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In the recent decades, lung ultrasound (LUS) witnessed a growing attention in the clinical setting, particularly in the emergency medicine, intensive care and pulmonology. Ultrasound is a highly sensitive and specific instrument for diagnosis and monitoring of a wide spectrum of lung and pleural diseases, with low costs and without exposure to ionizing radiation. Moreover, it is a simple, versatile tool that can be easily used at the patient’s bed as a guide for interventional procedures; the recent COVD-19 pandemic has augmented its employment. This versatile but “operator-dependent” technique requires an adequate training and acquisition of skills that are currently indispensable for modern pneumologist. This review provides a basic theoretical overview to promote better understanding and more widespread use of lung ultrasound. [ABSTRACT FROM AUTHOR]

Mechanical ventilation (MV) and non-invasive respiratory support (NIRS) can be counted among the cornerstones of modern medicine. These techniques have modified the prognosis and treatment of respiratory failure. Although references to respiratory assistance are common in the Bible, mechanical ventilators first appeared in the early 1800s as negative-pressure devices. During the polio epidemic in Denmark in 1952, there was a transition to invasive positive pressure ventilation. The diffusion of non-invasive positive pressure ventilation began in the 1980s, following the experience derived from the treatment of obstructive sleep apnoea. After this pioneering era NIRS, including high-flow oxygen therapy, have spread widely in clinical practice, with heterogeneous logistic and structural characteristics worldwide. The early use of NIRS in different settings has become a necessity and a crucial strategy for the treatment of Acute Respiratory failure COVID-19-related, showing increasing efficacy data, probably also due to the reduction of the use of invasive MV and related complications. This article reviews the history of respiratory supports in the treatment of respiratory failure; in particular highlight how the integration of physiology, medicine and technology have contributed to the development and advancement of NIRS in clinical practice. [ABSTRACT FROM AUTHOR]

The imbalance between the prevalence of patients with acute respiratory failure (ARF) and acute-on-chronic respiratory failure (ACRF) and the number of Intensive Care Unit (ICU) beds requires new solutions. The increasing use of non-invasive respiratory tools to support patients at earlier stages of ARF and the increased expertise of non-ICU clinicians in other types of supportive care have led to the development of adult Pulmonary Intensive Care Units (PICU) and Pulmonary Intermediate Care Units (PIMCU). As in other European countries, Italian PICUs and PIMCUs provide an intermediate level of care as the setting designed for managing ARF patients without severe non-pulmonary dysfunction. The PICUs and PIMCUs may also act as step-down units for weaning patients from prolonged mechanical ventilation, and for discharging patients still requiring ventilatory support at home. These units may play an important role in the on-going coronavirus disease 2019 (COVID-19) pandemic. This position paper promoted by the Italian Thoracic Society (ITS-AIPO) describes the models, facilities, staff, equipment and operating methods of PICUs and PIMCUs. [ABSTRACT FROM AUTHOR]

Copyright of Rassegna di Patologia dell'Apparato Respiratorio is the property of AIPO - Associazione Italiana Pneumologi Ospedalieri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Acute respiratory failure (IRA) is the most frequent complication in patients with advanced malignant lung cancer as a consequence of the extension of the neoplastic disease and / or the toxic effects of its treatment – including infectious bronchopulmonary events – and/ or the decompensation of cardiopulmonary comorbidities. The non-invasive respiratory supports (SRNI) that can be delivered through non-invasive ventilation (non-invasive ventilation, NIV) and/or heated and humidified high flow oxygen (High Flow Oxygen Therapy, HFOT) have the aim of improving gas exchange and reducing work of breathing, being able to prevent endotracheal intubation (EIT) and invasive mechanical ventilation (VMI) and its possible complications, especially infections, to which cancer patients are particularly exposed. The aim of this work is to report the pathophysiological rationale and data in literature for the use of SRNI in IRA complicating lung tumors in three different clinical conditions: absence of limitations of treatments with possible escalation to EIT, ceiling of treatment in patients with invasive life support techniques limitation, treatment with only palliative purposes. [ABSTRACT FROM AUTHOR]

Copyright of Rassegna di Patologia dell'Apparato Respiratorio is the property of AIPO - Associazione Italiana Pneumologi Ospedalieri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This Position Paper on Respiratory Intensive Care Units (RICUs) is an update of those previously published in the “Rassegna di Patologia dell'Apparato Respiratorio" in 1994 and 2004, respectively. The present document confirms the three levels of care for critical respiratory patients (Respiratory Monitoring Unit, Respiratory Intermediate Care Unit, RICU) and patient admission criteria to RICUs and to general intensive care unit have been revised. In the real life the organizational patterns of RICUs and Respiratory Units in Italy are heterogeneous reflecting the type of local hospital organization. The Italian Association of Hospital Pneumologists promoted this Position Paper in order to update both the contents of the last edition and the current healthcare framework. Compared to the previous one, this update provides the inclusion of some new expertise in Respiratory Care and new chapters such as palliation and end of life, respiratory rehabilitation in the critically ill and the role of transition medicine in RICU. Furthermore, the document provides update details for quality management within the units and the economic analysis in terms of cost-benefits, cost-utility combined to patient outcomes. [ABSTRACT FROM AUTHOR]