Search

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

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

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

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

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

During the coronavirus disease 2019 (COVID-19) pandemic, noninvasive respiratory support has played a central role in managing patients affected by moderate-to-severe acute hypoxemic respiratory failure, despite inadequate scientific evidence to support its usage. High-flow nasal cannula (HFNC) treatment has gained popularity because of its effectiveness in delivering a high fraction of humidified oxygen, which improves ventilatory efficiency and the respiratory pattern, as well as its reported high tolerability, ease of use, and application outside of ICUs. Nevertheless, the risk of infection transmission to health-care workers has raised some concerns about its use in the first wave of the pandemic outbreak, with controversial recommendations provided by different scientific societies. This narrative review provides an overview of the recent evidence on the physiologic rationale, risks, and benefits of using HFNC instead of conventional oxygen therapy and other types of noninvasive respiratory support devices, such as continuous positive airway pressure and noninvasive ventilation in patients affected by COVID-19 pneumonia with associated acute hypoxemic respiratory failure. It also summarizes the available evidence with regard to the clinical use of HFNC during the current pandemic and its reported outcomes, and highlights the risks of bioaerosol dispersion associated with HFNC use. [ABSTRACT FROM AUTHOR]

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

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

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

Transforming growth factor-β1 (TGF-β1) is crucially involved in the fibrotic events characterizing interstitial lung diseases (ILDs), as well as in the airway remodeling process typical of asthma. Within such a context, the aim of our study was to investigate, in primary cultures of normal and fibrotic human lung fibroblasts (HLFs), the effects of TGF-β1 on mitogen-activated protein kinase (MAPK) phosphorylation, cell proliferation, and production of interleukins 6 (IL-6) and 11 (IL-11), in the presence or absence of a pretreatment with budesonide (BUD). MAPK phosphorylation was detected by Western blotting, cell viability and proliferation were evaluated using Trypan blue staining and [3H]-thymidine incorporation assay, respectively, and the release of IL-6 and IL-11 into cell culture supernatants was assessed by ELISA. TGF-β1 (10 ng/ml) significantly stimulated MAPK phosphorylation (P < 0.01), and also enhanced cell proliferation as well as the secretion of both IL-6 and IL-11, which reached the highest increases at the 72nd h of cell exposure to this growth factor. All such effects were prevented by BUD (10-8 M) and, with the exception of IL-6 release, also by a mixture of MAPK inhibitors. Therefore, our findings suggest that the fibrotic action exerted by TGF-β1 in the lung is mediated at least in part by MAPK activation and by an increased synthesis of the profibrogenic cytokines IL-6 and IL-11; all these effects appear to be prevented by corticosteroids via inhibition of MAPK phosphorylation. J. Cell. Physiol. 210: 489–497, 2007. © 2006 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Background: High-flow nasal cannula (HFNC) has become a frequently used noninvasive form of respiratory support in acute settings; however, evidence supporting its use has only recently emerged. These guidelines provide evidence-based recommendations for the use of HFNC alongside other noninvasive forms of respiratory support in adults with acute respiratory failure (ARF)., Materials and Methodology: The European Respiratory Society task force panel included expert clinicians and methodologists in pulmonology and intensive care medicine. The task force used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methods to summarise evidence and develop clinical recommendations for the use of HFNC alongside conventional oxygen therapy (COT) and noninvasive ventilation (NIV) for the management of adults in acute settings with ARF., Results: The task force developed eight conditional recommendations, suggesting the use of 1) HFNC over COT in hypoxaemic ARF; 2) HFNC over NIV in hypoxaemic ARF; 3) HFNC over COT during breaks from NIV; 4) either HFNC or COT in post-operative patients at low risk of pulmonary complications; 5) either HFNC or NIV in post-operative patients at high risk of pulmonary complications; 6) HFNC over COT in nonsurgical patients at low risk of extubation failure; 7) NIV over HFNC for patients at high risk of extubation failure unless there are relative or absolute contraindications to NIV; and 8) trialling NIV prior to use of HFNC in patients with COPD and hypercapnic ARF., Conclusions: HFNC is a valuable intervention in adults with ARF. These conditional recommendations can assist clinicians in choosing the most appropriate form of noninvasive respiratory support to provide to patients in different acute settings., Competing Interests: Conflict of interest: S. Oczkowski reports support for the current manuscript from librarian support services; support for attending meetings and/or travel from ERS, European Society of Intensive Care Medicine and Society of Critical Care Medicine, outside the submitted work. Conflict of interest: B. Ergan has nothing to disclose. Conflict of interest: L. Bos reports grants from the Dutch Lung Foundation (young investigator grant), the Dutch Lung Foundation and Health Holland (public-private partnership grant), the Dutch Lung Foundation (Dirkje Postma Award), IMI COVID19 initiative and Amsterdam UMC fellowship, outside the submitted work. Conflict of interest: M. Chatwin reports lecture fees from ResMed UK, Breas Medical UK, MPR Italy; and since December 2020 has worked part time for Breas Medical as their global clinical specialist, including CAB membership and support for attending meetings and/or travel. Conflict of interest: M. Ferrer has nothing to disclose. Conflict of interest: C. Gregoretti reports consulting fees from Mindray and Air Liquide; lecture fees from Vivisol, Philips and Air Liquide; support for attending meetings and/or travel from Fisher & Paykel; outside the submitted work. Conflict of interest: L. Heunks reports grants from InflaRx; consulting fees from Liberate Medical, USA; speaker fees from Fisher & Paykel and Maquet; outside the submitted work. Conflict of interest: J-P. Frat reports funding, provision of study materials, personal fees for lectures, travels and accommodations expenses reimbursement from Fisher and Paykel Healthcare; personal fees as a member of a scientific board from SOS Oxygene; grants from French Ministry of health; outside the submitted work. Conflict of interest: F. Longhini reports honoraria for a lecture from Draeger; issued patent for a new device for noninvasive ventilation (European patent number 3320941) from Intersurgical SPA; outside the submitted work. Conflict of interest: S. Nava has nothing to disclose. Conflict of interest: P. Navalesi has nothing to disclose. Conflict of interest: A. Ozsancak Uğurlu has nothing to disclose. Conflict of interest: L. Pisani has nothing to disclose. Conflict of interest: T. Renda has nothing to disclose. Conflict of interest: A.W. Thille reports payments for lectures and support for attending meetings and/or travel from Fisher & Paykel; Fisher & Paykel provided the high-flow nasal oxygen equipment and masks for NIV in several randomised clinical trials coordinated by our center. Conflict of interest: J.C. Winck reports webinar fees from Armstrong Medical, Breas, Philips and Nippon Gases; outside the submitted work. Conflict of interest: W. Windisch reports grants from Philips/Respironics/USA, Löwenstein Medical/Germany, VitalAire/Germany and Vivisol/Germany; speaking fees from Philips/Respironics/USA, Löwenstein Medical/Germany and VitalAire/Germany; outside the submitted work. Conflict of interest: T. Tonia acts as ERS Methodologist. Conflict of interest: J. Boyd is an employee of the European Lung Foundation. Conflict of interest: G. Sotgiu has nothing to disclose. Conflict of interest: R. Scala has nothing to disclose., (Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.)

