Author: "Langer, T" / Topic: business - Searchworks@Jio Institute Digital Library Search Results

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1. Use of critical care resources during the first 2 weeks (February 24–March 8, 2020) of the Covid-19 outbreak in Italy

Author: Tonetti T., Grasselli G., Zanella A., Pizzilli G., Fumagalli R., Piva S., Lorini L., Iotti G., Foti G., Colombo S., Vivona L., Rossi S., Girardis M., Agnoletti V., Campagna A., Gordini G., Navalesi P., Boscolo A., Graziano A., Valeri I., Vianello A., Cereda D., Filippini C., Cecconi M., Locatelli F., Bartoletti M., Giannella M., Viale P., Antonelli M., Nava S., Pesenti A., Ranieri V. M., Albano G., Alborghetti A., Aldegheri G., Antonini B., Belgiorno N., Bellani G., Beretta E., Bonazzi S., Borelli M., Cabrini L., Carnevale L., Carnevale S., Castelli G., Catena E., Chiumello D., Coluccello A., Coppini D., Covello D., DeFilippi G., DeiPoli M., Dughi P., Gallioli G., Gnesin P., Greco S., Guatteri L., Guzzon D., Keim R., Landoni G., Langer T., Lombardo A., Marino G., Merli G., Merlo D., Mojoli F., Muttini S., Natalini G., Petrucci N., Pezzi A., Radrizzani D., Raimondi M., Riccio M., Storti E., Tavola M., Vitale G., Bosco E., Calo M. A., Danzi V., DeRosa S., Farnia A., Lazzari F., Meggiolaro M., Munari M., Saia M., Sella N., Serra E., Tiberio I., Baiocchi M., Benedetto M., Bordini M., Caramelli F., Cilloni N., DellaGiovampaola M., Fanelli A., Frascaroli G., Fusari M., Maitan S., Martino C., Melotti R. M., Merola R., Minardi F., Moro F., Nardi G., Nolli M., Pierucci E., Potalivo A., Repetti F., Salsi P., Terzitta M., Tosi M., Venturi S., Volta C. A., Zani G., Zanoni A (COVID-19 Northern Italian ICU Network), Landoni G, Tonetti, Tommaso, Grasselli, Giacomo, Zanella, Alberto, Pizzilli, Giacinto, Fumagalli, Roberto, Piva, Simone, Lorini, Luca, Iotti, Giorgio, Foti, Giuseppe, Colombo, Sergio, Vivona, Luigi, Rossi, Sandra, Girardis, Massimo, Agnoletti, Vanni, Campagna, Anselmo, Gordini, Giovanni, Navalesi, Paolo, Boscolo, Annalisa, Graziano, Alessandro, Valeri, Ilaria, Vianello, Andrea, Cereda, Danilo, Filippini, Claudia, Cecconi, Maurizio, Locatelli, Franco, Bartoletti, Michele, Giannella, Maddalena, Viale, Pierluigi, Antonelli, Massimo, Nava, Stefano, Pesenti, Antonio, Ranieri, V Marco, Tonetti, T, Grasselli, G, Zanella, A, Pizzilli, G, Fumagalli, R, Piva, S, Lorini, L, Iotti, G, Foti, G, Colombo, S, Vivona, L, Rossi, S, Girardis, M, Agnoletti, V, Campagna, A, Gordini, G, Navalesi, P, Boscolo, A, Graziano, A, Valeri, I, Vianello, A, Cereda, D, Filippini, C, Cecconi, M, Locatelli, F, Bartoletti, M, Giannella, M, Viale, P, Antonelli, M, Nava, S, Pesenti, A, Ranieri, V, Langer, T, Tonetti, T., Grasselli, G., Zanella, A., Pizzilli, G., Fumagalli, R., Piva, S., Lorini, L., Iotti, G., Foti, G., Colombo, S., Vivona, L., Rossi, S., Girardis, M., Agnoletti, V., Campagna, A., Gordini, G., Navalesi, P., Boscolo, A., Graziano, A., Valeri, I., Vianello, A., Cereda, D., Filippini, C., Cecconi, M., Locatelli, F., Bartoletti, M., Giannella, M., Viale, P., Antonelli, M., Nava, S., Pesenti, A., Ranieri, V. M., Albano, G., Alborghetti, A., Aldegheri, G., Antonini, B., Belgiorno, N., Bellani, G., Beretta, E., Bonazzi, S., Borelli, M., Cabrini, L., Carnevale, L., Carnevale, S., Castelli, G., Catena, E., Chiumello, D., Coluccello, A., Coppini, D., Covello, D., Defilippi, G., Deipoli, M., Dughi, P., Gallioli, G., Gnesin, P., Greco, S., Guatteri, L., Guzzon, D., Keim, R., Landoni, G., Langer, T., Lombardo, A., Marino, G., Merli, G., Merlo, D., Mojoli, F., Muttini, S., Natalini, G., Petrucci, N., Pezzi, A., Radrizzani, D., Raimondi, M., Riccio, M., Storti, E., Tavola, M., Vitale, G., Bosco, E., Calo, M. A., Danzi, V., Derosa, S., Farnia, A., Lazzari, F., Meggiolaro, M., Munari, M., Saia, M., Sella, N., Serra, E., Tiberio, I., Baiocchi, M., Benedetto, M., Bordini, M., Caramelli, F., Cilloni, N., Dellagiovampaola, M., Fanelli, A., Frascaroli, G., Fusari, M., Maitan, S., Martino, C., Melotti, R. M., Merola, R., Minardi, F., Moro, F., Nardi, G., Nolli, M., Pierucci, E., Potalivo, A., Repetti, F., Salsi, P., Terzitta, M., Tosi, M., Venturi, S., Volta, C. A., Zani, G., Zanoni, A (COVID-19 Northern Italian ICU Network), and Landoni, G
Subjects: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Respiratory rate, Socio-culturale, Critical Care and Intensive Care Medicine, Acute respiratory failure, acute respiratory failure, COVID-19, ICU, non-invasive ventilation, rationing, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, Intensive care, Retrospective analysis, Medicine, 030212 general & internal medicine, Non-invasive ventilation, Rationing, Case report form, business.industry, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Outbreak, lcsh:RC86-88.9, Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, 030228 respiratory system, Emergency medicine, Base excess, business
Abstract: Background A Covid-19 outbreak developed in Lombardy, Veneto and Emilia-Romagna (Italy) at the end of February 2020. Fear of an imminent saturation of available ICU beds generated the notion that rationing of intensive care resources could have been necessary. Results In order to evaluate the impact of Covid-19 on the ICU capacity to manage critically ill patients, we performed a retrospective analysis of the first 2 weeks of the outbreak (February 24–March 8). Data were collected from regional registries and from a case report form sent to participating sites. ICU beds increased from 1545 to 1989 (28.7%), and patients receiving respiratory support outside the ICU increased from 4 (0.6%) to 260 (37.0%). Patients receiving respiratory support outside the ICU were significantly older [65 vs. 77 years], had more cerebrovascular (5.8 vs. 13.1%) and renal (5.3 vs. 10.0%) comorbidities and less obesity (31.4 vs. 15.5%) than patients admitted to the ICU. PaO2/FiO2 ratio, respiratory rate and arterial pH were higher [165 vs. 244; 20 vs. 24 breath/min; 7.40 vs. 7.46] and PaCO2 and base excess were lower [34 vs. 42 mmHg; 0.60 vs. 1.30] in patients receiving respiratory support outside the ICU than in patients admitted to the ICU, respectively. Conclusions Increase in ICU beds and use of out-of-ICU respiratory support allowed effective management of the first 14 days of the Covid-19 outbreak, avoiding resource rationing.
Published: 2020

2. Prone position in intubated, mechanically ventilated patients with COVID-19: a multi-centric study of more than 1000 patients

Author: Langer, T., Brioni, M., Guzzardella, A., Carlesso, E., Cabrini, L., Castelli, G., Dalla Corte, F., De Robertis, E., Favarato, M., Forastieri, A., Forlini, C., Girardis, M., Grieco, D. L., Mirabella, L., Noseda, V., Previtali, P., Protti, A., Rona, R., Tardini, F., Tonetti, T., Zannoni, F., Antonelli, M., Foti, G., Ranieri, M., Pesenti, A., Fumagalli, R., Grasselli, G., Berselli, A., Bove, T., Calligari, P., Coloretti, I., Coluccello, A., Costantini, E., Fanelli, V., Gagliardi, G., Longhini, F., Mariani, F., Mascarello, A., Menga, L., Ottaviani, I., Pasero, D., Pedeferri, M., Pezzi, A., Servillo, G., Severgnini, P., Spadaro, S., Zambelli, V., Langer, T., Brioni, M., Guzzardella, A., Carlesso, E., Cabrini, L., Castelli, G., Dalla Corte, F., De Robertis, E., Favarato, M., Forastieri, A., Forlini, C., Girardis, M., Grieco, D. L., Mirabella, L., Noseda, V., Previtali, P., Protti, A., Rona, R., Tardini, F., Tonetti, T., Zannoni, F., Antonelli, M., Foti, G., Ranieri, M., Pesenti, A., Fumagalli, R., Grasselli, G., Berselli, A., Bove, T., Calligari, P., Coloretti, I., Coluccello, A., Costantini, E., Fanelli, V., Gagliardi, G., Longhini, F., Mariani, F., Mascarello, A., Menga, L., Ottaviani, I., Pasero, D., Pedeferri, M., Pezzi, A., Servillo, G., Severgnini, P., Spadaro, S., Zambelli, V., Langer T., Brioni M., Guzzardella A., Carlesso E., Cabrini L., Castelli G., Dalla Corte F., De Robertis E., Favarato M., Forastieri A., Forlini C., Girardis M., Grieco D.L., Mirabella L., Noseda V., Previtali P., Protti A., Rona R., Tardini F., Tonetti T., Zannoni F., Antonelli M., Foti G., Ranieri M., Pesenti A., Fumagalli R., Grasselli G., Berselli A., Bove T., Calligari P., Coloretti I., Coluccello A., Costantini E., Fanelli V., Gagliardi G., Longhini F., Mariani F., Mascarello A., Menga L., Ottaviani I., Pasero D., Pedeferri M., Pezzi A., Servillo G., Severgnini P., Spadaro S., Zambelli V., Langer, T, Brioni, M, Guzzardella, A, Carlesso, E, Cabrini, L, Castelli, G, Dalla Corte, F, De Robertis, E, Favarato, M, Forastieri, A, Forlini, C, Girardis, M, Grieco, D, Mirabella, L, Noseda, V, Previtali, P, Protti, A, Rona, R, Tardini, F, Tonetti, T, Zannoni, F, Antonelli, M, Foti, G, Ranieri, M, Pesenti, A, Fumagalli, R, and Grasselli, G
Subjects: Male, ARDS, Supine position, medicine.medical_treatment, COVID-19, Mechanical ventilation, Prone positioning, Refractory hypoxemia, Critical Care and Intensive Care Medicine, Cohort Studies, 0302 clinical medicine, Supine Position, 030212 general & internal medicine, education.field_of_study, Respiration, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, Prone position, Italy, Anesthesia, Practice Guidelines as Topic, Artificial, Female, Critical Care, Population, Ventilation/perfusion ratio, Patient Positioning, NO, 03 medical and health sciences, Intensive care, Settore MED/41 - ANESTESIOLOGIA, medicine, Prone Position, Humans, education, Aged, Retrospective Studies, Intubation, Respiration, Artificial, business.industry, Research, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, Respiratory failure, business
Abstract: Background Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. Methods Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position. Results Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p 2/FiO2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively). Conclusions During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching. Trial registration: clinicaltrials.gov number: NCT04388670
Published: 2021

3. Late Sequelae after Neuroblastoma-Associated Paraneoplastic Anti-Hu Syndrome in a 4-Year-Old Boy

Author: Rostasy K, Till A, Wandinger K, Winkler B, Ketzer J, Wunsch L, Langer T, Hero B, Tafazzoli K, Callsen F, Spiegler J, and Lauten M
Subjects: Pathology, medicine.medical_specialty, business.industry, Neuroblastoma, General Earth and Planetary Sciences, Medicine, Anti hu antibody, business, medicine.disease, General Environmental Science
Abstract: Anti-Hu syndrome is a rare autoantibody associated paraneoplastic disease of the central and peripheral nervous system resulting in a variety of neurological symptoms. In pediatric patients it is described in the context of (ganglio) neuroblastoma associated Opsoclonus-Myoclonus Syndrome (OMS) and other paraneoplastic syndromes. The timely diagnosis of paraneoplastic autoimmunity in childhood is hampered by its rarity as well as by the diversity of clinical symptoms that may occur. We report a 4-year-old boy with gastrointestinal disorder and neurological symptoms due to neuroblastomaassociated anti-Hu syndrome. The patient stabilized under a multimodal oncologic, immunosuppressive and antiepileptic treatment regimen. Treatment of neuroblastoma was individually modified and especially the specific anti- GD2 post-consolidation therapy was substituted by oral cyclophosphamide maintenance therapy in order not to aggravate autoimmune encephalitis. At the age of 8 years, the boy has been in ongoing complete oncologic remission for two years after end of relapse treatment. However, he suffers from neurologic symptoms like focal epilepsy and late sequelae of the oncologic disease. This case shows that treatment of paraneoplastic anti-Hu syndrome is challenging, encephalitis may persist long after oncologic remission and may lead to developmental delay and a variety of physical sequelae.
Published: 2021

4. Recommendations for ototoxicity surveillance for childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCare Consortium

Author: Clemens, Eva, Van den Heuvel - Eibrink, Marry, Mulder, RL, Kremer, LCM (Leontien), Hudson, MM, Skinner, R, Constine, LS, Bass, JK, Kuehni, CE, Langer, T, van Dalen, EC, Bardi, E, Bonne, NX, Brock, PR, Brooks, B, Carleton, B, Caron, E, Chang, KW, Johnston, K, Knight, K, Nathan, PC, Orgel, E, Prasad, PK, Rottenberg, J, Scheinemann, K, de Vries, A.C.H., Walwyn, T, Weiss, A, Zehnhoff-Dinnesen, AA, Cohn, RJ, Landier, W, Kadan-Lottick, N, Levitt, G, Hoetink, A, Mussman, J, Princess Máxima Center for Pediatric Oncology [Utrecht, Netherlands], Erasmus MC-Sophia Hospital [Rotterdam, Netherlands], Emma Children's Hospital [Amsterdam, Netherlands] (Academic Medical Center), University of Amsterdam [Amsterdam] (UvA), St Jude Children's Research Hospital, Great North Children’s Hospital [Newcastle Upon Tyne, UK], Northern Institute for Cancer Research [Newcastle] (NICR), Newcastle University [Newcastle], University of Rochester Medical Center (URMC), Institute of Social and Preventive Medicine [Bern] (ISPM), Universität Bern [Bern] (UNIBE), University Hospital for Children and Adolescents [Lübeck, Germany], Protéomique, Réponse Inflammatoire, Spectrométrie de Masse (PRISM) - U 1192 (PRISM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Otologie et d'Otoneurologie [CHU Lille], Centre Hospitalier Universitaire de Lille (CHU de Lille), Great Ormond Street Hospital for Children NHS Foundation Trust [London, UK] (GOSHC), University of British Columbia (UBC), Stanford University, Sydney Children's hospital, Oregon Health and Science University [Portland] (OHSU), The Hospital for sick children [Toronto] (SickKids), Children’s Hospital Los Angeles [Los Angeles], University of Southern California (USC), Louisiana State University (LSU), Children's Hospital at New Orleans, Masaryk University [Brno] (MUNI), Kantonsspital Aarau [Aarau, Switzerland], University Hospital Basel [Basel], McMaster University [Hamilton, Ontario], Perth Children's Hospital [Nedlands, WA, Australia], The University of Western Australia (UWA), University of Regensburg, University Hospital Münster - Universitaetsklinikum Muenster [Germany] (UKM), University of New South Wales [Sydney] (UNSW), University of Alabama at Birmingham [ Birmingham] (UAB), SALZET, Michel, Pediatrics, Universität Bern [Bern], Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), and Great Ormond Street Hospital for Children NHS Foundation Trust [London, UK]
Subjects: Shunt placement, Pediatrics, medicine.medical_specialty, Adolescent, [SDV]Life Sciences [q-bio], Childhood cancer, Harmonization, Antineoplastic Agents, Platinum Compounds, Article, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Ototoxicity, SDG 3 - Good Health and Well-being, Cancer Survivors, Neoplasms, otorhinolaryngologic diseases, Medicine, Humans, Young adult, 030223 otorhinolaryngology, Child, Evidence-Based Medicine, business.industry, Cancer, Guideline, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Oncology, 030220 oncology & carcinogenesis, Population Surveillance, Cranial Irradiation, business, Delivery of Health Care
Abstract: International audience; Childhood, adolescent, and young adult (CAYA) cancer survivors treated with platinum-based drugs, head or brain radiotherapy, or both have an increased risk of ototoxicity (hearing loss, tinnitus, or both). To ensure optimal care and reduce consequent problems—such as speech and language, social–emotional development, and learning difficulties—for these CAYA cancer survivors, clinical practice guidelines for monitoring ototoxicity are essential. The implementation of surveillance across clinical settings is hindered by differences in definitions of hearing loss, recommendations for surveillance modalities, and remediation. To address these deficiencies, the International Guideline Harmonization Group organised an international multidisciplinary panel, including 32 experts from ten countries, to evaluate the quality of evidence for ototoxicity following platinum-based chemotherapy and head or brain radiotherapy, and formulate and harmonise ototoxicity surveillance recommendations for CAYA cancer survivors.
Published: 2019

