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Bassi I, Guerrieri A, Carpano M, Gardini A, Prediletto I, Polastri M, Curtis JR, Nava S. Feasibility and efficacy of a multidisciplinary palliative approach in patients with advanced interstitial lung disease. A pilot randomised controlled trial. Pulmonology 2023; 29 Suppl 4:S54-S62. [PMID: 34969647 DOI: 10.1016/j.pulmoe.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Interstitial lung diseases (ILDs) encompass a heterogeneous group of parenchymal lung disorders which have a significant burden on quality of life and exercise. The primary purpose of this randomised pilot trial performed in advanced ILD was to determine the feasibility and efficacy of a multidisciplinary palliative care approach (including physiotherapist, psychologist, pulmonologists, and palliative care doctors) to relieve patients' symptoms of dyspnoea, depression measured with the Center for Epidemiological Studies-Depression (CES-D) scale and quality-of-life (QoL) at 6 and 12 months. MATHERIALS AND METHODS Fifty patients with confirmed interstitial lung disease at computed tomography (CT) scan and advanced disease were enrolled at our clinic. Patients were randomised to usual care group vs intervention group; in the intervention group, patients were scheduled to meet a physiotherapist, a psychologist, a palliative care doctor, and a pulmonologist specialized in ILD care. Data on dyspnoea, cough, quality of life and depression were recorded; patients in the intervention group were also tested to assess lower body flexibility and strength. RESULTS Both groups showed a worsening in dyspnoea during the time course of the trial, but the Borg scale was less in the intervention group at 6 and 12 months. A similar trend was observed also for the CES-D scale. No differences were observed for the other scales. CONCLUSIONS A multi-disciplinary palliative care intervention in patients with advanced fibrosing interstitial lung disease is feasible and effective. TRIAL REGISTRATION NCT02929966 on ClinGovTrial.
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Affiliation(s)
- I Bassi
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
| | - A Guerrieri
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
| | - M Carpano
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
| | - A Gardini
- Department of Statistical Sciences "P. Fortunati", Alma Mater University, Bologna, 40138, Italy
| | - I Prediletto
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
| | - M Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle WA, 98195, United States; Cambia Palliative Care Center of Excellence, UW Medicine, University of Washington, Seattle WA, 98195, United States
| | - S Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy.
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Vega ML, Schifino G, Pisani L, Catalanotti V, Prediletto I, Nava S. Diaphragm thickening fraction and inspiratory effort in patients with SARS-COV II pneumonia receiving different non-invasive respiratory supports. Pulmonology 2023; 29:424-427. [PMID: 36906464 PMCID: PMC9922577 DOI: 10.1016/j.pulmoe.2023.02.001] [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] [Received: 11/18/2022] [Revised: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Affiliation(s)
- M L Vega
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy
| | - G Schifino
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy
| | - L Pisani
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy
| | - V Catalanotti
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy
| | - I Prediletto
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy
| | - S Nava
- Alma Mater Studiorum, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit- Bologna, Italy.
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3
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Prediletto I, Giancotti G, Nava S. COPD Exacerbation: Why It Is Important to Avoid ICU Admission. J Clin Med 2023; 12:jcm12103369. [PMID: 37240474 DOI: 10.3390/jcm12103369] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/24/2023] [Revised: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality worldwide. Hospitalization due to acute exacerbations of COPD (AECOPD) is a relevant health problem both for its impact on disease outcomes and on health system resources. Severe AECOPD causing acute respiratory failure (ARF) often requires admission to an intensive care unit (ICU) with endotracheal intubation and invasive mechanical ventilation. AECOPD also acts as comorbidity in critically ill patients; this condition is associated with poorer prognoses. The prevalence reported in the literature on ICU admission rates ranges from 2 to 19% for AECOPD requiring hospitalization, with an in-hospital mortality rate of 20-40% and a re-hospitalization rate for a new severe event being 18% of the AECOPD cases admitted to ICUs. The prevalence of AECOPD in ICUs is not properly known due to an underestimation of COPD diagnoses and COPD misclassifications in administrative data. Non-invasive ventilation in acute and chronic respiratory failure may prevent AECOPD, reducing ICU admissions and disease mortality, especially when associated with a life-threating episode of hypercapnic ARF. In this review, we report on up to date evidence from the literature, showing how improving the knowledge and management of AECOPD is still a current research issue and clinical need.
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Affiliation(s)
- Irene Prediletto
- Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Science (DIMEC), Via Massarenti 9, 40138 Bologna, Italy
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit, Policlinico S. Orsola-Malpighi di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Gilda Giancotti
- Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Science (DIMEC), Via Massarenti 9, 40138 Bologna, Italy
| | - Stefano Nava
- Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Science (DIMEC), Via Massarenti 9, 40138 Bologna, Italy
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Respiratory and Critical Care Unit, Policlinico S. Orsola-Malpighi di Bologna, Via Albertoni 15, 40138 Bologna, Italy
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Polastri M, Carbonara P, Prediletto I, Gardini A, Venturoli F, Tagariello F, Neri L, Carpano M, Pacilli AMG, Nava S. Effects of early rehabilitation on motor function, dyspnoea intensity, respiratory muscle performance and handgrip strength in patients with COVID-19: an observational study. International Journal of Therapy and Rehabilitation 2022. [DOI: 10.12968/ijtr.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background/Aims Although an increasing volume of research is emerging, rehabilitative treatment of patients with COVID-19 still continues to be a matter of great importance that must be explored further. The purpose of the present study was to describe the effects of inpatient rehabilitation in acute patients treated in a sub-intensive hospital setting during the COVID-19 pandemic. Methods A retrospective analysis was conducted based on the prospectively collected data of 192 patients with COVID-19 undergoing a physiotherapeutic regimen during their hospitalisation. Patients were admitted because of COVID-19-related pneumonia from the periods of 25 March–12 June 2020 and 2 November 2020–9 June 2021. This study investigated dyspnoea intensity using the modified Borg scale, motor function through the 1-minute sit-to-stand test, and daily walked distance. In a subset of 57 patients, handgrip strength and respiratory muscle function was also evaluated. Measurements were taken at baseline and discharge. Results Patients were classified according to the severity of their ratio of arterial oxygen partial pressure to fractional inspired oxygen (mean 225 ± 82 mmHg). At discharge to home or to another hospital facility, patients performed a mean of 12 repetitions (1-minute sit-to-stand test); dyspnoea intensity was 1.4 (modified Borg scale), and they were able to walk a mean distance of 266.7 metres. The mean handgrip strength of the dominant hand was 29.3 kg, the maximal inspiratory pressure was 43.5 cmH2O, and the maximal expiratory pressure was 59.1 cmH2O. Overall, significant differences before and after treatment were detected for all clinical variables. Dyspnoea improved by 0.7 points; walked distance by 200 metres; the number of repetitions at the 1-minute sit-to-stand test by 5.6; the handgrip strength by 1.2 kg (right hand) and 1.7 kg (left hand); maximal inspiratory pressure by 7.7 cmH2O; and maximal expiratory pressure by 9.5 cmH2O. Conclusions Patients obtained significant improvements in functional capacity, dyspnoea perception, handgrip strength and respiratory muscle function. In addition, the treatment was feasible and well tolerated by patients, and no adverse related events were observed in a sub-intensive care setting.
