milan, Italy
| | - Simone Piva
- Anesthesia and Critical Care, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Luca Lorini
- Anesthesia and Critical Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giorgio Iotti
- Anesthesia and Critical Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Foti
- Anesthesia and Critical Care, ASST Ospedale San Gerardo Di Monza, University of Milano-Bicocca, Milan, Italy
| | - Sergio Colombo
- Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Vivona
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Sandra Rossi
- Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Di Parma, Parma, Italy
| | - Massimo Girardis
- Anesthesia and Critical Care, Policlinico Di Modena, Università Di Modena E Reggio Emilia, Modena, Italy
| | - Vanni Agnoletti
- Anesthesia and Critical Care Ospedale "M. Bufalini", Cesena, Italy
| | - Anselmo Campagna
- Assessorato Cura Della Persona, Regione Emilia-Romagna, Salute e Walfare, Bologna, Italy
| | - Giovanni Gordini
- Anesthesia and Critical Care Ospedale, Ospedale Maggiore, Bologna, Italy
| | - Paolo Navalesi
- Anesthesia and Critical Care, Department of Medicine, DIMED - University of Padua, University Hospital of Padua, Padua, Italy
| | - Annalisa Boscolo
- Anesthesia and Critical Care, Department of Medicine, DIMED - University of Padua, University Hospital of Padua, Padua, Italy
| | - Alessandro Graziano
- Anesthesia and Critical Care, Department of Medicine, DIMED - University of Padua, University Hospital of Padua, Padua, Italy
| | - Ilaria Valeri
- Anesthesia and Critical Care, Department of Medicine, DIMED - University of Padua, University Hospital of Padua, Padua, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division University-City Hospital of Padua, Padua, Italy
| | - Danilo Cereda
- Direzione Generale Welfare, Lombardy Region, Milan, Italy
| | - Claudia Filippini
- Dipartimento Di Scienze Chirurgiche, Università Di Torino, Torino, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy.,Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Sapienza University of Rome, IRCCS Ospedale Pediatrico Bambino Gesù. President of the "Consiglio Superiore Di Sanità", Rome, Italy
| | - Michele Bartoletti
- Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Infectious Diseases Unit, Università Di Bologna, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maddalena Giannella
- Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Infectious Diseases Unit, Università Di Bologna, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pierluigi Viale
- Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Infectious Diseases Unit, Università Di Bologna, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Massimo Antonelli
- Dept. of Intensive Care Emergency Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Nava
- Department of Clinical, Integrated, and Experimental Medicine (DIMES), Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Antonio Pesenti
- Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Anesthesia and Intensive Care Medicine, Università Di Bologna, Policlinico Di Sant'Orsola, Via Massarenti, 9 40138, Bologna, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - V Marco Ranieri
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | |
Collapse
|
32
|
Sakr Y, Giovini M, Leone M, Pizzilli G, Kortgen A, Bauer M, Tonetti T, Duclos G, Zieleskiewicz L, Buschbeck S, Ranieri VM, Antonucci E. The clinical spectrum of pulmonary thromboembolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: A European case series. J Crit Care 2020; 61:39-44. [PMID: 33075608 PMCID: PMC7518181 DOI: 10.1016/j.jcrc.2020.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/22/2022]
Abstract
Purpose To describe the clinical characteristics and outcomes of coronavirus disease-2019 (COVID-19)-associated pulmonary thromboembolism (PTE). Materials and methods A case series of five patients, representing the clinical spectrum of COVID-19 associated PTE. Patients were admitted to four hospitals in Germany, Italy, and France. Infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was confirmed using a real-time reverse transcription polymerase chain reaction test. Results The onset of PTE varied from 2 to 4 weeks after the occurrence of the initial symptoms of SARS-CoV-2 infection and led to deterioration of the clinical picture in all cases. PTE was the primary reason for hospital admission after a 2-week period of self-isolation at home (1 patient) and hospital readmission after initial uncomplicated hospital discharge (2 patients). Three of the patients had no past history of clinically relevant risk factors for venous thromboembolism (VTE). Severe disease progression was associated with concomitant increases in IL-6, ferritin, and D-Dimer levels. The outcome from PTE was related to the extent of vascular involvement, and associated complications. Conclusion PTE is a potential life-threatening complication, which occurs frequently in patients with COVID-19. Intermediate therapeutic dose of anticoagulants and extend thromboprophylaxis are necessary after meticulous risk-benefit assessment. Pulnonary thromboembolism (PTE) is a frequent life-threatening complication in patients with COVID-19. The onset of PTE varies from 2 to 4 weeks after the occurrence of the initial symptoms. PTE may occur in patients without past history of risk factors for venous thromboembolism and in those receiving standard prophylactic anticoagulation. Intermediate therapeutic dose of anticoagulants and extend thromboprophylaxis are necessary in these patients after meticulous risk-benefit assessment.
