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3. Proposal of a reliable scoring system for the histological assessment of multiorgan injury in large animal models of ischaemia and shock

Author

Palmieri, C., primary, See Hoe, L., additional, Dyer, W., additional, Heinsar, S., additional, Rozencwaig, S., additional, Tung, J.P., additional, Bartnikowski, N., additional, Passmore, M., additional, Bouquet, M., additional, Hislop, K., additional, Wilson, E., additional, Li Bassi, g., additional, Mcgiffin, D., additional, Suen, J., additional, and Fraser, J., additional

Published
2023
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4. Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies

Author

Mcnicholas, B, Rezoagli, E, Simpkin, A, Khanna, S, Suen, J, Yeung, P, Brodie, D, Li Bassi, G, Pham, T, Bellani, G, Fraser, J, Laffey, J, McNicholas, Bairbre A, Rezoagli, Emanuele, Simpkin, Andrew J, Khanna, Sankalp, Suen, Jacky Y, Yeung, Pauline, Brodie, Daniel, Li Bassi, Gianluigi, Pham, Tai, Bellani, Giacomo, Fraser, John F, Laffey, John, Mcnicholas, B, Rezoagli, E, Simpkin, A, Khanna, S, Suen, J, Yeung, P, Brodie, D, Li Bassi, G, Pham, T, Bellani, G, Fraser, J, Laffey, J, McNicholas, Bairbre A, Rezoagli, Emanuele, Simpkin, Andrew J, Khanna, Sankalp, Suen, Jacky Y, Yeung, Pauline, Brodie, Daniel, Li Bassi, Gianluigi, Pham, Tai, Bellani, Giacomo, Fraser, John F, and Laffey, John

Abstract

Background: Acute kidney injury (AKI) is a frequent and severe complication of both COVID-19-related acute respiratory distress syndrome (ARDS) and non-COVID-19-related ARDS. The COVID-19 Critical Care Consortium (CCCC) has generated a global data set on the demographics, management and outcomes of critically ill COVID-19 patients. The LUNG-SAFE study was an international prospective cohort study of patients with severe respiratory failure, including ARDS, which pre-dated the pandemic. Methods: The incidence, demographic profile, management and outcomes of early AKI in patients undergoing invasive mechanical ventilation for COVID-19-related ARDS were described and compared with AKI in a non-COVID-19-related ARDS cohort. Results: Of 18,964 patients in the CCCC data set, 1699 patients with COVID-19-related ARDS required invasive ventilation and had relevant outcome data. Of these, 110 (6.5%) had stage 1, 94 (5.5%) had stage 2, 151 (8.9%) had stage 3 AKI, while 1214 (79.1%) had no AKI within 48 h of initiating invasive mechanical ventilation. Patients developing AKI were older and more likely to have hypertension or chronic cardiac disease. There were geo-economic differences in the incidence of AKI, with lower incidence of stage 3 AKI in European high-income countries and a higher incidence in patients from middle-income countries. Both 28-day and 90-day mortality risk was increased for patients with stage 2 (HR 2.00, p < 0.001) and stage 3 AKI (HR 1.95, p < 0.001). Compared to non-COVID-19 ARDS, the incidence of shock was reduced with lower cardiovascular SOFA score across all patient groups, while hospital mortality was worse in all groups [no AKI (30 vs 50%), Stage 1 (38 vs 58%), Stage 2 (56 vs 74%), and Stage 3 (52 vs 72%), p < 0.001]. The time profile of onset of AKI also differed, with 56% of all AKI occurring in the first 48 h in patients with COVID-19 ARDS compared to 89% in the non-COVID-19 ARDS population. Conclusion: AKI is a common and serious com

Published
2023

5. Neurological manifestations of COVID-19 in adults and children

Author

Cho, Sm, White, N, Premraj, L, Battaglini, D, Fanning, J, Suen, J, Li Bassi, G, Fraser, J, Robba, C, Griffee, M, Singh, B, Citarella, Bw, Merson, L, Solomon, T, Thomson, D, Loforte, A, ISARIC Clinical Characterisation Group, Brazzi, Luca, and Group, ISARIC Clinical Characterisation

Subjects
encephalitis, seizure, COVID-19, meningitis, Neurology (clinical), neurological complication, stroke
Abstract

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age.

Published
2022

6. The efficacy of telavancin in comparison to linezolid on endotracheal tube biofilm in pigs with MRSA pneumonia

Author

KIAROSTAMI, K, primary, Battaglini, D, additional, Motos, A, additional, Bueno Freire, L, additional, Soler Comas, A, additional, Yang, H, additional, Yang, M, additional, Pagliara, F, additional, Aguilera Xiol, E, additional, Meli, A, additional, Bobi, J, additional, Senussi Testa, T, additional, Idone, F, additional, Rigol, M, additional, Li Bassi, G, additional, Fernández-Barat, L, additional, and Torres, A, additional

Published
2022
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7. Preliminary Assessment of Respiratory System Elastance Following Nebulisation of Various Electrically Conductive Solutions

Author

Li Bassi, G., primary, Ainola, C., additional, Fior, G., additional, Liu, K., additional, Colombo, S., additional, Abbate, G., additional, Sato, K., additional, Sato, N., additional, McGuire, D., additional, Heinsar, S., additional, Livingstone, S., additional, Wildi, K., additional, Morais, C., additional, Passmore, M., additional, Wilson, E., additional, Boquet, M., additional, Torres, A., additional, Suen, J., additional, and Fraser, J., additional

Published
2022
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8. Recovery of organ-specific tissue oxygen delivery at restrictive transfusion thresholds after fluid treatment in ovine haemorrhagic shock

Author

Dyer, WB, Simonova, G, Chiaretti, S, Bouquet, M, Wellburn, R, Heinsar, S, Ainola, C, Wildi, K, Sato, K, Livingstone, S, Suen, JY, Irving, DO, Tung, J-P, li Bassi, G, Fraser, JF, Dyer, WB, Simonova, G, Chiaretti, S, Bouquet, M, Wellburn, R, Heinsar, S, Ainola, C, Wildi, K, Sato, K, Livingstone, S, Suen, JY, Irving, DO, Tung, J-P, li Bassi, G, and Fraser, JF