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Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paolo Carbonara
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Irene Prediletto
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Aldo Gardini
- Department of Statistical Sciences ‘P. Fortunati’, University of Bologna, Bologna, Italy
| | - Francesca Venturoli
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Tagariello
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Lucia Neri
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Marco Carpano
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Angela Maria Grazia Pacilli
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Polastri M, Paganelli GM, Prediletto I. Combining thalassotherapy and exercise for people with respiratory diseases. International Journal of Therapy and Rehabilitation 2022. [DOI: 10.12968/ijtr.2022.0071] [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: 11/11/2022]
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gian Maria Paganelli
- Department of Cardiac-Thoracic-Vascular Diseases, Unit of Pneumonology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Irene Prediletto
- Department of Cardiac-Thoracic-Vascular Diseases, Unit of Pneumonology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Schifino G, Vega ML, Pisani L, Prediletto I, Catalanotti V, Comellini V, Bassi I, Zompatori M, Ranieri MV, Nava S. Effects of non-invasive respiratory supports on inspiratory effort in moderate-severe COVID-19 patients. A randomized physiological study. Eur J Intern Med 2022; 100:110-118. [PMID: 35483993 PMCID: PMC9023341 DOI: 10.1016/j.ejim.2022.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVE Various forms of Non-invasive respiratory support (NRS) have been used during COVID-19, to treat Hypoxemic Acute Respiratory Failure (HARF), but it has been suggested that the occurrence of strenuous inspiratory efforts may cause Self Induced Lung Injury(P-SILI). The aim of this investigation was to record esophageal pressure, when starting NRS application, so as to better understand the potential risk of the patients in terms of P-SILI and ventilator induced lung injury (VILI). METHODS AND MEASUREMENTS 21 patients with early de-novo respiratory failure due to COVID-19, underwent three 30 min trials applied in random order: high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and non-invasive ventilation (NIV). After each trial, standard oxygen therapy was reinstituted using a Venturi mask (VM). 15 patients accepted a nasogastric tube placement. Esophageal Pressure (ΔPes) and dynamic transpulmonary driving pressure (ΔPLDyn), together with the breathing pattern using a bioelectrical impedance monitor were recorded. Arterial blood gases were collected in all patients. MAIN RESULTS No statistically significant differences in breathing pattern and PaCO2 were found. PaO2/FiO2 ratio improved significantly during NIV and CPAP vs VM. NIV was the only NRS to reduce significantly ΔPes vs. VM (-10,2 ±5 cmH20 vs -3,9 ±3,4). No differences were found in ΔPLDyn between NRS (10,2±5; 9,9±3,8; 7,6±4,3; 8,8±3,6 during VM, HFNC, CPAP and NIV respectively). Minute ventilation (Ve) was directly dependent on the patient's inspiratory effort, irrespective of the NRS applied. 14% of patients were intubated, none of them showing a reduction in ΔPes during NRS. CONCLUSIONS In the early phase of HARF due to COVID-19, the inspiratory effort may not be markedly elevated and the application of NIV and CPAP ameliorates oxygenation vs VM. NIV was superior in reducing ΔPes, maintaining ΔPLDyn within a range of potential safety.
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Affiliation(s)
- Gioacchino Schifino
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Maria L Vega
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Lara Pisani
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Irene Prediletto
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Vito Catalanotti
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Vittoria Comellini
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Ilaria Bassi
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Maurizio Zompatori
- IRCCS MultiMedica, Division of Radiology Sesto, San Giovanni, Lombardia, Italy
| | - Marco Vito Ranieri
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Stefano Nava
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant´Orsola-Malpighi- Respiratory and Critical Care Unit- Bologna, Italy; Alma Mater Studiorum, University of Bologna, Department of Clinical Integrated and Experimental Medicine (DIMES), Bologna, Italy.
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7
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Polastri M, Paganelli GM, Dolci G, Di Ciaccio E, Prediletto I. Musculoskeletal syndrome treated with global postural re-education in double-redo lung transplantation: a case report with an 8-month follow-up. Reumatismo 2022; 74. [PMID: 35506322 DOI: 10.4081/reumatismo.2022.1386] [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: 12/16/2020] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Postoperative pain and persisting fatigue represent critical concerns for patients receiving lung transplantation. The purpose of this study was to illustrate the trajectory of symptoms in a patient who presented with a posttransplant musculoskeletal syndrome after double redo-lung transplantation and attended therapeutic sessions of global postural re-education during the symptomatic phase. A 32-year-old woman with interstitial lung disease underwent double lung transplantation. At 23 months, functional parameters deteriorated, and the patient was placed on the active list for a second double-lung transplantation. Twenty months after re-transplantation, the patient reported continuous thoracic-lumbar musculoskeletal pain exacerbated by moving or performing the standard motor activities. Lower body flexibility improved during the observation period changed from -10 cm to 0 cm at the Chair Sitand- Reach Test. Leg strength improved as well, and the patient was able to perform more repetitions at the Squat Test, improving from 14 to 39. Pain intensity changed from 7 to 4 on a numerical rating scale. We observed that outcomes strictly related to treatment, with lower body flexibility, pain intensity, and physical function improving over time. As a result global postural re-education proved to be effective in this patient.
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Affiliation(s)
- M Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St Orsola University Hospital, Bologna.
| | - G M Paganelli
- Heart and Lung Transplant Programme, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St Orsola University Hospital, Bologna, Italy; Department of Cardiac-Thoracic-Vascular Diseases, Pneumonology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St Orsola University Hospital, Bologna.
| | - G Dolci
- Heart and Lung Transplant Programme, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St Orsola University Hospital, Bologna; Department of Cardiac-Thoracic-Vascular Diseases, Thoracic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St Orsola University Hospital, Bologna.
| | | | - I Prediletto
- Department of Cardiac-Thoracic-Vascular Diseases, Pneumonology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St Orsola University Hospital, Bologna; Department of Clinical, Integrated and Experimental Medicine (DIMES), University of Bologna.
