Giorgio Emanuele Polistina

Ospedale Monaldi

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Co-Authors

Giuseppe Fiorentino

Ospedale Monaldi

Anna Annunziata

Ospedale Monaldi

Pasquale Imitazione

Ospedale Monaldi

Maurizia Lanza

Ospedale Monaldi

Marialuisa Bocchino

University of Naples Federico II

Angelo Canora

University of Naples Federico II

Gerardo Langella

Ospedale Monaldi

Francesca Simioli

Ospedale D. Cotugno

Serena Zanotta

Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale"

Giacomo Ghinassi

Ospedale San Donato

Cooperative Institutions

Istituti di Ricovero e Cura a Carattere Scientifico

271

University of Milan

135

University of Naples Federico II

108

University of Campania "Luigi Vanvitelli"

University of Brescia

Sapienza University of Rome

Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia

Ospedale Monaldi

Ospedale D. Cotugno

University of Padua

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Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

Journal of Translational Medicine (2020)

Francesco Perrone Maria Carmela Piccirillo Paolo A. Ascierto Carlo Salvarani Roberto Parrella

Abstract Background Tocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients. Methods A multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival. Results In the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6–24.0, P = 0.52) and 22.4% (97.5% CI: 17.2–28.3, P < 0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline. Conclusions Tocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline. Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092).

Tocilizumab

Clinical endpoint

10.1186/s12967-020-02573-9

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Citations (108)

[Three cases of primary subarachnoid hemorrhage and differential diagnosis].

PubMed (1949)

M Rapellini Giorgio Emanuele Polistina

Primary (astronomy)

Source

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Citations (0)

[Laterocervical tumors with thyroid structure].

PubMed (1966)

F Martuscelli Giorgio Emanuele Polistina Pasquale Spinelli

Thyroid tumors

Source

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High flow nasal cannula oxygen therapy in COVID-19 associated severe acute respiratory distress. A single center experience

Minerva Pneumologica (2020)

Francesca Simioli Anna Annunziata Gerardo Langella Giorgio Emanuele Polistina Maria Cristina De Martino

BACKGROUND: High flow nasal cannula (HFNC) showed better oxygenation than standard oxygen therapy delivered through a face mask in acute respiratory failure for all causes. HFNC may offer an alternative in patients with acute hypoxemia and potentially reduce mortality. It was widely applied in China during the COVID-19 emergency. However, no data have been published about settings and protocols. The purpose of this paper was to report a single center experience on effectiveness and safety of HFNC in weaning of COVID-19 associated respiratory failure.METHODS: We retrospectively analyzed patient records from Sub-intensive Care Unit (Cotugno Hospital, Naples, Italy). Four patients (3F; age: 60±9.23 years; BMI: 27.5±5.2) were de-escalated from ventilation (3 Helmet CPAP, 1 invasive mechanical ventilation) to HFNC oxygen therapy. All patients were admitted for severe acute respiratory failure and pneumonia due to SARS-COV-2 (PaO2/FiO2 at baseline: 104±42.3 mmHg) and showed a typical progressive stage at chest imaging. Weaning was initiated following a stable period of ventilation (PaO2/FiO2 in last days of first respiratory support: 377±60.2 mmHg). HFNC was set on 34 °C, with flow ranging from 50 to 60 L/min and FiO2 from 40 to 60%.RESULTS: Right after initiation of HFNC (day 1), the mean PaO2/FiO2 was 238 mmHg (±65), without clinical signs of respiratory distress. No difference was observed on lactate. After 3 days of therapy mean PaO2/FiO2 increased to 377 mmHg (±106.3). All patients recovered from respiratory failure (PaO2>60 mmHg in room air) after 7 days (±3.2).CONCLUSIONS: HFNC might be helpful in weaning severe respiratory distress. Clinical effectiveness and comfort should be assessed within 3 days. The correct timing should be ruled by PaO2/FiO2 during ventilation and clinical signs of distress. Further evidence is required for firm conclusions.

