38 results on '"Pellegrini, Mariangela"'
Search Results
2. Finding the optimal tidal volume in acute respiratory distress syndrome
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Pellegrini, Mariangela, Del Sorbo, Lorenzo, and Ranieri, V. Marco
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- 2024
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3. Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study
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Pellegrini, Mariangela, Sousa, Mayson L. A., Dubo, Sebastian, Menga, Luca S., Hsing, Vanessa, Post, Martin, and Brochard, Laurent J.
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- 2024
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4. Regional distribution of mechanical strain and macrophage-associated lung inflammation after ventilator-induced lung injury: an experimental study
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Liggieri, Francesco, Chiodaroli, Elena, Pellegrini, Mariangela, Puuvuori, Emmi, Sigfridsson, Jonathan, Velikyan, Irina, Chiumello, Davide, Ball, Lorenzo, Pelosi, Paolo, Stramaglia, Sebastiano, Antoni, Gunnar, Eriksson, Olof, and Perchiazzi, Gaetano
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- 2024
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5. Positive end-expiratory pressure limits inspiratory effort through modulation of the effort-to-drive ratio: an experimental crossover study
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Widing, Hannes, Pellegrini, Mariangela, Chiodaroli, Elena, Persson, Per, Hallén, Katarina, and Perchiazzi, Gaetano
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- 2024
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6. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies
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Grasselli, Giacomo, Calfee, Carolyn S., Camporota, Luigi, Poole, Daniele, Amato, Marcelo B. P., Antonelli, Massimo, Arabi, Yaseen M., Baroncelli, Francesca, Beitler, Jeremy R., Bellani, Giacomo, Bellingan, Geoff, Blackwood, Bronagh, Bos, Lieuwe D. J., Brochard, Laurent, Brodie, Daniel, Burns, Karen E. A., Combes, Alain, D’Arrigo, Sonia, De Backer, Daniel, Demoule, Alexandre, Einav, Sharon, Fan, Eddy, Ferguson, Niall D., Frat, Jean-Pierre, Gattinoni, Luciano, Guérin, Claude, Herridge, Margaret S., Hodgson, Carol, Hough, Catherine L., Jaber, Samir, Juffermans, Nicole P., Karagiannidis, Christian, Kesecioglu, Jozef, Kwizera, Arthur, Laffey, John G., Mancebo, Jordi, Matthay, Michael A., McAuley, Daniel F., Mercat, Alain, Meyer, Nuala J., Moss, Marc, Munshi, Laveena, Myatra, Sheila N., Ng Gong, Michelle, Papazian, Laurent, Patel, Bhakti K., Pellegrini, Mariangela, Perner, Anders, Pesenti, Antonio, Piquilloud, Lise, Qiu, Haibo, Ranieri, Marco V., Riviello, Elisabeth, Slutsky, Arthur S., Stapleton, Renee D., Summers, Charlotte, Thompson, Taylor B., Valente Barbas, Carmen S., Villar, Jesús, Ware, Lorraine B., Weiss, Björn, Zampieri, Fernando G., Azoulay, Elie, and Cecconi, Maurizio
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- 2023
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7. Sickle cell disease: embedding patient participation into an international conference can transform the role of lived experience
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Pellegrini, Mariangela, Chakravorty, Subarna, del Mar Manu Pereira, Maria, Gulbis, Beatrice, Gilmour-Hamilton, Catriona, Hayes, Sandy, de Montalembert, Mariane, Inusa, Baba Psalm Duniya, Colombatti, Raffaella, and Roy, Noémi BA
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- 2023
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8. Sickle cell disease landscape and challenges in the EU: the ERN-EuroBloodNet perspective
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Mañú Pereira, María del Mar, Colombatti, Raffaella, Alvarez, Federico, Bartolucci, Pablo, Bento, Celeste, Brunetta, Angelo Loris, Cela, Elena, Christou, Soteroula, Collado, Anna, de Montalembert, Mariane, Dedeken, Laurence, Fenaux, Pierre, Galacteros, Frédéric, Glenthøj, Andreas, Gutiérrez Valle, Victoria, Kattamis, Antonis, Kunz, Joachim, Lobitz, Stephan, McMahon, Corrina, Pellegrini, Mariangela, Reidel, Sara, Russo, Giovanna, Santos Freire, Miriam, van Beers, Eduard, Kountouris, Petros, and Gulbis, Béatrice
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- 2023
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9. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study
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Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R. J., Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J., Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J., and Cecconi, Maurizio
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- 2022
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10. Limitations of the ARDS criteria during high-flow oxygen or non-invasive ventilation: evidence from critically ill COVID-19 patients
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Hultström, Michael, Hellkvist, Ola, Covaciu, Lucian, Fredén, Filip, Frithiof, Robert, Lipcsey, Miklós, Perchiazzi, Gaetano, and Pellegrini, Mariangela
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- 2022
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11. Chest dual-energy CT to assess the effects of steroids on lung function in severe COVID-19 patients
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Perchiazzi, Gaetano, Larina, Aleksandra, Hansen, Tomas, Frithiof, Robert, Hultström, Michael, Lipcsey, Miklos, and Pellegrini, Mariangela
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- 2022
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12. Body mass index is associated with pulmonary gas and blood distribution mismatch in COVID-19 acute respiratory failure. A physiological study.
