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Find video protocols related to scientific articles indexed in Pubmed.
Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients.
Am. J. Respir. Crit. Care Med.
PUBLISHED: 07-26-2014
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The use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (ARF) in adults is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMO is a complex, high-risk, and costly modality, at present it should be conducted in centers with sufficient experience, volume, and expertise to ensure it is used safely. This position paper represents the consensus opinion of an international group of physicians and associated health-care workers who have expertise in therapeutic modalities used in the treatment of patients with severe ARF, with a focus on ECMO. The aim of this paper is to provide physicians, ECMO center directors and coordinators, hospital directors, health-care organizations, and regional, national, and international policy makers a description of the optimal approach to organizing ECMO programs for ARF in adult patients. Importantly, this will help ensure that ECMO is delivered safely and proficiently, such that future observational and randomized clinical trials assessing this technique may be performed by experienced centers under homogeneous and optimal conditions. Given the need for further evidence, we encourage restraint in the widespread use of ECMO until we have a better appreciation for both the potential clinical applications and the optimal techniques for performing ECMO.
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Clinical assessment of auto-positive end-expiratory pressure by diaphragmatic electrical activity during pressure support and neurally adjusted ventilatory assist.
Anesthesiology
PUBLISHED: 07-23-2014
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Auto-positive end-expiratory pressure (auto-PEEP) may substantially increase the inspiratory effort during assisted mechanical ventilation. Purpose of this study was to assess whether the electrical activity of the diaphragm (EAdi) signal can be reliably used to estimate auto-PEEP in patients undergoing pressure support ventilation and neurally adjusted ventilatory assist (NAVA) and whether NAVA was beneficial in comparison with pressure support ventilation in patients affected by auto-PEEP.
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Effect of prone positioning during mechanical ventilation on mortality among patients with acute respiratory distress syndrome: a systematic review and meta-analysis.
CMAJ
PUBLISHED: 05-26-2014
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Mechanical ventilation in the prone position is used to improve oxygenation and to mitigate the harmful effects of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). We sought to determine the effect of prone positioning on mortality among patients with ARDS receiving protective lung ventilation.
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Alveolar pentraxin 3 as an early marker of microbiologically confirmed pneumonia: a threshold-finding prospective observational study.
Crit Care
PUBLISHED: 04-24-2014
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IntroductionTimely diagnosis of pneumonia in intubated critically ill patients is rather challenging. Pentraxin 3 (PTX3) is an acute phase mediator produced by various cell types in the lungs. Animal studies showed that, during pneumonia, PTX3 participates in fine-tuning of inflammation (for example, microbes¿ clearance and recruitment of neutrophils). We previously described an association between alveolar PTX3 and lung infection in a small group of intubated patients. The present study aimed to determine a threshold level of alveolar PTX3 with elevated sensitivity and specificity for microbiologically confirmed pneumonia.MethodsWe recruited 82 intubated patients from two intensive care units (San Gerardo Hospital, Monza, Italy and Massachusetts General Hospital, Boston, MA) undergoing broncho-alveolar lavage (BAL) as per clinical decision. We collected BAL and plasma samples, together with relevant clinical and microbiological data. We assayed: in BAL, PTX3 and soluble triggering receptor expressed on myeloid cells (sTREM-1); in plasma, PTX3, sTREM-1, C-reactive protein (CRP) and Procalcitonin (PCT). Two blinded independent physicians reviewed patients¿ data to confirm pneumonia. Finally, we determined BAL PTX3 threshold for pneumonia and we compared it to other biomarkers.ResultsMicrobiologically confirmed pneumonia of bacterial (n¿=¿12), viral (n¿=¿4) or fungal (n¿=¿8) etiology was diagnosed in 24 patients (29%). BAL PTX3 predicted pneumonia with AUCROC¿=¿0.815 (95% CI¿=¿0.710 to 0.921, P <0.0001), while all other biomarkers were not effective. In particular, BAL PTX3¿¿¿1 ng/mL predicted pneumonia at univariate analysis (ß¿=¿2.784 with SE¿=¿0.792, P <0.001) with elevated sensitivity (92%), specificity (60%) and negative predictive value (95%). Net reclassification index values of BAL PTX3¿¿¿1 ng/mL for pneumonia indicated gain in sensitivity and/or specificity vs. all other mediators. These results did not change when we limited our analyses only to confirmed cases of bacterial pneumonia. Moreover, when we considered only the 70 cases that fulfilled clinical criteria for the diagnosis of pneumonia at BAL sampling, PTX3 diagnostic accuracy was confirmed at univariate and ROC curve analysis.ConclusionsIn this hypothesis generating convenience sample, BAL PTX3¿¿¿1 ng/mL was discriminative of microbiologically confirmed pneumonia in mechanically ventilated patients.