5. 36th International Symposium on Intensive Care and Emergency Medicine

Author: Bateman, R. M., Sharpe, M. D., Jagger, J. E., Ellis, C. G., Solé-Violán, J., López-Rodríguez, M., Herrera-Ramos, E., Ruíz-Hernández, J., Borderías, L., Horcajada, J., González-Quevedo, N., Rajas, O., Briones, M., Rodríguez de Castro, F., Rodríguez Gallego, C., Esen, F., Orhun, G., Ergin Ozcan, P., Senturk, E., Ugur Yilmaz, C., Orhan, N., Arican, N., Kaya, M., Kucukerden, M., Giris, M., Akcan, U., Bilgic Gazioglu, S., Tuzun, E., Riff, R., Naamani, O., Douvdevani, A., Takegawa, R., Yoshida, H., Hirose, T., Yamamoto, N., Hagiya, H., Ojima, M., Akeda, Y., Tasaki, O., Tomono, K., Shimazu, T., Ono, S., Kubo, T., Suda, S., Ueno, T., Ikeda, T., Ogura, H., Takahashi, H., Kang, J., Nakamura, Y., Kojima, T., Izutani, Y., Taniguchi, T., O, M., Dinter, C., Lotz, J., Eilers, B., Wissmann, C., Lott, R., Meili, M. M., Schuetz, P. S., Hawa, H., Sharshir, M., Aburageila, M., Salahuddin, N., Chantziara, V., Georgiou, S., Tsimogianni, A., Alexandropoulos, P., Vassi, A., Lagiou, F., Valta, M., Micha, G., Chinou, E., Michaloudis, G., Kodaira, A., Imaizumi, H., De la Torre-Prados, M. V., Garcia-De la Torre, A., Enguix-Armada, A., Puerto-Morlan, A., Perez-Valero, V., Garcia-Alcantara, A., Bolton, N., Dudziak, J., Bonney, S., Tridente, A., Nee, P., Nicolaes, G., Wiewel, M., Schultz, M., Wildhagen, K., Horn, J., Schrijver, R., Van der Poll, T., Reutelingsperger, C., Pillai, S., Davies, G., Mills, G., Aubrey, R., Morris, K., Williams, P., Evans, P., Gayat, E. G., Struck, J., Cariou, A., Deye, N., Guidet, B., Jabert, S., Launay, J., Legrand, M., Léone, M., Resche-Rigon, M., Vicaut, E., Vieillard-Baron, A., Mebazaa, A., Arnold, R., Capan, M., Linder, A., Akesson, P., Popescu, M., Tomescu, D., Sprung, C. L., Calderon Morales, R., Munteanu, G., Orenbuch-Harroch, E., Levin, P., Kasdan, H., Reiter, A., Volker, T., Himmel, Y., Cohen, Y., Meissonnier, J., Girard, L., Rebeaud, F., Herrmann, I., Delwarde, B., Peronnet, E., Cerrato, E., Venet, F., Lepape, A., Rimmelé, T., Monneret, G., Textoris, J., Beloborodova, N., Moroz, V., Osipov, A., Bedova, A., Sarshor, Y., Pautova, A., Sergeev, A., Chernevskaya, E., Odermatt, J., Bolliger, R., Hersberger, L., Ottiger, M., Christ-Crain, M., Mueller, B., Schuetz, P., Sharma, N. K., Tashima, A. K., Brunialti, M. K., Machado, F. R., Assuncao, M., Rigato, O., Salomao, R., Cajander, S. C., Rasmussen, G., Tina, E., Söderquist, B., Källman, J., Strålin, K., Lange, A. L., Sundén-Cullberg, J. S., Magnuson, A. M., Hultgren, O. H., Van der Geest, P., Mohseni, M., Linssen, J., De Jonge, R., Duran, S., Groeneveld, J., Miller, R., Lopansri, B. K., McHugh, L. C., Seldon, A., Burke, J. P., Johnston, J., Reece-Anthony, R., Bond, A., Molokhia, A., Mcgrath, C., Nsutebu, E., Bank Pedersen, P., Pilsgaard Henriksen, D., Mikkelsen, S., Touborg Lassen, A., Tincu, R., Cobilinschi, C., Ghiorghiu, Z., Macovei, R., Wiewel, M. A., Harmon, M. B., Van Vught, L. A., Scicluna, B. P., Hoogendijk, A. J., Zwinderman, A. H., Cremer, O. L., Bonten, M. J., Schultz, M. J., Juffermans, N. P., Wiersinga, W. J., Eren, G., Tekdos, Y., Dogan, M., Acicbe, O., Kaya, E., Hergunsel, O., Alsolamy, S., Ghamdi, G., Alswaidan, L., Alharbi, S., Alenezi, F., Arabi, Y., Heaton, J., Boyce, A., Nolan, L., Dukoff-Gordon, A., Dean, A., Mann Ben Yehudah, T., Fleischmann, C., Thomas-Rueddel, D., Haas, C., Dennler, U., Reinhart, K., Suntornlohanakul, O., Khwannimit, B., Breckenridge, F., Puxty, A., Szturz, P., Folwarzcny, P., Svancara, J., Kula, R., Sevcik, P., Caneva, L., Casazza, A., Bellazzi, E., Marra, S., Pagani, L., Vetere, M., Vanzino, R., Ciprandi, D., Preda, R., Boschi, R., Carnevale, L., Lopez, V., Aguilar Arzapalo, M., Barradas, L., Escalante, A., Gongora, J., Cetina, M., Adamik, B, Jakubczyk, D, Kübler, A, Radford, A., Lee, T., Singer, J., Boyd, J., Fineberg, D., Williams, M., Russell, J., Scarlatescu, E., Droc, G., Arama, S., Müller, M., Straat, M., Zeerleder, S. S., Fuchs, C. F., Scheer, C. S., Wauschkuhn, S. W., Vollmer, M. V., Meissner, K. M., Kuhn, S. K., Hahnenkamp, K. H., Rehberg, S. R., Gründling, M. G., Hamaguchi, S., Gómez-Sánchez, E., Heredia-Rodríguez, M., Álvarez-Fuente, E., Lorenzo-López, M., Gómez-Pesquera, E., Aragón-Camino, M., Liu-Zhu, P., Sánchez-López, A., Hernández-Lozano, A., Peláez-Jareño, M. T., Tamayo, E., Thomas-Rüddel, D. O., Adora, V., Kar, A., Chakraborty, A., Roy, S., Bandyopadhyay, A., Das, M., BenYehudah, G., Salim, M., Kumar, N., Arabi, L., Burger, T., Lephart, P., Toth-martin, E., Valencia, C., Hammami, N., Blot, S., Vincent, J. L., Lambert, M. L., Brunke, J., Riemann, T., Roschke, I., Nimitvilai, S., Jintanapramote, K., Jarupongprapa, S., Adukauskiene, D., Valanciene, D., Bose, G., Lostarakos, V., Carr, B., Khedher, S., Maaoui, A., Ezzamouri, A., Salem, M., Chen, J., Cranendonk, D. R., Day, M., Penrice, G., Roy, K., Robertson, P., Godbole, G., Jones, B., Booth, M., Donaldson, L., Kawano, Y., Ishikura, H., Al-Dorzi, H., Almutairi, M., Alhamadi, B., Crizaldo Toledo, A., Khan, R., Al Raiy, B., Talaie, H., Van Oers, J. 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R., Boutin, A., Moore, L., Lacroix, J., Lessard-Bonaventure, P., Turgeon, A. F., Green, R., Erdogan, M., Butler, M., Desjardins, P., Fergusson, D. A., Goncalves, B., Vidal, B., Valdez, C., Rodrigues, A. C., Miguez, L., Moralez, G., Hong, T., Kutz, A., Hausfater, P., Amin, D., Struja, T., Haubitz, S., Huber, A., Brown, T., Collinson, J., Pritchett, C., Slade, T., Le Guen, M., Hellings, S., Ramsaran, R., Alsheikhly, A., Abe, T., Kanapeckaite, L., Bahl, R., Russell, M. Q., Real, K. J., Lyon, R. M., Oveland, N. P., Penketh, J., Mcdonald, M., Kelly, F., Alfafi, M., Almutairi, W., Alotaibi, B., Van den Berg, A. E, Schriel, Y., Dawson, L., Meynaar, I. A., Silva, D., Fernandes, S., Gouveia, J., Santos Silva, J., Foley, J., Kaskovagheorgescu, A., Evoy, D., Cronin, J., Ryan, J., Huck, M., Hoffmann, C., Renner, J., Laitselart, P., Donat, N., Cirodde, A., Schaal, J. V., Masson, Y., Nau, A., Howarth, O., Davenport, K., Jeanrenaud, P., Raftery, S., MacTavish, P., Devine, H., McPeake, J., Daniel, M., Quasim, T., Alrabiee, S., Alrashid, A., Gundogan, O., Bor, C., Akýn Korhan, E., Demirag, K., Uyar, M., Frame, F., Ashton, C., Bergstrom Niska, L., Dilokpattanamongkol, P., Suansanae, T., Suthisisang, C., Morakul, S., Karnjanarachata, C., Tangsujaritvijit, V., Mahmood, S., Al Thani, H., Almenyar, A., Morton, S. E., Chiew, Y. S., Pretty, C., Chase, J. G., Shaw, G. M., Kordis, P., Grover, V., Kuchyn, I., Bielka, K., Aidoni, Z., Stavrou, G., Skourtis, C., Lee, S. D., Williams, K., Weltes, I. D., Berhane, S., Arrowsmith, C., Peters, C., Robert, S., Panerai, R. B., Robinson, T. G., Borg-Seng-Shu, E., De Lima Oliveira, M., Mian, N. C., Nogueira, R., Zeferino, S. P., Jacobsen Teixeira, M., Killeen, P., McPhail, M., Bernal, W., Maggs, J., Wendon, J., Hughes, T., Taniguchi, L. U., Siqueira, E. M., Vieira Jr, J. M., Azevedo, L. C., Ahmad, A. N., Helme, E., Hadfield, S., Shak, J., Senver, C., Howard-Griffin, R., Wacharasint, P., Fuengfoo, P., Sukcharoen, N., Rangsin, R., Sbiti-Rohr, D., Na, H., Song, S., Lee, S., Jeong, E., Lee, K., Zoumpelouli, E., Volakli, E. A, Chrysohoidou, V., Charisopoulou, K., Kotzapanagiotou, E., Manavidou, K., Stathi, Z., AlGhamdi, B., Marashly, Q., Zaza, K., Khurshid, M., Ali, Z., Malgapo, M., Jamil, M., Shafquat, A., Shoukri, M., Hijazi, M., Rocha, F. A., Ebecken, K., Rabello, L. S., Lima, M. F., Hatum, R., De Marco, F. V., Alves, A., Pinto, J. E., Godoy, M., Brasil, P. E., Bozza, F. A., Salluh, J. I., Soares, M., Krinsley, J., Kang, G., Perry, J., Hines, H., Wilkinson, K. M., Tordoff, C., Sloan, B., Bellamy, M. C., Moreira, E., Verga, F., Barbato, M., Burghi, G., Soares, M, Silva, U. V., Torelly, A. P., Kahn, J. M., Angus, D. C., Knibel, M. F., Marshall, R., Gilpin, T., Mota, D., Loureiro, B., Dias, J., Afonso, O., Coelho, F., Martins, A., Faria, F., Al Orainni, H., AlEid, F., Tlaygeh, H., Itani, A., Hejazi, A., Messika, J., Ricard, J. D., Guillo, S., Pasquet, B., Dubief, E., Tubach, F., James, K., Temblett, P., Davies, L., Lynch, C., Pereira, S., Cavaco, S., Fernandes, J., Moreira, I., Almeida, E., Seabra Pereira, F., Malheiro, M., Cardoso, F., Aragão, I., Cardoso, T., Fister, M., Muraray Govind, P., Brahmananda Reddy, N., Pratheema, R., Arul, E. D., Devachandran, J., Chin-Yee, N., D’Egidio, G., Thavorn, K., Kyeremanteng, K., Murchison, A. G., Swalwell, K., Mandeville, J., Stott, D., Guerreiro, I., Goossens, C., Marques, M. B., Derde, S., Vander Perre, S., Dufour, T., Thiessen, S. E., Güiza, F., Janssens, T., Hermans, G., Vanhorebeek, I., De Bock, K., Van den Berghe, G., Langouche, L., Miles, B., Madden, S., Weiler, M., Marques, P., Rodrigues, C., Boeira, M., Brenner, K., Leães, C., Machado, A., Townsend, R., Andrade, J., Kishore, R., Fenlon, C., Fiks, T., Ruijter, A., Te Raa, M., Spronk, P., Docherty, P., Dickson, J., Moltchanova, E., Scarrot, C., Hall, T., Ngu, W. C., Jack, J. M., Pavli, A., Gee, X., Akin Korhan, E., Shirazy, M., Fayed, A., Gupta, S., Kaushal, A., Dewan, S., Varma, A., Ghosh, E., Yang, L., Eshelman, L., Lord, B., Carlson, E., Broderick, R., Ramos, J., Forte, D., Yang, F., Feeney, J., Wilkinson, K., Shuker, K., Faulds, M., Bryden, D., England, L., Shuker, K, Tridente, A, Faulds, M, Matheson, A, Gaynor, J., Bryden, D, Peroni, B., Daglius-Dias, R., Miranda, L., Cohen, C., Carvalho, C., Velasco, I., Kelly, J. M., Neill, A., Rubenfeld, G., Masson, N., Min, A., Boezeman, E., Hofhuis, J., Hovingh, A., De Vries, R., Cabral-Campello, G., Van Mol, M., Nijkamp, M., Kompanje, E., Ostrowski, P., Kiss, K., Köves, B., Csernus, V., Molnár, Z., Hoydonckx, Y., Vanwing, S., Medo, V., Galvez, R., Miranda, J. P., Stone, C., Wigmore, T., Arunan, Y., Wheeler, A., Wong, Y., Poi, C., Gu, C., Molmy, P., Van Grunderbeeck, N., Nigeon, O., Lemyze, M., Thevenin, D., Mallat, J., Correa, M., Carvalho, R. T., Fernandez, A., McBride, C., Koonthalloor, E., Walsh, C., Webber, A., Ashe, M., Smith, K., Volakli, E. A., Dimitriadou, M., Mantzafleri, P., Vrani, O., Arbouti, A., Varsami, T., Bollen, J. A., Van Smaalen, T. C., De Jongh, W. C., Ten Hoopen, M. M., Ysebaert, D., Van Heurn, L. W., Van Mook, W. N., Roze des Ordons, A., Couillard, P., Doig, C., Van Keer, R. V., Deschepper, R. D., Francke, A. F., Huyghens, L. H., Bilsen, J. B., Nyamaizi, B., Dalrymple, C., Dobru, A., Marrinan, E., Ankuli, A., Struthers, R., Crawford, R., Mactavish, P., Morelli, P., Degiovanangelo, M., Lemos, F., MArtinez, V., Cabrera, J., Rutten, A., Van Ieperen, S., De Geer, S., Van Vugt, M., Der Kinderen, E., Giannini, A., Miccinesi, G, Marchesi, T, and Prandi, E
Subjects: Protocol (science), medicine.medical_specialty, business.industry, medicine.medical_treatment, French, 030208 emergency & critical care medicine, Compression (physics), Critical Care and Intensive Care Medicine, Meeting Abstracts, language.human_language, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Ventilation (architecture), Emergency medicine, language, Medicine, 030212 general & internal medicine, Cardiopulmonary resuscitation, business
Abstract: Table of contents P001 - Sepsis impairs the capillary response within hypoxic capillaries and decreases erythrocyte oxygen-dependent ATP efflux R. M. Bateman, M. D. Sharpe, J. E. Jagger, C. G. Ellis P002 - Lower serum immunoglobulin G2 level does not predispose to severe flu. J. Solé-Violán, M. López-Rodríguez, E. Herrera-Ramos, J. Ruíz-Hernández, L. Borderías, J. Horcajada, N. González-Quevedo, O. Rajas, M. Briones, F. Rodríguez de Castro, C. Rodríguez Gallego P003 - Brain protective effects of intravenous immunoglobulin through inhibition of complement activation and apoptosis in a rat model of sepsis F. Esen, G. Orhun, P. Ergin Ozcan, E. Senturk, C. Ugur Yilmaz, N. Orhan, N. Arican, M. Kaya, M. Kucukerden, M. Giris, U. Akcan, S. Bilgic Gazioglu, E. Tuzun P004 - Adenosine a1 receptor dysfunction is associated with leukopenia: A possible mechanism for sepsis-induced leukopenia R. Riff, O. Naamani, A. Douvdevani P005 - Analysis of neutrophil by hyper spectral imaging - A preliminary report R. Takegawa, H. Yoshida, T. Hirose, N. Yamamoto, H. Hagiya, M. Ojima, Y. Akeda, O. Tasaki, K. Tomono, T. Shimazu P006 - Chemiluminescent intensity assessed by eaa predicts the incidence of postoperative infectious complications following gastrointestinal surgery S. Ono, T. Kubo, S. Suda, T. Ueno, T. Ikeda P007 - Serial change of c1 inhibitor in patients with sepsis – A prospective observational study T. Hirose, H. Ogura, H. Takahashi, M. Ojima, J. Kang, Y. Nakamura, T. Kojima, T. Shimazu P008 - Comparison of bacteremia and sepsis on sepsis related biomarkers T. Ikeda, S. Suda, Y. Izutani, T. Ueno, S. Ono P009 - The changes of procalcitonin levels in critical patients with abdominal septic shock during blood purification T. Taniguchi, M. O P010 - Validation of a new sensitive point of care device for rapid measurement of procalcitonin C. Dinter, J. Lotz, B. Eilers, C. Wissmann, R. Lott P011 - Infection biomarkers in primary care patients with acute respiratory tract infections – Comparison of procalcitonin and C-reactive protein M. M. Meili, P. S. Schuetz P012 - Do we need a lower procalcitonin cut off? H. Hawa, M. Sharshir, M. Aburageila, N. Salahuddin P013 - The predictive role of C-reactive protein and procalcitonin biomarkers in central nervous system infections with extensively drug resistant bacteria V. Chantziara, S. Georgiou, A. Tsimogianni, P. Alexandropoulos, A. Vassi, F. Lagiou, M. Valta, G. Micha, E. Chinou, G. Michaloudis P014 - Changes in endotoxin activity assay and procalcitonin levels after direct hemoperfusion with polymyxin-b immobilized fiber A. Kodaira, T. Ikeda, S. Ono, T. Ueno, S. Suda, Y. Izutani, H. Imaizumi P015 - Diagnostic usefullness of combination biomarkers on ICU admission M. V. De la Torre-Prados, A. Garcia-De la Torre, A. Enguix-Armada, A. Puerto-Morlan, V. Perez-Valero, A. Garcia-Alcantara P016 - Platelet function analysis utilising the PFA-100 does not predict infection, bacteraemia, sepsis or outcome in critically ill patients N. Bolton, J. Dudziak, S. Bonney, A. Tridente, P. Nee P017 - Extracellular histone H3 levels are inversely correlated with antithrombin levels and platelet counts and are associated with mortality in sepsis patients G. Nicolaes, M. Wiewel, M. Schultz, K. Wildhagen, J. Horn, R. Schrijver, T. Van der Poll, C. Reutelingsperger P018 - Il-8: is this a more reliable biomarker for sepsis severity than CRP, Procalcitonin, E-selectin, IL-6 and TNF-[alpha] S. Pillai, G. Davies, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans P019 - Relation between adrenomedullin and short-term outcome in ICU patients: Results from the frog ICU study E. G. Gayat, J. Struck, A. Cariou, N. Deye, B. Guidet, S. Jabert, J. Launay, M. Legrand, M. Léone, M. Resche-Rigon, E. Vicaut, A. Vieillard-Baron, A. Mebazaa P020 - Impact of disease severity assessment on performance of heparin-binding protein for the prediction of septic shock R. Arnold, M. Capan, A. Linder, P. Akesson P021 - Kinetics and prognostic value of presepsin (sCD14) in septic patients. A pilot study M. Popescu, D. Tomescu P022 - Comparison of CD64 levels performed by the facs and accellix systems C. L. Sprung, R. Calderon Morales, G. Munteanu, E. Orenbuch-Harroch, P. Levin, H. Kasdan, A. Reiter, T. Volker, Y. Himmel, Y. Cohen, J. Meissonnier P023 - Diagnosing sepsis in 5 minutes: Nanofluidic technology study with pancreatic-stone protein (PSP/ reg) L. Girard, F. Rebeaud P024 - How nanotechnology-based approaches could contribute to sepsis prevention, diagnosis and treatment I. Herrmann P025 - Il7r transcriptional expression analysis during septic shock B. Delwarde, E. Peronnet, E. Cerrato, F. Venet, A. Lepape, T. Rimmelé, G. Monneret, J. Textoris P026 - Disbalance of microbial metabolites of aromatic acids affects the severity in critically ill patients N. Beloborodova, V. Moroz, A. Osipov, A. Bedova, Y. Sarshor, A. Pautova, A. Sergeev, E. Chernevskaya P027 - Copeptin predicts 10-year all-cause mortality in community patients J. Odermatt, R. Bolliger, L. Hersberger, M. Ottiger, M. Christ-Crain, B. Mueller, P. Schuetz P028 - Identification of differential proteomic response in septic patients secondary to community and hospital acquired pneumonia N. K. Sharma, A. K. Tashima, M. K. Brunialti, F. R. Machado, M. Assuncao, O. Rigato, R. Salomao P029 - Monocyte HLA-DR expression in community-acquired bacteremic sepsis - dynamics associated to aetiology and prediction of secondary sepsis S. C. Cajander, G. Rasmussen, E. Tina, B. Söderquist, J. Källman, K. Strålin P030 - Soluble B- and T-lymphocyte attenuator: A possible prognostic marker in sepsis A. L. Lange, J. S. Sundén-Cullberg, A. M. Magnuson, O. H. Hultgren P031 - Fractal dimension: A new biomarker for quantifying clot microstructure in patients across the sepsis spectrum G. Davies, S. Pillai, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans P032 - Comparison between the new biomarker for coagulation, clot microstructure (Df) with rotational thromboelastometry (ROTEM) in patients across the sepsis spectrum S. Pillai, G. Davies, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans P033 - Changes in fibrinolysis across the sepsis spectrum: The use of rotational thromboelastometry (ROTEM) lysis index (LI60) and D-Dimer concentration S. Pillai, G. Davies, G. Mills, R. Aubrey, K. Morris, P. Williams, P. Evans P034 - The intensive care infection score – a promising marker for the prediction of infection and its severity. P. Van der Geest, M. Mohseni, J. Linssen, R. De Jonge, S. Duran, J. Groeneveld P035 - Challenges in the clinical diagnosis of sepsis R. Miller III, B. K. Lopansri, L. C. McHugh, A. Seldon, J. P. Burke P036 - Does zero heat flux thermometry more accurately identify sepsis on intensive care? J. Johnston, R. Reece-Anthony, A. Bond, A. Molokhia P037 - Advancing quality (AQ) sepsis programme: Improving early identification & treatment of sepsis in North West England. C. Mcgrath, E. Nsutebu P038 - Prehospital transport of acute septic patients P. Bank Pedersen, D. Pilsgaard Henriksen, S. Mikkelsen, A. Touborg Lassen P039 - Vasodilatory plant extracts gel as an alternative treatment for fever in critically ill patients R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei P040 - Host response and outcome of hypothermic sepsis M. A. Wiewel, M. B. Harmon, L. A. Van Vught, B. P. Scicluna, A. J. Hoogendijk, J. Horn, A. H. Zwinderman, O. L. Cremer, M. J. Bonten, M. J. Schultz, T. Van der Poll, N. P. Juffermans, W. J. Wiersinga P041 - Septic shock alert over SIRS criteria has an impact on outcome but needs to be revised G. Eren, Y Tekdos, M. Dogan, O. Acicbe, E. Kaya, O. Hergunsel P042 - Association between previous prescription of βblockers and mortality rate among septic patients: A retrospective observational study S. Alsolamy, G. Ghamdi, L. Alswaidan, S. Alharbi, F. Alenezi, Y. Arabi P043 - Recognition and treatment of sepsis on labour ward– teaching & information resources can improve knowledge J. Heaton, A. Boyce, L. Nolan, J. Johnston, A. Dukoff-Gordon, A. Dean, A. Molokhia P044 - Culture negative sepsis in the ICU – what is unique to this patient population? T. Mann Ben Yehudah P045 - Organ dysfunction in severe sepsis patients identified in administrative data in Germany, 2007-2013 C. Fleischmann, D. Thomas-Rueddel, C. Haas, U. Dennler, K. Reinhart P046 - A comparison of residents’ knowledge regarding; the Surviving Sepsis Campaign 2012 guideline O. Suntornlohanakul, B. Khwannimit P047 - Effectiveness of a septic shock bundle to improve outcomes in the ICU F. Breckenridge, A. Puxty P048 - Dose of norepinephrine in the first 24 hours as a parameter evaluating the effectiveness of treatment in patients with severe sepsis and septic shock P. Szturz, P. Folwarzcny, J. Svancara, R. Kula, P. Sevcik P049 - Norepinephrine or vasopressin + norepinephrine in septic shock. A retrospective series of 39 patients L. Caneva, A. Casazza, E. Bellazzi, S. Marra, L. Pagani, M. Vetere, R. Vanzino, D. Ciprandi, R. Preda, R. Boschi, L. Carnevale P050 - Methylene blue effectiveness as contributory treatment in patients with septic shock V. Lopez, M. Aguilar Arzapalo, L. Barradas, A. Escalante, J. Gongora, M. Cetina P051 - Coagulation disorders in patients with severe sepsis and DIC evaluated with thromboelastometry. B Adamik, D Jakubczyk, A Kübler P052 - Frequency and outcome of early sepsis-associated coagulopathy A. Radford, T. Lee, J. Singer, J. Boyd, D. Fineberg, M. Williams, J. Russell P053 - Assessment of coagulopathy in cancer patients with severe sepsis or septic shock. A case-control pilot study E. Scarlatescu, D. Tomescu, G. Droc, S. Arama P054 - Thromboelastometry in critically ill patients with disseminated intravascular coagulation M. Müller, M. Straat, S. S. Zeerleder, N. P. Juffermans P055 - Cessation of a preexisting chronic antiplatelet therapy is associated with increased mortality rates in severe sepsis and septic shock C. F. Fuchs, C. S. Scheer, S. W. Wauschkuhn, M. V. Vollmer, K. M. Meissner, S. K. Kuhn, K. H. Hahnenkamp, S. R. Rehberg, M. G. Gründling P056 - Neutrophil Extracellular Traps (NETs) production under hypoxic condition N. Yamamoto, M. Ojima, S. Hamaguchi, T. Hirose, Y. Akeda, R. Takegawa, O. Tasaki, T. Shimazu, K. Tomono P057 - Impact of ultraviolet air sterilizer in intensive care unit room, and clinical outcomes of patients E. Gómez-Sánchez, M. Heredia-Rodríguez, E. Álvarez-Fuente, M. Lorenzo-López, E. Gómez-Pesquera, M. Aragón-Camino, P. Liu-Zhu, A. Sánchez-López, A. Hernández-Lozano, M. T. Peláez-Jareño, E. Tamayo P058 - Focus of infection in severe sepsis - comparison of administrative data and prospective cohorts from Germany D. O. Thomas-Rüddel, C. Fleischmann, C. Haas, U. Dennler, K. Reinhart P059 - “Zero CLABSI” – can we get there? Obstacles on the 4 year journey and our strategies to overcome them – experience from an Indian ICU V. Adora, A. Kar, A. Chakraborty, S. Roy, A. Bandyopadhyay, M. Das P060 - Novel molecular techniques to identify central venous catheter (CVC) associated blood stream infections (BSIs) T. Mann Ben Yehudah, G. Ben Yehudah, M. Salim, N. Kumar, L. Arabi, T. Burger, P. Lephart, E. Toth-martin P061 - Zero clabsi” – can we get there? Obstacles on the 4 year journey and our strategies to overcome them – experience from an Indian ICU R. Rao, A. Kar, A. Chakraborty P062 - Prevention of central line-associated bloodstream infections in intensive care units: An international online survey C. Valencia, N. Hammami, S. Blot, J. L. Vincent, M. L. Lambert P063 - 30 days antimicrobial efficacy of non-leaching central venous catheters J. Brunke, T. Riemann, I. Roschke P064 - Efficacy of noble metal alloy-coated catheter in prevention of bacteriuria R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei P065 - Predicting bacteremic urinary tract infection in community setting: A prospective observational study S. Nimitvilai, K. Jintanapramote, S. Jarupongprapa P066 - Eight-year analysis of acinetobacter spp. monobacteremia in surgical and medical intensive care units at university hospital in Lithuania D. Adukauskiene, D. Valanciene P067 - Group A and group B streptococcal infections in intensive care unit – our experience in a tertiary centre G. Bose, V. Lostarakos, B. Carr P068 - Improved detection of spontaneous bacterial peritonitis by uritop + tm strip test and inoculation of blood culture bottles with ascitic fluid S. Khedher, A. Maaoui, A. Ezzamouri, M. Salem P069 - Increased risk of cellulitis in patients with congestive heart failure: a population based cohort study J. Chen P070 - Outcomes of severe cellulitis and necrotizing fasciitis in the critically ill D. R. Cranendonk, L. A. Van Vught, M. A. Wiewel, O. L. Cremer, J. Horn, M. J. Bonten, M. J. Schultz, T. Van der Poll, W. J. Wiersinga P071 - Botulism outbreak associated with people who inject drugs (PWIDs) in Scotland. M. Day, G. Penrice, K. Roy, P. Robertson, G. Godbole, B. Jones, M. Booth, L. Donaldson P072 - Surveillance of ESBL-producing enterobacteriaceae fecal carriers in the ICU Y. Kawano, H. Ishikura P073 - Prevalence of ESBL and carbapenemase producing uropathogens in a newly opened hospital in south India S. Sreevidya, N. Brahmananda Reddy, P. Muraray Govind, R. Pratheema, J. Devachandran Apollo Speciality Hospital - OMR, Chennai, India P074 - Prevalence, risk factors and outcomes of methicillin-resistant staphylococcus aureus nasal colonization in critically ill patients H. Al-Dorzi, M. Almutairi, B. Alhamadi, A. Crizaldo Toledo, R. Khan, B. Al Raiy, Y. Arabi P075 - Multidrug-resistant Acinetobacter baumannii infection in intensive care unit patients in a hospital with building construction: Is there an association? H. Talaie P076 - Multidrug-resistant organisms in a Dutch ICU J. A. Van Oers, A. Harts, E. Nieuwkoop, P. Vos P077 - Epidemiology and risk factors of ICU acquired infections caused by multidrug-resistant gram negative bacilli Y. Boussarsar, F. Boutouta, S. Kamoun, I. Mezghani, S. Koubaji, A. Ben Souissi, A. Riahi, M. S. Mebazaa P078 - Improving outcomes of severe infections by multidrug-resistant pathogens with polyclonal IgM-enriched immunoglobulins E. Giamarellos-Bourboulis, N. Tziolos, C. Routsi, C. Katsenos, I. Tsangaris, I. Pneumatikos, G. Vlachogiannis, V. Theodorou, A. Prekates, E. Antypa, V. Koulouras, N. Kapravelos, C. Gogos, E. Antoniadou, K. Mandragos, A. Armaganidis P079 - Must change the medical practice in ICU? A. R. Robles Caballero, B. Civantos, J. C. Figueira, J. López P080 - Mediterranean spotted fever in an infectious diseases intensive care unit A. Silva-Pinto, F. Ceia, A. Sarmento, L. Santos P081 - Clinical features and outcomes of patients with Middle East respiratory syndrome requiring admission to a saudi intensive care unit: A retrospective analysis of 31 cases G. Almekhlafi, Y. Sakr P082 - The ICU response to a hospital outbreak of Middle East respiratory syndrome coronavirus infection H. Al-Dorzi, R. Khan, S. Baharoon, A. Aldawood, A. Matroud, J. Alchin, S. Al Johani, H. Balkhy, Y. Arabi P083 - Middle East respiratory syndrome: Surveillance data analysis S. Alsolamy, S. Y. Yousif, B. O. Alotabi, A. S. Alsaawi P085 - Use of Taqman array card molecular diagnostics in severe pneumonia: A case series J. Ang, MD Curran, D. Enoch, V. Navapurkar, A. Conway Morris P086 - ‘BUNS’: An investigation protocol improves the ICU management of pneumonia R. Sharvill, J. Astin P087 - Pneumonia in patients following secondary peritonitis: epidemiological features and impact on mortality M. Heredia-Rodríguez, E. Gómez-Sánchez, M. T. Peláez-Jareño, E. Gómez-Pesquera, M. Lorenzo-López, P. Liu-Zhu, M. Aragón-Camino, A. Hernández-Lozano, A. Sánchez-López, E. Álvarez-Fuente, E. Tamayo P088 - The use of the “CURB-65 score” by emergency room clinicians in a large teaching hospital J. Patel, C. Kruger P089 - Incidence of community acquired pneumonia with viral infection in mechanically ventilated patients in the medical intensive care unit J. O’Neal, H. Rhodes, J. Jancik P090 - The SAATELLITE Study: Prevention of S aureus Nosocomial Pneumonia (NP) with MEDI4893, a Human Monoclonal Antibody (mAb) Against S aureus B. François, P. F. Laterre, P. Eggimann, A. Torres, M. Sánchez, P. F. Dequin, G. L. Bassi, J. Chastre, H. S. Jafri P091 - Risk factors and microbiological profile for nosocomial infections in trauma patients M. Ben Romdhane, Z. Douira, S. Kamoun, M. Bousselmi, A. Ben Souissi, Y. Boussarsar, A. Riahi, M.S. Mebazaa P092 - Correlation between percentages of ventilated patients developed vap and use of antimicrobial agents in ICU patients. A. Vakalos, V. Avramidis P093 - A comparison of two ventilator associated pneumonia surveillance techniques T. H. Craven, G. Wojcik, K. Kefala, J. McCoubrey, J. Reilly, R. Paterson, D. Inverarity, I. Laurenson, T. S. Walsh P094 - Lung ultrasound before and after fiberbronchoscopy - modifications may improve ventilator-associated pneumonia diagnosis S. Mongodi, B. Bouhemad, A. Orlando, A. Stella, G. Via, G. Iotti, A. Braschi, F. Mojoli P095 - Comparing the accuracy of predictors of mortality in ventilator-associated pneumonia M. Haliloglu, B. Bilgili, U. Kasapoglu, I. Sayan, M. Süzer Aslan, A. Yalcın, I. Cinel P096 - Impact of pRBCs transfusion on percentage of ventilated patients developed VAP in ICU patients A. Vakalos, V. Avramidis P097 - The impact of a series of interventions on the rate of ventilator associated pneumonia in a large teaching hospital H. E. Ellis, K. Bauchmuller, D. Miller, A Temple P098 - The EVADE study: Prevention of Nosocomial Pneumonia (NP) caused by P aeruginosa with MEDI3902, a Novel Bispecific Monoclonal Antibody, against P aeruginosa virulence factors J. Chastre, B. François, A. Torres, C. E. Luyt, M. Sánchez, M. Singer, H. S. Jafri P099 - Short-term inhaled colistin adjunctive therapy for ventilator-associated pneumonia Y. Nassar, M. S. Ayad P100 - Effect of aerosolised colistin on weaning from mechanical ventilation A. Trifi, S. Abdellatif, F. Daly, R. Nasri, S. Ben Lakhal P101 - Septic shock is an independent risk factor for colistin-induced severe acute kidney injury: a retrospective cohort study B. Bilgili, M. Haliloglu, F. Gul, I. Cinel P102 - Nosocomial pneumonia - emphasis on inhaled tobramycin A. Kuzovlev, A. Shabanov, S. Polovnikov, V. Moroz P103 - In vitro evaluation of amikacin inhale and commercial nebulizers in a mechanical ventilator N. Kadrichu, T. Dang, K. Corkery, P. Challoner P104 - The effects of nebulized amikacin/fosfomycin and systemic meropenem on severe amikacin-resistant meropenem-susceptible P.aeruginosa pneumonia G. Li Bassi, E. Aguilera, C. Chiurazzi, C. Travierso, A. Motos, L. Fernandez, R. Amaro, T. Senussi, F. Idone, J. Bobi, M. Rigol, A. Torres P105 - Optimization of gentamicin peak concentrations in critically ill patients C. J. Hodiamont, N. P. Juffermans, J. M. Janssen, C. S. Bouman, R. A. Mathôt, M. D. De Jong, R. M. Van Hest P106 - Systematic review of cefepime induced neurotoxicity L. Payne, G. L. Fraser P107 - Unasyn® causes QT prolongation during treatment of intensive care patients B. Tudor, M. Lahner, G. Roth, C. Krenn P108 - Comparative study between teicoplanin and vancomycin in methicillin-resistant staphylococcus aureus (mrsa) infectious of toxicological intensive care unit (ticu) patients – Tehran, Iran H. Talaie P109 - Phage therapy against antimicrobial resistance, design of the first clinical study phagoburn P. Jault, J. Gabard, T. Leclerc, S. Jennes, Y. Que, A. Rousseau, F. Ravat P110 - Antibiotic dosing errors in critically ill patients with severe sepsis or septic shock H. Al-Dorzi, A. Eissa, S. Al-Harbi, T. Aldabbagh, R. Khan, Y. Arabi P111 - Does empiric antifungal therapy improve survival in septic critically ill patients? (immunocompromised excluded) A. Trifi, S. Abdellatif, F. Daly, R. Nasri, S. Ben Lakhal P112 - Neurocysticercosis-Qatar experience F. Paramba, N. Purayil, V. Naushad, O. Mohammad, V. Negi, P. Chandra P113 - Early indicators in acute haemorrhagic shock A. Kleinsasser P114 - Filtering of red blood cells reduces the inflammatory response of pulmonary cells in an in vitro model of mechanical ventilation M. R. Witrz, J. F. Buchner-Doeven, A. M. Tuip-de Boer, J. C. Goslings, N. P. Juffermans P115 - Microparticles from red blood cell transfusion induce a pro-coagulant and pro-inflammatory endothelial cell response M. Van Hezel, M. Straat, A Boing, R Van Bruggen, N Juffermans P116 - The contribution of cytokines on thrombosis development during hospitalization in ICU D. Markopoulou, K. Venetsanou, V. Kaldis, D. Koutete, D. Chroni, I. Alamanos P117 - Prophylactic enoxaparin dosing and adjustment through anti-xa monitoring in an inpatient burn unit L. Koch, J. Jancik, H. Rhodes, E. Walter P118 - Determination of optimal cut-off values of haemoglobin, platelet count and fibrinogen at 24 hours after injury associated with mortality in trauma patients K. Maekawa, M. Hayakawa, S. Kushimoto, A. Shiraishi, H. Kato, J. Sasaki, H. Ogura, T. Matauoka, T. Uejima, N. Morimura, H. Ishikura, A. Hagiwara, M. Takeda P119 - Trauma-induced coagulopathy - prothrombin complex concentrate vs fresh frozen plasma O. Tarabrin, S. Shcherbakow, D. Gavrychenko, G. Mazurenko, V. Ivanova, O. Chystikov P120 - First study to prove the superiority of prothrombin complex concentrates on mortality rate over fresh frozen plasma in patients with acute bleeding C. Plourde, J. Lessard, J. Chauny, R. Daoust P121 - Prothrombin complex concentrate vs fresh frozen plasma in obstetric massive bleeding S. Shcherbakow, O. Tarabrin, D. Gavrychenko, G. Mazurenko, O. Chystikov P122 - Impact of FFP transfusion on VAP in ICU patients A. Vakalos, V. Avramidis P123 - Preoperative platelet function test and the thrombin generation assay are predictive for blood loss after cardiac surgery L. Kropman, L. In het Panhuis, J. Konings, D. Huskens, E. Schurgers, M. Roest, B. De Laat, M. Lance P124 - Rotational thromboelastometry versus standard coagulation tests before surgical interventions M. Durila, P. Lukas, M. Astraverkhava, J. Jonas P125 - Correction of impaired clot quality and stability by fibrinogen and activated prothrombin complex concentrate in a model of severe thrombocytopenia I. Budnik, B. Shenkman P126 - Assessment of point-of-care prothrombin time analyzer as a monitor after cardiopulmonary bypass H. Hayami, Y. Koide, T. Goto P127 - Disseminated intravascular coagulation (dic) is underdiagnosed in critically ill patients: do we need d-dimer measurements? R. Iqbal, Y. Alhamdi, N. Venugopal, S. Abrams, C. Downey, C. H. Toh, I. D. Welters P128 - Validity of the age-adjusted d-dimer cutoff in patients with COPD B. Bombay, J. M. Chauny, R. D. Daoust, J. L. Lessard, M. M. Marquis, J. P. Paquet P129 - A scoping review of strategies for prevention and management of bleeding following paediatric cardiopulmonary bypass surgery K. Siemens, D. Sangaran, B. J. Hunt, A. Durward, A. Nyman, I. A. Murdoch, S. M. Tibby P130 - Nadir hemoglobulin during cardiopulmonary bypass: impact on postoperative morbidity and mortality F. Ampatzidou, D. Moisidou, E. Dalampini, M. Nastou, E. Vasilarou, V. Kalaizi, H. Chatzikostenoglou, G. Drossos P131 - Red blood cell transfusion do not influence the prognostic value of RDW in critically ill patients S. Spadaro, A. Fogagnolo, T. Fiore, A. Schiavi, V. Fontana, F. Taccone, C. Volta P132 - Reasons for admission in the paediatric intensive care unit and the need for blood and blood products transfusions E. Chochliourou, E. Volakli, A. Violaki, E. Samkinidou, G. Evlavis, V. Panagiotidou, M. Sdougka P133 - The implementation of a massive haemorrhage protocol (mhp) for the management of major trauma: a ten year, single-centre study R. Mothukuri, C. Battle, K. Guy, G. Mills, P. Evans P134 - An integrated major haemorrhage protocol for pre-hospital and retrieval medical teams J. Wijesuriya, S. Keogh P135 - The impact of transfusion thresholds on mortality and cardiovascular events in patients with cardiovascular disease (non-cardiac surgery): a systematic review and meta-analysis A. Docherty, R. O’Donnell, S. Brunskill, M. Trivella, C. Doree, L. Holst, M. Parker, M. Gregersen, J. Almeida, T. Walsh, S. Stanworth P136 - The relationship between poor pre-operative immune status and outcome from cardiac surgery is specific to the peri-operative antigenic threat S. Moravcova, J. Mansell, A. Rogers, R. A. Smith, C. Hamilton-Davies P137 - Impact of simple clinical practice guidelines for reducing post-operative atrial fibrillation after cardiac surgery. A. Omar, M. Allam, O. Bilala, A. Kindawi, H. Ewila P138 - Dexamethasone administration during cardiopulmonary bypass has no beneficial effects on elective postoperative cardiac surgery patients F. Ampatzidou, D. Moisidou, M. Nastou, E. Dalampini, A. Malamas, E. Vasilarou, G. Drossos P139 - Intra-aortic balloon counterpulsation in patients undergoing cardiac surgery (IABCS): preliminary results G. Ferreira, J. Caldas, J. Fukushima, E. A. Osawa, E. Arita, L. Camara, S. Zeferino, J. Jardim, F. Gaioto, L. Dallan, F. B. Jatene, R. Kalil Filho, .F Galas, L. A. Hajjar P140 - Effects of low-dose atrial natriuretic peptide infusion on cardiac surgery-associated acute kidney injury C. Mitaka, T. Ohnuma, T. Murayama, F. Kunimoto, M. Nagashima, T. Takei, M. Tomita P141 - Acute kidney injury influence on high sensitive troponin measurements after cardiac surgery A. Omar, K. Mahmoud, S. Hanoura, S. Sudarsanan, P. Sivadasan, H. Othamn, Y. Shouman, R. Singh, A. Al Khulaifi P142 - Complex evaluation of endothelial dysfunction markers for prognosis of outcomes in patients undergoing cardiac surgery I. Mandel, S. Mikheev, I. Suhodolo, V. Kiselev, Y. Svirko, Y. Podoksenov P143 - New-onset atrial fibrillation in intensive care: incidence, management and outcome S. A. Jenkins, R. Griffin P144 - One single spot measurement of the sublingual microcirculation during acute pulmonary hypertension in a pig model of shock M. S. Tovar Doncel, A. Lima, C. Aldecoa, C. Ince P145 - Assessment of levosimendan as a therapeutic option to recruit the microcirculation in cardiogenic shock – initial experience in cardiac ICU A. Taha, A. Shafie, M. Mostafa, N. Syed, H. Hon P146 - Terlipressin vs. norepinephrine in the Potential Multiorgan Donor(PMD) F. Righetti, E. Colombaroli, G. Castellano P147 - Echocardiography in the potential heart donor exposed to substitution hormonotherapy F. Righetti, E. Colombaroli P148 - Machine learning can reduce rate of monitor alarms M. Hravnak, L. C. Chen, A. D. Dubrawski, G. C. Clermont, M. R. Pinsky P149 - Peripherally inserted central catheters placed in the ICU S. Gonzalez, D. Macias, J. Acosta, P. Jimenez, A. Loza, A. Lesmes, F. Lucena, C. 