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Bjarnadóttir, Kristín J., Perchiazzi, Gaetano, Sidenbladh, Caroline Lördal, Larina, Aleksandra, Wallin, Ewa, Larsson, Ing-Marie, Franzén, Stephanie, Larsson, Anders O., Sousa, Mayson L. A., Segelsjö, Monica, Hansen, Tomas, Frithiof, Robert, Hultström, Michael, Lipcsey, Miklos, and Pellegrini, Mariangela
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BLOOD gases ,ADULT respiratory distress syndrome ,GAS distribution ,BODY mass index ,COMPUTED tomography - Abstract
Background: The effects of obesity on pulmonary gas and blood distribution in patients with acute respiratory failure remain unknown. Dual-energy computed tomography (DECT) is a X-ray-based method used to study regional distribution of gas and blood within the lung. We hypothesized that 1) regional gas/blood mismatch can be quantified by DECT; 2) obesity influences the global and regional distribution of pulmonary gas and blood; 3) regardless of ventilation modality (invasive vs. non-invasive ventilation), patients' body mass index (BMI) has an impact on pulmonary gas/blood mismatch. Methods: This single-centre prospective observational study enrolled 118 hypoxic COVID-19 patients (92 male) in need of respiratory support and intensive care who underwent DECT. The cohort was divided into three groups according to BMI: 1. BMI<25 kg/m2 (non-obese), 2. BMI = 25-40 kg/m2 (overweight to obese), and 3. BMI>40 kg/m2 (morbidly obese). Gravitational analysis of Hounsfield unit distribution of gas and blood was derived from DECT and used to calculate regional gas/blood mismatch. A sensitivity analysis was performed to investigate the influence of the chosen ventilatory modality and BMI on gas/blood mismatch and adjust for other possible confounders (i.e., age and sex). Results: 1) Regional pulmonary distribution of gas and blood and their mismatch were quantified using DECT imaging. 2) The BMI>40 kg/m2 group had less hyperinflation in the non-dependent regions and more lung collapse in the dependent regions compared to the other BMI groups. In morbidly obese patients, gas and blood were more evenly distributed; therefore, the mismatch was lower than in other patients (30% vs. 36%, p < 0.05). 3) An increase in BMI of 5 kg/m2 was associated with a decrease in mismatch of 3.3% (CI: 3.67% to -2.93%, p < 0.05). Neither the ventilatory modality nor age and sex affected the gas/blood mismatch (p > 0.05). Conclusion: 1) In a hypoxic COVID-19 population needing intensive care, pulmonary gas/blood mismatch can be quantified at a global and regional level using DECT. 2) Obesity influences the global and regional distribution of gas and blood within the lung, and BMI>40 kg/m2 improves pulmonary gas/blood mismatch. 3) This is true regardless of the ventilatory mode and other possible confounders, i.e., age and sex. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Correction to: Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study
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Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R. J., Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J., Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J., and Cecconi, Maurizio
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- 2022
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14. A quantitative analysis of extension and distribution of lung injury in COVID-19: a prospective study based on chest computed tomography
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Pellegrini, Mariangela, Larina, Aleksandra, Mourtos, Evangelos, Frithiof, Robert, Lipcsey, Miklos, Hultström, Michael, Segelsjö, Monica, Hansen, Tomas, and Perchiazzi, Gaetano
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- 2021
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15. Lung impedance changes during awake prone positioning in COVID-19. A non-randomized cross-over study.
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Rosén, Jacob, Frykholm, Peter, Jonsson Fagerlund, Malin, Pellegrini, Mariangela, Campoccia Jalde, Francesca, von Oelreich, Erik, and Fors, Diddi
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PATIENT positioning ,LUNGS ,ELECTRICAL impedance tomography ,COVID-19 ,INTENSIVE care patients ,RESPIRATORY mechanics - Abstract
Background: The effects of awake prone positioning (APP) on respiratory mechanics in patients with COVID-19 are not well characterized. The aim of this study was to investigate changes of global and regional lung volumes during APP compared with the supine position using electrical lung impedance tomography (EIT) in patients with hypoxemic respiratory failure due to COVID-19. Materials and methods: This exploratory non-randomized cross-over study was conducted at two university hospitals in Sweden between January and May 2021. Patients admitted to the intensive care unit with confirmed COVID-19, an arterial cannula in place, a PaO
2 /FiO2 ratio <26.6 kPa (<200 mmHg) and high-flow nasal oxygen or non-invasive ventilation were eligible for inclusion. EIT-data were recorded at supine baseline, at 30 and 60 minutes after APP-initiation, and 30 minutes after supine repositioning. The primary outcomes were changes in global and regional tidal impedance variation (TIV), center of ventilation (CoV), global and regional delta end-expiratory lung-impedance (dEELI) and global inhomogeneity (GI) index at the end of APP compared with supine baseline. Data were reported as median (IQR). Results: All patients (n = 10) were male and age was 64 (47–73) years. There were no changes in global or regional TIV, CoV or GI-index during the intervention. dEELI increased from supine reference value 0 to 1.51 (0.32–3.62) 60 minutes after APP (median difference 1.51 (95% CI 0.19–5.16), p = 0.04) and returned to near baseline values after supine repositioning. Seven patients (70%) showed an increase >0.20 in dEELI during APP. The other EIT-variables did not change during APP compared with baseline. Conclusion: Awake prone positioning was associated with a transient lung recruiting effect without changes in ventilation distribution measured with EIT in patients with hypoxemic respiratory failure due to COVID-19. [ABSTRACT FROM AUTHOR]- Published
- 2024
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16. International variation in the management of severe COVID-19 patients
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Azoulay, Elie, de Waele, Jan, Ferrer, Ricard, Staudinger, Thomas, Borkowska, Marta, Povoa, Pedro, Iliopoulou, Katerina, Artigas, Antonio, Schaller, Stefan J., Shankar-Hari, Manu, Pellegrini, Mariangela, Darmon, Michael, Kesecioglu, Jozef, and Cecconi, Maurizio
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- 2020
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17. Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study.
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Kloss, Philipp, Lindholz, Maximilian, Milnik, Annette, Azoulay, Elie, Cecconi, Maurizio, Citerio, Giuseppe, De Corte, Thomas, Duska, Frantisek, Galarza, Laura, Greco, Massimiliano, Girbes, Armand R. J., Kesecioglu, Jozef, Mellinghoff, Johannes, Ostermann, Marlies, Pellegrini, Mariangela, Teboul, Jean-Louis, De Waele, Jan, Wong, Adrian, Schaller, Stefan J., and for the ESICM UNITE COVID Investigators
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COVID-19 ,CRITICALLY ill ,LENGTH of stay in hospitals ,SCIENTIFIC observation ,FACTOR analysis - Abstract
Background: Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods: This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results: Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions: Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). [ABSTRACT FROM AUTHOR]
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- 2023
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18. Individual Airway Closure Characterized In Vivo by Phase-Contrast CT Imaging in Injured Rabbit Lung
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Broche, Ludovic, Pisa, Pauline, Porra, Liisa, Degrugilliers, Loïc, Bravin, Alberto, Pellegrini, Mariangela, Borges, João Batista, Perchiazzi, Gaetano, Larsson, Anders, Hedenstierna, Göran, and Bayat, Sam
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- 2019
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19. Robustness of two different methods of monitoring respiratory system compliance during mechanical ventilation
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Perchiazzi, Gaetano, Rylander, Christian, Pellegrini, Mariangela, Larsson, Anders, and Hedenstierna, Göran
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- 2017
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20. Monitoring of total positive end-expiratory pressure during mechanical ventilation by artificial neural networks
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Perchiazzi, Gaetano, Rylander, Christian, Pellegrini, Mariangela, Larsson, Anders, and Hedenstierna, Göran
