Corticosteroid and antimicrobial therapy in macrolide-resistant pneumococcal pneumonia porcine model.

Background: Streptococcus pneumoniae, a primary cause of community-acquired pneumonia (CAP), is typically treated with β-lactams and macrolides or quinolones. Corticosteroids are now recommended as adjunctive therapy in severe CAP to improve outcomes. In this prospective randomized animal study, we evaluated the bactericidal efficacy of various antibiotic regimens combined with corticosteroids using a porcine pneumococcal pneumonia model.

The role of inflammation and antithrombin supplementation on thromboelastographic parameters during veno-venous ECMO for respiratory failure.

Introduction: Extracorporeal membrane oxygenation (ECMO) may act as a driver or propagator of systemic inflammation. In turn, cytokine release can modify thromboelastographic (TEG) tests which are commonly used for anticoagulation monitoring. In this context, antithrombin (AT) supplementation might further modify TEG.

Agreement between the thromboelastography reaction time parameter using fresh and citrated whole blood during extracorporeal membrane oxygenation with Teg®5000 and Teg®6s.

Purpose: We aimed at assessing the correlation between TEG reaction time (TEG-R) in citrated and fresh blood samples with TEG5000 and TEG 6S during heparin administration in patients with and without ECMO support.

Materials And Methods: Paired TEG5000 (fresh and citrated whole blood, kaolin and kaolin-heparinase) and TEG6S (citrated whole blood) samples were obtained, together with standard coagulation laboratory tests. Bland-Altman analysis and Lin's concordance correlation coefficient were used to assess agreement.

Incidence, microbiological and immunological characteristics of ventilator-associated pneumonia assessed by bronchoalveolar lavage and endotracheal aspirate in a prospective cohort of COVID-19 patients: CoV-AP study.

Background: No univocal recommendation exists for microbiological diagnosis of ventilator-associated pneumonia (VAP). Sampling of either proximal or distal respiratory tract likely impacts on the broad range of VAP incidence between cohorts. Immune biomarkers to rule-in/rule-out VAP diagnosis, although promising, have not yet been validated.

A long-lasting porcine model of ARDS caused by pneumonia and ventilator-induced lung injury.

Background: Animal models of acute respiratory distress syndrome (ARDS) do not completely resemble human ARDS, struggling translational research. We aimed to characterize a porcine model of ARDS induced by pneumonia-the most common risk factor in humans-and analyze the additional effect of ventilator-induced lung injury (VILI).

Methods: Bronchoscopy-guided instillation of a multidrug-resistant Pseudomonas aeruginosa strain was performed in ten healthy pigs.

Agreement Between Viscoelastic Coagulation Monitor (VCM), TEG 5000, and Coagulation Tests in Critically Ill Patients: A Multicenter Study.

The performance of viscoelastic coagulation monitor (VCM) compared with TEG 5000 (TEG) is unknown. In this multicenter study, the authors evaluated the agreement among VCM/TEG parameters and their relationship with standard coagulation tests in critically ill patients. Viscoelastic coagulation monitor, TEG, and laboratory samples were analyzed simultaneously.

Inhaled amikacin for pneumonia treatment and dissemination prevention: an experimental model of severe monolateral Pseudomonas aeruginosa pneumonia.

Background: Pseudomonas aeruginosa pneumonia is commonly treated with systemic antibiotics to ensure adequate treatment of multidrug resistant (MDR) bacteria. However, intravenous (IV) antibiotics often achieve suboptimal pulmonary concentrations. We therefore aimed to evaluate the effect of inhaled amikacin (AMK) plus IV meropenem (MEM) on bactericidal efficacy in a swine model of monolateral MDR P.

Effects of Mechanical Insufflation-Exsufflation With Different Pressure Settings on Respiratory Mucus Displacement During Invasive Ventilation.

Background: Mechanical insufflation-exsufflation (MI-E) has been proposed as a potential strategy to generate high expiratory flows and simulate cough in the critically ill. However, efficacy and safety of MI-E during invasive mechanical ventilation are still to be fully elucidated. This study in intubated and mechanically ventilated pigs aimed to evaluate the effects of 8 combinations of insufflation-exsufflation pressures during MI-E on mucus displacement, respiratory flows, as well as respiratory mechanics and hemodynamics.