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Körner, M. Kubik, S. Kluge, D. Reuter, B. Saugel P155 - Hemodynamic monitoring in patients with septic shock (SS) – CPCCO (continuous pulse contour cardiac output) vs. TEE (transesophageal echocardiography) E. Colombaroli, F. Righetti, G. Castellano P156 - Cardiac output measurement with transthoracic echocardiography in critically ill patients: a pragmatic clinical study T. Tran, D. De Bels, A. Cudia, M. Strachinaru, P. Ghottignies, J. Devriendt, C. Pierrakos P157 - Left ventricular outflow tract velocity time integral correlates with stroke volume index in mechanically ventilated patients Ó. Martínez González, R. Blancas, J. Luján, D. Ballesteros, C. Martínez Díaz, A. Núñez, C. Martín Parra, B. López Matamala, M. Alonso Fernández, M. Chana P158 - Transpulmonary thermodilution (TPTD) derived from femoral vs. jugular central venous catheter: validation of a previously published correction formula and a proprietary correction formula for global end-diastolic volume index (GEDVI) W. Huber, M. Eckmann, F. Elkmann, A. Gruber, I. Klein, R. M. Schmid, T. Lahmer P160 - Dynamic arterial elastance calculated with lidcoplus monitor does not predict changes in arterial pressure after a fluid challenge in postsurgical patients D. Bastoni, H. Aya, L. Toscani, L. Pigozzi, A. Rhodes, M. Cecconi P159 - Venous return driving pressure and resistance in acute blood volume changes P. W. Moller, S. Sondergaard, S. M. Jakob, J. Takala, D. Berger P160 - Dynamic arterial elastance calculated with lidcoplus monitor does not predict changes in arterial pressure after a fluid challenge in postsurgical patients D. Bastoni, H. Aya, L. Toscani, L. Pigozzi, A. Rhodes, M. Cecconi P161 - Analysis of duration of post-operative goal-directed therapy protocol C. Ostrowska, H. Aya, A. Abbas, J. Mellinghoff, C. Ryan, D. Dawson, A. Rhodes, M. Cecconi P162 - Hemodynamic optimization – back to square one? M. Cronhjort, O. Wall, E. Nyberg, R. Zeng, C. Svensen, J. Mårtensson, E. Joelsson-Alm P163 - Effectiveness of fluid thoracic content measurement by bioimpedance guiding intravascular volume optimization in patients with septic shock M. Aguilar Arzapalo, L. Barradas, V. Lopez, M. Cetina P164 - A systematic review on the role of internal jugular vein ultrasound measurements in assessment of volume status in critical shock patients N. Parenti, C. Palazzi, L. A. Amidei, F. B. Borrelli, S. C. Campanale, F. T. Tagliazucchi, G. S. Sedoni, D. L. Lucchesi, E. C. Carella, A. L Luciani P165 - Importance of recognizing dehydration in medical Intensive Care Unit M. Mackovic, N. Maric, M. Bakula P166 - Effect of volume for a fluid challenge in septic patients H. Aya, A. Rhodes, R. M. Grounds, N. Fletcher, M. Cecconi P167 - Fluid bolus practices in a large Australian intensive care unit B. Avard, P. Zhang P168 - Liberal late fluid management is associated with longer ventilation duration and worst outcome in severe trauma patients: a retrospective cohort of 294 patients M. Mezidi, J. Charbit, M. Ould-Chikh, P. Deras, C. Maury, O. Martinez, X. Capdevila P169 - Association of fluids and outcomes in emergency department patients hospitalized with community-acquired pneumonia P. Hou, W. Z. Linde-Zwirble, I. D. Douglas, N. S. Shapiro P170 - Association of positive fluid balance with poor outcome in medicosurgical ICU patients A. Ben Souissi, I. Mezghani, Y. Ben Aicha, S. Kamoun, B. Laribi, B. Jeribi, A. Riahi, M. S. Mebazaa P171 - Impact of fluid balance to organ dysfunction in critically ill patients C. Pereira, R. Marinho, R. Antunes, A. Marinho P172 - Volume bolus in ICU patients: do we need to balance our crystalloids? M. Crivits, M. Raes, J. Decruyenaere, E. Hoste P173 - The use of 6 % HES solution do not reduce total fluid requirement in the therapy of patients with burn shock V. Bagin, V. Rudnov, A. Savitsky, M. Astafyeva, I. Korobko, V. Vein P174 - Electron microscopic assessment of acute kidney injury in septic sheep resuscitated with crystalloids or different colloids T. Kampmeier , P. Arnemann, M. Hessler, A. Wald, K. Bockbreder, A. Morelli, H. Van Aken, S. Rehberg, C. Ertmer P175 - Alterations of conjunctival microcirculation in a sheep model of haemorrhagic shock and resuscitation with 0.9 % saline or balanced tetrastarch P. Arnemann, M. Hessler, T. Kampmeier, S. Rehberg, H. Van Aken, C. Ince, C. Ertmer P176 - A single centre nested pilot study investigating the effect of using 0.9 % saline or Plasma-Lyte 148 ® as crystalloid fluid therapy on gastrointestinal feeding intolerance in mechanically ventilated patients receiving nasogastric enteral nutrition S. Reddy, M. Bailey, R. Beasley, R. Bellomo, D. Mackle, A. Psirides, P. 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Abisheganaden P182 - Plasma NGAL and urinary output: potential parameters for early initiation of renal replacement therapy K. Maas, H. De Geus P183 - Renal replacement therapy for critically ill patients: an intermittent continuity E. Lafuente, R. Marinho, J. Moura, R. Antunes, A. Marinho P184 - A survey of practices related to renal replacement therapy in critically ill patients in the north of England. T. E. Doris, D. Monkhouse, T. Shipley, S. Kardasz, I Gonzalez P185 - High initiation creatinine associated with lower 28-day mortality in critically ill patients necessitating continuous renal replacement therapy S. Stads, A. J. Groeneveld P186 - The impact of Karnofsky performance scale on outcomes in acute kidney injury patients receiving renal replacement therapy on the intensive care unit I. Elsayed, N. Ward, A. Tridente, A. Raithatha P187 - Severe hypophosphatemia during citrate-anticoagulated CRRT A. Steuber, C. Pelletier, S. Schroeder, E. Michael, T. Slowinski, D. Kindgen-Milles P188 - Citrate regional anticoagulation for post dilution continuous renal replacement therapy S. Ghabina P189 - Citrate 18 mmol/l improves anticoagulation during RRT with adsorbing filters F. Turani, A. Belli, S. Busatti, G. Barettin, F. Candidi, F. Gargano, R. Barchetta, M. Falco P190 - Calcium gluconate instead of calcium chloride in citrate-anticoagulated CVVHD O. Demirkiran, M. Kosuk, S. Bozbay P191 - Enhanced clearance of interleukin-6 with continuous veno-venous haemodialysis (CVVHD) using Ultraflux EMiC2 vs. Ultraflux AV1000S V. Weber, J. Hartmann, S. Harm, I. Linsberger, T. Eichhorn, G. Valicek, G. Miestinger, C. Hoermann P192 - Removal of bilirubin with a new adsorbent system: in vitro kinetics S. Faenza, D. Ricci, E. Mancini, C. Gemelli, A. Cuoghi, S. Magnani, M. Atti P193 - Case series of patients with severe sepsis and septic shock treated with a new extracorporeal sorbent T. Laddomada, A. Doronzio, B. Balicco P194 - In vitro adsorption of a broad spectrum of inflammatory mediators with CytoSorb® hemoadsorbent polymer beads M. C. Gruda, P. O’Sullivan, V. P. Dan, T. Guliashvili, A. Scheirer, T. D. Golobish, V. J. Capponi, P. P. Chan P195 - Observations in early vs. late use of cytosorb therapy in critically ill patients K. Kogelmann, M. Drüner, D. Jarczak P196 - Oxiris membrane decreases endotoxin during rrt in septic patients with basal EAA > 0,6 F. Turani, A. B. Belli, S. M. Martni, V. C. Cotticelli, F. Mounajergi, R. Barchetta P197 - An observational prospective study on the onset of augmented renal clearance: the first report S. Morimoto, H. Ishikura P198 - An ultrasound- guided algorithm for the management of oliguria in severe sepsis I. Hussain, N. Salahuddin, A. Nadeem, K. Ghorab, K. Maghrabi P199 - Ultrasound in acute kidney injury (aki). First findings of farius, an education-programme in structural ultrasonography S. K. Kloesel, C. Goldfuss, A. Stieglitz, A. S. 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Hana P205 - Early diagnosis of septic acute kidney injury in medical critical care patients with a urine cell cycle arrest marker: insulin like growth factor binding protein-7 (IGFBP-7) M. Aydogdu, N. Boyaci, S. Yuksel, G. Gursel, A. B. Cayci Sivri P206 - Urinary neutrophil gelatinase-associated lipocalin as early biomarker of severe acute kidney injury in intensive care J. Meza-Márquez, J. Nava-López, R. Carrillo-Esper P207 - Shrunken pore syndrome is associated with a sharp rise in mortality in patients undergoing elective coronary artery bypass grafting A. Dardashti, A. Grubb P208 - The biomarker nephrocheck™ can discriminate the septic shock patients with an akin 1 or 2 acute renal failure who will not progress toward the akin 3 level J. Maizel, M. Wetzstein, D. Titeca, L. Kontar, F. Brazier, B. De Cagny, A. Riviere, T. Soupison, M. Joris, M. Slama P209 - A worldwide multicentre evaluation of acute kidney injury in septic and non-septic critically ill patients: the intensive care over nations (icon) audit E. Peters, H. Njimi, P. Pickkers, J. L. Vincent P210 - Does enhanced recovery after surgery reduce the incidence of acute kidney injury in those undergoing major gynae-oncological surgery? M. Waraich , J. Doyle, T. Samuels, L. Forni P211 - Identification of risk factors for the development of acute kidney injury after lower limb arthroplasty N. Desai, R. Baumber, P. Gunning, A. Sell P212 - Incidences and associations of acute kidney injury after major trauma S. Lin, H. Torrence, M. O’Dwyer, C. Kirwan, J. Prowle P213 - Acute kidney injury of major trauma patients T Kim P214 - Trajectory of serum creatinine after major surgery and the diagnosis of acute kidney injury M. E. O’Connor, R. W. Hewson, C. J. Kirwan, R. M. Pearse, J. Prowle P215 - Epidemiology of acute kidney injury after cardiac surgery. 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Pavlovic, L. Lewerentz, A. Spassov, R. Schneider P227 - Long-term outcome and health-related quality of life in patients discharged from the intensive care unit with a tracheostomy and with or without prolonged mechanical ventilation S. De Smet, S. De Raedt, E. Derom, P Depuydt, S. Oeyen, D. Benoit, J. Decruyenaere P228 - Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (trachus): a randomized clinical trial A. Gobatto, B. Bese, P. Tierno, L. Melro, P. Mendes, F. Cadamuro, M. Park, L. M. Malbouisson P229 - Is it safe to discharge patients with tracheostomy from the ICU to the ward? B. C. Civanto, J. L. Lopez, A. Robles, J. Figueira, S. Yus, A. Garcia P230 - The application of tracheostomy in children in ICU A. Oglinda, G. Ciobanu, C. Oglinda, L. Schirca, T. Sertinean, V. Lupu P231 - The impact of passive humidifiers on aerosol drug delivery during mechanical ventilation P. Kelly, A. O’Sullivan, L. Sweeney, R. MacLoughlin P232 - Evaluation of vibrating mesh and jet nebuliser performance at two different attachment setups in line with a humidifier nebuliser system A. O’Sullivan, P. Kelly, L. Sweeney, E. Mukeria, M. Wolny , R. MacLoughlin P233 - Psv-niv versus cpap in the treatment of acute cardiogenic pulmonary edema A. Pagano, F. Numis, G. Vison, L. Saldamarco, T. Russo, G. Porta, F. Paladino P234 - Noninvasive ventilation in patients with haematologic malignancy: a retrospective review C. Bell, J. Liu, J. Debacker, C. Lee, E. Tamberg, V. Campbell, S. Mehta P235 - Use of non-invasive ventilation in infectious diseases besides classical indications A. Silva-Pinto, A. Sarmento, L. Santos P236 - The impact of fragility on noninvasive mechanical ventilation application and results in the ICU Ý. Kara, F. Yýldýrým, A. Zerman, Z. Güllü, N. Boyacý, B. Basarýk Aydogan, Ü. Gaygýsýz, K. Gönderen, G. Arýk, M. Turkoglu, M. Aydogdu, G. Aygencel, Z. Ülger, G. 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Diedrich P242 - A reduction in tidal volumes for ventilated patients on ICU calculated from IBW. can it minimise mortality in comparison to traditional strategies? A . Fuller, P. McLindon, K. Sim P243 - Predictive value of lung aeration scoring using lung ultrasound in weaning failure M. Shoaeir, K. Noeam, A. Mahrous, R. Matsa, A. Ali P244 - Conventional versus automated weaning from mechanical ventilation using SmartCare™ C. Dridi, S. Koubaji, S. Kamoun, F. Haddad, A. Ben Souissi, B. Laribi, A. Riahi, M. S. Mebazaa P245 - Ultrasonographic evaluation protocol for weaning from mechanichal ventilation A. Pérez-Calatayud, R. Carrillo-Esper, A. Zepeda-Mendoza, M. Diaz-Carrillo, E. Arch-Tirado P246 - Diaphragm ultrasonography: a method for weaning patients from mechanical ventilation S. Carbognin, L. Pelacani, F. Zannoni, A. Agnoli, G. Gagliardi P247 - Dorsal diaphragmatic excursion tracks transpulmonary pressure in ventilated ARDS patients: a potential non-invasive indicator of lung recruitment? R. Cho, A. Adams , S. Lunos, S. Ambur, R. Shapiro, M. Prekker P248 - Pulse oximetry in the icu patient: is the perfusion index of any value? M. Thijssen, L. Janssen, N. Foudraine P249 - Ventilation is a better assessment of respiratory status than EtCO2 C. J. Voscopoulos, J. Freeman P250 - Evaluation of the relationship between non-invasive minute ventilation and end-tidal CO2 in patients undergoing general vs spinal anesthesia C. J. Voscopoulos, J. Freeman, E. George P251 - Respiratory volume monitoring provides early warning of respiratory depression and can be used to reduce false alarms in non-intubated patients C. J. Voscopoulos, D. Eversole, J. Freeman, E. George P252 - P/i index: a predictive edi-derived weaning index during nava S. Muttini, R. Bigi, G. Villani, N. Patroniti P253 - Adequacy of ventilation in patients receiving opioids in the post anesthesia care unit: minute ventilation versus respiratory rate G. Williams, C. J. Voscopoulos, J. Freeman, E. George P254 - Comparison of regional and global expiratory time constants measured by electrical impedance tomography (EIT) A. Waldmann, S. Böhm, W. Windisch, S. Strassmann, C. Karagiannidis P255 - Electrical impedance tomography: robustness of a new pixel wise regional expiratory time constant calculation A. Waldmann, S. Böhm, W. Windisch, S. Strassmann, C. Karagiannidis P256 - Validation of regional and global expiratory time constant measurement by electrical impedance tomography in ards and obstructive pulmonary diseases C. K. Karagiannidis, A. W. Waldmann, S. B. Böhm, S. Strassmann, W. W. Windisch P257 - Transpulmonary pressure in a model with elastic recoiling lung and expanding chest wall P. Persson, S. Lundin, O. Stenqvist P258 - Lactate in pleural and abdominal effusion G. Porta, F. Numis, C. S. Serra, A. P. Pagano, M. M. Masarone, L. R. Rinaldi, A. A. Amelia, M. F. Fascione, L. A. Adinolfi, E. R. Ruggiero P259 - Outcome of patients admitted to the intensive care with pulmonary fibrosis F. Asota, K. O’Rourke, S. Ranjan, P. Morgan P260 - Sedation and analgesia practice in extra-corporeal membrane oxygenation (ECMO)-treated patients with acute respiratory distress syndrome (ARDS): a retrospective study J. W. DeBacker, E. Tamberg, L. O’Neill, L. Munshi, L. Burry, E. Fan, S. Mehta P261 - Characteristics and outcomes of patients deemed not eligible when referred for veno-venous extracorporeal membrane oxygenation (vv-ECMO) S. Poo, K. Mahendran, J. Fowles, C. Gerrard, A. Vuylsteke P262 - The SAVE SMR for veno-arterial ECMO R. Loveridge, C. Chaddock, S. Patel, V. Kakar, C. Willars, T. Hurst, C. Park, T. Best, A. Vercueil, G. Auzinger P263 - A simplified score to predict early (48 h) mortality in patients being considered for VA-ECMO A. Borgman, A. G. Proudfoot, E. Grins, K. E. Emiley, J. Schuitema, S. J. Fitch, G. Marco, J. Sturgill, M. G. Dickinson, M. Strueber, A. Khaghani, P. Wilton, S. M. Jovinge P264 - Lung function six months post extra corporeal membrane oxygenation (ECMO) for severe acute respiratory failure in adult survivors C. Sampson, S. Harris-Fox P265 - Bicarbonate dialysis removes carbon dioxide in hypoventilated rodents. M. E. Cove, L. H. Vu, A. Sen, W. J. Federspiel, J. A. Kellum P266 - Procalcitonin as predictor of primary graft dysfunction and mortality in post-lung transplantation C. Mazo Torre, J. Riera, S. Ramirez, B. Borgatta, L. Lagunes, J. Rello P267 - New molecular biomarkers of acute respiratory distress syndrome in abdominal sepsis A. K. Kuzovlev, V. Moroz, A. Goloubev, S. Polovnikov, S. Nenchuk P268 - Tight junction’s proteins claudin -5 and regulation by tnf in experimental murine lung injury model of ali/ards V. Karavana, C. Glynos, A. Asimakos, K. Pappas, C. Vrettou, M. Magkou, E. Ischaki, G. Stathopoulos, S. Zakynthinos P269 - Cell counts in endobronchial aspirate to assess airway inflammation in ARDS patients: a pilot study S. Spadaro, I. Kozhevnikova, F. Dalla Corte, S. Grasso, P. Casolari, G. Caramori, C. Volta P270 - Epidemiological and clinical profile of patients with acute respiratory distress syndrome in the surgical intensive care unit surgical, hospital JRA, Antananarivo T. Andrianjafiarinoa, T. Randriamandrato, T. Rajaonera P271 - Effect of high PEEP after recruitment maneuver on right ventricular function in ARDS. Is it good for the lung and for the heart? S. El-Dash, ELV Costa, MR Tucci, F Leleu, L Kontar, B. De Cagny, F. Brazier, D. Titeca, G. Bacari-Risal, J. Maizel, M. Amato, M. Slama P272 - Effect of recruitment maneuver on left ventricular systolic strain P. Mercado, J. Maizel, L. Kontar, D. Titeca, F. Brazier, A. Riviere, M. Joris, T. Soupison, B. De Cagny, S. El Dash, M. Slama P273 - Inhaled nitric oxide – is switching supplier cost effective? Remmington, A. Fischer, S. Squire, M. Boichat P274 - Epidemiological study of severe acute pancreatitis in Japan, comparison of the etiology and the patient outcomes on 1159 patients. H. Honzawa, H. Yasuda, T. Adati, S. Suzaki, M. Horibe, M. Sasaki, M. Sanui P275 - Extracorporeal liver support therapy. Experience in an intensive care unit R. Marinho, J. Daniel, H. Miranda, A. Marinho P276 - Accuracy of mortality prediction models in acute versus acute-on-chronic liver failure in the intensive care setting K. Milinis, M. Cooper, G. R. Williams, E. McCarron, S. Simants, I. Patanwala, I. Welters P277 - Risk of coronary artery disease in patients with chronic liver disease: a population based cohort study Y. Su P278 - 20 years of liver transplantation in Santiago de Compostela (Spain). Experience review J. Fernández Villanueva, R. Fernández Garda, A. López Lago, E. Rodríguez Ruíz, R. Hernández Vaquero, S. Tomé Martínez de Rituerto, E. Varo Pérez P279 - Diarrhea is a risk factor for liver injury and may lead to intestinal failure associated liver disease in critical illness N. Lefel, F. Schaap, D. Bergmans, S. Olde Damink, M. Van de Poll P280 - Bowel care on the intensive care unit: constipation guideline compliance and complications K. Tizard, C. Lister, L. Poole P281 - Malnutrition assessed by phase angle determines outcomes in low risk cardiac surgery patients D. Ringaitiene, D. Gineityte, V. Vicka, I. Norkiene, J. Sipylaite P282 - Preoperative fasting times in an irish hospital A. O’Loughlin, V. Maraj, J. Dowling P283 - Costs and final outcome of early x delayed feeding in a private Brazil ICU M. B. Velasco, D. M. Dalcomune, E. B. Dias, S. L. Fernandes P284 - Can ventilator derived energy expenditure measurements replace indirect calorimetry? T. Oshima, S. Graf, C. Heidegger, L. Genton, V. Karsegard, Y. Dupertuis, C. Pichard P285 - Revisiting the refeeding syndrome: results of a systematic review N. Friedli, Z. Stanga, B. Mueller, P. Schuetz P286 - Compliance with the new protocol for parenteral nutrition in our ICU L. Vandersteen, B. Stessel, S. Evers, A. Van Assche, L. Jamaer, J. Dubois P287 - Nutrition may be another treatment in the intensive care unit where less is more? R. Marinho, H. Castro, J. Moura, J. Valente, P. Martins, P. Casteloes, C. Magalhaes, S. Cabral, M. Santos, B. Oliveira, A. Salgueiro, A. Marinho P288 - Should we provide more protein to critically ill patients? R. Marinho, M. Santos, E. Lafuente, H. Castro, S. Cabral, J. Moura, P. Martins, B. Oliveira, A. Salgueiro, S. Duarte, S. Castro, M. Melo, P. Casteloes, A. Marinho P289 Protein provision in an adult intensive care unit S. Gray P290 - Prevalence and clinical outcomes of vitamin d deficiency in the medical critically ill patients in Songklanagarind hospital K. Maipang, R. Bhurayanontachai P291 - Vitamin d deficiency strongly predicts adverse medical outcome across different medical inpatient populations: results from a prospective study L. G. Grädel, P. Schütz P292 - Omega-3 fatty acids in patients undergoing cardiac surgery: a systematic review and meta-analysis P. Langlois, W. Manzanares P293 - Can 5-hydroxytriptophan prevent post-traumatic stress disorder in critically ill patients? R. Tincu, C. Cobilinschi, D. Tomescu, Z. Ghiorghiu, R. Macovei P294 - Parenteral selenium in the critically ill: an updated systematic review and meta-analysis W. Manzanares, P. Langlois, M. Lemieux, G. Elke, F. Bloos, K. Reinhart, D. Heyland P295 - Probiotics in the critically ill: an updated systematic review and meta-analysis P. Langlois, M. Lemieux, I. Aramendi, D. Heyland, W. Manzanares P296 - Diabetes with hyperglycemic crisis episodes may be associated with higher risk of pancreatic cancer: a population-based cohort study Y. 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Bertellini P318 Correlation between electroencephalographic findings and serum neuron specific enolase with outcome of post cardiac arrest patients A. Taha, T. Abdullah, S. Abdel Monem P319 Introduction of a targeted temperature management strategy following cardiac arrest in a district general hospital intensive care unit. S. Alcorn, S. McNeill, S. Russell P320 The evolution of cerebral oxygen saturation in post-cardiac arrest patients treated with therapeutic hypothermia W. Eertmans, C. Genbrugge, I. Meex, J. Dens, F. Jans, C. De Deyne P321 Prognostic factors and neurological outcomes of therapeutic hypothermia in comatose survivors from cardiac arrest: 8-year single center experience J. Cholkraisuwat, N. Kongpolprom P322 Adherence to targeted temperature management after out of hospital cardiac arrest B. Avard, R. Burns P323 Implementation of a therapeutic hypothermia protocol for comatose survivors of out-of-hospital cardiac arrest. A. Patarchi, T. 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Suchomel P343 - Evaluation of levetiracetam pharmacokinetics after severe traumatic brain injury in neurocritical care patients at a level one trauma center N. Ebert, J. Jancik, H. Rhodes P344 - Model based time series cluster analysis to determine unique patient states in traumatic brain injury T. Bylinski, C. Hawthorne, M. Shaw, I. Piper, J. Kinsella P345 - Brain compartment monitoring capabilities from ICP to BI (bioimpedance) during HS (hypertonic saline) administration. State of art simulation outcome depending on brain swelling type A. K. Kink , I. R. Rätsep P346 - Transfusion of red blood cells in patients with traumatic brain injury admitted to Canadian trauma health centers: a multicenter cohort study A. Boutin, L. Moore, M. Chasse, R. Zarychanski, F. Lauzier, S. English, L. McIntyre, J. Lacroix, D. Griesdale, P. Lessard-Bonaventure, A. F. 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Kelly P358 - Black widow envenomation in Saudi Arabia: a prospective observational case series M. Alfafi, S. Alsolamy, W. Almutairi, B. Alotaibi P359 - Mechanical ventilation in patients with overdose not yet intubated on icu admission A. E. Van den Berg, Y. Schriel, L. Dawson, I. A. Meynaar P360 - Central nervous system depressants poisoning and ventilator associated pneumonia: an underrated risk factor in toxicological intensive care unit H. Talaie P361 - Acute barium intoxication treated with hemodiafiltration D. Silva, S. Fernandes, J. Gouveia, J. Santos Silva P362 - Major trauma presenting to the emergency department. the spectrum of cycling injuries in Ireland J. Foley, A. Kaskovagheorgescu, D. Evoy, J. Cronin, J. Ryan P363 - Burns from French military operations: a 14-year retrospective observational analysis. M. Huck, C. Hoffmann, J. Renner, P. Laitselart, N. Donat, A. Cirodde, J. V. Schaal, Y. Masson, A. Nau, T. Leclerc P364 - A comparison of mortality scores in burns patients on the intensive care unit. O. Howarth, K. Davenport, P. Jeanrenaud, S. Raftery P365 - Clasification of pain and its treatment and an intensive care rehabiliation clinic P. MacTavish, H. Devine, J. McPeake, M. Daniel, J. Kinsella, T. Quasim P366 - Pain management adequacy in critical care areas ,the process and the barriers perceived by critical care nurses S. Alrabiee, A. Alrashid , S. Alsolamy P367 - Pain assessment in critically ill adult patients: validation of the Turkish version of the critical-care pain observation tool O. Gundogan, C. Bor, E. Akýn Korhan, K. Demirag , M. Uyar P368 - An audit of pain and sedation assessments in the intensive care unit: recommendations for clinical practice F. Frame, C. Ashton, L. Bergstrom Niska P369 - Impact of pharmaceutical care on treatment of pain and agitation in medical intensive care unit P. Dilokpattanamongkol, T. Suansanae, C. Suthisisang, S. Morakul, C. Karnjanarachata, V. Tangsujaritvijit P370 - Agitation in trauma ICU, prevention and outcome S. Mahmood, H. Al Thani, A. Almenyar P371 Correlation between percentages of ventilated patients developed vap and use of sedative agents in icu patients. A. Vakalos , V. Avramidis P372 - Improving recording of sedation events in the Emergency Department: The implementation of the SIVA International Taskforce adverse event reporting tool for procedural sedation R. Sharvill, J. Penketh P373 - Impact of sedative drug use on the length of mechanical ventilation S. E. Morton, Y. S. Chiew, C. Pretty, J. G. Chase, G. M. Shaw P374 - Co-administration of nitric oxide and sevoflurane using anaconda R. Knafelj, P. Kordis P375 - A retrospective study of the use of Dexmedetomidine in an oncological critical care setting S. Patel, V. Grover P376 - Dexmedetomidine and posttraumatic stress disorder incidence in alcohol withdrawal icu patients I. Kuchyn, K. Bielka P377 - Hemodynamic effects of dexmedetomidine in a porcine model of septic shock Z. Aidoni, V. Grosomanidis, K. Kotzampassi, G. Stavrou, B. Fyntanidou, S. Patsatzakis, C. Skourtis P378 - Ketamine for analgosedation in severe hypoxic respiratory failure S. D. Lee, K. Williams, I. D. Weltes P379 - Madness from the moon? lunar cycle and the incidence of delirium on the intensive care unit S. Berhane, C. Arrowsmith, C. Peters, S. Robert P380 - Impaired dynamic cerebral autoregulation after coronary artery bypass grafting and association with postoperative delirium J. Caldas, R. B. Panerai, T. G. Robinson, L. Camara, G. Ferreira, E. Borg-Seng-Shu, M. De Lima Oliveira, N. C. Mian, L. Santos, R. Nogueira, S. P. Zeferino, M. Jacobsen Teixeira, F. Galas, L. A. Hajjar P381 - Risk factors predicting prolonged intensive care unit length of stay after major elective surgery. P. Killeen, M. McPhail, W. Bernal, J. Maggs, J. Wendon, T. Hughes P382 - Systemic inflammatory response syndrome criteria and hospital mortality prediction in a brazilian cohort of critically ill patients L. U. Taniguchi, E. M. Siqueira, J. M. Vieira Jr, L. C. Azevedo P383 - Evaluating the efficacy of a risk predictor panel in identifying patients at elevated risk of morbidity following emergency admission A. N. Ahmad, M. Abu-Habsa, R. Bahl, E. Helme, S. Hadfield, R. Loveridge P384 - A retrospective comparison of outcomes for elective surgical patients admitted post-operatively to the critical care unit or general ward J. Shak, C. Senver, R. Howard-Griffin P385 - Effect of obesity on mortality in surgical critically ill patients. P. Wacharasint, P. Fuengfoo, N. Sukcharoen, R. Rangsin P386 - The national early warning score (news) reliably improves adverse clinical outcome prediction in community-acquired pneumonia - results from a 6 year follow-up D. Sbiti-Rohr, P. Schuetz P387 - Clinical usefulness of the charlson¡¯s weighted index of comorbidities _as prognostic factor in patients with prolonged acute mechanical ventilation H. Na, S. Song, S. Lee, E. Jeong, K. Lee P388 - Comparison of mortality prediction scoring systems in patients with cirrhosis admitted to general intensive care unit M. Cooper, K. Milinis, G. Williams, E. McCarron, S. Simants, I. Patanwala, I. D. Welters P389 - Impact of admission source and time of admission on outcome of pediatric intensive care patients: retrospective 15 years study E. Zoumpelouli, EA Volakli, V. Chrysohoidou, S. Georgiou, K. Charisopoulou, E. Kotzapanagiotou, V. Panagiotidou, K. Manavidou, Z. Stathi, M. Sdougka P390 - Heart rate variability and outcomes prediction in critical illness N. Salahuddin, B. AlGhamdi, Q. Marashly, K. Zaza, M. Sharshir, M. Khurshid, Z. Ali, M. Malgapo, M. Jamil, A. Shafquat, M. Shoukri, M. Hijazi P391 - The incidence and outcome of hyperlactatemia in the post anaesthesia care unit T. Abe, S. Uchino, M. Takinami P392 - Correlation between arterial blood gas disturbances and arterial lactate levels during hospitalization and outcome in critically septic patients N. R. Rangel Neto, S. Oliveira, F. Q. Reis, F. A. Rocha P393 - External validation of saps 3 and mpm iii scores in 48,816 patients from 72 brazilian icus G. Moralez, K. Ebecken, L. S. Rabello, M. F. Lima, R. Hatum, F. V. De Marco, A. Alves, J. E. Pinto, M. Godoy, P. E. Brasil, F. A. Bozza, J. I. Salluh, M. Soares P394 - The frailty penalty: pre-admission functional status confounds mortality prediction models in critically ill patients J. Krinsley, G. Kang P395 - ‘sooner rather than later”: how delayed discharge from critical care leads to increased out of hours discharges and subsequent increase in in-hospital mortality. J. Perry, H. Hines P396 - Identifying poor outcome patient groups in a resource-constrained critical care unit K. M. Wilkinson, C. Tordoff, B. Sloan, M. C. Bellamy P397 - Effects of icu weekend admission and discharge on mortality. E. Moreira, F. Verga, M. Barbato, G. Burghi P398 - Organizational factors, outcomes and resource use in 9,946 cancer patients admitted to 70 ICUs M Soares, U. V. Silva, L. C. Azevedo, A. P. Torelly, J. M. Kahn, D. C. Angus, M. F. Knibel, P. E. Brasil, F. A. Bozza, J. I. Salluh P399 - Evaluation of oncological critically ill patients, severity score and outcome compared to not oncological in a particular hospital cti. M. B. Velasco, D. M. Dalcomune P400 - Outcomes of patients admitted to a large uk critical care department with palliative oncological diagnoses R. Marshall, T. Gilpin, A. Tridente, A. Raithatha P401 - Predictors of mortality in febrile neutropenic patients with haematological malignancies admitted to an intensive care unit of a cancer center D. Mota, B. Loureiro, J. Dias, O. Afonso, F. Coelho, A. Martins, F. Faria P402 - Patients with hematologic malignancies requiring invasive mechanical ventilation: characteristics and predictors of mortality H. Al-Dorzi, H. Al Orainni , F. AlEid, H. Tlaygeh, A. Itani, A. Hejazi, Y. Arabi P403 - Patient-important outcomes in randomized controlled trials in critically ill patients: a systematic review S. Gaudry, J. Messika, J. D. Ricard, S. Guillo, B. Pasquet, E. Dubief, D. Dreyfuss, F. Tubach P404 - Alopecia in survivors of critical illness: a qualitative study C . Battle, K. James, P. Temblett P405 - The impact of mental health on icu admission L. Davies, C. Battle, C. Lynch P406 - Cognitive impairment 5 years after ICU discharge S. Pereira, S. Cavaco, J. Fernandes, I. Moreira, E. Almeida, F. Seabra Pereira, M. Malheiro, F. Cardoso, I. Aragão, T. Cardoso P407 - Apache ii versus apache iv for octagenerians in medical icu M. Fister, R. Knafelj P408 - Outcomes of octagenarians in an indian icu P. Muraray Govind, N. Brahmananda Reddy, R. Pratheema, E. D. Arul, J. Devachandran P409 - Mortality and outcomes in elderly patients 80 years of age or older admitted to the icu M. B. Velasco , D. M. Dalcomune P410 - Octagenerians in medical icu - adding days to life or life to days? R. Knafelj, M. Fister P411 - The very elderly admitted to intensive care unit: outcomes and economic evaluation N. Chin-Yee, G. D’Egidio, K. Thavorn, D. Heyland, K. Kyeremanteng P412 - The very elderly in intensive care: relationship between acuity of illness and long-term mortality A. G. Murchison, K. Swalwell, J. Mandeville, D. Stott P413 - Acquired weakness in an oncological intensive care unit I. Guerreiro P414 - Musculoskeletal problems in intensive care unit (ICU) patients post-discharge H. Devine, P. MacTavish, J. McPeake, T. Quasim, J. Kinsella, M. Daniel P415 - Premorbid obesity, but not nutrition, prevents critical illness-induced muscle wasting and weakness C. Goossens M. B. Marques, S. Derde, S. Vander Perre, T. Dufour, S. E. Thiessen, F. Güiza, T. Janssens, G. Hermans, I. Vanhorebeek, K. De Bock, G. Van den Berghe, L. Langouche P416 - Physical outcome measures for critical care patients following intensive care unit (icu) discharge H. Devine, P. MacTavish, T. Quasim, J. Kinsella, M. Daniel, J. McPeake P417 - Improving active mobilisation in a general intensive care unit B. Miles , S. Madden, H. Devine P418 - Mobilization in patients on vasoactive drugs use – a pilot study. M. Weiler, P. Marques, C. Rodrigues, M. Boeira, K. Brenner, C. Leães, A. Machado, R. Townsend, J. Andrade P419 - Pharmacy intervention at an intensive care rehabilitation clinic P. MacTavish, J. McPeake, H. Devine, J. Kinsella, M. Daniel, R. Kishore, C. Fenlon, T. Quasim P420 - Interactive gaming is feasible and potentially increases icu patients’ motivation to be engaged in rehabilitation programs T. Fiks, A. Ruijter, M. Te Raa, P. Spronk P421 - Simulation-based design of a robust stopping rule to ensure patient safety Y. S. Chiew, P. Docherty, J. Dickson, E. Moltchanova, C. Scarrot, C. Pretty, G. M. Shaw, J. G. Chase P422 - Are daily blood tests on the intensive care unit necessary? T. Hall, W. C. Ngu, J. M. Jack, P. Morgan P423 - Measuring urine output in ward patients: is it helpful? B. Avard, A. Pavli, X. Gee P424 - The incidence of pressure ulcers in an adult mixed intensive care unit in turkey C . Bor, E. Akin Korhan, K. Demirag, M. Uyar P425 - Intensivist/patient ratios in closed ICUs in Alexandria, Egypt; an overview M. Shirazy, A. Fayed P426 - Eicu (electronic intensive care unit): impact on ALOS (average length of stay) in a developing country like India S. Gupta, A. Kaushal, S. Dewan, A. Varma P427 - Predicting deterioration in general ward using early deterioration indicator E. Ghosh, L. Yang, L. Eshelman, B. Lord, E. Carlson P428 - High impact enhanced critical care outreach - the imobile service: making a difference E. Helme, R. Broderick, S. Hadfield, R. Loveridge P429 - Impact of bed availability and cognitive load on intensive care unit (ICU) bed allocation: a vignette-based trial J. Ramos, D. Forte P430 - Characteristics of critically ill patients admitted through the emergency department F. Yang, P. Hou P431 - Admission to critical care: the quantification of functional reserve J. Dudziak, J. Feeney, K. Wilkinson, K. Bauchmuller, K. Shuker, M. Faulds, A. Raithatha, D. Bryden, L. England, N. Bolton, A. Tridente P432 - Admission to critical care: the importance of frailty K. Bauchmuller, K Shuker, A Tridente, M Faulds, A Matheson, J. Gaynor, D Bryden, S South Yorkshire Hospitals Research Collaboration P433 - Development of an instrument to aid triage decisions for intensive care unit admission J. Ramos, B. Peroni, R. Daglius-Dias, L. Miranda, C. Cohen, C. Carvalho, I . Velasco, D. Forte P434 - Using selective serotonin re-uptake inhibitors and serotonin-norepinephrine re-uptake inhibitors in critical care: a systematic review of the evidence for benefit or harm J. M. Kelly, A. Neill, G. Rubenfeld, N. Masson, A. Min P435 - Measuring adaptive coping of hospitalized patients with a severe medical condition:the sickness insight in coping questionnaire (sicq) E. Boezeman, J. Hofhuis , A. Hovingh, R. De Vries, P. Spronk P436 - Results of a national survey regarding intensive care medicine training G. Cabral-Campello, I. Aragão, T. Cardoso P437 - Work engagement among healthcare professionals in the intensive care unit M. Van Mol, M. Nijkamp, E . Kompanje P438 - Empowering the intensive care practitioners. is it a burnout ameliorating intervention? P. Ostrowski, A. Omar P439 - Icu patients suffer from circadian rhythm desynchronisation K. Kiss , B. Köves, V. Csernus, Z. Molnár P440 - Noise reduction in the ICU: feasible ? Y. Hoydonckx, S. Vanwing, B. Stessel, A. Van Assche, L. Jamaer, J. Dubois P441 - Accidental removal of invasive devices in the critical patient into the bed-washing. does the presence of professional nurse modify his incidence? V. Medo, R. Galvez, J. P. Miranda P442 - Deprivation of liberty safeguards (dols): audit of compliance in a of a 16-bed specialist cancer critical care unit. C. Stone, T. Wigmore P443 - Use of a modified cristal score to predict futility of critical care in the elderly Y. Arunan, A. Wheeler, K. Bauchmuller, D. Bryden P444 - Improvement of Referral Rate to Palliative Care for Patients with Poor Prognosis in Neurosurgical Intensive Care Unit Y. Wong, C. Poi, C. Gu P445 - Factors associated with limitation of life supporting care (lsc) in a medico-surgical intermediate care unit, and outcome of patients with lsc limitation: a monocentric, six-month study. P. Molmy, N. Van Grunderbeeck, O. Nigeon, M. Lemyze, D. Thevenin, J. Mallat P446 - Palliative care consultation and intensive care unit admission request: a cohort study J. Ramos, M. Correa, R. T. Carvalho, D. Forte P447 - Nursing and medicine together in postsurgical intensive care unit: situations of prognostic conflict at the end of life. our critical care nurses suffer with our medical activism? A. Fernandez, C. McBride P448 - End of life who may decide E. Koonthalloor, C. Walsh P449 - Correctly diagnosing death A. Webber, M. Ashe, K. Smith, P. Jeanrenaud P450 - Skin procurement performed by intensive care physicians: yes, we can. A. Marudi , S. Baroni, F. Ragusa, E. Bertellini P451 - Death analysis in pediatric intensive care patients E. A. Volakli , E. Chochliourou, M. Dimitriadou, A. Violaki, P. Mantzafleri, E. Samkinidou, O. Vrani, A. Arbouti, T. Varsami, M. Sdougka P452 - The potential impact of euthanasia on organ donation: analysis of data from belgium J. A. Bollen, T. C. Van Smaalen, W. C. De Jongh, M. M. Ten Hoopen, D. Ysebaert, L. W. Van Heurn, W. N. Van Mook P453 - Communication within an intensive care setting K. Sim, A. Fuller P454 - Development and implementation of a longitudinal communication curriculum for critical care medicine fellows A. Roze des Ordons, P. Couillard, C. Doig P455 - Staff-family conflict in a multi-ethnic intensive care unit R. V. Van Keer, R. D. Deschepper, A. F. Francke, L. H. Huyghens, J. B. Bilsen P456 - Does the source of admission to critical care affect family satisfaction? B. Nyamaizi, C. Dalrymple, A. Molokhia, A. Dobru P457 - A simple alternative to the family satisfaction survey (fs-icu) E. Marrinan, A. Ankuli, A. Molokhia P458 - A study to explore the experiences of patient and family volunteers in a critical care environment: a phenomenological analysis J. McPeake, R. Struthers, R. Crawford , H. Devine , P. Mactavish , T. Quasim P459 - Prevalence and risk factors of anxiety and depression in relatives of burn patients. P. Morelli, M. Degiovanangelo, F. Lemos, V. MArtinez, F. Verga, J. Cabrera, G. Burghi P460 - Guidance of visiting children at an adult intensive care unit (icu) A. Rutten , S. Van Ieperen, S. De Geer, M. Van Vugt, E. Der Kinderen P461 - Visiting policies in Italian pediatric ICUs: an update A. Giannini, G Miccinesi, T Marchesi, E Prandi
Published: 2016

