uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Alternative names
Publications (10 of 23) Show all publications
Cereda, M., Xin, Y., Goffi, A., Herrmann, J., Kaczka, D. W., Kavanagh, B. P., . . . Rizi, R. R. (2019). Imaging the Injured Lung: Mechanisms of Action and Clinical Use. Anesthesiology, 131(3), 716-749
Open this publication in new window or tab >>Imaging the Injured Lung: Mechanisms of Action and Clinical Use
Show others...
2019 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 131, no 3, p. 716-749Article, review/survey (Refereed) Published
Abstract [en]

Acute respiratory distress syndrome (ARDS) consists of acute hypoxemic respiratory failure characterized by massive and heterogeneously distributed loss of lung aeration caused by diffuse inflammation and edema present in interstitial and alveolar spaces. It is defined by consensus criteria, which include diffuse infiltrates on chest imaging-either plain radiography or computed tomography. This review will summarize how imaging sciences can inform modern respiratory management of ARDS and continue to increase the understanding of the acutely injured lung. This review also describes newer imaging methodologies that are likely to inform future clinical decision-making and potentially improve outcome. For each imaging modality, this review systematically describes the underlying principles, technology involved, measurements obtained, insights gained by the technique, emerging approaches, limitations, and future developments. Finally, integrated approaches are considered whereby multimodal imaging may impact management of ARDS.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-395360 (URN)10.1097/ALN.0000000000002583 (DOI)000484161900034 ()30664057 (PubMedID)
Available from: 2019-10-22 Created: 2019-10-22 Last updated: 2019-10-22Bibliographically approved
Broche, L., Pisa, P., Porra, L., Degrugilliers, L., Bravin, A., Pellegrini, M., . . . Bayat, S. (2019). Individual Airway Closure Characterized In Vivo by Phase-Contrast CT Imaging in Injured Rabbit Lung. Critical Care Medicine, 47(9), E774-E781
Open this publication in new window or tab >>Individual Airway Closure Characterized In Vivo by Phase-Contrast CT Imaging in Injured Rabbit Lung
Show others...
2019 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 47, no 9, p. E774-E781Article in journal (Refereed) Published
Abstract [en]

Objectives: Airway closure is involved in adverse effects of mechanical ventilation under both general anesthesia and in acute respiratory distress syndrome patients. However, direct evidence and characterization of individual airway closure is lacking. Here, we studied the same individual peripheral airways in intact lungs of anesthetized and mechanically ventilated rabbits, at baseline and following lung injury, using high-resolution synchrotron phase-contrast CT.

Design: Laboratory animal investigation.

Setting: European synchrotron radiation facility.

Subjects: Six New-Zealand White rabbits.

Interventions: The animals were anesthetized, paralyzed, and mechanically ventilated in pressure-controlled mode (tidal volume, 6 mL/kg; respiratory rate, 40; Fio(2), 0.6; inspiratory:expiratory, 1:2; and positive end-expiratory pressure, 3 cm H2O) at baseline. Imaging was performed with a 47.5 x 47.5 x 47.5 mu m voxel size, at positive end-expiratory pressure 12, 9, 6, 3, and 0 cm H2O. The imaging sequence was repeated after lung injury induced by whole-lung lavage and injurious ventilation in four rabbits. Cross-sections of the same individual airways were measured.

Measurements and Main Results: The airways were measured at baseline (n = 48; radius, 1.7 to 0.21 mm) and after injury (n = 32). Closure was observed at 0 cm H2O in three of 48 airways (6.3%; radius, 0.350.08 mm at positive end-expiratory pressure 12) at baseline and five of 32 (15.6%; radius, 0.28 +/- 0.09 mm) airways after injury. Cross-section was significantly reduced at 3 and 0 cm H2O, after injury, with a significant relation between the relative change in cross-section and airway radius at 12 cm H2O in injured, but not in normal lung (R = 0.60; p < 0.001).

