Multidisciplinary Respiratory Medicine最新文献

{"title":"The pharmacoeconomics of the state-of-the-art drug treatments for asthma: a systematic review.","authors":"Francesco Menzella,&nbsp;Carla Galeone,&nbsp;Giulia Ghidoni,&nbsp;Patrizia Ruggiero,&nbsp;Maria D'Amato,&nbsp;Matteo Fontana,&nbsp;Nicola Facciolongo","doi":"10.4081/mrm.2021.787","DOIUrl":"https://doi.org/10.4081/mrm.2021.787","url":null,"abstract":"<p><p>Asthma is a chronic disease characterized by significant morbidities and mortality, with a large impact on socio-economic resources and a considerable burden on health-care systems. In the standard care of asthma, inhaled corticosteroids (ICS) associated with long-acting β-adrenoceptor agonists (LABA) are a reliable and often cost-effective choice, especially if based on the single inhaler therapy (SIT) strategy; however, in a subset of patients it is not possible to reach an adequate asthma control. In these cases, it is possible to resort to other pharmacologic options, including corticosteroids (OCS) or biologics. Unfortunately, OCS are associated with important side effects, whilst monoclonal antibodies (mAbs) allow excellent results, even if far more expensive. Up to now, the economic impact of asthma has not been compared with equivalent indicators in several studies. In fact, a significant heterogeneity of the cost analysis is evident in literature, for which the assessment of the real cost-effectiveness of asthma therapies is remarkably complex. To maximize the cost-effectiveness of asthma strategies, especially of biologics, attention must be paid on phenotyping and identification of predictors of response. Several studies were included, involving comparative analysis of drug treatments for asthma, comparative analysis of the costs and consequences of therapies, measurement and evaluation of direct drug costs, and the reduction of health service use. The initial research identified 389 articles, classified by titles and abstracts. A total of 311 articles were excluded as irrelevant and 78 articles were selected. Pharmacoeconomic studies on asthma therapies often report conflicting data also due to heterogeneous indicators and different populations examined. A careful evaluation of the existing literature is extremely important, because the scenario is remarkably complex, with an attempt to homogenize and interpret available data. Based on these studies, the improvement of prescriptive appropriateness and the reduction of the use of healthcare resources thanks to controller medications and to innovative therapies such as biologics partially reduce the economic burden of these treatments. A multidisciplinary stakeholder approach can also be extremely helpful in deciding between the available options and thus optimizing healthcare resources.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"787"},"PeriodicalIF":2.3,"publicationDate":"2021-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3b/42/mrm-16-1-787.PMC8404525.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39446572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A single-center comparative study of lung ultrasound versus chest computed tomography during the COVID-19 era.","authors":"Kobalava Zhanna Davidovna,&nbsp;Ayten Fuad Safarova,&nbsp;Flora Elisa Cabello Montoya,&nbsp;Maria Vasilevna Vatsik-Gorodetskaya,&nbsp;Karaulova Yulia Leonidovna,&nbsp;Zorya Olga Tairovna,&nbsp;Arutina Olga Valeryevna,&nbsp;Rajesh Rajan,&nbsp;Mohammed Al Jarallah,&nbsp;Peter A Brady,&nbsp;Ibrahim Al-Zakwani","doi":"10.4081/mrm.2021.766","DOIUrl":"https://doi.org/10.4081/mrm.2021.766","url":null,"abstract":"<p><strong>Background: </strong>Lung ultrasound (LUS) is a bedside imaging tool that has proven useful in identifying and assessing the severity of pulmonary pathology. The aim of this study was to determine LUS patterns, their clinical significance, and how they compare to CT findings in hospitalized patients with coronavirus infection.</p><p><strong>Methods: </strong>This observational study included 62 patients (33 men, age 59.3±15.9 years), hospitalized with pneumonia due to COVID-19, who underwent chest CT and bedside LUS on the day of admission. The CT images were analyzed by chest radiographers who calculated a CT visual score based on the expansion and distribution of ground-glass opacities and consolidations. The LUS score was calculated according to the presence, distribution, and severity of anomalies.