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Papers by antonio corrado

Research paper thumbnail of Alternative Techniques for Managing Acute Neuromuscular Respiratory Failure

Seminars in Neurology, 1995

Research paper thumbnail of Costs of the COPD. Differences between intensive care unit and respiratory intermediate care unit

Respiratory Medicine, 2005

Research paper thumbnail of Negative-pressure ventilation: is there still a role

European Respiratory Journal, 2002

Research paper thumbnail of Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled

British Medical Journal, 2000

To determine the effectiveness of ranitidine and sucralfate in the prevention of stress ulcer in ... more To determine the effectiveness of ranitidine and sucralfate in the prevention of stress ulcer in critical patients and to assess if these treatments affect the risk of nosocomial pneumonia. Design Published studies retrieved through Medline and other databases. Five meta-analyses evaluated effectiveness in terms of bleeding rates (A: ranitidine v placebo; B: sucralfate v placebo) and infectious complications in terms of incidence of nosocomial pneumonia (C: ranitidine v placebo; D: sucralfate v placebo; E: ranitidine v sucralfate). Trial quality was determined with an empirical ad hoc procedure. Main outcome measures Rates of clinically important gastrointestinal bleeding and nosocomial pneumonia (compared between the two study arms and expressed with odds ratios specific for individual studies and meta-analytic summary odds ratios). Results Meta-analysis A (five studies) comprised 398 patients; meta-analysis C (three studies) comprised 311 patients; meta-analysis D (two studies) comprised 226 patients: and meta-analysis E (eight studies) comprised 1825 patients. Meta-analysis B was not carried out as the literature search selected only one clinical trial. In meta-analysis A ranitidine was found to have the same effectiveness as placebo (odds ratio of bleeding 0.72, 95% confidence interval 0.30 to 1.70, P = 0.46). In placebo controlled studies (meta-analyses C and D) ranitidine and sucralfate had no influence on the incidence of nosocomial pneumonia. In comparison with sucralfate, ranitidine significantly increased the incidence of nosocomial pneumonia (meta-analysis E: 1.35, 1.07 to 1.70, P = 0.012). The mean quality score in the four analyses (on a 0 to 10 scale) ranged from 5.6 in meta-analysis E to 6.6 in meta-analysis A. Conclusions Ranitidine is ineffective in the prevention of gastrointestinal bleeding in patients in intensive care and might increase the risk of pneumonia. Studies on sucralfate do not provide conclusive results. These findings are based on small numbers of patients, and firm conclusions cannot presently be proposed.

Research paper thumbnail of European Respiratory Society Task Force on epidemiology of respiratory intermediate care in Europe

Research paper thumbnail of Intermittent negative pressure ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency

Research paper thumbnail of Tracheostomy in patients with long-term mechanical ventilation: A survey

Respiratory Medicine, 2010

Tracheostomy is increasingly performed in intensive care units (ICU), with many patients transfer... more Tracheostomy is increasingly performed in intensive care units (ICU), with many patients transferred to respiratory ICU (RICU). Indications/timing for closing tracheostomy are discussed.We report results of a one-year survey evaluating: 1) clinical characteristics, types of tracheostomy, complications in patients admitted to Italian RICU in 2006; 2) clinical criteria and systems for performing decannulation, and outcome of patients undergoing tracheostomy (number decannulated; number non-decannulated/non-ventilated; number non-decannulated/ventilated; dead/lost patients).22/32 RICUs replied. There were 846 admissions of 719 patients (Mean age 64,3 (±14.2) years, 489 (68%) males). Causes of admission were: acute respiratory failure with underlying chronic co-morbidities 176 (24.4%); exacerbation of Chronic Obstructive Pulmonary Disease 222 (34.4%); neuromuscular diseases 200 (27.8%); surgical patients 77 (10.7%); thoracic dysmorphism 28 (3.8%); obstructive sleep apnea syndrome 16 (2.2%). Percutaneous tracheostomies were 65.9%. Major complications after tracheostomy were 2%. 427 tracheostomies were evaluated for decannulation: 96 (22.5%) were closed; 175 patients (41%) were discharged with home mechanical ventilation; 114 patients (26.5%) maintained the tracheostomy despite weaning from mechanical ventilation and 42 patients (10%) died or lost.The clinical criteria chosen for decannulation were: stability of respiratory conditions, effective cough, underlying diseases and ability to swallow. The systems for evaluating feasibility of decannulation were: closure of tracheostomy tube; laryngo-tracheoscopy; use of tracheal button and down-sizing.There were few major complications of tracheostomy. A substantial proportion of patients maintain the tracheostomy despite not requiring mechanical ventilation. There was no agreement on indications and systems for closing tracheostomy.

