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Research paper thumbnail of Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey

European Respiratory Journal, 2005

Research paper thumbnail of Acute exacerbations in severe COLD patients. Treatment using positive pressure ventilation by nasal mask

Chest, 1992

can be found online on the World Wide Web at:

Research paper thumbnail of Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days

European Respiratory Journal, 1994

We studied survival and failure or success of weaning from mechanical ventilation (MV) in 42 cons... more We studied survival and failure or success of weaning from mechanical ventilation (MV) in 42 consecutive chronic obstructive pulmonary disease (COPD) patients requiring prolonged MV (more than 21 days) after an episode of acute respiratory failure requiring admission to our Intermediate Intensive Care Unit (IICU).

Research paper thumbnail of Effect of nasal pressure support ventilation and external PEEP on diaphragmatic activity in patients with severe stable COPD

Chest, 1993

can be found online on the World Wide Web at:

Research paper thumbnail of Non-invasive mechanical ventilation in severe chronic obstructive lung disease and acute respiratory failure: short-and long-term prognosis

Intensive Care Medicine, 1996

Objective To evaluate the short-and long-term prognosis of patients with chronic obstructive lung... more Objective To evaluate the short-and long-term prognosis of patients with chronic obstructive lung disease (COLD) who had noninvasive mechanical ventilation (NMV) for acute respiratory failure (ARF). Design Retrospective study. Setting Two respiratory intermediate intensive care units. Patients Two groups of patients suffering from COLD and an ARF episode requiring mechanical ventilation. Group 1 (30 patients) was given NMV using face masks (aged 64±9 years; pH=7.28±0.05; PaCO2=83±18 mmHg; PaO2/FIO2=141±61). Group 2 (27 patients) was composed of control patients (aged=65±8 years; pH=7.26±0.05; PaCO2=75±17 mmHg; PaO2/FIO2=167±41) given MV using endotracheal intubation (EI) when clinical and functional conditions had further deteriorated because the medical therapy failed and NMV was not available at the time. Causes of ARF were in group 1 and 2 respectively: pneumonia in 8(27%) and 11(41%), acute exacerbation of COLD in 19 (63%) and 14 (52%) and pulmonary embolism in 3 (10%) and 2 (7%) patients. Measurements and results Success rate, mortality during stay in ICU (at 3 months and at 1 year), and the need for rehospitalization during the year following ARF were measured in this study. Group 1 showed a success rate of 74%, only 8/30 patients needing EI and conventional MV. In group 2, the weaning success was 74% (20/27 patients). The mortality for group 1 was 20% in IICU, 23% at 3 months and 30% at 1 year; and 26% for group 2 in ICU, 48% at 3 months and 63% at 1 year. Within each group 1-year mortality was greater (p<0.01) in patients with pneumonia. The number of new ICU admissions during the follow-up at 1 year was 0.12 versus 0.30 in groups 1 and 2 respectivelyp<0.05). Conclusion For patients suffering from COLD who have undergone ARF, avoiding EI by early treatment with NMV is associated with better survival in comparison to patients bound to invasive MV. Pneumonia as a cause of ARF may worsen the prognosis in both groups of patients.

Research paper thumbnail of The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients

European Respiratory Journal, 2002

Chronic obstructive pulmonary disease (COPD) patients with chronic ventilatory failure (CVF) are ... more Chronic obstructive pulmonary disease (COPD) patients with chronic ventilatory failure (CVF) are more likely to develop exacerbations, which are an important determinant of health-related quality of life (HRQL). Long-term noninvasive positive-pressure ventilation (NPPV) has been proposed in addition to long-term oxygen therapy (LTOT) to treat CVF but little information is available on its effects on HRQL and resource consumption. Therefore, the current authors undertook a 2-yr multicentric, prospective, randomised, controlled trial to assess the effect of NPPVz LTOT on: 1) severity of hypercapnia; 2) use of healthcare resources, and 3) HRQL, in comparison with LTOT alone.