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Ferioli M, Prediletto I, Bensai S, Betti S, Daniele F, Di Scioscio V, Modolon C, Rimondi MR, De Molo C, Serra C, Nava S, Fasano L. Spontaneous Evolution of COVID-19 Lung Sequelae: Results from a Double-Step Follow-Up. Respiration 2022; 101:381-393. [PMID: 35042222 PMCID: PMC8805081 DOI: 10.1159/000521316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Few studies have reported a double-step follow-up of patients after hospitalization for COVID-19. Objectives We designed an observational double-step follow-up study with a clinical, functional, and radiological evaluation at 2 and 6 months after COVID-19. The primary outcome was to describe symptoms, spirometry, and 6-minute walking test (6MWT) at 2 and 6 months. Secondary outcomes were to identify if the lowest PaO<sub>2</sub>/FiO<sub>2</sub> during hospitalization is related with functional and radiological evolution and to assess the correlation between radiological and functional abnormalities at 6 months. Methods Symptoms, spirometry, and 6MWT were assessed at 2 and 6 months; arterial blood gas, chest x-ray, and lung ultrasound were performed at 2 months; body plethysmography, diffusing capacity for carbon monoxide (DLCO), and CT scan were performed at 6 months. Results Sixty-four per cent and 42% of patients reported at least one symptom at 2 and 6 months, respectively. The most common 6-month functional alteration was DLCO impairment (57% of patients). An improvement of FEV1, FVC, and 6MWT was observed between 2 and 6 months (p < 0.001). Patients with PaO<sub>2</sub>/FiO<sub>2</sub> <200 during hospitalization performed worse at 6MWT at 2 and 6 months (p < 0.05) and reported more extended radiological abnormalities at 6 months (p < 0.001) compared with patients with PaO<sub>2</sub>/FiO<sub>2</sub>>200. At 6 months, more extended radiological abnormalities were related with worse 6MWT, DLCO, and total lung capacity (p < 0.05). Discussion DLCO and 6MWT impairment seem to be the functional hallmark of COVID-19 and are related with the severity of acute pneumonia. At 6 months, radiological abnormalities were related to functional impairment.
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Affiliation(s)
- Martina Ferioli
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Irene Prediletto
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Serena Bensai
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Sara Betti
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Federico Daniele
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Valerio Di Scioscio
- Department of Diagnostic and Preventive Medicine, IRCCS Azienda Ospedaliero Universitaria of Bologna, Bologna, Italy.,Radiology Institute, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
| | - Cecilia Modolon
- Department of Diagnostic and Preventive Medicine, IRCCS Azienda Ospedaliero Universitaria of Bologna, Bologna, Italy.,Radiology Institute, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
| | - Maria Rita Rimondi
- Department of Diagnostic and Preventive Medicine, IRCCS Azienda Ospedaliero Universitaria of Bologna, Bologna, Italy.,Radiology Institute, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
| | - Chiara De Molo
- Department of Organ Failure and Transplantation, IRCCS Azienda Ospedaliero Universitaria of Bologna, Bologna, Italy.,Interventional and Diagnostic Ultrasound Unit, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
| | - Carla Serra
- Department of Organ Failure and Transplantation, IRCCS Azienda Ospedaliero Universitaria of Bologna, Bologna, Italy.,Interventional and Diagnostic Ultrasound Unit, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy
| | - Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luca Fasano
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University, Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria di Bologna, Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
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Prediletto I, Nava S, Palange P. Standardized PaO 2/FiO 2 ratio in COVID-19: Added value or risky assumption. Author's reply. Eur J Intern Med 2022; 95:106-107. [PMID: 34716076 PMCID: PMC8536563 DOI: 10.1016/j.ejim.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Irene Prediletto
- Alma Mater Studiorum University of Bologna, Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit, Bologna, Italy
| | - Stefano Nava
- Alma Mater Studiorum University of Bologna, Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit, Bologna, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Disease, Sapienza University of Rome - Italy. Pulmonology, Respiratory and Critical Care Unit, Policlinico Umberto I Hospital, Rome, Italy
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Gamberini L, Mazzoli CA, Prediletto I, Sintonen H, Scaramuzzo G, Allegri D, Colombo D, Tonetti T, Zani G, Capozzi C, Dalpiaz G, Agnoletti V, Cappellini I, Melegari G, Damiani F, Fusari M, Gordini G, Laici C, Lanza MC, Leo M, Marudi A, Papa R, Potalivo A, Montomoli J, Taddei S, Mazzolini M, Ferravante AF, Nicali R, Ranieri VM, Russo E, Volta CA, Spadaro S. Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study. Respir Med 2021; 189:106665. [PMID: 34717097 PMCID: PMC8531241 DOI: 10.1016/j.rmed.2021.106665] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) impairment is often reported among COVID-19 ICU survivors, and little is known about their long-term outcomes. We evaluated the HRQoL trajectories between 3 months and 1 year after ICU discharge, the factors influencing these trajectories and the presence of clusters of HRQoL profiles in a population of COVID-19 patients who underwent invasive mechanical ventilation (IMV). Moreover, pathophysiological correlations of residual dyspnea were tested. METHODS We followed up 178 survivors from 16 Italian ICUs up to one year after ICU discharge. HRQoL was investigated through the 15D instrument. Available pulmonary function tests (PFTs) and chest CT scans at 1 year were also collected. A linear mixed-effects model was adopted to identify factors associated with different HRQoL trajectories and a two-step cluster analysis was performed to identify HRQoL clusters. RESULTS We found that HRQoL increased during the study period, especially for the significant increase of the physical dimensions, while the mental dimensions and dyspnea remained substantially unchanged. Four main 15D profiles were identified: full recovery (47.2%), bad recovery (5.1%) and two partial recovery clusters with mostly physical (9.6%) or mental (38.2%) dimensions affected. Gender, duration of IMV and number of comorbidities significantly influenced HRQoL trajectories. Persistent dyspnea was reported in 58.4% of patients, and weakly, but significantly, correlated with both DLCO and length of IMV. CONCLUSIONS HRQoL impairment is frequent 1 year after ICU discharge, and the lowest recovery is found in the mental dimensions. Persistent dyspnea is often reported and weakly correlated with PFTs alterations. TRIAL REGISTRATION NCT04411459.
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Carlo Alberto Mazzoli
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Irene Prediletto
- Alma Mater Studiorum University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit, Bologna, Italy.
