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Marinakis G, Paraschos M, Patrani M, Tsoutsouras T, Vassiliou M. Non-interventional monitoring of expiratory flow limitation during experimental mechanical ventilation. ERJ Open Res 2021; 7:00264-2020. [PMID: 33532479 PMCID: PMC7836650 DOI: 10.1183/23120541.00264-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background Expiratory flow limitation (EFL) is common among patients in the intensive care unit under mechanical ventilation (MV) and may have significant clinical consequences. In the present study, we examine the possibility of non-interventional detection of EFL during experimental MV. Methods Eight artificially ventilated New Zealand rabbits were included in the experiments. EFL was induced during MV by application of negative expiratory pressure (−5, −8 and −10 hPa) and detected by the negative expiratory pressure technique. Airway pressure (Paw) and gas flow (V′) were digitally recorded and processed off-line for the evaluation of respiratory mechanics. The method is based on the computation and monitoring of instantaneous respiratory resistance Rrs(t). The resistive pressure (Paw,res(t)) is calculated by subtracting from Paw its elastic component and the end-expiratory pressure, as assessed by linear regression. Then, Rrs(t) is computed as the instant ratio Paw,res(t)/V′(t). Results Two completely different patterns of expiratory Rrs(t) separate the cases with EFL from those without EFL. Small and random fluctuations are noticed when EFL is absent, whereas the onset of EFL is accompanied by an abrupt and continuous rise in Rrs(t), towards the end of expiration. Thus, EFL is not only detected but may also be quantified from the volume still to be expired at the time EFL occurs. Conclusion The proposed technique is a simple, accurate and non-interventional tool for EFL monitoring during MV. Respiratory system resistance in expiratory flow limitation during mechanical ventilationhttps://bit.ly/34hU6Bv
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Affiliation(s)
- Giorgos Marinakis
- Dept of Critical Care Medicine, General Hospital of Athens, "Korgialenio - Benakio" Hellenic Red Cross, Athens, Greece
| | - Michael Paraschos
- Dept of Critical Care Medicine, General Hospital of Athens, "Korgialenio - Benakio" Hellenic Red Cross, Athens, Greece
| | - Maria Patrani
- Dept of Critical Care Medicine, General Hospital of Athens, "Korgialenio - Benakio" Hellenic Red Cross, Athens, Greece
| | - Theodoros Tsoutsouras
- Dept of Critical Care Medicine, General Hospital of Athens, "Korgialenio - Benakio" Hellenic Red Cross, Athens, Greece
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Mandragos E, Pistiki A, Tsangaris I, Routsi C, Paraschos M, Droggiti DI, Savvidou O, Mastrokalos D, Papagelopoulos PJ, Netea MG, Giamarellos-Bourboulis EJ. Survival after multiple traumas is associated with improved outcomes from gram-negative sepsis: Clinical and experimental evidence. J Infect 2016; 74:163-171. [PMID: 27826063 DOI: 10.1016/j.jinf.2016.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/17/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated the susceptibility to Gram-negative sepsis after multiple traumas (MT). METHODS From a prospective cohort of 5076 Greek patients with sepsis, 16 with Gram-negative bacteremia after MT were compared with 204 patients well-matched for severity, comorbidities and appropriateness of antimicrobials; circulating mononuclear cells were isolated and stimulated for the release of interleukin (IL)-10. Male C57Bl6J mice were subject to MT (right pneumothorax and right femur fracture) followed after 72 h by the intravenous challenge with Pseudomonas aeruginosa. Survival was recorded and splenocytes were isolated for cytokine stimulation. RESULTS 28-day mortality after MT was 18.8% compared to 48.0% of comparators (48.0%) (odds ratio 0.25, p: 0.035). This was confirmed after logistic regression analysis taking into consideration comorbidities and age. Stimulation of IL-10 was enhanced from MT patients. Survival of mice challenged by P. aeruginosa 72 h after MT was prolonged compared to mice challenged by P. aeruginosa without prior MT. Cytokine production was decreased 24 h after MT and restored 96 h thereafter. Production of IL-10 was particularly pronounced from splenocytes of mice challenged by P. aeruginosa after MT. CONCLUSIONS Survival after MT is accompanied by favorable immune responses allowing survival benefit from Gram-negative sepsis. This is associated with increased IL-10 release.
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Affiliation(s)
- Eleftherios Mandragos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Aikaterini Pistiki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Iraklis Tsangaris
- 2nd Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Christina Routsi
- 1st Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Michael Paraschos
- Intensive Care Unit, "Korgialeneion-Benakeion" General Hospital, Athens, Greece
| | - Dionyssia-Irene Droggiti
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Olga Savvidou
- 1st Department of Orthopaedics, National and Kapodistrian University of Athens, Medical School, Greece
| | - Dimitrios Mastrokalos
- 1st Department of Orthopaedics, National and Kapodistrian University of Athens, Medical School, Greece
| | | | - Mihai G Netea
- Department of Internal Medicine, Radboud University Nijmegen, The Netherlands
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Patrani M, Tsaganos T, Kotzampassi K, Paraschos M, Katsenos C, Giamarellos-Bourboulis EJ, Mandragos K. Soluble urokinase plasminogen activator receptor informs on the progression course after multiple injuries. Biomarkers 2016; 21:660-4. [PMID: 27121128 DOI: 10.3109/1354750x.2016.1171911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study is to study the use of soluble urokinase plasminogen activator receptor (suPAR) for the prognosis of multiple organ dysfunction (MOF) after multiple traumas. METHODS Serum suPAR was measured within the first 24 h after multiple injuries in 85 patients. Measurements were repeated after 4 d or at sepsis onset. RESULTS Odds ratio for trauma-associated MOF was 4.09 (p: 0.026) with admission suPAR greater than 8 ng/ml. More than 40% increases of suPAR were associated with odds ratio 9.33 (p: 0.047) for severe sepsis. CONCLUSIONS suPAR is a useful surrogate biomarker for development of MOF and severe sepsis after multiple traumas.