Abstract

BackgroundFluid resuscitation is the standard treatment to restore circulating blood volume and pressure after massive haemorrhage and shock. Packed red blood cells (PRBC) are transfused to restore haemoglobin levels. Restoration of microcirculatory flow and tissue oxygen delivery is critical for organ and patient survival, but these parameters are infrequently measured. Patient Blood Management is a multidisciplinary approach to manage and conserve a patient’s own blood, directing treatment options based on broad clinical assessment beyond haemoglobin alone, for which tissue perfusion and oxygenation could be useful. Our aim was to assess utility of non-invasive tissue-specific measures to compare PRBC transfusion with novel crystalloid treatments for haemorrhagic shock.MethodsA model of severe haemorrhagic shock was developed in an intensive care setting, with controlled haemorrhage in sheep according to pressure (mean arterial pressure 30–40 mmHg) and oxygen debt (lactate 4 mM) targets. We compared PRBC transfusion to fluid resuscitation with either PlasmaLyte or a novel crystalloid. Efficacy was assessed according to recovery of haemodynamic parameters and non-invasive measures of sublingual microcirculatory flow, regional tissue oxygen saturation, repayment of oxygen debt (arterial lactate), and a panel of inflammatory and organ function markers. Invasive measurements of tissue perfusion, oxygen tension and lactate levels were performed in brain, kidney, liver, and skeletal muscle. Outcomes were assessed during 4 h treatment and post-mortem, and analysed by one- and two-way ANOVA.ResultsEach treatment restored haemodynamic and tissue oxygen delivery parameters equivalently (p 0.05), despite haemodilution after crystalloid infusion to haemoglobin concentrations below 70 g/L (p 0.001). Recovery of vital organ-specific perfusion and oxygen tension commenced shortly before non-invasive measures improved. Lactate declined in all tissues and correlated with art

Published
2022

9. Non-Invasive Multimodal Neuromonitoring in Non-Critically Ill Hospitalized Adult Patients With COVID-19: A Systematic Review and Meta-Analysis

Author

Battaglini D, Premraj L, Huth S, Fanning J, Whitman G, Arora R, Bellapart J, Porto D, Taccone F, Suen J, Li Bassi G, Fraser J, Badenes R, Cho S, and Robba C

Subjects
coronavirus disease, COVID-19, hospital, electroencephalogram, neuromonitoring
Abstract

Introduction: Neurological complications are frequent in patients with coronavirus disease-2019 (COVID-19). The use of non-invasive neuromonitoring in subjects without primary brain injury but with potential neurological derangement is gaining attention outside the intensive care unit (ICU). This systematic review and meta-analysis investigates the use of non-invasive multimodal neuromonitoring of the brain in non-critically ill patients with COVID-19 outside the ICU and quantifies the prevalence of abnormal neuromonitoring findings in this population. Methods: A structured literature search was performed in MEDLINE/PubMed, Scopus, Cochrane, and EMBASE to investigate the use of non-invasive neuromonitoring tools, including transcranial doppler (TCD); optic nerve sheath diameter (ONSD); near-infrared spectroscopy (NIRS); pupillometry; and electroencephalography (EEG) inpatients with COVID-19 outside the ICU. The proportion of non-ICU patients with CVOID-19 and a particular neurological feature at neuromonitoring at the study time was defined as prevalence. Results: A total of 6,593 records were identified through literature searching. Twenty-one studies were finally selected, comprising 368 non-ICU patients, of whom 97 were considered for the prevalence of meta-analysis. The pooled prevalence of electroencephalographic seizures, periodic and rhythmic patterns, slow background abnormalities, and abnormal background on EEG was.17 (95% CI 0.04-0.29), 0.42 (95% CI 0.01-0.82), 0.92 (95% CI 0.83-1.01), and.95 (95% CI 0.088-1.09), respectively. No studies investigating NIRS and ONSD outside the ICU were found. The pooled prevalence for abnormal neuromonitoring findings detected using the TCD and pupillometry were incomputable due to insufficient data. Conclusions: Neuromonitoring tools are non-invasive, less expensive, safe, and bedside available tools with a great potential for both diagnosis and monitoring of patients with COVID-19 at risk of brain derangements. However, extensive literature searching reveals that they are rarely used outside critical care settings.