Research paper thumbnail of Ventilatory and Respiratory Muscle Responses to Hypercapnia in Patients with Paraplegia

... 1 Respiratory Intensive Care Unit, and Spinal Unit, Careggi Hospital, Firenze, Italy. Corresp... more ... 1 Respiratory Intensive Care Unit, and Spinal Unit, Careggi Hospital, Firenze, Italy. Correspondence and requests for reprints should be addressed to Dr. Massimo Gorini, Unità di Terapia Intensiva Respiratoria, Careggi Hospital, Villa D'Ognissanti ... Aliverti A.,; Cala SJ,; Duranti ...

Research paper thumbnail of Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered

European Respiratory Journal, 1996

Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure v... more Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure ventilators. Negative pressure ventilators, such as the "iron lung", support ventilation by exposing the surface of the chest wall to subatmospheric pressure during inspiration; whereas, expiration occurs when the pressure around the chest wall increases and becomes atmospheric or greater than atmospheric. In this review, after a description of the more advanced models of tank ventilators and the physiological effects of negative pressure ventilation (NPV), we summarize the recent application of this old technique in the treatment of acute respiratory failure (ARF). Several uncontrolled studies suggest that NPV may have a potential therapeutic role in the treatment of acute on chronic respiratory failure in patients with chronic obstructive pulmonary disease and restrictive thoracic disorders, reducing the need for endotracheal intubation. In the paediatric field, after substantial technical improvement, NPV has been successfully reintroduced for the treatment of ARF due to neonatal distress syndrome and bronchopulmonary dysplasia, and for the weaning from positive pressure ventilation in intubated patients. The positive results of these reports need to be formally confirmed by further prospective and controlled studies before recommending the generalized use of negative pressure ventilation in acute respiratory failure as a standard of care.

Research paper thumbnail of Respiratory intensive care units in Italy: a national census and prospective cohort study

Research paper thumbnail of Long-term negative pressure ventilation

Respiratory Care Clinics, 2002

Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure v... more Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure ventilators. Negative pressure ventilators support ventilation by exposing the surface of the chest wall to subatmospheric pressure during inspiration, whereas expiration occurs when the pressure around the chest wall increases and becomes equal to or greater than atmospheric pressure. In this article, a description of negative pressure ventilators and the physiologic effects of negative pressure ventilation (NPV) is given, and the application of this technique in the long-term treatment of chronic respiratory failure is summarized. Many studies, although uncontrolled, have shown that long-term treatment with NPV can improve respiratory muscle function, arterial blood gases, and survival in patients with neuromuscular and chest wall disorders. NPV devices, however, are more cumbersome and difficult to use than home positive pressure ventilators (PPVs) and tend to predispose to obstructive apnoeas during sleep. In the last several decades, NPV has been supplanted by mask PPV. In experienced hands, NPV remains a second viable option in patients with neuromuscular and chest wall disorders who, for technical or other reasons, cannot be offered mask PPV. There is no evidence, however, that long-term treatment with NPV can improve respiratory muscle function, exercise endurance, quality of life, and survival in patients with severe chronic obstructive pulmonary disease.

Research paper thumbnail of Iron lung versus conventional mechanical ventilation in acute exacerbation of COPD

European Respiratory Journal, 2004

The aim of this randomised study was to compare the effects of iron lung ventilation (ILV) with i... more The aim of this randomised study was to compare the effects of iron lung ventilation (ILV) with invasive mechanical ventilation (IMV) in patients with acute respiratory failure (ARF) due to exacerbation of chronic obstructive pulmonary disease.

Research paper thumbnail of Negative pressure ventilation versus conventional mechanical ventilation in the treatment of acute respiratory failure in COPD patients

European Respiratory Journal, 1998

Patients with chronic pulmonary disease frequently need mechanical ventilatory support for acute ... more Patients with chronic pulmonary disease frequently need mechanical ventilatory support for acute exacerbation of the disease. In these patients, however, endotracheal intubation and mechanical ventilation lead to several complications including tracheal injury, barotrauma, nosocomial pneumonia, and weaning difficulty . Complications and difficulty in weaning are the major factors in increasing the duration of hospitalization and for high costs, principally linked to the length of stay in very expensive facilities such as intensive care units (ICU).

Research paper thumbnail of Ventilazione meccanica con polmone d'acciaio vs ventilazione a maschera nel trattamento dell'insufficienza respiratoria cronica riacutizzata in pazienti BPCO

Obiettivi dello studio: Valutare l'efficacia della ventilazione a pressione negativa (NPV) realiz... more Obiettivi dello studio: Valutare l'efficacia della ventilazione a pressione negativa (NPV) realizzata per mezzo del polmone d'acciaio rispetto alla ventilazione non invasiva a pressione positiva (NIPPV) nel trattamento dei pazienti BPCO con insufficienza respiratoria cronica riacutizzata. Disegno sperimentale: Studio retrospettivo caso-controllo.

