Additional file 1: Table E1. Data from the 4 subgroups of patients stratified according the amoun... more Additional file 1: Table E1. Data from the 4 subgroups of patients stratified according the amount of secretions and application of recruiting manoeuvres.
Background Besides airway suctioning, patients undergoing invasive mechanical ventilation (iMV) b... more Background Besides airway suctioning, patients undergoing invasive mechanical ventilation (iMV) benefit of different combinations of chest physiotherapy techniques, to improve mucus removal. To date, little is known about the clearance effects of oscillating devices on patients with acute respiratory failure undergoing iMV. This study aimed to assess (1) the effects of high-frequency chest wall oscillation (HFCWO) on lung aeration and ventilation distribution, as assessed by electrical impedance tomography (EIT), and (2) the effect of the association of HFCWO with recruitment manoeuvres (RM). Methods Sixty critically ill patients, 30 classified as normosecretive and 30 as hypersecretive, who received ≥ 48 h of iMV, underwent HFCWO; patients from both subgroups were randomized to receive RM or not, according to two separated randomization sequences. We therefore obtained four arms of 15 patients each. After baseline record (T0), HFCWO was applied for 10 min. At the end of the treatme...
There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 af... more There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts’ opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision maki...
INTRODUCTION. Although a life-saving intervention, mechanical ventilation is apt to unwanted side... more INTRODUCTION. Although a life-saving intervention, mechanical ventilation is apt to unwanted side-effects and complications and should be interrupted as soon as possible. In acutely brain-injured patients, delaying weaning and liberation from mechanical ventilation increase the rate of ventilator-associated pneumonia, septic complications, and mortality. In neurologic and neurosurgical intubated patients, a systematic assessment of the patient\u2019s potential to be weaned off the ventilator has been demonstrated to reduce the risk of re- intubation following extubation failure, compared to the sole physician\u2019s clinical judgment. OBJECTIVES. We undertook this multicentre randomized controlled trial to evaluate whether a systematic approach to weaning is superior to the physician\u2019s judgment in pre- venting weaning failure occurring within 48 h, in neurologic patients undergoing mechanical ventilation through a tracheotomic cuffed tube. METHODS. Seventy-six neurosurgical and neurologic tracheotomized patients receiving mechanical ventilation were randomized to receive either protocolized weaning protocol (intervention group, IG) or a liberal weaning process according to the attending physicians\u2019 clinical judgment (control group, CG). Although in this last group the decision was left entirely to the discretion of the physicians, all the information collected and recorded for the IG were also available. The criteria for protocol failure were de\ufb01ned a priori. Patients were considered successfully weaned if they were not reconnected to the ventilator in the following 48 h. RESULTS. We included 38 patients in both groups. The average age of the patients enrolled was 54 \ub1 15 in IG, and 43 \ub1 17 in CG (p = 0.001), while the ratio between female and male was 11/27, and 17/21, respectively. The SAPII score at ICU admission was 41 \ub1 12 for IG, and 36 \ub1 17 for CG (p = 0.082). On study enrolment, the GCS was 9 \ub1 1 and 9 \ub1 2, for IG and CG, respectively (p = 0.14). There was no signi\ufb01cant difference with respect to weaning failure (7/38 in IG, 9/38 in CG); the days spent on mechanical ventilation were also no different between the two groups (17 \ub1 9 and 16 \ub1 8 days, for IG and CG, p = 0.66, respectively); the overall length of hospital stay was 22 \ub1 8 days in IG and 23 \ub1 9 days in CG (p = 0.64). CONCLUSIONS. In tracheotomized brain-injured patients receiving mechanical ventilation arranging physiologic and clinical data in a systematic fashion by means of a written \ufb02ow chart does not offer any advantage, as opposed to the sole clinical judgement