Nasal cannula

Oxygen therapy

10.23736/s0026-4954.20.01873-8

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Citations (4)

Correction to: Tocilizumab for patients with COVID-19 pneumonia. The single-arm TOCIVID-19 prospective trial

Journal of Translational Medicine (2021)

Francesco Perrone Maria Carmela Piccirillo Paolo A. Ascierto Carlo Salvarani Roberto Parrella

Tocilizumab

2019-20 coronavirus outbreak

Betacoronavirus

Coronavirus Infections

10.1186/s12967-021-03094-9

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Citations (1)

The “Traffic Light OSA-SARS”: a tool for the management of obstructive sleep apnea in the pandemic era

Journal of Clinical Sleep Medicine (2021)

Antonio Sanna Antonio Foresi Matteo Siciliano Roberto Torchio Antonino Attinà

Table 1-The "Traffic Light OSA-SARS" summarizes actions and procedures for OSA objective testing and PAP titration during the SARS-CoV-2 pandemic.

Pandemic

Sleep

2019-20 coronavirus outbreak

10.5664/jcsm.9572

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Citations (1)

Clinical outcomes of high-flow nasal cannula in COVID-19 associated postextubation respiratory failure. A single-centre case series

Anaesthesiology Intensive Therapy (2020)

Francesca Simioli Anna Annunziata Gerardo Langella Giorgio Emanuele Polistina Maria Teresa Di Martino

A high-flow nasal cannula (HFNC) is an alternative device for oxygena-tion, which improves gas exchange and reduces the work of breathing. Postextubation respiratory failure causes increased morbidity and mortality. HFNC has been widely employed during the COVID-19 pandemic. The purpose of this paper is to report a single-centre experience on the effectiveness and safety of HFNC in weaning COVID-19 patients.Nine patients showed severe acute respiratory failure and interstitial pneumonia due to SARS-CoV-2. After mechanical ventilation (5 Helmet CPAP, 4 invasive mechanical ventilation), they were de-escalated to HFNC. Settings were: 34-37°C, flow from 50 to 60 L min-1. FiO2 was set to achieve appropriate SpO2.Nine patients (4 females; age 63 ± 13.27 years; BMI 27.2 ± 4.27) showed a baseline PaO2/FiO2 of 109 ± 45 mm Hg. After a long course of ventilation all patients improved (PaO2/FiO2 336 ± 72 mm Hg). Immediately after initiation of HFNC (2 hours), PaO2/FiO2 was 254 ± 69.3 mm Hg. Mean ROX index at two hours was 11.17 (range: 7.38-14.4). It was consistent with low risk of HFNC failure. No difference was observed on lactate. After 48 hours of HFNC oxygen therapy (day 3), mean PaO2/FiO2 increased to 396 ± 83.5 mm Hg. All patients recovered from respiratory failure after 7 ± 4.1 days.HFNC might be helpful in weaning COVID-19 respiratory failure. Effectiveness and comfort should be assessed between 2 and 48 hours. Clinical outcomes, oxygenation, and ROX index should be considered, to rule out the need for intubation. Further evidence is required for firm conclusions.

Nasal cannula

2019-20 coronavirus outbreak

Single Center

10.5114/ait.2020.101007

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Citations (12)

SWITCHING ROLES: A RARE CASE OF MILIARY TB YEARS AFTER PULMONARY NTM DISEASE

CHEST Journal (2020)

Paola Castellotti M. Saporiti Maurizio Ferrarese Giorgio Emanuele Polistina P. Cariello

Rifabutin

Sputum culture

Productive Cough

10.1016/j.chest.2020.05.096

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PULMONARY TUBERCULOSIS PRE XDR AND LUNG CANCER: DOUBLE TROUBLE

CHEST Journal (2020)

Giorgio Emanuele Polistina P. Cariello Annunziata De Rosa Paola Castellotti M. Saporiti

10.1016/j.chest.2020.05.065

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Cavitary lung metastasis as relapse of prostate cancer

Respiratory Medicine Case Reports (2019)

Giorgio Emanuele Polistina Alessandro Matarese P. Cariello Danila Caroppo Alessandro Sanduzzi

Prostate cancer is the most common non-cutaneous malignancy diagnosed in men. It usually metastasizes to bone as osteoblastic lesions on radiographs and regional lymph nodes, and uncommonly to lung, liver and brain. Metastatic prostate cancer recurrence after definitive local therapy can occur in any tissue. The role of fine needle aspiration cytology (FNAC) for diagnosis of metastatic malignancies is well established in literature. We describe a 74 years old male, previously treated for localized prostate cancer, admitted to our Department after total body computed tomography revealed multiple irregular lung lesions some of which had an excavated appearance.

10.1016/j.rmcr.2019.100973

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Citations (6)