Research paper thumbnail of Iron lung versus mask ventilation in acute exacerbation of COPD: a randomised crossover study

Objective: To compare iron lung (ILV) versus mask ventilation (NPPV) in the treatment of COPD pat... more Objective: To compare iron lung (ILV) versus mask ventilation (NPPV) in the treatment of COPD patients with acute on chronic respiratory failure (ACRF). Design: Randomised multicentre study. Setting: Respiratory intermediate intensive care units very skilled in ILV. Patients and methods: A total of 141 patients met the inclusion criteria and were assigned: 70 to ILV and 71 to NPPV. To establish the failure of the technique employed as first line major and minor criteria for endotracheal intubation (EI) were used. With major criteria EI was promptly established. With at least two minor criteria patients were shifted from one technique to the other. Results: On admission, PaO 2 /FiO 2 , 198 (70) and 187 (64), PaCO 2 , 90.5 (14.1) and 88.7 (13.5) mmHg, and pH 7.25 (0.04) and 7.25 (0.05), were similar for ILV and NPPV groups. When used as first line, the success of ILV (87%) was significantly greater (P = 0.01) than NPPV (68%), due to the number of patients that met minor criteria for EI; after the shift of the techniques; however, the need of EI and hospital mortality was similar in both groups. The total rate of success using both techniques increased from 77.3 to 87.9% (P = 0.028). Conclusions: The sequential use of NPPV and ILV avoided EI in a large percentage of COPD patients with ACRF; ILV was more effective than NPPV on the basis of minor criteria for EI but after the crossover the need of EI on the basis of major criteria and mortality was similar in both groups of patients.

Research paper thumbnail of The Evolution and Current State of Respiratory Intensive Care in Europe

Clinical Pulmonary Medicine, 2002

ABSTRACT In Europe there is an extreme variability among countries regarding the distribution and... more ABSTRACT In Europe there is an extreme variability among countries regarding the distribution and availability of resources. The percentage of health care costs dedicated to intensive care ranges from 2.5% in The Netherlands to 1% in the United Kingdom. The number of acute hospital beds allocated to intensive care ranges from 2.6% to 4.1% in the United Kingdom and Denmark, respectively. A strategy to deal with the high cost is to provide graded levels of care to critically ill patients. Respiratory intensive care units (RICUs) are specialized intermediate care units devoted to treating patients with acute or acute chronic respiratory failure. The distribution of RICUs in Europe is uneven; 68 units are present in seven countries, with the major distribution in Italy, Germany, and France. There are differently graded levels of care that are provided in these units: intensive care (12 units), intermediate care (42 units), and monitoring (14 units). The median number of beds is seven (range, 4 to 18) in the RICU, six (range, 2 to 11) in the intermediate care unit, and six (range, 2 to 23) in the monitoring units. Seventeen of the 68 units are independent wards, and 48 are inside other wards (83% in pneumology ward). The type of intervention varies according to the three levels of care. In the RICU, invasive mechanical ventilation is performed in most cases, whereas in the intermediate unit, invasive mechanical ventilation, noninvasive mechanical ventilation, and monitoring are performed in a similar percentage of cases. In the monitoring unit, most interventions are noninvasive mechanical ventilation and monitoring only.

Research paper thumbnail of Effect of assist negative pressure ventilation by microprocessor based iron lung on breathing effort

Thorax, 2002

Background: The lack of patient triggering capability during negative pressure ventilation (NPV) ... more Background: The lack of patient triggering capability during negative pressure ventilation (NPV) may contribute to poor patient synchrony and induction of upper airway collapse. This study was undertaken to evaluate the performance of a microprocessor based iron lung capable of thermistor triggering. Methods: The effects of NPV with thermistor triggering were studied in four normal subjects and six patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) by measuring:

Research paper thumbnail of Iron lung versus mask ventilation in acute exacerbation of COPD: a randomised crossover study