Research paper thumbnail of Physiologic evaluation of pressure support ventilation by nasal mask in patients with stable COPD

Chest, 1992

Page 1. ABD = abdomen; APRV airway pressure-release ventilation; CPAP=c#{ 243}ntinuous positive a... more Page 1. ABD = abdomen; APRV airway pressure-release ventilation; CPAP=c#{ 243}ntinuous positive airway pressure; Edi integrated electromyogram of the diaphragm; INPVintermittent nega-five-pressure ventilation; IPPB ...

Research paper thumbnail of American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation

Research paper thumbnail of Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success

Thorax, 1995

Background -Non-invasive mechanical ventilation is increasingly used in the treatment of acute re... more Background -Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. Methods -Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one as successful (78%) or unsuccessful (22%) according to survival and to the need for endotracheal intubation. Results -Pneumonia was the cause of acute respiratory failure in 38% of the unsuccessful episodes but only in 9% of the successful ones. Success with non-invasive mechanical ventilation was associated with less severely abnormal baseline clinical and functional parameters, and with less severe levels of acidosis assessed during an initial trial of non-invasive mechanical ventilation. Conclusions -The severity of the episode of acute respiratory failure as assessed by clinical and functional compromise, and the level of acidosis and hypercapnia during an initial trial of non-invasive mechanical ventilation, have an influence on the likelihood for success with non-invasive mechanical ventilation and may prove to be useful in deciding whether to continue with this treatment. (Thorax 1995;50:755-757) Keywords: non-invasive mechanical ventilation, acute respiratory failure, chronic obstructive pulmonary disease.

Research paper thumbnail of Non-invasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COLD patients

Intensive Care Medicine, 1993

Objective 1) To compare the clinical usefulness of both non-invasive pressure support ventilation... more Objective 1) To compare the clinical usefulness of both non-invasive pressure support ventilation (NPSV) and non-invasive intermittent positive pressure ventilation in assist-control (A/C) mode (NIPPV) in chronic obstructive lung disease (COLD) patients with acute hypercapnic respiratory failure: 2) to compare retrospectively the usefulness of non-invasive mechanical ventilation (NMV) with standard medical therapy alone. Design Prospective randomized retrospective study. Setting 2 Respiratory intermediate intensive units. Patients 29 COLD patients (age: 62±8 years) with chronic respiratory failure were hospitalized in a department for rehabilitation during acute relapses of their disease. They were transferred to our intermediate intensive care unit (IICU) and submitted randomly to either NPSV (16 patients) or NIPPV (13 patients). Measurements and results Blood gas analysis, dynamic flows, clinical variables, success rate, time of ventilation, side effects and subjective score of compliance to therapy. Therapy was considered successful when endotracheal intubation was avoided and patients were returned to their condition prior to exacerbation. No statistically significant difference was found between NPSV and NIPPV in success rate (NPSV 87.5%; NIPPV 57%) or in time of ventilation (NPSV: 69±49; NIPPV: 57±49 h). A better compliance to non-invasive mechanical ventilation (NMV) was found in NPSV patients than in NIPPV patients; side effects were observed less frequently in the NPSV group. Comparison of the success rate of NMV was retrospectively performed with 35 control COLD patients with chronic respiratory insufficiency who had undergone an acute relapse of their disease in the 2 years preceding the institution of the IICU and had been treated with oxygen and medical therapy alone. Patients submitted to NMV showed a greater success rate than control (82 versus 54%) after a period of ventilation ranging from 4–216 h. Conclusion Non-invasive mechanical ventilation performed either by NPSV or NIPPV may improve the outcome of acute exacerbations of COLD, as compared to medical therapy alone. NPSV seems to be more acceptable to patients in comparison with NIPPV.

Research paper thumbnail of Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease A Randomized, Controlled Trial

In patients with acute exacerbations of chronic obstructive pulmonary disease, mechanical ventila... more In patients with acute exacerbations of chronic obstructive pulmonary disease, mechanical ventilation is often needed. The rate of weaning failure is high in these patients, and prolonged mechanical ventilation increases intubation-associated complications.