Collapse
Affiliation(s)
- Yasser Sakr
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
| | - Manuela Giovini
- Intermediate Care Unit, Emergency Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Marc Leone
- Service d'Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - Giacinto Pizzilli
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum - Università di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Andreas Kortgen
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Michael Bauer
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Tommaso Tonetti
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum - Università di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Gary Duclos
- Service d'Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - Samuel Buschbeck
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - V Marco Ranieri
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum - Università di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Elio Antonucci
- Intermediate Care Unit, Emergency Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| |
Collapse
|
33
|
Sakr Y, Giovini M, Leone M, Pizzilli G, Kortgen A, Bauer M, Tonetti T, Duclos G, Zieleskiewicz L, Buschbeck S, Ranieri VM, Antonucci E. Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review. Ann Intensive Care 2020; 10:124. [PMID: 32953201 PMCID: PMC7492788 DOI: 10.1186/s13613-020-00741-0] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/06/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Preliminary reports have described significant procoagulant events in patients with coronavirus disease-2019 (COVID-19), including life-threatening pulmonary embolism (PE). MAIN TEXT We review the current data on the epidemiology, the possible underlying pathophysiologic mechanisms, and the therapeutic implications of PE in relation to COVID-19. The incidence of PE is reported to be around 2.6-8.9% of COVID-19 in hospitalized patients and up to one-third of those requiring intensive care unit (ICU) admission, despite standard prophylactic anticoagulation. This may be explained by direct and indirect pathologic consequences of COVID-19, complement activation, cytokine release, endothelial dysfunction, and interactions between different types of blood cells. CONCLUSION Thromboprophylaxis should be started in all patients with suspected or confirmed COVID-19 admitted to the hospital. The use of an intermediate therapeutic dose of low molecular weight (LMWH) or unfractionated heparin can be considered on an individual basis in patients with multiple risk factors for venous thromboembolism, including critically ill patients admitted to the ICU. Decisions about extending prophylaxis with LMWH after hospital discharge should be made after balancing the reduced risk of venous thromboembolism (VTE) with the risk of increased bleeding events and should be continued for 7-14 days after hospital discharge or in the pre-hospital phase in case of pre-existing or persisting VTE risk factors. Therapeutic anticoagulation is the cornerstone in the management of patients with PE. Selection of an appropriate agent and correct dosing requires consideration of underlying comorbidities.
Collapse
Affiliation(s)
- Yasser Sakr
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany
| | - Manuela Giovini
- Intermediate Care Unit, Emergency Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Marc Leone
- Service d’Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - Giacinto Pizzilli
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Università di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | - Andreas Kortgen
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany
| | - Michael Bauer
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany
| | - Tommaso Tonetti
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Università di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | - Gary Duclos
- Service d’Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - Laurent Zieleskiewicz
- Service d’Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital Nord, Marseille, France
| | - Samuel Buschbeck
- Dept. of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany
| | - V. Marco Ranieri
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Università di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
| | - Elio Antonucci
- Intermediate Care Unit, Emergency Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| |
Collapse
|
34
|
Grasselli G, Tonetti T, Protti A, Langer T, Girardis M, Bellani G, Laffey J, Carrafiello G, Carsana L, Rizzuto C, Zanella A, Scaravilli V, Pizzilli G, Grieco DL, Di Meglio L, de Pascale G, Lanza E, Monteduro F, Zompatori M, Filippini C, Locatelli F, Cecconi M, Fumagalli R, Nava S, Vincent JL, Antonelli M, Slutsky AS, Pesenti A, Ranieri VM. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. Lancet Respir Med 2020; 8:1201-1208. [PMID: 32861276 PMCID: PMC7834127 DOI: 10.1016/s2213-2600(20)30370-2] [Citation(s) in RCA: 437] [Impact Index Per Article: 109.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/23/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023]
Abstract
