Article
Medicine, Research & Experimental
Domenico Luca Grieco, Salvatore Maurizio Maggiore, Giacomo Bellani, Savino Spadaro, Elena Spinelli, Tommaso Tonetti, Luca S. Menga, Marco Pozzi, Denise Battaglini, Rosa Di Mussi, Andrea Bruni, Andrea De Gaetano, Carmine Giovanni Iovino, Matteo Brioni, Francesco Mojoli, Giuseppe Foti, Carlo Aberto Volta, Paolo Pelosi, Paolo Navalesi, Salvatore Grasso, V. Marco Ranieri, Massimo Antonelli
Summary: The IPERPEEP trial aims to investigate whether an individualized PEEP setting protocol based on bedside assessment of lung recruitability can improve a composite clinical outcome in patients with moderate-to-severe ARDS.
Article
Critical Care Medicine
Monica Rodrigues da Cruz, Luciana Moises Camilo, Tiago Batista da Costa Xavier, Gabriel Casulari da Motta Ribeiro, Denise Machado Medeiros, Luis Felipe da Fonseca Reis, Bruno Leonardo da Silva Guimaraes, Andre Miguel Japiassu, Alysson Roncally Silva Carvalho
Summary: This study investigated the relationship between airway driving pressure (dP(aw)) and positive-end expiratory pressure (PEEP) in ARDS patients with COVID-19. The majority of patients exhibited a J-shaped curve, while a smaller proportion had a U-shaped or inverted J-shaped curve. Patients with inverted J-shaped curves had higher BMI and lower baseline partial pressure of arterial oxygen/FiO(2) ratio. These findings suggest that adjusting PEEP based on dP(aw) changes can enable individualized protective ventilation.
Article
Critical Care Medicine
Annemijn H. Jonkman, Glasiele C. Alcala, Bertrand Pavlovsky, Oriol Roca, Savino Spadaro, Gaetano Scaramuzzo, Lu Chen, Jose Dianti, Mayson L. de A. Sousa, Michael C. Sklar, Thomas Piraino, Huiqing Ge, Guang-Qiang Chen, Jian-Xin Zhou, Jie Li, Ewan C. Goligher, Eduardo Costa, Jordi Mancebo, Tommaso Mauri, Marcelo Amato, Laurent J. Brochard
Summary: This study used electrical impedance tomography (EIT) to quantify lung recruitability and proposed a method to select optimal positive end-expiratory pressure (PEEP) based on EIT. The researchers found that there is a wide variation in recruitability among COVID-19 patients, and EIT can help personalize PEEP setting to balance recruitability and overdistension.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2023)
Article
Medicine, General & Internal
Hong Ren, Li Xie, Zhulin Wang, Xiaoliao Tang, Botao Ning, Teng Teng, Juan Qian, Ying Wang, Lijun Fu, Zhanqi Zhao, Long Xiang
Summary: The study aims to compare the difference in positive end-expiratory pressure (PEEP) selection between chest electrical impedance tomography (EIT) and global dynamic respiratory system compliance (C-rs) in moderate-to-severe pediatric acute respiratory distress syndrome (pARDS). The results suggest that in moderate-to-severe pARDS, PEEP selected based on C-rs might not be inferior to EIT-guided regional ventilation.
FRONTIERS IN MEDICINE
(2022)
Article
Critical Care Medicine
Yi Xin, Kevin Martin, Caio C. A. Morais, Paolo Delvecchio, Sarah E. Gerard, Hooman Hamedani, Jacob Herrmann, Nicholas Abate, Austin Lenart, Shiraz Humayun, Uday Sidhu, Mihail Petrov, Kristan Reutlinger, Tal Mandelbaum, Ian Duncan, Nicholas Tustison, Stephen Kadlecek, Shampa Chatterjee, James C. Gee, Rahim R. Rizi, Lorenzo Berra, Maurizio Cereda
Summary: The effects of prone positioning on lung aeration may be influenced by the stage of lung injury, with less reinflation in late-stage patients compared to early-stage patients. Additionally, prone positioning decreased aeration in the anterior lung regions. These findings suggest that the efficacy of prone positioning in improving lung aeration may be limited by the stage of lung injury.