</p><p><strong>Results: </strong>All patients had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 8.1±2.9%. LUS identified 4 different abnormalities, with bilateral distribution (mean LUS score: 26.4±6.7), focal areas of non-confluent B lines, diffuse confluent B lines, small sub-pleural micro consolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (rho = 0.70; p<0.001). Correlation analysis of the CT and LUS severity scores showed good interclass correlation (ICC) (ICC =0.71; 95% confidence interval (CI): 0.52-0.83; p<0.001). Logistic regression was used to determine the cut-off value of ≥27 (area under the curve: 0.97; 95% CI: 90-99; sensitivity 88.5% and specificity 97%) of the LUS severity score that represented severe and critical pulmonary involvement on chest CT (CT: 3-4).</p><p><strong>Conclusion: </strong>When combined with clinical data, LUS can provide a potent diagnostic aid in patients with suspected COVID-19 pneumonia, reflecting CT findings.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"766"},"PeriodicalIF":2.3,"publicationDate":"2021-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/58/05/mrm-16-1-766.PMC8314678.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39273202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy and precision of pulse oximeter at different sensor locations in patients with heart failure.","authors":"Alaa Thabet Hassan,&nbsp;Soher Mostafa Ahmed,&nbsp;Azza Salah AbdelHaffeez,&nbsp;Sherif A A Mohamed","doi":"10.4081/mrm.2021.742","DOIUrl":"https://doi.org/10.4081/mrm.2021.742","url":null,"abstract":"<p><strong>Background: </strong>Despite its wide use in clinical practice, few studies have assessed the role of pulse oximetry in patients with heart failure. We aimed to evaluate the accuracy and precision of the pulse oximeter in patients with heart failure and to determine this accuracy at three different sensor locations.</p><p><strong>Methods: </strong>Comparison of pulse oximetry reading (SpO₂) with arterial oxygen saturation (SaO₂) was reported in 3 groups of patients with heart failure (HF); those with ejection fraction (EF) >40%, those with EF <40%, and those with acute HF (AHF) with ST and non-ST segment elevation acute myocardial infarction (STEMI and non-STEMI).</p><p><strong>Results: </strong>A total of 235 patients and 90 control subjects were enrolled. There were significant differences in O₂ saturation between control and patients' groups when O₂ saturation is measured at the finger and toe, but not the ear probes; p=0.029, p=0.049, and 0.051, respectively. In HF with EF>40% and AHF with O₂ saturations >90%, finger oximetry is the most accurate and reliable, while in HF with EF<40% and in patients with AHF with O₂ saturations <90%, ear oximetry is the most accurate.</p><p><strong>Conclusion: </strong>Pulse oximetry is a reliable tool in assessing oxygen saturation in patients with heart failure of different severity. In HF with EF>40% and in AHF with O₂ saturations >90%, finger oximetry is the most accurate and reliable, while in HF with EF<40% and in patients with AHF with O₂ saturations <90%, ear oximetry is the most accurate. Further studies are warranted.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"742"},"PeriodicalIF":2.3,"publicationDate":"2021-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b8/cf/mrm-16-1-742.PMC8278778.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39228481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency of computed tomography abnormalities in patients with chronic thromboembolic pulmonary hypertension: a comparative study between lung perfusion scan and computed tomography pulmonary angiography.","authors":"Ahmed Fathala,&nbsp;Alaa Aldurabi","doi":"10.4081/mrm.2021.753","DOIUrl":"https://doi.org/10.4081/mrm.2021.753","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the leading causes of pulmonary hypertension. Diagnosis of CTEPH can be established using various imaging techniques, including ventilation-perfusion scintigraphy (VQ) and multidetector computed tomography pulmonary angiography (CTPA). The aim of this study was to determine the frequency of direct pulmonary vascular, parenchymal lung, and cardiac abnormalities on CTPA in patients with CTEPH and to compare the diagnostic accuracy of both VQ scan CTPA in detecting CTEPH.</p><p><strong>Methods: </strong>We retrospectively included 54 patients who had been referred for pulmonary hypertension service (20 males, 34 females). All patients had VQ scan and CTPA within 15 days and underwent pulmonary artery endarterectomy (PEA) thereafter. VQ scans were reported according to modified PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) criteria. CTPA was considered as diagnostic for CTEPH if it showed presence of thrombus, webs, stenosis, or perfusion lung abnormalities.