1
|
Battaglia E, Banfi P, Compalati E, Nicolini A, Diaz DE Teran T, Gonzales M, Solidoro P. The pathogenesis of OSA-related hypertension: what are the determining factors? Minerva Med 2024; 115:68-82. [PMID: 37947781 DOI: 10.23736/s0026-4806.23.08466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Sleep-disordered breathing has a relatively high prevalence, which varies from 3-7% in males and from 2-5% in females in the adult population. Studies published in the literature have shown that sleep apnea is closely related to an increased risk of developing various pathologies, among which arterial hypertension stands out. The prevalence of hypertension in patients suffering from obstructive sleep apnea (OSA) ranges from 35-80% and appears to be related to OSA severity. Approximately 40-50% of patients affected by hypertension are also affected by OSA and this association seems to be stronger in young and middle-aged adults (<50 years of age). The primary objective of this narrative review is to provide an update on what are the main contributing comorbidities to the development of a hypertensive state in patients suffering from OSA, an independent risk factor for diurnal hypertension, implicated as a risk factor for the first stroke, recurrent stroke, and post-stroke mortality. There are a lot of factors that contribute to developing a hypertensive state in OSA patients, some more decisive, others less. More evidence from longitudinal studies is needed on the impact of OSA on cardiovascular risk in females, on the causal link between OSA and arterial hypertension or metabolic diseases, like diabetes and glucose intolerance, and the effect of different kinds of OSA treatment.
Collapse
Affiliation(s)
- Elvia Battaglia
- IRCCS Don Carlo Gnocchi Foundation - Santa Maria Nascente, Milan, Italy
| | - Paolo Banfi
- IRCCS Don Carlo Gnocchi Foundation - Santa Maria Nascente, Milan, Italy
| | - Elena Compalati
- IRCCS Don Carlo Gnocchi Foundation - Santa Maria Nascente, Milan, Italy -
| | | | - Teresa Diaz DE Teran
- Sleep Disorders and Non Invasive Ventilation Unit, Division of Pneumology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Monica Gonzales
- Sleep Disorders and Non Invasive Ventilation Unit, Division of Pneumology, Marqués de Valdecilla University Hospital, Santander, Spain
| | | |
Collapse
|
2
|
Pestelli MT, Grecchi B, Vottero E, Galli A, Nicolini A, Compalati E, Banfi P, Diaz DE Teran T, Gonzales M, D'Abrosca F, Lippi L, Ferraioli G, Sheridan S, Dimabuyu-Francisco M, Solidoro P. Effectiveness of a new "focused pulse" high-frequency chest wall oscillation in patients with moderate to severe COPD. Minerva Med 2024; 115:4-13. [PMID: 38261298 DOI: 10.23736/s0026-4806.23.08874-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Chest physiotherapy plays a crucial role in the treatment of COPD, although the optimal techniques for airway clearance have not been definitively established. Among the different techniques, high-frequency chest wall oscillation (HFCWO) has gained attention for its potential to create a widespread lung percussion, facilitating the removal of secretions and potentially clearing the peripheral bronchial tree. This study aims to assess the effectiveness of a novel "focused pulse" HFCWO in patients with moderate to severe COPD. METHODS Sixty patients were randomized to three groups: a group treated with the PEP technique, a group with "focused pulse "HFCWO" and a group with pharmacological therapy alone (control group). The primary outcomes were changes in respiratory function parameters, changes in dyspnea and quality of life scores as well as daily life activity and health status assessment. The secondary outcomes were the number of exacerbations and the number of practitioner or emergency department (ED) visits after 1, 3, and 6 months. RESULTS Sixty patients concluded the study with 20 patients allocated to each group. The two devices improved respiratory function tests, quality of life and health scores and dyspnea compared to the control group. Maximal expiratory pressure and diffusing lung carbon oxide were significantly improved in the focused pulse HFCWO group compared to the PEP group. Only pulse-focused HFCWO showed a statistically significant lower number of exacerbations and visits to ED or practitioner compared to the control group. CONCLUSIONS The focused pulse HFCWO technique improves daily life activities and lung function in patients with stable COPD. The device demonstrated significantly greater effectiveness in lowering COPD exacerbations as well as visits to ED or practitioner.
Collapse
Affiliation(s)
- Maria T Pestelli
- Physical Medicine and Rehabilitation, General Hospital, Sestri Levante, Genoa, Italy
| | - Bruna Grecchi
- Physical Medicine and Rehabilitation, General Hospital, Sestri Levante, Genoa, Italy
| | - Erica Vottero
- Physical Medicine and Rehabilitation, General Hospital, Sestri Levante, Genoa, Italy
| | - Alice Galli
- Physical Medicine and Rehabilitation, General Hospital, Sestri Levante, Genoa, Italy
| | - Antonello Nicolini
- Cardio-Pulmonary Rehabilitation Unit, IRCCS Don Gnocchi Foundation, Milan, Italy -
| | - Elena Compalati
- Cardio-Pulmonary Rehabilitation Unit, IRCCS Don Gnocchi Foundation, Milan, Italy
| | - Paolo Banfi
- Cardio-Pulmonary Rehabilitation Unit, IRCCS Don Gnocchi Foundation, Milan, Italy
| | - Teresa Diaz DE Teran
- Sleep and Ventilation Unit, Department of Pneumology, Marqués de Valdecilla University Hospital, Cantabria University, Santander, Spain
| | - Monica Gonzales
- Sleep and Ventilation Unit, Department of Pneumology, Marqués de Valdecilla University Hospital, Cantabria University, Santander, Spain
| | - Francesco D'Abrosca
- Department of Physical and Rehabilitative Medicine, University of Eastern Piedmont, Novara, Italy
- Infrastruttura Ricerca Formazione Innovazione (IRFI), SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Lorenzo Lippi
- Department of Physical and Rehabilitative Medicine, University of Eastern Piedmont, Novara, Italy
- Infrastruttura Ricerca Formazione Innovazione (IRFI), SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Gianluca Ferraioli
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | | | | | - Paolo Solidoro
- Unit of Pneumology, Cardiovascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| |
Collapse
|
3
|
Díaz DE Terán T, González P, González M, Cerveró A, Nicolini A, Banfi P, Solidoro P, Napal JJ, Valero C. Risk factors in developing retinal vein occlusion in subject with obstructive sleep apnea. Minerva Med 2023; 114:825-831. [PMID: 35315633 DOI: 10.23736/s0026-4806.22.07989-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with obstructive sleep apnea (OSA) have a higher risk of developing vascular diseases. In this study, we evaluated the clinical profile of patients with OSA who develop retinal vein occlusion (RVO) compared with a population of OSA patients without RVO. METHODS We analyzed patients with OSA diagnosed with RVO (21 cases; mean of age 61 years. range 44-87 years. 67% men), belonging to a large cohort of people with long-term follow-up for RVO (up to 12 years). We compared them with 21 patients with OSA, without RVO, matched by age and gender, selected from the Sleep Unit Registry (control group). RESULTS There were no differences in the prevalence of arterial hypertension (AHT) or Diabetes mellitus (DM), but the RVO patients presented a higher diastolic blood pressure compared to controls (87.6±12.6 mmHg vs. 77.9±10.1 mmHg respectively). The polygraphic parameters were similar in both groups. The Apnea-Hypopnea Index (IHA) similar in both groups (30.4±20.9 RVO vs. 33.7±22.1 controls). In addition, RVO patients had a less favorable lipid profile, with higher total cholesterol (218±52 mg/dL vs. 179±41 mg/dL), higher LDL cholesterol (139±47 mg/dL vs. 107±32 mg/dL) and higher atherogenic indices: LDL/HDL (2.78±0.95 RVO vs. 2.03±0.67 controls) and total cholesterol/HDL (4.37±1.08 vs. 3.45±0.84). Among the cases, 81% had peripheral RVO (superior temporal branch in 20 out of 21 cases) and 19% had central RVO. A percentage of 62% of the cases received intravitreal antiangiogenic therapy and dexamethasone implants and 33% received argon laser photocoagulation. CONCLUSIONS Poor control of cardiovascular risk factors, particularly dyslipidemias, in patients with OSA may lead to the development of this ocular complication.
Collapse
Affiliation(s)
- Teresa Díaz DE Terán
- Department of Internal Medicine, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Cantabria University, Santander, Spain
| | - Paula González
- Department of Internal Medicine, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Cantabria University, Santander, Spain
| | - Mónica González
- Department of Internal Medicine, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Cantabria University, Santander, Spain
| | - Andrea Cerveró
- Department of Ophthalmology, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | | | - Paolo Solidoro
- Division of Respiratory Diseases, Department of Cardiovascular and Thoracic Medicine, Città della Salute e della Scienza, Turin, Italy
| | - José J Napal
- Department of Internal Medicine, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Cantabria University, Santander, Spain
| | - Carmen Valero
- Department of Internal Medicine, Marqués de Valdecilla University Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Cantabria University, Santander, Spain -
| |
Collapse
|
4
|
Lax A, Nicolini A, DE Chiara F, Diaz DE Teran T, Gonzalez M, Ferraioli G, Compalati E, Fagetti L, Banfi P, Solidoro P. Prevalence of airflow obstruction in an apparently healthy population sample: a preliminary Italian study. Panminerva Med 2023; 65:402-404. [PMID: 37021979 DOI: 10.23736/s0031-0808.23.04852-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
- Agata Lax
- Unit of Respiratory Rehabilitation, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Antonello Nicolini
- Unit of Respiratory Rehabilitation, Fondazione Don Carlo Gnocchi, Milan, Italy -
| | | | - Teresa Diaz DE Teran
- Unit of Sleep and Ventilation, Department of Pneumology, Marqués de Valdecilla University Hospital, Cantabria University, Santander, Spain
| | - Monica Gonzalez
- Unit of Sleep and Ventilation, Department of Pneumology, Marqués de Valdecilla University Hospital, Cantabria University, Santander, Spain
| | - Gianluca Ferraioli
- Unit of Respiratory Diseases, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Elena Compalati
- Unit of Respiratory Rehabilitation, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Laura Fagetti
- Unit of Respiratory Rehabilitation, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paolo Banfi
- Unit of Respiratory Rehabilitation, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paolo Solidoro
- Unit of Pneumology, Department of Cardiovascular and Thoracic, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| |
Collapse
|
5
|
Volpi V, Volpato E, Compalati E, Pierucci P, Nicolini A, Lax A, Fagetti L, Annunziata A, Cauteruccio R, Fiorentino G, Banfi P. Is Intermittent Abdominal Pressure Ventilation Still Relevant? A Multicenter Retrospective Pilot Study. J Clin Med 2023; 12:jcm12072453. [PMID: 37048537 PMCID: PMC10095348 DOI: 10.3390/jcm12072453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
Non-invasive ventilatory support (NVS) is a technique used to reduce respiratory work in neuromuscular diseases, preventing the progression of respiratory failure. NVS is usually administered via a nasal or an oronasal mask, causing discomfort, especially in patients ventilated for more than 16 h/day. Intermittent abdominal pressure ventilation (IAPV) differs completely from conventional NVS and consists of a portable ventilator and a corset with Velcro closures as the interface. In our study, the practicability and efficacy of IAPV were studied in three Italian centers monitoring 28 neuromuscular patients using IAPV who were then retrospectively analyzed. The primary outcomes were an improvement in hypoxemia and the normalization of hypercapnia, and the secondary outcome was an improvement in quality of life. Data were collected at baseline (T0) and after two hours of ventilation (T1), with follow-ups at three months (T2) and six months (T3). Statistical significance was found for PaCO2 over time (F (2.42) = 7.63, p = 0.001) and PaO2 (W = 0.539, p = 0.033). The time of NVS usage also significantly affected the quality of life (F (2.14) = 6.90, p = 0.010), as seen when comparing T0 and T3. As an alternative ventilation method, IAPV is still relevant today and could become a key part of daytime support, especially for patients who do not tolerate standard daytime NVS with an oral interface.