Background Patients with COVID-19 can develop acute respiratory distress syndrome (ARDS), which is associated with high mortality. The aim of this study was to examine the functional and morphological features of COVID-19-associated ARDS and to compare these with the characteristics of ARDS unrelated to COVID-19. Methods This prospective observational study was done at seven hospitals in Italy. We enrolled consecutive, mechanically ventilated patients with laboratory-confirmed COVID-19 and who met Berlin criteria for ARDS, who were admitted to the intensive care unit (ICU) between March 9 and March 22, 2020. All patients were sedated, paralysed, and ventilated in volume-control mode with standard ICU ventilators. Static respiratory system compliance, the ratio of partial pressure of arterial oxygen to fractional concentration of oxygen in inspired air, ventilatory ratio (a surrogate of dead space), and D-dimer concentrations were measured within 24 h of ICU admission. Lung CT scans and CT angiograms were done when clinically indicated. A dataset for ARDS unrelated to COVID-19 was created from previous ARDS studies. Survival to day 28 was assessed. Findings Between March 9 and March 22, 2020, 301 patients with COVID-19 met the Berlin criteria for ARDS at participating hospitals. Median static compliance was 41 mL/cm H2O (33–52), which was 28% higher than in the cohort of patients with ARDS unrelated to COVID-19 (32 mL/cm H2O [25–43]; p<0·0001). 17 (6%) of 297 patients with COVID-19-associated ARDS had compliances greater than the 95th percentile of the classical ARDS cohort. Total lung weight did not differ between the two cohorts. CT pulmonary angiograms (obtained in 23 [8%] patients with COVID-19-related ARDS) showed that 15 (94%) of 16 patients with D-dimer concentrations greater than the median had bilateral areas of hypoperfusion, consistent with thromboembolic disease. Patients with D-dimer concentrations equal to or less than the median had ventilatory ratios lower than those of patients with D-dimer concentrations greater than the median (1·66 [1·32–1·95] vs 1·90 [1·50–2·33]; p=0·0001). Patients with static compliance equal to or less than the median and D-dimer concentrations greater than the median had markedly increased 28-day mortality compared with other patient subgroups (40 [56%] of 71 with high D-dimers and low compliance vs 18 [27%] of 67 with low D-dimers and high compliance, 13 [22%] of 60 with low D-dimers and low compliance, and 22 [35%] of 63 with high D-dimers and high compliance, all p=0·0001). Interpretation Patients with COVID-19-associated ARDS have a form of injury that, in many aspects, is similar to that of those with ARDS unrelated to COVID-19. Notably, patients with COVID-19-related ARDS who have a reduction in respiratory system compliance together with increased D-dimer concentrations have high mortality rates. Funding None.
Collapse
Affiliation(s)
- Giacomo Grasselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Tommaso Tonetti
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Alessandro Protti
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Dipartimento di Anestesia e Rianimazione, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Giacomo Bellani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Anesthesia and Intensive Care Medicine, ASST Monza-Ospedale San Gerardo, Monza, Italy
| | - John Laffey
- Regenerative Medicine Institute at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland; Anaesthesia and Intensive Care Medicine, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gianpaolo Carrafiello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Dipartimento di Scienze della Salute, University of Milan, Milan, Italy
| | - Luca Carsana
- Department of Anatomy and Histopathology, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Chiara Rizzuto
- Department of Anesthesia and Intensive Care Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Polo Universitario, University of Milan, Milan, Italy
| | - Alberto Zanella
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Vittorio Scaravilli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giacinto Pizzilli
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Letizia Di Meglio
- Dipartimento di Scienze della Salute, University of Milan, Milan, Italy
| | - Gennaro de Pascale
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Ezio Lanza
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Francesco Monteduro
- Dipartimento di Radiologia, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Maurizio Zompatori
- Dipartimento di Radiologia, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Claudia Filippini
- Dipartimento di Scienze Chirurgiche, Università di Torino, Torino, Italy
| | - Franco Locatelli
- Department of Pediatric Hemato-Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Dipartimento di Anestesia e Rianimazione, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine, Respiratory and Critical Care Unit, S Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Arthur S Slutsky
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Antonio Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - V Marco Ranieri
- Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum-Università di Bologna, Bologna, Italy.
| | | |
Collapse
|
35
|
Pisani L, Nava S, Desiderio E, Polverino M, Tonetti T, Ranieri VM. Extracorporeal CO2 removal (ECCO2R) in patients with stable COPD with chronic hypercapnia: a proof-of-concept study. Thorax 2020; 75:897-900. [DOI: 10.1136/thoraxjnl-2020-214744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/03/2022]
Abstract
AbstractDomiciliary non-invasive ventilation (NIV) effectively reduces arterial carbon dioxide pressure (PaCO2) in patients with stable hypercapnic chronic obstructive pulmonary disease, but a consistent percentage of them may remain hypercapnic. We hypothesised that extracorporeal CO2 removal (ECCO2R) may lower their PaCO2. Ten patients hypercapnic despite ≥6 months of NIV underwent a 24-hour trial of ECCO2R. Six patients completed the ECCO2R-trial with a PaCO2 drop ranging between 23% and 47%. Time to return to baseline after interruption ranged 48–96 hours. In four patients, mechanical events led to ECCO2R premature interruption, despite a decreased in PaCO2. This time window ‘free’ from hypercapnia might allow to propose the concept of ‘CO2 dialysis’.