Published
2022

10. Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis

Author

Li Bassi, G., Gibbons, K., Suen, J. Y., Dalton, H. J., White, N., Corley, A., Shrapnel, S., Hinton, S., Forsyth, S., Laffey, J. G., Fan, E., Fanning, J. P., Panigada, M., Bartlett, R., Brodie, D., Burrell, A., Chiumello, D., Elhazmi, A., Esperatti, M., Grasselli, G., Hodgson, C., Ichiba, S., Luna, C., Marwali, E., Merson, L., Murthy, S., Nichol, A., Ogino, M., Pelosi, P., Torres, A., P. Y., Ng, Fraser, J. F., Al-Dabbous, T., Alfoudri, H., Shamsah, M., Elapavaluru, S., Berg, A., Horn, C., Mayasi, Y., Schroll, S., Meyer, D., Velazco, J., Ploskanych, L., Fikes, W., Bagewadi, R., Dao, M., White, H., Ehlers, A., Shalabi-McGuire, M., Witt, T., Grazioli, L., Lorini, L., Grandin, E. W., Nunez, J., Reyes, T., Obriain, D., Hunter, S., Ramanan, M., Affleck, J., Veerendra, H. H., Rai, S., Russell-Brown, J., Nourse, M., Joseph, M., Mitchell, B., Tenzer, M., Abe, R., Cho, H. J., Jeong, I. S., Rahman, N., Kakar, V., Brozzi, N., Mehkri, O., Krishnan, S., Duggal, A., Houltham, S., Graf, J., Diaz, R., Orrego, R., Delgado, C., Gonzalez, J., Sanchez, M. S., Piagnerelli, M., Sarrazin, J. V., Zabert, A. /P. G., Espinosa, L., Delgado, P., Delgado, V., Rincon, D. F. B., Yanten, A. M. M., Duque, M. B., Al-Hudaib, A., Callahan, M., Taufik, M. A., Wardoyo, E. Y., Gunawan, M., Trisnaningrum, N. S., Irawany, V., Rayhan, M., Pesenti, A., Zanella, A., Leone, M., Coppola, S., Colombo, S., Antonelli, M., Carelli, S., Grieco, D. L., Asaki, M., Hoshino, K., Salazar, L., Duarte, L., Laffey, J., Mcnicholas, B., Cosgrave, D., Mccaffrey, J., Bone, A., Hakeem, Y., Winearls, J., Tallott, M., Thomson, D., Arnold-Day, C., Cupido, J., Fanie, Z., Miller, M., Seymore, L., van Straaten, D., Hssain, A. A., Aliudin, J., Alqahtani, A. -R., Mohamed, K., Mohamed, A., Tan, D., Villanueva, J., Zaqout, A., Kurtzman, E., Ademi, A., Dobrita, A., El Aoudi, K., Segura, J., Giwangkancana, G., Ohshimo, S., Hitoshi, S., Osatnik, J., Joosten, A., Yang, M., Motos, A., Arancibia, F., Williams, V., Noel, A., Luque, N., Trung, T. H., Yacoub, S., Fantini, M., Garcia, R. N. J., Alvarez, E. C., Greti, A., Ceccato, A., Sanchez, A., Vazquez, A. L., Roche-Campo, F., Franch-Llasat, D., Tuazon, D., Amato, M., Cassimiro, L., Pola, F., Ribeiro, F., Fonseca, G., Dalton, H., Desai, M., Osborn, E., Deeb, H., Arcadipane, A., Martucci, G., Panarello, G., Vitiello, C., Bianco, C., Occhipinti, G., Rossetti, M., Cuffaro, R., Cho, S. -M., Shimizu, H., Moriyama, N., Kim, J. -B., Kitamura, N., Gebauer, J., Yokoyama, T., Al-Fares, A., Buabbas, S., Alamad, E., Alawadhi, F., Alawadi, K., Tanaka, H., Hashimoto, S., Yamazaki, M., T. -H., Oh, Epler, M., Forney, C., Kruse, L., Feister, J., Williamson, J., Grobengieser, K., Gnall, E., Golden, S., Caroline, M., Shapiro, T., Karaj, C., Thome, L., Sher, L., Vanderland, M., Welch, M., Mcdermott, S., Brain, M., Mineall, S., Kimura, D., Brazzi, L., Sales, G., Ogston, T., Nagpal, D., Fischer, K., Lorusso, R., Rangappa, R., Appu, A., Carton, E. G., Sen, A., Palacios, A., Rainey, D., Samoukoviv, G., Campisi, J., Durham, L., Neumann, E., Seefeldt, C., Falcucci, O., Emmrich, A., Guy, J., Johns, C., Potzner, K., Zimmermann, C., Espinal, A., Buchtele, N., Schwameis, M., Stecher, S. -S., Singh, D., Barnikel, M., Arenz, L., Zaaqoq, A., Galloway, L. A., Merley, C., Csete, M., Quesada, L., Saba, I., Kasugai, D., Hiraiwa, H., Tanaka, T., Purnama, Y., Dewayanti, S. R., Ardiyan, Juzar, D. A., Siagian, D., Chen, Y. -S., Ratsep, I., Oigus, G., Erikson, K., Post, A. -M., Enneveer, L., Sillaots, P., Manetta, F., Mihelis, E., Sarmiento, I. C., Narasimhan, M., Varrone, M., Komats, M., Garcia-Diaz, J., Harmon, C., Satyapriya, S. V., Bhatt, A., Mokadam, N. A., Uribe, A., Gonzalez, A., Shi, H., Mckeown, J., Pasek, J., Fiorda, J., Echeverria, M., Moreno, R., Zakhary, B., Cavana, M., Cucino, A., Foti, G., Giani, M., Russotto, V., Castagna, V., Dellamore, A., Navalesi, P., Shum, H. -P., Vuysteke, A., Usman, A., Acker, A., Smood, B., Mergler, B., Sertic, F., Subramanian, M., Sperry, A., Rizer, N., Burhan, E., Rasmin, M., Akmal, E., Sitompul, F., Lolong, N., Naivedh, B., Erickson, S., Barrett, P., Dean, D., Daugherty, J., Loforte, A., Khan, I., Abraar Quraishi, M., Desantis, O., So, D., Kandamby, D., Mandei, J. M., Natanael, H., Yudhalantang, E., Lantang, A., Wijaya, S. O., Jung, A., Ng, G., W. Y., Ng, Fang, S., Tabah, A., Ratcliffe, M., Duroux, M., Adachi, S., Nakao, S., Blanco, P., Prieto, A., Sanchez, J., Nicholson, M., Butt, W., Serratore, A., Delzoppo, C., Janin, P., Yarad, E., Totaro, R., Coles, J., Pujo, B., Balk, R., Vissing, A., Kapania, E., Hays, J., Fox, S., Yantosh, G., Mishin, P., Yuliarto, S., Hari