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Alonso-Iñigo JM, Mazzinari G, Casañ-Pallardó M, Redondo-García JI, Viscasillas-Monteagudo J, Gutierrez-Bautista A, Ramirez-Faz J, Alonso-Pérez P, Díaz-Lobato S, Neto AS, Diaz-Cambronero O, Argente-Navarro P, Gama de Abreu M, Pelosi P, Schultz MJ. Pre-clinical validation of a turbine-based ventilator for invasive ventilation-The ACUTE-19 ventilator. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:544-555. [PMID: 36244956 PMCID: PMC9639442 DOI: 10.1016/j.redare.2021.09.006] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/07/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND The Severe Acute Respiratory Syndrome (SARS)-Coronavirus 2 (CoV-2) pandemic pressure on healthcare systems can exhaust ventilator resources, especially where resources are restricted. Our objective was a rapid preclinical evaluation of a newly developed turbine-based ventilator, named the ACUTE-19, for invasive ventilation. METHODS Validation consisted of (a) testing tidal volume (VT) delivery in 11 simulated models, with various resistances and compliances; (b) comparison with a commercial ventilator (VIVO-50) adapting the United Kingdom Medicines and Healthcare products Regulatory Agency-recommendations for rapidly manufactured ventilators; and (c) in vivo testing in a sheep before and after inducing acute respiratory distress syndrome (ARDS) by saline lavage. RESULTS Differences in VT in the simulated models were marginally different (largest difference 33ml [95%-confidence interval (CI) 31-36]; P<.001ml). Plateau pressure (Pplat) was not different (-0.3cmH2O [95%-CI -0.9 to 0.3]; P=.409), and positive end-expiratory pressure (PEEP) was marginally different (0.3 cmH2O [95%-CI 0.2 to 0.3]; P<.001) between the ACUTE-19 and the commercial ventilator. Bland-Altman analyses showed good agreement (mean bias, -0.29, [limits of agreement, 0.82 to -1.42], and mean bias 0.56 [limits of agreement, 1.94 to -0.81], at a Pplat of 15 and 30cmH2O, respectively). The ACUTE-19 achieved optimal oxygenation and ventilation before and after ARDS induction. CONCLUSIONS The ACUTE-19 performed accurately in simulated and animal models yielding a comparable performance with a VIVO-50 commercial device. The acute 19 can provide the basis for the development of a future affordable commercial ventilator.
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Affiliation(s)
- J M Alonso-Iñigo
- Research Group in Perioperative Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
| | - G Mazzinari
- Department of Anesthesia, Critical Care and Pain Medicine, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain
| | - M Casañ-Pallardó
- Department of Anesthesia, Critical Care and Pain Medicine, Hospital General Universitario de Castellón, Castellón de la Plana, Castellón, Spain
| | - J I Redondo-García
- Department of Veterinary Anesthesia, Hospital Clínico Veterinario CEU, Universidad CEU Cardenal Herrera, Alfara del Patriarca, Valencia, Spain
| | - J Viscasillas-Monteagudo
- Department of Veterinary Anesthesia, Hospital Clínico Veterinario CEU, Universidad CEU Cardenal Herrera, Alfara del Patriarca, Valencia, Spain
| | - A Gutierrez-Bautista
- Department of Veterinary Anesthesia, Hospital Clínico Veterinario CEU, Universidad CEU Cardenal Herrera, Alfara del Patriarca, Valencia, Spain
| | - J Ramirez-Faz
- Department of Electrical Engineering, Universidad de Córdoba, Córdoba, Spain
| | - P Alonso-Pérez
- Department of Research and Innovation, Tecnikoa and C&T Fabrication S. L., Alicante, Spain
| | - S Díaz-Lobato
- Medical Division, Nippon Gases HealthCare & Oximesa NG, Madrid, Spain
| | - A S Neto
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brasil; Cardio-Pulmonary Department, Pulmonary Division, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil; Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands
| | - O Diaz-Cambronero
- Research Group in Perioperative Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - P Argente-Navarro
- Research Group in Perioperative Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Gama de Abreu
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, Technische Universität Dresden, Dresden, Germany; Outcome Research Consortiu, Cleveland Clinic, Cleveland, OH, USA
| | - P Pelosi
- Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - M J Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Simonis FD, Einav S, Serpa Neto A, Hemmes SN, Pelosi P, Gama de Abreu M, Schultz MJ. Epidemiology, ventilation management and outcome in patients receiving intensive care after non-thoracic surgery - Insights from the LAS VEGAS study. Pulmonology 2021; 28:90-98. [PMID: 34906445 DOI: 10.1016/j.pulmoe.2021.10.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Information about epidemiology, ventilation management and outcome in postoperative intensive care unit (ICU) patients remains scarce. The objective was to test whether postoperative ventilation differs from that in the operation room. MATERIAL AND METHODS This was a substudy of the worldwide observational LAS VEGAS study, including patients undergoing non-thoracic surgeries. Of 146 study sites participating in the LAS VEGAS study, 117 (80%) sites reported on the postoperative ICU course, including ventilation and complications. The coprimary outcomes were two key elements of ventilator management, i.e., tidal volume (VT) and positive end-expiratory pressure (PEEP). Secondary outcomes included the proportion of patients receiving low VT ventilation (LTVV, defined as ventilation with a median VT < 8.0 ml/kg PBW), and the proportion of patients developing postoperative pulmonary complications (PPC), including ARDS, pneumothorax, pneumonia and need for escalation of ventilatory support, ICU and hospital length of stay, and mortality at day 28. RESULTS Of 653 patients who were admitted to the ICU after surgery, 274 (42%) patients received invasive postoperative ventilation. Median postoperative VT was 8.4 [7.3-9.8] ml/kg predicted body weight (PBW), PEEP was 5 [5-5] cm H2O, statistically significant but not meaningfully different from median intraoperative VT (8.1 [7.3-8.9] ml/kg PBW; P < 0.001) and PEEP (4 [2-5] cm H2O; P < 0.001). The proportion of patients receiving LTVV after surgery was 41%. The PPC rate was 10%. Length of stay in ICU and hospital was independent of development of a PPC, but hospital mortality was higher in patients who developed a PPC (24 versus 4%; P < 0.001). CONCLUSIONS In this observational study of patients undergoing non-thoracic surgeries, postoperative ventilation was not meaningfully different from that in the operating room. Like in the operating room, there is room for improved use of LTVV. Development of PPC is associated with mortality.
