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Article ; Online: Oesophageal pressure and respiratory muscle ultrasonographic measurements indicate inspiratory effort during pressure support ventilation.

Umbrello, Michele / Formenti, Paolo / Lusardi, Andrea C / Guanziroli, Mariateresa / Caccioppola, Alessio / Coppola, Silvia / Chiumello, Davide

British journal of anaesthesia

2020 Volume 125, Issue 1, Page(s) e148–e157

Abstract: Background: Bedside measures of patient effort are essential to properly titrate the level of pressure support ventilation. We investigated whether the tidal swing in oesophageal (ΔPes) and transdiaphragmatic pressure (ΔPdi), and ultrasonographic ... ...

Abstract	Background: Bedside measures of patient effort are essential to properly titrate the level of pressure support ventilation. We investigated whether the tidal swing in oesophageal (ΔPes) and transdiaphragmatic pressure (ΔPdi), and ultrasonographic changes in diaphragm (TFdi) and parasternal intercostal (TFic) thickening are reliable estimates of respiratory effort. The effect of diaphragm dysfunction was also considered. Methods: Twenty-one critically ill patients were enrolled: age 73 (14) yr, BMI 27 (7) kg m Results: Pressure support was 9.0 (1.6) cm H Conclusions: ΔPes and ΔPdi are adequate estimates of inspiratory effort. Diaphragm ultrasonography is a reliable indicator of inspiratory effort in the absence of diaphragm dysfunction. Additional measurement of parasternal intercostal thickening may discriminate a low inspiratory effort or a high effort in the presence of a dysfunctional diaphragm.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Critical Care/methods ; Critical Illness ; Diaphragm/physiology ; Esophagus/diagnostic imaging ; Esophagus/physiology ; Female ; Humans ; Male ; Middle Aged ; Positive-Pressure Respiration/methods ; Respiratory Muscles/diagnostic imaging ; Respiratory Muscles/physiology ; Ultrasonography/methods ; Work of Breathing/physiology
Language	English
Publishing date	2020-05-06
Publishing country	England
Document type	Journal Article
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2020.02.026
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Article ; Online: Bedside calculation of mechanical power during volume- and pressure-controlled mechanical ventilation.

Chiumello, Davide / Gotti, Miriam / Guanziroli, Mariateresa / Formenti, Paolo / Umbrello, Michele / Pasticci, Iacopo / Mistraletti, Giovanni / Busana, Mattia

Critical care (London, England)

2020 Volume 24, Issue 1, Page(s) 417

Abstract: Background: Mechanical power (MP) is the energy delivered to the respiratory system over time during mechanical ventilation. Our aim was to compare the currently available methods to calculate MP during volume- and pressure-controlled ventilation, ... ...

Abstract	Background: Mechanical power (MP) is the energy delivered to the respiratory system over time during mechanical ventilation. Our aim was to compare the currently available methods to calculate MP during volume- and pressure-controlled ventilation, comparing different equations with the geometric reference method, to understand whether the easier to use surrogate formulas were suitable for the everyday clinical practice. This would warrant a more widespread use of mechanical power to promote lung protection. Methods: Forty respiratory failure patients, sedated and paralyzed for clinical reasons, were ventilated in volume-controlled ventilation, at two inspiratory flows (30 and 60 L/min), and pressure-controlled ventilation with a similar tidal volume. Mechanical power was computed both with the geometric method, as the area between the inspiratory limb of the airway pressure and the volume, and with two algebraic methods, a comprehensive and a surrogate formula. Results: The bias between the MP computed by the geometric method and by the comprehensive algebraic method during volume-controlled ventilation was respectively 0.053 (0.77, - 0.81) J/min and - 0.4 (0.70, - 1.50) J/min at low and high flows (r Conclusions: Both for volume-controlled and pressure-controlled ventilation, the surrogate formulas approximate the reference method well enough to warrant their use in the everyday clinical practice. Given that these formulas require nothing more than the variables already displayed by the intensive care ventilator, a more widespread use of mechanical power should be encouraged to promote lung protection against ventilator-induced lung injury.
MeSH term(s)	Female ; Humans ; Lung/physiopathology ; Male ; Mechanical Phenomena ; Middle Aged ; Pressure ; Respiration, Artificial/classification ; Respiration, Artificial/methods ; Respiration, Artificial/standards ; Respiratory Insufficiency/physiopathology ; Respiratory Insufficiency/therapy ; Weights and Measures/instrumentation
Keywords	covid19
Language	English
Publishing date	2020-07-11
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-020-03116-w
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Article ; Online: Factors Associated with ICU Admission following Blunt Chest Trauma.

