Choosing a ventilator for home mechanical ventilation

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COVID-19 Vaccination Status among Adults Admitted to Intensive Care Units in Veneto, Italy

: This cohort study examines admissions to intensive care units for COVID-19–associated acute respiratory distress syndrome by COVID-19 vaccination status among adults in the Veneto region of Italy from May to December 2021

Automatic Forecast of Intensive Care Unit Admissions: The Experience During the COVID-19 Pandemic in Italy

The experience of the COVID-19 pandemic showed the importance of timely monitoring of admissions to the ICU admissions. The ability to promptly forecast the epidemic impact on the occupancy of beds in the ICU is a key issue for adequate management of the health care system. Despite this, most of the literature on predictive COVID-19 models in Italy has focused on predicting the number of infections, leaving trends in ordinary hospitalizations and ICU occupancies in the background. This work aims to present an ETS approach (Exponential Smoothing Time Series) time series forecasting tool for admissions to the ICU admissions based on ETS models. The results of the forecasting model are presented for the regions most affected by the epidemic, such as Veneto, Lombardy, Emilia-Romagna, and Piedmont. The mean absolute percentage errors (MAPE) between observed and predicted admissions to the ICU admissions remain lower than 11% for all considered geographical areas. In this epidemiological context, the proposed ETS forecasting model could be suitable to monitor, in a timely manner, the impact of COVID-19 disease on the health care system, not only during the early stages of the pandemic but also during the vaccination campaign, to quickly adapt possible preventive interventions

The Use of Tactile Sensors in Oral and Maxillofacial Surgery: An Overview

Background: This overview aimed to characterize the type, development, and use of haptic technologies for maxillofacial surgical purposes. The work aim is to summarize and evaluate current advantages, drawbacks, and design choices of presented technologies for each field of application in order to address and promote future research as well as to provide a global view of the issue. Methods: Relevant manuscripts were searched electronically through Scopus, MEDLINE/PubMed, and Cochrane Library databases until 1 November 2022. Results: After analyzing the available literature, 31 articles regarding tactile sensors and interfaces, sensorized tools, haptic technologies, and integrated platforms in oral and maxillofacial surgery have been included. Moreover, a quality rating is provided for each article following appropriate evaluation metrics. Discussion: Many efforts have been made to overcome the technological limits of computed assistant diagnosis, surgery, and teaching. Nonetheless, a research gap is evident between dental/maxillofacial surgery and other specialties such as endovascular, laparoscopic, and microsurgery; especially for what concerns electrical and optical-based sensors for instrumented tools and sensorized tools for contact forces detection. The application of existing technologies is mainly focused on digital simulation purposes, and the integration into Computer Assisted Surgery (CAS) is far from being widely actuated. Virtual reality, increasingly adopted in various fields of surgery (e.g., sino-nasal, traumatology, implantology) showed interesting results and has the potential to revolutionize teaching and learning. A major concern regarding the actual state of the art is the absence of randomized control trials and the prevalence of case reports, retrospective cohorts, and experimental studies. Nonetheless, as the research is fast growing, we can expect to see many developments be incorporated into maxillofacial surgery practice, after adequate evaluation by the scientific community

Tidal Volume Estimation during Helmet Noninvasive Ventilation: an Experimental Feasibility Study

We performed a bench (BS) and human (HS) study to test the hypothesis that estimation of tidal volume (VT) during noninvasive helmet pressure support ventilation (nHPSV) would be possible using a turbine driven ventilator (TDV) coupled with an intentional leak single-limb vented circuit. During the BS a mannequin was connected to a lung simulator (LS) and at different conditions of respiratory mechanics, positive end expiratory pressure (PEEP) levels and leaks (30, 50 and 80 L/min). All differences were within the 95% limits of agreement (LoA) in all conditions in the Bland-Altman plot. The overall bias (difference between VT measured by TDV and LS) was 35 ml (95% LoA 10 to 57 ml), 15 ml (95% LoA -40 to 70 ml), 141 ml (95% LoA 109 to 173 ml) in the normal, restrictive and obstructive conditions. The bias at different leaks flow in normal condition was 29 ml (95% LoA 19 to 38 ml). In the HS four healthy volunteers using nHPSV had a pneumotachograph (P) inserted through a mouthpiece to measure subject's VT.The bias showed a scarce clinical relevance. In conclusions, VT estimation seems to be feasible and accurate in all conditions but the obstructive one. Additional leaks seem not to affect VT reliability