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Affiliation(s)
- F D Simonis
- Department of Intensive Care, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands.
| | - S Einav
- General Intensive Care Unit, Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - A Serpa Neto
- Department of Intensive Care, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands; Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
| | - S N Hemmes
- Department of Anesthesiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands
| | - P Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy
| | - M Gama de Abreu
- Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Germany
| | - M J Schultz
- Department of Intensive Care, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands; Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Alonso-Iñigo J, Mazzinari G, Casañ-Pallardó M, Redondo-García J, Viscasillas-Monteagudo J, Gutierrez-Bautista A, Ramirez-Faz J, Alonso-Pérez P, Díaz-Lobato S, Neto A, Diaz-Cambronero O, Argente-Navarro P, Gama de Abreu M, Pelosi P, Schultz M. Validación preclínica de un respirador de turbina para la ventilación invasiva: el respirador ACUTE-19. Revista Española de Anestesiología y Reanimación 2021; 69:544-555. [PMID: 36337377 PMCID: PMC9617684 DOI: 10.1016/j.redar.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/07/2021] [Indexed: 12/04/2022]
Abstract
Antecedentes La pandemia producida por el síndrome respiratorio agudo severo por coronavirus 2 puede agotar los recursos sanitarios, especialmente de respiradores, en situaciones de escasez de recursos sanitarios. Nuestro objetivo fue realizar una evaluación preclínica rápida de un prototipo de respirador de turbina para la ventilación invasiva denominado ACUTE-19. Métodos La validación consistió en: a) evaluación de la administración de un volumen corriente en 11 modelos pulmonares simulados, con diversas resistencias y compliancias; b) comparación con un ventilador comercial (VIVO-50) adaptando las recomendaciones de la Agencia Reguladora de Medicamentos y Productos Sanitarios del Reino Unido para ventiladores de fabricación rápida, y c) realización de pruebas in vivo en una oveja antes y después de inducir el síndrome de distrés respiratorio agudo mediante lavado salino. Resultados Las diferencias de volumen corriente en los modelos simulados fueron mínimamente diferentes (la mayor diferencia fue de 33 ml [IC 95%: 31 a 36]; p < 0,001). La presión de meseta no fue diferente (−0,3 cmH2O [IC 95%: −0,9 a 0,3]; p = 0,409), y la presión positiva al final de la espiración fue levemente diferente (0,3 cmH2O [IC 95%: 0,2 a 0,3]; p < 0,001) comparando el ACUTE-19 y el ventilador comercial. El análisis de Bland-Altman mostró una buena concordancia (sesgo medio −0,29 [límites de concordancia 0,82 a −1,42], y sesgo medio 0,56 [límites de concordancia 1,94 a −0,81], a una presión de meseta de 15 y 30 cmH2O, respectivamente). El ACUTE-19 consiguió una oxigenación y ventilación óptimas antes y después de la inducción del síndrome de distrés respiratorio agudo en el modelo animal. Conclusiones El ACUTE-19 se comportó con precisión en los modelos simulados y animales, con un rendimiento comparable al del dispositivo comercial VIVO-50. El ACUTE-19 puede servir de base para el desarrollo de un futuro ventilador comercial asequible.
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Campos NS, Bluth T, Hemmes SNT, Librero J, Pozo N, Ferrando C, Ball L, Mazzinari G, Pelosi P, Gama de Abreu M, Schultz MJ, Neto AS. Re-evaluation of the effects of high PEEP with recruitment manoeuvres versus low PEEP without recruitment manoeuvres during general anaesthesia for surgery -Protocol and statistical analysis plan for an individual patient data meta-analysis of PROVHILO, iPROVE and PROBESE. ACTA ACUST UNITED AC 2020; 67:76-89. [PMID: 31955891 DOI: 10.1016/j.redar.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/25/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
- N S Campos
- Deptartment of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brasil; Cardio-Pulmonary Department, Pulmonary Division, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Pãulo, Brasil
| | - T Bluth
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - S N T Hemmes
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam UMC, University of Amsterdam, Ámsterdam, Holanda; Department of Anaesthesiology, AnaesthesiologyDepartment Amsterdam UMC location 'AMC', University of Amsterdam, Ámsterdam, Países Bajos
| | - J Librero
- Navarrabiomed-Fundación Miguel Servet, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Navarra, España
| | - N Pozo
- Department of Anesthesiology and Critical Care, Hospital Clínic de Barcelona, Barcelona, España
| | - C Ferrando
- Department of Anesthesiology and Critical Care, Hospital Clínic de Barcelona, Barcelona, España; CIBER of Respiratory Disease, Instituto de Salud Carlos III, Madrid, España
| | - L Ball
- IRCCS San Martino Policlinico Hospital, Genoa, Italia; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italia
| | - G Mazzinari
- Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia, España
| | - P Pelosi
- IRCCS San Martino Policlinico Hospital, Genoa, Italia; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italia
| | - M Gama de Abreu
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M J Schultz
- Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam UMC, University of Amsterdam, Ámsterdam, Holanda; Research Group in Perioperative Medicine, Instituto de Investigación Sanitaria La Fe, Valencia, España; Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Tailandia
| | - A S Neto
- Deptartment of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brasil; Cardio-Pulmonary Department, Pulmonary Division, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Pãulo, Brasil; Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam UMC, University of Amsterdam, Ámsterdam, Holanda.
