A5005137781- Respiratory Support and Mechanisms
- Neonatal Respiratory Health Research
- Cardiac Arrest and Resuscitation
- Mechanical Circulatory Support Devices
- Chronic Obstructive Pulmonary Disease (COPD) Research
- Intensive Care Unit Cognitive Disorders
- Sepsis Diagnosis and Treatment
- Transplantation: Methods and Outcomes
- Ultrasound in Clinical Applications
- Organ Transplantation Techniques and Outcomes
- Airway Management and Intubation Techniques
- Tracheal and airway disorders
- Medical Imaging and Pathology Studies
- Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
- Inhalation and Respiratory Drug Delivery
- Cardiac, Anesthesia and Surgical Outcomes
- Family and Patient Care in Intensive Care Units
- Thermal Regulation in Medicine
- Neuroscience of respiration and sleep
- Pleural and Pulmonary Diseases
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Congenital Diaphragmatic Hernia Studies
- Childhood Cancer Survivors' Quality of Life
- Hip and Femur Fractures
- Advances in Oncology and Radiotherapy
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
2013-2023
Ospedale Maggiore
2020
Policlinico San Matteo Fondazione
2020
University of Milan
2011-2019
Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo
2017
European Society of Intensive Care Medicine
2015
The ventilator works mechanically on the lung parenchyma. authors set out to obtain proof of concept that ventilator-induced injury (VILI) depends mechanical power applied lung.Mechanical was defined as function transpulmonary pressure, tidal volume (TV), and respiratory rate. Three piglets were ventilated with a known be lethal (TV, 38 ml/kg; plateau 27 cm H2O; rate, 15 breaths/min). Other groups (three each) same TV per kilogram pressure but at rates 12, 9, 6, 3 breaths/min. identified...
Rationale: Pressures and volumes needed to induce ventilator-induced lung injury in healthy lungs are far greater than those applied diseased lungs. A possible explanation may be the presence of local inhomogeneities acting as pressure multipliers (stress raisers).Objectives: To quantify patients with acute respiratory distress syndrome (ARDS).Methods: Retrospective quantitative analysis CT scan images 148 ARDS 100 control subjects. An ideally homogeneous would have same expansion all...
Abstract Background Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim this study is to investigate and effect population during first 2020 pandemic wave. Methods Retrospective, multicentre, national cohort conducted between February 24 June 14, 2020, Italian Intensive Care Units (ICU) adult needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical were collected...
Lung-protective ventilation strategy suggests the use of low tidal volume, depending on ideal body weight, and adequate levels PEEP. However, reducing volume according to weight does not always prevent overstress overstrain. On contrary, titrating mechanical airway driving pressure, computed as pressure changes from PEEP end-inspiratory plateau equivalent ratio between compliance respiratory system, should better reflect lung injury. possible in chest wall elastance could affect reliability...
The assessment of lung recruitability in patients with acute respiratory distress syndrome (ARDS) may be important for planning recruitment maneuvers and setting positive end-expiratory pressure (PEEP).To determine whether measured by mechanics is comparable computed tomography (CT).In 22 ARDS, was assessed at 5 15 cm H2O PEEP using mechanics-based methods: (1) increase gas volume between two pressure-volume curves (P-Vrs curve); (2) predicted on the basis expected static compliance system...
There is no consensus on the management of anticoagulation during extracorporeal membrane oxygenation (ECMO). ECMO currently burdened by a high rate hemostatic complications, possibly associated with inadequate monitoring heparin anticoagulation. This study aims to assess safety and feasibility an protocol for patients undergoing based thromboelastography (TEG) as opposed activated partial thromboplastin time (aPTT)-based protocol.We performed multicenter, randomized, controlled trial in two...
During mechanical ventilation, stress and strain may be locally multiplied in an inhomogeneous lung. The authors investigated whether, healthy lungs, during high pressure/volume injury begins at the interface of naturally structures as visceral pleura, bronchi, vessels, alveoli. wished also to characterize nature lesions (collapse vs. consolidation).Twelve piglets were ventilated with greater than 2.5 (tidal volume/end-expiratory lung volume) until whole edema developed. At least every 3 h,...
