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.artnumber","21"],["dc.bibliographiccitation.issue","1"],["dc.bibliographiccitation.journal","Intensive Care Medicine Experimental"],["dc.bibliographiccitation.volume","10"],["dc.contributor.author","Crooke, Philip S."],["dc.contributor.author","Gattinoni, Luciano"],["dc.contributor.author","Michalik, Michael"],["dc.contributor.author","Marini, John J."],["dc.date.accessioned","2022-07-01T07:35:23Z"],["dc.date.accessioned","2022-08-16T12:47:47Z"],["dc.date.available","2022-07-01T07:35:23Z"],["dc.date.available","2022-08-16T12:47:47Z"],["dc.date.issued","2022-06-01"],["dc.date.updated","2022-07-29T12:18:45Z"],["dc.description.abstract","Abstract\r\n \r\n Background\r\n Repeated expenditure of energy and its generation of damaging strain are required to injure the lung by ventilation (VILI). Mathematical modeling of passively inflated, single-compartment lungs with uniform parameters for resistance and compliance indicates that standard clinical modes (flow patterns) differ impressively with respect to the timing and intensity of energy delivery—the intracycle power (ICP) that determines parenchymal stress and strain. Although measures of elastic ICP may accurately characterize instantaneous rates of global energy delivery, how the ICP component delivered to a compartment affects the VILI-linked variable of strain is determined by compartmental mechanics, compartmental size and mode of gas delivery. We extended our one-compartment model of ICP to a multi-compartment setting that varied those characteristics.\r\n \r\n \r\n Main findings\r\n The primary findings of this model/simulation indicate that: (1) the strain and strain rate experienced within a modeled compartment are nonlinear functions of delivered energy and power, respectively; (2) for a given combination of flow profile and tidal volume, resting compartmental volumes influence their resulting maximal strains in response to breath delivery; (3) flow profile is a key determinant of the maximal strain as well as maximal strain rate experienced within a multi-compartment lung. By implication, different clinician-selected flow profiles not only influence the timing of power delivery, but also spatially distribute the attendant strains of expansion among compartments with diverse mechanical properties. Importantly, the contours and magnitudes of the compartmental ICP, strain, and strain rate curves are not congruent; strain and strain rate do not necessarily follow the compartmental ICP, and the hierarchy of amplitudes among compartments for these variables may not coincide.\r\n \r\n \r\n Conclusions\r\n Different flow patterns impact how strain and strain rate develop as compartmental volume crests to its final value. Notably, as inflation proceeds, strain rate may rise or fall even as total strain, a monotonic function of volume, steadily (and predictably) rises. Which flow pattern serves best to minimize the maximal strain rate and VILI risk experienced within any sector, therefore, may strongly depend on the nature and heterogeneity of the mechanical properties of the injured lung."],["dc.description.abstract","Take home message\r\n Potentially damaging tidal energy and power distribute asymmetrically within the heterogeneous environment of the acutely injured lung. Clinician-selected flow profiles not only influence the timing of power delivery, but also spatially distribute the attendant strains of expansion."],["dc.identifier.citation","Intensive Care Medicine Experimental. 2022 Jun 01;10(1):21"],["dc.identifier.doi","10.1186/s40635-022-00447-6"],["dc.identifier.pii","447"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/112156"],["dc.identifier.uri","https://resolver.sub.uni-goettingen.de/purl?gro-2/112745"],["dc.language.iso","en"],["dc.notes.intern","DOI-Import GROB-581"],["dc.relation.eissn","2197-425X"],["dc.rights","CC BY 4.0"],["dc.rights.holder","The Author(s)"],["dc.rights.uri","https://creativecommons.org/licenses/by/4.0"],["dc.subject","Mechanical ventilation"],["dc.subject","Ventilator-induced lung injury"],["dc.subject","VILI"],["dc.subject","Mechanical power"],["dc.subject","Stress"],["dc.subject","Strain"],["dc.subject","Multicompartment"],["dc.subject","Mathematical model"],["dc.subject","Ventilation mode"],["dc.subject","Flow pattern"],["dc.title","Intracycle power distribution in a heterogeneous multi-compartmental mathematical model: possible links to strain and VILI"],["dc.type","journal_article"],["dc.type.internalPublication","yes"],["dc.type.subtype","original_ja"],["dc.type.version","published_version"],["dspace.entity.type","Publication"]]