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Gaetano Scaramuzzo
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Davide Colombo
- Anaesthesia and Intensive Care Department - SS. Trinità Hospital, ASL Novara, Italy; Health Science Department - Eastern Piedmont University, Italy
| | - Tommaso Tonetti
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Chiara Capozzi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Vanni Agnoletti
- Anaesthesia and Intensive Care Unit - M.Bufalini Hospital, Cesena, Italy
| | - Iacopo Cappellini
- Department of Critical Care Section of Anesthesiology and Intensive Care, Azienda USL Toscana Centro, Prato, Italy
| | - Gabriele Melegari
- Department of Anaesthesiology, University Hospital of Modena, Via Del Pozzo 71, 41100, Modena, Italy
| | - Federica Damiani
- Department of Anaesthesia, Intensive Care and Pain Therapy - Imola Hospital, Imola, Italy
| | - Maurizio Fusari
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Giovanni Gordini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Cristiana Laici
- Postoperative Intensive Care Unit. Medical and Surgical Department of Digestive, Liver and Endocrine-Metabolic Diseases. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Concetta Lanza
- Department of Anesthesia and Intensive Care, G.B. Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Mirco Leo
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Marudi
- Department of Anaesthesiology, University Hospital of Modena, Via Del Pozzo 71, 41100, Modena, Italy
| | - Raffaella Papa
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Antonella Potalivo
- Department of Anaesthesia and Intensive Care - Infermi Hospital, Rimini, Italy
| | - Jonathan Montomoli
- Department of Anaesthesia and Intensive Care - Infermi Hospital, Rimini, Italy
| | - Stefania Taddei
- Anaesthesia and Intensive Care Unit, Bentivoglio Hospital, Bentivoglio, Italy
| | | | | | - Roberta Nicali
- Outpatient Pneumology Department. - SS. Trinità Hospital Borgomanero, ASL NO, Novara, Italy
| | - Vito Marco Ranieri
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Emanuele Russo
- Anaesthesia and Intensive Care Unit - M.Bufalini Hospital, Cesena, Italy
| | - Carlo Alberto Volta
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
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Prediletto I, D'Antoni L, Carbonara P, Daniele F, Dongilli R, Flore R, Pacilli AMG, Pisani L, Tomsa C, Vega ML, Ranieri VM, Nava S, Palange P. Standardizing PaO2 for PaCO2 in P/F ratio predicts in-hospital mortality in acute respiratory failure due to Covid-19: A pilot prospective study. Eur J Intern Med 2021; 92:48-54. [PMID: 34175182 PMCID: PMC8222796 DOI: 10.1016/j.ejim.2021.06.002] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Up to fifteen percent of patients with novel pandemic coronavirus disease (Covid-19) have acute respiratory failure (ARF). Ratio between arterial partial pressure of oxygen (PaO2) and fraction of inspired oxygen (FiO2), P/F, is currently used as a marker of ARF severity in Covid-19. P/F does not reflect the respiratory efforts made by patients to maintain arterial blood oxygenation, such as tachypnea and hyperpnea, leading to hypocapnia. Standard PaO2, the value of PaO2 adjusted for arterial partial pressure of carbon dioxide (PaCO2) of the subject, better reflects the pathophysiology of hypoxemic ARF. We hypothesized that the ratio between standard PaO2 over FiO2 (STP/F) better predicts Covid-19 ARF severity compared to P/F. METHODS Aim of this pilot prospectic observational study was to observe differences between STP/F and P/F in predicting outcome failure, defined as need of invasive mechanical ventilation and/or deaths in Covid-19 ARF. Accuracy was calculated using Receiver Operating Characteristics (ROC) analysis and areas under the ROC curve (AUROC) were compared. RESULTS 349 consecutive subjects admitted to our respiratory wards due to Covid-19 ARF were enrolled. STP/F was accurate to predict mortality and superior to P/F with, respectively, AUROC 0.710 versus 0.688, p = 0.012.Both STP/F and PF were accurate to predict outcome failure (AUROC respectively of 0.747 and 0.742, p = 0.590). DISCUSSION This is the first study assessing the role of STP/F in describing severity of ARF in Covid-19. According to results, STP/F is accurate and superior to P/F in predicting in-hospital mortality.
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Affiliation(s)
- Irene Prediletto
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit - Bologna, Italy; Alma Mater Studiorum University of Bologna, Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Letizia D'Antoni
- Department of Public Health and Infectious Disease, Sapienza University of Rome - Italy. Pulmonology, Respiratory and Critical Care Unit, Policlinico Umberto I Hospital - Rome, Italy
| | - Paolo Carbonara
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit - Bologna, Italy; Alma Mater Studiorum University of Bologna, Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Federico Daniele
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit - Bologna, Italy; Alma Mater Studiorum University of Bologna, Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Roberto Dongilli
- Division of Respiratory Diseases with Intermediate Respiratory Intensive Care Units, Central Hospital of Bolzano, Bolzano, Italy
| | - Roberto Flore
- Department of Public Health and Infectious Disease, Sapienza University of Rome - Italy. Pulmonology, Respiratory and Critical Care Unit, Policlinico Umberto I Hospital - Rome, Italy
| | - Angela Maria Grazia Pacilli
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit - Bologna, Italy; Alma Mater Studiorum University of Bologna, Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Lara Pisani
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit - Bologna, Italy; Alma Mater Studiorum University of Bologna, Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Corina Tomsa
- Department of Public Health and Infectious Disease, Sapienza University of Rome - Italy. Pulmonology, Respiratory and Critical Care Unit, Policlinico Umberto I Hospital - Rome, Italy
| | - María Laura Vega
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit - Bologna, Italy
| | - Vito Marco Ranieri
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Anesthesia and Intensive Care Medicine - Bologna, Italy; Alma Mater Studiorum University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
| | - Stefano Nava
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit - Bologna, Italy; Alma Mater Studiorum University of Bologna, Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy.
| | - Paolo Palange
- Department of Public Health and Infectious Disease, Sapienza University of Rome - Italy. Pulmonology, Respiratory and Critical Care Unit, Policlinico Umberto I Hospital - Rome, Italy
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Vega ML, Dongilli R, Olaizola G, Colaianni N, Sayat MC, Pisani L, Romagnoli M, Spoladore G, Prediletto I, Montiel G, Nava S. COVID-19 pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU. Authors' reply. Pulmonology 2021; 27:475-476. [PMID: 34334332 PMCID: PMC8321775 DOI: 10.1016/j.pulmoe.2021.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/21/2023] Open
Affiliation(s)
- M L Vega
- Non-Invasive Respiratory Support Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires. Argentina; IRCCS Azienda Ospedaliera-Universitaria, Division of Respiratory and Critical Care SantOrsola Hospital, Bologna Italia
| | - R Dongilli
- Division of Respiratory Diseases with intermediate respiratory intensive care units, Central Hospital of Bolzano, Bolzano, Italy
| | - G Olaizola
- Unidad Asistencial Cesar Milstein. Ciudad Autónoma de Buenos Aires. Argentina
| | - N Colaianni
- Non-Invasive Respiratory Support Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires. Argentina; Intensive Care Unit, Clínica Zabala, Ciudad Autónoma de Buenos Aires. Argentina
| | - M C Sayat
- Non-Invasive Respiratory Support Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires. Argentina; Intensive Care Unit, Clínica Zabala, Ciudad Autónoma de Buenos Aires. Argentina
| | - L Pisani
- IRCCS Azienda Ospedaliera-Universitaria, Division of Respiratory and Critical Care SantOrsol Hospital, Bologna Italia. Alma Mater Studiorum University of Bologna Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - M Romagnoli
- Pulmonology Unit, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | - G Spoladore
- Division of Infectious Diseases, Central Hospital of Bolzano, Bolzano, Italy
| | - I Prediletto
- IRCCS Azienda Ospedaliera-Universitaria, Division of Respiratory and Critical Care SantOrsol Hospital, Bologna Italia. Alma Mater Studiorum University of Bologna Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - G Montiel
- Non-Invasive Respiratory Support Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires. Argentina
| | - S Nava
- IRCCS Azienda Ospedaliera-Universitaria, Division of Respiratory and Critical Care SantOrsol Hospital, Bologna Italia. Alma Mater Studiorum University of Bologna Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy.