Collapse
|
36
|
Bellingan G, Ranieri VM, Karvonen MK. Intravenous Interferon β-1a for Severe ARDS-Reply. JAMA 2020; 324:515-516. [PMID: 32749487 DOI: 10.1001/jama.2020.7992] [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: 11/14/2022]
Affiliation(s)
- Geoff Bellingan
- Critical Care, University College London Hospitals, London, United Kingdom
| | | | | |
Collapse
|
37
|
|
38
|
Fanelli V, Del Sorbo L, Boffini M, Costamagna A, Balzano S, Musso T, Scutera S, Cappello P, Mazzeo A, Solidoro P, Baietto L, D'avolio A, Derosa FG, Brazzi L, Mascia L, Rinaldi M, Ranieri VM. Impact of imipenem concentration in lung perfusate and tissue biopsy during clinical ex-vivo lung perfusion of high-risk lung donors. Minerva Anestesiol 2020; 86:617-626. [DOI: 10.23736/s0375-9393.20.13840-9] [Citation(s) in RCA: 1] [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: 11/08/2022]
|
39
|
Tonetti T, Zanella A, Pizzilli G, Irvin Babcock C, Venturi S, Nava S, Pesenti A, Ranieri VM. One ventilator for two patients: feasibility and considerations of a last resort solution in case of equipment shortage. Thorax 2020; 75:517-519. [PMID: 32327566 PMCID: PMC7211107 DOI: 10.1136/thoraxjnl-2020-214895] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Tommaso Tonetti
- Department of Medical and Surgical Sciences (DIMEC), Anesthesia and Intensive Care Medicine, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Alberto Zanella
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Lombardia, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milano, Italy
| | - Giacinto Pizzilli
- Anesthesia and Intensive Care Medicine, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Charlene Irvin Babcock
- Department of Emergency Medicine, Ascension St John Hospital and Medical Center, Detroit, Michigan, USA
| | - Sergio Venturi
- Covid-19 Commissioner, Emilia-Romagna Region, Bologna, Emilia-Romagna, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Antonio Pesenti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Lombardia, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milano, Italy
| | - V Marco Ranieri
- Department of Medical and Surgical Sciences (DIMEC), Anesthesia and Intensive Care Medicine, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Emilia-Romagna, Italy
| |
Collapse
|
40
|
Abrams D, Schmidt M, Pham T, Beitler JR, Fan E, Goligher EC, McNamee JJ, Patroniti N, Wilcox ME, Combes A, Ferguson ND, McAuley DF, Pesenti A, Quintel M, Fraser J, Hodgson CL, Hough CL, Mercat A, Mueller T, Pellegrino V, Ranieri VM, Rowan K, Shekar K, Brochard L, Brodie D. Mechanical Ventilation for Acute Respiratory Distress Syndrome during Extracorporeal Life Support. Research and Practice. Am J Respir Crit Care Med 2020; 201:514-525. [DOI: 10.1164/rccm.201907-1283ci] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Darryl Abrams
- Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, New York, New York
- Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York
| | - Matthieu Schmidt
- INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Tài Pham
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - Jeremy R. Beitler
- Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, New York, New York
- Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ewan C. Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - James J. McNamee
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, United Kingdom
| | - Nicolò Patroniti
- Anaesthesia and Intensive Care, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) for Oncology, San Martino Policlinico Hospital, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - M. Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Alain Combes
- INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Niall D. Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Danny F. McAuley
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, United Kingdom
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Critical Care and Emergency Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Michael Quintel
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - John Fraser
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Physiotherapy Department and
| | - Catherine L. Hough
- Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Alain Mercat
- Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Centre Hospitalier Universitaire d’Angers, Université d’Angers, Angers, France
| | - Thomas Mueller
- Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany
| | - Vin Pellegrino
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia
| | - V. Marco Ranieri
- Alma Mater Studiorum–Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Università di Bologna, Bologna, Italy; and
| | - Kathy Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre, London, United Kingdom
| | - Kiran Shekar
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Daniel Brodie
- Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, New York, New York
- Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York
| |
Collapse
|
41
|
