0000000001276193

AUTHOR

Roberto Tonelli

showing 8 related works from this author

Nasal pressure swings as the measure of inspiratory effort in spontaneously breathing patients with de novo acute respiratory failure.

2022

Abstract Background Excessive inspiratory effort could translate into self-inflicted lung injury, thus worsening clinical outcomes of spontaneously breathing patients with acute respiratory failure (ARF). Although esophageal manometry is a reliable method to estimate the magnitude of inspiratory effort, procedural issues significantly limit its use in daily clinical practice. The aim of this study is to describe the correlation between esophageal pressure swings (ΔPes) and nasal (ΔPnos) as a potential measure of inspiratory effort in spontaneously breathing patients with de novo ARF. Methods From January 1, 2021, to September 1, 2021, 61 consecutive patients with ARF (83.6% related to COVID…

Self-inflicted lung injuryCritical Care and Intensive Care MedicineAcute respiratory failureself-inflicted lung injuryNon-invasive Mechanical ventilationesophageal pressure swingsacute respiratory failure non-invasive mechanical ventilation esophageal pressure swings nasal pressure swings endotracheal intubation COVID-19 respiratory monitoring inspiratory effort self-inflicted lung injuryHumansInspiratory effortendotracheal intubationEsophageal pressure swingsAcute respiratory failure Non-invasive Mechanical ventilation Esophageal pressure swings Nasal pressure swings Endotracheal intubation COVID-19 Respiratory monitoring Inspiratory effort Self-inflicted lung injuryRespiratory Distress Syndromeacute respiratory failurenon-invasive mechanical ventilationNoninvasive VentilationRespiratory monitoringCOVID-19Endotracheal intubationRespiration ArtificialAcute respiratory failure; COVID-19; Endotracheal intubation; Esophageal pressure swings; Inspiratory effort; Nasal pressure swings; Non-invasive Mechanical ventilation; Respiratory monitoring; Self-inflicted lung injuryNasal pressure swingsnasal pressure swingsrespiratory monitoringRespiratory Insufficiencyinspiratory effortCritical care (London, England)
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An umbrella review of systematic reviews with meta-analyses evaluating positive and negative outcomes of Hydroxychloroquine and chloroquine therapy

2021

Background & aims: Hydroxychloroquine (HCQ) and chloroquine (CQ) are anti-malarial drugs frequently used in the rheumatologic field. They were recently identified as potential therapeutic options for Coronavirus Disease (COVID-19). The present study aims to map and grade the diverse health outcomes associated with HCQ/CQ using an umbrella review approach. Methods: Umbrella review of systematic reviews of observational and intervention studies. For observational studies, random-effects summary effect size, 95% confidence interval, and 95% prediction interval were estimated. We also assessed heterogeneity, evidence for small-study effect, and evidence for excess significance bias. The quality…

0301 basic medicineMicrobiology (medical)medicine.medical_specialtyhydroxychloroquine030106 microbiologyDiseaseReviewlcsh:Infectious and parasitic diseaseslaw.inventionchloroquine03 medical and health sciences0302 clinical medicinesystematic reviewRandomized controlled triallawChloroquineInternal medicineDiabetes mellitusChloroquine; COVID-19; Hydroxychloroquine; umbrella review; COVID-19; Chloroquine; Humans; Hydroxychloroquine; SARS-CoV-2medicineHumanslcsh:RC109-216030212 general & internal medicineumbrella reviewbusiness.industrySARS-CoV-2COVID-19HydroxychloroquineChloroquineGeneral Medicinemedicine.diseaseConfidence intervalCOVID-19 Drug TreatmentInfectious DiseasesSystematic reviewObservational studybusinessmedicine.drugHumanHydroxychloroquine
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Use of corticosteroids in Coronavirus disease 2019 pneumonia: A systematic review of the literature

2020

The aim was to investigate the effectiveness of glucocorticoid therapy in patients with COVID-19. A systematic search of the literature across nine databases was conducted from inception until 15th March 2020, following the PRISMA guidelines. Patients with a validated diagnosis of COVID-19 and using corticosteroids were included, considering all health outcomes. Four studies with 542 Chinese participants were included. Two studies reported negative findings regarding the use of corticosteroids in patients with COVID-19, i.e., corticosteroids had a detrimental impact on clinical outcomes. One study reported no significant association between the use of corticosteroids and clinical outcomes. …

medicine.medical_specialtyARDSCoronavirus disease 2019 (COVID-19)SARS-Cov-2Coronavirucoronavirus030204 cardiovascular system & hematologyHealth outcomescorticosteroids03 medical and health sciences0302 clinical medicineInternal medicineMedicineCorticosteroidpneumoniaIn patient030212 general & internal medicinelcsh:R5-920business.industryCOVID-19General Medicinemedicine.diseasemethylprednisolonePneumoniaMethylprednisoloneGlucocorticoid therapyMedicineARDSRisk of deathSystematic ReviewCOVID-19 coronavirus corticosteroids methylprednisolone pneumonia ARDS SARS-Cov-2businesslcsh:Medicine (General)medicine.drug
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Accuracy of Nasal Pressure Swing to Predict Failure of High-Flow Nasal Oxygen in Patients with Acute Hypoxemic Respiratory Failure

2023

In a real-life cohort of patients with AHRF undergoing HFNO, ΔPnose showed excellent accuracy in predicting early failure, similar of that displayed by ROX. Giving that the decision to upgrade to NIV or MV was based on clinical variables, the high accuracy of ROX in predicting failure of HFNO is not surprising. The similar accuracy of ΔPnose (the only measurement that remained blinded to our clinical decision), strengthened the association with outcome, avoiding incorporation bias.

