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234 results on '"Pellegrini, Mariangela"'

1. Imitating the respiratory activity of the brain stem by using artificial neural networks: exploratory study on an animal model of lactic acidosis and proof of concept

Author

Perchiazzi, Gaetano, Kawati, Rafael, Pellegrini, Mariangela, Liangpansakul, Jasmine, Colella, Roberto, Bollella, Paolo, Rangaiah, Pramod, Cannone, Annamaria, Venkataramana, Deepthi Hulithala, Perez, Mauricio, Stramaglia, Sebastiano, Torsi, Luisa, Bellotti, Roberto, and Augustine, Robin

Published
2024
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6. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies

Author

Grasselli, Giacomo, Calfee, Carolyn S., Camporota, Luigi, Poole, Daniele, Amato, Marcelo B. P., Antonelli, Massimo, Arabi, Yaseen M., Baroncelli, Francesca, Beitler, Jeremy R., Bellani, Giacomo, Bellingan, Geoff, Blackwood, Bronagh, Bos, Lieuwe D. J., Brochard, Laurent, Brodie, Daniel, Burns, Karen E. A., Combes, Alain, D’Arrigo, Sonia, De Backer, Daniel, Demoule, Alexandre, Einav, Sharon, Fan, Eddy, Ferguson, Niall D., Frat, Jean-Pierre, Gattinoni, Luciano, Guérin, Claude, Herridge, Margaret S., Hodgson, Carol, Hough, Catherine L., Jaber, Samir, Juffermans, Nicole P., Karagiannidis, Christian, Kesecioglu, Jozef, Kwizera, Arthur, Laffey, John G., Mancebo, Jordi, Matthay, Michael A., McAuley, Daniel F., Mercat, Alain, Meyer, Nuala J., Moss, Marc, Munshi, Laveena, Myatra, Sheila N., Ng Gong, Michelle, Papazian, Laurent, Patel, Bhakti K., Pellegrini, Mariangela, Perner, Anders, Pesenti, Antonio, Piquilloud, Lise, Qiu, Haibo, Ranieri, Marco V., Riviello, Elisabeth, Slutsky, Arthur S., Stapleton, Renee D., Summers, Charlotte, Thompson, Taylor B., Valente Barbas, Carmen S., Villar, Jesús, Ware, Lorraine B., Weiss, Björn, Zampieri, Fernando G., Azoulay, Elie, and Cecconi, Maurizio

Published
2023
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8. Pulmonary Embolism in the ICU

Author

Pellegrini, Mariangela, Rodriguez-Ruiz, Emilio, Ortiz Suñer, Andrea, Cecconi, Maurizio, Series Editor, De Backer, Daniel, Series Editor, Pérez-Torres, David, editor, Martínez-Martínez, María, editor, and Schaller, Stefan J., editor

Published
2023
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9. Principles and Management of ARDS

Author

Scaramuzzo, Gaetano, Pellegrini, Mariangela, Borgstedt, Laura, Cecconi, Maurizio, Series Editor, De Backer, Daniel, Series Editor, Pérez-Torres, David, editor, Martínez-Martínez, María, editor, and Schaller, Stefan J., editor

Published
2023
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10. Sickle cell disease landscape and challenges in the EU: the ERN-EuroBloodNet perspective

Author

Mañú Pereira, María del Mar, Colombatti, Raffaella, Alvarez, Federico, Bartolucci, Pablo, Bento, Celeste, Brunetta, Angelo Loris, Cela, Elena, Christou, Soteroula, Collado, Anna, de Montalembert, Mariane, Dedeken, Laurence, Fenaux, Pierre, Galacteros, Frédéric, Glenthøj, Andreas, Gutiérrez Valle, Victoria, Kattamis, Antonis, Kunz, Joachim, Lobitz, Stephan, McMahon, Corrina, Pellegrini, Mariangela, Reidel, Sara, Russo, Giovanna, Santos Freire, Miriam, van Beers, Eduard, Kountouris, Petros, and Gulbis, Béatrice

Published
2023
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11. Imitating the respiratory activity of the brain stem by using artificial neural networks: exploratory study on an animal model of lactic acidosis and proof of concept

Author

Perchiazzi, Gaetano, primary, Kawati, Rafael, additional, Pellegrini, Mariangela, additional, Liangpansakul, Jasmine, additional, Colella, Roberto, additional, Bollella, Paolo, additional, Rangaiah, Pramod, additional, Cannone, Annamaria, additional, Venkataramana, Deepthi Hulithala, additional, Perez, Mauricio, additional, Stramaglia, Sebastiano, additional, Torsi, Luisa, additional, Bellotti, Roberto, additional, and Augustine, Robin, additional

Published
2024
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12. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Author

Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R. J., Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J., Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J., and Cecconi, Maurizio

Published
2022
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15. Lung impedance changes during awake prone positioning in COVID-19 : A non-randomized cross-over study

Author

Rosén, Jacob, Frykholm, Peter, Jonsson Fagerlund, Malin, Pellegrini, Mariangela, Campoccia Jalde, Francesca, von Oelreich, Erik, Fors, Diddi, Rosén, Jacob, Frykholm, Peter, Jonsson Fagerlund, Malin, Pellegrini, Mariangela, Campoccia Jalde, Francesca, von Oelreich, Erik, and Fors, Diddi

Abstract

Background The effects of awake prone positioning (APP) on respiratory mechanics in patients with COVID-19 are not well characterized. The aim of this study was to investigate changes of global and regional lung volumes during APP compared with the supine position using electrical lung impedance tomography (EIT) in patients with hypoxemic respiratory failure due to COVID-19. Materials and methods This exploratory non-randomized cross-over study was conducted at two university hospitals in Sweden between January and May 2021. Patients admitted to the intensive care unit with confirmed COVID-19, an arterial cannula in place, a PaO2/FiO2 ratio <26.6 kPa (<200 mmHg) and high-flow nasal oxygen or non-invasive ventilation were eligible for inclusion. EIT-data were recorded at supine baseline, at 30 and 60 minutes after APP-initiation, and 30 minutes after supine repositioning. The primary outcomes were changes in global and regional tidal impedance variation (TIV), center of ventilation (CoV), global and regional delta end-expiratory lung-impedance (dEELI) and global inhomogeneity (GI) index at the end of APP compared with supine baseline. Data were reported as median (IQR). Results All patients (n = 10) were male and age was 64 (47–73) years. There were no changes in global or regional TIV, CoV or GI-index during the intervention. dEELI increased from supine reference value 0 to 1.51 (0.32–3.62) 60 minutes after APP (median difference 1.51 (95% CI 0.19–5.16), p = 0.04) and returned to near baseline values after supine repositioning. Seven patients (70%) showed an increase >0.20 in dEELI during APP. The other EIT-variables did not change during APP compared with baseline. Conclusion Awake prone positioning was associated with a transient lung recruiting effect without changes in ventilation distribution measured with EIT in patients with hypoxemic respiratory failure due to COVID-19.

Published
2024
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16. Body mass index is associated with pulmonary gas and blood distribution mismatch in COVID-19 acute respiratory failure. A physiological study.

Author

Bjarnadóttir, Kristín J., Perchiazzi, Gaetano, Sidenbladh, Caroline Lördal, Larina, Aleksandra, Wallin, Ewa, Larsson, Ing-Marie, Franzén, Stephanie, Larsson, Anders O., Sousa, Mayson L. A., Segelsjö, Monica, Hansen, Tomas, Frithiof, Robert, Hultström, Michael, Lipcsey, Miklos, and Pellegrini, Mariangela

Subjects
BLOOD gases, ADULT respiratory distress syndrome, GAS distribution, BODY mass index, COMPUTED tomography
Abstract

Background: The effects of obesity on pulmonary gas and blood distribution in patients with acute respiratory failure remain unknown. Dual-energy computed tomography (DECT) is a X-ray-based method used to study regional distribution of gas and blood within the lung. We hypothesized that 1) regional gas/blood mismatch can be quantified by DECT; 2) obesity influences the global and regional distribution of pulmonary gas and blood; 3) regardless of ventilation modality (invasive vs. non-invasive ventilation), patients' body mass index (BMI) has an impact on pulmonary gas/blood mismatch. Methods: This single-centre prospective observational study enrolled 118 hypoxic COVID-19 patients (92 male) in need of respiratory support and intensive care who underwent DECT. The cohort was divided into three groups according to BMI: 1. BMI<25 kg/m2 (non-obese), 2. BMI = 25-40 kg/m2 (overweight to obese), and 3. BMI>40 kg/m2 (morbidly obese). Gravitational analysis of Hounsfield unit distribution of gas and blood was derived from DECT and used to calculate regional gas/blood mismatch. A sensitivity analysis was performed to investigate the influence of the chosen ventilatory modality and BMI on gas/blood mismatch and adjust for other possible confounders (i.e., age and sex). Results: 1) Regional pulmonary distribution of gas and blood and their mismatch were quantified using DECT imaging. 2) The BMI>40 kg/m2 group had less hyperinflation in the non-dependent regions and more lung collapse in the dependent regions compared to the other BMI groups. In morbidly obese patients, gas and blood were more evenly distributed; therefore, the mismatch was lower than in other patients (30% vs. 36%, p < 0.05). 3) An increase in BMI of 5 kg/m2 was associated with a decrease in mismatch of 3.3% (CI: 3.67% to -2.93%, p < 0.05). Neither the ventilatory modality nor age and sex affected the gas/blood mismatch (p > 0.05). Conclusion: 1) In a hypoxic COVID-19 population needing intensive care, pulmonary gas/blood mismatch can be quantified at a global and regional level using DECT. 2) Obesity influences the global and regional distribution of gas and blood within the lung, and BMI>40 kg/m2 improves pulmonary gas/blood mismatch. 3) This is true regardless of the ventilatory mode and other possible confounders, i.e., age and sex. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Dynamic Mechanical Interactions Between Neighboring Airspaces Determine Cyclic Opening and Closure in Injured Lung

Author

Broche, Ludovic, Perchiazzi, Gaetano, Porra, Liisa, Tannoia, Angela, Pellegrini, Mariangela, Derosa, Savino, Sindaco, Alessandra, Borges, João Batista, Degrugilliers, Loïc, Larsson, Anders, Hedenstierna, Göran, Wexler, Anthony S, Bravin, Alberto, Verbanck, Sylvia, Smith, Bradford J, Bates, Jason HT, and Bayat, Sam