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Assessing effort and work of breathing.
Curr Opin Crit Care
PUBLISHED: 04-12-2014
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Spontaneous breathing has been shown to induce both positive and negative effects on the function and on injury of lungs and diaphragm during critical illness; thus, monitoring of the breathing effort generated by the patient might be valuable for a better understanding of the mechanisms of disease and to set properly ventilation. The purpose of this review is to summarize the recent findings on the different techniques available to measure the patient's breathing effort, mainly during spontaneous assisted ventilation.
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Measurement of endotracheal tube secretions volume by micro computed tomography (MicroCT) scan: an experimental and clinical study.
BMC Anesthesiol
PUBLISHED: 03-20-2014
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Biofilm accumulates within the endotracheal tube (ETT) early after intubation. Contaminated secretions in the ETT are associated with increased risk for microbial dissemination in the distal airways and increased resistance to airflow. We evaluated the effectiveness of micro computed tomography (MicroCT) for the quantification of ETT inner volume reduction in critically ill patients.
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Albumin replacement in patients with severe sepsis or septic shock.
N. Engl. J. Med.
PUBLISHED: 03-18-2014
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Although previous studies have suggested the potential advantages of albumin administration in patients with severe sepsis, its efficacy has not been fully established.
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Modular extracorporeal life support: effects of ultrafiltrate recirculation on the performance of an extracorporeal carbon dioxide removal device.
ASAIO J.
PUBLISHED: 03-12-2014
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The combination of extracorporeal carbon dioxide removal (ECCO2R) and hemofiltration is a possible therapeutic strategy for patients needing both lung and renal support. We tested the effects of the recirculation of ultrafiltrate on membrane lung (ML) CO2 removal (VCO2ML). Three conscious, spontaneously breathing sheep were connected to a commercially produced ECCO2R device (Hemolung; Alung Technologies, Pittsburgh, PA) with a blood flow of 250 ml/min and a gas flow of 10 L/min. A hemofilter (NxStage, NxStage Medical, Lawrence, MA) was interposed in series after the ML. Ultrafiltrate flow was generated and recirculated before the ML. We tested four ultrafiltrate flows (0, 50, 100, and 150 ml/min) for 25 min each, eight times per animal, resulting in 24 randomized test repetitions. We recorded VCO2ML, hemodynamics and ventilatory variables, and natural lung CO2 transfer (VCO2NL) and collected arterial and circuitry blood samples. VCO2ML was unchanged by application of ultrafiltrate recirculation (40.5 ± 4.0, 39.7 ± 4.2, 39.8 ± 4.2, and 39.2 ± 4.1 ml/min, respectively, at ultrafiltrate flow of 0, 50, 100, and 150 ml/min). Minute ventilation, respiratory rate, VCO2NL, and arterial blood analyses were not affected by ultrafiltrate recirculation. In the tested configuration, ultrafiltrate recirculation did not affect VCO2ML. This modular technology may provide a suitable platform for coupling CO2 removal with various forms of blood purification.
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The application of esophageal pressure measurement in patients with respiratory failure.
Am. J. Respir. Crit. Care Med.
PUBLISHED: 01-29-2014
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This report summarizes current physiological and technical knowledge on esophageal pressure (Pes) measurements in patients receiving mechanical ventilation. The respiratory changes in Pes are representative of changes in pleural pressure. The difference between airway pressure (Paw) and Pes is a valid estimate of transpulmonary pressure. Pes helps determine what fraction of Paw is applied to overcome lung and chest wall elastance. Pes is usually measured via a catheter with an air-filled thin-walled latex balloon inserted nasally or orally. To validate Pes measurement, a dynamic occlusion test measures the ratio of change in Pes to change in Paw during inspiratory efforts against a closed airway. A ratio close to unity indicates that the system provides a valid measurement. Provided transpulmonary pressure is the lung-distending pressure, and that chest wall elastance may vary among individuals, a physiologically based ventilator strategy should take the transpulmonary pressure into account. For monitoring purposes, clinicians rely mostly on Paw and flow waveforms. However, these measurements may mask profound patient-ventilator asynchrony and do not allow respiratory muscle effort assessment. Pes also permits the measurement of transmural vascular pressures during both passive and active breathing. Pes measurements have enhanced our understanding of the pathophysiology of acute lung injury, patient-ventilator interaction, and weaning failure. The use of Pes for positive end-expiratory pressure titration may help improve oxygenation and compliance. Pes measurements make it feasible to individualize the level of muscle effort during mechanical ventilation and weaning. The time is now right to apply the knowledge obtained with Pes to improve the management of critically ill and ventilator-dependent patients.