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Prediletto I, Tavalazzi F, Perziano M, Fanfulla F, Fabiani A, Oldani S, Azzi N, Mutti C, Parrino L, Nava S. Sleep features in Lymphangioleiomyomatosis and their relationship with disease severity: a pilot study. Sleep Med 2021; 85:60-65. [PMID: 34274813 DOI: 10.1016/j.sleep.2021.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/27/2022]
Abstract
Lymphangioleiomyomatosis (LAM) is a rare pulmonary disease characterized by progressive airflow limitation. We conducted a pilot trial to investigate the incidence of sleep disorders, sleep quality and their relationship with disease severity. We performed pulmonary function tests, blood gas analysis, overnight 12-channels polysomnography and clinical assessments in 15 consecutive LAM patients. For statistics, p values < 0.05 were considered significant. Sleep efficiency (SE) was inversely correlated with RV/TLC (p = 0.035) and positively with daytime SpO2 (p = 0.010) and PaO2 (p = 0.011). Three cases had obstructive sleep apnea (OSA); seven patients (46.7%) showed a REMOSA. AHIREM was correlated with FEV1% (r = 0.75, p = 0.003), TLC% (r = 0.57, p = 0.026), RV% (r = 0.8, p=<0.0001) and RV/TLC (r = 0.77, p = 0.001). No correlations were observed between anxiety/depression and SE, CAP rate, pulmonary function test variables and AHIREM (p > 0.05). four subjects had nocturnal hypoxia (T90 ≥ 1% of TST) showing lower values of DLCO%, daytime SpO2%, PaO2, FEV1% and a higher value of VR/TLC comparing with the subgroup with normal T90 (p < 0.05). This pilot study shows that sleep alterations could be frequent in LAM and associated to disease severity. Nocturnal hypoxemia and SE were related to lung function impairment. A dysregulation of sleep seems to involve exclusively REM phase, while NREM appears to be preserved. This phenomenon might be linked to the pathophysiology of disease: our study, even with the limits of the small sample size, showed that the presence of REMOSA is related to the disease severity, in particular to the degree of airflow limitation and hyperinflation. More studies are needed to assess this topic.
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Affiliation(s)
- Irene Prediletto
- Alma Mater Studiorum University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine - DIMES (DIMES), Bologna, Italy; Rare Respiratory Diseases Center, Respiratory and Critical Care Unit, IRCCS Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
| | - Francesco Tavalazzi
- Respiratory and Bronchoendoscopic Unit, Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Massimiliano Perziano
- Respiratory and Critical Care Unit, IRCCS Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Fanfulla
- Sleep Medicine Unit Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Italy
| | - Andrea Fabiani
- Rare Respiratory Diseases Center, Respiratory and Critical Care Unit, IRCCS Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Stefano Oldani
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Nicoletta Azzi
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Italy
| | - Carlotta Mutti
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Italy
| | - Liborio Parrino
- Sleep Disorders Center, Department of Medicine and Surgery, University of Parma, Italy
| | - Stefano Nava
- Alma Mater Studiorum University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine - DIMES (DIMES), Bologna, Italy; Respiratory and Critical Care Unit, IRCCS Sant'Orsola-Malpighi University Hospital, Bologna, Italy
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Vega ML, Dongilli R, Olaizola G, Colaianni N, Sayat MC, Pisani L, Romagnoli M, Spoladore G, Prediletto I, Montiel G, Nava S. COVID-19 Pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU. Pulmonology 2021; 28:13-17. [PMID: 34049831 PMCID: PMC8103151 DOI: 10.1016/j.pulmoe.2021.04.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 01/20/2023] Open
Abstract
High flow nasal cannula (HFNC) is used to treat acute hypoxemic respiratory failure (AHRF) even outside the ICU and the ROX index (pulse oximetry/fraction of inspired oxygen/respiratory rate) may predict HFNC failure. Objective The purpose of this investigation was therefore to verify whether the ROX index is an accurate predictor of HFNC failure for COVID-19 patients treated outside the intensive care unit (ICU) and to evaluate the validity of the previously suggested threshold. Design Multicenter study. Retrospective observational analysis of prospectively collected data. Setting 3 centres specialized in non-invasive respiratory support (Buenos Aires, Argentina; Bolzano and Treviso, Italy). Patients treated outside the ICU were analysed Measurements The variables to calculate the ROX index were collected during the first day of therapy at 2, 6, 12 and 24 hours and then recorded every 24 hours. HFNC failure was defined as escalation of respiratory support to invasive mechanical ventilation (IMV) or death. Main results A total of 35 (29%) patients failed HFNC and required intubation. ROC analysis identified the 12-hour ROX index as the best predictor of intubation with an AUC of 0.7916[CI 95% 0.6905-0.8927] and the best threshold to be 5.99[Specificity 96% Sensitivity 62%]. In the survival analysis, a ROX value <5.99 was associated with an increased risk of failure (p = 0008 log – rank test). The threshold of 4,9 identified by Roca as the best predictor in non-COVID patients, was not able to discriminate between success and failure (p = 0.4 log-rank test) in our patients. Conclusions ROX index may be useful in guiding the clinicians in their decision to intubate patients, especially in patients with moderate ARF, treated therefore outside the ICU. Indeed, it also demonstrates a different threshold value than reported for non-COVID patients, possibly related to the different mechanisms of hypoxia.