Conclusions: Airway collapsibility increases in the injured lung with a significant dependence on airway caliber. We identify "compliant collapse" as the main mechanism of airway closure in initially patent airways, which can occur at more than one site in individual airways.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2019
Keywords
airway closure, mechanical ventilation, phase-contrast imaging, respiratory distress syndrome, adult, tomography, x-ray computed, ventilator-induced lung injury
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-394204 (URN)10.1097/CCM.0000000000003838 (DOI)000484224200007 ()31162202 (PubMedID)
Available from: 2019-10-04 Created: 2019-10-04 Last updated: 2019-10-04Bibliographically approved
Scaramuzzo, G., Broche, L., Pellegrini, M., Porra, L., Derosa, S., Tannoia, A. P., . . . Perchiazzi, G. (2019). Regional Behavior of Airspaces During Positive Pressure Reduction Assessed by Synchrotron Radiation Computed Tomography. Frontiers in Physiology, 10, Article ID 719.
Open this publication in new window or tab >>Regional Behavior of Airspaces During Positive Pressure Reduction Assessed by Synchrotron Radiation Computed Tomography
Show others...
2019 (English)In: Frontiers in Physiology, ISSN 1664-042X, E-ISSN 1664-042X, Vol. 10, article id 719Article in journal (Refereed) Published
Abstract [en]

Introduction: The mechanisms of lung inflation and deflation are only partially known. Ventilatory strategies to support lung function rely upon the idea that lung alveoli are isotropic balloons that progressively inflate or deflate and that lung pressure/volume curves derive only by the interplay of critical opening pressures, critical closing pressures, lung history, and position of alveoli inside the lung. This notion has been recently challenged by subpleural microscopy, magnetic resonance, and computed tomography (CT). Phase-contrast synchrotron radiation CT (PC-SRCT) can yield in vivo images at resolutions higher than conventional CT.

Objectives: We aimed to assess the numerosity (ASden) and the extension of the surface of airspaces (ASext) in healthy conditions at different volumes, during stepwise lung deflation, in concentric regions of the lung. Methods: The study was conducted in seven anesthetized New Zealand rabbits. They underwent PC-SRCT scans (resolution of 47.7 mu m) of the lung at five decreasing positive end expiratory pressure (PEEP) levels of 12, 9, 6, 3, and 0 cmH(2)O during end-expiratory holds. Three concentric regions of interest (ROIs) of the lung were studied: subpleural, mantellar, and core. The images were enhanced by phase contrast algorithms. ASden and ASext were computed by using the Image Processing Toolbox for MatLab. Statistical tests were used to assess any significant difference determined by PEEP or ROI on ASden and ASext.

Results: When reducing PEEP, in each ROI the ASden significantly decreased. Conversely, ASext variation was not significant except for the core ROI. In the latter, the angular coefficient of the regression line was significantly low.

Conclusion: The main mechanism behind the decrease in lung volume at PEEP reduction is derecruitment. In our study involving lung regions laying on isogravitational planes and thus equally influenced by gravitational forces, airspace numerosity and extension of surface depend on the local mechanical properties of the lung.

Keywords
recruitment, VILI, alveoli, kinetics, SRCT
National Category
Respiratory Medicine and Allergy Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-389594 (URN)10.3389/fphys.2019.00719 (DOI)000471313900001 ()31231245 (PubMedID)
Funder
Swedish Research Council, K2015-99X-22731-01-4Swedish Heart Lung Foundation
Available from: 2019-07-25 Created: 2019-07-25 Last updated: 2019-07-25Bibliographically approved
Ahlström, J. Z., Massaro, F., Mikolka, P., Feinstein, R., Perchiazzi, G., Basabe-Burgos, O., . . . Rising, A. (2019). Synthetic surfactant with a recombinant surfactant protein C analogue improves lung function and attenuates inflammation in a model of acute respiratory distress syndrome in adult rabbits. Respiratory Research, 20, Article ID 245.
Open this publication in new window or tab >>Synthetic surfactant with a recombinant surfactant protein C analogue improves lung function and attenuates inflammation in a model of acute respiratory distress syndrome in adult rabbits
Show others...
2019 (English)In: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 20, article id 245Article in journal (Refereed) Published
Abstract [en]

