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Cotoia A, Paradiso R, Ferrara G, Borriello G, Santoro F, Spina I, Mirabella L, Mariano K, Fusco G, Cinnella G, Singer P. Modifications of lung microbiota structure in traumatic brain injury ventilated patients according to time and enteral feeding formulas: a prospective randomized study. Crit Care 2023; 27:244. [PMID: 37344845 PMCID: PMC10283314 DOI: 10.1186/s13054-023-04531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Specialized diets enriched with immune nutrients could be an important supplement in patients (pts) with acute traumatic brain injury (TBI). Omega-3 and arginine may interact with immune response and microbiota. No data are available about the role of the specialized diets in modulating the lung microbiota, and little is known about the influence of lung microbiota structure in development of ventilator-associated pneumonia (VAP) in TBI pts. The aims of this study are to evaluate the impact of specific nutrients on the lung microbiota and the variation of lung microbiota in TBI pts developing VAP. METHODS A cohort of 31 TBI pts requiring mechanical ventilation in ICU was randomized for treatment with specialized (16pts) or standard nutrition (15pts). Alpha and beta diversity of lung microbiota were analyzed from bronco Alveolar Lavage (BAL) samples collected at admission and 7 days post-ICU admission in both groups. A further analysis was carried out on the same samples retrospectively grouped in VAP or no VAP pts. RESULTS None developed VAP in the first week. Thereafter, ten out of thirty-one pts developed VAP. The BAL microbiota on VAP group showed significant differences in beta diversity and Staphylococcus and Acinetobacter Genera were high. The specialized nutrition had influence on beta diversity that reached statistical significance only in Bray-Curtis distance. CONCLUSION Our data suggest that TBI patients who developed VAP during ICU stay have different structures of BAL microbiota either at admission and at 7 days post-ICU admission, while no correlation has been observed between different enteral formulas and microbiota composition in terms of richness and evenness. These findings suggest that targeting the lung microbiota may be a promising approach for preventing infections in critically ill patients.
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Affiliation(s)
- A. Cotoia
- Department of Intensive Care, University Hospital of Foggia, Foggia, Italy
| | - R. Paradiso
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - G. Ferrara
- Department of Intensive Care, University Hospital of Foggia, Foggia, Italy
| | - G. Borriello
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - F. Santoro
- Department of Intensive Care, University Hospital of Foggia, Foggia, Italy
| | - I. Spina
- Department of Intensive Care, University Hospital of Foggia, Foggia, Italy
| | - L. Mirabella
- Department of Intensive Care, University Hospital of Foggia, Foggia, Italy
| | - K. Mariano
- Department of Intensive Care, University Hospital of Foggia, Foggia, Italy
| | - G. Fusco
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - G. Cinnella
- Department of Intensive Care, University Hospital of Foggia, Foggia, Italy
| | - P. Singer
- Intensive Care Unit Herzlia Médical Center, Herzliya, Israel
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Bluth T, Serpa Neto A, Schultz MJ, Pelosi P, Gama de Abreu M, Bluth T, Bobek I, Canet JC, Cinnella G, de Baerdemaeker L, Gama de Abreu M, Gregoretti C, Hedenstierna G, Hemmes SNT, Hiesmayr M, Hollmann MW, Jaber S, Laffey J, Licker MJ, Markstaller K, Matot I, Mills GH, Mulier JP, Pelosi P, Putensen C, Rossaint R, Schmitt J, Schultz MJ, Senturk M, Serpa Neto A, Severgnini P, Sprung J, Vidal Melo MF, Wrigge H. Effect of Intraoperative High Positive End-Expiratory Pressure (PEEP) With Recruitment Maneuvers vs Low PEEP on Postoperative Pulmonary Complications in Obese Patients: A Randomized Clinical Trial. JAMA 2019; 321:2292-2305. [PMID: 31157366 PMCID: PMC6582260 DOI: 10.1001/jama.2019.7505] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE An intraoperative higher level of positive end-expiratory positive pressure (PEEP) with alveolar recruitment maneuvers improves respiratory function in obese patients undergoing surgery, but the effect on clinical outcomes is uncertain. OBJECTIVE To determine whether a higher level of PEEP with alveolar recruitment maneuvers decreases postoperative pulmonary complications in obese patients undergoing surgery compared with a lower level of PEEP. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 2013 adults with body mass indices of 35 or greater and substantial risk for postoperative pulmonary complications who were undergoing noncardiac, nonneurological surgery under general anesthesia. The trial was conducted at 77 sites in 23 countries from July 2014-February 2018; final follow-up: May 2018. INTERVENTIONS Patients were randomized to the high level of PEEP group (n = 989), consisting of a PEEP level of 12 cm H2O with alveolar recruitment maneuvers (a stepwise increase of tidal volume and eventually PEEP) or to the low level of PEEP group (n = 987), consisting of a PEEP level of 4 cm H2O. All patients received volume-controlled ventilation with a tidal volume of 7 mL/kg of predicted body weight. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of pulmonary complications within the first 5 postoperative days, including respiratory failure, acute respiratory distress syndrome, bronchospasm, new pulmonary infiltrates, pulmonary infection, aspiration pneumonitis, pleural effusion, atelectasis, cardiopulmonary edema, and pneumothorax. Among the 9 prespecified secondary outcomes, 3 were intraoperative complications, including hypoxemia (oxygen desaturation with Spo2 ≤92% for >1 minute). RESULTS Among 2013 adults who were randomized, 1976 (98.2%) completed the trial (mean age, 48.8 years; 1381 [69.9%] women; 1778 [90.1%] underwent abdominal operations). In the intention-to-treat analysis, the primary outcome occurred in 211 of 989 patients (21.3%) in the high level of PEEP group compared with 233 of 987 patients (23.6%) in the low level of PEEP group (difference, -2.3% [95% CI, -5.9% to 1.4%]; risk ratio, 0.93 [95% CI, 0.83 to 1.04]; P = .23). Among the 9 prespecified secondary outcomes, 6 were not significantly different between the high and low level of PEEP groups, and 3 were significantly different, including fewer patients with hypoxemia (5.0% in the high level of PEEP group vs 13.6% in the low level of PEEP group; difference, -8.6% [95% CI, -11.1% to 6.1%]; P < .001). CONCLUSIONS AND RELEVANCE Among obese patients undergoing surgery under general anesthesia, an intraoperative mechanical ventilation strategy with a higher level of PEEP and alveolar recruitment maneuvers, compared with a strategy with a lower level of PEEP, did not reduce postoperative pulmonary complications. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02148692.
