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Montalto, Francesca, Ippolito, Mariachiara, Noto, Alberto, Madotto, Fabiana, Gelardi, Filippa, Savatteri, Paolino, Giarratano, Antonino, Cortegiani, Andrea, Brescia, Fabrizio, Fabiani, Fabio, Zanier, Chiara, Nadalini, Elisa, Gambaretti, Eros, Gabriele, Francesco, Astuto, Marinella, Murabito, Paolo, Sanfilippo, Filippo, Misseri, Giovanni, Moscarelli, Alessandra, Spadaro, Savino, Bussolati, Enrico, Squadrani, Eleonora, Villa, Gianluca, D’Errico, Raffaella, Cocci, Giulia, Lanini, Iacopo, Mirabella, Lucia, Morelli, Alessandra, Tullo, Livio, Caggianelli, Girolamo, Ball, Lorenzo, Iiriti, Margherita, Giordani, Francesca, Giardina, Massimiliano, Mazzeo, Anna Teresa, Grasselli, Giacomo, Cattaneo, Emanuele, Alongi, Salvatore, Marenghi, Cristina, Marmiere, Marilena, Rocchi, Margherita, Turi, Stefano, Landoni, Giovanni, Torrano, Vito, Tinti, Giulia, Giorgi, Antonio, Fumagalli, Roberto, Salvo, Francesco, Blangetti, Ilaria, Cascella, Marco, Forte, Cira Antonietta, Navalesi, Paolo, Montalbano, Marta, Chiarelli, Valentina, Bonanno, Giuseppe, Ferrara, Francesco Paolo, Pernice, Innocenza, Catalisano, Giulia, Marino, Claudia, Presti, Gabriele, Fricano, Dario Calogero, Fucà, Rosa, Palmeri di Villalba, Cesira, Strano, Maria Teresa, Caruso, Sabrina, Scafidi, Antonino, Mazzarese, Vincenzo, Augugliaro, Ettore, Terranova, Valeria, Forfori, Francesco, Corradi, Francesco, Taddei, Erika, Isirdi, Alessandro, Pratesi, Giorgia, Puccini, Francesca, Paternoster, Gianluca, Barile, Alessio, Tescione, Marco, Santacaterina, Irene, Siclari, Eliana Maria, Tripodi, Vincenzo Francesco, Vadalà, Mariacristina, Agrò, Felice Eugenio, Pascarella, Giuseppe, Piliego, Chiara, Aceto, Paola, De Pascale, Gennaro, Dottarelli, Alessandra, Romanò, Bruno, Russo, Andrea, Covotta, Marco, Giorgerini, Valeria, Sardellitti, Federica, Vitelli, Giulia Maria, Coluzzi, Flaminia, Bove, Tiziana, Vetrugno, Luigi.
Journal of Anesthesia, Analgesia and Critical Care ; 1(1):17-17, 2021.
Article in English | BioMed Central | ID: covidwho-1542137
Minerva Anestesiol ; 87(4): 432-438, 2021 04.
Article in English | MEDLINE | ID: covidwho-1181857


BACKGROUND: The aim of this study was to evaluate whether measurement of diaphragm thickness (DT) by ultrasonography may be a clinically useful noninvasive method for identifying patients at risk of adverse outcomes defined as need of invasive mechanical ventilation or death. METHODS: We prospectively enrolled 77 patients with laboratory-confirmed COVID-19 infection admitted to our intermediate care unit in Pisa between March 5 and March 30, 2020, with follow-up until hospital discharge or death. Logistic regression was used identify variables potentially associated with adverse outcomes and those P<0.10 were entered into a multivariate logistic regression model. Cumulative probability for lack of adverse outcomes in patients with or without low baseline diaphragm muscle mass was calculated with the Kaplan-Meier product-limit estimator. RESULTS: The main findings of this study are that: 1) patients who developed adverse outcomes had thinner diaphragm than those who did not (2.0 vs. 2.2 mm, P=0.001); and 2) DT and lymphocyte count were independent significant predictors of adverse outcomes, with end-expiratory DT being the strongest (ß=-708; OR=0.492; P=0.018). CONCLUSIONS: Diaphragmatic ultrasound may be a valid tool to evaluate the risk of respiratory failure. Evaluating the need of mechanical ventilation treatment should be based not only on PaO2/FiO2, but on a more comprehensive assessment including DT because if the lungs become less compliant a thinner diaphragm, albeit free of intrinsic abnormality, may become exhausted, thus contributing to severe respiratory failure.

COVID-19/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Respiratory Muscles/anatomy & histology , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/therapy , Cohort Studies , Diaphragm/anatomy & histology , Diaphragm/pathology , Female , Hospital Mortality , Humans , Italy/epidemiology , Kaplan-Meier Estimate , Male , Middle Aged , Pilot Projects , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Predictive Value of Tests , Respiration, Artificial/statistics & numerical data , Respiratory Insufficiency/diagnostic imaging , Respiratory Insufficiency/etiology , Respiratory Insufficiency/mortality , Respiratory Muscles/diagnostic imaging , Treatment Outcome , Ultrasonography
Respir Physiol Neurobiol ; 284: 103585, 2021 02.
Article in English | MEDLINE | ID: covidwho-943569


BACKGROUND: In a variable number of Covid-19 patients with acute respiratory failure, non-invasive breathing support strategies cannot provide adequate oxygenation, thus making invasive mechanical ventilation necessary. Factors predicting this unfavorable outcome are unknown, but we hypothesized that diaphragmatic weakness may contribute. METHODS: We prospectively analyzed the data of 27 consecutive patients admitted to the general Intensive Care Unit (ICU) from March 19, 2020, to April 20, 2020 and submitted to continuous positive airway pressure (CPAP) before considering invasive ventilation. Diaphragmatic thickening fraction (DTF) inferred by ultrasound was determined before applying CPAP. RESULTS: Eighteen patients recovered with CPAP, whereas nine required invasive mechanical ventilation with longer stay in ICU (p < 0.001) and hospital (p = 0.003). At univariate logistic regression analysis, CPAP failure was significantly associated with low DTF [ß: -0.396; OR: 0.673; p < 0.001] and high respiratory rate [ß: 0.452; OR: 1.572; p < 0.001] but only DTF reached statistical significance at multivariate analysis [ß: -0.384; OR: 0.681; p < 0.001]. The DTF best threshold predicting CPAP failure was 21.4 % (AUC: 0.944; sensitivity: 94.4 %, specificity: 88.9 %). CONCLUSIONS: In critically ill patients with Covid-19 respiratory failure admitted to ICU, a reduced DTF could be a potential predictor of CPAP failure and requirement of invasive ventilation.

COVID-19/pathology , COVID-19/therapy , Continuous Positive Airway Pressure , Diaphragm/pathology , Treatment Outcome , Aged , Diaphragm/diagnostic imaging , Female , Humans , Male , Middle Aged , Pilot Projects , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology , SARS-CoV-2 , Ultrasonography