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Article: Aerosol delivery through high-flow nasal therapy: Technical issues and clinical benefits.

Calabrese, Cecilia / Annunziata, Anna / Mariniello, Domenica Francesca / Allocca, Valentino / Imitazione, Pasquale / Cauteruccio, Rosa / Simioli, Francesca / Fiorentino, Giuseppe

Frontiers in medicine

2023 Volume 9, Page(s) 1098427

Abstract: High-flow nasal cannula (HFNC) therapy is an oxygen delivery method particularly used in patients affected by hypoxemic respiratory failure. In comparison with the conventional "low flow" oxygen delivery systems, it showed several important clinical ... ...

Abstract	High-flow nasal cannula (HFNC) therapy is an oxygen delivery method particularly used in patients affected by hypoxemic respiratory failure. In comparison with the conventional "low flow" oxygen delivery systems, it showed several important clinical benefits. The possibility to nebulize drugs
Language	English
Publishing date	2023-01-18
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2022.1098427
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Article: Psychological Factors Influencing Adherence to NIV in Neuromuscular Patients Dependent on Non Invasive Mechanical Ventilation: Preliminary Results.

Annunziata, Anna / Calabrese, Cecilia / Simioli, Francesca / Coppola, Antonietta / Pierucci, Paola / Mariniello, Domenica Francesca / Fiorentino, Giuseppe

Journal of clinical medicine

2023 Volume 12, Issue 18

Abstract: Background: Non-invasive ventilation (NIV) is associated with improvement of both morbility and mortality in patients affected by neuromuscular diseases with chronic respiratory failure. Several studies have also shown that long-term NIV positively ... ...

Abstract	Background: Non-invasive ventilation (NIV) is associated with improvement of both morbility and mortality in patients affected by neuromuscular diseases with chronic respiratory failure. Several studies have also shown that long-term NIV positively impacts the patient's quality of life and perception of disease status. Its effectiveness is likely related to the adherence to NIV. Several factors, patient- and not patient-related, may compromise adherence to NIV, such as physical, behavioral, familiar, and social issues. Few data are currently available on the role of psychological factors in influencing NIV adherence. Materials and methods: In this pilot study, we evaluated the adherence to NIV in a group of 15 adult patients with neuromuscular diseases (Duchenne muscular dystrophy, myotonic dystrophy, and amyotrophic lateral sclerosis) in relation to their grade of depression assessed by the Beck Depression Inventory (BDI) questionnaire. Other data were collected, such as clinical features (age and sex), use of anxiolytic drugs, the presence of a family or professional caregiver, the quality of patient-physician relationship, the beginning of psychological support after BDI screening, and the family acceptance of NIV. NIV adherence was definied as the use of NIV for at least 4 h per night on 70% of nights in a month. Results: The overall rate of NIV adherence was 60%. Based on the BDI questionnaire, patients who were non-adherent to NIV had a higher rate of depression, mainly observed in the oldest patients. The acceptance of NIV by the family and positive physician-patient interaction seem to favor NIV adherence. Conclusion: Depression can interfere with NIV adherence in patients with neuromuscolar diseases.
Language	English
Publishing date	2023-09-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12185866
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Article: Therapeutic approach for severe COVID-19 and immunocompromised patients. A case series.

Simioli, Francesca / Martino, Maria / Annunziata, Anna / Carannante, Novella / Fiorentino, Giuseppe

Respiratory medicine case reports

2021 Volume 33, Page(s) 101397

Abstract: Background: COVID-19 is a potentially critical infectious disease. Inflammatory response and disease severity may vary according to immune system status. The aim of this case series is to investigate different presentation of COVID-19 in ... ...