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Affiliation(s)
| | - Thomas Bluth
- Department of Anesthesiology and Critical Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Ary Serpa Neto
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Marcus J Schultz
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Policlinico San Martino, Genoa, Italy
| | - Marcelo Gama de Abreu
- Department of Anesthesiology and Critical Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
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3
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Kiss T, Wittenstein J, Becker C, Birr K, Cinnella G, Cohen E, El Tahan MR, Falcão LF, Gregoretti C, Granell M, Hachenberg T, Hollmann MW, Jankovic R, Karzai W, Krassler J, Loop T, Licker MJ, Marczin N, Mills GH, Murrell MT, Neskovic V, Nisnevitch-Savarese Z, Pelosi P, Rossaint R, Schultz MJ, Neto AS, Severgnini P, Szegedi L, Vegh T, Voyagis G, Zhong J, de Abreu MG, Senturk M. Correction to: Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial. Trials 2019; 20:259. [PMID: 31068212 PMCID: PMC6505178 DOI: 10.1186/s13063-019-3371-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- T Kiss
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - J Wittenstein
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Becker
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - K Birr
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - G Cinnella
- Department of Anesthesia and Intensive Care, OO Riuniti Hospital, University of Foggia, Foggia, Italy
| | - E Cohen
- Department of Anesthesiology, The Mount Sinai Hospital, New York, USA
| | - M R El Tahan
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - L F Falcão
- Federal University of São Paulo, Sao Paulo, Brazil
| | - C Gregoretti
- UOC Anestesia e Rianimazione A.O.Universitaria "P. Giaccone", Dipartimento Di.Chir.On.S, Università degli Studi di Palermo, Palermo, Italy
| | - M Granell
- Hospital General Universitario de Valencia, Valencia, Spain
| | - T Hachenberg
- University Hospital Magdeburg, Magdeburg, Germany
| | - M W Hollmann
- Department of Anesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - R Jankovic
- Clinic for Anesthesia and Intensive Therapy, Clinical Center Nis, School of Medicine, University of Nis, Nis, Serbia
| | - W Karzai
- Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - T Loop
- Department of Anesthesiology and Intensive Care Medicine Clinic, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M J Licker
- University Hospital Geneva, Geneva, Switzerland
| | - N Marczin
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK.,Centre of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
| | - G H Mills
- Department of Anaesthesia and Intensive Care Medicine, Sheffield Teaching Hospitals, Sheffield University, Sheffield, UK
| | - M T Murrell
- Department of Anesthesiology, Weill Cornell Medicine, New York, USA
| | - V Neskovic
- Military Medical Academy, Belgrade, Serbia
| | | | - P Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,IRCCS San Martino Policlinico Hospital, Genoa, Italy
| | - R Rossaint
- Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
| | - M J Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - A Serpa Neto
- Department of Critical Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - P Severgnini
- Dipartimento di Biotecnologie e Scienze della Vita, Università degli Studi dell'Insubria, Varese, Italy
| | - L Szegedi
- Department of Anesthesiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - T Vegh
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary.,Outcomes Research Consortium, Cleveland, USA
| | - G Voyagis
- Department of Anaesthesia, Postoperative ICU, Pain Relief & Palliative Care Clinic, "Sotiria" Chest Diseases Hospital, Athens, Greece.,Department of Anaesthesiology and Critical Care Medicine, University of Patras, Patra, Greece
| | - J Zhong
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - M Gama de Abreu
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M Senturk
- Department of Anaesthesiology and Intensive Care, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
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Kiss T, Wittenstein J, Becker C, Birr K, Cinnella G, Cohen E, El Tahan MR, Falcão LF, Gregoretti C, Granell M, Hachenberg T, Hollmann MW, Jankovic R, Karzai W, Krassler J, Loop T, Licker MJ, Marczin N, Mills GH, Murrell MT, Neskovic V, Nisnevitch-Savarese Z, Pelosi P, Rossaint R, Schultz MJ, Serpa Neto A, Severgnini P, Szegedi L, Vegh T, Voyagis G, Zhong J, Gama de Abreu M, Senturk M. Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial. Trials 2019; 20:213. [PMID: 30975217 PMCID: PMC6460685 DOI: 10.1186/s13063-019-3208-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/17/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Postoperative pulmonary complications (PPC) may result in longer duration of in-hospital stay and even mortality. Both thoracic surgery and intraoperative mechanical ventilation settings add considerably to the risk of PPC. It is unclear if one-lung ventilation (OLV) for thoracic surgery with a strategy of intraoperative high positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM) reduces PPC, compared to low PEEP without RM. METHODS PROTHOR is an international, multicenter, randomized, controlled, assessor-blinded, two-arm trial initiated by investigators of the PROtective VEntilation NETwork. In total, 2378 patients will be randomly assigned to one of two different intraoperative mechanical ventilation strategies. Investigators screen patients aged 18 years or older, scheduled for open thoracic or video-assisted thoracoscopic surgery under general anesthesia requiring OLV, with a maximal body mass index of 35 kg/m2, and a planned duration of surgery of more than 60 min. Further, the expected duration of OLV shall be longer than two-lung ventilation, and lung separation is planned with a double lumen tube. Patients will be randomly assigned to PEEP of 10 cmH2O with lung RM, or PEEP of 5 cmH2O without RM. During two-lung ventilation tidal volume is set at 7 mL/kg predicted body weight and, during OLV, it will be decreased to 5 mL/kg. The occurrence of PPC will be recorded as a collapsed composite of single adverse pulmonary events and represents the primary endpoint. DISCUSSION PROTHOR is the first randomized controlled trial in patients undergoing thoracic surgery with OLV that is adequately powered to compare the effects of intraoperative high PEEP with RM versus low PEEP without RM on PPC. The results of the PROTHOR trial will support anesthesiologists in their decision to set intraoperative PEEP during protective ventilation for OLV in thoracic surgery. TRIAL REGISTRATION The trial was registered in clinicaltrials.gov ( NCT02963025 ) on 15 November 2016.
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Affiliation(s)
- T. Kiss
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J. Wittenstein
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C. Becker
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - K. Birr
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - G. Cinnella
- Department of Anesthesia and Intensive Care, OO Riuniti Hospital, University of Foggia, Foggia, Italy
| | - E. Cohen
- Department of Anesthesiology, The Mount Sinai Hospital, New York, USA
| | - M. R. El Tahan
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - L. F. Falcão
- Federal University of São Paulo, Sao Paulo, Brazil
| | - C. Gregoretti
- UOC Anestesia e Rianimazione A.O.Universitaria “P. Giaccone”, Dipartimento Di.Chir.On.S., Università degli Studi di Palermo, Palermo, Italy
| | - M. Granell
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | - M. W. Hollmann
- Department of Anesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - R. Jankovic
- Clinic for Anesthesia and Intensive Therapy, Clinical Center Nis, School of Medicine, University of Nis, Nis, Serbia
| | - W. Karzai
- Zentralklinik Bad Berka, Bad Berka, Germany
| | | | - T. Loop
- Department of Anesthesiology and Intensive Care Medicine Clinic, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - N. Marczin
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
- Centre of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
| | - G. H. Mills
- Department of Anaesthesia and Intensive Care Medicine, Sheffield Teaching Hospitals, Sheffield University, Sheffield, UK
| | - M. T. Murrell
- Department of Anesthesiology, Weill Cornell Medicine, New York, USA
| | | | | | - P. Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- IRCCS San Martino Policlinico Hospital, Genoa, Italy
| | - R. Rossaint
- Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
| | - M. J. Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - A. Serpa Neto
- Department of Critical Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - P. Severgnini
- Dipartimento di Biotecnologie e Scienze della Vita, Università degli Studi dell’Insubria, Varese, Italy
| | - L. Szegedi
- Department of Anesthesiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - T. Vegh
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
- Outcomes Research Consortium, Cleveland, USA
| | - G. Voyagis
- Department of Anaesthesia, Postoperative ICU, Pain Relief & Palliative Care Clinic, “Sotiria” Chest Diseases Hospital, Athens, Greece
- Department of Anaesthesiology and Critical Care Medicine, University of Patras, Patra, Greece
| | - J. Zhong
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - M. Gama de Abreu