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- 2017
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21. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave
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Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R.J., Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Póvoa, Pedro, Schaller, Stefan J., Teboul, Jean Louis, Wong, Adrian, De Waele, Jan, Cecconi, Maurizio, Bezzi, Marco, Gira, Alicia, Eller, Philipp, Hamid, Tarikul, Haque, Injamam Ull, De Buyser, Wim, Cudia, Antonella, De Backer, Daniel, Foulon, Pierre, Collin, Vincent, Van Hecke, Jolien, De Waele, Elisabeth, Van Malderen, Claire, Mesland, Jean Baptiste, Biston, Patrick, Piagnerelli, Michael, Haentjens, Lionel, De Schryver, Nicolas, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Centro de Estudos de Doenças Crónicas (CEDOC), and Comprehensive Health Research Centre (CHRC) - pólo NMS
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Critical care ,SARS-CoV-2 ,COVID-19 ,Pneumonia ,Critical Care and Intensive Care Medicine ,Surge capacity - Abstract
Funding Information: AE, FD, GDP, LG, VG, AJ, JK, AL, JM, SNM, MO, MP, MC declare no conflicts of interest. MG reports speaking fees from Baxter and Philips. TDC is supported by Research Foundation Flanders (Grant nr G085920N). MA reports Research Grant from GE, Honoraria from Fisher and Paykel, Pfizer, Orion and Gilead. GC reports grants, personal fees as Speakers’ Bureau Member and Advisory Board Member from Integra and Neuroptics, all outside the submitted work. ACM is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1). SE declares no financial COIs and the following non-financial disclosures: Cochrane editor, American Society of Anesthesiologist data review board member. LF reports research funding from NIHR, Baxter, Ortho-Clinical Diagnostics, Exthera Medical and lecture fees from Baxter, Fresenius, Paion, all outside the submitted work. GG received payment for lectures from Getinge, Draeger Medical, Fisher&Paykel, Biotest, MSD, Gilead and unrestricted research grants from Fisher&Paykel and MSD (all unrelated to the present work). MCMD declares potential conflict of interest with BD. PP declares potential conflicts of interest with Pfizer, MSD and Gilead. SJS reports personal fees from Springer-Verlag, GmbH (Vienna, Austria) for educational commitments grants and non-financial support from ESICM (Bruxelles, Belgium), Fresenius (Germany), Liberate Medical LLC (Crestwood, USA), STIMIT AG (Nidau, Switzerland) Reactive Robotics GmbH (Munich, Germany) as well as from Technical University of Munich, Germany, from national (e.g. DGAI) and international (e.g. ESICM) medical societies (or their congress organizers) in the field of anesthesiology and intensive care, all outside the submitted work; SJS holds stocks in small amounts from Alphabeth Inc., Bayer AG, Rhön-Klinikum AG, and Siemens AG. These did not have any influence on this study. AW reports Honorarium for delivery of educational material for Vygon, GE. JLT declares potential conflict of interest with Getinge. JDW has consulted for Pfizer, MSD (honoraria paid to institution), and is a senior clinical investigator funded by the Research Foundation Flanders (FWO, Ref. 1881020N). Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality. publishersversion published
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- 2022
22. The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome
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Widing, Carl Hannes, Pellegrini, Mariangela, Larsson, Anders, and Perchiazzi, Gaetano
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Anestesi och intensivvård ,VILI ,Anesthesiology and Intensive Care ,Physiology ,respiratory failure ,respiratory system ,mechanical ventilation ,respiratory tract diseases ,NAVA ,Physiology (medical) ,ARDS ,PEEP ,circulatory and respiratory physiology ,Original Research - Abstract
Background Whether spontaneous breathing (SB) should be used in early acute respiratory distress syndrome (ARDS) is questioned because it may cause ventilator-induced lung injury (VILI) by tidal high strain/stress and recruitment/derecruitment (R/D). However, SB has shown beneficial effects when used appropriately. We hypothesized that high levels of positive end-expiratory pressure (PEEP), during assisted SB, would prevent tidal R/D, reducing ventilatory variation and respiratory rate while potentially increasing transpulmonary pressure (P-TP). The aim was to test this hypothesis in experimental mild ARDS during continuous SB using neurally adjusted ventilator assist (NAVA) and uninterrupted computed tomography (CT) exposure. Methods Mild experimental ARDS (PaO2/FiO2-ratio of 250) was induced in anesthetized pigs (n = 5), ventilated using uninterrupted NAVA. PEEP was changed in steps of 3 cmH(2)O, from 0 to 15 and back to 0 cmH(2)O. Dynamic CT scans, ventilatory parameters, and esophageal pressure were acquired simultaneously. P-TP and R/D were calculated and compared among PEEP levels. Results When increasing PEEP from 0 to 15 cmH(2)O, tidal R/D decreased from 4.3 +/- 5.9 to 1.1 +/- 0.7% (p < 0.01), breath-to-breath variability decreased, and P-TP increased from 11.4 +/- 3.7 to 29.7 +/- 14.1 cmH(2)O (R-2 = 0.96). Conclusion This study shows that injurious phenomena like R/D and high P-TP are present in NAVA at the two extremes of the PEEP spectrum. Willing to titrate PEEP to limit these phenomena, the physician must choose the best compromise between restraining the R/D or P-TP.
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- 2019
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23. Regional Lung Mechanics and Influence of an Active Diaphragm in Experimental Lung Injury
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Pellegrini, Mariangela
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Anestesi och intensivvård ,Fysiologi ,Anesthesiology and Intensive Care ,Physiology ,animal model ,Respiratory Medicine and Allergy ,respiratory system ,acute respiratory distress syndrome ,diaphragm ,artificial respiration ,pulmonary atelectasis ,lung imaging ,Lungmedicin och allergi - Abstract
Despite being an essential life-support strategy in severe respiratory failure, mechanical ventilation can, if not optimally set and monitored, lead to injury of the lung parenchyma and diaphragm. These conditions are called ventilator-induced lung injury and ventilator-induced diaphragmatic dysfunction (VIDD), respectively. Although substantial progress has been made in the ventilator management of severely lung-injured patients, we are still far from a fully protective mechanical ventilation. In consideration of this gap of knowledge, this doctoral thesis aimed at investigating regional lung mechanics during both inspiration and expiration, in both controlled and assisted ventilation. Particular emphasis was placed on the expiratory phase, which is involved in expiratory flow limitation, airway closure and atelectasis formation, although commonly considered non-harmful. A novel methodological approach has been the fundamental basis for this research project. The combination of respiratory mechanics, diaphragmatic electromyographic activity and lung imaging enabled a breath-by-breath analysis at high temporal and spatial resolution. In Study I, the gravitational field affected the distribution of gas and transpulmonary pressures, as previously shown. This effect differed between healthy and injured lungs. Moreover, lung injury induced a heterogeneous distribution of gas within the lungs, as well as an increased gravitational gradient in transpulmonary pressure. Study I was mainly aimed at testing the new methodological approach centred on the investigation of regional lung mechanics. In Study II, the focus was on assisted ventilation and the phenomenon of gas redistribution within the lungs. Large pendelluft events had been demonstrated in disproportionate inspiratory efforts. In Study II, we showed that large pendelluft resulting from pathological respiratory drive could be attenuated by high positive end expiratory pressure (PEEP). Moreover, we showed that transient and widespread small gas redistribution events occur at all times during inspiration. Assisted ventilation and high PEEP reduced the size of gas redistribution as compared with controlled ventilation and low PEEP. In Study III, we demonstrated a diaphragmatic expiratory contraction in lungs prone to collapse, serving to brake the expiratory flow. It preserved end expiratory lung volume (EELV) and counteracted tidal atelectasis. However, the expiratory brake induced by diaphragmatic contraction is a known cause of VIDD. In Study IV, we tested the effects of external expiratory resistances (ExpR). We showed that, by applying ExpR, an expiratory brake was induced. The beneficial effects on EELV were retained, while the diaphragm could quickly relax during the expiration, thus reducing the risk of VIDD.
