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2 results on '"Michi T"'

1. High Failure Rate of Noninvasive Oxygenation Strategies in Critically Ill Subjects With Acute Hypoxemic Respiratory Failure Due to COVID-19.

Author

Menga LS, Cese LD, Bongiovanni F, Lombardi G, Michi T, Luciani F, Cicetti M, Timpano J, Ferrante MC, Cesarano M, Anzellotti GM, Rosà T, Natalini D, Tanzarella ES, Cutuli SL, Pintaudi G, De Pascale G, Dell'Anna AM, Bello G, Pennisi MA, Maggiore SM, Maviglia R, Grieco DL, and Antonelli M

Subjects
Critical Illness, Humans, Hypoxia etiology, Hypoxia therapy, SARS-CoV-2, COVID-19, Noninvasive Ventilation, Respiratory Insufficiency etiology, Respiratory Insufficiency therapy
Abstract

Background: The efficacy of noninvasive oxygenation strategies (NIOS) in treating COVID-19 disease is unknown. We conducted a prospective observational study to assess the rate of NIOS failure in subjects treated in the ICU for hypoxemic respiratory failure due to COVID-19., Methods: Patients receiving first-line treatment NIOS for hypoxemic respiratory failure due to COVID-19 in the ICU of a university hospital were included in this study; laboratory data were collected upon arrival, and 28-d outcome was recorded. After propensity score matching based on Simplified Acute Physiology (SAPS) II score, age, [Formula: see text] and [Formula: see text] at arrival, the NIOS failure rate in subjects with COVID-19 was compared to a previously published cohort who received NIOS during hypoxemic respiratory failure due to other causes., Results: A total of 85 subjects received first-line treatment with NIOS. The most frequently used methods were helmet noninvasive ventilation and high-flow nasal cannula; of these, 52 subjects (61%) required endotracheal intubation. Independent factors associated with NIOS failure were SAPS II score ( P = .009) and serum lactate dehydrogenase at enrollment ( P = .02); the combination of SAPS II score ≥ 33 with serum lactate dehydrogenase ≥ 405 units/L at ICU admission had 91% specificity in predicting the need for endotracheal intubation. In the propensity-matched cohorts (54 pairs), subjects with COVID-19 showed higher risk of NIOS failure than those with other causes of hypoxemic respiratory failure (59% vs 35%, P = .02), with an adjusted hazard ratio of 2 (95% CI 1.1-3.6, P = .01)., Conclusions: As compared to hypoxemic respiratory failure due to other etiologies, subjects with COVID-19 who were treated with NIOS in the ICU were burdened by a 2-fold higher risk of failure. Subjects with a SAPS II score ≥ 33 and serum lactate dehydrogenase ≥ 405 units/L represent the population with the greatest risk., (Copyright © 2021 by Daedalus Enterprises.)

Published
2021
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2. Long-term outcome of COVID-19 patients treated with helmet noninvasive ventilation vs. high-flow nasal oxygen: a randomized trial