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M. Senturk
- Department of Anaesthesiology and Intensive Care, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - the Research Workgroup PROtective VEntilation Network (PROVEnet) of the European Society of Anaesthesiology (ESA)
- Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Anesthesia and Intensive Care, OO Riuniti Hospital, University of Foggia, Foggia, Italy
- Department of Anesthesiology, The Mount Sinai Hospital, New York, USA
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Federal University of São Paulo, Sao Paulo, Brazil
- UOC Anestesia e Rianimazione A.O.Universitaria “P. Giaccone”, Dipartimento Di.Chir.On.S., Università degli Studi di Palermo, Palermo, Italy
- Hospital General Universitario de Valencia, Valencia, Spain
- University Hospital Magdeburg, Magdeburg, Germany
- Department of Anesthesiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Clinic for Anesthesia and Intensive Therapy, Clinical Center Nis, School of Medicine, University of Nis, Nis, Serbia
- Zentralklinik Bad Berka, Bad Berka, Germany
- Thoracic Center Coswig, Coswig, Germany
- Department of Anesthesiology and Intensive Care Medicine Clinic, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- University Hospital Geneva, Geneva, Switzerland
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
- Centre of Anaesthesia and Intensive Care, Semmelweis University, Budapest, Hungary
- Department of Anaesthesia and Intensive Care Medicine, Sheffield Teaching Hospitals, Sheffield University, Sheffield, UK
- Department of Anesthesiology, Weill Cornell Medicine, New York, USA
- Military Medical Academy, Belgrade, Serbia
- Penn State Hershey Anesthesiology & Perioperative Medicine, Hershey, USA
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- IRCCS San Martino Policlinico Hospital, Genoa, Italy
- Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Critical Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Dipartimento di Biotecnologie e Scienze della Vita, Università degli Studi dell’Insubria, Varese, Italy
- Department of Anesthesiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
- Outcomes Research Consortium, Cleveland, USA
- Department of Anaesthesia, Postoperative ICU, Pain Relief & Palliative Care Clinic, “Sotiria” Chest Diseases Hospital, Athens, Greece
- Department of Anaesthesiology and Critical Care Medicine, University of Patras, Patra, Greece
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Anaesthesiology and Intensive Care, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
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Netti GS, Sangregorio F, Staffieri F, Crovace A, Infante B, Maiorano AM, Castellano G, Di Palma AM, Gesualdo L, Stallone G, Cinnella G, Grandaliano G. FO015LPS REMOVAL REDUCES CD80-MEDIATED MICROALBUMINURIA IN CRITICALLY ILL PATIENTS WITH GRAM-NEGATIVE SEPSIS PREVENTING ACUTE TO CHRONIC KIDNEY DISEASE TRANSITION. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fo015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G S Netti
- Dept. of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - F Sangregorio
- Dept. of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - A Crovace
- DETO, University of Bari, Bari, Italy
| | - B Infante
- Dept. of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - A M Maiorano
- Dept. of Medical and Surgical Sciences, University of Bari, Foggia, Italy
| | | | | | | | - G Stallone
- Dept. of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - G Cinnella
- Dept. of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - G Grandaliano
- Dept. of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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6
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Sivakumar S, Taccone FS, Desai KA, Lazaridis C, Skarzynski M, Sekhon M, Henderson W, Griesdale D, Chapple L, Deane A, Williams L, Strickland R, Lange K, Heyland D, Chapman M, Rowland MJ, Garry P, Westbrook J, Corkill R, Antoniades CA, Pattinson KT, Fatania G, Strong AJ, Myers RB, Lazaridis C, Jermaine CM, Robertson CS, Rusin CG, Hofmeijer J, Sondag L, Tjepkema-Cloostermans MC, Beishuizen A, Bosch FH, van Putten MJAM, Carteron L, Patet C, Solari D, Oddo M, Ali MA, Dias C, Almeida R, Vaz-Ferreira A, Silva J, Monteiro E, Cerejo A, Rocha AP, Elsayed AA, Abougabal AM, Beshey BN, Alzahaby KM, Pozzebon S, Ortiz AB, Cristallini S, Lheureux O, Brasseur A, Vincent JL, Creteur J, Taccone FS, Hravnak M, Yousef K, Chang Y, Crago E, Friedlander RM, Abdelmonem SA, Tahon SA, Helmy TA, Meligy HS, Puig F, Dunn-Siegrist I, Pugin J, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Tomar DS, Shafi M, Harne R, Arora DP, Talwar N, Mazumdar S, Papakrivou EE, Makris D, Manoulakas E, Tsolaki B, Karadodas B, Zakynthinos E, Garcia IP, Martin AD, Encinares VS, Ibañez MP, Montero JG, Labrador G, Cangueiro TC, Poulose V, Koh J, Kam JW, Yeter H, Stepinska J, Pérez AG, Ordoñez PF, Giribet A, Cuervo MAA, Cuervo RA, Esteban MAR, Fraile LI, Mittelbrum CP, Albaiceta GM, Kara A, Koeze J, Keus F, Dieperink W, van der Horst ICC, van Meurs M, Zijlstra JG, Roberts S, Caballero CH, Isgro G, Hall D, Aktepe O, Beitland S, Trøseid AMS, Brusletto BS, Waldum-Grevbo BE, Berg JP, Sunde K, Huertas DG, Manzano F, Quintana MMJ, Osuna A, Topeli A, Santiago-Ruiz F, Rodríguez-Mejías C, Wangensteen R, Jamaati HR, Masjedi M, Zand F, Hashemian SMR, Sabetian G, Abbasi G, Khaloo V, Tsolakoglou I, Tabei SH, Kafilzadeh A, Bakhodaei HH, Diaz JA, Silva R, Garcia DJ, Luis E, Gomez MN, Soriano R, Gonzalez PL, Intas G, Ibrahim IA, Rafik MM, Al-Ansary AM, Algendi MA, Ali AA, Fuhrmann V, Roedl K, Horvatits T, Drolz A, Rutter K, Stergiannis P, Benten D, Kluwe J, Siedler S, Kluge S, Adedugbe I, Bird GT, Kennedy RM, 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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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E, Juliarena A, Bisso MC, Grando M, Tapia A, Camargo M, Ulla DV, Corzo L, dos Santos HP, Ramos A, Doglia JA, Estenssoro E, Carbonara M, Magnoni S, Donald CLM, Shimony JS, Conte V, Triulzi F, Stretti F, Macrì M, Snyder AZ, Stocchetti N, Brody DL, Podlepich V, Shimanskiy V, Savin I, Lapteva K, Chumaev A, Tjepkema-Cloostermans MC, Hofmeijer J, Beishuizen A, Hom H, Blans MJ, van Putten MJAM, Longhi L, Frigeni B, Curinga M, Mingone D, Beretta S, Patruno A, Gandini L, Vargiolu A, Ferri F, Ceriani R, Rottoli MR, Lorini L, Citerio G, Pifferi S, Battistini M, Cordolcini V, Agarossi A, Di Rosso R, Ortolano F, Stocchetti N, Lourido CM, Cabrera JLS, Santana JDM, Alzola LM, del Rosario CG, Pérez HR, Torrent RL, Eslami S, Dalhuisen A, Fiks T, Schultz MJ, Hanna AA, Spronk PE, Wood M, Maslove D. ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zöllner C, Morton B, Mitsi E, Pennington SH, Reine J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB, Koch R, Kox M, Rahamat-Langedoen J, Schloesser J, de Jonge M, Pickkers P, Bringue J, Guillamat-Prats R, Torrents E, Martinez ML, Camprubí-Rimblas M, Artigas A, Blanch L, Park SY, Park YB, Song DK, Shrestha S, Park SH, Koh Y, Park MJ, Hong CW, Lesur O, Coquerel D, Sainsily X, Cote J, Söllradl T, Murza A, Dumont L, Dumaine R, Grandbois M, Sarret P, Marsault E, Salvail D, Auger-Messier M, Chagnon F, Lauretta MP, Greco E, Dyson A, Singer M, Preau S, Ambler M, Sigurta A, Saeed S, Singer M, Sarıca LT, Zibandeh N, Genc D, Gul F, Akkoc T, Kombak E, Cinel L, Akkoc T, Cinel I, Pollen SJ, Arulkumaran N, Singer M, Torrance HD, Longbottom ER, Warnes G, Hinds CJ, Pennington DJ, Brohi K, O’Dwyer MJ, Kim HY, Na S, Kim J, Chang YF, Chao A, Shih PY, Lee CT, Yeh YC, Chen LW, Adriaanse M, Trogrlic Z, Ista E, Lingsma H, Rietdijk W, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cinnella G, Vendemiale G, Dambrosio M, Serviddio G, Pugliese PL, Aspromonte G, Altomare E. Effect of Propofol, Sevoflurane and Desflurane on Systemic Redox Balance. Int J Immunopathol Pharmacol 2016; 20:585-93. [PMID: 17880771 DOI: 10.1177/039463200702000316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We studied the effects of Propofol, Desflurane, and Sevoflurane on the systemic redox balance in patients undergoing laparohysterectomy. We measured blood concentration of glutathione (GSH), plasma antioxidant capacity (Trolox Equivalent Antioxidant Capacity-TEAC), and lipid peroxidation products (malondialdehyde (aMDA) and 4-hydroxynonenal (aHNE) protein adducts). Sixty patients were randomly placed into three groups of twenty people each. In Group P anesthesia was induced with Propofol 2 mg/kg and maintained with 12–10–8 mg/kg/min; in Groups S and D anesthesia was induced with 3 mg/kg Sodium Thiopental and maintained with 2% Sevoflurane and 6% Desflurane, respectively. Blood samples were collected prior to induction (T0bas), 60min and 24h postoperatively (T160' and T224 h). In Group P, GSH increased on T160' (p<0.02) and returned to baseline on T24h, while TEAC remained unmodified; in Groups S, GSH and TEAC decreased on T160' (p<0.01 vs. T0bas, p<0.03 vs. T0bas, respectively); in Group D, on T160' there was a slight decrease of GSH and TEAC. The levels of aMDA slightly decreased throughout the study periods in Group P, increased in Group D, and remained stable in Group S. Propofol showed antioxidant properties, while Sevoflurane and Desflurane seemed to shift the redox balance towards oxidation, yet without inducing overt oxidative damage.
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Affiliation(s)
- G Cinnella
- Institute of Anaesthesiology and Intensive Care, University of Foggia, Foggia, Italy.
