Article
Anesthesiology
Domenico Luca Grieco, Andrea Russo, Gian Marco Anzellotti, Bruno Romano, Filippo Bongiovanni, Antonio M. Dell'Anna, Luigi Mauti, Laura Cascarano, Valerio Gallotta, Tommaso Rosa, Francesco Varone, Luca S. Menga, Lorenzo Polidori, Marco D'Indinosante, Serena Cappuccio, Claudia Galletta, Lucia Tortorella, Barbara Costantini, Salvatore Gueli Alletti, Liliana Sollazzi, Giovanni Scambia, Massimo Antonelli
Summary: The study aimed to assess the effects of a protective ventilation strategy during Trendelenburg pneumoperitoneum surgery on postoperative oxygenation. A randomized trial was conducted with patients randomized into standard ventilation group and protective ventilation group during anesthesia. The results showed that there was no significant difference in PaO2/FiO2 one hour after extubation between the protective ventilation group and the standard ventilation group, but the protective ventilation group exhibited less injurious ventilation during the surgery.
JOURNAL OF CLINICAL ANESTHESIA
(2023)
Article
Engineering, Biomedical
Qianhui Sun, J. Geoffrey Chase, Cong Zhou, Merryn H. Tawhai, Jennifer L. Knopp, Knut Moeller, Serge J. Heines, Dennis C. Bergmans, Geoffrey M. Shaw
Summary: This research developed a novel deterministic virtual patient model to accurately predict pulmonary response to changes in mechanical ventilation (MV) settings, providing decision support for personalized and optimized care in real-time.
BIOMEDICAL SIGNAL PROCESSING AND CONTROL
(2022)
Article
Critical Care Medicine
Luca Bastia, Doreen Engelberts, Kohei Osada, Bhushan H. Katira, L. Felipe Damiani, Takeshi Yoshida, Lu Chen, Niall D. Ferguson, Marcelo B. P. Amato, Martin Post, Brian P. Kavanagh, Laurent Brochard
Summary: In cases of asymmetrical lung injury, pressures measured in the injured and noninjured lungs were found to be similar, with esophageal pressure serving as a reliable estimate of dorsal pleural pressure. Moderate PEEP was effective in homogenizing ventilation distribution between lungs without causing overdistension.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2021)
Article
Critical Care Medicine
Roberto Tonelli, Salvatore Grasso, Andrea Cortegiani, Lorenzo Ball, Ivana Castaniere, Luca Tabbi, Riccardo Fantini, Dario Andrisani, Filippo Gozzi, Antonio Moretti, Giulia Bruzzi, Linda Manicardi, Stefania Cerri, Anna Valeria Samarelli, Giulia Raineri, Francesco Murgolo, Andrea Carzoli, Rossella Di Mussi, Stefano Busani, Raffaella Rizzoni, Giacomo Grasselli, Enrico Clini, Alessandro Marchioni
Summary: This study aims to investigate the physiological effects of lung-protective ventilation in patients with AE-ILD-UIP and compare it with primary ARDS. The findings indicate that, unlike patients with primary ARDS, adjusting positive end-expiratory pressure to achieve a positive transpulmonary pressure significantly worsened lung mechanics in mechanically ventilated AE-ILD-UIP patients.
Article
Physiology
Nibaldo Aviles-Rojas, Daniel E. Hurtado
Summary: This study aims to create anatomical computational models of the lungs to predict clinically-relevant respiratory variables. A continuum poromechanical framework is formulated to account for the air-tissue interaction in the lung parenchyma. The proposed lung model accurately predicts physiological variables in mechanical ventilation and the supersyringe method. The findings demonstrate the potential of finite-element poromechanical models in predicting clinically-relevant variables in respiratory medicine.
FRONTIERS IN PHYSIOLOGY
(2022)
Article
Critical Care Medicine
Daniel D. Rowley, Susan R. Arrington, Kyle B. Enfield, Keith D. Lamb, Alexandra Kadl, John P. Davis, Danny J. Theodore
Summary: It was found in the study that for obese patients on mechanical ventilation, P-L-guided LPV settings resulted in better expiratory pressure, pulmonary mechanics, and oxygenation compared to non-P-L-guided LPV settings.
Article
Critical Care Medicine
Jose Dianti, Samira Fard, Jenna Wong, Timothy C. Y. Chan, Lorenzo Del Sorbo, Eddy Fan, Marcelo B. Passos Amato, John Granton, Lisa Burry, W. Darlene Reid, Binghao Zhang, Damian Ratano, Shaf Keshavjee, Arthur S. Slutsky, Laurent J. Brochard, Niall D. Ferguson, Ewan C. Goligher
Summary: This study aimed to optimize respiratory effort in patients with acute hypoxemic respiratory failure (AHRF) to achieve lung- and diaphragm-protective (LDP) targets. Titrating ventilation and sedation could optimize respiratory effort for lung and diaphragm protection in most patients, and the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) facilitated the delivery of a LDP strategy. Partial neuromuscular blockade (pNMBA) treatment was effective for patients with excessive respiratory effort.