CRITICAL CARE MEDICINE
(2021)
Article
Critical Care Medicine
Alessandro Protti, Alessandro Santini, Francesca Pennati, Chiara Chiurazzi, Massimo Cressoni, Michele Ferrari, Giacomo E. Iapichino, Luca Carenzo, Ezio Lanza, Giorgio Picardo, Pietro Caironi, Andrea Aliverti, Maurizio Cecconi
Summary: Patients with early ARDS due to COVID-19 have a large potential for lung recruitment, but their compliance and Pa-CO2 may not improve with higher PEEP, possibly due to hyperinflation.
Article
Critical Care Medicine
Ruiting Li, Yongran Wu, Hongling Zhang, Azhen Wang, Xin Zhao, Shiying Yuan, Le Yang, Xiaojing Zou, You Shang, Zhanqi Zhao
Summary: The aim of this study was to investigate the physiological impact of airway pressure release ventilation (APRV) on patients with early moderate-to-severe acute respiratory distress syndrome (ARDS) by electrical impedance tomography (EIT). The results showed that APRV optimizes the distribution of ventilation and perfusion, reducing lung heterogeneity, which potentially reduces the risk of ventilator-induced lung injury.
Article
Anesthesiology
Joaquin Araos, Leyla Alegria, Aline Garcia, Pablo Cruces, Dagoberto Soto, Benjamin Erranz, Tatiana Salomon, Tania Medina, Patricio Garcia, Sebastian Dubo, Maria C. Bachmann, Roque Basoalto, Emilio D. Valenzuela, Maximiliano Rovegno, Magdalena Vera, Jaime Retamal, Rodrigo Cornejo, Guillermo Bugedo, Alejandro Bruhn
Summary: In experimental severe ARDS with near-apnoeic ventilation and ECMO, a PEEP of 10 cm H2O minimised lung injury and improved gas exchange without compromising haemodynamic stability.
BRITISH JOURNAL OF ANAESTHESIA
(2021)
Article
Biophysics
Hui-Ju Hsu, Hou-Tai Chang, Zhanqi Zhao, Ping-Huai Wang, Jia-Hao Zhang, Yun-Sung Chen, Inez Frerichs, Knut Moeller, Feng Fu, Han-Shui Hsu, Shin-Ping Chuang, Hai-Yen Hsia, David Hung-Tsang Yen
Summary: The study aimed to compare PEEP titration using EIT and PV curve in moderate to severe ARDS patients. Results showed that PEEP guided by EIT may lead to improved driving pressure and survival rate in this patient population.
PHYSIOLOGICAL MEASUREMENT
(2021)
Article
Critical Care Medicine
Elena Spinelli, Michael Kircher, Birgit Stender, Irene Ottaviani, Maria C. Basile, Ines Marongiu, Giulia Colussi, Giacomo Grasselli, Antonio Pesenti, Tommaso Mauri
Summary: This study utilized EIT to evaluate unmatched ventilation and perfusion, finding that the percentage of unmatched units was significantly higher in non-survivors compared to survivors, and it was an independent predictor of mortality. Additionally, there were differences in ventilation and perfusion between different lung regions, and higher percentage of only perfused units correlated with lower dorsal ventilation and PaO2/FiO(2) ratio.
Article
Critical Care Medicine
Xuesong Liu, Xiao Liu, Jue Meng, Dongdong Liu, Yongbo Huang, Ling Sang, Yonghao Xu, Zhiheng Xu, Weiqun He, Sibei Chen, Rong Zhang, Xiaoqing Liu, Yimin Li
Summary: This study compared the respiratory mechanics in ARDS patients with or without COPD and found that PEEP titration guided by EIT in ARDS patients with COPD resulted in improvements in ventilation ratio, mechanical energy, cardiac index, and oxygen delivery with less adverse impact on hemodynamics.
Article
Critical Care Medicine
Peter Somhorst, Philip van der Zee, Henrik Endeman, Diederik Gommers
Summary: This study compared baseline PEEP according to the high PEEP-FiO(2) table and personalized PEEP following an EIT-guided PEEP trial. The results showed that an EIT-guided PEEP trial resulted in a relevant change in PEEP in 63% of patients, suggesting that personalized PEEP can improve respiratory mechanics and oxygenation in patients with ARDS.