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Regional blood acidification enhances extracorporeal carbon dioxide removal: a 48-hour animal study.
Anesthesiology
PUBLISHED: 01-24-2014
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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 efficacy and feasibility of such technology applied for 48 h.
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Extracorporeal carbon dioxide removal through ventilation of acidified dialysate: an experimental study.
J. Heart Lung Transplant.
PUBLISHED: 01-21-2014
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Extracorporeal (EC) carbon dioxide (CO(2)) removal (ECCO(2)R) 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 ECCO(2)R. We evaluated an innovative ECCO(2)R technique based on ventilation of acidified dialysate.
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New treatment bundles improve survival in out-of-hospital cardiac arrest patients: a historical comparison.
Resuscitation
PUBLISHED: 01-19-2014
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Before the introduction of the new international cardiac arrest treatment guidelines in 2005, patients with out-of-hospital cardiac arrest (OHCA) of cardiac origin in Northern Italy had very poor prognosis. Since 2006, a new bundle of care comprising use of automated external defibrillators (AEDs) and therapeutic hypothermia (TH) was started, while extracorporeal CPR program (ECPR) for selected refractory CA and dispatcher-assisted cardio-pulmonary resuscitation (CPR) was started in January 2010.
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A meta-analysis of complications and mortality of extracorporeal membrane oxygenation.
Crit Care Resusc
PUBLISHED: 08-16-2013
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To comprehensively assess published peer-reviewed studies related to extracorporeal membrane oxygenation (ECMO), focusing on outcomes and complications of ECMO in adult patients.
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Effect of percutaneous tracheostomy on gas exchange in hypoxemic and non-hypoxemic mechanically ventilated patients.
Respir Care
PUBLISHED: 07-09-2013
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The influence of percutaneous tracheostomy on ventilator-dependence and clinical outcomes has been investigated in a number of studies. However, except for the variations during the procedure, the impact of tracheostomy on gas exchange has been scarcely explored. We investigated the effect of tracheostomy on respiratory function in a cohort of ICU patients.
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Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure: impact and clinical fallout through the following 20 years.
Intensive Care Med
PUBLISHED: 06-26-2013
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In patients with acute respiratory distress syndrome (ARDS), in supine position, there is a decrease of inflation along the sternum vertebral axis, up to lung collapse. In 1991 we published a report showing that, in ARDS patients, shifting from supine to prone position led immediately to the inversion of the inflation gradient and to a redistribution of densities from dorsal to ventral lung regions. This led to a "sponge model" as a wet sponge, similar to a heavy edematous lung, squeezes out the gas in the most dependent regions, due to the weight-related increase of the compressive forces. The sponge model accounts for density distribution in prone position, for which the unloaded dorsal regions are recruited, while the loaded ventral region, collapses. In addition, the sponge model accounts for the mechanism through which the positive end-expiratory pressure acts as counterforce to oppose the collapsing, compressing forces. The final result of proning was that the inversion of gravitational forces, together with other factors such as lung-chest wall shape-matching and the heart weight led to a more homogeneous distribution of inflation throughout the lung parenchyma. This is associated with oxygenation improvement as the dorsal recruitment, for anatomical reasons, prevails on the ventral de-recruitment. The more homogeneous distribution of inflation (i.e. of stress and strain) decreases/prevents the ventilator-induced lung injury, as consistently shown in animal experiments. Finally, and a series of clinical trials led to the conclusion that in patients with severe ARDS, the prone position provides a significant survival advantage.
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Unilateral acid aspiration augments the effects of ventilator lung injury in the contralateral lung.
Anesthesiology
PUBLISHED: 05-18-2013
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Mechanical ventilation is necessary during acute respiratory distress syndrome, but it promotes lung injury because of the excessive stretch applied to the aerated parenchyma. The authors hypothesis was that after a regional lung injury, the noxious effect of mechanical ventilation on the remaining aerated parenchyma would be more pronounced.
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Infusion of 2.5 meq/min of lactic acid minimally increases CO2 production compared to an isocaloric glucose infusion in healthy anesthetized, mechanically ventilated pigs.
Crit Care
PUBLISHED: 03-27-2013
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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 total body CO2 production (VCO2), limiting the potential beneficial effects of this technique. The aim of our study was to compare VCO? during isocaloric infusion of lactic acid or glucose.
