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Papers by Alfredo Lissoni

Research paper thumbnail of ECMO in non intubated patients as a bridge to LTx: our experience

Background / Purpose: Extracorporeal membrane oxygenation (ECMO) has now been used by an expandin... more Background / Purpose: Extracorporeal membrane oxygenation (ECMO) has now been used by an expanding number of centres for bridging to heart and lung transplantation (LTx) in patients with advanced respiratory failure (1). In order to avoid the drawbacks and complications associated with prolonged mechanical ventilation, we hypothesized that the use of Venou-Venous ECMO (VV-ECMO) in awake and spontaneously breathing patients might be an option for respiratory support when severe deterioration occurs while waiting for lung transplantation. Main conclusion: Our experience shows that bridging to lung transplant with VV-ECMO in awake and spontaneously breathing patients is not only feasible, but is also successful. Survival to bridging LTx in our centre was 100%, while survival after bridging LTx is comparable to that of patients who were not on ECMO support.

Research paper thumbnail of Response

Research paper thumbnail of ECMO as a Bridge to Lung Transplant

ECMO-Extracorporeal Life Support in Adults, 2014

Research paper thumbnail of Simulation-Based Training of Extracorporeal Membrane Oxygenation During H1N1 Influenza Pandemic

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2012

On November 2009, the Italian health authorities set up a network of selected intensive care unit... more On November 2009, the Italian health authorities set up a network of selected intensive care unit (ICU) centers (ECMOnet) to prepare for the treatment of the sickest patients of influenza A (H1N1) by means of extracorporeal membrane oxygenation (ECMO).

Research paper thumbnail of Organ Allocation Waiting Time During Extracorporeal Bridge to Lung Transplant Affects Outcomes

CHEST Journal, 2013

The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTX) is sti... more The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTX) is still being debated. We performed a retrospective two-center analysis of the relationship between ECMO bridging duration and survival in 25 patients. Further survival analysis was obtained by dividing the patients according to waiting time on ECMO: up to 14 days (Early group) or longer (Late group). We also analyzed the impact of the ventilation strategy during ECMO bridging (ie, spontaneous breathing and noninvasive ventilation [NIV] or intubation and invasive mechanical ventilation [IMV]). Seventeen of 25 patients underwent a transplant (with a 76% 1-year survival), whereas eight patients died during bridging. In the 17 patients who underwent a transplant, mortality was positively related to waiting days until LTX (hazard ratio [HR], 1.12 per day; 95% CI, 1.02-1.23; P = .02), and the Early group showed better Kaplan-Meier curves (P = .02), higher 1-year survival rates (100% vs 50%, P = .03), and lower morbidity (days on IMV and length of stay in ICU and hospital). During the bridge to transplant, mortality increased steadily with time. Considering the overall outcome of the bridging program (25 patients), bridge duration adversely affected survival (HR, 1.06 per day; 95% CI, 1.01-1.11; P = .015) and 1-year survival (Early, 82% vs Late, 29%; P = .015). Morbidity indexes were lower in patients treated with NIV during the bridge. The duration of the ECMO bridge is a relevant cofactor in the mortality and morbidity of critically ill patients awaiting organ allocation. The NIV strategy was associated with a less complicated clinical course after LTX.

Research paper thumbnail of The Effects of Body Mass on Lung Volumes, Respiratory Mechanics, and Gas Exchange During General Anesthesia

Anesthesia & Analgesia, 1998

We investigated the effects of body mass index (BMI) on functional residual capacity (FRC), respi... more We investigated the effects of body mass index (BMI) on functional residual capacity (FRC), respiratory mechanics (compliance and resistance), gas exchange, and the inspiratory mechanical work done per liter of ventilation during general anesthesia. We used the esophageal balloon technique, together with rapid airway occlusion during constant inspiratory flow, to partition the mechanics of the respiratory system into its pulmonary and chest wall components.

Research paper thumbnail of Acute Respiratory Distress Syndrome Caused by Pulmonary and Extrapulmonary Disease

American Journal of Respiratory and Critical Care Medicine, 1998

Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather ... more Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather uncommon phenomenon. In most of the previously reported cases of MTD-related ARDS, MTD was ingested orally in the form of tablets in high or unknown amounts. Despite the fi ndings from the available literature, this case report is aimed at demonstrating that even small amounts of MTD syrup can cause ARDS earlier than it is usually expected. We present a non-addicted MTD-overdosed patient who developed ARDS after ingesting a very small amount of MTD syrup. We suggest close monitoring of MTD-overdosed patients from at least 48 h to 72 h for possible respiratory complications such as pulmonary oedema.

