Papers by Davide D'Antini
Journal of Multidisciplinary Healthcare, 2013
Anesthesiology, 2015
To test the hypothesis that in early, mild, acute respiratory distress syndrome (ARDS) patients w... more To test the hypothesis that in early, mild, acute respiratory distress syndrome (ARDS) patients with diffuse loss of aeration, the application of the open lung approach (OLA) would improve homogeneity in lung aeration and lung mechanics, without affecting hemodynamics. Patients were ventilated according to the ARDS Network protocol at baseline (pre-OLA). OLA consisted in a recruitment maneuver followed by a decremental positive end-expiratory pressure trial. Respiratory mechanics, gas exchange, electrical impedance tomography (EIT), cardiac index, and stroke volume variation were measured at baseline and 20 min after OLA implementation (post-OLA). Esophageal pressure was used for lung and chest wall elastance partitioning. The tomographic lung image obtained at the fifth intercostal space by EIT was divided in two ventral and two dorsal regions of interest (ROIventral and ROIDorsal). Fifteen consecutive patients were studied. The OLA increased arterial oxygen partial pressure/inspir...
Anesthesiology, 2015
To test the hypothesis that in early, mild, acute respiratory distress syndrome (ARDS) patients w... more To test the hypothesis that in early, mild, acute respiratory distress syndrome (ARDS) patients with diffuse loss of aeration, the application of the open lung approach (OLA) would improve homogeneity in lung aeration and lung mechanics, without affecting hemodynamics. Patients were ventilated according to the ARDS Network protocol at baseline (pre-OLA). OLA consisted in a recruitment maneuver followed by a decremental positive end-expiratory pressure trial. Respiratory mechanics, gas exchange, electrical impedance tomography (EIT), cardiac index, and stroke volume variation were measured at baseline and 20 min after OLA implementation (post-OLA). Esophageal pressure was used for lung and chest wall elastance partitioning. The tomographic lung image obtained at the fifth intercostal space by EIT was divided in two ventral and two dorsal regions of interest (ROIventral and ROIDorsal). Fifteen consecutive patients were studied. The OLA increased arterial oxygen partial pressure/inspired oxygen fraction from 216 ± 13 to 311 ± 19 mmHg (P < 0.001) and decreased elastance of the respiratory system from 29.4 ± 3 cm H2O/l to 23.6 ± 1.7 cm H2O/l (P < 0.01). The driving pressure (airway opening plateau pressure - total positive end-expiratory pressure) decreased from 17.9 ± 1.5 cm H2O pre-OLA to 15.4 ± 2.1 post-OLA (P < 0.05). The tidal volume fraction reaching the dorsal ROIs increased, and consequently the ROIVentral/Dorsal impedance tidal variation decreased from 2.01 ± 0.36 to 1.19 ± 0.1 (P < 0.01). The OLA decreases the driving pressure and improves the oxygenation and lung mechanics in patients with early, mild, diffuse ARDS. EIT is useful to assess the impact of OLA on regional tidal volume distribution.
European Journal of Anaesthesiology, 2014
INTRODUCTION. Patients with ARDS always have atelectasic lung regions and nonhomogeneous distribu... more INTRODUCTION. Patients with ARDS always have atelectasic lung regions and nonhomogeneous distribution of damage over the lungs. Alveolar recruitment strategy (ARS) are ventilatory strategies that aim to restore the aeration. They consist of a brief and controlled increment in airway pressure to open up collapsed areas of the lungs and sufficient positive end-expiratory pressure (PEEP) to keep them open afterward. OBJECTIVES.Our work compared the physiological effect of dynamic compliance based Positive End Expiration Pressure (PEEP) titration on the end-inspiratory transpulmonary pressure (PL) to keep the lung open after the recruitment manoeuvre. METHODS.A prospective study was conducted in 8 consecutive patients with mild ARDS undergoing mechanical ventilation. Esophageal pressure was used for partitioning respiratory mechanics between lung and chest wall and for measuring lung transpulmonary pressure. Respiratory mechanics, gas exchange, hemodynamic were measured before (TPre) an...
