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  1. Article: The Effects of Positive End Expiratory Pressure and Lung Volume on Diaphragm Thickness and Thickening.

    Formenti, Paolo / Miori, Sara / Galimberti, Andrea / Umbrello, Michele

    Diagnostics (Basel, Switzerland)

    2023  Volume 13, Issue 6

    Abstract: ... ...

    Abstract Introduction
    Language English
    Publishing date 2023-03-17
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662336-5
    ISSN 2075-4418
    ISSN 2075-4418
    DOI 10.3390/diagnostics13061157
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Metabolic Support in Acute Respiratory Distress Syndrome: A Narrative Review.

    Umbrello, Michele / Marini, John J / Formenti, Paolo

    Journal of clinical medicine

    2023  Volume 12, Issue 9

    Abstract: Nutritional support for acute respiratory distress syndrome (ARDS) patients shares metabolic notions common to other critically ill conditions. Nevertheless, it generates specific concern regarding the primary limitation of oxygen supply and the ... ...

    Abstract Nutritional support for acute respiratory distress syndrome (ARDS) patients shares metabolic notions common to other critically ill conditions. Nevertheless, it generates specific concern regarding the primary limitation of oxygen supply and the complications of carbon dioxide elimination, as well as the significant metabolic alterations due to the body's response to illness. In the present narrative review, after briefly summarizing the pathophysiology of critical illness stress response and patients' metabolic requirements, we focus on describing the characteristics of metabolic and artificial nutrition in patients with acute respiratory failure. In patients with ARDS, several aspects of metabolism assume special importance. The physiological effects of substrate metabolism are described for this setting, particularly regarding energy consumption, diet-induced thermogenesis, and the price of their clearance, transformation, and storage. Moreover, we review the possible direct effects of macronutrients on lung tissue viability during ARDS. Finally, we summarize the noteworthy characteristics of metabolic control in critically ill patients with ARDS and offer a suggestion as to the ideal methods of metabolic support for this problem.
    Language English
    Publishing date 2023-04-29
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12093216
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The Effects of Positive End Expiratory Pressure and Lung Volume on Diaphragm Thickness and Thickening

    Paolo Formenti / Sara Miori / Andrea Galimberti / Michele Umbrello

    Diagnostics, Vol 13, Iss 1157, p

    2023  Volume 1157

    Abstract: Introduction : Diaphragm dysfunction is common in patients undergoing mechanical ventilation. The application of positive end-expiratory pressure (PEEP) and the varying end-expiratory lung volume cause changes in diaphragm geometry. We aimed to assess ... ...

    Abstract Introduction : Diaphragm dysfunction is common in patients undergoing mechanical ventilation. The application of positive end-expiratory pressure (PEEP) and the varying end-expiratory lung volume cause changes in diaphragm geometry. We aimed to assess the impact of the level of PEEP and lung inflation on diaphragm thickness, thickening fraction and displacement. Methods : An observational study in a mixed medical and surgical ICU was conducted. The patients underwent a PEEP-titration trial with the application of three random levels of PEEP: 0 cmH 2 O (PEEP0), 8 cmH 2 O (PEEP8) and 15 cmH 2 O (PEEP15). At each step, the indices of respiratory effort were assessed, together with arterial blood and diaphragm ultrasound; end-expiratory lung volume was measured. Results : 14 patients were enrolled. The tidal volume, diaphragm displacement and thickening fraction were significantly lower with higher levels of PEEP, while both the expiratory and inspiratory thickness increased with higher PEEP levels. The inspiratory effort, as evaluated by the esophageal pressure swing, was unchanged. Both the diaphragm thickening fraction and displacement were significantly correlated with inspiratory effort in the whole dataset. For both measurements, the correlation was stronger at lower levels of PEEP. The difference in the diaphragm thickening fraction during tidal breathing between PEEP 15 and PEEP 0 was negatively related to the change in the functional residual capacity and the change in alveolar dead space. Conclusions : Different levels of PEEP significantly modified the diaphragmatic thickness and thickening fraction, showing a PEEP-induced decrease in the diaphragm contractile efficiency. When using ultrasound to assess diaphragm size and function, the potential effect of lung inflation should be taken into account.
    Keywords diaphragm ; ultrasound ; ARDS ; lung volume ; PEEP ; Medicine (General) ; R5-920
    Subject code 670
    Language English
    Publishing date 2023-03-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article: Ultrasonographic Features of Muscular Weakness and Muscle Wasting in Critically Ill Patients.

    Umbrello, Michele / Brogi, Etrusca / Formenti, Paolo / Corradi, Francesco / Forfori, Francesco

    Journal of clinical medicine

    2023  Volume 13, Issue 1

    Abstract: Muscle wasting begins as soon as in the first week of one's ICU stay and patients with multi-organ failure lose more muscle mass and suffer worse functional impairment as a consequence. Muscle wasting and weakness are mainly characterized by a ... ...