Collapse
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
| |
Collapse
|
6
|
Diaz de Teran T, Muñoz P, de Carlos F, Macias E, Cabello M, Cantalejo O, Banfi P, Nicolini A, Solidoro P, Gonzalez M. Mandibular Torus as a New Index of Success for Mandibular Advancement Devices. Int J Environ Res Public Health 2022; 19:14154. [PMID: 36361031 PMCID: PMC9657412 DOI: 10.3390/ijerph192114154] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In obstructive sleep apnoea (OSA), treatment with mandibular advancement devices (MADs) reduces patients' Apnoea-Hypopnoea index (AHI) scores and improves their sleepiness and quality of life. MADs are non-invasive alternatives for patients who cannot tolerate traditional continuous positive airway pressure (CPAP) therapy. The variability of responses to these devices makes it necessary to search for predictors of success. The aim of our study was to evaluate the presence of mandibular torus as a predictor of MAD efficacy in OSA and to identify other potential cephalometric factors that could influence the response to treatment. METHODS This was a retrospective cohort study. The study included 103 patients diagnosed of OSA who met the criteria for initiation of treatment with MAD. Structural variables were collected (cephalometric and the presence or absence of mandibular torus). Statistical analysis was performed to evaluate the existence of predictive factors for the efficacy of MADs. RESULTS A total of 103 patients who were consecutively referred for treatment with MAD were included (89.3% men); the mean age of the participants was 46.3 years, and the mean AHI before MAD was 31.4 (SD 16.2) and post- MAD 11.3 (SD 9.2). Thirty-three percent of patients had mandibular torus. Torus was associated with a better response (odds ratio (OR) = 2.854 (p = 0.035)) after adjustment for sex, age, body mass index (BMI; kg/m2), the angle formed by the occlusal plane to the sella-nasion plane (OCC plane to SN), overinjection, and smoking. No cephalometric predictors of efficacy were found that were predictive of MAD treatment success. CONCLUSIONS The presence of a mandibular torus practically triples the probability of MAD success. This is the simplest examination with the greatest benefits in terms of the efficacy of MAD treatment for OSA.
Collapse
Affiliation(s)
- Teresa Diaz de Teran
- Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Pedro Muñoz
- Cantabria Primary Health Care Management, Instituto Marqués de Valdecilla (IDIVAL), 39011 Santander, Spain
| | - Felix de Carlos
- Department of Surgery and Medical-Surgical Specialties, Area of Orthodontics, Faculty of Medicine, University of Oviedo, 33003 Oviedo, Spain
| | - Emilio Macias
- Department of Surgery and Medical-Surgical Specialties, Area of Orthodontics, Faculty of Medicine, University of Oviedo, 33003 Oviedo, Spain
| | - Marta Cabello
- Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Olga Cantalejo
- Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Paolo Banfi
- Don Gnocchi Foundation IRCCS, 20121 Milan, Italy
| | | | - Paolo Solidoro
- Division of Respiratory Diseases Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Monica Gonzalez
- Sleep and Ventilation Unit, Pneumology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
- Instituto Marqués de Valdecilla (IDIVAL), University of Cantabria, 39011 Santander, Spain
| |
Collapse
|
7
|
Guia M, Alpay N, Gerardo A, Madney Y, Abdelrahim M, Saeed H, Harb H, Gonçalves G, Cabrita B, Alqahtani J, El-Khatib M, Gómez-Ríos M, Fakharian A, Ciobanu L, Karim HMR, Piervincenzi E, Scharffenberg M, Steiropoulos P, LeMaster W, Barjaktarevic I, Wittenstein J, Diaz-Abad M, Perren A, Nicolini A, Spadaro S, Garuti G, Petroianni A, Esquinas A. High-Flow Nasal Oxygen Therapy in Acute Hypoxemic Respiratory Failure: Concise Review on Technology and Initial Methodology. Turk Thorac J 2022; 22:494-500. [PMID: 35110267 DOI: 10.5152/turkthoracj.2021.20213] [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] [Indexed: 11/22/2022]
Abstract
High-flow nasal cannula oxygen therapy (HFNCOT) system consists of an air/oxygen supply system capable of delivering up to 100% humidified and heated oxygen at a flow rate of up to 80 L/min. The system includes a blender, active humidifier, single heated tube, and nasal cannula. HFNCOT has many physiological advantages compared with other standard oxygen therapies, such as anatomical dead space washout, more constant fraction of inspired oxygen, positive end-expiratory (PEEP) effect, supplement of adequate humidification and maintenance of muco-ciliary function. HFNCOT is mostly used for hypoxemic acute respiratory failure, although it also has other indications. HFNCOT is a common choice of physicians as its technology makes it more silent and comfortable. Though HFNCOT is used in many clinical settings, there is a lack of publications addressing devices and initial settings. We present a review on HFNCOT, with focus on device and application methodology.
Collapse
Affiliation(s)
- Miguel Guia
- Pulmonology Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - Nilgun Alpay
- Department of Anesthesiology and Reanimation, Dentistry Faculty, Çukurova University, Adana, Turkey
| | - António Gerardo
- Pulmonology Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
| | - Yasmin Madney
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-suef University, Beni-suef, Egypt
| | - Mohamed Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-suef University, Beni-suef, Egypt
| | - Haitham Saeed
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-suef University, Beni-suef, Egypt
| | - Hadeer Harb
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-suef University, Beni-suef, Egypt
| | - Gil Gonçalves
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Bruno Cabrita
- Pulmonology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Jaber Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Mohamad El-Khatib
- Department of Anesthesiology, Director of Respiratory Therapy, American University of Beirut, Beirut, Lebanon
| | - Manuel Gómez-Ríos
- Department of Anaesthesia and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - Atefeh Fakharian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Laura Ciobanu
- Department of Internal Medicine, University of Medicine and Pharmacy "Grigore T Popa", Iasi, Romania
| | - Habib Md Reazaul Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India
| | - Edoardo Piervincenzi
- Department of Anesthesia and Intensive Care, Sapienza University of Rome, Rome, Italy
| | - Martin Scharffenberg
- Department of Anaesthesiology and Intensive Care Medicine University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
| | | | - William LeMaster
- Division of Pulmonary and Critical Care Medicine, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, UCLA David Geffen School of Medicine, Los Angeles, USA
| | - Jakob Wittenstein
- Department of Anaesthesiology and Intensive Care Medicine University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
| | - Montserrat Diaz-Abad
- Division of Pulmonary and Critical Care Medicine University of Maryland School of Medicine Baltimore, USA
| | - Andreas Perren
- Primario Medicina Intensiva, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Antonello Nicolini
- Respiratory Diseases Unit, General Hospital Sestri Levante, Sestri Levante, Italy
| | - Savino Spadaro
- Department Morphology, Surgery And Experimental Medicine, Intensive Care Unit, University of Ferrara, Ferrara, Italy
| | | | - Angelo Petroianni
- Respiratory Diseases Unit, Respiratory Intensive Care Unit, Policlinico Umberto I Sapienza University of Rome, Italy
| | | |
Collapse
|
8
|
Pestelli MT, D'Abrosca F, Tognetti P, Grecchi B, Nicolini A, Solidoro P. Do not forget the lungs: I/E mode physiotherapy for people recovering from COVID-19. Preliminary feasibility study. Panminerva Med 2021; 64:208-214. [PMID: 34664483 DOI: 10.23736/s0031-0808.21.04510-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Early chest physiotherapy is recommended for patients with post-COVID syndrome to improve dyspnea, relieve anxiety, minimize disability, preserve lung function and improve quality of life. However, there is still no consensus on the best treatments to manage respiratory symptoms. We aimed to test a method based on a guided in/expiratory (I/E) modulation to treat the lung inhomogeneity. METHODS Twenty patients with post-COVID syndrome and mild-to-moderate obstructive syndrome performed 3 15-min sessions/day using the I/E mode of the T-PEP®4 device, for 15 consecutive days. Lung function parameters, dyspnea and quality of life scores, as well as exercise capacity were assessed before and after treatment. RESULTS All patients concluded the treatment and showed significant improvements in symptoms (chest pain during deep inspiration, chest tightness, inability to yawn, fatigue during activities of daily living [ADL], desaturation ≥4% during ADL) and in health status (BCSS -1.75, p=0.0003; CAT -5.2, p=0.0001). Lung function (FVC +10.9%, p=0.0002; FEV1 +8%, p=0.0001) and respiratory muscle strength (MIP +13.8%, p<0.0001; SNIP +13.6%, p=0.0122; MEP +7.6%, p=0.0045) improved. Exercise capacity also improved (6MWT +14.2%, p=0.005). At the end of treatment, only 2 patients reported symptoms and ADL-induced desaturation, while 14 still had fatigue during ADL. CONCLUSIONS This study shows that chest physiotherapy using an I/E device to actively recruit peripheral lungs in COVID-19 patients early after hospital discharge improved lung function tests as well as respiratory muscle strength, exercise capacity and quality of life.
Collapse
Affiliation(s)
- Maria Teresa Pestelli
- Physical Medicine and Rehabilitation, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Francesco D'Abrosca
- Department of Health Sciences, University of Eastern Piedmont, Alessandria, Italy
| | - Paola Tognetti
- Physical Medicine and Rehabilitation, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Bruna Grecchi
- Physical Medicine and Rehabilitation, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Antonello Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy -
| | - Paolo Solidoro
- Division of Pulmonology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,Department of Medical Sciences, University of Torino, Turin, Italy
| |
Collapse
|
9
|
Puricelli C, Volpato E, Sciurello S, Nicolini A, Banfi P. Intermittent abdominal pressure ventilation: feasibility and efficacy in neuromuscular disease. A case report. Monaldi Arch Chest Dis 2021; 91. [PMID: 34351105 DOI: 10.4081/monaldi.2021.1828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/30/2021] [Indexed: 11/22/2022] Open
Abstract
he standard treatment for patients with neuromuscular respiratory failure is non-invasive ventilation (NIV) as non-invasive ventilation support-setting (NVS). NVS is administered through a nasal or face mask and/or mouthpiece with the potential to cause nasal ulcers, discomfort, and/or aesthetic issues, resulting in poor compliance. We reported the observation of a 45-year-old woman with limb-girdle muscular dystrophy (LGMD), secondary to Dysferlin deficiency, who was on NVS since 2017 for nocturnal hypoventilation. In 2018, despite nocturnal ventilation, due to weight gain and daytime hypoventilation, a nasal mask was introduced. We initiated daytime intermittent abdominal pressure ventilation (IAPV) to mitigate cosmetic problems, improving in pO2 and decreasing in pCO2 versus baseline (52>84 mmHg, 46>33 mmHg respectively) at 6 (85 mmHg, 42 mmHg) and 18 months (93 mmHg, 38 mmHg), respectively. IAPV was effective, safe, and well-tolerated in our patients who did not tolerate standard daytime NVS with the known interface.
Collapse
Affiliation(s)
| | - Eleonora Volpato
- IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi; Department of Psychology, Università Cattolica del Sacro Cuore, Milan.
| | | | | | - Paolo Banfi
- IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan.
| |
Collapse
|
10
|
Gandolfo C, Bonfiglio M, Spinetto G, Ferraioli G, Barlascini C, Nicolini A, Solidoro P. Pneumomediastinum associated with severe pneumonia related to COVID-19: diagnosis and management. Minerva Med 2021; 112:779-785. [PMID: 34142771 DOI: 10.23736/s0026-4806.21.07585-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pneumomediastinum (PNM) can develop as a severe complication of severe COVID 19 and may be correlated with greater morbidity and mortality. PNM is a rarely reported complication in COVID-19 patients and usually associated with endotracheal intubation. METHODS Our aim is to describe the characteristics of patients with PNM in twenty-one patients with COVID-19 related pneumonia and acute respiratory failure in a retrospective case series. RESULTS Twenty-one patients were diagnosed, two were treated with high flow nasal cannula, five with non invasive ventilation and four with invasive mechanical ventilation. In four cases PNM was massive PNM was often associated to subcuatneous emphysema; more rarely associated also with pneumothorax. Conservative management was the most used therapeutic strategy. CONCLUSIONS PNM should is s serious but not extremely rare complication of severe forms of pulmonary involvement of COVID 19. The clinician should consider this rare complication; moreover, we advise careful attention when clinicians start mechanical ventilation.