Intensive Care Medicine, 2009

Objective To compare iron lung (ILV) versus mask ventilation (NPPV) in the treatment of COPD pati... more Objective To compare iron lung (ILV) versus mask ventilation (NPPV) in the treatment of COPD patients with acute on chronic respiratory failure (ACRF). Design Randomised multicentre study. Setting Respiratory intermediate intensive care units very skilled in ILV. Patients and methods A total of 141 patients met the inclusion criteria and were assigned: 70 to ILV and 71 to NPPV. To establish the failure of the technique employed as first line major and minor criteria for endotracheal intubation (EI) were used. With major criteria EI was promptly established. With at least two minor criteria patients were shifted from one technique to the other. Results On admission, PaO2/FiO2, 198 (70) and 187 (64), PaCO2, 90.5 (14.1) and 88.7 (13.5) mmHg, and pH 7.25 (0.04) and 7.25 (0.05), were similar for ILV and NPPV groups. When used as first line, the success of ILV (87%) was significantly greater (P = 0.01) than NPPV (68%), due to the number of patients that met minor criteria for EI; after the shift of the techniques; however, the need of EI and hospital mortality was similar in both groups. The total rate of success using both techniques increased from 77.3 to 87.9% (P = 0.028). Conclusions The sequential use of NPPV and ILV avoided EI in a large percentage of COPD patients with ACRF; ILV was more effective than NPPV on the basis of minor criteria for EI but after the crossover the need of EI on the basis of major criteria and mortality was similar in both groups of patients.

Research paper thumbnail of Breathing pattern and carbon dioxide retention in severe chronic obstructive pulmonary disease

Thorax, 1996

Background -The factors leading to chronic hypercapnia and rapid shallow breathing in patients wi... more Background -The factors leading to chronic hypercapnia and rapid shallow breathing in patients with severe chronic obstructive pulmonary disease (COPD) are not completely understood. In this study the interrelations between chronic carbon dioxide retention, breathing pattern, dyspnoea, and the pressure required for breathing relative to inspiratory muscle strength in stable COPD patients with severe airflow obstruction were studied.

Research paper thumbnail of Iron Lung vs Mask Ventilation in the Treatment of Acute on Chronic Respiratory Failure in COPD Patients : A Multicenter Study

Chest, 2002

Study objectives: Evaluation of the effectiveness of negative-pressure ventilation (NPV) with the... more Study objectives: Evaluation of the effectiveness of negative-pressure ventilation (NPV) with the use of the iron lung vs noninvasive positive-pressure ventilation (NIPPV) in the treatment of COPD patients with acute on chronic respiratory failure. Design: A retrospective case-control study. Setting: Four Italian respiratory intermediate ICUs. Patients: Of a total of 393 COPD patients admitted to the ICU in 1996, 53 pairs were treated with the iron lung (NPV group). Patients treated with NIPPV (NIPPV group) were matched according to mean (؎ SD) age (70.3 ؎ 7.1 vs 70.3 ؎ 6.9 years, respectively), sex, causes of acute respiratory failure (ARF), APACHE (acute physiology and chronic health evaluation) II score (22.4 ؎ 5.3 vs 22.1 ؎ 4.6, respectively), pH (7.26 ؎ 0.05 vs 7.27 ؎ 0.04, respectively), and PaCO 2 (88.1 ؎ 11.5 vs 85.1 ؎ 13.5 mm Hg, respectively) on admission to the ICU. The effectiveness of matching was 98.4%. Results: Five patients from the NPV group (9.4%) and seven patients from the NIPPV group (13.2%) needed endotracheal intubation (EI). The treatment failure rate (ie, death and/or need of EI) was 20.7% in the NPV group and 24.5% in the NIPPV group (difference was not significant). The mean duration of mechanical ventilation (29.6 ؎ 28.6 vs 62.3 ؎ 35.7 h, respectively) and length of hospital stay (10.4 ؎ 4.3 vs 15 ؎ 5.2 d, respectively) among the 35 concordant surviving pairs were significantly lower in the NPV group than in the NIPPV group (p ‫؍‬ 0.001 and p ‫؍‬ 0.001, respectively). Conclusions: These data suggest that both ventilatory techniques are equally effective in avoiding EI and death in COPD patients with ARF. Prospective trials are needed to confirm these preliminary results. (CHEST 2002; 121:189 -195) Key words: acute respiratory failure; COPD; negative pressure ventilation; noninvasive positive-pressure ventilation; respiratory intermediate ICU Abbreviations: APACHE ϭ acute physiology and chronic health evaluation; ARF ϭ acute respiratory failure; CI ϭ confidence interval; EI ϭ endotracheal intubation; Fio 2 ϭ fraction of inspired oxygen; LTOT ϭ long-term oxygen therapy; NIPPV ϭ noninvasive positive-pressure ventilation; NPV ϭ negative-pressure ventilation; RIICU ϭ respiratory intermediate ICU; Ti/Ttot ϭ ratio of inspiratory time to total breathing cycle time

Research paper thumbnail of Alternative Techniques for Managing Acute Neuromuscular Respiratory Failure