AimIn acute respiratory distress syndrome (ARDS) damaged alveolar epithelium, leakage of plasma proteins into the alveolar space and inactivation of pulmonary surfactant lead to respiratory dysfunction. Lung function could potentially be restored with exogenous surfactant therapy, but clinical trials have so far been disappointing. These negative results may be explained by inactivation and/or too low doses of the administered surfactant. Surfactant based on a recombinant surfactant protein C analogue (rSP-C33Leu) is easy to produce and in this study we compared its effects on lung function and inflammation with a commercial surfactant preparation in an adult rabbit model of ARDS.MethodsARDS was induced in adult New Zealand rabbits by mild lung-lavages followed by injurious ventilation (V-T 20m/kg body weight) until P/F ratio<26.7kPa. The animals were treated with two intratracheal boluses of 2.5mL/kg of 2% rSP-C33Leu in DPPC/egg PC/POPG, 50:40:10 or poractant alfa (Curosurf (R)), both surfactants containing 80mg phospholipids/mL, or air as control. The animals were subsequently ventilated (V-T 8-9m/kg body weight) for an additional 3h and lung function parameters were recorded. Histological appearance of the lungs, degree of lung oedema and levels of the cytokines TNF alpha IL-6 and IL-8 in lung homogenates were evaluated.ResultsBoth surfactant preparations improved lung function vs. the control group and also reduced inflammation scores, production of pro-inflammatory cytokines, and formation of lung oedema to similar degrees. Poractant alfa improved compliance at 1h, P/F ratio and PaO2 at 1.5h compared to rSP-C33Leu surfactant.ConclusionThis study indicates that treatment of experimental ARDS with synthetic lung surfactant based on rSP-C33Leu improves lung function and attenuates inflammation.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
ARDS model, Surfactant protein analogues, Synthetic pulmonary surfactant, Lung function
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-398024 (URN)10.1186/s12931-019-1220-x (DOI)000495741500002 ()31694668 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20170531Swedish Heart Lung Foundation, 20150627Swedish Research Council, K2015-99X-22731-01-4Swedish Research Council, 2014-2408Swedish Research Council Formas, 2015-629Vinnova
Available from: 2019-12-05 Created: 2019-12-05 Last updated: 2019-12-05Bibliographically approved
Gudmundsson, M., Perchiazzi, G., Pellegrini, M., Vena, A., Hedenstierna, G. & Rylander, C. (2018). Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model. Acta Anaesthesiologica Scandinavica, 62(1), 94-104
Open this publication in new window or tab >>Atelectasis is inversely proportional to transpulmonary pressure during weaning from ventilator support in a large animal model
Show others...
2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 1, p. 94-104Article in journal (Refereed) Published
Abstract [en]

Background

In mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (PL) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between PL and atelectasis were known, monitoring of PL might help to avoid formation of atelectasis and cyclic collapse during weaning. The main purpose of this study was to determine the relation between PL and atelectasis in an experimental model representing weaning from mechanical ventilation.

Methods

Dynamic transverse computed tomography scans were acquired in ten anaesthetized, surfactant-depleted pigs with preserved spontaneous breathing, as ventilator support was lowered by sequentially reducing inspiratory pressure and positive end expiratory pressure in steps. The volumes of gas and atelectasis in the lungs were correlated with PL obtained using oesophageal pressure recordings. Work of breathing (WOB) was assessed from Campbell diagrams.

Results

Gradual decrease in PL in both end-expiration and end-inspiration caused a proportional increase in atelectasis and decrease in the gas content (linear mixed model with an autoregressive correlation matrix; P < 0.001) as the WOB increased. However, cyclic alveolar collapse during tidal ventilation did not increase significantly.

Conclusion

We found a proportional correlation between atelectasis and PL during the ‘weaning process’ in experimental mild lung injury. If confirmed in the clinical setting, a gradual tapering of ventilator support can be recommended for weaning without risk of sudden formation of atelectasis.

National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology and Intensive Care; Clinical Physiology
Identifiers
urn:nbn:se:uu:diva-342403 (URN)10.1111/aas.13015 (DOI)000417184800010 ()29058315 (PubMedID)
Funder
Swedish Research Council, 2008-5315; 2011-5315
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-03-05Bibliographically approved
Meyhoff, C. S., Larsson, A., Perchiazzi, G. & Hedenstierna, G. (2018). In Reply [Letter to the editor]. Anesthesiology, 128(1), 222-224
Open this publication in new window or tab >>In Reply
2018 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 128, no 1, p. 222-224Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-350092 (URN)10.1097/ALN.0000000000001942 (DOI)000422905300032 ()29232228 (PubMedID)
Note

Wos title: World Health Organization Responds to Concerns about Surgical Site Infection Prevention Recommendations Reply

Available from: 2018-05-04 Created: 2018-05-04 Last updated: 2018-12-06Bibliographically approved
Karbing, D. S., Perchiazzi, G., Rees, S. E. & Jaffe, M. B. (2018). Journal of Clinical Monitoring and Computing 2017 end of year summary: respiration. Journal of clinical monitoring and computing, 32(2), 197-205
Open this publication in new window or tab >>Journal of Clinical Monitoring and Computing 2017 end of year summary: respiration
2018 (English)In: Journal of clinical monitoring and computing, ISSN 1387-1307, E-ISSN 1573-2614, Vol. 32, no 2, p. 197-205Article, review/survey (Refereed) Published
Abstract [en]

This paper reviews 32 papers or commentaries published in Journal of Clinical Monitoring and Computing in 2016, within the field of respiration. Papers were published covering airway management, ventilation and respiratory rate monitoring, lung mechanics and gas exchange monitoring, in vitro monitoring of lung mechanics, CO2 monitoring, and respiratory and metabolic monitoring techniques.