6. The different features of congenital neuroblastomas: report about the sonographic diagnosis of three cases

Author: Langer T, Deeg Kh, Glöckel U, and Dachert C
Subjects: medicine.medical_specialty, Pathology, Congenital neuroblastoma, Adrenal Gland Neoplasms, Asymptomatic, Neuroblastoma, Spinal cord compression, medicine, Birth Weight, Humans, Radiology, Nuclear Medicine and imaging, Spinal canal, Ultrasonography, Doppler, Color, ADRENAL HAEMORRHAGE, business.industry, Liver Neoplasms, Infant, Newborn, Mediastinal Neuroblastoma, medicine.disease, Doppler sonography, medicine.anatomical_structure, Treatment Outcome, Abdominal Neoplasms, Female, Radiology, medicine.symptom, business, Perfusion, Infant, Premature
Abstract: We report on three infants with congenital neuroblastoma. Two clinically asymptomatic infants showed a suprarenal right-sided mass, one infant had a mediastinal tumour with tracheal compression causing immediate postnatal dyspnoea. Diagnosis was established by ultrasonography showing hypoechoic tumours without significant calcifications. The two suprarenal masses were characterised by small cystic areas. Colour coded Doppler sonography revealed perfusion of the tumours distinguishing the suprarenal masses from adrenal haemorrhage. The right-sided mediastinal neuroblastoma showed infiltration of the intervertebral foramina and spinal canal without spinal cord compression. All tumours were surgically removed with favourable clinical outcome.
Published: 2007

7. Visual-Evoked Potentials in Long-Term Survivors of Acute Lymphoblastic Leukemia in Childhood

Author: Langer T, J D Beck, D Wenzel, H Hertzberg, M A Uberall, and Meier W
Subjects: medicine.medical_specialty, genetic structures, business.industry, Leukodystrophy, General Medicine, medicine.disease, Gastroenterology, Asymptomatic, Nerve conduction velocity, Surgery, Leukemia, El Niño, Internal medicine, Acute lymphocytic leukemia, Relative risk, Pediatrics, Perinatology and Child Health, medicine, Methotrexate, Neurology (clinical), medicine.symptom, business, medicine.drug
Abstract: Visual-evoked potentials (VEPs) were studied in 92 asymptomatic long-term survivors of acute lymphoblastic leukemia (ALL) in first complete remission 6-7 years after cessation of therapy in order to detect therapy-related disturbances in conduction velocity capacities within central nerve fibers. Subjects were grouped with respect to CNS prophylaxis: a) ith. MTX and 18 Gy cranial irradiation (group A, n = 58), b) ith. MTX and iv. MHD-MTX, no cranial irradiation (group B, n = 34). At follow-up VEPs were abnormal in 10 subjects (10.9 %) with comparable rates in both CNS prophylaxis groups (A: 7/58 [12.1 %], B: 3/34 [8.8 %]; p = 0.56). Participants with radiological signs of leukodystrophy (n = 14), all within the irradiated CNS prophylaxis group, showed significantly prolonged P100 latencies and had a 6.1-fold increased relative risk to develop VEP disturbances. No correlation could be established between VEP outcome and illness- or treatment-related parameters. VEP outcome was not correlated with age at diagnosis or gender. Thus, VEP recordings showed a close relationship with radiation-induced CNS white-matter disturbances. However, their value for clinical practice, routinely performed follow-up evaluations or standardized posttreatment surveillance studies is negligible.
Published: 1996

8. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study

Author: Letizia Di Meglio, Antonio Pesenti, Amedeo Guzzardella, Marco Di Laudo, Claudia Filippini, Lorenzo Querci, Franco Locatelli, Massimo Antonelli, Vittorio Scaravilli, Arthur S. Slutsky, Alfredo Lissoni, Giacomo Bellani, Luca Carsana, Stefano Nava, V. Marco Ranieri, Carmen Seccafico, Jean Louis Vincent, Gianpaolo Carrafiello, Chiara Rizzuto, Francesco Monteduro, Maurizio Cecconi, Roberto Fumagalli, Domenico Luca Grieco, N Rossi, John G. Laffey, Massimo Girardis, Alberto Zanella, Gennaro De Pascale, Giacinto Pizzilli, Tommaso Tonetti, Carlo Valsecchi, Giacomo Grasselli, Ezio Lanza, Alessandro Protti, Francesca Bevilacqua, Fabiana Madotto, Thomas Langer, Maurizio Zompatori, Grasselli G., Tonetti T., Protti A., Langer T., Girardis M., Bellani G., Laffey J., Carrafiello G., Carsana L., Rizzuto C., Zanella A., Scaravilli V., Pizzilli G., Grieco D.L., Di Meglio L., de Pascale G., Lanza E., Monteduro F., Zompatori M., Filippini C., Locatelli F., Cecconi M., Fumagalli R., Nava S., Vincent J.-L., Antonelli M., Slutsky A.S., Pesenti A., Ranieri V.M., Lissoni A., Rossi N., Guzzardella A., Valsecchi C., Madotto F., Bevilacqua F., Di Laudo M., Querci L., Seccafico C., Grasselli, G, Tonetti, T, Protti, A, Langer, T, Girardis, M, Bellani, G, Laffey, J, Carrafiello, G, Carsana, L, Rizzuto, C, Zanella, A, Scaravilli, V, Pizzilli, G, Grieco, D, Di Meglio, L, de Pascale, G, Lanza, E, Monteduro, F, Zompatori, M, Filippini, C, Locatelli, F, Cecconi, M, Fumagalli, R, Nava, S, Vincent, J, Antonelli, M, Slutsky, A, Pesenti, A, and Ranieri, V
Subjects: Male, Pulmonary and Respiratory Medicine, ARDS, medicine.medical_specialty, Computed Tomography Angiography, Dead space, Pulmonary compliance, Pathophysiology, law.invention, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, 0302 clinical medicine, covid-19, acute respiratory distress syndrome, sars-cov-2, law, Settore MED/41 - ANESTESIOLOGIA, Correspondence, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Respiratory system, Lung, Pandemics, Aged, Respiratory Distress Syndrome, SARS-CoV-2, business.industry, COVID-19, Articles, COVID-19, ARDS, D-dimer, compliance, Middle Aged, medicine.disease, Respiration, Artificial, Intensive care unit, 030228 respiratory system, Cohort, Emergency medicine, Female, Observational study, business
Abstract: Background: Patients with COVID-19 can develop acute respiratory distress syndrome (ARDS), which is associated with high mortality. The aim of this study was to examine the functional and morphological features of COVID-19-associated ARDS and to compare these with the characteristics of ARDS unrelated to COVID-19. Methods: This prospective observational study was done at seven hospitals in Italy. We enrolled consecutive, mechanically ventilated patients with laboratory-confirmed COVID-19 and who met Berlin criteria for ARDS, who were admitted to the intensive care unit (ICU) between March 9 and March 22, 2020. All patients were sedated, paralysed, and ventilated in volume-control mode with standard ICU ventilators. Static respiratory system compliance, the ratio of partial pressure of arterial oxygen to fractional concentration of oxygen in inspired air, ventilatory ratio (a surrogate of dead space), and D-dimer concentrations were measured within 24 h of ICU admission. Lung CT scans and CT angiograms were done when clinically indicated. A dataset for ARDS unrelated to COVID-19 was created from previous ARDS studies. Survival to day 28 was assessed. Findings: Between March 9 and March 22, 2020, 301 patients with COVID-19 met the Berlin criteria for ARDS at participating hospitals. Median static compliance was 41 mL/cm H2O (33–52), which was 28% higher than in the cohort of patients with ARDS unrelated to COVID-19 (32 mL/cm H2O [25–43]; p
Published: 2020

