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Volpato E, Pierucci P, De Candia ML, Casparrini M, Volpi V, Pagnini F, Carpagnano GE, Banfi P. Life Experiences in Neuromuscular Tracheotomized Patients in Times of Covid-19. J Neuromuscul Dis 2023:JND221597. [PMID: 37212066 DOI: 10.3233/jnd-221597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The management of tracheotomy at home can be very complex, affecting the patient's quality of life. OBJECTIVES This case series study aimed to explore the experiences of patients affected by neuromuscular diseases (NMD) concerning tracheostomy and Invasive Mechanical Ventilation (IMV) management at home during the COVID-19 health emergency in Italy. METHODS Semi-structured interviews and the following instruments were used: Connor and Davidson Resilience Scale (CD-RISC-25); Acceptance and Action Questionnaire-II (AAQ-II); State-Trait Anxiety Inventory (STAI); Langer Mindfulness Scale (LMS). Descriptive analyses, correlations, and qualitative analyses were carried out. RESULTS 22 patients [50% female, mean age = 50.2 (SD = 21.2)] participated in the study. Participants who showed high levels of dispositional mindfulness in terms of novelty-seeking (r = 0.736, p = 0.013) and novelty production (r = 0.644, p = 0.033) were those with higher resilience. The main emotion that emerged was the fear of contagion (19 patients, 86.36%), due to the previous fragile condition, leading to a significant sense of abandonment. The tracheostomy's perception is seen in extremes as a lifesaver or a condemnation. The relationship with the health professionals moves from satisfaction to a feeling of abandonment with a lack of preparation. CONCLUSIONS The relationship between resilience, flexibility, state anxiety and dispositional mindfulness offers ways to reinforce tracheostomy management at home, even in critical periods when going to the hospital may be difficult.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Maria Luisa De Candia
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Massimo Casparrini
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | | | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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Volpi V, Volpato E, Compalati E, Pierucci P, Nicolini A, Lax A, Fagetti L, Annunziata A, Cauteruccio R, Fiorentino G, Banfi P. Is Intermittent Abdominal Pressure Ventilation Still Relevant? A Multicenter Retrospective Pilot Study. J Clin Med 2023; 12:jcm12072453. [PMID: 37048537 PMCID: PMC10095348 DOI: 10.3390/jcm12072453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
Non-invasive ventilatory support (NVS) is a technique used to reduce respiratory work in neuromuscular diseases, preventing the progression of respiratory failure. NVS is usually administered via a nasal or an oronasal mask, causing discomfort, especially in patients ventilated for more than 16 h/day. Intermittent abdominal pressure ventilation (IAPV) differs completely from conventional NVS and consists of a portable ventilator and a corset with Velcro closures as the interface. In our study, the practicability and efficacy of IAPV were studied in three Italian centers monitoring 28 neuromuscular patients using IAPV who were then retrospectively analyzed. The primary outcomes were an improvement in hypoxemia and the normalization of hypercapnia, and the secondary outcome was an improvement in quality of life. Data were collected at baseline (T0) and after two hours of ventilation (T1), with follow-ups at three months (T2) and six months (T3). Statistical significance was found for PaCO2 over time (F (2.42) = 7.63, p = 0.001) and PaO2 (W = 0.539, p = 0.033). The time of NVS usage also significantly affected the quality of life (F (2.14) = 6.90, p = 0.010), as seen when comparing T0 and T3. As an alternative ventilation method, IAPV is still relevant today and could become a key part of daytime support, especially for patients who do not tolerate standard daytime NVS with an oral interface.
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Affiliation(s)
- Valeria Volpi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Eleonora Volpato
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Elena Compalati
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, 70121 Bari, Italy
- Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', 70122 Bari, Italy
| | | | - Agata Lax
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Laura Fagetti
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Anna Annunziata
- Department of Respiratory Pathophysiology and Rehabilitation Monaldi-A.O. Dei Colli, 80131 Naples, Italy
| | - Rosa Cauteruccio
- Department of Intensive Care, Azienda Ospedaliera di Rilievo Nazionale dei Colli, 80131 Naples, Italy
| | - Giuseppe Fiorentino
- Department of Respiratory Pathophysiology and Rehabilitation Monaldi-A.O. Dei Colli, 80131 Naples, Italy
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
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Annunziata A, Pierucci P, Banfi PI, Carlucci A, Coppola A, Rao F, Schisano M, Simioli F, Crimi C, Esquinas AM, Karakurt Z, Mattei A, Marotta A, Bach JR, Fiorentino G. Intermittent abdominal pressure ventilation management in neuromuscular diseases: a Delphi panel Consensus. Expert Rev Respir Med 2023; 17:517-525. [PMID: 37323014 DOI: 10.1080/17476348.2023.2226391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 06/13/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Intermittent abdominal pressure ventilator (IAPV) use started in the 1930s for ventilatory assistance with muscular dystrophy patients. Later, the device was perfected and expanded for other neuromuscular disorders (NMD). In recent years, the morbidity and mortality tracheotomies and trach tubes related renewed the interest around IAPV. However, there are no guidelines for its use. This study aimed to establish a consensus among physicians involved in its practice to provide IAPV suggestions for the treatment of patients with NMD. METHOD A 3-step modified Delphi method was used to establish consensus. Fourteen respiratory physicians and one psychiatrist with strong experience in IAPV use and/or who published manuscripts on the topic participated in the panel. A systematic review of the literature was carried out according to the PRISMA to identify existing evidence on IAPV for patients with neuromuscular disorders. RESULTS In the first round, 34 statements were circulated. Panel members marked 'agree' or 'disagree' for each statement and provided comments. The agreement was reached after the second voting session for all 34 statements. CONCLUSIONS Panel members agreed and IAPV indications, parameter settings (including procedure protocol), potential limitations, contraindications, complications, monitoring, and follow-up are described. This is the first expert consensus on IAPV.
