194 results on '"Longhini, F."'
Search Results
2. Anesthetic Strategies in Oncological Surgery: Not Only a Simple Sleep, but Also Impact on Immunosuppression and Cancer Recurrence
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Longhini F, Bruni A, Garofalo E, De Sarro R, Memeo R, Navalesi P, Navarra G, Ranieri G, Currò G, and Ammendola M
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anesthesia ,anesthetic drugs ,anesthetic technique ,oncologic surgery ,immunosuppression ,cancer recurrence ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Federico Longhini,1 Andrea Bruni,1 Eugenio Garofalo,1 Rosalba De Sarro,2 Riccardo Memeo,3 Paolo Navalesi,4 Giuseppe Navarra,5 Girolamo Ranieri,6 Giuseppe Currò,7 Michele Ammendola7 1Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, “Magna Graecia” University, Catanzaro, Italy; 2Department of Clinical and Experimental Medicine, Section of Cardiology, G. Martino General Hospital, University of Messina, Messina, Italy; 3Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari 70124, Italy; 4Anesthesia and Intensive Care, University Hospital of Padua; Department of Medicine, University of Padua, Padua, Italy; 5Department of Human Pathology of Adult and Evolutive Age, Surgical Oncology Division, University Hospital of Messina, Messina 98100, Italy; 6Interventional Oncology Unit with Integrated Section of Translational Medical Oncology, National Cancer Research Centre, IstitutoTumori “Giovanni Paolo II”, Bari 70124, Italy; 7Department of Health Science, General Surgery Unit, University “Magna Graecia” Medical School, Catanzaro 88100, ItalyCorrespondence: Michele AmmendolaDepartment of Health Science, Digestive Surgery Unit, University of Catanzaro “Magna Graecia” Medical School, Viale Europa – Germaneto, Catanzaro 88100, ItalyTel +39 0961 3647218Email michele.ammendola@unicz.itAbstract: Tumor recurrences or metastases remain a major hurdle in improving overall cancer survival. In the perioperative period, the balance between the ability of the cancer to seed and grow at the metastatic site and the ability of the patient to fight against the tumor (i.e. the host antitumor immunity) may determine the development of clinically evident metastases and influence the patient outcome. Up to 80% of oncological patients receive anesthesia and/or analgesia for diagnostic, therapeutic or palliative interventions. Therefore, anesthesiologists are asked to administer drugs such as opiates and volatile or intravenous anesthetics, which may determine different effects on immunomodulation and cancer recurrence. For instance, some studies suggest that intravenous drugs, such as propofol, may inhibit the host immunity to a lower extent as compared to volatile anesthetics. Similarly, some studies suggest that analgesia assured by local anesthetics may provide a reduction of cancer recurrence rate; whilst on the opposite side, opioids may exert negative consequences in patients undergoing cancer surgery, by interacting with the immune system response via the modulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, or directly through the opioid receptors on the surface of immune cells. In this review, we summarize the main findings on the effects induced by different drugs on immunomodulation and cancer recurrence.Keywords: anesthesia, anesthetic drugs, anesthetic technique, oncologic surgery, immunosuppression, cancer recurrence
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- 2020
3. High flow through nasal cannula in exacerbated COPD patients: a systematic review
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Pisani, L., Astuto, M., Prediletto, I., and Longhini, F.
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- 2019
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4. Sigh in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: the PROTECTION pilot randomized clinical trial
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Mauri, T, Foti, G, Fornari, C, Grasselli, G, Pinciroli, R, Lovisari, F, Tubiolo, D, Volta, C, Spadaro, S, Rona, R, Rondelli, E, Navalesi, P, Garofalo, E, Knafelj, R, Gorjup, V, Colombo, R, Cortegiani, A, Zhou, J, D'Andrea, R, Calamai, I, Gonzalez, A, Roca, O, Grieco, D, Jovaisa, T, Bampalis, D, Becher, T, Battaglini, D, Ge, H, Luz, M, Constantin, J, Ranieri, M, Guerin, C, Mancebo, J, Pelosi, P, Fumagalli, R, Brochard, L, Pesenti, A, Papoff, A, Di Fenza, R, Gianni, S, Spinelli, E, Lissoni, A, Abbruzzese, C, Bronco, A, Villa, S, Russotto, V, Iachi, A, Ball, L, Patroniti, N, Spina, R, Giuntini, R, Peruzzi, S, Menga, L, Fossali, T, Castelli, A, Ottolina, D, Garcia-De-Acilu, M, Santafe, M, Schadler, D, Weiler, N, Carvajal, E, Calvo, C, Neou, E, Wang, Y, Zhou, Y, Longhini, F, Bruni, A, Leonardi, M, Gregoretti, C, Ippolito, M, Milazzo, Z, Querci, L, Ranieri, S, Insom, G, Berden, J, Noc, M, Mikuz, U, Arzenton, M, Lazzeri, M, Villa, A, Barreto, B, Rios, M, Gusmao-Flores, D, Phull, M, Barnes, T, Musarat, H, Conti, S, Mauri T., Foti G., Fornari C., Grasselli G., Pinciroli R., Lovisari F., Tubiolo D., Volta C. A., Spadaro S., Rona R., Rondelli E., Navalesi P., Garofalo E., Knafelj R., Gorjup V., Colombo R., Cortegiani A., Zhou J. -X., D'Andrea R., Calamai I., Gonzalez A. V., Roca O., Grieco D. L., Jovaisa T., Bampalis D., Becher T., Battaglini D., Ge H., Luz M., Constantin J. -M., Ranieri M., Guerin C., Mancebo J., Pelosi P., Fumagalli R., Brochard L., Pesenti A., Papoff A., Di Fenza R., Gianni S., Spinelli E., Lissoni A., Abbruzzese C., Bronco A., Villa S., Russotto V., Iachi A., Ball L., Patroniti N., Spina R., Giuntini R., Peruzzi S., Menga L. S., Fossali T., Castelli A., Ottolina D., Garcia-De-Acilu M., Santafe M., Schadler D., Weiler N., Carvajal E. R., Calvo C. P., Neou E., Wang Y. -M., Zhou Y. -M., Longhini F., Bruni A., Leonardi M., Gregoretti C., Ippolito M., Milazzo Z., Querci L., Ranieri S., Insom G., Berden J., Noc M., Mikuz U., Arzenton M., Lazzeri M., Villa A., Barreto B. B., Rios M. N. O., Gusmao-Flores D., Phull M., Barnes T., Musarat H., Conti S., Mauri, T, Foti, G, Fornari, C, Grasselli, G, Pinciroli, R, Lovisari, F, Tubiolo, D, Volta, C, Spadaro, S, Rona, R, Rondelli, E, Navalesi, P, Garofalo, E, Knafelj, R, Gorjup, V, Colombo, R, Cortegiani, A, Zhou, J, D'Andrea, R, Calamai, I, Gonzalez, A, Roca, O, Grieco, D, Jovaisa, T, Bampalis, D, Becher, T, Battaglini, D, Ge, H, Luz, M, Constantin, J, Ranieri, M, Guerin, C, Mancebo, J, Pelosi, P, Fumagalli, R, Brochard, L, Pesenti, A, Papoff, A, Di Fenza, R, Gianni, S, Spinelli, E, Lissoni, A, Abbruzzese, C, Bronco, A, Villa, S, Russotto, V, Iachi, A, Ball, L, Patroniti, N, Spina, R, Giuntini, R, Peruzzi, S, Menga, L, Fossali, T, Castelli, A, Ottolina, D, Garcia-De-Acilu, M, Santafe, M, Schadler, D, Weiler, N, Carvajal, E, Calvo, C, Neou, E, Wang, Y, Zhou, Y, Longhini, F, Bruni, A, Leonardi, M, Gregoretti, C, Ippolito, M, Milazzo, Z, Querci, L, Ranieri, S, Insom, G, Berden, J, Noc, M, Mikuz, U, Arzenton, M, Lazzeri, M, Villa, A, Barreto, B, Rios, M, Gusmao-Flores, D, Phull, M, Barnes, T, Musarat, H, Conti, S, Mauri T., Foti G., Fornari C., Grasselli G., Pinciroli R., Lovisari F., Tubiolo D., Volta C. A., Spadaro S., Rona R., Rondelli E., Navalesi P., Garofalo E., Knafelj R., Gorjup V., Colombo R., Cortegiani A., Zhou J. -X., D'Andrea R., Calamai I., Gonzalez A. V., Roca O., Grieco D. L., Jovaisa T., Bampalis D., Becher T., Battaglini D., Ge H., Luz M., Constantin J. -M., Ranieri M., Guerin C., Mancebo J., Pelosi P., Fumagalli R., Brochard L., Pesenti A., Papoff A., Di Fenza R., Gianni S., Spinelli E., Lissoni A., Abbruzzese C., Bronco A., Villa S., Russotto V., Iachi A., Ball L., Patroniti N., Spina R., Giuntini R., Peruzzi S., Menga L. S., Fossali T., Castelli A., Ottolina D., Garcia-De-Acilu M., Santafe M., Schadler D., Weiler N., Carvajal E. R., Calvo C. P., Neou E., Wang Y. -M., Zhou Y. -M., Longhini F., Bruni A., Leonardi M., Gregoretti C., Ippolito M., Milazzo Z., Querci L., Ranieri S., Insom G., Berden J., Noc M., Mikuz U., Arzenton M., Lazzeri M., Villa A., Barreto B. B., Rios M. N. O., Gusmao-Flores D., Phull M., Barnes T., Musarat H., and Conti S.
- Abstract
Background: Sigh is a cyclic brief recruitment maneuver: previous physiologic studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity, and increase release of surfactant. Research Question: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? Study Design and Methods: We conducted a multicenter noninferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or ARDS undergoing PSV. Patients were randomized to the no-sigh group and treated by PSV alone, or to the sigh group, treated by PSV plus sigh (increase in airway pressure to 30 cm H2O for 3 s once per minute) until day 28 or death or successful spontaneous breathing trial. The primary end point of the study was feasibility, assessed as noninferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiologic parameters in the first week from randomization, 28-day mortality, and ventilator-free days. Results: Two-hundred and fifty-eight patients (31% women; median age, 65 [54-75] years) were enrolled. In the sigh group, 23% of patients failed to remain on assisted ventilation vs 30% in the no-sigh group (absolute difference, –7%; 95% CI, –18% to 4%; P =. 015 for noninferiority). Adverse events occurred in 12% vs 13% in the sigh vs no-sigh group (P =. 852). Oxygenation was improved whereas tidal volume, respiratory rate, and corrected minute ventilation were lower over the first 7 days from randomization in the sigh vs no-sigh group. There was no significant difference in terms of mortality (16% vs 21%; P =. 337) and ventilator-free days (22 [7-26] vs 22 [3-25] days; P =. 300) for the sigh vs no-sigh group. Interpretation: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk.
