endotoxin-activity-assay-for-detection-whole-blood-endotoxemia

Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients

Lipopolysaccharide, also known as endotoxin, is a fundamental component of gram-negative bacteria and plays a crucial role in the development of sepsis ...

a-novel-inhalation-mask-system-to-deliver-high-concentrations-nitric

A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if ...

Niguarda Hospital

University of Milan-Bicocca Medical School

Massachusetts General Hospital and Harvard Medical School

To measure the prevalence of elevated Endotoxin Activity (EA) in a large cohort of patients with Septic Shock (SS), and to assess its value as an early indicator of Gram-Negative (GN) infection, disease severity, and patient risk.

Prevalence and clinical significance of early high Endotoxin Activity in septic shock: An observational study.

Major contraindication to the endotoxemia activity assay in septic shock patients - Authors' reply.

High Positive End-Expiratory Pressure Allows Extubation of an Obese Patient.

Biofilm on the surface of endotracheal tubes (ETTs) is associated with ventilator-associated pneumonia. The use of silver-coated ETTs has been suggested to reduce the occurrence of ventilator-associated pneumonia by preventing biofilm formation. However, mucus accumulation can reduce the antibacterial activity of silver-coated ETTs by isolating bacterial colonies from the silver surface. We hypothesized that, in mechanically ventilated subjects, periodic removal of secretions through the use of a cleaning device would enhance the antimicrobial properties of silver-coated ETTs and thus reduce bacterial colonization.

Silver-Coated Endotracheal Tubes Cleaned With a Mechanism for Secretion Removal.

Limited data exist regarding ventilation in patients with class III obesity [body mass index (BMI) > 40 kg/m] and acute respiratory distress syndrome (ARDS). The aim of the present study was to determine whether an individualized titration of mechanical ventilation according to cardiopulmonary physiology reduces the mortality in patients with class III obesity and ARDS.

A lung rescue team improves survival in obesity with acute respiratory distress syndrome.

There is an increasing interest in safely delivering high dose of inhaled nitric oxide (NO) as an antimicrobial and antiviral therapeutics for spontaneously breathing patients. A novel NO delivery system is described.

Ideation and assessment of a nitric oxide delivery system for spontaneously breathing subjects.

 Obesity is characterized by elevated pleural pressure (P) and worsening atelectasis during mechanical ventilation in patients with acute respiratory distress syndrome (ARDS).  To determine the effects of lung recruitment maneuver (LRM) in the presence of elevated P on hemodynamics, left and right ventricular pressures and pulmonary vascular resistance. We hypothesized that elevated P protects the cardiovascular system against high airway pressures and prevents lung overdistension.  First, an interventional crossover trial in adult subjects with ARDS and BMI ≥35 kg/m (n=21) was performed to explore the hemodynamic consequences of LRM. Second, cardiovascular function was studied during low/high PEEPs in a model of swine with ARDS and high P (n=9) versus healthy swine with normal P (n=6).  Subjects with ARDS and obesity (BMI=57±12 kg/m), following LRM, required an increase in PEEP of 8[7, 10] cmHO above traditional ARDSnet settings to improve lung function, oxygenation and ventilation/perfusion matching, without impairment of hemodynamics or right heart function. ARDS swine with high P demonstrated unchanged transmural left ventricle pressure and systemic blood pressure after LRM protocol. Pulmonary artery hypertension decreased 8[13, 4] mmHg, as did vascular resistance 1.5[2.2, 0.9] WU, and transmural right ventricle pressure 10[15, 6] mmHg during exhalation. LRM and PEEP decreased pulmonary vascular resistance and normalized ventilation/perfusion ratio.  High airway pressure is required to recruit lung atelectasis in patients with ARDS and class III obesity but causes minimal overdistension. Additionally, patients with ARDS and class III obesity tolerate hemodynamically LRM with high airway pressure.

ArticleTotal : 2	Year
Publication title	2019
Publication title	2021

Article	Year
Prevalence and clinical significance of early high Endotoxin Activity in septic shock: An observational study. Journal of critical care\| PubMed ID: 28525777	2017
Major contraindication to the endotoxemia activity assay in septic shock patients - Authors' reply. Journal of critical care\| PubMed ID: 29174464	2018
High Positive End-Expiratory Pressure Allows Extubation of an Obese Patient. American journal of respiratory and critical care medicine\| PubMed ID: 29702003	2018
Silver-Coated Endotracheal Tubes Cleaned With a Mechanism for Secretion Removal. Respiratory care\| PubMed ID: 30181363	2019
A lung rescue team improves survival in obesity with acute respiratory distress syndrome. Critical care (London, England)\| PubMed ID: 31937345	2020
Ideation and assessment of a nitric oxide delivery system for spontaneously breathing subjects. Nitric oxide : biology and chemistry\| PubMed ID: 32835810	2020
High Pleural Pressure Prevents Alveolar Overdistension and Hemodynamic Collapse in ARDS with Class III Obesity. American journal of respiratory and critical care medicine\| PubMed ID: 32876469	2020
Bedside Electrical Impedance Tomography Unveils Respiratory "Chimera" in COVID-19. American journal of respiratory and critical care medicine\| PubMed ID: 33196303	2021

Riccardo Pinciroli

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