The efficacy of noninvasive mechanical ventilation (NIMV) in improving breathing pattern and arte... more The efficacy of noninvasive mechanical ventilation (NIMV) in improving breathing pattern and arterial blood gases (ABG) in hypercapnic patients has been well documented; however, little attention has been given to the choice of the interface and the ventilatory mode. We evaluated the effects of three types of masks and two modes of ventilation on patients' ABG, breathing pattern, and tolerance to ventilation. Prospective randomized study. Two respiratory weaning centers. A total of 26 stable hypercapnic patients (pH, 7.38 +/- 0.04; PaCO2, 59.2. +/- 10.9 torr) had not received NIMV and were affected by restrictive thoracic disease or obstructive pulmonary disease. Three 30-min runs of NIMV, delivered using volume-assisted (n = 13) or pressure-assisted modes of partial mechanical support (n = 13), were performed in random order with a full-face mask, a nasal mask, and nasal plugs. ABG, breathing pattern, and patients' tolerance to ventilation. Compared with spontaneous breathing, the application of NIMV significantly improved ABG and minute ventilation, irrespective of the ventilatory mode, the underlying pathology or the type of mask. Overall, a nasal mask was better tolerated than the other two interfaces (p < .005 vs. nasal plugs and full-face mask). PaCO2 was significantly lower (p < .01) with a full-face mask or nasal plugs than with a nasal mask (49.5 +/- 9.4 torr, 49.7 +/- 8 torr, and 52.4 +/- 11 torr, respectively). Minute ventilation was significantly higher with a full-face mask than with a nasal mask because of an increase in tidal volume. No differences were observed in tolerance to ventilation, ABG, or breathing pattern, using assist control or pressure-assisted modes. In this physiologic study, we have shown that in patients with hypercapnic respiratory failure, irrespective of the underlying pathology, the type of interface affects the NIMV outcome more than the ventilatory mode.
To determine whether non-invasive ventilation (NIV) may be an effective and safe alternative to i... more To determine whether non-invasive ventilation (NIV) may be an effective and safe alternative to invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) meeting criteria for mechanical ventilation. Matched case-control study conducted in ICU. NIV was prospectively applied to 64 COPD patients with advanced ARF. Their outcomes were compared with those of a control group of 64 COPD patients matched on age, FEV(1), Simplified Acute Physiology Score II, and pH at ICU admission, previously treated in the same ICU with conventional invasive mechanical ventilation. NIV failed in 40 patients who required intubation. Mortality rate, duration of mechanical ventilation, and lengths of ICU and post-ICU stay were not different between the two groups. The NIV group had fewer complications ( P = 0.01) and showed a trend toward a lower proportion of patients remaining on mechanical ventilation after 30 days ( P = 0.056). Compared to the control group, the outcomes of the patients who failed NIV were no different. Compared to the patients who received intubation, those who succeeded NIV had reduced mortality rate and lengths of ICU and post-ICU stay. In COPD patients with advanced hypercapnic acute respiratory failure, NIV had a high rate of failure, but, nevertheless, provided some advantages, compared to conventional invasive ventilation. Subgroup analysis suggested that the delay in intubation was not deleterious in the patients who failed NIV, whereas a better outcome was confirmed for the patients who avoided intubation.
Purpose: To assess reporting completeness of the most frequent outcome measures used in randomize... more Purpose: To assess reporting completeness of the most frequent outcome measures used in randomized controlled trials (RCTs) of rehabilitation interventions for mechanical low back pain. Methods: We performed a cross-sectional study of RCTs included in all Cochrane systematic reviews (SRs) published up to May 2013. Two authors independently evaluated the type and frequency of each outcome measure reported, the methods used to measure outcomes, the completeness of outcome reporting using a eight-item checklist, and the proportion of outcomes fully replicable by an independent assessor. Results: Our literature search identified 11 SRs, including 185 RCTs. Thirty-six different outcomes were investigated across all RCTs. The 2 most commonly reported outcomes were pain (n=165 RCTs; 89.2%) and disability (n=118 RCTs; 63.8%), which were assessed by 66 and 44 measurement tools, respectively. Pain and disability outcomes were found replicable in only 10.3% (n=17) and 10.2% (n=12) of the RCTs,...
