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Pierucci P, Portacci A, Carpagnano GE, Banfi P, Crimi C, Misseri G, Gregoretti C. The right interface for the right patient in noninvasive ventilation: a systematic review. Expert Rev Respir Med 2022; 16:931-944. [PMID: 36093799 DOI: 10.1080/17476348.2022.2121706] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Research in the field of noninvasive ventilation (NIV) has contributed to the development of new NIV interfaces. However, interface tolerance plays a crucial role in determining the beneficial effects of NIV therapy. AREAS COVERED This systematic review explores the most significant scientific research on NIV interfaces, with a focus on the potential impact that their design might have on treatment adherence and clinical outcomes. The rationale on the choice of the right interface among the wide variety of devices that are currently available is discussed here. EXPERT OPINION The paradigm "The right mask for the right patient" seems to be difficult to achieve in real life. Ranging from acute to chronic settings, the gold standard should include the tailoring of NIV interfaces to patients' needs and preferences. However, such customization may be hampered by issues of economic nature. High production costs and the increasing demand represent consistent burdens and have to be considered when dealing with patient-tailored NIV interfaces. New research focusing on developing advanced and tailored NIV masks should be prioritized; indeed, interfaces should be designed according to the specific patient and clinical setting where they need to be used.
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Affiliation(s)
- Paola Pierucci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Andrea Portacci
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Giovanna Elisiana Carpagnano
- A. Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Dept. of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro'
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milano,Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | | | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Italy and Fondazione Istituto "G.Giglio" Cefalù', Palermo, Italy
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De Vita N, Scotti L, Cammarota G, Racca F, Pissaia C, Maestrone C, Colombo D, Olivieri C, Della Corte F, Barone-Adesi F, Navalesi P, Vaschetto R. Predictors of intubation in COVID-19 patients treated with out-of-ICU continuous positive airway pressure. Pulmonology 2021; 28:173-180. [PMID: 33500220 PMCID: PMC7817479 DOI: 10.1016/j.pulmoe.2020.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND As delayed intubation may worsen the outcome of coronavirus disease 2019 (COVID-19) patients treated with continuous positive airway pressure (CPAP), we sought to determine COVID-specific early predictors of CPAP failure. METHODS In this observational retrospective multicentre study, we included all COVID-19 patients treated with out-of-ICU CPAP, candidates for intubation in case of CPAP failure. From these patients, we collected demographic and clinical data. RESULTS A total of 397 COVID-19 patients were treated with CPAP for respiratory failure, with the therapeutic goal of providing intubation in case of CPAP failure. Univariable analysis showed that, age, lactate dehydrogenase (LDH) and white cell counts were all significantly lower in patients with successful CPAP treatment compared to those failing it and undergoing subsequent intubation. The percentage changes between baseline and CPAP application in the ratio of partial pressure arterial oxygen (PaO2) and fraction of inspired oxygen (FiO2), PaO2, respiratory rate and ROX index were higher in patients experiencing successful CPAP compared to those failing it. FiO2 and male gender were also significantly associated with intubation. Multivariable analysis adjusting for age, gender, Charlson comorbidity index, percentage change in PaO2/FiO2 or PaO2 and FiO2 separately, lactate, white blood cell count, LDH and C-reactive protein levels led to an area under the curve of 0.818 and confirmed that age, LDH and percentage increase in PaO2/FiO2 are predictors of intubation. CONCLUSIONS In COVID-19 patients requiring CPAP, age, LDH and percentage change in PaO2/FiO2 after starting CPAP are predictors of intubation.
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Affiliation(s)
- N De Vita
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Via Solaroli, 17 - 28100 Novara, Italy
| | - L Scotti
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Via Solaroli, 17 - 28100 Novara, Italy
| | - G Cammarota
- Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini, 18 - 28100 Novara, Italy
| | - F Racca
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Department of Anesthesia and Intensive Care, Via Venezia, 16 - 15121 Alessandria, Italy
| | - C Pissaia
- Ospedale Degli Infermi, Dipartimento di Anestesia e Terapia Intensiva, Via dei Ponderanesi, 2 - 13875 Ponderano, Biella, Italy
| | - C Maestrone
- Presidio Ospedaliero Domodossola e Verbania, Anestesia Rianimazione ASL VCO, Direzione Dipartimento Chirurgico, Largo Caduti Lager Nazisti, 1 - 28845 Domodossola, Verbania, Italy
| | - D Colombo
- Ospedale Ss. Trinità, Department of Anesthesia and Critical Care, Viale Zoppis, 10 - 28021 Borgomanero, Italy
| | - C Olivieri
- Azienda Ospedaliera Sant'Andrea, Department of Anesthesia and Critical Care, Corso M. Abbiate, 21 - 13100 Vercelli, Italy
| | - F Della Corte
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Via Solaroli, 17 - 28100 Novara, Italy; Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini, 18 - 28100 Novara, Italy
| | - F Barone-Adesi
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Via Solaroli, 17 - 28100 Novara, Italy
| | - P Navalesi
- Istituto di Anestesia e Rianimazione, Azienda Ospedale-Università di Padova, Dipartimento di Medicina - DIMED - Università di Padova, Via Gallucci, 13 - 35121 Padova, Italy
| | - R Vaschetto
- Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Via Solaroli, 17 - 28100 Novara, Italy; Azienda Ospedaliero Universitaria "Maggiore Della Carità", Anestesia e Terapia Intensiva, Corso Mazzini, 18 - 28100 Novara, Italy.
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Bocquillon V, Destors M, Guzun R, Doutreleau S, Pépin JL, Tamisier R. [Cardiac dysfunction and the obstructive sleep apnoea syndrome]. Rev Mal Respir 2019; 37:161-170. [PMID: 31866122 DOI: 10.1016/j.rmr.2019.07.011] [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: 12/06/2018] [Accepted: 07/04/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cardiac insufficiency affects nearly 2% of the population with increased morbidity/mortality despite advances in therapeutic management. The sleep apnoea syndrome (SAS) is a risk factor for, and cause of aggravation of, myocardial dysfunction. BACKGROUND SAS is found in 70% of patients with chronic cardiac failure, 65% of patients with refractory hypertension, 60% of patients with cerebro-vascular accidents and 50% of patients with atrial fibrillation. The associated cardiovascular mortality is multiplied by a factor of 2 to 3. The pathophysiological mechanisms are intermittent nocturnal hypoxia, variations in CO2 levels, variations in intrathoracic pressure and repeated arrousals from sleep, concurrent with sympathetic hyperactivity, endothelial dysfunction and systemic inflammation. CONCLUSIONS SAS and cardiological management in patients presenting with myocardial dysfunction should be combined. It is necessary to pursue the scientific investigations with the aim of determining a precise care pathway and the respective places of each of the cardiological and pulmonary measures.
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Affiliation(s)
- V Bocquillon
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - M Destors
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - R Guzun
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - S Doutreleau
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - J L Pépin
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - R Tamisier
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France.
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