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- 2019
24. Inspiratory Efforts, Positive End-Expiratory Pressure, and External Resistances Influence Intraparenchymal Gas Redistribution in Mechanically Ventilated Injured Lungs.
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Pellegrini, Mariangela, Hedenstierna, Göran, Larsson, Anders Sune, and Perchiazzi, Gaetano
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POSITIVE end-expiratory pressure ,ADULT respiratory distress syndrome ,COMPUTED tomography ,ARTIFICIAL respiration ,RESPIRATORY mechanics - Abstract
Background: Potentially harmful lung overstretch can follow intraparenchymal gas redistribution during mechanical ventilation. We hypothesized that inspiratory efforts characterizing spontaneous breathing, positive end-expiratory pressure (PEEP), and high inspiratory resistances influence inspiratory intraparenchymal gas redistribution. Methods: This was an experimental study conducted on a swine model of mild acute respiratory distress syndrome. Dynamic computed tomography and respiratory mechanics were simultaneously acquired at different PEEP levels and external resistances, during both spontaneous breathing and controlled mechanical ventilation. Images were collected at two cranial–caudal levels. Delta-volume images (ΔVOLs) were obtained subtracting pairs of consecutive inspiratory images. The first three ΔVOLs, acquired for each analyzed breath, were used for the analysis of inspiratory pendelluft defined as intraparenchymal gas redistribution before the start of inspiratory flow at the airway opening. The following ΔVOLs were used for the analysis of gas redistribution during ongoing inspiratory flow at the airway opening. Results: During the first flow-independent phase of inspiration, the pendelluft of gas was observed only during spontaneous breathing and along the cranial-to-caudal and nondependent-to-dependent directions. The pendelluft was reduced by high PEEP (p < 0.04 comparing PEEP 15 and PEEP 0 cm H
2 O) and low external resistances (p < 0.04 comparing high and low external resistance). During the flow-dependent phase of inspiration, two patterns were identified: (1) gas displacing characterized by large gas redistribution areas; (2) gas scattering characterized by small, numerous areas of gas redistribution. Gas displacing was observed at low PEEP, high external resistances, and it characterized controlled mechanical ventilation (p < 0.01, comparing high and low PEEP during controlled mechanical ventilation). Conclusions: Low PEEP and high external resistances favored inspiratory pendelluft. During the flow-dependent phase of the inspiration, controlled mechanical ventilation and low PEEP and high external resistances favored larger phenomena of intraparenchymal gas redistribution (gas displacing) endangering lung stability. [ABSTRACT FROM AUTHOR]- Published
- 2021
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25. Regional behavior of airspaces during positive pressure reduction assessed by synchrotron radiation computed tomography
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Scaramuzzo, Gaetano, Broche, Ludovic, Pellegrini, Mariangela, Porra, Liisa, Derosa, Savino, Tannoia, Angela Principia, Marzullo, Andrea, Batista Borges, João, Bayat, Sam, Bravin, Alberto, Larsson, Anders, Perchiazzi, Gaetano, Department of Physics, HUS Medical Imaging Center, Scaramuzzo, G, Broche, L, Pellegrini, M, Porra, L, Derosa, S, Tannoia, A, Marzullo, A, Borges, J, Bayat, S, Bravin, A, Larsson, A, and Perchiazzi, G
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RECRUITMENT ,Anestesi och intensivvård ,STRESS ,VILI ,Physiology ,Respiratory Medicine and Allergy ,SURFACE-TENSION ,VOLUME CURVE ,FIS/07 - FISICA APPLICATA (A BENI CULTURALI, AMBIENTALI, BIOLOGIA E MEDICINA) ,114 Physical sciences ,NO ,INFLATION ,Physiology (medical) ,ACUTE RESPIRATORY-FAILURE ,Original Research ,Lungmedicin och allergi ,Kinetic ,alveoli ,SRCT ,Anesthesiology and Intensive Care ,217 Medical engineering ,respiratory system ,MECHANICAL VENTILATION ,respiratory tract diseases ,MODEL ,recruitment ,FRELON CAMERA ,kinetics ,DERECRUITMENT ,recruitment, VILI, alveoli, kinetics, SRCT ,LUNG INJURY - Abstract
Introduction: The mechanisms of lung inflation and deflation are only partially known. Ventilatory strategies to support lung function rely upon the idea that lung alveoli are isotropic balloons that progressively inflate or deflate and that lung pressure/volume curves derive only by the interplay of critical opening pressures, critical closing pressures, lung history, and position of alveoli inside the lung. This notion has been recently challenged by subpleural microscopy, magnetic resonance, and computed tomography (CT). Phase-contrast synchrotron radiation CT (PC-SRCT) can yield in vivo images at resolutions higher than conventional CT. Objectives: We aimed to assess the numerosity (ASden) and the extension of the surface of airspaces (ASext) in healthy conditions at different volumes, during stepwise lung deflation, in concentric regions of the lung. Methods: The study was conducted in seven anesthetized New Zealand rabbits. They underwent PC-SRCT scans (resolution of 47.7 mu m) of the lung at five decreasing positive end expiratory pressure (PEEP) levels of 12, 9, 6, 3, and 0 cmH(2)O during end-expiratory holds. Three concentric regions of interest (ROIs) of the lung were studied: subpleural, mantellar, and core. The images were enhanced by phase contrast algorithms. ASden and ASext were computed by using the Image Processing Toolbox for MatLab. Statistical tests were used to assess any significant difference determined by PEEP or ROI on ASden and ASext. Results: When reducing PEEP, in each ROI the ASden significantly decreased. Conversely, ASext variation was not significant except for the core ROI. In the latter, the angular coefficient of the regression line was significantly low. Conclusion: The main mechanism behind the decrease in lung volume at PEEP reduction is derecruitment. In our study involving lung regions laying on isogravitational planes and thus equally influenced by gravitational forces, airspace numerosity and extension of surface depend on the local mechanical properties of the lung.
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- 2019
26. The use of positive end expiratory pressure in patients affected by COVID-19: Time to reconsider the relation between morphology and physiology.