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- 2021
5. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients
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Langer, T., Brioni, M., Guzzardella, A., Carlesso, E., Cabrini, L., Castelli, G., Dalla Corte, F., De Robertis, E., Favarato, M., Forastieri, A., Forlini, C., Girardis, M., Grieco, D. L., Mirabella, L., Noseda, V., Previtali, P., Protti, A., Rona, R., Tardini, F., Tonetti, T., Zannoni, F., Antonelli, M., Foti, G., Ranieri, M., Pesenti, A., Fumagalli, R., Grasselli, G., Berselli, A., Bove, T., Calligari, P., Coloretti, I., Coluccello, A., Costantini, E., Fanelli, V., Gagliardi, G., Longhini, F., Mariani, F., Mascarello, A., Menga, L., Ottaviani, I., Pasero, D., Pedeferri, M., Pezzi, A., Servillo, G., Severgnini, P., Spadaro, S., Zambelli, V., Langer, T., Brioni, M., Guzzardella, A., Carlesso, E., Cabrini, L., Castelli, G., Dalla Corte, F., De Robertis, E., Favarato, M., Forastieri, A., Forlini, C., Girardis, M., Grieco, D. L., Mirabella, L., Noseda, V., Previtali, P., Protti, A., Rona, R., Tardini, F., Tonetti, T., Zannoni, F., Antonelli, M., Foti, G., Ranieri, M., Pesenti, A., Fumagalli, R., Grasselli, G., Berselli, A., Bove, T., Calligari, P., Coloretti, I., Coluccello, A., Costantini, E., Fanelli, V., Gagliardi, G., Longhini, F., Mariani, F., Mascarello, A., Menga, L., Ottaviani, I., Pasero, D., Pedeferri, M., Pezzi, A., Servillo, G., Severgnini, P., Spadaro, S., Zambelli, V., Langer T., Brioni M., Guzzardella A., Carlesso E., Cabrini L., Castelli G., Dalla Corte F., De Robertis E., Favarato M., Forastieri A., Forlini C., Girardis M., Grieco D.L., Mirabella L., Noseda V., Previtali P., Protti A., Rona R., Tardini F., Tonetti T., Zannoni F., Antonelli M., Foti G., Ranieri M., Pesenti A., Fumagalli R., Grasselli G., Berselli A., Bove T., Calligari P., Coloretti I., Coluccello A., Costantini E., Fanelli V., Gagliardi G., Longhini F., Mariani F., Mascarello A., Menga L., Ottaviani I., Pasero D., Pedeferri M., Pezzi A., Servillo G., Severgnini P., Spadaro S., Zambelli V., Langer, T, Brioni, M, Guzzardella, A, Carlesso, E, Cabrini, L, Castelli, G, Dalla Corte, F, De Robertis, E, Favarato, M, Forastieri, A, Forlini, C, Girardis, M, Grieco, D, Mirabella, L, Noseda, V, Previtali, P, Protti, A, Rona, R, Tardini, F, Tonetti, T, Zannoni, F, Antonelli, M, Foti, G, Ranieri, M, Pesenti, A, Fumagalli, R, and Grasselli, G
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Male ,ARDS ,Supine position ,medicine.medical_treatment ,COVID-19 ,Mechanical ventilation ,Prone positioning ,Refractory hypoxemia ,Critical Care and Intensive Care Medicine ,Cohort Studies ,0302 clinical medicine ,Supine Position ,030212 general & internal medicine ,education.field_of_study ,Respiration ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Middle Aged ,Prone position ,Italy ,Anesthesia ,Practice Guidelines as Topic ,Artificial ,Female ,Critical Care ,Population ,Ventilation/perfusion ratio ,Patient Positioning ,NO ,03 medical and health sciences ,Intensive care ,Settore MED/41 - ANESTESIOLOGIA ,medicine ,Prone Position ,Humans ,education ,Aged ,Retrospective Studies ,Intubation ,Respiration, Artificial ,business.industry ,Research ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,medicine.disease ,Respiratory failure ,business - Abstract
Background Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. Methods Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position. Results Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p 2/FiO2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively). Conclusions During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching. Trial registration: clinicaltrials.gov number: NCT04388670
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- 2021
6. Time course of risk factors associated with mortality of 1260 critically ill patients with COVID-19 admitted to 24 Italian intensive care units
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Zanella, A., Florio, G., Antonelli, M., Bellani, G., Berselli, A., Bove, T., Cabrini, L., Carlesso, E., Castelli, G. P., Cecconi, M., Citerio, G., Coloretti, I., Corti, D., Dalla Corte, F., De Robertis, E., Foti, G., Fumagalli, R., Girardis, M., Giudici, R., Guiotto, L., Langer, T., Mirabella, L., Pasero, D., Protti, A., Ranieri, M. V., Rona, R., Scudeller, L., Severgnini, P., Spadaro, S., Stocchetti, N., Vigano, M., Pesenti, A., Grasselli, G., Aspesi, M., Baccanelli, F., Bassi, F., Bet, A., Biagioni, E., Biondo, A., Bonenti, C., Bottino, N., Brazzi, L., Buquicchio, I., Busani, S., Calini, A., Calligaro, P., Cantatore, L. P., Carelli, S., Carsetti, A., Cavallini, S., Cimicchi, G., Coppadoro, A., Dall'Ara, L., Di Gravio, V., Erba, M., Evasi, G., Facchini, A., Fanelli, V., Feliciotti, G., Fusarini, C. F., Ferraro, G., Garberi, R., Gay, H., Giacche, L., Grieco, D., Guzzardella, A., Longhini, F., Manzan, A., Maraggia, D., Milani, A., Mischi, A., Montalto, C., Mormina, S., Noseda, V., Paleari, C., Pedeferri, M., Pezzi, A., Pizzilli, G., Pozzi, M., Properzi, P., Rauseo, M., Russotto, V., Saccarelli, L., Servillo, G., Spano, S., Tagliabue, P., Tonetti, T., Tullo, L., Vetrugno, L., Vivona, L., Volta, C. A., Zambelli, V., Zanoni, A, Brazzi, L, Gagliardi, G., Zanella A., Florio G., Antonelli M., Bellani G., Berselli A., Bove T., Cabrini L., Carlesso E., Castelli G.P., Cecconi M., Citerio G., Coloretti I., Corti D., Dalla Corte F., De Robertis E., Foti G., Fumagalli R., Girardis M., Giudici R., Guiotto L., Langer T., Mirabella L., Pasero D., Protti A., Ranieri M.V., Rona R., Scudeller L., Severgnini P., Spadaro S., Stocchetti N., Vigano M., Pesenti A., Grasselli G., Aspesi M., Baccanelli F., Bassi F., Bet A., Biagioni E., Biondo A., Bonenti C., Bottino N., Brazzi L., Buquicchio I., Busani S., Calini A., Calligaro P., Cantatore L.P., Carelli S., Carsetti A., Cavallini S., Cimicchi G., Coppadoro A., Dall'Ara L., Di Gravio V., Erba M., Evasi G., Facchini A., Fanelli V., Feliciotti G., Fusarini C.F., Ferraro G., Gagliardi G., Garberi R., Gay H., Giacche L., Grieco D., Guzzardella A., Longhini F., Manzan A., Maraggia D., Milani A., Mischi A., Montalto C., Mormina S., Noseda V., Paleari C., Pedeferri M., Pezzi A., Pizzilli G., Pozzi M., Properzi P., Rauseo M., Russotto V., Saccarelli L., Servillo G., Spano S., Tagliabue P., Tonetti T., Tullo L., Vetrugno L., Vivona L., Volta C.A., Zambelli V., Zanoni A., Zanella, A, Florio, G, Antonelli, M, Bellani, G, Berselli, A, Bove, T, Cabrini, L, Carlesso, E, Castelli, G, Cecconi, M, Citerio, G, Coloretti, I, Corti, D, Dalla Corte, F, De Robertis, E, Foti, G, Fumagalli, R, Girardis, M, Giudici, R, Guiotto, L, Langer, T, Mirabella, L, Pasero, D, Protti, A, Ranieri, M, Rona, R, Scudeller, L, Severgnini, P, Spadaro, S, Stocchetti, N, Viganò, M, Pesenti, A, and Grasselli, G
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Male ,Original ,Critical Illness ,Socio-culturale ,Retrospective Studie ,Risk Factors ,Humans ,Intensive care unit ,Prospective Studies ,Mortality ,Aged ,Retrospective Studies ,COVID-19 ,Longitudinal models ,Predictors ,Time course ,SARS-CoV-2 ,Risk Factor ,Respiration ,Intensive Care Units ,Italy ,Middle Aged ,Respiration, Artificial ,Prospective Studie ,Longitudinal model ,Artificial ,Predictor ,Human - Abstract
Purpose To evaluate the daily values and trends over time of relevant clinical, ventilatory and laboratory parameters during the intensive care unit (ICU) stay and their association with outcome in critically ill patients with coronavirus disease 19 (COVID-19). Methods In this retrospective–prospective multicentric study, we enrolled COVID-19 patients admitted to Italian ICUs from February 22 to May 31, 2020. Clinical data were daily recorded. The time course of 18 clinical parameters was evaluated by a polynomial maximum likelihood multilevel linear regression model, while a full joint modeling was fit to study the association with ICU outcome. Results 1260 consecutive critically ill patients with COVID-19 admitted in 24 ICUs were enrolled. 78% were male with a median age of 63 [55–69] years. At ICU admission, the median ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) was 122 [89–175] mmHg. 79% of patients underwent invasive mechanical ventilation. The overall mortality was 34%. Both the daily values and trends of respiratory system compliance, PaO2/FiO2, driving pressure, arterial carbon dioxide partial pressure, creatinine, C-reactive protein, ferritin, neutrophil, neutrophil–lymphocyte ratio, and platelets were associated with survival, while for lactate, pH, bilirubin, lymphocyte, and urea only the daily values were associated with survival. The trends of PaO2/FiO2, respiratory system compliance, driving pressure, creatinine, ferritin, and C-reactive protein showed a higher association with survival compared to the daily values. Conclusion Daily values or trends over time of parameters associated with acute organ dysfunction, acid–base derangement, coagulation impairment, or systemic inflammation were associated with patient survival. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06495-y.
