Non-invasive continuous positive airway pressure in monolateral lung transplant patient with pneumonia and IPF

Patients who undergo lung transplantation are prone to develop lower respiratory tract infections, leading to severe acute respiratory failure (ARF). Endotracheal intubation may not be indicated in these patients in light of a higher rate of mortality due to infections. The application of non-invasive ventilation could play a role in bridging these patients through the episode of ARF waiting for medical treatment to have effect. We report the evidence of morphological and physiological effects of the application of non-invasive continuous positive airway pressure during ARF sustained by pneumonia in a patient who underwent left lung transplantation because of idiopathic pulmonary fibrosis (IPF). We studied the effects of the application of positive end-expiratory pressure on both the right native lung affected by IPF and the transplanted lung affected by pneumonia

Prophylactic antibiotic therapy in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) represents a huge epidemiological burden and is associated with a high incidence of morbidity and mortality. The disease is characterized by chronic inflammation and bacterial colonization. Chronic bacterial colonization leads to chronic inflammation and epithelial damage that in turn may increase bacterial colonization and predispose to acute bacterial infection. Acute exacerbations are a major cause of hospitalization and lead to a deterioration in pulmonary function. Antibiotic treatment of acute bacterial exacerbations is a cornerstone of medical treatment. Conversely, the role of antibiotic prophylaxis in COPD in the stable state is controversial. From a theoretical point of view, antibiotic prophylaxis is intriguing as it could break the vicious circle between chronic bacterial colonization, inflammation and epithelial damage; however, evidence is scarce. This paper reviews the literature and focuses on the most recent data shedding light on this fascinating dilemma

Acute Heart Failure in the Emergency Department: the SAFE-SIMEU Epidemiological Study

none8noBackground Patients with acute heart failure (AHF) have high rates of attendance to emergency departments (EDs), with significant health care costs. Objectives We aimed to describe the clinical characteristics of patients attending Italian EDs for AHF and their diagnostic and therapeutic work-up. Methods We carried out a retrospective analysis on 2683 cases observed in six Italian EDs for AHF (January 2011 to June 2012). Results The median age of patients was 84 years (interquartile range 12), with females accounting for 55.8% of cases (95% confidence interval [CI] 53.5â57.6%). A first episode of AHF was recorded in 55.3% (95% CI 55.4â57.2%). Respiratory disease was the main precipitating factor (approximately 30% of cases), and multiple comorbidities were recorded in > 50% of cases (history of acute coronary syndrome, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, valvular heart disease). The treatment was based on oxygen (69.7%; 67.9â71.5%), diuretics (69.2%; 67.9â71.5%), nitroglycerin (19.7%; 18.3â21.4%), and noninvasive ventilation (15.2%; 13.8â16.6%). Death occurred within 6 h in 2.5% of cases (2.0â3.1%), 6.4% (5.5â7.3%) were referred to the care of their general practitioners within a few hours from ED attendance or after short-term (< 24 h) observation 13.9% (12.6â15.2%); 60.4% (58.5â62.2%) were admitted to the hospital, and 16.8% (15.4â18.3%) were cared for in intensive care units according to disease severity. Conclusions Our study reporting the âreal-worldâ clinical activity indicates that subjects attending the Italian EDs for AHF are rather different from those reported in international registries. Subjects are older, with a higher proportion of females, and high prevalence of cardiac and noncardiac comorbidities.mixedFabbri, Andrea*; Marchesini, Giulio; Carbone, Giorgio; Cosentini, Roberto; Ferrari, Annamaria; Chiesa, Mauro; Bertini, Alessio; Rea, FedericoFabbri, Andrea*; Marchesini, Giulio; Carbone, Giorgio; Cosentini, Roberto; Ferrari, Annamaria; Chiesa, Mauro; Bertini, Alessio; Rea, Federic

Acute heart failure in the emergency department: a follow-up study

Acute heart failure (AHF) is a major public health issue due to high incidence and poor prognosis. Only a few studies are available on the long-term prognosis and on outcome predictors in the unselected population attending the emergency department (ED) for AHF. We carried out a 1-year follow-up analysis of 1234 consecutive patients from selected Italian EDs from January 2011 to June 2012 for an episode of AHF. Their prognosis and outcome-associated factors were tested by Cox proportional hazard model. Patients\u2019 mean age was 84, with 66.0\ua0% over 80\ua0years and 56.2\ua0% females. Comorbidities were present in over 50\ua0% of cases, principally a history of acute coronary syndrome, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, valvular heart disease. Death occurred within 6\ua0h in 24 cases (1.9\ua0%). At 30-day follow-up, death was registered in 123 cases (10.0\ua0%): 110 cases (89.4\ua0%) died of cardiovascular events and 13 (10.6\ua0%) of non-cardiovascular causes (cancer, gastrointestinal hemorrhages, sepsis, trauma). At 1-year follow-up, all-cause death was recorded in 50.1\ua0% (over 3 out of 4 cases for cardiovascular origin). Six variables (older age, diabetes, systolic arterial pressure\ua0<110\ua0mm/Hg, high NT pro-BNP, high troponin levels and impaired cognitive status) were selected as outcome predictors, but with limited discriminant capacity (AUC\ua0=\ua00.649; SE 0.015). Recurrence of AHF was registered in 31.0\ua0%. The study identifies a cluster of variables associated with 1-year mortality in AHF, but their predictive capacity is low. Old age and the presence of comorbidities, in particular diabetes are likely to play a major role in dictating the prognosis