117 results on '"Amato, MB"'
Search Results
2. Open Lung Approach for the Acute Respiratory Distress Syndrome: A Pilot, Randomized Controlled Trial
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Kacmarek RM, Villar J, Sulemanji D, Montiel R, Ferrando C, Blanco J, Koh Y, Soler JA, Martínez D, Hernández M, Tucci M, Borges JB, Lubillo S, Santos A, Araujo JB, Amato MB, Suárez-Sipmann F, and Open Lung Approach Network
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- 2016
3. Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): study protocol for a randomized controlled trial
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Cavalcanti, AB, Berwanger, O, Suzumura, ÉA, Amato, MB, Tallo, FS, Rezende, AC, Telles, MM, Romano, E, Guimarães, HP, Regenga, MM, Takahashi, LN, Oliveira, RP, Carvalho, VO, Díaz Quijano, FA, Carvalho, CR, Kodama, AA, Ribeiro, GF, Abreu, MO, Oliveira, IM, Guyatt, G, Ferguson, N, Walter, S, Vasconcelos, MO, Segundo, VJ, Ferraz, ÍL, Silva, RS, de Oliveira Filho, W, Silva, NB, Heirel, C, Takatani, RR, Neto, JA, Neto, JC, Almeida, SD, Chamy, G, Neto, GJ, Dias, AP, Silva, RR, Tavares, RC, Souza, ML, Decio, JC, Lima, CM, Neto, FF, Oliveira, KR, Dias, PP, Brandão, AL, Ramos, JE Jr, Vasconcelos, PT, Flôres, DG, Filho, GR, Andrade, IG, Martinez, A, França, GG, Monteiro, LL, Correia, EI, Ribeiro, W, Pereira, AJ, Andrade, W, Leite, PA, Feto, JE, Holanda, MA, Amorim, FF, Margalho, SB, Domingues, SM Jr, Ferreira, CS, Ferreira, CM, Rabelo, LA, Duarte, JN, Lima, FB, Kawaguchi, IA, Maia, MO, Correa, FG, Ribeiro, RA, Caser, E, Moreira, CL, Marcilino, A, Falcão, JG, Jesus, KR, Tcherniakovisk, L, Dutra, VG, Thompson, MM, Piras, C, Giuberti, J. Jr, Silva, AS, Santos, JR, Potratz, JL, Paula, LN, Bozi, GG, Gomes, BC, Vassallo, PF, Rocha, E, Lima, MH, Ferreira, A. F, Gonçalves, F, Pereira, SA, Nobrega, MS, Caixeta, CR, Moraes, AP, Carvalho, AG, Alves, JD, Carvalho, FB, Moreira, FB, Starling, CM, Couto, WA, Bitencourt, WS, Silva, SG, Felizardo, LR, Nascimento, FJ, Santos, D, Zanta, CC, Martins, MF, Naves, SA, Silva, FD, Laube, G. Jr, Galvão, EL, Sousa, MF, Souza, MM, Carvalho, FL, Bergo, RR, Rezende, CM, Tamazato, EY, Sarat, SC Jr, Almeida, PS, Gorski, AG, Matsui, M, Neto, EE, Nomoto, SH, Lima, ZB, Inagaki, AS, Gil, FS, Araújo, MF, Oliveira, AE, Correa, TA, Mendonça, A, Reis, H, Carneiro, SR, Rego, LR, Cunha, AF, Barra, WF, Carneiro, M, Batista, RA, Zoghbi, KK, Machado, NJ, Ferreira, R, Apoena, P, Leão, RM, Martins, ER, Oliveira, ME, Odir, I, Kleber, W, Tavares, D, Araújo, ME, Brilhante, YN, Tavares, DC, Carvalho, WL, Winveler, GF, Filho, AC, Cavalcanti, RA, Grion, CM, Reis, AT, Festti, J, Gimenez, FM, Larangeira, AS, Cardoso, LT, Mezzaroba, TS, Kauss, IA, Duarte, PA, Tozo, TC, Peliser, P, Germano, A, Gurgel, SJ, Silva, SR, Kuroda, CM, Herek, A, Yamada, SS, Schiavetto, PM, Wysocki, N, Matsubara, RR, Sales, JA Jr, Laprovita, MP, Pena, FM, Sá, A, Vianna, A, Verdeal, JC, Martins, GA, Salgado, DR, Coelho, AM, Coelho, M, Morong, AS, Poquiriqui, RM, Ferreira, AP, Lucena, DN, Marino, NF, Moreira, MA, Uratani, CC, Severino, MA, Silva, PN, Medeiros, LG, Filho, FG, Guimarães, DM, Rezende, VM, Carbonell, RC, Trindade, RS, Pellegrini, JA, Boniatti, MM, Santos, MC, Boldo, R, Oliveira, VM, Corrêa, VM, Nedel, W, Teixeira, C, Schaich, F, Tagliari, L, Savi, A, Schulz, LF, Maccari, JG, Seeger, GM, Foernges, RB, Rieder, MM, Becker, DA, Broilo, FP, Schwarz, P, Alencastro, A, Berto, P, Backes, F, Dias, FS, Blattner, C, Martins, ET, Scaglia, NC, Vieira, SR, Prado, KF, Fialkow, L, Franke, C, Vieira, DF, Moraes, RB, Marques, LS, Hopf, JL, Wawrzeniak, IC, Rech, TH, Albuquerque, RB, Guerreiro, MO, Teixeira, LO, Macedo, PL, Bainy, MP, Ferreira, EV, Martins, MA, Andrade, LA, Machado, FO, Burigo, AC, Pincelli, M, Kretzer, L, Maia, IS, Cordeiro, RB, Westphal, G, Cramer, AS, Dadam, MM, Barbosa, PO, Caldeira, M, Brilenger, CO, Horner, MB, Oliveira, GL, Germiniani, BC, Duarte, R, Assef, MG, Rosso, D, Bigolin, R, Vanzuita, R, Prado, LF, Oliveira, V, Reis, DL, Morais, MO, Bastos, RS, Santana, HS, Silva, AO, Cacau, LA, Almeida, MS, Canavessi, HS, Nogueira, EE, Pavia, CL, Araujo, JF, Lira, JA, Nienstedt, EC, Smith, TC, Romano, M, Barros D, Costa, AF, Takahashi, L, Werneck, V, Farran, J, Henriques, LA, Miura, C, Lopes, RD, Vendrame, LS, Sandri, P, Galassi, MS, Amato, P, Toufen, C. Jr, Santiago, RR, Hirota, AS, Park, M, Azevedo, LC, Malbouison, LM, Costa, MC, Taniguchi, L, Pompílio, CE, Baruzzi, C, Andrade, AH, Taira, EE, Taino, B, Oliveira, CS, Silva, AC, Ísola, A, Rezende, E, Rodrigues, RG, Rangel, VP, Luzzi, S, Giacomassi, IW, Nassar, AP Jr, Souza, AR, Rahal, L, Nunes, AL, Giannini, F, Menescal, B, Morais, JE, Toledo, D, Morsch, RD, Merluzzi, T, Amorim, DS, Bastos, AC, Santos, PL, Silva, SF, Gallego, RC, Santos, GD, Tucci, M, Costa, RT, Santos, LS, Demarzo, SE, Schettino, GP, Suzuki, VC, Patrocinio, AC, Martins, ML, Passos, DB, Cappi, SB, Gonçalves, I. Jr, Borges, MC, Lovato, W, Tavares, MV, Morales, D, Machado, LA, Torres, FC, Gomes, TM, Cerantola, RB, Góis, A, Marraccini, T, Margarida, K, Cavalcante, E, Machado, FR, Mazza, BF, Santana, HB, Mendez, VM, Xavier, PA, Rabelo, MV, Schievano, FR, Pinto, WA, Francisco, RS, Ferreira, EM, Silva, DC, Arduini, RG, Aldrighi, JR, Amaro, AF, Conde, KA, Pereira, CA, Tarkieltaub, E, Oliver, WR, Guadalupe, EG, Acerbi, PS, Tomizuka, CI, Oliveira, TA, Geha, NN, Mecatti, GC, Piovesan, MZ, Salomão, MC, Moreno, MS, Orsatti, VN, Miranda, W, Ray, A, Guerra, A, Filho, ML, Ferreira, FH Jr, Filho, EV, Canzi, RA, Giuberti, AF, Garcez, MC, Sala, AD, Suguitani, EO, Kazue, P, Oliveira, LR, Infantini, RM, Carvalho, FR, Andrade, LC, Santos, TM, Carmona, CV, Figueiredo, LC, Falcão, A, Dragosavak, D, Filho, WN, Lunardi, MC, Lago, R, Gatti, C, Chiasso, TM, Santos, GO, Araujo, AC, Ornellas, IB, Vieira, VM, Hajjar, LA, Figueiredo, AC, Damasceno, B, Hinestrosa, A, Diaz Quijano, FA, CORTEGIANI, Andrea, RAINERI, Santi Maurizio, Cavalcanti, AB, Berwanger, O, Suzumura, ÉA, Amato, MB, Tallo, FS, Rezende, AC, Telles, MM, Romano, E, Guimarães, HP, Regenga, MM, Takahashi, LN, Oliveira, RP, Carvalho, VO, Díaz-Quijano, FA, Carvalho, CR, Kodama, AA, Ribeiro, GF, Abreu, MO, Oliveira, IM, Guyatt, G, Ferguson, N, Walter, S, Vasconcelos, MO, Segundo, VJ, Ferraz, ÍL, Silva, RS, de Oliveira Filho, W, Silva, NB, Heirel, C, Takatani, RR, Neto, JA, Neto, JC, Almeida, SD, Chamy, G, Neto, GJ, Dias, AP, Silva, RR, Tavares, RC, Souza, ML, Decio, JC, Lima, CM, Neto, FF, Oliveira, KR, Dias, PP, Brandão, AL, Ramos, JE Jr, Vasconcelos, PT, Flôres, DG, Filho, GR, Andrade, IG, Martinez, A, França, GG, Monteiro, LL, Correia, EI, Ribeiro, W, Pereira, AJ, Andrade, W, Leite, PA, Feto, JE, Holanda, MA, Amorim, FF, Margalho, SB, Domingues, SM Jr, Ferreira, CS, Ferreira, CM, Rabelo, LA, Duarte, JN, Lima, FB, Kawaguchi, IA, Maia, MO, Correa, FG, Ribeiro, RA, Caser, E, Moreira, CL, Marcilino, A, Falcão, JG, Jesus, KR, Tcherniakovisk, L, Dutra, VG, Thompson, MM, Piras, C, Giuberti, J Jr, Silva, AS, Santos, JR, Potratz, JL, Paula, LN, Bozi, GG, Gomes, BC, Vassallo, PF, Rocha, E, Lima, MH, Ferreira, A F, Gonçalves, F, Pereira, SA, Nobrega, MS, Caixeta, CR, Moraes, AP, Carvalho, AG, Alves, JD, Carvalho, FB, Moreira, FB, Starling, CM, Couto, WA, Bitencourt, WS, Silva, SG, Felizardo, LR, Nascimento, FJ, Santos, D, Zanta, CC, Martins, MF, Naves, SA, Silva, FD, Laube, G Jr, Galvão, EL, Sousa, MF, Souza, MM, Carvalho, FL, Bergo, RR, Rezende, CM, Tamazato, EY, Sarat, SC Jr, Almeida, PS, Gorski, AG, Matsui, M, Neto, EE, Nomoto, SH, Lima, ZB, Inagaki, AS, Gil, FS, Araújo, MF, Oliveira, AE, Correa, TA, Mendonça, A, Reis, H, Carneiro, SR, Rego, LR, Cunha, AF, Barra, WF, Carneiro, M, Batista, RA, Zoghbi, KK, Machado, NJ, Ferreira, R, Apoena, P, Leão, RM, Martins, ER, Oliveira, ME, Odir, I, Kleber, W, Tavares, D, Araújo, ME, Brilhante, YN, Tavares, DC, Carvalho, WL, Winveler, GF, Filho, AC, Cavalcanti, RA, Grion, CM, Reis, AT, Festti, J, Gimenez, FM, Larangeira, AS, Cardoso, LT, Mezzaroba, TS, Kauss, IA, Duarte, PA, Tozo, TC, Peliser, P, Germano, A, Gurgel, SJ, Silva, SR, Kuroda, CM, Herek, A, Yamada, SS, Schiavetto, PM, Wysocki, N, Matsubara, RR, Sales, JA Jr, Laprovita, MP, Pena, FM, Sá, A, Vianna, A, Verdeal, JC, Martins, GA, Salgado, DR, Coelho, AM, Coelho, M, Morong, AS, Poquiriqui, RM, Ferreira, AP, Lucena, DN, Marino, NF, Moreira, MA, Uratani, CC, Severino, MA, Silva, PN, Medeiros, LG, Filho, FG, Guimarães, DM, Rezende, VM, Carbonell, RC, Trindade, RS, Pellegrini, JA, Boniatti, MM, Santos, MC, Boldo, R, Oliveira, VM, Corrêa, VM, Nedel, W, Teixeira, C, Schaich, F, Tagliari, L, Savi, A, Schulz, LF, Maccari, JG, Seeger, GM, Foernges, RB, Rieder, MM, Becker, DA, Broilo, FP, Schwarz, P, Alencastro, A, Berto, P, Backes, F, Dias, FS, Blattner, C, Martins, ET, Scaglia, NC, Vieira, SR, Prado, KF, Fialkow, L, Franke, C, Vieira, DF, Moraes, RB, Marques, LS, Hopf, JL, Wawrzeniak, IC, Rech, TH, Albuquerque, RB, Guerreiro, MO, Teixeira, LO, Macedo, PL, Bainy, MP, Ferreira, EV, Martins, MA, Andrade, LA, Machado, FO, Burigo, AC, Pincelli, M, Kretzer, L, Maia, IS, Cordeiro, RB, Westphal, G, Cramer, AS, Dadam, MM, Barbosa, PO, Caldeira, M, Brilenger, CO, Horner, MB, Oliveira, GL, Germiniani, BC, Duarte, R, Assef, MG, Rosso, D, Bigolin, R, Vanzuita, R, Prado, LF, Oliveira, V, Reis, DL, Morais, MO, Bastos, RS, Santana, HS, Silva, AO, Cacau, LA, Almeida, MS, Canavessi, HS, Nogueira, EE, Pavia, CL, Araujo, JF, Lira, JA, Nienstedt, EC, Smith, TC, Romano, M, Barros D, Costa, AF, Takahashi, L, Werneck, V, Farran, J, Henriques, LA, Miura, C, Lopes, RD, Vendrame, LS, Sandri, P, Galassi, MS, Amato, P, Toufen, C Jr, Santiago, RR, Hirota, AS, Park, M, Azevedo, LC, Malbouison, LM, Costa, MC, Taniguchi, L, Pompílio, CE, Baruzzi, C, Andrade, AH, Taira, EE, Taino, B, Oliveira, CS, Silva, AC, Ísola, A, Rezende, E, Rodrigues, RG, Rangel, VP, Luzzi, S, Giacomassi, IW, Nassar, AP Jr, Souza, AR, Rahal, L, Nunes, AL, Giannini, F, Menescal, B, Morais, JE, Toledo, D, Morsch, RD, Merluzzi, T, Amorim, DS, Bastos, AC, Santos, PL, Silva, SF, Gallego, RC, Santos, GD, Tucci, M, Costa, RT, Santos, LS, Demarzo, SE, Schettino, GP, Suzuki, VC, Patrocinio, AC, Martins, ML, Passos, DB, Cappi, SB, Gonçalves, I Jr, Borges, MC, Lovato, W, Tavares, MV, Morales, D, Machado, LA, Torres, FC, Gomes, TM, Cerantola, RB, Góis, A, Marraccini, T, Margarida, K, Cavalcante, E, Machado, FR, Mazza, BF, Santana, HB, Mendez, VM, Xavier, PA, Rabelo, MV, Schievano, FR, Pinto, WA, Francisco, RS, Ferreira, EM, Silva, DC, Arduini, RG, Aldrighi, JR, Amaro, AF, Conde, KA, Pereira, CA, Tarkieltaub, E, Oliver, WR, Guadalupe, EG, Acerbi, PS, Tomizuka, CI, Oliveira, TA, Geha, NN, Mecatti, GC, Piovesan, MZ, Salomão, MC, Moreno, MS, Orsatti, VN, Miranda, W, Ray, A, Guerra, A, Filho, ML, Ferreira, FH Jr, Filho, EV, Canzi, RA, Giuberti, AF, Garcez, MC, Sala, AD, Suguitani, EO, Kazue, P, Oliveira, LR, Infantini, RM, Carvalho, FR, Andrade, LC, Santos, TM, Carmona, CV, Figueiredo, LC, Falcão, A, Dragosavak, D, Filho, WN, Lunardi, MC, Lago, R, Gatti, C, Chiasso, TM, Santos, GO, Araujo, AC, Ornellas, IB, Vieira, VM, Hajjar, LA, Figueiredo, AC, Damasceno, B, Hinestrosa, A, Diaz-Quijano, FA, Raineri, SM, and Cortegiani, A
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Research design ,ARDS ,medicine.medical_specialty ,Time Factors ,Ventilator-Induced Lung Injury ,Alveolar recruitment ,Treatment outcome ,Randomized ,Medicine (miscellaneous) ,Settore MED/41 - Anestesiologia ,Hospital mortality ,law.invention ,Positive-Pressure Respiration ,Study Protocol ,Mechanical ventilation ,Clinical trials ,Randomized controlled trial ,Clinical Protocols ,law ,Medicine ,Humans ,Pharmacology (medical) ,Hospital Mortality ,PEEP ,Protocol (science) ,Respiratory Distress Syndrome ,Acute respiratory distress syndrome ,business.industry ,respiratory system ,Length of Stay ,medicine.disease ,Clinical trial ,Pulmonary Alveoli ,Intensive Care Units ,Treatment Outcome ,Multicenter study ,Barotrauma ,Research Design ,Physical therapy ,business ,Brazil - Abstract
Background Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH2O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure ≤30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method. Trial registration ClinicalTrials.gov Identifier: NCT01374022
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- 2012
4. ESICM LIVES 2016: part two : Milan, Italy. 1-5 October 2016
