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1. High flow nasal cannula combined with non-invasive ventilation versus high flow nasal cannula alone in patients with acute hypoxemic respiratory failure due to pneumonia: a randomized controlled trial

Author

Leonardo Ghezzi, Francesca Graziano, Giulia Bottani, Giulia Marullo, Nicolò Capsoni, Elisa Forni, Fabrizio Vincenti, Paola Rebora, and Andrea Bellone

Subjects
High Flow Nasal Cannula (HFNC), Non-Invasive Ventilation (NIV), acute hypoxemic respiratory failure (hARF), Medicine (General), R5-920
Abstract

In this monocentric, open label, randomized controlled trial we aimed to compare the efficacy of combined High Flow Nasal Cannula (HFNC) and Non invasive Ventilation (NIV) versus HFNC alone in acute hypoxemic respiratory failure (hARF) in patients affected by Community Acquired Pneumonia (CAP). We enrolled 49 patients affected by CAP with moderate to severe hypoxemic respiratory failure (P/F < 300). The patients were randomized into two groups: one has been treated with HFNC alone (group A) while the other received NIV alternated to HFNC every 3 hours (group B). The primary outcome was P/F change from baseline to 21 hours. Secondary outcomes included variation of pH and pCO2, need to continue HFNC or NIV/HFNC after 45 hours, orotracheal intubation, mortality rate, and the devices comfort. Not statistical significant differences between the two arms were shown in the P/F change at 21 hours since baseline, in pCO2 and pH variation, mortality at hospital and at follow-up. We emphasize the importance of combined HFNC with NIV as a first step for severe pneumonia treatment whereas HFNC might represent as the first step treatment in less severe patients and during the NIV intervals.

Published
2023
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2. Current application of high flow oxygen nasal cannula in acute hypoxemic respiratory failure in the emergency department

Author

Giulia Bottani, Fabio Centurioni, Giacomo Veronese, Fabrizio Vincenti, Elisa Forni, and Andrea Bellone

Subjects
hypoxemic respiratory failure, high flow oxygen nasal cannula, emergency medicine, Medicine (General), R5-920
Abstract

High flow oxygen with nasal cannula (HFONC) is a relatively new mode of oxygen delivery. Advantages of HFONC versus conventional oxygen therapy (COT) encompass carbon dioxide washout, generation of a slight positive end-expiratory pressure and maintenance of humidified gas flow through airways. These features are mostly shared with non-invasive mechanical ventilation (NIMV), although with lack of a clearly comparable efficacy. In the last few years, HFONC has gained interest as a third alternative to COT and NIMV in the management of acute hypoxemic respiratory failure in the critically ill patient, both in intensive care units and emergency departments. The aim of this article is to review indications, effects and existing evidence on HFONC, COT and NIMV in the setting of acute hypoxemic respiratory failure.

Published
2018
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3. Outcome at three months of COPD patients with acute hypercapnic respiratory failure treated with NPPV in an Acute Medicine Ward

Author

Fabrizio Vincenti, Adriano Basile, Ernesto Contro, Filippo Galbiati, Angela Oppizzi, Elisabetta Restelli, Maurizio Sommariva, and Daniele Coen

Subjects
COPD, hypercapnic respiratory failure, Acute Medicine Ward, Medicine (General), R5-920
Abstract

Non invasive positive pressure ventilation (NPPV) is increasingly used for patients with hypercapnic respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease (COPD). NPPV has been shown to improve arterial blood gas tensions and dyspnoea and to prevent the need for intubation in patients admitted to hospital with an exacerbation of COPD associated with respiratory acidosis. Although advantages of NPPV over conventional treatment have been convincingly documented in the short period, there are fewer data as to the outcomes following hospital discharge. We have undertaken a prospective descriptive study to obtain comprehensive data on the in hospital and 3 month outcomes of a cohort of 57 COPD patients treated with NPPV for acute hypercapnic respiratory failure as a first intervention in addition to usual medical care. Patients with a COPD exacerbation had better outcomes than patients with COPD complicated by other acute conditions. Pneumonia was specifically associated with a higher inhospital risk of death. In our series about one in four patients with an indicator of previous severe respiratory disease (past admission for acute respiratory failure, previous use of NPPV, long term oxygen therapy or home NPPV) was dead at three months after discharge and almost one in two was dead or had been readmitted. On the contrary, patients without indicators of previous severe respiratory disease benefited from NPPV during an acute episode of respiratory failure and had a chance of approximately 80% of being alive and free from recurrence at three months.

Published
2011
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4. CPAP Treatment In COVID-19 Patients: A Retrospective Observational Study In The Emergency Department

Author

Andrea Bellone, Marta Bergamaschi, Nicolò Capsoni, Valentina Albertini, Fabrizio Vincenti, Laura Angaroni, Eugenia Rocca, Daniele Privitera, Alberto Dal Molin, Chiara Airoldi, Federico Pierotti, Annamaria Mazzone, and Elisa Forni

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Emergency medicine, medicine, Cpap treatment, Retrospective cohort study, Emergency department, business
Abstract

Background During COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay. Methods A retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. Results A total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16–37] vs 15 days [IQR 9–17] (p = 0.005). The median invasive mechanical ventilation time was 11 days [IQR 7–21] with an ICU length of stay of 14.5 days [IQR 10–28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p = 0.003) and respiratory rate (RR) (p = 0.059). Conclusionss A short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient’s RR reduction. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.

Published
2020
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5. CPAP Use in Covid-19 Patients: A Retrospective Observational Study in the Emergency Department

Author

Nicolo Capsoni, Daniele Privitera, Annamaria Mazzone, Chiara Airoldi, Laura Angaroni, Elisa Forni, Federico Pierotti, Eugenia Rocca, Marta Bergamaschi, Valentina Albertini, Alberto Dal Molin, Fabrizio Vincenti, and Andrea Bellone

Abstract

BackgroundDuring COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay. Study design and MethodsA retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. ResultsA total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16-37] vs 15 days [IQR 9-17] (p=0.005). The median invasive mechanical ventilation time was 11 days [IQR 7-21] with an ICU length of stay of 14.5 days [IQR 10-28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p=0.003) and respiratory rate (RR) (p=0.059).ConclusionsA short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient’s SpO2 improvement and RR reduction. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.

Published
2020
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6. Flowchart for non-invasive ventilation support in COVID-19 patients from a northern Italy Emergency Department

Author

Nicolò Capsoni, Fabrizio Vincenti, Andrea Bellone, Laura Angaroni, Elisa Forni, Federico Pierotti, and Daniele Privitera

Subjects
medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Pneumonia, Viral, Endotracheal intubation, Guidelines as Topic, 030204 cardiovascular system & hematology, medicine.disease_cause, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Pandemic, medicine, Internal Medicine, Intubation, Intratracheal, Humans, 030212 general & internal medicine, Pandemics, Coronavirus, Noninvasive Ventilation, business.industry, SARS-CoV-2, COVID-19, Emergency department, Hypoxemic respiratory failure, Northern italy, Continuous positive airways pressure, Italy, Emergency medicine, Emergency Medicine, Non-invasive ventilation, business, Coronavirus Infections, Emergency Service, Hospital, IM-Point of view
Abstract

With the rapid pandemic spread of the novel coronavirus (SARS-CoV2), Emergency Departments of affected countries are facing an increasing number of patients presenting with hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). Providing mechanical support and endotracheal intubation can be challenging due to a number of patients larger than usual, often exceeding available resources. Considering the lack of recommendations available, we developed a flowchart to standardize the first approach to patients presenting to the Emergency Department with hypoxemic respiratory failure due to COVID-19.

Published
2020

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