Subjects
Biomedical and Clinical Sciences, Nursing, Clinical Sciences, Health Sciences, Lung, Bioengineering, Acute Lung Injury, Animals, Computer Simulation, Male, Positive-Pressure Respiration, Pressure, Pulmonary Alveoli, Rabbits, Synchrotrons, acute respiratory distress syndrome, assisted ventilation, imaging/computed tomography, pulmonary oedema, synchrotron, Public Health and Health Services, Emergency & Critical Care Medicine, Clinical sciences
Abstract

ObjectivesPositive pressure ventilation exposes the lung to mechanical stresses that can exacerbate injury. The exact mechanism of this pathologic process remains elusive. The goal of this study was to describe recruitment/derecruitment at acinar length scales over short-time frames and test the hypothesis that mechanical interdependence between neighboring lung units determines the spatial and temporal distributions of recruitment/derecruitment, using a computational model.DesignExperimental animal study.SettingInternational synchrotron radiation laboratory.SubjectsFour anesthetized rabbits, ventilated in pressure controlled mode.InterventionsThe lung was consecutively imaged at ~ 1.5-minute intervals using phase-contrast synchrotron imaging, at positive end-expiratory pressures of 12, 9, 6, 3, and 0 cm H2O before and after lavage and mechanical ventilation induced injury. The extent and spatial distribution of recruitment/derecruitment was analyzed by subtracting subsequent images. In a realistic lung structure, we implemented a mechanistic model in which each unit has individual pressures and speeds of opening and closing. Derecruited and recruited lung fractions (Fderecruited, Frecruited) were computed based on the comparison of the aerated volumes at successive time points.Measurements and main resultsAlternative recruitment/derecruitment occurred in neighboring alveoli over short-time scales in all tested positive end-expiratory pressure levels and despite stable pressure controlled mode. The computational model reproduced this behavior only when parenchymal interdependence between neighboring acini was accounted for. Simulations closely mimicked the experimental magnitude of Fderecruited and Frecruited when mechanical interdependence was included, while its exclusion gave Frecruited values of zero at positive end-expiratory pressure greater than or equal to 3 cm H2O.ConclusionsThese findings give further insight into the microscopic behavior of the injured lung and provide a means of testing protective-ventilation strategies to prevent recruitment/derecruitment and subsequent lung damage.

Published
2017

18. Correction to: Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Author

Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R. J., Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J., Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J., and Cecconi, Maurizio

Published
2022
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20. Early mobilisation in critically ill COVID-19 patients : a subanalysis of the ESICM-initiated UNITE-COVID observational study

Author

Kloss, Philipp, Lindholz, Maximilian, Milnik, Annette, Azoulay, Elie, Cecconi, Maurizio, Citerio, Giuseppe, De Corte, Thomas, Duska, Frantisek, Galarza, Laura, Greco, Massimiliano, Girbes, Armand R. J., Kesecioglu, Jozef, Mellinghoff, Johannes, Ostermann, Marlies, Pellegrini, Mariangela, Teboul, Jean-Louis, De Waele, Jan, Wong, Adrian, Schaller, Stefan J., Kloss, Philipp, Lindholz, Maximilian, Milnik, Annette, Azoulay, Elie, Cecconi, Maurizio, Citerio, Giuseppe, De Corte, Thomas, Duska, Frantisek, Galarza, Laura, Greco, Massimiliano, Girbes, Armand R. J., Kesecioglu, Jozef, Mellinghoff, Johannes, Ostermann, Marlies, Pellegrini, Mariangela, Teboul, Jean-Louis, De Waele, Jan, Wong, Adrian, and Schaller, Stefan J.

Abstract

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p <= 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI - 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI - 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility.

Published
2023
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21. Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Author