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Perchiazzi, Gaetano, Pellegrini, Mariangela, Chiodaroli, Elena, Urits, Ivan, Kaye, Alan D., Viswanath, Omar, Varrassi, Giustino, and Puntillo, Filomena
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Coronavirus disease 2019 (COVID-19) is a new disease with different phases that can be catastrophic for subpopulations of patients with cardiovascular and pulmonary disease states at baseline. Appreciation for these different phases and treatment modalities, including manipulation of ventilatory settings and therapeutics, has made it a less lethal disease than when it emerged earlier this year. Different aspects of the disease are still largely unknown. However, laboratory investigation and clinical course of the COVID-19 show that this new disease is not a typical acute respiratory distress syndrome process, especially during the first phase. For this reason, the best strategy to be applied is to treat differently the single phases and to support the single functions of the failing organs as they appear. [ABSTRACT FROM AUTHOR]
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- 2020
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27. Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak.
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Azoulay, Elie, De Waele, Jan, Ferrer, Ricard, Staudinger, Thomas, Borkowska, Marta, Povoa, Pedro, Iliopoulou, Katerina, Artigas, Antonio, Schaller, Stefan J., Hari, Manu Shankar, Pellegrini, Mariangela, Darmon, Michael, Kesecioglu, Jozef, and Cecconi, Maurizio
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COVID-19 pandemic ,INTENSIVE care units ,MEDICAL care surveys ,SYMPTOMS ,MEDICAL personnel ,PSYCHOLOGICAL distress - Abstract
Background: The COVID-19 pandemic has resulted in an unprecedented healthcare crisis with a high prevalence of psychological distress in healthcare providers. We sought to document the prevalence of burnout syndrome amongst intensivists facing the COVID-19 outbreak. Methods: Cross-sectional survey among intensivists part of the European Society of Intensive Care Medicine. Symptoms of severe burnout, anxiety and depression were collected. Factors independently associated with severe burnout were assessed using Cox model. Results: Response rate was 20% (1001 completed questionnaires were returned, 45 years [39–53], 34% women, from 85 countries, 12 regions, 50% university-affiliated hospitals). The prevalence of symptoms of anxiety and depression or severe burnout was 46.5%, 30.2%, and 51%, respectively, and varied significantly across regions. Rating of the relationship between intensivists and other ICU stakeholders differed significantly according to the presence of anxiety, depression, or burnout. Similar figures were reported for their rating of the ethical climate or the quality of the decision-making. Factors independently associated with anxiety were female gender (HR 1.85 [1.33–2.55]), working in a university-affiliated hospital (HR 0.58 [0.42–0.80]), living in a city of > 1 million inhabitants (HR 1.40 [1.01–1.94]), and clinician's rating of the ethical climate (HR 0.83 [0.77–0.90]). Independent determinants of depression included female gender (HR 1.63 [1.15–2.31]) and clinician's rating of the ethical climate (HR 0.84 [0.78–0.92]). Factors independently associated with symptoms of severe burnout included age (HR 0.98/year [0.97–0.99]) and clinician's rating of the ethical climate (HR 0.76 [0.69–0.82]). Conclusions: The COVID-19 pandemic has had an overwhelming psychological impact on intensivists. Follow-up, and management are warranted to assess long-term psychological outcomes and alleviate the psychological burden of the pandemic on frontline personnel. [ABSTRACT FROM AUTHOR]
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- 2020
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28. Expiratory Resistances Prevent Expiratory Diaphragm Contraction, Flow Limitation, and Lung Collapse.
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Pellegrini, Mariangela, Gudmundsson, Magni, Bencze, Reka, Segelsjo, Monica, Freden, Filip, Rylander, Christian, Hedenstierna, Göran, Larsson, Anders S., Perchiazzi, Gaetano, and Segelsjö, Monica
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ADULT respiratory distress syndrome ,EXPIRATORY flow ,ATELECTASIS ,RESPIRATORY mechanics ,HEMODYNAMICS - Abstract
Rationale: Tidal expiratory flow limitation (tidal-EFL) is not completely avoidable by applying positive end-expiratory pressure and may cause respiratory and hemodynamic complications in ventilated patients with lungs prone to collapse. During spontaneous breathing, expiratory diaphragmatic contraction counteracts tidal-EFL. We hypothesized that during both spontaneous breathing and controlled mechanical ventilation, external expiratory resistances reduce tidal-EFL.Objectives: To assess whether external expiratory resistances 1) affect expiratory diaphragmatic contraction during spontaneous breathing, 2) reduce expiratory flow and make lung compartments more homogeneous with more similar expiratory time constants, and 3) reduce tidal atelectasis, preventing hyperinflation.Methods: Three positive end-expiratory pressure levels and four external expiratory resistances were tested in 10 pigs after lung lavage. We analyzed expiratory diaphragmatic electric activity and respiratory mechanics. On the basis of computed tomography scans, four lung compartments-not inflated (atelectasis), poorly inflated, normally inflated, and hyperinflated-were defined.Measurements and Main Results: Consequently to additional external expiratory resistances, and mainly in lungs prone to collapse (at low positive end-expiratory pressure), 1) the expiratory transdiaphragmatic pressure decreased during spontaneous breathing by >10%, 2) expiratory flow was reduced and the expiratory time constants became more homogeneous, and 3) the amount of atelectasis at end-expiration decreased from 24% to 16% during spontaneous breathing and from 32% to 18% during controlled mechanical ventilation, without increasing hyperinflation.Conclusions: The expiratory modulation induced by external expiratory resistances preserves the positive effects of the expiratory brake while minimizing expiratory diaphragmatic contraction. External expiratory resistances optimize lung mechanics and limit tidal-EFL and tidal atelectasis, without increasing hyperinflation. [ABSTRACT FROM AUTHOR]
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- 2020
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29. The Diaphragm Acts as a Brake during Expiration to Prevent Lung Collapse.