Abstract	Background: COVID-19 is a potentially critical infectious disease. Inflammatory response and disease severity may vary according to immune system status. The aim of this case series is to investigate different presentation of COVID-19 in immunocompromised patients. Methods: this is a single centre case series about 17 immunocompromised patients admitted to our respiratory department during the recent COVID-19 pandemic. White blood cell count, C reactive protein, interleukin 6, lymphocytic subpopulation count (CD4 Results: the most common causes of immunosuppression observed in our severe COVID-19 population are hematological malignancies, immunosuppressant drugs for transplant, primary immunodeficiency and inflammatory bowel disease. Onset symptoms were fever (88%), cough (53%), dyspnoea (24%), asthenia (35%), anosmia and/or ageusia (17%), expectoration (12%). Compared to benign conditions, patients with malignancies show a lower lymphocytic count (490 vs 1100 cells/uL) and higher interleukin 6 (33 vs 13 pg/mL). Conclusions: immunocompromised patients are at risk of adverse outcome from COVID-19. Hematological malignancies and anti-CD20 therapies induce a high risk. Primary immunodeficiency and classical immunosuppressant such as calcineurin inhibitors and antimetabolites share an intermediate risk.
Language	English
Publishing date	2021-03-24
Publishing country	England
Document type	Case Reports
ZDB-ID	2666110-X
ISSN	2213-0071
ISSN	2213-0071
DOI	10.1016/j.rmcr.2021.101397
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Article: Versatility of Intermittent Abdominal Pressure Ventilation in a Case of Complicated Restrictive Respiratory Failure and COVID-19.

Simioli, Francesca / Annunziata, Anna / Coppola, Antonietta / Borriello, Ediva Myriam / Spinelli, Sara / Fiorentino, Giuseppe

Healthcare (Basel, Switzerland)

2022 Volume 10, Issue 6

Abstract: Background: The intermittent abdominal pressure ventilation (IAPV) is a non-invasive ventilation (NIV) technique that avoids facial interfaces and is a diurnal ventilatory support alternative for neuromuscular patients during stable chronic phases of ... ...

Abstract	Background: The intermittent abdominal pressure ventilation (IAPV) is a non-invasive ventilation (NIV) technique that avoids facial interfaces and is a diurnal ventilatory support alternative for neuromuscular patients during stable chronic phases of the disease. Coronavirus disease 2019 (COVID-19) is a novel infection possibly causing acute respiratory distress syndrome (ARDS). Neuromuscular diseases (NMD) and preexisting respiratory failure can be exacerbated by respiratory infection and progress to severe disease and ICU admission with a poor prognosis. Aim: To report on the versatility and feasibility of IAPV in acute restrictive respiratory failure exacerbated by COVID-19. Patient: We describe the case of a 33-year-old man with spastic tetraparesis, kyphoscoliosis, and impaired cough, eventually leading to a restrictive ventilation pattern. COVID-19 exacerbated respiratory failure and seizures. An NIV trial failed because of inadequate interface adhesion and intolerance. During NIV, dyspnea and seizures worsened. He underwent a high flow nasal cannula (HFNC) with a fluctuating benefit on gas exchange. IAPV was initiated and although there was a lack of cooperation and inability to sit; the compliance was good and a progressive improvement of gas exchange, respiratory rate, and dyspnea was observed. Conclusions: IAPV is a versatile type of NIV that can be adopted in complicated restrictive respiratory failure. COVID-19 exacerbates preexisting conditions and is destined to be a disease of frailty. COVID-19 is not a contraindication to IAPV and this kind of ventilation can be employed in selected cases in a specialistic setting. Moreover, this report suggests that IAPV is safe when used in combination with HFNC. This hybrid approach provides the opportunity to benefit from both therapies, and, in this particular case, prevented the intubation with all connected risks.
Language	English
Publishing date	2022-05-31
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare10061012
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Article: The role of dexmedetomidine in ARDS: an approach to non-intensive care sedation.

Simioli, Francesca / Annunziata, Anna / Coppola, Antonietta / Imitazione, Pasquale / Mirizzi, Angela Irene / Marotta, Antonella / D'Angelo, Rossella / Fiorentino, Giuseppe

Frontiers in medicine

2023 Volume 10, Page(s) 1224242

Abstract: Introduction: Severe COVID-19 is a life-threatening condition characterized by complications such as interstitial pneumonia, hypoxic respiratory failure, and acute respiratory distress syndrome (ARDS). Non-pharmacological intervention with mechanical ... ...

