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
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)
Review
Medicine, General & Internal
Jing Zhou, Zhimin Lin, Xiumei Deng, Baiyun Liu, Yu Zhang, Yongxin Zheng, Haichong Zheng, Yingzhi Wang, Yan Lai, Weixiang Huang, Xiaoqing Liu, Weiqun He, Yuanda Xu, Yimin Li, Yongbo Huang, Ling Sang
Summary: In mechanically ventilated patients without ARDS, higher PEEP was associated with significantly higher PaO2/FiO2 ratio and increased incidence of pneumothorax. However, no significant differences were observed among the four levels of PEEP in terms of other outcomes.
FRONTIERS IN MEDICINE
(2021)
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
Medicine, General & Internal
Chun Pan, Cong Lu, Xiaobin She, Haibo Ren, Huazhang Wei, Liang Xu, Yingzi Huang, Jia'an Xia, Yuetian Yu, Lu Chen, Bin Du, Haibo Qiu
Summary: Different PEEP strategies for COVID-19-induced ARDS patients were compared, with the ARDSnet low PEEP/FIO2 table and the best-oxygenation strategy leading to higher PEEP levels and potentially higher risk of ventilator-induced lung injury compared to the best-compliance strategy.
FRONTIERS IN MEDICINE
(2021)
Article
Medicine, General & Internal
Manuel Tisminetzky, Jose Dianti, Bruno L. Ferreyro, Federico Angriman, Lorenzo Del Sorbo, Sachin Sud, Daniel Talmor, Eddy Fan, Niall D. Ferguson, Ary Serpa Neto, Neill K. J. Adhikari, Ewan C. Goligher
Summary: This study aims to compare the effect of different PEEP selection strategies on all-cause mortality in adult patients with ARDS. Bayesian network meta-analyses will be conducted to obtain pooled estimates of potential head-to-head comparisons. The information gathered may inform clinical decision-making and help in designing future randomized trials.
SYSTEMATIC REVIEWS
(2021)
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
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
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
Critical Care Medicine
Yoann Zerbib, Alexis Lambour, Julien Maizel, Loay Kontar, Bertrand De Cagny, Thierry Soupison, Thomas Bradier, Michel Slama, Clement Brault
Summary: The study found that high recruitability patients showed a significant increase in respiratory system compliance after lung recruitment maneuvers, while low recruitability patients experienced a decrease in pulse pressure, potentially indicating a drop in cardiac output.
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)
Review
Critical Care Medicine
Jose Dianti, Manuel Tisminetzky, Bruno L. Ferreyro, Marina Englesakis, Lorenzo Del Sorbo, Sachin Sud, Daniel Talmor, Lorenzo Ball, Maureen Meade, Carol Hodgson, Jeremy R. Beitler, Sarina Sahetya, Alistair Nichol, Eddy Fan, Bram Rochwerg, Laurent Brochard, Arthur S. Slutsky, Niall D. Ferguson, Ary Serpa Neto, Neill K. J. Adhikari, Federico Angriman, Ewan C. Goligher
Summary: In patients with moderate to severe ARDS, a higher PEEP strategy without lung recruitment maneuver is associated with a lower risk of death compared to a lower PEEP strategy. However, a higher PEEP strategy with prolonged lung recruitment maneuver is associated with increased risk of death when compared with a higher PEEP without lung recruitment maneuver.
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
(2022)
Article
Medicine, General & Internal
Michela Di Pierro, Marco Giani, Alfio Bronco, Francesca Maria Lembo, Roberto Rona, Giacomo Bellani, Giuseppe Foti
Summary: This study aimed to retrospectively describe the results of EIT assessments in patients with COVID-19-associated ARDS and ARDS from other etiologies undergoing V-V ECMO support. The study found that EIT is feasible for adjusting PEEP settings and that there are similarities in respiratory characteristics between C-ARDS and NC-ARDS, but C-ARDS patients have a lower risk of overdistension at higher PEEP levels.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Critical Care Medicine
Saida Rezaiguia-Delclaux, Leo Ren, Aurelie Gruner, Calypso Roman, Thibaut Genty, Francois Stephan
Summary: The aim of this study is to compare the effects of driving pressure and PaO2/FiO2 ratio in determining the best PEEP level. The results show that the best PEEP level varies depending on the method chosen, but it is unclear which method is superior in terms of patient outcomes.