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Affiliation(s)
- María Laura Vega
- Non-Invasive Respiratory Support Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires. Argentina; IRCCS Azienda Ospedaliera-Universitaria, Division of Respiratory and Critical Care SantOrsola Hospital, Bologna Italia
| | - Roberto Dongilli
- Division of Respiratory Diseases with intermediate respiratory intensive care units, Central Hospital of Bolzano, Bolzano, Italy
| | - Gustavo Olaizola
- Unidad Asistencial Cesar Milstein. Ciudad Autónoma de Buenos Aires. Argentina
| | - Nicolás Colaianni
- Non-Invasive Respiratory Support Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires. Argentina; Intensive Care Unit, Clínica Zabala, Ciudad Autónoma de Buenos Aires. Argentina
| | - Mauro Castro Sayat
- Non-Invasive Respiratory Support Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires. Argentina; Intensive Care Unit, Clínica Zabala, Ciudad Autónoma de Buenos Aires. Argentina
| | - Lara Pisani
- IRCCS Azienda Ospedaliera-Universitaria, Division of Respiratory and Critical Care SantOrsol Hospital, Bologna Italia. Alma Mater Studiorum University of Bologna Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Micaela Romagnoli
- Pulmonology Unit, Santa Maria di Ca' Foncello Hospital, Treviso, Italy
| | - Greta Spoladore
- Division of Infectious Diseases, Central Hospital of Bolzano, Bolzano, Italy
| | - Irene Prediletto
- IRCCS Azienda Ospedaliera-Universitaria, Division of Respiratory and Critical Care SantOrsol Hospital, Bologna Italia. Alma Mater Studiorum University of Bologna Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy
| | - Guillermo Montiel
- Non-Invasive Respiratory Support Unit, Hospital Juan A. Fernández, Ciudad Autónoma de Buenos Aires. Argentina
| | - Stefano Nava
- IRCCS Azienda Ospedaliera-Universitaria, Division of Respiratory and Critical Care SantOrsol Hospital, Bologna Italia. Alma Mater Studiorum University of Bologna Department of Clinical, Integrated and Experimental Medicine (DIMES), Bologna, Italy.
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15
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Tonelli R, Pisani L, Tabbì L, Comellini V, Prediletto I, Fantini R, Marchioni A, Andrisani D, Gozzi F, Bruzzi G, Manicardi L, Busani S, Mussini C, Castaniere I, Bassi I, Carpano M, Tagariello F, Corsi G, d'Amico R, Girardis M, Nava S, Clini E. Early awake proning in critical and severe COVID-19 patients undergoing noninvasive respiratory support: A retrospective multicenter cohort study. Pulmonology 2021; 28:181-192. [PMID: 33824084 PMCID: PMC7983422 DOI: 10.1016/j.pulmoe.2021.03.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/MATERIALS AND METHODS This retrospective cohort study was conducted in two teaching hospitals over a 3-month period (March 2010-June 2020) comparing severe and critical COVID-19 patients admitted to Respiratory Intensive Care Unit for non-invasive respiratory support (NRS) and subjected to awake prone position (PP) with those receiving standard care (SC). Primary outcome was endotracheal intubation (ETI) rate. In-hospital mortality, time to ETI, tracheostomy, length of RICU and hospital stay served as secondary outcomes. Risk factors associated to ETI among PP patients were also investigated. RESULTS A total of 114 patients were included, 76 in the SC and 38 in the PP group. Unadjusted Kaplan-Meier estimates showed greater effect of PP compared to SC on ETI rate (HR = 0.45 95% CI [0.2-0.9], p = 0.02) even after adjustment for baseline confounders (HR = 0.59 95% CI [0.3-0.94], p = 0.03). After stratification according to non-invasive respiratory support, PP showed greater significant benefit for those on High Flow Nasal Cannulae (HR = 0.34 95% CI [0.12-0.84], p = 0.04). Compared to SC, PP patients also showed a favorable difference in terms of days free from respiratory support, length of RICU and hospital stay while mortality and tracheostomy rate were not significantly different. CONCLUSIONS Prone positioning in awake and spontaneously breathing Covid-19 patients is feasible and associated with a reduction of intubation rate, especially in those patients undergoing HFNC. Although our results are intriguing, further randomized controlled trials are needed to answer all the open questions remaining pending about the real efficacy of PP in this setting.
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Affiliation(s)
- Roberto Tonelli
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy.
| | - Lara Pisani
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy.
| | - Luca Tabbì
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.
| | - Vittoria Comellini
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy.
| | - Irene Prediletto
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy.
| | - Riccardo Fantini
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.
| | - Alessandro Marchioni
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.
| | - Dario Andrisani
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.
| | - Filippo Gozzi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.
| | - Giulia Bruzzi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.
| | - Linda Manicardi
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.
| | - Stefano Busani
- University Hospital of Modena, Intensive Care Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplants Oncology and Regenerative Medicine, University of Modena Reggio Emilia, Modena, Italy.
| | - Cristina Mussini
- University Hospital of Modena, Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, Modena, Italy.
| | - Ivana Castaniere
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy.
| | - Ilaria Bassi
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy.
| | - Marco Carpano
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy.
| | - Federico Tagariello
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy.
| | - Gabriele Corsi
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy.
| | - Roberto d'Amico
- Statistics Unit, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
| | - Massimo Girardis
- University Hospital of Modena, Intensive Care Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplants Oncology and Regenerative Medicine, University of Modena Reggio Emilia, Modena, Italy
| | - Stefano Nava
- IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola - Malpighi-Respiratory and Critical Care Unit, Bologna, Italy.
| | - Enrico Clini
- University Hospital of Modena, Respiratory Diseases Unit, Department of Medical and Surgical Sciences SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy.
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16
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Vitacca M, Ceriana P, Prediletto I, Carlucci A, Paneroni M, Ambrosino N, Nava S. Intrinsic Dynamic Positive End-Expiratory Pressure in Stable Patients with Chronic Obstructive Pulmonary Disease. Respiration 2020; 99:1129-1135. [PMID: 33271563 DOI: 10.1159/000511266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Assessment of intrinsic dynamic positive end-expiratory pressure (PEEPi,dyn) may be clinically important in stable patients with chronic obstructive pulmonary disease (COPD), but epidemiological data are scant. OBJECTIVES The aim of our study was (i) to assess the PEEPi,dyn in a large population of stable patients with COPD and (ii) to evaluate the correlations with some noninvasive measurements routinely assessed. METHOD Retrospective analysis of lung mechanics, dynamic volumes, arterial blood gases, dyspnoea by means of the Medical Research Council (MRC) scale, the COPD Assessment Test score, and maximal inspiratory/expiratory pressures in 87 hypercapnic and 62 normocapnic patients. RESULTS The mean PEEPi,dyn was significantly higher in hypercapnic than normocapnic patients (2.8 ± 2.2 vs. 1.9 ± 1.6 cm H2O, respectively, p = 0.0094). PEEPi,dyn did not differ according to Global Initiative for Chronic Obstructive Lung Disease stage, MRC score, or use or not of long-term oxygen therapy. There were significant although weak correlations between PEEPi,dyn and airway obstruction, hyperinflation, respiratory muscle function, arterial CO2 tension, and number of exacerbations/year. The transdiaphragmatic pressure was the strongest variable associated to PEEPi,dyn (R = 0.5713, p = 0.001). CONCLUSION In stable patients with COPD, PEEPi,dyn is higher in hypercapnic patients and weakly correlated to noninvasive measures of lung and respiratory muscle function.