Collapse
Affiliation(s)
- Corinna Gandolfo
- COVID 19 Intensive Care Unit, General Hospital Unit, Sestri Levante, Genova, Italy
| | - Monica Bonfiglio
- COVID 19 Intensive Care Unit, General Hospital Unit, Sestri Levante, Genova, Italy
| | - Giulia Spinetto
- COVID 19 Intensive Care Unit, General Hospital Unit, Sestri Levante, Genova, Italy
| | | | | | - Antonello Nicolini
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genova, Italy -
| | - Paolo Solidoro
- Medical Sciences Department, University of Torino, Turin, Italy.,Division of Respiratory Diseases, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| |
Collapse
|
11
|
Spina MF, Banfi PI, Nicolini A, Solidoro P. Severe asthma management during Covid pandemic. Minerva Med 2021; 113:571-572. [PMID: 33949183 DOI: 10.23736/s0026-4806.21.07484-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Antonello Nicolini
- Respiratory diseases Unit, General Hospital Sestri Levante, Sestri Levante, Genova, Italy
| | - Paolo Solidoro
- Unit of Pneumology U, Cardiovascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| |
Collapse
|
12
|
Nicolini A, Prato P, Beccarelli L, Grecchi B, Garuti G, Banfi P, D'Abrosca F. Comparison of two mechanical insufflation-exsufflation devices in patients with amyotrophic lateral sclerosis: a preliminary study. Panminerva Med 2021; 64:525-531. [PMID: 33687180 DOI: 10.23736/s0031-0808.21.04104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disease affecting upper and lower motor neurons and resulting in progressive skeletal muscle weakness. Weak cough and difficulty in clearing secretions are often the cause of pulmonary infections and acute respiratory failure. Cough assistance is commonly used to provide support in coughing for patients with ALS. METHODS This was a preliminary parallel randomized study comparing two cough-assist devices: one utilizing mechanical insufflation/exsufflation (MI/E) and expiratory flow accelerator (EFA) technology, the other utilizing only MI/E technology. The aim was to compare the effectiveness, safety and acceptability of the two devices. Thirty patients with ALS and similar severity and functional scale were enrolled. The primary outcome was the change in respiratory function, respiratory muscle function, gas exchange, and peak cough expiratory flow as an indicator of cough efficacy. Secondary outcomes were the number of exacerbations at 1, 6 and 12 months of treatment, and the patient-perceived comfort/distress related to the interventions together with the perceived efficacy of cough. RESULTS 30 subjects were recruited and randomized into the two groups (1:1 ratio). Primary outcomes: Respiratory function parameters decreased over time in both groups, but significantly less in the Kalos group, as did the respiratory muscle strength parameters and peak cough flows. Gas exchanges decreased over time in both groups with no clinically relevant differences between groups. SECONDARY OUTCOMES there were no significant differences between groups regarding the number of exacerbations over time. No adverse events were reported. All participants, in both groups, reported a similar increase in perceived cough efficacy and there was no significant difference in comfort and distress between the two treatments. CONCLUSIONS The cough-assist device with EFA technology performed better than a traditional MI/E device in ALS patients regarding respiratory function and cough efficacy, although number of exacerbations and acceptability of the two devices was similar. Following these promising preliminary results, further investigation is required in a larger cohort to confirm the superiority of EFA technology associated with a MI/E device.
Collapse
Affiliation(s)
- Antonello Nicolini
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genova, Italy - antonellonicolini#gmail.com
| | - Paola Prato
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genova, Italy
| | - Laura Beccarelli
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genova, Italy
| | - Bruna Grecchi
- Physical Medicine and Rehabilitation, General Hospital, Sestri Levante, Genova, Italy
| | - Giancarlo Garuti
- Department of Pulmonology, General Hospital, Mirandola, Modena, Italy
| | - Paolo Banfi
- Pulmonary Rehabilitation Unit, Don Gnocchi Foundation, IRCCS, Milan, Italy
| | | |
Collapse
|
13
|
Banfi P, Garuti G, Diaz de Teran T, Ruiz J, Ferraioli G, Russo G, Casu F, Gandolfo C, Cinque E, Gallo F, Cilloniz C, Torres A, Nicolini A. Differences between sexes concerning COVID-19-related pneumonia. Panminerva Med 2021; 64:517-524. [PMID: 33618509 DOI: 10.23736/s0031-0808.21.04165-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Pneumonia is both the most common type of lower respiratory tract infection and a major cause of morbidity and mortality worldwide. The COVID-19 pandemic caused by the SARS-CoV-2 raised an extremely serious concern, because its most frequent clinical presentation was pneumonia. Features such as sex play an active role in the incidence and outcomes of pneumonia. This study aimed to evaluate differences between sexes concerning COVID-19-related pneumonia. METHODS This was a retrospective, multicentre study that enrolled 340 consecutive adult patients admitted to hospital for COVID-19-related pneumonia. Of these patients, 219 were males (64.4%) and 121, females (35.6%). Primary endpoints were differences between both sexes as per clinical features, laboratory and radiologic results, and inhospital and 30-day mortality. Secondary outcomes included differences between both sexes and factors associated with mortality. RESULTS Males admitted to the COVID-19 Unit were older than females (74.5 ± 15.7 vs. 64.5 ± 11.9). Cardiovascular disorders were more frequent in males (19.17% vs 13.25%), whereas obesity was more common in females (54.5% vs 37.45%). In-hospital and 30-day mortality were higher in males than in females (23.3% vs 15.7%; 24.6% vs 19.8%, respectively). No differences were observed in hospital stay; however, males had a longer ICU stay when compared with females (11.04±5.4 vs 7.05±3.4). Variables associated with a higher mortality rate included older age, a lower number of lymphocytes upon admission and higher levels of ferritin and troponin upon admission. CONCLUSIONS Males had significantly higher mortality and longer ICU stay than females. More comorbidities in males than in females could explain the difference in mortality rates. The protective role of genetic factors can partially explain the better outcomes observed in female patients with COVID-19.
Collapse
Affiliation(s)
- Paolo Banfi
- Rehabilitation Pulmonology, Don Gnocchi Foundation, IRCCS, Milan, Italy
| | - Giancarlo Garuti
- Pulmonology Unit, Santa Maria Bianca Hospital, Mirandola, Modena, Italy
| | - Teresa Diaz de Teran
- Pulmonary, Sleep Disorders and Non-invasive Ventilation Unit, Hospital Marqués de Valdecilla, Santander, Spain
| | - Juan Ruiz
- Pulmonary, Sleep Disorders and Non-invasive Ventilation Unit, Hospital Marqués de Valdecilla, Santander, Spain
| | | | - Giuseppe Russo
- COVID Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - Francesco Casu
- COVID Unit, General Hospital, Sestri Levante, Genoa, Italy
| | | | - Enrico Cinque
- Intensive Care Unit, Tigullio Hospital, Lavagna, Genoa, Italy
| | - Fabrizio Gallo
- COVID Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - Catia Cilloniz
- Pulmonology Department, Hospital Clinic of Barcelona, University of Barcelona, CIBERES, Barcelona, Spain
| | - Antoni Torres
- Pulmonology Department, Hospital Clinic of Barcelona, University of Barcelona, CIBERES, Barcelona, Spain
| | - Antonello Nicolini
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genoa, Italy -
| |
Collapse
|
14
|
Diaz DE Teran T, Gonzales Martinez M, Banfi P, Garuti G, Ferraioli G, Russo G, Casu F, Vivarelli M, Bonfiglio M, Perazzo A, Barlascini C, Bauleo A, Nicolini A, Solidoro P. Management of patients with severe acute respiratory failure due to SARS-CoV-2 pneumonia with noninvasive ventilatory support outside Intensive Care Unit. Minerva Med 2021; 112:329-337. [PMID: 33464224 DOI: 10.23736/s0026-4806.21.07134-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND COVID-19 has high mortality rate mainly stemming from acute respiratory distress leading to respiratory failure (ARF). Aim of the study was to evaluate the management of severe ARF due to COVID-19 pneumonia using noninvasive ventilatory support (NIVS), studying safety and effectiveness of NIVS. METHODS This is a retrospective, multicenter study. Primary outcomes were NIVS failure with intubation rate and hospital mortality. Secondary outcomes were hospital stay and factors related to NIVS failure and mortality. These outcomes were compared with patients intubated and admitted to ICU. RESULTS One hundred sixty-two patients were hospitalized because of severe respiratory failure (PaO<inf>2</inf>/FiO<inf>2</inf> ratio <250). One hundred thirty-eight patients were admitted to Respiratory Intermediate Care Unit (RICU) for a NIVS trial. One hundred patients were treated successfully with NIVS (74.5%); 38 failed NIVS trial (27.5%). In-hospital mortality was 23.18% in RICU group and 30.55% in ICU group. Patients with NIVS failure were older, had a lower number of lymphocytes, a higher IL-6, lower PaO<inf>2</inf>, PaC O<inf>2</inf>, PaO<inf>2</inf>/FiO<inf>2</inf> ratio, higher respiratory rate (RR) and heart rate at admission and lower PaO2, and PaO<inf>2</inf>/FiO<inf>2</inf> ratio and higher RR after 1-6 hours. Multivariate analysis identified higher age, C-reactive protein as well as RR after 1-6 hours and PaO<inf>2</inf>/FiO<inf>2</inf> ratio after 1-6 hours as an independent predictor mortality. CONCLUSIONS NIVS is a safe and effective strategy in the treatment of severe ARF due to COVID-19 related pneumonia, that reduces mortality and length of hospital stay in the carefully selected patients.
Collapse
Affiliation(s)
- Teresa Diaz DE Teran
- Unit of Pulmonary Sleep Disorders and Noninvasive Ventilation, Marqués de Valdecilla Hospital, Santander, Spain
| | - Monica Gonzales Martinez
- Unit of Pulmonary Sleep Disorders and Noninvasive Ventilation, Marqués de Valdecilla Hospital, Santander, Spain
| | - Paolo Banfi
- Unit of Rehabilitation Pulmonology, IRCCS Don Gnocchi Foundation, Milan, Italy
| | - Giancarlo Garuti
- Unit of Pulmonology, Santa Maria Bianca Hospital, Mirandola, Modena, Italy
| | - Gianluca Ferraioli
- COVID Respiratory Intensive Care Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - Giuseppe Russo
- COVID Respiratory Intensive Care Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - Francesco Casu
- COVID Respiratory Intensive Care Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - Michela Vivarelli
- COVID Respiratory Intensive Care Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - Monica Bonfiglio
- COVID Respiratory Intensive Care Unit, General Hospital, Sestri Levante, Genoa, Italy
| | - Alessandro Perazzo
- Unit of Respiratory Diseases, General Hospital, Sestri Levante, Genoa, Italy
| | - Cornelius Barlascini
- Unit of Hygiene and Health Care Medicine, General Hospital, Sestri Levante, Genoa, Italy
| | | | - Antonello Nicolini
- Unit of Respiratory Diseases, General Hospital, Sestri Levante, Genoa, Italy -
| | - Paolo Solidoro
- Unit of Respiratory Diseases, Department Cardiovascular and Thoracic Diseases, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Science, University of Turin, Turin, Italy
| |
Collapse
|
15
|
Riboldazzi G, Spinazza G, Beccarelli L, Prato P, Grecchi B, D'Abrosca F, Nicolini A. Effectiveness of expiratory flow acceleration in patients with Parkinson's disease and swallowing deficiency: A preliminary study. Clin Neurol Neurosurg 2020; 199:106249. [PMID: 33039853 DOI: 10.1016/j.clineuro.2020.106249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) causes dysfunction both to swallowing and to the cough mechanism. Oropharyngeal dysphagia is the main cause of pneumonia, due to silent aspiration of food and saliva. Pneumonia is the leading cause of death in PD. Different strategies exist to reduce the risk of inhalation and associated lung infections, but evidence of their efficacy is still unclear. The aim of this preliminary study was to investigate if adding an expiratory flow acceleration (EFA®) technique to standard therapy (ST) for dysphagia can reduce the incidence of bronchopulmonary infections and improve quality of life, respiratory function parameters, cough, and airways encumbrance perception. MATERIALS AND METHODS Twenty-five patients with PD were randomized to two groups: ST vs. ST + EFA. Patients were re-assessed at 30, 180 and 360 days from start of treatment. The primary outcome was the incidence of respiratory exacerbations together with quality of life score (PDQ-39). Secondary outcomes were changes in respiratory function tests, cough capacity (CPEF), perceived health status (Euro-QOL-VAS), cough, and upper airways encumbrance perception evaluated by visual numeric scale (VNS). RESULTS Twenty patients concluded the study (10 each group). Albeit the difference was not significant, less respiratory infections, symptoms, hospital admissions and medical visits were found in the study group. Furthermore, there was a significant difference in cough effectiveness measured with the peak cough expiratory flow (PCEF) and other spirometry parameters (FEV1, FVC), and also in specific and generic health-related quality of life measures (PDQ-39, Euro-QoL-VAS). CONCLUSION The results of this preliminary study support the use of EFA® technology in Parkinson's patients with dysphagia to reduce the risk of respiratory complications. Nevertheless, further studies are needed in a larger, more representative sample to definitively confirm the usefulness of this technique in PD patients.