Ranieri VM, Pettilä V, Karvonen MK, Jalkanen J, Nightingale P, Brealey D, Mancebo J, Ferrer R, Mercat A, Patroniti N, Quintel M, Vincent JL, Okkonen M, Meziani F, Bellani G, MacCallum N, Creteur J, Kluge S, Artigas-Raventos A, Maksimow M, Piippo I, Elima K, Jalkanen S, Jalkanen M, Bellingan G. Effect of Intravenous Interferon β-1a on Death and Days Free From Mechanical Ventilation Among Patients With Moderate to Severe Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA 2020; 323:725-733. [PMID: 32065831 DOI: 10.1001/jama.2019.22525] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Acute respiratory distress syndrome (ARDS) is associated with high mortality. Interferon (IFN) β-1a may prevent the underlying event of vascular leakage. OBJECTIVE To determine the efficacy and adverse events of IFN-β-1a in patients with moderate to severe ARDS. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, double-blind, parallel-group trial conducted at 74 intensive care units in 8 European countries (December 2015-December 2017) that included 301 adults with moderate to severe ARDS according to the Berlin definition. The radiological and partial pressure of oxygen, arterial (Pao2)/fraction of inspired oxygen (Fio2) criteria for ARDS had to be met within a 24-hour period, and the administration of the first dose of the study drug had to occur within 48 hours of the diagnosis of ARDS. The last patient visit was on March 6, 2018. INTERVENTIONS Patients were randomized to receive an intravenous injection of 10 μg of IFN-β-1a (144 patients) or placebo (152 patients) once daily for 6 days. MAIN OUTCOMES AND MEASURES The primary outcome was a score combining death and number of ventilator-free days at day 28 (score ranged from -1 for death to 27 if the patient was off ventilator on the first day). There were 16 secondary outcomes, including 28-day mortality, which were tested hierarchically to control type I error. RESULTS Among 301 patients who were randomized (mean age, 58 years; 103 women [34.2%]), 296 (98.3%) completed the trial and were included in the primary analysis. At 28 days, the median composite score of death and number of ventilator-free days at day 28 was 10 days (interquartile range, -1 to 20) in the IFN-β-1a group and 8.5 days (interquartile range, 0 to 20) in the placebo group (P = .82). There was no significant difference in 28-day mortality between the IFN-β-1a vs placebo groups (26.4% vs 23.0%; difference, 3.4% [95% CI, -8.1% to 14.8%]; P = .53). Seventy-four patients (25.0%) experienced adverse events considered to be related to treatment during the study (41 patients [28.5%] in the IFN-β-1a group and 33 [21.7%] in the placebo group). CONCLUSIONS AND RELEVANCE Among adults with moderate or severe ARDS, intravenous IFN-β-1a administered for 6 days, compared with placebo, resulted in no significant difference in a composite score that included death and number of ventilator-free days over 28 days. These results do not support the use of IFN-β-1a in the management of ARDS. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02622724.
Collapse
Affiliation(s)
- V Marco Ranieri
- Alma Mater Studiorum-Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Bologna, Italy
| | - Ville Pettilä
- Division of Intensive Care, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Peter Nightingale
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - David Brealey
- Critical Care, University College London Hospitals, NHS Foundation Trust and National Institute for Health Research Biomedical Research Centre at University College London Hospitals NHS Foundation Trust and University College London, London, United Kingdom
| | - Jordi Mancebo
- Department of Intensive Care, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Ricard Ferrer
- Department of Intensive Care/SODIR Research Group-VHIR Hospital Universitari Vall d'Hebron UCI, Barcelona, Spain
| | - Alain Mercat
- Médecine Intensive-Réanimation CHU d'Angers, Université d'Angers, Angers, France
| | - Nicolò Patroniti
- Dipartimento di scienze diagnostiche e integrate, Università degli studi di Genova, Genova, Italy
| | - Michael Quintel
- Anesthesiology and Operative Intensive Care Medicine, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marjatta Okkonen
- Division of Intensive Care, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ferhat Meziani
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de réanimation, Strasbourg, France
| | | | - Niall MacCallum
- Critical Care, University College London Hospitals, NHS Foundation Trust and National Institute for Health Research Biomedical Research Centre at University College London Hospitals NHS Foundation Trust and University College London, London, United Kingdom
| | - Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan Kluge
- Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonio Artigas-Raventos
- Corporacion Sanitaria Universitaria Parc Tauli CIBER Enfermedades Respiratorias Autonomous University of Barcelona, Sabadell, Spain
| | | | | | - Kati Elima
- Medicity research Laboratory, University of Turku, Turku, Finland
| | - Sirpa Jalkanen
- Medicity research Laboratory, University of Turku, Turku, Finland
| | | | - Geoff Bellingan
- Critical Care, University College London Hospitals, NHS Foundation Trust and National Institute for Health Research Biomedical Research Centre at University College London Hospitals NHS Foundation Trust and University College London, London, United Kingdom
| | | |
Collapse
|
42
|
Affiliation(s)
- Piergiorgio Solli
- Department of Cardio-Thoracic Surgery, Policlinico S.Orsola Malpighi University Hospital, Bologna, Italy
| | - Giampiero Dolci
- Department of Cardio-Thoracic Surgery, Policlinico S.Orsola Malpighi University Hospital, Bologna, Italy
| | - V Marco Ranieri
- Anesthesia & Intensive Care Medicine, Alma Mater Studiorum University of Bologna, Policlinico di S.Orsola, Bologna, Italy
| |
Collapse
|
43
|
Busani S, Dall’Ara L, Tonelli R, Clini E, Munari E, Venturelli S, Meschiari M, Guaraldi G, Cossarizza A, Ranieri VM, Girardis M. Surfactant replacement might help recovery of low-compliance lung in severe COVID-19 pneumonia. Ther Adv Respir Dis 2020; 14:1753466620951043. [PMID: 32865137 PMCID: PMC7466887 DOI: 10.1177/1753466620951043] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Indexed: 02/05/2023] Open
Abstract
The reviews of this paper are available via the supplemental material section.