Research paper thumbnail of Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey

European Respiratory Journal, 2005

Research paper thumbnail of Acute exacerbations in severe COLD patients. Treatment using positive pressure ventilation by nasal mask

Chest, 1992

can be found online on the World Wide Web at:

Research paper thumbnail of Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days

European Respiratory Journal, 1994

We studied survival and failure or success of weaning from mechanical ventilation (MV) in 42 cons... more We studied survival and failure or success of weaning from mechanical ventilation (MV) in 42 consecutive chronic obstructive pulmonary disease (COPD) patients requiring prolonged MV (more than 21 days) after an episode of acute respiratory failure requiring admission to our Intermediate Intensive Care Unit (IICU).

Research paper thumbnail of Effect of nasal pressure support ventilation and external PEEP on diaphragmatic activity in patients with severe stable COPD

Chest, 1993

can be found online on the World Wide Web at:

Research paper thumbnail of Non-invasive mechanical ventilation in severe chronic obstructive lung disease and acute respiratory failure: short-and long-term prognosis

Intensive Care Medicine, 1996

Objective To evaluate the short-and long-term prognosis of patients with chronic obstructive lung... more Objective To evaluate the short-and long-term prognosis of patients with chronic obstructive lung disease (COLD) who had noninvasive mechanical ventilation (NMV) for acute respiratory failure (ARF). Design Retrospective study. Setting Two respiratory intermediate intensive care units. Patients Two groups of patients suffering from COLD and an ARF episode requiring mechanical ventilation. Group 1 (30 patients) was given NMV using face masks (aged 64±9 years; pH=7.28±0.05; PaCO2=83±18 mmHg; PaO2/FIO2=141±61). Group 2 (27 patients) was composed of control patients (aged=65±8 years; pH=7.26±0.05; PaCO2=75±17 mmHg; PaO2/FIO2=167±41) given MV using endotracheal intubation (EI) when clinical and functional conditions had further deteriorated because the medical therapy failed and NMV was not available at the time. Causes of ARF were in group 1 and 2 respectively: pneumonia in 8(27%) and 11(41%), acute exacerbation of COLD in 19 (63%) and 14 (52%) and pulmonary embolism in 3 (10%) and 2 (7%) patients. Measurements and results Success rate, mortality during stay in ICU (at 3 months and at 1 year), and the need for rehospitalization during the year following ARF were measured in this study. Group 1 showed a success rate of 74%, only 8/30 patients needing EI and conventional MV. In group 2, the weaning success was 74% (20/27 patients). The mortality for group 1 was 20% in IICU, 23% at 3 months and 30% at 1 year; and 26% for group 2 in ICU, 48% at 3 months and 63% at 1 year. Within each group 1-year mortality was greater (p<0.01) in patients with pneumonia. The number of new ICU admissions during the follow-up at 1 year was 0.12 versus 0.30 in groups 1 and 2 respectivelyp<0.05). Conclusion For patients suffering from COLD who have undergone ARF, avoiding EI by early treatment with NMV is associated with better survival in comparison to patients bound to invasive MV. Pneumonia as a cause of ARF may worsen the prognosis in both groups of patients.

Research paper thumbnail of The Italian multicentre study on noninvasive ventilation in chronic obstructive pulmonary disease patients

European Respiratory Journal, 2002

Chronic obstructive pulmonary disease (COPD) patients with chronic ventilatory failure (CVF) are ... more Chronic obstructive pulmonary disease (COPD) patients with chronic ventilatory failure (CVF) are more likely to develop exacerbations, which are an important determinant of health-related quality of life (HRQL). Long-term noninvasive positive-pressure ventilation (NPPV) has been proposed in addition to long-term oxygen therapy (LTOT) to treat CVF but little information is available on its effects on HRQL and resource consumption. Therefore, the current authors undertook a 2-yr multicentric, prospective, randomised, controlled trial to assess the effect of NPPVz LTOT on: 1) severity of hypercapnia; 2) use of healthcare resources, and 3) HRQL, in comparison with LTOT alone.

