Roberto Cosentini

Publications (61) View all

• Article: Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: a randomised feasibility trial.

  Stefano Nava, Miguel Ferrer, Antonio Esquinas, Raffaele Scala, Paolo Groff, Roberto Cosentini, Davide Guido, Ching-Hsiung Lin, Anna Maria Cuomo, Mario Grassi
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  ABSTRACT: Despite best-possible medical management, many patients with end-stage cancer experience breathlessness, especially towards the end of their lives. We assessed the acceptability and effectiveness of non-invasive mechanical ventilation (NIV) versus oxygen therapy in decreasing dyspnoea and the amount of opiates needed. In this randomised feasibility study, we recruited patients from seven centres in Italy, Spain, and Taiwan, who had solid tumours and acute respiratory failure and had a life expectancy of less than 6 months. We randomly allocated patients to receive either NIV (using the Pressure Support mode and scheduled on patients' request and mask comfort) or oxygen therapy (using a Venturi or a reservoir mask). We used a computer-generated sequence for randomisation, stratified on the basis of patients' hypercapnic status (PaCO >45 mm Hg or PaCO ≤45 mm Hg), and assigned treatment allocation using opaque, sealed envelopes. Patients in both groups were given sufficient subcutaneous morphine to reduce their dyspnoea score by at least one point on the Borg scale. Our primary endpoints were to assess the acceptability of NIV used solely as a palliative measure and to assess its effectiveness in reducing dyspnoea and the amount of opiates needed compared with oxygen therapy. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00533143. We recruited patients between Jan 15, 2008, and March 9, 2011. Of 234 patients eligible for recruitment, we randomly allocated 200 (85%) to treatment: 99 to NIV and 101 to oxygen. 11 (11%) patients in the NIV group discontinued treatment; no patients in the oxygen group discontinued treatment. Dyspnoea decreased more rapidly in the NIV group compared with the oxygen group (average change in Borg scale -0·58, 95% CI -0·92 to -0·23, p=0·0012), with most benefit seen after the first hour of treatment and in hypercapnic patients. The total dose of morphine during the first 48 h was lower in the NIV group than it was in the oxygen group (26·9 mg [37·3] for NIV vs 59·4 mg [SD 67·1] for oxygen; mean difference -32·4 mg, 95% CI -47·5 to -17·4). Adverse events leading to NIV discontinuation were mainly related to mask intolerance and anxiety. Morphine was suspended because of severe vomiting and nausea (one patient in each group), sudden respiratory arrest (one patient in the NIV group), and myocardial infarction (one patient in the oxygen group). Our findings suggest that NIV is more effective compared with oxygen in reducing dyspnoea and decreasing the doses of morphine needed in patients with end-stage cancer. Further studies are needed to confirm our findings and to assess the effectiveness of NIV on other outcomes such as survival. The use of NIV is, however, restricted to centres with NIV equipment, our findings are not generalisable to all cancer or palliative care units. None.
  The lancet oncology 03/2013; 14(3):219-27. · 14.47 Impact Factor
• Article: Thrombocytosis is a marker of poor outcome in community-acquired pneumonia.

  Elena Prina, Miquel Ferrer, Otavio T Ranzani, Eva Polverino, Catia Cillóniz, Encarnación Moreno, Josep Mensa, Beatriz Montull, Rosario Menéndez, Roberto Cosentini, Antoni Torres
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  ABSTRACT: ABSTRACT BACKGROUND: Thrombocytosis, often considered a marker of normal inflammatory reaction of infections, has been recently associated with increased mortality in hospitalized patients with community-acquired pneumonia (CAP). We assessed the characteristics and outcomes of patients with CAP and thrombocytosis (platelet count ≥4x105/mm3), compared with thrombocytopenia (platelet count <105/mm3) and normal platelet count. METHODS: We prospectively analyzed 2,423 consecutive hospitalized patients with CAP. We excluded patients with immunosuppression, neoplasm, active tuberculosis or hematological disease. RESULTS: Fifty-three patients (2%) presented thrombocytopenia, 204 (8%) thrombocytosis and 2,166 (90%) had normal platelet count. Patients with thrombocytosis were younger (p<0.001) while those with thrombocytopenia had more frequently chronic heart and liver disease (p<0.001 both). Patients with thrombocytosis presented more frequently respiratory complications such as complicated pleural effusion and empyema (p<0.001), whereas those with thrombocytopenia presented more often severe sepsis (p<0.001), septic shock (p=0.009), need for invasive mechanical ventilation (p<0.001) and intensive care unit admission (p=0.011). Patients with thrombocytosis and thrombocytopenia had longer hospital stay (p=0.004), higher 30-day mortality (p=0.001) and readmission rate (p=0.011) than those with normal platelet count. Multivariate analysis confirmed a significant association between thrombocytosis and 30-day mortality (OR 2.720, 95% CI 1.589-4.657; p<0.001). Adding thrombocytosis to the CRB-65 score slightly improved the accuracy to predict mortality (area under the ROC curve increased from 0.634 to 0.654 p=0.049). CONCLUSION: Thrombocytosis in patients with CAP is associated with poor outcome, complicated pleural effusion and empyema. The presence of thrombocytosis in CAP should encourage ruling out respiratory complication and could be considered for severity evaluation.1Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Spain.2Emergency Medicine Department, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.3Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain.4Respiratory Intensive Care Unit, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brazil.5Servicio de Enfermedades Infecciosas, Hospital Clínic, IDIBAPS, Barcelona, Spain.6Servicio de Neumologia, Hospital Universitario La Fe,Valencia, Spain.Correspondence: Dr. Miquel Ferrer. UVIR, Servei de Pneumologia, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain. E-mail: miferrer@clinic.ub.esFunded By: This work was supported by Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CibeRes CB06/06/0028)-Instituto de Salud Carlos III (ISCiii), 2009 SGR 911, PII de infecciones respiratorias of SEPAR, and IDIBAPS.
  Chest 09/2012; · 5.25 Impact Factor
• Article: Causes and correlates of anemia in 200 patients with acute cardiogenic pulmonary edema.