Kloss, P, Lindholz, M, Milnik, A, Azoulay, E, Cecconi, M, Citerio, G, De Corte, T, Duska, F, Galarza, L, Greco, M, Girbes, A, Kesecioglu, J, Mellinghoff, J, Ostermann, M, Pellegrini, M, Teboul, J, De Waele, J, Wong, A, Schaller, S, Aires, B, Gira, A, Eller, P, Hamid, T, Haque, I, De Buyser, W, Cudia, A, De Backer, D, Foulon, P, Collin, V, Van Hecke, J, De Waele, E, Van Malderen, C, Mesland, J, Biston, P, Piagnerelli, M, Haentjens, L, De Schryver, N, Van Leemput, J, Vanhove, P, Bulpa, P, Ilieva, V, Katz, D, Binnie, A, Geagea, A, Tirapegui, F, Lago, G, Graf, J, Perez-Araos, R, Vargas, P, Martinez, F, Labarca, E, Franco, D, Parra-Tanoux, D, Yepes, D, Hammouda, A, Elmandouh, O, Azzam, A, Hussein, A, Galal, I, Awad, A, Azab, M, Abdalla, M, Assal, H, Alfishawy, M, Ghozy, S, Tharwat, S, Eldaly, A, Ellervee, A, Reinhard, V, Chrisment, A, Poyat, C, Badie, J, Berdaguer Ferrari, F, Weiss, B, Schellenberg, C, Grunow, J, Lorenz, M, Spieth, P, Bota, M, Fichtner, F, Fuest, K, Lahmer, T, Herrmann, J, Meybohm, P, Markou, N, Vasileiadou, G, Chrysanthopoulou, E, Papamichalis, P, Soultati, I, Jog, S, Kalvit, K, Nainan Myatra, S, Krupa, I, Tharwat, A, Nichol, A, Mccarthy, A, Mahmoodpoor, A, Tonetti, T, Isoni, P, Spadaro, S, Volta, C, Mirabella, L, Noto, A, Florio, G, Guzzardella, A, Paleari, C, Baccanelli, F, Savi, M, Antonelli, M, De Pascale, G, Vaccarini, B, Montrucchio, G, Sales, G, Donadello, K, Gottin, L, Nizzero, M, Polati, E, De Rosa, S, Sulemanji, D, Abusalama, A, Elhadi, M, Jesus, M, Gonzalez, D, Robles, V, Canedo, N, Chavez, A, Dendane, T, Grady, B, de Jong, B, van der Heiden, E, Thoral, P, van den Bogaard, B, Spronk, P, Achterberg, S, Groeneveld, M, So, R, de Wijs, C, Scholten, H, Beishuizen, A, Cornet, A, Reidinga, A, Kranen, H, Mensink, R, den Boer, S, de Groot, M, Beck, O, Bethlehem, C, van Bussel, B, Frenzel, T, de Jong, C, Wilting, R, Mehagnoul-Schipper, J, Alasia, D, Kumar, A, Qayyum, A, Rana, M, Jayyab, M, Sierra, R, Hernandez, A, Taborda, L, Anselmo, M, Ramires, T, Silva, C, Roriz, C, Morais, R, Póvoa, P, Patricio, P, Pinto, A, Santos, M, Costa, V, Cunha, P, Gonçalves, C, Nunes, S, Camões, J, Adrião, D, Oliveira, A, Omrani, A, Maslamani, M, Elbuzidi, A, Qudah, B, Akkari, A, Alkhatteb, M, Baiou, A, Husain, A, Alwraidat, M, Saif, I, Bakdach, D, Ahmed, A, Aleef, M, Bintaher, A, Petrisor, C, Popov, E, Popova, K, Dementienko, M, Teplykh, B, Pyregov, A, Davydova, L, Vladislav, B, Neporada, E, Zverev, I, Meshchaninova, S, Sokolov, D, Gavrilova, E, Shlyk, I, Poliakov, I, Vlasova, M, Aljuhani, O, Alkhalaf, A, Humaid, F, Arabi, Y, Kuhail, A, Elrabi, O, Ghannam, M, Kansal, A, Ho, V, Ng, J, García, R, Fraga, X, del Pilar García-Bonillo, M, Padilla-Serrano, A, Cuadrado, M, Ferrando, C, Catalan-Monzon, I, Frutos-Vivar, F, Jimenez, J, Rodríguez-Solis, C, Franquesa-Gonzalez, E, Acosta, G, Cabrera, L, Parra, J, Gonzalez, F, del Carmen Conesa, M, Varela, I, Pravia, O, Delgado, M, de Cabo, C, Ioan, A, Perez-Calvo, C, Santos, A, Abad-Motos, A, Ripolles-Melchor, J, Martin, B, Teruel, S, Lucas, J, Ortiz, A, de Pablo Sánchez, R, Barrueco-Francioni, J, Espina, L, Bonell-Goytisolo, J, Salaverria, I, Mir, A, Rodriguez-Ruiz, E, Valverde, V, Cubero, P, Linde, F, Leganes, N, Romeu, J, Concha, P, Berezo-Garcia, J, Fraile, V, Cuenca-Rubio, C, Pérez-Torres, D, Serrano, A, Valero, C, Suner, A, Larrañaga, L, Legaristi, N, Ferrigno, G, Khlafalla, S, Bihariesingh-Sanchit, R, Zoerner, F, Grip, J, Kilsand, K, Mårtensson, J, Österlind, J, von Seth, M, Berkius, J, Ceruti, S, Glotta, A, Izdes, S, Turan, I, Cosar, A, Halacli, B, Dereli, N, Yilmaz, M, Akbas, T, Elay, G, Eyüpoğlu, S, Bílír, Y, Saraçoğlu, K, Kaya, E, Sahin, A, Ekren, P, Mengi, T, Suner, K, Tomak, Y, Eroglu, A, Alsabbah, A, Hanlon, K, Gervin, K, Mcmahon, S, Hagan, S, Higenbottam, C, Mullhi, R, Poulton, L, Torlinski, T, Gareth, A, Truman, N, Vijayakumar, G, Hall, C, Jubb, A, Cagova, L, Jones, N, Graham, S, Robin, N, Cowton, A, Donnelly, A, Singatullina, N, Kent, M, Boulanger, C, Campbell, Z, Potter, E, Duric, N, Szakmany, T, Kviatkovske, O, Marczin, N, Ellis, C, Saha, R, Sri-Chandana, C, Allan, J, Mumelj, L, Venkatesh, H, Gotz, V, Cochrane, A, Ficial, B, Kamble, S, Lumlertgul, N, Oddy, C, Jain, S, Crapelli, G, Vlachou, A, Golden, D, Garrioch, S, Henning, J, Loveleena, G, Davey, M, Grauslyte, L, Salciute-Simene, E, Cook, M, Barling, D, Broadhurst, P, Purvis, S, Spivey, M, Shuker, B, Grecu, I, Harding, D, Dean, J, Nielsen, N, Al-Bayati, S, Al-Sadawi, M, Charron, M, Stubenrauch, P, Santanilla, J, Wentowski, C, Rosenberger, D, Eksarko, P, Jawa, R, Kloss, Philipp, Lindholz, Maximilian, Milnik, Annette, Azoulay, Elie, Cecconi, Maurizio, Citerio, Giuseppe, De Corte, Thomas, Duska, Frantisek, Galarza, Laura, Greco, Massimiliano, Girbes, Armand R. J., Kesecioglu, Jozef, Mellinghoff, Johannes, Ostermann, Marlies, Pellegrini, Mariangela, Teboul, Jean-Louis, De Waele, Jan, Wong, Adrian, Schaller, Stefan J., Aires, Buenos, Gira, Alicia, Eller, Philipp, Hamid, Tarikul, Haque, Injamam Ull, De Buyser, Wim, Cudia, Antonella, De Backer, Daniel, Foulon, Pierre, Collin, Vincent, Van Hecke, Jolien, De Waele, Elisabeth, Van Malderen, Claire, Mesland, Jean-Baptiste, Biston, Patrick, Piagnerelli, Michael, Haentjens, Lionel, De Schryver, Nicolas, Van Leemput, Jan, Vanhove, Philippe, Bulpa, Pierre, Ilieva, Viktoria, Katz, David, Binnie, Alexandra, Geagea, Anna, Tirapegui, Fernando, Lago, Gustavo, Graf, Jerónimo, Perez-Araos, Rodrigo, Vargas, Patricio, Martinez, Felipe, Labarca, Eduardo, Franco, Daniel Molano, Parra-Tanoux, Daniela, Yepes, David, Hammouda, Ahmed, Elmandouh, Omar, Azzam, Ahmed, Hussein, Aliae Mohamed, Galal, Islam, Awad, Ahmed K., Azab, Mohammed A., Abdalla, Maged, Assal, Hebatallah, Alfishawy, Mostafa, Ghozy, Sherief, Tharwat, Samar, Eldaly, Abdullah, Ellervee, Anneli, Reinhard, Veronika, Chrisment, Anne, Poyat, Chrystelle, Badie, Julio, Berdaguer Ferrari, Fernando, Weiss, Björn, Schellenberg, Clara, Grunow, Julius J, Lorenz, Marco, Schaller, Stefan J, Spieth, Peter, Bota, Marc, Fichtner, Falk, Fuest, Kristina, Lahmer, Tobias, Herrmann, Johannes, Meybohm, Patrick, Markou, Nikolaos, Vasileiadou, Georgia, Chrysanthopoulou, Evangelia, Papamichalis, Panagiotis, Soultati, Ioanna, Jog, Sameer, Kalvit, Kushal, Nainan Myatra, Sheila, Krupa, Ivan, Tharwat, Aisa, Nichol, Alistair, McCarthy, Aine, Mahmoodpoor, Ata, Tonetti, Tommaso, Isoni, Paolo, Spadaro, Savino, Volta, Carlo Alberto, Mirabella, Lucia, Noto, Alberto, Florio, Gaetano, Guzzardella, Amedeo, Paleari, Chiara, Baccanelli, Federica, Savi, Marzia, Antonelli, Massimo, De Pascale, Gennaro, Vaccarini, Barbara, Montrucchio, Giorgia, Sales, Gabriele, Donadello, Katia, Gottin, Leonardo, Nizzero, Marta, Polati, Enrico, De Rosa, Silvia, Sulemanji, Demet, Abusalama, Abdurraouf, Elhadi, Muhammed, Jesus, Montelongo Felipe De, Gonzalez, Daniel Rodriguez, Robles, Victor Hugo Madrigal, Canedo, Nancy, Chavez, Alejandro Esquivel, Dendane, Tarek, Grady, Bart, de Jong, Ben, van der Heiden, Eveline, Thoral, Patrick, van den Bogaard, Bas, Spronk, Peter E., Achterberg, Sefanja, Groeneveld, Melanie, So, Ralph K. L., de Wijs, Calvin, Scholten, Harm, Beishuizen, Albertus, Cornet, Alexander D., Reidinga, Auke C., Kranen, Hetty, Mensink, Roos, den Boer, Sylvia, de Groot, Marcel, Beck, Oliver, Bethlehem, Carina, van Bussel, Bas, Frenzel, Tim, de Jong, Celestine, Wilting, Rob, Mehagnoul-Schipper, Jannet, Alasia, Datonye, Kumar, Ashok, Qayyum, Ahad, Rana, Muhammad, Jayyab, Mustafa Abu, Sierra, Rosario Quispe, Hernandez, Aaron Mark, Taborda, Lúcia, Anselmo, Mónica, Ramires, Tiago, Silva, Catarina, Roriz, Carolina, Morais, Rui, Póvoa, Pedro, Patricio, Patricia, Pinto, André, Santos, Maria Lurdes, Costa, Vasco, Cunha, Pedro, Gonçalves, Celina, Nunes, Sandra, Camões, João, Adrião, Diana, Oliveira, Ana, Omrani, Ali, Maslamani, Muna Al, elbuzidi, Abdurrahmaan Suei, qudah, Bara Mahmoud Al, Akkari, Abdel Rauof, Alkhatteb, Mohamed, Baiou, Anas, Husain, Ahmed, Alwraidat, Mohamed, Saif, Ibrahim Abdulsalam, Bakdach, Dana, Ahmed, Amna, Aleef, Mohamed, Bintaher, Awadh, Petrisor, Cristina, Popov, Evgeniy, Popova, Ksenia, Dementienko, Mariia, Teplykh, Boris, Pyregov, Alexey, Davydova, Liubov, Vladislav, Belskii, Neporada, Elena, Zverev, Ivan, Meshchaninova, Svetlana, Sokolov, Dmitry, Gavrilova, Elena, Shlyk, Irina, Poliakov, Igor, Vlasova, Marina, Aljuhani, Ohoud, Alkhalaf, Amina, Humaid, Felwa Bin, Arabi, Yaseen, Kuhail, Ahmed, Elrabi, Omar, Ghannam, Madihah E., Kansal, Amit, Ho, Vui Kian, Ng, Jensen, García, Raquel Rodrígez, Fraga, Xiana Taboada, del Pilar García-Bonillo, Ma, Padilla-Serrano, Antonio, Cuadrado, Marta Martin, Ferrando, Carlos, Catalan-Monzon, Ignacio, Frutos-Vivar, Fernando, Jimenez, Jorge, Rodríguez-Solis, Carmen, Franquesa-Gonzalez, Enric, Acosta, Guillermo Pérez, Cabrera, Luciano Santana, Parra, Juan Pablo Aviles, Gonzalez, Francisco Muñoyerro, del Carmen Conesa, Maria Lorente, Varela, Ignacio Yago Martinez, Pravia, Orville Victoriano Baez, Delgado, Maria Cruz Martin, de Cabo, Carlos Munoz, Ioan, Ana-Maria, Perez-Calvo, Cesar, Santos, Arnoldo, Abad-Motos, Ane, Ripolles-Melchor, Javier, Martin, Belén Civantos, Teruel, Santiago Yus, Lucas, Juan Higuera, Ortiz, Aaron Blandino, de Pablo Sánchez, Raúl, Barrueco-Francioni, Jesús Emilio, Espina, Lorena Forcelledo, Bonell-Goytisolo, José M., Salaverria, Iñigo, Mir, Antonia Socias, Rodriguez-Ruiz, Emilio, Valverde, Virginia Hidalgo, Cubero, Patricia Jimeno, Linde, Francisca Arbol, Leganes, Nieves Cruza, Romeu, Juan Maria, Concha, Pablo, Berezo-Garcia, José Angel, Fraile, Virginia, Cuenca-Rubio, Cristina, Pérez-Torres, David, Serrano, Ainhoa, Valero, Clara Martínez, Suner, Andrea Ortiz, Larrañaga, Leire, Legaristi, Noemi, Ferrigno, Gerardo, Khlafalla, Safa, Bihariesingh-Sanchit, Rosita, Zoerner, Frank, Grip, Jonathan, Kilsand, Kristina, Mårtensson, Johan, Österlind, Jonas, von Seth, Magnus, Berkius, Johan, Ceruti, Samuele, Glotta, Andrea, Izdes, Seval, Turan, Işıl Özkoçak, Cosar, Ahmet, Halacli, Burcin, Dereli, Necla, Yilmaz, Mehmet, Akbas, Türkay, Elay, Gülseren, Eyüpoğlu, Selin, Bílír, Yelíz, Saraçoğlu, Kemal Tolga, Kaya, Ebru, Sahin, Ayca Sultan, Ekren, Pervin Korkmaz, Mengi, Tuğçe, Suner, Kezban Ozmen, Tomak, Yakup, Eroglu, Ahmet, Alsabbah, Asad, Hanlon, Katie, Gervin, Kevin, McMahon, Sean, Hagan, Samantha, Higenbottam, Caroline V, Mullhi, Randeep, Poulton, Lottie, Torlinski, Tomasz, Gareth, Allen, Truman, Nick, Vijayakumar, Gopal, Hall, Chris, Jubb, Alasdair, Cagova, Lenka, Jones, Nicola, Graham, Sam, Robin, Nicole, Cowton, Amanda, Donnelly, Adrian, Singatullina, Natalia, Kent, Melanie, Boulanger, Carole, Campbell, Zoë, Potter, Elizabeth, Duric, Natalie, Szakmany, Tamas, Kviatkovske, Orinta, Marczin, Nandor, Ellis, Caroline, Saha, Rajnish, Sri-Chandana, Chunda, Allan, John, Mumelj, Lana, Venkatesh, Harish, Gotz, Vera Nina, Cochrane, Anthony, Ficial, Barbara, Kamble, Shruthi, Lumlertgul, Nuttha, Oddy, Christopher, Jain, Susan, Crapelli, Giulia Beatrice, Vlachou, Aikaterini, Golden, David, Garrioch, Sweyn, Henning, Jeremy, Loveleena, Gupta, Davey, Miriam, Grauslyte, Lina, Salciute-Simene, Erika, Cook, Martin, Barling, Danny, Broadhurst, Phil, Purvis, Sarah, Spivey, Michael, Shuker, Benjamin, Grecu, Irina, Harding, Daniel, Dean, James T., Nielsen, Nathan D., Al-Bayati, Sama, Al-Sadawi, Mohammed, Charron, Mariane, Stubenrauch, Peter, Santanilla, Jairo, Wentowski, Catherine, Rosenberger, Dorothea, Eksarko, Polikseni, Jawa, Randeep, Kloss, P, Lindholz, M, Milnik, A, Azoulay, E, Cecconi, M, Citerio, G, De