Research paper thumbnail of Simulation in Healthcare

journals.lww.com

The editors of this journal are pleased to offer electronic publication of accepted papers prior ... more The editors of this journal are pleased to offer electronic publication of accepted papers prior to print publication. These papers can be cited using the date of access and the unique DOI number. Any final changes in manuscripts will be made at the time of print publication and will be reflected in the final electronic version of the issue.

Research paper thumbnail of Sigh in Acute Respiratory Distress Syndrome

American Journal of Respiratory and Critical Care Medicine, 1999

Mechanical ventilation with plateau pressure lower than 35 cm H2O and high positive end-expirator... more Mechanical ventilation with plateau pressure lower than 35 cm H2O and high positive end-expiratory pressure (PEEP) has been recommended as lung protective strategy. Ten patients with ARDS (five from pulmonary [p] and five from extrapulmonary [exp] origin), underwent 2 h of lung protective strategy, 1 h of lung protective strategy with three consecutive sighs/min at 45 cm H2O plateau pressure, and 1 h of lung protective strategy. Total minute ventilation, PEEP (14.0 +/- 2.2 cm H2O), inspiratory oxygen fraction, and mean airway pressure were kept constant. After 1 h of sigh we found that: (1) PaO2 increased (from 92.8 +/- 18.6 to 137.6 +/- 23.9 mm Hg, p < 0.01), venous admixture and PaCO2 decreased (from 38 +/- 12 to 28 +/- 14%, p < 0.01; and from 52.7 +/- 19.4 to 49.1 +/- 18.4 mm Hg, p < 0.05, respectively); (2) end-expiratory lung volume increased (from 1.49 +/- 0.58 to 1.91 +/- 0.67 L, p < 0.01), and was significantly correlated with the oxygenation (r = 0.82, p < 0.01) and lung elastance (r = 0.76, p < 0.01) improvement. Sigh was more effective in ARDSexp than in ARDSp. After 1 h of sigh interruption, all the physiologic variables returned to baseline. The derecruitment was correlated with PaCO2 (r = 0.86, p < 0.01). We conclude that: (1) lung protective strategy alone at the PEEP level used in this study may not provide full lung recruitment and best oxygenation; (2) application of sigh during lung protective strategy may improve recruitment and oxygenation.

Research paper thumbnail of ECMO in non intubated patients as a bridge to LTx: our experience

Background / Purpose: Extracorporeal membrane oxygenation (ECMO) has now been used by an expandin... more Background / Purpose: Extracorporeal membrane oxygenation (ECMO) has now been used by an expanding number of centres for bridging to heart and lung transplantation (LTx) in patients with advanced respiratory failure (1). In order to avoid the drawbacks and complications associated with prolonged mechanical ventilation, we hypothesized that the use of Venou-Venous ECMO (VV-ECMO) in awake and spontaneously breathing patients might be an option for respiratory support when severe deterioration occurs while waiting for lung transplantation. Main conclusion: Our experience shows that bridging to lung transplant with VV-ECMO in awake and spontaneously breathing patients is not only feasible, but is also successful. Survival to bridging LTx in our centre was 100%, while survival after bridging LTx is comparable to that of patients who were not on ECMO support.

Research paper thumbnail of Response

Research paper thumbnail of ECMO as a Bridge to Lung Transplant

ECMO-Extracorporeal Life Support in Adults, 2014

Research paper thumbnail of Simulation-Based Training of Extracorporeal Membrane Oxygenation During H1N1 Influenza Pandemic

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2012

On November 2009, the Italian health authorities set up a network of selected intensive care unit... more On November 2009, the Italian health authorities set up a network of selected intensive care unit (ICU) centers (ECMOnet) to prepare for the treatment of the sickest patients of influenza A (H1N1) by means of extracorporeal membrane oxygenation (ECMO).

Research paper thumbnail of Organ Allocation Waiting Time During Extracorporeal Bridge to Lung Transplant Affects Outcomes