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Sivakumar, S, Taccone, FS, Desai, KA, Lazaridis, C, Skarzynski, M, Sekhon, M, Henderson, W, Griesdale, D, Chapple, L, Deane, A, Williams, L, Ilia, S, Henderson, A, Hugill, K, Howard, P, Roy, A, Bonner, S, Monteiro, E, Baudouin, S, Ramírez, CS, Escalada, SH, Banaszewski, M, Sertedaki, A, Kaymak, Ç, Viera, MA, Santana, MC, Balcázar, LC, Monroy, NS, Campelo, FA, Vázquez, CF, Santana, PS, Cerejo, A, Santana, SR, Charmadari, E, Carteron, L, Kovach, L, Patet, C, Quintard, H, Solari, D, Bouzat, P, Oddo, M, Wollersheim, T, Malleike, J, Haas, K, Stratakis, CA, Rocha, AP, Carbon, N, Şencan, I, Schneider, J, Birchmeier, C, Fielitz, J, Spuler, S, Weber-Carstens, S, Enseñat, L, Pérez-Madrigal, A, Briassouli, E, Saludes, P, Proença, L, Elsayed, AA, Meço, B, Gruartmoner, G, Espinal, C, Mesquida, J, Huber, W, Eckmann, M, Elkmann, F, Goukos, D, Gruber, A, Lahmer, T, Mayr, U, Herner, A, Özçelik, M, Abougabal, AM, Schellnegger, R, Schmid, RM, Ayoub, W, Psarra, K, Samy, W, Esmat, A, Battah, A, Mukhtar, S, Mongkolpun, W, Ünal, N, Cortés, DO, Beshey, BN, Cordeiro, CP, Vincent, JL, Leite, MA, Creteur, J, Funcke, S, Groesdonk, H, Saugel, B, Wagenpfeil, G, Wagenpfeil, S, Reuter, DA, Fernandez, MM, Alzahaby, KM, Botoula, E, Fernandez, R, Magret, M, González-Castro, A, Bouza, MT, Ibañez, M, García, C, Balerdi, B, Jenni-Moser, B, Mas, A, Arauzo, V, Tsagarakis, S, Añón, JM, Pozzebon, S, Ruiz, F, Ferreres, J, Tomás, R, Alabert, M, Tizón, AI, Altaba, S, Jeitziner, MM, Llamas, N, Haroon, BA, Edul, VS, Goligher, EC, Fan, E, Herridge, M, Ortiz, AB, Vorona, S, Sklar, M, Dres, M, Rittayamai, N, Lanys, A, Schreiber, J, Mageira, E, Urrea, C, Tomlinson, G, Reid, WD, Rubenfeld, GD, Kavanagh, BP, Cristallini, S, Brochard, LJ, Ferguson, ND, Neto, AS, De Abreu, MG, Routsi, C, Imiela, J, Galassi, MS, Pelosi, P, Schultz, MJ, PRoVENT investigators and the PROVE Network, Guérin, C, Papazian, L, Reignier, J, Lheureux, O, Ayzac, L, Nanas, S, Loundou, A, Forel, JM, Sales, FL, Rolland-Debord, C, Bureau, C, Poitou, T, Clavel, M, Perbet, S, Terzi, N, Kouatchet, A, Briassoulis, G, Brasseur, A, Similowski, T, Demoule, A, De Moraes, KC, Hunfeld, N, Trogrlic, Z, Ladage, S, Osse, RJ, Koch, B, Rietdijk, W, Boscolo, A, Devlin, J, Van der Jagt, M, Picetti, E, Batista, CL, Ceccarelli, P, Mensi, F, Malchiodi, L, Risolo, S, Rossi, I, Bertini, D, Antonini, MV, Servadei, F, Caspani, ML, Roquilly, A, Júnior, JA, Lasocki, S, Seguin, P, Geeraerts, T, Perrigault, PF, Campello, E, Dahyot-Fizelier, C, Paugam-Burtz, C, Cook, F, Cinotti, R, Dit Latte, DD, Mahe, PJ, Marcari, TB, Fortuit, C, Feuillet, F, Lucchetta, V, Asehnoune, K, Marzorati, C, Spina, S, Scaravilli, V, Vargiolu, A, Riva, M, Giussani, C, Lobato, R, Sganzerla, E, Hravnak, M, Osaku, EF, Citerio, G, Barbadillo, S, De Molina, FJ, Álvarez-Lerma, F, Rodríguez, A, SEMICYUC/GETGAG Working Group, Zakharkina, T, Martin-Loeches, I, Castro, CS, Matamoros, S, Fuhrmann, V, Piasentini, E, Povoa, P, Yousef, K, Torres, A, Kastelijn, J, Hofstra, JJ, De Jong, M, Schultz, M, Sterk, P, Artigas, A, De Souza, LM, Aktepe, O, Bos, LJ, Moreau, AS, Chang, Y, Salluh, J, Rodriguez, A, Nseir, S, TAVeM study group, De Jong, E, Fildisis, G, Rodrigues, FF, Van Oers, JA, Beishuizen, A, Girbes, AR, Nijsten, MW, Crago, E, De Lange, DW, Bonvicini, D, Labate, D, Benacchio, L, Radu, CM, Olivieri, A, Stepinska, J, Wruck, ML, Pizzirani, E, Lopez-Delgado, JC, Gonzalez-Romero, M, Fuentes-Mila, V, Berbel-Franco, D, Friedlander, RM, Romera-Peregrina, I, Manesso, L, Martinez-Pascual, A, Perez-Sanchez, J, Abellan-Lencina, R, Correa, NG, Ávila-Espinoza, RE, Moreno-Gonzalez, G, Sbraga, F, Griffiths, S, Grocott, MP, Creagh-Brown, B, Simioni, P, Abdelmonem, SA, POPC-CB investigators, Doyle, J, Wilkerson, P, Pelegrini, AM, Soon, Y, Huddart, S, Dickinson, M, Riga, A, Zuleika, A, Ori, C, Miyamoto, K, Kawazoe, Y, Tahon, SA, Morimoto, T, Yamamoto, T, Eid, RA, Fuke, A, Hashimoto, A, Koami, H, Beppu, S, Su, H, Katayama, Y, Ito, M, Ohta, Y, Yamamura, H, Helmy, TA, DESIRE (DExmedetomidine for Sepsis in ICU Randomized Evaluation) Trial Investigators, Timenetsky, KT, Rygård, SL, Holst, LB, Wetterslev, J, Lam, YM, Johansson, PI, Perner, A, Soliman, IW, Van Dijk, D, Van Delden, JJ, Meligy, HS, Cazati, D, Cremer, OL, Slooter, AJ, Willis, K, Peelen, LM, McWilliams, D, Snelson, C, Neves, AD, Loudet, CI, Busico, M, Vazquez, D, Villalba, D, Lobato, M, Puig, F, Kott, M, Pullar, V, Veronesi, M, Lischinsky, A, López, FJ, Mori, LB, Plotnikow, G, Díaz, A, Giannasi, S, Hernandez, R, Krzisnik, L, Diniz, PS, Hubner, RP, Cecotti, C, Dunn-Siegrist, I, Viola, L, Lopez, R, Sottile, JP, Benavent, G, Estenssoro, E, Chen, CM, Lai, CC, Cheng, KC, Costa, CR, Rocha, LL, Chou, W, Chan, KS, Pugin, J, Roeker, LE, Horkan, CM, Gibbons, FK, Christopher, KB, Weijs, PJ, Mogensen, KM, Furche, M, Rawn, JD, Cavalheiro, AM, Robinson, MK, Tang, Z, Gupta, S, Qiu, C, Ouyang, B, Cai, C, Guan, X, Tsang, JL, Regueira, T, Cea, L, Topeli, A, Lucinio, NM, Carlos, SJ, Elisa, B, Puebla, C, Vargas, A, Govil, D, Poulsen, MK, De Guadiana-Romualdo, LG, Thomsen, LP, Kjærgaard, S, Rees, SE, Karbing, DS, Schwedhelm, E, Frank, S, Müller, MC, Carbon, NM, Skrypnikov, V, Rebollo-Acebes, S, Srinivasan, S, Pickerodt, PA, Falk, R, Mahlau, A, Santos, ER, Lee, A, Inglis, R, Morgan, R, Barker, G, Esteban-Torrella, P, Kamata, K, Abe, T, Patel, SJ, Saitoh, D, Tokuda, Y, Green, RS, Norrenberg, M, Butler, MB, Erdogan, M, Hwa, HT, Jiménez-Sánchez, R, Gil, LJ, Vaquero, RH, Rodriguez-Ruiz, E, Lago, AL, N, JK, Allut, JL, Gestal, AE, Gleize, A, Gonzalez, MA, Thomas-Rüddel, DO, Jiménez-Santos, E, Schwarzkopf, D, Fleischmann, C, Reinhart, K, Suwanpasu, S, Sattayasomboon, Y, Filho, NM, Gupta, A, Oliveira, JC, Preiser, JC, Ballalai, CS, Zitta, K, Ortín-Freire, A, De Lucia, CV, Araponga, GP, Veiga, LN, Silva, CS, Garrido, ME, Ramos, BB, Ricaldi, EF, Gomes, SS, Tomar, DS, Simón, IF, Hernando-Holgado, A, GEMINI, Gemmell, L, MacKay, A, Wright, C, Docking, RI, Doherty, P, Black, E, Stenhouse, P, Plummer, MP, Finnis, ME, Albaladejo-Otón, MD, Carmona, SA, Shafi, M, Phillips, LK, Kar, P, Bihari, S, Biradar, V, Moodie, S, Horowitz, M, Shaw, JE, Deane, AM, Coelho, L, Yatabe, T, Valhonrat, IL, Inoue, S, Harne, R, Sakaguchi, M, Egi, M, Abdelhamid, YA, Motta, MF, Domínguez, JP, Arora, DP, Hokka, M, Pattinson, KT, Mizobuchi, S, Pérez, AG, Abellán, AN, Plummer, M, Giersch, E, Talwar, N, Summers, M, Pelenz, M, Hatzinikolas, S, Heller, S, Chapman, M, Jones, K, Almudévar, PM, Schweizer, R, Jacquet-Lagreze, M, Portran, P, Rabello, L, Mazumdar, S, Junot, S, Allaouchiche, B, Fellahi, JL, Guerci, P, Ergin, B, Lange, K, Kapucu, A, Ince, C, Cioccari, L, Luethi, N, Crisman, M, Papakrivou, EE, Bellomo, R, Mårtensson, J, Shinotsuka, CR, Fagnoul, D, Kluge, S, Orbegozo, D, Makris, D, Thooft, A, Brimioulle, S, Dávila, F, Iwasaka, H, Brandt, B, Tahara, S, Nagamine, M, Ichigatani, A, Cabrera, AR, Zepeda, EM, Granillo, JF, Manoulakas, E, Sánchez, JS, Montoya, AA, Rubio, JJ, Montenegro, AP, Blanco, GA, Robles, CM, Drolz, A, Horvatits, T, Roedl, K, Rutter, K, Tsolaki, B, Funk, GC, Póvoa, P, Ramos, AJ, Schneeweiss, B, Sabetian, G, Pooresmaeel, F, Zand, F, Ghaffaripour, S, Farbod, A, Tabei, H, Taheri, L, TAVeM study Group, Karadodas, B, Reina, Á, Anandanadesan, R, Metaxa, V, Teixeira, C, Pereira, SM, Hernández-Marrero, P, Carvalho, AS, Beckmann, M, Hartog, CS, Varis, E, Raadts, A, López, NP, Zakynthinos, E, Robertsen, A, Førde, R, Skaga, NO, Helseth, E, Honeybul, S, Ho, K, Vazquez, AR, Lopez, PM, Gonzalez, MN, Ortega, PN, Pérez, MA, Sola, EC, Garcia, IP, Spasova, T, De la Torre-Prados, MV, Kopecky, O, Rusinova, K, Pettilä, V, Waldauf, P, Cepeplikova, Z, Balik, M, Ordoñez, PF, Apolo, DX, Almudevar, PM, Martin, AD, Muñoz, JJ, Poukkanen, M, Castañeda, DP, Villamizar, PR, Ramos, JV, Pérez, LP, Lucendo, AP, Villén, LM, Ejarque, MC, Estella, A, Camps, VL, Neitzke, NM, Encinares, VS, Martín, MC, Masnou, N, Bioethics work group of SEMICYUC, Barbosa, S, Varela, A, Palma, I, López, FM, Cristina, L, Nunes, E, Jacob, S, Pereira, I, Campello, G, Ibañez, MP, Granja, C, Pande, R, Pandey, M, Varghese, S, Chanu, M, García, IP, Van Dam, MJ, Schildhauer, C, Karlsson, S, Ter Braak, EW, Gracia, M, Viciana, R, Montero, JG, Recuerda, M, Fontaiña, LP, Tharmalingam, B, Kovari, F, Zöllner, C, Rose, L, Mcginlay, M, Amin, R, Burns, K, Connolly, B, Hart, N, Labrador, G, Jouvet, P, Katz, S, Leasa, D, Takala, J, Izurieta, JR, Mawdsley, C, Mcauley, D, Blackwood, B, Denham, S, Worrall, R, Arshad, M, Cangueiro, TC, Isherwood, P, Wilkman, E, Khadjibaev, A, Guerrero, JJ, Sabirov, D, Rosstalnaya, A, Parpibaev, F, Sharipova, V, Guzman, CI, FINNAKI Study Group, Poulose, V, Renal Transplantation HUVR, Lundberg, OH, Koh, J, Calvert, S, Cha, YS, Lee, SJ, Tyagi, N, Rajput, RK, Birri, PN, Taneja, S, Singh, VK, Sharma, SC, Mittal, S, Quint, M, Kam, JW, Rao, BK, Ayachi, J, Fraj, N, Romdhani, S, Bergenzaun, L, Khedher, A, Meddeb, K, Sma, N, Azouzi, A, Bouneb, R, Giribet, A, Adeniji, K, Chouchene, I, Yeter, H, El Ghardallou, M, Rydén, J, Boussarsar, M, Jennings, R, Walter, E, Ribeiro, JM, Moniz, I, Marçal, R, Santos, AC, Young, R, Candeias, C, E Silva, ZC, Rosenqvist, M, Kara, A, Gomez, SE, Nieto, OR, Gonzalez, JA, Cuellar, AI, Mildh, H, Korhonen, AM, Shevill, DD, Elke, G, Moraes, MM, Ala-Kokko, T, Reinikainen, M, Robertson, E, Garside, P, Tavladaki, T, Isotti, P, De Vecchi, MM, Perduca, AE, Cuervo, MA, Melander, O, Negro, A, Villa, G, Manara, DF, Cabrini, L, Zangrillo, A, Frencken, JF, Spanaki, AM, Van Baal, L, Donker, DW, Chew, MS, Cuervo, RA, Horn, J, Van der Poll, T, Van Klei, WA, Bonten, MJ, Menard, CE, Kumar, A, Dimitriou, H, Rimmer, E, Doucette, S, Esteban, MA, Turgeon, AF, Houston, BL, Houston, DS, Zarychanski, R, Pinto, BB, Carrara, M, Ferrario, M, Bendjelid, K, Kondili, E, Nunes, J, Fraile, LI, Diaz, P, Silva, G, Escórcio, S, Chaves, S, Jardim, M, Fernandes, N, Câmara, M, Duarte, R, Pereira, CA, Choulaki, C, Mittelbrum, CP, Vieira, J, Nóbrega, JJ, De Oca-Sandoval, MA, Sánchez-Rodríguez, A, Joya-Galeana, JG, Correa-Morales, A, Camarena-Alejo, G, Aguirre-Sánchez, J, Franco-Granillo, J, Albaiceta, GM, Meleti, E, Soliman, M, Al Azab, A, El Hossainy, R, Nagy, H, Nirmalan, M, Crippa, IA, Cavicchi, FZ, Koeze, J, Kafetzopoulos, D, Chaari, A, Hakim, KA, Hassanein, H, Etman, M, El Bahr, M, Bousselmi, K, Khalil, ES, Kauts, V, Tsolakoglou, I, Casey, WF, Imahase, H, Georgopoulos, D, Sakamoto, Y, Yamada, KC, Miike, T, Nagashima, F, Iwamura, T, Keus, F, Hummitzsch, L, Kishihara, Y, Heyland, D, Spiezia, L, Dieperink, W, Souza, RB, Yasuda, H, Martins, AM, Liberatore, AM, Kang, YR, Nakamae, MN, La Torre, AG, Vieira, JC, Koh, IH, Hanslin, K, Wilske, F, Van der Horst, IC, Jaskowiak, JL, Skorup, P, Sjölin, J, Lipcsey, M, Long, WJ, Zhen, CE, Vakalos, A, Avramidis, V, Wu, SH, Shyu, LJ, Rebollo, S, Van Meurs, M, Li, CH, Yu, CH, Chen, HC, Wang, CH, Lin, KH, Aray, ZE, Gómez, CF, Tsvetanova-Spasova, T, Tejero, AP, Monge, DD, Zijlstra, JG, Losada, VM, Tarancón, CM, Cortés, SD, Gutiérrez, AM, Álvarez, TP, Rouze, A, Jaffal, K, Six, S, Jimenez, R, Nuevo-Ortega, P, Stolz, K, Roberts, S, Cattoen, V, Arnal, JM, Saoli, M, Novotni, D, Garnero, A, Becher, T, Torrella, PE, Buchholz, V, Schädler, D, Rueda-Molina, C, Caballero, CH, Frerichs, I, Weiler, N, Eronia, N, Mauri, T, Gatti, S, Maffezzini, E, Fernandez, A, Bronco, A, Alban, L, Sasso, T, Marenghi, C, Isgro, G, Fernández-Porcel, A, Grasselli, G, Pesenti, A, Bellani, G, Al-Fares, A, Dubin, A, Del Sorbo, L, Anwar, S, Facchin, F, Azad, S, Zamel, R, Hall, D, Ferguson, N, Camara-Sola, E, Cypel, M, Keshavjee, S, Sanchez, S, Durlinger, E, Spoelstra-de Man, A, Smit, B, De Grooth, HJ, Girbes, A, Beitland, S, Straaten, HO, Smulders, Y, Salido-Díaz, L, Ortin, A, Alfaro, MA, Parrilla, F, Meli, A, Pellegrini, M, Rodriguez, N, Goyeneche, JM, Morán, I, Intas, G, Aguirre, H, Mancebo, J, Bassi, GL, Heines, SJ, García-Alcántara, A, Strauch, U, Bergmans, DC, Blankman, P, Shono, A, Hasan, D, Gommers, D, Trøseid, AM, Chung, WY, Prats, RG, Lee, KS, Jung, YJ, Park, JH, Sheen, SS, Park, KJ, Worral, R, Brusletto, BS, Larraza, S, Dey, N, Spadaro, S, Brohus, JB, Winding, RW, Volta, CA, Silva, MM, Waldum-Grevbo, BE, Ampatzidou, F, Vlachou, A, Kehagioglou, G, Karaiskos, T, Madesis, A, Mauromanolis, C, Michail, N, Drossos, G, Aguilera, E, Saraj, N, Berg, JP, Rijkenberg, S, Feijen, HM, Endeman, H, Donnelly, AA, Morgan, E, Garrard, H, Buckley, H, Russell, L, Marti, D, Haase, N, Sunde, K, Goh, C, Mouyis, K, Woodward, CL, Halliday, J, Encina, GB, Ros, J, Ranzani, OT, Lagunes, L, Tabernero, J, Huertas, DG, Bosch, F, Rello, J, Manzano, F, Morente-Constantin, E, Rivera-Ginés, B, Rigol, M, Colmenero-Ruiz, M, Meleti, DE, Sanz, JG, Dogliotti, A, Simon, IF, Valbuena, BL, Pais, M, Ramalingam, S, Quintana, MM, Díaz, C, Fox, L, Santafe, M, Fernandez, L, Barba, P, García, M, Leal, S, Pérez, M, Pérez, ML, Osuna, A, Ferrer, M, Veganzones, J, Martínez, N, Santiago-Ruiz, F, Moors, I, Mokart, D, Pène, F, Lambert, J, Mayaux, J, Vincent, F, Nyunga, M, Bruneel, F, Stergiannis, P, Laisne, L, Rabbat, A, Lebert, C, Perez, P, Suberviola, B, Chaize, M, Renault, A, Meert, AP, Hamidfar, R, Jourdain, M, Rodríguez-Mejías, C, Lanziotti, VS, Darmon, M, Schlemmer, B, Chevret, S, Lemiale, V, Azoulay, E, Rowland, MJ, Riera, J, Benoit, D, Martins-Branco, D, Sousa, M, Wangensteen, R, Marum, S, Bouw, MJ, Galstyan, G, Makarova, P, Parovichnikova, E, Kuzmina, L, Troitskaya, V, Rellan, L, Drize, N, Zaponi, RS, Gemdzhian, E, Jamaati, HR, Savchenko, V, Chao, HC, Kılıc, E, Demiriz, B, Uygur, ML, Sürücü, M, Cınar, K, Yıldırım, AE, Pulcheri, L, Sanchez, M, Kiss, K, Masjedi, M, Köves, B, Csernus, V, Molnár, Z, Ntantana, A, Matamis, D, Savvidou, S, Giannakou, M, Ribeiro, MO, Gouva, M, Nakos, G, Robles, JC, Koulouras, V, Gaffney, S, Docking, R, Judge, C, Drew, T, Barbosa, AP, Misran, H, Munshi, R, McGovern, L, Coyle, M, Hashemian, SM, Lopez, E, Dunne, L, Deasy, E, Lavin, P, Fahy, A, Antoniades, CA, Ramos, A, Darcy, DM, Donnelly, M, Ismail, NH, Hall, T, Wykes, K, Jack, J, Vicente, R, Ngu, WC, Morgan, P, E