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Affiliation(s)
- Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy,
| | - Piero Ceriana
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Pavia, Pavia, Italy
| | - Irene Prediletto
- Università Alma Mater, Cattedra di Malattie dell'Apparato Respiratorio, Bologna, Italy
| | - Annalisa Carlucci
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Pavia, Pavia, Italy.,Università dell'Insubria, Dipartimento di Medicina e Chirurgia, Varese-Como, Italy
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, Pavia, Italy
| | - Stefano Nava
- Università Alma Mater, Cattedra di Malattie dell'Apparato Respiratorio, Bologna, Italy
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17
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Nava S, Prediletto I. Idiopathic pulmonary fibrosis management: caring is sparing. J Thorac Dis 2020; 12:5265-5268. [PMID: 33209360 PMCID: PMC7656405 DOI: 10.21037/jtd.2020.04.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy.,Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Irene Prediletto
- Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
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18
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Pisani L, Betti S, Biglia C, Fasano L, Catalanotti V, Prediletto I, Comellini V, Bacchi-Reggiani L, Fers SN. Effects of high-flow nasal cannula in patients with persistent hypercapnia after an acute COPD exacerbation: a prospective pilot study. BMC Pulm Med 2020; 20:12. [PMID: 31931776 PMCID: PMC6958745 DOI: 10.1186/s12890-020-1048-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Persistent hypercapnia after COPD exacerbation is associated with excess mortality and early rehospitalization. High Flow Nasal cannula (HFNC), may be theoretically an alternative to long-term noninvasive ventilation (NIV), since physiological studies have shown a reduction in PaCO2 level after few hours of treatment. In this clinical study we assessed the acceptability of HFNC and its effectiveness in reducing the level of PaCO2 in patients recovering from an Acute Hypercapnic Respiratory Failure (AHRF) episode. We also hypothesized that the response in CO2 clearance is dependent on baseline level of hypercapnia. METHODS Fifty COPD patients recovering from an acute exacerbation and with persistent hypercapnia, despite having attained a stable pH (i.e. pH > 7,35 and PaCO2 > 45 mmHg on 3 consecutive measurements), were enrolled and treated with HFNC for at least 8 h/day and during the nighttime RESULTS: HFNC was well tolerated with a global tolerance score of 4.0 ± 0.9. When patients were separated into groups with or without COPD/OSA overlap syndrome, the "pure" COPD patients showed a statistically significant response in terms of PaCO2 decrease (p = 0.044). In addition, the subset of patients with a lower pH at enrolment were those who responded best in terms of CO2 clearance (score test for trend of odds, p = 0.0038). CONCLUSIONS HFNC is able to significantly decrease the level of PaCO2 after 72 h only in "pure" COPD patients, recovering from AHRF. No effects in terms of CO2 reduction were found in those with overlap syndrome. The present findings will help guide selection of the best target population and allow a sample size calculation for future long-term randomized control trials of HFNC vs NIV. TRIAL REGISTRATION This study is registered with www. clinicaltrials.gov with identifier number NCT03759457.
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Affiliation(s)
- Lara Pisani
- Respiratory and Critical Care Unit, University Hospital St. Orsola-Malpighi, Via G. Massarenti 9, Pavilion 15, Bologna, Italy.
| | - Sara Betti
- Respiratory and Critical Care Unit, Department of Clinical, Integrated and Experimental Medicine (DIMES), University Hospital St. Orsola-Malpighi, Bologna, Italy.,School of Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Carlotta Biglia
- Respiratory and Critical Care Unit, Department of Clinical, Integrated and Experimental Medicine (DIMES), University Hospital St. Orsola-Malpighi, Bologna, Italy.,School of Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Fasano
- Respiratory and Critical Care Unit, University Hospital St. Orsola-Malpighi, Via G. Massarenti 9, Pavilion 15, Bologna, Italy
| | - Vito Catalanotti
- Respiratory and Critical Care Unit, Department of Clinical, Integrated and Experimental Medicine (DIMES), University Hospital St. Orsola-Malpighi, Bologna, Italy.,School of Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Irene Prediletto
- Respiratory and Critical Care Unit, Department of Clinical, Integrated and Experimental Medicine (DIMES), University Hospital St. Orsola-Malpighi, Bologna, Italy.,School of Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Vittoria Comellini
- Respiratory and Critical Care Unit, University Hospital St. Orsola-Malpighi, Via G. Massarenti 9, Pavilion 15, Bologna, Italy
| | - Letizia Bacchi-Reggiani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Stefano Nava Fers
- Respiratory and Critical Care Unit, Department of Clinical, Integrated and Experimental Medicine (DIMES), University Hospital St. Orsola-Malpighi, Bologna, Italy.,School of Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
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19
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Nava S, Prediletto I, Pisani L. Noninvasive Ventilation in Unplanned Endotracheal Extubation: Just a Little Help From My Friend? Respir Care 2019; 64:352-354. [PMID: 30850553 DOI: 10.4187/respcare.06886] [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: 11/05/2022]
Affiliation(s)
- Stefano Nava
- Respiratory and Critical Care Unit Department of Clinical, Integrated and Experimental Medicine (DIMES) University Hospital St. Orsola-Malpighi Bologna, Italy School of Medicine Alma Mater Studiorum University of Bologna Bologna, Italy
| | - Irene Prediletto
- Respiratory and Critical Care Unit Department of Clinical, Integrated and Experimental Medicine (DIMES) University Hospital St. Orsola-Malpighi Bologna, Italy School of Medicine Alma Mater Studiorum University of Bologna Bologna, Italy
| | - Lara Pisani
- Respiratory and Critical Care Unit University Hospital St. Orsola-Malpighi Bologna, Italy
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20
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Pisani L, Astuto M, Prediletto I, Longhini F. High flow through nasal cannula in exacerbated COPD patients: a systematic review. Pulmonology 2019; 25:348-354. [DOI: 10.1016/j.pulmoe.2019.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022] Open
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21
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Catalanotti V, Pisani L, Betti S, Bensai S, Prediletto I, Fasano L, Nava S. Noninvasive ventilation and renal replacement therapy in do-not-intubate order critically ill patients: A brief report. Clin Respir J 2019; 13:400-403. [PMID: 30942944 DOI: 10.1111/crj.13023] [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] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/19/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Multiple organ failure has been considered a contraindication for noninvasive ventilation (NIV). MATERIALS AND METHODS We described the outcome of Do-not-Intubate (DNI) patients with acute respiratory failure, treated with NIV and, subsequently, necessitating renal replacement therapy (RRT). RESULTS AND DISCUSSION Seven patients admitted to our Respiratory Intensive Care Unit, developed Acute Kidney Injury (AKI) during NIV treatment and received RRT for 12.8 ± 8 days together with NIV. All the patients but one, discontinued renal support because they regained a satisfactory urinary output; nevertheless mortality rate was high (71%). CONCLUSION Our data suggest that RRT could be feasible together with NIV. RRT was associated with an acute improvement in renal function but did not modify the mortality rate.