Collapse
Affiliation(s)
- Stefano Busani
- Terapia Intensiva Polivalente, Azienda Ospedaliera-Universitaria Policlinico di Modena, Via del Pozzo 71, Modena 41124, Italy
| | - Lorenzo Dall’Ara
- Anesthesia and Intensive Care Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Munari
- Anesthesia and Intensive Care Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Sophie Venturelli
- Anesthesia and Intensive Care Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Marianna Meschiari
- Infectious Disease Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Guaraldi
- Infectious Disease Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - V. Marco Ranieri
- Anesthesia and Intensive Care Medicine, University Hospital of Bologna Sant’Orsola, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Unit, University Hospital of Modena Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
44
|
Del Sorbo L, Nava S, Rubenfeld G, Thompson T, Ranieri VM. Assessing Risk and Treatment Responsiveness in ARDS. Beyond Physiology. Am J Respir Crit Care Med 2019; 197:1516-1518. [PMID: 29494207 DOI: 10.1164/rccm.201802-0273ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lorenzo Del Sorbo
- 1 Interdepartmental Division of Critical Care Medicine University of Toronto Toronto, Canada.,2 University Health Network Toronto, Canada
| | - Stefano Nava
- 3 Department of Medicine Alma Mater University of Bologna Bologna, Italy.,4 Italy Sant' Orsola Malpighi Hospital Bologna, Italy
| | - Gordon Rubenfeld
- 5 Sunnybrook Health Sciences Center University of Toronto Toronto, Canada
| | - Taylor Thompson
- 6 Division of Pulmonary and Critical Care Medicine Massachusetts General Hospital Boston, Massachusetts
| | - V Marco Ranieri
- 7 Department of Anesthesia and Intensive Care Medicine Sapienza University of Rome Rome, Italy and.,8 Umberto I Hospital Rome, Italy
| |
Collapse
|
45
|
Goligher EC, Combes A, Brodie D, Ferguson ND, Pesenti AM, Ranieri VM, Slutsky AS. Determinants of the effect of extracorporeal carbon dioxide removal in the SUPERNOVA trial: implications for trial design. Intensive Care Med 2019; 45:1219-1230. [PMID: 31432216 DOI: 10.1007/s00134-019-05708-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/18/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To describe the variability and determinants of the effect of extracorporeal CO2 removal (ECCO2R) on tidal volume (Vt), driving pressure (ΔP), and mechanical power (PowerRS) and to determine whether highly responsive patients can be identified for the purpose of predictive enrichment in ECCO2R trial design. METHODS Using data from the SUPERNOVA trial (95 patients with early moderate acute respiratory distress syndrome), the independent effects of alveolar dead space fraction (ADF), respiratory system compliance (Crs), hypoxemia (PaO2/FiO2), and device performance (higher vs lower CO2 extraction) on the magnitude of reduction in Vt, ΔP, and PowerRS permitted by ECCO2R were assessed by linear regression. Predicted and observed changes in ΔP were compared by Bland-Altman analysis. Hypothetical trials of ECCO2R, incorporating predictive enrichment and different target CO2 removal rates, were simulated in the SUPERNOVA study population. RESULTS Changes in Vt permitted by ECCO2R were independently associated with ADF and device performance but not PaO2/FiO2. Changes in ΔP and PowerRS were independently associated with ADF, Crs, and device performance but not PaO2/FiO2. The change in ΔP predicted from ADF and Crs was moderately correlated with observed change in ΔP (R2 0.32, p < 0.001); limits of agreement between observed and predicted changes in ΔP were ± 3.9 cmH2O. In simulated trials, restricting enrollment to patients with a larger predicted decrease in ΔP enhanced the average reduction in ΔP, increased predicted mortality benefit, and reduced sample size and screening size requirements. The increase in statistical power obtained by restricting enrollment based on predicted ΔP response varied according to device performance as specified by the target CO2 removal rate. CONCLUSIONS The lung-protective benefits of ECCO2R increase with higher alveolar dead space fraction, lower respiratory system compliance, and higher device performance. ADF and Crs, rather than severity of hypoxemia, should be the primary factors determining whether to enroll patients in clinical trials of ECCO2R.
