Antonio Pesenti - Academia.edu (original) (raw)

Papers by Antonio Pesenti

Research paper thumbnail of Low-Frequency Positive Pressure Ventilation with Extracorporeal Carbon Dioxide Removal (LFPPV-ECCO2R)

Anesthesia & Analgesia, 1978

Research paper thumbnail of Do spontaneous and mechanical breathing have similar effects on average transpulmonary and alveolar pressure? A clinical crossover study

Critical care (London, England), 2016

Preservation of spontaneous breathing (SB) is sometimes debated because it has potentially both n... more Preservation of spontaneous breathing (SB) is sometimes debated because it has potentially both negative and positive effects on lung injury in comparison with fully controlled mechanical ventilation (CMV). We wanted (1) to verify in mechanically ventilated patients if the change in transpulmonary pressure was similar between pressure support ventilation (PSV) and CMV for a similar tidal volume, (2) to estimate the influence of SB on alveolar pressure (Palv), and (3) to determine whether a reliable plateau pressure could be measured during pressure support ventilation (PSV). We studied ten patients equipped with esophageal catheters undergoing three levels of PSV followed by a phase of CMV. For each condition, we calculated the maximal and mean transpulmonary (ΔPL) swings and Palv. Overall, ΔPL was similar between CMV and PSV, but only loosely correlated. The differences in ΔPL between CMV and PSV were explained largely by different inspiratory flows, indicating that the resistive p...

Research paper thumbnail of Receptor for advanced glycation end products is associated with systemic and organ-specific severity of acute lung injury and acute respiratory distress syndrome

Research paper thumbnail of ECMO for Ischemic Cardiogenic Shock

Research paper thumbnail of Persisting high levels of plasma pentraxin 3 over the first days after severe sepsis and septic shock onset are associated with mortality

European Journal of Intensive Care Medicine, Jan 30, 2010

Persisting high levels of plasma pentraxin 3 over the first days after severe sepsis and septic s... more Persisting high levels of plasma pentraxin 3 over the first days after severe sepsis and septic shock onset are associated with mortality

Research paper thumbnail of Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives

Intensive Care Medicine, 2016

Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the... more Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning. Moreover, Pes monitoring permits accurate measurement of transmural vascular pressure and intrinsic positive end-expiratory pressure and facilitates detection of patient-ventilator asynchrony, thereby supporting specific diagnoses and interventions. Finally, some Pes-derived measures may also be obtained by monitoring electrical activity of the diaphragm. Pes monitoring provides unique bedside measures for a better understanding of the pathophysiology of acute respiratory failure patients. Including Pes monitoring in the intensivist's clinical armamentarium may enhance treatment to improve clinical outcomes.

Research paper thumbnail of Control of fever by continuous, low-dose diclofenac sodium infusion in acute cerebral damage patients

Intensive Care Medicine, May 1, 2000

Research paper thumbnail of “Awake” extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering

Critical Care, 2016

Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescu... more Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescue therapy for patients with respiratory failure not treatable with conventional mechanical ventilation alone. In recent years, however, the timing of ECMO initiation has been readdressed and ECMO is often started earlier in the time course of respiratory failure. Furthermore, some centers are starting to use ECMO as a first line of treatment, i.e., as an alternative to invasive mechanical ventilation in awake, non-intubated, spontaneously breathing patients with respiratory failure ("awake" ECMO). There is a strong rationale for this type of respiratory support as it avoids several side effects related to sedation, intubation, and mechanical ventilation. However, the complexity of the patient-ECMO interactions, the difficulties related to respiratory monitoring, and the management of an awake patient on extracorporeal support together pose a major challenge for the intensive care unit staff. Here, we review the use of vv-ECMO in awake, spontaneously breathing patients with respiratory failure, highlighting the pros and cons of this approach, analyzing the pathophysiology of patient-ECMO interactions, detailing some of the technical aspects, and summarizing the initial clinical experience gained over the past years.