Silva, JR, Ruiz-Ramos, J, Ramirez, P, Gordon, M, Villarreal, E, Frasquet, J, Poveda-Andrés, JL, Abbasi, G, Castellanos, A, Ijssennagger, CE, Miñambres, E, Soares, M, Ten Hoorn, S, Van Wijk, A, Van den Broek, JM, Tuinman, PR, Elmenshawy, AM, Hammond, BD, Gibbon, G, Khaloo, V, Belcham, T, Burton, K, Salluh, JI, Taniguchi, LU, Santibañez, M, Ramos, FJ, Momma, AK, Martins-Filho, AP, Bartocci, JJ, Lopes, MF, Sad, MH, Tabei, SH, Rodrigues, CM, Pires, EM, Vieira, JM, Le Guen, M, Murbach, LD, Barreto, J, Duarte, ST, Taba, S, Kolaros, AA, Miglioranza, D, Gund, DP, Lordani, CF, Ogasawara, SM, Moore, J, Jorge, AC, Duarte, PA, Capuzzo, M, Marqués, MG, Kafilzadeh, A, Corte, FD, Terranova, S, Scaramuzzo, G, Fogagnolo, A, Bertacchini, S, Bellonzi, A, Garry, P, Mason, N, Ragazzi, R, Moreno, AP, Bakhodaei, HH, Cruz, C, Nunes, A, Pereira, FS, Aragão, I, Cardoso, AF, Santos, C, Malheiro, MJ, Castro, H, Abentroth, LR, Windpassinger, M, Cardoso, T, Diaz, JA, Paratz, J, Kenardy, J, Comans, 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Perchiazzi, G, Borges, JB, Queen Square Neuroanaesthesia and Neurocritical Care Resreach Group, Bayat, S, Porra, L, Mirek, S, Broche, L, Hedenstierna, G, Larsson, A, Kennedy, RM, Roneus, A, Segelsjö, M, Vestito, MC, Zeman, PM, Gremo, E, Nyberg, A, Castegren, M, Pikwer, A, Sharma, S, Monfort, B, Yoshida, T, Engelberts, D, Otulakowski, G, Katira, B, Post, M, Brochard, L, Amato, MB, Stazi, E, PLUG Working group, Koch, N, Hoellthaler, J, Mair, S, Phillip, V, Van Ewijk, CE, Beitz, A, González, LR, Roig, AL, Baladrón, V, Yugi, G, Calvo, FJ, Padilla, D, Villarejo, P, Villazala, R, Yuste, AS, Bejarano, N, Steenstra, RJ, Jacobs, GE, Banierink, H, Hof, J, Martika, A, Hoekstra, M, Sterz, F, Horvatits, K, Herkner, H, Magnoni, S, Marando, M, Faivre, V, Pifferi, S, Conte, V, Ortolano, F, Alonso, DC, Carbonara, M, Bertani, G, Scola, E, Cadioli, M, Triulzi, F, Colombo, A, Nevière, R, Stocchetti, N, Fatania, G, Hernández-Sánchez, N, Rotzel, HB, Lázaro, AS, Prada, DA, Guimillo, MR, Piqueras, CS, Guia, JR, Simon, MG, Thiébaut, PA, Arizmendi, AM, Carratalá, A, Sánchez, RDEP, El Maraghi, S, Yehia, A, Bakry, M, Shoman, A, Backes, FN, Bianchin, MM, Vieira, SR, Maupoint, J, De Souza, A, Lucas, JH, Backes, AN, Klein, C, García-Guillen, FJ, Arunkumar, AS, Lozano, A, Mulder, P, Gallaher, C, Cattlin, S, Ñamendys-Silva, SA, Gordon, S, Picard, J, Fontana, V, Bond, O, Coquerel, D, Nobile, L, Mrozek, S, Delamarre, L, Maghsoudi, B, Capilla, F, Al-Saati, T, Fourcade, O, Renet, S, Dominguez-Berrot, AM, Gonzalez-Vaquero, M, Vallejo-Pascual, ME, Gupta, D, Ivory, BD, Chopra, M, Emami, M, Khaliq, W, McCarthy, J, Felderhof, CL, Do Rego, JC, MacNeil, C, Maggiorini, M, Duska, F, Department of Professional Development, ESICM, Fumis, RR, Junior, JM, Khosravi, MB, Amarante, G, Rieusset, J, Skorko, A, Sanders, S, Aron, J, Kroll, RJ, Redfearn, C, Harish, MM, Krishnan, P, Khalil, JE, Kongpolprom, N, Richard, V, Gulia, V, Lourenço, E, Duro, C, Baptista, G, Alves, A, Arminda, B, Rodrigues, M, Tamion, F, Tabatabaie, HR, Hayward, J, Baldwin, F, Gray, R, Katinakis, PA, Stijf, M, Ten Kleij, M, Jansen-Frederiks, M, Broek, R, De Bruijne, M, Mengelle, C, Spronk, PE, Sinha, K, Luney, M, Palmer, K, Keating, L, Abu-Habsa, M, Bahl, R, Baskaralingam, N, Ahmad, A, Kanapeckaite, L, Bhatti, P, Strong, AJ, Sabetiyan, G, Glace, S, Jeyabraba, S, Lewis, HF, Kostopoulos, A, Raja, M, West, A, Ely, A, Turkoglu, LM, Zolfaghari, P, Baptista, JP, Mokri, A, Marques, MP, Martins, P, Pimentel, J, Su, YC, Singer, M, Villacres, S, Stone, ME, Parsikia, A, Medar, S, O'Dea, KP, Nurses of the Central and General ICUs of Shiraz Namazi Hospital, Porter, J, Tirlapur, N, Jonathan, JM, Singh, S, Takata, M, Critical Care Research Group, McWhirter, E, Lyon, R, Troubleyn, J, Hariz, ML, Ferlitsch, A, Azmi, E, Alkhan, J, Smulders, YM, Movsisyan, V, Petrikov, S, Marutyan, Z, Aliev, I, Evdokimov, A, Antonucci, E, Diltoer, M, Merz, T, Hartmann, C, De Waard, MC, Calzia, E, Radermacher, P, Nußbaum, B, Huber-Lang, M, Fauler, G, Gröger, M, Jacobs, R, Zaleska-Kociecka, M, Van Straaten, HM, Trauner, M, Svoren-Jabalera, E, Davenport, EE, Humburg, P, Nguyen, DN, Knight, J, Hinds, CJ, Jun, IJ, Prabu, NR, Kim, WJ, Lee, EH, Besch, G, Perrotti, A, Puyraveau, M, Baltres, M, Eringa, EC, De Waele, E, Samain, E, Chocron, S, Pili-Floury, S, Plata-Menchaca, EP, Sabater-Riera, J, Estruch, M, Boza, E, Toscana-Fernández, J, Man, AM, Bruguera-Pellicer, E, De Regt, J, Ordoñez-Llanos, J, Pérez-Fernández, XL, SIRAKI group, Cavaleiro, P, Tralhão, A, Arrigo, M, Lopes, JP, Lebrun, M, Favier, B, Pischke, S, Cholley, B, PerezVela, JL, Honoré, PM, MarinMateos, H, Rivera, JJ, Llorente, MA, De Marcos, BG, Fernandez, FJ, Laborda, CG, Zamora, DF, Fischer, L, Alegría, L, Grupo ESBAGA, Delgado, JC, Imperiali, C, Myers, RB, Van Gorp, V, Dastis, M, Thaiss, F, Soto, D, Górka, J, Spapen, HD, Górka, K, Iwaniec, T, Koch, M, Frołow, M, Polok, K, Luengo, C, Fronczek, J, Kózka, M, Musiał, J, Szczeklik, W, Contreras, RS, Bangert, K, Gomez, J, Sileli, M, Havaldar, AA, Toapanta, ND, Jarufe, N, Moursia, C, Maleoglou, H, Leleki, K, Uz, Z, Ince, Y, Papatella, R, Bulent, E, Moreno, G, Grabowski, M, Bruhn, A, De Mol, B, Vicka, V, Gineityte, D, Ringaitiene, D, Norkiene, I, Sipylaite, J, Möller, C, Sabater, J, Castro, R, Thomas-Rueddel, DO, Vlasakov, V, Lohse, AW, Rochwerg, B, Theurer, P, Al Sibai, JZ, Camblor, PM, Kattan, E, Torrado, H, Siddiqui, S, Fernandez, PA, Gala, JM, Guisasola, JS, Tamura, T, Miyajima, I, Yamashita, K, Yokoyama, M, Tapia, P, Nashan, B, Gonzalez, M, Dalampini, E, Nastou, M, Baddour, A, Ignatiadis, A, Asteri, T, Hathorn, KE, Sterneck, M, Rebolledo, R, Purtle, SW, Marin, M, Viana, MV, Tonietto, TA, Gross, LA, Costa, VL, Faenza, S, Tavares, AL, Payen, D, Lisboa, BO, Moraes, RB, Farigola, E, Viana, LV, Azevedo, MJ, Ceniccola, GD, Pequeno, RS, Siniscalchi, A, Holanda, TP, Mendonça, VS, Achurra, P, Araújo, WM, Carvalho, LS, Segaran, E, Vickers, L, Gonzalez, A, Brinchmann, K, Pierucci, E, Wignall, I, De Brito-Ashurst, I, Ospina-Tascón, G, Del Olmo, R, Esteban, MJ, Vaquerizo, C, Carreño, R, Gálvez, V, Kaminsky, G, Mancini, E, Fernandez, J, Nieto, B, Fuentes, M, De la Torre, MA, Bakker, J, Torres, E, Alonso, A, Velayos, C, Saldaña, T, Escribá, A, Krishna, B, Grip, J, Kölegård, R, Vera, A, Sundblad, P, Rooyackers, O, Hernández, G, Naser, B, Jaziri, F, Jazia, AB, Barghouth, M, Ricci, D, Hentati, O, Skouri, W, El Euch, M, Mahfoudhi, M, Gisbert, X, Turki, S, Dąbrowski, M, Bertini, P, Abdelghni, KB, Abdallah, B, Gemelli, C, Maha, BN, Cánovas, J, Sotos, F, López, A, Lorente, M, Burruezo, A, Torres, D, Juliá, C, Guarracino, F, Cuoghi, A, Włudarczyk, A, Hałek, A, Bargouth, M, Bennasr, M, Baldassarri, R, Magnani, S, Uya, J, Abdelghani, KB, Abdallah, TB, Geenen, IL, Parienti, JJ, Straaten, HM, Shum, HP, King, HS, Kulkarni, AP, Pinsky, MR, Chan, KC, Corral, L, Yan, WW, Londoño, JG, Cardenas, CL, Pedrosa, MM, Gubianas, CM, Bertolin, CF, Batllori, NV, Atti, M, Sirvent, JM, Sedation an Delirium Group Hospital Universitari de Bellvitge, Mukhopadhyay, A, Chan, HY, Kowitlawakul, Y, Remani, D, Leong, CS, Henry, CJ, Vera, M, Puthucheary, ZA, Mendsaikhan, N, Begzjav, T, Elias-Jones, I, Lundeg, G, Dünser, M, Espinoza, ED, Welsh, SP, Guerra, E, Poppe, A, Zerpa, MC, Zechner, F, Berdaguer, F, Risso-Vazquez, A, Masevicius, FD, Greaney, D, Dreyse, J, Magee, A, Fitzpatrick, G, Lugo-Cob, RG, Jermaine, CM, Tejeda-Huezo, BC, Cano-Oviedo, AA, Carpio, D, Aydogan, MS, Togal, T, Taha, A, Chai, HZ, Sriram, S, Kam, C, Razali, SS, Sivasamy, V, Randall, D, Kuan, LY, Henriquez, C, Morales, MA, Pires, T, Adwaney, A, Wozniak, S, Gajardo, D, Herrera-Gutierrez, ME, Azevedo, LC, Blunden, M, Prowle, JR, Kirwan, CJ, Thomas, N, Martin, A, Owen, H, Darwin, L, Robertson, CS, Bravo, S, Barrueco-Francioni, J, Conway, D, Atkinson, D, Sharman, M, Barbanti, C, Amour, J, Gaudard, P, Rozec, B, Mauriat, P, M'rini, M, Arias-Verdú, D, Rusin, CG, Leger, PL, Cambonie, G, Liet, JM, Girard, C, Laroche, S, Damas, P, Assaf, Z, Loron, G, Lozano-Saez, R, Lecourt, L, Pouard, P, Hofmeijer, J, Kim, SH, Divatia, JV, Na, S, Kim, J, Jung, CW, Sondag, L, Yoo, SH, Min, SH, Chung, EJ, Quesada-Garcia, G, Lee, NJ, Lee, KW, Suh, KS, Ryu, HG, Marshall, DC, Goodson, RJ, Tjepkema-Cloostermans, MC, Salciccioli, JD, Shalhoub, J, Seller-Pérez, G, Potter, EK, Kirk-Bayley, J, Karanjia, ND, Forni, LG, Kim, S, Creagh-Brown, BC, Bossy, M, Nyman, M, Tailor, A, Figueiredo, A, SPACeR group (Surrey Peri-operative, Anaesthesia and Critical Care Collaborative Research Group), D'Antini, D, Valentino, F, Winkler, MS, Sollitto, F, Cinnella, G, Mirabella, L, Anzola, Y, Bosch, FH, Baladron, V, Villajero, P, Lee, M, Redondo, J, Liu, J, Shen, F, Teboul, JL, Anguel, N, Van Putten, MJ, Beurton, A, Bezaz, N, Richard, C, Park, SY, Monnet, X, Fossali, T, Pereira, R, Colombo, R, Ottolina, D, Rossetti, M, Mazzucco, C, Marchi, A, Porta, A, Catena, E, Piotrowska, K, So, S, Bento, L, Tollisen, KH, Andersen, G, Heyerdahl, F, Jacobsen, D, Van IJzendoorn, MC, Buter, H, Kingma, WP, Navis, GJ, Boerma, EC, Rulisek, J, Zacharov, S, Kim, HS, Jeon, SJ, Namgung, H, Lee, E, Lai, M, Kačar, MB, Cho, YJ, Lee, YJ, Huang, A, Deiana, M, Forsberg, M, Edman, G, Kačar, SM, Höjer, J, Forsberg, S, Freile, MT, Hidalgo, FN, Molina, JA, Lecumberri, R, Rosselló, AF, Travieso, PM, Leon, GT, Uddin, I, Sanchez, JG, Ali, MA, Frias, LS, Rosello, DB, Verdejo, JA, Serrano, JA, Winterwerp, D, Van Galen, T, Vazin, A, Karimzade, I, Belhaj, AM, Zand, A, Ozen, E, Ekemen, S, Akcan, A, Sen, E, Yelken, BB, Kureshi, N, Fenerty, L, Thibault-Halman, G, Aydın, MA, Walling, S, Almeida, R, Seller-Perez, G, Clarke, DB, Briassoulis, P, Kalimeris, K, Ntzouvani, A, Nomikos, T, Papaparaskeva, K, Avsec, D, Politi, E, Kostopanagiotou, G, Crewdson, K, Vardas, K, Rehn, M, Vaz-Ferreira, A, Weaver, A, Brohi, K, Lockey, D, Wright, S, Thomas, K, Mudersbach, E, Baker, C, Mansfield, L, Pozo, MO, Stafford, V, Wade, C, Watson, G, Silva, J, Bryant, A, Chadwick, T, Shen, J, Wilkinson, J, Kapuağası, A, Furneval, J, and Clinical Neurophysiology
- Subjects
Queen Square Neuroanaesthesia and Neurocritical Care Resreach Group ,TAVeM study Group ,Renal Transplantation HUVR ,Flow (psychology) ,lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] ,Critical Care and Intensive Care Medicine ,Grupo ESBAGA ,GEMINI ,03 medical and health sciences ,chemistry.chemical_compound ,SPACeR group (Surrey Peri-operative, Anaesthesia and Critical Care Collaborative Research Group) ,0302 clinical medicine ,Critical Care Research Group ,Journal Article ,PRoVENT investigators and the PROVE Network ,Medicine ,Sedation an Delirium Group Hospital Universitari de Bellvitge ,030212 general & internal medicine ,Bioethics work group of SEMICYUC ,GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries) ,SEMICYUC/GETGAG Working Group ,FINNAKI Study Group ,POPC-CB investigators ,business.industry ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,SIRAKI group ,030208 emergency & critical care medicine ,EDISVAL Group ,PLUG Working group ,DESIRE (DExmedetomidine for Sepsis in ICU Randomized Evaluation) Trial Investigators ,chemistry ,Anesthesia ,Carbon dioxide ,Breathing ,Department of Professional Development, ESICM ,business ,Nurses of the Central and General ICUs of Shiraz Namazi Hospital - Abstract
Contains fulltext : 172382.pdf (Publisher’s version ) (Open Access)
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- 2016
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5. Automation of expiratory trigger sensitivity in pressure support ventilation
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Amato Mb, Du Hl, and Yamada Y
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Evaluation data ,Pressure support ventilation ,Automation ,Respiration, Artificial ,Asynchrony (computer programming) ,Physical medicine and rehabilitation ,Materials Testing ,medicine ,Respiratory Mechanics ,Humans ,Sensitivity (control systems) ,Expiration ,business - Abstract
Patients under pressure support ventilation sometimes encounter patient-ventilator asynchrony in the transition from inspiration to expiration, that is, expiratory asynchrony. This problem is caused by the incompatibility of the fixed level of expiratory trigger sensitivity termination criteria (i.e., flow termination criteria) in the ICU ventilators to various patient conditions. The user-adjustable expiratory trigger sensitivity implemented in some newly released ventilators has been experienced to be difficult to use and unable to adapt ever-changing patient conditions without user intervention, although it provides more flexibility. This article elucidates the rationale for automatic control of the expiratory trigger sensitivity and evaluates the automation system with a bench setup. The evaluation data suggest that good expiratory synchronies can be achieved through automatic adjustments of expiratory trigger sensitivity.