9. Synergistic effect of static compliance and d-dimers to predict outcome of patients with covid-19-ards: A prospective multicenter study

Author: Giacomo Grasselli, Maurizio Cecconi, Vittorio Scaravilli, Francesco Pugliese, Giuseppe Foti, Roberto Fumagalli, Giacomo Bellani, Massimo Antonelli, Thomas Langer, Laura Pasin, Massimo Girardis, Paolo Navalesi, Alessandro Protti, Rita Maria Melotti, Chiara Mega, Vito Marco Ranieri, Paola Rucci, Domenico Luca Grieco, Alessio Dell'Olio, Stefano Nava, Stefano Busani, Tommaso Tonetti, Arthur S. Slutsky, Antonio Pesenti, Annalisa Boscolo, Nicolò Sella, L Mascia, Francesco Alessandri, Tonetti T., Grasselli G., Rucci P., Alessandri F., Dell'olio A., Boscolo A., Pasin L., Sella N., Mega C., Melotti R.M., Girardis M., Busani S., Bellani G., Foti G., Grieco D.L., Scaravilli V., Protti A., Langer T., Mascia L., Pugliese F., Cecconi M., Fumagalli R., Nava S., Antonelli M., Slutsky A.S., Navalesi P., Pesenti A., Ranieri V.M., Tonetti, T, Grasselli, G, Rucci, P, Alessandri, F, Dell'Olio, A, Boscolo, A, Pasin, L, Sella, N, Mega, C, Melotti, R, Girardis, M, Busani, S, Bellani, G, Foti, G, Grieco, D, Scaravilli, V, Protti, A, Langer, T, Mascia, L, Pugliese, F, Cecconi, M, Fumagalli, R, Nava, S, Antonelli, M, Slutsky, A, Navalesi, P, Pesenti, A, and Ranieri, V
Subjects: ARDS, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), QH301-705.5, medicine.medical_treatment, Medicine (miscellaneous), Pulmonary compliance, General Biochemistry, Genetics and Molecular Biology, Mechanical ventilation, Internal medicine, D-dimer, Medicine, Acute respiratory distress syndrome, COVID-19, Static compliance, Biology (General), acute respiratory distress syndrome, mechanical ventilation, static compliance, Receiver operating characteristic, business.industry, Proportional hazards model, Communication, medicine.disease, Multicenter study, business
Abstract: The synergic combination of D-dimer (as proxy of thrombotic/vascular injury) and static compliance (as proxy of parenchymal injury) in predicting mortality in COVID-19-ARDS has not been systematically evaluated. The objective is to determine whether the combination of elevated D-dimer and low static compliance can predict mortality in patients with COVID-19-ARDS. A “training sample” (March–June 2020) and a “testing sample” (September 2020–January 2021) of adult patients invasively ventilated for COVID-19-ARDS were collected in nine hospitals. D-dimer and compliance in the first 24 h were recorded. Study outcome was all-cause mortality at 28-days. Cut-offs for D-dimer and compliance were identified by receiver operating characteristic curve analysis. Mutually exclusive groups were selected using classification tree analysis with chi-square automatic interaction detection. Time to death in the resulting groups was estimated with Cox regression adjusted for SOFA, sex, age, PaO2/FiO2 ratio, and sample (training/testing). “Training” and “testing” samples amounted to 347 and 296 patients, respectively. Three groups were identified: D-dimer ≤ 1880 ng/mL (LD); D-dimer > 1880 ng/mL and compliance > 41 mL/cmH2O (LD-HC); D-dimer > 1880 ng/mL and compliance ≤ 41 mL/cmH2O (HD-LC). 28-days mortality progressively increased in the three groups (from 24% to 35% and 57% (training) and from 27% to 39% and 60% (testing), respectively; p < 0.01). Adjusted mortality was significantly higher in HD-LC group compared with LD (HR = 0.479, p < 0.001) and HD-HC (HR = 0.542, p < 0.01); no difference was found between LD and HD-HC. In conclusion, combination of high D-dimer and low static compliance identifies a clinical phenotype with high mortality in COVID-19-ARDS.
Published: 2021

10. Management of critically ill patients with COVID-19: suggestions and instructions from the coordination of intensive care units of Lombardy

Author: Giacomo Grasselli, Gian Paolo Castelli, N Bottino, Luca Guatteri, Giuseppe Foti, Antonio Pesenti, Maurizio Cecconi, Marco Ranucci, Danilo Radrizzani, Giacomo Monti, Alberto Giannini, Nicola Latronico, Roberto Fumagalli, Thomas Langer, Stefano Muttini, Vincenzo Russotto, Foti, G., Giannini, A., Bottino, N., Castelli, G. P., Cecconi, M., Grasselli, G., Uatteri, L., Latronico, N., Langer, T., Monti, G., Muttini, S., Pesenti, A., Radrizzani, D., Ranucci, M., Russotto, V., Fumagalli, R (COVID-19 Lombardy ICU Network), Zangrillo, A, Landoni, G, Foti, G, Giannini, A, Bottino, N, Castelli, G, Cecconi, M, Grasselli, G, Guatteri, L, Latronico, N, Langer, T, Monti, G, Muttini, S, Pesenti, A, Radrizzani, D, Ranucci, M, Russotto, V, and Fumagalli, R
Subjects: medicine.medical_specialty, Respiratory distress syndrome, medicine.medical_treatment, Critical Illness, Psychological intervention, MEDLINE, law.invention, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, law, Intensive care, medicine, Humans, Continuous positive airway pressure, Intensive care medicine, Pandemics, Mechanical ventilation, business.industry, adult, COVID-19, 030208 emergency & critical care medicine, Intensive Care Units, Italy, Coronavirus, medicine.disease, Intensive care unit, Pneumonia, Anesthesiology and Pain Medicine, Respiratory failure, ARDS, business
Abstract: With 63,098 confirmed cases on 17 April 2020 and 11,384 deaths, Lombardy has been the most affected region in Italy by coronavirus disease 2019 (COVID-19). To cope with this emergency, the COVID-19 Lombardy intensive care units (ICU) network was created. The network identified the need of defining a list of clinical recommendations to standardize treatment of patients with COVID-19 admitted to Intensive Care Unit (ICU). Three core topics were identified: 1) rational use of intensive care resources; 2) ventilation strategies; 3) non-ventilatory interventions. Identification of patients who may benefit from ICU treatment is challenging. Clinicians should consider baseline performance and frailty status and they should adopt disease-specific staging tools. Continuous positive airway pressure, mainly delivered through a helmet as elective method, should be considered as initial treatment for all patients with respiratory failure associated with COVID-19. In case of persisting dyspnea and/or desaturation despite 4-6 hours of noninvasive ventilation, endotracheal intubation and invasive mechanical ventilation should be considered. In the early phase, muscle relaxant use and volume-controlled ventilation is recommended. Prone position should be performed in patients with PaOinf2/inf/FiOinf2/inf≤100 mmHg. For patients admitted to ICU with COVID-19 interstitial pneumonia, we do not recommend empiric antibiotic therapy for community-acquired pneumonia. Consultation of an infectious disease specialist is suggested before start of any antiviral therapy. In conclusion, the COVID-19 Lombardy ICU Network identified a list of best practice statements supported by the available evidence and clinical experience or identified as panel members expert opinions for the management of critically ill patients with COVID-19.
Published: 2020

11. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy

Author: Grasselli, Giacomo, Greco, Massimiliano, Zanella, Alberto, Albano, Giovanni, Antonelli, Massimo, Bellani, Giacomo, Bonanomi, Ezio, Cabrini, Luca, Carlesso, Eleonora, Castelli, Gianpaolo, Cattaneo, Sergio, Cereda, Danilo, Colombo, Sergio, Coluccello, Antonio, Crescini, Giuseppe, Forastieri Molinari, Andrea, Foti, Giuseppe, Fumagalli, Roberto, Iotti, Giorgio Antonio, Langer, Thomas, Latronico, Nicola, Lorini, Ferdinando Luca, Mojoli, Francesco, Natalini, Giuseppe, Pessina, Carla Maria, Ranieri, Vito Marco, Rech, Roberto, Scudeller, Luigia, Rosano, Antonio, Storti, Enrico, Thompson, B. Taylor, Tirani, Marcello, Villani, Pier Giorgio, Pesenti, Antonio, Cecconi, Maurizio, Agosteo, Emiliano, Albertin, Andrea, Alborghetti, Armando, Aldegheri, Giorgio, Antonini, Benvenuto, Barbara, Enrico, Bardelloni, Giulia, Basilico, Sabrina, Belgiorno, Nicolangela, Beretta, Enrico, Berselli, Angela, Bianciardi, Leonardo, Bonazzi, Stefano, Borelli, Massimo, Bottino, Nicola, Bronzini, Nicola, Brusatori, Serena, Capra, Carlo, Carnevale, Livio, Catena, Emanuele, Celotti, Simona, Cerutti, Stefania, Chiumello, Davide, Cirri, Silvia, Citerio, Giuseppe, Coppini, Davide, Corona, Alberto, Cortellazzi, Paolo, Costantini, Elena, Covello, Remo Daniel, De Filippi, Gianluca, Dei Poli, Marco, Dughi, Paolo, Fieni, Fulvia, Florio, Gaetano, Galletti, Marco, Gallioli, Giorgio Antonio, Gay, Hedwige, Gemma, Marco, Gnesin, Paolo, Greco, Stefano, Grosso, Paolo, Guatteri, Luca, Guzzon, Davide, Keim, Roberto, Lombardo, Andrea, Mamprin, Filippo, Marino, Giovanni, Marino, Francesco, Merli, Guido, Micucci, Antonio, Militano, Carmine Rocco, Monti, Giacomo, Muttini, Stefano, Nadalin, Samantha, Perazzo, Paolo, Perego, Giovanni Battista, Perotti, Luciano, Petrucci, Nicola, Pezzi, Angelo, Piva, Simone, Portella, Gina, Protti, Alessandro, Racagni, Milena, Radrizzani, Danilo, Raimondi, Maurizio, Ranucci, Marco, Riccio, Mario, Ruggeri, Patrizia, Sala, Giuseppe, Salvi, Luca, Sebastiano, Pietro, Severgnini, Paolo, Sigurtà, Donato, Stocchetti, Nino, Subert, Matteo, Tavola, Mario, Todaro, Serena, Torriglia, Francesca, Tubiolo, Daniela, Valsecchi, Roberto, Viola, Uberto, Vitale, Giovanni, Zambon, Massimo, Zoia, Elena, Grasselli, G, Greco, M, Zanella, A, Albano, G, Antonelli, M, Bellani, G, Bonanomi, E, Cabrini, L, Carlesso, E, Castelli, G, Cattaneo, S, Cereda, D, Colombo, S, Coluccello, A, Crescini, G, Forastieri Molinari, A, Foti, G, Fumagalli, R, Iotti, G, Langer, T, Latronico, N, Lorini, F, Mojoli, F, Natalini, G, Pessina, C, Ranieri, V, Rech, R, Scudeller, L, Rosano, A, Storti, E, Thompson, B, Tirani, M, Villani, P, Pesenti, A, Cecconi, M, Grasselli G., Greco M., Zanella A., Albano G., Antonelli M., Bellani G., Bonanomi E., Cabrini L., Carlesso E., Castelli G., Cattaneo S., Cereda D., Colombo S., Coluccello A., Crescini G., Forastieri Molinari A., Foti G., Fumagalli R., Iotti G.A., Langer T., Latronico N., Lorini F.L., Mojoli F., Natalini G., Pessina C.M., Ranieri V.M., Rech R., Scudeller L., Rosano A., Storti E., Thompson B.T., Tirani M., Villani P.G., Pesenti A., and Cecconi M.
Subjects: medicine.medical_specialty, COVID19, mechanical ventilation, 01 natural sciences, law.invention, 03 medical and health sciences, 0302 clinical medicine, COVID-19, ICU, critical illness, mechanical ventilation, mortality, Interquartile range, law, Intensive care, Internal medicine, Internal Medicine, critical illness, Medicine, 030212 general & internal medicine, 0101 mathematics, Risk factor, business.industry, Mortality rate, 010102 general mathematics, Hazard ratio, COVID-19, Retrospective cohort study, mortality, Intensive care unit, ICU, na, business, Cohort study
Abstract: Importance Many patients with coronavirus disease 2019 (COVID-19) are critically ill and require care in the intensive care unit (ICU). Objective To evaluate the independent risk factors associated with mortality of patients with COVID-19 requiring treatment in ICUs in the Lombardy region of Italy. Design, Setting, and Participants This retrospective, observational cohort study included 3988 consecutive critically ill patients with laboratory-confirmed COVID-19 referred for ICU admission to the coordinating center (Fondazione IRCCS [Istituto di Ricovero e Cura a Carattere Scientifico] Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy) of the COVID-19 Lombardy ICU Network from February 20 to April 22, 2020. Infection with severe acute respiratory syndrome coronavirus 2 was confirmed by real-time reverse transcriptase–polymerase chain reaction assay of nasopharyngeal swabs. Follow-up was completed on May 30, 2020. Exposures Baseline characteristics, comorbidities, long-term medications, and ventilatory support at ICU admission. Main Outcomes and Measures Time to death in days from ICU admission to hospital discharge. The independent risk factors associated with mortality were evaluated with a multivariable Cox proportional hazards regression. Results Of the 3988 patients included in this cohort study, the median age was 63 (interquartile range [IQR] 56-69) years; 3188 (79.9%; 95% CI, 78.7%-81.1%) were men, and 1998 of 3300 (60.5%; 95% CI, 58.9%-62.2%) had at least 1 comorbidity. At ICU admission, 2929 patients (87.3%; 95% CI, 86.1%-88.4%) required invasive mechanical ventilation (IMV). The median follow-up was 44 (95% CI, 40-47; IQR, 11-69; range, 0-100) days; median time from symptoms onset to ICU admission was 10 (95% CI, 9-10; IQR, 6-14) days; median length of ICU stay was 12 (95% CI, 12-13; IQR, 6-21) days; and median length of IMV was 10 (95% CI, 10-11; IQR, 6-17) days. Cumulative observation time was 164 305 patient-days. Hospital and ICU mortality rates were 12 (95% CI, 11-12) and 27 (95% CI, 26-29) per 1000 patients-days, respectively. In the subgroup of the first 1715 patients, as of May 30, 2020, 865 (50.4%) had been discharged from the ICU, 836 (48.7%) had died in the ICU, and 14 (0.8%) were still in the ICU; overall, 915 patients (53.4%) died in the hospital. Independent risk factors associated with mortality included older age (hazard ratio [HR], 1.75; 95% CI, 1.60-1.92), male sex (HR, 1.57; 95% CI, 1.31-1.88), high fraction of inspired oxygen (Fio2) (HR, 1.14; 95% CI, 1.10-1.19), high positive end-expiratory pressure (HR, 1.04; 95% CI, 1.01-1.06) or low Pao2:Fio2ratio (HR, 0.80; 95% CI, 0.74-0.87) on ICU admission, and history of chronic obstructive pulmonary disease (HR, 1.68; 95% CI, 1.28-2.19), hypercholesterolemia (HR, 1.25; 95% CI, 1.02-1.52), and type 2 diabetes (HR, 1.18; 95% CI, 1.01-1.39). No medication was independently associated with mortality (angiotensin-converting enzyme inhibitors HR, 1.17; 95% CI, 0.97-1.42; angiotensin receptor blockers HR, 1.05; 95% CI, 0.85-1.29). Conclusions and Relevance In this retrospective cohort study of critically ill patients admitted to ICUs in Lombardy, Italy, with laboratory-confirmed COVID-19, most patients required IMV. The mortality rate and absolute mortality were high.
Published: 2020

12. Effect of sodium administration on fluid balance and sodium balance in health and the perioperative setting. Extended summary with additional insights from the MIHMoSA and TOPMAST studies

Author: Philippe G. Jorens, Niels Van Regenmortel, Manu Malbrain, Tim Van den Wyngaert, Ella Roelant, Tim De Weerdt, Thomas Langer, Van Regenmortel, N, Langer, T, De Weerdt, T, Roelant, E, Malbrain, M, Van den Wyngaert, T, and Jorens, P
Subjects: Sodium balance, Maintenance, Sodium, Water-Electrolyte Imbalance, Physiology, chemistry.chemical_element, Renal function, Urine, Acid-Base Imbalance, Kidney, Critical Care and Intensive Care Medicine, Excretion, chemistry.chemical_compound, Humans, Medicine, Balance (ability), Aldosterone, business.industry, Isotonic, Perioperative, Water-Electrolyte Balance, Fluid balance, Regimen, chemistry, Fluid overload, Human medicine, business
Abstract: Purpose: We aimed to provide an extended analysis of the physiological handling of of the sodium burden induced by maintenance fluids. Materials and methods: We revisited two studies that demonstrated, in healthy volunteers and in surgical patients, that maintenance fluids with 154 mmol/L of sodium lead to a more positive fluid balance than a regimen containing 54 mmol/L. We report different unpublished data on the renal handling of the imposed sodium bur -dens with specific attention to the resulting fluid and sodium balances. Results: The kidneys adapt to the sodium-rich fluids not only by altering sodium excretion, but also by retaining extra free water by concentrating urine. Realigning urinary sodium excretion with an increased administration takes around one day in health and much longer in the clinical setting. This difference may be explained by the presence of hypovolemia-induced aldosterone secretion in the latter group. Non-osmotic storage of sodium limits an unrestrained fluid retention even when very high amounts of sodium are administered but fluid accu-mulation will inevitably be further prolonged. Conclusions: Sodium administration induced by sodium-rich maintenance fluids leads, especially in the clinical setting, to prolonged fluid retention when compared with a regimen that resembles a healthy dietary sodium in-take, even when kidney function is normal. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Published: 2022

13. Addition of 5% CO2 to Inspiratory Gas Prevents Lung Injury in an Experimental Model of Pulmonary Artery Ligation

Author: Gianluca Lopez, Eleonora Scotti, Stefano Ferrero, Valentina Vaira, Alessandra Mazzucco, Elena Spinelli, Tommaso Mauri, Ines Marongiu, Michele Battistin, Osvaldo Biancolilli, Thomas Langer, Francesca Roma, Giulia Colussi, Caterina Lonati, Stefano Gatti, Antonio Pesenti, Leonardo Manesso, Lorenzo Rosso, Yu Mei Wang, Alberto Zanella, Marongiu, I, Spinelli, E, Scotti, E, Mazzucco, A, Wang, Y, Manesso, L, Colussi, G, Biancolilli, O, Battistin, M, Langer, T, Roma, F, Lopez, G, Lonati, C, Vaira, V, Rosso, L, Ferrero, S, Gatti, S, Zanella, A, Pesenti, A, and Mauri, T
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Care, VILI, Lung injury, Critical Care and Intensive Care Medicine, Ischemia, medicine.artery, Internal medicine, medicine, Humans, Lung, inhalation, CO2 inhalation, Experimental model, business.industry, Original Articles, Carbon Dioxide, pulmonary perfusion, CO, Reperfusion Injury, Pulmonary artery, Cardiology, Ligation, business, therapeutic hypercapnia
Abstract: Rationale: Unilateral ligation of the pulmonary artery may induce lung injury through multiple mechanisms, which might be dampened by inhaled CO2. Objectives: This study aims to characterize bilateral lung injury owing to unilateral ligation of the pulmonary artery in healthy swine undergoing controlled mechanical ventilation and its prevention by 5% CO2 inhalation and to investigate relevant pathophysiological mechanisms. Methods: Sixteen healthy pigs were allocated to surgical ligation of the left pulmonary artery (ligation group), seven to surgical ligation of the left pulmonary artery and inhalation of 5% CO2 (ligation + FiCO2 5%), and six to no intervention (no ligation). Then, all animals received mechanical ventilation with Vt 10 ml/kg, positive end-expiratory pressure 5 cm H2O, respiratory rate 25 breaths/min, and FiO2 50% (±FiCO2 5%) for 48 hours or until development of severe lung injury. Measurements and Main Results: Histological, physiological, and quantitative computed tomography scan data were compared between groups to characterize lung injury. Electrical impedance tomography and immunohistochemistry analysis were performed in a subset of animals to explore mechanisms of injury. Animals from the ligation group developed bilateral lung injury as assessed by significantly higher histological score, larger increase in lung weight, poorer oxygenation, and worse respiratory mechanics compared with the ligation + FiCO2 5% group. In the ligation group, the right lung received a larger fraction of Vt and inflammation was more represented, whereas CO2 dampened both processes. Conclusions: Mechanical ventilation induces bilateral lung injury within 48 hours in healthy pigs undergoing left pulmonary artery ligation. Inhalation of 5% CO2 prevents injury, likely through decreased stress to the right lung and antiinflammatory effects.
Published: 2021

14. Cardiopulmonary Resuscitation–associated Lung Edema (CRALE). A Translational Study

Author: Leonello Avalli, Giacomo Grasselli, Giacomo Bellani, Davide Olivari, Emanuele Rezoagli, D. De Zani, Antonio Pesenti, Giuseppe Ristagno, Martina Manfredi, Thomas Langer, Aurora Magliocca, Francesca Fumagalli, Daria De Giorgio, Roberto Latini, Magliocca, A, Rezoagli, E, Zani, D, Manfredi, M, De Giorgio, D, Olivari, D, Fumagalli, F, Langer, T, Avalli, L, Grasselli, G, Latini, R, Pesenti, A, Bellani, G, and Ristagno, G
Subjects: Pulmonary and Respiratory Medicine, Cardiopulmonary resuscitation, Lung, business.industry, medicine.medical_treatment, Intrathoracic pressure, Cardiac arrest, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, 030228 respiratory system, Anesthesia, Acute lung injury, Medicine, Chest compression, 030212 general & internal medicine, LUNG EDEMA, business
Abstract: Rationale: Cardiopulmonary resuscitation is the cornerstone of cardiac arrest (CA) treatment. However, lung injuries associated with it have been reported. Objectives: To assess 1) the presence and characteristics of lung abnormalities induced by cardiopulmonary resuscitation and 2) the role of mechanical and manual chest compression (CC) in its development. Methods: This translational study included 1) a porcine model of CA and cardiopulmonary resuscitation (n = 12) and 2) a multicenter cohort of patients with out-of-hospital CA undergoing mechanical or manual CC (n = 52). Lung computed tomography performed after resuscitation was assessed qualitatively and quantitatively along with respiratory mechanics and gas exchanges. Measurements and Main Results: The lung weight in the mechanical CC group was higher compared with the manual CC group in the experimental (431 6 127 vs. 273 6 66, P = 0.022) and clinical study (1,208 6 630 vs. 837 6 306, P = 0.006). The mechanical CC group showed significantly lower oxygenation (P = 0.043) and respiratory system compliance (P, 0.001) compared with the manual CC group in the experimental study. The variation of right atrial pressure was significantly higher in the mechanical compared with the manual CC group (54 6 11 vs. 31 6 6 mm Hg, P = 0.001) and significantly correlated with lung weight (r = 0.686, P = 0.026) and respiratory system compliance (r = 20.634, P = 0.027). Incidence of abnormal lung density was higher in patients treated with mechanical compared with manual CC (37% vs. 8%, P = 0.018). Conclusions: This study demonstrated the presence of cardiopulmonary resuscitation–associated lung edema in animals and in patients with out-of-hospital CA, which is more pronounced after mechanical as opposed to manual CC and correlates with higher swings of right atrial pressure during CC.
Published: 2021

15. Development of machine learning models to predict RT-PCR results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with influenza-like symptoms using only basic clinical data

Author: Thomas Langer, Martina Favarato, Riccardo Giudici, Gabriele Bassi, Roberta Garberi, Fabiana Villa, Hedwige Gay, Anna Zeduri, Sara Bragagnolo, Alberto Molteni, Andrea Beretta, Matteo Corradin, Mauro Moreno, Chiara Vismara, Carlo Federico Perno, Massimo Buscema, Enzo Grossi, Roberto Fumagalli, Langer, T, Favarato, M, Giudici, R, Bassi, G, Garberi, R, Villa, F, Gay, H, Zeduri, A, Bragagnolo, S, Molteni, A, Beretta, A, Corradin, M, Moreno, M, Vismara, C, Perno, C, Buscema, M, Grossi, E, and Fumagalli, R
Subjects: Male, Influenza-like symptoms, Artificial intelligence, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Critical Care and Intensive Care Medicine, Machine learning, computer.software_genre, Sensitivity and Specificity, Machine Learning, 03 medical and health sciences, 0302 clinical medicine, Emergency service, hospital, Interquartile range, Medicine, Humans, Severe acute respiratory syndrome coronavirus 2, In patient, 030212 general & internal medicine, Diagnosis, Computer-Assisted, Supervised machine learning, Pandemics, 030304 developmental biology, Original Research, Aged, Retrospective Studies, Protocol (science), 0303 health sciences, Pandemic, business.industry, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2, lcsh:Medical emergencies. Critical care. Intensive care. First aid, COVID-19, Retrospective cohort study, lcsh:RC86-88.9, Middle Aged, Critical care, Research centre, Radiological weapon, Emergency Medicine, Female, business, computer, Software
Abstract: Background Reverse Transcription-Polymerase Chain Reaction (RT-PCR) for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) diagnosis currently requires quite a long time span. A quicker and more efficient diagnostic tool in emergency departments could improve management during this global crisis. Our main goal was assessing the accuracy of artificial intelligence in predicting the results of RT-PCR for SARS-COV-2, using basic information at hand in all emergency departments. Methods This is a retrospective study carried out between February 22, 2020 and March 16, 2020 in one of the main hospitals in Milan, Italy. We screened for eligibility all patients admitted with influenza-like symptoms tested for SARS-COV-2. Patients under 12 years old and patients in whom the leukocyte formula was not performed in the ED were excluded. Input data through artificial intelligence were made up of a combination of clinical, radiological and routine laboratory data upon hospital admission. Different Machine Learning algorithms available on WEKA data mining software and on Semeion Research Centre depository were trained using both the Training and Testing and the K-fold cross-validation protocol. Results Among 199 patients subject to study (median [interquartile range] age 65 [46–78] years; 127 [63.8%] men), 124 [62.3%] resulted positive to SARS-COV-2. The best Machine Learning System reached an accuracy of 91.4% with 94.1% sensitivity and 88.7% specificity. Conclusion Our study suggests that properly trained artificial intelligence algorithms may be able to predict correct results in RT-PCR for SARS-COV-2, using basic clinical data. If confirmed, on a larger-scale study, this approach could have important clinical and organizational implications.
Published: 2020