Research paper thumbnail of Application of guidelines for severe head trauma: data from an Italian database

European Journal of Emergency Medicine, Apr 1, 2003

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for European Journal ... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for European Journal of Emergency Medicine. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information ...

Research paper thumbnail of The Ratio of Inspiratory Pressure Over Electrical Activity of the Diaphragm Remains Stable During ICU Stay and Is Not Related to Clinical Outcome

Respiratory Care, 2016

We previously described an index, defined as the ratio between the inspiratory muscle pressure (P... more We previously described an index, defined as the ratio between the inspiratory muscle pressure (Pmus) and the electrical activity of the diaphragm (Edi) (Pmus/Edi index). In the present work, we describe the trend of Pmus/Edi index over time, investigating whether it could be an indicator of muscular efficiency associated with risk factors for diaphragmatic injury and/or clinical outcomes. This work is a retrospective analysis of subjects with measurements of Pmus/Edi index obtained, on different days, during assisted ventilation. Effects of Pmus/Edi index absolute value on clinical outcomes were investigated dividing subjects into those with Pmus/Edi index higher or lower than the median. Effects of Pmus/Edi index trend over time were analyzed, distinguishing between subjects with Pmus/Edi index increasing or decreasing. Mean Pmus/Edi index was 1.04 ± 0.67, and the median (interquartile range) was 1.00 (0.59-1.34), without a systematic trend over the days. Demographic, ventilator, or outcome data did not significantly differ between subjects with Pmus/Edi index higher or lower than the median. Similarly, we did not find relevant differences in subjects with Pmus/Edi index increasing or decreasing over time. The Pmus/Edi index value remained constant in each subject over time, although the inter-individual variability was high. Neither the Pmus/Edi index nor its trends appeared to be associated with ventilatory variables or clinical outcome.

Research paper thumbnail of Ultrasound-guided inguinal field block performed by anesthesiologists compared to field block infiltration performed by surgeons in inguinal hernia surgery: a randomized, double blind, controlled trial

European Journal of Anaesthesiology, 2014

Research paper thumbnail of Combining multiple ECG features does not improve prediction of defibrillation outcome compared to single features in a large population of out-of-hospital cardiac arrests

Critical care (London, England), 2015

Quantitative electrocardiographic (ECG) waveform analysis provides a noninvasive reflection of th... more Quantitative electrocardiographic (ECG) waveform analysis provides a noninvasive reflection of the metabolic milieu of the myocardium during resuscitation and is a potentially useful tool to optimize the defibrillation strategy. However, whether combining multiple ECG features can improve the capability of defibrillation outcome prediction in comparison to single feature analysis is still uncertain. A total of 3828 defibrillations from 1617 patients who experienced out-of-hospital cardiac arrest were analyzed. A 2.048-s ECG trace prior to each defibrillation without chest compressions was used for the analysis. Sixteen predictive features were optimized through the training dataset that included 2447 shocks from 1050 patients. Logistic regression, neural network and support vector machine were used to combine multiple features for the prediction of defibrillation outcome. Performance between single and combined predictive features were compared by area under receiver operating chara...

Research paper thumbnail of Hemodynamic Instability After Cardiac Surgery: Transesophageal Echocardiographic Diagnosis of a Localized Pericardial Tamponade

J Cardiothorac Vasc Anesth, 2005

P ERICARDIAL TAMPONADE represents a rare yet potentially life-threatening complication after card... more P ERICARDIAL TAMPONADE represents a rare yet potentially life-threatening complication after cardiac surgery. 1 It may present with peculiar characteristics that make the diagnosis particularly difficult if clinicians rely only on clinical and hemodynamic data, because the classic features of pericardial tamponade are absent, or at least blunted, in this setting. Conversely, transesophageal echocardiography (TEE) allows a rapid diagnosis and the prompt institution of appropriate therapeutic options.