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- 2001
6. First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation
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Park, M, primary, Azevedo, LC, additional, Mendes, PV, additional, Carvalho, CR, additional, Amato, MB, additional, Schettino, GP, additional, Tucci, M, additional, Maciel, AT, additional, Taniguchi, LU, additional, Barbosa, EV, additional, Nardi, RO, additional, Ignacio, MN, additional, Machtans, CC, additional, Neves, WA, additional, Hirota, AS, additional, and Costa, EL, additional
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- 2012
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7. A New Experimental Model of the Acute Lung Injury.
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Gomes, S, primary, Belmino, R, additional, Hirota, A, additional, Costa, EL, additional, Barbeiro, DF, additional, Tucci, MR, additional, Gregores, GB, additional, Beraldo, MA, additional, Timenetsky, K, additional, Borges, JB, additional, Carvalho, CR, additional, and Amato, MB, additional
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- 2009
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8. Small Airways Remodeling in Acute Respiratory Distress Syndrome (ARDS).
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Morales, MM, primary, Pires-Neto, RC, additional, Lancas, T, additional, Silva, LF, additional, Inforsato, N, additional, Mauad, T, additional, Amato, MB, additional, Carvalho, CR, additional, and Dolhnikoff, M, additional
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- 2009
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9. Tidal Recruitment Detected by Electrical Impedance Tomography (EIT) and Crackling Sounds in an ARDS Model.
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Belmino, R, primary, Gomes, S, additional, Hirota, A, additional, Valenga, MH, additional, Nohama, P, additional, Moryia, HT, additional, Amato, MB, additional, and Alencar, A, additional
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- 2009
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10. Long-Term Effects of Two Protective-Ventilation Strategies in an ARDS Model.
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Timenetsky, K, primary, Gomes, S, additional, Belmino, R, additional, Hirota, A, additional, Beraldo, MA, additional, Borges, JB, additional, Costa, EL, additional, Tucci, MR, additional, Carvalho, CR, additional, and Amato, MB, additional
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- 2009
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11. Einfluss der CT-Bildrekonstruktion auf die quantitative Messung der alveolären Belüftung: Intraindividueller Vergleich bei Tieren mit normaler und experimentell geschädigter Lunge
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Busse, H, primary, Schwarzkopf, P, additional, Seiwerts, M, additional, Borges, JB, additional, Costa, EL, additional, Kahn, T, additional, Amato, MB, additional, and Reske, AW, additional
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- 2008
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12. The new definition for acute lung injury and acute respiratory distress syndrome: is there room for improvement?
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Costa EL and Amato MB
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- 2013
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13. Real-time detection of pneumothorax using electrical impedance tomography.
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Costa EL, Chaves CN, Gomes S, Beraldo MA, Volpe MS, Tucci MR, Schettino IA, Bohm SH, Carvalho CR, Tanaka H, Lima RG, and Amato MB
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- 2008
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14. ESICM LIVES 2016: part three : Milan, Italy. 1-5 October 2016
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Velasquez, T., Mackey, G., Lusk, J., Kyle, Ug, Fontenot, T., Marshall, P., Shekerdemian, Ls, Coss-Bu, Ja, Nishigaki, A., Yatabe, T., Tamura, T., Yamashita, K., Yokoyama, M., Ruiz-Rodriguez, Jc, Encina, B., Belmonte, R., Troncoso, I., Tormos, P., Riveiro, M., Baena, J., Sanchez, A., Bañeras, J., Cordón, J., Duran, N., Ruiz, A., Caballero, J., Nuvials, X., Riera, J., Serra, J., Rutten, Am, Ieperen, Sn, Kinderen, Ep, Logten, T., Kovacikova, L., Skrak, P., Zahorec, M., Akcan-Arikan, A., Silva, Jc, Goldsworthy, M., Wood, D., Harrison, D., Parslow, R., Davis, P., Pappachan, J., Goodwin, S., Ramnarayan, P., Chernyshuk, S., Yemets, H., Zhovnir, V., Pulitano, Sm, Rosa, S., Mancino, A., Villa, G., Tosi, F., Franchi, P., Conti, G., Patel, B., Khine, H., Shah, A., Sung, D., Singer, L., Haghbin, S., Inaloo, S., Serati, Z., Idei, M., Nomura, T., Yamamoto, N., Sakai, Y., Yoshida, T., Matsuda, Y., Yamaguchi, Y., Takaki, S., Yamaguchi, O., Goto, T., Longani, N., Medar, S., Abdel-Aal, Ir, El Adawy, As, Mohammed, Hm, Mohamed, An, Parry, Sm, Knight, Ld, Denehy, L., Morton, N., Baldwin, Ce, Sani, D., Kayambu, G., Da Silva, Vz, Phongpagdi, P., Puthucheary, Za, Granger, Cl, Rydingsward, Je, Horkan, Cm, Christopher, Kb, Mcwilliams, D., Jones, C., Reeves, E., Atkins, G., Snelson, C., Aitken, Lm, Rattray, J., Kenardy, J., Hull, Am, Ullman, A., Le Brocque, R., Mitchell, M., Davis, C., Macfarlane, B., Azevedo, Jc, Rocha, Ll, Freitas, Ff, Cavalheiro, Am, Lucinio, Nm, Lobato, Ms, Ebeling, G., Kraegpoeth, A., Laerkner, E., Brito-Ashurst, I., White, C., Gregory, S., Forni, Lg, Flowers, E., Curtis, A., Wood, Ca, Siu, K., Venkatesan, K., Muhammad, Jb, Ng, L., Seet, E., Baptista, N., Escoval, A., Tomas, E., Agrawal, R., Mathew, R., Varma, A., Dima, E., Charitidou, E., Perivolioti, E., Pratikaki, M., Vrettou, C., Giannopoulos, A., Zakynthinos, S., Routsi, C., Atchade, E., Houzé, S., Jean-Baptiste, S., Thabut, G., Genève, C., Tanaka, S., Lortat-Jacob, B., Augustin, P., Desmard, M., Montravers, P., Molina, Fj, Barbadillo, S., Alejandro, R., Álvarez-Lerma, F., Vallés, J., Catalán, Rm, Palencia, E., Jareño, A., Granada, Rm, Ignacio, Ml, Getgag, Working Group, Cui, N., Liu, D., Wang, H., Su, L., Qiu, H., Li, R., Jaffal, K., Rouzé, A., Poissy, J., Sendid, B., Nseir, S., Paramythiotou, E., Rizos, M., Frantzeskaki, F., Antoniadou, A., Vourli, S., Zerva, L., Armaganidis, A., Gottlieb, J., Greer, M., Wiesner, O., Martínez, M., Acuña, M., Rello, J., Welte, T., Mignot, T., Soussi, S., Dudoignon, E., Ferry, A., Chaussard, M., Benyamina, M., Alanio, A., Touratier, S., Chaouat, M., Lafaurie, M., Mimoun, M., Mebazaa, A., Legrand, M., Sheils, Ma, Patel, C., Mohankumar, L., Akhtar, N., Noriega, Sk, Aldana, Nn, León, Jl, Baquero, Jd, Bernal, Ff, Ahmadnia, E., Hadley, Js, Millar, M., Hall, D., Hewitt, H., Yasuda, H., Sanui, M., Komuro, T., Kawano, S., Andoh, K., Yamamoto, H., Noda, E., Hatakeyama, J., Saitou, N., Okamoto, H., Kobayashi, A., Takei, T., Matsukubo, S., Jseptic, Clinical Trial Group, Rotzel, Hb, Lázaro, As, Prada, Da, Gimillo, MR, Barinas, Od, Cortes, Ml, Franco, Jf, Roca, Jm, Carratalá, A., Gonçalves, B., Turon, R., Mendes, A., Miranda, F., Mata, Pj, Cavalcanti, D., Melo, N., Lacerda, P., Kurtz, P., Righy, C., Rosario, Le, Lesmes, Sp, Romero, Jc, Herrera, An, Pertuz, Ed, Sánchez, Mj, Sanz, Er, Hualde, Jb, Hernández, Aa, Irazabal, Jm, Spatenkova, V., Bradac, O., Suchomel, P., Urli, T., Lazzeri, Eh, Aspide, R., Zanello, M., Perez-Borrero, L., Garcia-Alvarez, Jm, Arias-Verdu, Md, Aguilar-Alonso, E., Rivera-Fernandez, R., Mora-Ordoñez, J., La Fuente-Martos, C., Castillo-Lorente, E., Guerrero-Lopez, F., Ramírez, Jr, León, Jp, Navarro-Guillamón, L., Cordovilla-Guardia, S., Iglesias-Santiago, A., Guerrero-López, F., Fernández-Mondéjar, E., Vidal, A., Perez, M., Juez, A., Arias, N., Colino, L., Perez, Jl, Pérez, H., Calpe, P., Alcala, Ma, Robaglia, D., Perez, C., Lan, Sk, Cunha, Mm, Moreira, T., Santos, F., Lafuente, E., Fernandes, Mj, Silva, Jg, Echeverría, Jg, Podlepich, V., Sokolova, E., Alexandrova, E., Lapteva, K., Shuinotsuka, C., Rabello, L., Vianna, G., Reis, A., Cairus, C., Salluh, J., Bozza, F., Torres, Jc, Araujo, Nj, García-Olivares, P., Keough, E., Dalorzo, M., Tang, Lk, Sousa, I., Díaz, M., Marcos-Zambrano, Lj, Guerrero, Je, Gomez, Se, Lopez, Gd, Cuellar, Ai, Nieto, Or, Gonzalez, Ja, Bhasin, D., Rai, S., Singh, H., Gupta, O., Bhattal, Mk, Sampley, S., Sekhri, K., Nandha, R., Aliaga, Fa, Olivares, F., Appiani, F., Farias, P., Alberto, F., Hernández, A., Pons, S., Sonneville, R., Bouadma, L., Neuville, M., Mariotte, E., Radjou, A., Lebut, J., Chemam, S., Voiriot, G., Dilly, Mp, Mourvillier, B., Dorent, R., Nataf, P., Wolff, M., Timsit, Jf, Ediboglu, O., Ataman, S., Ozkarakas, H., Kirakli, C., Vakalos, A., Avramidis, V., Obukhova, O., Kurmukov, Ia, Kashiya, S., Golovnya, E., Baikova, Vn, Ageeva, T., Haritydi, T., Kulaga, Ev, Rios-Toro, Jj, Lopez-Caler, C., Rodriguez-Fernandez, S., Sanchez-Orézzoli, Mg, Martin-Gallardo, F., 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Kouatchet, A., Similowski, T., Demoule, A., Diaz, P., Nunes, J., Escórcio, S., Silva, G., Chaves, S., Jardim, M., Câmara, M., Fernandes, N., Duarte, R., Jardim, Jj, Pereira, Ca, Nóbrega, Jj, Chen, Cm, Lai, Cc, Cheng, Kc, Chou, W., Lee, Sj, Cha, Ys, Lee, Wy, Onodera, M., Nakataki, E., Oto, J., Imanaka, H., Nishimura, M., Khadjibaev, A., Sabirov, D., Rosstalnaya, A., Akalaev, R., Parpibaev, F., Antonucci, E., Rossini, P., Gandolfi, S., Montini, E., Orlando, S., Nes, M., Karachi, F., Hanekom, S., Pereira, Uv, Parkin, Ms, Moore, M., Carvalho, Kv, Min, Hj, Kim, Hj, Choi, Yy, Lee, Ey, Song, I., Kim, Dj, E, Yy, Kim, Jw, Park, Js, Lee, Jh, Suh, Jw, Jo, Yh, Ferrero-Calleja, J., Merino-Vega, D., González-Jiménez, Ai, Sigcha, Ms, Hernández-Tejedor, A., Martin-Vivas, A., Gabán-Díez, Á, Luna, Rr, La Calle-Pedrosa, N., Temprano-Gómez, I., Afonso-Rivero, D., Pellin-Ariño, Ji, Algora-Weber, A., Fumis, Rr, Ferraz, Ab, Junior, Jm, Kirca, H., Cakin, O., Unal, M., Mutlu, H., Ramazanoglu, A., Cengiz, M., Nicolini, Ea, Pelisson, Fg, Nunes, Rs, Da Silva, Sl, Carreira, Mm, Bellissimo-Rodrigues, F., Ferez, Ma, Basile-Filho, A., Chao, Hc, Chen, L., Hravnak, M., Clermont, G., Pinsky, M., Dubrawski, A., Varas, Jl, Montero, Rm, Sánchez-Elvira, La, Díaz, Pv, Delgado, Cp, Ruiz, Bl, Guerrero, Ap, Galache, Ja, Sherif, H., Hassanin, H., El Hossainy, R., Samy, W., Ly, H., David, H., Burtin, P., Charpentier, C., Barral, M., Courant, P., Fournel, E., Gaide-Chevronnay, L., Durand, M., Albaladejo, P., Payen, Jf, Chavanon, O., Ortiz, Ab, Pozzebon, S., Fumagalli, F., Scala, S., Affatato, R., Maglie, M., Zani, D., Novelli, D., Marra, C., Luciani, A., Luini, M., Letizia, T., Pravettoni, D., Staszewsky, L., Belloli, A., Di Giancamillo, M., Scanziani, E., Kye, Yc, Yu, Km, Babini, G., Grassi, L., Reinikainen, M., Skrifvars, M., Kappler, F., Blobner, M., Schaller, Sj, Roasio, A., Costanzo, E., Cardellino, S., Fontana, V., Park, M., You, Km, Ko, Sb, Beane, A., Thilakasiri, Mc, Silva, Ap, Stephens, T., Sigera, Cs, Athapattu, P., Jayasinghe, S., Padeniya, A., Haniffa, R., Sáez, Vc, Ruiz-Ruano, Rdel, González, As, Kunze-Szikszay, N., Wand, S., Klapsing, P., Wetz, A., Heyne, T., Schwerdtfeger, K., Troeltzsch, M., Bauer, M., Quintel, M., Moerer, O., Cook, Dj, Rutherford, Wb, Scales, Dc, Adhikari, Nk, Cuthbertson, Bh, Suzuki, T., Fushimi, K., Iwamoto, M., Nakagawa, S., Mendsaikhan, N., Begzjav, T., Lundeg, G., Dünser, Mw, Romero, Dg, Padilla, Ys, Kleinpell, R., Chouris, I., Radu, V., Stougianni, M., Lavrentieva, A., Lagonidis, D., Price, Rd, Day, A., Arora, N., Henderson, Ma, Hickey, S., Costa, Mi, Carvalho, Jp, Gomes, Aa, Mergulhão, Pj, Chan, Kk, Maghsoudi, B., Tabei, Sh, Sabetian, G., Tabatabaei, Hr, Akbarzadeh, A., Student Research Committee - Shiraz University of Medical Sciences, Saigal, S., Pakhare, A., Joshi, R., Pattnaik, Sk, Ray, B., Rousseau, Af, Michel, L., Bawin, M., Cavalier, E., Reginster, Jy, Damas, P., Bruyere, O., Zhou, Jc, Cauwenberghs, H., Backer, A., Neels, H., Deblier, I., Berghmans, J., Himpe, D., Barea-Mendoza, Ja, Portillo, Ip, Fernández, Mv, Gigorro, Rg, Vela, Jl, Mateos, Hm, Alves, Sc, Varas, Gm, Rodriguez-Biendicho, A., Carreño, Er, González, Jc, Yang, Js, Lin, Kl, Choi, Yj, Yoon, Sz, Gordillo-Brenes, A., Fernandez-Zamora, Md, Herruzo-Aviles, A., Garcia-Delgado, M., Hinojosa-Perez, R., ARIAM-ANDALUCIA, Pascual, Oa, Pérez, Ag, Fernández, Pa, Amor, Ll, Albaiceta, Gm, Calvo, Sa, Spazzadeschi, A., Marrazzo, F., Gandola, A., Sciurti, R., Savi, C., Tseng, Cj, Bertini, P., Sanctis, F., Guarracino, F., Baldassarri, R., Buitinck, Sh, Voort, Ph, Tsunano, Y., Izawa, M., Tane, N., Ghosh, S., Gupta, A., Gasperi, A., Mazza, E., Limuti, R., Prosperi, M., Bissenova, N., Yergaliyeva, A., Talan, L., Yılmaz, G., Güven, G., Yoruk, F., Altıntas, Nd, Mukherjee, Dn, Agarwal, Lk, Mandal, K., Balsera, B., Martinez, M., Garcia, M., Castellana, D., Lopez, R., Barcenilla, F., Kaminsky, Ge, Carreño, R., Escribá, A., Fuentes, M., Gálvez, V., Del Olmo, R., Nieto, B., Vaquerizo, C., Alvarez, J., La Torre, Ma, Torres, E., Bogossian, E., Nouer, Sa, Salgado, Dr, Jiménez, Gj, Gaite, Fb, Martínez, Mp, Doganci, M., Izdes, S., Besevli, Sg, Alkan, A., Kayaaslan, B., Penichet, Sm, López, Ma, Repessé, X., Artiguenave, M., Paktoris-Papine, S., Espinasse, F., Dinh, A., El Sayed, F., Charron, C., Géri, G., Vieillard-Baron, A., Dimitroulakis, K., Ferré, A., Guillot, M., Teboul, Jl, Lichtenstein, D., Mézière, G., Richard, C., Monnet, X., Prīdāne, S., Sabeļņikovs, O., Bianchi, I., Kondili, E., Psarologakis, C., Kokkini, S., Amargianitakis, V., Babalis, D., Chytas, A., Chouvarda, I., Vaporidi, K., Georgopoulos, D., Trapp, O., Kalenka, A., Karbing, Ds, Gioia, A., Moro, F., Corte, Fd, Mauri, T., Rees, Se, Plug working group, Petrova, Mv, Mohan, R., Butrov, Av, Beeharry, Sd, Vatsik, Mv, Sakieva, Fi, Gobert, F., Fernandez, R., Labaune, Ma, Burle, Jf, Barbier, J., Vincent, B., Cleyet, M., Shinotsuka, Cr, Törnblom, S., Nisula, S., Vaara, S., Poukkanen, M., Andersson, S., Pesonen, E., Xie, Z., Liao, X., Kang, Y., Zhang, J., Kubota, K., Egi, M., Mizobuchi, S., Hegazy, S., El-Keraie, A., El Sayed, E., El Hamid, Ma, Rodrigues, Nj, Pereira, M., Godinho, I., Gameiro, J., Neves, M., Gouveia, J., E Silva, Zc, Lopes, Ja, Mckinlay, J., Kostalas, M., Kooner, G., Dudas, G., Horton, A., Kerr, C., Karanjia, N., Creagh-Brown, B., Yamazaki, A., Ganuza, Ms, Molina, Ja, Martinez, Fh, Freile, Mt, Fernandez, Ng, Travieso, Pm, Bandert, A., Frithiof, R., Lipcsey, M., Smekal, D., Schlaepfer, P., Durovray, Jd, Plouhinec, V., Chiappa, C., Bellomo, R., Schneider, Ag, Mitchell, S., Durrant, J., Street, H., Dunthorne, E., Shears, J., Caballero, Ch, Hutchison, R., Schwarze, S., Ghabina, S., Thompson, E., Prowle, Jr, Kirwan, Cj, Gonzalez, Ca, Pinto, Jl, Orozco, V., Patiño, Ja, Garcia, Pk, Contreras, Km, Rodriguez, P., and Echeverri, Je
15. Ventilation strategies for acute lung injury and acute respiratory distress syndrome.
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Borges JB, Carvalho CR, Amato MB, Borges, João Batista, Carvalho, Carlos Roberto Ribeiro, and Amato, Marcelo Britto Passos
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- 2008
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16. Extrapolation in the analysis of lung aeration by computed tomography: a validation study.