Abstract	Introduction: Severe COVID-19 is a life-threatening condition characterized by complications such as interstitial pneumonia, hypoxic respiratory failure, and acute respiratory distress syndrome (ARDS). Non-pharmacological intervention with mechanical ventilation plays a key role in treating COVID-19-related ARDS but is influenced by a high risk of failure in more severe patients. Dexmedetomidine is a new generation highly selective α2-adrenergic receptor (α2-AR) agonist that provides sedative effects with preservation of respiratory function. The aim of this study is to assess how dexmedetomidine influences gas exchange during non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) in moderate to severe ARDS caused by COVID-19 in a non-intensive care setting. Methods: This is a single center retrospective cohort study. We included patients who showed moderate to severe respiratory distress. All included subjects had indication to NIV and were suitable for a non-intensive setting of care. A total of 170 patients were included, divided in a control group ( Results: A total of 170 patients were hospitalized for moderate to severe ARDS and COVID-19. The median age was 71 years, 29% females. The median Charlson comorbidity index (CCI) was 2.5. Obesity affected 21% of the study population. The median pO Conclusion: Dexmedetomidine provides a "calm and arousal" status which allows spontaneous ventilation in awake patients treated with NIV and HFNC. The adjunctive therapy with dexmedetomidine is associated with a higher pO
Language	English
Publishing date	2023-08-31
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2023.1224242
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Long-Term High Flow Nasal Cannula Therapy in Primary and Secondary Bronchiectasis.

Simioli, Francesca / Fiorentino, Giuseppe / Cauteruccio, Rosa / Coppola, Antonietta / Imitazione, Pasquale / Marotta, Antonella / Di Spirito, Valentina / Annunziata, Anna

Healthcare (Basel, Switzerland)

2023 Volume 11, Issue 9

Abstract: Background: Bronchiectasis is the consequence of chronic bronchial inflammation, inappropriate mucus clearance, bacterial colonization, and recurrent or chronic infection. High flow therapy (HFT) is a type of non-invasive respiratory therapy, usually ... ...

Abstract	Background: Bronchiectasis is the consequence of chronic bronchial inflammation, inappropriate mucus clearance, bacterial colonization, and recurrent or chronic infection. High flow therapy (HFT) is a type of non-invasive respiratory therapy, usually delivered through a nasal cannula interface (HFNC). It delivers heated and humidified air with a stable fraction of inspired oxygen and a wide range of possible flow rates. Aim of the study: Determine the effectiveness of HFNC as add-on therapy in adult primary and secondary bronchiectasis with frequent acute exacerbations (AEs) and/or hospitalizations. Methods: This is a single-center crossover study on long-term home therapy with HFNC in adult bronchiectasis. Pharmacological therapy included pulse therapy with mucolytics and bronchodilators. After one year, all patients were switched to additional HFNC. The temperature range was 31-37 °C. The flow range was 35-60 L/m. FiO Results: Seventy-eight patients completed the follow-up; 54% were females; the median age was 70 years (IQR 60-76). The etiology of bronchiectasis was mainly post-infective (51%), COPD related (26%), and congenital (11%). AEs at baseline were 2.81 (±2.15). A significant reduction in AEs was observed after 24 months with a mean of 0.45 (±0.66) (f-ratio value 79.703. Conclusions: HFNC is a well-tolerated add-on therapy for adult bronchiectasis. Dyspnea improved after 2 months and further after 2 years. The exacerbation rate decreased during the 2 years follow-up. No significant difference was observed in lung function.
Language	English
Publishing date	2023-04-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare11091250
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Article: The Role of High Flow Nasal Cannula in COVID-19 Associated Pneumomediastinum and Pneumothorax.

Simioli, Francesca / Annunziata, Anna / Polistina, Giorgio Emanuele / Coppola, Antonietta / Di Spirito, Valentina / Fiorentino, Giuseppe

Healthcare (Basel, Switzerland)

2021 Volume 9, Issue 6

Abstract: Background: Pneumomediastinum, subcutaneous emphysema and pneumothorax are not rarely observed during the COVID-19 pandemic. Such complications can worsen gas exchange and the overall prognosis in critical patients. The aim of this study is to ... ...