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D'Ambrosio A, Spadaro S, Mirabella L, Natale C, Cotoia A, De Capraris A, Menga R, Salatto P, Malvasi A, Brizzi A, Tinelli A, Dambrosio M, Cinnella G. The anaesthetic and recovery profile of two concentrations (0.25% and 0.50%), of intrathecal isobaric levobupivacaine for combined spinal-epidural (CSE) anaesthesia in patients undergoing modified Stark method caesarean delivery: a double blinded randomized trial. Eur Rev Med Pharmacol Sci 2013; 17:3229-3236. [PMID: 24338466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND In spinal anaesthesia for a Caesarean delivery, it is important to limit anaesthesia only at the surgical area, and to resolve fast motor block. We compared the intraoperative effectiveness, hemodynamic effects, anaesthetic recovery times and patients satisfaction after isobaric levobupivacaine (L) 0.25% versus L0.50% spinal anaesthesia during elective Caesarean deliveries performed with the Stark technique. PATIENTS AND METHODS In this double-blinded prospective study, seventy women undergoing elective caesarean delivery were randomized to receive either intrathecal 7.5 mg Levobupivacaine 0.25% plus sufentanil 2.5 μg (Group L0.25), or intrathecal 7.5 mg L 0.50% plus sufentanil 2.5 μg (GroupControl). The onset time, duration of anaesthesia, analgesia and sensory and motor block and hemodynamic parameters were measured from the beginning of spinal anaesthesia until four hours after spinal anaesthesia (T240). RESULTS Onset time, duration of anaesthesia and haemodynamic variations were similar in the two groups. No patients required general anesthesia to complete surgery. Motor block vanished faster in Group L0.25 as compared with GroupControl (p < .01). The cephalad spread of the 0.50% solution was higher than that of the 0.25% solution: no patient in Group L0.25 experienced paresthesia of the upper limbs vs 14% in GroupControl (p < .05). In GroupControl anaesthesia reached the dermatome T1 in 15% of cases. Maternal and surgeon satisfaction was good in every patient. CONCLUSIONS Levobupivacaine 7.5 milligrams at 0.25% may be used as a suitable alternative to L 0.50% for spinal anaesthesia for caesarean deliveris with the Stark technique with good maternal satisfaction. In Group L0.25 a lower appearance of nausea and hypotension were observed and motor and sensitive block developed and diminished faster while no clinically significant differences in hemodynamic behavior was observed between groups.
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Affiliation(s)
- A D'Ambrosio
- Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy.
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Pugliese PL, Cinnella G, Raimondo P, De Capraris A, Salatto P, Sforza D, Menga R, D'Ambrosio A, Fede RN, D'Onofrio C, Consoletti L, Malvasi A, Brizzi A, Dambrosio M. Implementation of epidural analgesia for labor: is the standard of effective analgesia reachable in all women? An audit of two years. Eur Rev Med Pharmacol Sci 2013; 17:1262-1268. [PMID: 23690198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Social and cultural factors combined with little information may prevent the diffusion of epidural analgesia for pain relief during childbirth. The present study was launched contemporarily to the implementation of analgesia for labor in our Department in order to perform a 2 years audit on its use. The goal is to evaluate the epidural acceptance and penetration into hospital practice by women and care givers and safety and efficacy during childbirth. PATIENTS AND METHODS This audit cycle measured epidural analgesia performance against 4 standards: (1) Implementation of epidural analgesia for labor to all patients; (2) Acceptance and good satisfaction level reported by patients and caregivers. (3) Effectiveness of labor analgesia; (4) No maternal or fetal side effects. RESULTS During the audit period epidural analgesia increased from 15.5% of all labors in the first trimester of the study to 51% in the last trimester (p < 0.005). Satisfaction levels reported by patients and care givers were good. A hierarchical clustering analysis identified two clusters based on VAS (Visual Analogue Scale) time course: in 226 patients (cluster 1) VAS decreased from 8.5±1.4 before to 4.1±1.3 after epidural analgesia; in 1002 patients (cluster 2) VAS decreased from 8.12±1.7 before (NS vs cluster 1), to 0.76±0.79 after (p < 0.001 vs before and vs cluster 2 after). No other differences between clusters were observed. CONCLUSIONS Present audit shows that the process of implementation of labor analgesia was quick, successful and safe, notwithstanding the identification of one cluster of women with suboptimal response to epidural analgesia that need to be further studies, overall pregnant womens'adhesion to labor analgesia was satisfactory.
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Affiliation(s)
- P L Pugliese
- Department of Anaesthesia and Intensive Care, University of Foggia, Foggia, Italy
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De Capraris A, Cinnella G, Marolla A, Salatto P, Da Lima S, Vetuschi P, Consoletti L, Gesualdo L, Dambrosio M. Micro Opioid Receptor A118G Polymorphism and Post-Operative Pain: Opioids' Effects on Heterozigous Patients. Int J Immunopathol Pharmacol 2011; 24:993-1004. [DOI: 10.1177/039463201102400417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Single-Nucleotide-Polymorphism (SNP) 118A>G in the μ-1 Opioid Receptor gene (OPRM1) is associated with a decrease in the analgesic effects of opioids. The aim of this study is to assess whether 118A>G polymorphism could influence the analgesic response to opioid-based postoperative pain (POP) therapy. The study consisted of two parts: section α, observational, included 199 subjects undergoing scheduled surgical procedures with pain management standardized on surgery invasiveness and on expected level of postoperative pain; section β, randomized, included 41 women undergoing scheduled caesarean delivery with continuous intra-operative epidural anesthesia and post-operative analgesia (CEA). In both sections, POP was measured over 48 h (T6h-T24h-T48h) by the visual analogue scale (VAS). In section β we also tested the responsiveness of hypothalamic-pituitary-adrenal axis (HPA) expressed by Cortisol levels. In section α, with cluster analysis, subjects were analyzed according to their genotype: a group (#1) of 34 patients reporting VAS score >3 at every time lapse was identified and included only A118G carriers, while wild-type (A118A - absence of 118A>G polymorphism) patients were unevenly distributed between those with cluster #2 (VAS score <3 at every study steps) and those with cluster #3 (VAS score progressively reducing from T6h). In section (3, A118G carriers receiving epidural sufentanil had the lowest VAS scores at T24h; also in these patients, Cortisol levels remained more stable, with a mild decrease at T6h. This study shows that the OPRM1 118A>G polymorphism affects postoperative pain response in heterozygous patients: they have a different postoperative pain response than patients with wild-type genes, which may affect the efficacy of the analgesic therapy.
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Affiliation(s)
- A. De Capraris
- Unit of Anesthesia and Intensive Care, University Hospital of Foggia, Foggia
| | - G. Cinnella
- Department of Surgical Science, Unit of Anesthesia and Intensive Care, University Hospital of Foggia, Foggia
| | - A. Marolla
- Department of Surgical Sciences, University Hospital of Foggia, Foggia
| | - P. Salatto
- Unit of Anesthesia and Intensive Care, University Hospital of Foggia, Foggia
| | - S. Da Lima
- Unit of Anesthesia and Intensive Care, University Hospital of Foggia, Foggia
| | - P. Vetuschi
- Unit of Anesthesia and Intensive Care, University Hospital of Foggia, Foggia
| | - L. Consoletti
- Unit of Anesthesia and Intensive Care, University Hospital of Foggia, Foggia
| | - L. Gesualdo
- Department of Biomedical Sciences, Unit of Nephrology, University Hospital of Foggia, Foggia, Italy
| | - M. Dambrosio
- Department of Surgical Science, Unit of Anesthesia and Intensive Care, University Hospital of Foggia, Foggia
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Cinnella G, Grasso S, Natale C, Sollitto F, Cacciapaglia M, Angiolillo M, Pavone G, Mirabella L, Dambrosio M. Physiological effects of a lung-recruiting strategy applied during one-lung ventilation. Acta Anaesthesiol Scand 2008; 52:766-75. [PMID: 18582305 DOI: 10.1111/j.1399-6576.2008.01652.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND One-lung ventilation (OLV) affects respiratory mechanics and ventilation/perfusion matching, reducing functional residual capacity of the ventilated lung. While the application of a lung-recruiting manoeuvre (RM) on the ventilated lung has been shown to improve oxygenation, data regarding the impact of RM on respiratory mechanics are not available. METHODS Thirteen patients undergoing lung resection in lateral decubitus were studied. During OLV, a lung-recruiting strategy consisting in a RM lasting 1 min followed by the application of positive end-expiratory pressure 5 cmH(2)O was applied to the ventilated lung. Haemodynamics, gas exchange and respiratory mechanics parameters were recorded on two-lung ventilation (TLV(baseline)), OLV before and 20 min after the RM (OLV(pre-RM), OLV(post-RM), respectively) and TLV(end). Haemodynamics parameters were also recorded during the RM. RESULTS The PaO(2)/FiO(2) ratio was 358+/-126 on TLV(baseline); it decreased to 235+/-113 on OLV(pre-RM) (P<0.01) increased to 351+/-120 on OLV(post-RM) (P<0.01 vs. OLV(pre-RM)), and remain stable thereafter. During the RM, CI decreased from 3.04+/-0.7 l/m(2) OLV(pre-RM) to 2.4+/-0.6 l/m(2) (P<0.05), and returned to baseline on OLV(post-RM) (3.1+/-0.7 l/m(2), NS vs. OLV(pre-RM)). The RM resulted in alveolar recruitment and caused a significant decrease in static elastance of the dependent lung (16.6+/-8.9 cmH(2)O/ml OLV(post-RM) vs. 22.3+/-8.1 cmH(2)O/ml OLV(pre-RM)) (P<0.01). CONCLUSIONS During OLV in lateral decubitus for thoracic surgery, application to the dependent lung a recruiting strategy significantly recruits the dependent lung, improving arterial oxygenation and respiratory mechanics until the end of surgery. However, the transient haemodynamic derangement occurring during the RM should be taken into account.