Review
Critical Care Medicine
John J. Marini, Luciano Gattinoni
Summary: Regional variations in lung and chest wall properties can modify transpulmonary pressures and suggest potential benefits of judicious application of external pressure. Observations in late-phase C-ARDS patients have shown unexpected mechanical responses to local chest wall compressions, challenging assumptions and conventional approaches to lung protection, opening avenues for further research with possible therapeutic implications.
Article
Critical Care Medicine
Raquel F. de Magalhaes, Daniela G. Cruz, Mariana A. Antunes, Marcos V. de S. Fernandes, Milena V. Oliveira, Cassia L. Braga, Joshua Satalin, Penny Andrews, Nader Habashi, Gary Nieman, Cassiano F. Goncalves de-Albuquerque, Adriana R. Silva, Roseli V. Ribeiro, Vera L. Capelozzi, Fernanda F. Cruz, Cynthia dos S. Samary, Patricia R. M. Rocco, Pedro L. Silva
Summary: In an animal study comparing time-controlled adaptive ventilation with volume-controlled ventilation in a Pseudomonas aeruginosa-induced pneumonia model, time-controlled adaptive ventilation showed lower lung damage, bacteremia, and reduced gene expression of inflammatory mediators compared to volume-controlled ventilation with similar mean airway pressure.
CRITICAL CARE MEDICINE
(2021)
Article
Critical Care Medicine
Anne-Fleur Haudebourg, Elsa Moncomble, Arnaud Lesimple, Flora Delamaire, Bruno Louis, Armand Mekontso Dessap, Alain Mercat, Jean-Christophe Richard, Francois Beloncle, Guillaume Carteaux
Summary: This study proposes a novel method for assessing airway opening pressure (AOP) during volume assist control ventilation at a constant-flow rate of 60 L/min. The P-cond method, which compares the airway pressure waveform to detect and measure AOP, was validated and showed good respiratory and hemodynamic tolerance compared to the standard low-flow method.
Article
Anesthesiology
Martin Scharffenberg, Maura Mandelli, Thomas Bluth, Francesca Simonassi, Jakob Wittenstein, Robert Teichmann, Katharina Birr, Thomas Kiss, Lorenzo Ball, Paolo Pelosi, Marcus J. Schultz, Marcelo Gama de Abreu, Robert Huhle
Summary: The study aimed to examine the impact of low or high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RM) on intra-tidal recruitment/derecruitment and overdistension in obese patients. The results showed that higher PEEP and RM reduced intra-tidal recruitment/derecruitment, driving pressure, elastance, resistance, and mechanical power.
JOURNAL OF CLINICAL ANESTHESIA
(2024)
Article
Critical Care Medicine
Colin K. Grissom, Michael J. Lanspa, Danielle Groat, Jason R. Jacobs, Lori Carpenter, Kathryn G. Kuttler, Lindsay Leither, Ithan D. Peltan, Samuel M. Brown, Rajendu Srivastava
Summary: This study implemented a computerized protocol for low tidal volume ventilation to improve the management and outcomes of mechanically ventilated patients. After the implementation, the set tidal volume decreased and more patients received the protocol. However, no improvement in clinical outcomes was observed.
CRITICAL CARE MEDICINE
(2023)
Article
Critical Care Medicine
Clement Brault, Jordi Mancebo, Juan-Carlos Suarez Montero, Tracey Bentall, Karen E. A. Burns, Thomas Piraino, Francois Lellouche, Pierre-Alexandre Bouchard, Emmanuel Charbonney, Guillaume Carteaux, Tommaso Maraffi, Gaetan Beduneau, Alain Mercat, Yoanna Skrobik, Fei Zuo, Myriam Lafreniere-Roula, Kevin Thorpe, Laurent Brochard, Karen J. Bosma
Summary: A simple algorithm was developed to identify patients who were ready to be liberated from mechanical ventilation but were still predicted by clinicians to require ongoing ventilation. This algorithm was successful in identifying a quarter of the enrolled patients who were ready for extubation.
Article
Anesthesiology
Hong Li, Zhi-Nan Zheng, Nan-Rong Zhang, Jing Guo, Kai Wang, Wei Wang, Lin-Gui Li, Jing Jin, Jing Tang, Yao-Jun Liao, San-Qing Jin
Summary: Among at-risk patients undergoing laparoscopic colorectal cancer resection under low-tidal-volume ventilation, an open-lung strategy with a PEEP of 6-8 cmH(2)O and repeated LRMs reduced postoperative complications compared with a strategy using zero PEEP without LRMs. However, caution should be taken when using LRMs in patients with hemodynamic instability.