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Affiliation(s)
- Anna Annunziata
- Unit of Respiratory Physiopathology and Rehabilitation, A.O.R.N. "Dei Colli" - Monaldi Hospital, Naples, Italy
| | - Paola Pierucci
- Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, Cardiothoracic Department, University of Bari 'Aldo Moro', Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari, Italy
| | - Paolo Innocente Banfi
- Respiratory rehabilitation department, IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Annalisa Carlucci
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Antonietta Coppola
- Sub-Intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, Naples, Italy
| | - Fabrizio Rao
- Respiratory Unit, NEuroMuscular OmniCentre (NeMo), Serena Onlus Foundation, Niguarda Hospital, Milan, Italy
| | - Matteo Schisano
- Respiratory Medicine Unit Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - Francesca Simioli
- Sub-Intensive Care Unit, Department of Respiratory Pathophysiology and Rehabilitation, Monaldi Hospital, Naples, Italy
| | - Claudia Crimi
- Respiratory Unit, NEuroMuscular OmniCentre (NeMo), Serena Onlus Foundation, Niguarda Hospital, Milan, Italy
| | - Antonio M Esquinas
- Intensive Care Unit, Hospital Morales Meseguer, Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain
| | - Zuhal Karakurt
- Department of Chest Diseases, Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, İ̇stanbul, Turkey
| | - Alessio Mattei
- Department of Cardio-Thoracic Diseases, "Città della Salute E della Scienza" University Hospital, Turin, Italy
| | - Antonella Marotta
- Department of Physical Medicine and Rehabilitation, Rutgers University-New Jersey Medical School, Newark, New Jersey; Center for Ventilator Management Alternatives, University Hospital of Newark, Newark, New Jersey
| | - John R Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University-New Jersey Medical School, Newark, New Jersey; Center for Ventilator Management Alternatives, University Hospital of Newark, Newark, New Jersey
| | - Giuseppe Fiorentino
- Unit of Respiratory Physiopathology and Rehabilitation, A.O.R.N. "Dei Colli" - Monaldi Hospital, Naples, Italy
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Simioli F, Annunziata A, Coppola A, Borriello EM, Spinelli S, Fiorentino G. Versatility of Intermittent Abdominal Pressure Ventilation in a Case of Complicated Restrictive Respiratory Failure and COVID-19. Healthcare (Basel) 2022; 10:healthcare10061012. [PMID: 35742063 PMCID: PMC9222416 DOI: 10.3390/healthcare10061012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The intermittent abdominal pressure ventilation (IAPV) is a non-invasive ventilation (NIV) technique that avoids facial interfaces and is a diurnal ventilatory support alternative for neuromuscular patients during stable chronic phases of the disease. Coronavirus disease 2019 (COVID-19) is a novel infection possibly causing acute respiratory distress syndrome (ARDS). Neuromuscular diseases (NMD) and preexisting respiratory failure can be exacerbated by respiratory infection and progress to severe disease and ICU admission with a poor prognosis. Aim: To report on the versatility and feasibility of IAPV in acute restrictive respiratory failure exacerbated by COVID-19. Patient: We describe the case of a 33-year-old man with spastic tetraparesis, kyphoscoliosis, and impaired cough, eventually leading to a restrictive ventilation pattern. COVID-19 exacerbated respiratory failure and seizures. An NIV trial failed because of inadequate interface adhesion and intolerance. During NIV, dyspnea and seizures worsened. He underwent a high flow nasal cannula (HFNC) with a fluctuating benefit on gas exchange. IAPV was initiated and although there was a lack of cooperation and inability to sit; the compliance was good and a progressive improvement of gas exchange, respiratory rate, and dyspnea was observed.Conclusions: IAPV is a versatile type of NIV that can be adopted in complicated restrictive respiratory failure. COVID-19 exacerbates preexisting conditions and is destined to be a disease of frailty. COVID-19 is not a contraindication to IAPV and this kind of ventilation can be employed in selected cases in a specialistic setting. Moreover, this report suggests that IAPV is safe when used in combination with HFNC. This hybrid approach provides the opportunity to benefit from both therapies, and, in this particular case, prevented the intubation with all connected risks.
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