Seminars in Neurology, 1995

Research paper thumbnail of Costs of the COPD. Differences between intensive care unit and respiratory intermediate care unit

Respiratory Medicine, 2005

Research paper thumbnail of Negative-pressure ventilation: is there still a role

European Respiratory Journal, 2002

Research paper thumbnail of Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled

British Medical Journal, 2000

To determine the effectiveness of ranitidine and sucralfate in the prevention of stress ulcer in ... more To determine the effectiveness of ranitidine and sucralfate in the prevention of stress ulcer in critical patients and to assess if these treatments affect the risk of nosocomial pneumonia. Design Published studies retrieved through Medline and other databases. Five meta-analyses evaluated effectiveness in terms of bleeding rates (A: ranitidine v placebo; B: sucralfate v placebo) and infectious complications in terms of incidence of nosocomial pneumonia (C: ranitidine v placebo; D: sucralfate v placebo; E: ranitidine v sucralfate). Trial quality was determined with an empirical ad hoc procedure. Main outcome measures Rates of clinically important gastrointestinal bleeding and nosocomial pneumonia (compared between the two study arms and expressed with odds ratios specific for individual studies and meta-analytic summary odds ratios). Results Meta-analysis A (five studies) comprised 398 patients; meta-analysis C (three studies) comprised 311 patients; meta-analysis D (two studies) comprised 226 patients: and meta-analysis E (eight studies) comprised 1825 patients. Meta-analysis B was not carried out as the literature search selected only one clinical trial. In meta-analysis A ranitidine was found to have the same effectiveness as placebo (odds ratio of bleeding 0.72, 95% confidence interval 0.30 to 1.70, P = 0.46). In placebo controlled studies (meta-analyses C and D) ranitidine and sucralfate had no influence on the incidence of nosocomial pneumonia. In comparison with sucralfate, ranitidine significantly increased the incidence of nosocomial pneumonia (meta-analysis E: 1.35, 1.07 to 1.70, P = 0.012). The mean quality score in the four analyses (on a 0 to 10 scale) ranged from 5.6 in meta-analysis E to 6.6 in meta-analysis A. Conclusions Ranitidine is ineffective in the prevention of gastrointestinal bleeding in patients in intensive care and might increase the risk of pneumonia. Studies on sucralfate do not provide conclusive results. These findings are based on small numbers of patients, and firm conclusions cannot presently be proposed.

Research paper thumbnail of European Respiratory Society Task Force on epidemiology of respiratory intermediate care in Europe

Research paper thumbnail of Intermittent negative pressure ventilation in the treatment of hypoxic hypercapnic coma in chronic respiratory insufficiency

Research paper thumbnail of Tracheostomy in patients with long-term mechanical ventilation: A survey

Respiratory Medicine, 2010

Tracheostomy is increasingly performed in intensive care units (ICU), with many patients transfer... more Tracheostomy is increasingly performed in intensive care units (ICU), with many patients transferred to respiratory ICU (RICU). Indications/timing for closing tracheostomy are discussed.We report results of a one-year survey evaluating: 1) clinical characteristics, types of tracheostomy, complications in patients admitted to Italian RICU in 2006; 2) clinical criteria and systems for performing decannulation, and outcome of patients undergoing tracheostomy (number decannulated; number non-decannulated/non-ventilated; number non-decannulated/ventilated; dead/lost patients).22/32 RICUs replied. There were 846 admissions of 719 patients (Mean age 64,3 (±14.2) years, 489 (68%) males). Causes of admission were: acute respiratory failure with underlying chronic co-morbidities 176 (24.4%); exacerbation of Chronic Obstructive Pulmonary Disease 222 (34.4%); neuromuscular diseases 200 (27.8%); surgical patients 77 (10.7%); thoracic dysmorphism 28 (3.8%); obstructive sleep apnea syndrome 16 (2.2%). Percutaneous tracheostomies were 65.9%. Major complications after tracheostomy were 2%. 427 tracheostomies were evaluated for decannulation: 96 (22.5%) were closed; 175 patients (41%) were discharged with home mechanical ventilation; 114 patients (26.5%) maintained the tracheostomy despite weaning from mechanical ventilation and 42 patients (10%) died or lost.The clinical criteria chosen for decannulation were: stability of respiratory conditions, effective cough, underlying diseases and ability to swallow. The systems for evaluating feasibility of decannulation were: closure of tracheostomy tube; laryngo-tracheoscopy; use of tracheal button and down-sizing.There were few major complications of tracheostomy. A substantial proportion of patients maintain the tracheostomy despite not requiring mechanical ventilation. There was no agreement on indications and systems for closing tracheostomy.