Research paper thumbnail of Physiologic evaluation of pressure support ventilation by nasal mask in patients with stable COPD

Chest, 1992

Page 1. ABD = abdomen; APRV airway pressure-release ventilation; CPAP=c#{ 243}ntinuous positive a... more Page 1. ABD = abdomen; APRV airway pressure-release ventilation; CPAP=c#{ 243}ntinuous positive airway pressure; Edi integrated electromyogram of the diaphragm; INPVintermittent nega-five-pressure ventilation; IPPB ...

Research paper thumbnail of American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation

Research paper thumbnail of Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success

Thorax, 1995

Background -Non-invasive mechanical ventilation is increasingly used in the treatment of acute re... more Background -Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. Methods -Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one as successful (78%) or unsuccessful (22%) according to survival and to the need for endotracheal intubation. Results -Pneumonia was the cause of acute respiratory failure in 38% of the unsuccessful episodes but only in 9% of the successful ones. Success with non-invasive mechanical ventilation was associated with less severely abnormal baseline clinical and functional parameters, and with less severe levels of acidosis assessed during an initial trial of non-invasive mechanical ventilation. Conclusions -The severity of the episode of acute respiratory failure as assessed by clinical and functional compromise, and the level of acidosis and hypercapnia during an initial trial of non-invasive mechanical ventilation, have an influence on the likelihood for success with non-invasive mechanical ventilation and may prove to be useful in deciding whether to continue with this treatment. (Thorax 1995;50:755-757) Keywords: non-invasive mechanical ventilation, acute respiratory failure, chronic obstructive pulmonary disease.

Research paper thumbnail of Non-invasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COLD patients

Intensive Care Medicine, 1993

Objective 1) To compare the clinical usefulness of both non-invasive pressure support ventilation... more Objective 1) To compare the clinical usefulness of both non-invasive pressure support ventilation (NPSV) and non-invasive intermittent positive pressure ventilation in assist-control (A/C) mode (NIPPV) in chronic obstructive lung disease (COLD) patients with acute hypercapnic respiratory failure: 2) to compare retrospectively the usefulness of non-invasive mechanical ventilation (NMV) with standard medical therapy alone. Design Prospective randomized retrospective study. Setting 2 Respiratory intermediate intensive units. Patients 29 COLD patients (age: 62±8 years) with chronic respiratory failure were hospitalized in a department for rehabilitation during acute relapses of their disease. They were transferred to our intermediate intensive care unit (IICU) and submitted randomly to either NPSV (16 patients) or NIPPV (13 patients). Measurements and results Blood gas analysis, dynamic flows, clinical variables, success rate, time of ventilation, side effects and subjective score of compliance to therapy. Therapy was considered successful when endotracheal intubation was avoided and patients were returned to their condition prior to exacerbation. No statistically significant difference was found between NPSV and NIPPV in success rate (NPSV 87.5%; NIPPV 57%) or in time of ventilation (NPSV: 69±49; NIPPV: 57±49 h). A better compliance to non-invasive mechanical ventilation (NMV) was found in NPSV patients than in NIPPV patients; side effects were observed less frequently in the NPSV group. Comparison of the success rate of NMV was retrospectively performed with 35 control COLD patients with chronic respiratory insufficiency who had undergone an acute relapse of their disease in the 2 years preceding the institution of the IICU and had been treated with oxygen and medical therapy alone. Patients submitted to NMV showed a greater success rate than control (82 versus 54%) after a period of ventilation ranging from 4–216 h. Conclusion Non-invasive mechanical ventilation performed either by NPSV or NIPPV may improve the outcome of acute exacerbations of COLD, as compared to medical therapy alone. NPSV seems to be more acceptable to patients in comparison with NIPPV.

Research paper thumbnail of Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease A Randomized, Controlled Trial

In patients with acute exacerbations of chronic obstructive pulmonary disease, mechanical ventila... more In patients with acute exacerbations of chronic obstructive pulmonary disease, mechanical ventilation is often needed. The rate of weaning failure is high in these patients, and prolonged mechanical ventilation increases intubation-associated complications.