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Affiliation(s)
- Maria Patrani
- a Intensive Care Unit, Korgialeneion Benakeion General Hospital , Athens , Greece
| | - Thomas Tsaganos
- b 4th Department of Internal Medicine , National and Kapodistrian University of Athens, Medical School , Athens , Greece
| | - Katerina Kotzampassi
- c Department of Surgery , Aristotle University of Thessaloniki, Faculty of Medicine, AHEPA Hospital , Thessaloniki , Greece
| | - Michael Paraschos
- a Intensive Care Unit, Korgialeneion Benakeion General Hospital , Athens , Greece
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Patrani M, Paraschos M, Georgitsi M, Giamarellos-Bourboulis E, Mandragos K. Soluble usokinase plasminogen activator receptor as a useful biomarker to define advent of sepsis in patients with multiple injuries. Crit Care 2012. [PMCID: PMC3363442 DOI: 10.1186/cc10631] [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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Paraschos M, Patrani M, Pistiki A, Van der Meer J, Netea M, Giamarellos-Bourboulis E, Mandragos K. Blunted IL-17 responses early after advent of multiple injuries. Crit Care 2012. [PMCID: PMC3363427 DOI: 10.1186/cc10616] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Georgopoulou AP, Savva A, Giamarellos-Bourboulis EJ, Georgitsi M, Raftogiannis M, Antonakos N, Apostolidou E, Carrer DP, Dimopoulos G, Economou A, Efthymiou G, Galanakis N, Galani L, Gargalianos P, Karaiskos I, Katsenos C, Kavatha D, Koratzanis E, Labropoulos P, Lada M, Nakos G, Paggalou E, Panoutsopoulos G, Paraschos M, Pavleas I, Pontikis K, Poulakou G, Prekates A, Sybardi S, Theodorakopoulou M, Trakatelli C, Tsiaoussis P, Gogos C, Giamarellou H, Armaganidis A, Meisner M. Early changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis. J Crit Care 2010; 26:331.e1-7. [PMID: 20869839 DOI: 10.1016/j.jcrc.2010.07.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study is to define if early changes of procalcitonin (PCT) may inform about prognosis and appropriateness of administered therapy in sepsis. METHODS A prospective multicenter observational study was conducted in 289 patients. Blood samples were drawn on day 1, that is, within less than 24 hours from advent of signs of sepsis, and on days 3, 7, and 10. Procalcitonin was estimated in serum by the ultrasensitive Kryptor assay (BRAHMS GmbH, Hennigsdorf, Germany). Patients were divided into the following 2 groups according to the type of change of PCT: group 1, where PCT on day 3 was decreased by more than 30% or was below 0.25 ng/mL, and group 2, where PCT on day 3 was either increased above 0.25 ng/mL or decreased less than 30%. RESULTS Death occurred in 12.3% of patients of group 1 and in 29.9% of those of group 2 (P < .0001). Odds ratio for death of patients of group 1 was 0.328. Odds ratio for the administration of inappropriate antimicrobials of patients of group 2 was 2.519 (P = .003). CONCLUSIONS Changes of serum PCT within the first 48 hours reflect the benefit or not of the administered antimicrobial therapy. Serial PCT measurements should be used in clinical practice to guide administration of appropriate antimicrobials.
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Tsoros G, Paraschos M, Michail M, Amygdalou A, Moukas M, Vassiliou M, Mandragos C. Crit Care 2005; 9:P414. [DOI: 10.1186/cc3477] [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: 11/10/2022] Open
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Livaditis IG, Paraschos M, Dimopoulos K. Massive pulmonary embolism with ST elevation in leads V1-V3 and successful thrombolysis with tenecteplase. Heart 2004; 90:e41. [PMID: 15201267 PMCID: PMC1768302 DOI: 10.1136/hrt.2004.036335] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 42 year old woman was referred to the emergency department from the radiology department after having a syncopal episode during a triplex examination of the lower extremities for acute painful right leg swelling five hours earlier that morning. She had no significant medical history, smoked 3-5 cigarettes a day, and had been taking contraceptive medication for menorrhagia for the preceding three months. On presentation she was cyanotic, dyspnoeic, and haemodynamically unstable. ECG showed sinus tachycardia of 120 beats/min with ST elevations from V1 through V3 mimicking anteroseptal acute myocardial infarction. Ten minutes after presentation she was thrombolysed with 80 mg tenecteplase leading to ST elevation resolution and remarkable haemodynamic recovery after 20 minutes. This case shows how pulmonary embolism can mimic anteroseptal acute myocardial infarction on ECG and the life saving results from rapid thrombolysis with tenecteplase.
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Affiliation(s)
- I G Livaditis
- 1st Cardiology Department, Red Cross Hospital, Athens 11635, Greece.
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