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- 2021
7. Insufficienza respiratoria acuta e cronica
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Bonsignore MR, Clini EM, Confalonieri Marco, Corsi S, Crimi C, Crisafulli E, Longhini F, Marchioni A, Nava S, Navalesi P, Pisani L, Spanevello A, Tonelli R, Carlo Rugarli, Bonsignore, Mr, Clini, Em, Confalonieri, Marco, Corsi, S, Crimi, C, Crisafulli, E, Longhini, F, Marchioni, A, Nava, S, Navalesi, P, Pisani, L, Spanevello, A, and Tonelli, R
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ventilazione meccanica ,BPCO ,ossigenoterapia ,Insufficienza respiratoria ,ARDS ,ventilazione non invasiva - Abstract
Insufficienza respiratoria acuta e cronica
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- 2021
8. Sigh in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: the PROTECTION pilot randomized clinical trial
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Mauri T., Foti G., Fornari C., Grasselli G., Pinciroli R., Lovisari F., Tubiolo D., Volta C. A., Spadaro S., Rona R., Rondelli E., Navalesi P., Garofalo E., Knafelj R., Gorjup V., Colombo R., Cortegiani A., Zhou J. -X., D'Andrea R., Calamai I., Gonzalez A. V., Roca O., Grieco D. L., Jovaisa T., Bampalis D., Becher T., Battaglini D., Ge H., Luz M., Constantin J. -M., Ranieri M., Guerin C., Mancebo J., Pelosi P., Fumagalli R., Brochard L., Pesenti A., Papoff A., Di Fenza R., Gianni S., Spinelli E., Lissoni A., Abbruzzese C., Bronco A., Villa S., Russotto V., Iachi A., Ball L., Patroniti N., Spina R., Giuntini R., Peruzzi S., Menga L. S., Fossali T., Castelli A., Ottolina D., Garcia-De-Acilu M., Santafe M., Schadler D., Weiler N., Carvajal E. R., Calvo C. P., Neou E., Wang Y. -M., Zhou Y. -M., Longhini F., Bruni A., Leonardi M., Gregoretti C., Ippolito M., Milazzo Z., Querci L., Ranieri S., Insom G., Berden J., Noc M., Mikuz U., Arzenton M., Lazzeri M., Villa A., Barreto B. B., Rios M. N. O., Gusmao-Flores D., Phull M., Barnes T., Musarat H., Conti S., Mauri, Tommaso, Foti, Giuseppe, Fornari, Carla, Grasselli, Giacomo, Pinciroli, Riccardo, Lovisari, Federica, Tubiolo, Daniela, Volta, Carlo Alberto, Spadaro, Savino, Rona, Roberto, Rondelli, Egle, Navalesi, Paolo, Garofalo, Eugenio, Knafelj, Rihard, Gorjup, Vojka, Colombo, Riccardo, Cortegiani, Andrea, Zhou, Jian-Xin, D'Andrea, Rocco, Calamai, Italo, González, Ánxela Vidal, Roca, Oriol, Grieco, Domenico Luca, Jovaisa, Toma, Bampalis, Dimitrio, Becher, Tobia, Battaglini, Denise, Ge, Huiqing, Luz, Mariana, Constantin, Jean-Michel, Ranieri, Marco, Guerin, Claude, Mancebo, Jordi, Pelosi, Paolo, Fumagalli, Roberto, Brochard, Laurent, Pesenti, Antonio, PROTECTION collaborators: Alessandra Papoff, Raffaele Di Fenza, Stefano Gianni, Elena Spinelli, Alfredo Lissoni, Chiara Abbruzzese, Alfio Bronco, Silvia Villa, Vincenzo Russotto, Arianna Iachi, Lorenzo Ball, Nicolò Patroniti, Rosario Spina, Romano Giuntini, Simone Peruzzi, Luca Salvatore Menga, Tommaso Fossali, Antonio Castelli, Davide Ottolina, Marina García-de-Acilu, Manel Santafè, Dirk Schädler, Norbert Weiler, Emilia Rosas Carvajal, César Pérez Calvo, Evangelia Neou, Yu-Mei Wang, Yi-Min Zhou, Federico Longhini, Andrea Bruni, Mariacristina Leonardi, Cesare Gregoretti, Mariachiara Ippolito, Zelia Milazzo, Lorenzo Querci, Serena Ranieri, Giulia Insom, Jernej Berden, Marko Noc, Ursa Mikuz, Matteo Arzenton, Marta Lazzeri, Arianna Villa, Bruna Brandão Barreto, Marcos Nogueira Oliveira Rios, Dimitri Gusmao-Flores, Mandeep Phull, Tom Barnes, Hussain Musarat, Sara Conti, Mauri, T, Foti, G, Fornari, C, Grasselli, G, Pinciroli, R, Lovisari, F, Tubiolo, D, Volta, C, Spadaro, S, Rona, R, Rondelli, E, Navalesi, P, Garofalo, E, Knafelj, R, Gorjup, V, Colombo, R, Cortegiani, A, Zhou, J, D'Andrea, R, Calamai, I, Gonzalez, A, Roca, O, Grieco, D, Jovaisa, T, Bampalis, D, Becher, T, Battaglini, D, Ge, H, Luz, M, Constantin, J, Ranieri, M, Guerin, C, Mancebo, J, Pelosi, P, Fumagalli, R, Brochard, L, Pesenti, A, Papoff, A, Di Fenza, R, Gianni, S, Spinelli, E, Lissoni, A, Abbruzzese, C, Bronco, A, Villa, S, Russotto, V, Iachi, A, Ball, L, Patroniti, N, Spina, R, Giuntini, R, Peruzzi, S, Menga, L, Fossali, T, Castelli, A, Ottolina, D, Garcia-De-Acilu, M, Santafe, M, Schadler, D, Weiler, N, Carvajal, E, Calvo, C, Neou, E, Wang, Y, Zhou, Y, Longhini, F, Bruni, A, Leonardi, M, Gregoretti, C, Ippolito, M, Milazzo, Z, Querci, L, Ranieri, S, Insom, G, Berden, J, Noc, M, Mikuz, U, Arzenton, M, Lazzeri, M, Villa, A, Barreto, B, Rios, M, Gusmao-Flores, D, Phull, M, Barnes, T, Musarat, H, and Conti, S
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pressure support ,ventilation ,sigh ,ARDS ,mechanical ventilation ,feasibility - Abstract
Background: Sigh is a cyclic brief recruitment manoeuvre: previous physiological studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity and increase release of surfactant. Research question: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? Study design and methods: We conducted a multi-center non-inferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or acute respiratory distress syndrome undergoing PSV. Patients were randomized to the No Sigh group and treated by PSV alone, or to the Sigh group, treated by PSV plus sigh (increase of airway pressure to 30 cmH2Ofor 3 seconds once per minute) until day 28 or death or successful spontaneous breathing trial. The primary endpoint of the study was feasibility, assessed as non-inferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiological parameters in the first week from randomization, 28-day mortality and ventilator-free days. Results: Two-hundred fifty-eight patients (31% women; median age 65 [54-75] years) were enrolled. In the Sigh group, 23% of patients failed to remain on assisted ventilation vs. 30% in the No Sigh group (absolute difference -7%, 95%CI -18% to 4%; p=0.015 for non-inferiority). Adverse events occurred in 12% vs. 13% in Sigh vs. No Sigh (p=0.852). Oxygenation was improved while tidal volume, respiratory rate and corrected minute ventilation were lower over the first 7 days from randomization in Sigh vs. No Sigh. There was no significant difference in terms of mortality (16% vs. 21%, p=0.342) and ventilator-free days (22 [7-26] vs. 22 [3-25] days, p=0.300) for Sigh vs. No Sigh. Interpretation: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk.
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- 2020
9. Severe myocarditis due to influenza A(H1N1)pdm09 viral infection in a young woman successfully treated with intravenous zanamivir: A case report
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Mazzitelli, M., Garofalo, E., Bruni, A., Barreca, G. S., Quirino, A., Giancotti, A., Serapide, F., Indolfi, C., Matera, G., Navalesi, P., Trecarichi, E. M., Torti, C., Longhini, F., Peronace, C., Pisani, V., Costa, C., Greco, G., La Gamba, V., Scaglione, V., Biamonte, E., Brescia, V., De Leonardis, B., Karim, A., Cimino, G., La Torre, P., Gemelli, A., Tropea, F. A., Picicco, F., and Gallo, L.
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Drug ,intravenous zanamivir ,medicine.medical_specialty ,Oseltamivir ,Myocarditis ,viruses ,media_common.quotation_subject ,lcsh:Medicine ,Case Report ,Case Reports ,030204 cardiovascular system & hematology ,Viral infection ,Gastroenterology ,influenza A(H1N1)pdm09 virus ,Intestinal malabsorption ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Zanamivir ,Internal medicine ,myocarditis ,medicine ,In patient ,media_common ,lcsh:R5-920 ,business.industry ,lcsh:R ,food and beverages ,virus diseases ,Influenza a ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,respiratory tract diseases ,chemistry ,030220 oncology & carcinogenesis ,lcsh:Medicine (General) ,business ,medicine.drug - Abstract
In patients with influenza‐related myocarditis, prompt diagnosis and treatment are important. Intravenous zanamivir can be an alternative to oral oseltamivir, especially in severe cases and when drug intestinal malabsorption is suspected or proven.
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- 2019
10. Bench comparative evaluation of a new generation and standard helmet for delivering non-invasive ventilation
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Olivieri, C., Costa, R., Spinazzola, G., Ferrone, G., Longhini, F., Cammarota, G., and Conti, G.
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Continuous positive airway pressure -- Comparative analysis ,Health care industry - Abstract
Objective To evaluate the performance of a new helmet (NH) recently introduced into clinical use relative to that of the standard helmet (SH) in terms of delivering non-invasive continuous positive airway pressure (nCPAP) and pressure support ventilation (nPSV). Design This was a bench study using a mannequin connected to an active lung simulator. The SH was fastened to the mannequin by armpit braces, which are not needed to secure the NH. Measurements The inspiratory and expiratory variations in nCPAP delivered with two different simulated efforts (Pmus), were determined relative to the preset CPAP level. nPSV was applied at two simulated respiratory rates (RR) and two cycling-off flow thresholds. We measured inspiratory trigger delay (Delay.sub.trinsp), expiratory trigger delay (Delay.sub.trexp), time of synchrony (Time.sub.sync), trigger pressure drop ([DELTA]P.sub.trigger), airway pressure-time product during the triggering phase (PTPt), the initial 200 ms from the onset of the ventilator pressurization (PTP.sub.200), and the initial 300 and 500 ms from the onset of the simulated effort; this two latter parameters were expressed as the percentage of the area of ideal pressurization (PTP.sub.300-index and PTP.sub.500-index, respectively). Results In nCPAP, at both Pmus, the differences between the two interfaces at both Pmus were small and clinically irrelevant. In nPSV, regardless of the setting, NH resulted in significantly smaller trigger delays, [DELTA]P.sub.trigger, and PTPt. Time.sub.sync, PTP.sub.200, PTP.sub.300-index, and PTP.sub.500-index were also significantly higher with the NH compared to the SH, irrespective of the setting. Conclusions Compared to the SH, the NH is equally effective in delivering nCPAP and more effective in delivering nPSV, and it is used to avoid the need for armpit braces., Author(s): C. Olivieri [sup.1], R. Costa [sup.2], G. Spinazzola [sup.2], G. Ferrone [sup.2], F. Longhini [sup.3], G. Cammarota [sup.1], G. Conti [sup.2], P. Navalesi [sup.3] [sup.4] [sup.5] Author Affiliations: (1) [...]
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- 2013
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11. Insufficienza respiratoria acuta e cronica (cap.21)
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Bonsignore, Mr, Clini, E, Confalonieri, M, Costi, S, Crimi, C, Crisafulli, E, Longhini, F, Marchioni, A, Nava, S, Navalesi, P, Pisani, L, Spanevello, A, and Tonelli, R.
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riabilitazione respiratoria ,insufficienza respiratoria ,sindrome delle apnee del sonno ,ARDS ,ossigenoterapia domiciliare ,insufficienza respiratoria, sindrome delle apnee del sonno, riabilitazione respiratoria, ARDS, ossigenoterapia domiciliare - Published
- 2021
12. Rugarli. Medicina interna sistematica
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Bonsignore, Mr, Clini, E, Confalonieri, M, Costi, S, Crimi, C, Crisafulli, E, Longhini, F, Marchioni, A, Nava, S, Navalesi, P, Pisani, L, Spanevello, A, and Tonelli, R.
