Showing papers by "Fabiana Madotto published in 2017"
University of Milan1, University of Toronto2, University of Paris3, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico4, University of Belgrade5, University of Angers6, University of Lausanne7, Canberra Hospital8, Australian National University9, Uppsala University10, Queen's University Belfast11, Mayo Clinic12, King Saud bin Abdulaziz University for Health Sciences13, Sapienza University of Rome14, Catholic University of the Sacred Heart15, Harvard University16, Leipzig University17
TL;DR: NIV was used in 15% of patients with ARDS, irrespective of severity category, and NIV seems to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mm Hg.
Abstract: Rationale: Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse.Objectives: To determine whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful.Methods: The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of the PaO2/FiO2 ratio in classifying patients receiving NIV, and the impact of NIV on outcome.Measurements and Main Results: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on PaO2/FiO2 ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV fa...
429 citations
University of Milano-Bicocca1, St. Michael's Hospital2, University of Toronto3, University of Paris4, Mount Sinai Hospital, Toronto5, Bombay Hospital, Indore6, National Guard Health Affairs7, King Saud bin Abdulaziz University for Health Sciences8, King Abdulaziz Medical City9, Harvard University10, Pontifical Catholic University of Chile11, Charles University in Prague12, National University of Ireland, Galway13, VU University Amsterdam14, International University of Health and Welfare15, Oslo University Hospital16, European University of Madrid17, Queen's University Belfast18, University Hospital of Lausanne19, Southeast University20, University of Costa Rica21, Canberra Hospital22, Australian National University23, Sapienza University of Rome24, Sunnybrook Health Sciences Centre25, Leipzig University26, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico27
TL;DR: Important geo-economic differences exist in the severity, clinician recognition, and management of ARDS, and in patients' outcomes, and high gross national income per person was associated with increased survival in ARDS.
85 citations
TL;DR: The article evaluated the epidemiology of idiopathic pulmonary fibrosis in 18-year-olds in the USA and found pitfalls in methodologies and data interpretation.
Abstract: It was interesting to read the paper by Raghu et al. [1] in the July issue of the European Respiratory Journal ( ERJ ). The article evaluated the epidemiology of idiopathic pulmonary fibrosis (IPF) in 18–64 year-olds in the USA.
Epidemiological studies in IPF: pitfalls in methodologies and data interpretation
12 citations
TL;DR: Focusing on drug purchases, sufficient statistical power is reached to study PM10 effect outside large urban areas and conclude that short‐term increments in PM10 concentrations might cause mild cardiorespiratory disease episodes.
11 citations
TL;DR: The data suggests that work may influence the metabolic compliance in adults with PKU, in particular, a part-time employment could allow for a better metabolic compliance, while daily work should be preferred to shift work.
Abstract: Background: Phenylketonuria (PKU) is an inborn error of metabolism characterized by increased blood concentrations of phenylalanine (Phe) Objectives: The aim of the present study was to assess the association between the metabolic compliance of adult patients affected by classic PKU and the characteristics of their present and past occupations Methods: The study population consisted of working adults, affected by classic PKU, and following a dietary treatment Univariate linear-mixed models and multivariate analysis were applied to assess the association between Phe blood levels and individual covariates: age, sex, time at diagnosis, educational level and work characteristics Results: A linear relationship was found with age (an average annual increase of 3056 μMol/L (CI 95%: 753; 5360) in the mean Phe blood levels) Full-time work appeared to be associated with a worse metabolic compliance when compared to part-time work (mean Phe blood levels >28111 μMol/L) Shift work was related to a worse metabolic compliance, with mean Phe plasmatic levels >35673 μMol/L Conclusions: Our data suggests that work may influence the metabolic compliance in adults with PKU In particular, a part-time employment could allow for a better metabolic compliance, while daily work should be preferred to shift work
2 citations
TL;DR: The analyses suggest that traffic-related pollution might have a role in the development of IPF, biologically plausible, especially in light of new findings that linked traffic pollution with telomere shortening.
Abstract: Background: There is evidence that the clinical course of idiopathic pulmonary fibrosis (IPF) is affected in the short-term by exposure to ozone (O 3 ) and nitrogen dioxide (NO 2 ), but no information is available on how air pollution can impact the incidence of the disease. Aims and Objectives: To investigate the association between exposure to NO 2 and O 3 and the incidence of IPF from 2005 to 2010, using a large sample of cases, in Lombardy, a region of Northern Italy. Methods: We gathered daily average NO 2 and O 3 concentrations form all monitoring stations managed by the regional environment protection agency of Lombardy, and we computed average concentrations over the study period in all municipalities close to a station. We identified IPF incident cases from 2005 to 2010 based on inpatients and outpatient visits recorded in administrative databases, and we computed the number of cases for each municipality. We assessed the association between the incidence rate of IPF and the average NO 2 and O 3 concentrations through negative binomial models. Results: We identified 2,093 incident cases of IPF. We could estimate the exposure to NO 2 for 91% of them, while for O 3 the percentage fell to 81%. The incidence rate of IPF was not associated with O 3 , but it increased by 0.64% (95% Confidence Interval: -0.01; 1.29) for each 1 µg/m 3 increment in the average NO 2 concentration. Conclusions: Our analyses suggest that traffic-related pollution might have a role in the development of IPF. This is biologically plausible, especially in light of new findings that linked traffic pollution with telomere shortening, a mechanisms that might be involved in the genesis of IPF.
1 citations
TL;DR: It is puzzling why a baseline PEEP level affected hospital mortality but not ICU mortality, and LUNG SAFE suggests that pending an adequate prospective study, the two parameters should be closely monitored.
Abstract: • Figure 2 shows that higher PEEP was associated with improved survival only in moderate ARDS. Moreover, this observation is at variance with the results of a meta-analysis which found beneficial effects of higher PEEP in both moderate and severe ARDS [2]. • There was no benefit of higher PEEP on ICU mortality (see “supplementary appendix”). It is puzzling why a baseline PEEP level affected hospital mortality but not ICU mortality. • The authors equate statistical and causal links. The association of higher PEEP with survival might reflect the fact that patients with better prognosis tolerated higher PEEP. • The authors “forced” PEEP in their multivariate analysis. Though acceptable this is not specified in the “Methods”, which indicate that only variables with P < 0.05 on bivariate analysis were entered in multivariate analyses. P values for association of PEEP with mortality were >0.6. Analysis of patients with true plateau pressure measurement deserves more attention to the respective interest of driving and plateau pressures. Both parameters predicted mortality with acceptable accuracy and neither seemed superior. LUNG SAFE suggests that pending an adequate prospective study, the two parameters should be closely monitored. The advantage of plateau pressure is that it requires no computation. Clinicians should not consider that dynamic distension (reflected by driving pressure) is the major culprit in ventilator-associated complications. Maximal distension, irrespective of driving pressure, is an important contributor to both the generation of ventilator-induced lung injury and mortality [3]. Physicians should simply monitor plateau pressure and adequately use early muscle paralysis and prone positioning in severe cases. LUNG SAFE brilliantly shows that these simple tools are too rarely used.
TL;DR: This paper presents a meta-analysis of immune checkpoint checkpoints in rats that shows clear patterns of decline in the progression of disease in rats housed at Mount Sinai Hospital over a 12-month period.
Abstract: 4 Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; 4 Department of Medicine, University Health Network and Mount Sinai Hospital; and Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada;