Antonello Nicolini

Azienda Sanitaria Locale 4 Chiavarese | ASL 4 Chiavarese · Internal Medicine

Background: Patients with obstructive sleep apnoea (OSA) have a higher risk of developing vascular diseases. In this study, we evaluated the clinical profile of patients with OSA who develop Retinal Vein Occlusion (RVO) compared with a population of OSA patients without RVO. Methods: We analysed patients with OSA diagnosed with RVO (21 cases; me...

High-flow nasal cannula oxygen therapy (HFNCOT) system consists of an air/oxygen supply system capable of delivering up to 100% humidified and heated oxygen at a flow rate of up to 80 L/min. The system includes a blender, active humidifier, single heated tube, and nasal cannula. HFNCOT has many physiological advantages compared with other standard...

he standard treatment for patients with neuromuscular respiratory failure is non-invasive ventilation (NIV) as non-invasive ventilation support-setting (NVS). NVS is administered through a nasal or face mask and/or mouthpiece with the potential to cause nasal ulcers, discomfort, and/or aesthetic issues, resulting in poor compliance. We reported the...

Background: COVID-19 has high mortality rate mainly stemming from acute respiratory distress leading to respiratory failure (ARF ). Aim of the study is evaluating the management of severe ARF due to COVID-19 pneumonia using non-invasive ventilatory support (NIVS), studing safety and effectiveness of non-invasive ventilatory support (NIVS). Method...

Objectives Parkinson's disease (PD) causes dysfunction both to swallowing and to the cough mechanism. Oropharyngeal dysphagia is the main cause of pneumonia, due to silent aspiration of food and saliva. Pneumonia is the leading cause of death in PD. Different strategies exist to reduce the risk of inhalation and associated lung infections, but evid...

Thunderstorm asthma is a rare event: in this letter we describe two cases observed during the same month of 2018 at an Italian Emergency department, assessed by the same medical team and according to the same methodology and approach. Given the infrequency of such a phenomenon and the debate around its nature, frequency, and - at times - existence,...

Introduction Severe asthma occurs in 5–10% of asthmatic patients, with nasal polyposis as one of the most frequent comorbidity. Benralizumab was recently marketed, thus we could analyse its effects in real-life in severe asthma, and compare the effects of the drug in patients with and without polyposis. Methods Patients with severe asthma, receivi...

Patients with chronic obstructive pulmonary disease (COPD) who develop hypercapnic respiratory failure have more severe illness and an increased risk for exacerbations, hospitalization, and mortality [1]. Mechanical ventilation in chronic hypercapnic respiratory failure aims at the unloading of the respiratory muscles, which leads to at least a red...

Background: Chest physiotherapy is an important tool in the treatment of bronchiectasis. High frequency chest wall oscillation (HFCWO) is a technique designed to create a global percussion of the lung which moves secretions and probably clears the peripheral bronchial tree. We propose the comparison between an existing device (SmartVest) and a new...

Introduction: Community-acquired pneumonia (CAP) is the most common type of lower respiratory tract infection and a major cause of morbidity and mortality in adults worldwide. Sex and gender play an active role in the incidence and outcomes of major infectious diseases, including CAP. Evidence acquisition: We searched the following electronic da...

Background: Respiratory disorders are a major cause of morbidity and mortality in amyotrophic lateral sclerosis (ALS). Current guidelines suggest the provision of noninvasive ventilation (NIV) for symptomatic hypoventilation in patients with ALS. Inspite of these results the proportion of ALS patients on tracheostomy invasive ventilation (TIV) is...

Respiratory physiotherapy and rehabilitation are important therapeutic options in non-cystic fibrosis bronchiectasis (NCFB). The aims of this review of clinical trials were to evaluate the safety and the effects on physiologic and clinical outcomes of airway clearance techniques (ACTs) and rehabilitation in NCFB patients, in comparison to usual car...

An ageing population and steady increase in the rates of neoplasms and chronic degenerative diseases poses a challenge for societies and their healthcare systems. Because of the recent and continued advances in therapies, such as the development and widespread use of non-invasive ventilation (NIV), survival rates have increased for these pathologie...

Background: People with Chronic Obstructive Pulmonary Disease (COPD) suffer from dyspnoea, which may be increased by anxiety. Previous studies suggest that relaxation techniques may have positive effects in pulmonary rehabilitation. The main aim of this study is to explore the clinical impact of a quick, one-session, relaxation training for people...

Over the past three decades, the use of noninvasive ventilation or “NIV” to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechan...

Over the past three decades, the use of noninvasive ventilation or “NIV” to assuage symptoms of hypoventilation for patients with early onset or mild ventilatory pump failure has been extended to up to the use of continuous noninvasive ventilatory support (CNVS) at full ventilatory support settings as a definitive alternative to tracheostomy mechan...