Article
Biophysics
Alfio Bronco, Alice Grassi, Valeria Meroni, Cecilia Giovannoni, Francesca Rabboni, Emanuele Rezoagli, Maddalena Teggia-Droghi, Giuseppe Foti, Giacomo Bellani
Summary: This study demonstrated the clinical experience of using EIT in managing mechanical ventilation in patients with acute respiratory failure. EIT was shown to be an optimal noninvasive tool for real-time monitoring of the PEEP effect and ventilation distribution.
PHYSIOLOGICAL MEASUREMENT
(2021)
Article
Critical Care Medicine
Todd Sarge, Elias Baedorf-Kassis, Valerie Banner-Goodspeed, Victor Novack, Stephen H. Loring, Michelle N. Gong, Deborah Cook, Daniel Talmor, Jeremy R. Beitler
Summary: This study found that the effect of Pes-guided PEEP on survival in ARDS patients varied based on the severity of multiorgan dysfunction, and that PEEP titration achieving end-expiratory transpulmonary pressure near 0 cm H2O was associated with lower mortality.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2021)
Article
Medicine, General & Internal
Thomas Muders, Benjamin Hentze, Stefan Kreyer, Karin Henriette Wodack, Steffen Leonhardt, Goeran Hedenstierna, Hermann Wrigge, Christian Putensen
Summary: Individualized positive end-expiratory pressure (PEEP) titration based on the time disparity of regional ventilation curves measured by electrical impedance tomography (EIT) during slow inflations can minimize tidal recruitment. The bias and scatter of individualized PEEP levels increase with further reduction in slow inflation volumes.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Anesthesiology
Alberto Fogagnolo, Salvatore Grasso, Martin Dres, Loreto Gesualdo, Francesco Murgolo, Elena Morelli, Irene Ottaviani, Elisabetta Marangoni, Carlo Alberto Volta, Savino Spadaro
Summary: Mechanically ventilated patients with ARDS due to SARS-CoV-2 are more susceptible to AKI, with a more compromised renal blood flow and higher renal resistivity index compared to patients with classical ARDS. There is a linear correlation between PEEP and RRI in SARS-CoV-2 ARDS patients. The occurrence of AKI is higher in SARS-CoV-2 ARDS patients compared to ARDS patients.
JOURNAL OF CLINICAL MONITORING AND COMPUTING
(2022)
Review
Respiratory System
Dipayan Chaudhuri, Rehman Jinah, Karen E. A. Burns, Federico Angriman, Bruno L. Ferreyro, Laveena Munshi, Ewan Goligher, Damon Scales, Deborah J. Cook, Tommaso Mauri, Bram Rochwerg
Summary: Helmet noninvasive ventilation may reduce mortality and intubation in hypoxic and hypercapnic respiratory failure, but its effects on other outcomes remain uncertain.
EUROPEAN RESPIRATORY JOURNAL
(2022)
Letter
Critical Care Medicine
Elena Spinelli, Tommaso Mauri
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2022)
Article
Critical Care Medicine
Tommaso Fossali, Bertrand Pavlovsky, Davide Ottolina, Riccardo Colombo, Maria Cristina Basile, Antonio Castelli, Roberto Rech, Beatrice Borghi, Andrea Ianniello, Nicola Flor, Elena Spinelli, Emanuele Catena, Tommaso Mauri
Summary: This study assessed the physiological effects of prone positioning in COVID-19 patients. The results showed that prone positioning can increase lung recruitment, reduce atelectrauma, and improve ventilation-perfusion matching, which may be associated with more protective ventilation.
CRITICAL CARE MEDICINE
(2022)
Article
Peripheral Vascular Disease
Alberto Lucchini, Stefano Elli, Daniele Piovera, Mario Grossule, Luciano Giannini, Luigi Cannizzo, Andrea Crosignani, Roberto Rona, Guseppe Foti, Marco Giani
Summary: This study retrospectively assessed the micro-motion of ECMO cannulae and the rate of bleeding events at the insertion site. The use of sutureless devices for cannula and tubing securement allowed for safe line stabilization, with no significant impact of prone positioning maneuvers on cannulae micro-motion.
