Time course of the Bioelectrical Impedance Vector Analysis and muscular ultrasound in critically ill patients.

Purpose: Several different tools have been developed to integrate the clinical and biochemical nutritional evaluations in critical care patients. Aims of this study were to evaluate the changes in the Bioelectrical Impedance Vector Analysis (BIVA) and ultrasonographic features of the diaphragm (DTee) and rectus femoris (RFCSA) during the first week of ICU stay.

Materials And Methods: Ninety-six adult mechanically ventilated patients enrolled within 24 h after the admission to the ICU (T1).

Hysteresis and Lung Recruitment in Acute Respiratory Distress Syndrome Patients: A CT Scan Study.

Objectives: Hysteresis of the respiratory system pressure-volume curve is related to alveolar surface forces, lung stress relaxation, and tidal reexpansion/collapse. Hysteresis has been suggested as a means of assessing lung recruitment. The objective of this study was to determine the relationship between hysteresis, mechanical characteristics of the respiratory system, and lung recruitment assessed by a CT scan in mechanically ventilated acute respiratory distress syndrome patients.

Effect of mechanical power on intensive care mortality in ARDS patients.

Background: In ARDS patients, mechanical ventilation should minimize ventilator-induced lung injury. The mechanical power which is the energy per unit time released to the respiratory system according to the applied tidal volume, PEEP, respiratory rate, and flow should reflect the ventilator-induced lung injury. However, similar levels of mechanical power applied in different lung sizes could be associated to different effects.

Dynamic hyperinflation and intrinsic positive end-expiratory pressure in ARDS patients.

Background: In ARDS patients, changes in respiratory mechanical properties and ventilatory settings can cause incomplete lung deflation at end-expiration. Both can promote dynamic hyperinflation and intrinsic positive end-expiratory pressure (PEEP). The aim of this study was to investigate, in a large population of ARDS patients, the presence of intrinsic PEEP, possible associated factors (patients' characteristics and ventilator settings), and the effects of two different external PEEP levels on the intrinsic PEEP.

Gas exchange, specific lung elastance and mechanical power in the early and persistent ARDS.

Purpose: Aim of this study was to evaluate the effect of acute respiratory distress syndrome (ARDS) duration on gas-exchange, respiratory mechanics, specific lung elastance and mechanical power.

Materials And Methods: In a single center prospective study 28 ARDS patients (66.4 ± 10.

Global and Regional Diagnostic Accuracy of Lung Ultrasound Compared to CT in Patients With Acute Respiratory Distress Syndrome.

Objectives: Lung CT is the reference imaging technique for acute respiratory distress syndrome, but requires transportation outside the intensive care and x-ray exposure. Lung ultrasound is a promising, inexpensive, radiation-free, tool for bedside imaging. Aim of the present study was to compare the global and regional diagnostic accuracy of lung ultrasound and CT scan.

Clinical review: peripheral muscular ultrasound in the ICU.

Muscular weakness developing from critical illness neuropathy, myopathy and muscle atrophy has been characterized as intensive care unit-acquired weakness (ICUAW). This entity occurs commonly during and after critical care stay. Various causal factors for functional incapacity have been proposed.

Different routes and formulations of melatonin in critically ill patients. A pharmacokinetic randomized study.

Background And Objectives: Critically ill patients present reduced endogenous melatonin blood levels, and they might benefit from its exogenous supplementation. The aim of this research was to evaluate the feasibility of different routes of administration and drug formulations of melatonin. The efficiency of absorption was assessed as well as the adequacy in achieving and maintaining the physiological nocturnal blood peak.

Respiratory Mechanics, Lung Recruitability, and Gas Exchange in Pulmonary and Extrapulmonary Acute Respiratory Distress Syndrome.

Objectives: Acute respiratory distress syndrome is a clinical syndrome characterized by a refractory hypoxemia due to an inflammatory and high permeability pulmonary edema secondary to direct or indirect lung insult (pulmonary and extrapulmonary form). Aim of this study was to evaluate in a large database of acute respiratory distress syndrome patients, the pulmonary versus extrapulmonary form in terms of respiratory mechanics, lung recruitment, gas exchange, and positive end-expiratory pressure response.

Design: A secondary analysis of previously published data.

Low-dose CT scan in stone detection for stone treatment follow-up: is there a relation between stone composition and radiation delivery? Study on a porcine-kidney model.