Background: The use of remote rehabilitation in children was limited before the COVID-19 pandemic... more Background: The use of remote rehabilitation in children was limited before the COVID-19 pandemic, due to culture, technology access, regulatory and reimbursement barriers.Methods: The study was conducted according to the STROBE (The Strengthening the Reporting of Observational Studies in Epidemiology) checklist in order to provide qualitative and quantitative data about experience of patients with disabilities and their caregivers during Phase 1 of the COVID-19 pandemic, and their level of satisfaction. An online survey was developed using Google Forms and sent via email. The outcome measures were rated using a 5-point Likert Scale. Two additional open-ended questions were used to collect qualitative data.Results: 128 out of 261 families responded to the survey: 80.5% of the caregivers reported they were satisfied with the remote rehabilitation. More than a half (53%) of the families reported a high level of satisfaction with the involvement they received in defining and sharing of...
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace, 2021
In February 2020 the first COVID-19 case was reported in Italy and afterwards the virus started s... more In February 2020 the first COVID-19 case was reported in Italy and afterwards the virus started spreading rapidly, increasing dramatically the number of infected subjects. To face the pandemic outbreak, hospitals converted wards to assure COVID-19 patients' care and adopted measures to reduce virus diffusion. The aim of this study was to determine how many physiotherapists, in the Lombardy region, worked during pandemic, whether they continued their usual practice or were employed in COVID-19 wards and in which tasks they were involved. The survey was submitted online by the national professional order. The response rate was 11.79%. During the pandemic, 648 (53.9%) respondents interrupted their services. Less than 20% of the physiotherapists that continued working were assigned to COVID-19 wards with the role of physiotherapist. Only a small proportion of respondents had advanced skills in respiratory physiotherapy. Moreover, this study showed a limited involvement of physiother...
Additional file 1: Table E1. Data from the 4 subgroups of patients stratified according the amoun... more Additional file 1: Table E1. Data from the 4 subgroups of patients stratified according the amount of secretions and application of recruiting manoeuvres.
Background Besides airway suctioning, patients undergoing invasive mechanical ventilation (iMV) b... more Background Besides airway suctioning, patients undergoing invasive mechanical ventilation (iMV) benefit of different combinations of chest physiotherapy techniques, to improve mucus removal. To date, little is known about the clearance effects of oscillating devices on patients with acute respiratory failure undergoing iMV. This study aimed to assess (1) the effects of high-frequency chest wall oscillation (HFCWO) on lung aeration and ventilation distribution, as assessed by electrical impedance tomography (EIT), and (2) the effect of the association of HFCWO with recruitment manoeuvres (RM). Methods Sixty critically ill patients, 30 classified as normosecretive and 30 as hypersecretive, who received ≥ 48 h of iMV, underwent HFCWO; patients from both subgroups were randomized to receive RM or not, according to two separated randomization sequences. We therefore obtained four arms of 15 patients each. After baseline record (T0), HFCWO was applied for 10 min. At the end of the treatme...
There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 af... more There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts’ opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision maki...