    Abstract Muscle wasting begins as soon as in the first week of one's ICU stay and patients with multi-organ failure lose more muscle mass and suffer worse functional impairment as a consequence. Muscle wasting and weakness are mainly characterized by a generalized, bilateral lower limb weakness. However, the impairment of the respiratory and/or oropharyngeal muscles can also be observed with important consequences for one's ability to swallow and cough. Muscle wasting represents the result of the disequilibrium between breakdown and synthesis, with increased protein degradation relative to protein synthesis. It is worth noting that the resulting functional disability can last up to 5 years after discharge, and it has been estimated that up to 50% of patients are not able to return to work during the first year after ICU discharge. In recent years, ultrasound has played an increasing role in the evaluation of muscle. Indeed, ultrasound allows an objective evaluation of the cross-sectional area, the thickness of the muscle, and the echogenicity of the muscle. Furthermore, ultrasound can also estimate the thickening fraction of muscle. The objective of this review is to analyze the current understanding of the pathophysiology of acute skeletal muscle wasting and to describe the ultrasonographic features of normal muscle and muscle weakness.
    Language English
    Publishing date 2023-12-20
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm13010026
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Effect of Acupuncture on Diaphragm Function in Healthy Volunteers: A Pilot Clinical Study.

    Formenti, Paolo / Galimberti, Andrea / Pinciroli, Riccardo / Umbrello, Michele

    Evidence-based complementary and alternative medicine : eCAM

    2022  Volume 2022, Page(s) 6608200

    Abstract: Introduction: In western medicine, the diaphragm is the main inspiratory muscle. It is involved in the postural control of the trunk and contributes to balance performance. In traditional Chinese medicine (TCM), the diaphragm represents a gateway ... ...

    Abstract Introduction: In western medicine, the diaphragm is the main inspiratory muscle. It is involved in the postural control of the trunk and contributes to balance performance. In traditional Chinese medicine (TCM), the diaphragm represents a gateway between the lower and upper parts of the body, and it regulates the descending and ascending functions of the whole organism. The aim of this study was to assess the effect of acupuncture on diaphragm function.
    Methods: A proof-of-concept, prospective, controlled, pilot trial in healthy volunteers. Respiratory rate, inspired volume, diaphragm excursion, and thickening were measured during tidal and maximal breathing at baseline and after sham or real acupuncture. Acupuncture was performed on Yanglingquan (GB34), Tai Chong (LV3), Danzhong (CV17), Geshu (BL17), and Geguan (BL46).
    Results: Ten participants were enrolled (6 males, weight 71 ± 12 kg, height 173 ± 9 cm, BMI 21 ± 1.3 kg/m
    Conclusions: Acupuncture significantly influenced diaphragm function in healthy volunteers, improving its inspiratory thickening fraction during breaths at vital capacity, as compared to no or sham acupuncture.
    Language English
    Publishing date 2022-05-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2171158-6
    ISSN 1741-4288 ; 1741-427X
    ISSN (online) 1741-4288
    ISSN 1741-427X
    DOI 10.1155/2022/6608200
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Ultrasonographic Features of Muscular Weakness and Muscle Wasting in Critically Ill Patients

    Michele Umbrello / Etrusca Brogi / Paolo Formenti / Francesco Corradi / Francesco Forfori

    Journal of Clinical Medicine, Vol 13, Iss 1, p

    2023  Volume 26

    Abstract: Muscle wasting begins as soon as in the first week of one’s ICU stay and patients with multi-organ failure lose more muscle mass and suffer worse functional impairment as a consequence. Muscle wasting and weakness are mainly characterized by a ... ...

    Abstract Muscle wasting begins as soon as in the first week of one’s ICU stay and patients with multi-organ failure lose more muscle mass and suffer worse functional impairment as a consequence. Muscle wasting and weakness are mainly characterized by a generalized, bilateral lower limb weakness. However, the impairment of the respiratory and/or oropharyngeal muscles can also be observed with important consequences for one’s ability to swallow and cough. Muscle wasting represents the result of the disequilibrium between breakdown and synthesis, with increased protein degradation relative to protein synthesis. It is worth noting that the resulting functional disability can last up to 5 years after discharge, and it has been estimated that up to 50% of patients are not able to return to work during the first year after ICU discharge. In recent years, ultrasound has played an increasing role in the evaluation of muscle. Indeed, ultrasound allows an objective evaluation of the cross-sectional area, the thickness of the muscle, and the echogenicity of the muscle. Furthermore, ultrasound can also estimate the thickening fraction of muscle. The objective of this review is to analyze the current understanding of the pathophysiology of acute skeletal muscle wasting and to describe the ultrasonographic features of normal muscle and muscle weakness.
    Keywords intensive care unit acquired weakness ; muscle weakness ; ultrasound evaluation ; critical care ; proteolysis ; Medicine ; R
    Subject code 610
    Language English
    Publishing date 2023-12-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Foot drop in critically ill patients: a narrative review of an elusive complication with intricate implications for recovery and rehabilitation.