16. Accuracy of Physicians in Differentiating Type 1 and Type 2 Myocardial Infarction Based on Clinical Information

Author: Andre Ferreira Azeredo-da-Silva, Kendeep Kaila, Terence Yung, Ron Ree, Ameen Patel, Carolina Alboim, Flávia Kessler Borges, Tej Sheth, Carisi Anne Polanczyk, Maria Cristina Vedovati, Antonio Galzerano, Erin N. Sloan, Jessica Spence, Maura Marcucci, Alessandra Bertoletti, Thomas Langer, Philip J. Devereaux, Federico Germini, Borges, F, Sheth, T, Patel, A, Marcucci, M, Yung, T, Langer, T, Alboim, C, Polanczyk, C, Germini, F, Azeredo-da-Silva, A, Sloan, E, Kaila, K, Ree, R, Bertoletti, A, Vedovati, M, Galzerano, A, Spence, J, and Devereaux, P
Subjects: Response rate (survey), medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, business.industry, MEDLINE, Perioperative, medicine.disease, Confidence interval, diagnosi, myocardial infarction, lcsh:RC666-701, Internal medicine, Etiology, Medicine, Medical history, Original Article, Myocardial infarction, Thrombus, Cardiology and Cardiovascular Medicine, business
Abstract: Background: Physicians commonly judge whether a myocardial infarction (MI) is type 1 (thrombotic) vs type 2 (supply/demand mismatch) based on clinical information. Little is known about the accuracy of physicians’ clinical judgement in this regard. We aimed to determine the accuracy of physicians’ judgement in the classification of type 1 vs type 2 MI in perioperative and nonoperative settings. Methods: We performed an online survey using cases from the Optical Coherence Tomographic Imaging of Thrombus (OPTIMUS) Study, which investigated the prevalence of a culprit lesion thrombus based on intracoronary optical coherence tomography (OCT) in patients experiencing MI. Four MI cases, 2 perioperative and 2 nonoperative, were selected randomly, stratified by etiology. Physicians were provided with the patient’s medical history, laboratory parameters, and electrocardiograms. Physicians did not have access to intracoronary OCT results. The primary outcome was the accuracy of physicians' judgement of MI etiology, measured as raw agreement between physicians and intracoronary OCT findings. Fleiss’ kappa and Gwet’s AC1 were calculated to correct for chance. Results: The response rate was 57% (308 of 536). Respondents were 62% male; median age was 45 years (standard deviation ± 11); 45% had been in practice for > 15 years. Respondents’ overall accuracy for MI etiology was 60% (95% confidence interval [CI] 57%-63%), including 63% (95% CI 60%-68%) for nonoperative cases, and 56% (95% CI 52%-60%) for perioperative cases. Overall chance-corrected agreement was poor (kappa = 0.05), consistent across specialties and clinical scenarios. Conclusions: Physician accuracy in determining MI etiology based on clinical information is poor. Physicians should consider results from other testing, such as invasive coronary angiography, when determining MI etiology. Résumé: Contexte: Les médecins déterminent généralement s’ils sont en présence d’un infarctus du myocarde (IM) de type 1 (thrombotique) ou de type 2 (demande accrue ou apport réduit en oxygène) sur la base des renseignements cliniques. On en sait cependant très peu au sujet de la justesse du jugement clinique des médecins à cet égard. Nous avons donc cherché à déterminer si les médecins réussissent à distinguer correctement les IM de type 1 et de type 2 dans les contextes périopératoire et non opératoire. Méthodologie: Nous avons mené une enquête en ligne en utilisant les cas de l’étude OPTIMUS (Optical Coherence Tomographic Imaging of Thrombus), qui avait évalué la prévalence des lésions causant un thrombus au moyen de la tomographie par cohérence optique (TCO) endocoronaire chez les patients subissant un IM. Nous avons choisi au hasard quatre cas d’IM stratifiés en fonction de leur cause : deux cas en contexte périopératoire et deux cas en contexte non opératoire. Les médecins avaient accès aux antécédents médicaux, aux résultats des analyses de laboratoire et aux électrocardiogrammes des patients, mais pas aux résultats de la TCO endocoronaire. Le principal paramètre d’évaluation était la justesse du jugement du médecin concernant la cause de l’IM, mesurée en fonction de la concordance approximative entre le jugement du médecin et les observations à la TCO endocoronaire. Les coefficients de concordance kappa de Fleiss et AC1 de Gwet ont servi à corriger pour le hasard. Résultats: Le taux de réponse était de 57 % (308 sur 536). Des participants, 62 % étaient des hommes et 45 % exerçaient depuis plus de 15 ans; l’âge médian était de 45 ans (écart-type : ± 11). La justesse globale avec laquelle les répondants ont déterminé la cause des IM était de 60 % (intervalle de confiance [IC] à 95 % : 57-63 %) : 63 % (IC à 95 % : 60-68 %) dans le cas des IM en contexte non opératoire et 56 % (IC à 95 % : 52-60 %) dans le cas des IM en contexte périopératoire. La concordance globale corrigée pour le hasard était faible (kappa = 0,05) et demeurait constante, sans égard au domaine de spécialité ou au scénario clinique. Conclusions: La justesse du jugement des médecins évaluant la cause d’un IM en fonction des renseignements cliniques est faible. Les médecins devraient envisager de recourir à des tests additionnels, y compris la coronarographie invasive, avant de déterminer la cause d’un IM.
Published: 2020

17. Tracheostomy in Mechanically Ventilated Patients With SARS-CoV-2-ARDS: Focus on Tracheomalacia

Author: Marcello Guarnieri, Patrizia Andreoni, Hedwige Gay, Riccardo Giudici, Maurizio Bottiroli, Michele Mondino, Gianpaolo Casella, Osvaldo Chiara, Oscar Morelli, Serena Conforti, Thomas Langer, Roberto Fumagalli, Guarnieri, M, Andreoni, P, Gay, H, Giudici, R, Bottiroli, M, Mondino, M, Casella, G, Chiara, O, Morelli, O, Conforti, S, Langer, T, and Fumagalli, R
Subjects: Pulmonary and Respiratory Medicine, Adult, ARDS, 66(12), Percutaneous, medicine.medical_treatment, Population, MED/21 - CHIRURGIA TORACICA, Airway management, MED/31 - OTORINOLARINGOIATRIA, Critical Care and Intensive Care Medicine, Mechanical ventilation, Tracheostomy, Intubation, Intratracheal, Medicine, Humans, MED/41 - ANESTESIOLOGIA, education, Original Research, Retrospective Studies, Tracheomalacia, education.field_of_study, Respiratory Distress Syndrome, Noninvasive Ventilation, business.industry, SARS-CoV-2, Incidence (epidemiology), COVID-19, General Medicine, medicine.disease, Respiration, Artificial, Trachea, Editorial, Respiratory failure, Severe acute respiratory syndrome, Anesthesia, Female, business, Tra-cheomalacia. [Respir Care 2021
Abstract: BACKGROUND: The SARS-CoV-2 pandemic increased the number of patients needing invasive mechanical ventilation, either through an endotracheal tube or through a tracheostomy. Tracheomalacia is a rare but potentially severe complication of mechanical ventilation, which can significantly complicate the weaning process. The aim of this study was to describe the strategies of airway management in mechanically ventilated patients with respiratory failure due to SARS-CoV-2, the incidence of severe tracheomalacia, and investigate the factors associated with its occurrence. METHODS: This retrospective, single-center study was performed in an Italian teaching hospital. All adult subjects admitted to the ICU between February 24, 2020, and June 30, 2020, treated with invasive mechanical ventilation for respiratory failure caused by SARS-CoV-2 were included. Clinical data were collected on the day of ICU admission, whereas information regarding airway management was collected daily. RESULTS: A total of 151 subjects were included in the study. On admission, ARDS severity was mild in 21%, moderate in 62%, and severe in 17% of the cases, with an overall mortality of 40%. A tracheostomy was performed in 73 (48%), open surgical technique in 54 (74%), and percutaneous Ciaglia technique in 19 (26%). Subjects who had a tracheostomy performed had, compared to the other subjects, a longer duration of mechanical ventilation and longer ICU and hospital stay. Tracheomalacia was diagnosed in 8 (5%). The factors associated with tracheomalacia were female sex, obesity, and tracheostomy. CONCLUSIONS: In our population, approximately 50% of subjects with ARDS due to SARS-CoV-2 were tracheostomized. Tracheostomized subjects had a longer ICU and hospital stay. In our population, 5% were diagnosed with tracheomalacia. This percentage is 10 times higher than what is reported in available literature, and the underlying mechanisms are not fully understood.
Published: 2021

18. Short-term Physiologic Consequences of Regional Pulmonary Vascular Occlusion in Pigs

Author: Thomas Langer, Alessandro Santini, Valentina Castagna, Tommaso Mauri, Serena Brusatori, Antonio Pesenti, Alberto Zanella, Langer, T, Castagna, V, Brusatori, S, Santini, A, Mauri, T, Zanella, A, and Pesenti, A
Subjects: CT scan, medicine.medical_specialty, Bronchoconstriction, Dead space, medicine.medical_treatment, experimental model, Ventilation perfusion mismatch, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Internal medicine, medicine, Lung, Hypocapnia, business.industry, Pulmonary artery catheter, 030208 emergency & critical care medicine, Left pulmonary artery, medicine.disease, Arterial occlusion, Pulmonary embolism, Anesthesiology and Pain Medicine, medicine.anatomical_structure, 030228 respiratory system, Pulmonary artery, Cardiology, business
Abstract: Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Acute unilateral pulmonary arterial occlusion causes ventilation–perfusion mismatch of the affected lung area. A diversion of ventilation from nonperfused to perfused lung areas, limiting the increase in dead space, has been described. The hypothesis was that the occlusion of a distal branch of the pulmonary artery would cause local redistribution of ventilation and changes in regional lung densitometry as assessed with quantitative computed tomography. Methods In eight healthy, anesthetized pigs (18.5 ± 3.8 kg) ventilated with constant ventilatory settings, respiratory mechanics, arterial blood gases, and quantitative computed tomography scans were recorded at baseline and 30 min after the inflation of the balloon of a pulmonary artery catheter. Regional (left vs. right lung and perfused vs. nonperfused area) quantitative computed tomography was performed. Results The balloon always occluded a branch of the left pulmonary artery perfusing approximately 30% of lung tissue. Physiologic dead space increased (0.37 ± 0.17 vs. 0.43 ± 0.17, P = 0.005), causing an increase in Paco2 (39.8 [35.2 to 43.0] vs. 41.8 [37.5 to 47.1] mmHg, P = 0.008) and reduction in pH (7.46 [7.42 to 7.50] vs. 7.42 [7.38 to 7.47], P = 0.008). Respiratory system compliance was reduced (24.4 ± 4.2 vs. 22.8 ± 4.8 ml · cm H2O−1, P = 0.028), and the reduction was more pronounced in the left hemithorax. Quantitative analysis of the nonperfused lung area revealed a significant reduction in lung density (−436 [−490 to −401] vs. −478 [−543 to −474] Hounsfield units, P = 0.016), due to a reduction in lung tissue (90 ± 23 vs. 81 ± 22 g, P < 0.001) and an increase in air volume (70 ± 22 vs. 82 ± 26 ml, P = 0.022). Conclusions Regional pulmonary vascular occlusion is associated with a diversion of ventilation from nonperfused to perfused lung areas. This compensatory mechanism effectively limits ventilation perfusion mismatch. Quantitative computed tomography documented acute changes in lung densitometry after pulmonary vascular occlusion. In particular, the nonperfused lung area showed an increase in air volume and reduction in tissue mass, resulting in a decreased lung density.
Published: 2019

19. Barotrauma in mechanically ventilated patients with Coronavirus disease 2019: a survey of 38 hospitals in Lombardy, Italy

Author: Antonio Pesenti, Giacomo Bellani, Matteo Filippini, Anna Maria Vilardo, Roberto Fumagalli, Alessandro Santini, Giuseppe Foti, Maurizio Cecconi, Giacomo Grasselli, Sofia Spano, Massimiliano Greco, Thomas Langer, Pier Francesco Caruso, Fernando Frutos-Vivar, Alessandro Protti, Antonio Anzueto, Giuseppe Citerio, Martina Villa, Protti, A, Greco, M, Filippini, M, Vilardo, A, Langer, T, Tavola, M, Frutos-Vivar, F, Santini, A, Caruso, P, Spano, S, Anzueto, A, Citerio, G, Bellani, G, Foti, G, Fumagalli, R, Pesenti, A, Grasselli, G, and Cecconi, M
Subjects: Adult, Male, Critical Care, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, law.invention, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030202 anesthesiology, law, Tidal Volume, Humans, Medicine, In patient, Tidal volume, Mechanical ventilation, Air Pressure, Respiratory Distress Syndrome, business.industry, Respiration, Incidence, Incidence (epidemiology), COVID-19, Outbreak, 030208 emergency & critical care medicine, Middle Aged, respiratory system, Respiration, Artificial, Intensive care unit, Anesthesiology and Pain Medicine, Barotrauma, Italy, Anesthesia, Artificial, Female, Tomography, X-Ray Computed, business, Airway
Abstract: BACKGROUND: The aim was to describe the incidence and risk factors of barotrauma in patients with the Coronavirus disease 2019 (COVID-19) on invasive mechanical ventilation, during the outbreak in our region (Lombardy, Italy). METHODS: The study was an electronic survey open from March 27th to May 2nd, 2020. Patients with COVID-19 who developed barotrauma while on invasive mechanical ventilation from 61 hospitals of the COVID-19 Lombardy Intensive Care Unit network were involved. RESULTS: The response rate was 38/61 (62%). The incidence of barotrauma was 145/2041 (7.1%; 95%-CI: 6.1-8.3%). Only a few cases occurred with ventilatory settings that may be considered non-protective such as a plateau airway pressure >35 cmH2O (2/113 [2%]), a driving airway pressure >15 cmH2O (30/113 [27%]), or a tidal volume >8 mL/kg of ideal body weight and a plateau airway pressure >30 cmH2O (12/134 [9%]). CONCLUSIONS: Within the limits of a survey, patients with COVID-19 might be at high risk for barotrauma during invasive (and allegedly lung-protective) mechanical ventilation.
Published: 2021

20. A patient-specific approach for quantitative and automatic analysis of computed tomography images in lung disease: Application to COVID-19 patients

Author: C. De Mattia, Francesco Rizzetto, Alberto Torresin, Domenico Lizio, Stefano Carrazza, Roberto Fumagalli, P.E. Colombo, Angelo Vanzulli, Thomas Langer, L. Berta, Berta, L, De Mattia, C, Rizzetto, F, Carrazza, S, Colombo, P, Fumagalli, R, Langer, T, Lizio, D, Vanzulli, A, and Torresin, A
Subjects: FOS: Computer and information sciences, Lung Diseases, Male, Gaussian, General Physics and Astronomy, Image analysis, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Statistics - Machine Learning, Image Processing, Computer-Assisted, Gaussian function, Lung volumes, Lung, Computed tomography, Mathematics, Aged, 80 and over, General Medicine, Middle Aged, Data point, medicine.anatomical_structure, Radiology Nuclear Medicine and imaging, 030220 oncology & carcinogenesis, symbols, Biomarker (medicine), Female, Radiomic, Algorithms, Adult, Adolescent, Biophysics, FOS: Physical sciences, Machine Learning (stat.ML), Quantitative imaging, Young Adult, 03 medical and health sciences, symbols.namesake, Histogram, medicine, Humans, Radiology, Nuclear Medicine and imaging, Independence (probability theory), Aged, Original Paper, business.industry, COVID-19, Pattern recognition, Physics - Medical Physics, Medical Physics (physics.med-ph), Artificial intelligence, Image analysi, Tomography, X-Ray Computed, business, QCT
Abstract: Quantitative metrics in lung computed tomography (CT) images have been widely used, often without a clear connection with physiology. This work proposes a patient-independent model for the estimation of well-aerated volume of lungs in CT images (WAVE). A Gaussian fit, with mean (Mu.f) and width (Sigma.f) values, was applied to the lower CT histogram data points of the lung to provide the estimation of the well-aerated lung volume (WAVE.f). Independence from CT reconstruction parameters and respiratory cycle was analysed using healthy lung CT images and 4DCT acquisitions. The Gaussian metrics and first order radiomic features calculated for a third cohort of COVID-19 patients were compared with those relative to healthy lungs. Each lung was further segmented in 24 subregions and a new biomarker derived from Gaussian fit parameter Mu.f was proposed to represent the local density changes. WAVE.f resulted independent from the respiratory motion in 80% of the cases. Differences of 1%, 2% and up to 14% resulted comparing a moderate iterative strength and FBP algorithm, 1 and 3 mm of slice thickness and different reconstruction kernel. Healthy subjects were significantly different from COVID-19 patients for all the metrics calculated. Graphical representation of the local biomarker provides spatial and quantitative information in a single 2D picture. Unlike other metrics based on fixed histogram thresholds, this model is able to consider the inter-and intra-subject variability. In addition, it defines a local biomarker to quantify the severity of the disease, independently of the observer., 31 pages, 7 figures, accepted in EJMP
Published: 2021

21. Analgesia and sedation in patients with ARDS

Author: Timothy D. Girard, Yahya Shehabi, Bram Rochwerg, Bhakti K. Patel, Sangeeta Mehta, Samir Jaber, Thomas Langer, Jean François Payen, Hanne T. Olsen, John P. Kress, Claude Guérin, Gilles L. Fraser, E. Wesley Ely, Thomas Strøm, Michael J. Murray, John W. Devlin, Kathleen Puntillo, Jean-Michel Constantin, Matthieu Jabaudon, Gerald Chanques, Céline Gélinas, Pratik P. Pandharipande, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Northeastern University [Boston], Brigham & Women’s Hospital [Boston] (BWH), Harvard Medical School [Boston] (HMS), Vanderbilt University Medical Center [Nashville], Vanderbilt University [Nashville], Tufts University School of Medicine [Boston], McGill University = Université McGill [Montréal, Canada], Lady Davis Institute for Medical Research [Montréal], McGill University = Université McGill [Montréal, Canada]-Jewish General Hospital, University of Pittsburgh School of Medicine, Pennsylvania Commonwealth System of Higher Education (PCSHE), Université de Lyon, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Génétique, Reproduction et Développement (GReD ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), CHU Clermont-Ferrand, University of Toronto, Università degli Studi di Milano-Bicocca [Milano] (UNIMIB), ASST Grande Ospedale Metropolitano Niguarda, University of Arizona, University of Chicago, CHU Grenoble, [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), University of California [San Francisco] (UCSF), University of California, McMaster University [Hamilton, Ontario], Monash University [Clayton], University of New South Wales [Sydney] (UNSW), Odense University Hospital, Odense C, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), University of California [San Francisco] (UC San Francisco), University of California (UC), Chanques, G, Constantin, J, Devlin, J, Ely, E, Fraser, G, Gelinas, C, Girard, T, Guerin, C, Jabaudon, M, Jaber, S, Mehta, S, Langer, T, Murray, M, Pandharipande, P, Patel, B, Payen, J, Puntillo, K, Rochwerg, B, Shehabi, Y, Strom, T, Olsen, H, Kress, J, and MORNET, Dominique
Subjects: medicine.medical_specialty, ARDS, Sedation, medicine.medical_treatment, Pain medicine, [SDV]Life Sciences [q-bio], Remifentanil, Guidelines as Topic, Review, Critical Care and Intensive Care Medicine, law.invention, 03 medical and health sciences, Mechanical ventilation, 0302 clinical medicine, law, Anesthesiology, medicine, Humans, Hypnotics and Sedatives, Pain Management, Intensive care unit, MED/41 - ANESTESIOLOGIA, Intensive care medicine, ComputingMilieux_MISCELLANEOUS, Respiratory Distress Syndrome, Acute respiratory distress syndrome, business.industry, Rehabilitation, COVID-19, 030208 emergency & critical care medicine, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], 030228 respiratory system, Delirium, Analgesia, medicine.symptom, business, medicine.drug
Abstract: Acute Respiratory Distress Syndrome (ARDS) is one of the most demanding conditions in an Intensive Care Unit (ICU). Management of analgesia and sedation in ARDS is particularly challenging. An expert panel was convened to produce a “state-of-the-art” article to support clinicians in the optimal management of analgesia/sedation in mechanically ventilated adults with ARDS, including those with COVID-19. Current ICU analgesia/sedation guidelines promote analgesia first and minimization of sedation, wakefulness, delirium prevention and early rehabilitation to facilitate ventilator and ICU liberation. However, these strategies cannot always be applied to patients with ARDS who sometimes require deep sedation and/or paralysis. Patients with severe ARDS may be under-represented in analgesia/sedation studies and currently recommended strategies may not be feasible. With lightened sedation, distress-related symptoms (e.g., pain and discomfort, anxiety, dyspnea) and patient-ventilator asynchrony should be systematically assessed and managed through interprofessional collaboration, prioritizing analgesia and anxiolysis. Adaptation of ventilator settings (e.g., use of a pressure-set mode, spontaneous breathing, sensitive inspiratory trigger) should be systematically considered before additional medications are administered. Managing the mechanical ventilator is of paramount importance to avoid the unnecessary use of deep sedation and/or paralysis. Therefore, applying an “ABCDEF-R” bundle (R = Respiratory-drive-control) may be beneficial in ARDS patients. Further studies are needed, especially regarding the use and long-term effects of fast-offset drugs (e.g., remifentanil, volatile anesthetics) and the electrophysiological assessment of analgesia/sedation (e.g., electroencephalogram devices, heart-rate variability, and video pupillometry). This review is particularly relevant during the COVID-19 pandemic given drug shortages and limited ICU-bed capacity.
Published: 2020

22. Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep

Author: Andrea Cislaghi, Stefano Scalia Catenacci, Antonio Pesenti, Marta Guerrini, Tiziana Marchesi, Edoardo Calderini, Thomas Langer, Giulia C. I. Spolidoro, Veronica D’Oria, Giovanna Chidini, Carlo Agostoni, Langer, T, D'Oria, V, Spolidoro, G, Chidini, G, Scalia Catenacci, S, Marchesi, T, Guerrini, M, Cislaghi, A, Agostoni, C, Pesenti, A, and Calderini, E
Subjects: Intensive care units, pediatric, Critical Illness, medicine.medical_treatment, Sodium, chemistry.chemical_element, Chloride, Enteral administration, 03 medical and health sciences, 0302 clinical medicine, Hyperchloremia, Chlorides, Fluid therapy, Maintenance fluid, 030225 pediatrics, Edema, medicine, Water-Electrolyte Balance, Humans, 030212 general & internal medicine, Renal replacement therapy, Child, Retrospective Studies, Pediatric intensive care unit, Maintenance fluids, business.industry, lcsh:RJ1-570, Water, lcsh:Pediatrics, medicine.disease, Respiration, Artificial, Parenteral nutrition, Pharmaceutical Preparations, chemistry, Child, Preschool, Anesthesia, Pediatrics, Perinatology and Child Health, Fluid overload, Water-electrolyte balance, medicine.symptom, business, Research Article, medicine.drug
Abstract: Background Fluid therapy is a cornerstone of pediatric intensive care medicine. We aimed at quantifying the load of water, sodium and chloride due to different fluid indications in our pediatric intensive care unit (PICU). We were particularly interested in the role of fluid creep, i.e. fluid administered mainly as the vehicle for drugs, and the association between sodium load and water balance. Methods Critically ill children aged ≤3 years and invasively ventilated for ≥48 h between 2016 and 2019 in a single tertiary center PICU were retrospectively enrolled. Need for renal replacement therapy, plasmapheresis or parenteral nutrition constituted exclusion criteria. Quantity, quality and indication of fluids administered intravenously or enterally, urinary output and fluid balance were recorded for the first 48 h following intubation. Concentrations of sodium and chloride provided by the manufacturers were used to compute the electrolyte load. Results Forty-three patients (median 7 months (IQR 3–15)) were enrolled. Patients received 1004 ± 284 ml of water daily (153 ± 36 ml/kg/day), mainly due to enteral (39%), creep (34%) and maintenance (24%) fluids. Patients received 14.4 ± 4.8 mEq/kg/day of sodium and 13.6 ± 4.7 mEq/kg/day of chloride, respectively. The majority of sodium and chloride derived from fluid creep (56 and 58%). Daily fluid balance was 417 ± 221 ml (64 ± 30 ml/kg/day) and was associated with total sodium intake (r2 = 0.49, p Conclusions Critically ill children are exposed, especially in the acute phase, to extremely high loads of water, sodium and chloride, possibly contributing to edema development. Fluid creep is quantitatively the most relevant fluid in the PICU and future research efforts should address this topic in order to reduce the inadvertent water and electrolyte burden and improve the quality of care of critically ill children.
Published: 2020

23. Rapid reorganization of the Milan metropolitan public safety answering point operations during the initial phase of the COVID‐19 outbreak in Italy

Author: Annapaola D'Ambrosio, Stefano Spina, Mario Teruzzi, Francesco Marrazzo, Riccardo Stucchi, Paul E. Pepe, Thomas Langer, Giuseppe Maria Sechi, Carmela Graci, Marco Sacchi, Paola Manzoni, Filippo Bernasconi, Cristina Frigerio, Roberto Fumagalli, Maurizio Migliari, Federica Lovisari, Fabio Sangalli, Alessandra Sforza, Sara Baraldi, Marrazzo, F, Spina, S, Pepe, P, D'Ambrosio, A, Bernasconi, F, Manzoni, P, Graci, C, Frigerio, C, Sacchi, M, Stucchi, R, Teruzzi, M, Baraldi, S, Lovisari, F, Langer, T, Sforza, A, Migliari, M, Sechi, G, Sangalli, F, and Fumagalli, R
Subjects: medicine.medical_specialty, Emergency Medical Services, Referral, Population, emergency medical service, COVID-19 pandemic, call centers, Call volume, ambulances, emergency medical dispatch, medicine, Emergency medical services, ambulance, education, Original Research, education.field_of_study, business.industry, Public health, SARS-CoV-2 infection, COVID‐19 pandemic, medicine.disease, Metropolitan area, Triage, SARS‐CoV‐2 infection, disaster planning, Emergency medical dispatch, Medical emergency, business, call center
Abstract: Objective: To quantify how the first public announcement of confirmed coronavirus disease 2019 (COVID-19) in Italy affected a metropolitan region's emergency medical services (EMS) call volume and how rapid introduction of alternative procedures at the public safety answering point (PSAP) managed system resources. Methods: PSAP processes were modified over several days including (1) referral of non-ill callers to public health information call centers; (2) algorithms for detection, isolation, or hospitalization of suspected COVID-19 patients; and (3) specialized medical teams sent to the PSAP for triage and case management, including ambulance dispatches or alternative dispositions. Call volumes, ambulance dispatches, and response intervals for the 2 weeks after announcement were compared to 2017-2019 data and the week before. Results: For 2 weeks following outbreak announcement, the primary-level PSAP (police/fire/EMS) averaged 56% more daily calls compared to prior years and recorded 9281 (106% increase) on Day 4, averaging â¼400/hour. The secondary-level (EMS) PSAP recorded an analogous 63% increase with 3863 calls (â¼161/hour; 264% increase) on Day 3. The COVID-19 response team processed the more complex cases (n = 5361), averaging 432 ± 110 daily (â¼one-fifth of EMS calls). Although community COVID-19 cases increased exponentially, ambulance response intervals and dispatches (averaging 1120 ± 46 daily) were successfully contained, particularly compared with the week before (1174 ± 40; P = 0.02). Conclusion: With sudden escalating EMS call volumes, rapid reorganization of dispatch operations using tailored algorithms and specially assigned personnel can protect EMS system resources by optimizing patient dispositions, controlling ambulance allocations and mitigating hospital impact. Prudent population-based disaster planning should strongly consider pre-establishing similar highly coordinated medical taskforce contingencies.
Published: 2020

24. Physiologic Effects of Pulmonary Artery Occlusion: Reply

Author: Antonio Pesenti, Thomas Langer, Alessandro Santini, Alberto Zanella, Langer, T, Santini, A, Zanella, A, and Pesenti, A
Subjects: medicine.medical_specialty, business.industry, Swine, Arterial Occlusive Diseases, Pulmonary Artery, Anesthesiology and Pain Medicine, Internal medicine, medicine.artery, Occlusion, Pulmonary artery, Cardiology, respiratory physiology, Medicine, Animals, MED/41 - ANESTESIOLOGIA, business, Lung, Pulmonary arterial occlusion
Published: 2020

