Alfredo Lissoni - Profile on Academia.edu (original) (raw)

Papers by Alfredo Lissoni

Critical Care

Background Optimal noninvasive respiratory support for patients with hypoxemic respiratory failur... more Background Optimal noninvasive respiratory support for patients with hypoxemic respiratory failure should minimize work of breathing without increasing the transpulmonary pressure. Recently, an asymmetrical high flow nasal cannula (HFNC) interface (Duet, Fisher & Paykel Healthcare Ltd), in which the caliber of each nasal prong is different, was approved for clinical use. This system might reduce work of breathing by lowering minute ventilation and improving respiratory mechanics. Methods We enrolled 10 patients ≥ 18 years of age who were admitted to the Ospedale Maggiore Policlinico ICU in Milan, Italy, and had a PaO2/FiO2 < 300 mmHg during HFNC support with a conventional cannula. We investigated whether the asymmetrical interface, compared to a conventional high flow nasal cannula, reduces minute ventilation and work of breathing. Each patient underwent support with the asymmetrical interface and the conventional interface, applied in a randomized sequence. Each interface was p...

Redistribution of Perfusion by Prone Positioning Improves Shunt in a Patient with Unilateral Lung Injury

American Journal of Respiratory and Critical Care Medicine

Journal of Clinical Medicine

During the first outbreak of COVID-19 in Italy, based on the only few cases reported from a Chine... more During the first outbreak of COVID-19 in Italy, based on the only few cases reported from a Chinese centre at the time, we performed lung transplantation in two patients with irreversible acute respiratory distress syndrome (ARDS) after COVID-19 at our centre. After two years, we report the outcomes of these cases and some considerations. The first patient, an 18-year-old male, is in excellent conditions twenty-four months after surgery. The second patient was a 48-year-old man; his airways were colonized by carbapenemase-producing klebsiella pneumoniae at the time of lung transplantation, and he had previously suffered from delirium and hallucinations in the intensive care unit. His postoperative clinical course was complicated by dysexecutive behaviour and then septic shock; he died 62 days after surgery. The recently reported experience of different transplantation centres has led to the inclusion of irreversible acute respiratory distress syndrome (ARDS) after COVID-19 among the...

Journal of Nephrology

Introduction The clinical trajectory of post-operative acute kidney injury (AKI) following lung t... more Introduction The clinical trajectory of post-operative acute kidney injury (AKI) following lung transplantation for cystic fibrosis is unknown. Methods Incidence and risk factors for post-operative AKI, acute kidney disease (AKD) and chronic kidney disease (CKD) were retrospectively analyzed in cystic fibrosis patients undergoing lung transplantation. Logistic regressions, Chi-square, Cuzick rank tests, and Cox-proportional hazard models were used. Results Eighty-three patients were included. Creatinine peaked 3[2–4] days after transplantation, with 15(18%), 15(18%), and 20(24%) patients having post-operative AKI stages 1, 2, and 3, while 15(18%), 19(23%) and 10(12%) developed AKD stage 1, stage 2 and 3, respectively. Higher AKI stage was associated with worsening AKD (p = 0.009) and CKD (p = 0.015) stages. Of the 50 patients with AKI, 32(66%) transitioned to AKD stage > 0, and then 27 (56%) to CKD stage > 1. Female sex, extracorporeal membrane oxygenation support as a bridge ...

Supporto respiratorio extracorporeo con by-pass veno-venoso come ponte al trapianto di polmone. Nostra iniziale esperienza

Supporto ventilatorio extracorporeo con by pass veno-venoso come ponte al trapianto di polmone

Heparin-Free Lung Transplantation on Venovenous Extracorporeal Membrane Oxygenation Bridge

ASAIO Journal, 2021

Extracorporeal membrane oxygenation (ECMO) bridge to lung transplantation (LuTX) exposes the pati... more Extracorporeal membrane oxygenation (ECMO) bridge to lung transplantation (LuTX) exposes the patients to a high risk of perioperative bleeding secondary to systemic anticoagulation and coagulation factors deficiency. With this case series, we propose innovative “no-heparin” management of ECMO-bridge support during LuTX, based upon 1) control heparin resistance with antithrombin III in the preoperative period; 2) relying upon a fully functional, brand new heparinized ECMO circuit; 3) completely avoiding perioperative heparin; 4) hampering fibrinolysis with tranexamic acid; and 5) limiting venoarterial (VA) ECMO escalation, and the following need for full anticoagulation. Following the application of this new approach, we carried out three challenging clinical cases of bilateral ECMO-bridged LuTX effectively, with limited intraoperative blood requirement and no major postoperative bleeding or thromboembolic events. Of note, two of them had an extremely high risk for hemorrhage due to ...