Collapse
Affiliation(s)
- Giulio Riboldazzi
- Parkinson's Disease Unit, Gaetano and Piera Borghi Foundation, Brebbia, Italy
| | - Giada Spinazza
- Neurology Rehabilitation Department, Hospital of Cuasso al Monte, Italy
| | - Laura Beccarelli
- Pulmonary Rehabilitation Unit, General Hospital, Sestri Levante, Italy
| | - Paola Prato
- Pulmonary Rehabilitation Unit, General Hospital, Sestri Levante, Italy
| | - Bruna Grecchi
- Physical Medicine and Rehabilitation Department, General Hospital, Sestri Levante, Italy
| | | | | |
Collapse
|
16
|
Spina MF, Banfi PI, Nicolini A. Thunderstorm-asthma, two cases observed in Northern Italy. Multidiscip Respir Med 2020; 15:679. [PMID: 32983454 PMCID: PMC7499097 DOI: 10.4081/mrm.2020.679] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022] Open
Abstract
Thunderstorm asthma is a rare event: in this letter we describe two cases observed during the same month of 2018 at an Italian Emergency department, assessed by the same medical team and according to the same methodology and approach. Given the infrequency of such a phenomenon and the debate around its nature, frequency, and - at times - existence, we strongly believe it is important for all specialists who observe such cases to report them, building an evidence base to expand its knowledge and understanding.
Collapse
Affiliation(s)
| | | | - Antonello Nicolini
- Respiratory Diseases Unit, General Hospital of Sestri Levante (GE), Italy
| |
Collapse
|
17
|
Bagnasco D, Brussino L, Bonavia M, Calzolari E, Caminati M, Caruso C, D'Amato M, De Ferrari L, Di Marco F, Imeri G, Di Bona D, Gilardenghi A, Guida G, Lombardi C, Milanese M, Nicolini A, Riccio AM, Rolla G, Santus P, Senna G, Passalacqua G. Efficacy of Benralizumab in severe asthma in real life and focus on nasal polyposis. Respir Med 2020; 171:106080. [PMID: 32917354 DOI: 10.1016/j.rmed.2020.106080] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Severe asthma occurs in 5-10% of asthmatic patients, with nasal polyposis as one of the most frequent comorbidity. Benralizumab was recently marketed, thus we could analyse its effects in real-life in severe asthma, and compare the effects of the drug in patients with and without polyposis. METHODS Patients with severe asthma, receiving Benralizumab were enrolled in Italian asthma centres. The efficacy criteria for asthma (exacerbation rate, oral corticosteroid intake, hospitalizations, pulmonary function, exhaled nitric oxide) were evaluated at baseline and after 24 weeks of treatment. Patients were then sub-analysed according to the presence/absence of nasal polyposis. RESULTS Fifty-nine patients with severe uncontrolled asthma (21 males, age range 32-78) and treated with benralizumab for at least 24 weeks has been evaluated, showing significant improvements in asthma-related outcomes, except for pulmonary function and exhaled nitric oxide. This included a reduction in the sino-nasal outcome-22 score versus baseline of 13.7 points (p = .0037) in the 34 patients with nasal polyposis. Anosmia disappeared in 31% patients (p = .0034). When comparing the groups with and without nasal polyposis, a similar reduction of exacerbations was seen, with a greater reduction of the steroid dependence in patients with polyposis (-72% vs -53%; p < .0001), whereas lung function was significantly more improved (12% vs 34%, p = .0064) without polyposis patients. CONCLUSIONS Benralizumab, after 6 months of treatment, confirmed its efficacy in severe asthma, and also in nasal polyposis, which is the most frequent comorbidity. The efficacy of Benralizumab in reducing steroid dependence was even higher in patients with polyposis.
Collapse
Affiliation(s)
- Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy.
| | - Luisa Brussino
- Mauriziano Hospital, Department of Medical Science, University of Turin, Italy
| | - Marco Bonavia
- Pneumology Unit, Ospedale La Colletta, Arenzano, Italy
| | - Elisa Calzolari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Marco Caminati
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCSS, Rome, Italy
| | - Maria D'Amato
- Department of Pneumology, AO "Dei Colli" Federico II University, Naples, Italy
| | - Laura De Ferrari
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gianluca Imeri
- Department of Health Sciences, University of Milan, Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Andrea Gilardenghi
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S.Croce e Carle, Cuneo, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Manlio Milanese
- Division of Pneumology, S.Corona Hospital, Pietra Ligure, Italy
| | - Antonello Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy
| | - Anna Maria Riccio
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| | - Giovanni Rolla
- Mauriziano Hospital, Department of Medical Science, University of Turin, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Division of Respiratory Diseases, Università degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, Via G.B. Grassi, 74-20157, Milano, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, Verona University and General Hospital, Department of Medicine, University of Verona, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Department of Internal Medicine (DIMI), Genoa, Italy
| |
Collapse
|
18
|
Nicolini A, Grecchi B, Banfi P. Effectiveness of two high frequency chest wall oscillation techniques in patients with bronchiectasis: a randomized controlled preliminary study. Panminerva Med 2020; 64:235-243. [PMID: 32192317 DOI: 10.23736/s0031-0808.20.03735-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chest physiotherapy is an important tool in the treatment of bronchiectasis. High frequency chest wall oscillation (HFCWO) is a technique designed to create a global percussion of the lung which moves secretions and probably clears the peripheral bronchial tree. We propose the comparison between an existing device (SmartVest) and a new device (RespIn 11). METHODS Sixty patients were randomized into three groups: a group was treated with SmartVest, a group with RespIn 11, and a group with pharmacological therapy alone. Primary outcome measures included exacerbations at 3, 6 and 12 months after the end of treatment. Secondary outcome measures were pulmonary function testing, arterial blood gas analysis (ABG), and hematological examinations, cough, dyspnea, health and quality of life scores (Bronchiectasis Health Questionnaire [BHQ], Breathlessness, Cough, and Sputum Scale [BCSS], COPD Assessment Test [CAT], Leicester Cough Questionnaire [LCT]). A 5-point Likert scale was used to evaluate patient's preference. RESULTS Both patients in the HFCWO groups showed a significant improvement in the tests of dyspnea, cough and health and quality of life score evaluations (BHQ, BCSS, CAT, LCT) compared to the control group, but not in pulmonary function tests and ABG. Only RespIn 11 significantly reduced exacerbations in comparison with the control group. RespIn 11 also had a higher score regarding patients' preference. CONCLUSIONS The two machines have improved health and quality of life scores in patients with bronchiectasis. RespIn 11 also demonstrated a significant lowering of exacerbations and a better patient acceptance.
Collapse
Affiliation(s)
- Antonello Nicolini
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genova, Italy -
| | - Bruna Grecchi
- Rehabilitation Unit, General Hospital, Sestri Levante, Genova, Italy
| | - Paolo Banfi
- Pulmonary Rehabilitation Department, Don Gnocchi Foundation, IRCCS, Milan, Italy
| |
Collapse
|
19
|
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is the most common type of lower respiratory tract infection and a major cause of morbidity and mortality in adults worldwide. Sex and gender play an active role in the incidence and outcomes of major infectious diseases, including CAP. EVIDENCE ACQUISITION We searched the following electronic databases from January 2001 to December 2018: MEDLINE, EMBASE, CINHAIL, CENTRAL (Cochrane Central register of Controlled Trials), DARE (Database of Abstracts of Reviews of Effectiveness), Cochrane Database of Systematic Reviews and ACP Journal Club database. EVIDENCE SYNTHESIS Several studies have reported higher male susceptibility to pulmonary infections and higher risk of death due to sepsis. Biological differences (e.g. hormonal cycles and cellular immune-mediated responses) together with cultural, behavioral and socio-economic differences are important determinants of the course and outcome of CAP. However, gender-related bias in the provision of care and use of hospital resources has been reported among women, resulting in delayed hospital admission and consequently necessary care. CONCLUSIONS CAP is more severe in males than in females, leading to higher mortality in males, especially in older age. To identify gender differences in CAP can guide patient's prognostication and management.
Collapse
Affiliation(s)
- Elena Barbagelata
- Department of Internal Medicine, General Hospital, Sestri Levante, Genoa, Italy
| | - Catia Cillóniz
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAP S, Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), University of Barcelona, Barcelona, Spain
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAP S, Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), University of Barcelona, Barcelona, Spain
| | - Antonello Nicolini
- Unit of Respiratory Diseases, General Hospital, Sestri Levante, Genoa, Italy -
| | - Paolo Solidoro
- Unit of Pneumology U, Cardiovascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| |
Collapse
|
20
|
Nicolini A, Parrinello L, Grecchi B, Braido F, Baiardini I, Ghirotti C, Banfi P. Diurnal mouthpiece ventilation and nocturnal non-invasive ventilation versus tracheostomy invasive ventilation in patients with amyotrophic lateral sclerosis. Panminerva Med 2020; 62:19-25. [DOI: 10.23736/s0031-0808.19.03644-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
21
|
Annoni S, Bellofiore A, Repossini E, Lazzeri M, Nicolini A, Tarsia P. Effectiveness of chest physiotherapy and pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: a narrative review. Monaldi Arch Chest Dis 2020; 90. [PMID: 32072797 DOI: 10.4081/monaldi.2020.1107] [Citation(s) in RCA: 4] [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: 06/03/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022] Open
Abstract
Respiratory physiotherapy and rehabilitation are important therapeutic options in non-cystic fibrosis bronchiectasis (NCFB). The aims of this review of clinical trials were to evaluate the safety and the effects on physiologic and clinical outcomes of airway clearance techniques (ACTs) and rehabilitation in NCFB patients, in comparison to usual care. The search was performed on March 2018 by using PubMed and PeDro databases. 33 studies were selected. The use of ACTs for NCFB were effective in increasing sputum volume although no benefit in quality of life (QoL) or pulmonary exacerbations were observed. There were no differences in effectiveness between the several techniques used. Humidification and saline inhalation were able to aid airway clearance. Hypertonic solution (HS) was more effective than isotonic solutions (IS) in improving expectoration and sputum viscosity. Pulmonary rehabilitation (PR) was found to be associated with short term benefits in exercise capacity, dyspnea and fatigue. Exercise training seems to improve quality of life and lower exacerbation rate, but long-term data are not available. Further studies are necessary to identify the most feasible long-term outcomes such as QoL and exacerbation rate.
