91 research outputs found
High flow through nasal cannula in exacerbated COPD patients: a systematic review
No full textChronic 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
Cardiac tamponade due to apixaban therapy in patient with unknown pericardial hemangioma
No full textLONG-TERM EVOLUTION OF RESPIRATORY IMPAIRMENT AFTER ACUTE RESPIRATORY FAILURE DUE TO COVID-19
No full textSingle breath nitrogen test in an epidemiologic survey in North Italy. Reliability, reference values and relationships with symptoms
No full textSleep features in Lymphangioleiomyomatosis and their relationship with disease severity: a pilot study
No full textLymphangioleiomyomatosis (LAM) is a rare pulmonary disease characterized by progressive airflow limitation. We conducted a pilot trial to investigate the incidence of sleep disorders, sleep quality and their relationship with disease severity. We performed pulmonary function tests, blood gas analysis, overnight 12-channels polysomnography and clinical assessments in 15 consecutive LAM patients. For statistics, p values < 0.05 were considered significant. Sleep efficiency (SE) was inversely correlated with RV/TLC (p = 0.035) and positively with daytime SpO2 (p = 0.010) and PaO2 (p = 0.011). Three cases had obstructive sleep apnea (OSA); seven patients (46.7%) showed a REMOSA. AHIREM was correlated with FEV1% (r = 0.75, p = 0.003), TLC% (r = 0.57, p = 0.026), RV% (r = 0.8, p=<0.0001) and RV/TLC (r = 0.77, p = 0.001). No correlations were observed between anxiety/depression and SE, CAP rate, pulmonary function test variables and AHIREM (p > 0.05). four subjects had nocturnal hypoxia (T90 ≥ 1% of TST) showing lower values of DLCO%, daytime SpO2%, PaO2, FEV1% and a higher value of VR/TLC comparing with the subgroup with normal T90 (p < 0.05). This pilot study shows that sleep alterations could be frequent in LAM and associated to disease severity. Nocturnal hypoxemia and SE were related to lung function impairment. A dysregulation of sleep seems to involve exclusively REM phase, while NREM appears to be preserved. This phenomenon might be linked to the pathophysiology of disease: our study, even with the limits of the small sample size, showed that the presence of REMOSA is related to the disease severity, in particular to the degree of airflow limitation and hyperinflation. More studies are needed to assess this topic
Single breath nitrogen test in an epidemiologic survey in North Italy. Reliability, reference values and relationships with symptoms
No full textThe usefulness of single breath nitrogen test (SBN2) was evaluated in a cross-sectional epidemiologic survey on a general population sample (n = 3,289) of North Italy. Each subject was submitted to CNR standardized questionnaire and to lung function testing using automated equipment (Hewlett-Packard 47804S). Acceptable closing volume (CV) and slope of alveolar plateau (DN2%/L) tracings were performed by only 1,370 and 1,982 subjects respectively, in comparison with the 2,638 diffusing capacity and the 3,079 forced vital capacity acceptable maneuvers. Prediction equations were computed on normal subjects for CV indices, with the exception of DN2%L: they were similar to those found in other studies. Significant differences among smoking categories were found for all the SBN2 parameters in males, but only for DN2%/L in females. The latter was also able to distinguish either subjects with airway obstruction from those without it or symptomatic from asymptomatic individuals, but DN2%/L did not give more information than V̇max75, a sensitive index of flow volume curve. Our results suggest that the place of SBN2 in large scale epidemiologic testing has not been justified
Effects of early rehabilitation on motor function, dyspnoea intensity, respiratory muscle performance and handgrip strength in patients with COVID-19: an observational study
Get PDFBackground/aims Although an increasing volume of research is emerging, rehabilitative treatment of patients with COVID-19 still continues to be a matter of great importance that must be explored further. The purpose of the present study was to describe the effects of inpatient rehabilitation in acute patients treated in a sub-intensive hospital setting during the COVID-19 pandemic.Methods A retrospective analysis was conducted based on the prospectively collected data of 192 patients with COVID-19 undergoing a physiotherapeutic regimen during their hospitalisation. Patients were admitted because of COVID-19-related pneumonia from the periods of 25 March-12 June 2020 and 2 November 2020-9 June 2021. This study investigated dyspnoea intensity using the modified Borg scale, motor function through the 1-minute sit-to-stand test, and daily walked distance. In a subset of 57 patients, handgrip strength and respiratory muscle function was also evaluated. Measurements were taken at baseline and