Publications by authors named "Giuseppe Francesco Sferrazza Papa"

Article Synopsis
  • Acute respiratory failure (ARF) is a sudden condition where the respiratory system fails to provide enough oxygen, often caused by diseases like pneumonia, asthma, and neuromuscular disorders, particularly affecting children more severely than adults.
  • Diagnosing ARF in children is challenging due to their inability to express symptoms and their limited cooperation during tests, making clinical assessments crucial for identifying the severity and underlying causes.
  • Effective treatment involves immediate actions like providing oxygen and possibly mechanical ventilation, while the review highlights advancements in understanding ARF through new imaging techniques, biomarkers, and the use of artificial intelligence.
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Long COVID syndrome has emerged as a long-lasting consequence of acute SARS-CoV-2 infection in adults. In addition, children may be affected by Long COVID, with potential clinical issues in different fields, including problems in school performance and daily activities. Yet, the pathophysiologic bases of Long COVID in children are largely unknown, and it is difficult to predict who will develop the syndrome.

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Article Synopsis
  • The study investigates the psychological effects experienced by COVID-19 patients hospitalized during the pandemic, specifically focusing on anxiety, depression, PTSD, and post-traumatic growth six months after discharge.
  • Out of 100 participants, significant percentages reported anxiety (34%), depression (24%), and 20% showed signs of potential PTSD, with these symptoms linked to prior mood disorders and receiving psychological care post-discharge.
  • Younger patients and those who sought psychological consultation after discharge experienced higher levels of post-traumatic growth, highlighting the importance of mental health support for recovering COVID-19 patients.
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Our aim was to investigate the distribution of acid-base disorders in patients with COVID-19 ARDS using both the Henderson-Hasselbalch and Stewart's approach and to explore if hypoxemia can influence acid-base disorders. COVID-19 ARDS patients, within the first 48 h of the need for a non-invasive respiratory support, were retrospectively enrolled. Respiratory support was provided by helmet continuous positive airway pressure (CPAP) or by non-invasive ventilation.

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Background: We hypothesized that as CARDS may present different pathophysiological features than classic ARDS, the application of high levels of end-expiratory pressure is questionable. Our first aim was to investigate the effects of 5-15 cmHO of PEEP on partitioned respiratory mechanics, gas exchange and dead space; secondly, we investigated whether respiratory system compliance and severity of hypoxemia could affect the response to PEEP on partitioned respiratory mechanics, gas exchange and dead space, dividing the population according to the median value of respiratory system compliance and oxygenation. Thirdly, we explored the effects of an additional PEEP selected according to the Empirical PEEP-FiO table of the EPVent-2 study on partitioned respiratory mechanics and gas exchange in a subgroup of patients.

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Article Synopsis
  • The study investigates the effectiveness of noninvasive respiratory strategies, specifically CPAP and NIV, in managing COVID-19 pneumonia and the subsequent need for endotracheal intubation (ETI).
  • From 156 patients treated with CPAP, 30% required ETI, with a mortality rate of 18% and an average hospital stay of 24 days.
  • The research suggests that trying NIV after CPAP failure may be beneficial, as it doesn't worsen the situation and could decrease the necessity for ETI in patients.
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The aim of this study was to compare the number of the Pediatric Emergency Department (PED) visits for young allergic patients with respiratory or cutaneous symptoms during the first wave of the coronavirus disease 19 (COVID-19) pandemic in 2020 with the same period in 2019, evaluating the percentage of positive cases to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We carried out a retrospective analysis using data from young patients who visited the PED with cutaneous or respiratory symptoms in the period from 20 February to 12 May of the years 2020 and 2019. Data on allergy and COVID-19 nasal swab were also collected.

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Respiratory infection diseases are among the major causes of morbidity and mortality in children. Diagnosis is focused on clinical presentation, yet signs and symptoms are not specific and there is a need for new non-radiating diagnostic tools. Among these, lung ultrasound (LUS) has recently been included in point-of-care protocols showing interesting results.

