Tonetti, Tommaso

[["dc.bibliographiccitation.artnumber","46"],["dc.bibliographiccitation.issue","1"],["dc.bibliographiccitation.journal","Intensive Care Medicine Experimental"],["dc.bibliographiccitation.volume","5"],["dc.contributor.author","Cambiaghi, Barbara"],["dc.contributor.author","Vasques, Francesco"],["dc.contributor.author","Mörer, Onnen"],["dc.contributor.author","Ritter, Christian"],["dc.contributor.author","Mauri, Tommaso"],["dc.contributor.author","Kunze-Szikszay, Nils"],["dc.contributor.author","Holke, Karin"],["dc.contributor.author","Collino, Francesca"],["dc.contributor.author","Maiolo, Giorgia"],["dc.contributor.author","Rapetti, Francesca"],["dc.contributor.author","Schulze-Kalthoff, Elias"],["dc.contributor.author","Tonetti, Tommaso"],["dc.contributor.author","Hahn, Günter"],["dc.contributor.author","Quintel, Michael"],["dc.contributor.author","Gattinoni, Luciano"],["dc.date.accessioned","2020-12-10T18:41:24Z"],["dc.date.available","2020-12-10T18:41:24Z"],["dc.date.issued","2017"],["dc.description.abstract","Abstract Background Severe hypoperfusion can cause lung damage. We studied the effects of regional perfusion block in normal lungs and in the lungs that had been conditioned by lavage with 500 ml saline and high V T (20 ml kg−1) ventilation. Methods Nineteen pigs (61.2 ± 2.5 kg) were randomized to five groups: controls (n = 3), the right lower lobe block alone (n = 3), lavage and high V T (n = 4), lung lavage, and high V T plus perfusion block of the right (n = 5) or left (n = 4) lower lobe. Gas exchange, respiratory mechanics, and hemodynamics were measured hourly. After an 8-h observation period, CT scans were obtained at 0 and 15 cmH2O airway pressure. Results Perfusion block did not damage healthy lungs. In conditioned lungs, the left perfusion block caused more edema in the contralateral lung (777 ± 62 g right lung vs 484 ± 204 g left; p < 0.05) than the right perfusion block did (581 ± 103 g right lung vs 484 ± 204 g left; p n.s.). The gas/tissue ratio, however, was similar (0.5 ± 0.3 and 0.8 ± 0.5; p n.s.). The lobes with perfusion block were not affected (gas/tissue ratio right 1.6 ± 0.9; left 1.7 ± 0.5, respectively). Pulmonary artery pressure, PaO2/FiO2, dead space, and lung mechanics were more markedly affected in animals with left perfusion block, while the gas/tissue ratios were similar in the non-occluded lobes. Conclusions The right and left perfusion blocks caused the same “intensity” of edema in conditioned lungs. The total amount of edema in the two lungs differed because of differences in lung size. If capillary permeability is altered, increased blood flow may induce or increase edema."],["dc.identifier.doi","10.1186/s40635-017-0161-2"],["dc.identifier.eissn","2197-425X"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/15183"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/77572"],["dc.language.iso","en"],["dc.notes.intern","DOI Import GROB-354"],["dc.notes.intern","Merged from goescholar"],["dc.publisher","Springer"],["dc.rights","CC BY 4.0"],["dc.rights.uri","https://creativecommons.org/licenses/by/4.0"],["dc.title","Effects of regional perfusion block in healthy and injured lungs"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.issue","1"],["dc.bibliographiccitation.journal","Critical Care"],["dc.bibliographiccitation.volume","21"],["dc.contributor.author","Gattinoni, Luciano"],["dc.contributor.author","Marini, John J."],["dc.contributor.author","Collino, Francesca"],["dc.contributor.author","Maiolo, Giorgia"],["dc.contributor.author","Rapetti, Francesca"],["dc.contributor.author","Tonetti, Tommaso"],["dc.contributor.author","Vasques, Francesco"],["dc.contributor.author","Quintel, Michael"],["dc.date.accessioned","2019-07-09T11:43:44Z"],["dc.date.available","2019-07-09T11:43:44Z"],["dc.date.issued","2017"],["dc.identifier.doi","10.1186/s13054-017-1750-x"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/14668"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/58963"],["dc.notes.intern","Merged from goescholar"],["dc.rights","CC BY 4.0"],["dc.rights.uri","https://creativecommons.org/licenses/by/4.0"],["dc.title","The future of mechanical ventilation: lessons from the present and the past"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.artnumber","312"],["dc.bibliographiccitation.issue","Suppl 3"],["dc.bibliographiccitation.journal","Critical Care"],["dc.bibliographiccitation.volume","21"],["dc.contributor.author","Gattinoni, Luciano"],["dc.contributor.author","Tonetti, Tommaso"],["dc.contributor.author","Quintel, Michael"],["dc.date.accessioned","2018-04-18T14:43:17Z"],["dc.date.accessioned","2021-10-27T13:21:03Z"],["dc.date.available","2018-04-18T14:43:17Z"],["dc.date.available","2021-10-27T13:21:03Z"],["dc.date.issued","2017-12-28"],["dc.date.updated","2018-04-18T14:43:17Z"],["dc.description.abstract","The acute respiratory distress (ARDS) lung is usually characterized by a high degree of inhomogeneity. Indeed, the same lung may show a wide spectrum of aeration alterations, ranging from completely gasless regions, up to hyperinflated areas. This inhomogeneity is normally caused by the presence of lung edema and/or anatomical variations, and is deeply influenced by the gravitational forces. For any given airway pressure generated by the ventilator, the pressure acting directly on the lung (i.e., the transpulmonary pressure or lung stress) is determined by two main factors: 1) the ratio between lung elastance and the total elastance of the respiratory system (which has been shown to vary widely in ARDS patients, between 0.2 and 0.8); and 2) the lung size. In severe ARDS, the ventilatable parenchyma is strongly reduced in size (‘baby lung’); its resting volume could be as low as 300 mL, and the total inspiratory capacity could be reached with a tidal volume of 750–900 mL, thus generating lethal stress and strain in the lung. Although this is possible in theory, it does not explain the occurrence of ventilator-induced lung injury (VILI) in lungs ventilated with much lower tidal volumes. In fact, the ARDS lung contains areas acting as local stress multipliers and they could multiply the stress by a factor ~ 2, meaning that in those regions the transpulmonary pressure could be double that present in other parts of the same lung. These ‘stress raisers’ widely correspond to the inhomogenous areas of the ARDS lung and can be present in up to 40% of the lung. Although most of the literature on VILI concentrates on the possible dangers of tidal volume, mechanical ventilation in fact delivers mechanical power (i.e., energy per unit of time) to the lung parenchyma, which reacts to it according to its anatomical structure and pathophysiological status. The determinants of mechanical power are not only the tidal volume, but also respiratory rate, inspiratory flow, and positive end-expiratory pressure (PEEP). In the end, decreasing mechanical power, increasing lung homogeneity, and avoiding reaching the anatomical limits of the ‘baby lung’ should be the goals for safe ventilation in ARDS."],["dc.identifier.doi","10.1186/s13054-017-1905-9"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/15164"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/15502"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/91991"],["dc.language.rfc3066","en"],["dc.notes.intern","Merged from goescholar"],["dc.relation.orgunit","Universitätsmedizin Göttingen"],["dc.rights","CC BY 4.0"],["dc.rights.holder","The Author(s)."],["dc.rights.uri","https://creativecommons.org/licenses/by/4.0"],["dc.title","Regional physiology of ARDS"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.version","published_version"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]