Corte, T, Duska, F, Galarza, L, Greco, M, Girbes, A, Kesecioglu, J, Mellinghoff, J, Ostermann, M, Pellegrini, M, Teboul, J, De Waele, J, Wong, A, Schaller, S, Aires, B, Gira, A, Eller, P, Hamid, T, Haque, I, De Buyser, W, Cudia, A, De Backer, D, Foulon, P, Collin, V, Van Hecke, J, De Waele, E, Van Malderen, C, Mesland, J, Biston, P, Piagnerelli, M, Haentjens, L, De Schryver, N, Van Leemput, J, Vanhove, P, Bulpa, P, Ilieva, V, Katz, D, Binnie, A, Geagea, A, Tirapegui, F, Lago, G, Graf, J, Perez-Araos, R, Vargas, P, Martinez, F, Labarca, E, Franco, D, Parra-Tanoux, D, Yepes, D, Hammouda, A, Elmandouh, O, Azzam, A, Hussein, A, Galal, I, Awad, A, Azab, M, Abdalla, M, Assal, H, Alfishawy, M, Ghozy, S, Tharwat, S, Eldaly, A, Ellervee, A, Reinhard, V, Chrisment, A, Poyat, C, Badie, J, Berdaguer Ferrari, F, Weiss, B, Schellenberg, C, Grunow, J, Lorenz, M, Spieth, P, Bota, M, Fichtner, F, Fuest, K, Lahmer, T, Herrmann, J, Meybohm, P, Markou, N, Vasileiadou, G, Chrysanthopoulou, E, Papamichalis, P, Soultati, I, Jog, S, Kalvit, K, Nainan Myatra, S, Krupa, I, Tharwat, A, Nichol, A, Mccarthy, A, Mahmoodpoor, A, Tonetti, T, Isoni, P, Spadaro, S, Volta, C, Mirabella, L, Noto, A, Florio, G, Guzzardella, A, Paleari, C, Baccanelli, F, Savi, M, Antonelli, M, De Pascale, G, Vaccarini, B, Montrucchio, G, Sales, G, Donadello, K, Gottin, L, Nizzero, M, Polati, E, De Rosa, S, Sulemanji, D, Abusalama, A, Elhadi, M, Jesus, M, Gonzalez, D, Robles, V, Canedo, N, Chavez, A, Dendane, T, Grady, B, de Jong, B, van der Heiden, E, Thoral, P, van den Bogaard, B, Spronk, P, Achterberg, S, Groeneveld, M, So, R, de Wijs, C, Scholten, H, Beishuizen, A, Cornet, A, Reidinga, A, Kranen, H, Mensink, R, den Boer, S, de Groot, M, Beck, O, Bethlehem, C, van Bussel, B, Frenzel, T, de Jong, C, Wilting, R, Mehagnoul-Schipper, J, Alasia, D, Kumar, A, Qayyum, A, Rana, M, Jayyab, M, Sierra, R, Hernandez, A, Taborda, L, Anselmo, M, Ramires, T, Silva, C, Roriz, C, Morais, R, Póvoa, P, Patricio, P, Pinto, A, Santos, M, Costa, V, Cunha, P, Gonçalves, C, Nunes, S, Camões, J, Adrião, D, Oliveira, A, Omrani, A, Maslamani, M, Elbuzidi, A, Qudah, B, Akkari, A, Alkhatteb, M, Baiou, A, Husain, A, Alwraidat, M, Saif, I, Bakdach, D, Ahmed, A, Aleef, M, Bintaher, A, Petrisor, C, Popov, E, Popova, K, Dementienko, M, Teplykh, B, Pyregov, A, Davydova, L, Vladislav, B, Neporada, E, Zverev, I, Meshchaninova, S, Sokolov, D, Gavrilova, E, Shlyk, I, Poliakov, I, Vlasova, M, Aljuhani, O, Alkhalaf, A, Humaid, F, Arabi, Y, Kuhail, A, Elrabi, O, Ghannam, M, Kansal, A, Ho, V, Ng, J, García, R, Fraga, X, del Pilar García-Bonillo, M, Padilla-Serrano, A, Cuadrado, M, Ferrando, C, Catalan-Monzon, I, Frutos-Vivar, F, Jimenez, J, Rodríguez-Solis, C, Franquesa-Gonzalez, E, Acosta, G, Cabrera, L, Parra, J, Gonzalez, F, del Carmen Conesa, M, Varela, I, Pravia, O, Delgado, M, de Cabo, C, Ioan, A, Perez-Calvo, C, Santos, A, Abad-Motos, A, Ripolles-Melchor, J, Martin, B, Teruel, S, Lucas, J, Ortiz, A, de Pablo Sánchez, R, Barrueco-Francioni, J, Espina, L, Bonell-Goytisolo, J, Salaverria, I, Mir, A, Rodriguez-Ruiz, E, Valverde, V, Cubero, P, Linde, F, Leganes, N, Romeu, J, Concha, P, Berezo-Garcia, J, Fraile, V, Cuenca-Rubio, C, Pérez-Torres, D, Serrano, A, Valero, C, Suner, A, Larrañaga, L, Legaristi, N, Ferrigno, G, Khlafalla, S, Bihariesingh-Sanchit, R, Zoerner, F, Grip, J, Kilsand, K, Mårtensson, J, Österlind, J, von Seth, M, Berkius, J, Ceruti, S, Glotta, A, Izdes, S, Turan, I, Cosar, A, Halacli, B, Dereli, N, Yilmaz, M, Akbas, T, Elay, G, Eyüpoğlu, S, Bílír, Y, Saraçoğlu, K, Kaya, E, Sahin, A, Ekren, P, Mengi, T, Suner, K, Tomak, Y, Eroglu, A, Alsabbah, A, Hanlon, K, Gervin, K, Mcmahon, S, Hagan, S, Higenbottam, C, Mullhi, R, Poulton, L, Torlinski, T, Gareth, A, Truman, N, Vijayakumar, G, Hall, C, Jubb, A, Cagova, L, Jones, N, Graham, S, Robin, N, Cowton, A, Donnelly, A, Singatullina, N, Kent, M, Boulanger, C, Campbell, Z, Potter, E, Duric, N, Szakmany, T, Kviatkovske, O, Marczin, N, Ellis, C, Saha, R, Sri-Chandana, C, Allan, J, Mumelj, L, Venkatesh, H, Gotz, V, Cochrane, A, Ficial, B, Kamble, S, Lumlertgul, N, Oddy, C, Jain, S, Crapelli, G, Vlachou, A, Golden, D, Garrioch, S, Henning, J, Loveleena, G, Davey, M, Grauslyte, L, Salciute-Simene, E, Cook, M, Barling, D, Broadhurst, P, Purvis, S, Spivey, M, Shuker, B, Grecu, I, Harding, D, Dean, J, Nielsen, N, Al-Bayati, S, Al-Sadawi, M, Charron, M, Stubenrauch, P, Santanilla, J, Wentowski, C, Rosenberger, D, Eksarko, P, Jawa, R, Kloss, Philipp, Lindholz, Maximilian, Milnik, Annette, Azoulay, Elie, Cecconi, Maurizio, Citerio, Giuseppe, De Corte, Thomas, Duska, Frantisek, Galarza, Laura, Greco, Massimiliano, Girbes, Armand R. J., Kesecioglu, Jozef, Mellinghoff, Johannes, Ostermann, Marlies, Pellegrini, Mariangela, Teboul, Jean-Louis, De Waele, Jan, Wong, Adrian, Schaller, Stefan J., Aires, Buenos, Gira, Alicia, Eller, Philipp, Hamid, Tarikul, Haque, Injamam Ull, De Buyser, Wim, Cudia, Antonella, De Backer, Daniel, Foulon, Pierre, Collin, Vincent, Van Hecke, Jolien, De Waele, Elisabeth, Van Malderen, Claire, Mesland, Jean-Baptiste, Biston, Patrick, Piagnerelli, Michael, Haentjens, Lionel, De Schryver, Nicolas, Van Leemput, Jan, Vanhove, Philippe, Bulpa, Pierre, Ilieva, Viktoria, Katz, David, Binnie, Alexandra, Geagea, Anna, Tirapegui, Fernando, Lago, Gustavo, Graf, Jerónimo, Perez-Araos, Rodrigo, Vargas, Patricio, Martinez, Felipe, Labarca, Eduardo, Franco, Daniel Molano, Parra-Tanoux, Daniela, Yepes, David, Hammouda, Ahmed, Elmandouh, Omar, Azzam, Ahmed, Hussein, Aliae Mohamed, Galal, Islam, Awad, Ahmed K., Azab, Mohammed A., Abdalla, Maged, Assal, Hebatallah, Alfishawy, Mostafa, Ghozy, Sherief, Tharwat, Samar, Eldaly, Abdullah, Ellervee, Anneli, Reinhard, Veronika, Chrisment, Anne, Poyat, Chrystelle, Badie, Julio, Berdaguer Ferrari, Fernando, Weiss, Björn, Schellenberg, Clara, Grunow, Julius J, Lorenz, Marco, Schaller, Stefan J, Spieth, Peter, Bota, Marc, Fichtner, Falk, Fuest, Kristina, Lahmer, Tobias, Herrmann, Johannes, Meybohm, Patrick, Markou, Nikolaos, Vasileiadou, Georgia, Chrysanthopoulou, Evangelia, Papamichalis, Panagiotis, Soultati, Ioanna, Jog, Sameer, Kalvit, Kushal, Nainan Myatra, Sheila, Krupa, Ivan, Tharwat, Aisa, Nichol, Alistair, McCarthy, Aine, Mahmoodpoor, Ata, Tonetti, Tommaso, Isoni, Paolo, Spadaro, Savino, Volta, Carlo Alberto, Mirabella, Lucia, Noto, Alberto, Florio, Gaetano, Guzzardella, Amedeo, Paleari, Chiara, Baccanelli, Federica, Savi, Marzia, Antonelli, Massimo, De Pascale, Gennaro, Vaccarini, Barbara, Montrucchio, Giorgia, Sales, Gabriele, Donadello, Katia, Gottin, Leonardo, Nizzero, Marta, Polati, Enrico, De Rosa, Silvia, Sulemanji, Demet, Abusalama, Abdurraouf, Elhadi, Muhammed, Jesus, Montelongo Felipe De, Gonzalez, Daniel Rodriguez, Robles, Victor Hugo Madrigal, Canedo, Nancy, Chavez, Alejandro Esquivel, Dendane, Tarek, Grady, Bart, de Jong, Ben, van der Heiden, Eveline, Thoral, Patrick, van den Bogaard, Bas, Spronk, Peter E., Achterberg, Sefanja, Groeneveld, Melanie, So, Ralph K. L., de Wijs, Calvin, Scholten, Harm, Beishuizen, Albertus, Cornet, Alexander D., Reidinga, Auke C., Kranen, Hetty, Mensink, Roos, den Boer, Sylvia, de Groot, Marcel, Beck, Oliver, Bethlehem, Carina, van Bussel, Bas, Frenzel, Tim, de Jong, Celestine, Wilting, Rob, Mehagnoul-Schipper, Jannet, Alasia, Datonye, Kumar, Ashok, Qayyum, Ahad, Rana, Muhammad, Jayyab, Mustafa Abu, Sierra, Rosario Quispe, Hernandez, Aaron Mark, Taborda, Lúcia, Anselmo, Mónica, Ramires, Tiago, Silva, Catarina, Roriz, Carolina, Morais, Rui, Póvoa, Pedro, Patricio, Patricia, Pinto, André, Santos, Maria Lurdes, Costa, Vasco, Cunha, Pedro, Gonçalves, Celina, Nunes, Sandra, Camões, João, Adrião, Diana, Oliveira, Ana, Omrani, Ali, Maslamani, Muna Al, elbuzidi, Abdurrahmaan Suei, qudah, Bara Mahmoud Al, Akkari, Abdel Rauof, Alkhatteb, Mohamed, Baiou, Anas, Husain, Ahmed, Alwraidat, Mohamed, Saif, Ibrahim Abdulsalam, Bakdach, Dana, Ahmed, Amna, Aleef, Mohamed, Bintaher, Awadh, Petrisor, Cristina, Popov, Evgeniy, Popova, Ksenia, Dementienko, Mariia, Teplykh, Boris, Pyregov, Alexey, Davydova, Liubov, Vladislav, Belskii, Neporada, Elena, Zverev, Ivan, Meshchaninova, Svetlana, Sokolov, Dmitry, Gavrilova, Elena, Shlyk, Irina, Poliakov, Igor, Vlasova, Marina, Aljuhani, Ohoud, Alkhalaf, Amina, Humaid, Felwa Bin, Arabi, Yaseen, Kuhail, Ahmed, Elrabi, Omar, Ghannam, Madihah E., Kansal, Amit, Ho, Vui Kian, Ng, Jensen, García, Raquel Rodrígez, Fraga, Xiana Taboada, del Pilar García-Bonillo, Ma, Padilla-Serrano, Antonio, Cuadrado, Marta Martin, Ferrando, Carlos, Catalan-Monzon, Ignacio, Frutos-Vivar, Fernando, Jimenez, Jorge, Rodríguez-Solis, Carmen, Franquesa-Gonzalez, Enric, Acosta, Guillermo Pérez, Cabrera, Luciano Santana, Parra, Juan Pablo Aviles, Gonzalez, Francisco Muñoyerro, del Carmen Conesa, Maria Lorente, Varela, Ignacio Yago Martinez, Pravia, Orville Victoriano Baez, Delgado, Maria Cruz Martin, de Cabo, Carlos Munoz, Ioan, Ana-Maria, Perez-Calvo, Cesar, Santos, Arnoldo, Abad-Motos, Ane, Ripolles-Melchor, Javier, Martin, Belén Civantos, Teruel, Santiago Yus, Lucas, Juan Higuera, Ortiz, Aaron Blandino, de Pablo Sánchez, Raúl, Barrueco-Francioni, Jesús Emilio, Espina, Lorena Forcelledo, Bonell-Goytisolo, José M., Salaverria, Iñigo, Mir, Antonia Socias, Rodriguez-Ruiz, Emilio, Valverde, Virginia Hidalgo, Cubero, Patricia Jimeno, Linde, Francisca Arbol, Leganes, Nieves Cruza, Romeu, Juan Maria, Concha, Pablo, Berezo-Garcia, José Angel, Fraile, Virginia, Cuenca-Rubio, Cristina, Pérez-Torres, David, Serrano, Ainhoa, Valero, Clara Martínez, Suner, Andrea Ortiz, Larrañaga, Leire, Legaristi, Noemi, Ferrigno, Gerardo, Khlafalla, Safa, Bihariesingh-Sanchit, Rosita, Zoerner, Frank, Grip, Jonathan, Kilsand, Kristina, Mårtensson, Johan, Österlind, Jonas, von Seth, Magnus, Berkius, Johan, Ceruti, Samuele, Glotta, Andrea, Izdes, Seval, Turan, Işıl Özkoçak, Cosar, Ahmet, Halacli, Burcin, Dereli, Necla, Yilmaz, Mehmet, Akbas, Türkay, Elay, Gülseren, Eyüpoğlu, Selin, Bílír, Yelíz, Saraçoğlu, Kemal Tolga, Kaya, Ebru, Sahin, Ayca Sultan, Ekren, Pervin Korkmaz, Mengi, Tuğçe, Suner, Kezban Ozmen, Tomak, Yakup, Eroglu, Ahmet, Alsabbah, Asad, Hanlon, Katie, Gervin, Kevin, McMahon, Sean, Hagan, Samantha, Higenbottam, Caroline V, Mullhi, Randeep, Poulton, Lottie, Torlinski, Tomasz, Gareth, Allen, Truman, Nick, Vijayakumar, Gopal, Hall, Chris, Jubb, Alasdair, Cagova, Lenka, Jones, Nicola, Graham, Sam, Robin, Nicole, Cowton, Amanda, Donnelly, Adrian, Singatullina, Natalia, Kent, Melanie, Boulanger, Carole, Campbell, Zoë, Potter, Elizabeth, Duric, Natalie, Szakmany, Tamas, Kviatkovske, Orinta, Marczin, Nandor, Ellis, Caroline, Saha, Rajnish, Sri-Chandana, Chunda, Allan, John, Mumelj, Lana, Venkatesh, Harish, Gotz, Vera Nina, Cochrane, Anthony, Ficial, Barbara, Kamble, Shruthi, Lumlertgul, Nuttha, Oddy, Christopher, Jain, Susan, Crapelli, Giulia Beatrice, Vlachou, Aikaterini, Golden, David, Garrioch, Sweyn, Henning, Jeremy, Loveleena, Gupta, Davey, Miriam, Grauslyte, Lina, Salciute-Simene, Erika, Cook, Martin, Barling, Danny, Broadhurst, Phil, Purvis, Sarah, Spivey, Michael, Shuker, Benjamin, Grecu, Irina, Harding, Daniel, Dean, James T., Nielsen, Nathan D., Al-Bayati, Sama, Al-Sadawi, Mohammed, Charron, Mariane, Stubenrauch, Peter, Santanilla, Jairo, Wentowski, Catherine, Rosenberger, Dorothea, Eksarko, Polikseni, and Jawa, Randeep