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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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Bluth T, Kiss T, Kircher M, Braune A, Bozsak C, Huhle R, Scharffenberg M, Herzog M, Roegner J, Herzog P, Vivona L, Millone M, Dössel O, Andreeff M, Koch T, Kotzerke J, Stender B, Gama de Abreu M. Measurement of relative lung perfusion with electrical impedance and positron emission tomography: an experimental comparative study in pigs. Br J Anaesth 2019; 123:246-254. [PMID: 31160064 DOI: 10.1016/j.bja.2019.04.056] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 10/19/2018] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Electrical impedance tomography (EIT) with indicator dilution may be clinically useful to measure relative lung perfusion, but there is limited information on the performance of this technique. METHODS Thirteen pigs (50-66 kg) were anaesthetised and mechanically ventilated. Sequential changes in ventilation were made: (i) right-lung ventilation with left-lung collapse, (ii) two-lung ventilation with optimised PEEP, (iii) two-lung ventilation with zero PEEP after saline lung lavage, (iv) two-lung ventilation with maximum PEEP (20/25 cm H2O to achieve peak airway pressure 45 cm H2O), and (v) two-lung ventilation under unilateral pulmonary artery occlusion. Relative lung perfusion was assessed with EIT and central venous injection of saline 3%, 5%, and 10% (10 ml) during breath holds. Relative perfusion was determined by positron emission tomography (PET) using 68Gallium-labelled microspheres. EIT and PET were compared in eight regions of equal ventro-dorsal height (right, left, ventral, mid-ventral, mid-dorsal, and dorsal), and directional changes in regional perfusion were determined. RESULTS Differences between methods were relatively small (95% of values differed by less than 8.7%, 8.9%, and 9.5% for saline 10%, 5%, and 3%, respectively). Compared with PET, EIT underestimated relative perfusion in dependent, and overestimated it in non-dependent, regions. EIT and PET detected the same direction of change in relative lung perfusion in 68.9-95.9% of measurements. CONCLUSIONS The agreement between EIT and PET for measuring and tracking changes of relative lung perfusion was satisfactory for clinical purposes. Indicator-based EIT may prove useful for measuring pulmonary perfusion at bedside.
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Affiliation(s)
- T Bluth
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - T Kiss
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M Kircher
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - A Braune
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - C Bozsak
- Drägerwerk AG & Co. KGaA, Lübeck, Germany
| | - R Huhle
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M Scharffenberg
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M Herzog
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J Roegner
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - P Herzog
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - L Vivona
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - M Millone
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; IRCCS AOU San Martino IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - O Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - M Andreeff
- Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - T Koch
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J Kotzerke
- Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - B Stender
- Drägerwerk AG & Co. KGaA, Lübeck, Germany
| | - M Gama de Abreu
- Pulmonary Engineering Group Dresden, Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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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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8
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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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9
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Cortegiani A, Gregoretti C, Neto AS, Hemmes SNT, Ball L, Canet J, Hiesmayr M, Hollmann MW, Mills GH, Melo MFV, Putensen C, Schmid W, Severgnini P, Wrigge H, Gama de Abreu M, Schultz MJ, Pelosi P. Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications. Br J Anaesth 2019; 122:361-369. [PMID: 30770054 DOI: 10.1016/j.bja.2018.10.063] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/21/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). METHODS LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8:00 AM and 7:59 PM, and as 'night-time' when induction was between 8:00 PM and 7:59 AM. RESULTS Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P=0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P=0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P=0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09-1.90; P=0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89-1.90; P=0.15). CONCLUSIONS Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events. CLINICAL TRIAL REGISTRATION NCT01601223.
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Affiliation(s)
- A Cortegiani
- Department of Surgical, Oncological and Oral Science, Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy.