Annals of the American Thoracic Society, 2021

Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress... more Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress syndrome (ARDS). To date, no evidence supports the use of prone positioning (PP) during venovenous extracorporeal oxygenation (ECMO). The aim of the study was to assess the feasibility, safety, and effect on oxygenation and lung mechanics of PP during ECMO. As a secondary exploratory aim, we assessed the association between PP and hospital mortality. Methods: We performed a multicenter retrospective cohort study in six Italian ECMO centers, including patients managed with PP during ECMO support (prone group; four centers) and patients managed in the supine position (control group; two centers). Physiological variables were analyzed at four time points (supine before PP, start of PP, end of PP, and supine after PP). The association between PP and hospital mortality was assessed by multivariate analysis and propensity score-matching. Results: A total of 240 patients were included, with 107 in the prone group and 133 in the supine group. The median duration of the 326 pronation cycles was 15 (12-18) hours. Minor reversible complications were reported in 6% of PP maneuvers. PP improved oxygenation and reduced intrapulmonary shunt. Unadjusted hospital mortality was lower in the prone group (34 vs. 50%; P = 0.017). After adjusting for covariates, PP remained significantly associated with a reduction of hospital mortality (odds ratio, 0.50; 95% confidence interval, 0.29-0.87). Sixty-six propensity scorematched patients were identified in each group. In this matched sample, patients who underwent pronation had higher ECMO duration (16 vs. 10 d; P = 0.0344) but lower hospital mortality (30% vs. 53%; P = 0.0241). Conclusions: PP during ECMO improved oxygenation and was associated with a reduction of hospital mortality.

Chest, 2021

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in Engli... more Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

British Journal of Anaesthesia, 2020

Minerva Anestesiologica, 2020

Routes to care -the itineraries of people living with HIV Resumo O adoecimento pelo HIV na atuali... more Routes to care -the itineraries of people living with HIV Resumo O adoecimento pelo HIV na atualidade apresenta-se como crônico e controlável. Assim, torna-se pertinente considerar as implicações das trajetórias individuais da busca de cuidado na vida cotidiana de seus portadores. Essas trajetórias são configuradas pelos caminhos que os usuários fazem em busca de respostas a seu adoecimento. Este estudo, de caráter qualitativo, objetivou analisar o itinerário terapêutico das pessoas convivendo com HIV/Aids. Os sujeitos da pesquisa foram homens e mulheres com o vírus HIV, assistidos em um Serviço de Assistência Especializada e no Hospital Universitário, ambos públicos localizados em um município de Minas Gerais. A abordagem dos participantes deu-se por meio de entrevista e para análise dos dados elegeu-se a técnica de análise temática. Dos caminhos singulares que desenharam essas narrativas, emergiram os itinerários dessas pessoas que convivem com o HIV. Estes abrangeram temas como as peregrinações e a forma de entrada no sistema de atendimento, as implicações do custo e acesso, a gestão do tratamento e a importância das relações de vínculo. Essas questões que nortearam a organização do trabalho permitiram inferir sobre as fragilidades e as fortalezas presentes no sistema de atendimento ao portador do HIV, ao ser considerada a vivência pessoal desses indivíduos em primeiro plano. Palavras-chave HIV,

Critical Care Medicine, 2020

Objectives: Supplementation of antithrombin might decrease the amount of heparin needed to achiev... more Objectives: Supplementation of antithrombin might decrease the amount of heparin needed to achieve a given anticoagulation target during extracorporeal membrane oxygenation. However, exogenous antithrombin itself may increase the risk of bleeding. We conceived a study to evaluate the effect of antithrombin supplementation in adult patients requiring venovenous extracorporeal membrane oxygenation for respiratory failure on heparin dose, adequacy of anticoagulation, and safety. Design: Prospective randomized controlled trial. Setting: ICUs of two Italian referral extracorporeal membrane oxygenation centers. Patients: Adult patients requiring venovenous extracorporeal membrane oxygenation for severe respiratory failure and unfractionated heparin for systemic anticoagulation. Interventions: Before extracorporeal membrane oxygenation start, patients were randomized to either receive antithrombin concentrate to maintain a plasmatic level 80–120% (treatment) or not (control) during the ext...

