Purpose: Hypovitaminosis D is a highly spread condition correlated with increased risk of respiratory tract infections. Nowadays, the world is in the grip of the Coronavirus disease 19 (COVID 19) pandemic. In these patients, cytokine storm is associated with disease severity. In consideration of the role of vitamin D in the immune system, aim of this study was to analyse vitamin D levels in patients with acute respiratory failure due to COVID-19 and to assess any correlations with disease severity and prognosis. Methods: In this retrospective, observational study, we analysed demographic, clinical and laboratory data of 42 patients with acute respiratory failure due to COVID-19, treated in Respiratory Intermediate Care Unit (RICU) of the Policlinic of Bari from March, 11 to April 30, 2020. Results: Eighty one percent of patients had hypovitaminosis D. Based on vitamin D levels, the population was stratified into four groups: no hypovitaminosis D, insufficiency, moderate deficiency, and severe deficiency. No differences regarding demographic and clinical characteristics were found. A survival analysis highlighted that, after 10 days of hospitalization, severe vitamin D deficiency patients had a 50% mortality probability, while those with vitamin D ≥ 10 ng/mL had a 5% mortality risk (p = 0.019). Conclusions: High prevalence of hypovitaminosis D was found in COVID-19 patients with acute respiratory failure, treated in a RICU. Patients with severe vitamin D deficiency had a significantly higher mortality risk. Severe vitamin D deficiency may be a marker of poor prognosis in these patients, suggesting that adjunctive treatment might improve disease outcomes.

The recent Coronavirus disease 19 (COVID-19) pandemic, first in China and then also in Italy, brought to the attention the problem of the saturation of Intensive Care Units (ICUs). Almost all previous reports showed that in ICU less than half of patients were treated with invasive mechanical ventilation (IMV) and the rest of them with non-invasive respiratory support. This highlighted the role of respiratory intensive care units (RICUs), where patients with moderate to severe respiratory failure can be treated with non-invasive respiratory support, avoiding ICU admission. In this report, we describe baseline characteristics and clinical outcomes of 97 patients with moderate to severe respiratory failure due to COVID-19 admitted to the RICU of the Policlinico of Bari from March 11th to May 31st 2020. In our population, most of the subjects were male (72%), non-smokers (76%), with a mean age of 69.65±14 years. Ninety-one percent of patients presented at least one comorbidity and 60% had more than two comorbidities. At admission, 40% of patients showed PaO2/FiO2 ratio between 100 and 200 and 17% showed Pa02/FiO2 ratio <100. Mean Pa02/FiO2 ratio at admission was 186.4±80. These patients were treated with non-invasive respiratory support 40% with CPAP, 38% with BPAP, 3% with HFNC, 11% with standard oxygen therapy or with IMV through tracheostomy (patients in step down from ICU, 8%). Patients discharged to general ward (GW) were 51%, 30% was transferred to ICU and 19% died. To the best of our knowledge, this is one of the few described experiences of patients with respiratory failure due to COVID-19 treated outside the ICU, in a RICU. Outcomes of our patients, characterized by several risk factors for disease progression, were satisfactory compared with other experiences regarding patients treated with non-invasive respiratory support in ICU. The strategical allocation of our RICU, between ED and ICU, might have positively influenced clinical outcomes of our patients.

Noninvasive ventilation has become the initial treatment for symptomatic ventilatory pump failure but, when used at ventilatory support settings, can be an alternative to tracheostomy mechanical ventilation. The intermittent abdominal pressure ventilator, a corset with an internal air sack inflated by a ventilator, allows to increase tidal volumes through the raising of the diaphragm and its consequent passive descent. It has been used for daytime support for more than 70 yrs, but its knowledge among clinicians is scarce. A narrative review was performed by searching PubMed, Medline, and the Cochrane Database of Systematic Reviews using the terms “IAPV” or “pneumobelt.” One hundred forty patients were cited using the intermittent abdominal pressure ventilator from 1946 until it went off the market in the 1970s, although many continued to use it. There was only one publication on its use from 2003 to 2017, but three publications from 2017 through 2021. It has been used for full diurnal ventilatory support by some patients for more than 50 yrs and has even been used throughout the labor of a mother with no ventilator-free breathing ability. The intermittent abdominal pressure ventilator is a ventilatory support alternative for patients with ventilatory pump failure. It can be effective and well tolerated and maintain quality of life without facial interfaces. More widespread application is warranted.

Purpose: Positive airway pressure (PAP) treatment for obstructive sleep apnea syndrome (OSAS) is often burdened by lower adherence rates. Patients’ perception and acceptance of PAP therapy play a crucial role in achieving acceptable adherence. Method: We conducted a prospective cohort study to assess patients’ initial impressions of PAP therapy using a six-item questionnaire. The questionnaire evaluated CPAP tolerance, interface comfort, titration pressure, likelihood of CPAP use, expected health benefits, and overall attitude toward PAP therapy. Patients underwent a baseline awake PAP therapy trial (T0) followed by titration with an automatic device (APAP). After one month of titration, a fixed CPAP value was set (T1). Follow-ups occurred at 1 (T2), 3 (T3), and 6 (T4) months after the start of treatment. Adherence to PAP therapy was considered sufficient if the mean device usage was ≥ 4 h/night at T4. Results: After six months, 77% of the enrolled patients achieved high PAP treatment adherence. Questionnaire scores generally improved from T0 to T4, particularly in CPAP tolerance, likelihood of treatment adherence, expected health benefits, and overall judgment of PAP therapy. Time-to-event analysis revealed that higher baseline scores in titration pressure comfort, likelihood of CPAP adherence, and overall judgment of PAP therapy were significantly associated with higher adherence likelihood. Conclusion: Patients’ first judgement on PAP therapy could significantly influence short-term adherence. Early identification and management of patients’ complaints and discomforts could improve adherence rates and PAP perception over time.

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder characterized by recurrent upper airway collapse. Continuous positive airway pressure (CPAP) is the gold standard treatment but is burdened by low adherence rates. Nighttime hypoxia may alter sleep structure and OSA symptoms, potentially affecting PAP treatment adherence. This study aims to evaluate whether nocturnal hypoxia measures could predict long-term PAP adherence. We conducted a real-life, retrospective study including 207 OSA patients. Clinical data were collected on symptoms, comorbidities, home sleep apnea test (HSAT) metrics, prescribed therapy and objective adherence data via in-built device software. Nocturnal respiratory failure (NRF) was defined as a total sleep time with SpO₂ < 90% (TST90) ≥ 30%. Among the cohort, 119 patients met the criteria for NRF. These patients exhibited higher BMI, more severe OSA and a higher prevalence of COPD compared to those without NRF. At follow-up, patients with NRF demonstrated significantly better treatment adherence and more frequently reported improvement in several daytime and nighttime symptoms. Time-to-event analysis and adjusted multivariable regressions showed a higher probability of good long-term PAP adherence in patients with TST90 ≥ 30%. These findings suggest that prolonged nocturnal hypoxemia may identify a subgroup of patients more likely to maintain long-term PAP treatment.