| | - C Gregoretti
- Department of Surgical, Oncological and Oral Science, Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | - A S Neto
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesia, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - S N T Hemmes
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesia, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - L Ball
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - J Canet
- Department of Anesthesiology and Postoperative Care, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - M Hiesmayr
- Division of Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - M W Hollmann
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - G H Mills
- Operating Services, Critical Care and Anesthesia, Sheffield Teaching Hospitals, Sheffield and University of Sheffield, Sheffield, UK
| | - M F V Melo
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - C Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - W Schmid
- Division of Cardiac, Thoracic, Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - P Severgnini
- Department of Biotechnology and Sciences of Life, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - H Wrigge
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
| | - M Gama de Abreu
- Department of Anaesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - M J Schultz
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesia, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - P Pelosi
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
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10
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Kiss T, Silva PL, Huhle R, Moraes L, Santos RS, Felix NS, Santos CL, Morales MM, Capelozzi VL, Kasper M, Pelosi P, Gama de Abreu M, Rocco PRM. Comparison of different degrees of variability in tidal volume to prevent deterioration of respiratory system elastance in experimental acute lung inflammation. Br J Anaesth 2018; 116:708-15. [PMID: 27106975 DOI: 10.1093/bja/aew093] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Variable ventilation improves respiratory function, but it is not known whether the amount of variability in tidal volume (VT) can be reduced in recruited lungs without a deterioration of respiratory system elastance. METHODS Acute lung inflammation was induced by intratracheal instillation of lipopolysaccharide in 35 Wistar rats. Twenty-eight animals were anaesthetized and ventilated in volume-controlled mode. Lungs were recruited by random variation of VT (mean 6 ml kg(-1), coefficient of variation 30%, normal distribution) for 30 min. Animals were randomly assigned to different amounts of VT variability (n=7 for 90 min per group): 30, 15, 7.5, or 0%. Lung function, diffuse alveolar damage, and gene expression of biological markers associated with cell mechanical stress, inflammation, and fibrogenesis were assessed. Seven animals were not ventilated and served as controls for post-mortem analyses. RESULTS A VT variability of 30%, but not 15, 7.5, or 0%, prevented deterioration of respiratory system elastance [Mean (SD) -7.5 (8.7%), P<0.05; 21.1 (9.6%), P<0.05; 43.3 (25.9), P<0.05; and 41.2 (16.4), P<0.05, respectively]. Diffuse alveolar damage was lower with a VT variability of 30% than with 0% and without ventilation, because of reduced oedema and haemorrhage. A VT variability of 30, 15, or 7.5% reduced the gene expression of amphiregulin, cytokine-induced neutrophil chemoattractant-1, and tumour necrosis factor α compared with a VT variability of 0%. CONCLUSIONS In this model of acute lung inflammation, a VT variability of 30%, compared with 15 and 7.5%, was necessary to avoid deterioration of respiratory system elastance and was not associated with lung histological damage.
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Affiliation(s)
- T Kiss
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil
| | - P L Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil
| | - R Huhle
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - L Moraes
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil
| | - R S Santos
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil
| | - N S Felix
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil
| | - C L Santos
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil
| | - M M Morales
- Laboratory of Cellular and Molecular Physiology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil
| | - V L Capelozzi
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - M Kasper
- Institute of Anatomy, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - P Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - M Gama de Abreu
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - P R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil
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11
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Mazzinari G, Ball L, Serpa Neto A, Errando C, Dondorp A, Bos L, Gama de Abreu M, Pelosi P, Schultz M. The fragility of statistically significant findings in randomised controlled anaesthesiology trials: systematic review of the medical literature. Br J Anaesth 2018; 120:935-941. [DOI: 10.1016/j.bja.2018.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/21/2017] [Accepted: 01/14/2018] [Indexed: 10/18/2022] Open