Keywords
Review, Respiration, Monitoring, Capnography, Respiration rate, Perioperative period, Postoperative period
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-355822 (URN)10.1007/s10877-018-0121-8 (DOI)000426788500002 ()29480384 (PubMedID)
Available from: 2018-07-06 Created: 2018-07-06 Last updated: 2018-07-06Bibliographically approved
Perchiazzi, G., Pellegrini, M., Hedenstierna, G., Roneus, A. & Larsson, A. S. (2018). Multiple Transients of Local Gas Redistribution During Spontaneous Breathing Are Influenced by Ventilatory Settings. Paper presented at International Conference of the American-Thoracic-Society, MAY 18-23, 2018, San Diego, CA.. American Journal of Respiratory and Critical Care Medicine, 197
Open this publication in new window or tab >>Multiple Transients of Local Gas Redistribution During Spontaneous Breathing Are Influenced by Ventilatory Settings
Show others...
2018 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 197Article in journal, Meeting abstract (Other academic) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-373348 (URN)000449980304539 ()
Conference
International Conference of the American-Thoracic-Society, MAY 18-23, 2018, San Diego, CA.
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Note

Meeting Abstract: A7213

Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-01-21Bibliographically approved
Pellegrini, M., Hedenstierna, G., Roneus, A., Larsson, A. S. & Perchiazzi, G. (2018). Onset and Magnitude of Pendelluft During Spontaneous Breathing Depend on Lung Volume. Paper presented at International Conference of the American-Thoracic-Society, MAY 18-23, 2018, San Diego, CA.. American Journal of Respiratory and Critical Care Medicine, 197
Open this publication in new window or tab >>Onset and Magnitude of Pendelluft During Spontaneous Breathing Depend on Lung Volume
Show others...
2018 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 197Article in journal, Meeting abstract (Other academic) Published
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-373347 (URN)000449980301157 ()
Conference
International Conference of the American-Thoracic-Society, MAY 18-23, 2018, San Diego, CA.
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Note

Meeting Abstract: A5126

Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-01-21Bibliographically approved
Höstman, S., Kawati, R., Perchiazzi, G. & Larsson, A. (2018). THAM administration reduces pulmonary carbon dioxide elimination in hypercapnia: an experimental porcine study. Acta Anaesthesiologica Scandinavica, 62(6), 820-828
Open this publication in new window or tab >>THAM administration reduces pulmonary carbon dioxide elimination in hypercapnia: an experimental porcine study
2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 6, p. 820-828Article in journal (Refereed) Published
Abstract [en]

Background: In a previous study, we found a rebound of arterial carbon dioxide tension (PaCO2) after stopping THAM buffer administration. We hypothesized that this was due to reduced pulmonary CO2 elimination during THAM administration. The aim of this study was to investigate this hypothesis in an experimental porcine hypercapnic model.

Methods: In seven, initially normoventilated, anesthetized pigs (22-27 kg) minute ventilation was reduced by 66% for 7 h. Two hours after commencing hypoventilation, THAM was infused IV for 3 h in a dose targeting a pH of 7.35 followed by a 2 h observation period. Acid-base status, blood-gas content and exhaled CO2 were measured.

Results: THAM raised pH (7.07 0.04 to 7.41 +/- 0.04, P < 0.05) and lowered PaCO2 (15.2 +/- 1.4 to 12.2 +/- 1.1 kPa, P < 0.05). After the infusion, pH decreased and PaCO2 increased again. At the end of the observation period, pH and PaCO2 were 7.24 +/- 0.03 and 16.6 +/- 1.2 kPa, respectively (P < 0.05). Pulmonary CO2 excretion decreased from 109 +/- 12 to 74 +/- 12 ml/min (P < 0.05) during the THAM infusion but returned at the end of the observation period to 111 +/- 15 ml/min (P < 0.05). The estimated reduction of pulmonary CO2 elimination during the infusion was 5800 ml.

Conclusions: In this respiratory acidosis model, THAM reduced PaCO2, but seemed not to increase the total CO2 elimination due to decreased pulmonary CO2 excretion(,) suggesting only cautious use of THAM in hypercapnic acidosis.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-358364 (URN)10.1111/aas.13097 (DOI)000434205100012 ()29532468 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung Foundation
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-08-31Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6834-6399

Search in DiVA

Show all publications