CHEST Journal, 2013

The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTX) is sti... more The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTX) is still being debated. We performed a retrospective two-center analysis of the relationship between ECMO bridging duration and survival in 25 patients. Further survival analysis was obtained by dividing the patients according to waiting time on ECMO: up to 14 days (Early group) or longer (Late group). We also analyzed the impact of the ventilation strategy during ECMO bridging (ie, spontaneous breathing and noninvasive ventilation [NIV] or intubation and invasive mechanical ventilation [IMV]). Seventeen of 25 patients underwent a transplant (with a 76% 1-year survival), whereas eight patients died during bridging. In the 17 patients who underwent a transplant, mortality was positively related to waiting days until LTX (hazard ratio [HR], 1.12 per day; 95% CI, 1.02-1.23; P = .02), and the Early group showed better Kaplan-Meier curves (P = .02), higher 1-year survival rates (100% vs 50%, P = .03), and lower morbidity (days on IMV and length of stay in ICU and hospital). During the bridge to transplant, mortality increased steadily with time. Considering the overall outcome of the bridging program (25 patients), bridge duration adversely affected survival (HR, 1.06 per day; 95% CI, 1.01-1.11; P = .015) and 1-year survival (Early, 82% vs Late, 29%; P = .015). Morbidity indexes were lower in patients treated with NIV during the bridge. The duration of the ECMO bridge is a relevant cofactor in the mortality and morbidity of critically ill patients awaiting organ allocation. The NIV strategy was associated with a less complicated clinical course after LTX.

Research paper thumbnail of The Effects of Body Mass on Lung Volumes, Respiratory Mechanics, and Gas Exchange During General Anesthesia

Anesthesia & Analgesia, 1998

We investigated the effects of body mass index (BMI) on functional residual capacity (FRC), respi... more We investigated the effects of body mass index (BMI) on functional residual capacity (FRC), respiratory mechanics (compliance and resistance), gas exchange, and the inspiratory mechanical work done per liter of ventilation during general anesthesia. We used the esophageal balloon technique, together with rapid airway occlusion during constant inspiratory flow, to partition the mechanics of the respiratory system into its pulmonary and chest wall components.

Research paper thumbnail of Acute Respiratory Distress Syndrome Caused by Pulmonary and Extrapulmonary Disease

American Journal of Respiratory and Critical Care Medicine, 1998

Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather ... more Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather uncommon phenomenon. In most of the previously reported cases of MTD-related ARDS, MTD was ingested orally in the form of tablets in high or unknown amounts. Despite the fi ndings from the available literature, this case report is aimed at demonstrating that even small amounts of MTD syrup can cause ARDS earlier than it is usually expected. We present a non-addicted MTD-overdosed patient who developed ARDS after ingesting a very small amount of MTD syrup. We suggest close monitoring of MTD-overdosed patients from at least 48 h to 72 h for possible respiratory complications such as pulmonary oedema.

Research paper thumbnail of Simulation in Healthcare

journals.lww.com

The editors of this journal are pleased to offer electronic publication of accepted papers prior ... more The editors of this journal are pleased to offer electronic publication of accepted papers prior to print publication. These papers can be cited using the date of access and the unique DOI number. Any final changes in manuscripts will be made at the time of print publication and will be reflected in the final electronic version of the issue.

Research paper thumbnail of Sigh in Acute Respiratory Distress Syndrome

American Journal of Respiratory and Critical Care Medicine, 1999

Mechanical ventilation with plateau pressure lower than 35 cm H2O and high positive end-expirator... more Mechanical ventilation with plateau pressure lower than 35 cm H2O and high positive end-expiratory pressure (PEEP) has been recommended as lung protective strategy. Ten patients with ARDS (five from pulmonary [p] and five from extrapulmonary [exp] origin), underwent 2 h of lung protective strategy, 1 h of lung protective strategy with three consecutive sighs/min at 45 cm H2O plateau pressure, and 1 h of lung protective strategy. Total minute ventilation, PEEP (14.0 +/- 2.2 cm H2O), inspiratory oxygen fraction, and mean airway pressure were kept constant. After 1 h of sigh we found that: (1) PaO2 increased (from 92.8 +/- 18.6 to 137.6 +/- 23.9 mm Hg, p < 0.01), venous admixture and PaCO2 decreased (from 38 +/- 12 to 28 +/- 14%, p < 0.01; and from 52.7 +/- 19.4 to 49.1 +/- 18.4 mm Hg, p < 0.05, respectively); (2) end-expiratory lung volume increased (from 1.49 +/- 0.58 to 1.91 +/- 0.67 L, p < 0.01), and was significantly correlated with the oxygenation (r = 0.82, p < 0.01) and lung elastance (r = 0.76, p < 0.01) improvement. Sigh was more effective in ARDSexp than in ARDSp. After 1 h of sigh interruption, all the physiologic variables returned to baseline. The derecruitment was correlated with PaCO2 (r = 0.86, p < 0.01). We conclude that: (1) lung protective strategy alone at the PEEP level used in this study may not provide full lung recruitment and best oxygenation; (2) application of sigh during lung protective strategy may improve recruitment and oxygenation.