25. Spontaneous breathing patterns during maximum extracorporeal co2 removal in subjects with early severe ards

Author: Thomas Langer, Elena Spinelli, Alfredo Lissoni, Giacomo Grasselli, Carla Fornari, Paola Tagliabue, Marco Albanese, S Crotti, Tommaso Mauri, Antonio Pesenti, Carlo Alberto Volta, Spinelli, E, Mauri, T, Lissoni, A, Crotti, S, Langer, T, Albanese, M, Volta, C, Fornari, C, Tagliabue, P, Grasselli, G, and Pesenti, A
Subjects: Pulmonary and Respiratory Medicine, Respiratory rate, ARDS, Computed tomography, ECMO, Spontaneous breathing, Ventilatory response, medicine.medical_treatment, Socio-culturale, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Extracorporeal membrane oxygenation, Medicine, Tidal volume, Shallow breathing, business.industry, Apnea, General Medicine, 030228 respiratory system, Anesthesia, Rapid shallow breathing index, Breathing, medicine.symptom, business
Abstract: BACKGROUND: Switching patients affected by early severe ARDS and undergoing extracorporeal membrane oxygenation (ECMO) from controlled ventilation to spontaneous breathing can be either beneficial or harmful, depending on how effectively the breathing pattern is controlled with ECMO. Identifying the factors associated with ineffective control of spontaneous breathing with ECMO may advance our pathophysiologic understanding of this syndrome. METHODS: We conducted a prospective study in subjects with severe ARDS who were on ECMO support ≤ 7 d. Subjects were switched to minimal sedation and pressure-support ventilation while extracorporeal CO2 removal was increased to approximate the subject’s total CO2 production ( V ˙ C O 2 ). We calculated the rapid shallow breathing index (RSBI) as breathing frequency divided by tidal volume. We explored the correlation between certain characteristics recorded during pretest controlled ventilation and the development of apnea (ie, expiratory pause lasting > 10 s; n= 3), normal breathing pattern (ie, apnea to RSBI ≤ 105 breaths/min/L; n= 6), and rapid shallow breathing (RSBI > 105 breaths/min/L; n= 6) that occurred during the test study. RESULTS: The ratio of extracorporeal CO2 removal to the subjects’ V ˙ C O 2 was >90% in all 15 subjects, and arterial blood gases remained within normal ranges. Baseline pretest Sequential Organ Failure Assessment score, total V ˙ C O 2 and ventilatory ratio increased steadily, whereas P aO 2 / F IO 2 was higher in subjects with apnea compared to intermediate RSBI ≤105 breaths/min/L and elevated RSBI >105 breaths/min/L. In subjects with rapid shallow breathing, baseline lung weight measured with quantitative computed tomography scored higher, as well. CONCLUSIONS: In early severe ARDS, the factors associated with rapid shallow breathing despite maximum extracorporeal CO2 extraction include less efficient CO2 and O2 exchange by the natural lung, higher severity of organ failure, and greater magnitude of lung edema.
Published: 2020

26. Extracorporeal Chloride Removal by Electrodialysis. A Novel Approach to Correct Acidemia

Author: Emanuele Rezoagli, Daniele Dondossola, Vittorio Scaravilli, Federico Magni, Eleonora Scotti, Salua Abd El Aziz El Sayed Deab, Domenico Salerno, Stefano Gatti, Luciano Gattinoni, Antonio Pesenti, Michele Ferrari, Pietro Caironi, Alberto Zanella, Tommaso Mauri, M Chiodi, Thomas Langer, Luigi Castagna, Francesco Zadek, Zanella, A, Caironi, P, Castagna, L, Rezoagli, E, Salerno, D, Scotti, E, Scaravilli, V, Deab, S, Langer, T, Mauri, T, Ferrari, M, Dondossola, D, Chiodi, M, Zadek, F, Magni, F, Gatti, S, Gattinoni, L, and Pesenti, A
Subjects: Pulmonary and Respiratory Medicine, extracorporeal circulation, chloride, Swine, acidosi, electrolyte, electrodyalisi, Critical Care and Intensive Care Medicine, Chloride, Extracorporeal, Acidosis, Electrodialysis, Electrolytes, Extracorporeal circulation, Animals, Chlorides, Electricity, Extracorporeal Circulation, Renal Dialysis, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, medicine, 030212 general & internal medicine, Sodium bicarbonate, business.industry, Critically ill, 3. Good health, 030228 respiratory system, chemistry, Anesthesia, medicine.symptom, business, medicine.drug
Abstract: Rationale: Acidemia is a severe condition among critically ill patients. Despite lack of evidence, sodium bicarbonate is frequently used to correct pH; however, its administration is burdened by several side effects. We hypothesized that the reduction of plasma chloride concentration could be an alternative strategy to correct acidemia.Objectives: To evaluate feasibility, safety, and effectiveness of a novel strategy to correct acidemia through extracorporeal chloride removal by electrodialysis.Methods: Ten swine (six treated and four control animals) were sedated, mechanically ventilated and connected to an extracorporeal electrodialysis device capable of selectively removing chloride. In random order, an arterial pH of 7.15 was induced either through reduction of ventilation (respiratory acidosis) or through lactic acid infusion (metabolic acidosis). Acidosis was subsequently sustained for 12-14 hours. In treatment pigs, soon after reaching target acidemia, electrodialysis was started to restore pH.Measurements and Main Results: During respiratory acidosis, electrodialysis reduced plasma chloride concentration by 26 ± 5 mEq/L within 6 hours (final pH = 7.36 ± 0.04). Control animals exhibited incomplete and slower compensatory response to respiratory acidosis (final pH = 7.29 ± 0.03; P
Published: 2020

27. Hypotonic or isotonic maintenance fluids for paediatric patients : the never-ending story

Author: Niels Van Regenmortel, Manu L N G Malbrain, Thomas Langer, Langer, T, L Malbrain, M, and Van Regenmortel, N
Subjects: MEDLINE, acid-base, Critical Care and Intensive Care Medicine, Anesthesiology, Isotonic, Medicine, Humans, RD78.3-87.3, Child, Infusions, Intravenous, hypotonic, fluid overload, Paediatric patients, Evidence-Based Medicine, business.industry, RC86-88.9, intravenous fluid therapy, Medical emergencies. Critical care. Intensive care. First aid, General Medicine, Anesthesiology and Pain Medicine, Hypotonic Solutions, Anesthesia, Tonicity, Fluid Therapy, Human medicine, Isotonic Solutions, business, Hyponatremia
Published: 2020

28. Respiratory Acid-Base Disorders

Author: Paolo Pelosi, Pietro Caironi, Thomas Langer, Langer, T, Pelosi, P, and Caironi, P
Subjects: business.industry, Treatment options, Signs and symptoms, medicine.disease, Pathophysiology, Hypocapnia, Anesthesia, Breathing, medicine, medicine.symptom, Respiratory system, business, Acid-base equilibrium, Hypercapnia, Hypocapnia, Hypercapnia, Acid-base disorders
Abstract: The present chapter summarizes (1) the mechanisms regulating spontaneous breathing activity fundamental to understand the pathophysiology of respiratory acid-base disorders, (2) the compensatory mechanisms, (3) signs and symptoms of hypercapnia and hypocapnia, and (4) causes of and treatment options for acute and chronic respiratory acid-base disorders.
Published: 2019

29. Severe diaphragmatic dysfunction with preserved activity of accessory respiratory muscles in a critically ill child : a case report of failure of neurally adjusted ventilatory assist (NAVA) and successful support with pressure support ventilation (PSV)

Author: Giovanna Chidini, Giacomo Grasselli, Thomas Langer, Tiziana Marchesi, Serena Baio, Antonio Pesenti, Edoardo Calderini, Langer, T, Baio, S, Chidini, G, Marchesi, T, Grasselli, G, Pesenti, A, and Calderini, E
Subjects: Natural Orifice Endoscopic Surgery, medicine.medical_specialty, Control of breathing, Respiratory rate, Critical Illness, Diaphragm, Diaphragmatic breathing, Pressure support ventilation, Quadriplegia, Respiratory system, Positive-Pressure Respiration, 03 medical and health sciences, Work of breathing, Craniopharyngioma, 0302 clinical medicine, Postoperative Complications, Ventilators, mechanical, 030225 pediatrics, Internal medicine, Case report, Neurally adjusted ventilatory assist, Tidal Volume, Medicine, Humans, Pituitary Neoplasms, 030212 general & internal medicine, Treatment Failure, mechanical, Child, Ventilator, business.industry, Electromyography, lcsh:RJ1-570, lcsh:Pediatrics, Respiratory Muscles, Interactive ventilatory support, Dyspnea, Pediatrics, Perinatology and Child Health, Cardiology, Breathing, Female, business, Interactive Ventilatory Support, Ventilator Weaning, Respiratory minute volume, Craniotomy
Abstract: Background Neurally adjusted ventilatory assist (NAVA) is an alternative to pressure support ventilation (PSV) potentially improving patient-ventilator interaction. During NAVA, diaphragmatic electrical activity (EAdi) is used to trigger the ventilator and perform a proportional respiratory assistance. We present a case in which the presence of severe bilateral diaphragmatic dysfunction led to a failure of NAVA. On the contrary, the preserved activity of the accessory inspiratory muscles allowed a successful respiratory assistance using PSV. Case presentation A 10-year-old girl developed quadriplegia after neurological surgery. Initially, no spontaneous breathing activity was present and volume controlled ventilation was necessary. Two months later spontaneous inspiratory efforts were observed and a maximal negative inspiratory force of − 20 cmH2O was recorded. In addition, a NAVA nasogastric tube was placed. The recorded EAdi signal, despite showing a phasic activity, had a very low amplitude (1–2 μV). Two brief (15 min) breathing trials to compare PSV (pressure support = 8 cmH2O) with NAVA (Gain = 5 cmH2O/μV, inspiratory trigger = 0.3 μV) were performed. On PSV, the patient was well adapted with stable tidal volumes, respiratory rates, minute ventilation, end-tidal and venous carbon dioxide levels. When switched to NAVA, her breathing pattern became irregular and she showed clear sign of increased work of breathing and distress: tidal volume dropped and respiratory rate rose, leading to an increase in total minute ventilation. Nevertheless, end-tidal and venous carbon dioxide rapidly increased (from 49 to 55 mmHg and from 52 to 57 mmHg, respectively). An electromyographic study documented an impairment of the diaphragm with preserved activity of the accessory inspiratory muscles. Conclusions We document the failure of mechanical assistance performed with NAVA due to bilateral diaphragmatic dysfunction in a critically ill child. The preserved activity of some accessory respiratory muscles allowed to support the patient effectively with pressure support ventilation, i.e. by applying a pneumatic trigger. The present case underlines (i) the importance of the integrity of the respiratory centers, phrenic nerves and diaphragm in order to perform NAVA and (ii) the possible diagnostic role of EAdi monitoring in complex cases of weaning failure.
Published: 2019

30. Electron Microscopy as a Tool for Assessment of Anticoagulation Strategies During Extracorporeal Life Support: The Proof Is on the Membrane

Author: Kevin K. Chung, Andrew P. Cap, Kathryn A Negaard, Leopoldo C. Cancio, Brendan M Beely, Andrew D. Meyer, Andriy I. Batchinsky, James E. Campbell, Thomas Langer, Beely, B, Campbell, J, Meyer, A, Langer, T, Negaard, K, Chung, K, Cap, A, Cancio, L, and Batchinsky, A
Subjects: endocrine system, medicine.medical_specialty, ARDS, medicine.medical_treatment, Biomedical Engineering, Biophysics, Pilot Projects, Bioengineering, 030204 cardiovascular system & hematology, extracorporeal life support, Article, Extracorporeal, Biomaterials, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Bolus (medicine), Extracorporeal membrane oxygenation, medicine, Animals, anticoagulation, medicine (all), Oxygenators, Membrane, Retrospective Studies, Mechanical ventilation, Respiratory Distress Syndrome, Sheep, Heparin, business.industry, biomaterial, Anticoagulants, Thrombosis, 030208 emergency & critical care medicine, General Medicine, acute respiratory distress syndrome, medicine.disease, biophysic, Surgery, Life support, Microscopy, Electron, Scanning, business, medicine.drug
Abstract: Extracorporeal life support (ECLS) is fast becoming more common place for use in adult patients failing mechanical ventilation. Management of coagulation and thrombosis has long been a major complication in the use of ECLS therapies. Scanning electron microscopy (SEM) of membrane oxygenators (MOs) after use in ECLS circuits can offer novel insight into any thrombotic material deposition on the MO. In this pilot study, we analyzed five explanted MOs immediately after use in a sheep model of different acute respiratory distress syndrome (ARDS). We describe our methods of MO dissection, sample preparation, image capture, and results. Of the five MOs analyzed, those that received continuous heparin infusion showed very little thrombosis formation or other clot material, whereas those that were used with only initial heparin bolus showed readily apparent thrombotic material.
Published: 2016

31. Low-Dose Heparin Anticoagulation During Extracorporeal Life Support for Acute Respiratory Distress Syndrome in Conscious Sheep

Author: Nicolas Prat, Andrew P. Cap, Bijaya K. Parida, Andrew D. Meyer, Robbie K. Montgomery, Andriy I. Batchinsky, Thomas Langer, Prat, N, Meyer, A, Langer, T, Montgomery, R, Parida, B, Batchinsky, A, and Cap, A
Subjects: ARDS, Platelet Aggregation, Ventilator-Induced Lung Injury, medicine.medical_treatment, Critical Care and Intensive Care Medicine, extracorporeal life support, law.invention, Cohort Studies, Random Allocation, Anoxia, law, anticoagulation, Hypoxia, blood platelet, Respiratory Distress Syndrome, Cardiopulmonary Bypass, Acute respiratory distress syndrome, Cardiopulmonary Bypa, Respiration, Flow Cytometry, Thrombelastography, trauma, surgical procedures, operative, Artificial, Emergency Medicine, Critical Illne, Female, Adult, medicine.medical_specialty, Critical Illness, Disease Model, Lung injury, Extracorporeal, Extracorporeal Membrane Oxygenation, medicine, Extracorporeal membrane oxygenation, Cardiopulmonary bypass, Animals, Intensive care medicine, Hemostasis, Sheep, Animal, Heparin, Platelet Count, business.industry, Anticoagulant, Basic Science Aspects, Anticoagulants, Hemostasi, medicine.disease, Respiration, Artificial, Blood Cell Count, Disease Models, Animal, Respiratory failure, Life support, Cohort Studie, business, Oleic Acid
Abstract: Background: Over 32% of burned battlefield causalities develop trauma-induced hypoxic respiratory failure, also known as acute respiratory distress syndrome (ARDS). Recently, 9 out of 10 US combat soldiers’ survived life-threatening trauma-induced ARDS supported with extracorporeal membrane oxygenation (ECMO), a portable form of cardiopulmonary bypass. Unfortunately, the size, incidence of coagulation complications, and the need for systematic anticoagulation for traditional ECMO devices have prevented widespread use of this lifesaving technology. Therefore, a compact, mobile, ECMO system using minimal anticoagulation may be the solution to reduce ARDS in critically ill military and civilian patients. Methods: We conducted a prospective cohort laboratory investigation to evaluate the coagulation function in an ovine model of oleic acid induced ARDS supported with veno-venous ECMO. The experimental design approximated the time needed to transport from a battlefield setting to an advanced facility and compared bolus versus standard heparin anticoagulation therapy. Results: Comprehensive coagulation and hemostasis assays did not show any difference because of ECMO support over 10 h between the two groups but did show changes because of injury. Platelet count and function did decrease with support on ECMO, but there was no significant bleeding or clot formation during the entire experiment. Conclusions: A bolus heparin injection is sufficient to maintain ECMO support for up to 10 h in an ovine model of ARDS. With a reduced need for systematic anticoagulation, ECMO use for battlefield trauma could reduce significant morbidity and mortality from ventilator-induced lung injury and ARDS. Future studies will investigate the mechanisms and therapies to support patients for longer periods on ECMO without coagulation complications. Level of Evidence: V—therapeutic animal experiment.
Published: 2015

32. Prediction of Resting Energy Expenditure in Children: May Artificial Neural Networks Improve Our Accuracy?

Author: Giulia C. I. Spolidoro, Gregorio P. Milani, Ramona De Amicis, Alessandro Leone, Alberto Battezzati, Valentina De Cosmi, Thomas Langer, Simona Bertoli, Ludovica Leone, Edoardo Calderini, Silvia Scaglioni, Silvia Bettocchi, Alessandra Mazzocchi, Carlo Agostoni, Veronica D’Oria, Enzo Grossi, Andrea Foppiani, Cosmi, V, Mazzocchi, A, Milani, G, Calderini, E, Scaglioni, S, Bettocchi, S, D'Oria, V, Langer, T, Spolidoro, G, Leone, L, Battezzati, A, Bertoli, S, Leone, A, Amicis, R, Foppiani, A, Agostoni, C, and Grossi, E
Subjects: neural network, Energy metabolism, lcsh:Medicine, Energy requirement, Article, World health, 03 medical and health sciences, 0302 clinical medicine, children, 030225 pediatrics, energy expenditure, Weight management, Statistics, Medicine, Resting energy expenditure, Lower grade, Artificial neural network, business.industry, lcsh:R, Nutritional status, General Medicine, neural networks, nutrition, 030211 gastroenterology & hepatology, business, metabolism
Abstract: The inaccuracy of resting energy expenditure (REE) prediction formulae to calculate energy metabolism in children may lead to either under- or overestimated real caloric needs with clinical consequences. The aim of this paper was to apply artificial neural networks algorithms (ANNs) to REE prediction. We enrolled 561 healthy children (2&ndash, 17 years). Nutritional status was classified according to World Health Organization (WHO) criteria, and 113 were obese. REE was measured using indirect calorimetry and estimated with WHO, Harris&ndash, Benedict, Schofield, and Oxford formulae. The ANNs considered specific anthropometric data to model REE. The mean absolute error (mean &plusmn, SD) of the prediction was 95.8 &plusmn, 80.8 and was strongly correlated with REE values (R2 = 0.88). The performance of ANNs was higher in the subgroup of obese children (101 &plusmn, 91.8) with a lower grade of imprecision (5.4%). ANNs as a novel approach may give valuable information regarding energy requirements and weight management in children.
Published: 2020

33. Intraoperative hypotension is not associated with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia for surgery: results of a randomized controlled pilot trial

Author: Franco Valenza, Maura Marcucci, Silvia Inglese, Francesco Zadek, Francesca Rosini, C. Marenghi, Valentina Cordolcini, Barbara Bonanomi, P. Pugni, Luciano Gattinoni, M Chiodi, Antonio Pesenti, Alessandro Santini, Thomas Langer, Langer, T, Santini, A, Zadek, F, Chiodi, M, Pugni, P, Cordolcini, V, Bonanomi, B, Rosini, F, Marcucci, M, Valenza, F, Marenghi, C, Inglese, S, Pesenti, A, and Gattinoni, L
Subjects: Male, medicine.medical_specialty, Mean arterial pressure, Randomization, Pilot Projects, anesthesia, Anesthesia, General, law.invention, Postoperative Complications, Randomized controlled trial, law, medicine, Humans, Cognitive Dysfunction, Prospective Studies, Intraoperative Complications, Geriatric Assessment, Aged, 80 and over, business.industry, Incidence (epidemiology), Incidence, Neuropsychology, Delirium, medicine.disease, Frail elderly, Surgery, Causality, Anesthesiology and Pain Medicine, Blood pressure, general, Anesthesia, Female, medicine.symptom, Hypotension, business, Postoperative cognitive dysfunction
Abstract: Study objective: To assess the effect of different intraoperative blood pressure targets on the development of POCD and test the feasibility of a larger trial. Design: Randomized controlled pilot trial. Setting: Perioperative care in a tertiary care teaching hospital with outpatient follow-up. Patients: One hundred one patients aged >= 75 years with ASA physical status < 4, undergoing elective, non-cardiac surgery under general anesthesia and 33 age-matched healthy controls. Interventions: Randomization to a personalized intraoperative blood pressure target, mean arterial pressure (MAP) >= 90% of preoperative values (Target group), or to a more liberal intraoperative blood pressure management (No-Target group). Strategies to reach intraoperative blood pressure target were at discretion of anesthesiologists. Measurements: An experienced neuropsychologist performed a validated battery of neurocognitive tests preoperatively and 3 months after surgery. Incidence of POCD at three months and postoperative delirium were assessed. Intraoperative time spent with MAP >= 90% of preoperative values, recruitment and drop-out rate at 3 months were feasibility outcomes. Main results: The Target group spent a higher percentage of intraoperative time with MAP >= 90% of preoperative values (65 +/- 25% vs. 49 +/- 28%, p < 0.01). Incidence of POCD (11% vs. 7%, relative risk 1.52; 95% CI, 0.41 to 6.3; p = 0.56) and delirium (6% vs. 14%, relative risk, 0.44; 95% CI, 0.12 to 1.60; p = 0.21) did not differ between groups. No correlation was found between intraoperative hypotension and postoperative cognitive performance (p = 0.75) or delirium (p = 0.19). Recruitment rate was of 6 patients/month (95% confidential interval (CI), 5 to 7) and drop-out rate at 3 months was 24% (95% CI, 14 to 33%). Conclusions: Intraoperative hypotension did not correlate with postoperative cognitive dysfunction or delirium occurrence in elderly patients undergoing general anesthesia for non-cardiac surgery. A multicenter randomized controlled trial is needed in order to confirm the effect of intraoperative blood pressure on the development of POCD
Published: 2018

34. Electrolyte shifts across the artificial lung in patients on extracorporeal membrane oxygenation: Interdependence between partial pressure of carbon dioxide and strong ion difference

Author: Pietro Caironi, Luciano Gattinoni, Loredana Zani, Eleonora Scotti, Eleonora Carlesso, Alessandro Protti, Monica Chierichetti, Thomas Langer, Langer, T, Scotti, E, Carlesso, E, Protti, A, Zani, L, Chierichetti, M, Caironi, P, and Gattinoni, L
Subjects: Adult, Anions, Male, medicine.medical_specialty, Partial Pressure, medicine.medical_treatment, Analytical chemistry, chemistry.chemical_element, Electrolyte, Respiratory failure, Critical Care and Intensive Care Medicine, Oxygen, Artificial lung, Electrolytes, chemistry.chemical_compound, Chlorides, Stewart approach, Gas exchange, medicine, Extracorporeal membrane oxygenation, Humans, business.industry, Sodium, Hemoglobin A, Partial pressure, Carbon Dioxide, Hydrogen-Ion Concentration, Electrolyte shift, Acid-base equilibrium, Surgery, chemistry, Carbon dioxide, Arterial blood, Female, Acid–base reaction, business
Abstract: Purpose: Partial pressure of carbon dioxide (Pco2), strong ion difference (SID), and total amount of weak acids independently regulate pH. When blood passes through an extracorporeal membrane lung, Pco2 decreases. Furthermore, changes in electrolytes, potentially affecting SID, were reported. We analyzed these phenomena according to Stewart's approach. Methods: Couples of measurements of blood entering (venous) and leaving (arterial) the extracorporeal membrane lung were analyzed in 20 patients. Changes in SID, Pco2, and pH were computed and pH variations in the absence of measured SID variations calculated. Results: Passing from venous to arterial blood, Pco2 was reduced (46.5 ± 7.7 vs 34.8 ± 7.4 mm Hg, P < .001), and hemoglobin saturation increased (78 ± 8 vs 100% ± 2%, P < .001). Chloride increased, and sodium decreased causing a reduction in SID (38.7 ± 5.0 vs 36.4 ± 5.1 mEq/L, P < .001). Analysis of quartiles of {increment}Pco2 revealed progressive increases in chloride (P < .001), reductions in sodium (P < .001), and decreases in SID (P < .001), at constant hemoglobin saturation variation (P = .12). Actual pH variation was lower than pH variations in the absence of measured SID variations (0.09 ± 0.03 vs 0.12 ± 0.04, P < .001). Conclusions: When Pco2 is reduced and oxygen added, several changes in electrolytes occur. These changes cause a Pco2-dependent SID reduction that, by acidifying plasma, limits pH correction caused by carbon dioxide removal. In this particular setting, Pco2 and SID are interdependent.
Published: 2015

35. Extremely high transpulmonary pressure in a spontaneously breathing patient with early severe ARDS on ECMO

Author: Antonio Pesenti, Giacomo Grasselli, Tommaso Mauri, Thomas Langer, Alberto Zanella, Mauri, T, Langer, T, Zanella, A, Grasselli, G, and Pesenti, A
Subjects: medicine.medical_specialty, ARDS, Fatal outcome, business.industry, Medicine (all), 030208 emergency & critical care medicine, Critical Care and Intensive Care Medicine, medicine.disease, 03 medical and health sciences, Pneumonia, 0302 clinical medicine, 030228 respiratory system, Internal medicine, medicine, Cardiology, Breathing, business, Transpulmonary pressure
Published: 2016

36. Spontaneous breathing: a double-edged sword to handle with care

Author: Thomas Langer, Elena Spinelli, Giacomo Grasselli, Tommaso Mauri, Barbara Cambiaghi, Mauri, T, Cambiaghi, B, Spinelli, E, Langer, T, and Grasselli, G
Subjects: ARDS, Physiology, business.industry, Medicine (all), Hemodynamics, 030208 emergency & critical care medicine, General Medicine, Respiratory monitoring, Review Article, Lung injury, medicine.disease, Diaphragm (structural system), 03 medical and health sciences, Ventilator-induced lung injury (VILI), 0302 clinical medicine, 030228 respiratory system, Esophageal pressure (Pes), Spontaneous breathing, Anesthesia, medicine, Breathing, Acute respiratory distress syndrome (ARDS), business, Tidal volume, Transpulmonary pressure
Abstract: In acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) patients, spontaneous breathing is associated with multiple physiologic benefits: it prevents muscles atrophy, avoids paralysis, decreases sedation needs and is associated with improved hemodynamics. On the other hand, in the presence of uncontrolled inspiratory effort, severe lung injury and asynchronies, spontaneous ventilation might also worsen lung edema, induce diaphragm dysfunction and lead to muscles exhaustion and prolonged weaning. In the present review article, we present physiologic mechanisms driving spontaneous breathing, with emphasis on how to implement basic and advanced respiratory monitoring to assess lung protection during spontaneous assisted ventilation. Then, key benefits and risks associated with spontaneous ventilation are described. Finally, we propose some clinical means to promote protective spontaneous breathing at the bedside. In summary, early switch to spontaneous assisted breathing of acutely hypoxemic patients is more respectful of physiology and might yield several advantages. Nonetheless, risk of additional lung injury is not completely avoided during spontaneous breathing and careful monitoring of target physiologic variables such as tidal volume (Vt) and driving transpulmonary pressure should be applied routinely. In clinical practice, multiple interventions such as extracorporeal CO 2 removal exist to maintain inspiratory effort, Vt and driving transpulmonary pressure within safe limits but more studies are needed to assess their long-term efficacy.
Published: 2017

37. Extracorporeal Gas Exchange and Spontaneous Breathing for the Treatment of Acute Respiratory Distress Syndrome

Author: Andriy I. Batchinsky, Leopoldo C. Cancio, Luciano Gattinoni, Vittoria Vecchi, Slava Belenkiy, Thomas Langer, Kevin K. Chung, Jeremy W. Cannon, Langer, T, Vecchi, V, Belenkiy, S, Cannon, J, Chung, K, Cancio, L, Gattinoni, L, and Batchinsky, A
Subjects: healthy lung, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Risk Assessment, Severity of Illness Index, transpulmonary pressure, Random Allocation, Extracorporeal Membrane Oxygenation, Reference Values, medicine, Extracorporeal membrane oxygenation, Animals, Lung transplantation, control of breathing, Mechanical ventilation, Analysis of Variance, Respiratory Distress Syndrome, Sheep, Lung, Pulmonary Gas Exchange, business.industry, Respiration, Recovery of Function, acute respiratory distress syndrome, Respiration, Artificial, Survival Rate, Transplantation, Disease Models, Animal, medicine.anatomical_structure, Control of respiration, Anesthesia, spontaneous breathing, Linear Models, Breathing, Female, business, Transpulmonary pressure
Abstract: OBJECTIVES: Venovenous extracorporeal gas exchange is increasingly used in awake, spontaneously breathing patients as a bridge to lung transplantation. Limited data are available on a similar use of extracorporeal gas exchange in patients with acute respiratory distress syndrome. The aim of this study was to investigate the use of extracorporeal gas exchange in awake, spontaneously breathing sheep with healthy lungs and with acute respiratory distress syndrome and describe the interactions between the native lung (healthy and diseased) and the artificial lung (extracorporeal gas exchange) in this setting. DESIGN: Laboratory investigation. SETTING: Animal ICU of a governmental laboratory. SUBJECTS: Eleven awake, spontaneously breathing sheep on extracorporeal gas exchange. INTERVENTIONS: Sheep were studied before (healthy lungs) and after the induction of acute respiratory distress syndrome via IV injection of oleic acid. Six gas flow settings (1-10 L/min), resulting in different amounts of extracorporeal CO2 removal (20-100% of total CO2 production), were tested in each animal before and after the injury. MEASUREMENTS AND MAIN RESULTS: Respiratory variables and gas exchange were measured for every gas flow setting. Both healthy and injured sheep reduced minute ventilation according to the amount of extracorporeal CO2 removal, up to complete apnea. However, compared with healthy sheep, sheep with acute respiratory distress syndrome presented significantly increased esophageal pressure variations (25 ± 9 vs 6 ± 3 cm H2O; p < 0.001), which could be reduced only with very high amounts of CO2 removal (> 80% of total CO2 production). CONCLUSIONS: Spontaneous ventilation of both healthy sheep and sheep with acute respiratory distress syndrome can be controlled via extracorporeal gas exchange. If this holds true in humans, extracorporeal gas exchange could be used in awake, spontaneously breathing patients with acute respiratory distress syndrome to support gas exchange. A deeper understanding of the pathophysiology of spontaneous breathing during acute respiratory distress syndrome is however warranted in order to be able to propose extracorporeal gas exchange as a safe and valuable alternative to mechanical ventilation for the treatment of patients with acute respiratory distress syndrome
Published: 2014