Collapse
Affiliation(s)
- Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. .,Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada. .,Toronto General Hospital Research Institute, 585 University Ave., 11-PMB Room 192, Toronto, ON, M5G 2N2, Canada.
| | - Alain Combes
- APHP Hôpital Pitié-Salpêtrière, Institut de Cardiologie, Institute of Cardio-metabolism and Nutrition, and Service de Médecine Intensive-réanimation, UMRS_1166-ICAN, INSERM, Sorbonne Université, Paris, France
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada.,Toronto General Hospital Research Institute, 585 University Ave., 11-PMB Room 192, Toronto, ON, M5G 2N2, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada
| | - Antonio M Pesenti
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - V Marco Ranieri
- Policlinico di Sant'Orsola, Anesthesia and Intensive Care Medicine, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | | |
Collapse
|
46
|
Combes A, Tonetti T, Fanelli V, Pham T, Pesenti A, Mancebo J, Brodie D, Ranieri VM. Efficacy and safety of lower versus higher CO2 extraction devices to allow ultraprotective ventilation: secondary analysis of the SUPERNOVA study. Thorax 2019; 74:1179-1181. [DOI: 10.1136/thoraxjnl-2019-213591] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/11/2019] [Accepted: 07/05/2019] [Indexed: 11/04/2022]
Abstract
Retrospective analysis of the SUPERNOVA trial exploring the hypothesis that efficacy and safety of extracorporeal carbon dioxide removal (ECCO2R) to facilitate reduction of tidal volume (VT) to 4 mL/kg in patients with acute respiratory distress syndrome (ARDS) may differ between systems with lower (area of membrane length 0.59 m2; blood flow 300–500 mL/min) and higher (membrane area 1.30 m2; blood flow between 800 and 1000 mL/min) CO2 extraction capacity. Ninety-five patients with moderate ARDS were included (33 patients treated with lower and 62 patients treated with higher CO2 extraction devices). We found that (1) VT of 4 mL/kg was reached by 55% and 64% of patients with the lower extraction versus 90% and 92% of patients with higher extraction devices at 8 and 24 hours from baseline, respectively (p<0.001), and (2) percentage of patients experiencing episodes of ECCO2R-related haemolysis and bleeding was higher with lower than with higher extraction devices (21% vs 6%, p=0.045% and 27% vs 6%, p=0.010, respectively). Although V T of 4 mL/kg could have been obtained with all devices, this was achieved frequently and with a lower rate of adverse events by devices with higher CO2 extraction capacity.
Collapse
|
47
|
Baccolini V, de Soccio P, D'Egidio V, Migliara G, Marzuillo C, De Vito C, Ranieri VM, Villari P. Role of a multimodal intervention to promote hand hygiene compliance among healthcare workers. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - P de Soccio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - V D'Egidio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - G Migliara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - C De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - VM Ranieri
- Department of Anesthesiology and Critical Care, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - P Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
48
|
Fanelli V, Cantaluppi V, Alessandri F, Costamagna A, Cappello P, Brazzi L, Pugliese F, Biancone L, Terragni P, Ranieri VM. Extracorporeal CO2 Removal May Improve Renal Function of Patients with Acute Respiratory Distress Syndrome and Acute Kidney Injury: An Open-Label, Interventional Clinical Trial. Am J Respir Crit Care Med 2018; 198:687-690. [DOI: 10.1164/rccm.201712-2575le] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
49
|
Brodie D, Vincent JL, Brochard LJ, Combes A, Ferguson ND, Hodgson CL, Laffey JG, Mercat A, Pesenti A, Quintel M, Slutsky AS, Ranieri VM. Research in Extracorporeal Life Support: A Call to Action. Chest 2018; 153:788-791. [PMID: 29355550 DOI: 10.1016/j.chest.2017.12.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 01/19/2023] Open
Affiliation(s)
- Daniel Brodie
- Department of Medicine, Columbia University College of Physicians & Surgeons, and New York-Presbyterian Hospital, New York, NY.