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- 2021
13. Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)
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Vetrugno, L., Boero, E., Bignami, E., Cortegiani, A., Raineri, S. M., Spadaro, S., Moro, F., D'Inca, S., D'Orlando, L., Agro, F. E., Bernardinetti, M., Forfori, F., Corradi, F., Pregnolato, S., Mosconi, M., Bellini, V., Franchi, F., Mongelli, P., Leonardi, S., Giuffrida, C., Tescione, M., Bruni, A., Garofalo, E., Longhini, F., Cammarota, G., De Robertis, E., Giglio, G., Urso, F., Bove, T., Mattuzzi, L., Federici, N., Delrio, S., Meroi, F., Flaibani, L., Zaghis, C., Orso, D., Tomasino, S., Dottore, B., Divella, M., Mussetta, S., Musso, G., Minunno, A., Barbero, C., Puppo, M., Saturno, F., Galvano, A. N., Ippolito, M., Massari, L., Bianconi, M., Caruso, G., Ragazzi, R., Volta, C. A., Mongodi, S., Mojoli, F., Riccone, F., Scolletta, S., Macheda, S., Vulcano, S., Cosco, G., Vadala, E., Taddei, E., Isirdi, A., Vetrugno, Luigi, Boero, Enrico, Bignami, Elena, Cortegiani, Andrea, Raineri, Santi Maurizio, Spadaro, Savino, Moro, Federico, D'Incà, Stefano, D'Orlando, Lori, Agrò, Felice Eugenio, Bernardinetti, Mattia, Forfori, Francesco, Corradi, Francesco, Pregnolato, Sandro, Mosconi, Mario, Bellini, Valentina, Franchi, Federico, Mongelli, Pierpaolo, Leonardi, Salvatore, Giuffrida, Clemente, Tescione, Marco, Bruni, Andrea, Garofalo, Eugenio, Longhini, Federico, Cammarota, Gianmaria, De Robertis, Edoardo, Giglio, Giuseppe, Urso, Felice, Bove, Tiziana, and Lisa Mattuzzi, Nicola Federici, Silvia Delrio, Francesco Meroi, Luca Flaibani, Clara Zaghis, Daniele Orso, Serena Tomasino, Bruno Dottore, Michele Divella, Sabrina Mussetta, Gaia Musso, Angela Minunno, Carlo Barbero, Mattia Puppo, Francesco Saturno, Alberto Nicolò Galvano, Mariachiara Ippolito, Leo Massari, Margherita Bianconi, Gaetano Caruso, Riccardo Ragazzi, Carlo Alberto Volta, Silvia Mongodi, Francesco Mojoli, Filippo Riccone, Sabino Scolletta, Sebastiano Macheda, Serafino Vulcano, Giovanni Cosco, Eugenio Vadalà, Erika Taddei, Alessandro Isirdi
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medicine.medical_specialty ,R895-920 ,Physical examination ,030204 cardiovascular system & hematology ,law.invention ,NO ,Medical physics. Medical radiology. Nuclear medicine ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Prospective cohort study ,lung ultrasound ,Hip surgery ,Hip fracture ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,medicine.disease ,Surgery ,Orthopedic surgery ,Observational study ,Original Article ,business - Abstract
Background Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of “indirect” and “direct” cardiac and pulmonary lung ultrasound signs. Methods LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns—each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. Conclusions Lung ultrasound (LU), as a tool within the anesthesiologist’s armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.
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- 2021
14. Neuron-specific enolase serum levels in COVID-19 are related to the severity of lung injury
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Cione E., Siniscalchi A., Gangemi P., Cosco L., Colosimo M., Longhini F., Luciani F., De Sarro G., G, SP Working Group, Giuseppe Spaziano, Berrino L., D'Agostino B., Gallelli L., Cione, E., Siniscalchi, A., Gangemi, P., Cosco, L., Colosimo, M., Longhini, F., Luciani, F., De Sarro, G., G&, SP Working Group, Spaziano, Giuseppe, Berrino, L., D'Agostino, B., and Gallelli, L.
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RNA viruses ,Male ,Viral Diseases ,Pulmonology ,Coronaviruses ,Biochemistry ,Severity of Illness Index ,Gastroenterology ,Lung and Intrathoracic Tumors ,Procalcitonin ,Small Cell Lung Cancer ,Medical Conditions ,Epidemiology ,Immunologic Test ,Pathology and laboratory medicine ,Multidisciplinary ,Lung Injury ,Medical microbiology ,Middle Aged ,C-Reactive Proteins ,Infectious Diseases ,medicine.anatomical_structure ,Oncology ,Italy ,Viruses ,Medicine ,Tuberculosis Diagnosis and Management ,Female ,SARS CoV 2 ,Pathogens ,Research Article ,Human ,Adult ,medicine.medical_specialty ,SARS coronavirus ,Coronavirus disease 2019 (COVID-19) ,Science ,Enolase ,Immunologic Tests ,Lung injury ,Microbiology ,Respiratory Disorders ,Diagnostic Medicine ,Internal medicine ,Severity of illness ,medicine ,Humans ,Medicine and health sciences ,Chemiluminescence assay ,Lung ,Biology and life sciences ,SARS-CoV-2 ,business.industry ,Organisms ,Viral pathogens ,Proteins ,Cancers and Neoplasms ,COVID-19 ,Covid 19 ,Biomarker ,Microbial pathogens ,Dyspnea ,Phosphopyruvate Hydratase ,Respiratory Infections ,business ,Biomarkers - Abstract
The multifunctional role of neuron-specific enolase (NSE) in lung diseases is well established. As the lungs are greatly affected in COVID-19, we evaluated serum NSE levels in COVID-19 patients with and without dyspnea. In this study, we evaluated both SARS-CoV-2-infected and uninfected patients aged >18 years who were referred to hospitals in Catanzaro, Italy from March 30 to July 30, 2020. Epidemiological, clinical, and radiological characteristics, treatment, and outcome data were recorded and reviewed by a trained team of physicians. In total, 323 patients (178 men, 55.1% and 145 women, 44.9%) were enrolled; of these, 128 were COVID-19 patients (39.6%) and 195 were control patients (60.4%). Westergren’s method was used to determine erythroid sedimentation rate. A chemiluminescence assay was used for measurement of interleukin-6, procalcitonin, C-reactive protein, and NSE. We detected significantly higher NSE values (P
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- 2021
15. Helmet continuous positive airway pressure and prone positioning: A proposal for an early management of COVID-19 patients
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Longhini, F., Bruni, A., Garofalo, E., Navalesi, P., Grasselli, G., Cosentini, R., Foti, G., Mattei, A., Ippolito, M., Accurso, G., Vitale, F., Cortegiani, A., and Gregoretti, C.
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- 2020
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16. Sigh in Patients With Acute Hypoxemic Respiratory Failure and ARDS: The PROTECTION Pilot Randomized Clinical Trial
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Mauri, T., Foti, G., Fornari, C., Grasselli, G., Pinciroli, R., Lovisari, F., Tubiolo, D., Volta, C. A., Spadaro, S., Rona, R., Rondelli, E., Navalesi, P., Garofalo, E., Knafelj, R., Gorjup, V., Colombo, R., Cortegiani, A., Zhou, J. -X., D'Andrea, R., Calamai, I., Gonzalez, A. V., Roca, O., Grieco, D. L., Jovaisa, T., Bampalis, D., Becher, T., Battaglini, D., Ge, H., Luz, M., Constantin, J. -M., Ranieri, M., Guerin, C., Mancebo, J., Pelosi, P., Fumagalli, R., Brochard, L., Pesenti, A., Papoff, A., Di Fenza, R., Gianni, S., Spinelli, E., Lissoni, A., Abbruzzese, C., Bronco, A., Villa, S., Russotto, V., Iachi, A., Ball, L., Patroniti, N., Spina, R., Giuntini, R., Peruzzi, S., Menga, L. S., Fossali, T., Castelli, A., Ottolina, D., Garcia-De-Acilu, M., Santafe, M., Schadler, D., Weiler, N., Carvajal, E. R., Calvo, C. P., Neou, E., Wang, Y. -M., Zhou, Y. -M., Longhini, F., Bruni, A., Leonardi, M., Gregoretti, C., Ippolito, M., Milazzo, Z., Querci, L., Ranieri, S., Insom, G., Berden, J., Noc, M., Mikuz, U., Arzenton, M., Lazzeri, M., Villa, A., Barreto, B. B., Rios, M. N. O., Gusmao-Flores, D., Phull, M., Barnes, T., Musarat, H., and Conti, S.
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Male ,RCT, Randomized Control Trial ,VFDs, Ventilator- free days ,sigh ,PaO2/FiO2 ratio, Arterial Partial Pressure of O2/ Fraction of Inspired Oxygen ,SpO2/FiO2 ratio, Peripheral Oxygen Saturation/ Fraction of Inspired Oxygen ,Pilot Projects ,ESICM, European Society of Intensive Care Medicine ,NO ,Positive-Pressure Respiration ,ICU, Intensive Care Unit ,Vt, Tidal Volume ,SBT, Spontaneous Breathing Trial ,Intubation, Intratracheal ,Humans ,PEEP, Positive End Expiratory Pressure ,RR, Respiratory Rate ,FiO2, Fraction of Inspired Oxygen ,ARDS ,feasibility ,pressure support ,ventilation ,Aged ,Female ,Middle Aged ,Respiratory Distress Syndrome ,Respiratory Insufficiency ,Respiratory Mechanics ,Original Research ,GEE, Generalize Estimate Equation ,RASS, Richmond Agitation- Sedation Scale ,ARDS, Acute Respiratory Distress Syndrome ,P-SILI, Patient - Self Inflicted Lung Injury ,AHRF, Acute Hypoxemic Respiratory Failure ,PBW, Predicted Body Weight ,PSV, Pressure Support Ventilation ,SOFA, Sequence Organ Failure Assessment ,Intratracheal ,SAPS II, Simplified Acute Physiology Score II ,SpO2, Peripheral Oxygen Saturation ,PaCO2, Arterial Partial Pressure of CO2 ,TRALI, Transfusion-Related Acute Lung Injury ,BMI, Body Mass Index ,Intubation ,MV, Mechanical Ventilation - Abstract
BACKGROUND: Sigh is a cyclic brief recruitment maneuver: previous physiologic studies showed that its use could be an interesting addition to pressure support ventilation to improve lung elastance, decrease regional heterogeneity, and increase release of surfactant. RESEARCH QUESTION: Is the clinical application of sigh during pressure support ventilation (PSV) feasible? STUDY DESIGN AND METHODS: We conducted a multicenter noninferiority randomized clinical trial on adult intubated patients with acute hypoxemic respiratory failure or ARDS undergoing PSV. Patients were randomized to the no-sigh group and treated by PSV alone, or to the sigh group, treated by PSV plus sigh (increase in airway pressure to 30 cm H2O for 3 s once per minute) until day 28 or death or successful spontaneous breathing trial. The primary end point of the study was feasibility, assessed as noninferiority (5% tolerance) in the proportion of patients failing assisted ventilation. Secondary outcomes included safety, physiologic parameters in the first week from randomization, 28-day mortality, and ventilator-free days. RESULTS: Two-hundred and fifty-eight patients (31% women; median age, 65 [54-75] years) were enrolled. In the sigh group, 23% of patients failed to remain on assisted ventilation vs 30% in the no-sigh group (absolute difference, -7%; 95% CI, -18% to 4%; P = .015 for noninferiority). Adverse events occurred in 12% vs 13% in the sigh vs no-sigh group (P = .852). Oxygenation was improved whereas tidal volume, respiratory rate, and corrected minute ventilation were lower over the first 7 days from randomization in the sigh vs no-sigh group. There was no significant difference in terms of mortality (16% vs 21%; P = .337) and ventilator-free days (22 [7-26] vs 22 [3-25] days; P = .300) for the sigh vs no-sigh group. INTERPRETATION: Among hypoxemic intubated ICU patients, application of sigh was feasible and without increased risk.