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Affiliation(s)
- G Cinnella
- Dipartimento di Scienze Chirurgiche, Sezione di Anestesiologia e Rianimazione, Università degli Studi di Foggia, Policlinico Riuniti, Foggia, Italy.
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Abstract
Intra-abdominal hypertension (IAH) can affect liver hemodynamics but it is not known if has a significant clinical impact on liver function. The aim of this study was to investigate the relationship between IAH and liver function. A prospective study was performed in 110 adult intensive care unit (ICU) patients. Intra-abdominal pressure (IAP) was measured on admission and every other day, and liver sequential organ failure assessment (SOFA) score was collected whenever IAP was measured. IAH was defined by a IAP >or= 10 mm Hg, and liver dysfunction was defined by a hepatic SOFA score >or= 2. An overall IAH incidence of 56.3% was found (n = 62). Thirty-three patients presented a liver SOFA score >or= 2, with an overall incidence of 30%. Liver SOFA score of the group of patients with abdominal hypertension was higher than in group of patients without abdominal hypertension. (0.8 +/- 1.05 vs 0.4 +/- 0.7; P < .05), but IAH and liver dysfunction were not significantly associated (chi2 = 2.03; P = .15). When the whole sample was divided according to the worst IAP score (IAP < 10, IAP between 10 and 15, and IAP > 15), the corresponding liver dysfunction scores in the three groups were 0.35 +/- 0.6, 0.74 +/- 1, and 1.2 +/- 1.3, respectively (P = .01). A strict association between IAH and liver dysfunction was not found. Most likely, low levels of IAH, although able to reduce liver blood flow, are not per se sufficient to produce a real dysfunction; however, a correlation between the degree of IAH and the degree of hyperbilirubinemia exists. IAH does not seem to be an "on-off" phenomenon, but produces liver alterations for increasing levels of its severity.
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Affiliation(s)
- L Dalfino
- Emergency and Organ Transplantation Department, Anesthesia and Intensive Care Division, University of Bari, Bari, Italy.
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Cinnella G, Giardina C, Fischetti A, Lecce G, Fiore MG, Serio G, Carravetta G, Dambrosio M, Fiore T. Airways humidification during mechanical ventilation. Effects on tracheobronchial ciliated cells morphology. Minerva Anestesiol 2005; 71:585-93. [PMID: 16163148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIM Airways humidification during mechanical ventilation (MV) can be performed by means of heat and moisture exchangers (HME). Good performance of selected hygroscopic HME was shown in terms of tracheal temperature and humidity control and low tube obstruction rates. However, few data are available on their effects on tracheobronchial ciliated cells. The purpose of this study was to evaluate the effects of 2 different HME on ciliated cell during MV. METHODS Twenty consecutive patients undergoing elective surgery lasting <4 h were randomly assigned to be treated with Rusch (Group 1) or Mediflux (Group 2) hygroscopic HME. The morphology of tracheobronchial ciliated cells was evaluated from cytologic smears of endotracheal aspirate. Smears were prepared by using the thin-prep processor, stained using the Papanicolau method and examined in triplicate: recognizable respiratory cells were graded on a six-point scale, according to the normal appearance of cilia, cytoplasm and nucleus. RESULTS In Group 1, 178.3+37 cells were retrieved from aspirates and , 155.6+58 in Group 2 (NS). The score was 739+241 in Group 1 and 617+329 in Group 2 (NS). Cilia and end plate were undamaged in 80+17% and 81+20% cells respectively in Group 1 and in 56+23% and 62+22% cells respectively in Group 2 (P<0.01 and <0.05). CONCLUSIONS During MV epithelial tracheobronchial cells can be affected by the humidification device used. Our findings suggest that the 2 HME tested in the present study have a different impact on ciliated cells structure.
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Affiliation(s)
- G Cinnella
- Department of Anaesthesiology and Intensive Care, University of Foggia-Maternity Hospital, Via IV Novembre 1, 71100 Foggia, Italy
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Dambrosio M, Tullo L, Moretti B, Patella V, Simone C, Calò MN, Dalfino L, Cinnella G. [Hemodynamic and respiratory changes during hip and knee arthroplasty. An echocardiographic study]. Minerva Anestesiol 2002; 68:537-47. [PMID: 12105410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND The "bone cement implantation syndrome" is a rare but severe complication observed especially during the insertion of cemented prostheses in hip and knee replacement surgery. Several mechanisms are involved: effects of methylmethacrilate, embolism of fat, air and bone marrow, and release of tissue thromboplastin during acetabular and femoral reaming. Aim of this study was to detect embolic events, right heart impairment, hemodynamic and respiratory changes during hip and knee replacement surgery. METHODS DESIGN Prospective study, between February-May 2001. ENVIRONMENT Orthopedic Operative room. PATIENTS Twenty-one patients who underwent total hip or knee arthroplasty under general anesthesia. Patients were divided in methylmethacrylate cemented prostheses groups (CEM, n=10) and totally uncemented prostheses (NON CEM, n=11). DATA COLLECTION Standard anesthesia monitoring and omniplane TEE were performed. TEE probe was positioned in order to obtain "inflow-outflow" views of right heart. Measurements were obtained after anesthesia induction (T1), during femoral realing (T2) at prostheses insertion (T3), and at the end of surgery (T4). RESULTS Hemodynamic and respiratory parameters measured in different phases of surgical procedures were not different within groups and between groups. Fourtheen patients had TEE evidence of emboli, and the phenomenon was more evident in CEM group (Z= -347; p<0.001). During prostheses insertion, a slight, not significant increase in right ventricular dimensions was observed in both groups, without any right ventricular wall kinetic abnormality. No difference was observed between groups. No adverse cardiac or cerebrovascular events in intra- and postoperatory period were observed. CONCLUSIONS In normal patients total hip or knee arthroplasty is associated with embolic phenomena, without any significant change in systemic and right heart hemodynamics. Insertion of cemented prostheses does not modify hemodynamic profile. It remains to be elucidated if the occurrence of emboli has a critical role in patients with cardiorespiratory disease.
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Affiliation(s)
- M Dambrosio
- Cattedra di Anestesia e Rianimazione, Università degli Studi, Foggia, Italy.