Research paper thumbnail of Pentraxin 3 (PTX3): Possible Role in Critical Care Medicine

Research paper thumbnail of Con EMERGENCY contro Ebola in Sierra Leone

Ricerca Pratica, Mar 1, 2015

Research paper thumbnail of Lung Regional Metabolic Activity and Gas Volume Changes Induced by Tidal Ventilation in Patients with Acute Lung Injury

American Journal of Respiratory and Critical Care Medicine, Dec 20, 2012

Rationale: During acute lung injury (ALI), mechanical ventilation can aggravate inflammation by p... more Rationale: During acute lung injury (ALI), mechanical ventilation can aggravate inflammation by promoting alveolar distension and cyclic recruitment-derecruitment. As an estimate of the intensity of inflammation, metabolic activity can be measured by positron emission tomography imaging of [ 18 F]fluoro-2-deoxy-D-glucose. Objectives: To assess the relationship between gas volume changes induced by tidal ventilation and pulmonary metabolic activity in patients with ALI. Methods: In 13 mechanically ventilated patients with ALI and relatively high positive end-expiratory pressure, we performed a positron emission tomography scan of the chest and three computed tomography scans: at mean airway pressure, end-expiration, and end-inspiration. Metabolic activity was measured from the [ 18 F]fluoro-2-deoxy-D-glucose uptake rate. The computed tomography scans were used to classify lung regions as derecruited throughout the respiratory cycle, undergoing recruitment-derecruitment, and normally aerated. Measurements and Main Results: Metabolic activity of normally aerated lung was positively correlated both with plateau pressure, showing a pronounced increase above 26 to 27 cm H 2 O, and with regional VT normalized by end-expiratory lung gas volume. This relationship did not appear to be caused by a higher underlying parenchymal metabolic activity in patients with higher plateau pressure. Regions undergoing cyclic recruitment-derecruitment did not have higher metabolic activity than those collapsed throughout the respiratory cycle. Conclusions: In patients with ALI managed with relatively high endexpiratory pressure, metabolic activity of aerated regions was associated with both plateau pressure and regional VT normalized by end-expiratory lung gas volume, whereas no association was found between cyclic recruitment-derecruitment and increased metabolic activity.

Research paper thumbnail of Apparatus for Assisted Ventilation and Corresponding Regulation Method

Research paper thumbnail of Spatial Orientation and Mechanical Properties of the Human Trachea: A Computed Tomography Study

Respiratory care, Jan 9, 2014

The literature generally describes the trachea as oriented toward the right and back, but there i... more The literature generally describes the trachea as oriented toward the right and back, but there is very little detailed characterization. Therefore, the aim of this study was to precisely determine the spatial orientation and to better characterize the physical properties of the human trachea. We analyzed lung computed tomography scans of 68 intubated and mechanically ventilated subjects suffering from acute lung injury/ARDS at airway pressures (Paw) of 5, 15, and 45 cm H2O. At each Paw, the inner edge of the trachea from the subglottal space to the carina was captured. Tracheal length and diameter were measured. Tracheal orientation and compliance were estimated from processing barycenter and surface tracheal sections. Tracheal orientation at a Paw of 5 cm H2O showed a 4.2 ± 5.3° angle toward the right and a 20.6 ± 6.9° angle downward toward the back, which decreased significantly while increasing Paw (19.4 ± 6.9° at 15 cm H2O and 17.1 ± 6.8° at 45 cm H2O, P < .001). Tracheal co...

Research paper thumbnail of Imaging in acute lung injury and acute respiratory distress syndrome

Current opinion in critical care, 2012

The review focuses on recent achievements obtained by means of imaging techniques in clinical and... more The review focuses on recent achievements obtained by means of imaging techniques in clinical and experimental studies on acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The review focuses on four imaging techniques: computed tomography (CT), PET, electrical impedance tomography (EIT) and ultrasound, highlighting the most recent developments for each technique. Whereas CT and ultrasound are primarily based on detection of density, EIT and PET are aimed at providing more functional data. Major improvements were recently obtained in imaging structure and several functions of the lungs, with the potential of positively impacting the clinical practice.