Background: Non-contrast CT scan (NCCT) is becoming the standard imaging modality in urinary stone disease. Radiation dose remains an issue, especially for those patients who may need to undergo several CT scans for this indication during their lifetime. Low-dose and ultra-low-dose protocols exist, but there is limited data on the relationship between the minimum radiation dose capable of detecting stone fragments and stone composition.

What's Next After ARDS: Long-Term Outcomes.

ARDS is a life-threatening organ failure due to several pulmonary and extrapulmonary injuries with an incidence between 5 and 60 cases/100,000 persons/y. Patients with ARDS have non-cardiogenic pulmonary edema and dyspnea often requiring invasive mechanical ventilation and intensive care admission. Although the short-term mortality rate has significantly decreased in the last decade, mainly due to the widespread application of lung-protective ventilation and better general support, long-term outcomes are still unsatisfactory.

The occlusion tests and end-expiratory esophageal pressure: measurements and comparison in controlled and assisted ventilation.

Background: Esophageal pressure is used as a reliable surrogate of the pleural pressure. It is conventionally measured by an esophageal balloon placed in the lower part of the esophagus. To validate the correct position of the balloon, a positive pressure occlusion test by compressing the thorax during an end-expiratory pause or a Baydur test obtained by occluding the airway during an inspiratory effort is used.

A standardized model of brain death, donor treatment, and lung transplantation for studies on organ preservation and reconditioning.

Background: We set a model of brain death, donor management, and lung transplantation for studies on lung preservation and reconditioning before transplantation.

Methods: Ten pigs (39.7 ± 5.

β-blockers in critically ill patients: from physiology to clinical evidence.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015.

Extracorporeal life support as bridge to lung transplantation: a systematic review.

Introduction: Patients with acute respiratory failure requiring respiratory support with invasive mechanical ventilation while awaiting lung transplantation are at a high risk of death. Extracorporeal membrane oxygenation (ECMO) has been proposed as an alternative bridging strategy to mechanical ventilation. The aim of this study was to assess the current evidence regarding how the ECMO bridge influences patients' survival and length of hospital stay.

Fluid resuscitation in trauma patients: what should we know?

Purpose Of Review: Fluid resuscitation in trauma patients could reduce organ failure, until blood components are available and hemorrhage is controlled. However, the ideal fluid resuscitation strategy in trauma patients remains a debated topic. Different types of trauma can require different types of fluids and different volume of infusion.

Low-dose chest computed tomography for quantitative and visual anatomical analysis in patients with acute respiratory distress syndrome.

Purpose: Chest computed tomography (CT) is a fundamental tool for the characterization of acute respiratory distress syndrome (ARDS). Its frequent use is, however, hindered by the associated radiation exposure. The aim of the present study was to evaluate, in patients with ARDS, the accuracy of quantitative and visual anatomical lung analysis performed on low-dose CT.

Ex vivo lung perfusion to improve donor lung function and increase the number of organs available for transplantation.

This paper describes the initial clinical experience of ex vivo lung perfusion (EVLP) at the Fondazione Ca' Granda in Milan between January 2011 and May 2013. EVLP was considered if donor PaO2 /FiO2 was below 300 mmHg or if lung function was doubtful. Donors with massive lung contusion, aspiration, purulent secretions, pneumonia, or sepsis were excluded.

Clinical review: Lung imaging in acute respiratory distress syndrome patients--an update.

Over the past 30 years lung imaging has greatly contributed to the current understanding of the pathophysiology and the management of acute respiratory distress syndrome (ARDS). In the past few years, in addition to chest X-ray and lung computed tomography, newer functional lung imaging techniques, such as lung ultrasound, positron emission tomography, electrical impedance tomography and magnetic resonance, have been gaining a role as diagnostic tools to optimize lung assessment and ventilator management in ARDS patients. Here we provide an updated clinical review of lung imaging in ARDS over the past few years to offer an overview of the literature on the available imaging techniques from a clinical perspective.

Sodium bicarbonate treatment during transient or sustained lactic acidemia in normoxic and normotensive rats.

Introduction: Lactic acidosis is a frequent cause of poor outcome in the intensive care settings. We set up an experimental model of lactic acid infusion in normoxic and normotensive rats to investigate the systemic effects of lactic acidemia per se without the confounding factor of an underlying organic cause of acidosis.

Methodology: Sprague Dawley rats underwent a primed endovenous infusion of L(+) lactic acid during general anesthesia.