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Reske AW, Rau A, Reske AP, Koziol M, Gottwald B, Alef M, Ionita JC, Spieth PM, Hepp P, Seiwerts M, Beda A, Born S, Scheuermann G, Amato MB, Wrigge H, Reske, Andreas W, Rau, Anna, Reske, Alexander P, Koziol, Manja, and Gottwald, Beate
- Abstract
Introduction: Computed tomography (CT) is considered the gold standard for quantification of global or regional lung aeration and lung mass. Quantitative CT, however, involves the exposure to ionizing radiation and requires manual image processing. We recently evaluated an extrapolation method which calculates quantitative CT parameters characterizing the entire lung from only 10 reference CT-slices thereby reducing radiation exposure and analysis time. We hypothesized that this extrapolation method could be further validated using CT-data from pigs and sheep, which have a different thoracic anatomy.Methods: We quantified volume and mass of the total lung and differently aerated lung compartments in 168 ovine and 55 porcine whole-lung CTs covering lung conditions from normal to gross deaeration. Extrapolated volume and mass parameters were compared to the respective values obtained by whole-lung analysis. We also tested the accuracy of extrapolation for all possible numbers of CT slices between 15 and 5. Bias and limits of agreement (LOA) were analyzed by the Bland-Altman method.Results: For extrapolation from 10 reference slices, bias (LOA) for the total lung volume and mass of sheep were 18.4 (-57.2 to 94.0) ml and 4.2 (-21.8 to 30.2) grams, respectively. The corresponding bias (LOA) values for pigs were 5.1 (-55.2 to 65.3) ml and 1.6 (-32.9 to 36.2) grams, respectively. All bias values for differently aerated lung compartments were below 1% of the total lung volume or mass and the LOA never exceeded ± 2.5%. Bias values diverged from zero and the LOA became considerably wider when less than 10 reference slices were used.Conclusions: The extrapolation method appears robust against variations in thoracic anatomy, which further supports its accuracy and potential usefulness for clinical and experimental application of quantitative CT. [ABSTRACT FROM AUTHOR]- Published
- 2011
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17. Effects of Mechanical Insufflation-Exsufflation With Different Pressure Settings on Respiratory Mucus Displacement During Invasive Ventilation.
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Martí JD, Martínez-Alejos R, Pilar-Diaz X, Yang H, Pagliara F, Battaglini D, Meli A, Yang M, Bobi J, Rigol M, Tronstad O, Volpe MS, Passos Amato MB, Bassi GL, and Torres A
- Subjects
- Animals, Female, Cough, Lung, Mucus, Respiration, Artificial adverse effects, Respiration, Artificial methods, Swine, Insufflation methods, Noninvasive Ventilation
- Abstract
Background: Mechanical insufflation-exsufflation (MI-E) has been proposed as a potential strategy to generate high expiratory flows and simulate cough in the critically ill. However, efficacy and safety of MI-E during invasive mechanical ventilation are still to be fully elucidated. This study in intubated and mechanically ventilated pigs aimed to evaluate the effects of 8 combinations of insufflation-exsufflation pressures during MI-E on mucus displacement, respiratory flows, as well as respiratory mechanics and hemodynamics., Methods: Six healthy Landrace-Large White female pigs were orotracheally intubated, anesthetized, and invasively ventilated for up to 72 h. Eight combinations of insufflation-exsufflation pressures (+40/-40, +40/-50, +40/-60, +40/-70, +50/-40, +50/-50, +50/-60, +50/-70 cm H
2 O) were applied in a randomized order. The MI-E device was set to automatic mode, medium inspiratory flow, and an inspiratory-expiratory time 3 and 2 s, respectively, with a 1-s pause between cycles. We performed 4 series of 5 insufflation-exsufflation cycles for each combination of pressures. Velocity and direction of movement of a mucus simulant containing radio-opaque markers were assessed through sequential lateral fluoroscopic images of the trachea. We also evaluated respiratory flows, respiratory mechanics, and hemodynamics before, during, and after each combination of pressures., Results: In 3 of the animals, experiments were conducted twice; and for the remaining 3, they were conducted once. In comparison to baseline mucus movement (2.85 ± 2.06 mm/min), all insufflation-exsufflation pressure combinations significantly increased mucus velocity ( P = .01). Particularly, +40/-70 cm H2 O was the most effective combination, increasing mucus movement velocity by up to 4.8-fold ( P < .001). Insufflation pressure of +50 cm H2 O resulted in higher peak inspiratory flows ( P = .004) and inspiratory transpulmonary pressure ( P < .001) than +40 cm H2 O., Conclusions: MI-E appeared to be an efficient strategy to improve mucus displacement during invasive ventilation, particularly when set at +40/-70 cm H2 O. No safety concerns were identified although a transient significant increase of transpulmonary pressure was observed., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2022 by Daedalus Enterprises.)- Published
- 2022
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18. Acute Effects of Lung Expansion Maneuvers in Comatose Subjects With Prolonged Bed Rest.
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Morais CC, Campos SL, Lima CS, Monte LJ, Bandeira MCP, Brandão DC, Costa EL, Aliverti A, Amato MB, and Andrade AD
- Subjects
- Coma etiology, Coma therapy, Electric Impedance, Humans, Lung, Positive-Pressure Respiration, Bed Rest, Pulmonary Atelectasis etiology
- Abstract
Background: Patients with decreased consciousness are prone to prolonged bed rest and respiratory complications. If effective in reducing atelectasis, lung expansion maneuvers could be used to prevent these complications. In comatose, bedridden subjects, we aimed to assess the acute effect on regional lung aeration of 2 lung expansion techniques: expiratory positive airway pressure and the breath-stacking maneuver. Our secondary aim was to evaluate the influence of these lung expansion techniques on regional ventilation distribution, regional ventilation kinetics, respiratory pattern, and cardiovascular system., Methods: We enrolled 10 subjects status post neurosurgery, unable to follow commands, and with prolonged bed rest. All subjects were submitted to both expansion techniques in a randomized order. Regional lung aeration, ventilation distribution, and regional ventilation kinetics were measured with electrical impedance tomography., Results: Lung aeration increased significantly during the application of both expiratory positive airway pressure and breath-stacking ( P < .001) but returned to baseline values seconds afterwards. The posterior lung regions had the largest volume increase ( P < .001 for groups). Both maneuvers induced asynchronous inflation and deflation between anterior and posterior lung regions. There were no significant differences in cardiovascular variables., Conclusions: In comatose subjects with prolonged bed rest, expiratory positive airway pressure and breath-stacking promoted brief increases in lung aeration. (ClinicalTrials.gov registration NCT02613832.)., Competing Interests: This work was supported in part by FACEPE - Fundação de Amparo a Ciência e Tecnologia do Estado de Pernambuco (0154-4.08/15). Drs Costa and Amato report relationships with Timpel SA. The other authors have disclosed no conflicts of interest., (Copyright © 2021 by Daedalus Enterprises.)
- Published
- 2021
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19. Intraoperative pulmonary hyperdistention estimated by transthoracic lung ultrasound: A pilot study.
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Tonelotto B, Pereira SM, Tucci MR, Vaz DF, Vieira JE, Malbouisson LM, Gay F, Simões CM, Carvalho Carmona MJ, Monsel A, Amato MB, Rouby JJ, and Costa Auler JO Jr
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- Humans, Lung diagnostic imaging, Pilot Projects, Respiration, Artificial, Positive-Pressure Respiration, Pulmonary Atelectasis diagnostic imaging
- Abstract
Introduction: Transthoracic lung ultrasound can assess atelectasis reversal and is considered as unable to detect associated hyperdistention. In this study, we describe an ultrasound pattern highly suggestive of pulmonary hyperdistention., Methods: Eighteen patients with normal lungs undergoing lower abdominal surgery were studied. Electrical impedance tomography was calibrated, followed by anaesthetic induction, intubation and mechanical ventilation. To reverse posterior atelectasis, a recruitment manoeuvre was performed. Positive-end expiratory pressure (PEEP) titration was then obtained during a descending trial - 20, 18, 16, 14, 12, 10, 8, 6 and 4cmH
2 O. Ultrasound and electrical impedance tomography data were collected at each PEEP level and interpreted by two independent observers. Spearman correlation test and receiving operating characteristic curve were used to compare lung ultrasound and electrical impedance tomography data., Results: The number of horizontal A lines increased linearly with PEEP: from 3 (0, 5) at PEEP 4cmH2 O to 10 (8, 13) at PEEP 20cmH2 O. The increase number of A lines was associated with a parallel and significant decrease in intercostal space thickness (p=0.001). The lung ultrasound threshold for detecting pulmonary hyperdistention was defined as the number of A lines counted at the PEEP preceding the PEEP providing the best respiratory compliance. Six A lines was the median threshold for detecting pulmonary hyperdistention. The area under the receiving operating characteristic curve was 0.947., Conclusions: Intraoperative transthoracic lung ultrasound can detect lung hyperdistention during a PEEP descending trial. Six or more A lines detected in normally aerated regions can be considered as indicating lung hyperdistention., Trial Registration: NCT02314845 Registered on ClinicalTrials.gov., (Copyright © 2020 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.)- Published
- 2020
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20. Effect of Cardiogenic Oscillations on Trigger Delay During Pressure Support Ventilation.
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Plens GM, Morais CC, Nakamura MA, Souza PN, Amato MB, Tucci MR, and Costa EL
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- Computer Simulation, Heart physiopathology, Humans, Oscillometry, Reaction Time, Work of Breathing physiology, Equipment Failure, Hemodynamics, Positive-Pressure Respiration instrumentation, Respiratory Mechanics, Ventilators, Mechanical
- Abstract
Background: Sensitive flow or pressure triggers are usually applied to improve ventilator response time. Conversely, too sensitive triggers can incur risk of auto-triggering, a type of asynchrony in which a breath is triggered without inspiratory muscle activity. A frequent cause of auto-triggering is cardiogenic oscillations, characterized by cyclical variations in pressure and flow waveforms caused by cardiac contractions. Our goal was to test trigger performance and capacity to abolish auto-triggering in 5 different ICU ventilators using different simulated levels of cardiogenic oscillations., Methods: A mechanical breathing simulator was used to test 5 different ICU ventilators' trigger response time and capacity to minimize auto-triggering in conditions with 0, 0.25, 0.5, and 1 cm H
2 O cardiogenic oscillation. Each ventilator was evaluated until an ideal trigger was found (the most sensitive that abolished auto-triggering). When the least sensitive flow trigger was unable to avoid auto-triggering, a pressure trigger was used. We compared time delay, airway pressure drop until triggering, and work of breathing before each trigger, all at the ideal trigger level for each cardiogenic oscillation amplitude. We also assessed the proportion of auto-triggered breaths in the whole range of trigger levels tested., Results: Larger cardiogenic oscillations were associated with more frequent auto-triggering. To avoid auto-triggering, less sensitive triggers were required (+2.51 L/min per 1 cm H2 O increase in cardiogenic oscillation; 95% CI 2.26-2.76, P < .001). Time delay increased with larger cardiogenic oscillations, because less sensitive trigger levels were required to abolish auto-triggering (4.79-ms increase per 1 L/min increment on flow trigger)., Conclusions: More sensitive triggers led to faster ventilator response, but also to more frequent auto-triggering. To avoid auto-triggering, less sensitive triggers were required, with consequent slower trigger response. To compare trigger performance in a scenario that more closely represents clinical practice, evaluation of the tradeoff between time delay and frequency of auto-triggering should be considered., (Copyright © 2018 by Daedalus Enterprises.)- Published
- 2018
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21. Monitoring of Pneumothorax Appearance with Electrical Impedance Tomography during Recruitment Maneuvers.
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Morais CC, De Santis Santiago RR, Filho JR, Hirota AS, Pacce PH, Ferreira JC, Camargo ED, Amato MB, and Costa EL
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- Aged, Cross Infection etiology, Cross Infection microbiology, Disease Progression, Humans, Male, Monitoring, Physiologic, Pneumonia, Bacterial microbiology, Pneumothorax etiology, Point-of-Care Systems, Positive-Pressure Respiration methods, Pseudomonas aeruginosa isolation & purification, Respiratory Distress Syndrome diagnostic imaging, Respiratory Distress Syndrome therapy, Shock, Septic microbiology, Electric Impedance, Pneumonia, Bacterial complications, Pneumothorax diagnostic imaging, Pseudomonas Infections complications, Respiratory Distress Syndrome complications, Shock, Septic etiology, Tomography methods
- Published
- 2017
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22. Fifty Years of Research in ARDS. Spontaneous Breathing during Mechanical Ventilation. Risks, Mechanisms, and Management.
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Yoshida T, Fujino Y, Amato MB, and Kavanagh BP
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- Humans, Risk, Respiration, Respiration, Artificial adverse effects, Respiratory Distress Syndrome complications, Respiratory Distress Syndrome physiopathology, Ventilator-Induced Lung Injury complications, Ventilator-Induced Lung Injury physiopathology
- Abstract
Spontaneous respiratory effort during mechanical ventilation has long been recognized to improve oxygenation, and because oxygenation is a key management target, such effort may seem beneficial. Also, disuse and loss of peripheral muscle and diaphragm function is increasingly recognized, and thus spontaneous breathing may confer additional advantage. Reflecting this, epidemiologic data suggest that the use of partial (vs. full) support modes of ventilation is increasing. Notwithstanding the central place of spontaneous breathing in mechanical ventilation, accumulating evidence indicates that it may cause-or worsen-acute lung injury, especially if acute respiratory distress syndrome is severe and spontaneous effort is vigorous. This Perspective reviews the evidence for this phenomenon, explores mechanisms of injury, and provides suggestions for clinical management and future research.
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- 2017
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23. Effect of Intensive vs Moderate Alveolar Recruitment Strategies Added to Lung-Protective Ventilation on Postoperative Pulmonary Complications: A Randomized Clinical Trial.
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Costa Leme A, Hajjar LA, Volpe MS, Fukushima JT, De Santis Santiago RR, Osawa EA, Pinheiro de Almeida J, Gerent AM, Franco RA, Zanetti Feltrim MI, Nozawa E, de Moraes Coimbra VR, de Moraes Ianotti R, Hashizume CS, Kalil Filho R, Auler JO Jr, Jatene FB, Gomes Galas FR, and Amato MB
- Subjects
- Aged, Barotrauma epidemiology, Blood Pressure physiology, Critical Care statistics & numerical data, Female, Heart Rate physiology, Hospital Mortality, Humans, Hypoxia etiology, Incidence, Length of Stay, Lung Diseases prevention & control, Male, Middle Aged, Odds Ratio, Oxygen Inhalation Therapy statistics & numerical data, Partial Pressure, Positive-Pressure Respiration methods, Postoperative Complications prevention & control, Tidal Volume, Cardiac Surgical Procedures adverse effects, Hypoxia therapy, Oxygen Inhalation Therapy methods, Postoperative Complications therapy, Pulmonary Alveoli physiology, Respiration, Artificial methods, Severity of Illness Index
- Abstract
Importance: Perioperative lung-protective ventilation has been recommended to reduce pulmonary complications after cardiac surgery. The protective role of a small tidal volume (VT) has been established, whereas the added protection afforded by alveolar recruiting strategies remains controversial., Objective: To determine whether an intensive alveolar recruitment strategy could reduce postoperative pulmonary complications, when added to a protective ventilation with small VT., Design, Setting, and Participants: Randomized clinical trial of patients with hypoxemia after cardiac surgery at a single ICU in Brazil (December 2011-2014)., Interventions: Intensive recruitment strategy (n=157) or moderate recruitment strategy (n=163) plus protective ventilation with small VT., Main Outcomes and Measures: Severity of postoperative pulmonary complications computed until hospital discharge, analyzed with a common odds ratio (OR) to detect ordinal shift in distribution of pulmonary complication severity score (0-to-5 scale, 0, no complications; 5, death). Prespecified secondary outcomes were length of stay in the ICU and hospital, incidence of barotrauma, and hospital mortality., Results: All 320 patients (median age, 62 years; IQR, 56-69 years; 125 women [39%]) completed the trial. The intensive recruitment strategy group had a mean 1.8 (95% CI, 1.7 to 2.0) and a median 1.7 (IQR, 1.0-2.0) pulmonary complications score vs 2.1 (95% CI, 2.0-2.3) and 2.0 (IQR, 1.5-3.0) for the moderate strategy group. Overall, the distribution of primary outcome scores shifted consistently in favor of the intensive strategy, with a common OR for lower scores of 1.86 (95% CI, 1.22 to 2.83; P = .003). The mean hospital stay for the moderate group was 12.4 days vs 10.9 days in the intensive group (absolute difference, -1.5 days; 95% CI, -3.1 to -0.3; P = .04). The mean ICU stay for the moderate group was 4.8 days vs 3.8 days for the intensive group (absolute difference, -1.0 days; 95% CI, -1.6 to -0.2; P = .01). Hospital mortality (2.5% in the intensive group vs 4.9% in the moderate group; absolute difference, -2.4%, 95% CI, -7.1% to 2.2%) and barotrauma incidence (0% in the intensive group vs 0.6% in the moderate group; absolute difference, -0.6%; 95% CI, -1.8% to 0.6%; P = .51) did not differ significantly between groups., Conclusions and Relevance: Among patients with hypoxemia after cardiac surgery, the use of an intensive vs a moderate alveolar recruitment strategy resulted in less severe pulmonary complications while in the hospital., Trial Registration: clinicaltrials.gov Identifier: NCT01502332.