Bellone, Andrea / Bossi, Ilaria / Etteri, Massimiliano / Cantaluppi, Francesca / Pina, Paolo / Guanziroli, Massimo / Bianchi, AnnaMaria / Casazza, Giovanni

Canadian respiratory journal

2016 Volume 2016, Page(s) 3257846

Abstract: ... ...

Abstract	Background
MeSH term(s)	Aged ; Female ; Humans ; Intensive Care Units ; Italy/epidemiology ; Male ; Middle Aged ; Patient Admission/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Thoracic Injuries/epidemiology
Language	English
Publishing date	2016
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	1213103-9
ISSN	1916-7245 ; 1198-2241
ISSN (online)	1916-7245
ISSN	1198-2241
DOI	10.1155/2016/3257846
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Article ; Online: Opening pressures and atelectrauma in acute respiratory distress syndrome.

Cressoni, Massimo / Chiumello, Davide / Algieri, Ilaria / Brioni, Matteo / Chiurazzi, Chiara / Colombo, Andrea / Colombo, Angelo / Crimella, Francesco / Guanziroli, Mariateresa / Tomic, Ivan / Tonetti, Tommaso / Luca Vergani, Giordano / Carlesso, Eleonora / Gasparovic, Vladimir / Gattinoni, Luciano

Intensive care medicine

2017 Volume 43, Issue 5, Page(s) 603–611

Abstract: Purpose: Open lung strategy during ARDS aims to decrease the ventilator-induced lung injury by minimizing the atelectrauma and stress/strain maldistribution. We aim to assess how much of the lung is opened and kept open within the limits of mechanical ... ...

Abstract	Purpose: Open lung strategy during ARDS aims to decrease the ventilator-induced lung injury by minimizing the atelectrauma and stress/strain maldistribution. We aim to assess how much of the lung is opened and kept open within the limits of mechanical ventilation considered safe (i.e., plateau pressure 30 cmH Methods: Prospective study from two university hospitals. Thirty-three ARDS patients (5 mild, 10 moderate, 9 severe without extracorporeal support, ECMO, and 9 severe with it) underwent two low-dose end-expiratory CT scans at PEEP 5 and 15 cmH Results: The lung tissue which is opened between 30 and 45 cmH Conclusions: Data show that the prerequisites of the open lung strategy are not satisfied using PEEP up to 15 cmH Trial registration: Clinicaltrials.gov identifier: NCT01670747 ( www.clinicaltrials.gov ).
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung/diagnostic imaging ; Lung/physiopathology ; Lung Compliance ; Lung Volume Measurements ; Male ; Middle Aged ; Positive-Pressure Respiration/methods ; Prospective Studies ; Respiratory Distress Syndrome, Adult/physiopathology ; Respiratory Distress Syndrome, Adult/therapy ; Severity of Illness Index ; Tomography, X-Ray Computed ; Ventilator-Induced Lung Injury/prevention & control
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-017-4754-8
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Book ; Thesis: Comparison of the experimental cross-sections of high-mass muon pairs produced by negative pions on deuterium and tungsten

Guanziroli, Mario

1986

Author's details	Mario Guanziroli
Language	English
Size	III, 91, 43 S, graph. Darst
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Inst. of Technology, Diss.--Zürich, 1986
Database	Former special subject collection: coastal and deep sea fishing