Santoso, K., Djajalaksana, S., Fatoni, A. Z., Fukuda, M., Liu, K., Battaglini, D., Jimenez, J. F. M., Bastos, D., Gaiao, S., Rusmawatiningtyas, D., Buchner, J., Cho, Y. -J., Lee, S. H., Kawasaki, T., Munshi, L., Sakiyalak, P., Nitayavardhana, P., Seitz, T., Arora, R., Kent, D., Marino, D., Parwar, S., Cheng, A., Miller, J., Fujitani, S., Shimizu, N., Madhok, J., Owyang, C., Buscher, H., Reynolds, C., Maasikas, O., Beljantsev, A., Mihnovits, V., Akimoto, T., Aizawa, M., Horibe, K., Onodera, R., Young, M., George, T., Shekar, K., Mcguinness, N., Irvine, L., Flynn, B., Endo, T., Sugiyama, K., Shimizu, K., Exconde, K., Lussier, L., Lotz, G., Malfertheiner, M., Maier, L., Dreier, E., Kusumastuti, N. P., Mccloskey, C., Dabaliz, A. -A., Elshazly, T. B., Smith, J., Szuldrzynski, K. S., Bielanski, P., Wille, K., Parhar, K. K. S., Fiest, K. M., Codan, C., Shahid, A., Fayed, M., Evans, T., Garcia, R., Gutierrez, A., Song, T., Rose, R., Bennett, S., Richardson, D., Peek, G., Arora, L., Rappapport, K., Rudolph, K., Sibenaller, Z., Stout, L., Walter, A., Herr, D., Vedadi, N., Thompson, S., Sindt, L., Rajnic, S., Ewald, C., Hoffman, J., Ying, X., Kennedy, R., Griffee, M., Ciullo, A., Kida, Y., Roca, R. F., Riera, J. I., Contreras, S., Alegre, C., Kay, C., Fischer, I., Renner, E., Taniguci, H., Fraser, J., Bassi, G. L., Suen, J., Barnett, A., Pearse, I., Abbate, G., Hassan, H., Heinsar, S., Karnik, V. A., Ki, K., Oneill, H. F., Obonyo, N., Pimenta, L. P., Reid, J. D., Sato, K., Vuorinen, A., Wildi, K. S., Wood, E. S., Yerkovich, S., Lee, J., Plotkin, D., Citarella, B. W., Hartley, E., Lubis, B., Ikeyama, T., Bhaskar, B., Jung, J. -S., Mcguinness, S., Eastwood, G., Marta, S. R., Guarracino, F., Gerle, S., Coxon, E., Claro, B., Loverde, D., Patil, N., Parrini, V., Mcbride, A., Negaard, K., Ratsch, A., Abdelaziz, A., Uribe, J. D., Peris, A., Sanders, M., Emerson, D., Kamal, M., Povoa, P., Francis, R., Cherif, A., Joseph, S., Di Nardo, M., Heard, M., Kyle, K., Blackwell, R. A., Biston, P., Jeong, H. W., Smith, R., Prawira, Y., Montrucchio, G., Garcia, A. H., Salterain, N., Meyns, B., Moreno, M., Walia, R., Mehta, A., Schweda, A., Supriatna, M., Kirakli, C., Williams, M., Kim, K. H., Assad, A., Giraldo, E., Karolak, W., Balik, M., Pocock, E., Gajkowski, E., Masafumi, K., Barrett, N., Takeyama, Y., Park, S., Amin, F., Andriyani, F. M., Sudakevych, S., Vera, M., Cornejo, R., Schwarz, P., Mardini, A. C., de Paula, T., Neto, A. S., Villoldo, A., Colafranceschi, A. S., Iglesias, A. U., Granjean, J., Melro, L. M. G., Romualdo, G. F., Gaia, D., Souza, H., Galas, F., Mendiluce, R. M., Sosa, A., Martinez, I., Kurosawa, H., Salgado, J., Hugi-MayrCharbonneau, B. E., Barzilai, V. S., Monteiro, V., de Souza, R. R., Harper, M., Suzuki, H., Adams, C., Brieva, J., Nyale, G., Eltatar, F. S., Fatani, J., Baeissa, H., Masri, A. A., Rabie, A., Hui, M. Y., Yamane, M., Jung, H., Margaret, A. M., Nacpil, N., Ruck, K., Bakken, R., Jara, C., Felton, T., Berra, L., Shah, B., Chakraborty, A., Cardona, M., Capatos, G., Akkanti, B., Orija, A., Jain, H., Ito, A., Housni, B., Low, S., Iihara, K., Chavez, J., Ramanathan, K., Zabert, G., Naidoo, K., Seppelt, I., Vandyk, M., Macdonald, S., Mcgregor, R., Siebenaler, T., Flynn, H., Lofton, K., Aokage, T., Shigemitsu, K., Moscatelli, A., Fiorentino, G., Baumgaertel, M., Mba, S. E., Assy, J., Hutahaean, A., Roush, H., Sichting, K. A., Alessandri, F., Burns, D., Salt, G., Garabedian, C. P., Millar, J., Sim, M., Mattke, A., Mcauley, D., Tadili, J., Frenzel, T., Bar-Lavie, Y., Ortiz, A. B., Stone, J., Attokaran, A., Farquharson, M., Patel, B., Gunning, D., Baillie, K., Watson, P., Tamai, K., Sajinadiyasa, G. K., Kanyawati, D., Salgado, M., Sassine, A., Yudo, B., Mccaul, S., Lee, B., Lee, S. M., Afek, A., Iwashita, Y., Semedi, B. P., Metiva, J., Van Belle, N., Martin-Loeches, I., Ivatt, L., Woon, C. Y., Kang, H. M., Smith, T., James, E., Al-Rawas, N., Iwasaki, Y., King-Chung, K. C., Gudzenko, V., Hugi-Mayr, B., Taccone, F., Perdhana, F., Lamarche, Y., Ribeiro, J. M., Bradic, N., Van den Bossche, K., Lansink, O., Singh, G., Debeuckelaere, G., Stelfox, H. T., Yi, C., Elia, J., Tribble, T., Shankar, S., Padmanabhan, R., Hallinan, B., Paoletti, L., Leyva, Y., Fykuda, T., Badulak, J., Koch, J., Hackman, A., Janowaik, L., Hernandez, D., Osofsky, J., Donadello, K., Lawang, A., Fine, J., Davidson, B., Vazquez, A. O. R., COVID-19 Critical Care Consortium, and Consortium, COVID-19 Critical Care