Author

Michi T., Mattana C., Menga L. S., Bocci M. G., Cesarano M., Rosa T., Gualano M. R., Montomoli J., Spadaro S., Tosato M., Rota E., Landi F., Cutuli S. L., Tanzarella E. S., Pintaudi G., Piervincenzi E., Bello G., Tonetti T., Rucci P., De Pascale G., Maggiore S. M., Grieco D. L., Conti G., Antonelli M., Maviglia R., Mercurio G., De Santis P., Pennisi M. A., Anzellotti G. M., Torrini F., Rubino C., Morena T. C., Gennenzi V., Postorino S., Vargas J., Filetici N., Settanni D., Durante M., Cascarano L., Di Muro M., Scarascia R., Bitondo M. M., Murdolo M., Mele A., Silva S., Zaccone C., Pozzana F., Maccaglia A., Savino M., Potalivo A., Ceccaroni F., Scavone A., Lombardi G., Montini L., Dell'Anna A. M., Volta C. A., Ranieri V. M., Falo G., Carelli S., Natalini D., Berardi C., Delle Cese L., Vetrugno L., Balzani E., Michi T., Mattana C., Menga L.S., Bocci M.G., Cesarano M., Rosa T., Gualano M.R., Montomoli J., Spadaro S., Tosato M., Rota E., Landi F., Cutuli S.L., Tanzarella E.S., Pintaudi G., Piervincenzi E., Bello G., Tonetti T., Rucci P., De Pascale G., Maggiore S.M., Grieco D.L., Conti G., Antonelli M., Maviglia R., Mercurio G., De Santis P., Pennisi M.A., Anzellotti G.M., Torrini F., Rubino C., Morena T.C., Gennenzi V., Postorino S., Vargas J., Filetici N., Settanni D., Durante M., Cascarano L., Di Muro M., Scarascia R., Bitondo M.M., Murdolo M., Mele A., Silva S., Zaccone C., Pozzana F., Maccaglia A., Savino M., Potalivo A., Ceccaroni F., Scavone A., Lombardi G., Montini L., Dell'Anna A.M., Volta C.A., Ranieri V.M., Falo G., Carelli S., Natalini D., Berardi C., Delle Cese L., Vetrugno L., and Balzani E.

Subjects
Helmet, COVID-19, Acute respiratory failure, High-flow nasal oxygen, Noninvasive ventilation, Patient self-inflicted lung injury (P-SILI)
Abstract

Background: Long-term outcomes of patients treated with helmet noninvasive ventilation (NIV) are unknown: safety concerns regarding the risk of patient self-inflicted lung injury and delayed intubation exist when NIV is applied in hypoxemic patients. We assessed the 6-month outcome of patients who received helmet NIV or high-flow nasal oxygen for COVID-19 hypoxemic respiratory failure. Methods: In this prespecified analysis of a randomized trial of helmet NIV versus high-flow nasal oxygen (HENIVOT), clinical status, physical performance (6-min-walking-test and 30-s chair stand test), respiratory function and quality of life (EuroQoL five dimensions five levels questionnaire, EuroQoL VAS, SF36 and Post-Traumatic Stress Disorder Checklist for the DSM) were evaluated 6months after the enrollment. Results: Among 80 patients who were alive, 71 (89%) completed the follow-up: 35 had received helmet NIV, 36 high-flow oxygen. There was no inter-group difference in any item concerning vital signs (N = 4), physical performance (N = 18), respiratory function (N = 27), quality of life (N = 21) and laboratory tests (N = 15). Arthralgia was significantly lower in the helmet group (16% vs. 55%, p = 0.002). Fifty-two percent of patients in helmet group vs. 63% of patients in high-flow group had diffusing capacity of the lungs for carbon monoxide < 80% of predicted (p = 0.44); 13% vs. 22% had forced vital capacity < 80% of predicted (p = 0.51). Both groups reported similar degree of pain (p = 0.81) and anxiety (p = 0.81) at the EQ-5D-5L test; the EQ-VAS score was similar in the two groups (p = 0.27). Compared to patients who successfully avoided invasive mechanical ventilation (54/71, 76%), intubated patients (17/71, 24%) had significantly worse pulmonary function (median diffusing capacity of the lungs for carbon monoxide 66% [Interquartile range: 47–77] of predicted vs. 80% [71–88], p = 0.005) and decreased quality of life (EQ-VAS: 70 [53–70] vs. 80 [70–83], p = 0.01). Conclusions: In patients with COVID-19 hypoxemic respiratory failure, treatment with helmet NIV or high-flow oxygen yielded similar quality of life and functional outcome at 6months. The need for invasive mechanical ventilation was associated with worse outcomes. These data indicate that helmet NIV, as applied in the HENIVOT trial, can be safely used in hypoxemic patients. Trial registration Registered on clinicaltrials.gov NCT04502576 on August 6, 2020

Published
2023

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