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- 2020
17. The Mini-Sigh Test: A New Haemodynamic Test of Fluid Responsiveness in Icu Patients Undergoing Pressure Support Ventilation
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Messina, A, Colombo, D, Romagnoli, S, Bonicolini, E, De Mattei, G, Longhini, F, De Gaudio, AR, Della Corte, F, and Navalesi, P
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- 2015
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18. Different effects of propofol and dexmedetomidine on preload dependency in endotoxemic shock with norepinephrine infusion: a randomized case-control study
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Yu, T, Pan, C, Liu, S, Guo, F, Longhini, F, Yang, Y, and Qiu, H
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- 2014
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19. Diaphragm microcirculatory dysfunction and lipid accumulation in endotoxemic rabbits during mechanical ventilation
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Yang, Y, Yu, T, Liu, J, Pan, C, Longhini, F, Liu, L, Huang, Y, Guo, F, and Qiu, H
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- 2014
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20. A new setting to improve noninvasive neurally adjusted ventilatory assist by helmet
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Longhini, F, Cammarota, G, Olivieri, C, Perucca, R, Vaschetto, R, Colombo, D, Messina, A, Della Corte, F, and Navalesi, P
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- 2014
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21. New setting of neurally adjusted ventilatory assist during mask noninvasive ventilation
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Longhini, F, Pan, C, Cammarota, G, Vaschetto, R, Xie, J, Liu, L, Yian, Y, Della Corte, F, Navalesi, P, and Qiu, H
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- 2014
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22. Clinical outcomes of patients treated with intravenous zanamivir for severe influenza A(H1N1)pdm09 infection: A case report series
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Torti, C., Mazzitelli, M., Longhini, F., Garofalo, E., Bruni, A., Giancotti, A., Barreca, G. S., Quirino, A., Liberto, M. C., Serapide, F., Matera, G., Trecarichi, E. M., Navalesi, P., Pisani, V., Costa, C., Greco, G., Scaglione, V., Lionello, R., La Gamba, V., Biamonte, E., La Valle, O., Cimino, G., La Torre, P., Karim, A., and Gemelli, A.
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0301 basic medicine ,medicine.medical_specialty ,medicine.medical_treatment ,030106 microbiology ,Case Report ,Severe influenza ,Antiviral Agents ,law.invention ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Influenza A Virus, H1N1 Subtype ,0302 clinical medicine ,Zanamivir ,Medical microbiology ,Randomized controlled trial ,law ,Internal medicine ,Influenza, Human ,ECMO ,ICU ,Influenza A(H1N1)pdm09 ,Humans ,medicine ,Extracorporeal membrane oxygenation ,Influenza A Virus ,lcsh:RC109-216 ,H1N1 Subtype ,030212 general & internal medicine ,Mechanical ventilation ,business.industry ,virus diseases ,Intensive care unit ,Influenza ,respiratory tract diseases ,Infectious Diseases ,Concomitant ,business ,medicine.drug ,Human - Abstract
Background Intravenous (IV) zanamivir could be a suitable alternative for the treatment of severe influenza A(H1N1)pdm09 infection in patients who are unable to take oral or inhaled medication, for example, those on mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, data on the clinical outcomes of such patients is limited. Case presentation We report the clinical outcomes of four patients who were admitted at the intensive care unit during the 2017–2018 influenza season with severe sepsis (SOFA score > 11) and acute respiratory distress syndrome requiring ECMO and mechanical ventilation. Two patients were immune-compromised. The A(H1N1)pdm09 genome was confirmed by polymerase chain reaction (PCR) on nasopharyngeal specimen swabs prior to administration of IV zanamivir at a dose of 600 mg twice daily. Weekly qualitative PCR analysis was done to monitor viral clearance, with zanamivir treatment being discontinued upon receipt of negative results. In addition, the patients were managed for concomitant multidrug-resistant bacterial infections, with infection resolution confirmed with blood cultures. The median time for zanamivir treatment was 10 days (IQR 10–17). The clinical outcome was favourable with all four patients surviving and improving clinically. All four patients achieved viral clearance of A(H1N1)pdm09 genome, and resolution of multidrug-resistant bacterial infections. Conclusions IV zanamivir could be a good therapeutic option in patients with severe influenza A(H1N1)pdm09 infection who are unable to take oral or aerosolised antiviral medication. We recommend prospective randomized control trials to support this hypothesis.
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- 2019
23. Comparisons of two diaphragm ultrasound-teaching programs: a multicenter randomized controlled educational study
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Garofalo, Serafina, Bruni, A, Pelaia, C, Landoni, G, Zangrillo, A, Antonelli, Massimo, Conti, Giorgio, Biasucci, Dg, Mercurio, Giovanna, Cortegiani, A, Giarratano, A, Vetrugno, L, Bove, Patrizia Fiorella, Forfori, F, Corradi, F, Vaschetto, R, Cammarota, Giovanni, Astuto, M, Murabito, P, Bellini, V, Zambon, M, Longhini, F, Navalesi, Paolo, Bignami, E, Garofalo E, Antonelli M (ORCID:0000-0003-3007-1670), Conti G (ORCID:0000-0002-8566-9365), Mercurio G, Bove T, Cammarota G (ORCID:0000-0002-3626-6148), Navalesi P, Garofalo, Serafina, Bruni, A, Pelaia, C, Landoni, G, Zangrillo, A, Antonelli, Massimo, Conti, Giorgio, Biasucci, Dg, Mercurio, Giovanna, Cortegiani, A, Giarratano, A, Vetrugno, L, Bove, Patrizia Fiorella, Forfori, F, Corradi, F, Vaschetto, R, Cammarota, Giovanni, Astuto, M, Murabito, P, Bellini, V, Zambon, M, Longhini, F, Navalesi, Paolo, Bignami, E, Garofalo E, Antonelli M (ORCID:0000-0003-3007-1670), Conti G (ORCID:0000-0002-8566-9365), Mercurio G, Bove T, Cammarota G (ORCID:0000-0002-3626-6148), and Navalesi P
- Abstract
BACKGROUND: This study aims to ascertain whether (1) an educational program is sufficient to achieve adequate Diaphragm Ultrasound (DUS) assessments on healthy volunteers and (2) combining a video tutorial with a practical session is more effective in making learners capable to obtain accurate DUS measurements, as opposed to sole video tutorial. RESULTS: We enrolledstep 1: 172 volunteers naïve to ultrasound. After watching a video tutorial, a questionnaire was administered and considered to be passed when at least 70% of the questions were correctly answered. Course participants who passed the theoretical test were randomized to either intervention or control group. Learners randomized to the interventional group underwent to a practical training, tutored by an expert, before accessing DUS examination. Participants randomized to the control group directly accessed DUS examination, without any practical training. DUS measurements by learners and tutors were recorded and checked for accuracy, according to predefined criteria. Detection of both acoustic windows and accurate DUS assessment was achieved by 83.7% learners of the intervention group while 3.5% only among controls (p < 0.0001). The subcostal view of the diaphragm was correctly identified by 92% and 65% learners in the intervention and control groups, respectively (p < 0.0001) while the apposition zone by 86% and 71% learners, respectively (p = 0.026). An accurate diaphragm displacement (DD) measurement was obtained by 91% and 45% learners in the intervention and control groups, respectively (p < 0.0001) while an accurate thickening fraction (TF) measurement by 99% and 21%, respectively (p < 0.0001). DD measurements by both groups of learners were significantly correlated with those assessed by expert tutors; however, a significant improvement of measurement accuracy was found in learners randomized to receive also the practical training, compared to controls. CONCLUSIONS: A combined approach con
- Published
- 2019
24. Emerging modes for non-invasive ventilation
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Navalesi, P, Longhini, F, Vaschetto, R, and Messina, A.
- Published
- 2018
25. Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial
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Vaschetto, R, Longhini, F Persona, P, Ori, C, Stefani, G, Liu, S, Yi, Y, Lu, W, Yu, T, Luo, X, Tang, R, Li, M, Li, J, Cammarota, G, Bruni, A, Garofalo, E, Jin, Z, Yan, J, Zheng, R, Yin, J, Guido, S, Della Corte, F, Fontana, T, Gregoretti, C, Cortegiani, A, Giarratano, A, Montagnini, C, Cavuto, S, Qiu, H, and Navalesi, P
- Published
- 2018
26. Intensive care unit patients with lower respiratory tract nosocomial infections: The ENIRRIs project
- Author
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De Pascale, G. Ranzani, O.T. Nseir, S. Chastre, J. Welte, T. Antonelli, M. Navalesi, P. Garofalo, E. Bruni, A. Coelho, L.M. Skoczynski, S. Longhini, F. Taccone, F.S. Grimaldi, D. Salzer, H.J.F. Lange, C. Froes, F. Artigas, A. Díaz, E. Vallés, J. Rodríguez, A. Panigada, M. Comellini, V. Fasano, L. Soave, P.M. Spinazzola, G. Luyt, C.-E. Alvarez-Lerma, F. Marin, J. Masclans, J.R. Chiumello, D. Pezzi, A. Schultz, M. Mohamed, H. Van Der Eerden, M. Hoek, R.A.S. Gommers, D.A.M.P.J. Di Pasquale, M. Civljak, R. Kutleša, M. Bassetti, M. Dimopoulos, G. Nava, S. Rios, F. Zampieri, F.G. Povoa, P. Bos, L.D. Aliberti, S. Torres, A. Martín-Loeches, I.
- Abstract
The clinical course of intensive care unit (ICU) patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by specific epidemiological, clinical and microbiological aspects. A European network for ICU-related respiratory infections (ENIRRIs), supported by the European Respiratory Society, has been recently established, with the aim at studying all respiratory tract infective episodes except community-acquired ones. A multicentre, observational study is in progress, enrolling more than 1000 patients fulfilling the clinical, biochemical and radiological findings consistent with a LRTI. This article describes the methodology of this study. A specific interest is the clinical impact of non- ICU-acquired nosocomial pneumonia requiring ICU admission, non-ventilator-associated LRTIs occurring in the ICU, and ventilator-associated tracheobronchitis. The clinical meaning of microbiologically negative infectious episodes and specific details on antibiotic administration modalities, dosages and duration are also highlighted. Recently released guidelines address many unresolved questions which might be answered by such large-scale observational investigations. In light of the paucity of data regarding such topics, new interesting information is expected to be obtained from our network research activities, contributing to optimisation of care for critically ill patients in the ICU. © ERS 2017.
- Published
- 2017
27. Efficacy of ventilator waveform observation for detection of patient-ventilator asynchrony during NIV: a multicentre study
- Author
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Longhini, F., Colombo, D., Pisani, L., Idone, F., Chun, P., Doorduin, J., Ling, L., Alemani, M., Bruni, A., Zhaochen, J., Tao, Y., Lu, W., Garofalo, E., Carenzo, L., Maggiore, S.M., Qiu, H., Heunks, L., Antonelli, M., Nava, S., Navalesi, P., Longhini, F., Colombo, D., Pisani, L., Idone, F., Chun, P., Doorduin, J., Ling, L., Alemani, M., Bruni, A., Zhaochen, J., Tao, Y., Lu, W., Garofalo, E., Carenzo, L., Maggiore, S.M., Qiu, H., Heunks, L., Antonelli, M., Nava, S., and Navalesi, P.
- Abstract
Contains fulltext : 182479.pdf (publisher's version ) (Open Access), The objective of this study was to assess ability to identify asynchronies during noninvasive ventilation (NIV) through ventilator waveforms according to experience and interface, and to ascertain the influence of breathing pattern and respiratory drive on sensitivity and prevalence of asynchronies. 35 expert and 35 nonexpert physicians evaluated 40 5-min NIV reports displaying flow-time and airway pressure-time tracings; identified asynchronies were compared with those ascertained by three examiners who evaluated the same reports displaying, additionally, tracings of diaphragm electrical activity. We determined: 1) sensitivity, specificity, and positive and negative predictive values; 2) the correlation between the double true index (DTI) of each report (i.e., the ratio between the sum of true positives and true negatives, and the overall breath count) and the corresponding asynchrony index (AI); and 3) the influence of breathing pattern and respiratory drive on both AI and sensitivity. Sensitivities to detect asynchronies were low either according to experience (0.20 (95% CI 0.14-0.29) for expert versus 0.21 (95% CI 0.12-0.30) for nonexpert, p=0.837) or interface (0.28 (95% CI 0.17-0.37) for mask versus 0.10 (95% CI 0.05-0.16) for helmet, p<0.0001). DTI inversely correlated with the AI (r(2)=0.67, p<0.0001). Breathing pattern and respiratory drive did not affect prevalence of asynchronies and sensitivity. Patient-ventilator asynchrony during NIV is difficult to recognise solely by visual inspection of ventilator waveforms.