Collapse
Affiliation(s)
- Sara Annoni
- Physical Medicine and Rehabilitation Unit, San Gerardo Hospital, Monza.
| | | | | | | | | | | |
Collapse
|
22
|
Volpato E, Banfi P, Nicolini A, Pagnini F. Quick relaxation exercise for people with chronic obstructive pulmonary disease: explorative randomized controlled trial. Multidiscip Respir Med 2019. [DOI: 10.4081/mrm.2018.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: People with Chronic Obstructive Pulmonary Disease (COPD) suffer from dyspnoea, which may be increased by anxiety. Previous studies suggest that relaxation techniques may have positive effects in pulmonary rehabilitation. The main aim of this study is to explore the clinical impact of a quick, one-session, relaxation training for people with COPD. Methods: In this perspective, 38 participants with COPD were recruited and randomly assigned to listen to a relaxing audio or to watch a neutral stimulus, during their routine exams. Participants were assessed for psychological and physiological variables, analysed through non-parametric tests. Results: Those who joined the relaxation training showed more positive outcomes about respiratory and cardiac assessments, as well as for state anxiety and positive affections, in comparison with the baseline and the control group. Conclusions: Study results suggest that relaxation has a potential to produce improvements in respiratory and cardiac functions, together with a positive emotional effect and a reduction of anxiety.
Collapse
|
23
|
Banfi P, Pierucci P, Volpato E, Nicolini A, Lax A, Robert D, Bach J. Daytime noninvasive ventilatory support for patients with ventilatory pump failure: a narrative review. Multidiscip Respir Med 2019; 14:38. [PMID: 31798866 PMCID: PMC6884796 DOI: 10.1186/s40248-019-0202-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
Over the past three decades, the use of noninvasive ventilation or "NIV" to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechanical ventilation. NVS, along with mechanical insufflation-exsufflation, now provides a noninvasive option for the management of both chronic and acute respiratory failure for these patients. The most common diagnoses for which these methods are useful include chest wall deformities, neuromuscular diseases, morbid obesity, high level spinal cord injury and idiopathic, primary or secondary disorders of the ventilatory control. Thus, NVS is being used in diverse settings: critical care units, medical wards, at home, and in extended care. The aim of this review is to examine the techniques used for daytime support.
Collapse
Affiliation(s)
- Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Paola Pierucci
- Cardio Thoracic Department, Respiratory and Sleep Disorders Unit, Bari Policlinic, Bari, Italy
| | - Eleonora Volpato
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Antonello Nicolini
- Respiratory Rehabilitation Unit, ASL 4 Chiavarese, Hospital of Sestri Levante, Sestri Levante, Italy
| | - Agata Lax
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro, 66 20148 Milan, Italy
| | - Dominique Robert
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Réanimation Médicale, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - John Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University New Jersey Medical School, Newark, USA
| |
Collapse
|
24
|
Banfi P, Pierucci P, Volpato E, Nicolini A, Lax A, Robert D, Bach J. Daytime noninvasive ventilatory support for patients with ventilatory pump failure: a narrative review. Multidiscip Respir Med 2019. [DOI: 10.4081/mrm.2019.486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Over the past three decades, the use of noninvasive ventilation or “NIV” to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechanical ventilation. NVS, along with mechanical insufflation-exsufflation, now provides a noninvasive option for the management of both chronic and acute respiratory failure for these patients. The most common diagnoses for which these methods are useful include chest wall deformities, neuromuscular diseases, morbid obesity, high level spinal cord injury and idiopathic, primary or secondary disorders of the ventilatory control. Thus, NVS is being used in diverse settings: critical care units, medical wards, at home, and in extended care. The aim of this review is to examine the techniques used for daytime support.
Collapse
|
25
|
Nicolini A, Garuti G, Perazzo T, Banfi P, Clini E. Gender differences in chronic obstructive pulmonary disease: Can be the DRG-based diagnosis the best way for a right analysis? Ital J Med 2019. [DOI: 10.4081/itjm.2019.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Not available
Collapse
|
26
|
Diaz de Teran T, Barbagelata E, Cilloniz C, Nicolini A, Perazzo T, Perren A, Ocak Serin S, Scharffenberg M, Fiorentino G, Zaccagnini M, Khatib MI, Papadakos P, Rezaul Karim HM, Solidoro P, Esquinas A. Non-invasive ventilation in palliative care: a systematic review. Minerva Med 2019; 110:555-563. [PMID: 31359741 DOI: 10.23736/s0026-4806.19.06273-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION An ageing population and steady increase in the rates of neoplasms and chronic degenerative diseases poses a challenge for societies and their healthcare systems. Because of the recent and continued advances in therapies, such as the development and widespread use of non-invasive ventilation (NIV), survival rates have increased for these pathologies. For patients with end-stage chronic respiratory diseases, the use of NIV following the onset of acute or severe chronic respiratory failure is a valid option when intubation has been excluded. EVIDENCE ACQUISITION The following electronic databases were searched from their inception to January 2000 to December 2017: MEDLINE, EMBASE, CINHAIL, CENTRAL (Cochrane Central register of Controlled Trials), DARE (Database of Abstracts of Reviews of Effectiveness), the Cochrane Database of Systematic Reviews, ACP Journal Club database. EVIDENCE SYNTHESIS The available evidence strongly supports the use of NIV in patients presenting with an exacerbation of chronic obstructive pulmonary disease, as well end-stage neuromuscular disease. Few studies support the use of NIV in end-stage interstitial lung disease and in morbid obesity patients. In patients with cancer has been recommend offering NIV as palliative care to improve dyspnea. CONCLUSIONS The decision regarding the treatment should be made by the patient, ideally before reaching the terminal stage and after having a frank dialogue with healthcare professionals and family members.
Collapse
Affiliation(s)
- Teresa Diaz de Teran
- Unit of Sleep and Non-Invasive Ventilation, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Elena Barbagelata
- Department of Internal Medicine, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Catia Cilloniz
- Department of Pneumology, Clinical Institute of Thoracic Surgery, August Pi i Sunyer Institute of Biomedical Research (IDIBAPS), Hospital Clínic, Barcelona, University of Barcelona (UB), Barcelona, Spain.,Unit SGR 911, Center for Biomedical Network Research for Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Antonello Nicolini
- Department of Respiratory Diseases, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy -
| | - Tommaso Perazzo
- Department of Respiratory Diseases, General Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Andreas Perren
- Department of Intensive Care, Regional Hospital of Bellinzona, Bellinzona, Switzerland
| | - Sibel Ocak Serin
- University of Health Science, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Martin Scharffenberg
- Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus Faculty of Medicine, Technical University of Dresden, Dresden, Germany
| | - Giuseppe Fiorentino
- Unit of Respiratory Pathophysiology, Diseases, and Rehabilitation, Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Marco Zaccagnini
- Department of Anesthesia and Critical Care, McGill University Health Center, Montreal, QC, Canada
| | - Mohamad I Khatib
- Department of Anesthesiology, School of Medicine, American University of Beirut, Beirut, Lebanon
| | - Peter Papadakos
- Department of Anesthesiology, University of Rochester, Rochester, NY, USA
| | - Habib M Rezaul Karim
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, India
| | - Paolo Solidoro
- Unit of Pneumology U, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Antonio Esquinas
- Unit of Intensive Care, Morales Meseguer Hospital, Murcia, Spain
| |
Collapse
|
27
|
Patrizio G, D'Andria M, D'Abrosca F, Cabiaglia A, Tanzi F, Garuti G, Nicolini A. Airway Clearance with Expiratory Flow Accelerator Technology: Effectiveness of the "Free Aspire" Device in Patients with Severe COPD. Turk Thorac J 2019; 20:209-215. [PMID: 31390330 DOI: 10.5152/turkthoracj.2018.18053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/14/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) is associated with a higher risk of pulmonary infections. This risk not only negatively affects patients' quality of life but also increases social and health costs. Hence, there is a need for an effective rehabilitative treatment including airway clearance. The aim of this pilot study was to evaluate the efficacy of a new tool for bronchial clearance based on expiratory flow accelerator (EFA) technology compared with positive expiratory pressure (PEP) treatment. MATERIALS AND METHODS Twenty stable patients with COPD, Global Initiative for Chronic Obstructive Lung Disease 3-4 stage, were enrolled and allocated to treatment with EFA or Bubble-PEP (BP) for 20 days during a pulmonary rehabilitation program. At baseline and the end of treatment, the following parameters were measured: arterial blood gases (ABG); respiratory function, including peak cough expiratory flow (PCEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure exercise capacity using the 6-minute walk test (6MWT), dyspnea using the Medical Research Council scale, and quality of life using the St. George's Respiratory Questionnaire. RESULTS Expiratory flow accelerator showed a significant pre- and post-improvement in ABG and a significantly greater improvement than BP in PCEF, MIP, and 6MWT post-treatment. CONCLUSION Expiratory flow accelerator is a valid device compared with BP as an adjunctive therapy for the treatment of patients with severe COPD.
Collapse
Affiliation(s)
- Giorgia Patrizio
- Pulmonology and Rehabilitation Unit, Cuasso al Monte Hospital, Varese, Italy
| | | | - Francesco D'Abrosca
- SITRA, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Cabiaglia
- Pulmonology and Rehabilitation Unit, Cuasso al Monte Hospital, Varese, Italy
| | - Fabio Tanzi
- Physical Medicine and Rehabilitation, General Hospital, Varese, Italy
| | | | - Antonello Nicolini
- Respiratory Diseases Unit, General Hospital Sestri Levante, Sestri Levante, Italy
| |
Collapse
|
28
|
Barbagelata E, Nicolini A, Tognetti P. Swallowing dysfunctions in Parkinson’s disease patients: a novel challenge for the internist. Ital J Med 2019. [DOI: 10.4081/itjm.2019.1117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Parkinson’s disease (PD) is a chronic neurodegenerative disorder with a typical movement pattern, as well as different, less studied non-motor symptoms such as dysphagia. Disease-related disorders in efficacy or safety in the process of swallowing usually lead to malnutrition, dehydration or pneumonia. Dysphagia and subsequent aspiration pneumonia are common causes of morbidity and mortality in those with PD. The aim of this review is to identify and evaluate the existing literature on swallowing disorders in PD and providing recommendations for clinical practice routine.
Collapse
|
29
|
Nicolini A, Diaz de Teran T, Barbagelata E, Esquinas A. Non-invasive positive pressure ventilation in pneumonia outside ICU. Can it be definitely justified? Eur J Intern Med 2019; 64:e8. [PMID: 31202478 DOI: 10.1016/j.ejim.2019.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/20/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | - Teresa Diaz de Teran
- Hospital Universitario Marqués de Valdecilla, Sleep and Non Invasive Ventilation Unit, Pulmonary, Santander, Spain
| | | | | |
Collapse
|
30
|
Karim HMR, Burns KEA, Ciobanu LD, El-Khatib M, Nicolini A, Vargas N, Hernández-Gilsoul T, Skoczyński S, Falcone VA, Arnal JM, Bach J, De Santo LS, Lucchini A, Steier J, Purro A, Petroianni A, Sassoon CS, Bambi S, Aguiar M, Soubani AO, Taniguchi C, Mollica C, Berlin DA, Piervincenzi E, Rao F, Luigi FS, Ferrari R, Garuti G, Laier-Groeneveld G, Fiorentino G, Ho KM, Alqahtani JS, Luján M, Moerer O, Resta O, Pierucci P, Papadakos P, Steiner S, Stieglitz S, Dikmen Y, Duan J, Bhakta P, Iglesias AU, Corcione N, Caldeira V, Karakurt Z, Valli G, Kondili E, Ruggieri MP, Raposo MS, Bottino F, Soler-González R, Gurjar M, Sandoval-Gutierrez JL, Jafari B, Arroyo-Cozar M, Noval AR, Corcione N, Barjaktarevic I, Sarc I, Mina B, Szkulmowski Z, Taniguchi C, Esquinas AM. Noninvasive ventilation: education and training. A narrative analysis and an international consensus document. Adv Respir Med 2019; 87:36-45. [PMID: 30830962 DOI: 10.5603/arm.a2019.0006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/22/2019] [Accepted: 02/05/2019] [Indexed: 11/25/2022]
Abstract
Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients' lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess the importance of NIV education and training. Literature search was conducted (MEDLINE: 1990 to June, 2018) to identify randomized controlled studies and systematic reviews with the results analyzed by a team of experts across the world through e-mail based communications. Clinical trials examining the impact of education and training in NIV as the primary objective was not found. A few studies with indirect evidence, a simulation-based training study, and narrative reviews were identified. Currently organized training in NIV is implemented only in a few developed countries. Due to a lack of high-grade experimental evidence, an international consensus on NIV education and training based on opinions from 64 experts across the twenty-one different countries of the world was formulated. Education and training have the potential to increase knowledge and skills of the clinical staff who deliver medical care using NIV. There is a genuine need to develop structured, organized NIV education and training programs, especially for the developing countries.