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Topographic distribution of tidal ventilation in acute respiratory distress syndrome: effects of positive end-expiratory pressure and pressure support.
Crit. Care Med.
PUBLISHED: 03-20-2013
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Acute respiratory distress syndrome is characterized by collapse of gravitationally dependent lung regions that usually diverts tidal ventilation toward nondependent regions. We hypothesized that higher positive end-expiratory pressure and enhanced spontaneous breathing may increase the proportion of tidal ventilation reaching dependent lung regions in patients with acute respiratory distress syndrome undergoing pressure support ventilation.
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Estimation of patients inspiratory effort from the electrical activity of the diaphragm.
Crit. Care Med.
PUBLISHED: 03-13-2013
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To calculate an index (termed Pmusc/Eadi index) relating the pressure generated by the respiratory muscles (Pmusc) to the electrical activity of the diaphragm (Eadi), during assisted mechanical ventilation and to assess if the Pmusc/Eadi index is affected by the type and level of ventilator assistance. The Pmusc/Eadi index was also used to measure the patients inspiratory effort from Eadi without esophageal pressure.
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Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO.
Crit Care
PUBLISHED: 02-13-2013
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INTRODUCTION: H1N1 influenza can cause severe acute lung injury (ALI). Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for H1N1-associated ALI. METHODS: CENTRAL, Google Scholar, MEDLINE/PubMed and Scopus (updated 2 January 2012) were systematically searched. Studies reporting on 10 or more patients with H1N1 infection treated with ECMO were included. Baseline, procedural, outcome and validity data were systematically appraised and pooled, when appropriate, with random-effect methods. RESULTS: From 1,196 initial citations, 8 studies were selected, including 1,357 patients with confirmed/suspected H1N1 infection requiring intensive care unit admission, 266 (20%) of whom were treated with ECMO. Patients had a median Sequential Organ Failure Assessment (SOFA) score of 9, and had received mechanical ventilation before ECMO implementation for a median of two days. ECMO was implanted before inter-hospital patient transfer in 72% of cases and in most patients (94%) the veno-venous configuration was used. ECMO was maintained for a median of 10 days. Outcomes were highly variable among the included studies, with in-hospital or short-term mortality ranging between 8% and 65%, mainly depending on baseline patient features. Random-effect pooled estimates suggested an overall in-hospital mortality of 28% (95% confidence interval 18% to 37%; I2 = 64%). CONCLUSIONS: ECMO is feasible and effective in patients with ALI due to H1N1 infection. Despite this, prolonged support (more than one week) is required in most cases, and subjects with severe comorbidities or multiorgan failure remain at high risk of in-hospital death.
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Nonconventional support of respiration.
Curr Opin Crit Care
PUBLISHED: 08-10-2011
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Several alternative treatments have been proposed to decrease mortality of patients with acute respiratory distress syndrome (ARDS). We will discuss most recent trials and meta-analysis studies on nonconventional ventilatory and pharmacological treatments of ARDS patients.
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Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: 5-year experience.
Int J Artif Organs
PUBLISHED: 05-21-2011
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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.
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Bronchopleural fistulae and pulmonary ossification in posttraumatic acute respiratory distress syndrome: successful treatment with extracorporeal support.
ASAIO J.
PUBLISHED: 05-11-2011
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We report a case of severe posttraumatic acute respiratory distress syndrome (ARDS) complicated by bronchopleural fistulae (BPF). The stiff ARDS lung and huge air leaks from BPF resulted in the failure of different protective mechanical ventilation strategies to provide viable gas exchange. Lung rest, achieved by extracorporeal carbon dioxide removal (ECCO?R), allowed weaning from mechanical ventilation, closure of BPF, and resumption of spontaneous breathing.
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Respiratory pattern during neurally adjusted ventilatory assist in acute respiratory failure patients.
Intensive Care Med
PUBLISHED: 03-09-2011
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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 (V (T)) above 8 and 10 ml/kg in acute respiratory failure patients.
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The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks.
Intensive Care Med
PUBLISHED: 03-02-2011
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In view of the expected 2009 influenza A(H1N1) pandemic, the Italian Health Authorities set up a national referral network of selected intensive care units (ICU) able to provide advanced respiratory care up to extracorporeal membrane oxygenation (ECMO) for patients with acute respiratory distress syndrome (ARDS). We describe the organization and results of the network, known as ECMOnet.
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Performance of different continuous positive airway pressure helmets equipped with safety valves during failure of fresh gas supply.
