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Article ; Online: High-flow nasal oxygenation during gastrointestinal endoscopy. Systematic review and meta-analysis.

Carron, Michele / Tamburini, Enrico / Safaee Fakhr, Bijan / De Cassai, Alessandro / Linassi, Federico / Navalesi, Paolo

BJA open

2022 Volume 4, Page(s) 100098

Abstract: Background: The use of high-flow nasal oxygen (HFNO) has the potential to improve patient safety by limiting hypoxaemia during gastrointestinal endoscopy. The degree of benefit is not adequately established.: Methods: English language literature ... ...

Abstract	Background: The use of high-flow nasal oxygen (HFNO) has the potential to improve patient safety by limiting hypoxaemia during gastrointestinal endoscopy. The degree of benefit is not adequately established. Methods: English language literature searches of PubMed, Scopus, Web of Science, and Cochrane Library electronic databases were performed to identify randomised controlled trials comparing HFNO and conventional oxygen therapy (COT) for patients undergoing gastrointestinal endoscopy under deep sedation. The primary endpoint was the incidence of hypoxic events observed during endoscopic procedures. The secondary endpoints were the incidence of recourse to rescue manoeuvres, procedure interruption, and adverse events. A meta-analysis and a Results: A total of 2867 patients from six randomised controlled trials were considered. Desaturation was observed in 5.2% and 27.2% of patients receiving HFNO and COT, respectively. Desaturation <90% was observed in 1.8% and 12.6% of the patients receiving HFNO and COT, respectively. In the subgroup analysis, desaturation occurrence was lower during HFNO than during COT in non-obese patients (2.2% Conclusions: The evidence reviewed suggests that compared with COT, HFNO has fewer hypoxaemic events during gastrointestinal endoscopy, but this may not apply to all patients and clinical scenarios.
Language	English
Publishing date	2022-10-18
Publishing country	England
Document type	Journal Article ; Review
ISSN	2772-6096
ISSN (online)	2772-6096
DOI	10.1016/j.bjao.2022.100098
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Article ; Online: High-Dose Inhaled Nitric Oxide in Acute Hypoxemic Respiratory Failure Due to COVID-19: A Multicenter Phase II Trial.

Di Fenza, Raffaele / Shetty, Naman S / Gianni, Stefano / Parcha, Vibhu / Giammatteo, Valentina / Safaee Fakhr, Bijan / Tornberg, Daniel / Wall, Olof / Harbut, Piotr / Lai, Peggy S / Li, Jonathan Z / Paganoni, Sabrina / Cenci, Stefano / Mueller, Ariel L / Houle, Timothy T / Akeju, Oluwaseun / Bittner, Edward A / Bose, Somnath / Scott, Louie K /

Carroll, Ryan W / Ichinose, Fumito / Hedenstierna, Magnus / Arora, Pankaj / Berra, Lorenzo

American journal of respiratory and critical care medicine

2023 Volume 208, Issue 12, Page(s) 1293–1304

Abstract: Rationale: ...

Abstract	Rationale:
MeSH term(s)	Adult ; Humans ; Nitric Oxide/therapeutic use ; COVID-19/complications ; Single-Blind Method ; Respiratory Insufficiency/drug therapy ; Respiratory Insufficiency/etiology ; Respiration, Artificial ; Administration, Inhalation
Chemical Substances	Nitric Oxide (31C4KY9ESH)
Language	English
Publishing date	2023-09-28
Publishing country	United States
Document type	Randomized Controlled Trial ; Multicenter Study ; Clinical Trial, Phase II ; Journal Article
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.202304-0637OC
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Article ; Online: Pronation Reveals a Heterogeneous Response of Global and Regional Respiratory Mechanics in Patients With Acute Hypoxemic Respiratory Failure.

Morais, Caio C A / Alcala, Glasiele / De Santis Santiago, Roberta R / Valsecchi, Carlo / Diaz, Eduardo / Wanderley, Hatus / Fakhr, Bijan Safaee / Di Fenza, Raffaele / Gianni, Stefano / Foote, Sara / Chang, Marvin G / Bittner, Edward A / Carroll, Ryan W / Costa, Eduardo L V / Amato, Marcelo B P / Berra, Lorenzo

Critical care explorations

2023 Volume 5, Issue 10, Page(s) e0983

Abstract: Objectives: Experimental models suggest that prone position and positive end-expiratory pressure (PEEP) homogenize ventral-dorsal ventilation distribution and regional respiratory compliance. However, this response still needs confirmation on humans. ... ...

