Positive End-expiratory Pressure and Mechanical Power.

Background: Positive end-expiratory pressure is usually considered protective against ventilation-induced lung injury by reducing atelectrauma and improving lung homogeneity. However, positive end-expiratory pressure, together with tidal volume, gas flow, and respiratory rate, contributes to the mechanical power required to ventilate the lung. This study aimed at investigating the effects of increasing mechanical power by selectively modifying its positive end-expiratory pressure component.

Effectiveness of spinal anesthesia in transanal endoscopic microsurgery: a 3-year experience.

Background: The feasibility and safety of transanal endoscopic microsurgery (TEM) performed under spinal anesthesia (SA) has been recently demonstrated. This retrospective study compared the differences in opioid consumption and postoperative recovery in patients undergoing TEM under GA and SA.

Methods: All consecutive patients who underwent TEM at Città della Salute e della Scienza Hospital of Turin (Italy) between January 2012 and December 2015 were enrolled.

Reclassifying Acute Respiratory Distress Syndrome.

Rationale: The ratio of Pa to Fi (P/F) defines acute respiratory distress syndrome (ARDS) severity and suggests appropriate therapies.

Objectives: We investigated 1) whether a 150-mm-Hg P/F threshold within the range of moderate ARDS (100-200 mm Hg) would define two subgroups that were more homogeneous; and 2) which criteria led the clinicians to apply extracorporeal membrane oxygenation (ECMO) in severe ARDS.

Methods: At the 150-mm-Hg P/F threshold, moderate patients were split into mild-moderate (n = 50) and moderate-severe (n = 55) groups.

Effects of regional perfusion block in healthy and injured lungs.

Background: Severe hypoperfusion can cause lung damage. We studied the effects of regional perfusion block in normal lungs and in the lungs that had been conditioned by lavage with 500 ml saline and high V (20 ml kg) ventilation.

Methods: Nineteen pigs (61.

Positive end-expiratory pressure: how to set it at the individual level.

The positive end-expiratory pressure (PEEP), since its introduction in the treatment of acute respiratory failure, up to the 1980s was uniquely aimed to provide a viable oxygenation. Since the first application, a large debate about the criteria for selecting the PEEP levels arose within the scientific community. Lung mechanics, oxygen transport, venous admixture thresholds were all proposed, leading to PEEP recommendations from 5 up to 25 cmHO.

Driving pressure and mechanical power: new targets for VILI prevention.

Several factors have been recognized as possible triggers of ventilator-induced lung injury (VILI). The first is pressure (thus the 'barotrauma'), then the volume (hence the 'volutrauma'), finally the cyclic opening-closing of the lung units ('atelectrauma'). Less attention has been paid to the respiratory rate and the flow, although both theoretical considerations and experimental evidence attribute them a significant role in the generation of VILI.

The future of mechanical ventilation: lessons from the present and the past.

The adverse effects of mechanical ventilation in acute respiratory distress syndrome (ARDS) arise from two main causes: unphysiological increases of transpulmonary pressure and unphysiological increases/decreases of pleural pressure during positive or negative pressure ventilation. The transpulmonary pressure-related side effects primarily account for ventilator-induced lung injury (VILI) while the pleural pressure-related side effects primarily account for hemodynamic alterations. The changes of transpulmonary pressure and pleural pressure resulting from a given applied driving pressure depend on the relative elastances of the lung and chest wall.

Role and potentials of low-flow CO(2) removal system in mechanical ventilation.

Purpose Of Review: An analysis of the technological implementation of extracorporeal CO(2) removal (ECCO(2)R) techniques and of its clinical application. A new classification of ECCO(2)R, based on technological aspects, clinical properties and physiological performance, is proposed.

Recent Findings: The use of a ventilation with lower tidal volumes has been proved successful in acute respiratory distress syndrome (ARDS) patients but can be extremely problematic, especially when dealing with respiratory acidosis.