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12
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Abbott T, Fowler A, Pelosi P, Gama de Abreu M, Møller A, Canet J, Creagh-Brown B, Mythen M, Gin T, Lalu M, Futier E, Grocott M, Schultz M, Pearse R, Myles P, Gan T, Kurz A, Peyton P, Sessler D, Tramèr M, Cyna A, De Oliveira G, Wu C, Jensen M, Kehlet H, Botti M, Boney O, Haller G, Grocott M, Cook T, Fleisher L, Neuman M, Story D, Gruen R, Bampoe S, Evered L, Scott D, Silbert B, van Dijk D, Kalkman C, Chan M, Grocott H, Eckenhoff R, Rasmussen L, Eriksson L, Beattie S, Wijeysundera D, Landoni G, Leslie K, Biccard B, Howell S, Nagele P, Richards T, Lamy A, Gabreu M, Klein A, Corcoran T, Jamie Cooper D, Dieleman S, Diouf E, McIlroy D, Bellomo R, Shaw A, Prowle J, Karkouti K, Billings J, Mazer D, Jayarajah M, Murphy M, Bartoszko J, Sneyd R, Morris S, George R, Moonesinghe R, Shulman M, Lane-Fall M, Nilsson U, Stevenson N, van Klei W, Cabrini L, Miller T, Pace N, Jackson S, Buggy D, Short T, Riedel B, Gottumukkala V, Alkhaffaf B, Johnson M. A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. Br J Anaesth 2018; 120:1066-1079. [DOI: 10.1016/j.bja.2018.02.007] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/01/2018] [Accepted: 02/12/2018] [Indexed: 02/02/2023] Open
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Spieth P, Güldner A, Uhlig C, Bluth T, Kiss T, Conrad C, Bischlager K, Braune A, Huhle R, Insorsi A, Tarantino F, Ball L, Schultz M, Abolmaali N, Koch T, Pelosi P, Gama de Abreu M. Variable versus conventional lung protective mechanical ventilation during open abdominal surgery (PROVAR): a randomised controlled trial. Br J Anaesth 2018; 120:581-591. [DOI: 10.1016/j.bja.2017.11.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 07/31/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022] Open
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14
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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, 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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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Colino L, Perez JL, Pérez H, Calpe P, Alcala MA, Robaglia D, Perez C, Lan SK, Cunha MM, Moreira T, Santos F, Lafuente E, Fernandes MJ, Silva JG, Rosario LEDLC, Lesmes SPG, Herrera ANG, Romero JCG, Pertuz EDD, Sánchez MJG, Sanz ER, Echeverría JGA, Hernández AA, Hualde JB, Podlepich V, Sokolova E, Alexandrova E, Lapteva K, Kurtz P, Shuinotsuka C, Rabello L, Vianna G, Reis A, Cairus C, Salluh J, Bozza F, Torres JCB, Araujo NJF, García-Olivares P, Keough E, Dalorzo M, Tang LK, De Sousa I, Díaz M, Marcos-Zambrano LJ, Guerrero JE, Gomez SEZ, Lopez GDH, Cuellar AIV, Nieto ORP, Gonzalez JAC, Bhasin D, Rai S, Singh H, Gupta O, Bhattal MK, Sampley S, Sekhri K, Nandha R, Aliaga FA, Olivares F, Appiani F, Farias P, Alberto F, Hernández A, Pons S, Sonneville R, Bouadma L, Neuville M, Mariotte E, Radjou A, Lebut J, Chemam S, Voiriot G, Dilly MP, Mourvillier B, Dorent R, Nataf P, Wolff M, Timsit JF, Ediboglu O, Ataman S, Ozkarakas H, Kirakli C, Vakalos A, Avramidis V, Obukhova O, Kurmukov IA, Kashiya S, Golovnya E, Baikova VN, Ageeva T, Haritydi T, Kulaga EV, Rios-Toro JJ, Perez-Borrero L, Aguilar-Alonso E, Arias-Verdu MD, Garcia-Alvarez JM, Lopez-Caler C, De La Fuente-Martos C, Rodriguez-Fernandez S, Sanchez-Orézzoli MG, Martin-Gallardo F, Nikhilesh J, Joshi V, Villarreal E, Ruiz J, Gordon M, Quinza A, Gimenez J, Piñol M, Castellanos A, Ramirez P, Jeon YD, Jeong WY, Kim MH, Jeong IY, Ahn MY, Ahn JY, Han SH, Choi JY, Song YG, Kim JM, Ku NS, Shah H, Kellner F, Rezai F, Mistry N, Yodice P, Ovnanian V, Fless K, Handler E, Alejos RM, Romeu JDM, Antón DG, Quinart A, Martí AT, Llaurado-Serra M, Lobo-Civico A, Ventura-Rosado A, Piñol-Tena A, Pi-Guerrero M, Paños-Espinosa C, Peralvo-Bernat M, Marine-Vidal J, Gonzalez-Engroba R, Montesinos-Cerro N, Treso-Geira M, Valeiras-Valero A, Martinez-Reyes L, Sandiumenge A, Jimenez-Herrera MF, Helyar S, Riozzi P, Noon A, Hallows G, Cotton H, Keep J, Hopkins PA, Taggu A, Renuka S, Sampath S, Rood PJT, Frenzel T, Verhage R, Bonn M, Pickkers P, van der Hoeven JG, van den Boogaard M, Corradi F, Melnyk L, Moggia F, Pienovi R, Adriano G, Brusasco C, Mariotti L, Lattuada M, Bloomer MJ, Coombs M, Ranse K, Endacott R, Maertens B, Blot K, Blot S, Amerongen MPVN, van der Heiden ES, Twisk JWR, Girbes ARJ, Spijkstra JJ, Riozzi P, Helyar S, Cotton H, Hallows G, Noon A, Bell C, Peters K, Feehan A, Keep J, Hopkins PA, Churchill K, Hawkins K, Brook R, Paver N, Endacott R, Maistry N, van Wijk A, Rouw N, van Galen T, Evelein-Brugman S, Taggu A, Krishna B, Sampath S, Putzu A, Fang M, Berto MB, Belletti A, Cassina T, Cabrini L, Mistry M, Alhamdi Y, Welters I, Abrams ST, Toh CH, Han HS, Gil EM, Lee DS, Park CM, Winder-Rhodes S, Lotay R, Doyle J, Ke MW, Huang WC, Chiang CH, Hung WT, Cheng CC, Lin KC, Lin SC, Chiou KR, Wann SR, Shu CW, Kang PL, Mar GY, Liu CP, Dubó S, Aquevedo A, Jibaja M, Berrutti D, Labra C, Lagos R, García MF, Ramirez V, Tobar M, Picoita F, Peláez C, Carpio D, Alegría L, Hidalgo C, Godoy K, Bakker J, Hernández G, Sadamoto Y, Katabami