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https://www.readbyqxmd.com/read/28636403/applying-precision-medicine-to-trial-design-using-physiology-extracorporeal-co2-removal-for-ards
#1
Ewan C Goligher, Marcelo B P Amato, Arthur S Slutsky
In clinical trials of therapies for ARDS, the average treatment effect in the study population may be attenuated because individual patient responses vary widely. This inflates sample size requirements and increases the cost and difficulty of conducting successful clinical trials. One solution is to enrich the study population with patients most likely to benefit based on predicted patient response to treatment (predictive enrichment). In this perspective, we apply the precision medicine paradigm to the emerging use of extracorporeal CO2 removal (ECCO2R) for ultra-protective ventilation in ARDS...
June 21, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28593243/the-increasing-call-for-protective-ventilation-during-anesthesia
#2
João Batista Borges, Marcelo B P Amato, Göran Hedenstierna
No abstract text is available yet for this article.
June 7, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28459336/an-official-american-thoracic-society-european-society-of-intensive-care-medicine-society-of-critical-care-medicine-clinical-practice-guideline-mechanical-ventilation-in-adult-patients-with-acute-respiratory-distress-syndrome
#3
Eddy Fan, Lorenzo Del Sorbo, Ewan C Goligher, Carol L Hodgson, Laveena Munshi, Allan J Walkey, Neill K J Adhikari, Marcelo B P Amato, Richard Branson, Roy G Brower, Niall D Ferguson, Ognjen Gajic, Luciano Gattinoni, Dean Hess, Jordi Mancebo, Maureen O Meade, Daniel F McAuley, Antonio Pesenti, V Marco Ranieri, Gordon D Rubenfeld, Eileen Rubin, Maureen Seckel, Arthur S Slutsky, Daniel Talmor, B Taylor Thompson, Hannah Wunsch, Elizabeth Uleryk, Jan Brozek, Laurent J Brochard
BACKGROUND: This document provides evidence-based clinical practice guidelines on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS). METHODS: A multidisciplinary panel conducted systematic reviews and metaanalyses of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. RESULTS: For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4-8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure < 30 cm H2O) (moderate confidence in effect estimates)...
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28409685/monitoring-of-pneumothorax-appearance-with-electrical-impedance-tomography-during-recruitment-maneuvers
#4
Caio C A Morais, Roberta R De Santis Santiago, José R B de Oliveira Filho, Adriana S Hirota, Pedro H D Pacce, Juliana C Ferreira, Erick D L B Camargo, Marcelo B P Amato, Eduardo L V Costa
No abstract text is available yet for this article.
April 15, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28322416/effect-of-intensive-vs-moderate-alveolar-recruitment-strategies-added-to-lung-protective-ventilation-on-postoperative-pulmonary-complications-a-randomized-clinical-trial
#5
RANDOMIZED CONTROLLED TRIAL
Alcino Costa Leme, Ludhmila Abrahao Hajjar, Marcia S Volpe, Julia Tizue Fukushima, Roberta Ribeiro De Santis Santiago, Eduardo A Osawa, Juliano Pinheiro de Almeida, Aline Muller Gerent, Rafael Alves Franco, Maria Ignez Zanetti Feltrim, Emília Nozawa, Vera Regina de Moraes Coimbra, Rafael de Moraes Ianotti, Clarice Shiguemi Hashizume, Roberto Kalil Filho, Jose Otavio Costa Auler, Fabio Biscegli Jatene, Filomena Regina Barbosa Gomes Galas, Marcelo Britto Passos Amato
Importance: Perioperative lung-protective ventilation has been recommended to reduce pulmonary complications after cardiac surgery. The protective role of a small tidal volume (VT) has been established, whereas the added protection afforded by alveolar recruiting strategies remains controversial. Objective: To determine whether an intensive alveolar recruitment strategy could reduce postoperative pulmonary complications, when added to a protective ventilation with small VT...