Subjects
Male, Respiratory Distress Syndrome, COVID-19, Intensive care unit, Mechanical ventilation, Neuromuscular blocking agent, SARS-CoV-2, Aged, Female, Humans, Intensive Care Units, Middle Aged, Propensity Score, Respiration, Artificial, Neuromuscular Blocking Agents, Respiration, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Settore MED/41 - Anestesiologia, Critical Care and Intensive Care Medicine, COVID-19 Drug Treatment, Artificial, Human medicine
Abstract

Background The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. Methods We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. Results Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28 days, VFD were 16 (IQR 0–25) and 25 (IQR 7–26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0–87) and 87 (IQR 0–88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p = 0.177). Conclusions In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting.

Published
2022
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11. Post-Transplant Cardiac Contractility and Mitochondrial Function is Preserved Following 8 Hours Hypothermic Ex Vivo Perfusion in Sheep

Author

See Hoe, L., primary, Bouquet, M., additional, Hyslop, K., additional, Passmore, M., additional, Wells, M., additional, Sato, K., additional, Wilson, E., additional, Wildi, K., additional, Skeggs, K., additional, Palmeri, C., additional, Reid, J., additional, O'Neill, H., additional, Bartnikowski, N., additional, Jung, J., additional, Ainola, C., additional, Abbate, G., additional, Colombo, S., additional, Obonyo, N., additional, McDonald, C., additional, Shuker, T., additional, Heinsar, S., additional, Haymet, A., additional, Engkilde-Pedersen, S., additional, Peart, J., additional, Molenaar, P., additional, Li Bassi, G., additional, Suen, J., additional, McGiffin, D., additional, and Fraser, J., additional

Published
2022
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14. An appraisal of respiratory system compliance in mechanically ventilated covid-19 patients.

Author

Li Bassi, G, Suen, JY, Dalton, HJ, White, N, Shrapnel, S, Fanning, JP, Liquet, B, Hinton, S, Vuorinen, A, Booth, G, Millar, JE, Forsyth, S, Panigada, M, Laffey, J, Brodie, D, Fan, E, Torres, A, Chiumello, D, Corley, A, Elhazmi, A, Hodgson, C, Ichiba, S, Luna, C, Murthy, S, Nichol, A, Ng, PY, Ogino, M, Pesenti, A, Trieu, HT, Fraser, JF, COVID-19 Critical Care Consortium, Li Bassi, G, Suen, JY, Dalton, HJ, White, N, Shrapnel, S, Fanning, JP, Liquet, B, Hinton, S, Vuorinen, A, Booth, G, Millar, JE, Forsyth, S, Panigada, M, Laffey, J, Brodie, D, Fan, E, Torres, A, Chiumello, D, Corley, A, Elhazmi, A, Hodgson, C, Ichiba, S, Luna, C, Murthy, S, Nichol, A, Ng, PY, Ogino, M, Pesenti, A, Trieu, HT, Fraser, JF, and COVID-19 Critical Care Consortium

Abstract

BACKGROUND: Heterogeneous respiratory system static compliance (CRS) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level. METHODS: We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe CRS-calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]-and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide. RESULTS: We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of CRS within the first seven days of MV. Median (IQR) age was 62 (52-71), patients were predominantly males (68%) and from Europe/North and South America (88%). CRS, within 48 h from endotracheal intubation, was available in 649 patients and was neither associated with the duration from onset of symptoms to commencement of MV (p = 0.417) nor with PaO2/FiO2 (p = 0.100). Females presented lower CRS than males (95% CI of CRS difference between females-males: - 11.8 to - 7.4 mL/cmH2O p < 0.001), and although females presented higher body mass index (BMI), association of BMI with CRS was marginal (p = 0.139). Ventilatory management varied across CRS range, resulting in a significant association between CRS and driving pressure (estimated decrease - 0.31 cmH2O/L per mL/cmH20 of CRS, 95% CI - 0.48 to - 0.14, p < 0.001). Overall, 28-day ICU mortality, accounting for the competing risk of being discharged within the period, was 35.6% (SE 1.7). Cox proportional hazard analysis demonstrated that CRS (+ 10 mL/cm H2O) was only associated with being discharge from the ICU within 28 days (HR 1.14, 95% CI 1.02-1.

Published
2021

15. An Ovine Model of Hemorrhagic Shock and Resuscitation, to Assess Recovery of Tissue Oxygen Delivery and Oxygen Debt, and Inform Patient Blood Management.

Author

Dyer, WB, Tung, J-P, Li Bassi, G, Wildi, K, Jung, J-S, Colombo, SM, Rozencwajg, S, Simonova, G, Chiaretti, S, Temple, FT, Ainola, C, Shuker, T, Palmieri, C, Shander, A, Suen, JY, Irving, DO, Fraser, JF, Dyer, WB, Tung, J-P, Li Bassi, G, Wildi, K, Jung, J-S, Colombo, SM, Rozencwajg, S, Simonova, G, Chiaretti, S, Temple, FT, Ainola, C, Shuker, T, Palmieri, C, Shander, A, Suen, JY, Irving, DO, and Fraser, JF

Abstract

BACKGROUND: Aggressive fluid or blood component transfusion for severe hemorrhagic shock may restore macrocirculatory parameters, but not always improve microcirculatory perfusion and tissue oxygen delivery. We established an ovine model of hemorrhagic shock to systematically assess tissue oxygen delivery and repayment of oxygen debt; appropriate outcomes to guide Patient Blood Management. METHODS: Female Dorset-cross sheep were anesthetized, intubated, and subjected to comprehensive macrohemodynamic, regional tissue oxygen saturation (StO2), sublingual capillary imaging, and arterial lactate monitoring confirmed by invasive organ-specific microvascular perfusion, oxygen pressure, and lactate/pyruvate levels in brain, kidney, liver, and skeletal muscle. Shock was induced by stepwise withdrawal of venous blood until MAP was 30 mm Hg, mixed venous oxygen saturation (SvO2) < 60%, and arterial lactate >4 mM. Resuscitation with PlasmaLyte® was dosed to achieve MAP > 65 mm Hg. RESULTS: Hemorrhage impacted primary outcomes between baseline and development of shock: MAP 89 ± 5 to 31 ± 5 mm Hg (P < 0.01), SvO2 70 ± 7 to 23 ± 8% (P < 0.05), cerebral regional tissue StO2 77 ± 11 to 65 ± 9% (P < 0.01), peripheral muscle StO2 66 ± 8 to 16 ± 9% (P < 0.01), arterial lactate 1.5 ± 1.0 to 5.1 ± 0.8 mM (P < 0.01), and base excess 1.1 ± 2.2 to -3.6 ± 1.7 mM (P < 0.05). Invasive organ-specific monitoring confirmed reduced tissue oxygen delivery; oxygen tension decreased and lactate increased in all tissues, but moderately in brain. Blood volume replacement with PlasmaLyte® improved primary outcome measures toward baseline, confirmed by organ-specific measures, despite hemoglobin reduced from baseline 10.8 ± 1.2 to 5.9 ± 1.1 g/dL post-resuscitation (P < 0.01). CONCLUSION: Non-invasive measures of tissue oxygen delivery and oxygen debt repayment are suitable outcomes to inform Patient Blood Management of hemorrhagic shock, translatable for pre-clinical assessment of novel resuscitation s