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Discriminating between cardiac and pulmonary dyspnea is essential for patients' management. We investigated the feasibility and ability of forced oscillation techniques (FOT) in distinguishing between acute exacerbation of COPD (AECOPD), and acute decompensated heart failure (ADHF) in a clinical emergency setting. We enrolled 49 patients admitted to the emergency department (ED) for dyspnea and acute respiratory failure for AECOPD, or ADHF, and 11 healthy subjects.

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Objective: To investigate whether the decrease in dyspnea in neuromuscular diseases after air stacking (AS) occurs mostly in patients with decreased inspiratory muscle force and ensuing chest wall restriction or heterogeneous ventilation across the lungs.

Design: Interventional, before-after study.

Setting: A neurorehabilitation inpatient and outpatient center.

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Article Synopsis
  • A study on ALS patients aimed to see how different mouthpiece interfaces affect vital capacity (VC) measurements and the potential learning effect over a week.
  • In patients with bulbar ALS, a flanged mouthpiece provided 8.4% higher VC than a cylindrical mouthpiece, while spinal ALS patients saw a 4.6% increase with the flanged mouthpiece compared to an oronasal mask.
  • The results suggested that using a flanged mouthpiece not only gave the highest VC readings but also showed improvements when measured again after a week, indicating a possible learning effect.
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The presence of respiratory symptoms in Parkinson's disease (PD) has been known since the first description of the disease, even though the prevalence and incidence of these disturbances are not well defined. Several causes have been reported, comprising obstructive and restrictive pulmonary disease and changes in the central ventilatory control, and different pathogenetic mechanisms have been postulated accordingly. In our review, we encompass the current knowledge about respiratory abnormalities in PD, as well as the impact of anti-Parkinsonian drugs as either risk or protective factors.

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Article Synopsis
  • - The study focused on understanding how COVID-19 patients were managed in hospitals across Italy, using a survey sent to physicians who care for these patients.
  • - Key findings showed that chest CT scans were the primary method for monitoring pneumonia, with non-invasive techniques like CPAP being commonly used for acute respiratory failure; most experts also favored hydroxychloroquine for treatment.
  • - Despite the insights gathered, there was notable disagreement among experts regarding treatment approaches, highlighting a need for more robust evidence-based guidelines and the importance of developing respiratory therapy programs for recovering patients.
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  • * A survey sent to 2010 Italian physicians resulted in 514 responses, with 99% affirming the clinical significance of thoracic ultrasound; 79% use it monthly mainly in pulmonology wards, focusing on conditions like pleural effusion and pneumothorax.
  • * Key barriers to wider use include the lack of available ultrasound systems (52%), insufficient training and protected time (22%), and competition from other specialists (15%).
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Objectives: Lung CT is the reference imaging technique for acute respiratory distress syndrome, but requires transportation outside the intensive care and x-ray exposure. Lung ultrasound is a promising, inexpensive, radiation-free, tool for bedside imaging. Aim of the present study was to compare the global and regional diagnostic accuracy of lung ultrasound and CT scan.

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Interstitial lung diseases (ILDs) may be complicated by chronic respiratory failure (CRF), especially in the advanced stages. Aim of this narrative review is to evaluate the current evidence in management of CRF in ILDs. Many physiological mechanisms underlie CRF in ILDs, including lung restriction, ventilation/perfusion mismatch, impaired diffusion capacity and pulmonary vascular damage.

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Chest imaging in patients with acute respiratory failure plays an important role in diagnosing, monitoring and assessing the underlying disease. The available modalities range from plain chest X-ray to computed tomography, lung ultrasound, electrical impedance tomography and positron emission tomography. Surprisingly, there are presently no clear-cut recommendations for critical care physicians regarding indications for and limitations of these different techniques.

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Article Synopsis
  • Interstitial lung diseases (ILDs) are a range of conditions that cause lung inflammation and fibrosis, leading to common issues like respiratory failure, especially in later stages or after acute worsening of the disease.
  • This review evaluates the best practices for managing acute respiratory failure (ARF) in patients with ILDs by analyzing literature from medical databases up to November 2017.
  • Effective management of ARF requires accurate diagnosis based on whether the patient has a known chronic ILD or a new case, with necessary investigations into potential causes and treatment options, including the consideration of high-flow nasal oxygen and non-invasive ventilation in specific scenarios, though the overall outcomes for advanced ILDs remain poor.
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