Abstract	Objectives: Experimental models suggest that prone position and positive end-expiratory pressure (PEEP) homogenize ventral-dorsal ventilation distribution and regional respiratory compliance. However, this response still needs confirmation on humans. Therefore, this study aimed to assess the changes in global and regional respiratory mechanics in supine and prone positions over a range of PEEP levels in acute respiratory distress syndrome (ARDS) patients. Design: A prospective cohort study. Patients: Twenty-two intubated patients with ARDS caused by COVID-19 pneumonia. Interventions: Electrical impedance tomography and esophageal manometry were applied during PEEP titrations from 20 cm H Measurements: Global respiratory system compliance (Crs), chest wall compliance, regional lung compliance, ventilation distribution in supine and prone positions. Main results: Compared with supine position, the maximum level of Crs changed after prone position in 59% of ARDS patients ( Conclusions: Prone position modifies global respiratory compliance in most patients with ARDS. Only a subgroup of patients with a positive change in Crs postpronation presented a consistent improvement in dorsal ventilation and compliance. These data suggest that the response to pronation on global and regional mechanics can vary among ARDS patients, with some patients presenting more dorsal lung recruitment than others.
Language	English
Publishing date	2023-10-02
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000983
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Article: A Prospective Observational Study on Short and Long-Term Outcomes of COVID-19 Patients with Acute Hypoxic Respiratory Failure Treated with High-Flow Nasal Cannula.

Journal of clinical medicine

2023 Volume 12, Issue 4

Abstract: 1) The use of high-flow nasal cannula (HFNC) combined with frequent respiratory monitoring in patients with acute hypoxic respiratory failure due to COVID-19 has been shown to reduce intubation and mechanical ventilation. (2) This prospective, single- ... ...

Abstract	(1) The use of high-flow nasal cannula (HFNC) combined with frequent respiratory monitoring in patients with acute hypoxic respiratory failure due to COVID-19 has been shown to reduce intubation and mechanical ventilation. (2) This prospective, single-center, observational study included consecutive adult patients with COVID-19 pneumonia treated with a high-flow nasal cannula. Hemodynamic parameters, respiratory rate, inspiratory fraction of oxygen (F
Language	English
Publishing date	2023-02-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12041249
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Article ; Online: Successful Versus Failed Transition From Controlled Ventilation to Pressure Support Ventilation in COVID-19 Patients: A Retrospective Cohort Study.

Polo Friz, Melisa / Rezoagli, Emanuele / Safaee Fakhr, Bijan / Florio, Gaetano / Carlesso, Eleonora / Giudici, Riccardo / Forlini, Clarissa / Tardini, Francesca / Langer, Thomas / Laratta, Matteo / Casella, Giampaolo / Forastieri Molinari, Andrea / Protti, Alessandro / Cecconi, Maurizio / Cabrini, Luca / Biagioni, Emanuela / Berselli, Angela / Mirabella, Lucia / Tonetti, Tommaso /

De Robertis, Edoardo / Grieco, Domenico Luca / Antonelli, Massimo / Citerio, Giuseppe / Fumagalli, Roberto / Foti, Giuseppe / Zanella, Alberto / Grasselli, Giacomo / Bellani, Giacomo

Critical care explorations

2024 Volume 6, Issue 2, Page(s) e1039

Abstract: Objectives: In patients with COVID-19 respiratory failure, controlled mechanical ventilation (CMV) is often necessary during the acute phases of the disease. Weaning from CMV to pressure support ventilation (PSV) is a key objective when the patient's ... ...

Abstract	Objectives: In patients with COVID-19 respiratory failure, controlled mechanical ventilation (CMV) is often necessary during the acute phases of the disease. Weaning from CMV to pressure support ventilation (PSV) is a key objective when the patient's respiratory functions improve. Limited evidence exists regarding the factors predicting a successful transition to PSV and its impact on patient outcomes. Design: Retrospective observational cohort study. Setting: Twenty-four Italian ICUs from February 2020 to May 2020. Patients: Mechanically ventilated ICU patients with COVID-19-induced respiratory failure. Intervention: The transition period from CMV to PSV was evaluated. We defined it as "failure of assisted breathing" if the patient returned to CMV within the first 72 hours. Measurements and main results: Of 1260 ICU patients screened, 514 were included. Three hundred fifty-seven patients successfully made the transition to PSV, while 157 failed. Pao Conclusions: Our study emphasizes that the Pao
Language	English
Publishing date	2024-02-08
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000001039
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Article ; Online: Bedside Electrical Impedance Tomography Unveils Respiratory "Chimera" in COVID-19.