Research paper thumbnail of Ventilatory and Respiratory Muscle Responses to Hypercapnia in Patients with Paraplegia

... 1 Respiratory Intensive Care Unit, and Spinal Unit, Careggi Hospital, Firenze, Italy. Corresp... more ... 1 Respiratory Intensive Care Unit, and Spinal Unit, Careggi Hospital, Firenze, Italy. Correspondence and requests for reprints should be addressed to Dr. Massimo Gorini, Unità di Terapia Intensiva Respiratoria, Careggi Hospital, Villa D'Ognissanti ... Aliverti A.,; Cala SJ,; Duranti ...

Research paper thumbnail of Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered

European Respiratory Journal, 1996

Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure v... more Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure ventilators. Negative pressure ventilators, such as the "iron lung", support ventilation by exposing the surface of the chest wall to subatmospheric pressure during inspiration; whereas, expiration occurs when the pressure around the chest wall increases and becomes atmospheric or greater than atmospheric. In this review, after a description of the more advanced models of tank ventilators and the physiological effects of negative pressure ventilation (NPV), we summarize the recent application of this old technique in the treatment of acute respiratory failure (ARF). Several uncontrolled studies suggest that NPV may have a potential therapeutic role in the treatment of acute on chronic respiratory failure in patients with chronic obstructive pulmonary disease and restrictive thoracic disorders, reducing the need for endotracheal intubation. In the paediatric field, after substantial technical improvement, NPV has been successfully reintroduced for the treatment of ARF due to neonatal distress syndrome and bronchopulmonary dysplasia, and for the weaning from positive pressure ventilation in intubated patients. The positive results of these reports need to be formally confirmed by further prospective and controlled studies before recommending the generalized use of negative pressure ventilation in acute respiratory failure as a standard of care.

Research paper thumbnail of Respiratory intensive care units in Italy: a national census and prospective cohort study

Research paper thumbnail of Long-term negative pressure ventilation

Respiratory Care Clinics, 2002

Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure v... more Noninvasive mechanical ventilatory techniques include the use of negative and positive pressure ventilators. Negative pressure ventilators support ventilation by exposing the surface of the chest wall to subatmospheric pressure during inspiration, whereas expiration occurs when the pressure around the chest wall increases and becomes equal to or greater than atmospheric pressure. In this article, a description of negative pressure ventilators and the physiologic effects of negative pressure ventilation (NPV) is given, and the application of this technique in the long-term treatment of chronic respiratory failure is summarized. Many studies, although uncontrolled, have shown that long-term treatment with NPV can improve respiratory muscle function, arterial blood gases, and survival in patients with neuromuscular and chest wall disorders. NPV devices, however, are more cumbersome and difficult to use than home positive pressure ventilators (PPVs) and tend to predispose to obstructive apnoeas during sleep. In the last several decades, NPV has been supplanted by mask PPV. In experienced hands, NPV remains a second viable option in patients with neuromuscular and chest wall disorders who, for technical or other reasons, cannot be offered mask PPV. There is no evidence, however, that long-term treatment with NPV can improve respiratory muscle function, exercise endurance, quality of life, and survival in patients with severe chronic obstructive pulmonary disease.

Research paper thumbnail of Iron lung versus conventional mechanical ventilation in acute exacerbation of COPD

European Respiratory Journal, 2004

The aim of this randomised study was to compare the effects of iron lung ventilation (ILV) with i... more The aim of this randomised study was to compare the effects of iron lung ventilation (ILV) with invasive mechanical ventilation (IMV) in patients with acute respiratory failure (ARF) due to exacerbation of chronic obstructive pulmonary disease.

Research paper thumbnail of Negative pressure ventilation versus conventional mechanical ventilation in the treatment of acute respiratory failure in COPD patients

European Respiratory Journal, 1998

Patients with chronic pulmonary disease frequently need mechanical ventilatory support for acute ... more Patients with chronic pulmonary disease frequently need mechanical ventilatory support for acute exacerbation of the disease. In these patients, however, endotracheal intubation and mechanical ventilation lead to several complications including tracheal injury, barotrauma, nosocomial pneumonia, and weaning difficulty . Complications and difficulty in weaning are the major factors in increasing the duration of hospitalization and for high costs, principally linked to the length of stay in very expensive facilities such as intensive care units (ICU).