April 11, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28306327/fifty-years-of-research-in-ards-respiratory-mechanics-in-acute-respiratory-distress-syndrome
#6
William R Henderson, Lu Chen, Marcelo B P Amato, Laurent J Brochard
Acute respiratory distress syndrome is a multifactorial lung injury that continues to be associated with high levels of morbidity and mortality. Mechanical ventilation, while lifesaving, is associated with new iatrogenic injury. Current best practice involves the use of small tidal volumes, low plateau and driving pressures, and high levels of positive end expiratory pressure. Collectively, these interventions are termed "lung protective ventilation". Recent investigations suggest that individualized measurements of pulmonary mechanical variables rather than population based ventilation prescriptions may be used to set the ventilator with the potential to improve outcomes beyond those achieved with standard lung protective ventilation...
March 17, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28212050/volume-controlled-ventilation-does-not-prevent-injurious-inflation-during-spontaneous-effort
#7
Takeshi Yoshida, Susumu Nakahashi, Maria Aparecida Miyuki Nakamura, Yukiko Koyama, Rollin Roldan, Vinicius Torsani, Roberta R De Santis, Susimeire Gomes, Akinori Uchiyama, Marcelo B P Amato, Brian P Kavanagh, Yuji Fujino
RATIONALE: Spontaneous breathing during mechanical ventilation increases transpulmonary pressure and tidal volume, and worsens lung injury. Intuitively, controlling tidal volume and transpulmonary pressure might limit injury from added spontaneous effort. OBJECTIVES: To test the hypothesis that during spontaneous effort in injured lungs, tidal volume and transpulmonary pressure limitation by volume-controlled ventilation results in less injurious patterns of inflation...
February 17, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28079607/mapping-regional-differences-of-local-pressure-volume-curves-with-electrical-impedance-tomography
#8
Alessandro Beda, Alysson R Carvalho, Nadja C Carvalho, Sören Hammermüller, Marcelo B P Amato, Thomas Muders, Claudia Gittel, Katharina Noreikat, Hermann Wrigge, Andreas W Reske
OBJECTIVES: Lung-protective mechanical ventilation aims to prevent alveolar collapse and overdistension, but reliable bedside methods to quantify them are lacking. We propose a quantitative descriptor of the shape of local pressure-volume curves derived from electrical impedance tomography, for computing maps that highlight the presence and location of regions of presumed tidal recruitment (i.e., elastance decrease during inflation, pressure-volume curve with upward curvature) or overdistension (i...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/27786562/fifty-years-of-research-in-ards-spontaneous-breathing-during-mechanical-ventilation-risks-mechanisms-and-management
#9
REVIEW
Takeshi Yoshida, Yuji Fujino, Marcelo B P Amato, Brian P Kavanagh
Spontaneous respiratory effort during mechanical ventilation has long been recognized to improve oxygenation, and because oxygenation is a key management target, such effort may seem beneficial. Also, disuse and loss of peripheral muscle and diaphragm function is increasingly recognized, and thus spontaneous breathing may confer additional advantage. Reflecting this, epidemiologic data suggest that the use of partial (vs. full) support modes of ventilation is increasing. Notwithstanding the central place of spontaneous breathing in mechanical ventilation, accumulating evidence indicates that it may cause-or worsen-acute lung injury, especially if acute respiratory distress syndrome is severe and spontaneous effort is vigorous...
April 15, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27596161/chest-electrical-impedance-tomography-examination-data-analysis-terminology-clinical-use-and-recommendations-consensus-statement-of-the-translational-eit-development-study-group
#10
Inéz Frerichs, Marcelo B P Amato, Anton H van Kaam, David G Tingay, Zhanqi Zhao, Bartłomiej Grychtol, Marc Bodenstein, Hervé Gagnon, Stephan H Böhm, Eckhard Teschner, Ola Stenqvist, Tommaso Mauri, Vinicius Torsani, Luigi Camporota, Andreas Schibler, Gerhard K Wolf, Diederik Gommers, Steffen Leonhardt, Andy Adler
Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use...