    Formenti, Paolo / Sabbatini, Giovanni / Brenna, Giovanni / Galimberti, Andrea / Mattei, Luca / Umbrello, Michele / Iezzi, Massimiliano / Uldedaj, Ersil / Pezzi, Angelo / Gotti, Miriam

    Minerva anestesiologica

    2024  

    Abstract: Foot drop is a condition characterized by the inability to lift the foot upwards towards the shin bone. This condition may affect a proportion of critically ill patients, impacting on their recovery after the acute phase of the illness. The occurrence of ...

    Abstract Foot drop is a condition characterized by the inability to lift the foot upwards towards the shin bone. This condition may affect a proportion of critically ill patients, impacting on their recovery after the acute phase of the illness. The occurrence of foot drop in critical care patients may result from various underlying causes, including neurological injuries, muscular dysfunction, nerve compression, or vascular compromise. Understanding the etiology and assessing the severity of foot drop in these patients is essential for implementing appropriate management strategies and ensuring better patient outcomes. In this comprehensive review, we explore the complexities of foot drop in critically ill patients. We search for the potential risk factors that contribute to its development during critical illness, the impact it has on patients' functional abilities, and the various diagnostic techniques adopted to evaluate its severity. Additionally, we discuss current treatment approaches, rehabilitation strategies, and preventive measures to mitigate the adverse effects of foot drop in the critical care setting. Furthermore, we explore the roles of critical care physical therapists, neurologists, and other healthcare professionals in the comprehensive care of patients with foot drop syndrome and in such highlighting the importance of a multidisciplinary approach.
    Language English
    Publishing date 2024-03-29
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 123584-9
    ISSN 1827-1596 ; 0026-4717 ; 0375-9393
    ISSN (online) 1827-1596
    ISSN 0026-4717 ; 0375-9393
    DOI 10.23736/S0375-9393.24.17912-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Effect of Acupuncture on Diaphragm Function in Healthy Volunteers

    Paolo Formenti / Andrea Galimberti / Riccardo Pinciroli / Michele Umbrello

    Evidence-Based Complementary and Alternative Medicine, Vol

    A Pilot Clinical Study

    2022  Volume 2022

    Abstract: Introduction. In western medicine, the diaphragm is the main inspiratory muscle. It is involved in the postural control of the trunk and contributes to balance performance. In traditional Chinese medicine (TCM), the diaphragm represents a gateway between ...

    Abstract Introduction. In western medicine, the diaphragm is the main inspiratory muscle. It is involved in the postural control of the trunk and contributes to balance performance. In traditional Chinese medicine (TCM), the diaphragm represents a gateway between the lower and upper parts of the body, and it regulates the descending and ascending functions of the whole organism. The aim of this study was to assess the effect of acupuncture on diaphragm function. Methods. A proof-of-concept, prospective, controlled, pilot trial in healthy volunteers. Respiratory rate, inspired volume, diaphragm excursion, and thickening were measured during tidal and maximal breathing at baseline and after sham or real acupuncture. Acupuncture was performed on Yanglingquan (GB34), Tai Chong (LV3), Danzhong (CV17), Geshu (BL17), and Geguan (BL46). Results. Ten participants were enrolled (6 males, weight 71 ± 12 kg, height 173 ± 9 cm, BMI 21 ± 1.3 kg/m2). During tidal breathing, tidal volume, diaphragm displacement, and end-expiratory diaphragm thickness did not change with sham or real acupuncture as compared to baseline; thickening ratio was 43.5 ± 16.6 vs. 31.3 ± 14.9 (sham) vs. 30.8 ± 15.3% (baseline), p=0.1066. During breaths at vital capacity, the acupuncture group, as compared to both baseline and sham acupuncture, had a trend toward a larger tidal volume (3840 ± 690 vs. 3110 ± 880 vs. 3230 ± 750 ml, p=0.1247) and showed a significantly higher thickening ratio (270.6 ± 136.4 vs. 172.4 ± 57.4 vs. 188.6 ± 41.7%, p=0.0414). Conclusions. Acupuncture significantly influenced diaphragm function in healthy volunteers, improving its inspiratory thickening fraction during breaths at vital capacity, as compared to no or sham acupuncture.
    Keywords Other systems of medicine ; RZ201-999
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Hindawi Limited
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. Article ; Online: Violence and unsafety in Italian hospitals: Experience and perceptions of nursing students.