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | - Laurent J Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Keenan Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Alain Combes
- Medical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, and Sorbonne Pierre-Marie Curie University Paris, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, and Department of Medicine, Division of Respirology & Critical Care, Toronto General Research Institute, University Health Network and Sinai Health System, Toronto, ON, Canada
| | - Carol L Hodgson
- Australian & New Zealand Intensive Care Research Centre, Monash University, Melbourne, and the Alfred Hospital, Prahran, Australia
| | - John G Laffey
- Departments of Anesthesia and Critical Care Medicine, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, and Departments of Anesthesia, Physiology, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Alain Mercat
- Département de Réanimation Médicale et Médecine Hyperbare, CHU d' Angers, Université d'Angers, Angers, France
| | | | - Michael Quintel
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, and Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - V Marco Ranieri
- Anesthesia and Intensive Care Medicine, Sapienza Università di Rome, Rome, Italy
| | | |
Collapse
|
50
|
Bellingan G, Brealey D, Mancebo J, Mercat A, Patroniti N, Pettilä V, Quintel M, Vincent JL, Maksimow M, Jalkanen M, Piippo I, Ranieri VM. Comparison of the efficacy and safety of FP-1201-lyo (intravenously administered recombinant human interferon beta-1a) and placebo in the treatment of patients with moderate or severe acute respiratory distress syndrome: study protocol for a randomized controlled trial. Trials 2017; 18:536. [PMID: 29132404 PMCID: PMC5683224 DOI: 10.1186/s13063-017-2234-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/10/2017] [Accepted: 10/04/2017] [Indexed: 11/11/2022] Open
Abstract
Background Acute respiratory distress syndrome (ARDS) results in vascular leakage, inflammation and respiratory failure. There are currently no approved pharmacological treatments for ARDS and standard of care involves treatment of the underlying cause, and supportive care. The vascular leakage may be related to reduced concentrations of local adenosine, which is involved in maintaining endothelial barrier function. Interferon (IFN) beta-1a up-regulates the cell surface ecto-5′-nucleotidase cluster of differentiation 73 (CD73), which increases adenosine levels, and IFN beta-1 may, therefore, be a potential treatment for ARDS. In a phase I/II, open-label study in 37 patients with acute lung injury (ALI)/ARDS, recombinant human IFN beta-1a was well tolerated and mortality rates were significantly lower in treated than in control patients. Methods/design In this phase III, double-blind, randomized, parallel-group trial, the efficacy and safety of recombinant human IFN beta-1a (FP-1201-lyo) will be compared with placebo in adult patients with ARDS. Patients will be randomly assigned to receive 10 μg FP-1201-lyo or placebo administered intravenously once daily for 6 days and will be monitored for 28 days or until discharged from the intensive care unit. Follow-up visits will then take place at days 90, 180 and 360. The primary endpoint is a composite endpoint including any cause of death at 28 days and days free of mechanical ventilation within 28 days among survivors. Secondary endpoints include: all-cause mortality at 28, 90, 180 and 360 days; organ failure-free days; length of hospital stay; pharmacodynamic assessment including measurement of myxovirus resistance protein A concentrations; and measures of quality of life, respiratory and neurological function at 180 and 360 days. The estimated sample size to demonstrate a reduction in the primary outcome between groups from 30% to 15% is 300 patients, and the study will be conducted in 70–80 centers in nine countries across Europe. Discussion There are no effective specific treatments for patients with ARDS and mortality rates remain high. The results from this study will provide evidence regarding the efficacy of a potential new therapeutic agent, FP-1201-lyo, in improving the clinical course and outcome for patients with moderate/severe ARDS. Trial registration European Union Clinical Trials Register, no: 2014-005260-15. Registered on 15 July 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2234-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Geoff Bellingan
- Division of Critical Care, University College London Hospitals, NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - David Brealey
- Division of Critical Care, University College London Hospitals, NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK.,The NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals, NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, UK
| | - Jordi Mancebo
- Department of Intensive Care, Hospital de la Santa Creu I Sant Pau, Carrer de Sant Quintí, 89, 08026, Barcelona, Spain
| | - Alain Mercat
- Service de Réanimation, CHU D'Angers, 4 Rue Larrey, 49100, Angers, France
| | - Nicolò Patroniti
- Dipartimento di Emergenza e Urgenza, Azienda Ospedaliera San Gerardo, Via Giambattista Pergolesi 33, 20052, Monza, Italy
| | - Ville Pettilä
- Department of Intensive Care, Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00290, Finland
| | - Michael Quintel
- Anesthesiology and Operative Intensive Care Medicine, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| | - Mikael Maksimow
- Faron Pharmaceuticals Oy, Joukahaisenkatu 6, 20520, Turku, Finland
| | - Markku Jalkanen
- Faron Pharmaceuticals Oy, Joukahaisenkatu 6, 20520, Turku, Finland
| | - Ilse Piippo
- Faron Pharmaceuticals Oy, Joukahaisenkatu 6, 20520, Turku, Finland
| | - V Marco Ranieri
- Department of Anesthesia and Critical Care Medicine, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
| |
Collapse
|