Unlike general anaesthesia, neuraxial anaesthesia (NA) reduces the burden and risk of respiratory adverse events in the post-operative period. However, both patients affected by chronic obstructive pulmonary disease (COPD) and chest wall disorders and/or neuromuscular diseases may experience the development or the worsening of respiratory failure,...

An ageing population and steady increase in the rates of neoplasms and chronic degenerative diseases poses a challenge for societies and their healthcare systems. Because of the recent and continued advances in therapies, such as the development and widespread use of non-invasive ventilation (NIV), survival rates have increased for these pathologie...

Introduction: An ageing population and steady increase in the rates of neoplasms and chronic degenerative diseases poses a challenge for societies and their healthcare systems. Because of the recent and continued advances in therapies, such as the development and widespread use of non-invasive ventilation (NIV), survival rates have increased for t...

Gender differences in asthma incidence, prevalence and clinical phenotypes have been extensively reported worldwide. A number of studies have shown that respiratory allergy, and especially asthma, is prevalent in males during childhood, whereas it becomes more frequent and severe in females between adolescence and adulthood, suggesting that sex hor...

Parkinson’s disease (PD) is a chronic neurodegenerative disorder with a typical movement pattern, as well as different, less studied non-motor symptoms such as dysphagia. Disease-related disorders in efficacy or safety in the process of swallowing usually lead to malnutrition, dehydration or pneumonia. Dysphagia and subsequent aspiration pneumonia...

In the article recently published in Microorganisms [...]

Introduction: Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients’ lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess...

INTRODUCTION: Acute respiratory failure (ARF) frequently complicates severe community-acquired pneumonia (CAP) that together with sepsis increases patient mortality. The background of the noninvasive ventilation (NIV) use is to overcome an episode of ARF avoiding invasive mechanical ventilation (IMV) and its associated morbidity. EVIDENCE ACQUISITI...

Worldwide, there is growing concern about the burden of pneumonia. Severe community-acquired pneumonia (CAP) is frequently complicated by pulmonary and extra-pulmonary complications, including sepsis, septic shock, acute respiratory distress syndrome, and acute cardiac events, resulting in significantly increased intensive care admission rates and...

Objective A new type of device has recently been introduced in chest physiotherapy as an aid to tracheo-bronchial airway clearance: expiratory flow accelerator (EFA). It promotes mucus clearance without generating any pressure gradient, allowing patients to breathe at tidal volume against no resistance. Design Pilot randomized controlled study. S...

Letter to editor: an review of the difference between clinical significance and statistical significance in a COPD study. The difficulty of aapplying the conccept of number needed to treat In COPD syndromes

Introduction: Non-invasive ventilation (NIV) has been used successfully for the management of acute respiratory failure (ARF) more often in the last two decades compared to prior decades. There are particular groups of patients that are more likely to benefit from NIV. One of these groups is patients with obesity hypoventilation syndrome (OHS). Th...

Objectives: Chronic obstructive pulmonary disease (COPD) is associated with a higher risk of pulmonary infections. This risk not only negatively affects patients' quality of life but also increases social and health costs. Hence, there is a need for an effective rehabilitative treatment including airway clearance. The aim of this pilot study was t...

Background People with Chronic Obstructive Pulmonary Disease (COPD) suffer from dyspnoea, which may be increased by anxiety. Previous studies suggest that relaxation techniques may have positive effects in pulmonary rehabilitation. The main aim of this study is to explore the clinical impact of a quick, one-session, relaxation training for people w...

Chronic obstructive pulmonary disease (COPD) has traditionally been viewed as a disease affecting older men with a history of smoking, while being neglected and under-diagnosed in women. This scenario has changed in recent years as there has been a steady increase in COPD prevalence and mortality rates in women. The increased prevalence of COPD amo...

Community-acquired pneumonia (CAP) remains a major health problem worldwide. The incidence of pneumonia increases with both age and the presence of specific risk factors, which lead to increased health care costs. However, although there is some controversy over the observed trend in CAP mortality over recent decades, it is clear that mortality in...

Chronic obstructive pulmonary disease (COPD) is generally considered to be prevalent in males. However, smoking is rising in women in developing and developed countries, while exposure to biomass fuel for domestic purposes is a recognized risk factor among females. Females developing more severe COPD patterns due to tobacco exposure than men maybe...

Severe community-acquired pneumonia is the most common cause of acute respiratory distress syndrome (ARDS). Despite multiple improvements in the last 10 years, this syndrome remains highly prevalent worldwide and is associated with high mortality and long-term morbidity rates. Several factors are related to the increasing risk of ARDS. Clinicians s...

The growing interest in the quality of patient care at the levels of the health care managers, insurance companies, and health professionals is evident. Further, the growing population requires good quality health services. In this review, we analyzed the cost-effectiveness of noninvasive ventilation (NIV) in an acute setting for the treatment of r...