Article
Critical Care Medicine
Tommaso Pettenuzzo, Annalisa Boscolo, Alessandro De Cassai, Nicolo Sella, Francesco Zarantonello, Paolo Persona, Laura Pasin, Giovanni Landoni, Paolo Navalesi
Summary: The study found that for ICU patients not suffering from ARDS, the use of higher positive end-expiratory pressure (PEEP) was not significantly associated with hospital mortality compared to lower PEEP. However, it was associated with improved oxygenation, higher respiratory system compliance, and reduced risk of hypoxemia and ARDS.
Article
Critical Care Medicine
D. Chiumello, S. Coppola, P. Formenti, A. Ciabattoni, M. Lucenteforte, G. Liu, W. Mao, T. Pozzi
Summary: The repeatability and accuracy of measured mechanical power at different PEEP values and tidal volume were investigated, and it was found that the mechanical power measured by the new automatic real-time system within a mechanical ventilator was similar and accurate compared to calculated results.
JOURNAL OF CRITICAL CARE
(2022)
Article
Critical Care Medicine
P. Formenti, M. Umbrello, V Castagna, S. Cenci, F. Bichi, T. Pozzi, M. Bonifazi, S. Coppola, D. Chiumello
Summary: This study investigated the ultrasound characteristics of respiratory and peripheral muscles in COVID19 patients requiring mechanical ventilation in the ICU, finding significant differences in echogenicity between survivors and non-survivors. The findings suggest that proactive early therapies aimed at preserving muscle architecture may reduce days on mechanical ventilation.
JOURNAL OF CRITICAL CARE
(2022)
Article
Integrative & Complementary Medicine
Paolo Formenti, Andrea Galimberti, Riccardo Pinciroli, Michele Umbrello
Summary: This study assessed the effect of acupuncture on diaphragm function in healthy volunteers. The results showed that acupuncture significantly improved inspiratory thickening fraction during breaths at vital capacity compared to no or sham acupuncture.
EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE
(2022)
Article
Critical Care Medicine
Formenti Paolo, Silvia Coppola, Michele Umbrello, Sara Froio, Alessio Cacioppola, Valentina De Giorgis, Valentina Galanti, Andrea Clarissa Lusardi, Erica Ferrari, Donatella Noe, Carnier Simone, Franco Folli, Chiumello Davide
Summary: The study found significant changes in body composition in ICU patients during the first week of admission. BIVA may be useful in determining hydration status, but does not seem to track muscle mass. Different temporal trends of specific BIVA and muscle ultrasound parameters were observed in patients with high or low severity of illness.
JOURNAL OF CRITICAL CARE
(2022)
Article
Public, Environmental & Occupational Health
Lara Carelli, Stefano Terzoni, Anne Destrebecq, Paolo Formenti, Fatime Soumahoro, Anna Esposito, Paolo Ferrara
Summary: This study assessed the psychometric properties of the Italian version of the Alarm Fatigue Questionnaire and explored the phenomenon of alarm fatigue among nurses working in intensive care settings. The results showed that the questionnaire has good internal consistency and construct validity.
WORK-A JOURNAL OF PREVENTION ASSESSMENT & REHABILITATION
(2022)
Article
Public, Environmental & Occupational Health
Paolo Ferrara, Anne Destrebecq, Mauro Parozzi, Paolo Formenti, Stefano Terzoni
Summary: This study found that a specific communication educational course and a clinical internship experience have a positive impact on nursing students' attitudes towards effective communication. Educational intervention and clinical training can improve students' positive attitudes and reduce negative attitudes.
KONTAKT-JOURNAL OF NURSING AND SOCIAL SCIENCES RELATED TO HEALTH AND ILLNESS
(2022)
Article
Public, Environmental & Occupational Health
Paolo Ferrara, Stefano Terzoni, Anne Destrebecq, Federico Ruta, Elena Sala, Paolo Formenti, Michele Maugeri
Summary: This survey study found that nursing students are commonly subjected to physical and non-physical violence during their clinical experiences, which influences their perception of risk.
