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Valentino MR, Annunziata A, Atripaldi L, Fiorentino G. An unusual way to improve lung function in congenital myopathies: the power of singing. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2023; 42:86-88. [PMID: 38090546 PMCID: PMC10712659 DOI: 10.36185/2532-1900-357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/04/2023] [Indexed: 12/18/2023]
Abstract
Congenital myopathies (CMs) are a clinically and genetically heterogeneous group of disorders characterized by early onset weakness, hypotonia and characteristic structural abnormalities in muscle fibres. Hypotonia and weakness can be present at birth or appear in infancy, and a static or slowly progressive clinical course may present with muscle weakness, loss of spontaneous movement, involuntary muscle activity, and muscle atrophy. Often patients develop a restrictive syndrome and respiratory failure and require respiratory support In our case, we described lung improvement and respiratory muscle training due to singing in a young patient, affected by CMs with a poor adherence to non-invasive mechanical ventilation.
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Affiliation(s)
| | - Anna Annunziata
- UOC Malattie, Fisiopatologia e Riabilitazione dell’Apparato Respiratorio, Monaldi Hospital, Naples, 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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Effect of Noninvasive Positive Pressure Ventilation on Prognosis and Blood Gas Level in COPD Patients Complicated with Respiratory Failure. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3089227. [PMID: 35966741 PMCID: PMC9374560 DOI: 10.1155/2022/3089227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a respiratory disease caused by chronic bronchitis, which seriously threatens the life safety of patients. Noninvasive positive pressure ventilation (NIPPV) has great advantages in its treatment. Here, we explore the effect of NIPPV on prognosis and blood gas level in COPD patients complicated with respiratory failure (RF). A case control study was retrospectively analyzed, where 36 COPD patients with RF were regarded as the regular group to carry on the routine treatment, and 42 patients were assigned to the research group to carry out the routine treatment plus NIPPV. The monofactorial analysis showed that the overall response rate, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC in the research group were higher than those in the regular group, while partial pressure of arterial carbondioxide (PaCO2), posttreatment endotracheal intubation (EI), length of stay (LOS), tumor necrosis factor (TNF-α), interleukin (IL)-6, IL-1β, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and modified Medical Research Council (mMRC) scores in the research group were lower than those in the regular group. These results indicated that NIPPV can improve the curative effect of emergency medicine patients with RF, improve BG level and PF, reduce inflammation, and facilitate patient's recovery.
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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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Annunziata A, Calabrese C, Simioli F, Coppola A, Flora M, Marotta A, Di Spirito V, Didonna F, Cicalese M, Fiorentino G. Negative-Pressure Ventilation in Neuromuscular Diseases in the Acute Setting. J Clin Med 2022; 11:2589. [PMID: 35566729 PMCID: PMC9101364 DOI: 10.3390/jcm11092589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/23/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
Mechanical ventilation started with negative-pressure ventilation (NPV) during the 1950s to assist patients with respiratory failure, secondary to poliomyelitis. Over the years, technological evolution has allowed for the development of more comfortable devices, leading to an increased interest in NPV. The patients affected by neuromuscular diseases (NMD) with chronic and acute respiratory failure (ARF) may benefit from NPV. The knowledge of the available respiratory-support techniques, indications, contraindications, and adverse effects is necessary to offer the patient a personalized treatment that considers the pathology's complexity.
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Affiliation(s)
- Anna Annunziata
- Department of Intensive Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy; (F.S.); (A.C.); (M.F.); (A.M.); (V.D.S.); (F.D.); (G.F.)
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy;
| | - Francesca Simioli
- Department of Intensive Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy; (F.S.); (A.C.); (M.F.); (A.M.); (V.D.S.); (F.D.); (G.F.)
| | - Antonietta Coppola
- Department of Intensive Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy; (F.S.); (A.C.); (M.F.); (A.M.); (V.D.S.); (F.D.); (G.F.)
| | - Martina Flora
- Department of Intensive Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy; (F.S.); (A.C.); (M.F.); (A.M.); (V.D.S.); (F.D.); (G.F.)
| | - Antonella Marotta
- Department of Intensive Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy; (F.S.); (A.C.); (M.F.); (A.M.); (V.D.S.); (F.D.); (G.F.)
| | - Valentina Di Spirito
- Department of Intensive Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy; (F.S.); (A.C.); (M.F.); (A.M.); (V.D.S.); (F.D.); (G.F.)
| | - Francesco Didonna
- Department of Intensive Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy; (F.S.); (A.C.); (M.F.); (A.M.); (V.D.S.); (F.D.); (G.F.)
| | - Marcellino Cicalese
- Department of Surgery, Unit of Thoracic Surgery, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy;
| | - Giuseppe Fiorentino
- Department of Intensive Care, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy; (F.S.); (A.C.); (M.F.); (A.M.); (V.D.S.); (F.D.); (G.F.)
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Carannante N, Annunziata A, Coppola A, Simioli F, Marotta A, Bernardo M, Piscitelli E, Imitazione P, Fiorentino G. Diagnosis and treatment of pneumonia, a common cause of respiratory failure in patients with neuromuscular disorders. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2021; 40:124-131. [PMID: 34632294 PMCID: PMC8489170 DOI: 10.36185/2532-1900-053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/13/2021] [Indexed: 11/12/2022]
Abstract
Patients with neuromuscular diseases, during their illness are more susceptible to respiratory infections due to predisposing factors. Ineffective cough and the presence of atelectasis and hypoventilation, dysphagia and drooling can represent risk factors for the development of respiratory infection and fatal respiratory failure. Infections of respiratory tract with acute respiratory failure are the most common reason for hospitalizations, and pneumonia is among the leading causes of morbidity and mortality worldwide. The setting in which pneumonia is acquired heavily influences diagnostic and therapeutic choices. We will focus on aetiopathogenesis, diagnosis and treatment of pneumonia in these subjects, particularly considering the disease severity, rates of antibiotic resistance and the possible complications. In this case consultations with specialized physicians are strongly recommended.
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Affiliation(s)
| | - Anna Annunziata
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
| | - Antonietta Coppola
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
| | - Francesca Simioli
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
| | - Antonella Marotta
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
| | - Mariano Bernardo
- Unit of Microbiology and Virology AO Ospedali dei Colli, Naples, Italy
| | | | - Pasquale Imitazione
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
| | - Giuseppe Fiorentino
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
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