Intensive Care Med
PUBLISHED: 02-16-2011
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We assessed the performance of different continuous positive airway pressure (CPAP) helmets equipped with a safety valve during discontinuation of fresh gas flow.
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Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis.
Crit Care
PUBLISHED: 02-09-2011
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Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case. Randomised studies of the effectiveness of intensive care are difficult to justify on ethical grounds; therefore, this observational study examined the cost effectiveness of ICU admission by comparing patients who were accepted into ICU after ICU triage to those who were not accepted, while attempting to adjust such comparison for confounding factors.
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Tracheal secretion management in the mechanically ventilated patient: comparison of standard assessment and an acoustic secretion detector.
Respir Care
PUBLISHED: 01-27-2011
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Standard indications for endotracheal suctioning are often based on clinical judgment on the deterioration of the patients condition, and/or routine suctioning. TBA Care is a secretion detector that analyses airway sounds and indicates the need for suctioning.
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Lung regional metabolic activity and gas volume changes induced by tidal ventilation in patients with acute lung injury.
Am. J. Respir. Crit. Care Med.
PUBLISHED: 01-21-2011
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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 be measured by positron emission tomography imaging of [(18)F]fluoro-2-deoxy-D-glucose.
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Carbon dioxide dialysis will save the lung.
Crit. Care Med.
PUBLISHED: 12-18-2010
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Mechanical ventilation and ventilator-associated lung injury could be avoided by decreasing the ventilatory needs of the patient by extracorporeal carbon dioxide removal. The reasons for the increased ventilatory needs of the patients with acute respiratory distress syndrome are outlined, as well as some of the mechanisms of continuing damage. Extracorporeal gas exchange has been used mainly as a rescue procedure for severely hypoxic patients. Although this indication remains valid, we propose that extracorporeal carbon dioxide removal could control the ventilatory needs of the patient and allow the maintenance of spontaneous breathing while avoiding intubation and decreasing the concurrent sedation needs. A scenario is depicted whereby an efficient carbon dioxide removal device can maintain blood gas homeostasis of the patient with invasiveness comparable to hemodialysis. High carbon dioxide removal efficiency may be achieved by combinations of hemofiltration and metabolizable acid loads.
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Elevated plasma and alveolar levels of soluble receptor for advanced glycation endproducts are associated with severity of lung dysfunction in ARDS patients.
Tohoku J. Exp. Med.
PUBLISHED: 09-30-2010
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Acute lung injury and acute respiratory distress syndrome (ALI/ARDS) are severe forms of bilateral lung inflammation with poor clinical outcomes. However, the pathophysiology of ALI/ARDS remains largely obscure. Soluble receptor for advanced glycation endproducts (sRAGE) plays a key regulatory role during the acute phase of inflammation, and baseline plasma levels of sRAGE were recently found to be associated with severity of ALI/ARDS. We analyzed, in ALI/ARDS patients, plasma and alveolar levels of sRAGE over time and the association with severity of lung injury. We enrolled 21 ALI/ARDS patients admitted to our intensive care unit (ICU) and assayed plasma sRAGE on the first 2 days after diagnosis, every three days for the first month and then once a week, until ICU discharge or death. We also measured sRAGE levels in bronchoalveolar lavage fluids, obtained when clinically indicated. At each sampling time, we recorded physiological and clinical data of the patients. Plasma sRAGE levels peaked at day 1 and decreased over time. When all samples were considered, plasma and alveolar sRAGE levels were significantly higher in patients with worse oxygenation and higher need for ventilatory support (i.e., patients with more severe lung dysfunction). Moreover, the presence of lung infection yielded higher alveolar sRAGE levels. In conclusion, we show that the plasma and alveolar levels of sRAGE in ALI/ARDS patients are correlated to lung injury severity and to lung infection. Our findings may, in time, lead to the development of more effective therapies against ALI/ARDS.
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Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness).
Circulation
PUBLISHED: 08-02-2010
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Transnasal evaporative cooling has sufficient heat transfer capacity for effective intra-arrest cooling and improves survival in swine. The aim of this study was to determine the safety, feasibility, and cooling efficacy of prehospital transnasal cooling in humans and to explore its effects on neurologically intact survival to hospital discharge.
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Increase of oxygen consumption during a progressive decrease of ventilatory support is lower in patients failing the trial in comparison with those who succeed.
Anesthesiology
PUBLISHED: 07-09-2010
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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).
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Percutaneous vascular cannulation for extracorporeal life support (ECLS): a modified technique.