Published
2021

19. Efficacy of Telavancin in Comparison to Linezolid in a Porcine Model of Severe Methicillin-Resistant Staphylococcus aureus Pneumonia

Author

Battaglini, D., primary, Motos, A., additional, Li Bassi, G., additional, Yang, H., additional, Pagliara, F., additional, Yang, M., additional, Aguilera Xiol, E., additional, Meli, A., additional, Bobi, J., additional, Frigola, G., additional, Senussi, T., additional, Idone, F., additional, Travierso, C., additional, Chiurazzi, C., additional, Fernandez-Barat, L., additional, Rigol, M., additional, Ramirez, J., additional, Pelosi, P., additional, Chiumello, D., additional, Antonelli, M., additional, Nicolau, D. P., additional, Bringue, J., additional, Artigas, A., additional, Guerrero, L., additional, Soy, D., additional, and Torres, A., additional

Published
2020
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23. The Effects of Different Ventilatory Strategies on Pulmonary Mechanics and Gas Exchange During Heart Transplant: An Experimental Study

Author

Li Bassi, G., primary, Colombo, S., additional, Heinsar, S., additional, Wildi, K., additional, Ainola, C., additional, Jung, J.-S., additional, Abbate, G., additional, See Hoe, L., additional, Sato, K., additional, Wang, X., additional, Skeggs, K., additional, Livingstone, S., additional, Boquet, M., additional, Passmore, M., additional, Sato, N., additional, Reid, J., additional, James, L., additional, Wilson, E., additional, McGiffin, D., additional, Suen, J., additional, and Fraser, J., additional

Published
2020
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24. Pulmonary Injury Caused by Severe Pneumococcal Pneumonia: Appraisal of the Benefits of Corticosteroids and Macrolides

Author

Barbeta, E.R., primary, Yang, M., additional, Li Bassi, G., additional, Motos, A., additional, Hua, Y., additional, Bobi, Q., additional, Battaglini, D., additional, Meli, A., additional, Cabrera, R., additional, Giacomo, T., additional, Vargas, C.R., additional, Laia, F.-B., additional, Rigol, M., additional, and Torres, A., additional

Published
2020
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25. Corticosteroids in Hypoinflammatory and Hyperinflammatory Acute Respiratory Distress Syndrome Subphenotypes: An Experimental Study

Author

Wildi, K., primary, Li Bassi, G., additional, Ainola, C., additional, Livingstone, S., additional, Colombo, S., additional, Sato, K., additional, Wang, X., additional, Heinsar, S., additional, Abbate, G., additional, Bouquet, M., additional, Passmore, M., additional, Reid, J., additional, O`Neill, H., additional, Wood, E., additional, Ki, K., additional, Jung, J.S., additional, Suen, J., additional, and Fraser, J., additional

Published
2020
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26. Pulmonary Derangement in Two Novel Ovine Model of Acute Respiratory Distress Syndrome Subphenotypes

Author

Wildi, K., primary, Li Bassi, G., additional, Ainola, C., additional, Livingstone, S., additional, Colombo, S.M., additional, Sato, K., additional, Wang, X., additional, Heinsar, S., additional, Abbate, G., additional, Bouquet, M., additional, Passmore, M., additional, Reid, J., additional, O`Neill, H., additional, Wood, E., additional, Ki, K., additional, Jung, J.S., additional, Fraser, J., additional, and Suen, J., additional

Published
2020
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27. 120 Hypothermic Ex Vivo Perfusion of Brain Dead Donor Hearts Improves Survival, Systemic Inflammation and Cardiac Function Following Heart Transplantation

Author

See Hoe, L., primary, McGiffin, D., additional, Wildi, K., additional, Obonyo, N., additional, Bouquet, M., additional, Wells, M., additional, Skeggs, K., additional, McDonald, C., additional, Engkilde-Pedersen, S., additional, Bartnikowski, N., additional, Colombo, S., additional, Ainola, C., additional, Passmore, M., additional, Hyslop, K., additional, Wood, E., additional, Shuker, T., additional, Sato, K., additional, Jung, J., additional, Heinser, S., additional, James, L., additional, Reid, J., additional, O'Neill, H., additional, Livingstone, S., additional, Abbate, G., additional, He, P., additional, Sato, N., additional, Boon, C., additional, Black, D., additional, Haymet, A., additional, Mullins, D., additional, Marasco, S., additional, Chan, W., additional, Chan, J., additional, Platts, D., additional, Diab, S., additional, Millar, J., additional, Li Bassi, G., additional, Suen, J., additional, and Fraser, J., additional

Published
2020
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28. 121 Hypothermic Ex Vivo Perfusion Preserves Post-Transplant Donor Cardiac Function