January 2017: Thorax
https://www.readbyqxmd.com/read/27348299/genomic-analysis-of-local-variation-and-recent-evolution-in-plasmodium-vivax
#11
Richard D Pearson, Roberto Amato, Sarah Auburn, Olivo Miotto, Jacob Almagro-Garcia, Chanaki Amaratunga, Seila Suon, Sivanna Mao, Rintis Noviyanti, Hidayat Trimarsanto, Jutta Marfurt, Nicholas M Anstey, Timothy William, Maciej F Boni, Christiane Dolecek, Hien Tinh Tran, Nicholas J White, Pascal Michon, Peter Siba, Livingstone Tavul, Gabrielle Harrison, Alyssa Barry, Ivo Mueller, Marcelo U Ferreira, Nadira Karunaweera, Milijaona Randrianarivelojosia, Qi Gao, Christina Hubbart, Lee Hart, Ben Jeffery, Eleanor Drury, Daniel Mead, Mihir Kekre, Susana Campino, Magnus Manske, Victoria J Cornelius, Bronwyn MacInnis, Kirk A Rockett, Alistair Miles, Julian C Rayner, Rick M Fairhurst, Francois Nosten, Ric N Price, Dominic P Kwiatkowski
The widespread distribution and relapsing nature of Plasmodium vivax infection present major challenges for the elimination of malaria. To characterize the genetic diversity of this parasite in individual infections and across the population, we performed deep genome sequencing of >200 clinical samples collected across the Asia-Pacific region and analyzed data on >300,000 SNPs and nine regions of the genome with large copy number variations. Individual infections showed complex patterns of genetic structure, with variation not only in the number of dominant clones but also in their level of relatedness and inbreeding...
August 2016: Nature Genetics
https://www.readbyqxmd.com/read/27334266/esophageal-and-transpulmonary-pressure-in-the-clinical-setting-meaning-usefulness-and-perspectives
#12
REVIEW
Tommaso Mauri, Takeshi Yoshida, Giacomo Bellani, Ewan C Goligher, Guillaume Carteaux, Nuttapol Rittayamai, Francesco Mojoli, Davide Chiumello, Lise Piquilloud, Salvatore Grasso, Amal Jubran, Franco Laghi, Sheldon Magder, Antonio Pesenti, Stephen Loring, Luciano Gattinoni, Daniel Talmor, Lluis Blanch, Marcelo Amato, Lu Chen, Laurent Brochard, Jordi Mancebo
PURPOSE: Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. METHODS: This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. RESULTS: After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning...
September 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27248585/the-recruitability-paradox
#13
Marcelo B P Amato, Roberta R De Santis Santiago
No abstract text is available yet for this article.
June 1, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27033882/imaging-in-acute-respiratory-distress-syndrome
#14
REVIEW
Antonio Pesenti, Guido Musch, Daniel Lichtenstein, Francesco Mojoli, Marcelo B P Amato, Gilda Cinnella, Luciano Gattinoni, Michael Quintel
PURPOSE: Imaging has become increasingly important across medical specialties for diagnostic, monitoring, and investigative purposes in acute respiratory distress syndrome (ARDS). METHODS: This review addresses the use of imaging techniques for the diagnosis and management of ARDS as well as gaining knowledge about its pathogenesis and pathophysiology. The techniques described in this article are computed tomography, positron emission tomography, and two easily accessible imaging techniques available at the bedside-ultrasound and electrical impedance tomography (EIT)...
May 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27002273/spontaneous-effort-during-mechanical-ventilation-maximal-injury-with-less-positive-end-expiratory-pressure
#15
Takeshi Yoshida, Rollin Roldan, Marcelo A Beraldo, Vinicius Torsani, Susimeire Gomes, Roberta R De Santis, Eduardo L V Costa, Mauro R Tucci, Raul G Lima, Brian P Kavanagh, Marcelo B P Amato
OBJECTIVES: We recently described how spontaneous effort during mechanical ventilation can cause "pendelluft," that is, displacement of gas from nondependent (more recruited) lung to dependent (less recruited) lung during early inspiration. Such transfer depends on the coexistence of more recruited (source) liquid-like lung regions together with less recruited (target) solid-like lung regions. Pendelluft may improve gas exchange, but because of tidal recruitment, it may also contribute to injury...