Abstract

Background: Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods: This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results: Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions: Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04

Published
2023

22. ESICM guidelines on acute respiratory distress syndrome:definition, phenotyping and respiratory support strategies

Author

Grasselli, Giacomo, Calfee, Carolyn S., Camporota, Luigi, Poole, Daniele, Amato, Marcelo B.P., Antonelli, Massimo, Arabi, Yaseen M., Baroncelli, Francesca, Beitler, Jeremy R., Bellani, Giacomo, Bellingan, Geoff, Blackwood, Bronagh, Bos, Lieuwe D.J., Brochard, Laurent, Brodie, Daniel, Burns, Karen E.A., Combes, Alain, D’Arrigo, Sonia, De Backer, Daniel, Demoule, Alexandre, Einav, Sharon, Fan, Eddy, Ferguson, Niall D., Frat, Jean Pierre, Gattinoni, Luciano, Guérin, Claude, Herridge, Margaret S., Hodgson, Carol, Hough, Catherine L., Jaber, Samir, Juffermans, Nicole P., Karagiannidis, Christian, Kesecioglu, Jozef, Kwizera, Arthur, Laffey, John G., Mancebo, Jordi, Matthay, Michael A., McAuley, Daniel F., Mercat, Alain, Meyer, Nuala J., Moss, Marc, Munshi, Laveena, Myatra, Sheila N., Ng Gong, Michelle, Papazian, Laurent, Patel, Bhakti K., Pellegrini, Mariangela, Perner, Anders, Pesenti, Antonio, Piquilloud, Lise, Grasselli, Giacomo, Calfee, Carolyn S., Camporota, Luigi, Poole, Daniele, Amato, Marcelo B.P., Antonelli, Massimo, Arabi, Yaseen M., Baroncelli, Francesca, Beitler, Jeremy R., Bellani, Giacomo, Bellingan, Geoff, Blackwood, Bronagh, Bos, Lieuwe D.J., Brochard, Laurent, Brodie, Daniel, Burns, Karen E.A., Combes, Alain, D’Arrigo, Sonia, De Backer, Daniel, Demoule, Alexandre, Einav, Sharon, Fan, Eddy, Ferguson, Niall D., Frat, Jean Pierre, Gattinoni, Luciano, Guérin, Claude, Herridge, Margaret S., Hodgson, Carol, Hough, Catherine L., Jaber, Samir, Juffermans, Nicole P., Karagiannidis, Christian, Kesecioglu, Jozef, Kwizera, Arthur, Laffey, John G., Mancebo, Jordi, Matthay, Michael A., McAuley, Daniel F., Mercat, Alain, Meyer, Nuala J., Moss, Marc, Munshi, Laveena, Myatra, Sheila N., Ng Gong, Michelle, Papazian, Laurent, Patel, Bhakti K., Pellegrini, Mariangela, Perner, Anders, Pesenti, Antonio, and Piquilloud, Lise

Abstract

The aim of these guidelines is to update the 2017 clinical practice guideline (CPG) of the European Society of Intensive Care Medicine (ESICM). The scope of this CPG is limited to adult patients and to non-pharmacological respiratory support strategies across different aspects of acute respiratory distress syndrome (ARDS), including ARDS due to coronavirus disease 2019 (COVID-19). These guidelines were formulated by an international panel of clinical experts, one methodologist and patients’ representatives on behalf of the ESICM. The review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations and the quality of reporting of each study based on the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) network guidelines. The CPG addressed 21 questions and formulates 21 recommendations on the following domains: (1) definition; (2) phenotyping, and respiratory support strategies including (3) high-flow nasal cannula oxygen (HFNO); (4) non-invasive ventilation (NIV); (5) tidal volume setting; (6) positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM); (7) prone positioning; (8) neuromuscular blockade, and (9) extracorporeal life support (ECLS). In addition, the CPG includes expert opinion on clinical practice and identifies the areas of future research.

