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Gïacomo Bellani

John G Laffey, Tài Pham, Giacomo Bellani
PURPOSE OF REVIEW: Timely recognition of acute respiratory distress syndrome (ARDS) may allow for more prompt management and less exacerbation of lung injury. However, the absence of a diagnostic test for ARDS means that the diagnosis of ARDS requires clinician recognition in what is usually a complicated and evolving illness. We review data concerning the extent of recognition of ARDS in the era of the Berlin definition of ARDS. RECENT FINDINGS: ARDS continues to be under-recognized - even in the era of the more recent 'Berlin' definition, and significant delay in its recognition is common...
December 5, 2016: Current Opinion in Critical Care
Tommaso Mauri, Marta Lazzeri, Alfio Bronco, Giacomo Bellani, Antonio Pesenti
No abstract text is available yet for this article.
December 2, 2016: American Journal of Respiratory and Critical Care Medicine
Giacomo Bellani, Jean-Jaques Rouby, Jean-Michel Constantin, Antonio Pesenti
PURPOSE OF REVIEW: Advanced imaging techniques have provided invaluable insights in understanding of acute respiratory distress syndrome (ARDS) and the effect of therapeutic strategies, thanks to the possibility of gaining regional information and moving from simple 'anatomical' information to in-vivo functional imaging. RECENT FINDINGS: Computed tomography (CT) led to the understanding of several ARDS mechanisms and interaction with mechanical ventilation. It is nowadays frequently part of routine diagnostic workup, often leading to treatment changes...
November 30, 2016: Current Opinion in Critical Care
John G Laffey, Giacomo Bellani, Tài Pham, Eddy Fan, Fabiana Madotto, Ednan K Bajwa, Laurent Brochard, Kevin Clarkson, Andres Esteban, Luciano Gattinoni, Frank van Haren, Leo M Heunks, Kiyoyasu Kurahashi, Jon Henrik Laake, Anders Larsson, Daniel F McAuley, Lia McNamee, Nicolas Nin, Haibo Qiu, Marco Ranieri, Gordon D Rubenfeld, B Taylor Thompson, Hermann Wrigge, Arthur S Slutsky, Antonio Pesenti
PURPOSE: To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality. METHODS: The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents...
October 18, 2016: Intensive Care Medicine
Giacomo Bellani, John G Laffey, Tài Pham, Fabiana Madotto, Eddy Fan, Laurent Brochard, Andres Esteban, Luciano Gattinoni, Vesna Bumbasirevic, Lise Piquilloud, Frank van Haren, Anders Larsson, Daniel F McAuley, Philippe R Bauer, Yaseen M Arabi, Marco Ranieri, Massimo Antonelli, Gordon D Rubenfeld, B Taylor Thompson, Hermann Wrigge, Arthur S Slutsky, Antonio Pesenti
BACKGROUND: Non-invasive ventilation (NIV) is increasingly used in patients with Acute Respiratory Distress Syndrome (ARDS). Whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful is unknown. The evidence supporting NIV use in patients with ARDS remains relatively sparse. METHODS: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study described the management of patients with ARDS...
October 18, 2016: American Journal of Respiratory and Critical Care Medicine
Giovanni Mistraletti, Michele Umbrello, Stefania Anania, Elisa Andrighi, Alessandra Di Carlo, Federica Martinetti, Serena Barello, Giovanni Sabbatini, Paolo Formenti, Tommaso Maraffi, Francesco Marrazzo, Alessandra Palo, Giacomo Bellani, Riccarda Russo, Silvia Francesconi, Federico Valdambrini, Marco Cigada, Francesca Riccardi, Egidio A Moja, Gaetano Iapichino
BACKGROUND: International guidelines recommend systematic assessment of pain, agitation/sedation and delirium with validated scales for all ICU patients. However, these evaluations are often not done. We have created an e-learning training platform for the continuous medical education, and assessed its efficacy in increasing the use of validated tools by all medical and nursing staff of the participating ICUs during their daily practice. METHODS: Multicenter, randomized, before and after study...
