PELOSI , Paolo Pasqualino

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The occurrence of a critical illness initiates a complex chain of pathophysiologic, psychological and social mechanisms, contributing to a relevant burden of care and affecting long-term outcome. Clinical routine offers a partial perspective on this issue to the intensive care unit (ICU) caregivers: often seen as the last relevant event in...

Tidal airway closure occurs when the closing volume exceeds the end-expiratory lung volume, and it is commonly observed in general anaesthesia, particularly in obese patients. Animal studies suggest that tidal airway closure causes injury to peripheral airways, characterized histologically by rupture of alveolar-airway attachments, denuded...

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Tracheostomy is one of the most frequent procedures carried out in critically ill patients with major advantages compared to translaryngeal endotracheal intubation such as reduced laryngeal anatomical alterations, reduced inspiratory load, better patient's tolerance and nursing. Thus, tracheostomy can enhance patient's care in patients who need...

Abstract The occurrence of moderate to severe acute respiratory distress syndrome due to traumatic brain injury is not uncommon and is associated with an extremely high incidence of morbidity and mortality. Owing to the complex interaction between the lung and brain, protective ventilation for the lung with lower tidal volume and higher...

Abstract INTRODUCTION: To investigate haemodynamic and respiratory changes during lung recruitment and decremental positive end-expiratory pressure (PEEP) titration for open lung ventilation in patients with acute respiratory distress syndrome (ARDS) a prospective, clinical trial was performed involving 12 adult patients with ARDS treated in...

PURPOSE OF REVIEW: The aims of this review are: to discuss the physiological rationale for noninvasive respiratory support (NRS) in the perioperative period; to give some practical recommendations to safely apply NRS; and to review available clinical data on preventive and curative NRS after cardiac, thoracic and abdominal surgery. RECENT...

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Delivering care to patients suffering from a severe depression of the immune system is a challenge for the intensivist. Such patients pose relevant issues in terms of choice of the appropriate treatment and resource allocation, as well as relevant ethical issues in both clinical practice and research. Especially in the past, the poor prognosis...

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Intra-abdominal hypertension is frequent in surgical and medical critically ill patients. Intra-abdominal hypertension has a serious impact on the function of respiratory as well as peripheral organs. In the presence of alveolar capillary damage, which occurs in acute respiratory distress syndrome (ARDS), intra-abdominal hypertension promotes...

Obesity is a metabolic disease that is on the increase all over the world. Up to 35% of the population in North America and 15-20% in Europe can be considered obese. Since these patients are characterised by several systemic physiopathological alterations, the perioperative management may present some problems, mainly related to their...

Abstract Acute respiratory distress syndrome (ARDS) is one of the devastating sequelae of sepsis, and so far no specific promising pharmacotherapies have been proven to decrease mortality from it. Stem cell therapy is a novel therapy that can promote earlier and more effective remodeling and repair of damaged lung tissue. Bone marrow-derived...

Numerous events affect patients' outcome for various surgical procedures. Evidence shows that several factors might affect postoperative course, such as routine use of surgical safety checklists, clinical pathways, enhanced recovery strategy or fast-track surgery, volume of cases, presence of general versus specialised surgeons, the ability to...

Brain or lung injury or both are frequent causes of admission to intensive care units and are associated with high morbidity and mortality rates. Mechanical ventilation, which is commonly used in the management of these critically ill patients, can induce an inflammatory response, which may be involved in distal organ failure. Thus, there may...

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The extracellular matrix (ECM) plays an important role in the biomechanical behaviour of the lung parenchyma. The ECM is composed of a three-dimensional fibre mesh filled with different macromolecules, including the glycosaminoglycans and the proteoglycans, which have important functions in many lung pathophysiological processes: (1) regulating...

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In the last few years prone positioning has been used increasingly in the treatment of patients with acute respiratory distress syndrome (ARDS) and this manoeuvre is now considered a simple and safe method to improve oxygenation. However, the physiological mechanisms causing respiratory function improvement as well as the real clinical benefit...

Abstract PURPOSE OF REVIEW: This article discusses the methods available to evaluate chest wall mechanics and the relationship between intraabdominal pressure (IAP) and chest wall mechanics during general anaesthesia in normal and obese individuals, as well as in acute lung injury/acute respiratory distress syndrome. RECENT FINDINGS: The...