Although computed tomography (CT) is widely used to investigate different pathologies, quantitative data from normal populations are scarce. Reference values may be useful estimate the anatomical or physiological changes induced by various diseases.We analyzed 100 helical CT scans taken for clinical purposes and referred as nonpathological radiologist. Profiles were manually outlined on each scan slice voxel was classified according its gas/tissue ratio. For regional analysis, lungs divided...
Definitive guidelines for anticoagulation management during veno-venous extracorporeal membrane oxygenation (VV ECMO) are lacking, whereas bleeding complications continue to pose major challenges.
Abstract Background: It has been suggested that higher positive end-expiratory pressure (PEEP) should be used only in patients with lung recruitability. In this study, the authors investigated relationship between recruitability and PEEP necessary to counteract compressive forces leading collapse. Methods: Fifty-one acute respiratory distress syndrome (7 mild, 33 moderate, 11 severe) were enrolled. Patients underwent whole-lung computed tomography (CT) scan at 5 45 cm H2O. Recruitability was...
The Berlin definition of acute respiratory distress syndrome has introduced three classes severity according to PaO2/FIO2 thresholds. level positive end-expiratory pressure applied may greatly affect PaO2/FIO2, thereby masking severity, which should reflect the underlying lung injury (lung edema and recruitability). We hypothesized that assessment at standardized low improve association between injury, as detected by CT, PaO2/FIO2-derived severity.Retrospective analysis.Four university...
The aim of the study was to determine size and location homogeneous inflamed/noninflamed inhomogeneous lung compartments their association with acute respiratory distress syndrome (ARDS) severity.In total, 20 ARDS patients underwent 5 45 cmH2O computed tomography (CT) scans measure recruitability. [(18)F]2-fluoro-2-deoxy-d-glucose ([(18)F]FDG) uptake inhomogeneities were quantified a positron emission tomography-CT scan at 10 cmH2O. We defined four normal/abnormal [(18)F]FDG homogeneity.The...
In sedated and paralyzed children with acute respiratory failure, the compliance of system functional residual capacity were significantly reduced compared healthy subjects. However, no major studies in ARDS have investigated role different levels PEEP tidal volume on partitioned mechanic (lung chest wall), stress (transpulmonary pressure) strain (inflated above capacity).The end-expiratory lung was measured using a simplified closed circuit helium dilution method. During an inspiratory...
Acute respiratory distress syndrome is a clinical characterized by refractory hypoxemia due to an inflammatory and high permeability pulmonary edema secondary direct or indirect lung insult (pulmonary extrapulmonary form). Aim of this study was evaluate in large database acute patients, the versus form terms mechanics, recruitment, gas exchange, positive end-expiratory pressure response.A analysis previously published data.One-hundred eighty-one sedated paralyzed patients (age 60 yr [46-72...
Abstract Background Catheter-related thrombosis (CRT) incidence, rate, and risk factors vary in literature due to differences populations, catheters, diagnostic methods, statistical approaches. The aim of this single-center, prospective, observational study was assess incidence rate (IR), cumulative by means IR ratio (IRR) asymptomatic CRT a non-oncologic Intensive Care Unit (ICU) population. development assessed daily ultrasound screening. proportions patients catheters developing rates,...
Non-invasive ventilation (NIV) or invasive mechanical (MV) is frequently needed in patients with acute hypoxemic respiratory failure due to severe syndrome coronavirus 2 (SARS-CoV-2) infection. While NIV can be delivered hospital wards and nonintensive care environments, intubated require intensive unit (ICU) admission support. Thus, the lack of ICU beds generated by pandemic has often forced use severely treated outside ICU. In this context, awake prone positioning been widely adopted...
Viscoelastic coagulation monitor (VCM) is a portable device developed to evaluate the viscoelastic properties of whole blood activated by contact with glass. In this study, VCM was employed analyze profiles 36 COVID-19 intensive care patients. Full anticoagulant dose heparin (unfractionated [UFH]; low molecular weight [LMWH]) administrated all The association between and laboratory parameters retrospectively analyzed. administration UFH-influenced prolonging clotting time (CT) clot formation...