Respiratory Care, 2020

BACKGROUND: Switching patients affected by early severe ARDS and undergoing extracorporeal membra... more BACKGROUND: Switching patients affected by early severe ARDS and undergoing extracorporeal membrane oxygenation (ECMO) from controlled ventilation to spontaneous breathing can be either beneficial or harmful, depending on how effectively the breathing pattern is controlled with ECMO. Identifying the factors associated with ineffective control of spontaneous breathing with ECMO may advance our pathophysiologic understanding of this syndrome. METHODS: We conducted a prospective study in subjects with severe ARDS who were on ECMO support ^7 d. Subjects were switched to minimal sedation and pressure-support ventilation while extracorporeal CO 2 removal was increased to approximate the subject's total CO 2 production ( _ V CO 2 ). We calculated the rapid shallow breathing index (RSBI) as breathing frequency divided by tidal volume. We explored the correlation between certain characteristics recorded during pretest controlled ventilation and the development of apnea (ie, expiratory pause lasting > 10 s; n 5 3), normal breathing pattern (ie, apnea to RSBI ^105 breaths/min/L; n 5 6), and rapid shallow breathing (RSBI > 105 breaths/min/L; n 5 6) that occurred during the test study. RESULTS: The ratio of extracorporeal CO 2 removal to the subjects' _ V CO 2 was >90% in all 15 subjects, and arterial blood gases remained within normal ranges. Baseline pretest Sequential Organ Failure Assessment score, total _ V CO 2 and ventilatory ratio increased steadily, whereas P aO 2 /F IO 2 was higher in subjects with apnea compared to intermediate RSBI ^105 breaths/min/L and elevated RSBI >105 breaths/min/L. In subjects with rapid shallow breathing, baseline lung weight measured with quantitative computed tomography scored higher, as well. CONCLUSIONS: In early severe ARDS, the factors associated with rapid shallow breathing despite maximum extracorporeal CO 2 extraction include less efficient CO 2 and O 2 exchange by the natural lung, higher severity of organ failure, and greater magnitude of lung edema.

Respiratory Drive of ARDS Patients on ECMO Is Correlated to Dead Space and Lung Edema

B24. CRITICAL CARE: GONE WITH THE WIND - MECHANICAL VENTILATION: HFNC, NIV AND INVASIVE, 2019

Effects of Inspiratory Airflow on Lung Stress and Heterogeneity in Acute Respiratory Distress Syndrome (ARDS) Patients: A Physiological Study

A25. CRITICAL CARE: THE WIND IN THE WILLOWS - ARDS: OF SWINE AND MEN, 2019

ASAIO Journal, 2019

In patients undergoing extracorporeal membrane oxygenation (ECMO) for acute respiratory distress ... more In patients undergoing extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS), it is unknown which clinical physiologic variables should be monitored to follow the evolution of lung injury and extrapulmonary organ dysfunction and to differentiate patients according to their course. We analyzed the time-course of prospectively collected clinical physiologic variables in 83 consecutive ARDS patients undergoing ECMO at a single referral center. Selected variables—including ventilator settings, respiratory system compliance, intrapulmonary shunt, arterial blood gases, central hemodynamics, and sequential organ failure assessment (SOFA) score—were compared according to outcome at time-points corresponding to 0%, 25%, 50%, 75%, and 100% of the entire ECMO duration and daily during the first 7 days. A logistic regression analysis was performed to identify changes between ECMO start and end that independently predicted hospital mortality. Tidal volume, int...

Journal of Applied Physiology, 1997

Pelosi, P., M. Croci, I. Ravagnan, M. Cerisara, P. Vicardi, A. Lissoni, and L. Gattinoni. Respira... more Pelosi, P., M. Croci, I. Ravagnan, M. Cerisara, P. Vicardi, A. Lissoni, and L. Gattinoni. Respiratory system mechanics in sedated, paralyzed, morbidly obese patients J. Appl. Physiol. 82(3): 811–818, 1997.—The effects of inspiratory flow and inflation volume on the mechanical properties of the respiratory system in eight sedated and paralyzed postoperative morbidly obese patients (aged 37.6 ± 11.8 yr who had never smoked and had normal preoperative seated spirometry) were investigated by using the technique of rapid airway occlusion during constant-flow inflation. With the patients in the supine position, we measured the interrupter resistance (Rint,rs), which in humans probably reflects airway resistance, the “additional” resistance (ΔRrs) due to viscoelastic pressure dissipation and time-constant inequalities, and static respiratory elastance (Est,rs). Intra-abdominal pressure (IAP) was measured by using a bladder catheter, and functional residual capacity was measured by the heli...