La ventilazione non invasiva in Medicina Interna

Legenda delle più comuni abbreviazioni e acronimi Prefazione P. Navalesi Presentazione M. Campanini La NIV in Medicina Interna F. Lari Il ventilatore e i suoi componenti F. Lari Maschere ed interfacce F. Lari Sistemi CPAP (pressione positiva continua applicata alle vie aeree) F. Lari Principi e tecniche di ventilazione meccanica F. Giostra, E. Di Flaviano Insufficienza respiratoria acuta cardiogena - ruolo della ventilazione non invasiva F. Ventrella Riacutizzazione di broncopneumopatia cronica ostruttiva M. La Regina, F. Orlandini Altre indicazioni alla ventilazione meccanica non invasiva F. Pieralli, O. Para, C. Nozzoli Le apnee del sonno: competenza multidisciplinare e ruolo dell’internista F. Lari La ventilazione meccanica non invasiva nella palliazione del paziente oncologico terminale S. Orlando, M. Giorgi-Pierfranceschi La NIV nel paziente con insufficienza respiratoria cronica, la gestione domiciliare - Competenza specialistica nelle patologie pneumologiche pure A. Marchioni, E.M. Clini, B. Beghé Approccio al paziente internistico, candidato alla ventilazione meccanica non invasiva: key messages M. Giorgi Pierfranceschi La ventilazione meccanica non invasiva: conclusioni M. Errico, A. Greco NIV in Medicina Interna: sono necessari sistemi di monitoraggio emodinamico? N. Di Battista, F. Savell

Effect of awake prone position on diaphragmatic thickening fraction in patients assisted by noninvasive ventilation for hypoxemic acute respiratory failure related to novel coronavirus disease

Background: Awake prone position is an emerging rescue therapy applied in patients undergoing noninvasive ventilation (NIV) for acute hypoxemic respiratory failure (ARF) related to novel coronavirus disease (COVID-19). Although applied to stabilize respiratory status, in awake patients, the application of prone position may reduce comfort with a consequent increase in the workload imposed on respiratory muscles. Thus, we primarily ascertained the effect of awake prone position on diaphragmatic thickening fraction, assessed through ultrasound, in COVID-19 patients undergoing NIV. Methods: We enrolled all COVID-19 adult critically ill patients, admitted to intensive care unit (ICU) for hypoxemic ARF and undergoing NIV, deserving of awake prone positioning as a rescue therapy. Exclusion criteria were pregnancy and any contraindication to awake prone position and NIV. On ICU admission, after NIV onset, in supine position, and at 1\ua0h following awake prone position application, diaphragmatic thickening fraction was obtained on the right side. Across all the study phases, NIV was maintained with the same setting present at study entry. Vital signs were monitored throughout the entire study period. Comfort was assessed through numerical rating scale (0 the worst comfort and 10 the highest comfort level). Data were presented in median and 25th\u201375th percentile range. Results: From February to May 2021, 20 patients were enrolled and finally analyzed. Despite peripheral oxygen saturation improvement [96 (94\u201397)% supine vs 98 (96\u201399)% prone, p = 0.008], turning to prone position induced a worsening in comfort score from 7.0 (6.0\u20138.0) to 6.0 (5.0\u20137.0) (p = 0.012) and an increase in diaphragmatic thickening fraction from 33.3 (25.7\u201340.5)% to 41.5 (29.8\u201350.0)% (p = 0.025). Conclusions: In our COVID-19 patients assisted by NIV in ICU, the application of awake prone position improved the oxygenation at the expense of a greater diaphragmatic thickening fraction compared to supine position. Trial registration ClinicalTrials.gov, number NCT04904731. Registered on 05/25/2021, retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04904731

Comparisons of two diaphragm ultrasound-teaching programs: a multicenter randomized controlled educational study

This study aims to ascertain whether (1) an educational program is sufficient to achieve adequate Diaphragm Ultrasound (DUS) assessments on healthy volunteers and (2) combining a video tutorial with a practical session is more effective in making learners capable to obtain accurate DUS measurements, as opposed to sole video tutorial