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5 results on '"Mauro Castro-Sayat"'

1. Lung ultrasound score predicts outcomes in patients with acute respiratory failure secondary to COVID-19 treated with non-invasive respiratory support: a prospective cohort study

Author

Mauro Castro-Sayat, Nicolás Colaianni-Alfonso, Luigi Vetrugno, Gustavo Olaizola, Cristian Benay, Federico Herrera, Yasmine Saá, Guillermo Montiel, Santiago Haedo, Ignacio Previgliano, Ada Toledo, and Catalina Siroti

Subjects
COVID-19, Acute respiratory failure, Ultrasonography, Non-invasive ventilation, Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

Abstract Background Lung ultrasound has demonstrated its usefulness in several respiratory diseases management. One derived score, the Lung Ultrasound (LUS) score, is considered a good outcome predictor in patients with Acute Respiratory Failure (ARF). Nevertheless, it has not been tested in patients undergoing non-invasive respiratory support (NIRS). Taking this into account, the aim of this study is to evaluate LUS score as a predictor of 90-day mortality, ETI (Endotracheal intubation) and HFNC (High Flow Nasal Cannula) failure in patients with ARF due to COVID-19 admitted to a Respiratory Intermediate Care Unit (RICU) for NIRS management. Results One hundred one patients were admitted to the RICU during the study period. Among these 76% were males and the median age was 55 (45–64) years. Initial ARF management started with HFNC, the next step was the use of Continuous Positive Airway Pressure (CPAP) devices and the last intervention was ETI and Intensive Care Unit (ICU) admission. Of the total study population, CPAP was required in 40%, ETI in 26%, while 15% died. By means of a ROC analysis, a LUS ≥ 25 points was identified as the cut-off point for mortality(AUC 0.81, OR 1.40, 95% CI 1.14 to 1.71; p

Published
2024
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2. Use of Non-Invasive Respiratory Support in Critically Ill Patients Post-Extubation: a Narrative Review

Author

Nicolás Colaianni- Alfonso, Guillermo Montiel, and Mauro Castro-Sayat

Subjects
weaning, extubation, high-flow nasal cannula, non-invasive ventilation, Medicine (General), R5-920
Abstract

The rate of re-intubation after extubation is recorded at 10-20%. The use of non-invasive respiratory support (NIRS) post-extubation such as High-Flow Nasal Cannula, non-invasive ventilation (bilevel pressure) and continuous positive airway pressure (CPAP) have been shown to be safe and effective post-extubation. The pre-weaning period represents a crucial time in the management of critically ill patients, as extubation failure, defined as the need for re-intubation within 2-7 days, showed worse outcomes with mortality increasing by 25-50%. This situation leads to the requirement for prolonged mechanical ventilation, ventilator-associated pneumonia and long lengths of hospital stay. Therefore, it is essential to identify patients who will benefit from NIRS post extubation.

Published
2024
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4. COVID-19 Pneumonia and ROX index: Time to set a new threshold for patients admitted outside the ICU

Author

Gustavo Olaizola, Mauro Castro Sayat, Nicolás Colaianni, Greta Spoladore, Stefano Nava, Irene Prediletto, Roberto Dongilli, Maria Laura Vega, Lara Pisani, Micaela Romagnoli, Guillermo Montiel, Vega M.L., Dongilli R., Olaizola G., Colaianni N., Sayat M.C., Pisani L., Romagnoli M., Spoladore G., Prediletto I., Montiel G., and Nava S.

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Respiratory rate, medicine.medical_treatment, Brief Communication, medicine.disease_cause, HFNC, law.invention, Diseases of the respiratory system, 03 medical and health sciences, ROX index, 0302 clinical medicine, Respiratory Rate, AHRF, law, Fraction of inspired oxygen, Non invasive respiratory support, Intubation, Intratracheal, medicine, Humans, Intubation, Oximetry, 030212 general & internal medicine, Acute hypoxemic respiratory failure, Survival analysis, Retrospective Studies, Mechanical ventilation, Noninvasive Ventilation, RC705-779, medicine.diagnostic_test, SARS-CoV-2, business.industry, Oxygen Inhalation Therapy, COVID-19, Intensive care unit, High flow nasal cannula, Intensive Care Units, Pulse oximetry, 030228 respiratory system, Emergency medicine, Respiratory Insufficiency, business, Nasal cannula
Abstract