Int J Artif Organs
PUBLISHED: 07-07-2010
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Vascular access and cannulation are crucial issues to maximize the efficiency of extracorporeal circulation techniques and to preserve patients safety. Techniques of cannulation have changed over the years, from surgical cutdown to percutaneous approaches, which are now considered standard practice. We describe an original modified percutaneous cannulation technique developed in our Department and we report our clinical experience and complications observed.
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Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study.
Intensive Care Med
PUBLISHED: 06-16-2010
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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 end expiratory pressures (PEEP) in reducing fluid leakage across the cuff.
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The effect of a single bolus of exogenous surfactant on lung compliance persists until two weeks after treatment in a model of acid aspiration pneumonitis.
Pulm Pharmacol Ther
PUBLISHED: 05-04-2010
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Aspiration pneumonitis, a direct cause of acute lung injury, is associated to a severe deterioration of lung function due in part to endogenous surfactant system impairment. We evaluated the effects of selective exogenous surfactant administration in a murine model of acid-induced lung injury both at short and long term. Hydrochloric acid was instilled into the right bronchus of the mice (0.1 M, 1.5 ml/kg). Six hours from acid instillation, they received, in the injured lung, a 1 ml/kg bolus of porcine surfactant (Curosurf®) 40 or 80 mg phospholipids/ml (Surf?? or Surf??), or saline (0.9% NaCl, vehicle) Functional, biochemical, histological and inflammatory results were obtained 24 h after injury. In the Surf?? and vehicle group, lung mechanics and histology were assessed again after two weeks. Micro-Computed Tomography scans were performed at 24 h and two weeks. 24 h after injury in the Surf?? group respiratory system compliance and oxygenation were significantly improved compared to the vehicle, while neutrophilic fraction in bronchoalveolar lavage was significantly lower. Surfactant-treated mice maintained a better compliance and a significantly reduced inflammatory infiltrate also two weeks after treatment compared to vehicle. Micro-Computed Tomography scan suggested a more pronounced reduction of injury in surfactant-treated animals two weeks after injury (p = 0.09). We showed a beneficial effect on lung function of a single bolus of exogenous surfactant in unilateral acid-induced lung injury up to two weeks after treatment. Our results may suggest a role of surfactant replacement in modulating spontaneous evolution of injury.
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Role of absolute lung volume to assess alveolar recruitment in acute respiratory distress syndrome patients.
Crit. Care Med.
PUBLISHED: 03-24-2010
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It is commonly assumed that lung volume at zero end-expiratory pressure (functional residual capacity) is not affected by positive end-expiratory pressure (PEEP) even in presence of alveolar recruitment, and it is often ignored when measuring lung recruitment by pressure-volume curves. Aim of the study was to investigate the effect of PEEP on functional residual capacity, and quantify the error of considering equal functional residual capacity in measuring alveolar recruitment.
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Continuous flow biphasic positive airway pressure by helmet in patients with acute hypoxic respiratory failure: effect on oxygenation.
Intensive Care Med
PUBLISHED: 03-23-2010
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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.
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Lateral-horizontal patient position and horizontal orientation of the endotracheal tube to prevent aspiration in adult surgical intensive care unit patients: a feasibility study.
Respir Care
PUBLISHED: 03-04-2010
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Recent data suggest that during mechanical ventilation the lateral-horizontal patient position (in which the endotracheal tube is horizontal) decreases the risk of ventilator-associated pneumonia, compared to the recommended semi-recumbent position (in which the endotracheal tube slopes downward into the trachea). We tested the feasibility of the lateral-horizontal patient position, measured the incidence of aspiration of gastric contents, and watched for any adverse effects related to the lateral-horizontal position.
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Airway pressure and flow monitoring.
Curr Opin Crit Care
PUBLISHED: 02-20-2010
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We report on the evolution of airway pressure and flow monitoring from a pathophysiological tool to the cornerstone of ventilator-induced lung injury (VILI) prevention.
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Persisting high levels of plasma pentraxin 3 over the first days after severe sepsis and septic shock onset are associated with mortality.
Intensive Care Med
PUBLISHED: 01-30-2010
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Pentraxin 3 (PTX3) is an inflammatory mediator produced by neutrophils, macrophages, myeloid dendritic and endothelial cells. During sepsis a massive inflammatory activation and coagulation/fibrinolysis dysfunction occur. PTX3, as a mediator of inflammation, may represent an early marker of severity and outcome in sepsis.
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Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial.