Morais, Caio C A / Safaee Fakhr, Bijan / De Santis Santiago, Roberta R / Di Fenza, Raffaele / Marutani, Eizo / Gianni, Stefano / Pinciroli, Riccardo / Kacmarek, Robert M / Berra, Lorenzo

American journal of respiratory and critical care medicine

2020 Volume 203, Issue 1, Page(s) 120–121

MeSH term(s)	COVID-19/diagnosis ; COVID-19/epidemiology ; Electric Impedance ; Humans ; Lung/physiopathology ; Pandemics ; Point-of-Care Systems ; SARS-CoV-2 ; Tomography/methods
Language	English
Publishing date	2020-11-16
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.202005-1801IM
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Article ; Online: Rescue Treatment With High-Dose Gaseous Nitric Oxide in Spontaneously Breathing Patients With Severe Coronavirus Disease 2019.

Wiegand, Steffen B / Safaee Fakhr, Bijan / Carroll, Ryan W / Zapol, Warren M / Kacmarek, Robert M / Berra, Lorenzo

Critical care explorations

2020 Volume 2, Issue 11, Page(s) e0277

Abstract: Treatment options are limited for patients with respiratory failure due to coronavirus disease 2019. Conventional oxygen therapy and awake proning are options, but the use of high-flow nasal cannula and continuous positive airway pressure are ... ...

Abstract	Treatment options are limited for patients with respiratory failure due to coronavirus disease 2019. Conventional oxygen therapy and awake proning are options, but the use of high-flow nasal cannula and continuous positive airway pressure are controversial. There is an urgent need for effective rescue therapies. Our aim is to evaluate the role of inhaled nitric oxide 160 ppm as a possible rescue therapy in nonintubated coronavirus disease 2019 patients. Design: Retrospective evaluation of coronavirus disease 2019 patients in respiratory distress receiving nitric oxide gas as rescue therapy. Setting: Massachusetts General Hospital, between March 18, 2020, and May 20, 2020, during the local coronavirus disease 2019 surge. Patients: Coronavirus disease 2019 patients at high risk for acute hypoxemic respiratory failure with worsening symptoms despite use of supplemental oxygen and/or awake proning. Interventions: Patients received nitric oxide at concentrations of 160 ppm for 30 minutes twice per day via a face mask until resolution of symptoms, discharge, intubation, or the transition to comfort measures only. Measurements and main results: Between March 18, 2020, and May 20, 2020, five patients received nitric oxide inhalation as a rescue therapy for coronavirus disease 2019 at Massachusetts General Hospital. All received at least one dosage. The three patients that received multiple treatments (ranging from five to nine) survived and were discharged home. Maximum methemoglobin concentration after 30 minutes of breathing nitric oxide was 2.0% (1.7-2.3%). Nitrogen dioxide was below 2 ppm. No changes in mean arterial pressure or heart rate were observed during or after nitric oxide treatment. Oxygenation and the respiratory rate remained stable during and after nitric oxide treatments. For two patients, inflammatory marker data were available and demonstrate a reduction or a cessation of escalation after nitric oxide treatment. Conclusions: Nitric oxide at 160 ppm may be an effective adjuvant rescue therapy for patients with coronavirus disease 2019.
Language	English
Publishing date	2020-11-16
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000277
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Article ; Online: A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects.

Pinciroli, Riccardo / Traeger, Lisa / Fischbach, Anna / Gianni, Stefano / Morais, Caio Cesar Araujo / Fakhr, Bijan Safaee / Di Fenza, Raffaele / Robinson, Dianna / Carroll, Ryan / Zapol, Warren M / Berra, Lorenzo

Journal of visualized experiments : JoVE

2021 , Issue 171

Abstract: Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if administered at high concentration. Inhaled NO gas is routinely used to increase systemic ... ...