Purpose Chest physiotherapy is an important tool in the treatment of COPD. Intrapulmonary percussive ventilation (IPV) and high-frequency chest wall oscillation (HFCWO) are techniques designed to create a global percussion of the lung which removes secretions and probably clears the peripheral bronchial tree. We tested the hypothesis that adding IP...

Patients who are likely to benefit from noninvasive ventilation (NIV) need to be identified early [1, 2]. Failure to do so often results in increased morbidity and mortality as well as inappropriate use of limited resources [2].

Non-invasive ventilation (NIV) has been used successfully for the management of acute respiratory failure (ARF) more often in the last two decades than previously. Unfortunately, NIV can have failure rates ranging from 5% to 50% and patient selection is the key to success. There are particular groups of patients that are more likely to benefit from...

Parenteral nutrition is indicated in amyotrophic lateral sclerosis (ALS) when dysphagia, loss of appetite, and difficulty protecting the airways cause malnutrition, severe weight loss, dehydration, and increased risk of aspiration pneumonia. The aim of this review is to compare percutaneous endoscopic gastrostomy (PEG), radiologically inserted G-tu...

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective and safe technique associated with a very low complication rate for the sampling of lymph nodes in those presenting with mediastinal and hilar adenopathy.” We report a rare case describing the development of pneumomediastinum following EBUS-TBNA in a young...

Introduction: Positive expiratory pressure (PEP) is one of the most used technique of airway clearance for chronic pulmonary obstructive diseases. Objective: To compare the effectiveness of two devices which use PEP: Temporary -PEP (T-PEP) and Oscillatory -PEP (O-PEP) .Both therapies apply a low expiratory pressure of 1 cm H2O creating oscillations...

See DOI: 10.1111/resp.13074

Polymicrobial pneumonia may be caused by the combination of respiratory viruses, bacteria and fungi in a host. Colonization by Streptococcus pneumoniae was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection, whereas the colonization by methicillin sensible Staphylococcus aureus co-infectio...

Noninvasive ventilatory support (NVS) is sometimes reported as suboptimal in patients with neuromuscular disease (NMD). The reasons for this include inadequate ventilator settings and/or lack of interface tolerance. NVS has been used for many years in patients with NMD disorders as a viable alternative to continuous ventilatory support via a trache...

Background: Temporary positive airway pressure (T-PEP) is a tool recently introduced in the treatment of chronic obstructive pulmonary disease (COPD) or bronchiectasis. It demonstrated encouraging results also in severe COPD patients. The aim of this study is verify if adding T-PEP to best bronchodilator therapy both in clinic and home administeri...

Background: Temporary positive airway pressure (T-PEP) is a tool recently introduced in the treatment of chronic obstructive pulmonary disease (COPD) or bronchiectasis. It demonstrated encouraging results also in severe COPD patients. The aim of this study is verify if adding T-PEP to best bronchodilator therapy both in clinic and home administerin...

Resumen Introducción La aplicación de dispositivos de presión espiratoria positiva (PEP) durante el ejercicio se había propuesto con el objetivo de contrarrestar la hiperinflación pulmonar, reducir la disnea y mejorar así la tolerancia al ejercicio de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) grave. En este ensayo controlado...

Background: The application of positive expiratory pressure (PEP) devices during exercise had been proposed in order to counteract the pulmonary hyperinflation, reduce the dyspnea and thus increase the exercise tolerance in patients with severe chronic obstructive pulmonary disease (COPD). This randomized controlled crossover trial investigated th...

Anti-synthetase syndrome (ASS) is defined as a heterogeneous connective tissue disorder characterized by the association of an interstitial lung disease (ILD) with or without inflammatory myositis with the presence of anti-aminoacyl-tRNA-synthetase antibodies. ILD is one of the major extra-muscular manifestations of polymyositis and dermatomyositis...

The treatment of acute respiratory failure with non-invasive ventilation (NIV) as a first-line therapy is increasingly common in intensive care units. The reduced invasiveness of NIV leads to better outcomes than endotracheal intubation in carefully selected groups of patients. Furthermore, the use of NIV as a palliative treatment for respiratory f...

The increasing prevalence of obesity has lead to an increase in the prevalence of sleep disordered breathing in the general population. Obesity is a serious disorder resulting in significant health impairment. Obese adults are at increased risk of morbidity and mortality from acute and chronic medical conditions. Obesity is associated with anatomic...

Objectives. The possibility of prolonging and augmenting the quality of life of respiratory patients in end-stage disease and in particular neuromuscular disease patients depends on an increased level of care. Amyotrophic lateral sclerosis (ALS) is a neurological disease characterized by a fast progressive impairment of respiratory function which l...

Tracheostomy is one of the most frequently performed procedures in the intensive care unit (ICU) [1], especially after the introduction of percutaneous techniques [2]. It is performed in critically ill patients to protect the airway, remove secretions, or provide ventilatory support [3].The indications for placement of a tracheostomy tube include f...