Collapse
Affiliation(s)
- Habib Mohammad Reazaul Karim
- Department of Anesthesiology and Critical Care. All India Institute of Medical Sciences, Raipur, Great Eastern Road, Tatibandh, Raipur (CG)., 492099 Raipur, India
| | - Karen E A Burns
- Associate Professor, Clinician Scientist. Critical Care Medicine, Li Ka Shing Knowledge Insitute, St. Michael's Hospital,, 30 Bond Street, 4-045 Donnelly Wing. Toronto,, M5B 1W8 Ontario, Canada
| | - Laura D Ciobanu
- Assoc Professor, University of Medicine and Pharmacy, Romania, Romania
| | - Mohamad El-Khatib
- Department of Anesthesiology, American University of Beirut-Medical Center. School of Medicine,, Beirut-Lebanon, Lebanon
| | | | - Nicola Vargas
- Geriatric and Intensive Geriatric Cares,, Avelllino, Italy
| | - Thierry Hernández-Gilsoul
- Head of Emergency Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Critical Care, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas., Mexico
| | - Szymon Skoczyński
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia,, Katowice, Poland
| | - Vito Antonio Falcone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs - Section of Respiratory Disease, University of Bari Aldo Moro,, Bari, Italy
| | | | - John Bach
- Rutgers University New Jersey Medical School, New Jersey, United States
| | - Luca Salvatore De Santo
- Università della Campania Luigi Vanvitelli, Napoli and Cardiac Surgery Unit,, AORN dei Colli, Naples, Italy
| | - Alberto Lucchini
- General intensive care unit - San Gerardo Hospital, Milano-Bicocca University,, Milan, Italy
| | - Joerg Steier
- Professor of Respiratory and Sleep Medicine, King's College London, Faculty of Life Sciences and Medicine,, London, United Kingdom
| | - Andrea Purro
- Head of Intensive Care Unit, Humanitas Gradenigo Hospital., Turin, Italy
| | - Angelo Petroianni
- Respiratory Diseases Unit, Department of Cardiovascular and Respiratory Diseases, Policlinico Umberto I, Sapienza University of Rome,, Rome, Italy
| | - Catherine S Sassoon
- Professor of Medicine, Division of Pulmonary and Critical Care Medicine University of California, Irvine, CA,; VA Long Beach Healthcare System,, Long Beach, CA, United States
| | - Stefano Bambi
- Medical & Surgical Intensive Care Unit, Careggi University Hospital,, Florence, Italy
| | - Margarida Aguiar
- Pulmonologist, Pulmonary service, Hospital Beatriz Ângelo,, Loures, Portugal
| | - Ayman O Soubani
- Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine. Wayne State University School of Medicine, 3990 John R-3 Hudson, Detroit, MI, 48201, United States
| | - Corinne Taniguchi
- Physiotherapist Specialized in Intenvise Care and Pneumology- FMUSP/HCSão,, Paulo-SP, Brazil
| | | | - David A Berlin
- Department of Medicine, Weill Cornell Medicine New York, New York, United States
| | | | - Fabrizio Rao
- Respiratory Unit, Neuromuscular OmniCentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital,, Milan, Italy
| | | | - Rodolfo Ferrari
- Emergency Department, University Hospital Sant'Orsola, Malpighi,, Bologna, Italy
| | - Giancarlo Garuti
- Respiratory Unit, Santa Maria Bianca Hospital, Mirandola (MO),, ASL Modena, Modena, Italy
| | | | | | - Kwok M Ho
- Department of Intensive Care Medicine, Royal Perth Hospital; School of Population & Global Health, University of Western Australia; and School of Veterinary & Life Sciences, Murdoch University., Perth, Australia
| | - Jaber Saud Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences,, Dhahran, P.O. Box 33048, Dammam 31448, Saudi Arabia
| | - Manuel Luján
- Pneumology Service. Hospital of Sabadell, Universitat Autónoma de Barcelona., Sabadell, Spain
| | - Onnen Moerer
- Dept. of Anaesthesiology, Georg-August-University, University Medical Center Göttingen, Germany
| | - Onofrio Resta
- Cardiothoracic department, Respiratory and Sleep medicine Unit, Policlinic, Bari "Aldo Moro" University,, Italy
| | - Paola Pierucci
- Cardiothoracic department, Respiratory and Sleep medicine Unit, Policlinic, Bari "Aldo Moro" University,, Italy
| | - Peter Papadakos
- Department of Anesthesiology and Surgery. Director CCM. University of Rochester,, Rochester, New York, United States
| | - Stephan Steiner
- Departement of Cardiology, Pneumology and Intensive care, St Vincenz Hospital Limburg,, Limburg, Germany
| | - Sven Stieglitz
- Petrus Hospital Wuppertal, Academic Teaching Hospital of the University of Duesseldorf, Carnaper Str. 48, Clinic for Pneumology, Allergology, Sleep- and Intensive Care,, 42283 Wuppertal, Germany
| | - Yalim Dikmen
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Intensive Care,, Fatih, Istanbul, Turkey
| | - Jun Duan
- Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University,, Youyi Road 1, Yuzhong District, Chongqing, 400016, China
| | - Pradipta Bhakta
- Department of Anaesthesia and Intensive Care, University Hospital Limerick,, Dooradoyle, Limerick, Ireland
| | - Alejandro Ubeda Iglesias
- Intensive Care Unit, Hospital Punta de Europa, Algeciras Ctra, Getares,, s/n, 11207 Algeciras, Cádiz, Spain
| | - Nadia Corcione
- Departement of Anesthesia, Critical Care and Emergency. Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico., Milano, Italy
| | - Vânia Caldeira
- Pneumology Department, Hospital Santa Marta,, Lisboa, Portugal
| | - Zuhal Karakurt
- Assoc Prof, Pulmonary and Critical Care Department, Pulmonology and Intensivist, Dean in Hospital, University of Health Sciences,, Istanbul, Turkey
| | - Gabriele Valli
- Department of Emergency Medicine, San Giovanni Addolorata,, Rome, Italy
| | - Eumorfia Kondili
- Associate Professor of Intensive Care Medicine, Medical School , University of Crete Greece, ICU University Hospital of Heraklion,, Crete, Greece
| | - Maria Pia Ruggieri
- Direttore UOC PS-Breve Osservazione DEAI II livello AO San Giovanni Addolorata, Roma, Italy
| | - Margarida Simões Raposo
- Pulmonologist. Centro Hospitalar de Lisboa Ocidental Egas, Moniz Hospital,, Lisboa, Portugal
| | | | | | - Mohan Gurjar
- Department of Critical Care Medicine. Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS),, Rae Bareli Road, Lucknow (UP), 226014 Lucknow, India
| | | | - Behrouz Jafari
- Director, VALBHCS Sleep Program, Asst Professor of Medicine, Section of Pulmonary and Critical Care Medicine. University of California, Irvine. VA Long Beach Healthcare System 5901 East 7th Street (11/111P), Long Beach, CA, United States
| | | | - Ana Roca Noval
- Servicio de neumologia, Hospital Universitario La Princesa,, Madrid, Spain
| | - Nadia Corcione
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at University of California, Los Angeles, USA
| | - Irena Sarc
- Noninvasive ventilation department, University clinic for pulmonary and allergic diseases, Golnik, Slovenia
| | - Bushra Mina
- Department of Medicine, Pulmonary and Critical Care Medicine, Northwell Health, Lenox Hill Hospital, New York, NY USA
| | - Zbigniew Szkulmowski
- Departament of Anesthesia and ICU. University Hospital No 1 in Bydgoszcz. Collegium Medicum in Bydgoszcz. University Nicolaus Copernicus in Toruń. Bydgoszcz. Poland
| | | | - Antonio M Esquinas
- Intensive Care Unit. Hospital Morales Meseguer Murcia, Murcia, 30008, Spain.
| |
Collapse
|
31
|
Cillóniz C, Dominedò C, Nicolini A, Torres A. PES Pathogens in Severe Community-Acquired Pneumonia. Microorganisms 2019; 7:microorganisms7020049. [PMID: 30759805 PMCID: PMC6406253 DOI: 10.3390/microorganisms7020049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/09/2019] [Accepted: 02/09/2019] [Indexed: 12/16/2022] Open
Abstract
Worldwide, there is growing concern about the burden of pneumonia. Severe community-acquired pneumonia (CAP) is frequently complicated by pulmonary and extra-pulmonary complications, including sepsis, septic shock, acute respiratory distress syndrome, and acute cardiac events, resulting in significantly increased intensive care admission rates and mortality rates. Streptococcus pneumoniae (Pneumococcus) remains the most common causative pathogen in CAP. However, several bacteria and respiratory viruses are responsible, and approximately 6% of cases are due to the so-called PES (Pseudomonas aeruginosa, extended-spectrum β-lactamase Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus) pathogens. Of these, P. aeruginosa and methicillin-resistant Staphylococcus aureus are the most frequently reported and require different antibiotic therapy to that for typical CAP. It is therefore important to recognize the risk factors for these pathogens to improve the outcomes in patients with CAP.
Collapse
Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)-SGR 911-Ciber de Enfermedades Respiratorias (Ciberes), 08036 Barcelona, Spain.
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Antonello Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, 16039 Sestri Levante, Italy.
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)-SGR 911-Ciber de Enfermedades Respiratorias (Ciberes), 08036 Barcelona, Spain.
| |
Collapse
|
32
|
Cavalleri MA, Diaz DE Teran T, Barlascini CO, Banfi P, Nicolini A. How to treat COPD: a critical appraisal of the FLAME Trial. Panminerva Med 2019; 64:115-116. [PMID: 30727710 DOI: 10.23736/s0031-0808.19.03569-9] [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: 11/08/2022]
Affiliation(s)
- Maurizio A Cavalleri
- Department of Internal Medicine, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Teresa Diaz DE Teran
- Unit of Sleep and non Invasive Ventilation, Pulmonary, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Cornelius O Barlascini
- Unit of Hygiene and Health Medicine, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | - Paolo Banfi
- Unit of Pulmonary Medicine, Don Gnocchi IRCCS Foundation, Milan, Italy
| | - Antonello Nicolini
- Unit of Respiratory Diseases, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy -
| |
Collapse
|
33
|
Nicolini A, Pisani L, Cillóniz C, Ferraioli G. Early noninvasive ventilation treatment for respiratory failure due to severe community-acquired pneumonia. ACTA ACUST UNITED AC 2019. [DOI: 10.23736/s0026-4954.19.01840-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
34
|
Rotolo N, Cattoni M, D'Andria M, Cavanna L, Patrizio G, Imperatori A, Nicolini A. Comparison of an expiratory flow accelerator device versus positive expiratory pressure for tracheobronchial airway clearance after lung cancer lobectomy: a preliminary study. Physiotherapy 2019; 110:34-41. [PMID: 33563372 DOI: 10.1016/j.physio.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/16/2017] [Accepted: 01/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE A new type of device has recently been introduced in chest physiotherapy as an aid to tracheo-bronchial airway clearance: expiratory flow accelerator (EFA). It promotes mucus clearance without generating any pressure gradient, allowing patients to breathe at tidal volume against no resistance. DESIGN Pilot randomized controlled study. SETTING Tertiary hospital. PARTICIPANTS Fifty adult patients who underwent lung cancer lobectomy were randomized to undergo chest physiotherapy with EFA (n=26) or PEP (n=24). INTERVENTIONS EFA; PEP bottle. MAIN OUTCOMES Incidence of postoperative pulmonary complications (PPC) and length of stay. SECONDARY OUTCOMES trends in inspiratory capacity, respiratory rate, oxygen saturation, and dyspnoea. Patients rated user-friendliness of the two devices on a 5-point Likert scale. RESULTS A slightly different incidence of PPCs was observed between the EFA and PEP group. Nevertheless, the length of stay was similar in the two groups. No substantial differences were seen in trends of inspiratory capacity, respiratory rate, oxygen saturation, dyspnoea between the two groups. Patient-reported user-friendliness of the two devices did not differ significantly, although the use of the EFA device appeared less strenuous. CONCLUSIONS Results of this pilot study point to the use of EFA as an alternative treatment option rather than as a replacement for the PEP bottle in chest physiotherapy following lung cancer lobectomy. EFA may be preferable for weaker patients and/or with airway leakages in whom PEP has limited indications. Further investigation in a larger sample is required to statistically confirm the findings. Clinical Trial Registration Number ChiCTR-ONC-17013255.