Published
2023

23. Sickle cell disease landscape and challenges in the EU: the ERN-EuroBloodNet perspective

Author

Poli Van Creveldkliniek Medisch, Child Health, Mañú Pereira, María Del Mar, Colombatti, Raffaella, Alvarez, Federico, Bartolucci, Pablo, Bento, Celeste, Brunetta, Angelo Loris, Cela, Elena, Christou, Soteroula, Collado, Anna, de Montalembert, Mariane, Dedeken, Laurence, Fenaux, Pierre, Galacteros, Frédéric, Glenthøj, Andreas, Gutiérrez Valle, Victoria, Kattamis, Antonis, Kunz, Joachim, Lobitz, Stephan, McMahon, Corrina, Pellegrini, Mariangela, Reidel, Sara, Russo, Giovanna, Santos Freire, Miriam, van Beers, Eduard, Kountouris, Petros, Gulbis, Béatrice, Poli Van Creveldkliniek Medisch, Child Health, Mañú Pereira, María Del Mar, Colombatti, Raffaella, Alvarez, Federico, Bartolucci, Pablo, Bento, Celeste, Brunetta, Angelo Loris, Cela, Elena, Christou, Soteroula, Collado, Anna, de Montalembert, Mariane, Dedeken, Laurence, Fenaux, Pierre, Galacteros, Frédéric, Glenthøj, Andreas, Gutiérrez Valle, Victoria, Kattamis, Antonis, Kunz, Joachim, Lobitz, Stephan, McMahon, Corrina, Pellegrini, Mariangela, Reidel, Sara, Russo, Giovanna, Santos Freire, Miriam, van Beers, Eduard, Kountouris, Petros, and Gulbis, Béatrice

Published
2023

27. Variation in communication and family visiting policies in intensive care within and between countries during the Covid-19 pandemic: The COVISIT international survey

Author

Tabah, Alexis, primary, Elhadi, Muhammed, additional, Ballard, Emma, additional, Cortegiani, Andrea, additional, Cecconi, Maurizio, additional, Unoki, Takeshi, additional, Galarza, Laurą, additional, Rosa, Regis Goulart, additional, Barbier, Francois, additional, Azoulay, Elie, additional, Laupland, Kevin B., additional, Kai, Nathalie Ssi Yan, additional, Ostermann, Marlies, additional, Francois, Guy, additional, De Waele, Jan J., additional, Fiest, Kirsten, additional, Spronk, Peter, additional, Benbenishty, Julie, additional, Pellegrini, Mariangela, additional, Rose, Louise, additional, Ramanan, Mahesh, additional, Bailey, Rachel, additional, Kronberger, Irmgard E., additional, Cerovac, Anis, additional, Sligl, Wendy, additional, Peršec, Jasminka, additional, Lincango-Naranjo, Eddy, additional, Osman, Nermin, additional, Tanas, Yousef, additional, Dean, Yomna, additional, Abbas, Ahmed Mohamed, additional, Elbahnasawy, Mohamed Gamal, additional, Elshennawy, Eslam Mohamed, additional, Elmandouh, Omar, additional, Ahmed, Fatima Hamed, additional, Koulenti, Despoina, additional, Tsakiridis, Ioannis, additional, Gurjar, Mohan, additional, Cindryani, Marilaeta, additional, Mahmoodpoor, Ata, additional, Aldawoody, Hogir Imad Rasheed, additional, Zuccaro, Francesco, additional, Iozzo, Pasquale, additional, Ippolito, Mariachiara, additional, Katayama, Yukiko, additional, Kuribara, Tomoki, additional, Miyazaki, Satoko, additional, Nakayama, Asami, additional, Ouchi, Akira, additional, Sakuramoto, Hideaki, additional, Tamoto, Mitsuhiro, additional, Yamada, Toru, additional, Serhan, Hashem Abdulaziz Abu, additional, Alsakarneh, Saqr Ghaleb Ghassab, additional, Kaligozhin, Zhannur, additional, Viderman, Dmitriy, additional, Karout, Lina, additional, Hasan, Mohd Shahnaz, additional, Zakaria, Andee Dzulkarnaen, additional, Ñamendys-Silva, Silvio A., additional, Rai, Lajpat, additional, Abello, Antonio Thaddeus R., additional, Povoa, Pedro, additional, Tomescu, Dana, additional, Drozdov, Evgeniy, additional, Gallego, Alberto Orejas, additional, Jariod-Ferrer, Ursula M., additional, Nuñez-Garçia, Bernardo, additional, Mohamed, Ahmed Mohamed Ibrahim, additional, George, Abram Raymon Moneer, additional, Jeitziner, Marie-Madlen, additional, Saracoglu, Kemal Tolga, additional, Isik, Arda, additional, Aslan, Abdullah Tarik, additional, and Torlinski, Tomasz, additional

Published
2022
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29. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave

Author

Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R.J., Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Póvoa, Pedro, Schaller, Stefan J., Teboul, Jean Louis, Wong, Adrian, De Waele, Jan, Cecconi, Maurizio, Bezzi, Marco, Gira, Alicia, Eller, Philipp, Hamid, Tarikul, Haque, Injamam Ull, De Buyser, Wim, Cudia, Antonella, De Backer, Daniel, Foulon, Pierre, Collin, Vincent, Van Hecke, Jolien, De Waele, Elisabeth, Van Malderen, Claire, Mesland, Jean Baptiste, Biston, Patrick, Piagnerelli, Michael, Haentjens, Lionel, De Schryver, Nicolas, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Centro de Estudos de Doenças Crónicas (CEDOC), and Comprehensive Health Research Centre (CHRC) - pólo NMS

Subjects
Critical care, SARS-CoV-2, COVID-19, Pneumonia, Critical Care and Intensive Care Medicine, Surge capacity
Abstract

Funding Information: AE, FD, GDP, LG, VG, AJ, JK, AL, JM, SNM, MO, MP, MC declare no conflicts of interest. MG reports speaking fees from Baxter and Philips. TDC is supported by Research Foundation Flanders (Grant nr G085920N). MA reports Research Grant from GE, Honoraria from Fisher and Paykel, Pfizer, Orion and Gilead. GC reports grants, personal fees as Speakers’ Bureau Member and Advisory Board Member from Integra and Neuroptics, all outside the submitted work. ACM is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1). SE declares no financial COIs and the following non-financial disclosures: Cochrane editor, American Society of Anesthesiologist data review board member. LF reports research funding from NIHR, Baxter, Ortho-Clinical Diagnostics, Exthera Medical and lecture fees from Baxter, Fresenius, Paion, all outside the submitted work. GG received payment for lectures from Getinge, Draeger Medical, Fisher&Paykel, Biotest, MSD, Gilead and unrestricted research grants from Fisher&Paykel and MSD (all unrelated to the present work). MCMD declares potential conflict of interest with BD. PP declares potential conflicts of interest with Pfizer, MSD and Gilead. SJS reports personal fees from Springer-Verlag, GmbH (Vienna, Austria) for educational commitments grants and non-financial support from ESICM (Bruxelles, Belgium), Fresenius (Germany), Liberate Medical LLC (Crestwood, USA), STIMIT AG (Nidau, Switzerland) Reactive Robotics GmbH (Munich, Germany) as well as from Technical University of Munich, Germany, from national (e.g. DGAI) and international (e.g. ESICM) medical societies (or their congress organizers) in the field of anesthesiology and intensive care, all outside the submitted work; SJS holds stocks in small amounts from Alphabeth Inc., Bayer AG, Rhön-Klinikum AG, and Siemens AG. These did not have any influence on this study. AW reports Honorarium for delivery of educational material for Vygon, GE. JLT declares potential conflict of interest with Getinge. JDW has consulted for Pfizer, MSD (honoraria paid to institution), and is a senior clinical investigator funded by the Research Foundation Flanders (FWO, Ref. 1881020N). Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality. publishersversion published

Published
2022

30. Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Author

Greco, M, De Corte, T, Ercole, A, Antonelli, M, Azoulay, E, Citerio, G, Morris, A, De Pascale, G, Duska, F, Elbers, P, Einav, S, Forni, L, Galarza, L, Girbes, A, Grasselli, G, Gusarov, V, Jubb, A, Kesecioglu, J, Lavinio, A, Delgado, M, Mellinghoff, J, Myatra, S, Ostermann, M, Pellegrini, M, Povoa, P, Schaller, S, Teboul, J, Wong, A, De Waele, J, Cecconi, M, Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R J, Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J, Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J, Cecconi, Maurizio, Greco, M, De Corte, T, Ercole, A, Antonelli, M, Azoulay, E, Citerio, G, Morris, A, De Pascale, G, Duska, F, Elbers, P, Einav, S, Forni, L, Galarza, L, Girbes, A, Grasselli, G, Gusarov, V, Jubb, A, Kesecioglu, J, Lavinio, A, Delgado, M, Mellinghoff, J, Myatra, S, Ostermann, M, Pellegrini, M, Povoa, P, Schaller, S, Teboul, J, Wong, A, De Waele, J, Cecconi, M, Greco, Massimiliano, De Corte, Thomas, Ercole, Ari, Antonelli, Massimo, Azoulay, Elie, Citerio, Giuseppe, Morris, Andy Conway, De Pascale, Gennaro, Duska, Frantisek, Elbers, Paul, Einav, Sharon, Forni, Lui, Galarza, Laura, Girbes, Armand R J, Grasselli, Giacomo, Gusarov, Vitaly, Jubb, Alasdair, Kesecioglu, Jozef, Lavinio, Andrea, Delgado, Maria Cruz Martin, Mellinghoff, Johannes, Myatra, Sheila Nainan, Ostermann, Marlies, Pellegrini, Mariangela, Povoa, Pedro, Schaller, Stefan J, Teboul, Jean-Louis, Wong, Adrian, De Waele, Jan J, and Cecconi, Maurizio

Abstract

Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.