- Published
- 2017
28. Intensive care unit patients with lower respiratory tract nosocomial infections: The ENIRRIs project
- Author
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de Pascale, G. (Gennaro), Ranzani, O.T. (Otavio T.), Nseir, S. (Saad), Chastre, J. (Jean), Welte, T. (Tobias), Antonelli, M. (Massimo), Navalesi, P., Garofalo, E. (Eugenio), Bruni, A. (Andrea), Coelho, L.M. (Luis Miguel), Skoczyński, S. (Szymon), Longhini, F. (Federico), Taccone, F.S. (Fabio), Grimaldi, D. (David), Salzer, H.J.F. (Helmut J. F.), Lange, C. (Christoph), Froes, F. (Filipe), Artigas, A. (Antonio), Díaz, E. (Emili), Vallés, J. (Jordi), Rodriguez, A.H., Panigada, M. (Mauro), Comellini, V. (Vittoria), Fasano, L. (Luca), Soave, P.M. (Paolo M.), Spinazzola, G. (Giorgia), Luyt, C.-E. (Charles-Edouard), Alvarez-Lerma, F. (Francisco), Marin, J. (Judith), Masclans, J.R. (Joan Ramon), Chiumello, D. (Davide), Pezzi, A. (Angelo), Schultz, M.J. (Marcus), Mohamed, H. (Hafiz), Eerden, M. (Menno) van der, Hoek, R.A.S. (Roger A. S.), Gommers, D.A.M.P.J. (Diederik), di Pasquale, M. (Marta), Civljak, R. (Rok), Kutleša, M. (Marko), Bassetti, M. (Matteo), Dimopoulos, G. (George), Nava, S. (Stefano), Rios, F. (Fernando), Zampieri, F.G. (Fernando G.), Povoa, P. (Pedro), Bos, L.D. (Lieuwe D.), Aliberti, S. (Stefano), Torres, A., Martin-Loeches, I., de Pascale, G. (Gennaro), Ranzani, O.T. (Otavio T.), Nseir, S. (Saad), Chastre, J. (Jean), Welte, T. (Tobias), Antonelli, M. (Massimo), Navalesi, P., Garofalo, E. (Eugenio), Bruni, A. (Andrea), Coelho, L.M. (Luis Miguel), Skoczyński, S. (Szymon), Longhini, F. (Federico), Taccone, F.S. (Fabio), Grimaldi, D. (David), Salzer, H.J.F. (Helmut J. F.), Lange, C. (Christoph), Froes, F. (Filipe), Artigas, A. (Antonio), Díaz, E. (Emili), Vallés, J. (Jordi), Rodriguez, A.H., Panigada, M. (Mauro), Comellini, V. (Vittoria), Fasano, L. (Luca), Soave, P.M. (Paolo M.), Spinazzola, G. (Giorgia), Luyt, C.-E. (Charles-Edouard), Alvarez-Lerma, F. (Francisco), Marin, J. (Judith), Masclans, J.R. (Joan Ramon), Chiumello, D. (Davide), Pezzi, A. (Angelo), Schultz, M.J. (Marcus), Mohamed, H. (Hafiz), Eerden, M. (Menno) van der, Hoek, R.A.S. (Roger A. S.), Gommers, D.A.M.P.J. (Diederik), di Pasquale, M. (Marta), Civljak, R. (Rok), Kutleša, M. (Marko), Bassetti, M. (Matteo), Dimopoulos, G. (George), Nava, S. (Stefano), Rios, F. (Fernando), Zampieri, F.G. (Fernando G.), Povoa, P. (Pedro), Bos, L.D. (Lieuwe D.), Aliberti, S. (Stefano), Torres, A., and Martin-Loeches, I.
- Abstract
The clinical course of intensive care unit (ICU) patients may be complicated by a large spectrum of lower respiratory tract infections (LRTI), defined by specific epidemiological, clinical and microbiological aspects. A European network for ICU-related respiratory infections (ENIRRIs), supported by the European Respiratory Society, has been recently established, with the aim at studying all respiratory tract infective episodes except community-acquired ones. A multicentre, observational study is in progress, enrolling more than 1000 patients fulfilling the clinical, biochemical and radiological findings consistent with a LRTI. This article describes the methodology of this study. A specific interest is the clinical impact of non- ICU-acquired nosocomial pneumonia requiring ICU admission, non-ventilator-associated LRTIs occurring in the ICU, and ventilator-associated tracheobronchitis. The clinical meaning of microbiologically negative infectious episodes and specific details on antibiotic administration modalities, dosages and duration are also highlighted. Recently released guidelines address many unresolved questions which might be answered by such large-scale observational investigations. In light of the paucity of data regarding such topics, new interesting information is expected to be obtained from our network research activities, contributing to optimisation of care for critically ill patients in the ICU.
- Published
- 2017
- Full Text
- View/download PDF
29. NIV to avoid re-intubation
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Navalesi, P and Longhini, F.
- Published
- 2015
30. Insufficienza Respiratoria acuta e cronica (cap.21)
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Clini, Enrico, Bonsignore, M, Confalonieri, Marco, Corrado, Arianna, Crisafulli, E, Fabbri, Leonardo, Longhini, F, Marchioni, Alessandro, Moretti, Matteo, Navalesi, P, Potena, A, Scala, R, Spanevello, A, and Torregiani, C.
- Published
- 2015
31. Neurally adjusted ventilatory assist in preterm neonates with acute respiratory failure
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Longhini, F, Ferrero, F, De Luca, D, Cosi, G, Alemani, M, Colombo, D, Cammarota, G, Berni, P, Conti, Giorgio, Bona, G, Della Corte, F, Navalesi, P., Conti, Giorgio (ORCID:0000-0002-8566-9365), Longhini, F, Ferrero, F, De Luca, D, Cosi, G, Alemani, M, Colombo, D, Cammarota, G, Berni, P, Conti, Giorgio, Bona, G, Della Corte, F, Navalesi, P., and Conti, Giorgio (ORCID:0000-0002-8566-9365)
- Abstract
Neurally adjusted ventilatory assist (NAVA) is a novel mode of ventilation that has been demonstrated to improve infant-ventilator interaction, compared to the conventional modes in retrospective and short-term studies.
- Published
- 2015
32. PHYSIOLOGIC COMPARISON BETWEEN A NEW HELMET AND THE CONVENTIONAL HELMET IN DELIVERING NONINVASIVE VENTILATION
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Longhini, F, Olivieri, C, Repetto, V, Candriella, M, Pagni, Am, Cammarota, G, Della Corte, F, and Navalesi, P
- Published
- 2013
33. A NEW SETTING TO IMPROVE NON INVASIVE NEURALLY ADJUSTED VENTILATORY ASSIST BY HELMET
- Author
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Cammarota, G., Longhini, F., Olivieri, C., Sasu, L., Vaschetto, R., Colombo, D., Antonio Messina, Repetto, V., Della Corte, F., and Navalesi, P.
- Published
- 2013
34. Bench comparative evaluation between a new generation and a standard helmet to deliver noninvasive ventilation
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Olivieri, C, Costa, R, Spinazzola, G, Ferrone, G, Longhini, F, Cammarota, G, Conti, G, and Navalesi, P
- Published
- 2012
35. NON INVASIVE VENTILATION (NIV) BY HELMET FOR TREATMENT OF HYPOXEMIC ACUTE RESPIRATORY FAILURE (ARF): PRESSURE SUPPORT (PS) VS. NEURALLY ADJUSTED VENTILATORY ASSIST (NAVA)
- Author
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Cammarota, G, Costa, R, Blando, C, Longhini, F, Colombo, D, Vaschetto, R, Spinazzola, G, Della Corte, F, Conti, G, and Navalesi, P
- Published
- 2009
36. EFFECTS OF PROPOFOL INFUSION ON PATIENT-VENTILATOR INTERACTION DURING PRESSURE SUPPORT AND NEURALLY ADJUSTED VENTILATORY ASSIST IN INTUBATED PATIENTS WITH ACUTE RESPIRATORY FAILURE OF VARIED ETIOLOGY
- Author
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Cammarota, G, Longhini, F, Colombo, D, Vaschetto, R, Giovanniello, A, Della Corte, F, and Navalesi, P
- Published
- 2009
37. PS-145 Preterm Infants Transportation Between Tertiary Care Centres (tcc) Within First Hours Of Life: Restrospective Cohort Study
- Author
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Jourdain, G, primary, Longhini, F, additional, Quentin, P, additional, Boët, A, additional, Julé, L, additional, Ammar, F, additional, Chabernaud, JL, additional, and De Luca, D, additional
- Published
- 2014
- Full Text
- View/download PDF
38. Bench comparative evaluation of a new generation and standard helmet for delivering non-invasive ventilation
- Author
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Olivieri, C., primary, Costa, R., additional, Spinazzola, G., additional, Ferrone, G., additional, Longhini, F., additional, Cammarota, G., additional, Conti, G., additional, and Navalesi, P., additional
- Published
- 2012
- Full Text
- View/download PDF
39. Optimization of a Variable Geometry Exhaust System Through Design of Experiment
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Millo, F., primary, Badami, M., additional, Longhini, F., additional, Rubino, M., additional, Gambarotto, M., additional, and Lasana, M., additional
- Published
- 2008
- Full Text
- View/download PDF
40. SAMPLING AND ANALYSIS OF ALVEOLAR EXHALED BREATH CONDENSATE IN MECHANICALLY VENTILATED PATIENTS: A FEASIBILITY STUDY
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Vaschetto, R., Goldoni, M., Cancelliere, L., Pulvirenti, S., Fazzini, U., Costagliola, R., Capuzzi, F., Longhini, F., Cammarota, G., Della Corte, F., Antonio Mutti, Corradi, M., and Navalesi, P.
41. Insufficienza respiratoria acuta e cronica (cap.21)
- Author
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Rugarli, C., Bonsignore, Mr, Enrico Clini, Confalonieri, M., Stefania Costi, Crimi, C., Crisafulli, E., Longhini, F., Marchioni, A., Nava, S., Navalesi, P., Pisani, L., Spanevello, A., and Roberto Tonelli
42. Novel Biological Therapies for Severe Asthma Endotypes
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Corrado Pelaia, Giulia Pelaia, Claudia Crimi, Angelantonio Maglio, Anna Agnese Stanziola, Cecilia Calabrese, Rosa Terracciano, Federico Longhini, Alessandro Vatrella, Pelaia, C, Pelaia, G, Crimi, C, Maglio, A, Stanziola, Aa, Calabrese, C, Terracciano, R, Longhini, F, Vatrella, A., Pelaia, C., Pelaia, G., Crimi, C., Maglio, A., Stanziola, A. A., Calabrese, C., Terracciano, R., and Longhini, F.