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- 2017
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24. Mapping Regional Differences of Local Pressure-Volume Curves With Electrical Impedance Tomography.
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Beda A, Carvalho AR, Carvalho NC, Hammermüller S, Amato MB, Muders T, Gittel C, Noreikat K, Wrigge H, and Reske AW
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- Animals, Disease Models, Animal, Elasticity, Lung physiopathology, Positive-Pressure Respiration, Pressure, Respiratory Distress Syndrome physiopathology, Respiratory Distress Syndrome therapy, Swine, Electric Impedance, Lung diagnostic imaging, Respiratory Distress Syndrome diagnostic imaging, Tomography
- Abstract
Objectives: Lung-protective mechanical ventilation aims to prevent alveolar collapse and overdistension, but reliable bedside methods to quantify them are lacking. We propose a quantitative descriptor of the shape of local pressure-volume curves derived from electrical impedance tomography, for computing maps that highlight the presence and location of regions of presumed tidal recruitment (i.e., elastance decrease during inflation, pressure-volume curve with upward curvature) or overdistension (i.e., elastance increase during inflation, downward curvature)., Design: Secondary analysis of experimental cohort study., Setting: University research facility., Subjects: Twelve mechanically ventilated pigs., Interventions: After induction of acute respiratory distress syndrome by hydrochloric acid instillation, animals underwent a decremental positive end-expiratory pressure titration (steps of 2 cm H2O starting from ≥ 26 cm H2O)., Measurements and Main Results: Electrical impedance tomography-derived maps were computed at each positive end-expiratory pressure-titration step, and whole-lung CT taken every second steps. Airway flow and pressure were recorded to compute driving pressure and elastance. Significant correlations between electrical impedance tomography-derived maps and positive end-expiratory pressure indicate that, expectedly, tidal recruitment increases in dependent regions with decreasing positive end-expiratory pressure (p < 0.001) and suggest that overdistension increases both at high and low positive end-expiratory pressures in nondependent regions (p < 0.027), supporting the idea of two different scenarios of overdistension occurrence. Significant correlations with CT measurements were observed: electrical impedance tomography-derived tidal recruitment with poorly aerated regions (r = 0.43; p < 0.001); electrical impedance tomography-derived overdistension with nonaerated regions at lower positive end-expiratory pressures and with hyperaerated regions at higher positive end-expiratory pressures (r ≥ 0.72; p < 0.003). Even for positive end-expiratory pressure levels minimizing global elastance and driving pressure, electrical impedance tomography-derived maps showed nonnegligible regions of presumed overdistension and tidal recruitment., Conclusions: Electrical impedance tomography-derived maps of pressure-volume curve shapes allow to detect regions in which elastance changes during inflation. This could promote individualized mechanical ventilation by minimizing the probability of local tidal recruitment and/or overdistension. Electrical impedance tomography-derived maps might become clinically feasible and relevant, being simpler than currently available alternative approaches.
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- 2017
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25. Chest electrical impedance tomography examination, data analysis, terminology, clinical use and recommendations: consensus statement of the TRanslational EIT developmeNt stuDy group.
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Frerichs I, Amato MB, van Kaam AH, Tingay DG, Zhao Z, Grychtol B, Bodenstein M, Gagnon H, Böhm SH, Teschner E, Stenqvist O, Mauri T, Torsani V, Camporota L, Schibler A, Wolf GK, Gommers D, Leonhardt S, and Adler A
- Subjects
- Adolescent, Adult, Cardiac Output, Child, Child, Preschool, Consensus, Humans, Infant, Infant, Newborn, Lung Diseases therapy, Pulmonary Circulation, Respiration, Artificial, Terminology as Topic, Electric Impedance, Lung Diseases diagnostic imaging, Lung Diseases physiopathology, Tomography methods
- Abstract
Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use. Recommendations of how EIT findings can be applied to generate diagnoses and impact clinical decision-making and therapy planning are required. This consensus paper was prepared by an international working group, collaborating on the clinical promotion of EIT called TRanslational EIT developmeNt stuDy group. It addresses the stated needs by providing (1) a new classification of core processes involved in chest EIT examinations and data analysis, (2) focus on clinical applications with structured reviews and outlooks (separately for adult and neonatal/paediatric patients), (3) a structured framework to categorise and understand the relationships among analysis approaches and their clinical roles, (4) consensus, unified terminology with clinical user-friendly definitions and explanations, (5) a review of all major work in thoracic EIT and (6) recommendations for future development (193 pages of online supplements systematically linked with the chief sections of the main document). We expect this information to be useful for clinicians and researchers working with EIT, as well as for industry producers of this technology., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
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- 2017
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26. Spontaneous Effort During Mechanical Ventilation: Maximal Injury With Less Positive End-Expiratory Pressure.
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Yoshida T, Roldan R, Beraldo MA, Torsani V, Gomes S, De Santis RR, Costa EL, Tucci MR, Lima RG, Kavanagh BP, and Amato MB
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- Animals, Female, Lung physiopathology, Positive-Pressure Respiration methods, Pulmonary Gas Exchange physiology, Pulmonary Surfactants metabolism, Respiratory Distress Syndrome, Respiratory Mechanics physiology, Swine, Tidal Volume, Respiration, Artificial adverse effects, Respiration, Artificial methods, Ventilator-Induced Lung Injury epidemiology
- Abstract
Objectives: We recently described how spontaneous effort during mechanical ventilation can cause "pendelluft," that is, displacement of gas from nondependent (more recruited) lung to dependent (less recruited) lung during early inspiration. Such transfer depends on the coexistence of more recruited (source) liquid-like lung regions together with less recruited (target) solid-like lung regions. Pendelluft may improve gas exchange, but because of tidal recruitment, it may also contribute to injury. We hypothesize that higher positive end-expiratory pressure levels decrease the propensity to pendelluft and that with lower positive end-expiratory pressure levels, pendelluft is associated with improved gas exchange but increased tidal recruitment., Design: Crossover design., Setting: University animal research laboratory., Subjects: Anesthetized landrace pigs., Interventions: Surfactant depletion was achieved by saline lavage in anesthetized pigs, and ventilator-induced lung injury was produced by ventilation with high tidal volume and low positive end-expiratory pressure. Ventilation was continued in each of four conditions: positive end-expiratory pressure (low or optimized positive end-expiratory pressure after recruitment) and spontaneous breathing (present or absent). Tidal recruitment was assessed using dynamic CT and regional ventilation/perfusion using electric impedance tomography. Esophageal pressure was measured using an esophageal balloon manometer., Measurements and Results: Among the four conditions, spontaneous breathing at low positive end-expiratory pressure not only caused the largest degree of pendelluft, which was associated with improved ventilation/perfusion matching and oxygenation, but also generated the greatest tidal recruitment. At low positive end-expiratory pressure, paralysis worsened oxygenation but reduced tidal recruitment. Optimized positive end-expiratory pressure decreased the magnitude of spontaneous efforts (measured by esophageal pressure) despite using less sedation, from -5.6 ± 1.3 to -2.0 ± 0.7 cm H2O, while concomitantly reducing pendelluft and tidal recruitment. No pendelluft was observed in the absence of spontaneous effort., Conclusions: Spontaneous effort at low positive end-expiratory pressure improved oxygenation but promoted tidal recruitment associated with pendelluft. Optimized positive end-expiratory pressure (set after lung recruitment) may reverse the harmful effects of spontaneous breathing by reducing inspiratory effort, pendelluft, and tidal recruitment.
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- 2016
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27. There is no cephalocaudal gradient of computed tomography densities or lung behavior in supine patients with acute respiratory distress syndrome.
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El-Dash SA, Borges JB, Costa EL, Tucci MR, Ranzani OT, Caramez MP, Carvalho CR, and Amato MB
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- Adolescent, Adult, Aged, 80 and over, Female, Humans, Male, Middle Aged, Positive-Pressure Respiration, Pulmonary Alveoli diagnostic imaging, Pulmonary Alveoli physiopathology, Supine Position physiology, Young Adult, Lung diagnostic imaging, Lung physiopathology, Respiratory Distress Syndrome diagnostic imaging, Respiratory Distress Syndrome physiopathology, Tomography, X-Ray Computed methods
- Abstract
Background: There is debate whether pressure transmission within the lungs and alveolar collapse follow a hydrostatic pattern or the compression exerted by the weight of the heart and the diaphragm causes collapse localized in the areas adjacent to these structures. The second hypothesis proposes the existence of a cephalocaudal gradient in alveolar collapse. We aimed to define whether or not lung density and collapse follow a 'liquid-like' pattern with homogeneous isogravitational layers along the cephalocaudal axis in acute respiratory distress syndrome lungs., Methods: Acute respiratory distress syndrome patients were submitted to full lung computed tomography scans at positive end-expiratory pressure (PEEP) zero (before) and 25 cmH2 O after a maximum-recruitment maneuver. PEEP was then decreased by 2 cmH2 O every 4 min, and a semi-complete scan performed at the end of each PEEP step., Results: Lung densities were homogeneous within each lung layer. Lung density increased along the ventrodorsal axis toward the dorsal region (β = 0.49, P < 0.001), while there was no increase, but rather a slight decrease, toward the diaphragm along the cephalocaudal axis and toward the heart. Higher PEEP attenuated density gradients. At PEEP 18 cmH2 O, dependent lung regions started to collapse massively, while best compliance was only reached at a lower PEEP., Conclusions: We could not detect cephalocaudal gradients in lung densities or in alveolar collapse. Likely, external pressures applied on the lung by the chest wall, organs, and effusions are transmitted throughout the lung in a hydrostatic pattern with homogeneous consequences at each isogravitational layer. A single cross-sectional image of the lung could fully represent the heterogeneous mechanical properties of dependent and non-dependent lung regions., (© 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)
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- 2016
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28. The Recruitability Paradox.
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Amato MB and Santiago RR
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- Humans, Positive-Pressure Respiration, Respiratory Distress Syndrome
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- 2016
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29. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data.
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Neto AS, Hemmes SN, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E, Gajic O, El-Tahan MR, Ghamdi AA, Günay E, Jaber S, Kokulu S, Kozian A, Licker M, Lin WQ, Maslow AD, Memtsoudis SG, Reis Miranda D, Moine P, Ng T, Paparella D, Ranieri VM, Scavonetto F, Schilling T, Selmo G, Severgnini P, Sprung J, Sundar S, Talmor D, Treschan T, Unzueta C, Weingarten TN, Wolthuis EK, Wrigge H, Amato MB, Costa EL, de Abreu MG, Pelosi P, and Schultz MJ
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- Adult, Aged, Anesthesia, General methods, Female, Humans, Intraoperative Period, Male, Middle Aged, Positive-Pressure Respiration methods, Randomized Controlled Trials as Topic, Tidal Volume, Anesthesia, General adverse effects, Lung Diseases etiology, Positive-Pressure Respiration adverse effects, Postoperative Complications etiology
- Abstract
Background: Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications., Methods: We did a meta-analysis of individual patient data from randomised controlled trials of protective ventilation during general anesthaesia for surgery published up to July 30, 2015. The main outcome was development of postoperative pulmonary complications (postoperative lung injury, pulmonary infection, or barotrauma)., Findings: We included data from 17 randomised controlled trials, including 2250 patients. Multivariate analysis suggested that driving pressure was associated with the development of postoperative pulmonary complications (odds ratio [OR] for one unit increase of driving pressure 1·16, 95% CI 1·13-1·19; p<0·0001), whereas we detected no association for tidal volume (1·05, 0·98-1·13; p=0·179). PEEP did not have a large enough effect in univariate analysis to warrant inclusion in the multivariate analysis. In a mediator analysis, driving pressure was the only significant mediator of the effects of protective ventilation on development of pulmonary complications (p=0·027). In two studies that compared low with high PEEP during low tidal volume ventilation, an increase in the level of PEEP that resulted in an increase in driving pressure was associated with more postoperative pulmonary complications (OR 3·11, 95% CI 1·39-6·96; p=0·006)., Interpretation: In patients having surgery, intraoperative high driving pressure and changes in the level of PEEP that result in an increase of driving pressure are associated with more postoperative pulmonary complications. However, a randomised controlled trial comparing ventilation based on driving pressure with usual care is needed to confirm these findings., Funding: None., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
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- 2016
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30. Experimental blunt chest trauma--cardiorespiratory effects of different mechanical ventilation strategies with high positive end-expiratory pressure: a randomized controlled study.
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Schreiter D, Carvalho NC, Katscher S, Mende L, Reske AP, Spieth PM, Carvalho AR, Beda A, Lachmann B, Amato MB, Wrigge H, and Reske AW
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- Animals, Positive-Pressure Respiration methods, Random Allocation, Respiratory Distress Syndrome etiology, Respiratory Distress Syndrome physiopathology, Swine, Thoracic Injuries complications, Thoracic Injuries physiopathology, Wounds, Nonpenetrating complications, Wounds, Nonpenetrating physiopathology, Respiration, Artificial methods, Respiratory Distress Syndrome therapy, Respiratory Mechanics physiology, Thoracic Injuries therapy, Wounds, Nonpenetrating therapy
- Abstract
Background: Uncertainty persists regarding the optimal ventilatory strategy in trauma patients developing acute respiratory distress syndrome (ARDS). This work aims to assess the effects of two mechanical ventilation strategies with high positive end-expiratory pressure (PEEP) in experimental ARDS following blunt chest trauma., Methods: Twenty-six juvenile pigs were anesthetized, tracheotomized and mechanically ventilated. A contusion was applied to the right chest using a bolt-shot device. Ninety minutes after contusion, animals were randomized to two different ventilation modes, applied for 24 h: Twelve pigs received conventional pressure-controlled ventilation with moderately low tidal volumes (VT, 8 ml/kg) and empirically chosen high external PEEP (16 cmH2O) and are referred to as the HP-CMV-group. The other group (n = 14) underwent high-frequency inverse-ratio pressure-controlled ventilation (HFPPV) involving respiratory rate of 65 breaths · min(-1), inspiratory-to-expiratory-ratio 2:1, development of intrinsic PEEP and recruitment maneuvers, compatible with the rationale of the Open Lung Concept. Hemodynamics, gas exchange and respiratory mechanics were monitored during 24 h. Computed tomography and histology were analyzed in subgroups., Results: Comparing changes which occurred from randomization (90 min after chest trauma) over the 24-h treatment period, groups differed statistically significantly (all P values for group effect <0.001, General Linear Model analysis) for the following parameters (values are mean ± SD for randomization vs. 24-h): PaO2 (100% O2) (HFPPV 186 ± 82 vs. 450 ± 59 mmHg; HP-CMV 249 ± 73 vs. 243 ± 81 mmHg), venous admixture (HFPPV 34 ± 9.8 vs. 11.2 ± 3.7%; HP-CMV 33.9 ± 10.5 vs. 21.8 ± 7.2%), PaCO2 (HFPPV 46.9 ± 6.8 vs. 33.1 ± 2.4 mmHg; HP-CMV 46.3 ± 11.9 vs. 59.7 ± 18.3 mmHg) and normally aerated lung mass (HFPPV 42.8 ± 11.8 vs. 74.6 ± 10.0 %; HP-CMV 40.7 ± 8.6 vs. 53.4 ± 11.6%). Improvements occurring after recruitment in the HFPPV-group persisted throughout the study. Peak airway pressure and VT did not differ significantly. HFPPV animals had lower atelectasis and inflammation scores in gravity-dependent lung areas., Conclusions: In this model of ARDS following unilateral blunt chest trauma, HFPPV ventilation improved respiratory function and fulfilled relevant ventilation endpoints for trauma patients, i.e. restoration of oxygenation and lung aeration while avoiding hypercapnia and respiratory acidosis.
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- 2016
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31. Correlation of lung collapse and gas exchange - a computer tomographic study in sheep and pigs with atelectasis in otherwise normal lungs.
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Wolf SJ, Reske AP, Hammermüller S, Costa EL, Spieth PM, Hepp P, Carvalho AR, Kraßler J, Wrigge H, Amato MB, and Reske AW
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- Anesthesia, General, Animals, Humans, Lung diagnostic imaging, Lung pathology, Partial Pressure, Pulmonary Atelectasis diagnostic imaging, Pulmonary Atelectasis pathology, Respiration, Artificial, Respiratory Distress Syndrome diagnostic imaging, Respiratory Distress Syndrome pathology, Sheep, Species Specificity, Swine, Tomography, X-Ray Computed, Vasoconstriction, Lung physiopathology, Pulmonary Atelectasis physiopathology, Pulmonary Gas Exchange, Respiratory Distress Syndrome physiopathology
- Abstract
Background: Atelectasis can provoke pulmonary and non-pulmonary complications after general anaesthesia. Unfortunately, there is no instrument to estimate atelectasis and prompt changes of mechanical ventilation during general anaesthesia. Although arterial partial pressure of oxygen (PaO2) and intrapulmonary shunt have both been suggested to correlate with atelectasis, studies yielded inconsistent results. Therefore, we investigated these correlations., Methods: Shunt, PaO2 and atelectasis were measured in 11 sheep and 23 pigs with otherwise normal lungs. In pigs, contrasting measurements were available 12 hours after induction of acute respiratory distress syndrome (ARDS). Atelectasis was calculated by computed tomography relative to total lung mass (Mtotal). We logarithmically transformed PaO2 (lnPaO2) to linearize its relationships with shunt and atelectasis. Data are given as median (interquartile range)., Results: Mtotal was 768 (715-884) g in sheep and 543 (503-583) g in pigs. Atelectasis was 26 (16-47) % in sheep and 18 (13-23) % in pigs. PaO2 (FiO2 = 1.0) was 242 (106-414) mmHg in sheep and 480 (437-514) mmHg in pigs. Shunt was 39 (29-51) % in sheep and 15 (11-20) % in pigs. Atelectasis correlated closely with lnPaO2 (R2 = 0.78) and shunt (R2 = 0.79) in sheep (P-values<0.0001). The correlation of atelectasis with lnPaO2 (R2 = 0.63) and shunt (R2 = 0.34) was weaker in pigs, but R2 increased to 0.71 for lnPaO2 and 0.72 for shunt 12 hours after induction of ARDS. In both, sheep and pigs, changes in atelectasis correlated strongly with corresponding changes in lnPaO2 and shunt., Discussion and Conclusion: In lung-healthy sheep, atelectasis correlates closely with lnPaO2 and shunt, when blood gases are measured during ventilation with pure oxygen. In lung-healthy pigs, these correlations were significantly weaker, likely because pigs have stronger hypoxic pulmonary vasoconstriction (HPV) than sheep and humans. Nevertheless, correlations improved also in pigs after blunting of HPV during ARDS. In humans, the observed relationships may aid in assessing anaesthesia-related atelectasis.
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- 2015
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32. Driving pressure as a key ventilation variable.