</p><p><strong>Results: </strong>The mean age of the study population was 41±10 years. The mean pulmonary artery pressure was 53±13 mmHg. Fifty-three out of 54 patients in the study population had high probability VQ scan and one patient had intermediate probability. CTPA was suggestive of CTEPH in all patients. The most frequent CTPA findings in the central pulmonary arteries and peripheral arteries were presence of thrombotic materials, abnormal vessel tapering and abrupt vessels-cut off (76% <i>vs</i> 65%, 67% <i>vs</i> 48%, and 48% <i>vs</i> 22%), respectively. The mosaic lung perfusion was present in 78% of the patients, and various cardiac morphology abnormalities were present and most common was abnormal right to left ventricle ratio (69%).</p><p><strong>Conclusion: </strong>Our findings indicate that both VQ scan and CTPA are highly sensitive for the detection of CTEPH confirmed by PEA. Most CTEPH patients had several pulmonary vascular, parenchymal lung and cardiac abnormalities. There was no sign with 100% sensitivity on CTPA for CTEPH detection.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"753"},"PeriodicalIF":2.3,"publicationDate":"2021-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ec/fe/mrm-16-1-753.PMC8273626.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39255918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of patients with COVID-19 who are optimal for methylprednisolone pulse therapy.","authors":"Shosei Ro,&nbsp;Naoki Nishimura,&nbsp;Ryosuke Imai,&nbsp;Yutaka Tomishima,&nbsp;Clara So,&nbsp;Manabu Murakami,&nbsp;Kohei Okafuji,&nbsp;Atsushi Kitamura,&nbsp;Torahiko Jinta,&nbsp;Tomohide Tamura","doi":"10.4081/mrm.2021.781","DOIUrl":"https://doi.org/10.4081/mrm.2021.781","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids have been reported to reduce the mortality rates in patients with coronavirus disease 2019 (COVID-19). Additionally, the role of high-dose methylprednisolone pulse therapy in reducing mortality in critically ill patients has also been documented. The purpose of this study is to identify patients with COVID-19 who are suitable for methylprednisolone pulse therapy.</p><p><strong>Methods: </strong>This was a retrospective study that included patients with COVID-19 receiving methylprednisolone pulse therapy (≥250 mg/day for 3 days) with subsequent tapering doses at our hospital between June 2020 and January 2021. We examined the differences in background clinical factors between the surviving group and the deceased group.</p><p><strong>Results: </strong>Out of 156 patients who received steroid therapy, 17 received methylprednisolone pulse therapy. Ten patients recovered (surviving group) and seven patients died (deceased group). The median age of the surviving and deceased groups was 64.5 years (range, 57-85) and 79 years (73-90), respectively, with a significant difference (p=0.004). Five of the deceased patients (71%) had developed serious complications associated with the cause of death, including pneumothorax, pneumomediastinum, COVID-19-associated pulmonary aspergillosis, cytomegalovirus infection, and bacteremia. On the other hand, out of the 10 survivors, only one elderly person had cytomegalovirus infection and the rest recovered without complications.</p><p><strong>Conclusion: </strong>Administration of methylprednisolone pulse therapy with subsequent tapering may be an effective treatment in patients with COVID-19 up to the age of early 70s; however, severe complications may be seen in elderly patients.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"781"},"PeriodicalIF":2.3,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0d/cb/mrm-16-1-781.PMC8273631.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39255919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Londrina activities of daily living protocol and Glittre ADL test on cardio-pulmonary response in patients with COPD: a cross-sectional study.","authors":"Chaitali Deshpande,&nbsp;Gopala Krishna Alaparthi,&nbsp;Shyam Krishnan,&nbsp;Kalyan Chakravarthy Bairapareddy,&nbsp;Anand Ramakrishna,&nbsp;Vishak Acharya","doi":"10.4081/mrm.2020.694","DOIUrl":"https://doi.org/10.4081/mrm.2020.694","url":null,"abstract":"<p><strong>Background: </strong>In COPD patients it is very important to assess the activities of daily living (ADL) due to an impairment of independence and quality of life. There is a lack of retrievable data regarding the cardio-pulmonary response to Londrina ADL protocol in patients with COPD. The aim of the present study was to assess the cardio-pulmonary response to Londrina ADL protocol in patients with COPD and to compare this with responses to the Glittre ADL test.