Research paper thumbnail of Effects on membrane lung gas exchange of an intermittent high gas flow recruitment maneuver: preliminary data in veno-venous ECMO patients

Journal of Artificial Organs, 2015

Gas exchange capabilities of polymethylpentene membrane lungs (MLs) worsen over time. ML deterior... more Gas exchange capabilities of polymethylpentene membrane lungs (MLs) worsen over time. ML deterioration is related to protein deposit and clot formation. Condensation and trapping of water vapor inside ML hollow fibers might affect ML performances as well. Increasing sweep gas flow (GF) could remove such fluid. The purpose of this study was to evaluate the effects on ML gas exchange of a recruitment maneuver (RM) based on a brief increase in GF, during veno-venous ECMO support. Short-term (15 min) effects of 20 RMs were assessed. RM raised ML CO2 removal from 149 ± 37 to 174 ± 41 ml/min (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Conversely, RM did not improve ML O2 transfer (155 ± 31 and 158 ± 31 ml/min before and after RM, respectively). ML outlet pCO2 decreased after RM from 51.2 ± 5.8 to 45.8 ± 5.4 mmHg (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), while ML outlet pO2 increased from 520 ± 61 to 555 ± 51 mmHg (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Both ML dead space and shunt fractions decreased from 47.8 ± 15.3 to 29.6 ± 14.7 % (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and from 8.8 ± 4.2 to 7.0 ± 3.8 % (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), respectively. Furthermore, a subset of 5 RMs was evaluated on a 6-h time frame. The beneficial effects on ML performances due to the RM gradually diminished and waned over a 6-h interval after the RM. The RM improved ML CO2 removal substantially, albeit temporarily. ML oxygenation performance was marginally affected.

Research paper thumbnail of Low-Frequency Positive Pressure Ventilation with Extracorporeal Carbon Dioxide Removal (LFPPV-ECCO2R)

Anesthesia & Analgesia, 1978

Research paper thumbnail of Do spontaneous and mechanical breathing have similar effects on average transpulmonary and alveolar pressure? A clinical crossover study

Critical care (London, England), 2016

Preservation of spontaneous breathing (SB) is sometimes debated because it has potentially both n... more Preservation of spontaneous breathing (SB) is sometimes debated because it has potentially both negative and positive effects on lung injury in comparison with fully controlled mechanical ventilation (CMV). We wanted (1) to verify in mechanically ventilated patients if the change in transpulmonary pressure was similar between pressure support ventilation (PSV) and CMV for a similar tidal volume, (2) to estimate the influence of SB on alveolar pressure (Palv), and (3) to determine whether a reliable plateau pressure could be measured during pressure support ventilation (PSV). We studied ten patients equipped with esophageal catheters undergoing three levels of PSV followed by a phase of CMV. For each condition, we calculated the maximal and mean transpulmonary (ΔPL) swings and Palv. Overall, ΔPL was similar between CMV and PSV, but only loosely correlated. The differences in ΔPL between CMV and PSV were explained largely by different inspiratory flows, indicating that the resistive p...

Research paper thumbnail of Receptor for advanced glycation end products is associated with systemic and organ-specific severity of acute lung injury and acute respiratory distress syndrome

Research paper thumbnail of ECMO for Ischemic Cardiogenic Shock

Research paper thumbnail of Persisting high levels of plasma pentraxin 3 over the first days after severe sepsis and septic shock onset are associated with mortality

European Journal of Intensive Care Medicine, Jan 30, 2010

Persisting high levels of plasma pentraxin 3 over the first days after severe sepsis and septic s... more Persisting high levels of plasma pentraxin 3 over the first days after severe sepsis and septic shock onset are associated with mortality