Abstract	Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if administered at high concentration. Inhaled NO gas is routinely used to increase systemic oxygenation in different disease conditions. The administration of high concentrations of NO also exerts a virucidal effect in vitro. Owing to its favorable pharmacodynamic and safety profiles, the familiarity in its use by critical care providers, and the potential for a direct virucidal effect, NO is clinically used in patients with coronavirus disease-2019 (COVID-19). Nevertheless, no device is currently available to easily administer inhaled NO at concentrations higher than 80 parts per million (ppm) at various inspired oxygen fractions, without the need for dedicated, heavy, and costly equipment. The development of a reliable, safe, inexpensive, lightweight, and ventilator-free solution is crucial, particularly for the early treatment of non-intubated patients outside of the intensive care unit (ICU) and in a limited-resource scenario. To overcome such a barrier, a simple system for the non-invasive NO gas administration up to 250 ppm was developed using standard consumables and a scavenging chamber. The method has been proven safe and reliable in delivering a specified NO concentration while limiting nitrogen dioxide levels. This paper aims to provide clinicians and researchers with the necessary information on how to assemble or adapt such a system for research purposes or clinical use in COVID-19 or other diseases in which NO administration might be beneficial.
MeSH term(s)	Administration, Inhalation ; COVID-19/drug therapy ; Critical Care ; Humans ; Intensive Care Units ; Nitric Oxide/administration & dosage ; Nitric Oxide/therapeutic use ; Respiratory Protective Devices ; SARS-CoV-2 ; Ventilators, Mechanical
Chemical Substances	Nitric Oxide (31C4KY9ESH)
Language	English
Publishing date	2021-05-04
Publishing country	United States
Document type	Journal Article ; Video-Audio Media
ZDB-ID	2259946-0
ISSN	1940-087X ; 1940-087X
ISSN (online)	1940-087X
ISSN	1940-087X
DOI	10.3791/61769
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Article ; Online: High-Dose Nitric Oxide From Pressurized Cylinders and Nitric Oxide Produced by an Electric Generator From Air.

Gianni, Stefano / Fenza, Raffaele Di / Morais, Caio C Araujo / Fakhr, Bijan Safaee / Mueller, Ariel L / Yu, Binglan / Carroll, Ryan W / Ichinose, Fumito / Zapol, Warren M / Berra, Lorenzo

Respiratory care

2021 Volume 67, Issue 2, Page(s) 201–208

Abstract: Background: High-dose (≥ 80 ppm) inhaled nitric oxide (INO) has antimicrobial effects. We designed a trial to test the preventive effects of high-dose NO on coronavirus disease 2019 (COVID-19) in health care providers working with patients with COVID-19. ...

Abstract	Background: High-dose (≥ 80 ppm) inhaled nitric oxide (INO) has antimicrobial effects. We designed a trial to test the preventive effects of high-dose NO on coronavirus disease 2019 (COVID-19) in health care providers working with patients with COVID-19. The study was interrupted prematurely due to the introduction of COVID-19 vaccines for health care professionals. We thereby present data on safety and feasibility of breathing 160 ppm NO using 2 different NO sources, namely pressurized nitrogen/NO cylinders (INO) and electric NO (eNO) generators. Methods: NO gas was inhaled at 160 ppm in air for 15 min twice daily, before and after each work shift, over 14 d by health care providers (NCT04312243). During NO administration, vital signs were continuously monitored. Safety was assessed by measuring transcutaneous methemoglobinemia (SpMet) and the inhaled nitrogen dioxide (NO Results: Twelve healthy health care professionals received a collective total of 185 administrations of high-dose NO (160 ppm) for 15 min twice daily. One-hundred and seventy-one doses were delivered by INO and 14 doses by eNO. During NO administration, SpMet increased similarly in both groups ( Conclusions: This pilot study testing high-dose INO (160 ppm) for 15 min twice daily using eNO seems feasible and similarly safe when compared with INO.
MeSH term(s)	Administration, Inhalation ; COVID-19 ; COVID-19 Vaccines ; Humans ; Nitric Oxide ; Oxygen Saturation ; Pilot Projects ; SARS-CoV-2
Chemical Substances	COVID-19 Vaccines ; Nitric Oxide (31C4KY9ESH)
Language	English
Publishing date	2021-08-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.09308
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Article ; Online: Bedside monitoring of lung perfusion by electrical impedance tomography in the time of COVID-19.

Safaee Fakhr, Bijan / Araujo Morais, Caio C / De Santis Santiago, Roberta R / Di Fenza, Raffaele / Gibson, Lauren E / Restrepo, Paula A / Chang, Marvin G / Bittner, Edward A / Pinciroli, Riccardo / Fintelmann, Florian J / Kacmarek, Robert M / Berra, Lorenzo

British journal of anaesthesia

2020 Volume 125, Issue 5, Page(s) e434–e436

MeSH term(s)	Aged ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/physiopathology ; Electric Impedance ; Humans ; Lung/diagnostic imaging ; Lung/physiopathology ; Male ; Pandemics ; Pneumonia, Viral/physiopathology ; Point-of-Care Systems ; Pulmonary Ventilation/physiology ; SARS-CoV-2 ; Tomography/methods
Keywords	covid19
Language	English
Publishing date	2020-08-07
Publishing country	England
Document type	Case Reports ; Letter
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2020.08.001
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