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Book ; Thesis: Comparison of the experimental cross-sections of high-mass muon pairs produced by negative pions on deuterium and tungsten

Guanziroli, Mario

1986

Author's details	Mario Guanziroli
Language	English
Size	III, 91, 43 S, graph. Darst
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Inst. of Technology, Diss.--Zürich, 1986
Database	Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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Book ; Online ; Thesis: Comparison of the experimental cross-sections of high-mass muon pairs produced by negative pions on deuterium and tungsten

Guanziroli, Mario

1986

Author's details	Mario Guanziroli
Language	English
Size	Online-Ressource (91+43 S), 30 cm
Publishing place	Zürich
Document type	Book ; Online ; Thesis
Thesis / German Habilitation thesis	Diss. Naturwiss. ETH Zürich, Nr. 7989. Ref.: Telegdi, V.L. ; Korref.: Hofer, H--Zürich, 7989
Database	Former special subject collection: coastal and deep sea fishing

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Book ; Online ; Thesis: Comparison of the experimental cross-sections of high-mass muon pairs produced by negative pions on deuterium and tungsten

Guanziroli, Mario

1986

Author's details	Mario Guanziroli
Language	English
Size	Online-Ressource (91+43 S), 30 cm
Publishing place	Zürich
Document type	Book ; Online ; Thesis
Thesis / German Habilitation thesis	Diss. Naturwiss. ETH Zürich, Nr. 7989. Ref.: Telegdi, V.L. ; Korref.: Hofer, H--Zürich, 7989
Database	Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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Article ; Online: Inflammation and primary graft dysfunction after lung transplantation: CT-PET findings.

Minerva anestesiologica

2018 Volume 84, Issue 10, Page(s) 1169–1177

Abstract: Background: The leading cause of early mortality after lung transplantation is Primary graft dysfunction (PGD). We assessed the lung inflammation, inflation status and inhomogeneities after lung transplantation. Our purpose was to investigate the ... ...

Abstract	Background: The leading cause of early mortality after lung transplantation is Primary graft dysfunction (PGD). We assessed the lung inflammation, inflation status and inhomogeneities after lung transplantation. Our purpose was to investigate the possible differences between patients who did or did not develop PGD. Methods: We designed a prospective observational study enrolling patients who underwent a CT-PET study within 1 week after lung transplantation. Twenty-four patients (10 after double- and 14 after single-lung) were enrolled. Respiratory and hemodynamic data were collected before, during and after lung transplantation. Each patient underwent computed tomography-positron emission tomography (CT-PET) scan early after surgery. Broncho-alveolar lavage (BAL) fluid collection was performed to analyze inflammatory mediators. Results: The grafts showed a [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) uptake rate of 26[18-33]10-4 mLblood/mLtissue/min (reference values 11[7-15]10-4). Three double- and six single-lung recipients developed PGD. The grafts of patients who developed PGD had similar [18F]FDG uptake than grafts of patients who did not (28[18-26]10-4 versus 26[22-31]10-4, P=0.79). Not-inflated tissue fraction was significantly higher (28[20-38]% versus 14[7-21]%, P=0.01) while well-inflated fraction was significantly lower (29[25-41]% versus 53[39-65]%, P<0.01). Inhomogeneity extent was higher in patients who developed PGD (23[18-26]% versus 14[10-20]%, P=0.01)The lung weight was 650[591-820]g versus 597[480-650]g (P=0.09)). BAL fluid analysis for inflammatory mediators did not detect a difference between the study groups. Conclusions: Compared to healthy lungs, all the grafts showed increased [18F]FDG uptake rate, but there were no differences between patients who developed PGD and patients who did not. Of note, the PGD patients showed a worse inflation status of lungs and a higher inhomogeneity extent.
MeSH term(s)	Fluorodeoxyglucose F18 ; Humans ; Lung Transplantation ; Pneumonia/diagnostic imaging ; Positron Emission Tomography Computed Tomography ; Postoperative Complications/diagnostic imaging ; Primary Graft Dysfunction/diagnostic imaging ; Prospective Studies ; Radiopharmaceuticals
Chemical Substances	Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2018-05-28
Publishing country	Italy
Document type	Journal Article ; Observational Study
ZDB-ID	123584-9
ISSN	1827-1596 ; 0026-4717 ; 0375-9393
ISSN (online)	1827-1596
ISSN	0026-4717 ; 0375-9393
DOI	10.23736/S0375-9393.18.12651-4
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Article ; Online: Mechanical Power and Development of Ventilator-induced Lung Injury.