</p><p><strong>Methods: </strong>This cross-sectional study was done on 30 COPD subjects. Each subject was taken to perform the Londrina ADL protocol, Glittre ADL test, twice each, on subsequent days. The Londrina ADL protocol comprises 5 activities representing ADL, involving upper limbs, lower limbs, and trunk movements. The Glittre ADL test consists of completing a circuit while carrying a weighted backpack (2.5 kg for women, 5.0 kg for men). The better value of the two was taken into consideration. For the Londrina ADL protocol and Glittre ADL test the outcome of primary interest was time and for the six-minute walk test was the distance walked. The secondary outcomes for all tests were heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, saturation of oxygen in blood and dyspnea.</p><p><strong>Results: </strong>The COPD subjects of age group 63.27±11.07 years took 5.94±0.36 min to complete trial 2 of the Londrina ADL protocol. Significant physiological increases in heart rate (p≤0.01), respiratory rate (p≤0.01), blood pressure (p≤0.01) and severity of dyspnea (p≤0.01) were observed, whereas saturation of oxygen in blood (p≤0.01) was reduced at the end of the Londrina ADL protocol and Glittre ADL test. There was a positive, non-significant correlation between the six-minute walk test distance and the Londrina ADL protocol time (r=0.236) (p=0.209). A positive, not significant correlation was observed between the Glittre ADL test (time) and the Londrina ADL protocol (time) (r=0.194) (p=0.304) and a negative but not significant correlation between the six-minute walk test (distance) and the Glittre ADL test (time) (r= -0.184) (p=0.330).</p><p><strong>Conclusion: </strong>The Londrina ADL protocol can be used as an assessment tool for the evaluation of functional performance and activities of daily living in COPD along with other test protocols in pulmonary rehabilitation.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"694"},"PeriodicalIF":2.3,"publicationDate":"2020-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6f/41/mrm-15-1-694.PMC7731885.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38718737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel therapeutic approaches for the management of cystic fibrosis.","authors":"Ryan Jaques, Arslan Shakeel, Cameron Hoyle","doi":"10.4081/mrm.2020.690","DOIUrl":"10.4081/mrm.2020.690","url":null,"abstract":"<p><p>Cystic fibrosis (CF) is a genetic condition characterised by the build-up of thick, sticky mucus that can damage many of the body's organs. It is a life-long disease that results in a shortened life expectancy, often due to the progression of advanced lung disease. Treatment has previously targeted the downstream symptoms such as diminished mucus clearance and recurrent infection. More recently, significant advances have been made in treating the cause of the disease by targeting the faulty gene responsible. Hope for the development of potential therapies lies with ongoing research into new pharmacological agents and gene therapy. This review gives an overview of CF, and summarises the current evidence regarding the disease management and upcoming strategies aimed at treating or potentially curing this condition.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"690"},"PeriodicalIF":2.0,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/26/5f/mrm-15-1-690.PMC7706361.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38341003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive assessment of peripheral skeletal muscle weakness in idiopathic pulmonary fibrosis: a pilot study with multiparametric MRI of the rectus femoris muscle.","authors":"Wagner Diniz de Paula,&nbsp;Marcelo Palmeira Rodrigues,&nbsp;Nathali Mireise Costa Ferreira,&nbsp;Viviane Vieira Passini,&nbsp;César Augusto Melo-Silva","doi":"10.4081/mrm.2020.707","DOIUrl":"https://doi.org/10.4081/mrm.2020.707","url":null,"abstract":"<p><strong>Background: </strong>To investigate differences in magnetic resonance imaging (MRI) features of rectus femoris muscle between idiopathic pulmonary fibrosis (IPF) patients and healthy volunteers.</p><p><strong>Methods: </strong>Thirteen IPF patients with GAP Index stage II disease were subjected to pulmonary function tests, 6-minute walk test (6MWT), quadriceps femoris muscle strength measurement and MRI of the thigh at rest. At MRI, muscle cross-sectional areas, T2 and T2* relaxometry, and 3-point Dixon fat fraction were measured. The results were compared to those of eight healthy sedentary volunteers.