Research paper thumbnail of Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives

Intensive Care Medicine, 2016

Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the... more Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning. Moreover, Pes monitoring permits accurate measurement of transmural vascular pressure and intrinsic positive end-expiratory pressure and facilitates detection of patient-ventilator asynchrony, thereby supporting specific diagnoses and interventions. Finally, some Pes-derived measures may also be obtained by monitoring electrical activity of the diaphragm. Pes monitoring provides unique bedside measures for a better understanding of the pathophysiology of acute respiratory failure patients. Including Pes monitoring in the intensivist&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinical armamentarium may enhance treatment to improve clinical outcomes.

Research paper thumbnail of Control of fever by continuous, low-dose diclofenac sodium infusion in acute cerebral damage patients

Intensive Care Medicine, May 1, 2000

Research paper thumbnail of “Awake” extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering

Critical Care, 2016

Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescu... more Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescue therapy for patients with respiratory failure not treatable with conventional mechanical ventilation alone. In recent years, however, the timing of ECMO initiation has been readdressed and ECMO is often started earlier in the time course of respiratory failure. Furthermore, some centers are starting to use ECMO as a first line of treatment, i.e., as an alternative to invasive mechanical ventilation in awake, non-intubated, spontaneously breathing patients with respiratory failure (&amp;amp;amp;amp;quot;awake&amp;amp;amp;amp;quot; ECMO). There is a strong rationale for this type of respiratory support as it avoids several side effects related to sedation, intubation, and mechanical ventilation. However, the complexity of the patient-ECMO interactions, the difficulties related to respiratory monitoring, and the management of an awake patient on extracorporeal support together pose a major challenge for the intensive care unit staff. Here, we review the use of vv-ECMO in awake, spontaneously breathing patients with respiratory failure, highlighting the pros and cons of this approach, analyzing the pathophysiology of patient-ECMO interactions, detailing some of the technical aspects, and summarizing the initial clinical experience gained over the past years.

Research paper thumbnail of Application of guidelines for severe head trauma: data from an Italian database

European Journal of Emergency Medicine, Apr 1, 2003

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for European Journal ... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for European Journal of Emergency Medicine. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information ...

Research paper thumbnail of The Ratio of Inspiratory Pressure Over Electrical Activity of the Diaphragm Remains Stable During ICU Stay and Is Not Related to Clinical Outcome

Respiratory Care, 2016

We previously described an index, defined as the ratio between the inspiratory muscle pressure (P... more We previously described an index, defined as the ratio between the inspiratory muscle pressure (Pmus) and the electrical activity of the diaphragm (Edi) (Pmus/Edi index). In the present work, we describe the trend of Pmus/Edi index over time, investigating whether it could be an indicator of muscular efficiency associated with risk factors for diaphragmatic injury and/or clinical outcomes. This work is a retrospective analysis of subjects with measurements of Pmus/Edi index obtained, on different days, during assisted ventilation. Effects of Pmus/Edi index absolute value on clinical outcomes were investigated dividing subjects into those with Pmus/Edi index higher or lower than the median. Effects of Pmus/Edi index trend over time were analyzed, distinguishing between subjects with Pmus/Edi index increasing or decreasing. Mean Pmus/Edi index was 1.04 ± 0.67, and the median (interquartile range) was 1.00 (0.59-1.34), without a systematic trend over the days. Demographic, ventilator, or outcome data did not significantly differ between subjects with Pmus/Edi index higher or lower than the median. Similarly, we did not find relevant differences in subjects with Pmus/Edi index increasing or decreasing over time. The Pmus/Edi index value remained constant in each subject over time, although the inter-individual variability was high. Neither the Pmus/Edi index nor its trends appeared to be associated with ventilatory variables or clinical outcome.