JAMA
PUBLISHED: 11-12-2009
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Post hoc analysis of a previous trial has suggested that prone positioning may improve survival in patients with severe hypoxemia and with acute respiratory distress syndrome (ARDS).
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Decreasing pulmonary ventilation through bicarbonate ultrafiltration: an experimental study.
Crit. Care Med.
PUBLISHED: 07-16-2009
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: To demonstrate the technical feasibility of CO2 removal with a commercial hemofilter and a replacement solution containing sodium hydroxide to replace bicarbonate.
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Is helmet CPAP first line pre-hospital treatment of presumed severe acute pulmonary edema?
Intensive Care Med
PUBLISHED: 07-14-2009
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Non-invasive continuous positive airway pressure (CPAP) is effective in reducing intubation rate and mortality of patient with acute cardiogenic pulmonary edema (ACPE). We report our experience on pre-hospital application of CPAP by helmet as an adjunct to medical therapy or as a stand alone procedure in patient with presumed ACPE.
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Lungs of patients with acute respiratory distress syndrome show diffuse inflammation in normally aerated regions: a [18F]-fluoro-2-deoxy-D-glucose PET/CT study.
Crit. Care Med.
PUBLISHED: 06-03-2009
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Neutrophilic inflammation plays a key role in the pathogenesis of acute respiratory distress syndrome (ARDS) and acute lung injury (ALI). Positron emission tomography (PET) with [F]-fluoro-2-deoxy-D-glucose (FDG) can be used to image cellular metabolism that, during lung inflammatory processes, likely reflects neutrophils activity. The aim of this study was to assess the magnitude and regional distribution of inflammatory metabolic activity in the lungs of patients with ALI/ARDS by PET with FDG.
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Tight glycemic control may favor fibrinolysis in patients with sepsis.
Crit. Care Med.
PUBLISHED: 05-07-2009
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To investigate whether tight glycemic control, in patients with sepsis, may restore a normal fibrinolysis by lowering plasminogen activator inhibitor (PAI)-1 levels.
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Anaesthesiological strategies in elective craniotomy: randomized, equivalence, open trial--the NeuroMorfeo trial.
Trials
PUBLISHED: 04-06-2009
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Many studies have attempted to determine the "best" anaesthetic technique for neurosurgical procedures in patients without intracranial hypertension. So far, no study comparing intravenous (IA) with volatile-based neuroanaesthesia (VA) has been able to demonstrate major outcome differences nor a superiority of one of the two strategies in patients undergoing elective supratentorial neurosurgery. Therefore, current practice varies and includes the use of either volatile or intravenous anaesthetics in addition to narcotics. Actually the choice of the anaesthesiological strategy depends only on the anaesthetists preferences or institutional policies. This trial, named NeuroMorfeo, aims to assess the equivalence between volatile and intravenous anaesthetics for neurosurgical procedures.
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Blood acidification enhances carbon dioxide removal of membrane lung: an experimental study.
Intensive Care Med
PUBLISHED: 02-03-2009
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Extracorporeal CO2 removal 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 CO2 transfer through the membrane lung (ML) may lower the demand of extracorporeal blood flow and consequently allow for a wider clinical application of this technique. Since only the dissolved CO2 (5% of the total CO2 content) is easily removed by the ML, we tested whether acidifying the blood entering the ML to convert bicarbonate ions towards dissolved CO2 could enhance the CO2 transfer though the ML.
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Short-term evaluation of sedation with sevoflurane administered by the anesthetic conserving device in critically ill patients.
Intensive Care Med
PUBLISHED: 02-03-2009
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Assessing feasibility and physiological effects of sedation with sevoflurane, administered with the anesthetic conserving device (AnaConDa), in comparison with propofol and remifentanil.
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Extracorporeal gas exchange.
Curr Opin Crit Care
PUBLISHED: 01-31-2009
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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.
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An improved Boussignac device for the delivery of non-invasive CPAP: the SUPER-Boussignac.
Intensive Care Med
PUBLISHED: 01-24-2009
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The purpose of this study is to describe and test a modified Boussignac system for non-invasive continuous positive airway pressure, aimed at reducing the decrease in inspiratory oxygen fraction (FiO(2)) with higher inspiratory peak flow rates.
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Patient-ventilator interaction in ARDS patients with extremely low compliance undergoing ECMO: a novel approach based on diaphragm electrical activity.
Intensive Care Med
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Patients with acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) usually present very low respiratory system compliance (Cst(rs)) values (i.e., severe restrictive respiratory syndrome patients). As a consequence, they are at high risk of experiencing poor patient-ventilator interaction during assisted breathing. We hypothesized that monitoring of diaphragm electrical activity (EAdi) may enhance asynchrony assessment and that neurally adjusted ventilatory assist (NAVA) may reduce asynchrony, especially in more severely restricted patients.