- Subjects
type 2 severe asthma ,pro-inflammatory cytokine ,alarmins ,Medicine (miscellaneous) ,monoclonal antibodies ,IgE ,alarmin ,pro-inflammatory cytokines ,monoclonal antibodie ,General Biochemistry, Genetics and Molecular Biology - Abstract
Severe asthma comprises several heterogeneous phenotypes, underpinned by complex pathomechanisms known as endotypes. The latter are driven by intercellular networks mediated by molecular components which can be targeted by specific monoclonal antibodies. With regard to the biological treatments of either allergic or non-allergic eosinophilic type 2 asthma, currently available antibodies are directed against immunoglobulins E (IgE), interleukin-5 (IL-5) and its receptor, the receptors of interleukins-4 (IL-4) and 13 (IL-13), as well as thymic stromal lymphopoietin (TSLP) and other alarmins. Among these therapeutic strategies, the best choice should be made according to the phenotypic/endotypic features of each patient with severe asthma, who can thus respond with significant clinical and functional improvements. Conversely, very poor options so far characterize the experimental pipelines referring to the perspective biological management of non-type 2 severe asthma, which thereby needs to be the focus of future thorough research.
- Published
- 2022
43. High flow through nasal cannula in exacerbated COPD patients: a systematic review
- Author
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Federico Longhini, Marinella Astuto, Lara Pisani, Irene Prediletto, Pisani L., Astuto M., Prediletto I., and Longhini F.
- Subjects
Pulmonary and Respiratory Medicine ,Chronic obstructive pulmonary disease ,High flow nasal cannula ,Hypercapnia ,Non-invasive ventilation ,Oxygen ,Positive-pressure respiration ,Respiratory insufficiency ,Respiratory therapy ,Exacerbation ,medicine.medical_treatment ,medicine.disease_cause ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,Work of breathing ,0302 clinical medicine ,Respiratory Rate ,Oxygen therapy ,medicine ,Humans ,030212 general & internal medicine ,Work of Breathing ,lcsh:RC705-779 ,COPD ,Noninvasive Ventilation ,business.industry ,lcsh:Diseases of the respiratory system ,medicine.disease ,Respiratory acidosis ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Anesthesia ,Disease Progression ,Acidosis, Respiratory ,Blood Gas Analysis ,medicine.symptom ,business ,Nasal cannula ,Respiratory tract - Abstract
Chronic Obstructive Pulmonary Disease (COPD) history is characterized by episodes of exacerbation of varying severity, featured by acute worsening of respiratory symptoms, commonly precipitated by respiratory tract infection. The recent ERS/ATS clinical practice guidelines strongly recommend the application of non invasive ventilation (NIV) for patients with acute respiratory failure (ARF) leading to acute or acute-on-chronic respiratory acidosis (pH 7.35) and not for those patients with acute exacerbation of COPD (AECOPD) and hypercapnia who are not acidotic. In recent years, High-Flow through Nasal Cannula (HFNC) has been introduced in the clinical practice.We designed the present systematic review of the literature to assess all effects of HFNC use reported in exacerbated COPD patients. In this setting, HFNC is able to keep PaCO2 unmodified, while oxygenation slightly deteriorates as opposed to NIV. Furthermore, the work of breathing is reduced with HFNC by a similar extent to NIV, while it increases by 40–50% during conventional oxygen therapy (COT). HFNC is also reported to be more comfortable than COT and NIV. Despite these results, little and limited evidence for improved clinical outcomes is currently available. Keywords: Chronic obstructive pulmonary disease, Oxygen, High flow nasal cannula, Non-invasive ventilation, Respiratory therapy, Respiratory insufficiency, Hypercapnia, Positive-pressure respiration
- Published
- 2019
44. High-flow nasal therapy versus noninvasive ventilation in COPD patients with mild-to-moderate hypercapnic acute respiratory failure: study protocol for a noninferiority randomized clinical trial
- Author
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Maria Rita Taliani, Vittoria Comellini, Uberto Maccari, Antonino Giarratano, Raffaele Scala, Federico Longhini, Eugenio Garofalo, Luigi Vetrugno, Paolo Groff, Giovanni Misseri, Cesare Gregoretti, Andrea Cortegiani, Enrico Lupia, Andrea Bruni, Annalisa Carlucci, Stefano Nava, Paolo Navalesi, Cortegiani A., Longhini F., Carlucci A., Scala R., Groff P., Bruni A., Garofalo E., Taliani M.R., MacCari U., Vetrugno L., Lupia E., Misseri G., Comellini V., Giarratano A., Nava S., Navalesi P., Gregoretti C., Cortegiani, Andrea, Longhini, Federico, Carlucci, Annalisa, Scala, Raffaele, Groff, Paolo, Bruni, Andrea, Garofalo, Eugenio, Taliani, Maria Rita, Maccari, Uberto, Vetrugno, Luigi, Lupia, Enrico, Misseri, Giovanni, Comellini, Vittoria, Giarratano, Antonino, Nava, Stefano, Navalesi, Paolo, and Gregoretti, Cesare
- Subjects
Chronic Obstructive ,Time Factors ,Exacerbation ,Respiratory rate ,medicine.medical_treatment ,Medicine (miscellaneous) ,Equivalence Trials as Topic ,Acute respiratory failure ,law.invention ,Pulmonary Disease ,Hypercapnia ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,Study Protocol ,0302 clinical medicine ,Carbon dioxide ,Chronic obstructive pulmonary disease ,Emergency department ,High-flow oxygen therapy through nasal cannula ,Intensive care unit ,Noninvasive ventilation ,Acute Disease ,Humans ,Italy ,Lung ,Multicenter Studies as Topic ,Oxygen Inhalation Therapy ,Prospective Studies ,Respiratory Insufficiency ,Treatment Outcome ,Noninvasive Ventilation ,Randomized controlled trial ,law ,medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Tidal volume ,Mechanical ventilation ,COPD ,lcsh:R5-920 ,business.industry ,medicine.disease ,Respiratory acidosis ,Anesthesia ,business ,lcsh:Medicine (General) ,030217 neurology & neurosurgery - Abstract
Background Noninvasive ventilation (NIV) is indicated to treat respiratory acidosis due to exacerbation of chronic obstructive pulmonary disease (COPD). Recent nonrandomized studies also demonstrated some physiological effects of high-flow nasal therapy (HFNT) in COPD patients. We designed a prospective, unblinded, multicenter, randomized controlled trial to assess the noninferiority of HFNT compared to NIV with respect to the reduction of arterial partial pressure of carbon dioxide (PaCO2) in patients with hypercapnic acute respiratory failure with mild-to-moderate respiratory acidosis. Methods We will enroll adult patients with acute hypercapnic respiratory failure, as defined by arterial pH between 7.25 and 7.35 and PaCO2 ≥ 55 mmHg. Patients will be randomly assigned 1:1 to receive NIV or HFNT. NIV will be applied through a mask with a dedicated ventilator in pressure support mode. Positive end-expiratory pressure will be set at 3–5 cmH2O with inspiratory support to obtain a tidal volume between 6 and 8 ml/kg of ideal body weight. HFNT will be initially set at a temperature of 37 °C and a flow of 60 L/min. At 2 and 6 h we will assess arterial blood gases, vital parameters, respiratory rate, treatment intolerance and failure, need for endotracheal intubation, time spent under mechanical ventilation (both invasive and NIV), intensive care unit and hospital length of stay, and hospital mortality. Based on an α error of 5% and a β error of 80%, with a standard deviation for PaCO2 equal to 15 mmHg and a noninferiority limit of 10 mmHg, we computed a sample size of 56 patients. Considering potential drop-outs and nonparametric analysis, the final computed sample size was 80 patients (40 per group). Discussion HFNT is more comfortable than NIV in COPD patients recovering from an episode of exacerbation. If HFNT would not be inferior to NIV, HFNT could be considered as an alternative to NIV to treat COPD patients with mild-to-moderate respiratory acidosis. Trial registration ClinicalTrials.gov, NCT03370666. Registered on December 12, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3514-1) contains supplementary material, which is available to authorized users.
- Published
- 2019
45. COVID-19: High-JAKing of the Inflammatory 'Flight' by Ruxolitinib to Avoid the Cytokine Storm
- Author
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Cirino Botta, Alessia Indrieri, Eugenio Garofalo, Flavia Biamonte, Andrea Bruni, Pino Pasqua, Francesco Cesario, Francesco Saverio Costanzo, Federico Longhini, Francesco Mendicino, Botta C., Indrieri A., Garofalo E., Biamonte F., Bruni A., Pasqua P., Cesario F., Costanzo F.S., Longhini F., and Mendicino F.
- Subjects
0301 basic medicine ,Cancer Research ,Ruxolitinib ,ruxolitinib ,medicine.medical_treatment ,lcsh:RC254-282 ,Proinflammatory cytokine ,03 medical and health sciences ,0302 clinical medicine ,Fibrosis ,medicine ,Myelofibrosis ,business.industry ,ferritin ,hyperinflammation ,COVID-19 ,Immunotherapy ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,030104 developmental biology ,Cytokine ,Oncology ,JAK2 ,030220 oncology & carcinogenesis ,Immunology ,Perspective ,business ,Janus kinase ,Cytokine storm ,medicine.drug - Abstract
Since SARS-CoV-2 outbreak in December 2019, world health-system has been severely impacted with increased hospitalization, Intensive-Care-Unit (ICU) access and high mortality rates, mostly due to severe acute respiratory failure and multi-organ failure. Excessive and uncontrolled release of proinflammatory cytokines (cytokine release/storm syndrome, CRS) have been linked to the development of these events. The recent advancements of immunotherapy for the treatment of hematologic and solid tumors shed light on many of the molecular mechanisms underlying this phenomenon, thus rendering desirable a multidisciplinary approach to improve COVID-19 patients’ outcome. Indeed, currently available therapeutic-strategies to overcome CRS, should be urgently evaluated for their capability of reducing COVID-19 mortality. Notably, COVID-19 shares different pathogenic aspects with acute graft-versus-host-disease (aGVHD), hemophagocytic-lymphohistiocytosis (HLH), myelofibrosis, and CAR-T-associated CRS. Specifically, similarly to aGVHD, an induced tissue damage (caused by the virus) leads to increased cytokine release (TNFα and IL-6) which in turn leads to exaggerated dendritic cells, macrophages (like in HLH) and lymphocytes (as in CAR-T) activation, immune-cells migration, and tissue-damage (including late-stage fibrosis, similar to myelofibrosis). Janus Kinase (JAK) signaling represents a molecular hub linking all these events, rendering JAK-inhibitors suitable to limit deleterious effects of an overwhelming inflammatory-response. Accordingly, ruxolitinib is the only selective JAK1 and JAK2-inhibitor approved for the treatment of myelofibrosis and aGVHD. Here, we discuss, from a molecular and hematological point of view, the rationale for targeting JAK signaling in the management of COVID-19 patients and report the clinical results of a patient admitted to ICU among the firsts to be treated with ruxolitinib in Italy.
- Published
- 2021
46. Helmet continuous positive airway pressure and prone positioning: A proposal for an early management of COVID-19 patients
- Author
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Mariachiara Ippolito, Andrea Bruni, Giuseppe Accurso, Giuseppe Foti, Andrea Cortegiani, Paolo Navalesi, Roberto Cosentini, Cesare Gregoretti, Giacomo Grasselli, Alessio Mattei, Federico Longhini, Eugenio Garofalo, Filippo Vitale, Longhini F., Bruni A., Garofalo E., Navalesi P., Grasselli G., Cosentini R., Foti G., Mattei A., Ippolito M., Accurso G., Vitale F., Cortegiani A., and Gregoretti C.