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Cinnella G, Dambrosio M, Brienza N, Giuliani R, Bruno F, Fiore T, Brienza A. Independent lung ventilation in patients with unilateral pulmonary contusion. Monitoring with compliance and EtCO(2). Intensive Care Med 2001; 27:1860-7. [PMID: 11797020 DOI: 10.1007/s00134-001-1149-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2001] [Accepted: 10/09/2001] [Indexed: 12/21/2022]
Abstract
OBJECTIVE a) to describe a non-barotraumatic ventilatory setting for independent lung ventilation (ILV); b) to determine the utility of single lung end-tidal CO(2) (EtCO(2)) monitoring to evaluate the ventilation to perfusion (V/Q) matching in each lung during ILV and for ILV weaning. DESIGN prospective study. SETTING general intensive care unit in a university teaching hospital. PATIENTS twelve patients with unilateral thoracic trauma needing ILV. INTERVENTIONS AND RESULTS ILV was started with each lung ventilated with the same tidal volume (Vt): plateau airway pressure (Pplat) was 34.2+/-3.2 cmH2O in diseased lungs (DL) and 18.1+/-1.9 cmH2O in normal lungs (NL) ( P<0.01). Static compliance (Cst) was 9.9+/-1.1 ml/cmH(2)O in DL and 19.3+/-1.7 ml/cmH(2)O in NL ( P<0.01). EtCO2 was 22.5+/-2.2 mmHg in DL and 36.6+/-1.9 mmHg in NL ( P<0.01). PaO(2)/FiO(2) was at 151+/-20. PEEP was applied on the DL and each lung was ventilated with a Vt that developed Pplat < or =26 cmH2O. With this setting, Vt given to the NL was unchanged, whereas it was reduced in the DL (238+/-30 ml vs 350+/-31 ml; P<0.01). Cst and EtCO2 were still significantly lower in the DL ( P<0.01, respectively), while the PaO(2)/FiO(2) ratio remained unchanged. Vt was then progressively increased in the DL as Pplat decreased, but remained unchanged in the NL. ILV was discontinued when Vt, Cst and EtCO(2) were the same in each lung. PaO(2)/FiO(2) ratio had then increased to 295+/-18. CONCLUSIONS a) during ILV, adequate oxygenation and a reduction in V/Q mismatch can be obtained by setting Vt and PEEP to keep Pplat below a safe threshold for barotrauma; b) measurement of single lung EtCO2 can be useful to evaluate progressive V/Q matching.
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Affiliation(s)
- G Cinnella
- Department of Anesthesia and Intensive Care, University of Foggia, Italy
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Cinnella G, Dambrosio M, Brienza N, Bruno F, Brienza A. Compliance and capnography monitoring during independent lung ventilation: report of two cases. Anesthesiology 2000; 93:275-8. [PMID: 10861174 DOI: 10.1097/00000542-200007000-00043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- G Cinnella
- Istituto di Anestesiologia e Rianimazione, Policlinico, Università di Bari, Italia.
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Affiliation(s)
- G Cinnella
- Istituto di Anestesiologia e Ranimazione-Policlinico, Bari, Italy
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Villafane MC, Cinnella G, Lofaso F, Isabey D, Harf A, Lemaire F, Brochard L. Gradual reduction of endotracheal tube diameter during mechanical ventilation via different humidification devices. Anesthesiology 1996; 85:1341-9. [PMID: 8968181 DOI: 10.1097/00000542-199612000-00015] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Limited data suggest that increased resistance to flow within endotracheal tubes (ETT) may occur in patients whose lungs are mechanically ventilated for more than 48 h, especially when airway humidification is inadequate. This could lead to sudden ETT obstruction or induce excessive loading during spontaneous breathing. METHODS Twenty-three such patients were randomly assigned to three types of airway humidifier based on three different working principles: a Fisher Paykell hot water system (n = 7), a Pall BB2215 heat and moisture exchanger (HME) hydrophobic filter (n = 8), and a Dar Hygrobac 35254111 HME hygroscopic filter (n = 8). The decrease in internal pressure along the ETT and the flow rate were measured in each patient every 2 days. An "effective inner diameter" was derived from these measurements and allowed the inner ETT configuration to be monitored. RESULTS On the first day of intubation, the mean diameter was similar in the three groups, and was slightly smaller than the in vitro diameter (mean +/- SD: 7.6 +/- 0.6 mm for Fisher-Paykell, 7.7 +/- 0.4 for Pall, and 7.5 +/- 0.4 for Dar). The mean diameter tended to decrease from day to day. At the end of the study, the overall reduction in mean diameter was significantly greater with the hydrophobic HME (Pall) than with the two other systems (Pall: -6.5 +/- 4% vs. 2.5 +/- 2.5% for Dar and 1.5 +/- 3% for Fisher-Paykell; P < 0.01 with analysis of variance). The same was true of the mean reduction in effective inner ETT diameter expressed per day of ventilation (-1.6 +/- 1.5% per day for Pall vs. -0.5 +/- 0.4% for Dar and -0.2 +/- 0.4% for Fisher-Paykell; P < 0.01). In four patients, the ETT became obstructed and emergency repeated tracheal intubation was required. The Pall HME and the Fisher-Paykell system were being used in three and one patient, respectively. Before obstruction, the reduction in ETT diameter was significantly greater for these four patients than for the remaining 23 patients (7.8 +/- 1.4% vs. 3.1 +/- 4.1%; P < 0.01). CONCLUSIONS During prolonged mechanical ventilation, significant alterations in inner ETT configuration occur frequently and are influenced by the type of humidification device used. In vivo monitoring of ETT mechanical properties might be clinically useful.
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Affiliation(s)
- M C Villafane
- Department of Physiology, Hôpital Henri Mondor, Université Paris XII, Créteil, France
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Conti G, Cinnella G, Barboni E, Lemaire F, Harf A, Brochard L. Estimation of occlusion pressure during assisted ventilation in patients with intrinsic PEEP. Am J Respir Crit Care Med 1996; 154:907-12. [PMID: 8887584 DOI: 10.1164/ajrccm.154.4.8887584] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We conducted a study to assess the validity of the occlusion pressure (P0.1) measured during activation of the trigger mechanism (P0.1(aw)trig) in patients showing variable levels of PEEPi during pressure-support ventilation. We first compared P0.1(aw)trig and P0.1 measured with the conventional method (i.e., the airway pressure drop after the first 100 ms of an occluded inspiration) in 16 patients with chronic obstructive pulmonary disease (COPD). We observed good agreement and a highly significant correlation (r = 0.99; bias = 0.3 +/- 0.5 cm H20) between the two methods. In a second part of the study, we compared, in 17 patients, P0.1(aw)trig with (P0.1(es)), measured as the depression generated on the esophageal pressure tracing in the first 100 ms of the inspiratory negative swing, and with P0.1 measured on the P(es) tracing simultaneously with P(aw)trig (P0.1(es-synchro)). Our results showed a good correlation and good agreement between P(aw)trig and P0.1(es) (r = 0.92; bias = 0.3 +/- 0.5 cm H20); P(aw)trig and P0.1(es-synchro) (r = 0.97; bias = 0.1 +/- 0.2 cm H20); and P0.1(es) and P0.1(es-synchro) (r = 0.95, bias = 0.2 +/- 0.4 cm H20), respectively. This study suggests that reliable measurements of inspiratory drive can be obtained easily, on a breath-by-breath basis, from airway pressure tracings during pressure-support ventilation in patients with variable levels of PEEPi.