INTRODUCTION. Although a life-saving intervention, mechanical ventilation is apt to unwanted side... more INTRODUCTION. Although a life-saving intervention, mechanical ventilation is apt to unwanted side-effects and complications and should be interrupted as soon as possible. In acutely brain-injured patients, delaying weaning and liberation from mechanical ventilation increase the rate of ventilator-associated pneumonia, septic complications, and mortality. In neurologic and neurosurgical intubated patients, a systematic assessment of the patient\u2019s potential to be weaned off the ventilator has been demonstrated to reduce the risk of re- intubation following extubation failure, compared to the sole physician\u2019s clinical judgment. OBJECTIVES. We undertook this multicentre randomized controlled trial to evaluate whether a systematic approach to weaning is superior to the physician\u2019s judgment in pre- venting weaning failure occurring within 48 h, in neurologic patients undergoing mechanical ventilation through a tracheotomic cuffed tube. METHODS. Seventy-six neurosurgical and neurologic tracheotomized patients receiving mechanical ventilation were randomized to receive either protocolized weaning protocol (intervention group, IG) or a liberal weaning process according to the attending physicians\u2019 clinical judgment (control group, CG). Although in this last group the decision was left entirely to the discretion of the physicians, all the information collected and recorded for the IG were also available. The criteria for protocol failure were de\ufb01ned a priori. Patients were considered successfully weaned if they were not reconnected to the ventilator in the following 48 h. RESULTS. We included 38 patients in both groups. The average age of the patients enrolled was 54 \ub1 15 in IG, and 43 \ub1 17 in CG (p = 0.001), while the ratio between female and male was 11/27, and 17/21, respectively. The SAPII score at ICU admission was 41 \ub1 12 for IG, and 36 \ub1 17 for CG (p = 0.082). On study enrolment, the GCS was 9 \ub1 1 and 9 \ub1 2, for IG and CG, respectively (p = 0.14). There was no signi\ufb01cant difference with respect to weaning failure (7/38 in IG, 9/38 in CG); the days spent on mechanical ventilation were also no different between the two groups (17 \ub1 9 and 16 \ub1 8 days, for IG and CG, p = 0.66, respectively); the overall length of hospital stay was 22 \ub1 8 days in IG and 23 \ub1 9 days in CG (p = 0.64). CONCLUSIONS. In tracheotomized brain-injured patients receiving mechanical ventilation arranging physiologic and clinical data in a systematic fashion by means of a written \ufb02ow chart does not offer any advantage, as opposed to the sole clinical judgement
The efficacy of noninvasive mechanical ventilation (NIMV) in improving breathing pattern and arte... more The efficacy of noninvasive mechanical ventilation (NIMV) in improving breathing pattern and arterial blood gases (ABG) in hypercapnic patients has been well documented; however, little attention has been given to the choice of the interface and the ventilatory mode. We evaluated the effects of three types of masks and two modes of ventilation on patients' ABG, breathing pattern, and tolerance to ventilation. Prospective randomized study. Two respiratory weaning centers. A total of 26 stable hypercapnic patients (pH, 7.38 +/- 0.04; PaCO2, 59.2. +/- 10.9 torr) had not received NIMV and were affected by restrictive thoracic disease or obstructive pulmonary disease. Three 30-min runs of NIMV, delivered using volume-assisted (n = 13) or pressure-assisted modes of partial mechanical support (n = 13), were performed in random order with a full-face mask, a nasal mask, and nasal plugs. ABG, breathing pattern, and patients' tolerance to ventilation. Compared with spontaneous breathing, the application of NIMV significantly improved ABG and minute ventilation, irrespective of the ventilatory mode, the underlying pathology or the type of mask. Overall, a nasal mask was better tolerated than the other two interfaces (p < .005 vs. nasal plugs and full-face mask). PaCO2 was significantly lower (p < .01) with a full-face mask or nasal plugs than with a nasal mask (49.5 +/- 9.4 torr, 49.7 +/- 8 torr, and 52.4 +/- 11 torr, respectively). Minute ventilation was significantly higher with a full-face mask than with a nasal mask because of an increase in tidal volume. No differences were observed in tolerance to ventilation, ABG, or breathing pattern, using assist control or pressure-assisted modes. In this physiologic study, we have shown that in patients with hypercapnic respiratory failure, irrespective of the underlying pathology, the type of interface affects the NIMV outcome more than the ventilatory mode.