  Angelo Rovellini, Giovanna Graziadei, Christian Folli, Anna Maria Brambilla, Roberto Cosentini, Ciro Canetta, Valter Monzani
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  ABSTRACT: BACKGROUND: Acute heart failure has a poor prognosis and the presence of anemia may increase the risk of adverse outcomes. However, the clinical and laboratory characteristics of anemia in acute heart failure are poorly known. We aimed to assess the causes and the clinical and laboratory correlates of anemia in patients with acute cardiogenic pulmonary edema (ACPE). METHODS: This observational study, performed in an Emergency Unit, enrolled 200 patients treated with medical therapy and continuous positive airway pressure. RESULTS: Anemia was found in 36% of patients (38.5% of females and 32.5% of males) and was severe (hemoglobin <9g/dL) in 6.9% of cases. The most frequent causes of anemia were chronic renal failure (27.8%), chronic inflammatory states (27.8%) and the clustering of multiple factors (18.1%). A wider spectrum of etiological factors was found in females than in males. Microcytic anemia was observed only in females (20% of those anemic), mainly due to iron deficiency/chronic blood loss. Glomerular filtration rate, serum iron, serum albumin, total cholesterol and diastolic blood pressure were independently associated with hemoglobin levels. CONCLUSIONS: The etiology of anemia in ACPE is heterogeneous, with several causal factors besides impaired renal function. The pattern of anemia is different between genders, suggesting that sex-specific diagnostic and therapeutic targets should be implemented.
  European Journal of Internal Medicine 07/2012; · 2.00 Impact Factor
• Article: The use of non-invasive ventilation during acute respiratory failure due to pneumonia.

  Miquel Ferrer, Roberto Cosentini, Stefano Nava
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  ABSTRACT: The use of non-invasive ventilation in patients with community-acquired pneumonia is controversial since this is associated with high rates of treatment failure, compared with other causes of severe acute respiratory failure. The populations of patients with community-acquired pneumonia who have demonstrated better response to non-invasive ventilation are those with previous cardiac or respiratory disease, particularly chronic obstructive pulmonary disease. By contrast, the use of non-invasive ventilation in patients with community-acquired pneumonia without these pre-existing diseases should be very cautious and under strict monitoring conditions, since there are increasing evidences that the unnecessary delay in intubation of those patients who fail treatment with non-invasive ventilation is associated with lower survival. Pulmonary complications of immunosuppressed patients are associated with high rates of intubation and mortality. The use of non-invasive ventilation in these patients may decrease the need for intubation and improve the poor outcome associated with these complications. Continuous positive airway pressure has been used to treat acute respiratory failure in several conditions characterised by alveolar collapse. While this is extremely useful in patients with acute cardiogenic pulmonary oedema, the efficacy in pneumonia seems limited to immunosuppressed patients with pulmonary complications. Conversely, there are no sufficient evidences on the efficacy of continuous positive airway pressure in immunocompetent patients with pneumonia and severe acute respiratory failure.
  European Journal of Internal Medicine 07/2012; 23(5):420-8. · 2.00 Impact Factor
• Article: Mechanical ventilation in emergency departments: Non invasive or invasive mechanical ventilation. Where is the answer?

  Antonio M Esquinas Rodriguez, Roberto Cosentini, Peter J Papadakos
  Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 06/2012; 20(1):40. · 1.85 Impact Factor