September 20, 2016: Minerva Anestesiologica
Tommaso Mauri, Nilde Eronia, Cecilia Turrini, Marta Battistini, Giacomo Grasselli, Roberto Rona, Carlo Alberto Volta, Giacomo Bellani, Antonio Pesenti
PURPOSE: Higher positive end-expiratory pressure might induce lung inflation and recruitment, yielding enhanced regional lung protection. We measured positive end-expiratory pressure-related lung volume changes by electrical impedance tomography and by the helium dilution technique. We also used electrical impedance tomography to assess the effects of positive end-expiratory pressure on regional determinants of ventilator-induced lung injury. METHODS: A prospective randomized crossover study was performed on 20 intubated adult patients: 12 with acute hypoxemic respiratory failure and 8 with acute respiratory distress syndrome...
October 2016: Intensive Care Medicine
Anna Sigurta', Vanessa Zambelli, Giacomo Bellani
Ventilator-induced diaphragmatic dysfunction is a feared complication of mechanical ventilation that adversely affects the outcome of intensive care patients. Human and animal studies demonstrate atrophy and ultrastructural alteration of diaphragmatic muscular fibers attributable to increased oxidative stress, depression of the anabolic pathway regulated by Insulin-like growing factor 1 and increased proteolysis. The renin-angiotensin system, through its main peptide Angiotensin II, plays a major role in skeletal muscle diseases, mainly increasing oxidative stress and inducing insulin resistance, atrophy and fibrosis...
September 2016: Medical Hypotheses
Giacomo Bellani, Tai Pham, John Laffey
No abstract text is available yet for this article.
July 19, 2016: JAMA: the Journal of the American Medical Association
Alessandro Silvestri, Vanessa Zambelli, Anna M Ferretti, Domenico Salerno, Giacomo Bellani, Laura Polito
The development of new molecules able to efficiently act as long-circulating computed tomography (CT) contrast agents is one of the most crucial topics in the biomedical field. In the last years, the chance to manipulate materials at the nano-size level gave new boost to this research, with the specific aim to design innovative nanoprobes. Gold nanoparticles (AuNPs) have showed unique X-rays attenuation properties which, combined with their easy surface functionalization, makes them ideal candidates for the next generation of contrast agents...
July 4, 2016: Contrast Media & Molecular Imaging
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
Giacomo Bellani, Giacomo Grasselli, Maddalena Teggia-Droghi, Tommaso Mauri, Andrea Coppadoro, Laurent Brochard, Antonio Pesenti
BACKGROUND: Preservation of spontaneous breathing (SB) is sometimes debated because it has potentially both negative and positive effects on lung injury in comparison with fully controlled mechanical ventilation (CMV). We wanted (1) to verify in mechanically ventilated patients if the change in transpulmonary pressure was similar between pressure support ventilation (PSV) and CMV for a similar tidal volume, (2) to estimate the influence of SB on alveolar pressure (Palv), and (3) to determine whether a reliable plateau pressure could be measured during pressure support ventilation (PSV)...
April 28, 2016: Critical Care: the Official Journal of the Critical Care Forum
Tommaso Mauri, Giacomo Grasselli, Grazia Suriano, Nilde Eronia, Savino Spadaro, Cecilia Turrini, Nicolo' Patroniti, Giacomo Bellani, Antonio Pesenti
BACKGROUND: The amount of extracorporeal carbon dioxide removal may influence respiratory drive in acute respiratory distress syndrome (ARDS) patients undergoing extracorporeal membrane oxygenation (ECMO). The authors evaluated the effects of different levels of extracorporeal carbon dioxide removal in patients recovering from severe ARDS undergoing pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA). METHODS: The authors conducted a prospective, randomized, crossover study on eight spontaneously breathing ARDS patients undergoing venovenous ECMO since 28 ± 20 days...
July 2016: Anesthesiology
Giacomo Bellani, John G Laffey, Tài Pham, Eddy Fan, Laurent Brochard, Andres Esteban, Luciano Gattinoni, Frank van Haren, Anders Larsson, Daniel F McAuley, Marco Ranieri, Gordon Rubenfeld, B Taylor Thompson, Hermann Wrigge, Arthur S Slutsky, Antonio Pesenti
IMPORTANCE: Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVES: To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTS: The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents...
