A5027011634- Respiratory Support and Mechanisms
- Cardiac Arrest and Resuscitation
- Mechanical Circulatory Support Devices
- Chronic Obstructive Pulmonary Disease (COPD) Research
- Renal function and acid-base balance
- Hemodynamic Monitoring and Therapy
- Intensive Care Unit Cognitive Disorders
- Sepsis Diagnosis and Treatment
- Cardiac Structural Anomalies and Repair
- Neonatal Respiratory Health Research
- Pleural and Pulmonary Diseases
- Thermal Regulation in Medicine
- Heart Rate Variability and Autonomic Control
- Biomarkers in Disease Mechanisms
- Blood transfusion and management
- Clinical Nutrition and Gastroenterology
- Electrolyte and hormonal disorders
- Heart Failure Treatment and Management
- Public Health and Nutrition
- Venous Thromboembolism Diagnosis and Management
- Cardiac Ischemia and Reperfusion
- Infective Endocarditis Diagnosis and Management
- Potassium and Related Disorders
- Central Venous Catheters and Hemodialysis
- Ion Transport and Channel Regulation
Guy's and St Thomas' NHS Foundation Trust
2022-2025
St Thomas' Hospital
2023-2025
National Health Service
2023-2025
King's College London
2022-2024
University of Turin
2018-2023
Universitätsmedizin Göttingen
2020-2022
University of Göttingen
2019-2021
Azienda Ospedaliera Citta' della Salute e della Scienza di Torino
2021
Committee on Publication Ethics
2020
Abstract Background Mechanical power is a summary variable including all the components which can possibly cause VILI (pressures, volume, flow, respiratory rate). Since complexity of its mathematical computation one major factors that delay clinical use, we propose here simple and easy to remember equation estimate mechanical under volume-controlled ventilation: $$ \mathrm{Mechanical}\ \mathrm{Power}=\frac{\mathrm{VE}\times \left(\mathrm{Peak}\ \mathrm{Pressure}+\mathrm{PEEP}+F/6\right)}{20}...
BACKGROUND: In the early stages of COVID-19 pneumonia, hypoxemia has been described in absence dyspnea ("silent" or "happy" hypoxemia). Our aim was to report its prevalence and outcome a series hypoxemic patients upon Emergency Department admission.METHODS: this retrospective observational cohort study we enrolled population consisting 213 with PaO2/FiO2 ratio <300 mmHg at hospital admission. Two groups (silent dyspneic hypoxemia) were defined. Symptoms, blood gas analysis, chest X-ray (CXR)...
Hypothesizing that the non-aerated lung fraction as evaluated by quantitative analysis of computed tomography (CT) equals shunt (V A /Q = 0), we used a computational approach to estimate magnitude ventilation–perfusion mismatch in severe COVID-19. The results show hyperperfusion poorly ventilated region is likely cause hypoxemia observed. extensive microthrombosis pulmonary circulation may represent pathophysiological mechanism such V distribution.
Excessive tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP) are all potential causes of ventilator-induced lung injury, contribute to a single variable: the mechanical power. The authors aimed determine whether high volume or rate PEEP at iso-mechanical power produce similar different injury.Three ventilatory strategies-high (twice baseline functional residual capacity), (40 bpm), (25 cm H2O)-were each applied two levels (15 30 J/min) for 48 h in six groups seven...
ViewpointThe buffer power of blood: a reappraisal its mathematical expressions with implications on the role albumin as bufferLorenzo Giosa, Francesco Zadek, and Thomas LangerLorenzo Giosa1Centre for Human Applied Physiological Sciences, King's College London, United Kingdom, Zadek2Department Medicine Surgery, University Milano-Bicocca, Monza, Italy, Langer* Corresponding Author; email: [email protected]2Department Italy3Department Anesthesia Intensive Care Medicine, Niguarda Ca' Granda,...
The extent of ventilator-induced lung injury may be related to the intensity mechanical ventilation--expressed as power. In present study, we investigated whether there is a safe threshold, below which damage absent. Three groups six healthy pigs (29.5 ± 2.5 kg) were ventilated prone for 48 h at power 3, 7, or 12 J/min. Strain never exceeded 1.0. PEEP was set 4 cmH2 O. Lung volumes measured every h; respiratory, hemodynamics, and gas exchange variables 6. End-experiment histological findings...