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Costa EL, Slutsky AS, and Amato MB
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- Humans, Positive-Pressure Respiration methods, Respiratory Distress Syndrome mortality, Tidal Volume
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- 2015
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33. Lung inflammation persists after 27 hours of protective Acute Respiratory Distress Syndrome Network Strategy and is concentrated in the nondependent lung.
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Borges JB, Costa EL, Bergquist M, Lucchetta L, Widström C, Maripuu E, Suarez-Sipmann F, Larsson A, Amato MB, and Hedenstierna G
- Subjects
- Animals, Disease Models, Animal, Fluorodeoxyglucose F18, Male, Pneumonia diagnostic imaging, Positron-Emission Tomography, Swine, Ventilator-Induced Lung Injury diagnostic imaging, Pneumonia physiopathology, Respiration, Artificial methods, Ventilator-Induced Lung Injury physiopathology
- Abstract
Objective: PET with [18F]fluoro-2-deoxy-D-glucose can be used to image cellular metabolism, which during lung inflammation mainly reflects neutrophil activity, allowing the study of regional lung inflammation in vivo. We aimed at studying the location and evolution of inflammation by PET imaging, relating it to morphology (CT), during the first 27 hours of application of protective-ventilation strategy as suggested by the Acute Respiratory Distress Syndrome Network, in a porcine experimental model of acute respiratory distress syndrome., Design: Prospective laboratory investigation., Setting: University animal research laboratory., Subjects: Ten piglets submitted to an experimental model of acute respiratory distress syndrome., Interventions: Lung injury was induced by lung lavages and 210 minutes of injurious mechanical ventilation using low positive end-expiratory pressure and high inspiratory pressures. During 27 hours of controlled mechanical ventilation according to Acute Respiratory Distress Syndrome Network strategy, the animals were studied with dynamic PET imaging of [18F]fluoro-2-deoxy-D-glucose at two occasions with 24-hour interval between them., Measurements and Main Results: [18F]fluoro-2-deoxy-D-glucose uptake rate was computed for the total lung, four horizontal regions from top to bottom (nondependent to dependent regions) and for voxels grouped by similar density using standard Hounsfield units classification. The global lung uptake was elevated at 3 and 27 hours, suggesting persisting inflammation. In both PET acquisitions, nondependent regions presented the highest uptake (p = 0.002 and p = 0.006). Furthermore, from 3 to 27 hours, there was a change in the distribution of regional uptake (p = 0.003), with more pronounced concentration of inflammation in nondependent regions. Additionally, the poorly aerated tissue presented the largest uptake concentration after 27 hours., Conclusions: Protective Acute Respiratory Distress Syndrome Network strategy did not attenuate global pulmonary inflammation during the first 27 hours after severe lung insult. The strategy led to a concentration of inflammatory activity in the upper lung regions and in the poorly aerated lung regions. The present findings suggest that the poorly aerated lung tissue is an important target of the perpetuation of the inflammatory process occurring during ventilation according to the Acute Respiratory Distress Syndrome Network strategy.
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- 2015
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34. Real-time ventilation and perfusion distributions by electrical impedance tomography during one-lung ventilation with capnothorax.
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Reinius H, Borges JB, Fredén F, Jideus L, Camargo ED, Amato MB, Hedenstierna G, Larsson A, and Lennmyr F
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- Analysis of Variance, Animals, Carbon Dioxide administration & dosage, Cardiac Output physiology, Disease Models, Animal, Electric Impedance, Pleural Cavity, Pulmonary Circulation physiology, Swine, Hemodynamics physiology, Insufflation methods, One-Lung Ventilation
- Abstract
Background: Carbon dioxide insufflation into the pleural cavity, capnothorax, with one-lung ventilation (OLV) may entail respiratory and hemodynamic impairments. We investigated the online physiological effects of OLV/capnothorax by electrical impedance tomography (EIT) in a porcine model mimicking the clinical setting., Methods: Five anesthetized, muscle-relaxed piglets were subjected to first right and then left capnothorax with an intra-pleural pressure of 19 cm H2 O. The contra-lateral lung was mechanically ventilated with a double-lumen tube at positive end-expiratory pressure 5 and subsequently 10 cm H2 O. Regional lung perfusion and ventilation were assessed by EIT. Hemodynamics, cerebral tissue oxygenation and lung gas exchange were also measured., Results: During right-sided capnothorax, mixed venous oxygen saturation (P = 0.018), as well as a tissue oxygenation index (P = 0.038) decreased. There was also an increase in central venous pressure (P = 0.006), and a decrease in mean arterial pressure (P = 0.045) and cardiac output (P = 0.017). During the left-sided capnothorax, the hemodynamic impairment was less than during the right side. EIT revealed that during the first period of OLV/capnothorax, no or very minor ventilation on the right side could be seen (3 ± 3% vs. 97 ± 3%, right vs. left, P = 0.007), perfusion decreased in the non-ventilated and increased in the ventilated lung (18 ± 2% vs. 82 ± 2%, right vs. left, P = 0.03). During the second OLV/capnothorax period, a similar distribution of perfusion was seen in the animals with successful separation (84 ± 4% vs. 16 ± 4%, right vs. left)., Conclusion: EIT detected in real-time dynamic changes in pulmonary ventilation and perfusion distributions. OLV to the left lung with right-sided capnothorax caused a decrease in cardiac output, arterial oxygenation and mixed venous saturation., (© 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)
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- 2015
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35. Driving pressure and survival in the acute respiratory distress syndrome.
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Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, Stewart TE, Briel M, Talmor D, Mercat A, Richard JC, Carvalho CR, and Brower RG
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- Humans, Lung anatomy & histology, Lung physiology, Lung Compliance, Multivariate Analysis, Pressure, Prognosis, Proportional Hazards Models, Respiratory Distress Syndrome physiopathology, Respiratory Distress Syndrome therapy, Risk, Positive-Pressure Respiration methods, Respiratory Distress Syndrome mortality, Tidal Volume
- Abstract
Background: Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (VT), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (CRS) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size), we hypothesized that driving pressure (ΔP=VT/CRS), in which VT is intrinsically normalized to functional lung size (instead of predicted lung size in healthy persons), would be an index more strongly associated with survival than VT or PEEP in patients who are not actively breathing., Methods: Using a statistical tool known as multilevel mediation analysis to analyze individual data from 3562 patients with ARDS enrolled in nine previously reported randomized trials, we examined ΔP as an independent variable associated with survival. In the mediation analysis, we estimated the isolated effects of changes in ΔP resulting from randomized ventilator settings while minimizing confounding due to the baseline severity of lung disease., Results: Among ventilation variables, ΔP was most strongly associated with survival. A 1-SD increment in ΔP (approximately 7 cm of water) was associated with increased mortality (relative risk, 1.41; 95% confidence interval [CI], 1.31 to 1.51; P<0.001), even in patients receiving "protective" plateau pressures and VT (relative risk, 1.36; 95% CI, 1.17 to 1.58; P<0.001). Individual changes in VT or PEEP after randomization were not independently associated with survival; they were associated only if they were among the changes that led to reductions in ΔP (mediation effects of ΔP, P=0.004 and P=0.001, respectively)., Conclusions: We found that ΔP was the ventilation variable that best stratified risk. Decreases in ΔP owing to changes in ventilator settings were strongly associated with increased survival. (Funded by Fundação de Amparo e Pesquisa do Estado de São Paulo and others.).
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- 2015
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36. First-time imaging of effects of inspired oxygen concentration on regional lung volumes and breathing pattern during hypergravity.
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Borges JB, Hedenstierna G, Bergman JS, Amato MB, Avenel J, and Montmerle-Borgdorff S
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- Adult, Gravity Suits, Humans, Lung drug effects, Male, Tidal Volume, Tomography, Hypergravity adverse effects, Hyperoxia physiopathology, Inhalation, Lung physiology, Oxygen toxicity, Respiration
- Abstract
Purpose: Aeroatelectasis can develop in aircrew flying the latest generation high-performance aircraft. Causes alleged are relative hyperoxia, increased gravity in the head-to-foot direction (+Gz), and compression of legs and stomach by anti-G trousers (AGT). We aimed to assess, in real time, the effects of hyperoxia, +Gz accelerations and AGT inflation on changes in regional lung volumes and breathing pattern evaluated in an axial plane by electrical impedance tomography (EIT)., Methods: The protocol mimicked a routine peacetime flight in combat aircraft. Eight subjects wearing AGT were studied in a human centrifuge during 1 h 15 min exposure of +1 to +3.5Gz. They performed this sequence three times, breathing AIR, 44.5 % O2 or 100 % O2. Continuous recording of functional EIT enabled uninterrupted assessment of regional lung volumes at the 5th intercostal level. Breathing pattern was also monitored., Results: EIT data showed that +3.5Gz, compared with any moment without hypergravity, caused an abrupt decrease in regional tidal volume (VT) and regional end-expiratory lung volume (EELV) measured in the EIT slice, independently of inspired oxygen concentration. Breathing AIR or 44.5 % O2, sub-regional EELV measured in the EIT slice decreased similarly in dorsal and ventral regions, but sub-regional VT measured in the EIT slice decreased significantly more dorsally than ventrally. Breathing 100 % O2, EELV and VT decreased similarly in both regions. Inspired tidal volume increased in hyperoxia, whereas breathing frequency increased in hypergravity and hyperoxia., Conclusions: Our findings suggest that hypergravity and AGT inflation cause airway closure and air trapping in gravity-dependent lung regions, facilitating absorption atelectasis formation, in particular during hyperoxia.
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- 2015
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37. Moderately high frequency ventilation with a conventional ventilator allows reduction of tidal volume without increasing mean airway pressure.
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Cordioli RL, Park M, Costa EL, Gomes S, Brochard L, Amato MB, and Azevedo LC
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Background: The aim of this study was to explore if positive-pressure ventilation delivered by a conventional ICU ventilator at a moderately high frequency (HFPPV) allows a safe reduction of tidal volume (V T) below 6 mL/kg in a porcine model of severe acute respiratory distress syndrome (ARDS) and at a lower mean airway pressure than high-frequency oscillatory ventilation (HFOV)., Methods: This is a prospective study. In eight pigs (median weight 34 [29,36] kg), ARDS was induced by pulmonary lavage and injurious ventilation. The animals were ventilated with a randomized sequence of respiratory rates: 30, 60, 90, 120, 150, followed by HFOV at 5 Hz. At each step, V T was adjusted to allow partial pressure of arterial carbon dioxide (PaCO2) to stabilize between 57 and 63 mmHg. Data are shown as median [P25th,P75th]., Results: After lung injury, the PaO2/FiO2 (P/F) ratio was 92 [63,118] mmHg, pulmonary shunt 26 [17,31]%, and static compliance 11 [8,14] mL/cmH2O. Positive end-expiratory pressure (PEEP) was 14 [10,17] cmH2O. At 30 breaths/min, V T was higher than 6 (7.5 [6.8,10.2]) mL/kg, but at all higher frequencies, V T could be reduced and PaCO2 maintained, leading to reductions in plateau pressures and driving pressures. For frequencies of 60 to 150/min, V T progressively fell from 5.2 [5.1,5.9] to 3.8 [3.7,4.2] mL/kg (p < 0.001). There were no detrimental effects in terms of lung mechanics, auto-PEEP generation, hemodynamics, or gas exchange. Mean airway pressure was maintained constant and was increased only during HFOV., Conclusions: During protective mechanical ventilation, HFPPV delivered by a conventional ventilator in a severe ARDS swine model safely allows further tidal volume reductions. This strategy also allowed decreasing airway pressures while maintaining stable PaCO2 levels.
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- 2014
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38. Effects of alveolar recruitment maneuvers on clinical outcomes in patients with acute respiratory distress syndrome: a systematic review and meta-analysis.
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Suzumura EA, Figueiró M, Normilio-Silva K, Laranjeira L, Oliveira C, Buehler AM, Bugano D, Passos Amato MB, Ribeiro Carvalho CR, Berwanger O, and Cavalcanti AB
- Subjects
- Hospital Mortality, Humans, Pulmonary Alveoli, Treatment Outcome, Respiratory Distress Syndrome therapy, Respiratory Therapy
- Abstract
Purpose: To assess the effects of alveolar recruitment maneuvers (ARMs) on clinical outcomes in patients with acute respiratory distress syndrome (ARDS)., Methods: We conducted a search of the MEDLINE, EMBASE, LILACS, CINAHL, CENTRAL, Scopus, and Web of Science (from inception to July 2014) databases for all (i.e. no language restriction) randomized controlled trials (RCTs) evaluating the effects of ARMs versus no ARMs in adults with ARDS. Four teams of two reviewers independently assessed the eligibility of the studies identified during the search and appraised the risk of bias and extracted data from those which were assessed as meeting the inclusion criteria. Data were pooled using the random-effects model. Trial sequential analysis (TSA) was used to establish monitoring boundaries to limit global type I error due to repetitive testing for our primary outcome (in-hospital mortality). The GRADE system was used to rate the quality of evidence., Results: Our database search identified ten RCTs (1,594 patients, 612 events) which satisfied the inclusion criteria. The meta-analysis assessing the effect of ARMs on in-hospital mortality showed a risk ratio (RR) of 0.84 [95 % confidence interval (CI) 0.74-0.95; I(2) = 0 %], although the quality of evidence was considered to be low due to the risk of bias in the included trials and the indirectness of the evidence--that is, ARMs were usually conducted together with other ventilatory interventions which may affect the outcome of interest. There were no differences in the rates of barotrauma (RR 1.11; 95 % CI 0.78-1.57; I(2) = 0 %) or need for rescue therapies (RR 0.76, 95 % CI 0.41-1.40; I(2) = 56 %). Most trials found no difference between groups in terms of duration of mechanical ventilation and length of stay in the intensive care unit and hospital. The TSA showed that the available evidence for the effect of ARMs on in-hospital mortality is precise in the case of a type I error of 5 %, but it is not precise with a type I error of 1 %., Conclusions: Although ARMs may decrease the mortality of patients with ARDS without increasing the risk for major adverse events, current evidence is not definitive. Large-scale ongoing trials addressing this question may provide data better applicable to clinical practice.
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- 2014
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39. Brazilian recommendations of mechanical ventilation 2013. Part 2.
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Barbas CS, Ísola AM, Farias AM, Cavalcanti AB, Gama AM, Duarte AC, Vianna A, Serpa Neto A, Bravim Bde A, Pinheiro Bdo V, Mazza BF, de Carvalho CR, Toufen Júnior C, David CM, Taniguchi C, Mazza DD, Dragosavac D, Toledo DO, Costa EL, Caser EB, Silva E, Amorim FF, Saddy F, Galas FR, Silva GS, de Matos GF, Emmerich JC, Valiatti JL, Teles JM, Victorino JA, Ferreira JC, Prodomo LP, Hajjar LA, Martins LC, Malbouisson LM, Vargas MA, Reis MA, Amato MB, Holanda MA, Park M, Jacomelli M, Tavares M, Damasceno MC, Assunção MS, Damasceno MP, Youssef NC, Teixeira PJ, Caruso P, Duarte PA, Messeder O, Eid RC, Rodrigues RG, de Jesus RF, Kairalla RA, Justino S, Nemer SN, Romero SB, and Amado VM
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- Brazil, Critical Care standards, Critical Illness therapy, Humans, Intensive Care Units standards, Quality of Health Care, Critical Care methods, Practice Guidelines as Topic, Respiration, Artificial methods
- Abstract
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
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- 2014
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40. Cycling-off modes during pressure support ventilation: effects on breathing pattern, patient effort, and comfort.
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Hoff FC, Tucci MR, Amato MB, Santos LJ, and Victorino JA
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- Aged, Analysis of Variance, Cross-Over Studies, Exhalation physiology, Female, Humans, Male, Middle Aged, Tidal Volume, Time Factors, Positive-Pressure Respiration methods, Respiration, Respiratory Rate physiology, Stress, Physiological, Ventilator Weaning methods
- Abstract
Purpose: Expiratory asynchrony during pressure support ventilation (PSV) has been recognized as a cause of patient discomfort, increased workload, and impaired weaning process. We evaluated breathing pattern, patient comfort, and patient effort during PSV comparing 2 flow termination criteria: fixed at 5% of peak inspiratory flow vs automatic, real-time, breath-by-breath adjustment within the range of 5% to 55%., Materials and Methods: Randomized crossover clinical trial. Sixteen awake patients, in the process of weaning, under PSV for more than 24 hours were subjected to 3 phases of PSV, each lasting 1 hour and using 1 of the 2 aforementioned termination criteria., Results: Effective pressure support during automatic adjustment (AA) was 12.5±3.2 cm H2O vs 12.5±3.9 cm H2O (P=.9) with the fixed termination criterion, and external positive end-expiratory pressure was 6.2±1.8 vs 6.8±2 (P<.05). The effective termination criterion was higher during AA (31% [23-39] vs 12% [6-23]; P<.01), but without producing premature breath terminations. Pressure overshoots and alternative cycling-off were also decreased. Throughout the AA period, we observed a higher respiratory rate (24±8 breaths/min vs 19±6 breaths/min; P<.001), lower tidal volume (484 ± 88 mL vs 518±102 mL; P<.001), and shorter inspiratory times (1.0±0.3 seconds vs 1.3±0.3 seconds; P<.001). Automatic adjustment was associated with lower airway occlusion pressure after 0.1 second (P0.1) (1.8±0.9 cm H2O vs 2.4±1 cm H2O; P<.01), lower pressure-time product to trigger the ventilator, and lower subjective discomfort (visual analog scale, 3.7±1.3 vs 4.5±1.2; P<.001)., Conclusions: When compared with a fixed termination criterion, the use of a variable, real-time-adjusted termination criterion improved some indices of patient-ventilator synchrony, producing better breathing pattern, less discomfort, and slightly lower patient effort during PSV., (Copyright © 2014 Elsevier Inc. All rights reserved.)
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- 2014
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41. Brazilian recommendations of mechanical ventilation 2013. Part I.
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Barbas CS, Isola AM, Farias AM, Cavalcanti AB, Gama AM, Duarte AC, Vianna A, Serpa Neto A, Bravim Bde A, Pinheiro Bdo V, Mazza BF, Carvalho CR, Toufen Júnior C, David CM, Taniguchi C, Mazza DD, Dragosavac D, Toledo DO, Costa EL, Caser EB, Silva E, Amorim FF, Saddy F, Galas FR, Silva GS, Matos GF, Emmerich JC, Valiatti JL, Teles JM, Victorino JA, Ferreira JC, Prodomo LP, Hajjar LA, Martins LC, Malbouisson LM, Vargas MA, Reis MA, Amato MB, Holanda MA, Park M, Jacomelli M, Tavares M, Damasceno MC, Assunção MS, Damasceno MP, Youssef NC, Teixeira PJ, Caruso P, Duarte PA, Messeder O, Eid RC, Rodrigues RG, Jesus RF, Kairalla RA, Justino S, Nemer SN, Romero SB, and Amado VM
- Subjects
- Brazil, Critical Care methods, Humans, Intensive Care Units standards, Quality of Health Care, Critical Illness therapy, Practice Guidelines as Topic, Respiration, Artificial methods
- Abstract
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumonia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
- Published
- 2014
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42. Lung reaeration and reventilation after aspiration of pleural effusions. A study using electrical impedance tomography.
