Gattinoni, Luciano

[["dc.bibliographiccitation.artnumber","55"],["dc.bibliographiccitation.issue","1"],["dc.bibliographiccitation.journal","Intensive Care Medicine Experimental"],["dc.bibliographiccitation.volume","9"],["dc.contributor.author","Marini, John J."],["dc.contributor.author","Crooke, Philip S."],["dc.contributor.author","Tawfik, Pierre"],["dc.contributor.author","Chatburn, Robert L."],["dc.contributor.author","Dries, David J."],["dc.contributor.author","Gattinoni, Luciano"],["dc.date.accessioned","2021-11-25T11:25:12Z"],["dc.date.accessioned","2022-08-18T12:41:27Z"],["dc.date.available","2021-11-25T11:25:12Z"],["dc.date.available","2022-08-18T12:41:27Z"],["dc.date.issued","2021-11-01"],["dc.date.updated","2022-07-29T12:18:45Z"],["dc.description.abstract","Abstract\r\n \r\n Background\r\n High rates of inflation energy delivery coupled with transpulmonary tidal pressures of sufficient magnitude may augment the risk of damage to vulnerable, stress-focused units within a mechanically heterogeneous lung. Apart from flow amplitude, the clinician-selected flow waveform, a relatively neglected dimension of inflation power, may distribute inflation energy of each inflation cycle non-uniformly among alveoli with different mechanical properties over the domains of time and space. In this initial step in modeling intracycle power distribution, our primary objective was to develop a mathematical model of global intracycle inflation power that uses clinician-measurable inputs to allow comparisons of instantaneous ICP profiles among the flow modes commonly encountered in clinical practice: constant, linearly decelerating, exponentially decelerating (pressure control), and spontaneous (sinusoidal).\r\n \r\n \r\n Methods\r\n We first tested the predictions of our mathematical model of passive inflation with the actual physical performance of a mechanical ventilator–lung system that simulated ventilation to three types of patients: normal, severe ARDS, and severe airflow obstruction. After verification, model predictions were then generated for 5000 ‘virtual ARDS patients’. Holding constant the tidal volume and inflation time between modes, the validated model then varied the flow profile and quantitated the resulting intensity and timing of potentially damaging ‘elastic’ energy and intracycle power (pressure–flow product) developed in response to random combinations of machine settings and severity levels for ARDS.\r\n \r\n \r\n Results\r\n Our modeling indicates that while the varied flow patterns ultimately deliver similar total amounts of alveolar energy during each breath, they differ profoundly regarding the potentially damaging pattern with which that energy distributes over time during inflation. Pressure control imposed relatively high maximal intracycle power.\r\n \r\n \r\n Conclusions\r\n Flow amplitude and waveform may be relatively neglected and modifiable determinants of VILI risk when ventilating ARDS."],["dc.identifier.citation","Intensive Care Medicine Experimental. 2021 Nov 01;9(1):55"],["dc.identifier.doi","10.1186/s40635-021-00420-9"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/93554"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/112993"],["dc.language.iso","en"],["dc.publisher","Springer International Publishing"],["dc.rights","CC BY 4.0"],["dc.rights.holder","The Author(s)"],["dc.subject","Mechanical ventilation"],["dc.subject","Mathematical model"],["dc.subject","Ventilator-induced lung injury"],["dc.subject","VILI"],["dc.subject","Power"],["dc.subject","Intracycle power"],["dc.subject","Energetics"],["dc.subject","Modes of ventilation"],["dc.title","Intracycle power and ventilation mode as potential contributors to ventilator-induced lung injury"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.issue","1"],["dc.bibliographiccitation.journal","Intensive Care Medicine Experimental"],["dc.bibliographiccitation.volume","6"],["dc.contributor.author","Cortes-Puentes, Gustavo A."],["dc.contributor.author","Gard, Kenneth E."],["dc.contributor.author","Adams, Alexander B."],["dc.contributor.author","Dries, David J."],["dc.contributor.author","Quintel, Michael"],["dc.contributor.author","Oeckler, Richard A."],["dc.contributor.author","Gattinoni, Luciano"],["dc.contributor.author","Marini, John J."],["dc.date.accessioned","2020-12-10T18:41:25Z"],["dc.date.available","2020-12-10T18:41:25Z"],["dc.date.issued","2018"],["dc.identifier.doi","10.1186/s40635-018-0175-4"],["dc.identifier.eissn","2197-425X"],["dc.identifier.purl","https://resolver.sub.uni-goettingen.de/purl?gs-1/15517"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/77574"],["dc.language.iso","en"],["dc.notes.intern","DOI Import GROB-354"],["dc.notes.intern","Merged from