High flow nasal cannula (HFNC) is used to treat acute hypoxemic respiratory failure (AHRF) even outside the ICU and the ROX index (pulse oximetry/fraction of inspired oxygen/respiratory rate) may predict HFNC failure. OBJECTIVE: The purpose of this investigation was therefore to verify whether the ROX index is an accurate predictor of HFNC failure for COVID-19 patients treated outside the intensive care unit (ICU) and to evaluate the validity of the previously suggested threshold. DESIGN: Multicenter study. Retrospective observational analysis of prospectively collected data. SETTING: 3 centres specialized in non-invasive respiratory support (Buenos Aires, Argentina; Bolzano and Treviso, Italy). Patients treated outside the ICU were analysed MEASUREMENTS: The variables to calculate the ROX index were collected during the first day of therapy at 2, 6, 12 and 24 hours and then recorded every 24 hours. HFNC failure was defined as escalation of respiratory support to invasive mechanical ventilation (IMV) or death. MAIN RESULTS: A total of 35 (29%) patients failed HFNC and required intubation. ROC analysis identified the 12-hour ROX index as the best predictor of intubation with an AUC of 0.7916[CI 95% 0.6905-0.8927] and the best threshold to be 5.99[Specificity 96% Sensitivity 62%]. In the survival analysis, a ROX value

Published
2022
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5. Combined Noninvasive Respiratory Support Therapies to Treat COVID-19

Author

Ignacio Previgliano, Ada Toledo, Guido Mazzinari, Catalina Siroti, Maria Laura Vega, Guillermo Montiel, Santiago Haedo, Mauro Castro-Sayat, Jose Miguel Alonso-Iñigo, and Nicolas Colaianni-Alfonso

Subjects
Pulmonary and Respiratory Medicine, Respiratory rate, medicine.medical_treatment, Critical Care and Intensive Care Medicine, medicine.disease_cause, Medicine, Intubation, Cannula, Humans, Continuous positive airway pressure, Respiratory system, Prospective cohort study, Original Research, Noninvasive Ventilation, business.industry, SARS-CoV-2, Mortality rate, Oxygen Inhalation Therapy, COVID-19, General Medicine, Respiratory failure, Anesthesia, COVID-19, SARS-CoV-2, combined therapy, continuous positive airway pressure, high-flow nasal cannula, hypoxemic respiratory failure, business, Respiratory Insufficiency, Nasal cannula
Abstract

BACKGROUND: The roles of high-flow nasal cannula (HFNC) and CPAP in coronavirus disease 2019 (COVID-19) are controversial. The objective of the study was to evaluate the impact of the application of a noninvasive respiratory support algorithm on clinical outcomes in subjects with COVID-19 and with acute respiratory failure. METHODS: We performed a single-center prospective observational study of subjects with respiratory failure from COVID-19 managed with HFNC and with CPAP plus HFNC (combined therapy). The main outcome was the intubation rate, which defined failure of therapy. We also analyzed the role of the ROX index ([ S pO 2 / F IO 2 ]/breathing frequency) to predict the need for intubation. RESULTS: From June to December 2020, 113 subjects with COVID-19 respiratory failure were admitted to our respiratory intermediate care unit. HFNC was applied in 65 subjects (57.52%) and combined therapy in 48 subjects (42.47%). A total of 83 subjects (73.45%) were successfully treated with noninvasive respiratory support. The intubation rate was 26.54%, and the overall mortality rate was 14.15%. The mortality rate in subjects who were intubated was 55.2%. An ROX index of 6.28 at 12 h predicted noninvasive respiratory support failure, with 97.6% sensitivity and 51.8% specificity. CONCLUSIONS: Data from our cohort managed in a respiratory intermediate care unit showed that combined noninvasive respiratory support was feasible, with favorable outcomes. Further prospective studies are required.

Published
2021

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