Published
2022

31. Variation in communication and family visiting policies in intensive care within and between countries during the Covid-19 pandemic : The COVISIT international survey

Author

Tabah, Alexis, Elhadi, Muhammed, Ballard, Emma, Cortegiani, Andrea, Cecconi, Maurizio, Unoki, Takeshi, Galarza, Laurą, Rosa, Regis Goulart, Barbier, Francois, Azoulay, Elie, Laupland, Kevin B., Ssi Yan Kai, Nathalie, Ostermann, Marlies, Francois, Guy, De Waele, Jan J., Fiest, Kirsten, Spronk, Peter, Benbenishty, Julie, Pellegrini, Mariangela, Rose, Louise, other, and, Tabah, Alexis, Elhadi, Muhammed, Ballard, Emma, Cortegiani, Andrea, Cecconi, Maurizio, Unoki, Takeshi, Galarza, Laurą, Rosa, Regis Goulart, Barbier, Francois, Azoulay, Elie, Laupland, Kevin B., Ssi Yan Kai, Nathalie, Ostermann, Marlies, Francois, Guy, De Waele, Jan J., Fiest, Kirsten, Spronk, Peter, Benbenishty, Julie, Pellegrini, Mariangela, Rose, Louise, and other, and

Abstract

Background: During the COVID-19 pandemic, intensive care units (ICU) introduced restrictions to in-person family visiting to safeguard patients, healthcare personnel, and visitors. Methods: We conducted a web-based survey (March–July 2021) investigating ICU visiting practices before the pandemic, at peak COVID-19 ICU admissions, and at the time of survey response. We sought data on visiting policies and communication modes including use of virtual visiting (videoconferencing). Results: We obtained 667 valid responses representing ICUs in all continents. Before the pandemic, 20% (106/525) had unrestricted visiting hours; 6% (30/525) did not allow in-person visiting. At peak, 84% (558/667) did not allow in-person visiting for patients with COVID-19; 66% for patients without COVID-19. This proportion had decreased to 55% (369/667) at time of survey reporting. A government mandate to restrict hospital visiting was reported by 53% (354/646). Most ICUs (55%, 353/615) used regular telephone updates; 50% (306/667) used telephone for formal meetings and discussions regarding prognosis or end-of-life. Virtual visiting was available in 63% (418/667) at time of survey. Conclusions: Highly restrictive visiting policies were introduced at the initial pandemic peaks, were subsequently liberalized, but without returning to pre-pandemic practices. Telephone became the primary communication mode in most ICUs, supplemented with virtual visits.

Published
2022

35. Inspiratory Efforts, Positive End-Expiratory Pressure, and External Resistances Influence Intraparenchymal Gas Redistribution in Mechanically Ventilated Injured Lungs

Author

Pellegrini, Mariangela, Hedenstierna, Göran, Larsson, Anders Sune, Perchiazzi, Gaetano, Pellegrini, Mariangela, Hedenstierna, Göran, Larsson, Anders Sune, and Perchiazzi, Gaetano

Abstract

Background: Potentially harmful lung overstretch can follow intraparenchymal gas redistribution during mechanical ventilation. We hypothesized that inspiratory efforts characterizing spontaneous breathing, positive end-expiratory pressure (PEEP), and high inspiratory resistances influence inspiratory intraparenchymal gas redistribution. Methods: This was an experimental study conducted on a swine model of mild acute respiratory distress syndrome. Dynamic computed tomography and respiratory mechanics were simultaneously acquired at different PEEP levels and external resistances, during both spontaneous breathing and controlled mechanical ventilation. Images were collected at two cranial-caudal levels. Delta-volume images (ΔVOLs) were obtained subtracting pairs of consecutive inspiratory images. The first three ΔVOLs, acquired for each analyzed breath, were used for the analysis of inspiratory pendelluft defined as intraparenchymal gas redistribution before the start of inspiratory flow at the airway opening. The following ΔVOLs were used for the analysis of gas redistribution during ongoing inspiratory flow at the airway opening. Results: During the first flow-independent phase of inspiration, the pendelluft of gas was observed only during spontaneous breathing and along the cranial-to-caudal and nondependent-to-dependent directions. The pendelluft was reduced by high PEEP (p < 0.04 comparing PEEP 15 and PEEP 0 cm H2O) and low external resistances (p < 0.04 comparing high and low external resistance). During the flow-dependent phase of inspiration, two patterns were identified: (1) gas displacing characterized by large gas redistribution areas; (2) gas scattering characterized by small, numerous areas of gas redistribution. Gas displacing was observed at low PEEP, high external resistances, and it characterized controlled mechanical ventilation (p < 0.01, comparing high and low PEEP during controlled mechanical ventilation). Conclusions: Low PEEP and high ex

Published
2021
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39. The use of positive end expiratory pressure in patients affected by COVID-19 : Time to reconsider the relation between morphology and physiology

Author

Perchiazzi, Gaetano, Pellegrini, Mariangela, Chiodaroli, Elena, Urits, Ivan, Kaye, Alan D., Viswanath, Omar, Varrassi, Giustino, Puntillo, Filomena, Perchiazzi, Gaetano, Pellegrini, Mariangela, Chiodaroli, Elena, Urits, Ivan, Kaye, Alan D., Viswanath, Omar, Varrassi, Giustino, and Puntillo, Filomena

Abstract

Coronavirus disease 2019 (COVID-19) is a new disease with different phases that can be catastrophic for subpopulations of patients with cardiovascular and pulmonary disease states at baseline. Appreciation for these different phases and treatment modalities, including manipulation of ventilatory settings and therapeutics, has made it a less lethal disease than when it emerged earlier this year. Different aspects of the disease are still largely unknown. However, laboratory investigation and clinical course of the COVID-19 show that this new disease is not a typical acute respiratory distress syndrome process, especially during the first phase. For this reason, the best strategy to be applied is to treat differently the single phases and to support the single functions of the failing organs as they appear.

Published
2020
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40. Expiratory Resistances Prevent Expiratory Diaphragm Contraction, Flow Limitation, and Lung Collapse

Author

Pellegrini, Mariangela, Gudmundsson, Magni, Bencze, Reka, Segelsjö, Monica, Fredén, Filip, Rylander, Christian, Hedenstierna, Göran, Larsson, Anders, Perchiazzi, Gaetano, Pellegrini, Mariangela, Gudmundsson, Magni, Bencze, Reka, Segelsjö, Monica, Fredén, Filip, Rylander, Christian, Hedenstierna, Göran, Larsson, Anders, and Perchiazzi, Gaetano

Abstract

Rationale: Tidal expiratory flow limitation (tidal-EFL) is not completely avoidable by applying positive end-expiratory pressure and may cause respiratory and hemodynamic complications in ventilated patients with lungs prone to collapse. During spontaneous breathing, expiratory diaphragmatic contraction counteracts tidal-EFL. We hypothesized that during both spontaneous breathing and controlled mechanical ventilation, external expiratory resistances reduce tidal-EFL. Objectives: To assess whether external expiratory resistances 1) affect expiratory diaphragmatic contraction during spontaneous breathing, 2) reduce expiratory flow and make lung compartments more homogeneous with more similar expiratory time constants, and 3) reduce tidal atelectasis, preventing hyperinflation. Methods: Three positive end-expiratory pressure levels and four external expiratory resistances were tested in 10 pigs after lung lavage. We analyzed expiratory diaphragmatic electric activity and respiratory mechanics. On the basis of computed tomography scans, four lung compartments-not inflated (atelectasis), poorly inflated, normally inflated, and hyperinflated-were defined. Measurements and Main Results: Consequently to additional external expiratory resistances, and mainly in lungs prone to collapse (at low positive end-expiratory pressure), 1) the expiratory transdiaphragmatic pressure decreased during spontaneous breathing by >10%, 2) expiratory flow was reduced and the expiratory time constants became more homogeneous, and 3) the amount of atelectasis at end-expiration decreased from 24% to 16% during spontaneous breathing and from 32% to 18% during controlled mechanical ventilation, without increasing hyperinflation. Conclusions: The expiratory modulation induced by external expiratory resistances preserves the positive effects of the expiratory brake while minimizing expiratory diaphragmatic contraction. External expiratory resistances optimize lung mechanics and limit tidal-EFL an

Published
2020
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41. International variation in the management of severe COVID-19 patients

Author

Medische Staf Intensive Care, Brain, Infection & Immunity, Azoulay, Elie, de Waele, Jan, Ferrer, Ricard, Staudinger, Thomas, Borkowska, Marta, Povoa, Pedro, Iliopoulou, Katerina, Artigas, Antonio, Schaller, Stefan J, Shankar-Hari, Manu, Pellegrini, Mariangela, Darmon, Michael, Kesecioglu, Jozef, Cecconi, Maurizio, Medische Staf Intensive Care, Brain, Infection & Immunity, Azoulay, Elie, de Waele, Jan, Ferrer, Ricard, Staudinger, Thomas, Borkowska, Marta, Povoa, Pedro, Iliopoulou, Katerina, Artigas, Antonio, Schaller, Stefan J, Shankar-Hari, Manu, Pellegrini, Mariangela, Darmon, Michael, Kesecioglu, Jozef, and Cecconi, Maurizio

Published
2020

42. The Effects of Positive End-Expiratory Pressure on Transpulmonary Pressure and Recruitment–Derecruitment During Neurally Adjusted Ventilator Assist: A Continuous Computed Tomography Study in an Animal Model of Acute Respiratory Distress Syndrome

Author

Widing, Carl Hannes, Pellegrini, Mariangela, Larsson, Anders, and Perchiazzi, Gaetano

Subjects
Anestesi och intensivvård, VILI, Anesthesiology and Intensive Care, Physiology, respiratory failure, respiratory system, mechanical ventilation, respiratory tract diseases, NAVA, Physiology (medical), ARDS, PEEP, circulatory and respiratory physiology, Original Research
Abstract

Background Whether spontaneous breathing (SB) should be used in early acute respiratory distress syndrome (ARDS) is questioned because it may cause ventilator-induced lung injury (VILI) by tidal high strain/stress and recruitment/derecruitment (R/D). However, SB has shown beneficial effects when used appropriately. We hypothesized that high levels of positive end-expiratory pressure (PEEP), during assisted SB, would prevent tidal R/D, reducing ventilatory variation and respiratory rate while potentially increasing transpulmonary pressure (P-TP). The aim was to test this hypothesis in experimental mild ARDS during continuous SB using neurally adjusted ventilator assist (NAVA) and uninterrupted computed tomography (CT) exposure. Methods Mild experimental ARDS (PaO2/FiO2-ratio of 250) was induced in anesthetized pigs (n = 5), ventilated using uninterrupted NAVA. PEEP was changed in steps of 3 cmH(2)O, from 0 to 15 and back to 0 cmH(2)O. Dynamic CT scans, ventilatory parameters, and esophageal pressure were acquired simultaneously. P-TP and R/D were calculated and compared among PEEP levels. Results When increasing PEEP from 0 to 15 cmH(2)O, tidal R/D decreased from 4.3 +/- 5.9 to 1.1 +/- 0.7% (p < 0.01), breath-to-breath variability decreased, and P-TP increased from 11.4 +/- 3.7 to 29.7 +/- 14.1 cmH(2)O (R-2 = 0.96). Conclusion This study shows that injurious phenomena like R/D and high P-TP are present in NAVA at the two extremes of the PEEP spectrum. Willing to titrate PEEP to limit these phenomena, the physician must choose the best compromise between restraining the R/D or P-TP.