Research paper thumbnail of Ventilazione meccanica con polmone d'acciaio vs ventilazione a maschera nel trattamento dell'insufficienza respiratoria cronica riacutizzata in pazienti BPCO

Obiettivi dello studio: Valutare l'efficacia della ventilazione a pressione negativa (NPV) realiz... more Obiettivi dello studio: Valutare l'efficacia della ventilazione a pressione negativa (NPV) realizzata per mezzo del polmone d'acciaio rispetto alla ventilazione non invasiva a pressione positiva (NIPPV) nel trattamento dei pazienti BPCO con insufficienza respiratoria cronica riacutizzata. Disegno sperimentale: Studio retrospettivo caso-controllo.

Research paper thumbnail of Iron lung versus mask ventilation in acute exacerbation of COPD: a randomised crossover study

Objective: To compare iron lung (ILV) versus mask ventilation (NPPV) in the treatment of COPD pat... more Objective: To compare iron lung (ILV) versus mask ventilation (NPPV) in the treatment of COPD patients with acute on chronic respiratory failure (ACRF). Design: Randomised multicentre study. Setting: Respiratory intermediate intensive care units very skilled in ILV. Patients and methods: A total of 141 patients met the inclusion criteria and were assigned: 70 to ILV and 71 to NPPV. To establish the failure of the technique employed as first line major and minor criteria for endotracheal intubation (EI) were used. With major criteria EI was promptly established. With at least two minor criteria patients were shifted from one technique to the other. Results: On admission, PaO 2 /FiO 2 , 198 (70) and 187 (64), PaCO 2 , 90.5 (14.1) and 88.7 (13.5) mmHg, and pH 7.25 (0.04) and 7.25 (0.05), were similar for ILV and NPPV groups. When used as first line, the success of ILV (87%) was significantly greater (P = 0.01) than NPPV (68%), due to the number of patients that met minor criteria for EI; after the shift of the techniques; however, the need of EI and hospital mortality was similar in both groups. The total rate of success using both techniques increased from 77.3 to 87.9% (P = 0.028). Conclusions: The sequential use of NPPV and ILV avoided EI in a large percentage of COPD patients with ACRF; ILV was more effective than NPPV on the basis of minor criteria for EI but after the crossover the need of EI on the basis of major criteria and mortality was similar in both groups of patients.

Research paper thumbnail of The Evolution and Current State of Respiratory Intensive Care in Europe

Clinical Pulmonary Medicine, 2002

ABSTRACT In Europe there is an extreme variability among countries regarding the distribution and... more ABSTRACT In Europe there is an extreme variability among countries regarding the distribution and availability of resources. The percentage of health care costs dedicated to intensive care ranges from 2.5% in The Netherlands to 1% in the United Kingdom. The number of acute hospital beds allocated to intensive care ranges from 2.6% to 4.1% in the United Kingdom and Denmark, respectively. A strategy to deal with the high cost is to provide graded levels of care to critically ill patients. Respiratory intensive care units (RICUs) are specialized intermediate care units devoted to treating patients with acute or acute chronic respiratory failure. The distribution of RICUs in Europe is uneven; 68 units are present in seven countries, with the major distribution in Italy, Germany, and France. There are differently graded levels of care that are provided in these units: intensive care (12 units), intermediate care (42 units), and monitoring (14 units). The median number of beds is seven (range, 4 to 18) in the RICU, six (range, 2 to 11) in the intermediate care unit, and six (range, 2 to 23) in the monitoring units. Seventeen of the 68 units are independent wards, and 48 are inside other wards (83% in pneumology ward). The type of intervention varies according to the three levels of care. In the RICU, invasive mechanical ventilation is performed in most cases, whereas in the intermediate unit, invasive mechanical ventilation, noninvasive mechanical ventilation, and monitoring are performed in a similar percentage of cases. In the monitoring unit, most interventions are noninvasive mechanical ventilation and monitoring only.

Research paper thumbnail of Effect of assist negative pressure ventilation by microprocessor based iron lung on breathing effort

Thorax, 2002

Background: The lack of patient triggering capability during negative pressure ventilation (NPV) ... more Background: The lack of patient triggering capability during negative pressure ventilation (NPV) may contribute to poor patient synchrony and induction of upper airway collapse. This study was undertaken to evaluate the performance of a microprocessor based iron lung capable of thermistor triggering. Methods: The effects of NPV with thermistor triggering were studied in four normal subjects and six patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) by measuring:

Research paper thumbnail of Iron lung versus mask ventilation in acute exacerbation of COPD: a randomised crossover study