Delayed emesis induced by moderately emetogenic chemotherapy: Do we need to treat all patients?

Annals of Oncology, 1997

The pattern and prognostic factors of delayed nausea and vomiting induced by moderately emetogeni... more The pattern and prognostic factors of delayed nausea and vomiting induced by moderately emetogenic chemotherapy have not yet been adequately studied. Data are derived from a large and well defined population of patients studied to evaluate the efficacy and tolerability of granisetron, dexamethasone and their combination in the control of acute emesis over repeated cycles of moderately emetogenic chemotherapy. Patients were monitored on days 2-5 without receiving any prophylactic treatment for delayed emesis. There were 395 evaluable patients at the first, 352 at the second and 319 at the third cycle of chemotherapy. Overall, 32.7% patients suffered symptoms of delayed vomiting and/or moderate-severe nausea at the first, 32.1% at the second and 35.1% at the third cycle of chemotherapy. More precisely, the incidence of delayed vomiting was 21.3% at the first, 18.5% at the second and 21.0% at the third cycle of chemotherapy, while the incidence of delayed moderate-severe nausea was 25.1%, 25.0% and 26.0%, respectively. The incidence of delayed vomiting and moderate-severe nausea was very low in patients who obtained good control of acute vomiting and moderate-severe nausea, but it remained substantial in patients who experienced them during the first 24 hours after chemotherapy. In fact, at first/second/third cycle of chemotherapy delayed vomiting occurred in 12.3%/11.8%/ 13.1% of patients who did not suffer from acute vomiting and in 54.1%/48.4%/55.9% of those who had acute vomiting, respectively, Similar data were obtained for delayed moderate-severe nausea. Patients without acute vomiting or moderate-severe acute nausea may not need any antiemetic prophylaxis for delayed vomiting or nausea, while those with a history of acute vomiting or moderate-severe acute nausea should always be treated for delayed emesis. Selection bias and dependence effect of delayed emesis on acute emesis can cause misinterpretation of data derived from clinical trials in patients submitted to multiple cycles of chemotherapy.

Intensive care medicine, Jan 31, 2017

Limited data exist on the correlation between higher flow rates of high-flow nasal cannula (HFNC)... more Limited data exist on the correlation between higher flow rates of high-flow nasal cannula (HFNC) and its physiologic effects in patients with acute hypoxemic respiratory failure (AHRF). We assessed the effects of HFNC delivered at increasing flow rate on inspiratory effort, work of breathing, minute ventilation, lung volumes, dynamic compliance and oxygenation in AHRF patients. A prospective randomized cross-over study was performed in non-intubated patients with patients AHRF and a PaO2/FiO2 (arterial partial pressure of oxygen/fraction of inspired oxygen) ratio of ≤300 mmHg. A standard non-occlusive facial mask and HFNC at different flow rates (30, 45 and 60 l/min) were randomly applied, while maintaining constant FiO2 (20 min/step). At the end of each phase, we measured arterial blood gases, inspiratory effort, based on swings in esophageal pressure (ΔPes) and on the esophageal pressure-time product (PTPPes), and lung volume, by electrical impedance tomography. Seventeen patient...

Anesthesiology, 2017

Background We evaluate the clinical feasibility of spontaneous breathing on extracorporeal membra... more Background We evaluate the clinical feasibility of spontaneous breathing on extracorporeal membrane oxygenation and the interactions between artificial and native lungs in patients bridged to lung transplant or with acute exacerbation of chronic obstructive pulmonary disease (COPD) or acute respiratory distress syndrome. Methods The clinical course of a total of 48 patients was analyzed. Twenty-three of 48 patients were enrolled in the prospective study (nine bridged to lung transplant, six COPD, and eight acute respiratory distress syndrome). The response to the carbon dioxide removal was evaluated in terms of respiratory rate and esophageal pressure swings by increasing (“relief” threshold) and decreasing (“distress” threshold) the extracorporeal membrane oxygenation gas flow, starting from baseline condition. Results Considering all 48 patients, spontaneous breathing extracorporeal membrane oxygenation was performed in 100% bridge to lung transplant (9 of 9 extubated), 86% COPD (...