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Pellegrini, Mariangela, Hedenstierna, Göran, Roneus, Agneta, Segelsjö, Monica, Larsson, Anders, and Perchiazzi, Gaetano
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Rationale: The diaphragm is the major inspiratory muscle and is assumed to relax during expiration. However, electrical postinspiratory activity has been observed. Whether there is an expiratory diaphragmatic contraction that preserves lung patency has yet to be explored.Objectives: We hypothesized the occurrence of an expiratory diaphragmatic contraction directed at stabilizing peripheral airways and preventing or reducing cyclic expiratory lung collapse.Methods: Mild acute respiratory distress syndrome was induced in 10 anesthetized, spontaneously breathing pigs. Lung volume was decreased by lowering end-expiratory airway pressure in a stepwise manner. We recorded the diaphragmatic electric activity during expiration, dynamic computed tomographic scans, and respiratory mechanics. In five pigs, the same protocol was repeated during mechanical ventilation after muscle paralysis.Measurements and Main Results: Diaphragmatic electric activity during expiration increased by decreasing end-expiratory lung volume during spontaneous breathing. This enhanced the diaphragm muscle force, to a greater extent with lower lung volume, indicating a diaphragmatic electromechanical coupling during spontaneous expiration. In turn, the resulting diaphragmatic contraction delayed and reduced the expiratory collapse and increased lung aeration compared with mechanical ventilation with muscle paralysis and absence of diaphragmatic activity.Conclusions: The diaphragm is an important regulator of expiration. Its expiratory activity seems to preserve lung volume and to protect against lung collapse. The loss of diaphragmatic expiratory contraction during mechanical ventilation and muscle paralysis may be a contributing factor to unsuccessful respiratory support. [ABSTRACT FROM AUTHOR]- Published
- 2017
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30. Dynamic Mechanical Interactions Between Neighboring Airspaces Determine Cyclic Opening and Closure in Injured Lung.
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Broche, Ludovic, Perchiazzi, Gaetano, Porra, Liisa, Tannoia, Angela, Pellegrini, Mariangela, Derosa, Savino, Sindaco, Alessandra, Batista Borges, João, Degrugilliers, Loïc, Larsson, Anders, Hedenstierna, Göran, Wexler, Anthony S., Bravin, Alberto, Verbanck, Sylvia, Smith, Bradford J., Bates, Jason H. T., and Bayat, Sam
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- 2017
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31. Effects of superimposed tissue weight on regional compliance of injured lungs.
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Pellegrini, Mariangela, Derosa, Savino, Tannoia, Angela, Rylander, Christian, Fiore, Tommaso, Larsson, Anders, Hedenstierna, Göran, and Perchiazzi, Gaetano
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LUNG injuries , *COMPUTED tomography , *POSITIVE end-expiratory pressure , *F-test (Mathematical statistics) , *INJURY risk factors - Abstract
Computed tomography (CT), together with image analysis technologies, enable the construction of regional volume (V REG ) and local transpulmonary pressure (P TP,REG ) maps of the lung. Purpose of this study is to assess the distribution of V REG vs P TP,REG along the gravitational axis in healthy (HL) and experimental acute lung injury conditions (eALI) at various positive end-expiratory pressures (PEEPs) and inflation volumes. Mechanically ventilated pigs underwent inspiratory hold maneuvers at increasing volumes simultaneously with lung CT scans. eALI was induced via the iv administration of oleic acid. We computed voxel-level V REG vs P TP,REG curves into eleven isogravitational planes by applying polynomial regressions. Via F-test, we determined that V REG vs P TP,REG curves derived from different anatomical planes (p-values < 1.4E-3), exposed to different PEEPs (p-values < 1.5E-5) or subtending different lung status (p-values < 3E-3) were statistically different (except for two cases of adjacent planes). Lung parenchyma exhibits different elastic behaviors based on its position and the density of superimposed tissue which can increase during lung injury. [ABSTRACT FROM AUTHOR]
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- 2016
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32. Reabsorption atelectasis in a porcine model of ARDS: regional and temporal effects of airway closure, oxygen, and distending pressure.
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Derosa, Savino, Borges, João Batista, Segelsjö, Monica, Tannoia, Angela, Pellegrini, Mariangela, Larsson, Anders, Perchiazzi, Gaetano, and Hedenstierna, Göran
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ATELECTASIS ,COMPUTED tomography - Abstract
Little is known about the small airways dysfunction in acute respiratory distress syndrome (ARDS). By computed tomography (CT) imaging in a porcine experimental model of early ARDS, we aimed at studying the location and magnitude of peripheral airway closure and alveolar collapse under high and low distending pressures and high and low inspiratory oxygen fraction (F
I O2 ). Six piglets were mechanically ventilated under anesthesia and muscle relaxation. Four animals underwent saline-washout lung injury, and two served as healthy controls. Beyond the site of assumed airway closure, gas was expected to be trapped in the injured lungs, promoting alveolar collapse. This was tested by ventilation with an FI O2 of 0.25 and 1 in sequence during low and high distending pressures. In the most dependent regions, the gas/tissue ratio of end-expiratory CT, after previous ventilation with FI O2 0.25 low-driving pressure, was significantly higher than after ventilation with FI O2 1; with high-driving pressure, this difference disappeared. Also, significant reduction in poorly aerated tissue and a correlated increase in nonaerated tissue in endexpiratory CT with FI O2 1 low-driving pressure were seen. When high-driving pressure was applied or after previous ventilation with FI O2 0.25 and low-driving pressure, this pattern disappeared. The findings suggest that low distending pressures produce widespread dependent airway closure and with high FI O2 , subsequent absorption atelectasis. Low FI O2 prevented alveolar collapse during the study period because of slow absorption of gas behind closed airways. [ABSTRACT FROM AUTHOR]- Published
- 2013
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33. ERN-EurobloodNet: A European Reference Network for Rare Blood Diseases and a Model for Emulation.
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Fenaux, Pierre, Gulbis, Béatrice, Pereira, Maria del Mar Mañú, Valle, Victoria Gutierrez, and Pellegrini, Mariangela
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BLOOD diseases ,RARE diseases ,MEDICAL personnel ,SICKLE cell anemia ,BLOOD coagulation disorders - Abstract
ERN-EuroBloodNet, the European Reference Center in Rare Hematological Diseases (RHD) involves more than 450 RHD encompassing oncological and non oncological rare hematological diseases: rare anemias, rare coagulation disorders, polycythemia, myeloid and lymphoid tumors and rare hereditary hemochromatosis. (1) Availability of next generation sequencing for rare anemia disorders across the EU; (2) European Network of Sickle Cell Disease Patients' Organizations; (3) Training sessions for sickle cell disease patients; (4) Cross-Border collaborations agreements for bone marrow transplantation as a model for cross-border referral system; (5) Preceptorships for health professional cases based in EuroBloodNet healthcare providers and coordinated by Euro BloodNet sickle cell disease experts. In addition, RADeep, the Rare Anemia Disorders European Epidemiological Platform, is a joint venture conceived in the core of ERN-EuroBloodNet aiming at engaging clinical and basic research on Rare anemia disorders by facilitating the identification of patients' cohorts across Europe. [Extracted from the article]
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- 2019
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34. The Effect of Positive End-Expiratory Pressure on Lung Micromechanics Assessed by Synchrotron Radiation Computed Tomography in an Animal Model of ARDS.