K, Wada T, Ono Y, Maekawa K, Hayakawa M, Sawamura A, Gando S, Marin-Mateos H, Perez-Vela JL, Garcia-Gigorro R, Peiretti MAC, Lopez-Gude MJ, Chacon-Alves S, Renes-Carreño E, Montejo-González JC, Parlevliet KL, Touw HRW, Beerepoot M, Boer C, Elbers PWG, Tuinman PR, Abdelmonem SA, Helmy TA, El Sayed I, Ghazal S, Akhlagh SH, Masjedi M, Hozhabri K, Kamali E, Zýková I, Paldusová B, Sedlák P, Morman D, Youn AM, Ohta Y, Sakuma M, Bates D, Morimoto T, Su PL, Chang WY, Lin WC, Chen CW, Facchin F, Zarantonello F, Panciera G, De Cassai A, Venrdramin A, Ballin A, Tonetti T, Persona P, Ori C, Del Sorbo L, Rossi S, Vergani G, Cressoni M, Chiumello D, Chiurazzi C, Brioni M, Algieri I, Tonetti T, Guanziroli M, Colombo A, Tomic I, Colombo A, Crimella F, Carlesso E, Gasparovic V, Gattinoni L, Neto AS, Schmidt M, Pham T, Combes A, de Abreu MG, Pelosi P, Schultz MJ, Katira BH, Engelberts D, Giesinger RE, Ackerley C, Yoshida T, Zabini D, Otulakowski G, Post M, Kuebler WM, McNamara PJ, Kavanagh BP, Pirracchio R, Rigon MR, Carone M, Chevret S, Annane D, Eladawy S, El-Hamamsy M, Bazan N, Elgendy M, De Pascale G, Vallecoccia MS, Cutuli SL, Di Gravio V, Pennisi MA, Conti G, Antonelli M, Andreis DT, Khaliq W, Singer M, Hartmann J, Harm S, Carmona SA, Almudevar PM, Abellán AN, Ramos JV, Pérez LP, Valbuena BL, Sanz NM, Simón IF, Arrigo M, Feliot E, Deye N, Cariou A, Guidet B, Jaber S, Leone M, Resche-Rigon M, Baron AV, Legrand M, Gayat E, Mebazaa A, Balik M, Kolnikova I, Maly M, Waldauf P, Tavazzi G, Kristof J, Herpain A, Su F, Post E, Taccone F, Vincent JL, Creteur J, Lee C, Hatib F, Jian Z, Buddi S, Cannesson M, Fileković S, Turel M, Knafelj R, Gorjup V, Stanić R, Gradišek P, Cerović O, Mirković T, Noč M, Tirkkonen J, Hellevuo H, Olkkola KT, Hoppu S, Lin KC, Hung WT, Chiang CC, Huang WC, Juan WC, Lin SC, Cheng CC, Lin PH, Fong KY, Hou DS, Kang PL, Wann SR, Chen YS, Mar GY, Liu CP, Paul M, Bougouin W, Geri G, Dumas F, Champigneulle B, Legriel S, Charpentier J, Mira JP, Sandroni C, Cariou A, Zimmerman J, Sullivan E, Noursadeghi M, Fox B, Sampson D, McHugh L, Yager T, Cermelli S, Seldon T, Bhide S, Brandon RA, Brandon RB, Zwaag J, Beunders R, Pickkers P, Kox M, Gul F, Arslantas MK, Genc D, Zibandah N, Topcu L, Akkoc T, Cinel I, Greco E, Lauretta MP, Andreis DT, Singer M, Garcia IP, Cordero M, Martin AD, Pallás TA, Montero JG, Rey JR, Malo LR, Montoya AAT, Martinez ADCA, Ayala LYD, Zepeda EM, Granillo JF, Sanchez JA, Alejo GC, Cabrera AR, Montenegro AP, Pham T, Beduneau G, Schortgen F, Piquilloud L, Zogheib E, Jonas M, Grelon F, Runge I, Terzi N, Grangé S, Barberet G, Guitard PG, Frat JP, Constan A, Chrétien JM, Mancebo J, Mercat A, Richard JCM, Brochard L, Soilemezi E, Koco E, Savvidou S, Nouris C, Matamis D, Di Mussi R, Spadaro S, Volta CA, Mariani M, Colaprico A, Antonio C, Bruno F, Grasso S, Rodriguez A, Martín-Loeches I, Díaz E, Masclans JR, Gordo F, Solé-Violán J, Bodí M, Avilés-Jurado FX, Trefler S, Magret M, Reyes LF, Marín-Corral J, Yebenes JC, Esteban A, Anzueto A, Aliberti S, Restrepo MI, Larsson JS, Redfors B, Ricksten SE, Haines R, Powell-Tuck J, Leonard H, Ostermann M, Berthelsen RE, Itenov TS, Perner A, Jensen JU, Ibsen M, Jensen AEK, Bestle MH, Bucknall T, Dixon J, Boa F, MacPhee I, Philips BJ, Doyle J, Saadat F, Samuels T, Huddart S, McCormick B, DeBrunnar R, Preece J, Swart M, Peden C, Richardson S, Forni L, Kalfon P, Baumstarck K, Estagnasie P, Geantot MA, Berric A, Simon G, Floccard B, Signouret T, Boucekine M, Fromentin M, Nyunga M, Sossou A, Venot M, Robert R, Follin A, Renault A, Garrouste M, Collange O, Levrat Q, Villard I, Thévenin D, Pottecher J, Patrigeon RG, Revel N, Vigne C, Mimoz O, Auquier P, Pawar S, Jacques T, Deshpande K, Pusapati R, Wood B, Pulham RA, Wray J, Brown K, Pierce C, Nadel S, Ramnarayan P, Azevedo JR, Montenegro WS, Rodrigues DP, Sousa SC, Araujo VF, Leitao AL, Prazeres PH, Mendonca AV, Paula MP, Das Neves A, Loudet CI, Busico M, Vazquez D, Villalba D, Lischinsky A, Veronesi M, Emmerich M, Descotte 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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Hemmes S, Serpa Neto A, Gama de Abreu M, Pelosi P, Schultz M. Intraoperative ventilation: improving physiology, or preventing harm? Br J Anaesth 2016; 116:438-9. [PMID: 26865144 DOI: 10.1093/bja/aew013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Maia L, Samary CDS, de Oliveira MV, Santos CL, Huhle R, Gama de Abreu M, Pelosi P, Silva PL, Rocco PRM. Biological impact of different ventilatory strategies during open abdominal surgery in a rat model. Intensive Care Med Exp 2015. [PMCID: PMC4796234 DOI: 10.1186/2197-425x-3-s1-a568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Heller AR, Heger J, Gama de Abreu M, Müller MP. Cafedrine/theodrenaline in anaesthesia: influencing factors in restoring arterial blood pressure. Anaesthesist 2015; 64:190-6. [PMID: 25757552 PMCID: PMC4383809 DOI: 10.1007/s00101-015-0005-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 11/26/2022]
Abstract