- Subjects
Pulmonary and Respiratory Medicine ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,coronavirus ,Article ,Patient Positioning ,Positive-Pressure Respiration ,Betacoronavirus ,Pandemic ,medicine ,Humans ,Continuous positive airway pressure ,Hypoxia ,Lung Compliance ,Pandemics ,lcsh:RC705-779 ,Respiratory Distress Syndrome ,Continuous Positive Airway Pressure ,biology ,SARS-CoV-2 ,business.industry ,helmet ,COVID-19 ,lcsh:Diseases of the respiratory system ,biology.organism_classification ,Prone position ,Vasoconstriction ,prone position ,Emergency medicine ,Head Protective Devices ,Coronavirus Infections ,Respiratory Insufficiency ,business ,CPCP, COVID-19, SARS-CoV-2 - Abstract
In late December 2019, clusters of patients with interstitial pneumonia of unknown cause were reported by some local health facilities in Wuhan (China). The Chinese Centre for Disease Control conducted an epidemiologic and etiologic investigation, leading to the identification of a novel coronavirus (SARS-CoV-2).1, 2 On March 11th, the World Health Organization (WHO) declared the novel coronavirus disease (COVID-19) a pandemic. In the area of Wuhan, COVID-19 mainly affected male patients (around 60%), with a median age of about 50 years; 40% of patients developed Acute Respiratory Distress Syndrome (ARDS) 5% requiring intensive care. The mortality rate was around 2%.3, 4 However, Grasselli et al. found that the mortality was 26% in ICU. The death rate was higher among those who were older.5. The hypothesis is that in case of a pandemic, selected COVID-19 patients may benefit from the combination of early hCPAP and prone position sessions, in order to reduce the need for intubation and invasive mechanical ventilation, “buying time” for the disease to heal.
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- 2020
47. Diaphragmatic Dysfunction After Elective Cardiac Surgery: A Prospective Observational Study
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Gianmaria Cammarota, MaGIC, Andrea Bruni, Giovanni Landoni, Giuseppe Filiberto Serraino, Laura Pasin, Rosalba Lembo, Federico Longhini, Eugenio Garofalo, Paolo Navalesi, Pasquale Mastroroberto, Bruni, A., Garofalo, E., Pasin, L., Serraino, G. F., Cammarota, G., Longhini, F., Landoni, G., Lembo, R., Mastroroberto, P., and Navalesi, P.
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medicine.medical_specialty ,diaphragm dysfunction ,medicine.medical_treatment ,Diaphragm ,Diaphragmatic breathing ,030204 cardiovascular system & hematology ,mechanical ventilation ,Spontaneous breathing trial ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,law ,Cardiopulmonary bypass ,Medicine ,Humans ,Cardiac Surgical Procedures ,Mechanical ventilation ,business.industry ,Incidence (epidemiology) ,weaning ,Respiration ,Intensive care unit ,Respiration, Artificial ,Diaphragm (structural system) ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Anesthesia ,Artificial ,cardiac surgery ,cardiopulmonary bypass ,Airway Extubation ,Cardiology and Cardiovascular Medicine ,business ,Ventilator Weaning - Abstract
Objectives: To determine the incidence of postoperative diaphragm dysfunction as diagnosed by ultrasonography. Design: Explorative prospective observational study. Setting: University intensive care unit. Participants: One hundred consecutive patients undergoing elective cardiac surgery. Interventions: Diaphragm ultrasound was performed the day before surgery during unassisted breath (D-1), at the first spontaneous breathing trial attempt (DSBT), 24 hours after surgery (D+1), and at intensive care unit (ICU) discharge (DICU). Diaphragm displacement, inspiratory and expiratory thickness, and the thickening fraction were measured at all timepoints. Measurements and Main Results: Primary outcome was assessing the rate of postoperative diaphragm dysfunction, defined as a thickening fraction
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- 2020
48. High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-inferiority randomized trial
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Cortegiani, Andrea, Longhini, Federico, Madotto, Fabiana, Groff, Paolo, Scala, Raffaele, Crimi, Claudia, Carlucci, Annalisa, Bruni, Andrea, Garofalo, Eugenio, Raineri, Santi Maurizio, Tonelli, Roberto, Comellini, Vittoria, Lupia, Enrico, Vetrugno, Luigi, Clini, Enrico, Giarratano, Antonino, Nava, Stefano, Navalesi, Paolo, Gregoretti, Cesare, Lorenzo Ball, Tiziana Bove, Raffaele Campisi, Paola Chirco, Maria Stella Dionisi, Mariachiara Ippolito, Riccardo Fantini, Luca Guidelli, Uberto Maccari, Luca Tabbì, Maria Rita Taliani, Cortegiani A., Longhini F., Madotto F., Groff P., Scala R., Crimi C., Carlucci A., Bruni A., Garofalo E., Raineri S.M., Tonelli R., Comellini V., Lupia E., Vetrugno L., Clini E., Giarratano A., Nava S., Navalesi P., Gregoretti C., Ball L., Bove T., Campisi R., Chirco P., Dionisi M.S., Ippolito M., Guidelli L., Maccari U., Taliani M.R., Cortegiani, Andrea, Longhini, Federico, Madotto, Fabiana, Groff, Paolo, Scala, Raffaele, Crimi, Claudia, Carlucci, Annalisa, Bruni, Andrea, Garofalo, Eugenio, Raineri, Santi Maurizio, Tonelli, Roberto, Comellini, Vittoria, Lupia, Enrico, Vetrugno, Luigi, Clini, Enrico, Giarratano, Antonino, Nava, Stefano, Navalesi, Paolo, Gregoretti, Cesare, and Lorenzo Ball, Tiziana Bove, Raffaele Campisi, Paola Chirco, Maria Stella Dionisi, Mariachiara Ippolito, Riccardo Fantini, Luca Guidelli, Uberto Maccari, Luca Tabbì, Maria Rita Taliani
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Male ,Exacerbation ,Equivalence Trials as Topic ,Critical Care and Intensive Care Medicine ,Acute respiratory failure ,law.invention ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Randomized controlled trial ,law ,Clinical endpoint ,medicine ,Humans ,Cannula ,Chronic obstructive pulmonary disease ,High flow nasal cannula ,High flow nasal therapy ,Noninvasive ventilation ,030212 general & internal medicine ,Aged ,COPD ,business.industry ,Research ,high flow oxygen therapy, high flow nasal cannula, noninvasive ventilation, COPD, carbon dioxide, acute respiratory failure ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Oxygen Inhalation Therapy ,lcsh:RC86-88.9 ,Middle Aged ,medicine.disease ,Symptom Flare Up ,Confidence interval ,030228 respiratory system ,Italy ,Anesthesia ,Breathing ,Female ,High flow ,business ,Human - Abstract
Background The efficacy and safety of high flow nasal therapy (HFNT) in patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease (AECOPD) are unclear. Our aim was to evaluate the short-term effect of HFNT versus NIV in patients with mild-to-moderate AECOPD, with the hypothesis that HFNT is non-inferior to NIV on CO2 clearance after 2 h of treatment. Methods We performed a multicenter, non-inferiority randomized trial comparing HFNT and noninvasive ventilation (NIV) in nine centers in Italy. Patients were eligible if presented with mild-to-moderate AECOPD (arterial pH 7.25–7.35, PaCO2 ≥ 55 mmHg before ventilator support). Primary endpoint was the mean difference of PaCO2 from baseline to 2 h (non-inferiority margin 10 mmHg) in the per-protocol analysis. Main secondary endpoints were non-inferiority of HFNT to NIV in reducing PaCO2 at 6 h in the per-protocol and intention-to-treat analysis and rate of treatment changes. Results Seventy-nine patients were analyzed (80 patients randomized). Mean differences for PaCO2 reduction from baseline to 2 h were − 6.8 mmHg (± 8.7) in the HFNT and − 9.5 mmHg (± 8.5) in the NIV group (p = 0.404). By 6 h, 32% of patients (13 out of 40) in the HFNT group switched to NIV and one to invasive ventilation. HFNT was statistically non-inferior to NIV since the 95% confidence interval (CI) upper boundary of absolute difference in mean PaCO2 reduction did not reach the non-inferiority margin of 10 mmHg (absolute difference 2.7 mmHg; 1-sided 95% CI 6.1; p = 0.0003). Both treatments had a significant effect on PaCO2 reductions over time, and trends were similar between groups. Similar results were found in both per-protocol at 6 h and intention-to-treat analysis. Conclusions HFNT was statistically non-inferior to NIV as initial ventilatory support in decreasing PaCO2 after 2 h of treatment in patients with mild-to-moderate AECOPD, considering a non-inferiority margin of 10 mmHg. However, 32% of patients receiving HFNT required NIV by 6 h. Further trials with superiority design should evaluate efficacy toward stronger patient-related outcomes and safety of HFNT in AECOPD. Trial registration: The study was prospectively registered on December 12, 2017, in ClinicalTrials.gov (NCT03370666).
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- 2020
49. Monoclonal Antibodies Targeting Alarmins: A New Perspective for Biological Therapies of Severe Asthma
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Federico Longhini, Angela Sciacqua, Corrado Pelaia, Cecilia Calabrese, G. Pelaia, Alessandro Vatrella, Claudia Crimi, Luca Gallelli, Pelaia, C., Pelaia, G., Longhini, F., Crimi, C., Calabrese, C., Gallelli, L., Sciacqua, A., and Vatrella, A.
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Anti-alarmin ,Tezepelumab ,Thymic stromal lymphopoietin ,QH301-705.5 ,medicine.drug_class ,Medicine (miscellaneous) ,Context (language use) ,Review ,Monoclonal antibody ,General Biochemistry, Genetics and Molecular Biology ,IL-25 ,Immunophenotyping ,Medicine ,Biology (General) ,Asthma ,business.industry ,Innate lymphoid cell ,anti-alarmins ,medicine.disease ,Interleukin 33 ,TSLP ,Immunology ,IL-33 ,Respiratory epithelium ,business - Abstract
Alarmins are innate cytokines, including thymic stromal lymphopoietin (TSLP), interleukin-33 (IL-33), and interleukin-25 (IL-25), which are mainly produced by airway epithelium and exert a prominent role in asthma pathobiology. In particular, several environmental factors such as allergens, cigarette smoking, airborne pollutants, and infectious agents trigger the release of alarmins, which in turn act as upstream activators of pro-inflammatory pathways underlying type 2 (T2-high) asthma. Indeed, alarmins directly activate group 2 innate lymphoid cells (ILC2), eosinophils, basophils, and mast cells and also stimulate dendritic cells to drive the commitment of naïve T helper (Th) cells towards the Th2 immunophenotype. Therefore, TSLP, IL-33, and IL-25 represent suitable targets for add-on therapies of severe asthma. Within this context, the fully human anti-TSLP monoclonal antibody tezepelumab has been evaluated in very promising randomized clinical trials. Tezepelumab and other anti-alarmins are thus likely to become, in the near future, valuable therapeutic options for the biological treatment of uncontrolled severe asthma.
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- 2021
50. Predatory Open-Access Publishing in Palliative and Supportive Care
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Andrea Bruni, Federico Longhini, Eugenio Garofalo, Filippo Sanfilippo, Andrea Cortegiani, Cortegiani A., Garofalo E., Bruni A., Sanfilippo F., and Longhini F.
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Palliative care ,business.industry ,Predatory Publishers ,Palliative Care ,MEDLINE ,Anesthesiology and Pain Medicine ,Nursing ,Open access publishing ,Open Access Publishing ,Medicine ,Humans ,Neurology (clinical) ,business ,General Nursing - Published
- 2018
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