38. Noninvasive Carbon Dioxide Monitoring in a Porcine Model of Acute Lung Injury Due to Smoke Inhalation and Burns

Author: Thomas Langer, Jose Salinas, William E. Baker, Katherine M. Ivey, Leopoldo C. Cancio, Slava Belenkiy, Corina Necsoiu, Andriy I. Batchinsky, Belenkiy, S, Ivey, K, Batchinsky, A, Langer, T, Necsoiu, C, Baker, W, Salinas, J, and Cancio, L
Subjects: Breath Test, Mean arterial pressure, Monitoring, Partial Pressure, Smoke inhalation, medicine.medical_treatment, Acute Lung Injury, Sus scrofa, Hemodynamics, Burn, Disease Model, Lung injury, Critical Care and Intensive Care Medicine, Transcutaneou, Capnography, medicine, Animals, Hemodynamic, Physiologic, Monitoring, Physiologic, Mechanical ventilation, medicine.diagnostic_test, Animal, business.industry, Respiration, Carbon Dioxide, Smoke Inhalation Injury, respiratory system, medicine.disease, Respiration, Artificial, Gas analyzer, respiratory tract diseases, Disease Models, Animal, Breath Tests, Anesthesia, Artificial, Blood Gas Monitoring, Emergency Medicine, Arterial blood, Female, Burns, business, Blood Gas Monitoring, Transcutaneous
Abstract: In critically ill intubated patients, assessment of adequacy of ventilation relies on measuring partial pressure of arterial carbon dioxide (PaCO2), which requires invasive arterial blood gas analysis. Alternative noninvasive technologies include transcutaneous CO2 (tPCO2) and end-tidal CO2 (EtCO2) monitoring. We evaluated accuracy of tPCO2 and EtCO2 monitoring in a porcine model of acute lung injury (ALI) due to smoke inhalation and burns. Eight anesthetized Yorkshire pigs underwent mechanical ventilation, wood-bark smoke inhalation injury, and 40% total body surface area thermal injury. tPCO2 was measured with a SenTec system (SenTec AG, Therwil, Switzerland) and EtCO2 with a Capnostream-20 (Oridion Medical, Jerusalem, Israel). These values were compared with PaCO2 measurements from an arterial blood gas analyzer. Paired measurements of EtCO2-PaCO2 (n = 276) and tPCO2-PaCO2 (n = 250) were recorded in the PaCO2 range of 25 to 85 mmHg. Overlapping data sets were analyzed based on respiratory and hemodynamic status of animals. Acute lung injury was defined as PaO2/FIO2 ≤ 300 mmHg; hemodynamic instability was defined as mean arterial pressure ≤ 60 mmHg. Before ALI, EtCO2 demonstrated moderate correlation with PaCO2 (R = 0.45; P < 0.0001), which deteriorated after onset of ALI (R = 0.12; P < 0.0001). Before ALI, tPCO2 demonstrated moderate correlation (R = 0.51, P < 0.0001), which was sustained after onset of ALI (R = 0.78; P < 0.0001). During hemodynamic stability, EtCO2 demonstrated moderate correlation with PaCO2 (R = 0.44; P < 0.0001). During hemodynamic instability, EtCO2 did not correlate with PaCO2 (R = 0.03; P = 0.29). tPCO2 monitoring demonstrated strong correlation with PaCO2 during hemodynamic stability (R = 0.80, P < 0.0001), which deteriorated under hemodynamically unstable conditions (R = 0.39; P < 0.0001). Noninvasive carbon dioxide monitors are acceptable for monitoring trends in PaCO2 under conditions of hemodynamic and pulmonary stability. Under unstable conditions, reevaluation of patient status and increased caution in the interpretation of results are required.
Published: 2013

39. Understanding the role of the cerebrospinal fluid in acid-base disorders

Author: Pietro Caironi, Thomas Langer, Alberto Zanella, Langer, T, Zanella, A, and Caironi, P
Subjects: Cognitive science, Acid base, CSF, business.industry, Respiration, Acid-Base Imbalance, Hydrogen-Ion Concentration, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Plasma chloride, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Homeostasis, Humans, Medicine, 030212 general & internal medicine, business, Acid-base disorders, Cerebrospinal Fluid
Abstract: The importance of acid–base interpretation is witnessed by the bulk of literature constantly being published on the topic [1, 2]. However, none of the recently published papers specifically addresses the acid–base equilibrium of the cerebrospinal fluid (CSF), which is an important compartment, since it influences the activity of the central controllers of respiration. Here, we will briefly discuss the characteristics of CSF acid–base equilibrium and their implications on the control of breathing, basing our reasoning on Stewart’s approach [3]. Moreover, we will highlight some clinical implications that, we believe, are usually not fully considered by clinicians.
Published: 2016

40. Skeletal muscle lactate overproduction during metformin intoxication: An animal study with reverse microdialysis

Author: Stefano Ferrero, Silvia Guenzani, Alessandro Protti, Luciano Gattinoni, Alessandro Santini, Nino Stocchetti, Giulia Alessandra Bassani, Sandra Magnoni, Paolo Properzi, Thomas Langer, Protti, A, Properzi, P, Magnoni, S, Santini, A, Langer, T, Guenzani, S, Ferrero, S, Bassani, G, Stocchetti, N, and Gattinoni, L
Subjects: 0301 basic medicine, medicine.medical_specialty, Microdialysis, Time Factors, Swine, medicine.medical_treatment, Diabete, Toxicology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Pyruvic Acid, medicine, Animals, Hypoglycemic Agents, Infusions, Parenteral, Lactic Acid, Muscle, Skeletal, Saline, business.industry, Skeletal muscle, 030208 emergency & critical care medicine, General Medicine, medicine.disease, Metformin, Mitochondria, Muscle, Mitochondria, 030104 developmental biology, Endocrinology, medicine.anatomical_structure, Gluconeogenesis, chemistry, Lactic acidosi, Microdialysi, Anaerobic glycolysis, Lactic acidosis, Acidosis, Lactic, Pyruvic acid, business, Glycolysis, medicine.drug
Abstract: Lactic acidosis during metformin intoxication is classically mainly attributed to diminished lactate clearance through liver gluconeogenesis. Here we studied 6 healthy, sedated and mechanically ventilated pigs to clarify whether high dose of metformin also increases skeletal muscle lactate production. Each animal had two microdialysis catheters inserted in gluteus muscles, one per side. One catheter was infused with saline (control) while the other one was infused with metformin diluted in saline (1 M), both at a rate of 0.3 μl/min. Dialysate lactate concentration and lactate-to-pyruvate ratio, a marker of the balance between anaerobic glycolysis and aerobic (mitochondrial) metabolism, were measured every 3 h, for 12 h. Continuous infusion of metformin caused a progressive rise in dialysate lactate level (p = 0.007) and lactate-to-pyruvate ratio (p < 0.001) compared to that of saline, as for mitochondrial "poisoning". These findings suggest that skeletal muscle lactate overproduction contributes to the development of metformin-induced lactic acidosis.
Published: 2016

41. 'Awake' extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering

Author: Alessandro Santini, Luciano Gattinoni, N Bottino, Antonio Pesenti, Thomas Langer, S Crotti, Andriy I. Batchinsky, Langer, T, Santini, A, Bottino, N, Crotti, S, Batchinsky, A, Pesenti, A, and Gattinoni, L
Subjects: invasive mechanical ventilation, medicine.medical_specialty, Consciousness, Ventilator-Induced Lung Injury, medicine.medical_treatment, active rehabilitation, Review, Respiratory monitoring, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Extracorporeal, law.invention, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, law, medicine, Extracorporeal membrane oxygenation, Humans, Intubation, carbon-dioxide removal, Intensive care medicine, life-support, Mechanical ventilation, Respiratory Distress Syndrome, respiratory-distress-syndrome, pressure support ventilation, business.industry, Respiration, noninvasive ventilation, Respiration, Artificial, Intensive care unit, Intensive Care Units, surgical procedures, operative, gas-exchange, 030228 respiratory system, Respiratory failure, acute lung injury, Breathing, CO2 removal, Respiratory Insufficiency, business
Abstract: Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescue therapy for patients with respiratory failure not treatable with conventional mechanical ventilation alone. In recent years, however, the timing of ECMO initiation has been readdressed and ECMO is often started earlier in the time course of respiratory failure. Furthermore, some centers are starting to use ECMO as a first line of treatment, i.e., as an alternative to invasive mechanical ventilation in awake, non-intubated, spontaneously breathing patients with respiratory failure (“awake” ECMO). There is a strong rationale for this type of respiratory support as it avoids several side effects related to sedation, intubation, and mechanical ventilation. However, the complexity of the patient–ECMO interactions, the difficulties related to respiratory monitoring, and the management of an awake patient on extracorporeal support together pose a major challenge for the intensive care unit staff. Here, we review the use of vv-ECMO in awake, spontaneously breathing patients with respiratory failure, highlighting the pros and cons of this approach, analyzing the pathophysiology of patient–ECMO interactions, detailing some of the technical aspects, and summarizing the initial clinical experience gained over the past years.
Published: 2016

42. Do we really need postoperative ICU management after elective surgery? No, not any more!

Author: Thomas Langer, Giacomo Grasselli, Paolo Taccone, Taccone, P, Langer, T, and Grasselli, G
Subjects: medicine.medical_specialty, High-risk surgery, business.industry, General surgery, Pain medicine, cohort, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, intensive-care, 030202 anesthesiology, Anesthesiology, Intensive care, Cohort, medicine, Elective surgery, High risk surgery, business, 030217 neurology & neurosurgery
Published: 2017

43. Intravenous balanced solutions: from physiology to clinical evidence

Author: Manu L N G Malbrain, Eleonora Scotti, Niels Van Regenmortel, Pietro Caironi, Alessandro Santini, Thomas Langer, Langer, T, Santini, A, Scotti, E, van Regenmortel, N, Malbrain, M, Caironi, P, Supporting clinical sciences, and Intensive Care
Subjects: medicine.medical_specialty, medicine.medical_treatment, Renal function, Critical Care and Intensive Care Medicine, law.invention, Hyperchloremia, balanced solution, Randomized controlled trial, Chlorides, acid-base equilibrium, balanced solutions, colloids, crystalloids, fluid therapy, law, medicine, Humans, Magnesium, colloid, Intensive care medicine, Saline, Medicine(all), Acid-Base Equilibrium, business.industry, General Medicine, Water-Electrolyte Balance, medicine.disease, Kidney Transplantation, Clinical trial, crystalloid, Anesthesiology and Pain Medicine, Potassium, Tonicity, Fluid Therapy, Observational study, Calcium, business, Hypervolemia
Abstract: "Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Recently, the term "balanced" solution has been also employed to indicate intravenous fluids with low chloride content, being the concentration of this electrolyte the most altered and supra-physiologic in 0.9% NaCl as compared to plasma, and based upon a suggested detrimental effect on renal function associated with hyperchloremia. Despite efforts for its identification, the ideal balanced solution, with minimal effects on acid-base status, low chloride content, and adequate tonicity, is not yet available. After the accumulation of pre-clinical and clinical physiologic data, in the last three years, several clinical trials, mostly observational and retrospective, have addressed the question of whether the use of balanced solutions has beneficial effects as compared to the standard of care, sometimes even suggesting an improvement in survival. Nonetheless, the first large randomized controlled trial comparing the effects of a balanced vs. unbalanced solution on renal function in critically-ill patients (SPLIT trial, the 0.9% Saline vs Plasma-Lyte 148 for Intensive Cate Unit Fluid Therapy), just recently published, showed identical equipoise between the two treatments. In the present review, we offer a comprehensive and updated summary on this issue, firstly, by providing a full physiological background of balanced solutions, secondly, by summarizing their potential pathophysiologic effects, and lastly, by presenting the clinical evidence available to support, at the moment, their use.
Published: 2015

44. Albumin in critically ill patients: The ideal colloid?

Author: Pietro Caironi, Luciano Gattinoni, Thomas Langer, Caironi, P, Langer, T, and Gattinoni, L
Subjects: Liver Cirrhosis, medicine.medical_specialty, Sepsi, Critical Illness, Liver Cirrhosi, Critical Care and Intensive Care Medicine, Severity of Illness Index, law.invention, Sepsis, Randomized controlled trial, Fluid therapy, law, Albumins, medicine, Humans, Albumin, Critically ill, Fluids, Acute Kidney Injury, Colloids, Fluid Therapy, Shock, Septic, Intensive care medicine, business.industry, medicine.disease, Shock, Septic, Critical illness, Colloid, Critical Illne, Fluid, business, Human
Abstract: The use of albumin-containing solutions in critically ill patients has been recently revisited, following evidence on harmful effects of synthetic colloids, and novel randomized controlled trials (RCTs) in sepsis. Here, we review the most recent findings on albumin administration in acutely ill and septic patients.The revision of Starling's theory on microvascular fluid dynamics has highlighted the role of albumin in preserving intravascular compartment volume. In cirrhosis, albumin may be important in maintaining immune system reactivity and cardiac contractility. Preliminary analyses indicate albumin as beneficial in patients with burn, while being associated with increased risk of acute kidney injury after cardiac surgery. The first RCT (ALBIOS trial) testing the efficacy of albumin replacement in severe sepsis did not show a survival benefit associated with albumin, although observing at post-hoc analysis a benefit in septic shock. All the eight meta-analyses performed on albumin in sepsis reveal an absence of harm, and likely a benefit lower than expected, whereas suggesting an advantage, to be verified, in septic shock.Further studies are needed to clarify physiology and clinical impact of albumin in critically ill patients, considering specific phenotypes and secondary outcomes other than survival, yet clinically relevant.
Published: 2015

45. Urinary Electrolyte Monitoring in the Critically Ill: Revisiting Renal Physiology

Author: Michele Ferrari, Thomas Langer, Pietro Caironi, J.L. Vincent, Caironi, P, Langer, T, and Ferrari, M
Subjects: medicine.medical_specialty, Kidney, Electrolyte monitoring, Critically ill, business.industry, Urinary system, medicine.disease, Renal physiology, Renal tubular acidosis, Acid-base equilibrium, medicine.anatomical_structure, medicine, Intensive care medicine, business, Organism, Homeostasis
Abstract: The kidney, being one of the most fascinating and commonly studied organs within human physiology, has a crucial role in maintaining the homeostasis of our organism from several different perspectives, from clearing of cellular catabolism products, to body fluids and electrolyte content regulation, hemodynamic stability and acid-base equilibrium [1]. Consequently, despite the existence of many strategies to support its function, the renal system is often the focus of our attention during the clinical management of the critically ill, because its function is frequently altered in this category of patients [2].
Published: 2015

46. Intravenous fluid therapy for hospitalized and critically ill children: rationale, available drugs and possible side effects

Author: Rosamaria Limuti, Antonio Pesenti, Thomas Langer, Niels Van Regenmortel, Concezione Tommasino, Pietro Caironi, Els L.I.M. Duval, Manu L N G Malbrain, Langer, T, Limuti, R, Tommasino, C, van Regenmortel, N, Duval, E, Caironi, P, Malbrain, M, Pesenti, A, Supporting clinical sciences, and Intensive Care
Subjects: medicine.medical_specialty, Resuscitation, Critical Illness, Body water, paediatric critical care, Critical Care and Intensive Care Medicine, intravenous fluids, Intravenous fluid, medicine, Humans, intravenous fluid, Available drugs, Child, Infusions, Intravenous, Intensive care medicine, acid-base equilibrium, crystalloids, paediatric anaesthesia, High prevalence, Medical treatment, Critically ill, business.industry, General Medicine, Water-Electrolyte Balance, Hospitalization, crystalloid, Anesthesiology and Pain Medicine, Fluid Therapy, Human medicine, business, Antidiuretic
Abstract: Human beings are constituted mainly of water. In particular, children's total body water might reach 75-80% of their body weight, compared to 60-70% in adults. It is therefore not surprising, that children, especially hospitalized new-borns and infants, are markedly prone to water and electrolyte imbalances. Parenteral fluid therapy is a cornerstone of medical treatment and is thus of exceptional relevance in this patient population. It is crucial to appreciate the fact that intravenous fluids are drugs with very different characteristics, different indications, contraindications and relevant side effects. In the present review, we will summarize the physiology and pathophysiology of water and electrolyte balance, underlining the importance and high prevalence of non-osmotic antidiuretic hormone release in hospitalized and critically ill children. Furthermore, we will discuss the characteristics and potential side effects of available crystalloids for the paediatric population, making a clear distinction between fluids that are hypotonic or isotonic as compared to normal plasma. Finally, we will review the current clinical practice regarding the use of different parenteral fluids in children, outlining both the current consensus on fluids employed for resuscitation and replacement and the ongoing debate concerning parenteral maintenance fluids.
Published: 2014

47. Low-dose chest computed tomography for quantitative and visual anatomical analysis in patients with acute respiratory distress syndrome

Author: Vittoria Vecchi, Luciano Gattinoni, Matteo Brioni, Andrea Colombo, Sara Froio, S Luoni, M. Lazzerini, Davide Chiumello, Alessandro Protti, Silvia Coppola, I Cigada, Thomas Langer, Chiumello, D, Langer, T, Vecchi, V, Luoni, S, Colombo, A, Brioni, M, Froio, S, Cigada, I, Coppola, S, Protti, A, Lazzerini, M, and Gattinoni, L
Subjects: Male, medicine.medical_specialty, ARDS, Radiography, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Effective dose (radiation), Radiation dosage, Anesthesiology, medicine, Humans, Prospective Studies, Prospective cohort study, Computed tomography, Reduction (orthopedic surgery), Aged, Respiratory Distress Syndrome, Lung, Acute respiratory distress syndrome, business.industry, fungi, medicine.disease, medicine.anatomical_structure, Italy, Linear Models, Female, Radiography, Thoracic, Radiology, Tomography, business, Tomography, X-Ray Computed
Abstract: Chest computed tomography (CT) is a fundamental tool for the characterization of acute respiratory distress syndrome (ARDS). Its frequent use is, however, hindered by the associated radiation exposure. The aim of the present study was to evaluate, in patients with ARDS, the accuracy of quantitative and visual anatomical lung analysis performed on low-dose CT. We hypothesized that low-dose CT would provide accurate quantitative and visual anatomical results. Chest CT was performed in 45 ARDS patients in static conditions at set airway pressures of 45 and 15 or 45 and 5 cmH(2)O. During each pause, two consecutive scans were obtained at two different tube current-time products (mAs). In 24 patients 110 mAs was coupled with 60 mAs; in 21 patients 110 was coupled with 30 mAs. All other CT parameters were kept unaltered. Quantitative and visual anatomical results obtained at different mAs were compared via Bland-Altman analysis. Good agreements were observed between 110 and 60 mAs and between 110 and 30 mAs both for quantitative and visual anatomical results (all biases below 1.5 %). Estimated mean effective dose at 110, 60, and 30 mAs corresponded to 5.3 +/- A 1.6, 2.8 +/- A 0.8, and 1.4 +/- A 0.3 mSv, respectively. In patients with ARDS a reduction of mAs up to 30 (70 % effective dose reduction) can be achieved without significant effect on quantitative and visual anatomical results. Low-dose chest CT, with related quantitative and visual anatomical analysis, could be a valuable tool to characterize and potentially monitor lung disease in patients with ARDS
Published: 2014

48. Effects of intravenous solutions on acid-base equilibrium: from crystalloids to colloids and blood components

Author: Luciano Gattinoni, Luca Zazzeron, Michele Ferrari, Pietro Caironi, Thomas Langer, Langer, T, Ferrari, M, Zazzeron, L, Gattinoni, L, and Caironi, P
Subjects: medicine.medical_specialty, Alkalosis, blood components, Blood Component Transfusion, Critical Care and Intensive Care Medicine, Stewart’s approach, Colloid, chemistry.chemical_compound, colloids, medicine, Humans, intravenous infusion, Infusions, Intravenous, colloid, albumin, Acidosis, Chromatography, business.industry, Albumin, Water, Crystalloid Solutions, General Medicine, medicine.disease, Surgery, Dilution, acid-base equilibrium, intravenous infusions, crystalloids, Solutions, Solvent, Anesthesiology and Pain Medicine, crystalloid, chemistry, Carbon dioxide, Fluid Therapy, Acid–base reaction, Isotonic Solutions, medicine.symptom, business
Abstract: Intravenous fluid administration is a medical intervention performed worldwide on a daily basis. Nevertheless, only a few physicians are aware of the characteristics of intravenous fluids and their possible effects on plasma acid-base equilibrium. According to Stewart’s theory, pH is independently regulated by three variables: partial pressure of carbon dioxide, strong ion difference (SID), and total amount of weak acids (A TOT ). When fluids are infused, plasma SID and A TOT tend toward the SID and A TOT of the administered fluid. Depending on their composition, fluids can therefore lower, increase, or leave pH unchanged. As a general rule, crystalloids having a SID greater than plasma bicarbonate concentration (HCO 3 – ) cause an increase in plasma pH (alkalosis), those having a SID lower than HCO 3 – cause a decrease in plasma pH (acidosis), while crystalloids with a SID equal to HCO 3 – leave pH unchanged, regardless of the extent of the dilution. Colloids and blood components are composed of a crystalloid solution as solvent, and the abovementioned rules partially hold true also for these fluids. The scenario is however complicated by the possible presence of weak anions (albumin, phosphates and gelatins) and their effect on plasma pH. The present manuscript summarises the characteristics of crystalloids, colloids, buffer solutions and blood components and reviews their effect on acid-base equilibrium. Understanding the composition of intravenous fluids, along with the application of simple physicochemical rules best described by Stewart’s approach, are pivotal steps to fully elucidate and predict alterations of plasma acid-base equilibrium induced by fluid therapy.
Published: 2014

49. Lung stress and strain during mechanical ventilation: any difference between statics and dynamics?

Author: M Monti, Emiliano Votta, Luciano Gattinoni, Alessandro Protti, Alessandro Santini, O. Leopardi, Stefano Gatti, Luciano Lombardi, Serge Masson, Thomas Langer, Cristina Carin Sparacino, Davide T. Andreis, Massimo Cressoni, Protti, A, Andreis, D, Monti, M, Santini, A, Sparacino, C, Langer, T, Votta, E, Gatti, S, Lombardi, L, Leopardi, O, Masson, S, Cressoni, M, and Gattinoni, L
Subjects: Swine, medicine.medical_treatment, Acute Lung Injury, experimental model, Pulmonary Edema, Critical Care and Intensive Care Medicine, Stress (mechanics), Stress, Physiological, medicine, Tidal Volume, Animals, Statics, Tidal volume, Positive end-expiratory pressure, Mechanical ventilation, Lung, business.industry, Pulmonary Gas Exchange, Stress–strain curve, Hemodynamics, Mechanics, Respiration, Artificial, Radiography, Disease Models, Animal, medicine.anatomical_structure, Ventilator-induced lung injury: Respiratory failure, Anesthesia, Respiratory Mechanics, business, Transpulmonary pressure
Abstract: OBJECTIVE: Tidal volume (VT) and volume of gas caused by positive end-expiratory pressure (VPEEP) generate dynamic and static lung strains, respectively. Our aim was to clarify whether different combinations of dynamic and static strains, resulting in the same large global strain, constantly produce lung edema. DESIGN:: Laboratory investigation. SETTING: Animal unit. SUBJECTS:: Twenty-eight healthy pigs. INTERVENTIONS: After lung computed tomography, 20 animals were ventilated for 54 hrs at a global strain of 2.5, either entirely dynamic (VT 100% and VPEEP 0%), partly dynamic and partly static (VT 75-50%and VPEEP 25-50%), or mainly static (VT 25% and VPEEP 75%) and then killed. In eight other pigs (VT 25% and VPEEP 75%), VPEEP was abruptly zeroed after 36-54 hrs and ventilation continued for 3 hrs. MEASUREMENTS AND MAIN RESULTS: Edema was diagnosed when final lung weight (balance) exceeded the initial weight (computed tomography). Mortality, lung mechanics, gas exchange, pulmonary histology, and inflammation were evaluated. All animals ventilated with entirely dynamic strain (VT 825 ± 424 mL) developed pulmonary edema (lung weight from 334 ± 38 to 658 ± 99 g, p < 0.01), whereas none of those ventilated with mainly static strain (VT 237 ± 21 mL and VPEEP 906 ± 114 mL, corresponding to 19 ± 1 cm H2O of positive end-expiratory pressure) did (from 314 ± 55 to 277 ± 46 g, p = 0.65). Animals ventilated with intermediate combinations finally had normal or largely increased lung weight. Smaller dynamic and larger static strains lowered mortality (p < 0.01), derangement of lung mechanics (p < 0.01), and arterial oxygenation (p < 0.01), histological injury score (p = 0.03), and bronchoalveolar interleukin-6 concentration (p < 0.01). Removal of positive end-expiratory pressure did not result in abrupt increase in lung weight (from 336 ± 36 to 351 ± 77 g, p = 0.51). CONCLUSIONS Lung edema forms (possibly as an all-or-none response) depending not only on global strain but also on its components. Large static are less harmful than large dynamic strains, but not because the former merely counteracts fluid extravasation
Published: 2013

50. Pressure-guided positioning of bicaval dual-lumen catheters for venovenous extracorporeal gas exchange

Author: Thomas Langer, Andriy I. Batchinsky, Vittoria Vecchi, Leopoldo C. Cancio, Luciano Gattinoni, Slava Belenkiy, Langer, T, Vecchi, V, Belenkiy, S, Cancio, L, Gattinoni, L, and Batchinsky, A
Subjects: medicine.medical_specialty, Cardiac Catheterization, Catheterization, Central Venous, Catheters, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Extracorporeal, Extracorporeal Membrane Oxygenation, Jugular vein, Extracorporeal membrane oxygenation, Medicine, Fluoroscopy, Animals, Experimental model, Tricuspid valve, Sheep, medicine.diagnostic_test, Acute respiratory distress syndrome, business.industry, Surgery, Catheter, medicine.anatomical_structure, Ventricle, Catheterization, Swan-Ganz, cardiovascular system, Venae cavae, Jugular Veins, ECMO, business
Abstract: PURPOSE: Bicaval dual-lumen catheters allow for single-site cannulation venovenous extracorporeal gas exchange and facilitate early mobilization of patients. Using these catheters blood is drained from the superior and inferior venae cavae, pumped through a respiratory membrane, and returned into the right atrium. The insertion of these catheters is challenging as their correct positioning is fundamental to reduce recirculation and avoid severe complications. We describe here a new technique for the positioning of bicaval dual-lumen catheters. MATERIALS AND METHODS: The right internal jugular vein was percutaneously cannulated in nine sheep. The distance between skin and tricuspid valve was measured from the point of pressure change in the waveform of a Swan-Ganz catheter being retracted from the right ventricle into the right atrium. The atrium-tricuspid valve-ventricle axis was determined by observing the fluctuations of the tip of the Swan-Ganz entering the ventricle during fluoroscopy. A bicaval dual-lumen catheter was placed on the basis of these evaluations and connected to an extracorporeal respiratory support system. RESULTS: The position of the catheter was verified at necropsy approximately 18 h after insertion. In all cases the catheter was correctly placed, with the central port situated in front of the tricuspid valve. CONCLUSIONS: The described technique may help to position bicaval dual-lumen catheters for venovenous extracorporeal gas exchange without the use of transesophageal echocardiography or contrast media during fluoroscopy
Published: 2013

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