EUROPEAN JOURNAL OF ANAESTHESIOLOGY
(2021)
Article
Pediatrics
Almos Schranc, Adam L. Balogh, John Diaper, Roberta Sudy, Ferenc Petak, Walid Habre, Gergely Albu
Summary: This study observed the effects of flow-controlled ventilation (FCV) and pressure-regulated volume control (PRVC) ventilation on lung mechanics, gas exchange, and lung aeration in a pediatric model. The results showed that FCV and PRVC provided adequate gas exchange in healthy and injured lungs. FCV resulted in better lung aeration in the ventral dependent zones compared to PRVC, but this difference was not seen in injured lungs.
FRONTIERS IN PEDIATRICS
(2022)
Article
Critical Care Medicine
Tommaso Mauri, Giuseppe Foti, Carla Fornari, Giacomo Grasselli, Riccardo Pinciroli, Federica Lovisari, Daniela Tubiolo, Carlo Alberto Volta, Savino Spadaro, Roberto Rona, Egle Rondelli, Paolo Navalesi, Eugenio Garofalo, Rihard Knafelj, Vojka Gorjup, Riccardo Colombo, Andrea Cortegiani, Jian-Xin Zhou, Rocco D'Andrea, Italo Calamai, Anxela Vidal Gonzalez, Oriol Roca, Domenico Luca Grieco, Tomas Jovaisa, Dimitrios Bampalis, Tobias Becher, Denise Battaglini, Huiqing Ge, Mariana Luz, Jean-Michel Constantin, Marco Ranieri, Claude Guerin, Jordi Mancebo, Paolo Pelosi, Roberto Fumagalli, Laurent Brochard, Antonio Pesenti
Summary: A multicenter clinical trial on intubated adult patients with acute hypoxemic respiratory failure or ARDS showed that the application of sigh during pressure support ventilation was feasible and did not pose an increased risk.
Article
Critical Care Medicine
Tobias Becher, Valerie Buchholz, Daniel Hassel, Timo Meinel, Dirk Schaedler, Inez Frerichs, Norbert Weiler
Summary: The EIT-based protocol allows individualization of ventilator settings with improved oxygenation and reduced alveolar cycling without promoting global overdistension.
ANNALS OF INTENSIVE CARE
(2021)
Editorial Material
Anesthesiology
Tobias Becher, Dirk Schadler, Inez Frerichs
JOURNAL OF CLINICAL MONITORING AND COMPUTING
(2022)
Article
Biophysics
Claas Strodthoff, Toni Kahkonen, Richard H. Bayford, Tobias Becher, Inez Frerichs, Merja Kallio
Summary: This study aimed to investigate the bronchodilator effect on respiratory mechanics during intensive care using electrical impedance tomography (EIT) and assess the feasibility of EIT in this context. The results showed that continuous monitoring with EIT could help optimize the treatment of lower respiratory tract infections in pediatric intensive care units. EIT-based regional expiratory time constants could provide an objective assessment of the effects of bronchodilators and other respiratory therapies.
PHYSIOLOGICAL MEASUREMENT
(2022)
Article
Critical Care Medicine
Tobias Becher, Andreas Meiser, Ulf Guenther, Martin Bellgardt, Jan Wallenborn, Klaus Kogelmann, Hendrik Bracht, Andreas Falthauser, Jonas Nilsson, Peter Sackey, Patrick Kellner
Summary: In patients with acute hypoxemic respiratory failure (AHRF), inhaled sedation with isoflurane for 48 hours did not lead to improved oxygenation compared to intravenous sedation with propofol.
ANNALS OF INTENSIVE CARE
(2022)
Letter
Critical Care Medicine
Irene Telias, Matias Madorno, Tai Pham, Thomas Piraino, Remi Coudroy, Michael C. Sklar, Eumorfia Kondili, Savino Spadaro, Tobias Becher, Chang-Wen Chen, Tommaso Mauri, Lise Piquilloud, Laurent Brochard
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2023)
Article
Multidisciplinary Sciences
Christine Eimer, Knut G. Rump, Gunnar Elke, Tobias H. Becher, Norbert Weiler, Amke Caliebe, Dirk Schaedler
Summary: The purpose of this study was to assess the effect of different levels of positive end-expiratory pressure (PEEP) on the distance from the subclavian vein (SCV) to the parietal pleura (DVP) and on the cross-sectional area (CSA) of the SCV. The results showed that an increase in PEEP did not have clinically relevant effects on DVP and CSA. Therefore, PEEP optimization is not indicated for subclavian vein cannulation.