Mechanical Ventilation for COVID-19 Patients.

Non-invasive ventilation (NIV) or invasive mechanical ventilation (MV) is frequently needed in patients with acute hypoxemic respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While NIV can be delivered in hospital wards and nonintensive care environments, intubated patients require intensive care unit (ICU) admission and support. Thus, the lack of ICU beds generated by the pandemic has often forced the use of NIV in severely hypoxemic patients treated outside the ICU.

Different Inspiratory Flow Waveform during Volume-Controlled Ventilation in ARDS Patients.

The most used types of mechanical ventilation are volume- and pressure-controlled ventilation, respectively characterized by a square and a decelerating flow waveform. Nowadays, the clinical utility of different inspiratory flow waveforms remains unclear. The aim of this study was to assess the effects of four different inspiratory flow waveforms in ARDS patients.

Viscoelastic Coagulation Monitor as a Novel Device to Assess Coagulation at the Bedside. A Single-Center Experience During the COVID-19 Pandemic.

Viscoelastic coagulation monitor (VCM) is a portable device developed to evaluate the viscoelastic properties of whole blood activated by contact with glass. In this study, VCM was employed to analyze the viscoelastic profiles of 36 COVID-19 intensive care patients. Full anticoagulant dose heparin (unfractionated [UFH]; low molecular weight [LMWH]) was administrated to all patients.

Lateral position during severe mono-lateral pneumonia: an experimental study.

Patients with mono-lateral pneumonia and severe respiratory failure can be positioned in lateral decubitus, with the healthy lung dependent, to improve ventilation-perfusion coupling. Oxygenation response to this manoeuvre is heterogeneous and derecruitment of dependent lung has not been elucidated. Nine pigs (32.

Optimal approaches to preventing severe community-acquired pneumonia.

: Community-acquired pneumonia (CAP) has the highest rate of mortality of all infectious diseases, especially among the elderly. Severe CAP (sCAP) is defined as a CAP in which intensive care management is required and is associated with an unfavorable clinical course. : This review aims to identify prevention strategies for reducing the incidence of CAP and optimized management of sCAP.

Risk and Prognostic Factors in Very Old Patients with Sepsis Secondary to Community-Acquired Pneumonia.

Little is known about risk and prognostic factors in very old patients developing sepsis secondary to community-acquired pneumonia (CAP). We conducted a retrospective observational study of data prospectively collected at the Hospital Clinic of Barcelona over a 13-year period. Consecutive patients hospitalized with CAP were included if they were very old (≥80 years) and divided into those with and without sepsis for comparison.

Short-Term Appraisal of the Effects and Safety of Manual Versus Ventilator Hyperinflation in an Animal Model of Severe Pneumonia.

Background: In patients on mechanical ventilation, lung hyperinflation is often performed to reverse atelectasis and clear retained mucus. We evaluated the effects of manual hyperinflation and ventilator hyperinflation on mucus clearance, gas exchange, pulmonary mechanics, and hemodynamics.

Methods: Six mechanically ventilated pigs with severe pneumonia randomly received either 12 manual hyperinflation breaths over a period of 2 min (through a gradual manual compression of a resuscitation bag within 4 s to achieve 40 cm HO of airway pressure), or 12 ventilator hyperinflation over 2 min to achieve the same ventilatory end points as in manual hyperinflation.

An in-vitro study to evaluate high-volume low-pressure endotracheal tube cuff deflation dynamics.

Background: High-volume low-pressure (HVLP) endotracheal tube (ETT) cuffs for critically ill patients often deflate during the course of mechanical ventilation. We performed an in-vitro study to comprehensively assess HVLP cuff deflation dynamics and potential preventive measures.

Methods: We evaluated 24-hour deflation of seven HVLP cuffs of cylindrical or tapered shape, and made of polyvinylchloride or polyurethane.

Appraisal of systemic inflammation and diagnostic markers in a porcine model of VAP: secondary analysis from a study on novel preventive strategies.