Collapse
Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Michele D'Andria
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Laura Cavanna
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Giorgia Patrizio
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | | |
Collapse
|
35
|
Nicolini A, Ferrando M, Solidoro P, Di Marco F, Facchini F, Braido F. Non-invasive ventilation in acute respiratory failure of patients with obesity hypoventilation syndrome. Minerva Med 2019; 109:1-5. [PMID: 30642143 DOI: 10.23736/s0026-4806.18.05921-9] [Citation(s) in RCA: 5] [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] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Non-invasive ventilation (NIV) has been used successfully for the management of acute respiratory failure (ARF) more often in the last two decades compared to prior decades. There are particular groups of patients that are more likely to benefit from NIV. One of these groups is patients with obesity hypoventilation syndrome (OHS). The aim of this review is to evalue the effectiveness of NIV in acute ARF. EVIDENCE ACQUISITION MEDLINE, EMBASE, CINHAIL, Cochrane Central Register of Controlled Trials, DARE, the Cochrane Database of Systematic Reviews, and the ACP Journal Club database were searched from January 2001 to December 2017. EVIDENCE SYNTHESIS More than 30% of them have been diagnosed when hospitalized for ARF. NIV rarely failed in reversing ARF. OHS patients who exhibited early NIV failure had a high severity score and a low HCO3 level at admission; more than half of hypercapnic patients with decompensated OHS exhibited a delayed but successful response to NIV. CONCLUSIONS Patients with decompensation of OHS have a better prognosis and response to NIV than other hypercapnic patients. They required more aggressive NIV settings, a longer time to reduce paCO2 levels, and showed more frequently a delayed but successful response to NIV.
Collapse
Affiliation(s)
- Antonello Nicolini
- Unit of Respiratory Diseases, Hospital of Sestri Levante, Sestri Levante, Italy -
| | - Matteo Ferrando
- Unit of Respiratory Diseases and Allergies, Department of Internal Medicine (DiMI), San Martino University Hospital, Genoa, Italy
| | - Paolo Solidoro
- Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Molinette University Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Fabrizio Facchini
- Department of Pulmonary Medicine, Valiant Clinic, Meraas HealthCare, Dubai, United Arab Emirates
| | - Fulvio Braido
- Unit of Respiratory Diseases and Allergies, Department of Internal Medicine (DiMI), San Martino University Hospital, Genoa, Italy
| |
Collapse
|
36
|
Nicolini A, Barbagelata E, Tagliabue E, Colombo D, Monacelli F, Braido F. Gender differences in chronic obstructive pulmonary diseases: a narrative review. Panminerva Med 2018; 60:192-199. [DOI: 10.23736/s0031-0808.18.03463-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
37
|
Barbagelata E, Nicolini A, Ambrosino I, Politi C. Gender differences and chronic obstructive pulmonary disease: an update on the literature. Ital J Med 2018. [DOI: 10.4081/itjm.2018.987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) has traditionally been viewed as a disease affecting older men with a history of smoking, while being neglected and under-diagnosed in women. This scenario has changed in recent years as there has been a steady increase in COPD prevalence and mortality rates in women. The increased prevalence of COPD among women is likely attributable to several factors including the increased rates of cigarette smoking observed in women during recent years, exposure to indoor air pollution as well as increased occupational exposures since women take on previously male-dominated occupational roles related to risk exposure. In this review we have analyzed the difference in COPD phenotypes and features related to gender difference.
Collapse
|
38
|
Cavalleri M, Barbagelata E, Diaz de Teran T, Ferraioli G, Esquinas A, Nicolini A. Noninvasive and invasive ventilation in severe pneumonia: Insights for the noninvasive ventilatory approach. J Crit Care 2018; 48:479. [PMID: 30126747 DOI: 10.1016/j.jcrc.2018.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Elena Barbagelata
- Internal Medicine Department, General Hospital, Sestri Levante, Italy
| | - Teresa Diaz de Teran
- Hospital Universitario Marqués de Valdecilla, Sleep and Non Invasive Ventilation Unit, Pulmonary, Santander, Spain
| | | | | | | |
Collapse
|
39
|
Volpato E, Banfi P, Nicolini A, Pagnini F. A quick relaxation exercise for people with chronic obstructive pulmonary disease: explorative randomized controlled trial. Multidiscip Respir Med 2018; 13:13. [PMID: 29744054 PMCID: PMC5932751 DOI: 10.1186/s40248-018-0124-9] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background People with Chronic Obstructive Pulmonary Disease (COPD) suffer from dyspnoea, which may be increased by anxiety. Previous studies suggest that relaxation techniques may have positive effects in pulmonary rehabilitation. The main aim of this study is to explore the clinical impact of a quick, one-session, relaxation training for people with COPD. Methods In this perspective, 38 participants with COPD were recruited and randomly assigned to listen to a relaxing audio or to watch a neutral stimulus, during their routine exams. Participants were assessed for psychological and physiological variables, analysed through non-parametric tests. Results Those who joined the relaxation training showed more positive outcomes about respiratory and cardiac assessments, as well as for state anxiety and positive affections, in comparison with the baseline and the control group. Conclusions Study results suggest that relaxation has a potential to produce improvements in respiratory and cardiac functions, together with a positive emotional effect and a reduction of anxiety. Trial registration ClinicalTrials.gov ID: NCT02698904. Record Registration: February 2016.
Collapse
Affiliation(s)
- Eleonora Volpato
- 1Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, Milan, Italy.,IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paolo Banfi
- IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Antonello Nicolini
- Unità di Riabilitazione Respiratoria, ASL 4 Chiavarese, Ospedale di Sestri Levante, Sestri Levante, Italy
| | - Francesco Pagnini
- 1Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, Milan, Italy.,4Department of Psychology, Harvard University, Cambridge, MA USA
| |
Collapse
|
40
|
Nicolini A, Carpi A, Ferrari P, Anselmi L. Clinical use of Tumor Markers in the Postoperative Management of Breast Cancer Patients: New Concepts. Int J Biol Markers 2018; 12:181-6. [PMID: 9582609 DOI: 10.1177/172460089701200408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Nicolini
- Second Medical Clinic, University of Pisa, Italy
| | | | | | | |
Collapse
|
41
|
Cavalleri MA, Barbagelata E, Scudeletti M, Nicolini A. Effectiveness of non-invasive ventilation in acute respiratory failure of obese patients: a brief narrative review. Ital J Med 2018. [DOI: 10.4081/itjm.2018.916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Non-invasive ventilation (NIV) has been used successfully for the management of acute respiratory failure (ARF) more often in the last two decades compared to prior decades; nevertheless, NIV can have failure rates ranging from 5% to 50%. However, there are particular groups of patients that are more likely to benefit from NIV. One of these groups is patients with hypoventilation syndrome (OHS). The aim of this review is to seek evaluation of the effectiveness of NIV in acute setting. Only a few studies have investigated NIV success or failure in OHS patients. More than 30% of them were diagnosed when hospitalized for ARF. NIV rarely failed in reversing ARF. OHS patients who exhibited early NIV failure had a high severity score and a low HCO3 level at admission; more than half of hypercapnic patients with decompensated OHS exhibited a delayed but successful response to NIV. Patients with decompensation of OHS have a better prognosis and response to NIV than other hypercapnic patients. They require more aggressive NIV settings, a longer time to reduce PaCO2 levels, and more frequently a delayed but successful response to NIV.
Collapse
|
42
|
Nicolini A, Grecchi B, Ferrari-Bravo M, Barlascini C. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:617-625. [PMID: 29497290 PMCID: PMC5819581 DOI: 10.2147/copd.s145440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/15/2023] Open
Abstract
Purpose Chest physiotherapy is an important tool in the treatment of COPD. Intrapulmonary percussive ventilation (IPV) and high-frequency chest wall oscillation (HFCWO) are techniques designed to create a global percussion of the lung which removes secretions and probably clears the peripheral bronchial tree. We tested the hypothesis that adding IPV or HFCWO to the best pharmacological therapy (PT) may provide additional clinical benefit over chest physiotherapy in patients with severe COPD. Methods Sixty patients were randomized into three groups (20 patients in each group): IPV group (treated with PT and IPV), PT group with (treated with PT and HFCWO), and control group (treated with PT alone). Primary outcome measures included results on the dyspnea scale (modified Medical Research Council) and Breathlessness, Cough, and Sputum scale (BCSS), as well as an evaluation of daily life activity (COPD Assessment Test [CAT]). Secondary outcome measures were pulmonary function testing, arterial blood gas analysis, and hematological examinations. Moreover, sputum cell counts were performed at the beginning and at the end of the study. Results Patients in both the IPV group and the HFCWO group showed a significant improvement in the tests of dyspnea and daily life activity evaluations (modified Medical Research Council scale, BCSS, and CAT) compared to the control group, as well as in pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity%, total lung capacity, residual volume, diffusing lung capacity monoxide, maximal inspiratory pressure, maximal expiratory pressure) and arterial blood gas values. However, in the group comparison analysis for the same variables between IPV group and HFCWO group, we observed a significant improvement in the IPV group maximal inspiratory pressure, maximal expiratory pressure, BCSS, and CAT. Similar results were observed in changes of sputum cytology with reduction of inflammatory cells (neutrophils and macrophages). Conclusion The two techniques improved daily life activities and lung function in patients with severe COPD. IPV demonstrated a significantly greater effectiveness in improving some pulmonary function tests linked to the small bronchial airways obstruction and respiratory muscle strength and scores on health status assessment scales (BCSS and CAT) as well as a reduction of sputum inflammatory cells compared with HFCWO.
Collapse
Affiliation(s)
- Antonello Nicolini
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy
| | - Bruna Grecchi
- Rehabilitation Unit, ASL4 Chiavarese, Chiavari, Italy
| | | | | |
Collapse
|
43
|
Nicolini A, Stieglitz S, Bou-Khalil P, Esquinas A. Cost-utility of non-invasive mechanical ventilation: Analysis and implications in acute respiratory failure. A brief narrative review. Respir Investig 2018; 56:207-213. [PMID: 29773291 DOI: 10.1016/j.resinv.2017.12.011] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/09/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
The growing interest in the quality of patient care at the levels of the health care managers, insurance companies, and health professionals is evident. Further, the growing population requires good quality health services. In this review, we analyzed the cost-effectiveness of noninvasive ventilation (NIV) in an acute setting for the treatment of respiratory failure. The strength of this review is that it identified and summarized the most relevant studies regarding various aspects of the cost-utility of NIV in an acute setting. This is the first review that focuses on the importance of the skills and training of the team in the reduction of costs associated with NIV. However, the small number of studies, heterogeneity of quality, and different outcomes of the different studies are the greatest limitations of this review. In conclusion, although there is great variation in the data drawn from the literature, NIV seems to be a cost-effective tool, especially in specific patients (those with chronic obstructive pulmonary disease) for whom the addition of NIV improves outcomes and has a positive impact on this expenditure.