August 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/26947624/association-between-driving-pressure-and-development-of-postoperative-pulmonary-complications-in-patients-undergoing-mechanical-ventilation-for-general-anaesthesia-a-meta-analysis-of-individual-patient-data
#16
Ary Serpa Neto, Sabrine N T Hemmes, Carmen S V Barbas, Martin Beiderlinden, Ana Fernandez-Bustamante, Emmanuel Futier, Ognjen Gajic, Mohamed R El-Tahan, Abdulmohsin A Al Ghamdi, Ersin Günay, Samir Jaber, Serdar Kokulu, Alf Kozian, Marc Licker, Wen-Qian Lin, Andrew D Maslow, Stavros G Memtsoudis, Dinis Reis Miranda, Pierre Moine, Thomas Ng, Domenico Paparella, V Marco Ranieri, Federica Scavonetto, Thomas Schilling, Gabriele Selmo, Paolo Severgnini, Juraj Sprung, Sugantha Sundar, Daniel Talmor, Tanja Treschan, Carmen Unzueta, Toby N Weingarten, Esther K Wolthuis, Hermann Wrigge, Marcelo B P Amato, Eduardo L V Costa, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz
BACKGROUND: Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications...
April 2016: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/26289012/understanding-recruitment-maneuvers
#17
REVIEW
Erica Aranha Suzumura, Marcelo Britto Passos Amato, Alexandre Biasi Cavalcanti
No abstract text is available yet for this article.
May 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/26266914/moderately-high-frequency-ventilation-with-a-conventional-ventilator-allows-reduction-of-tidal-volume-without-increasing-mean-airway-pressure
#18
Ricardo Luiz Cordioli, Marcelo Park, Eduardo Leite Vieira Costa, Susimeire Gomes, Laurent Brochard, Marcelo Britto Passos Amato, Luciano Cesar Pontes Azevedo
BACKGROUND: The aim of this study was to explore if positive-pressure ventilation delivered by a conventional ICU ventilator at a moderately high frequency (HFPPV) allows a safe reduction of tidal volume (V T) below 6 mL/kg in a porcine model of severe acute respiratory distress syndrome (ARDS) and at a lower mean airway pressure than high-frequency oscillatory ventilation (HFOV). METHODS: This is a prospective study. In eight pigs (median weight 34 [29,36] kg), ARDS was induced by pulmonary lavage and injurious ventilation...
December 2014: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/26258686/correlation-of-lung-collapse-and-gas-exchange-a-computer-tomographic-study-in-sheep-and-pigs-with-atelectasis-in-otherwise-normal-lungs
#19
Samuel J Wolf, Alexander P Reske, Sören Hammermüller, Eduardo L V Costa, Peter M Spieth, Pierre Hepp, Alysson R Carvalho, Jens Kraßler, Hermann Wrigge, Marcelo B P Amato, Andreas W Reske
BACKGROUND: Atelectasis can provoke pulmonary and non-pulmonary complications after general anaesthesia. Unfortunately, there is no instrument to estimate atelectasis and prompt changes of mechanical ventilation during general anaesthesia. Although arterial partial pressure of oxygen (PaO2) and intrapulmonary shunt have both been suggested to correlate with atelectasis, studies yielded inconsistent results. Therefore, we investigated these correlations. METHODS: Shunt, PaO2 and atelectasis were measured in 11 sheep and 23 pigs with otherwise normal lungs...
2015: PloS One
https://www.readbyqxmd.com/read/25746507/lung-inflammation-persists-after-27-hours-of-protective-acute-respiratory-distress-syndrome-network-strategy-and-is-concentrated-in-the-nondependent-lung
#20
João Batista Borges, Eduardo L V Costa, Maria Bergquist, Luca Lucchetta, Charles Widström, Enn Maripuu, Fernando Suarez-Sipmann, Anders Larsson, Marcelo B P Amato, Göran Hedenstierna
OBJECTIVE: PET with [18F]fluoro-2-deoxy-D-glucose can be used to image cellular metabolism, which during lung inflammation mainly reflects neutrophil activity, allowing the study of regional lung inflammation in vivo. We aimed at studying the location and evolution of inflammation by PET imaging, relating it to morphology (CT), during the first 27 hours of application of protective-ventilation strategy as suggested by the Acute Respiratory Distress Syndrome Network, in a porcine experimental model of acute respiratory distress syndrome...
May 2015: Critical Care Medicine
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