Author

Sato, K., primary, See Hoe, L., additional, Obonyo, N., additional, Wildi, K., additional, Colombo, S., additional, Bouquet, M., additional, Passmore, M., additional, Bartnikowski, N., additional, Wells, M., additional, Skeggs, K., additional, McDonald, C., additional, Hyslop, K., additional, Wood, E., additional, Heinser, S., additional, Ainola, C., additional, Jung, J., additional, James, L., additional, Abbate, G., additional, Haymet, A., additional, Engkilde-Pedersen, S., additional, Reid, J., additional, O'Neill, H., additional, Shuker, T., additional, He, P., additional, Sato, N., additional, Diab, S., additional, Mullins, D., additional, Livingstone, S., additional, Wang, X., additional, Rozencwajg, S., additional, Malfertheiner, M., additional, Platts, D., additional, Chan, J., additional, Li Bassi, G., additional, Suen, J., additional, McGiffin, D., additional, and Fraser, J., additional

Published
2020
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29. 111 Epicardial Echocardiography in a Novel Ovine Model of Cardiopulmonary Failure

Author

Sato, K., primary, Heinsar, S., additional, Rozencwajg, S., additional, Colombo, S., additional, Wildi, K., additional, Jung, J., additional, Ainola, C., additional, Wang, X., additional, Abbate, G., additional, Sato, N., additional, Reid, J., additional, Bouquet, M., additional, Lo Cocco, V., additional, Wood, E., additional, Suen, J., additional, Combes, A., additional, Lorusso, R., additional, Pesenti, A., additional, Li Bassi, G., additional, Chan, J., additional, and Fraser, J., additional

Published
2020
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30. Nebulized Amikacin and Fosfomycin for Severe Pseudomonas aeruginosa Pneumonia: An Experimental Study

Author

Li Bassi, G., Motos, A., Fernandez-Barat, L., Aguilera Xiol, E., Chiurazzi, C., Senussi, T., Saco, M. A., Fuster, C., Carbonara, M., Bobi, J., Amaro, R., De Rosa, F., Comaru, T., Yang, H., Ranzani, O. T., Marti, J. -D., Rinaudo, M., Comino Trinidad, O., Rigol, M., Bringue, J., Ramirez, J., Nicolau, D. P., Pelosi, P., Antonelli, Massimo, Blasi, F., Artigas, A., Montgomery, A. B., Torres, A., Antonelli M. (ORCID:0000-0003-3007-1670), Li Bassi, G., Motos, A., Fernandez-Barat, L., Aguilera Xiol, E., Chiurazzi, C., Senussi, T., Saco, M. A., Fuster, C., Carbonara, M., Bobi, J., Amaro, R., De Rosa, F., Comaru, T., Yang, H., Ranzani, O. T., Marti, J. -D., Rinaudo, M., Comino Trinidad, O., Rigol, M., Bringue, J., Ramirez, J., Nicolau, D. P., Pelosi, P., Antonelli, Massimo, Blasi, F., Artigas, A., Montgomery, A. B., Torres, A., and Antonelli M. (ORCID:0000-0003-3007-1670)

Abstract

OBJECTIVES: Latest trials failed to confirm merits of nebulized amikacin for critically ill patients with nosocomial pneumonia. We studied various nebulized and IV antibiotic regimens in a porcine model of severe Pseudomonas aeruginosa pneumonia, resistant to amikacin, fosfomycin, and susceptible to meropenem. DESIGN: Prospective randomized animal study. SETTING: Animal Research, University of Barcelona, Spain. SUBJECTS: Thirty female pigs. INTERVENTIONS: The animals were randomized to receive nebulized saline solution (CONTROL); nebulized amikacin every 6 hours; nebulized fosfomycin every 6 hours; IV meropenem alone every 8 hours; nebulized amikacin and fosfomycin every 6 hours; amikacin and fosfomycin every 6 hours, with IV meropenem every 8 hours. Nebulization was performed through a vibrating mesh nebulizer. The primary outcome was lung tissue bacterial concentration. Secondary outcomes were tracheal secretions P. aeruginosa concentration, clinical variables, lung histology, and development of meropenem resistance. MEASUREMENTS AND MAIN RESULTS: We included five animals into each group. Lung P. aeruginosa burden varied among groups (p < 0.001). In particular, IV meropenem and amikacin and fosfomycin + IV meropenem groups presented lower P. aeruginosa concentrations versus amikacin and fosfomycin, amikacin, CONTROL, and fosfomycin groups (p < 0.05), without significant difference between these two groups undergoing IV meropenem treatment. The sole use of nebulized antibiotics resulted in dense P. aeruginosa accumulation at the edges of the interlobular septa. Amikacin, amikacin and fosfomycin, and amikacin and fosfomycin + IV meropenem effectively reduced P. aeruginosa in tracheal secretions (p < 0.001). Pathognomonic clinical variables of respiratory infection did not differ among groups. Resistance to meropenem increased in IV meropenem group versus amikacin and fosfomycin + meropenem (p = 0.004). CONCLUSIONS: Our findings corroborate that amikacin and

Published
2019

31. In‐vitro analysis of a novel ‘add‐on’ silicone cuff to improve sealing properties of tracheal tubes

Author

Li Bassi, G., primary, Chiurazzi, C., additional, Aguilera, E., additional, Travierso, C., additional, Battaglini, D., additional, Yang, M., additional, Motos, A., additional, Yang, H., additional, Meli, A., additional, Marti, D., additional, Ranzani, O. T., additional, Blasi, F., additional, Pelosi, P., additional, Chiumello, D., additional, and Torres, A., additional

Published
2018
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32. Applicability and safety of the lateral-Trendelenburg position for the prevention of ventilator-associated pneumonia

Author

Li Bassi, G., primary, Panigada, M., additional, Zanella, A., additional, Ranzani, O., additional, Cressoni, M., additional, Berra, L., additional, Parrini, V., additional, Kandil, H., additional, Salati, G., additional, Livigni, S., additional, Amatu, A., additional, Girardis, M., additional, Barbagallo, M., additional, Moise, G., additional, Mercurio, G., additional, Costa, A., additional, Vezzani, A., additional, Lindau, S., additional, Babel, J., additional, Cavana, M., additional, and Torres, A., additional

Published
2018
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34. Photoinitiators for energy curing