Background: We previously evaluated the efficacy of a ventilatory strategy to achieve expiratory flow bias and positive end-expiratory pressure (EFB + PEEP) or the Trendelenburg position (TP) for the prevention of ventilator-associated pneumonia (VAP). These preventive measures were aimed at improving mucus clearance and reducing pulmonary aspiration of bacteria-laden oropharyngeal secretions. This secondary analysis is aimed at evaluating the effects of aforementioned interventions on systemic inflammation and to substantiate the value of clinical parameters and cytokines in the diagnosis of VAP.

A novel linkage-isomeric pair of dinuclear Pd(II) complexes bearing a bis-bidentate tetraphos ligand.

The tetraphosphane all trans tetrakis-(di(2-methoxyphenyl)phosphanyl)cyclobutane) (o-MeO-dppcb) has been employed to coordinate metal dichlorides (metal = Ni(II), Pd(II) and Pt(II)), stereoselectively yielding the dinuclear complexes [Ni(2)Cl(4)(micro-(kappaP(1):kappaP(2):kappaP(3):kappaP(4)-o-MeO-dppcb))] and [Pt(2)Cl(4)(micro-(kappaP(1),kappaP(2):kappaP(3),kappaP(4)-o-MeO-dppcb))], characterized by two six and two five-membered metallacycles, respectively. Conversely, the reaction with PdCl(2) led, under comparable synthetic conditions, to the formation of the linkage-isomeric pair [Pd(2)Cl(4)(micro-(kappaP(1),kappaP(2):kappaP(3),kappaP(4)-o-MeO-dppcb))] and [Pd(2)Cl(4)(micro-(kappaP(1):kappaP(2):kappaP(3):kappaP(4)-o-MeO-dppcb))] in a ca. 4 : 1 ratio.

Synthesis of palladium(II) complexes containing a new alpha-D-xylofuranose-modified diphosphine and their application as catalyst precursors in the co- and terpolymerization of CO-ethene and propene.

The diphosphine 3,5-dideoxy-1,2-O-isopropylidene-3,5-bis(di(2-methoxyphenyl)phosphanyl)-alpha-D-xylofuranose (o-MeO-xylophos), which differs from the known 3,5-dideoxy-1,2-O-isopropylidene-3,5-bis(diphenylphosphanyl)-alpha-D-xylofuranose (xylophos) by the presence of 2-methoxy substituents on the P-aryl rings, has been synthesized and characterized. These two ligands have been employed to stabilize the Pd(II) complexes [PdCl2(o-MeO-xylophos)] (1a), [PdCl2(xylophos)] (2a), [PdClMe(o-MeO-xylophos)] (1b), [PdClMe(xylophos)] (2b), [Pd(OTs)(H2O)(o-MeO-xylophos)](OTs) (1c) and [Pd(OTs)(H2O)(xylophos)](OTs) (2c). All complexes have been characterized by multinuclear-NMR spectroscopy.

Ligand effects in the non-alternating CO-ethylene copolymerization by palladium(II) catalysis.

In this paper we report on a comparative study of the non-alternating CO-C(2)H(4) copolymerization catalyzed by neutral Pd(II) complexes with the phosphine-sulfonate ligands bis(o-methoxyphenyl)phosphinophenylenesulfonate and bis(o-methoxyphenyl)phosphino-ethylenesulfonate. The former ligand, featuring a lower skeletal flexibility, has been found to form more active catalysts as well as produce polyketones with higher molecular weight and higher extra-ethylene incorporation. Operando high-pressure NMR studies have allowed us to intercept, for the first time, Pd(II)(phosphine-sulfonate) beta-chelates in the non-alternating copolymerization cycle, while model organometallic reactions have contributed to demonstrate that Pd(II) (phosphine-sulfonate) fragments do not form stable carbonyl complexes.

Synthesis and characterization of palladium(II) complexes with new diphosphonium-diphosphine and diphosphine ligands. Production of low molecular weight alternating polyketones via catalytic CO/ethene copolymerisation.

The bis-cationic diphosphonium-diphosphine 6,7-di(di-2-methoxyphenyl)phosphinyl-2,2,4,4-tetra(di-2-methoxyphenyl)-2 lambda 4,4 lambda 4-diphosphoniumbicyclo[3.1.1]heptane-bis(PF6) ((o-MeO-PCP)(PF6)2) and the diphosphine rac-2,4-bis((di-2-methoxyphenyl)phosphino)pentane (rac-o-MeO-bdpp) have been synthesized.