WORK-A JOURNAL OF PREVENTION ASSESSMENT & REHABILITATION
(2022)
Article
Medicine, General & Internal
Paolo Formenti, Silvia Coppola, Laura Massironi, Giacomo Annibali, Francesco Mazza, Lisa Gilardi, Tommaso Pozzi, Davide Chiumello
Summary: This study aimed to evaluate the presence of diastolic dysfunction in mechanically ventilated ARDS patients and found those with diastolic dysfunction had higher lung edema and worse outcomes, but the impact on oxygenation and respiratory mechanics was not significant.
JOURNAL OF CLINICAL MEDICINE
(2022)
Review
Integrative & Complementary Medicine
Paolo Formenti, Gabriele Piuri, Roberto Bisatti, Riccardo Pinciroli, Michele Umbrello
Summary: Acupuncture, a part of Traditional Chinese Medicine for 2000 years, aims to balance the energy flow in the body. It has been shown effective for the management of critical illness. However, the integration of acupuncture into Western medicine is infrequent in Europe and the United States.
JOURNAL OF TRADITIONAL AND COMPLEMENTARY MEDICINE
(2023)
Article
Environmental Sciences
G. Foret, V Michoud, S. Kotthaus, J-E Petit, A. Baudic, G. Siour, Y. Kim, J-F Doussin, J-C Dupont, P. Formenti, C. Gaimoz, V Ghersi, A. Gratien, V Gros, J-L Jaffrezo, M. Haeffelin, M. Kreitz, F. Ravetta, K. Sartelet, L. Simon, Y. Te, G. Uzu, S. Zhang, O. Favez, M. Beekmann
ATMOSPHERIC ENVIRONMENT
(2022)
Letter
Critical Care Medicine
P. Formenti, M. Umbrello, V. Castagna, S. Cenci, F. Bichi, T. Pozzi, M. Bonifazi, S. Coppola, D. Chiumello
JOURNAL OF CRITICAL CARE
(2022)
Review
Medicine, General & Internal
Michele Umbrello, John J. J. Marini, Paolo Formenti
Summary: Nutritional support for ARDS patients is important due to the specific metabolic alterations caused by the body's response to illness and the limitations in oxygen supply. This narrative review focuses on the characteristics of metabolic and artificial nutrition in patients with acute respiratory failure, including substrate metabolism, energy consumption, and the effects of macronutrients on lung tissue viability. It also provides suggestions for the ideal methods of metabolic support for critically ill patients with ARDS.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Medicine, General & Internal
Elena Maria Alessandra Mantovani, Paolo Formenti, Stefano Pastori, Vincenzo Roccaforte, Miriam Gotti, Rossella Panella, Andrea Galimberti, Roberto Costagliola, Francesco Vetrone, Michele Umbrello, Angelo Pezzi, Giovanni Sabbatini
Summary: The diagnosis of sepsis is difficult and delayed, leading to high mortality rates. The study evaluated the role of Neutrophil-Reactive Intensity (NEUT-RI) in the diagnosis of sepsis. NEUT-RI can be used as an early indicator to rule out sepsis and is not influenced by renal function.
Article
Medicine, General & Internal
Paolo Formenti, Sara Miori, Andrea Galimberti, Michele Umbrello
Summary: This study aimed to assess the impact of different levels of positive end-expiratory pressure (PEEP) and lung inflation on diaphragm thickness, thickening fraction, and displacement. It found that higher levels of PEEP resulted in lower tidal volume, diaphragm displacement, and thickening fraction, while increasing both expiratory and inspiratory thickness. The study also showed that there was a correlation between diaphragm thickness and thickening fraction with inspiratory effort, which was stronger at lower levels of PEEP.
Article
Critical Care Medicine
Mark E. Haaksma, Jasper M. Smit, Alain Boussuges, Alexandre Demoule, Martin Dres, Giovanni Ferrari, Paolo Formenti, Ewan C. Goligher, Leo Heunks, Endry H. T. Lim, Lidwine B. Mokkink, Eleni Soilemezi, Zhonghua Shi, Michele Umbrello, Luigi Vetrugno, Emmanuel Vivier, Lei Xu, Massimo Zambon, Pieter R. Tuinman
Summary: This study provides a consensus-based statement on the methodology of diaphragm ultrasonography through expert consensus, aiming to ensure high-quality and homogeneous measurements in daily clinical practice and research. Additionally, important gaps in current knowledge and key areas for research are identified.