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Affiliation(s)
- G Conti
- Service de Réanimation Medicale, INSERM U296, Hôpital Henri Mondor, Creteil, France
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Török T, Kardos A, Rudas L, Paprika D, McLuckie A, Beale RJ, Bihari D, Keller H, Seltzer N, Weimer A, Menning H, Ulrich P, Staedt U, Kirschstein W, Kasai T, Endo S, Arakawa N, Sato N, Suzuki T, Taniguchi S, Inada K, Hiramori K, Schmidt W, Meineke I, Nottrott M, Frerichs I, Müller S, Hellige G, De Blasio E, De Sio A, Sibilio G, Papa A, Golia D, Grassia V, Bove G, Zehelgruber M, Mundigler G, Christ G, Merhaut C, Klaar U, Kratochwill C, Hofmann S, Siostrzonek P, Suarez F, Corrales M, Rábago R, Gonzalez-Arenas P, Morales R, Sanchez J, Fraile J, Rey M, Martinell J, Niederst PN, Mellwig KP, Schmidt HK, Gleichmann U, Körfer R, Di Bartolomeo S, Bertolissi M, Nardi G, De Monte A, Janssens U, Ochs JG, Klues HG, Hanrath P, Sajjanhar T, Tibby SM, Hatherill M, Anderson D, Murdoch IA, Krivec B, Voga G, Žuran I, Skale R, Parežnik R, Podbregar M, Bonnefoy E, Chevalier P, Kirkorian G, Guidolet J, Marchand A, Bouchayer D, Marcaz PB, Touboul P, Welte T, Molling J, Jepsen MS, Claus G, Klein H, Cinnella G, Dambrosio M, Brienza N, Conte M, Maggiore SM, Leone AM, Brienza A, DiVenere N, Vandewoude K, Poelaert J, Vogelaers D, Garcia RB, Buylaert W, Roosens C, Colardyn F, Annane D, Béllissant E, Pussard E, Asmar R, Lacombe F, Lanata E, Madonna O, Safar M, Giudicelli JF, Raphael JC, Gajdos P, Mattys M, Dumont L, Annaert JF, Mardirosoff C, Goldstein J, Verbeet T, Massaut J, Haas NA, Uhlemann F, Daehnert I, Berger F, Stiller B, Dittrich S, Schulze-Neick I, Eweit P, Lange PE, Langenherp CJM, Pietersen H, Geskes G, Wagenmakers A, Soeters P, Maggiorini M, Brimioulle S, Lejeune P, Delcroix M, Vermeulen F, Stephanazzi J, Naeije R, Kunert M, Stolzenburg H, Scheuble L, Emmerich K, Ulbricht LJ, Krakau I, Gülker H, Broch MJ, Valentín V, Murcia B, Bartual E, Málaga A, Miralles LL, Valls F, Wallin CJ, Sidenö B, Vaage J, Leksell LG, Stuchlinger HG, Seidler D, Hollenstein U, Janata K, Muellner M, Loeffler W, Gamper G, Bur A, Malzer R, Laggner AN, Hirschl MM, Binder M, Herkner H, Bur A, Laggner AN, Turani F, Ceraso C, Lironcurti A, Senesi P, Leonardis C, Sabato AF, Pietersen HG, Langenberg CJM, Geskes G, Wagenmakers AJM, de Lange S, Soeters PB, Royira A, Oussedik L, Cambray C, Glmeno C, Cerda M, Sanchez MA, Lesmes A, Guerrero M, Vigil E, Ortega F, Lucena F, Righini ER, Alvisi R, Marangoni E, Gritti G, Ordóñez A, Hernández A, Pérez-Bernal J, Hinojosa R, Borrego JM, Franco A, López-Barneo J, Pérez-Bernal J, Gutiérrez E, Hinojosa R, Hernández A, Borrego JM, Cerro J, Rincón D, Ordóñez A, Martin R, Saussine M, Sany CL, Calvet B, Raison D, Frapier JM, Wallin CJ, Olsson Å, Nordländer R, Leksell LG, Vasilkov V, Safronov A, Marinchev V, Rodrigues AC, Moraes A, Galas F, Angelim V, Medeiros C, Auler JO, Bellotti G, Pilleggi F, Carmona MJ, Messias ERR, Joseph D, Baigorri F, Artigas A, Blanch L, Wagner F, Dandel M, Günther G, Schulze-Neick I, Weng Y, Loebe M, Hetzer R, Colreavy F, Balea M, Cahalan M, Carpintero JL, de la Fuente MC, Estecha MA, Molina JM, del Fresno LR, Daga D, Toro R, Poullet A, de la Torre MV, Garcia AJ, Michalopoulos A, Rellos K, Skambas D, Liakopoulos O, Geroulanos S. Posters. Intensive Care Med 1996. [DOI: 10.1007/bf03216414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dambrosio M, Cinnella G, Brienza N, Ranieri VM, Giuliani R, Bruno F, Fiore T, Brienza A. Effects of positive end-expiratory pressure on right ventricular function in COPD patients during acute ventilatory failure. Intensive Care Med 1996; 22:923-32. [PMID: 8905427 DOI: 10.1007/bf02044117] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the effects of external positive end-expiratory pressure (PEEP) on right ventricular function in chronic obstructive pulmonary disease (COPD) patients with intrinsic PEEP (PEEPi). DESIGN Prospective study. SETTING General intensive care unit in a university teaching hospital. PATIENTS Seven mechanically ventilated flow-limited COPD patients (PEEPi = 9.7 +/- 1.3 cmH2O, mean +/- SD) with acute respiratory failure. INTERVENTION Hemodynamic and respiratory mechanic data were collected at four different levels of PEEP (0-5-10-15 cmH2O). MEASUREMENTS AND RESULTS Hemodynamic parameters were obtained by a Swan-Ganz catheter with a fast response thermistor. Cardiac index (CI) and end-expiratory lung volume (EELV) reductions started simultaneously when the applied PEEP was approximately 90% of PEEPi measured on 0 cmH2O (ZEEP). Changes in transmural intrathoracic pressure (PEEPi,cw) started only at a PEEP value much higher (120%) than PEEPi. The reduction in CI was related to a decrease in the right end-diastolic ventricular volume index (RVEDVI) (r = 0.61; p < 0.001). No correlation between CI and transmural right atrial pressure was observed. The RVEDVI was inversely correlated with PEEP-induced changes in EELV (r = -55; p < 0.001), but no with PEEPi,cw (r = -0.08; NS). The relationship between RVEDVI and right ventricular stroke work index, considered an index of contractility, was significant in three patients, i.e., PEEP did not change contractility. In the other patients, an increase in contractility seemed to occur. CONCLUSIONS In COPD patients an external PEEP exceeding 90% of PEEPi causes lung hyperinflation and reduces the CI due to a preload effect. The reduction in RVEDVI seems related to changes in EELV, rather than to changes in transmural pressures, suggesting a lung/heart volume interaction in the cardiac fossa. Thus, in COPD patients, application of an external PEEP level lower than PEEPi may affect right ventricular function.
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Affiliation(s)
- M Dambrosio
- Istituto di Anestesiologia e Rianimazione, Università degli Studi di Bari, Italy
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Dambrosio M, Fiore G, Brienza N, Cinnella G, Marucci M, Ranieri VM, Greco M, Brienza A. Right ventricular myocardial function in ARF patients. PEEP as a challenge for the right heart. Intensive Care Med 1996; 22:772-80. [PMID: 8880246 DOI: 10.1007/bf01709520] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the hemodynamic effects of external positive end-expiratory pressure (PEEP) on right ventricular (RV) function in acute respiratory failure (ARF) patients. DESIGN Prospective, with retrospective analysis on the basis of RV volume response to PEEP. SETTING General intensive care unit in a university teaching hospital. PATIENTS 20 mechanically ventilated ARF patients (mean lung injury score = 2.6 +/- 0.45 SD). INTERVENTION Incremental levels of PEEP (0-5-10-15 cmH2O) were applied and RV hemodynamics were studied by means of a Swan-Ganz catheter with a fast-response thermistor for right ventricular ejection fraction (RVEF) measurement. According to their response to PEEP 15, two groups of patients were defined: group A (9 patients) with unchanged or increased RV end-diastolic volume index (RVEDVI) and group B (11 patients) with decreased RVEDVI. MEASUREMENTS AND RESULTS At zero PEEP (ZEEP) the hemodynamic parameters of the two groups did not differ. In group A, cardiac index (CI) and stroke volume index (SI) decreased at all PEEP levels (5, 10, and 15 cmH2O), while RVEF started to decrease only at a PEEP of 10 cmH2O (-10.8%), and RVES(systolic)VI increased only at PEEP 15 cmH2O (+21.5%). RVEDVI was not affected by PEEP. In group B, CI and SI decreased at all PEEP levels (5, 10, and 15 cmH2O). Similarly, RVEDVI started to decrease at PEEP 5 cmH2O, while RVESVI decreased only at PEEP 15 cmH2O (-21.4%). RVEF was not affected by PEEP in this group. In each patient the slope of the relationship between RVEDVI and right ventricular stroke work index (RVSWI), expressing RV myocardial performance, was studied. This relationship was significant (no change in RV contractility) in 8 of 11 patients in group B and in only 2 patients in group A. In 4 patients in group A, PEEP shifted the RVSWI/RVEDVI ratio rightward in the plot, indicating a decrease in RV myocardial performance in these patients. CONCLUSIONS PEEP affects RV function in ARF patients. The decrease in cardiac output is more often associated with a preload decrease and no change in RV contractility. On the other hand, the finding of increased RV volumes with PEEP may be associated with a reduction in RV myocardial performance. Thus, these results suggest that assessment of RV function by PEEP and preload recruitable stroke work may disclose otherwise unpredictable alterations in RV function.