It is commonly assumed that changes in plasma strong ion difference (SID) result equal whole blood base excess (BE). However, at varying pH, albumin ionic-binding and transerythrocyte shifts alter the SID of without affecting (SID
During veno-venous extracorporeal membrane oxygenation (V-V ECMO), blood is drained from the central venous circulation to be oxygenated and decarbonated by an artificial lung. It then reinfused into right heart pulmonary where further gas-exchange occurs. Each of these steps characterized a peculiar physiology that this manuscript analyses, with aim providing bedside tools for clinical care: we begin describing factors affect efficiency drainage, such as patient cannulae position, fluid...
Rationale: Weaning from venovenous extracorporeal membrane oxygenation (VV-ECMO) is based on and not carbon dioxide elimination. Objectives: To predict readiness to wean VV-ECMO. Methods: In this multicenter study of mechanically ventilated adults with severe acute respiratory distress syndrome receiving VV-ECMO, we investigated a variable CO2 The included prospective interventional physiological cohort (n = 26) retrospective clinical 638). Measurements Main Results: failure in the cohorts...
Rationale: Understanding the physiology of CO2 stores mobilization is a prerequisite for intermittent extracorporeal removal (ECCO2R) in patients with chronic hypercapnia.Objectives: To describe dynamics stores.Methods: Fifteen pigs (61.7 ± 4.3 kg) were randomized to 48 hours hyperventilation (group "Hyper," n = 4); hypoventilation "Hypo," 24 plus normoventilation "Hypo-Baseline," or ECCO2R "Hypo-ECCO2R," 3). Forty-eight after randomization, current [Formula: see text]e was reduced by 50%...
Background Several studies explored the interdependence between Paco2 and bicarbonate during respiratory acid–base derangements. The authors aimed to reframe adaptation disorders according physical–chemical approach, hypothesizing that (1) concentration derangements is associated with strong ion difference; (2) acute disorders, difference changes are not standard base excess. Methods This an individual participant data meta-analysis from multiple canine human experiments published up April...
In this retrospective observational cohort study, we aimed to describe the rate of extracorporeal membrane oxygenation (ECMO) circuit change, associated risk factors and its relationship with patient characteristics outcome in patients receiving venovenous (VV) ECMO at our center between January 2015 November 2017. Twenty-seven percent VV (n = 224) had least one which was lower ICU survival (68% vs 82% p=0.032) longer stay (30 . 17 days p < 0.001). Circuit duration similar when stratified...
Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery determinants esophageal and intrathoracic pressures their differences. The (through balloon) intrathoracic/pleural chest tube on side) were measured in 28 patients immediately lobectomy or wedge resection. Measurements made nondependent lateral position (without with ventilation operated lung) supine position. In lung, collapsed ventilated, differences between amounted to...
Abstract Background in COVID-19 acute respiratory failure, the effects of CPAP and FiO 2 on effort lung stress are unclear. We hypothesize that, compliant lungs early Sars-CoV-2 pneumonia, application positive pressure through Helmet-CPAP may not decrease effort, rather worsen oxygenation when compared to higher delivered via oxygen masks. Methods In this single-center (S.Luigi Gonzaga University-Hospital, Turin, Italy), randomized, crossover study, we included patients receiving for (<...
Background Despite the fervent scientific effort, a state-of-the art assessment of different causes hypoxemia (shunt, ventilation-perfusion mismatch and diffusion limitation) in COVID-19 ARDS is currently lacking. In this study we aimed to understand what relative contribution mechanisms disease their relationship with distribution tissue blood within lung. Methods We prospectively enrolled 10 patients ARDS, intubated for &lt;7 days. performed Multiple Inert Gas Elimination Technique...
ABSTRACT Objective: To investigate the behavior of pentraxin-3 (PTX3), troponin T (hsTnT), N-terminal pro-B type Natriuretic Peptide (NT-proBNP) in sepsis and their relationships with severity oxygen transport/utilization impairment. Design: Retrospective analysis PTX3, hsTnT, NT-proBNP levels at day 1, 2, 7 after admission intensive care unit a subset Albumin Italian Outcome Sepsis database. Setting: Forty units. Patients: Nine hundred fifty-eight septic patients enrolled randomized...