goescholar"],["dc.notes.intern","In goescholar not merged with http://resolver.sub.uni-goettingen.de/purl?gs-1/15184 but duplicate"],["dc.rights","CC BY 4.0"],["dc.rights.holder","The Author(s)."],["dc.rights.uri","https://creativecommons.org/licenses/by/4.0"],["dc.title","Positional effects on the distributions of ventilation and end-expiratory gas volume in the asymmetric chest—a quantitative lung computed tomographic analysis"],["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","26"],["dc.contributor.author","Selickman, John"],["dc.contributor.author","Tawfik, Pierre"],["dc.contributor.author","Crooke, Philip S."],["dc.contributor.author","Dries, David J."],["dc.contributor.author","Shelver, Jonathan"],["dc.contributor.author","Gattinoni, Luciano"],["dc.contributor.author","Marini, John J."],["dc.date.accessioned","2022-09-01T09:50:56Z"],["dc.date.available","2022-09-01T09:50:56Z"],["dc.date.issued","2022"],["dc.description.abstract","Abstract\n \n Background\n \n Chest wall loading has been shown to paradoxically improve respiratory system compliance (C\n RS\n ) in patients with moderate to severe acute respiratory distress syndrome (ARDS). The most likely, albeit unconfirmed, mechanism is relief of end-tidal overdistension in ‘baby lungs’ of low-capacity. The purpose of this study was to define how small changes of tidal volume (V\n T\n ) and positive end-expiratory pressure (PEEP) affect C\n RS\n (and its associated airway pressures) in patients with ARDS who demonstrate a paradoxical response to chest wall loading. We hypothesized that small reductions of V\n T\n or PEEP would alleviate overdistension and favorably affect C\n RS\n and conversely, that small increases of V\n T\n or PEEP would worsen C\n RS\n .\n \n \n \n Methods\n \n Prospective, multi-center physiologic study of seventeen patients with moderate to severe ARDS who demonstrated paradoxical responses to chest wall loading. All patients received mechanical ventilation in volume control mode and were passively ventilated. Airway pressures were measured before and after decreasing/increasing V\n T\n by 1 ml/kg predicted body weight and decreasing/increasing PEEP by 2.5 cmH\n 2\n O.\n \n \n \n Results\n \n Decreasing either V\n T\n or PEEP improved C\n RS\n in all patients. Driving pressure (DP) decreased by a mean of 4.9 cmH\n 2\n O (supine) and by 4.3 cmH\n 2\n O (prone) after decreasing V\n T\n , and by a mean of 2.9 cmH\n 2\n O (supine) and 2.2 cmH\n 2\n O (prone) after decreasing PEEP. C\n RS\n increased by a mean of 3.1 ml/cmH\n 2\n O (supine) and by 2.5 ml/cmH\n 2\n O (prone) after decreasing V\n T.\n C\n RS\n increased by a mean of 5.2 ml/cmH\n 2\n O (supine) and 3.6 ml/cmH\n 2\n O (prone) after decreasing PEEP (\n P\n  < 0.01 for all). Small increments of either V\n T\n or PEEP worsened C\n RS\n in the majority of patients.\n \n \n \n Conclusion\n \n Patients with a paradoxical response to chest wall loading demonstrate uniform improvement in both DP and C\n RS\n following a reduction in either V\n T\n or PEEP, findings in keeping with prior evidence suggesting its presence is a sign of end-tidal overdistension. The presence of ‘paradox’ should prompt re-evaluation of modifiable determinants of end-tidal overdistension, including V\n T\n , PEEP, and body position."],["dc.identifier.doi","10.1186/s13054-022-04073-2"],["dc.identifier.pii","4073"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/113840"],["dc.language.iso","en"],["dc.notes.intern","DOI-Import GROB-597"],["dc.relation.eissn","1364-8535"],["dc.rights.uri","https://creativecommons.org/licenses/by/4.0"],["dc.title","Paradoxical response to chest wall loading predicts a favorable mechanical response to reduction in tidal volume or PEEP"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dspace.entity.type","Publication"]]

[["dc.bibliographiccitation.journal","Critical Care Medicine"],["dc.bibliographiccitation.volume","Publish Ahead of Print"],["dc.contributor.author","Selickman, John"],["dc.contributor.author","Crooke, Philip S."],["dc.contributor.author","Tawfik, Pierre"],["dc.contributor.author","Dries, David J."],["dc.contributor.author","Gattinoni, Luciano"],["dc.contributor.author","Marini, John J."],["dc.date.accessioned","2022-09-01T09:50:34Z"],["dc.date.available","2022-09-01T09:50:34Z"],["dc.date.issued","2022"],["dc.identifier.doi","10.1097/CCM.0000000000005631"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/113744"],["dc.language.iso","en"],["dc.notes.intern","DOI-Import GROB-597"],["dc.relation.issn","0090-3493"],["dc.title","Paradoxical Positioning: Does “Head Up” Always Improve Mechanics and Lung Protection?"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dspace.entity.type","Publication"]]