Published
2019
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44. Time for Change? The Why, What and How of Promoting Innovation to Tackle Rare Diseases – Is It Time to Update the EU’s Orphan Regulation? And if so, What Should be Changed?

Author

Horgan, Denis, primary, Moss, Barbara, additional, Boccia, Stefania, additional, Genuardi, Maurizio, additional, Gajewski, Maciej, additional, Capurso, Gabriele, additional, Fenaux, Pierre, additional, Gulbis, Beatrice, additional, Pellegrini, Mariangela, additional, Mañú Pereira, Maria del Mar, additional, Gutiérrez Valle, Victoria, additional, Gutiérrez Ibarluzea, Iñaki , additional, Kent, Alastair, additional, Cattaneo, Ivana, additional, Jagielska, Beata, additional, Belina, Ivica, additional, Tumiene, Birute, additional, Ward, Adrian, additional, and Papaluca, Marisa, additional

Published
2020
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47. Regional Lung Mechanics and Influence of an Active Diaphragm in Experimental Lung Injury

Author

Pellegrini, Mariangela

Subjects
Anestesi och intensivvård, Fysiologi, Anesthesiology and Intensive Care, Physiology, animal model, Respiratory Medicine and Allergy, respiratory system, acute respiratory distress syndrome, diaphragm, artificial respiration, pulmonary atelectasis, lung imaging, Lungmedicin och allergi
Abstract

Despite being an essential life-support strategy in severe respiratory failure, mechanical ventilation can, if not optimally set and monitored, lead to injury of the lung parenchyma and diaphragm. These conditions are called ventilator-induced lung injury and ventilator-induced diaphragmatic dysfunction (VIDD), respectively. Although substantial progress has been made in the ventilator management of severely lung-injured patients, we are still far from a fully protective mechanical ventilation. In consideration of this gap of knowledge, this doctoral thesis aimed at investigating regional lung mechanics during both inspiration and expiration, in both controlled and assisted ventilation. Particular emphasis was placed on the expiratory phase, which is involved in expiratory flow limitation, airway closure and atelectasis formation, although commonly considered non-harmful. A novel methodological approach has been the fundamental basis for this research project. The combination of respiratory mechanics, diaphragmatic electromyographic activity and lung imaging enabled a breath-by-breath analysis at high temporal and spatial resolution. In Study I, the gravitational field affected the distribution of gas and transpulmonary pressures, as previously shown. This effect differed between healthy and injured lungs. Moreover, lung injury induced a heterogeneous distribution of gas within the lungs, as well as an increased gravitational gradient in transpulmonary pressure. Study I was mainly aimed at testing the new methodological approach centred on the investigation of regional lung mechanics. In Study II, the focus was on assisted ventilation and the phenomenon of gas redistribution within the lungs. Large pendelluft events had been demonstrated in disproportionate inspiratory efforts. In Study II, we showed that large pendelluft resulting from pathological respiratory drive could be attenuated by high positive end expiratory pressure (PEEP). Moreover, we showed that transient and widespread small gas redistribution events occur at all times during inspiration. Assisted ventilation and high PEEP reduced the size of gas redistribution as compared with controlled ventilation and low PEEP. In Study III, we demonstrated a diaphragmatic expiratory contraction in lungs prone to collapse, serving to brake the expiratory flow. It preserved end expiratory lung volume (EELV) and counteracted tidal atelectasis. However, the expiratory brake induced by diaphragmatic contraction is a known cause of VIDD. In Study IV, we tested the effects of external expiratory resistances (ExpR). We showed that, by applying ExpR, an expiratory brake was induced. The beneficial effects on EELV were retained, while the diaphragm could quickly relax during the expiration, thus reducing the risk of VIDD.

Published
2019

48. Expiratory Resistances Prevent Expiratory Diaphragm Contraction, Flow Limitation, and Lung Collapse

Author

Pellegrini, Mariangela, Gudmundsson, Magni, Bencze, Reka, Segelsjö, Monica, Fredén, Filip, Rylander, Christian, Hedenstierna, Göran, Larsson, Anders, Perchiazzi, Gaetano, Pellegrini, Mariangela, Gudmundsson, Magni, Bencze, Reka, Segelsjö, Monica, Fredén, Filip, Rylander, Christian, Hedenstierna, Göran, Larsson, Anders, and Perchiazzi, Gaetano

Abstract

Rationale: Tidal expiratory flow limitation (tidal-EFL) is not completely avoidable by applying positive end-expiratory pressure and may cause respiratory and hemodynamic complications in ventilated patients with lungs prone to collapse. During spontaneous breathing, expiratory diaphragmatic contraction counteracts tidal-EFL. We hypothesized that during both spontaneous breathing and controlled mechanical ventilation, external expiratory resistances reduce tidal-EFL. Objectives: To assess whether external expiratory resistances 1) affect expiratory diaphragmatic contraction during spontaneous breathing, 2) reduce expiratory flow and make lung compartments more homogeneous with more similar expiratory time constants, and 3) reduce tidal atelectasis, preventing hyperinflation. Methods: Three positive end-expiratory pressure levels and four external expiratory resistances were tested in 10 pigs after lung lavage. We analyzed expiratory diaphragmatic electric activity and respiratory mechanics. On the basis of computed tomography scans, four lung compartments—not inflated (atelectasis), poorly inflated, normally inflated, and hyperinflated—were defined. Measurements and Main Results: Consequently to additional external expiratory resistances, and mainly in lungs prone to collapse (at low positive end-expiratory pressure), 1) the expiratory transdiaphragmatic pressure decreased during spontaneous breathing by >10%, 2) expiratory flow was reduced and the expiratory time constants became more homogeneous, and 3) the amount of atelectasis at end-expiration decreased from 24% to 16% during spontaneous breathing and from 32% to 18% during controlled mechanical ventilation, without increasing hyperinflation. Conclusions: The expiratory modulation induced by external expiratory resistances preserves the positive effects of the expiratory brake while minimizing expiratory diaphragmatic contraction. External expiratory resistances optimize lung mechanics and limit tidal-EFL an

Published
2019
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49. The Effect of Positive End-Expiratory Pressure on Lung Micromechanics Assessed by Synchrotron Radiation Computed Tomography in an Animal Model of ARDS

Author

Scaramuzzo, Gaetano, Broche, Ludovic, Pellegrini, Mariangela, Porra, Liisa, Derosa, Savino, Tannoia, Angela Principia, Marzullo, Andrea, Borges, Joao Batista, Bayat, Sam, Bravin, Alberto, Larsson, Anders, Perchiazzi, Gaetano, Scaramuzzo, Gaetano, Broche, Ludovic, Pellegrini, Mariangela, Porra, Liisa, Derosa, Savino, Tannoia, Angela Principia, Marzullo, Andrea, Borges, Joao Batista, Bayat, Sam, Bravin, Alberto, Larsson, Anders, and Perchiazzi, Gaetano

Abstract

Modern ventilatory strategies are based on the assumption that lung terminal airspaces act as isotropic balloons that progressively accommodate gas. Phase contrast synchrotron radiation computed tomography (PCSRCT) has recently challenged this concept, showing that in healthy lungs, deflation mechanisms are based on the sequential de-recruitment of airspaces. Using PCSRCT scans in an animal model of acute respiratory distress syndrome (ARDS), this study examined whether the numerosity (ASnum) and dimension (ASdim) of lung airspaces change during a deflation maneuver at decreasing levels of positive end-expiratory pressure (PEEP) at 12, 9, 6, 3, and 0 cmH(2)O. Deflation was associated with significant reduction of ASdim both in the whole lung section (passing from from 13.1 +/- 2.0 at PEEP 12 to 7.6 +/- 4.2 voxels at PEEP 0) and in single concentric regions of interest (ROIs). However, the regression between applied PEEP and ASnum was significant in the whole slice (ranging from 188 +/- 52 at PEEP 12 to 146.4 +/- 96.7 at PEEP 0) but not in the single ROIs. This mechanism of deflation in which reduction of ASdim is predominant, differs from the one observed in healthy conditions, suggesting that the peculiar alveolar micromechanics of ARDS might play a role in the deflation process.

Published
2019
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50. Regional Behavior of Airspaces During Positive Pressure Reduction Assessed by Synchrotron Radiation Computed Tomography

Author

Scaramuzzo, Gaetano, Broche, Ludovic, Pellegrini, Mariangela, Porra, Liisa, Derosa, Savino, Tannoia, Angela Principia, Marzullo, Andrea, Batista Borges, João, Bayat, Sam, Bravin, Alberto, Larsson, Anders, Perchiazzi, Gaetano, Scaramuzzo, Gaetano, Broche, Ludovic, Pellegrini, Mariangela, Porra, Liisa, Derosa, Savino, Tannoia, Angela Principia, Marzullo, Andrea, Batista Borges, João, Bayat, Sam, Bravin, Alberto, Larsson, Anders, and Perchiazzi, Gaetano

Abstract

Introduction: The mechanisms of lung inflation and deflation are only partially known. Ventilatory strategies to support lung function rely upon the idea that lung alveoli are isotropic balloons that progressively inflate or deflate and that lung pressure/volume curves derive only by the interplay of critical opening pressures, critical closing pressures, lung history, and position of alveoli inside the lung. This notion has been recently challenged by subpleural microscopy, magnetic resonance, and computed tomography (CT). Phase-contrast synchrotron radiation CT (PC-SRCT) can yield in vivo images at resolutions higher than conventional CT. Objectives: We aimed to assess the numerosity (ASden) and the extension of the surface of airspaces (ASext) in healthy conditions at different volumes, during stepwise lung deflation, in concentric regions of the lung. Methods: The study was conducted in seven anesthetized New Zealand rabbits. They underwent PC-SRCT scans (resolution of 47.7 mu m) of the lung at five decreasing positive end expiratory pressure (PEEP) levels of 12, 9, 6, 3, and 0 cmH(2)O during end-expiratory holds. Three concentric regions of interest (ROIs) of the lung were studied: subpleural, mantellar, and core. The images were enhanced by phase contrast algorithms. ASden and ASext were computed by using the Image Processing Toolbox for MatLab. Statistical tests were used to assess any significant difference determined by PEEP or ROI on ASden and ASext. Results: When reducing PEEP, in each ROI the ASden significantly decreased. Conversely, ASext variation was not significant except for the core ROI. In the latter, the angular coefficient of the regression line was significantly low. Conclusion: The main mechanism behind the decrease in lung volume at PEEP reduction is derecruitment. In our study involving lung regions laying on isogravitational planes and thus equally influenced by gravitational forces, airspace numerosity and extension of surface depend on t

Published
2019
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