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Predicting mortality risk in patients undergoing venovenous ECMO for ARDS due to influenza A (H1N1) pneumonia: the ECMOnet score.
Intensive Care Med
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The decision to start venovenous extracorporeal membrane oxygenation (VV ECMO) is commonly based on the severity of respiratory failure, with little consideration of the extrapulmonary organ function. The aim of the study was to identify predictors of mortality and to develop a score allowing a better stratification of patients at the time of VV ECMO initiation.
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Inhalation versus endovenous sedation in subarachnoid hemorrhage patients: effects on regional cerebral blood flow.
Crit. Care Med.
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Isoflurane is a volatile anesthetic that has a vasodilating effect on cerebral vessels producing a cerebral blood flow increase. Furthermore, it has been shown in animal studies that isoflurane, when used as a preconditioning agent, has neuroprotective properties, inducing tolerance to ischemia. However, it is not routinely used in neurointensive care because of the potential increase in intracranial pressure caused by the rise in cerebral blood flow. Nevertheless, subarachnoid hemorrhage patients who are at risk for vasospasm may benefit from an increase in cerebral blood flow. We measured regional cerebral blood flow during intravenous sedation with propofol and during sedation with isoflurane in patients with severe subarachnoid hemorrhage not having intracranial hypertension.
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Assessment of patient-ventilator breath contribution during neurally adjusted ventilatory assist.
Intensive Care Med
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During neurally adjusted ventilatory assist (NAVA), it is difficult to quantify the relative contribution of the patient versus the ventilator to the inspiratory tidal volume (Vt(insp)). To solve this problem, we developed an index, the "patient-ventilator breath contribution" (PVBC), using the inspiratory deflection of the diaphragmatic electrical activity (?EAdi) and Vt(insp) during assisted and non-assisted breaths. This study evaluated the PVBC index in an experimental setup.
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A multicentre, randomised, open-label, controlled trial evaluating equivalence of inhalational and intravenous anaesthesia during elective craniotomy.
Eur J Anaesthesiol
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A clear preference for intravenous or inhalational anaesthesia has not been established for craniotomy in patients without signs of cerebral hypertension.
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Clinical review: Respiratory monitoring in the ICU - a consensus of 16.
Crit Care
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Monitoring plays an important role in the current management of patients with acute respiratory failure but sometimes lacks definition regarding which signals and derived variables should be prioritized as well as specifics related to timing (continuous versus intermittent) and modality (static versus dynamic). Many new techniques of respiratory monitoring have been made available for clinical use recently, but their place is not always well defined. Appropriate use of available monitoring techniques and correct interpretation of the data provided can help improve our understanding of the disease processes involved and the effects of clinical interventions. In this consensus paper, we provide an overview of the important parameters that can and should be monitored in the critically ill patient with respiratory failure and discuss how the data provided can impact on clinical management.
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Use of extracorporeal respiratory support during pregnancy: a case report and literature review.
ASAIO J.
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We describe the case of a 25 year-old woman at 27 weeks of gestation who was admitted to our intensive care unit (ICU) for acute respiratory distress syndrome (ARDS) caused by pandemic 2009 H1N1 influenza A. She presented with septic shock and refractory hypoxemia unresponsive to rescue therapies such as recruitment maneuvers, prone positioning, and nitric oxide inhalation. Extracorporeal membrane oxygenation (ECMO) for respiratory support was instituted, and the patients clinical conditions progressively improved: she was extubated after 16 days and discharged from the ICU 3 days later. No fetal complications were observed. At 38 weeks of gestation she gave birth to a healthy baby.
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ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure.
Intensive Care Med
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To assess whether partitioning the elastance of the respiratory system (E (RS)) between lung (E (L)) and chest wall (E (CW)) elastance in order to target values of end-inspiratory transpulmonary pressure (PPLAT(L)) close to its upper physiological limit (25 cmH(2)O) may optimize oxygenation allowing conventional treatment in patients with influenza A (H1N1)-associated ARDS referred for extracorporeal membrane oxygenation (ECMO).
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Time course of metabolic activity and cellular infiltration in a murine model of acid-induced lung injury.
Intensive Care Med
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This study investigates whether positron emission tomography (PET) can be used to monitor the inflammatory response and its correlation with the later fibroproliferative phase in an experimental model of acute lung injury.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.