Papers by Chiara Fragnoli
Computational and Mathematical Methods in Medicine, 2012
Biological organisms have intrinsic control systems that act in response to internal and external... more Biological organisms have intrinsic control systems that act in response to internal and external stimuli maintaining homeostasis. Human heart rate is not regular and varies in time and such variability, also known as heart rate variability (HRV), is not random. HRV depends upon organism's physiologic and/or pathologic state. Physicians are always interested in predicting patient's risk of developing major and life-threatening complications. Understanding biological signals behavior helps to characterize patient's state and might represent a step toward a better care. The main advantage of signals such as HRV indexes is that it can be calculated in real time in noninvasive manner, while all current biomarkers used in clinical practice are discrete and imply blood sample analysis. In this paper HRV linear and nonlinear indexes are reviewed and data from real patients are provided to show how these indexes might be used in clinical practice.
Respiratory Care, Jun 4, 2013
Background This trial was conducted to carry out an age and etiology-based analysis of the clinic... more Background This trial was conducted to carry out an age and etiology-based analysis of the clinical efficacy of non-invasive ventilation (NIV) in acute hypercapnic respiratory failure (AHRF). Methods This single center, prospective, cohort study included patients aged ≥65 years with chronic obstructive pulmonary disease (COPD), acute cardiogenic pulmonary edema (ACPE), community-acquired pneumonia (CAP), bronchiectasis, and kyphoscoliosis, who were treated with NIV for AHRF in the intensive care unit within a 4-year period. Results From 496 patients aged 65 years or older treated with NIV for AHRF, 162 patients were included. Of the patients 71 were aged 65-74 years, 70 were 75-84 years, and 21 were aged ≥85 years. Of the patients 90 had COPD, 31 had ACPE, 19 had CAP, 15 had bronchiectasis exacerbation and 7 had kyphoscoliosis as the AHRF etiology. The treatment with NIV Fatma Çiftci designed the study, performed the literature search and data collection, and reviewed and submitted the manuscript. Aydın Çiledag designed the study, performed data collection, and prepared and reviewed the manuscript. Serhat Erol performed data collection and prepared and reviewed the manuscript. Akın Kaya designed the study and prepared and reviewed the manuscript.
Annals of intensive care, 2015
Patients with severe cardiogenic pulmonary edema (CPE) are frequently hypercapnic, possibly becau... more Patients with severe cardiogenic pulmonary edema (CPE) are frequently hypercapnic, possibly because of associated underlying chronic lung disease (CLD). Since hypercapnia has been associated with outcome, we aimed to identify factors associated to hypercapnia and its role on outcome of patients with CPE and no underlying CLD. Observational cohort study using data prospectively collected over a 3-year period. After excluding patients with any CLD or obstructive sleep apneas, all patients treated by non-invasive ventilation (NIV) for severe CPE were included. Hypercapnia was defined as PaCO2 >45 mmHg and non-rapid favorable outcome was defined as the need for intubation or continuation of NIV for more than 48 h. After excluding 60 patients with underlying CLD or sleep apneas, 112 patients were studied. The rates of intubation and of prolonged NIV were 6.3 % (n = 7) and 21.4 % (n = 24), respectively. Half of the patients (n = 56) had hypercapnia upon admission. Hypercapnic patients ...
Annales Françaises d'Anesthésie et de Réanimation, 2014
Mate´riel et me´thodes E ´tude pre ´liminaire monocentrique incluant tous les patients admis dans... more Mate´riel et me´thodes E ´tude pre ´liminaire monocentrique incluant tous les patients admis dans le service de re ´animation dans les suites d'une TH entre janvier et juin 2013. Pour ces patients, une surveillance hebdomadaire de colonisation a `candida est re ´alise ´e ainsi qu'un dosage sanguin hebdomadaire (au cours du premier mois apre `s TH) de BDG (Fungitell ; Cape Cod Inc, E ´tats-Unis) e ´tait re ´alise ´. De plus, le score pre ´dictif de candidose (Candida score) est calcule ´toutes les semaines. Re´sultats Durant la pe ´riode d'e ´tude, 52 TH ont e ´te ´re ´alise ´es dans notre centre. L'a ˆge moyen du receveur est de 55 [31-69]. Le MELD moyen du receveur est de 27 [6-40]. Les principaux motifs de la transplantation sont une cirrhose (52 %), un carcinome he ´patocellulaire (36 %). Quarante-deux patients (81 %) ont une colonisation a `Candida dont le plus fre ´quent est le C. glabrata (55 %). Le taux de candidose invasive documente ´e est de 9,6 % (5/52), avec un taux de BDG > 250 pg/mL et un Candida score ! 4. L'aire sous la courbe ROC (Receiver Operating Characteristic) du BDG pour pre ´dire la survenue d'une candidose invasive e ´tait de 0,93 ([95 % confidence intervalle (CI) 0,86-1,0], p = 0,001). Avec un seuil de 80 pg/mL, la sensibilite ´, spe ´cificite ´, valeur pre ´dictive positive (VPP) et une valeur pre ´dictive ne ´gative du BDG pour le diagnostic de candidose invasive est respectivement de 100 %, 48 %, 17 % et 100 %. Discussion La de ´tection dans le se ´rum du BDG, apre `s transplantation he ´patique, semble e ˆtre un outil prometteur pour e ´liminer le diagnostic de candidose invasive chez les patients a `haut risque. Cette e ´tude sugge `re de prendre en conside ´ration un traitement antifongique pre ´emptif chez les patients septiques ayant un Candida Score ! 4 et dont le dosage de BDG est > 250 pg/mL. De´claration d'inte´re ˆts Les auteurs n'ont pas transmis de de ´claration de conflits d'inte ´re ˆts.