Background Hypotensive states that require fast stabilisation of blood pressure can occur during anaesthesia. In 1963, the 20:1 mixture of cafedrine/theodrenaline (Akrinor®) was introduced in Germany for use in anaesthesia and emergency medicine in the first-line management of hypotensive states. Though on the market for many years, few pharmacodynamic data are available on this combination net beta-mimetic agent. Aim This study aimed to examine the drug combination in real-life clinical practice and recorded time to 10 % mean arterial blood pressure (MAP) increase and heart rate. Furthermore, potential factors that influence drug effectiveness under anaesthesia were assessed. Methods Data were collected within a standardised anaesthesia protocol. A total of 353 consecutive patients (female/male = 149/204) who received cafedrine/theodrenaline after a drop in MAP ≥ 5 % were included in the study. The time to 10 % increase in MAP, dosage of cafedrine/theodrenaline, volume loading, blood pressure and heart rate were monitored over time. Results Patients were a mean (standard deviation) of 64.4 ± 15.1 years old with a baseline MAP of 82 ± 14 mmHg, which dropped to a mean of 63 ± 10 mmHg during anaesthesia without gender differences. Cafedrine/theodrenaline (1.27 ± 1.0 mg/kg; 64 ± 50 µg/kg) significantly increased MAP (p < 0.001) by 11 ± 16 mmHg within 5 min, reaching peak values within 17.4 ± 9.0 min. Heart rate was not affected in a clinically significant manner. Cafedrine/theodrenaline induced a 10 % MAP increase after 7.2 ± 4.6 min (women) and after 8.6 ± 6.3 min (men) (p = 0.018). Independent of gender, the dose of cafedrine/theodrenaline required to achieve the observed MAP increase of 14 ± 16 mmHg at 15 min was significantly different in patients with heart failure [1.78 ± 1.67 mg/kg (cafedrine)/89.0 ± 83.5 µg/kg (theodrenaline)] compared with healthy patients [1.16 ± 0.77 mg/kg (cafedrine)/58.0 ± 38.5 µg/kg (theodrenaline)] (p = 0.005). Concomitant medication with beta-blocking agents significantly prolonged the time to 10 % MAP increase [9.0 ± 7.0 vs. 7.3 ± 4.3 min (p = 0.008)]. Conclusion Cafedrine/theodrenaline quickly restores MAP during anaesthesia. Female gender is associated with higher effectiveness, while heart failure and beta-blocker administration lower the anti-hypotonic effect. Prospective studies in defined patient populations are warranted to further characterise the effect of cafedrine/theodrenaline.
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Affiliation(s)
- A R Heller
- Department of Anaesthesia and Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany,
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Moraes L, Samary C, Santos RS, Ornellas DS, Santos CL, Felix NS, Huhle R, Pelosi P, Gama de Abreu M, Silva PL, Rocco PRM. 0427. Respiratory effects of noisy ventilation depend on the etiology of acute respiratory distress syndrome. Intensive Care Med Exp 2014. [PMCID: PMC4796162 DOI: 10.1186/2197-425x-2-s1-p25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Schranz C, Riedlinger A, Huhle R, Braune A, Gama de Abreu M, Koch E, Möller K. Selection Criteria for Competing Models of Respiratory Mechanics. BIOMED ENG-BIOMED TE 2013; 58 Suppl 1:/j/bmte.2013.58.issue-s1-N/bmt-2013-4326/bmt-2013-4326.xml. [PMID: 24043038 DOI: 10.1515/bmt-2013-4326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pohlmann G, Iwatschenko P, Koch W, Windt H, Rast M, de Abreu MG, Taut FJH, De Muynck C. A novel continuous powder aerosolizer (CPA) for inhalative administration of highly concentrated recombinant surfactant protein-C (rSP-C) surfactant to preterm neonates. J Aerosol Med Pulm Drug Deliv 2013; 26:370-9. [PMID: 23421901 DOI: 10.1089/jamp.2012.0996] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In pulmonary medicine, aerosolization of substances for continuous inhalation is confined to different classes of nebulizers with their inherent limitations. Among the unmet medical needs is the lack of an aerosolized surfactant preparation for inhalation by preterm neonates, to avoid the risks associated with endotracheal intubation and surfactant bolus instillation. In the present report, we describe a high-concentration continuous powder aerosolization system developed for delivery of inhalable surfactant to preterm neonates. METHODS The developed device uses a technique that allows efficient aerosolization of dry surfactant powder, generating a surfactant aerosol of high concentration. In a subsequent humidification step, the heated aerosol particles are covered with a surface layer of water. The wet surfactant aerosol is then delivered to the patient interface (e.g., nasal prongs) through a tube. RESULTS The performance characteristics of the system are given as mass concentration, dose rate, and size distribution of the generated aerosol. Continuous aerosol flows of about 0.84 L/min can be generated from dry recombinant surfactant protein-C surfactant, with concentrations of up to 12 g/m(3) and median particle sizes of the humidified particles in the range of 3 to 3.5 μm at the patient interface. The system has been successfully used in preclinical studies. CONCLUSION The device with its continuous high-concentration delivery is promising for noninvasive delivery of surfactant aerosol to neonates and has the potential for becoming a versatile disperser platform closing the gap between continuously operating nebulizers and discontinuously operating dry powder inhaler devices.