Intensive Care Medicine, 2009

Objective To compare iron lung (ILV) versus mask ventilation (NPPV) in the treatment of COPD pati... more Objective To compare iron lung (ILV) versus mask ventilation (NPPV) in the treatment of COPD patients with acute on chronic respiratory failure (ACRF). Design Randomised multicentre study. Setting Respiratory intermediate intensive care units very skilled in ILV. Patients and methods A total of 141 patients met the inclusion criteria and were assigned: 70 to ILV and 71 to NPPV. To establish the failure of the technique employed as first line major and minor criteria for endotracheal intubation (EI) were used. With major criteria EI was promptly established. With at least two minor criteria patients were shifted from one technique to the other. Results On admission, PaO2/FiO2, 198 (70) and 187 (64), PaCO2, 90.5 (14.1) and 88.7 (13.5) mmHg, and pH 7.25 (0.04) and 7.25 (0.05), were similar for ILV and NPPV groups. When used as first line, the success of ILV (87%) was significantly greater (P = 0.01) than NPPV (68%), due to the number of patients that met minor criteria for EI; after the shift of the techniques; however, the need of EI and hospital mortality was similar in both groups. The total rate of success using both techniques increased from 77.3 to 87.9% (P = 0.028). Conclusions The sequential use of NPPV and ILV avoided EI in a large percentage of COPD patients with ACRF; ILV was more effective than NPPV on the basis of minor criteria for EI but after the crossover the need of EI on the basis of major criteria and mortality was similar in both groups of patients.

Research paper thumbnail of Breathing pattern and carbon dioxide retention in severe chronic obstructive pulmonary disease

Thorax, 1996

Background -The factors leading to chronic hypercapnia and rapid shallow breathing in patients wi... more Background -The factors leading to chronic hypercapnia and rapid shallow breathing in patients with severe chronic obstructive pulmonary disease (COPD) are not completely understood. In this study the interrelations between chronic carbon dioxide retention, breathing pattern, dyspnoea, and the pressure required for breathing relative to inspiratory muscle strength in stable COPD patients with severe airflow obstruction were studied.

Research paper thumbnail of Iron Lung vs Mask Ventilation in the Treatment of Acute on Chronic Respiratory Failure in COPD Patients : A Multicenter Study

Chest, 2002

Study objectives: Evaluation of the effectiveness of negative-pressure ventilation (NPV) with the... more Study objectives: Evaluation of the effectiveness of negative-pressure ventilation (NPV) with the use of the iron lung vs noninvasive positive-pressure ventilation (NIPPV) in the treatment of COPD patients with acute on chronic respiratory failure. Design: A retrospective case-control study. Setting: Four Italian respiratory intermediate ICUs. Patients: Of a total of 393 COPD patients admitted to the ICU in 1996, 53 pairs were treated with the iron lung (NPV group). Patients treated with NIPPV (NIPPV group) were matched according to mean (؎ SD) age (70.3 ؎ 7.1 vs 70.3 ؎ 6.9 years, respectively), sex, causes of acute respiratory failure (ARF), APACHE (acute physiology and chronic health evaluation) II score (22.4 ؎ 5.3 vs 22.1 ؎ 4.6, respectively), pH (7.26 ؎ 0.05 vs 7.27 ؎ 0.04, respectively), and PaCO 2 (88.1 ؎ 11.5 vs 85.1 ؎ 13.5 mm Hg, respectively) on admission to the ICU. The effectiveness of matching was 98.4%. Results: Five patients from the NPV group (9.4%) and seven patients from the NIPPV group (13.2%) needed endotracheal intubation (EI). The treatment failure rate (ie, death and/or need of EI) was 20.7% in the NPV group and 24.5% in the NIPPV group (difference was not significant). The mean duration of mechanical ventilation (29.6 ؎ 28.6 vs 62.3 ؎ 35.7 h, respectively) and length of hospital stay (10.4 ؎ 4.3 vs 15 ؎ 5.2 d, respectively) among the 35 concordant surviving pairs were significantly lower in the NPV group than in the NIPPV group (p ‫؍‬ 0.001 and p ‫؍‬ 0.001, respectively). Conclusions: These data suggest that both ventilatory techniques are equally effective in avoiding EI and death in COPD patients with ARF. Prospective trials are needed to confirm these preliminary results. (CHEST 2002; 121:189 -195) Key words: acute respiratory failure; COPD; negative pressure ventilation; noninvasive positive-pressure ventilation; respiratory intermediate ICU Abbreviations: APACHE ϭ acute physiology and chronic health evaluation; ARF ϭ acute respiratory failure; CI ϭ confidence interval; EI ϭ endotracheal intubation; Fio 2 ϭ fraction of inspired oxygen; LTOT ϭ long-term oxygen therapy; NIPPV ϭ noninvasive positive-pressure ventilation; NPV ϭ negative-pressure ventilation; RIICU ϭ respiratory intermediate ICU; Ti/Ttot ϭ ratio of inspiratory time to total breathing cycle time