Omalizumab is a humanized monoclonal anti-IgE antibody recently approved for the treatment of severe allergic asthma. This drug inhibits allergic responses by binding to serum IgE, thus preventing their interactions with cellular IgE receptors. Omalizumab is also capable of downregulating the expression of high-affinity IgE receptors on inflammatory cells, as well as the numbers of eosinophils in both blood and induced sputum. The clinical effects of omalizumab include relevant improvements in respiratory symptoms and quality of life, paralleled by a marked reduction of asthma exacerbations, emergency room visits, and use of systemic corticosteroids and rescue bronchodilators. Omalizumab is relatively well tolerated, and only rarely induces anaphylactic reactions. Therefore, this drug represents a valid option as add-on therapy for patients with severe persistent allergic asthma, inadequately controlled by high doses of standard inhaled treatments.

Transforming growth factor-beta1 (TGF-beta1) is crucially involved in the fibrotic events characterizing interstitial lung diseases (ILDs), as well as in the airway remodeling process typical of asthma. Within such a context, the aim of our study was to investigate, in primary cultures of normal and fibrotic human lung fibroblasts (HLFs), the effects of TGF-beta1 on mitogen-activated protein kinase (MAPK) phosphorylation, cell proliferation, and production of interleukins 6 (IL-6) and 11 (IL-11), in the presence or absence of a pretreatment with budesonide (BUD). MAPK phosphorylation was detected by Western blotting, cell viability and proliferation were evaluated using Trypan blue staining and [(3)H]-thymidine incorporation assay, respectively, and the release of IL-6 and IL-11 into cell culture supernatants was assessed by ELISA. TGF-beta1 (10 ng/ml) significantly stimulated MAPK phosphorylation (P < 0.01), and also enhanced cell proliferation as well as the secretion of both IL-6 and IL-11, which reached the highest increases at the 72nd h of cell exposure to this growth factor. All such effects were prevented by BUD (10(-8) M) and, with the exception of IL-6 release, also by a mixture of MAPK inhibitors. Therefore, our findings suggest that the fibrotic action exerted by TGF-beta1 in the lung is mediated at least in part by MAPK activation and by an increased synthesis of the profibrogenic cytokines IL-6 and IL-11; all these effects appear to be prevented by corticosteroids via inhibition of MAPK phosphorylation.