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Longhini F, Colombo D, Pisani L, Idone F, Chun P, Doorduin J, Ling L, Alemani M, Bruni A, Zhaochen J, Tao Y, Lu W, Garofalo E, Carenzo L, Maggiore SM, Qiu H, Heunks L, Antonelli M, Nava S, Navalesi P. Efficacy of ventilator waveform observation for detection of patient-ventilator asynchrony during NIV: a multicentre study. ERJ Open Res 2017; 3:00075-2017. [PMID: 29204431 PMCID: PMC5703352 DOI: 10.1183/23120541.00075-2017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 06/21/2017] [Accepted: 07/30/2017] [Indexed: 12/17/2022] Open
Abstract
The objective of this study was to assess ability to identify asynchronies during noninvasive ventilation (NIV) through ventilator waveforms according to experience and interface, and to ascertain the influence of breathing pattern and respiratory drive on sensitivity and prevalence of asynchronies. 35 expert and 35 nonexpert physicians evaluated 40 5-min NIV reports displaying flow–time and airway pressure–time tracings; identified asynchronies were compared with those ascertained by three examiners who evaluated the same reports displaying, additionally, tracings of diaphragm electrical activity. We determined: 1) sensitivity, specificity, and positive and negative predictive values; 2) the correlation between the double true index (DTI) of each report (i.e., the ratio between the sum of true positives and true negatives, and the overall breath count) and the corresponding asynchrony index (AI); and 3) the influence of breathing pattern and respiratory drive on both AI and sensitivity. Sensitivities to detect asynchronies were low either according to experience (0.20 (95% CI 0.14–0.29) for expert versus 0.21 (95% CI 0.12–0.30) for nonexpert, p=0.837) or interface (0.28 (95% CI 0.17–0.37) for mask versus 0.10 (95% CI 0.05–0.16) for helmet, p<0.0001). DTI inversely correlated with the AI (r2=0.67, p<0.0001). Breathing pattern and respiratory drive did not affect prevalence of asynchronies and sensitivity. Patient–ventilator asynchrony during NIV is difficult to recognise solely by visual inspection of ventilator waveforms. Detection of patient–ventilator asynchrony during NIV by visual inspection of ventilator waveforms is difficulthttp://ow.ly/3ce930eGdn6
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Affiliation(s)
- Federico Longhini
- Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy
| | - Davide Colombo
- Anesthesia and Intensive Care, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Lara Pisani
- Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Idone
- Dept of Anesthesiology and Intensive Care, Agostino Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pan Chun
- Dept of Critical Care Medicine, Zhongda Hospital, Southeast University, School of Medicine, Nanjing, China
| | - Jonne Doorduin
- Dept of Intensive Care Medicine and Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Liu Ling
- Dept of Critical Care Medicine, Zhongda Hospital, Southeast University, School of Medicine, Nanjing, China
| | - Moreno Alemani
- Dept of Anesthesiology and Intensive Care, Ospedale Civile "G. Fornaroli", Magenta, Italy
| | - Andrea Bruni
- Dept of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Jin Zhaochen
- Dept of Critical Care Medicine, Zhenjiang First People's Hospital, Zhenjiang, China
| | - Yu Tao
- Dept of Critical Care Medicine, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, China
| | - Weihua Lu
- Dept of Critical Care Medicine, First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, China
| | - Eugenio Garofalo
- Dept of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Luca Carenzo
- Anesthesia and Intensive Care, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Salvatore Maurizio Maggiore
- Dept of Anesthesiology, Perioperative Care and Intensive Care, "S.S. Annunziata" Hospital, "Gabriele d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Haibo Qiu
- Dept of Critical Care Medicine, Zhongda Hospital, Southeast University, School of Medicine, Nanjing, China
| | - Leo Heunks
- Dept of Intensive Care Medicine, VU University Medical Centre, Amsterdam, the Netherlands
| | - Massimo Antonelli
- Dept of Anesthesiology and Intensive Care, Agostino Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Nava
- Alma Mater University, Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paolo Navalesi
- Dept of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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Longhini F, Ferrero F, De Luca D, Cosi G, Alemani M, Colombo D, Cammarota G, Berni P, Conti G, Bona G, Della Corte F, Navalesi P. Neurally adjusted ventilatory assist in preterm neonates with acute respiratory failure. Neonatology 2015; 107:60-7. [PMID: 25401284 DOI: 10.1159/000367886] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neurally adjusted ventilatory assist (NAVA) is a novel mode of ventilation that has been demonstrated to improve infant-ventilator interaction, compared to the conventional modes in retrospective and short-term studies. OBJECTIVES To prospectively evaluate the physiologic effects of NAVA in comparison with pressure-regulated volume control (PRVC) in two nonrandomized 12-hour periods. METHODS We studied 14 consecutive intubated preterm neonates receiving mechanical ventilation for acute respiratory failure. Peak airway pressure (Pawpeak), diaphragm electrical activity (EAdi), tidal volume (VT), mechanical (RRmec) and neural (RRneu) respiratory rates, neural apneas, and the capillary arterialized blood gases were measured. The RRmec-to-RRneu ratio (MNR) and the asynchrony index were also calculated. The amount of fentanyl administered was recorded. RESULTS Pawpeak and VT were greater in PRVC (p < 0.01). Blood gases and RRmec were not different between modes, while RRneu and the EAdi swings were greater in NAVA (p = 0.02 and p < 0.001, respectively). MNR and the asynchrony index were remarkably lower in NAVA than in PRVC (p = 0.03 and p < 0.001, respectively). 1,841 neural apneas were observed during PRVC, with none in NAVA. Less fentanyl was administered during NAVA, as opposed to PRVC (p < 0.01). CONCLUSIONS In acutely ill preterm neonates, NAVA can be safely and efficiently applied for 12 consecutive hours. Compared to PRVC, NAVA is well tolerated with fewer sedatives.
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Affiliation(s)
- Federico Longhini
- Department of Translational Medicine, Eastern Piedmont University 'A. Avogadro', Novara, Italy
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Fernandez-Torrente I, Franke KJ, Henningsen N, Schulze G, Alemani M, Roth C, Rurali R, Lorente N, Pascual JI. Spontaneous Formation of Triptycene Supramolecules on Surfaces. J Phys Chem B 2006; 110:20089-92. [PMID: 17034178 DOI: 10.1021/jp065149x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the limit of weak molecular interaction with an inorganic surface, noncovalent interactions between molecules dominate the nucleation and thin-film growth. Here, we report on the formation of three-dimensional triptycene clusters with a particularly stable structure. Once formed at the early stage of molecular adsorption, the clusters are stable for all temperatures until desorption. Furthermore, the clusters diffuse and nucleate as individual entities, therefore constituting building blocks for the later thin-film formation. High resolution scanning tunneling microscopy images indicate that the cluster is stabilized by C-H-pi interactions. The formation of such molecular structures at a surface is possible because the three-dimensional structure of the triptycene molecule leads to a very weak and mobile adsorption state. These results show that it is possible to investigate complex pathways in the formation of three-dimensional supramolecules at surfaces using a scanning tunneling microscope.
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