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Affiliation(s)
- M Dambrosio
- Istituto di Anestesiologia e Rianimazione, Università degli Studi di Bari, Policlinico, Bari, Italy.
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Brienza N, Dambrosio M, Cinnella G, Conte M, Puntillo N, Bruno F. [Effects of PEEP on intrathoracic and extrathoracic blood volumes evaluated with the COLD system in patients with acute respiratory failure. Preliminary study]. Minerva Anestesiol 1996; 62:235-42. [PMID: 8999373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM OF THE STUDY To evaluate the effects of positive end expiratory pressure (PEEP) on intrathoracic and extrathoracic blood volumes in patients with acute respiratory failure (ARF). METHODS In 4 ARF patients, we have measured cardiac output (CI), intrathoracic blood volume (ITBVI), global end-diastolic ventricular volume (GEDVI), pulmonary (PBVI) and total (TBVI) blood volumes, during application of two PEEP levels (0 and 10 cm H2O). These measurements have been performed by PULSION COLD Z-021 system, using the double indicator dilution technique (thermal and dye dilution). RESULTS PEEP application caused a significant reduction in CI (from 3.8 +/- 0.4 to 2.9 +/- 0.1 1/min/m2) and ITBVI (from 888 +/- 48 to 698 +/- 25 ml/m2). The reduction in intrathoracic blood volume was associated with a significant reduction in GEDVI and PBVI. After PEEP application, there was a significant reduction in TBVI (from 2437 +/- 135 to 1984 +/- 49 ml/m2). CONCLUSIONS PEEP application decreases cardiac index, mainly through a preload reduction, as evidenced by the reduction in intrathoracic and end-diastolic ventricular blood volumes. The preload effect is due to an increase in intrathoracic pressure with reduction in total circulating blood volume. TBVI reduction is consistent with blood pooling in vascular compartments, e.g., splanchnic compartment, characterized by long vascular time constant.
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Affiliation(s)
- N Brienza
- Istituto di Anestesia e Rianimazione, Università degli Studi, Bari
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Cinnella G, Conti G, Lofaso F, Lorino H, Harf A, Lemaire F, Brochard L. Effects of assisted ventilation on the work of breathing: volume-controlled versus pressure-controlled ventilation. Am J Respir Crit Care Med 1996; 153:1025-33. [PMID: 8630541 DOI: 10.1164/ajrccm.153.3.8630541] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
During assisted ventilation, the same tidal volume can be delivered in different ways, with the possibility for the physician to vary the ventilatory target (pressure or volume) and the peak flow setting. We compared the effects on the respiratory work rate of assisted ventilation, delivered either with a square wave flow pattern (assist control ventilation [ACV]) or with a decelerating flow pattern and a constant pressure (assisted pressure-control ventilation [APCV]). In the first part of the study where seven patients were studied, inspiratory time and tidal volume were similar in the two modes of ventilation. High and moderate levels of tidal volume (VT) were studied (12 ml/kg and 8 ml/kg, respectively). To obtain moderate VT, inspiratory time was kept constant and, therefore, mean inspiratory flow was reduced. At high VT, no difference between ACV and APCV was noted for breathing pattern, respiratory drive indexes, respiratory muscle work, or arterial blood gases. All patients exhibited respiratory alkalosis. At moderate VT, normal pH was achieved. In this situation significantly lower levels were observed during APCV than during ACV for the power of breathing (10 +/- 2 versus 19 +/- 5 J/min, p<0.05), transdiaphragmatic pressure swing (7 +/- 1 versus 11 +/- 2 cm H2O, p<0.05), and pressure-time index (252 +/- 43 versus 484 +/- 114 cm H2O.s, p<0.05), even though breathing pattern and gas exchange were similar. In the second part of the study where six additional patients were studied, tidal volume was kept constant at a moderate level (8 ml/kg), and we studied the effect of shortening inspiratory time and increasing mean inspiratory flow. At moderate VT and high inspiratory flow, no significant differences could be found between ACV and APCV, and although pressure-time index tended to be lower during APCV, absolute levels of effort were of small magnitude (56 +/- 55 versus 76 +/- 55 cm H2O.s). We conclude that at moderate VT and low flow rates only, inspiratory assistance delivered at a constant pressure reduces the respiratory work rate more effectively than assist control ventilation.
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Affiliation(s)
- G Cinnella
- Medical Intensive Care Unit, Paris XII University, Hôpital Henri Mondor, Créteil France
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Ranieri VM, Giuliani R, Cinnella G, Pesce C, Brienza N, Ippolito EL, Pomo V, Fiore T, Gottfried SB, Brienza A. Physiologic effects of positive end-expiratory pressure in patients with chronic obstructive pulmonary disease during acute ventilatory failure and controlled mechanical ventilation. Am Rev Respir Dis 1993; 147:5-13. [PMID: 8420430 DOI: 10.1164/ajrccm/147.1.5] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Dynamic hyperinflation and intrinsic positive end-expiratory pressure (PEEPi) are observed in patients with chronic obstructive pulmonary disease (COPD) and flow limitation. Several reports suggest that PEEP levels approaching PEEPi reduce inspiratory load due to PEEPi, without further hyperinflation. Hence PEEP should not increase intrathoracic pressure or affect hemodynamics and gas exchange. To verify this hypothesis, the effects of PEEP (0 to 15 cm H2O) on respiratory mechanics, hemodynamics, and gas exchange were studied in nine COPD patients during controlled mechanical ventilation. PEEP levels approaching PEEPi (9.8 +/- 0.5 cm H2O) did not affect the expiratory flow/volume relationship, confirming the presence of flow limitation. PEEP levels of 5 and 10 cm H2O did not change lung volume and PEEPi in the respiratory system (PEEPtot,rs) and chest wall (PEEPtot,cw) or affect hemodynamics and gas exchange. When applied PEEP overcame PEEPi, changes in lung volume and the expiratory flow/volume relationship were observed. PEEPtot,rs and PEEPtot,cw also increased. Under these circumstances, PEEP increased static elastance in both the respiratory system and the chest wall, reducing cardiac index and affecting hemodynamics and gas exchange. Our data show that in mechanically ventilated COPD patients with PEEPi due to flow limitation, PEEP levels exceeding the 85% of PEEPi (Pcrit) caused further hyperinflation and compromised hemodynamics and gas exchange.
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Affiliation(s)
- V M Ranieri
- Istituto di Anestesiologia e Rianimazione, Policlinico, Università di Bari, Italy
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Pesce C, Giuliani R, Ranieri VM, Cinnella G, Carravetta G, Marella G, Bruno F. [Alveolar recluting induced by positive end-expiratory pressure in patients with chronic bronchopathy]. Minerva Anestesiol 1991; 57:844. [PMID: 1961510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- C Pesce
- Istituto di Anestesiologia e Rianimazione, Università degli Studi, Bari
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31
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Ranieri VM, Giuliani R, Dambrosio M, Carravetta G, Cinnella G, Brienza N, Pesce C, Marella G. [Effect of PEEP on the pulmonary volume in patients with chronic obstructive bronchopathy during mechanical ventilation]. Minerva Anestesiol 1991; 57:848. [PMID: 1961513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- V M Ranieri
- Istituto di Anestesiologia e Rianimazione, Università degli Studi, Bari
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32
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Giuliani R, Ranieri VM, Carravetta G, Cinnella G, Pesce C, Marella G, Massaro M. [Effect of PEEP on the profile of the flow (F)/time (T) in patients with chronic obstructive bronchopathy]. Minerva Anestesiol 1991; 57:845. [PMID: 1961511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R Giuliani
- Istituto di Anestesiologia e Rianimazione, Università degli Studi, Bari
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33
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Greco M, Brienza N, Cinnella G, Dambrosio M, Fiore G, Marucci M, Giuliani R. [Prognostic significance of pulmonary hypertension in acute respiratory insufficiency: study on 114 patients]. Minerva Anestesiol 1991; 57:944-5. [PMID: 1961564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- M Greco
- Istituto di Anestesiologia e Rianimazione, Università degli Studi, Bari
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34
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Cinnella G, Ranieri VM, Carravetta G, Greco M, Fiore G, Giuliani R, Bruno F. [In vivo and in vitro resistance behavior of the endotracheal tube]. Minerva Anestesiol 1991; 57:763. [PMID: 1798569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- G Cinnella
- Istituto di Anestesiologia e Rianimazione, Università degli Studi, Bari
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