Research paper thumbnail of Ultrasound-guided inguinal field block performed by anesthesiologists compared to field block infiltration performed by surgeons in inguinal hernia surgery: a randomized, double blind, controlled trial

European Journal of Anaesthesiology, 2014

Research paper thumbnail of Combining multiple ECG features does not improve prediction of defibrillation outcome compared to single features in a large population of out-of-hospital cardiac arrests

Critical care (London, England), 2015

Quantitative electrocardiographic (ECG) waveform analysis provides a noninvasive reflection of th... more Quantitative electrocardiographic (ECG) waveform analysis provides a noninvasive reflection of the metabolic milieu of the myocardium during resuscitation and is a potentially useful tool to optimize the defibrillation strategy. However, whether combining multiple ECG features can improve the capability of defibrillation outcome prediction in comparison to single feature analysis is still uncertain. A total of 3828 defibrillations from 1617 patients who experienced out-of-hospital cardiac arrest were analyzed. A 2.048-s ECG trace prior to each defibrillation without chest compressions was used for the analysis. Sixteen predictive features were optimized through the training dataset that included 2447 shocks from 1050 patients. Logistic regression, neural network and support vector machine were used to combine multiple features for the prediction of defibrillation outcome. Performance between single and combined predictive features were compared by area under receiver operating chara...

Research paper thumbnail of Hemodynamic Instability After Cardiac Surgery: Transesophageal Echocardiographic Diagnosis of a Localized Pericardial Tamponade

J Cardiothorac Vasc Anesth, 2005

P ERICARDIAL TAMPONADE represents a rare yet potentially life-threatening complication after card... more P ERICARDIAL TAMPONADE represents a rare yet potentially life-threatening complication after cardiac surgery. 1 It may present with peculiar characteristics that make the diagnosis particularly difficult if clinicians rely only on clinical and hemodynamic data, because the classic features of pericardial tamponade are absent, or at least blunted, in this setting. Conversely, transesophageal echocardiography (TEE) allows a rapid diagnosis and the prompt institution of appropriate therapeutic options.

Research paper thumbnail of Pentraxin 3 (PTX3): Possible Role in Critical Care Medicine

Research paper thumbnail of Con EMERGENCY contro Ebola in Sierra Leone

Ricerca Pratica, Mar 1, 2015

Research paper thumbnail of Lung Regional Metabolic Activity and Gas Volume Changes Induced by Tidal Ventilation in Patients with Acute Lung Injury

American Journal of Respiratory and Critical Care Medicine, Dec 20, 2012

Rationale: During acute lung injury (ALI), mechanical ventilation can aggravate inflammation by p... more Rationale: During acute lung injury (ALI), mechanical ventilation can aggravate inflammation by promoting alveolar distension and cyclic recruitment-derecruitment. As an estimate of the intensity of inflammation, metabolic activity can be measured by positron emission tomography imaging of [ 18 F]fluoro-2-deoxy-D-glucose. Objectives: To assess the relationship between gas volume changes induced by tidal ventilation and pulmonary metabolic activity in patients with ALI. Methods: In 13 mechanically ventilated patients with ALI and relatively high positive end-expiratory pressure, we performed a positron emission tomography scan of the chest and three computed tomography scans: at mean airway pressure, end-expiration, and end-inspiration. Metabolic activity was measured from the [ 18 F]fluoro-2-deoxy-D-glucose uptake rate. The computed tomography scans were used to classify lung regions as derecruited throughout the respiratory cycle, undergoing recruitment-derecruitment, and normally aerated. Measurements and Main Results: Metabolic activity of normally aerated lung was positively correlated both with plateau pressure, showing a pronounced increase above 26 to 27 cm H 2 O, and with regional VT normalized by end-expiratory lung gas volume. This relationship did not appear to be caused by a higher underlying parenchymal metabolic activity in patients with higher plateau pressure. Regions undergoing cyclic recruitment-derecruitment did not have higher metabolic activity than those collapsed throughout the respiratory cycle. Conclusions: In patients with ALI managed with relatively high endexpiratory pressure, metabolic activity of aerated regions was associated with both plateau pressure and regional VT normalized by end-expiratory lung gas volume, whereas no association was found between cyclic recruitment-derecruitment and increased metabolic activity.