Abstract	Background: Pneumomediastinum, subcutaneous emphysema and pneumothorax are not rarely observed during the COVID-19 pandemic. Such complications can worsen gas exchange and the overall prognosis in critical patients. The aim of this study is to investigate what predisposing factors are related to pneumomediastinum and pneumothorax in SARS-CoV2-Acute Respiratory Distress Syndrome (ARDS), what symptoms may predict a severe and potentially fatal complication and what therapeutical approach may provide a better outcome. Methods: In this single center cohort study, we recorded data from 45 critically ill COVID-19 patients who developed one or more complicating events among pneumomediastinum, subcutaneous emphysema and pneumothorax. All patients showed ARDS and underwent non-invasive ventilation (NIV) at baseline. Patients with mild to moderate ARDS and pneumomediastinum/pneumothorax ( Results: Pneumomediastinum/pneumothorax developed in 10.5% of subjects affected by SARS-coV2-ARDS. Dyspnea affected 40% and cough affected 37% of subjects. High resolution computed tomography of the chest showed bilateral diffuse ground glass opacities (GGO) in 100% of subjects. Traction bronchiolectasis, reticulation, crazy paving and distortion were observed in 64%. Furthermore, 36% showed subcutaneous emphysema. Non-severe ARDS cases received HFNC, and 76% patients recovered from pneumomediastinum/pneumothorax over a median follow up of 5 days. Among severe ARDS cases the recovery rate of pneumomediastinum/pneumothorax was 70% with the HFNC approach, and 10% with IMV. Conclusion: HFNC is a safe and effective ventilatory approach for critical COVID-19 and has a positive role in associated complications such as pneumomediastinum and pneumothorax.
Language	English
Publishing date	2021-05-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare9060620
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Article ; Online: Early Prone Positioning and Non-Invasive Ventilation in a Critical COVID-19 Subset. A Single Centre Experience in Southern Italy.

Simioli, Francesca / Annunziata, Anna / Langella, Gerardo / Martino, Maria / Musella, Salvatore / Fiorentino, Giuseppe

Turkish thoracic journal

2021 Volume 22, Issue 1, Page(s) 57–61

Abstract: Objective: Prone positioning (PP) has demonstrated to be a safe adjunctive therapy for severe acute respiratory distress syndrome (ARDS). There is limited evidence of PP effects on awake patients. This study aimed to investigate the effects and ... ...

Abstract	Objective: Prone positioning (PP) has demonstrated to be a safe adjunctive therapy for severe acute respiratory distress syndrome (ARDS). There is limited evidence of PP effects on awake patients. This study aimed to investigate the effects and feasibility of PP on coronavirus disease 2019 (COVID-19)-associated awake patients with ARDS in a subintensive setting of care. Material and methods: This is a single-center case-control study involving patients with severe COVID-19 infection. A total of 29 patients underwent noninvasive ventilation, and PP was initiated 12 h from admission; 18 patients tolerated prone and side positioning for at least 10 h/d and cycled their position every 2 h, and 11 patients had no complaints with PP. Results: A total of 29 patients (25 men and 4 women) with a median age of 64 years showed the average baseline white blood cell count of 8.45×10 Conclusion: COVID-19 can lead to a severe impairment of gas exchange regardless of inflammatory status. Therefore, respiratory support may play a major role in COVID-19 treatment. We documented substantial efficacy of PP when started early and for at least 10 h/d. On awake patients, PP feasibility strictly depends on patient's compliance. The interface should be carefully chosen to best fit every patient.
Language	English
Publishing date	2021-01-01
Publishing country	Turkey
Document type	Journal Article
ISSN	2149-2530
ISSN (online)	2149-2530
DOI	10.5152/TurkThoracJ.2021.20158
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Article ; Online: Versatility of Intermittent Abdominal Pressure Ventilation in a Case of Complicated Restrictive Respiratory Failure and COVID-19

Francesca Simioli / Anna Annunziata / Antonietta Coppola / Ediva Myriam Borriello / Sara Spinelli / Giuseppe Fiorentino