Collapse
Affiliation(s)
- Antonello Nicolini
- Respiratory Diseases Unit, General Hospital, Via Terzi 43, 16039 Sestri Levante, Italy.
| | - Sven Stieglitz
- Department of Pulmonology and Cardiology, Petrus Hospital Academic Teaching, Wuppertal, Germany
| | - Pierre Bou-Khalil
- Division of Pulmonary and Critical Care, Department of Internal Medicine, American University of Beirut Medical Center, Lebanon
| | | |
Collapse
|
44
|
Nicolini A, Lemyze M, Esquinas A, Barlascini C, Cavalleri M. Predyktory Niepowodzenia Wentylacji Nieinwazyjnej u Krytycznie Chorych i Otyłych Pacjentów—Krótki Przegląd Piśmiennictwa. Adv Respir Med 2018. [DOI: 10.5603/arm.57160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
W ciągu ostatnich dwóch dekad obserwuje się coraz częstsze stosowanie wentylacji nieinwazyjnej (NIV) w leczeniu ostrej niewydolności oddechowej (ARF). Wskaźnik niepowodzeń NIV waha się jednak od 5% do 50%, a warunkiem powodzenia jest dobór pacjentów. Istnieją jednak grupy pacjentów, w których jest większe prawdopodobieństwo skuteczności NIV. Jedna z nich to chorzy na zespół hipowentylacji osób otyłych (OHS). W niniejszym przeglądzie podjęto próbę oceny skuteczności stosowania NIV u chorych z ostrą niewydolnością oddechową i określenia predyktorów niepowodzenia NIV u pacjentów z otyłością patologiczną. Zaledwie w kilku badaniach podjęto problem oceny skuteczności NIV w tej grupie chorych. Metoda ta okazywała się skuteczniejsza przy bardziej restrykcyjnej selekcji pacjentów. Otyli, u których niepowodzenie NIV było zauważalne wcześnie, charakteryzowali się wysokim stopniem ciężkości choroby przy przyjęciu do szpitala. Natomiast u więcej niż połowy pacjentów z hiperkapnią i zdekompensowanym zespołem OHS występowała opóźniona, aczkolwiek pozytywna odpowiedź na NIV. U pacjentów z dekompensacją OHS zaobserwowano korzystniejsze rokowanie i lepszą reakcję na NIV niż u innych chorych z hiperkapnią. Potrzebowali oni wyższych nastawień aparatu, dłuższego czasu do obniżenia PaCO2, częściej występowała u nich opóźniona, ale pozytywna odpowiedź na zastosowane leczenie, co powinno raczej przekonywać do stosowania NIV zamiast wczesnej intubacji. Ponieważ nie odnotowano wyraźnych predyktorów niepowodzenia stosowania NIV, konieczna jest dalsza uważna i długookresowa obserwacja.
Collapse
|
45
|
Nicolini A, Campani D, Miccoli P, Spinelli C, Carpi A, Menicagli M, Ferrari P, Gadducci G, Rossi G, Fini M, Giavaresi G, Bonazzi V, Giardino R. Vascular Endothelial Growth Factor (Vegf) and Other Common Tissue Prognostic Indicators in Breast Cancer: A Case-Control Study. Int J Biol Markers 2018; 19:275-81. [PMID: 15646833 DOI: 10.1177/172460080401900404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
VEGF is a specific mitogen and survival factor for endothelial cells and a key promoter of angiogenesis in physiological and pathological conditions. Nevertheless, VEGF tissue evaluation in cancer patients as a prognostic factor compared to the conventional histological and biological parameters is still controversial. In this case-control study, tissue VEGF was retrospectively determined by immunohistochemistry and related to T, N, ER, PgR, c-erbB-2, p53, MIB-1 and cyclin D1 in 129 breast cancer patients. Seventy-four of these patients had developed distant metastases postoperatively. The remaining 55 patients had remained disease-free >10 years after surgery. In 17 (13%) of the 129 patients (six with distant metastases and eleven disease-free) tissue and plasma VEGF were concomitantly evaluated. In univariate analysis no significant differences in VEGF and tumor size were found between metastatic and disease-free patients, whereas there were significant differences in N, ER, PgR, c-erbB-2, p53, MIB-1 and cyclin D1 (p ranging from 0.001 to 0.0001). In multivariate analysis VEGF showed less significance than N, ER, c-erbB-2, MIB-1 and cyclin D1 (p=0.012, p=0.007, p=0.005, p=0.005, p=0.002 and p=0.001, respectively). VEGF was a significant unfavorable prognostic indicator only in the N+ subset (p=0.015), while ER (p=0.05 and p=0.021) and MIB-1 (p=0.031 and p=0.022) were significant in both the N+ and N– subgroups. In multivariate analysis in the 74 metastatic cases VEGF did not show any significance in relation to disease-free interval and overall survival from the time of mastectomy and from the time of relapse, whereas N and PgR did (p ranging from 0.018 to 0.001). In conclusion, tissue VEGF does not seem a suitable candidate to replace conventional histological and other common biological prognostic factors in breast cancer.
Collapse
Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Nicolini A, Lemyze M, Esquinas A, Barlascini C, Cavalleri MA. Predictors of noninvasive ventilation failure in critically ill obese patients: a brief narrative review. Adv Respir Med 2017; 85:264-270. [PMID: 29083022 DOI: 10.5603/arm.a2017.0044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 04/30/2017] [Revised: 07/03/2017] [Accepted: 08/29/2017] [Indexed: 11/25/2022]
Abstract
Non-invasive ventilation ( NIV ) has been used successfully for the management of acute respiratory failure (ARF) more often in the last two decades than previously. Unfortunately, NIV can have failure rates ranging from 5% to 50% and patient selection is the key to success. There are particular groups of patients that are more likely to benefit from NIV. For patients with hypoventilation syndrome (OHS) this treatment can be beneficial. This review seeks to evaluate the effectiveness of NIV in acute ARF and determine predictors of NIV failure in morbidly obese patients. Only a few studies have investigated NIV success or failure in these patients. NIV was most often effective when patients were carefully selected. Obese patients who exhibited early NIV failure had a high severity score at admission. In contrast, more than half of hypercapnic patients with decompensated OHS exhibited a delayed but successful response to NIV. Patients with decompensation of OHS had better prognosis and response to NIV than other hypercapnic patients. They required more aggressive NIV settings, a longer time to reduce paCO₂ levels , and more frequently a delayed but successful response to NIV which should encourage the use of NIV rather than early intubation. Since clear predictors of NIV failure have not been identified, a strict and prolonged monitoring is mandatory.
Collapse
Affiliation(s)
- Antonello Nicolini
- Department of Respiratory and Critical Care Medicine, Schaffner Hospital, lens; Intensive Care Unit Hospital Morales Meseguer, Murcia; Internal Medicine Department, via Terzi 43, Sestri Levante.
| | | | | | | | | |
Collapse
|
47
|
Banfi P, Volpato E, Valota C, D'Ascenzo S, Alunno CB, Lax A, Nicolini A, Ticozzi N, Silani V, Bach JR. Use of Noninvasive Ventilation During Feeding Tube Placement. Respir Care 2017; 62:1474-1484. [PMID: 28807987 DOI: 10.4187/respcare.05031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Parenteral nutrition is indicated in amyotrophic lateral sclerosis (ALS) when dysphagia, loss of appetite, and difficulty protecting the airways cause malnutrition, severe weight loss, dehydration, and increased risk of aspiration pneumonia. The aim of this review is to compare percutaneous endoscopic gastrostomy (PEG), radiologically inserted G-tube (RIG), and percutaneous radiologic gastrostomy (PRG) in patients with ALS, performed with or without noninvasive ventilation (NIV). We searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the EBSCO Online Research Database, and Scopus up to December 2015. A priori selection included all randomized controlled trials (RCTs), quasi-randomized trials, and prospective and retrospective studies. The primary outcome was 30-d survival. We found no RCTs or quasi-RCTs. Seven studies about the implementation of the PEG/RIG procedure during the use of NIV and 5 studies without NIV were included. In another study of 59 subjects undergoing open gastrostomy, all with vital capacity < 30% of normal, 18 of whom were dependent on continuous NIV at full ventilatory support settings, there were no respiratory complications. Thus, the use of NIV during the implementation of these procedures, especially when used at full ventilatory support settings of pressure preset 18-25 cm H2O, can support alveolar ventilation before, during, and after the procedures and prevent respiratory complications. The procedures investigated appear equivalent, but the methodological quality of the studies could be improved. Possible benefits with regard to nutrition parameters, quality of life, and psychological features need to be further investigated.
Collapse
Affiliation(s)
- Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
| | - Eleonora Volpato
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Chiara Valota
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | | | - Agata Lax
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Antonello Nicolini
- Respiratory Rehabilitation Unit, ASL 4 Chiavarese, Hospital of Sestri Levante, Italy
| | - Nicola Ticozzi
- Unit of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico and the Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Unit of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico and the Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
| | - John R Bach
- Department of Physical Medicine and Rehabilitation, Rutgers University-New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
48
|
Nicolini A, Mascardi V, Grecchi B, Ferrari-Bravo M, Banfi P, Barlascini C. Comparison of effectiveness of temporary positive expiratory pressure versus oscillatory positive expiratory pressure in severe COPD patients. Clin Respir J 2017; 12:1274-1282. [PMID: 28665556 DOI: 10.1111/crj.12661] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/28/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In chronic obstructive pulmonary disease (COPD) patients few modalities of airway clearance have demonstrated effectiveness in reducing hypersecretion and bronchial obstruction. Positive expiratory pressure (PEP) is one of these. OBJECTIVE Our goal was to compare the effectiveness of 2 devices Temporary PEP (T-PEP) and Oscillatory PEP (O-PEP) which use PEP applied at a low expiratory pressure of 1 cm H2 O which creates oscillations that decrease bronchial obstruction in reducing COPD exacerbations and improving respiratory and health status assessment parameters. Each has different mechanism of action. METHODS A 26 week randomized controlled study evaluated their efficacy in reducing exacerbations and improving health status assessment tests as well as respiratory function parameters in severe to very severe COPD patients. One hundred-twenty patients were enrolled: 40 patients received T-PEP therapy; 40 underwent treatment with O-PEP; 40 constituted the control group. The primary outcome was the reduction of exacerbations after 1, 3 and 6 months; secondary outcomes were improvement of lung function and health status assessment tests [Modified Medical Research Council (MMRC) scale, Breathlessness, Cough, and Sputum Scale (BCSS) scale, and COPD Assessment Test (CAT) score]. RESULTS Only T-PEP statistically reduced the exacerbations after 1 and 3 months compared to the control group. Both the 2 devices improved dyspnea scale (MMRC), lung function parameters, and health status assessment (CAT) tests compared to the control group. Both interventions were well-tolerated by our patients. CONCLUSIONS O-PEP and T-PEP are useful for COPD treatment but only T-PEP reduces exacerbations. Adding tools for airway clearance to medical therapy can help the management of COPD.
Collapse
Affiliation(s)
| | | | - Bruna Grecchi
- Physical Medicine and Rehabilitation, ASL 4 Chiavarese, Italy
| | | | | | | |
Collapse
|
49
|
Nicolini A, Scala R, Cavalleri MA. Real-time visual-feedback mask-fitting during non-invasive ventilation: A 'technological' gain over 'human' sensing? Respirology 2017; 22:1245-1246. [PMID: 28612978 DOI: 10.1111/resp.13101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, San Donato Hospital, Arezzo, Italy
| | | |
Collapse
|
50
|
Cinque E, Piroddi IMG, Barlascini C, Perazzo A, Nicolini A. Non-invasive ventilation in the treatment of severe polymicrobial community-acquired pneumonia. Ital J Med 2017. [DOI: 10.4081/itjm.2017.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Polymicrobial pneumonia may be caused by the combination of respiratory viruses, bacteria and fungi in a host. Colonization by <em>Streptococcus pneumoniae</em> was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection, whereas the colonization by methicillin sensible <em>Staphylococcus aureus</em> co-infection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral co-infection, and accounts approximately for 39% of microbiological diagnosed cases of CAP. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: no clinical signs or radiological findings help the clinician to suspect to the diagnosis. Patients with polymicrobial infections are more likely to have underlying medical conditions and have more severe outcome. Severe respiratory failure and need of mechanical ventilation occur in several cases. Non invasive ventilation (NIV) use aims to avoid invasive mechanical ventilation. NIV treatment is controversial owing to high reported treatment failure. In this case series we report three cases of severe polymicrobial CAP: all of them required NIV with a good outcome.
Collapse
|