Cressoni, Massimo / Gotti, Miriam / Chiurazzi, Chiara / Massari, Dario / Algieri, Ilaria / Amini, Martina / Cammaroto, Antonio / Brioni, Matteo / Montaruli, Claudia / Nikolla, Klodiana / Guanziroli, Mariateresa / Dondossola, Daniele / Gatti, Stefano / Valerio, Vincenza / Vergani, Giordano Luca / Pugni, Paola / Cadringher, Paolo / Gagliano, Nicoletta / Gattinoni, Luciano

Anesthesiology

2016 Volume 124, Issue 5, Page(s) 1100–1108

Abstract: Background: The ventilator works mechanically on the lung parenchyma. The authors set out to obtain the proof of concept that ventilator-induced lung injury (VILI) depends on the mechanical power applied to the lung.: Methods: Mechanical power was ... ...

Abstract	Background: The ventilator works mechanically on the lung parenchyma. The authors set out to obtain the proof of concept that ventilator-induced lung injury (VILI) depends on the mechanical power applied to the lung. Methods: Mechanical power was defined as the function of transpulmonary pressure, tidal volume (TV), and respiratory rate. Three piglets were ventilated with a mechanical power known to be lethal (TV, 38 ml/kg; plateau pressure, 27 cm H2O; and respiratory rate, 15 breaths/min). Other groups (three piglets each) were ventilated with the same TV per kilogram and transpulmonary pressure but at the respiratory rates of 12, 9, 6, and 3 breaths/min. The authors identified a mechanical power threshold for VILI and did nine additional experiments at the respiratory rate of 35 breaths/min and mechanical power below (TV 11 ml/kg) and above (TV 22 ml/kg) the threshold. Results: In the 15 experiments to detect the threshold for VILI, up to a mechanical power of approximately 12 J/min (respiratory rate, 9 breaths/min), the computed tomography scans showed mostly isolated densities, whereas at the mechanical power above approximately 12 J/min, all piglets developed whole-lung edema. In the nine confirmatory experiments, the five piglets ventilated above the power threshold developed VILI, but the four piglets ventilated below did not. By grouping all 24 piglets, the authors found a significant relationship between the mechanical power applied to the lung and the increase in lung weight (r = 0.41, P = 0.001) and lung elastance (r = 0.33, P < 0.01) and decrease in PaO2/FIO2 (r = 0.40, P < 0.001) at the end of the study. Conclusion: In piglets, VILI develops if a mechanical power threshold is exceeded.
MeSH term(s)	Air Pressure ; Animals ; Elasticity ; Equipment Design ; Inspiratory Capacity ; Lung/diagnostic imaging ; Lung/pathology ; Lung/physiopathology ; Mechanical Phenomena ; Organ Size ; Pulmonary Edema/chemically induced ; Pulmonary Edema/pathology ; Radiography ; Respiratory Rate ; Sus scrofa ; Ventilator-Induced Lung Injury/pathology ; Ventilator-Induced Lung Injury/physiopathology ; Ventilators, Mechanical
Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	269-0
ISSN	1528-1175 ; 0003-3022
ISSN (online)	1528-1175
ISSN	0003-3022
DOI	10.1097/ALN.0000000000001056
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