Healthcare, Vol 10, Iss 1012, p

2022 Volume 1012

Abstract	Background: The intermittent abdominal pressure ventilation (IAPV) is a non-invasive ventilation (NIV) technique that avoids facial interfaces and is a diurnal ventilatory support alternative for neuromuscular patients during stable chronic phases of the disease. Coronavirus disease 2019 (COVID-19) is a novel infection possibly causing acute respiratory distress syndrome (ARDS). Neuromuscular diseases (NMD) and preexisting respiratory failure can be exacerbated by respiratory infection and progress to severe disease and ICU admission with a poor prognosis. Aim: To report on the versatility and feasibility of IAPV in acute restrictive respiratory failure exacerbated by COVID-19. Patient: We describe the case of a 33-year-old man with spastic tetraparesis, kyphoscoliosis, and impaired cough, eventually leading to a restrictive ventilation pattern. COVID-19 exacerbated respiratory failure and seizures. An NIV trial failed because of inadequate interface adhesion and intolerance. During NIV, dyspnea and seizures worsened. He underwent a high flow nasal cannula (HFNC) with a fluctuating benefit on gas exchange. IAPV was initiated and although there was a lack of cooperation and inability to sit; the compliance was good and a progressive improvement of gas exchange, respiratory rate, and dyspnea was observed.Conclusions: IAPV is a versatile type of NIV that can be adopted in complicated restrictive respiratory failure. COVID-19 exacerbates preexisting conditions and is destined to be a disease of frailty. COVID-19 is not a contraindication to IAPV and this kind of ventilation can be employed in selected cases in a specialistic setting. Moreover, this report suggests that IAPV is safe when used in combination with HFNC. This hybrid approach provides the opportunity to benefit from both therapies, and, in this particular case, prevented the intubation with all connected risks.
Keywords	hypercapnia ; mucociliary clearance ; high flow nasal cannula ; non-invasive ventilation ; pneumonia ; kyphoscoliosis ; Medicine ; R
Subject code	610
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article: The Management of Phaeochromocytomas and Paragangliomas in the Era of Precision Medicine: Where Are We Now? Evidence-Based Systemic Treatment Options and Future Cluster Oriented Perspectives.

Bracigliano, Alessandra / Marretta, Antonella Lucia / Guerrera, Luigi Pio / Simioli, Roberto / Clemente, Ottavia / Granata, Vincenza / Minopoli, Anita / Della Vittoria Scarpati, Giuseppina / Picozzi, Fernanda / Cannella, Lucia / Pizzolorusso, Antonio / Di Gennaro, Francesca / Tafuto, Roberto / Sarno, Maria Rosaria / Cavalcanti, Ernesta / Ribera, Dario / Tafuto, Salvatore

Pharmaceuticals (Basel, Switzerland)

2024 Volume 17, Issue 3

Abstract: Pheochromocytomas (PCCs) and Paragangliomas (PGLs), commonly known as PPGLs to include both entities, are rare neuroendocrine tumors that may arise in the context of hereditary syndromes or be sporadic. However, even among sporadic PPGLs, identifiable ... ...

Abstract	Pheochromocytomas (PCCs) and Paragangliomas (PGLs), commonly known as PPGLs to include both entities, are rare neuroendocrine tumors that may arise in the context of hereditary syndromes or be sporadic. However, even among sporadic PPGLs, identifiable somatic alterations in at least one of the known susceptibility genes can be detected. Therefore, about 3/4 of all PPGL patients can be assigned to one of the three molecular clusters that have been identified in the last years with difference in the underlying pathogenetic mechanisms, biochemical phenotype, metastatic potential, and prognosis. While surgery represents the mainstay of treatment for localized PPGLs, several therapeutic options are available in advanced and/or metastatic setting. However, only few of them hinge upon prospective data and a cluster-oriented approach has not yet been established. In order to render management even more personalized and improve the prognosis of this molecularly complex disease, it is undoubtable that genetic testing for germline mutations as well as genome profiling for somatic mutations, where available, must be improved and become standard practice. This review summarizes the current evidence regarding diagnosis and treatment of PPGLs, supporting the need of a more cluster-specific approach in clinical practice.
Language	English
Publishing date	2024-03-08
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2193542-7
ISSN	1424-8247
ISSN	1424-8247
DOI	10.3390/ph17030354
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