JOURNAL OF VASCULAR ACCESS
(2023)
Article
Cardiac & Cardiovascular Systems
Marco Giani, Andrea Pisa, Eliseo Passera, Leonello Avalli, Roberto Rona, Giuseppe Foti
Summary: This article reports a case of a 47-year-old man with no medical history who was diagnosed with severe COVID-19 ARDS and pulmonary embolism. The patient was treated with ECMO support and successfully weaned off ECMO after clinical improvement. Tracheal stenting was performed and ECMO support was re-established to ensure the safety of the procedure. The patient made a full recovery and was discharged home in good condition.
Review
Cell Biology
Alberto Fogagnolo, Gianluca Calogero Campo, Matilde Mari, Graziella Pompei, Rita Pavasini, Carlo Alberto Volta, Savino Spadaro
Summary: In addition to their role in hemostasis, platelets also play a significant role in the immune response. Thrombocytopenia, a decrease in platelet count, is a known risk factor for mortality and disease severity. Platelets' response to infections goes beyond a simple decrease in count, involving changes in morphology, receptor expression, and aggregation.
Article
Cardiac & Cardiovascular Systems
Marco Giani, Alberto Lucchini, Gloria Magni, Silvia Villa, Roberto Rona, Roberto Fumagalli, Giuseppe Foti
Summary: This retrospective cohort study explored the role of end tidal CO2 (etCO(2)) monitoring during venovenous ECMO start. The findings suggest that etCO(2) monitoring is feasible and can help adjust gas flow and ventilator settings to minimize changes in arterial CO2 levels.
Article
Medicine, General & Internal
Enrico Bussolati, Rosario Cultrera, Alessandra Quaranta, Valentina Cricca, Elisabetta Marangoni, Riccardo La Rosa, Sara Bertacchini, Alessandra Bellonzi, Riccardo Ragazzi, Carlo Alberto Volta, Savino Spadaro, Gaetano Scaramuzzo
Summary: This study investigated the incidence, characteristics, and risk factors for ICU-associated HAIs in non-COVID-19 invasively ventilated patients during the first wave of the COVID-19 pandemic. It also evaluated the ICU antimicrobial prescription strategies. The study found that ICU admission during the pandemic did not increase the risk of ICU-associated HAIs, but there was a significant decrease in antimicrobial use.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Critical Care Medicine
Antonio Pesenti, Douglas Slobod, Sheldon Magder
INTENSIVE CARE MEDICINE
(2023)
Article
Health Care Sciences & Services
Riccardo La Rosa, Benedetta Grechi, Riccardo Ragazzi, Valentina Alvisi, Giacomo Montanari, Elisabetta Marangoni, Carlo Alberto Volta, Savino Spadaro, Gaetano Scaramuzzo
Summary: Acute kidney injury is common among critically ill COVID-19 patients undergoing prone positioning. Bedside clinical variables can be used to predict the occurrence of prone positioning-associated acute kidney injury.
Correction
Critical Care Medicine
Alberto Fogagnolo, Fabio Silvio Taccone, Jean Louis Vincent, Giulia Benetto, Elaine Cavalcante, Elisabetta Marangoni, Riccardo Ragazzi, Jacques Creteur, Carlo Alberto Volta, Savino Spadaro
Article
Critical Care Medicine
Bertrand Pavlovsky, Antonio Pesenti, Elena Spinelli, Gaetano Scaramuzzo, Ines Marongiu, Paola Tagliabue, Savino Spadaro, Giacomo Grasselli, Alain Mercat, Tommaso Mauri
Summary: Higher PEEP levels in patients with ARDS improve ventilation/perfusion mismatch by optimizing the distribution of both ventilation (in non-dependent areas) and perfusion (in middle and dependent lung). Improved ventilation/perfusion mismatch is associated with lung recruitability and changes in regional tidal volume.
Meeting Abstract
Critical Care Medicine
T. Mauri, B. Pavlovsky, E. Spinelli, G. Scaramuzzo, I. Marongiu, P. Tagliabue, S. Spadaro, G. Grasselli, A. Mercat, A. Pesenti
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2022)
Meeting Abstract
Critical Care Medicine
T. Mauri, E. Spinelli, A. Damia, I. Marongiu, A. Caccioppola, E. Garbelli, V. Figgiaconi, G. Giudici, G. Dal Santo, G. Lopez, F. Damarco, C. Lonati, O. Biancolilli, M. Battistin, L. Rosso, V. Vaira, S. Gatti, A. Pesenti
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2022)