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Affiliation(s)
- G Pohlmann
- 1 Fraunhofer Institute for Toxicology and Experimental Medicine ITEM , D-30625 Hannover, Germany
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Spieth PM, Güldner A, Carvalho AR, Kasper M, Pelosi P, Uhlig S, Koch T, Gama de Abreu M. Open lung approach vs acute respiratory distress syndrome network ventilation in experimental acute lung injury. Br J Anaesth 2011; 107:388-97. [PMID: 21652617 PMCID: PMC9174723 DOI: 10.1093/bja/aer144] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Setting and strategies of mechanical ventilation with positive end-expiratory pressure (PEEP) in acute lung injury (ALI) remains controversial. This study compares the effects between lung-protective mechanical ventilation according to the Acute Respiratory Distress Syndrome Network recommendations (ARDSnet) and the open lung approach (OLA) on pulmonary function and inflammatory response. Methods Eighteen juvenile pigs were anaesthetized, mechanically ventilated, and instrumented. ALI was induced by surfactant washout. Animals were randomly assigned to mechanical ventilation according to the ARDSnet protocol or the OLA (n=9 per group). Gas exchange, haemodynamics, pulmonary blood flow (PBF) distribution, and respiratory mechanics were measured at intervals and the lungs were removed after 6 h of mechanical ventilation for further analysis. Results PEEP and mean airway pressure were higher in the OLA than in the ARDSnet group [15 cmH2O, range 14–18 cmH2O, compared with 12 cmH2O; 20.5 (sd 2.3) compared with 18 (1.4) cmH2O by the end of the experiment, respectively], and OLA was associated with improved oxygenation compared with the ARDSnet group after 6 h. OLA showed more alveolar overdistension, especially in gravitationally non-dependent regions, while the ARDSnet group was associated with more intra-alveolar haemorrhage. Inflammatory mediators and markers of lung parenchymal stress did not differ significantly between groups. The PBF shifted from ventral to dorsal during OLA compared with ARDSnet protocol [−0.02 (−0.09 to −0.01) compared with −0.08 (−0.12 to −0.06), dorsal–ventral gradients after 6 h, respectively]. Conclusions According to the OLA, mechanical ventilation improved oxygenation and redistributed pulmonary perfusion when compared with the ARDSnet protocol, without differences in lung inflammatory response.
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Affiliation(s)
- P M Spieth
- Department of Anesthesia and Intensive Care Therapy, University Hospital Dresden, Dresden, Germany.
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Hübler M, Gäbler R, Ehm B, Oertel R, Gama de Abreu M, Koch T. Successful resuscitation following ropivacaine-induced systemic toxicity in a neonate. Anaesthesia 2010; 65:1137-40. [DOI: 10.1111/j.1365-2044.2010.06449.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gama de Abreu M, Güldner A, Koch T. Protektive Beatmung im Operationssaal. Anaesthesist 2010; 59:593-4. [DOI: 10.1007/s00101-010-1746-2] [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: 10/19/2022]
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de Abreu MG, Spieth PM, Carvalho AR, Pelosi P, Koch T. Combination of variability with pressure support ventilation enhances lung protection and function in experimental acute lung injury. Crit Care 2009. [PMCID: PMC4083923 DOI: 10.1186/cc7201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Carvalho A, Spieth P, Pelosi P, Neykova B, Heller A, Koch T, de Abreu MG. Pressure support ventilation improves oxygenation by redistribution of pulmonary blood flow in experimental lung injury. Crit Care 2008. [PMCID: PMC4088651 DOI: 10.1186/cc6501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gama de Abreu M, Kirschfink M, Quintel M, Albrecht DM. White blood cell counts and plasma C3a have synergistic predictive value in patients at risk for acute respiratory distress syndrome. Crit Care Med 1998; 26:1040-8. [PMID: 9635653 DOI: 10.1097/00003246-199806000-00025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/25/2022]
Abstract
OBJECTIVE To investigate and select nonassociated variables with predictive value for acute respiratory distress syndrome (ARDS) in patients at risk. DESIGN Prospective, observational study. SETTING A university hospital intensive care unit. PATIENTS Twenty-four critically ill patients with different risk factors for ARDS. INTERVENTIONS Arterial and mixed venous blood, as well as urine samples, were collected. Invasive hemodynamic measurements were performed. MEASUREMENTS AND MAIN RESULTS Fifty-nine variables pertaining to the cardiorespiratory, hepatic, immunologic, and renal systems and including plasma complement activation products C3a and SC5b-9 and polymorphonuclear elastase, were determined every 6 hrs for 3 days in patients at risk for ARDS. Associations among variables were investigated and the predictive value of nonassociated variables for ARDS was determined. Patients who developed ARDS (n=8) had lower white blood cell counts at the time they entered the study (p=.006) and during the first 24 hrs thereafter (p=.032). Also, plasma C3a concentrations were markedly higher during the first 24 hrs in patients who developed ARDS (p=.006). Plasma C3a had better predictive value than did white blood cell counts for cutoff points set by discriminant analysis at 1075 ng/mL (1.075 x 10(-3) g/L) and 5700 cells/mL, respectively. The combination of both variables in a discriminant function improved the predictive value for ARDS. CONCLUSIONS The most notable and nonassociated alterations observed in patients who developed ARDS were lower white blood cell counts and higher plasma C3a concentrations compared with counts and concentrations in patients who did not develop ARDS. Plasma C3a concentrations showed better predictive value than white blood cell counts. The combination of white blood cell counts with plasma C3a concentrations synergistically improved the predictive value for ARDS. This combination may prove useful for identifying subpopulations at highest risk for ARDS and may contribute to make treatment at an early stage of the syndrome possible.
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Affiliation(s)
- M Gama de Abreu
- Clinic of Anesthesiology and Intensive Care Medicine, University Clinic Carl Gustav Carus, Technical University Dresden, Germany
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Gama de Abreu M, Albrecht D. Bettseitige pulmonale Blutflußmessung mittels partieller CO 2-Rückatmung. Anasthesiol Intensivmed Notfallmed Schmerzther 1998. [DOI: 10.1055/s-2007-994868] [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: 10/21/2022]
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