To determine whether non-invasive ventilation (NIV) may be an effective and safe alternative to i... more To determine whether non-invasive ventilation (NIV) may be an effective and safe alternative to invasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) meeting criteria for mechanical ventilation. Matched case-control study conducted in ICU. NIV was prospectively applied to 64 COPD patients with advanced ARF. Their outcomes were compared with those of a control group of 64 COPD patients matched on age, FEV(1), Simplified Acute Physiology Score II, and pH at ICU admission, previously treated in the same ICU with conventional invasive mechanical ventilation. NIV failed in 40 patients who required intubation. Mortality rate, duration of mechanical ventilation, and lengths of ICU and post-ICU stay were not different between the two groups. The NIV group had fewer complications ( P = 0.01) and showed a trend toward a lower proportion of patients remaining on mechanical ventilation after 30 days ( P = 0.056). Compared to the control group, the outcomes of the patients who failed NIV were no different. Compared to the patients who received intubation, those who succeeded NIV had reduced mortality rate and lengths of ICU and post-ICU stay. In COPD patients with advanced hypercapnic acute respiratory failure, NIV had a high rate of failure, but, nevertheless, provided some advantages, compared to conventional invasive ventilation. Subgroup analysis suggested that the delay in intubation was not deleterious in the patients who failed NIV, whereas a better outcome was confirmed for the patients who avoided intubation.
Purpose: To assess reporting completeness of the most frequent outcome measures used in randomize... more Purpose: To assess reporting completeness of the most frequent outcome measures used in randomized controlled trials (RCTs) of rehabilitation interventions for mechanical low back pain. Methods: We performed a cross-sectional study of RCTs included in all Cochrane systematic reviews (SRs) published up to May 2013. Two authors independently evaluated the type and frequency of each outcome measure reported, the methods used to measure outcomes, the completeness of outcome reporting using a eight-item checklist, and the proportion of outcomes fully replicable by an independent assessor. Results: Our literature search identified 11 SRs, including 185 RCTs. Thirty-six different outcomes were investigated across all RCTs. The 2 most commonly reported outcomes were pain (n=165 RCTs; 89.2%) and disability (n=118 RCTs; 63.8%), which were assessed by 66 and 44 measurement tools, respectively. Pain and disability outcomes were found replicable in only 10.3% (n=17) and 10.2% (n=12) of the RCTs,...
Background: The use of remote rehabilitation in children was limited before the COVID-19 pandemic... more Background: The use of remote rehabilitation in children was limited before the COVID-19 pandemic, due to culture, technology access, regulatory and reimbursement barriers.Methods: The study was conducted according to the STROBE (The Strengthening the Reporting of Observational Studies in Epidemiology) checklist in order to provide qualitative and quantitative data about experience of patients with disabilities and their caregivers during Phase 1 of the COVID-19 pandemic, and their level of satisfaction. An online survey was developed using Google Forms and sent via email. The outcome measures were rated using a 5-point Likert Scale. Two additional open-ended questions were used to collect qualitative data.Results: 128 out of 261 families responded to the survey: 80.5% of the caregivers reported they were satisfied with the remote rehabilitation. More than a half (53%) of the families reported a high level of satisfaction with the involvement they received in defining and sharing of...
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace, 2021
In February 2020 the first COVID-19 case was reported in Italy and afterwards the virus started s... more In February 2020 the first COVID-19 case was reported in Italy and afterwards the virus started spreading rapidly, increasing dramatically the number of infected subjects. To face the pandemic outbreak, hospitals converted wards to assure COVID-19 patients' care and adopted measures to reduce virus diffusion. The aim of this study was to determine how many physiotherapists, in the Lombardy region, worked during pandemic, whether they continued their usual practice or were employed in COVID-19 wards and in which tasks they were involved. The survey was submitted online by the national professional order. The response rate was 11.79%. During the pandemic, 648 (53.9%) respondents interrupted their services. Less than 20% of the physiotherapists that continued working were assigned to COVID-19 wards with the role of physiotherapist. Only a small proportion of respondents had advanced skills in respiratory physiotherapy. Moreover, this study showed a limited involvement of physiother...
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