Author

Romagnano, S., Norcini, G., Li Bassi, G., Visconti, M., Dietlin, Céline, Allonas, Xavier, Fouassier, Jean-Pierre, and Turck, Colette

Subjects
[CHIM.MATE] Chemical Sciences/Material chemistry, [CHIM.POLY] Chemical Sciences/Polymers
Published
2009

35. Hydroxamic esters as photoinitiators

Author

Casiraghi, A., Visconti, M., Norcini, G., Dietlin, Céline, Allonas, X., Fouassier, Jean-Pierre, Li Bassi, G., and Turck, Colette

Subjects
[CHIM.MATE] Chemical Sciences/Material chemistry, [CHIM.POLY] Chemical Sciences/Polymers
Published
2008

36. New radical photoinitiators

Author

Casiraghi, A., Visconti, M., Norcini, G., Li Bassi, G., Dietlin, Céline, Allonas, Xavier, Fouassier, Jean-Pierre, and Turck, Colette

Subjects
[CHIM.MATE] Chemical Sciences/Material chemistry
Published
2007

37. Photochemical reactivity of difunctional radical photoinitiators

Author

Dietlin, Céline, Lalevee, Jacques, Allonas, Xavier, Fouassier, Jean-Pierre, Visconti, M., Li Bassi, G., Norcini, G., and Turck, Colette

Subjects
[CHIM.MATE] Chemical Sciences/Material chemistry, [CHIM.POLY] Chemical Sciences/Polymers
Published
2007

44. Effects of duty cycle and positive end-expiratory pressure on mucus clearance during mechanical ventilation*.

Author

Li Bassi G, Saucedo L, Marti JD, Rigol M, Esperatti M, Luque N, Ferrer M, Gabarrus A, Fernandez L, Kolobow T, and Torres A

Abstract

OBJECTIVES: During mechanical ventilation, air flows may play a role in mucus transport via two-phase gas liquid flow. The aim of this study was to evaluate effects of duty cycles and positive end-expiratory pressure on mucus clearance in pigs using mechanical ventilation, and to assess their safety. DESIGN: Prospective randomized animal study. SETTING: Animal research facility, University of Barcelona, Spain. SUBJECTS: Eight healthy pigs. INTERVENTIONS: Pigs were intubated and on volume-control mechanical ventilation for up to 84 hrs. After 4, 24, 48, and 72 hrs of mechanical ventilation, six levels of duty cycle (0.26, 0.33, 0.41, 0.50, 0.60, and 0.75) with no associated positive end-expiratory pressure or 5 cm H2O of positive end-expiratory pressure were randomly applied. Surgical bed was oriented 30 degrees in the reverse Trendelenburg position, as in the semirecumbent position. MEASUREMENT AND MAIN RESULTS: Inspiratory and expiratory flows and hemodynamics were measured after each 30-min ventilation period. Mucus movement was assessed through fluoroscopy tracking of radio-opaque markers. Mucus velocity was described by a positive vector (toward the glottis) or negative vector (toward the lungs). No effect of positive end-expiratory pressure was found; however, as duty cycle was increasingly prolonged, a trend toward reduced velocity of mucus moving toward the lungs and increased outward mucus velocity was found (p = .064). Two clusters of mucus velocities were identified as duty cycle was prolonged beyond 0.41. Thus, duty cycle >0.41 increased mean expiratory-inspiratory flow bias from -4.1 ± 4.6 to 7.9 ± 5.9 L/min (p < .0001) and promoted outward mucus velocity from -0.22 ± 1.71 mm/min (range, -5.78 to 2.42) to 0.53 ± 1.06 mm/min (-1.91 to 3.88; p = .0048). Duty cycle of 0.75 resulted in intrinsic positive end-expiratory pressure (2.1 ± 1.1 cm H2O [p < .0001] vs. duty cycle 0.26-0.5), with no hemodynamic compromise. CONCLUSIONS: In the semirecumbent position, mucus clearance is improved with prolongation of the duty cycle. However, in clinical practice, positive findings must be balanced against the potentially adverse hemodynamic and respiratory effects. [ABSTRACT FROM AUTHOR]

Published
2012
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46. A 72-hour study to test the efficacy and safety of the 'Mucus Slurper' in mechanically ventilated sleep.

Author

Li Bassi G, Curto F, Zanella A, Stylianou M, and Kolobow T

Abstract

Objective: In patients intubated with endotracheal tubes (ETTs), suctioning is routinely performed to remove mucus from within the ETT and trachea. The Mucus Slurper is a novel ETT with built-in suction ports arranged radially at its tip. We evaluated the safety and efficacy of the Mucus Slurper, compared with conventional tracheal suction, to prevent airway obstruction in sheep with the ETT and trachea oriented below horizontal.Design: Prospective randomized animal study.Setting: Animal research facility at the National Institutes of Health.Subjects: Twelve healthy sheep.Interventions: Sheep were randomized to be intubated with either the Mucus Slurper (study group) or a Hi-Lo Tracheal Tube (Mallinckrodt, St. Louis, MO) (control group) and mechanically ventilated for 72 hrs. In the study group, automatic, timed tracheal aspiration lasted 0.3 secs, was repeated every 2 mins, and was synchronized with the early expiratory phase. In the control group, tracheal suction was performed every 6 hrs or as required.Measurements and Main Results: In the control group, tracheal secretions accumulated progressively within the ETT and the trachea. In the study group, all mucus that reached the tip of the Mucus Slurper was aspirated, keeping the lumen of the ETT, and proximal trachea, free from secretions. In the study group, expiratory water trap protein concentration, a crude index to measure mucus drainage through the ETT, was consistently less than the control group (p < .001). At autopsy, no macroscopic injury to the tracheal mucosa was found in either group. In the study group, the respiratory circuit was less colonized than in the control group. There were no statistically significant differences between the two groups in bacterial colonization of the lungs/bronchi.Conclusions: The Mucus Slurper, combined with orientation of the trachea below horizontal, prevents accumulation of secretions within the lumen of the ETT and trachea, without need for conventional tracheal suctioning. [ABSTRACT FROM AUTHOR]

Published
2007
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