Article
Medicine, General & Internal
Lukas M. M. Mueller-Wirtz, Tobias Becher, Ulf Guenther, Martin Bellgardt, Peter Sackey, Thomas Volk, Andreas Meiser
Summary: Comparing the effects of different devices and methods on respiration, it was found that Sedaconda ACD-L significantly increased minute ventilation, tidal volume, respiratory rate, and arterial carbon dioxide pressure compared to ACD-S. ACD-S had no significant effect on ventilation and had slightly lower volatile anesthetic consumption. Therefore, ACD-S is the preferred device in order to minimize the impact on ventilation.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Critical Care Medicine
David G. Tingay, Hannah Naidu, Hamish D. Tingay, Prue M. Pereira-Fantini, Martin C. J. Kneyber, Tobias Becher
Summary: Mechanical power is a key factor in lung injury and mortality in adults on mechanical ventilation. The role of mechanical power in neonatal lung injury is unknown. This study aims to investigate the potential usefulness of mechanical power in expanding our understanding of preterm lung disease.
INTENSIVE CARE MEDICINE EXPERIMENTAL
(2023)
Article
Engineering, Biomedical
Carolin M. Geitner, Tobias Becher, Inez Frerichs, Norbert Weiler, Jason H. T. Bates, Wolfgang A. Wall
Summary: We propose a new approach to computationally model the lungs of diseased human using physics-based methods. Our model incorporates the dynamics of airway recruitment/derecruitment to accurately simulate the respiratory system mechanics, airway dimensions, and the properties of the lining fluid. This approach allows for more precise predictions of mechanical stress locations in the lungs, which play a crucial role in the development and propagation of injury. By matching the model to patient data and using medical CT images, we demonstrate the potential of the model to reveal underlying abnormalities in the specific case of acute respiratory distress syndrome (ARDS). The model accurately reproduces clinically measured quantities and exhibits physiologically reasonable lung recruitment dynamics, providing a valuable tool for personalized studies and optimized therapies.
INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING
(2023)
Article
Engineering, Biomedical
Carolin M. Geitner, Lea J. Koeglmeier, Inez Frerichs, Patrick Langguth, Matthias Lindner, Dirk Schaedler, Norbert Weiler, Tobias Becher, Wolfgang A. Wall
Summary: We present a novel computational model for simulating alveolar recruitment/derecruitment dynamics, which considers the characteristics observed in injured lungs and introduces patient-specific parameter determination. Applying this model to clinical data of mechanically ventilated patients allows for accurate estimation of individual tissue straining and cyclic derecruitment, contributing to the development of personalized protective ventilation strategies.
INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING
(2023)
Article
Multidisciplinary Sciences
Daniel Schwarzkopf, Claudia Tanja Matthaeus-Kraemer, Daniel O. Thomas-Ruddel, Hendrik Rueddel, Bernhard Poidinger, Friedhelm Bach, Herwig Gerlach, Matthias Grundling, Matthias Lindner, Christian Scheer, Philipp Simon, Manfred Weiss, Konrad Reinhart, Frank Bloos
Summary: Sepsis is a major cause of preventable hospital deaths. An educational intervention did not show improvements in sepsis management or outcomes. A second intervention phase with a multifaceted educational intervention resulted in some improvements in sepsis management and outcomes. Quality improvement programs should include all elements of sepsis guidelines and provide hospitals with sufficient resources.
SCIENTIFIC REPORTS
(2022)
Article
Respiratory System
Tobias H. Becher, Martijn Miedema, Merja Kallio, Thalia Papadouri, Christina Karaoli, Louiza Sophocleous, Marika Rahtu, Ruud W. van Leuteren, Andreas D. Waldmann, Claas Strodthoff, Rebecca Yerworth, Antoine Dupre, Mohamed-Rida Benissa, Sven Nordebo, Davood Khodadad, Richard Bayford, Roseanne Vliegenthart, Peter C. Rimensberger, Anton H. van Kaam, Inez Frerichs
Summary: This study evaluated the feasibility and safety of long-term monitoring using electrical impedance tomography (EIT) in neonates and young children with respiratory failure. The results showed that EIT allowed continuous monitoring of lung function for up to 72 hours with minimal adverse effects. The study also found that ventilation distribution was influenced by body position and varied depending on the postmenstrual age of the patients.
ANNALS OF THE AMERICAN THORACIC SOCIETY
(2022)
Article
Critical Care Medicine
Hendrik Ruddel, Daniel O. Thomas-Ruddel, Konrad Reinhart, Friedhelm Bach, Herwig Gerlach, Matthias Lindner, John C. Marshall, Philipp Simon, Manfred Weiss, Frank Bloos, Daniel Schwarzkopf
Summary: The timing of antimicrobial therapy and surgical source control in patients with sepsis has a significant impact on clinical outcomes. Early anti-infective treatment can reduce mortality, while delays in source control may lead to disease progression.