February 23, 2016: JAMA: the Journal of the American Medical Association
Giacomo Bellani, Andrea Coppadoro, Matteo Pozzi, Alfio Bronco, Daniela Albiero, Nilde Eronia, Valeria Meroni, Giacomo Grasselli, Antonio Pesenti
BACKGROUND: We previously described an index, defined as the ratio between the inspiratory muscle pressure (Pmus) and the electrical activity of the diaphragm (EA(di)) (Pmus/EA(di) index). In the present work, we describe the trend of Pmus/EA(di) index over time, investigating whether it could be an indicator of muscular efficiency associated with risk factors for diaphragmatic injury and/or clinical outcomes. METHODS: This work is a retrospective analysis of subjects with measurements of Pmus/EA(di) index obtained, on different days, during assisted ventilation...
April 2016: Respiratory Care
Andrea Coppadoro, Giacomo Bellani, Alfio Bronco, Alberto Lucchini, Simone Bramati, Vanessa Zambelli, Roberto Marcolin, Antonio Pesenti
BACKGROUND: Early after intubation, a layer of biofilm covers the inner lumen of the endotracheal tube (ETT). Cleaning the ETT might prevent airways colonization by pathogens, reduce resistance to airflow, and decrease sudden ETT obstruction. We investigated the effectiveness of a cleaning closed suction system in maintaining the endotracheal tube free from secretions. METHODS: We conducted a single center, randomized controlled trial, in the general intensive care unit of a tertiary-level university hospital...
December 2015: Annals of Intensive Care
Vittorio Scaravilli, Giacomo Grasselli, Luigi Castagna, Alberto Zanella, Stefano Isgrò, Alberto Lucchini, Nicolò Patroniti, Giacomo Bellani, Antonio Pesenti
PURPOSE: Prone positioning (PP) improves oxygenation and outcome of patients with acute respiratory distress syndrome undergoing invasive ventilation. We evaluated feasibility and efficacy of PP in awake, non-intubated, spontaneously breathing patients with hypoxemic acute respiratory failure (ARF). MATERIAL AND METHODS: We retrospectively studied non-intubated subjects with hypoxemic ARF treated with PP from January 2009 to December 2014. Data were extracted from medical records...
December 2015: Journal of Critical Care
Vanessa Zambelli, Giacomo Bellani, Roberto Borsa, Federico Pozzi, Alice Grassi, Margherita Scanziani, Vittoria Castiglioni, Serge Masson, Alessandra Decio, John G Laffey, Roberto Latini, Antonio Pesenti
BACKGROUND: The renin-angiotensin system (RAS) plays a role in the pathogenesis of ARDS, Angiotensin II (Ang-II) contributing to the pathogenesis of inflammation and fibrogenesis. Angiotensin-(1-7) (Ang-(1-7)) may antagonize the effects of Ang-II. This study was aimed at evaluating the potential for Ang-(1-7) to reduce injury, inflammation and fibrosis in an experimental model of ARDS in the acute and late phases. METHODS: Male Sprague Dawley rats underwent an instillation of 0...
December 2015: Intensive Care Medicine Experimental
Elisabetta Grecchi, Mattia Veronese, Rosa Maria Moresco, Giacomo Bellani, Antonio Pesenti, Cristina Messa, Alessandra Bertoldo
PURPOSE: This work aims to investigate lung glucose metabolism using 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG) positron emission tomography (PET) imaging in acute lung injury (ALI) patients. PROCEDURES: Eleven ALI patients and five healthy controls underwent a dynamic [(18)F]FDG PET/X-ray computed tomography (CT) scan. The standardized uptake values (SUV) and three different methods for the quantification of glucose metabolism (i.e., ratio, Patlak, and spectral analysis iterative filter, SAIF) were applied both at the region and the voxel levels...
February 2016: Molecular Imaging and Biology: MIB: the Official Publication of the Academy of Molecular Imaging
Tommaso Mauri, Nilde Eronia, Chiara Abbruzzese, Roberto Marcolin, Andrea Coppadoro, Savino Spadaro, Nicolo' Patroniti, Giacomo Bellani, Antonio Pesenti
OBJECTIVE: In acute respiratory failure patients undergoing pressure support ventilation, a short cyclic recruitment maneuver (Sigh) might induce reaeration of collapsed lung regions, possibly decreasing regional lung strain and improving the homogeneity of ventilation distribution. We aimed to describe the regional effects of different Sigh rates on reaeration, strain, and ventilation heterogeneity, as measured by thoracic electrical impedance tomography. DESIGN: Prospective, randomized, cross-over study...
September 2015: Critical Care Medicine
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