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Affiliation(s)
| | - Lara Pisani
- Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Sara Betti
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Serena Bensai
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Irene Prediletto
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Fasano
- Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Nava
- Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.,Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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22
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Prediletto I, Vasile E, Bruno R, Macerola E, Pasquini G, Fontanini G, Falcone A. Pre-treatment EGFR-T790M subclones in lung adenocarcinoma harboring activating mutation of EGFR: A positive prognostic factor for survival? Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.045] [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: 11/14/2022] Open
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23
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Macerola E, Bruno R, Prediletto I, Sensi E, Chella A, Landi L, Alì G, Fontanini G. P3.02b-034 Clinical Impact of Pretreatment EGFR T790M Mutation in Lung Adenocarcinoma Patients. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Alì G, Bruno R, Giordano M, Prediletto I, Marconi L, Zupo S, Fedeli F, Ribechini A, Chella A, Fontanini G. Small cell lung cancer transformation and the T790M mutation: A case report of two acquired mechanisms of TKI resistance detected in a tumor rebiopsy and plasma sample of EGFR-mutant lung adenocarcinoma. Oncol Lett 2016; 12:4009-4012. [PMID: 27895763 DOI: 10.3892/ol.2016.5193] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/28/2016] [Indexed: 11/05/2022] Open
Abstract
The present study describes the case of a 45-year-old man diagnosed with metastatic lung adenocarcinoma, which harbored a deletion within exon 19 of the epidermal growth factor receptor (EGFR) gene. The patient was subsequently treated with gefitinib (250 mg/day orally from May 2013 to March 2014), but developed acquired resistance to the drug following 11 months of treatment. Tumor burden molecular analysis was performed on a tumor rebiopsy and plasma sample, and histological analysis was also performed on the tumor rebiopsy. A small cell transformation retaining the original EGFR mutation was detected in the tumor rebiopsy, while the T790M mutation together with the activating ex19del mutation were identified only in the plasma sample. The patient was treated with cytotoxic chemotherapy (off-label schedule with epirubicin 80 mg/mq and paclitaxel 160 mg/mq every 21 days for 6 cycles) and radiation (50.4 Gy administered in 28 fractions of 1.8 Gy once daily for 5.5 weeks) specific for small cell lung cancer, and may also have benefitted from treatment with a third generation T790M-specific EGFR-TKI. To better describe the mechanisms of resistance to TKI inhibitors and to optimize therapeutic regimens, the simultaneous analysis of tumor biopsies and circulating tumor DNA should be considered.
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Affiliation(s)
- Greta Alì
- Unit of Pathological Anatomy, University Hospital of Pisa, I-56126 Pisa, Italy
| | - Rossella Bruno
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, I-56126 Pisa, Italy
| | - Mirella Giordano
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, I-56126 Pisa, Italy
| | - Irene Prediletto
- Unit of Pneumology, University Hospital of Pisa, I-56124 Pisa, Italy
| | - Letizia Marconi
- Unit of Pneumology, University Hospital of Pisa, I-56124 Pisa, Italy
| | - Simonetta Zupo
- Unit of Molecular Diagnostics, Institute of Hospitalization and Scientific Care, National Institute for Cancer Research, I-16132 Genova, Italy
| | - Franco Fedeli
- Unit of Pathological Anatomy, Sant'Andrea Hospital, I-19124 La Spezia, Italy
| | - Alessandro Ribechini
- Endoscopic Section of Pneumology, University Hospital of Pisa, I-56124 Pisa, Italy
| | - Antonio Chella
- Unit of Pneumology, University Hospital of Pisa, I-56124 Pisa, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, I-56126 Pisa, Italy; Program of Pleuropulmonary Pathology, University Hospital of Pisa, I-56126 Pisa, Italy
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Crinò L, Bidoli P, Delmonte A, Grossi F, de Marinis F, Sperandi F, Piantedosi F, Vitali M, Soto Parra H, Scagnoli S, Minuti G, Calabrò L, Tiseo M, Turci D, Quadrini S, Antonelli P, Manzo A, Prediletto I, Giannarelli D, Galetta D. Italian cohort of nivolumab Expanded Access Programme (EAP): efficacy and safety data from a real-world population. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw332.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Crino L, Bidoli P, Delmonte A, Grossi F, De Marinis F, Sperandi F, Vitiello F, Vitali M, Soto Parra HJ, Scagnoli S, Minuti G, Calabrò L, Tiseo M, Turci D, Quadrini S, Antonelli P, Manzo A, Prediletto I, Giannarelli D, Galetta D. Italian cohort of nivolumab Expanded Access Programme (EAP): Preliminary data from a real-world population. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lucio Crino
- Clinical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Angelo Delmonte
- Medical Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Francesco Grossi
- AOU San Martino IST, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Filippo De Marinis
- Thoracic Oncology Division, European Institute of Oncology, Milan, Italy
| | | | | | - Milena Vitali
- Department of Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Hector J. Soto Parra
- Medical Oncology, University Hospital Policlinico, Vittorio Emanuele, Catania, Italy
| | | | - Gabriele Minuti
- Istituto Toscano Tumori, Department of Medical Oncology, Civil Hospital of Livorno, Livorno, Italy
| | - Luana Calabrò
- Medical Oncology and Immunotherapy, University Hospital of Siena, Siena, Italy
| | - Marcello Tiseo
- Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | | | | | | | | | - Irene Prediletto
- UO Pneumologia 1, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Domenico Galetta
- Medical Oncology Department, IRCCS Giovanni Paolo II, Bari, Italy
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27
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Martino F, Neri T, Prediletto I, Villari L, Zurlo M, Cini S, Chella A, Mariancini E, Palla A, Celi A, Tavanti L. Peripheral blood microparticle-associated tissue factor activity in stage III and IV lung cancer. Thromb Res 2012. [DOI: 10.1016/s0049-3848(12)70076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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