    Ferrara, Paolo / Terzoni, Stefano / Destrebecq, Anne / Ruta, Federico / Sala, Elena / Formenti, Paolo / Maugeri, Michele

    Work (Reading, Mass.)

    2022  Volume 73, Issue 1, Page(s) 211–217

    Abstract: Background: Assessment of workplace violence towards healthcare workers represents a challenge for healthcare organizations worldwide. Workers' experience and perceived risk of violence may have a serious impact on job satisfaction and retention of ... ...

    Abstract Background: Assessment of workplace violence towards healthcare workers represents a challenge for healthcare organizations worldwide. Workers' experience and perceived risk of violence may have a serious impact on job satisfaction and retention of workers. To date, no studies have been conducted on nursing students.
    Objectives: To assess the prevalence of physical and non-physical violence among nursing students during their clinical experiences and to analyze the perceived risk of violence.
    Methods: Multicentre, cross-sectional survey. We enrolled a convenience sample of nursing students of the bachelor's degree in Nursing of the University of Milan (Italy). The students completed a structured questionnaire prepared in accordance with the available literature on violence in healthcare settings.
    Results: Out of 1185 questionnaires sent, 603 were collected (50.89%). 35.1% had experience of verbal violence during the clinical internship training period, while 8.1% were victims of physical violence. 202 students (33.5%) reported unsafety, which was related to experience of physical or psychological violence, witnessed episodes of violence, gender, hospital structure and efficacy of the safety policies.
    Conclusions: Our findings highlight that nursing students are exposed to the risk of violence which influences their perception of risk.
    MeSH term(s) Cross-Sectional Studies ; Hospitals ; Humans ; Italy/epidemiology ; Students, Nursing ; Surveys and Questionnaires ; Workplace Violence/psychology
    Language English
    Publishing date 2022-07-31
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1394194-x
    ISSN 1875-9270 ; 1051-9815
    ISSN (online) 1875-9270
    ISSN 1051-9815
    DOI 10.3233/WOR-210488
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Alarm fatigue in nurses working in intensive care units: A multicenter study.

    Carelli, Lara / Terzoni, Stefano / Destrebecq, Anne / Formenti, Paolo / Soumahoro, Fatime / Esposito, Anna / Ferrara, Paolo

    Work (Reading, Mass.)

    2022  Volume 72, Issue 2, Page(s) 651–656

    Abstract: Background: Technological progress improves health care efficiency, quality, safety, and cost, supporting clinical activity in various scenarios, such as Intensive Care Unit (ICU). A timely response to alarms from monitors and other ICU electromedical ... ...

    Abstract Background: Technological progress improves health care efficiency, quality, safety, and cost, supporting clinical activity in various scenarios, such as Intensive Care Unit (ICU). A timely response to alarms from monitors and other ICU electromedical devices is therefore crucial. The number of false alarms tend to desensitize care providers increasing the risk of experiencing alarm fatigue and, at times, lead to severe consequences for patients.
    Objectives: To assess the psychometric properties of the Italian version of the Alarm Fatigue Questionnaire and to explore the phenomenon of alarm fatigue among nurses working in intensive care settings.
    Methods: The CVI-I was calculated to evaluate the validity of the content of the tool. Construct validity was investigated through exploratory factor analysis. Cronbach's alpha coefficient (α) was used to examine the internal consistency of the scale and Spearman's rho coefficient to test for stability.We designed a multicentre cross-sectional survey. A convenience sample of nurses from 4 Major Italian hospitals was recruited. The nurses completed the Italian version of the Alarm Fatigue Questionnaire.
    Results: The content validity index CVI-S of the scale (CVI-S) was 91.11%; Cronbach's alpha coefficient was 0.71. The Italian version of the tool explained 67.18%of the overall variance. 396 nurses were enrolled (79.84%). The overall level of alarm fatigue was Me = 29 [22;30]. 42.17%of the sample reported prior experience with alarm fatigue incidents.
    Conclusions: The extension of alarm fatigue requires the adoption of a preventive intervention plan. The Italian version of the Alarm Fatigue Questionnaire shows promising psychometric properties.
    MeSH term(s) Clinical Alarms ; Critical Care ; Cross-Sectional Studies ; Humans ; Intensive Care Units ; Psychometrics ; Surveys and Questionnaires
    Language English
    Publishing date 2022-05-26
    Publishing country Netherlands
    Document type Journal Article ; Multicenter Study
    ZDB-ID 1394194-x
    ISSN 1875-9270 ; 1051-9815
    ISSN (online) 1875-9270
    ISSN 1051-9815
    DOI 10.3233/WOR-210552
    Database MEDical Literature Analysis and Retrieval System OnLINE

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