</p><p><strong>Results: </strong>IPF patients had significantly lower %predicted FVC, FEV¹ and DL_CO (p<0.001 for the three variables) and walked significantly less in the 6MWT (p=0.008). Mean quadriceps femoris muscle strength also was significantly lower in IPF patients (p=0.041). Rectus femoris muscle T2* measurements were significantly shorter in IPF patients (p=0.027). No significant intergroup difference was found regarding average muscle cross-sectional areas (p=0.790 for quadriceps and p=0.816 for rectus femoris) or rectus femoris fat fraction (p=0.901). Rectus femoris T2 values showed a non-significant trend to be shorter in IPF patients (p=0.055).</p><p><strong>Conclusions: </strong>Our preliminary findings suggest that, besides disuse atrophy, other factors such as hypoxia (but not inflammation) may play a role in the peripheral skeletal muscle dysfunction observed in IPF patients. This might impact the rehabilitation strategies for IPF patients and warrants further investigation.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"707"},"PeriodicalIF":2.3,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/00/9d/mrm-15-1-707.PMC7686790.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38341004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19: general overview, pharmacological options and ventilatory support strategies.","authors":"Francesco Menzella, Andrea Matucci, Alessandra Vultaggio, Chiara Barbieri, Mirella Biava, Chiara Scelfo, Matteo Fontana, Nicola Cosimo Facciolongo","doi":"10.4081/mrm.2020.708","DOIUrl":"10.4081/mrm.2020.708","url":null,"abstract":"<p><p>The novel coronavirus called \"Severe Acute Respiratory Syndrome Coronavirus 2\" (SARS-CoV-2) caused an outbreak in December 2019, starting from the Chinese city of Wuhan, in the Hubei province, and rapidly spreading to the rest of the world. Consequently, the World Health Organization (WHO) declared that the coronavirus disease of 2019 (COVID-19) can be characterized as a pandemic. During COVID-19 several immunological alterations have been observed: in plasma of severe patients, inflammatory cytokines are at a much higher concentration (\"cytokine storm\"). These aspects are associated with pulmonary inflammation and parenchymal infiltrates with an extensive lung tissue damage in COVID-19 patients. To date, clinical evidence and guidelines based on reliable data and randomized clinical trials (RCTs) for the treatment of COVID-19 are lacking. In the absence of definitive management protocols, many treatments are currently being evaluated worldwide. Some of these options were soon abandoned due to ineffectiveness, while others showed promising results. As for ventilatory strategies, at the moment there are still no consistent data published about the different approaches and how they may influence disease progression. What will probably represent the real solution to this pandemic is the identification of a safe and effective vaccine, for which enormous efforts and investments are being put in place. This review will summarize the state-of-the-art of COVID-19 current treatment options and those potentially available in the future, as well as high flow oxygen therapy and non-invasive mechanical ventilation approaches.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"708"},"PeriodicalIF":2.0,"publicationDate":"2020-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/33/mrm-15-1-708.PMC7662457.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38341005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy.","authors":"Valentina Di Lecce,&nbsp;Giovanna Elisiana Carpagnano,&nbsp;Paola Pierucci,&nbsp;Vitaliano Nicola Quaranta,&nbsp;Federica Barratta,&nbsp;Annapaola Zito,&nbsp;Enrico Buonamico,&nbsp;Onofrio Resta","doi":"10.4081/mrm.2020.704","DOIUrl":"https://doi.org/10.4081/mrm.2020.704","url":null,"abstract":"<p><p>The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11^th to May 31^st 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO²/FiO₂ ratio between 100 and 200 and 17% showed Pa0₂/FiO₂ ratio <100. Mean Pa0₂/FiO₂ ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% were transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"15 1","pages":"704"},"PeriodicalIF":2.3,"publicationDate":"2020-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/9f/mrm-15-1-704.PMC7662452.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38341002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}