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Scaramuzzo, Gaetano, Broche, Ludovic, Pellegrini, Mariangela, Porra, Liisa, Derosa, Savino, Tannoia, Angela Principia, Marzullo, Andrea, Borges, João Batista, Bayat, Sam, Bravin, Alberto, Larsson, Anders, and Perchiazzi, Gaetano
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POSITIVE end-expiratory pressure ,SYNCHROTRON radiation ,ADULT respiratory distress syndrome ,LUNGS ,MICROMECHANICS - Abstract
Modern ventilatory strategies are based on the assumption that lung terminal airspaces act as isotropic balloons that progressively accommodate gas. Phase contrast synchrotron radiation computed tomography (PCSRCT) has recently challenged this concept, showing that in healthy lungs, deflation mechanisms are based on the sequential de-recruitment of airspaces. Using PCSRCT scans in an animal model of acute respiratory distress syndrome (ARDS), this study examined whether the numerosity (ASnum) and dimension (ASdim) of lung airspaces change during a deflation maneuver at decreasing levels of positive end-expiratory pressure (PEEP) at 12, 9, 6, 3, and 0 cmH
2 O. Deflation was associated with significant reduction of ASdim both in the whole lung section (passing from from 13.1 ± 2.0 at PEEP 12 to 7.6 ± 4.2 voxels at PEEP 0) and in single concentric regions of interest (ROIs). However, the regression between applied PEEP and ASnum was significant in the whole slice (ranging from 188 ± 52 at PEEP 12 to 146.4 ± 96.7 at PEEP 0) but not in the single ROIs. This mechanism of deflation in which reduction of ASdim is predominant, differs from the one observed in healthy conditions, suggesting that the peculiar alveolar micromechanics of ARDS might play a role in the deflation process. [ABSTRACT FROM AUTHOR]- Published
- 2019
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35. Variation in communication and family visiting policies in intensive care within and between countries during the Covid-19 pandemic: The COVISIT international survey
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Alexis Tabah, Muhammed Elhadi, Emma Ballard, Andrea Cortegiani, Maurizio Cecconi, Takeshi Unoki, Laurą Galarza, Regis Goulart Rosa, Francois Barbier, Elie Azoulay, Kevin B. Laupland, Nathalie Ssi Yan Kai, Marlies Ostermann, Guy Francois, Jan J. De Waele, Kirsten Fiest, Peter Spronk, Julie Benbenishty, Mariangela Pellegrini, Louise Rose, Mahesh Ramanan, Rachel Bailey, Irmgard E. Kronberger, Anis Cerovac, Wendy Sligl, Jasminka Peršec, Eddy Lincango-Naranjo, Nermin Osman, Yousef Tanas, Yomna Dean, Ahmed Mohamed Abbas, Mohamed Gamal Elbahnasawy, Eslam Mohamed Elshennawy, Omar Elmandouh, Fatima Hamed Ahmed, Despoina Koulenti, Ioannis Tsakiridis, Mohan Gurjar, Marilaeta Cindryani, Ata Mahmoodpoor, Hogir Imad Rasheed Aldawoody, Francesco Zuccaro, Pasquale Iozzo, Mariachiara Ippolito, Yukiko Katayama, Tomoki Kuribara, Satoko Miyazaki, Asami Nakayama, Akira Ouchi, Hideaki Sakuramoto, Mitsuhiro Tamoto, Toru Yamada, Hashem Abdulaziz Abu Serhan, Saqr Ghaleb Ghassab Alsakarneh, Zhannur Kaligozhin, Dmitriy Viderman, Lina Karout, Mohd Shahnaz Hasan, Andee Dzulkarnaen Zakaria, Silvio A. Ñamendys-Silva, Lajpat Rai, Antonio Thaddeus R. Abello, Pedro Povoa, Dana Tomescu, Evgeniy Drozdov, Alberto Orejas Gallego, Ursula M. Jariod-Ferrer, Bernardo Nuñez-Garçia, Ahmed Mohamed Ibrahim Mohamed, Abram Raymon Moneer George, Marie-Madlen Jeitziner, Kemal Tolga Saracoglu, Arda Isik, Abdullah Tarik Aslan, Tomasz Torlinski, Tabah, Alexi, Elhadi, Muhammed, Ballard, Emma, Cortegiani, Andrea, Cecconi, Maurizio, Unoki, Takeshi, Galarza, Laurą, Rosa, Regis Goulart, Barbier, Francoi, Azoulay, Elie, Laupland, Kevin B, Ssi Yan Kai, Nathalie, Ostermann, Marlie, Francois, Guy, De Waele, Jan J, Fiest, Kirsten, Spronk, Peter, Benbenishty, Julie, Pellegrini, Mariangela, Rose, Louise, and Mahesh Ramanan (Australia), Rachel Bailey (Australia), Irmgard E. Kronberger (Austria), Anis Cerovac (Bosnia and Herzegovina), Wendy Sligl (Canada), Jasminka Peršec (Croatia), Eddy Lincango-Naranjo (Ecuador), Nermin Osman (Egypt), Yousef Tanas (Egypt), Yomna Dean (Egypt), Ahmed Mohamed Abbas (Egypt), Mohamed Gamal Elbahnasawy (Egypt), Eslam Mohamed Elshennawy (Egypt), Omar Elmandouh (Egypt), Fatima Hamed Ahmed. (Egypt), Despoina Koulenti (Greece), Ioannis Tsakiridis (Greece), Mohan Gurjar (India), Marilaeta Cindryani (Indonesia), Ata Mahmoodpoor (Iran), Hogir Imad Rasheed Aldawoody (Iraq), Francesco Zuccaro (Italy), Pasquale Iozzo, Mariachiara Ippolito, Yukiko Katayama (Japan), Tomoki Kuribara (Japan), Satoko Miyazaki (Japan), Asami Nakayama (Japan), Akira Ouchi (Japan), Hideaki Sakuramoto (Japan), Mitsuhiro Tamoto (Japan), Toru Yamada (Japan), Hashem Abdulaziz Abu Serhan (Jordan), Saqr Ghaleb Ghassab Alsakarneh (Jordan), Zhannur Kaligozhin (Kazakhstan), Dmitriy Viderman (Kazakhstan), Lina Karout (Lebanon), Mohd Shahnaz Hasan (Malaysia), Andee Dzulkarnaen Zakaria (Malaysia), Silvio A Ñamendys-Silva (Mexico), Lajpat Rai (Pakistan), Antonio Thaddeus R. Abello (Philippines), Pedro Povoa (Portugal), Dana Tomescu (Romania), Evgeniy Drozdov (Russia), Alberto Orejas Gallego. (Spain), Ursula M. Jariod- Ferrer (Spain), Bernardo Núñez García (Spain), Ahmed Mohamed Ibrahim Mohamed (Sudan), Abram Raymon Moneer George (Sudan), Marie-Madlen Jeitziner (Switzerland), Kemal Tolga Saracoglu (Turkey), Arda Isik (Turkey), Abdullah Tarik Aslan (Turkey), Tomasz Torlinski (United Kingdom).