Pulmonary and Respiratory Medicineself-inflicted lung injuryacute respiratory failurenon-invasive mechanical ventilationhigh flow nasal cannulaesophageal pressure swingshigh flow nasal cannulaacute respiratory failure high flow nasal cannula non-invasive mechanical ventilation esophageal pressure swings nasal pressure swings respiratory monitoring inspiratory effort self-inflicted lung injurynasal pressure swingsCritical Care and Intensive Care MedicineAcute respiratory failurerespiratory monitoringinspiratory effort
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Additional file 1 of High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-i…

2020

Additional file 1: Description of data: CONSORT (consolidated standards of reporting trials) Checklist for Non-inferiority and Equivalence Trials Checklist for Non-inferiority and Equivalence Trials.

humanities
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High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-inferiority randomized…

2020

Abstract Background The efficacy and safety of high flow nasal therapy (HFNT) in patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease (AECOPD) are unclear. Our aim was to evaluate the short-term effect of HFNT versus NIV in patients with mild-to-moderate AECOPD, with the hypothesis that HFNT is non-inferior to NIV on CO2 clearance after 2 h of treatment. Methods We performed a multicenter, non-inferiority randomized trial comparing HFNT and noninvasive ventilation (NIV) in nine centers in Italy. Patients were eligible if presented with mild-to-moderate AECOPD (arterial pH 7.25–7.35, PaCO2 ≥ 55 mmHg before ventilator support). Primary endpoint was the mean di…

MaleExacerbationEquivalence Trials as TopicCritical Care and Intensive Care MedicineAcute respiratory failurelaw.invention03 medical and health sciencesPulmonary Disease Chronic Obstructive0302 clinical medicineRandomized controlled triallawClinical endpointmedicineHumansCannulaAcute respiratory failure; Chronic obstructive pulmonary disease; High flow nasal cannula; High flow nasal therapy; Noninvasive ventilation030212 general & internal medicineHigh flow nasal therapyAgedCOPDbusiness.industryResearchhigh flow oxygen therapy high flow nasal cannula noninvasive ventilation COPD carbon dioxide acute respiratory failureChronic obstructive pulmonary diseaselcsh:Medical emergencies. Critical care. Intensive care. First aidOxygen Inhalation Therapylcsh:RC86-88.9Middle Agedmedicine.diseaseSymptom Flare UpConfidence intervalHigh flow nasal cannula030228 respiratory systemItalyAnesthesiaBreathingNoninvasive ventilationFemaleHigh flowbusinessNoninvasive ventilationHuman
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Additional file 2 of High flow nasal therapy versus noninvasive ventilation as initial ventilatory strategy in COPD exacerbation: a multicenter non-i…

2020

Additional file 2: Table S1: Characteristics of interventions in the high flow nasal therapy (HFNT) and noninvasive ventilation group (NIV); Table S2: Per-protocol 2 h. Patients’ characteristics in the noninvasive ventilation (NIV) and high flow nasal therapy (HFNT) groups at baseline; Table S3: Per-protocol 6 h. Patients’ characteristics in the noninvasive ventilation (NIV) and high flow nasal therapy (HFNT) groups at baseline; Figure S1: Absolute difference between HFNT and NIV treatment in mean PaCO2 reduction after 6 h (and 1-Sided 95% confidence interval), according to conducted analyses: intention-to-treat (ITT) and per-protocol on patients who completed the treatment originally alloc…

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Additional file 1 of Nasal pressure swings as the measure of inspiratory effort in spontaneously breathing patients with de novo acute respiratory fa…

2022

Additional file 1: eTable 1. Esophageal and nasal pressure swings according to acute respiratory failure etiology. Data are presented as median and interquartile ranges (IQR). eFigure 1. Pearson���s R showing correlations between ��Pes and ��Pnos at 24 hours after splitting the study population according to the NRS received. eFigure 2. Bland-Altman analysis assessing the agreement between ��Pes measured with esophageal manometry and estimated based on ��Pnos (��Pes, estimated) and computed as k����Pnos, where k is the average ratio of ��Pes to ��Pnos measured at baseline. At T2 Bland-Altman methods showed a bias of 0.1 cmH2O and 95% limits of agreement, LoA, from ���2.0 to 2.1 cmH2O (95.1% …

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