Research paper thumbnail of Apparatus for Assisted Ventilation and Corresponding Regulation Method

Research paper thumbnail of Spatial Orientation and Mechanical Properties of the Human Trachea: A Computed Tomography Study

Respiratory care, Jan 9, 2014

The literature generally describes the trachea as oriented toward the right and back, but there i... more The literature generally describes the trachea as oriented toward the right and back, but there is very little detailed characterization. Therefore, the aim of this study was to precisely determine the spatial orientation and to better characterize the physical properties of the human trachea. We analyzed lung computed tomography scans of 68 intubated and mechanically ventilated subjects suffering from acute lung injury/ARDS at airway pressures (Paw) of 5, 15, and 45 cm H2O. At each Paw, the inner edge of the trachea from the subglottal space to the carina was captured. Tracheal length and diameter were measured. Tracheal orientation and compliance were estimated from processing barycenter and surface tracheal sections. Tracheal orientation at a Paw of 5 cm H2O showed a 4.2 ± 5.3° angle toward the right and a 20.6 ± 6.9° angle downward toward the back, which decreased significantly while increasing Paw (19.4 ± 6.9° at 15 cm H2O and 17.1 ± 6.8° at 45 cm H2O, P < .001). Tracheal co...

Research paper thumbnail of Imaging in acute lung injury and acute respiratory distress syndrome

Current opinion in critical care, 2012

The review focuses on recent achievements obtained by means of imaging techniques in clinical and... more The review focuses on recent achievements obtained by means of imaging techniques in clinical and experimental studies on acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The review focuses on four imaging techniques: computed tomography (CT), PET, electrical impedance tomography (EIT) and ultrasound, highlighting the most recent developments for each technique. Whereas CT and ultrasound are primarily based on detection of density, EIT and PET are aimed at providing more functional data. Major improvements were recently obtained in imaging structure and several functions of the lungs, with the potential of positively impacting the clinical practice.

Research paper thumbnail of Effects on membrane lung gas exchange of an intermittent high gas flow recruitment maneuver: preliminary data in veno-venous ECMO patients

Journal of Artificial Organs, 2015

Gas exchange capabilities of polymethylpentene membrane lungs (MLs) worsen over time. ML deterior... more Gas exchange capabilities of polymethylpentene membrane lungs (MLs) worsen over time. ML deterioration is related to protein deposit and clot formation. Condensation and trapping of water vapor inside ML hollow fibers might affect ML performances as well. Increasing sweep gas flow (GF) could remove such fluid. The purpose of this study was to evaluate the effects on ML gas exchange of a recruitment maneuver (RM) based on a brief increase in GF, during veno-venous ECMO support. Short-term (15 min) effects of 20 RMs were assessed. RM raised ML CO2 removal from 149 ± 37 to 174 ± 41 ml/min (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Conversely, RM did not improve ML O2 transfer (155 ± 31 and 158 ± 31 ml/min before and after RM, respectively). ML outlet pCO2 decreased after RM from 51.2 ± 5.8 to 45.8 ± 5.4 mmHg (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), while ML outlet pO2 increased from 520 ± 61 to 555 ± 51 mmHg (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Both ML dead space and shunt fractions decreased from 47.8 ± 15.3 to 29.6 ± 14.7 % (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and from 8.8 ± 4.2 to 7.0 ± 3.8 % (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), respectively. Furthermore, a subset of 5 RMs was evaluated on a 6-h time frame. The beneficial effects on ML performances due to the RM gradually diminished and waned over a 6-h interval after the RM. The RM improved ML CO2 removal substantially, albeit temporarily. ML oxygenation performance was marginally affected.