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Critical Care ,Communication ,COVID-19 ,Visitors to Patients ,Critical Care and Intensive Care Medicine ,Organizational Policy ,Intensive Care Units ,Policy ,Intensive care ,Restriction ,Humans ,Family ,Pandemics ,visiting restriction intensive care ,Visiting - Abstract
Background: During the COVID-19 pandemic, intensive care units (ICU) introduced restrictions to in-person family visiting to safeguard patients, healthcare personnel, and visitors. Methods: We conducted a web-based survey (March– July 2021) investigating ICU visiting practices before the pandemic, at peak COVID-19 ICU admissions, and at the time of survey response. We sought data on visiting pol icies and communication modes including use of virtual visiting (videoconferencing). Results: We obtained 667 valid responses representing ICUs in all continents. Before the pandemic, 20% (106/ 525) had unrestricted visiting hours ; 6% (30/525) did not allow in-person visiting. At peak, 84% (558/667) did not allow in-person visiting for patients with COVID-19 ; 66% for patients without COVID-19. This proportion had decreased to 55% (369/667) at time of survey reporting. A government mandate to restrict hospital visiting was reported by 53% (354/646). Most ICUs (55%, 353/615) used regular telephone updates ; 50% (306/667) used telephone for formal meetings and discussions regarding prognosis or end-of-life. Virtual visiting was available in 63% (418/667) at time of survey. Conclusions: Highly restrictive visiting policies were introduced at the initial pandemic peaks, were subsequently liberalized, but without returning to pre-pandemic practices. Telephone became the primary communication mode in most ICUs, supplemented with virtual visits.
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- 2022
36. Regional distribution of lung compliance by image analysis of computed tomograms.
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Perchiazzi, Gaetano, Rylander, Christian, Derosa, Savino, Pellegrini, Mariangela, Pitagora, Loredana, Polieri, Debora, Vena, Antonio, Tannoia, Angela, Fiore, Tommaso, and Hedenstierna, Göran
- Subjects
- *
RESPIRATORY mechanics , *HOMOGENEITY , *OLEIC acid , *LUNG injuries , *IMAGE analysis , *COMPUTED tomography - Abstract
Computed tomography (CT) can yield quantitative information about volume distribution in the lung. By combining information provided by CT and respiratory mechanics, this study aims at quantifying regional lung compliance (CL) and its distribution and homogeneity in mechanically ventilated pigs. The animals underwent inspiratory hold maneuvers at 12 lung volumes with simultaneous CT exposure at two end-expiratory pressure levels and before and after acute lung injury (ALI) by oleic acid administration. CL and the sum of positive voxel compliances from CT were linearly correlated; negative compliance areas were found. A remarkably heterogeneous distribution of voxel compliance was found in the injured lungs. As the lung inflation increased, the homogeneity increased in healthy lungs but decreased in injured lungs. Image analysis brought novel findings regarding spatial homogeneity of compliance, which increases in ALI but not in healthy lungs by applying PEEP after a recruitment maneuver. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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37. Variation in communication and family visiting policies in intensive care within and between countries during the Covid-19 pandemic: The COVISIT international survey.
- Author
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Tabah A, Elhadi M, Ballard E, Cortegiani A, Cecconi M, Unoki T, Galarza L, Rosa RG, Barbier F, Azoulay E, Laupland KB, Kai NSY, Ostermann M, Francois G, De Waele JJ, Fiest K, Spronk P, Benbenishty J, Pellegrini M, and Rose L
- Subjects
- Communication, Critical Care, Family, Humans, Intensive Care Units, Organizational Policy, Pandemics, Policy, COVID-19, Visitors to Patients
- Abstract
Background: During the COVID-19 pandemic, intensive care units (ICU) introduced restrictions to in-person family visiting to safeguard patients, healthcare personnel, and visitors., Methods: We conducted a web-based survey (March-July 2021) investigating ICU visiting practices before the pandemic, at peak COVID-19 ICU admissions, and at the time of survey response. We sought data on visiting policies and communication modes including use of virtual visiting (videoconferencing)., Results: We obtained 667 valid responses representing ICUs in all continents. Before the pandemic, 20% (106/525) had unrestricted visiting hours; 6% (30/525) did not allow in-person visiting. At peak, 84% (558/667) did not allow in-person visiting for patients with COVID-19; 66% for patients without COVID-19. This proportion had decreased to 55% (369/667) at time of survey reporting. A government mandate to restrict hospital visiting was reported by 53% (354/646). Most ICUs (55%, 353/615) used regular telephone updates; 50% (306/667) used telephone for formal meetings and discussions regarding prognosis or end-of-life. Virtual visiting was available in 63% (418/667) at time of survey., Conclusions: Highly restrictive visiting policies were introduced at the initial pandemic peaks, were subsequently liberalized, but without returning to pre-pandemic practices. Telephone became the primary communication mode in most ICUs, supplemented with virtual visits., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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38. Time for Change? The Why, What and How of Promoting Innovation to Tackle Rare Diseases - Is It Time to Update the EU's Orphan Regulation? And if so, What Should be Changed?
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Horgan D, Moss B, Boccia S, Genuardi M, Gajewski M, Capurso G, Fenaux P, Gulbis B, Pellegrini M, Mañú Pereira MDM, Gutiérrez Valle V, Gutiérrez Ibarluzea I, Kent A, Cattaneo I, Jagielska B, Belina I, Tumiene B, Ward A, and Papaluca M
- Abstract
Since developments are global in the healthcare arena, more should be done to align EU and other big markets' regulatory practices for rare disease patients. Notwithstanding efforts and cooperation between the US and EU aimed to harmonize their strategic plans in the field of orphan drugs, regulatory criteria and procedures to gain the designation, terms and classifications should be still harmonised. Aligning the criteria of prevalence and support to orphan medicines in the various jurisdictions internationally, would facilitate patient recruitment eventually at global level, so as to gain the data and the biological insights required to identify biomarkers and appropriate endpoints needed for progressing clinical development. A conducive regulatory environment can further support the development of medicines to treat rare diseases. Overall there is a need for joined-up regulatory process coordination. Better integration of regulatory pathways and better integration of regulatory systems, such as scientific tools and methods to generate evidence, would be helpful. There is a need to revise and agree the current frameworks to be improved which will take into account the considerations and challenges to diagnose and treat different rare diseases and improve quality of life. Deliberative processes with multi-stakeholders' involvement for reimbursement should be considered. This paper explores the successes and limitation of both the regulation and its implementation mechanisms in the current regulatory context, and suggests some improvements that could maximise its benefits and boost rare disease research even further., Competing Interests: All authors declare that they have no competing interests. Ivana Cattaneo is a Novartis employee and has stock options in Novartis., (Copyright © 2020 by S. Karger AG, Basel.)
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- 2020
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