M Amato

Obstructive respiratory failure in cicatricial pemphigoid.

A 20 year old woman died of respiratory failure due to cicatricial pemphigoid of the trachea and bronchi. This is the first case with the lower airways affected to be reported.

Noninvasive positive pressure ventilation can prevent reintubation after acute respiratory failure: results of a prospective and randomized study

We hypothesize that the use of noninvasive positive pressure ventilation can be helpful in preventing reintubation after weaning of mechanical ventilation in patients with acute respiratory failure (ARF).

Low tidal volume in association with low positive end expiratory pressure in acute respiratory distress syndrome: a suboptimal strategy? A computed tomography-based analysis

In a recent trial, ARDSNet investigators found no benefit with the association of an intermediary PEEP to a low-tidal-volume (6 ml/kg) ventilatory strategy. The goal of maximal recruitment strategy (MRS) guided by thoracic CT scan is to minimize alveolar collapse and tidal recruitment (TR).

Long-term effects of two protective-ventilation strategies in an ARDS model: Open Lung Approach by EIT versus ARDSnet

Different ventilatory strategies for the acute respiratory distress syndrome have been proposed. The Open Lung Approach (OLA) emphasizes the recruitment of airway units with avoidance of tidal recruitment. The ARDSnet strategy simply emphasizes the reduction of and hyperdistension. We studied the long-term VT consequences of both strategies in a controlled experiment where pigs where randomized and submitted to one of both strategies for 48 hours. Lung injury was induced by saline lavage followed by 3 hours of injurious mechanical ventilation. In the OLA arm, PEEP was selected by the EIT after a recruitment maneuver (RM), trying to keep lung collapse to a minimum, while the ARDSnet group followed a PEEP × FiO2 table. We scrutinized lung function at the end of a 48-hour period of lung protection, after a standardized RM. The concept was to provide equivalent conditions for lungs to perform, irrespective of lung history or treatment in previous days, in terms of gas exchange or alveolar stability during slow-deflation maneuvers. Before sacrifice and after maximum RM, we collected blood gases and expiratory pressure versus ΔZ (impedance changes by electric impedance tomography). Oxygenation and alveolar stability were equally impaired in both arms after injury. However, at the end of the 48 hours there was significant improvement in the capacity of oxygenation in the OLA arm (mean = 494 mmHg; P = 0.043), but not in the ARDSNet arm (mean = 278; P = 0.285). The potential to maintain airspace volumes improved along the protective period in the OLA arm, but deteriorated in the ARDSnet arm. (See Figure ​Figure11.) Figure 1

Quantification of lung collapse during peeptitration by electrical impedance tomography in experimental ards - comparison with quantitative ct analysis

Tidal recruitment of nonaerated lung is a main cause of ventilator associated lung injury. CT as the gold standard for quantifying lung collapse (CT-collapse) is associated with certain risks for the patient (e.g. radiation exposure or transportation) and cannot be used for repeated assessments. Electrical impedance tomography (EIT) instead is a bed-side non-invasive radiation-free continuous technique for monitoring of changes in thoracic air content and distribution. EIT may also allow quantification of recruitable lunge collapse (EIT-collapse) [1].

Immediate effect of lung expansion techniques in neurosurgery patients detected by electrical impedance tomography: a randomized crossover study

The survival of patients with lesions in the central nervous system is usually accompanied by physical and mental sequelae. These impairments favor the prolonged restriction to the bed, which may contribute with changes in respiratory function. In this context, lung re-expansion techniques are used to prevent or treat the various respiratory complications.

Maximum recruitment strategy revealed efficiency and a larger recruitable lung in a prospective series of early ARDS patients

A recent meta-analysis demonstrated that higher levels of PEEP were associated with improved survival among the subgroup of patients with ARDS. The maximum recruitment strategy (MRS) guided by thoracic CT scan is capable of reversing alveolar collapse almost completely, allowing PEEP titration to sustain lungs almost fully open, homogenizing tidal ventilation and possibly reducing ventilator-induced lung injury.

Maximal recruitment strategy guided by thoracic computed tomography scan in acute respiratory distress syndrome patients: preliminary results of a clinical study.

There is great controversy concerning protective ventilatory strategy in ARDS. Recruitment maneuvers and PEEP titration sufficient to avoid collapse and tidal recruitment in the lung are the major goals of the maximal recruitment strategy (MRS) guided by computed tomography (CT).

PxV curve behavior inside and outside the thorax in normal rats

PxV curve is a good way to study the mechanical behavior of the respiratory system in animal models; however, it is important to distinguish between the behavior of the PxV curve inside the thorax (PxV curve of the respiratory system) and outside the thorax (PxV curve of the lung) as we studied in isolated lungs models.