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Alves SH, Amato MB, Terra RM, Vargas FS, and Caruso P
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- Aged, Electric Impedance, Female, Humans, Male, Middle Aged, Pleural Effusion, Malignant diagnosis, Prospective Studies, Treatment Outcome, Lung physiology, Paracentesis methods, Pleural Effusion, Malignant therapy, Pulmonary Ventilation physiology, Tomography methods
- Abstract
Rationale: Lung reexpansion after pleural effusion aspiration is composed of reaeration and reventilation. Previous studies evaluated only the immediate reaeration, and the reventilation was not evaluated using a direct lung ventilation measurement method. Also, indirect evidence indicates that the effusion could cause ventilator asynchrony between the lungs. The electrical impedance tomography can directly and reliably measure lung reaeration, reventilation, and synchrony., Objectives: To evaluate lung reaeration, reventilation, and ventilator synchrony before and over 1 hour after a pleural aspiration., Methods: A prospective and observational study using electrical impedance tomography to measure the lung reaeration, reventilation, and ventilatory synchrony between the lungs (through phase angle) before and over 1 hour after the pleural aspiration of 22 patients with unilateral malignant effusions., Measurements and Main Results: The ipsilateral (affected by the effusion) (P < 0.001) and contralateral (P = 0.008) lung reaerated immediately without further reaeration over the next hour. However, the reventilation response was heterogeneous, with patients increasing, maintaining, or decreasing ipsilateral lung ventilation after the aspiration. The pleural effusion had caused ventilatory asynchrony (93 ± 71 degrees) that was immediately reversed by the aspiration. In some patients, the asynchrony was so extreme that one lung was inflating while the other was deflating, causing paradoxical ventilation., Conclusions: After a pleural effusion aspiration, the ipsilateral and contralateral lungs reaerate immediately without further reaeration over the next hour. The reventilation shows a heterogeneous response, with patients increasing, maintaining, or decreasing the ipsilateral lung ventilation. The pleural effusion causes a ventilatory asynchrony between the lungs that is immediately decreased by the aspiration. In some patients, that asynchrony is so intense that it causes paradoxical ventilation.
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- 2014
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43. Spontaneous effort causes occult pendelluft during mechanical ventilation.
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Yoshida T, Torsani V, Gomes S, De Santis RR, Beraldo MA, Costa EL, Tucci MR, Zin WA, Kavanagh BP, and Amato MB
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- Adult, Animals, Humans, Male, Plethysmography, Impedance, Respiratory Distress Syndrome therapy, Swine, Tidal Volume, Tomography, Lung physiopathology, Pleura physiopathology, Positive-Pressure Respiration, Pressure, Respiration, Respiratory Distress Syndrome physiopathology
- Abstract
Rationale: In normal lungs, local changes in pleural pressure (P(pl)) are generalized over the whole pleural surface. However, in a patient with injured lungs, we observed (using electrical impedance tomography) a pendelluft phenomenon (movement of air within the lung from nondependent to dependent regions without change in tidal volume) that was caused by spontaneous breathing during mechanical ventilation., Objectives: To test the hypotheses that in injured lungs negative P(pl) generated by diaphragm contraction has localized effects (in dependent regions) that are not uniformly transmitted, and that such localized changes in P(pl) cause pendelluft., Methods: We used electrical impedance tomography and dynamic computed tomography (CT) to analyze regional inflation in anesthetized pigs with lung injury. Changes in local P(pl) were measured in nondependent versus dependent regions using intrabronchial balloon catheters. The airway pressure needed to achieve comparable dependent lung inflation during paralysis versus spontaneous breathing was estimated., Measurements and Main Results: In all animals, spontaneous breathing caused pendelluft during early inflation, which was associated with more negative local P(pl) in dependent regions versus nondependent regions (-13.0 ± 4.0 vs. -6.4 ± 3.8 cm H2O; P < 0.05). Dynamic CT confirmed pendelluft, which occurred despite limitation of tidal volume to less than 6 ml/kg. Comparable inflation of dependent lung during paralysis required almost threefold greater driving pressure (and tidal volume) versus spontaneous breathing (28.0 ± 0.5 vs. 10.3 ± 0.6 cm H2O, P < 0.01; 14.8 ± 4.6 vs. 5.8 ± 1.6 ml/kg, P < 0.05)., Conclusions: Spontaneous breathing effort during mechanical ventilation causes unsuspected overstretch of dependent lung during early inflation (associated with reciprocal deflation of nondependent lung). Even when not increasing tidal volume, strong spontaneous effort may potentially enhance lung damage.
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- 2013
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44. Assessment of regional lung ventilation by electrical impedance tomography in a patient with unilateral bronchial stenosis and a history of tuberculosis.
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Marinho LS, Sousa NP, Barros CA, Matias MS, Monteiro LT, Beraldo Mdo A, Costa EL, Amato MB, and Holanda MA
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- Constriction, Pathologic physiopathology, Continuous Positive Airway Pressure, Electric Impedance, Female, Humans, Middle Aged, Multidetector Computed Tomography methods, Sleep Apnea, Obstructive physiopathology, Bronchial Diseases physiopathology, Pulmonary Ventilation, Tuberculosis, Pulmonary physiopathology
- Abstract
Bronchial stenosis can impair regional lung ventilation by causing abnormal, asymmetric airflow limitation. Electrical impedance tomography (EIT) is an imaging technique that allows the assessment of regional lung ventilation and therefore complements the functional assessment of the lungs. We report the case of a patient with left unilateral bronchial stenosis and a history of tuberculosis, in whom regional lung ventilation was assessed by EIT. The EIT results were compared with those obtained by ventilation/perfusion radionuclide imaging. The patient was using nasal continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. Therefore, we studied the effects of postural changes and of the use of nasal CPAP. The EIT revealed heterogeneous distribution of regional lung ventilation, the ventilation being higher in the right lung, and this distribution was influenced by postural changes and CPAP use. The EIT assessment of regional lung ventilation produced results similar to those obtained with the radionuclide imaging technique and had the advantage of providing a dynamic evaluation without radiation exposure.
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- 2013
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45. Evaluation of manual resuscitators used in ICUs in Brazil.
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Ortiz Tde A, Forti G Jr, Volpe MS, Beraldo Mdo A, Amato MB, Carvalho CR, and Tucci MR
- Subjects
- Brazil, Comparative Effectiveness Research methods, Computer Simulation standards, Female, Humans, Male, Observer Variation, Respiratory Mechanics physiology, Tidal Volume, Ventilators, Mechanical standards, Intensive Care Units, Resuscitation instrumentation, Ventilators, Mechanical statistics & numerical data
- Abstract
Objective: To evaluate the performance of manual resuscitators (MRs) used in Brazil in accordance with international standards., Methods: Using a respiratory system simulator, four volunteer physiotherapists employed eight MRs (five produced in Brazil and three produced abroad), which were tested for inspiratory and expiratory resistance of the patient valve; functioning of the pressure-limiting valve; and tidal volume (VT) generated when the one-handed and two-handed techniques were used. The tests were performed and analyzed in accordance with the American Society for Testing and Materials (ASTM) F920-93 criteria., Results: Expiratory resistance was greater than 6 cmH2O . L-1 . s-1 in only one MR. The pressure-limiting valve, a feature of five of the MRs, opened at low pressures (< 17 cmH2O), and the maximal pressure was 32.0-55.9 cmH2O. Mean VT varied greatly among the MRs tested. The mean VT values generated with the one-handed technique were lower than the 600 mL recommended by the ASTM. In the situations studied, mean VT was generally lower from the Brazilian-made MRs that had a pressure-limiting valve., Conclusions: The resistances imposed by the patient valve met the ASTM criteria in all but one of the MRs tested. The pressure-limiting valves of the Brazilian-made MRs usually opened at low pressures, providing lower VT values in the situations studied, especially when the one-handed technique was used, suggesting that both hands should be used and that the pressure-limiting valve should be closed whenever possible.
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- 2013
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46. Regional lung derecruitment and inflammation during 16 hours of mechanical ventilation in supine healthy sheep.
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Tucci MR, Costa EL, Wellman TJ, Musch G, Winkler T, Harris RS, Venegas JG, Amato MB, and Melo MF
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- Animals, Fluorodeoxyglucose F18, Image Processing, Computer-Assisted, Leukocyte Count, Lung cytology, Lung diagnostic imaging, Lung Volume Measurements, Neutrophils pathology, Nitrogen Radioisotopes, Pneumonia diagnostic imaging, Positive-Pressure Respiration, Positron-Emission Tomography, Radiopharmaceuticals, Lung physiology, Pneumonia pathology, Respiration, Artificial, Sheep physiology, Supine Position physiology
- Abstract
Background: Lung derecruitment is common during general anesthesia. Mechanical ventilation with physiological tidal volumes could magnify derecruitment, and produce lung dysfunction and inflammation. The authors used positron emission tomography to study the process of derecruitment in normal lungs ventilated for 16 h and the corresponding changes in regional lung perfusion and inflammation., Methods: Six anesthetized supine sheep were ventilated with VT=8 ml/kg and positive end-expiratory pressure=0. Transmission scans were performed at 2-h intervals to assess regional aeration. Emission scans were acquired at baseline and after 16 h for the following tracers: (1) F-fluorodeoxyglucose to evaluate lung inflammation and (2) NN to calculate regional perfusion and shunt fraction., Results: Gas fraction decreased from baseline to 16 h in dorsal (0.31±0.13 to 0.14±0.12, P<0.01), but not in ventral regions (0.61±0.03 to 0.63±0.07, P=nonsignificant), with time constants of 1.5-44.6 h. Although the vertical distribution of relative perfusion did not change from baseline to 16 h, shunt increased in dorsal regions (0.34±0.23 to 0.63±0.35, P<0.01). The average pulmonary net F-fluorodeoxyglucose uptake rate in six regions of interest along the ventral-dorsal direction increased from 3.4±1.4 at baseline to 4.1±1.5 10(-3)/min after 16 h (P<0.01), and the corresponding average regions of interest F-fluorodeoxyglucose phosphorylation rate increased from 2.0±0.2 to 2.5±0.2 10(-2)/min (P<0.01)., Conclusions: When normal lungs are mechanically ventilated without positive end-expiratory pressure, loss of aeration occurs continuously for several hours and is preferentially localized to dorsal regions. Progressive lung derecruitment was associated with increased regional shunt, implying an insufficient hypoxic pulmonary vasoconstriction. The increased pulmonary net uptake and phosphorylation rates of F-fluorodeoxyglucose suggest an incipient inflammation in these initially normal lungs.
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- 2013
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47. Ultra-protective tidal volume: how low should we go?
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Costa EL and Amato MB
- Subjects
- Female, Humans, Male, Respiration, Artificial methods, Respiratory Distress Syndrome diagnosis, Respiratory Distress Syndrome therapy, Tidal Volume physiology
- Abstract
Applying tidal volumes of less than 6 mL/kg might improve lung protection in patients with acute respiratory distress syndrome. In a recent article, Retamal and colleagues showed that such a reduction is feasible with conventional mechanical ventilation and leads to less tidal recruitment and overdistension without causing carbon dioxide retention or auto-positive end-expiratory pressure. However, whether the compensatory increase in the respiratory rate blunts the lung protection remains unestablished.
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- 2013
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48. Noninvasive ventilation immediately after extubation improves weaning outcome after acute respiratory failure: a randomized controlled trial.
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Ornico SR, Lobo SM, Sanches HS, Deberaldini M, Tófoli LT, Vidal AM, Schettino GP, Amato MB, Carvalho CR, and Barbas CS
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- Adult, Aged, Airway Extubation trends, Female, Humans, Male, Middle Aged, Noninvasive Ventilation trends, Prospective Studies, Treatment Outcome, Ventilator Weaning trends, Airway Extubation methods, Noninvasive Ventilation methods, Respiratory Distress Syndrome diagnosis, Respiratory Distress Syndrome therapy, Ventilator Weaning methods
- Abstract
Introduction: Noninvasive ventilation (NIV), as a weaning-facilitating strategy in predominantly chronic obstructive pulmonary disease (COPD) mechanically ventilated patients, is associated with reduced ventilator-associated pneumonia, total duration of mechanical ventilation, length of intensive care unit (ICU) and hospital stay, and mortality. However, this benefit after planned extubation in patients with acute respiratory failure of various etiologies remains to be elucidated. The aim of this study was to determine the efficacy of NIV applied immediately after planned extubation in contrast to oxygen mask (OM) in patients with acute respiratory failure (ARF)., Methods: A randomized, prospective, controlled, unblinded clinical study in a single center of a 24-bed adult general ICU in a university hospital was carried out in a 12-month period. Included patients met extubation criteria with at least 72 hours of mechanical ventilation due to acute respiratory failure, after following the ICU weaning protocol. Patients were randomized immediately before elective extubation, being randomly allocated to one of the study groups: NIV or OM. We compared both groups regarding gas exchange 15 minutes, 2 hours, and 24 hours after extubation, reintubation rate after 48 hours, duration of mechanical ventilation, ICU length of stay, and hospital mortality., Results: Forty patients were randomized to receive NIV (20 patients) or OM (20 patients) after the following extubation criteria were met: pressure support (PSV) of 7 cm H2O, positive end-expiratory pressure (PEEP) of 5 cm H2O, oxygen inspiratory fraction (FiO2)≤40%, arterial oxygen saturation (SaO2)≥90%, and ratio of respiratory rate and tidal volume in liters (f/TV)<105. Comparing the 20 patients (NIV) with the 18 patients (OM) that finished the study 48 hours after extubation, the rate of reintubation in NIV group was 5% and 39% in OM group (P=0.016). Relative risk for reintubation was 0.13 (CI=0.017 to 0.946). Absolute risk reduction for reintubation showed a decrease of 33.9%, and analysis of the number needed to treat was three. No difference was found in the length of ICU stay (P=0.681). Hospital mortality was zero in NIV group and 22.2% in OM group (P=0.041)., Conclusions: In this study population, NIV prevented 48 hours reintubation if applied immediately after elective extubation in patients with more than 3 days of ARF when compared with the OM group., Trial Registration Number Isrctn: 41524441.
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- 2013
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49. Bedside estimation of nonaerated lung tissue using blood gas analysis.
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Reske AW, Costa EL, Reske AP, Rau A, Borges JB, Beraldo MA, Gottschaldt U, Seiwerts M, Schreiter D, Petroff D, Kaisers UX, Wrigge H, and Amato MB
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Animals, Brazil, Female, Germany, Humans, Intensive Care Units, Lung diagnostic imaging, Male, Middle Aged, Models, Animal, Prospective Studies, Swine, Tomography, X-Ray Computed, Young Adult, Blood Gas Analysis methods, Lung physiopathology, Point-of-Care Systems
- Abstract
Objectives: Studies correlating the arterial partial pressure of oxygen to the fraction of nonaerated lung assessed by CT shunt yielded inconsistent results. We systematically analyzed this relationship and scrutinized key methodological factors that may compromise it. We hypothesized that both physiological shunt and the ratio between PaO2 and the fraction of inspired oxygen enable estimation of CT shunt at the bedside., Design: : Prospective observational clinical and laboratory animal investigations., Setting: ICUs (University Hospital Leipzig, Germany) and Experimental Pulmonology Laboratory (University of São Paulo, Brazil). PATIENTS, SUBJECTS AND INTERVENTIONS: Whole-lung CT and arterial blood gases were acquired simultaneously in 77 patients mechanically ventilated with pure oxygen. A subgroup of 28 patients was submitted to different Fio2. We also studied 19 patients who underwent repeat CT. Furthermore we studied ten pigs with acute lung injury at multiple airway pressures, as well as a theoretical model relating PaO2 and physiological shunt. We logarithmically transformed the PaO2/Fio2 to change this nonlinear relationship into a linear regression problem., Measurements and Main Results: We observed strong linear correlations between Riley's approximation of physiological shunt and CT shunt (R = 0.84) and between logarithmically transformed PaO2/Fio2 and CT shunt (R = 0.86), allowing us to construct a look-up table with prediction intervals. Strong linear correlations were also demonstrated within-patients (R = 0.95). Correlations were significantly improved by the following methodological issues: measurement of PaO2/Fio2 during pure oxygen ventilation, use of logarithmically transformed PaO2/Fio2 instead of the "raw" PaO2/Fio2, quantification of nonaerated lung as percentage of total lung mass and definition of nonaerated lung by the [-200 to +100] Hounsfield Units interval, which includes shunting units within less opacified lung regions., Conclusion: During pure oxygen ventilation, logarithmically transformed PaO2/Fio2 allows estimation of CT shunt and its changes in patients during systemic inflammation. Relevant intrapulmonary shunting seems to occur in lung regions with CT numbers between [-200 and +100] Hounsfield Units.
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- 2013
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50. Experimental study on the efficiency and safety of the manual hyperinflation maneuver as a secretion clearance technique.
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Ortiz Tde A, Forti G, Volpe MS, Carvalho CR, Amato MB, and Tucci MR
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- Analysis of Variance, Humans, Models, Biological, Pulmonary Disease, Chronic Obstructive physiopathology, Respiratory Therapy education, Lung metabolism, Pulmonary Disease, Chronic Obstructive therapy, Pulmonary Ventilation physiology, Respiratory Therapy methods
- Abstract
Objective: To evaluate, in a lung model simulating a mechanically ventilated patient, the efficiency and safety of the manual hyperinflation (MH) maneuver as a means of removing pulmonary secretions., Methods: Eight respiratory therapists (RTs) were asked to use a self-inflating manual resuscitator on a lung model to perform MH as if to remove secretions, under two conditions: as routinely applied during their clinical practice; and after receiving verbal instructions based on expert recommendations. In both conditions, three clinical scenarios were simulated: normal lung function, restrictive lung disease, and obstructive lung disease., Results: Before instruction, it was common for an RT to compress the resuscitator bag two times, in rapid succession. Proximal pressure (Pprox) was higher before instruction than after. However, alveolar pressure (Palv) never exceeded 42.5 cmH₂O (median, 16.1; interquartile range [IQR], 11.7-24.5), despite Pprox values as high as 96.6 cmH₂O (median, 36.7; IQR, 22.9-49.4). The tidal volume (VT) generated was relatively low (median, 640 mL; IQR, 505-735), and peak inspiratory flow (PIF) often exceeded peak expiratory flow (PEF), the median values being 1.37 L/s (IQR, 0.99-1.90) and 1.01 L/s (IQR, 0.55-1.28), respectively. A PIF/PEF ratio < 0.9 (which theoretically favors mucus migration toward the central airways) was achieved in only 16.7% of the maneuvers., Conclusions: Under the conditions tested, MH produced safe Palv levels despite high Pprox. However, the MH maneuver was often performed in a way that did not favor secretion removal (PIF exceeding PEF), even after instruction. The unfavorable PIF/ PEF ratio was attributable to overly rapid inflations and low VT.
- Published
- 2013
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