Minerva anestesiologica
Aim.The primiry aim of this study was to evaluate wheter perioperative fluid management with esop... more Aim.The primiry aim of this study was to evaluate wheter perioperative fluid management with esophageal Doppler caused an increased left ventricle wall stress due to fluid overload inducing an increase of BNP production. Furthermore our group compared Flow time corrected (Ftc) and BNP as predictors of fluid responsiveness. Materials and methods. In this prospective randomized control study we enrolled 19 consecutive patients who were randomized into two groups: control group (CG) that received intravenous fluid treatment according to conventional parameters including Heart Rate, Blood Pressure and Urine Output; protocol group (PG) that was subjected to haemodinamic optimization using the Gan’ s protocol for fluid replacement. Baseline Ftc < 350 ms discriminated responders (R) from non responders (NR). 3 blood samples were collected for BNP assay: baseline (T0), at 30 minutes from the achievement of the gaol (T1) and at the end of the surgery (T2). Results.The PG received more flu...
In this prospective physiological observational study, we applied a strategy to estimate the end-... more In this prospective physiological observational study, we applied a strategy to estimate the end-expiratory pleural pressure (P pl,ee ) using esophageal manometry to measure the esophageal pressure (P es ) directly. The estimated P pl,ee was used to assess the end-expiratory transpulmonary pressure (P L,ee ), in order to obtain a parameter to target PEEP, thereby minimizing alveolar collapse and resulting hypoxemia at end expiration during normal and one lung ventilation (OLV) in supine and lateral decubitus in Thoracic Surgery.
Open Access Emergency Medicine, 2013
Background: Patients with severe hypercapnia represent a particularly serious condition in an eme... more Background: Patients with severe hypercapnia represent a particularly serious condition in an emergency department (ED), requiring immediate attention. Noninvasive ventilation (NIV) is an integral part of the treatment for acute respiratory failure. The present study aimed to validate the measurement of end-tidal CO 2 (EtCO 2 ) as a noninvasive technique to evaluate the effectiveness of NIV in acute hypercapnic respiratory failure. Methods: Twenty consecutive patients admitted to the ED with severe dyspnea were enrolled in the study. NIV by means of bilevel positive airway pressure, was applied to the patients simultaneously with standard medical therapy and continued for 12 hours; the arterial blood gases and side-stream nasal/oral EtCO 2 were measured at subsequent times: T0 (admission to the ED), T1h (after 1 hour), T6h (after 6 hours), and T12h (after 12 hours) during NIV treatment. Results: The arterial CO 2 partial pressure (PaCO 2 )-EtCO 2 gradient decreased progressively, reaching at T6h and T12h values lower than baseline (P , 0.001), while arterial pH increased during the observation period (P , 0.001). A positive correlation was found between EtCO 2 and PaCO 2 values (r = 0.89, P , 0.001) at the end of the observation period. Conclusion: In our hypercapnic patients, the effectiveness of the NIV was evidenced by the progressive reduction of the PaCO 2 -EtCO 2 gradient. The measurement of the CO 2 gradient could be a reliable method in monitoring the effectiveness of NIV in acute hypercapnic respiratory failure in the ED.
Journal of Multidisciplinary Healthcare, 2013
Expert Review of Respiratory Medicine, 2014
Mechanical ventilation (MV) is the main supportive treatment in respiratory failure due to differ... more Mechanical ventilation (MV) is the main supportive treatment in respiratory failure due to different etiologies. However, MV might aggravate ventilator-associated lung injury (VALI). Four main mechanisms leading to VALI are: 1) increased stress and strain, induced by high tidal volume (VT); 2) increased shear stress, i.e. opening and closing, of previously atelectatic alveolar units; 3) distribution of perfusion and 4) biotrauma. In severe acute respiratory distress syndrome patients, low VT, higher levels of positive end expiratory pressure, long duration prone position and neuromuscular blockade within the first 48 hours are associated to a better outcome. VALI can also occur by using high VT in previously non injured lungs. We believe that prevention is the target to minimize injurious effects of MV. This review aims to describe pathophysiology of VALI, the possible prevention and treatment as well as monitoring MV to minimize VALI.
Critical Care Medicine, 2011
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Papers by Davide D'Antini