ZANELLA , Alberto

During noninvasive continuous positive airway pressure (CPAP) the patient's respiratory system is maintained throughout the whole respiratory cycle at a constant pressure higher than the atmospheric pressure, usually termed the positive end-expiratory pressure (PEEP). Noninvasive CPAP is void of any active support for the patient's work of...

Purpose of Review: To describe a physiopathological-based approach to clinical management of severely hypoxemic patients that integrates the most recent findings on the use of rescue therapies. Recent Findings: Several techniques are available to improve oxygenation in severely hypoxemic patients. Survival benefits have not been proved for most...

Purpose of review We report on recent advances and achievements on the use of extracorporeal gas exchange for long-term application in the therapy of critically ill patients with various forms of respiratory failure. Recent findings The most important results regarding the use of extracorporeal gas exchange are expected from the Conventional...

Objective: To assess the behavior of different helmets after discontinuation of fresh gas flow by disconnection at the helmet inlet, flow generator, or gas source. Design and setting: Randomized physiological study in a university research laboratory. Patients: Five healthy volunteers. Intervention: CPAP (FIO250%, PEEP 5 cmH2O) delivered in...

Purpose: Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distress syndrome undergoing invasive ventilation. We evaluated feasibility and efficacy of PP in awake, non-intubated, spontaneously breathing patients with hypoxemic acute respiratory failure (ARF). Material and Methods: We retrospectively...

Purpose: We investigated the effects of periodical high pressure breaths (SIGH) or biphasic positive pressure ventilation (BIPAP) during helmet continuous positive airway pressure (CPAP) in patients with acute hypoxic respiratory failure. Methods: We used a recently developed electromechanical expiratory valve (TwinPAP®, StarMed, Mirandola,...

OBJECTIVE: To demonstrate the technical feasibility of CO2 removal with a commercial hemofilter and a replacement solution containing sodium hydroxide to replace bicarbonate. DESIGN: Prospective animal experiment in sheep. SUBJECTS: Seven mixed-breed female sheep. INTERVENTIONS: Blood ultrafiltrate containing half of the metabolic production of...

Background: The aim of this study was to test the hypothesis that, during weaning from mechanical ventilation, when the pressure support level is reduced, oxygen consumption increases more in patients unable to sustain the decrease in ventilatory assistance (weaning failure). Methods: Patients judged eligible for weaning were enrolled. Starting...

Rationale: During acute lung injury (ALI), mechanical ventilation can aggravate inflammation by promoting alveolar distension and cyclic recruitment-derecruitment. As an estimate of the intensity of inflammation,metabolic activity can bemeasured by positrone-mission tomography imaging of [18F]fluoro-2-deoxy-D-glucose. Objectives: To assess the...

Purpose: Standard polyvinylchloride (PVC) endotracheal tube (ETT) cuffs do not protect from aspiration across the cuff, a leading cause of ventilator-associated pneumonia (VAP). In a long-lasting in vitro study we compared the effect of different cuff materials (PVC, polyurethane, and guayule latex), shapes (cylindrical, conical), and positive...

Purpose: Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal Membrane Oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO transportation program was instituted in 2004; here we report results after 5 years of activity. Methods: This is a clinical observational study....

Purpose: Extracorporeal CO2removal is an effective procedure to allow a protective ventilatory strategy in ARDS patients, but it is technically challenging due to the high blood flow required. Increasing the CO2transfer through the membrane lung (ML) may lower the demand of extracorporeal blood flow and consequently allow for a wider clinical...

Intraoperative allergic reactions are rare but serious events associated with increased morbidity and mortality. We report the salvage of intraoperative anaphylaxis leading to extreme hypercapnic respiratory failure by veno-venous extracorporeal membrane oxygenation (ECMO). A 38-year-old woman undergoing thyroidectomy developed intractable...

Purpose: To investigate the effect of a wide range of assistance levels during neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) on respiratory pattern, breathing variability, and incidence of tidal volumes (VT) above 8 and 10 ml/kg in acute respiratory failure patients. Methods: Eight increasing NAVA levels...

Purpose: We assessed the performance of different continuous positive airway pressure (CPAP) helmets equipped with a safety valve during discontinuation of fresh gas flow. Methods: This was a physiological study of five healthy volunteers. We delivered CPAP (fresh gas flow 60 l/min, FiO260%, PEEP 5 cmH2O) with three different helmets in a...

Introduction: Blood acidification by lactic acid infusion converts bicarbonate to CO2. This effect can be exploited to increase the transmembrane PCO2 gradient of an extracorporeal membrane lung, resulting in a significant increase of extracorporeal CO2 removal. Lactic acid, however, is an energetic substrate and its metabolism might increase...

Background: Extracorporeal (EC) carbon dioxide (CO2) removal (ECCO2R) may be a powerful alternative to ventilation, possibly avoiding the need for mechanical ventilation and endotracheal intubation. We previously reported how an infusion of lactic acid before a membrane lung (ML) effectively enhances ECCO2R. We evaluated an innovative ECCO2R...

BACKGROUND:: Extracorporeal carbon dioxide removal has been proposed to achieve protective ventilation in patients at risk for ventilator-induced lung injury. In an acute study, the authors previously described an extracorporeal carbon dioxide removal technique enhanced by regional extracorporeal blood acidification. The current study evaluates...

Purpose To develop a mathematical model of oxygenation during venovenous extracorporeal membrane oxygenation (vv-ECMO). Material and methods Total oxygen consumption, cardiac output, blood flow, recirculation, intrapulmonary shunt, hemoglobin, natural lung, and membrane lung oxygen fractions were chosen as inputs. Content, partial pressure, and...

Gas exchange capabilities of polymethylpentene membrane lungs (MLs) worsen over time. ML deterioration is related to protein deposit and clot formation. Condensation and trapping of water vapor inside ML hollow fibers might affect ML performances as well. Increasing sweep gas flow (GF) could remove such fluid. The purpose of this study was to...

Rationale: We developed an innovative, minimally invasive, highly efficient extracorporeal CO2 removal (ECCO2R) technique called respiratory electrodialysis (R-ED). Objectives: To evaluate the efficacy of R-ED in controlling ventilation compared with conventional ECCO2R technology. Methods: Five mechanically ventilated swine were connected to a...