Respiratory Care, 2013
Background This trial was conducted to carry out an age and etiology-based analysis of the clinic... more Background This trial was conducted to carry out an age and etiology-based analysis of the clinical efficacy of non-invasive ventilation (NIV) in acute hypercapnic respiratory failure (AHRF). Methods This single center, prospective, cohort study included patients aged ≥65 years with chronic obstructive pulmonary disease (COPD), acute cardiogenic pulmonary edema (ACPE), community-acquired pneumonia (CAP), bronchiectasis, and kyphoscoliosis, who were treated with NIV for AHRF in the intensive care unit within a 4-year period. Results From 496 patients aged 65 years or older treated with NIV for AHRF, 162 patients were included. Of the patients 71 were aged 65-74 years, 70 were 75-84 years, and 21 were aged ≥85 years. Of the patients 90 had COPD, 31 had ACPE, 19 had CAP, 15 had bronchiectasis exacerbation and 7 had kyphoscoliosis as the AHRF etiology. The treatment with NIV Fatma Çiftci designed the study, performed the literature search and data collection, and reviewed and submitted the manuscript. Aydın Çiledag designed the study, performed data collection, and prepared and reviewed the manuscript. Serhat Erol performed data collection and prepared and reviewed the manuscript. Akın Kaya designed the study and prepared and reviewed the manuscript.
Computational and Mathematical Methods in Medicine, 2012
Biological organisms have intrinsic control systems that act in response to internal and external... more Biological organisms have intrinsic control systems that act in response to internal and external stimuli maintaining homeostasis. Human heart rate is not regular and varies in time and such variability, also known as heart rate variability (HRV), is not random. HRV depends upon organism's physiologic and/or pathologic state. Physicians are always interested in predicting patient's risk of developing major and life-threatening complications. Understanding biological signals behavior helps to characterize patient's state and might represent a step toward a better care. The main advantage of signals such as HRV indexes is that it can be calculated in real time in noninvasive manner, while all current biomarkers used in clinical practice are discrete and imply blood sample analysis. In this paper HRV linear and nonlinear indexes are reviewed and data from real patients are provided to show how these indexes might be used in clinical practice.
Critical Care, 2013
We assessed rates and predictive factors of non-invasive ventilation (NIV) failure in patients ad... more We assessed rates and predictive factors of non-invasive ventilation (NIV) failure in patients admitted to the intensive care unit (ICU) for non-hypercapnic acute hypoxemic respiratory failure (AHRF). Methods: This is an observational cohort study using data prospectively collected over a three-year period in a medical ICU of a university hospital. Results: Among 113 patients receiving NIV for AHRF, 82 had acute respiratory distress syndrome (ARDS) and 31 had non-ARDS. Intubation rates significantly differed between ARDS and non-ARDS patients (61% versus 35%, P = 0.015) and according to clinical severity of ARDS: 31% in mild, 62% in moderate, and 84% in severe ARDS (P = 0.0016). In-ICU mortality rates were 13% in non-ARDS, and, respectively, 19%, 32% and 32% in mild, moderate and severe ARDS (P = 0.22). Among patients with moderate ARDS, NIV failure was lower among those having a PaO 2 /FiO 2 >150 mmHg (45% vs. 74%, p = 0.04). NIV failure was associated with active cancer, shock, moderate/ severe ARDS, lower Glasgow coma score and lower positive end-expiratory pressure level at NIV initiation. Among intubated patients, ICU mortality rate was 46% overall and did not differ according to the time to intubation. Conclusions: With intubation rates below 35% in non-ARDS and mild ARDS, NIV stands as the first-line approach; NIV may be attempted in ARDS patients with a PaO 2 /FiO 2 > 150. By contrast, 84% of severe ARDS required intubation and NIV did not appear beneficial in this subset of patients. However, the time to intubation had no influence on mortality.
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Papers by Chiara Fragnoli