discharge.Results Patients were classified according to the severity of their ratio of arterial oxygen partial pressure to fractional inspired oxygen (mean 225 +/- 82 mmHg). At discharge to home or to another hospital facility, patients performed a mean of 12 repetitions (1-minute sit-to-stand test); dyspnoea intensity was 1.4 (modified Borg scale), and they were able to walk a mean distance of 266.7 metres. The mean handgrip strength of the dominant hand was 29.3 kg, the maximal inspiratory pressure was 43.5 cmH(2)O, and the maximal expiratory pressure was 59.1 cmH(2)O. Overall, significant differences before and after treatment were detected for all clinical variables. Dyspnoea improved by 0.7 points; walked distance by 200 metres; the number of repetitions at the 1-minute sit-to-stand test by 5.6; the handgrip strength by 1.2 kg (right hand) and 1.7 kg (left hand); maximal inspiratory pressure by 7.7 cmH(2)O; and maximal expiratory pressure by 9.5 cmH(2)O.Conclusions Patients obtained significant improvements in functional capacity, dyspnoea perception, handgrip strength and respiratory muscle function. In addition, the treatment was feasible and well tolerated by patients, and no adverse related events were observed in a sub-intensive care setting
Standardizing PaO2 for PaCO2 in P/F ratio predicts in-hospital mortality in acute respiratory failure due to Covid-19: A pilot prospective study
No full textIntroduction: Up to fifteen percent of patients with novel pandemic coronavirus disease (Covid-19) have acute respiratory failure (ARF). Ratio between arterial partial pressure of oxygen (PaO2) and fraction of inspired oxygen (FiO2), P/F, is currently used as a marker of ARF severity in Covid-19. P/F does not reflect the respiratory efforts made by patients to maintain arterial blood oxygenation, such as tachypnea and hyperpnea, leading to hypocapnia. Standard PaO2, the value of PaO2 adjusted for arterial partial pressure of carbon dioxide (PaCO2) of the subject, better reflects the pathophysiology of hypoxemic ARF. We hypothesized that the ratio between standard PaO2 over FiO2 (STP/F) better predicts Covid-19 ARF severity compared to P/F. Methods: Aim of this pilot prospectic observational study was to observe differences between STP/F and P/F in predicting outcome failure, defined as need of invasive mechanical ventilation and/or deaths in Covid-19 ARF. Accuracy was calculated using Receiver Operating Characteristics (ROC) analysis and areas under the ROC curve (AUROC) were compared. Results: 349 consecutive subjects admitted to our respiratory wards due to Covid-19 ARF were enrolled. STP/F was accurate to predict mortality and superior to P/F with, respectively, AUROC 0.710 versus 0.688, p = 0.012.Both STP/F and PF were accurate to predict outcome failure (AUROC respectively of 0.747 and 0.742, p = 0.590). Discussion: This is the first study assessing the role of STP/F in describing severity of ARF in Covid-19. According to results, STP/F is accurate and superior to P/F in predicting in-hospital mortality
NETosis as Source of Autoantigens in Rheumatoid Arthritis
Get PDFIn neutrophils (but also in eosinophils and in mast cells), different inflammatory stimuli
induce histone deimination, chromatin decondensation, and NET formation. These
web-like structures that trap and kill microbes contain DNA, cationic granule proteins,
and antimicrobial peptides, but the most abundant proteins are core histones. Histones
contained in NETs have been deiminated, and arginines are converted in citrullines.
While deimination is a physiological process amplified in inflammatory conditions, only
individuals carrying genetic predisposition to develop rheumatoid arthritis (RA) make
antibodies to deiminated proteins. These antibodies, collectively identified as anticitrullinated
proteins/peptides antibodies (ACPA), react with different deiminated proteins
and display partially overlapping specificities. In this paper, we will summarize current
evidence supporting the role of NETosis as critical mechanism in the breach of tolerance
to self-antigens and in supporting expansion and differentiation of autoreactive cells.
In fact, several lines of evidence connect NETosis with RA: RA unstimulated synovial fluid
neutrophils display enhanced NETosis; sera from RA patients with Felty’s syndrome bind
deiminated H3 and NETs; a high number of RA sera bind deiminated H4 contained in
NETs; human monoclonal antibodies generated from RA synovial B cells decorate NETs
and bind deiminated histones. In RA, NETs represent on one side an important source
of autoantigens bearing posttranslational modifications and fueling the production of
ACPA. On the other side, NETs deliver signals that maintain an inflammatory milieu and
contribute to the expansion and differentiation of ACPA-producing B cells
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